The Experts below are selected from a list of 126 Experts worldwide ranked by ideXlab platform
Klaus Zielke - One of the best experts on this subject based on the ideXlab platform.
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Effects of the combined VDS-Zielke and Harrington operation on the frontal rib cage deformity of double major curves in idiopathic scoliosis.
Spine, 1995Co-Authors: Panagiotis Korovessis, Kriton S. Filos, Klaus ZielkeAbstract:Study Design. This study analyzed the changes in the frontal plane of the deformed lower rib cage and the scoliosis-related alterations on the spine in patients with double major curve-pattern idiopathic scoliosis. Objectives. The results obtained preoperatively, after the Zielke operation, postoperatively after the Harrington Instrumentation, and at the follow-up evaluation were compared to investigate which changes of the elements of the rib cage deformity are caused by each of the two Instrumentations. Summary of Background Data. Previously, Wojcik reported on the effects of a Zielke operation on the lower rib in mild S-shaped idiopathic scoliosis. No previous data exist regarding the lower rib cage deformities in severe idiopathic double major-pattern scoliosis and their changes after combined VDS-Zielke and Harrington Instrumentation. Methods. Fifteen patients who underwent the staged Zielke operation followed by Harrington rod Instrumentation were followed-up for an average period of 31.1 months. The methods used in our study included Cobb angle and a segmental analysis (T7-T12) of each of convex and concave rib-vertebra angles, rib-vertebra angle differences, vertebral rotation, and vertebral tilt. Results. In this series, the apical convex ribs showed an increased droop preoperatively compared with the concave apical ribs. The VDS-Zielke operation corrected the lumbar scoliosis in an average of 63% of patients, whereas the thoracic scoliosis showed an immediate spontaneous correction of 30%. The VDS-Zielke operation also produced a significant correction of the scoliosis-related vertebral tilt (T10-T12), derotated the lumbar vertebrae and the T12 vertebra significantly, elevated the mobile concave ribs, and increased the droop of the lower (T11, T12) mobile convex ribs. The Harrington Instrumentation did not change the vertebral rotation, the vertebral tilt, the convex rib-vertebra angle, or the L4 obliquity, but significantly changed the apical concave rib-vertebra angle. The combined Zielke-Harrington Instrumentation reduced the thoracic kyphosis and the thoracolumbar junction-kyphosis significantly, whereas the lumbar lordosis remained practically unchanged. Conclusions. Only the anterior VDS-Zielke Instrumentation significantly corrects severe spinal deformities, elevates the three lower ribs on the concavity, and increases the droop of the two lower ribs on the convexity in the severe idiopathic double major curve-pattern scoliosis combined operated (Zielke-Harrington). Therefore, the Harrington Instrumentation should have only limited use in cosmetic scoliosis surgery and should be replaced with posterior multi-hook Instrumentation with a derotation effect.
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Does the combined ventral derotation system (VDS) followed by Harrington Instrumentation improve the vital capacity in patients with idiopathic double major curve pattern scoliosis? An analysis of 33 cases and review of the literature.
Clinical orthopaedics and related research, 1992Co-Authors: Panagiotis Korovessis, Klaus ZielkeAbstract:A young, homogenous population of 33 patients with idiopathic scoliosis of double major curve pattern (DMC), a mean thoracic curve of 70.6 degrees (standard deviation [SD] = 20.6), and a mean lumbar curve of 72.9 degrees (SD = 15), had a measurement of the vital capacity (VC) at rest before and at a minimum of one year after combined ventral derotation system (VDS). This was followed by Harrington Instrumentation and fusion to evaluate the effect of scoliosis, kyphosis, and their surgical correction on VC at rest. A regression analysis showed that the VC was significantly lowered before operation to 69.6% of predicted value, whereas individuals with thoracic curvatures greater than 70 degrees had a lower VC. The surgical correction of the thoracic curve of 50.8% and the lumbar curve of 68.4% was permanent in the follow-up evaluation, and the functional improvement in postoperative VC was 4.36%, statistically not very significant. The time between the two evaluations did have a significant statistical correlation with the observed improvement of the VC. The longer the interval between the two evaluations, the better the improvement of the VC. The age of the patient at the time of the first (VDS) operation influences the changes of the observed VC, significantly favoring the younger patients. The number of the functional vertebral segments included by the spinal Instrumentation and fusion does not improve the VC.(ABSTRACT TRUNCATED AT 250 WORDS)
Panagiotis Korovessis - One of the best experts on this subject based on the ideXlab platform.
