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Tamas Illes - One of the best experts on this subject based on the ideXlab platform.
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sagittal plane correction in idiopathic scoliosis
Spine, 2002Co-Authors: Tamas De Jonge, Jean Dubousset, Tamas IllesAbstract:STUDY DESIGN: Patients with idiopathic scoliosis who had undergone posterior fusion by means of posterior multisegmented hook instrumentation were studied retrospectively. OBJECTIVES: To present the changes in projected thoracic hypokyphosis and the behavior of lumbar lordosis within and below the fusion. SUMMARY OF BACKGROUND DATA: Scoliosis is a three-dimensional deformity of the spine. The idiopathic cases usually exhibit a flattening of the sagittal curves, which had further deteriorated when the Harrington technique was used. The consequences included the flat back, angular increase of the lumbar lordosis below the fusion, and low back pain. Previous studies showed no or only moderate correction of thoracic hypokyphosis when using Cotrel-Dubousset instrumentation or its modifications were used. Harrington Rod systems resulted in decreased lumbar lordosis in the fusion area and increased lordosis below the fusion. No background data were found concerning the effects of multisegmented hook instrumentation on the lumbar spine within and below the fusion. METHODS: For this study, 306 patients with idiopathic scoliosis who had undergone posterior spinal fusion with multisegmented hook systems using the derotation maneuver were analyzed after a mean follow-up period of 5 years and 4 months. The coronal plane curvature, the sagittal plane projection of the thoracic kyphosis, and the lumbar lordosis within and below the fusion were evaluated. RESULTS: The average coronal plane correction was 67.1%. Analysis of the sagittal contours demonstrated that the preoperative thoracic hypokyphosis (less than 20 degrees between T4 and T12) increased by an average of 12 degrees, and that 55.1% of hypokyphotic backs were corrected to the normal range (20 degrees to 40 degrees ). In patients with frank lordosis (kyphosis less than 10 degrees ), the degree of correction was higher (average, 16 degrees ), but complete correction was achieved in only 38.5% of the cases. In patients with mild lordosis (kyphosis between 10 degrees and 20 degrees ), the average correction was 8 degrees, and 71.3% of the patients were in the normal range after surgery. The normal preoperative thoracic kyphosis was preserved in 81.3% of the cases. In the lumbar area, the Cotrel-Dubousset instrumentation was capable of correcting the preoperative hypolordosis (less than -20 degrees between L1 and L5) in 94.4% of the cases. The normal preoperative lordosis (-20 degrees to -60 degrees ) was preserved in 97.9% of the cases. The hyperlordosis was corrected in all cases. Analysis of the data in terms of lower fusion limit showed that the lower the caudal hook, the greater the increase in the segmental lordosis within the fusion, without any increase distal to the fusion. No segmental hyperlordosis was observed below the fusion. CONCLUSIONS: The Cotrel-Dubousset technique ensures considerable sagittal correction of the spine. In the course of scoliosis correction, it is possible to preserve the normal preoperative sagittal profile of the spine, to correct the slightly flattened thoracic kyphosis, to increase materially the kyphosis of the frankly hypokyphotic spine, to preserve or restore normal lumbar lordosis in a considerable percentage of the cases, to avoid angular segmental hyperlordosis at the level of the first disc below the fusion, and to avoid retrolisthesis of the last fused vertebra.
Lodewijk W Van Rhijn - One of the best experts on this subject based on the ideXlab platform.
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the destroyed lung syndrome report of a case after Harrington Rod instrumentation and fusion for idiopathic scoliosis
Spine, 2002Co-Authors: Andre Van Ooij, Arne Van Belle, Ruud Timmer, Lodewijk W Van RhijnAbstract:STUDY DESIGN A case report is described. OBJECTIVE To describe the very rare complication of destroyed lung syndrome after scoliosis correction. SUMMARY OF BACKGROUND DATA The destroyed lung syndrome has, to our knowledge, never been associated with scoliosis in the literature. Bronchial kinking and compression by the vertebral column have been described in severe scoliosis cases. METHODS The patient, a 40-year-old woman was operated on in 1976 for a thoracic scoliosis and hypokyphosis using Harrington Rod instrumentation and fusion with autologous bone graft. With a follow-up of 26 years, she has developed a very severe functional defect of the right lung, the so-called destroyed lung syndrome. RESULTS After the index procedure, the patient developed various episodes of pneumonia and abscess formation in the right lung because of kinking and obstruction of the bronchial tree of the right lung. This seemed to be caused by a severe hypokyphosis and by residual scoliosis of the thoracic spine with direct compression of the right bronchus by the vertebral column. Eventually two stents were placed, but this prevented further deterioration only temporarily. CONCLUSIONS After Harrington instrumentation and fusion for thoracic hypokyphotic idiopathic scoliosis, kinking and obstruction of a main bronchus are possible. In this patient, this complication gave rise to recurrent infections of the right lung, eventually progressing to destroyed lung syndrome.
