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Scoliosis and hydrocephalus in myelocele patients

The effects of ventricular shunting

Peter Hall, Richard Lindseth, Robert Campbell, John E. Kalsbeck and Alonso Desousa

S pinal deformities are a major problem in the long-term management of myelocele patients. 14 Scoliosis is particularly common, occurring in 50% to 70% of these patients. 21, 22, 24 It may either be congenital (the result of vertebral anomalies present at birth) or, more frequently, developmental (generally considered to result from a paralytic, collapsing spine). 11, 21, 22, 24 The mechanism by which developmental scoliosis arises remains unclear. Unapposed action of the iliopsoas has been suggested, 22, 23 but it does not explain the thoracic location of

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Michael G. Muhonen, Arnold H. Menezes, Paul D. Sawin and Stuart L. Weinstein

T he association between pediatric Chiari malformations and the development of scoliosis has been well documented in the spina bifida population. 17–19, 31, 34, 36–38 Scoliosis occurs in 50% to 70% of these patients, and is therefore a common cause of functional decline. 36 The scoliosis is thought to be secondary to a generalized paresis of the trunk musculature, to congenital structural changes in the vertebrae, and to the effects of abnormal intramedullary pressure with interference of the postural tonic reflexes. 34 The association between scoliosis and

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Sasha C. Burn, Reinhard Zeller and James M. Drake

musculoskeletal contractures, and improvement of function. 1 In depth discussion regarding the etiological basis of scoliosis is beyond the scope of this paper, but suffice it to say that there is a well-recognized link between rapid growth prior to skeletal maturation and a high risk of developing scoliosis. 5 Treatment plans depend on the ability to assess growth potential and therefore the likelihood of curve development or progression. In girls, skeletal maturity can be predicted by using a combination of age at menarche, Risser signs, and peak height velocity. 3 There

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Jennifer Strahle, Brandon W. Smith, Melaine Martinez, J. Rajiv Bapuraj, Karin M. Muraszko, Hugh J. L. Garton and Cormac O. Maher

associated with scoliosis in some individuals, 3 , 18 , 19 , 36 perhaps as a result of asymmetrical injury to the spinal cord from an expanding cyst. 16 Although most researchers agree that CM-I can cause a spinal syrinx and that a spinal syrinx can cause scoliosis, 3 , 5 , 6 , 11 , 12 , 15 , 20 the association of CM-I and scoliosis in the absence of a syrinx has never been defined properly and remains controversial. Some researchers have speculated that asymmetrical compression of the cervicomedullary junction by the cerebellar tonsils can result in scoliosis even in

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R. Shane TUBBS, W. Jerry Oakes and Robert F. Heimburger

Professor of Surgery (Neurosurgery), at Indiana University School of Medicine, was acknowledged for his assistance at the end of Garceau's paper. Heimburger submitted the paper presented here, which describes cases of scoliosis that had come to clinical attention some decades earlier, for publication in the medical literature. The patients in these cases underwent sectioning of tight terminal fila and all experienced good outcomes. Heimburger's paper regarding what is now known as the spinal cord traction syndrome, was not well received when submitted for publication

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Frank J. Attenello, Matthew J. McGirt, April Atiba, Muraya Gathinji, Ghazala Datoo, Jon Weingart, Benjamin Carson and George I. Jallo

C hiari malformation Type I, defined as caudal displacement of the cerebellar tonsils into the cervical canal, was first documented by Hans Chiari 4 in 1891. Over the last century, multiple symptoms of cerebellar, brainstem, and spinal cord pathology have been attributed to this complex disease. 11 , 13 , 14 Standard surgical management for CM-I remains posterior fossa decompression. 2 , 5 , 10 Up to 30% of all patients with CM-I and 60% of patients with Chiari malformation–associated syringomyelia will present with scoliosis. 1 , 3 , 6–9 , 12 , 13

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Nishit Mummareddy, Michael C. Dewan, Michael R. Mercier, Robert P. Naftel, John C. Wellons III and Christopher M. Bonfield

M yelomeningocele (MMC), characterized as a protruding sac of both the meninges and spinal cord, is the most frequent manifestation of neural tube defects, affecting nearly 1500 newborns in the United States annually and 0.2–6.5 newborns from every 1000 births globally. 4 , 13 , 27 , 30 One of the most common and most severe skeletal complications of MMC is scoliosis, 45 which can result in respiratory compromise, decreased mobility, skin breakdown, sitting and ambulation issues, and worsening of neurological symptoms. 11 , 42 Thus, an understanding of the

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Hsuan-Kan Chang, Huang-Chou Chang, Jau-Ching Wu, Tsung-Hsi Tu, Li-Yu Fay, Peng-Yuan Chang, Ching-Lan Wu, Wen-Cheng Huang and Henrich Cheng

weight lifting, and degenerative disc disease. 2 , 3 , 14 , 15 , 20 Furthermore, the degree of annular competence, type of herniation, and protrusion type of LDH have been demonstrated to increase the risk of the recurrence of LDH. 10 Patients with adolescent idiopathic scoliosis have altered biomechanics in the lower lumbar spine. 7 , 13 It is not clear whether this change in weight bearing causes a higher incidence of LDH. 1 The effect of scoliosis in terms of risk of LDH recurrence is unknown. Therefore, the optimal management of LDH in scoliosis patients

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Matthew J. McGirt, Vivek Mehta, Giannina Garces-Ambrossi, Oren Gottfried, Can Solakoglu, Ziya L. Gokaslan, Amer Samdani and George I. Jallo

frequently associated with scoliosis. 10 As many as 18% of patients presenting with congenital scoliosis have a contributory intraspinal abnormality. 9 More recent reports have suggested that as many as 20–58% of cases of congenital scoliosis may be associated with intraspinal abnormalities. 1 , 2 , 10 , 12–14 Tethered cord as a direct cause of scoliosis was first demonstrated in 1990 by McLone et al. 8 after they observed stabilization or improvement in scoliosis in patients after myelomeningocele repair and tethered cord release. They postulated that scoliosis may

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Mark D. Krieger, Yuri Falkinstein, Ira E. Bowen, Vernon T. Tolo and J. Gordon McComb

C hiari malformations Type I, consisting of downward herniation of the cerebellar tonsils, have been discovered with increasing frequency in children, 4 , 9 , 25 , 30 largely due to the recognition that many cases of scoliosis in young children are associated with a CM-I and concomitant hydrosyringomyelia. Management of this combined diagnosis typically consists of surgical treatment of the CM-I, followed by treatment of the scoliosis, which may consist of serial observation, bracing, and/or corrective spinal surgery. 1 , 2 , 6–8 , 17 , 21 , 22 , 28