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Effects of the combined VDS-Zielke and Harrington operation on the frontal rib cage deformity of double major curves in idiopathic scoliosis.
Spine, 1995Co-Authors: Panagiotis Korovessis, Kriton S. Filos, Klaus ZielkeAbstract:Study Design. This study analyzed the changes in the frontal plane of the deformed lower rib cage and the scoliosis-related alterations on the spine in patients with double major curve-pattern idiopathic scoliosis. Objectives. The results obtained preoperatively, after the Zielke operation, postoperatively after the Harrington Instrumentation, and at the follow-up evaluation were compared to investigate which changes of the elements of the rib cage deformity are caused by each of the two Instrumentations. Summary of Background Data. Previously, Wojcik reported on the effects of a Zielke operation on the lower rib in mild S-shaped idiopathic scoliosis. No previous data exist regarding the lower rib cage deformities in severe idiopathic double major-pattern scoliosis and their changes after combined VDS-Zielke and Harrington Instrumentation. Methods. Fifteen patients who underwent the staged Zielke operation followed by Harrington rod Instrumentation were followed-up for an average period of 31.1 months. The methods used in our study included Cobb angle and a segmental analysis (T7-T12) of each of convex and concave rib-vertebra angles, rib-vertebra angle differences, vertebral rotation, and vertebral tilt. Results. In this series, the apical convex ribs showed an increased droop preoperatively compared with the concave apical ribs. The VDS-Zielke operation corrected the lumbar scoliosis in an average of 63% of patients, whereas the thoracic scoliosis showed an immediate spontaneous correction of 30%. The VDS-Zielke operation also produced a significant correction of the scoliosis-related vertebral tilt (T10-T12), derotated the lumbar vertebrae and the T12 vertebra significantly, elevated the mobile concave ribs, and increased the droop of the lower (T11, T12) mobile convex ribs. The Harrington Instrumentation did not change the vertebral rotation, the vertebral tilt, the convex rib-vertebra angle, or the L4 obliquity, but significantly changed the apical concave rib-vertebra angle. The combined Zielke-Harrington Instrumentation reduced the thoracic kyphosis and the thoracolumbar junction-kyphosis significantly, whereas the lumbar lordosis remained practically unchanged. Conclusions. Only the anterior VDS-Zielke Instrumentation significantly corrects severe spinal deformities, elevates the three lower ribs on the concavity, and increases the droop of the two lower ribs on the convexity in the severe idiopathic double major curve-pattern scoliosis combined operated (Zielke-Harrington). Therefore, the Harrington Instrumentation should have only limited use in cosmetic scoliosis surgery and should be replaced with posterior multi-hook Instrumentation with a derotation effect.
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Does the combined ventral derotation system (VDS) followed by Harrington Instrumentation improve the vital capacity in patients with idiopathic double major curve pattern scoliosis? An analysis of 33 cases and review of the literature.
Clinical orthopaedics and related research, 1992Co-Authors: Panagiotis Korovessis, Klaus ZielkeAbstract:A young, homogenous population of 33 patients with idiopathic scoliosis of double major curve pattern (DMC), a mean thoracic curve of 70.6 degrees (standard deviation [SD] = 20.6), and a mean lumbar curve of 72.9 degrees (SD = 15), had a measurement of the vital capacity (VC) at rest before and at a minimum of one year after combined ventral derotation system (VDS). This was followed by Harrington Instrumentation and fusion to evaluate the effect of scoliosis, kyphosis, and their surgical correction on VC at rest. A regression analysis showed that the VC was significantly lowered before operation to 69.6% of predicted value, whereas individuals with thoracic curvatures greater than 70 degrees had a lower VC. The surgical correction of the thoracic curve of 50.8% and the lumbar curve of 68.4% was permanent in the follow-up evaluation, and the functional improvement in postoperative VC was 4.36%, statistically not very significant. The time between the two evaluations did have a significant statistical correlation with the observed improvement of the VC. The longer the interval between the two evaluations, the better the improvement of the VC. The age of the patient at the time of the first (VDS) operation influences the changes of the observed VC, significantly favoring the younger patients. The number of the functional vertebral segments included by the spinal Instrumentation and fusion does not improve the VC.(ABSTRACT TRUNCATED AT 250 WORDS)
K. H. Bridwell - One of the best experts on this subject based on the ideXlab platform.
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Spinal Instrumentation in the management of adolescent scoliosis : Spinal Instrumentation
Clinical Orthopaedics and Related Research, 1997Co-Authors: K. H. BridwellAbstract:A multitude of posterior and anterior segmental spinal Instrumentation systems are now available for the treatment of idiopathic scoliosis. As a consequence, fixation strategies are more complex than they were with Harrington Instrumentation. The newer systems provide better sagittal control and more stable fixation, allowing quicker mobilization of the patient. On thin patients, the bulk of these implants may be a problem. The techniques of fusion and the fusion levels remain constant.