C. Milano - One of the best experts on this subject based on the ideXlab platform.
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Minimum 20-year follow-up results of Harrington Rod fusion for idiopathic scoliosis
European Spine Journal, 2005Co-Authors: M. Mariconda, O. Galasso, P. Barca, C. MilanoAbstract:We evaluated the outcome of spinal fusion with a single Harrington distraction Rod in patients with idiopathic scoliosis. At follow-up visits a minimum of 20 years post-surgery, we studied 24 patients who had been operated on by the same surgeon. The Scoliosis Research Society (SRS) Instrument and an additional questionnaire of our own, along with an invitation for a follow-up visit, were originally mailed to 28 consecutive patients of the surgeon. The SRS Instrument has seven domains dealing with back pain, general self-image, self-image after surgery, general function, function in terms of level of activity, function after surgery, and degree of satisfaction with the surgery. The length of time between surgery and the follow-up visit averaged 22.9 years (20.2–27.3). The mean age at surgery and follow-up were 15.8 (13–22) and 38.8 (35–48) years, respectively. Twenty-four patients sent back the completed questionnaires and 16 of them participated in the clinic and radiographic follow-up. To assess the meaning of the questionnaires’ results, a control group of the same sex, age and geographic provenance was selected from our outpatients without scoliosis. The average follow-up score on the SRS Instrument for the patients was 100.8 (78–110). When we compared the study and control groups, no significant differences in the single SRS domain scores were observed. The mean Cobb angle and rib cage deformity before surgery were 70.46° (40–120) and 36.4 mm (20–60 mm), respectively, whereas on follow-up they were 41.23° (16–75) and 22.3 mm (5–50 mm), respectively. These long-term results lead us to consider Harrington fusion a procedure that pRoduces a long-lasting high degree of self-reported post-operative satisfaction.
Tomislav Dapic - One of the best experts on this subject based on the ideXlab platform.
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more than 20 year follow up Harrington instrumentation in the treatment of severe idiopathic scoliosis
European Spine Journal, 2007Co-Authors: Marko Pecina, Tomislav DapicAbstract:On the basis of our own experience, we would like to support the results reported in the article “Minimum 20-year follow-up results of Harrington Rod fusion for idiopathic scoliosis” [2]. The number of patients that we evaluated and the duration of their follow-up are almost the same as those reported in the article. The only difference is that we evaluated only the patients with severe idiopathic scoliosis and that there was a difference in the application of Harrington Rod. It is obvious from the report, especially from Fig. 3, that the investigators did not contour the Harrington Rod in the sagittal plane. We, on the other hand, always did it. One of our authors (M.P.), i.e., the one who operated on all the patients, used French Rod bender to contour Harrington Rod in sagittal plane depending on the length of spondylodesis. He secured the round end of the Rod in the lower laminar hook and then squeezed the hook, using special pincer. Thus, the round end of the Rod was fixated in the hook, which prevented the rotation during distraction. The first author learned this procedure working with Dr Pierre Stagnara. With respect to the application of the autologous bone transplant, postoperative immobilization, and rehabilitation, the procedure were followed was the same as the one described by the authors of the article. Between 1980 and 1983, 25 patients, 19 women and 6 men with severe idiopathic scoliosis (Cobb angle ≥70°) were treated with posterior spinal arthRodesis and Harrington instrumentation at our Department. The mean age of patients at the time of intervention was 23 years, ranging from 13 to 31 years. The follow-up lasted 22 years and 5 months on average (range 22–25 years) and none of the patients were lost. Two patients had a type I curve, 5 had a type II curve, 11 had a type III curve, 5 had a type IV curve, and 2 had a type V curve according to the classification of King et al. [1]. All patients were treated by Stagnara operative technique and Stagnara postoperative protocol [3]. A junior orthopedic surgeon who did not assist at the operations evaluated all the patients. The preoperative Cobb angle of the primary curve was 87° on average (range 74°–125°). Postoperatively, the curve was 51° on average (range 35°–85°), i.e., the obtained correction of the curve was 40% (range 15–58%). Only three patients had to undergo reoperation, one because of pseudarthrosis and two because the caudal hook dislodged. There were no neurological complications. At the most recent follow-up visit, an average loss of correction was 10° (range 0°–22°). The average spine score was 84 points (range 26–98 points). The average level of pain on the analog scale was 2.6 points (range 0–7.2 points). Actually 23 patients are full-time workers and two patients are employed as part-time. None of our patients had a flat back syndrome. In our opinion, it is due to Harrington Rod modeling and achieving the balance of the spine in sagittal plane (Fig. 1). Fig. 1 Standing sagittal view radiograph with contured Harrington Rod, 23-year follow-up Comparing our results with those reported in the article, we concluded that they were almost identical. It should be mentioned, however, that the primary scoliotic curve was reduced practically by the same percentage with respect to the preoperative angle in both groups of patients. Both studies showed that the long-term effect of Harrington instrumentation can be successful even in severe and adult idiopathic scoliosis. In our opinion, it is possible to achieve grace to Stagnara operative technique (solid spondylodesis, sagittal configuration of the Harrington Rod, and rib resection) and Stagnara postoperative treatment.
