K yphotic deformity in the lumbar or thoracolumbar spine is a well-documented complication of the surgical treatment of scoliosis, spinal trauma (such as burst fractures), and extensive laminectomy. 2, 3, 5, 10, 17–22, 25 In several reports the authors have cited the loss of normal sagittal contour as an untoward sequela of posterior distraction instrumentation in the correction of scoliosis. 2, 3, 5, 20, 21 There are also reports of patients who develop progressive lumbar kyphosis along fusion segments after fusion and placement of anterior instrumentation
Olumide A. Danisa, Dennis Turner and William J. Richardson
Cheerag D. Upadhyaya, Philip A. Starr and Praveen V. Mummaneni
P arkinson disease is a neurodegenerative disorder that affects over 1 million people in the US. 19 It is estimated that the lifetime risk of developing PD is 1.5%. 7 , 10 With the aging of the US population, the prevalence of PD will likely continue to grow. 35 A recent estimate of the prevalence of deformities (involuntary trunk flexion/camptocormia, anterocollis, scoliosis) in PD was 33.5%. 2 The cardinal motor signs of PD are 4–6-Hz resting tremor, rigidity, bradykinesia, and gait disorder/postural instability. Other symptoms include stooped posture
Christopher P. Ames, Justin S. Smith, Robert Eastlack, Donald J. Blaskiewicz, Christopher I. Shaffrey, Frank Schwab, Shay Bess, Han Jo Kim, Gregory M. Mundis Jr., Eric Klineberg, Munish Gupta, Michael O’Brien, Richard Hostin, Justin K. Scheer, Themistocles S. Protopsaltis, Kai-Ming G. Fu, Robert Hart, Todd J. Albert, K. Daniel Riew, Michael G. Fehlings, Vedat Deviren, Virginie Lafage and International Spine Study Group
D espite the complexity of cervical spine deformity (CSD) and its substantial impact on patient quality of life, there exists no comprehensive classification system to serve as the basis of communication among physicians and to facilitate effective clinical and radiographic study of patients with these deformities. Without a standardized classification system, studies of CSD may suffer from heterogeneity, which compromises the study findings and negatively impacts communication of the results. Other spinal conditions, including adult and pediatric
Tim E. Darsaut, Muthana M. Sartawi, Perry Dhaliwal and Richard J. Fox
deformity. 1 , 8 , 10 Optimal traction weight for CVJ deformities depends on the nature of the lesion and the habitus of the individual, so emphasis is usually placed on time in traction, rather than the amount of weight. 5 , 8 Historically, traction for severe CVJ deformities might require up to 1–4 weeks, 5 , 10 although this has been reduced to 48–72 hours in most modern spine centers. In spite of this decrease, patients in traction remain at risk for respiratory decompensation, thromboembolic disease, and decubitus ulcers. 5 , 13 Patients with RA in particular do
Sean M. Jones-Quaidoo, Scott Yang and Vincent Arlet
Characteristics Patients with neuromuscular scoliosis may have a variety of scoliotic curve types depending on the severity of CP involvement. Lonstein and Akbarnia 37 characterized the deformity into 2 groups that were most common: 1) Group 1 curves are single thoracic or double thoracic and lumbar curves with a level pelvis, commonly noted in ambulatory patients with CP; and 2) Group 2 curves are long thoracolumbar or C-shaped curves with associated pelvic obliquity, often noted in more involved and dependent patients with CP. Hyperlordosis of the lumbar spine or
Richard P. Schlenk, Robert J. Kowalski and Edward C. Benzel
The correction of spinal deformity may be achieved by a variety of methods, each of which has advantages and disadvantages. The goals of spinal deformity surgery include reasonable correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, optimization of cosmetic issues, and restoration/preservation of function. The failure to consider all these factors appropriately may result in a suboptimal outcome. Understanding fundamental biomechanical principles involved in the formation, progression, and treatment of spinal deformities is essential in the clinical decision-making process.
Gregory C. Wiggins, Michael J. Rauzzino, Henry M. Bartkowski, Russ P. Nockels and Christopher I. Shaffrey
N eurosurgeons are performing complex spinal surgeries including those for deformity correction and scoliosis. The Scoliosis Research Society defines scoliosis as a lateral curvature of the spine greater than 10° as measured by the Cobb method on a standing radiograph. King, et al., 21 classified idiopathic thoracic curves (Type I—V) as thoracic primary, lumbar primary, isolated thoracic, thoracolumbar, and double thoracic curve. Instrumentation in conjunction with spinal fusion has been an important part of the management for significant scoliotic deformity
Justin Kunes, George H. Thompson, Sunil Manjila, Connie Poe-Kochert and Alan R. Cohen
in cases of IIH has sometimes been reported at 2 or 3 times that number. 38 Permanent severe visual disturbance occurs in cases of undiagnosed IIH in up to 24% of cases that have been monitored for 5–41 years. 43 We present 3 cases of IIH in a previously unreported setting of pediatric spinal deformity correction surgery ( Table 1 ). The aim of the current report is to alert neurological and orthopedic surgeons that visual disturbances and headaches in the early postoperative period can represent a serious, but treatable, condition. In addition, we propose a
Gregory C. Wiggins, Christopher I. Shaffrey, Mark F. Abel and Arnold H. Menezes
Pediatric spinal deformity results from multiple conditions including congenital anomalies, neuromuscular disorders, skeletal dysplasia, and developmental disorders (idiopathic). Pediatric spinal deformities can be progressive and cause pulmonary compromise, neurological deficits, and cardiovascular compromise. The classification and treatment of these disorders have evolved since surgical treatment was popularized when Harrington distraction instrumentation was introduced.
The advent of anterior-spine instrumentation systems has challenged the concepts of length of fusion needed to arrest curvature progression. Segmental fixation revolutionized the surgical treatment of these deformities. More recently, pedicle screw–augmented segmental fixation has been introduced and promises once again to shift the standard of surgical therapy. Recent advances in thoracoscopic surgery have made this technique applicable to scoliosis surgery.
Not only has surgical treatment progressed but also the classification of different forms of pediatric deformity continues to evolve. Recently, Lenke and associates proposed a new classification for adolescent idiopathic scoliosis. This classification attempts to address some of the shortcomings of the King classification system.
In this article the authors review the literature on pediatric spinal deformities and highlight recent insights into classification, treatment, and surgery-related complications.
Paul Steinbok, Tufan Hicdonmez, Bonita Sawatzky, Richard Beauchamp and Diane Wickenheiser
limbs is expected. The impact of SDR on the immature spine of the child, and in particular, on the later occurrence of spinal deformities has not been well defined but should be of concern. Children with spastic CP are known to be at higher risk of spinal deformity, particularly scoliosis, than the normal population. 5, 11, 22, 23 Furthermore, the risk of spinal deformities developing in patients may be increased after they undergo laminectomies or laminoplasties such as those performed in conjunction with SDR, although this may be less of a problem in the lumbar or