Keith H. Bridwell - One of the best experts on this subject based on the ideXlab platform.
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Spinal Instrumentation in the management of adolescent scoliosis.
Clinical orthopaedics and related research, 1997Co-Authors: Keith H. BridwellAbstract:A multitude of posterior and anterior segmental spinal Instrumentation systems are now available for the treatment of idiopathic scoliosis. As a consequence, fixation strategies are more complex than they were with Harrington Instrumentation. The newer systems provide better sagittal control and more stable fixation, allowing quicker mobilization of the patient. On thin patients, the bulk of these implants may be a problem. The techniques of fusion and the fusion levels remain constant.
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Ability of Cotrel-Dubousset Instrumentation to preserve distal lumbar motion segments in adolescent idiopathic scoliosis.
Journal of spinal disorders, 1993Co-Authors: Lawrence G. Lenke, Keith H. Bridwell, Christy Baldus, Kathy Blanke, Perry L. SchoeneckerAbstract:Between 1985 and 1990, 44 patients with adolescent idiopathic scoliosis were treated with Cotrel-Dubousset Instrumentation when Harrington Instrumentation would have extended into the distal lumbar spine (L3, L4, or L5) for these curve patterns. Twenty-four of these 44 (group I) patients had one distal fusion level preserved using Cotrel-Dubousset Instrumentation, whereas the other 20 patients (group II) were instrumented/fused with Cotrel-Dubousset Instrumentation to the expected Harrington Instrumentation level in the lower lumbar spine. All patients have a minimum 2-year follow-up, and the average follow-up is 39 months (range 24-74). The characteristics of the group I curves that allowed us to stop the Instrumentation a level short included minimal rotation and tilt of the anticipated lowest instrumented vertebra, overall coronal curve flexibility, and nonstructural components to the lumbosacral region of the spine. There were no major differences between these two groups when comparing postoperative coronal and sagittal balance parameters at the most recent follow-up. In select cases, dependent on the preoperative criteria to be discussed, Cotrel-Dubousset Instrumentation (vs. traditional Harrington Instrumentation) does allow distal lumbar fusion levels to be saved while maintaining acceptable coronal and sagittal balance.
Thomas Niemeyer - One of the best experts on this subject based on the ideXlab platform.
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Spontaneus bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report
Journal of medical case reports, 2012Co-Authors: Peter Obid, Alexander Richter, Hüseyin Übeyli, Thomas NiemeyerAbstract:Introduction Spontaneous fractures of the spine are a common entity. They usually occur in older people with osteoporosis. This case is presented on account of its rarity. To the best of the authors' knowledge only one case of an osteoporotic pedicle fracture after Harrington Instrumentation has been described before.
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Low back pain after spinal fusion and Harrington Instrumentation for idiopathic scoliosis.
International orthopaedics, 2004Co-Authors: Thomas Niemeyer, Albert Schulze Bövingloh, Sarah Grieb, Jürgen Schaefer, Henry Halm, Torsten KlubaAbstract:We reviewed 41 patients with adolescent idiopathic scoliosis treated with spinal fusion and Harrington Instrumentation between 1973 and 1992. The mean follow-up was 23 (11-30) years. All patients completed self-administered questionnaires, Oswestry Low Back Pain Disability Score (ODS), Roland Morris score (RLS), and Visual Analog Pain Intensity Scale (VAS). We found a high degree of satisfaction with more than three quarters of the patients in work. The outcome of ODS, RLS, and VAS showed low scores. We found a significant correlation between the scores and the Cobb angle preoperatively as well as at follow-up. The patient-oriented outcome did not correlate with the type of curve, extension of vertebral fusion, tilt angle of the lowest instrumented vertebra, postoperative Cobb angle, loss of correction, or lumbar lordosis. This long-term follow-up of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life.