Tamas De Jonge - One of the best experts on this subject based on the ideXlab platform.
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sagittal plane correction in idiopathic scoliosis
Spine, 2002Co-Authors: Tamas De Jonge, Jean Dubousset, Tamas IllesAbstract:STUDY DESIGN: Patients with idiopathic scoliosis who had undergone posterior fusion by means of posterior multisegmented hook instrumentation were studied retrospectively. OBJECTIVES: To present the changes in projected thoracic hypokyphosis and the behavior of lumbar lordosis within and below the fusion. SUMMARY OF BACKGROUND DATA: Scoliosis is a three-dimensional deformity of the spine. The idiopathic cases usually exhibit a flattening of the sagittal curves, which had further deteriorated when the Harrington technique was used. The consequences included the flat back, angular increase of the lumbar lordosis below the fusion, and low back pain. Previous studies showed no or only moderate correction of thoracic hypokyphosis when using Cotrel-Dubousset instrumentation or its modifications were used. Harrington Rod systems resulted in decreased lumbar lordosis in the fusion area and increased lordosis below the fusion. No background data were found concerning the effects of multisegmented hook instrumentation on the lumbar spine within and below the fusion. METHODS: For this study, 306 patients with idiopathic scoliosis who had undergone posterior spinal fusion with multisegmented hook systems using the derotation maneuver were analyzed after a mean follow-up period of 5 years and 4 months. The coronal plane curvature, the sagittal plane projection of the thoracic kyphosis, and the lumbar lordosis within and below the fusion were evaluated. RESULTS: The average coronal plane correction was 67.1%. Analysis of the sagittal contours demonstrated that the preoperative thoracic hypokyphosis (less than 20 degrees between T4 and T12) increased by an average of 12 degrees, and that 55.1% of hypokyphotic backs were corrected to the normal range (20 degrees to 40 degrees ). In patients with frank lordosis (kyphosis less than 10 degrees ), the degree of correction was higher (average, 16 degrees ), but complete correction was achieved in only 38.5% of the cases. In patients with mild lordosis (kyphosis between 10 degrees and 20 degrees ), the average correction was 8 degrees, and 71.3% of the patients were in the normal range after surgery. The normal preoperative thoracic kyphosis was preserved in 81.3% of the cases. In the lumbar area, the Cotrel-Dubousset instrumentation was capable of correcting the preoperative hypolordosis (less than -20 degrees between L1 and L5) in 94.4% of the cases. The normal preoperative lordosis (-20 degrees to -60 degrees ) was preserved in 97.9% of the cases. The hyperlordosis was corrected in all cases. Analysis of the data in terms of lower fusion limit showed that the lower the caudal hook, the greater the increase in the segmental lordosis within the fusion, without any increase distal to the fusion. No segmental hyperlordosis was observed below the fusion. CONCLUSIONS: The Cotrel-Dubousset technique ensures considerable sagittal correction of the spine. In the course of scoliosis correction, it is possible to preserve the normal preoperative sagittal profile of the spine, to correct the slightly flattened thoracic kyphosis, to increase materially the kyphosis of the frankly hypokyphotic spine, to preserve or restore normal lumbar lordosis in a considerable percentage of the cases, to avoid angular segmental hyperlordosis at the level of the first disc below the fusion, and to avoid retrolisthesis of the last fused vertebra.
