Vertebral anomalies were studied in 144 patients. The specific anatomic defects were defined by serial roentgenograms: anterior approaches were used in 42 operations and posterior approaches in 74 operations. Growth features of the spine were examined histologically in 15 embryos and fetuses ranging in length from 6 to 120 mm. After an extensive review of the literature on normal human spine embryology and fetal development, and after defining the specific vertebral anatomic defects and their pathogenesis, some new concepts of congenital vertebral anomalies formation are proposed. Old concepts are found to be inadequate in light of our current knowledge of embryogenesis. The authors' new and all-inclusive classification of congenital vertebral anomalies is based on specific defects, pathogenesis, and time for origin in embryonic or fetal development.

Female↗

PubMed1976

Halo-pelvic distraction apparatus. An analysis of one hundred and fifty consecutive patients.

One hundred and fifty consecutive patients on whom the halo-pelvic apparatus was used were analyzed. Sixty-six per cent had tuberculous kyphosis or paralytic scoliosis. The apparatus was of great value in holding and correcting spines with tuberculous kyphosis and the results were gratifying, even though the average correction of the kyphos was only 20 per cent. In paralytic scoliosis a 46 per cent correction was obtained, but presently Dwyer and Harrington instrumentation are used for the majority of such cases. The halo-pelvic apparatus was effective in holding and correcting severe congenital curves and kyphoscoliosis secondary to neurofibromatosis, especially when there were signs of cord compression. The complication rate was high early in the series, but has been lowered by strict patient selection and close adherence to specific guidelines in the application of the apparatus. The apparatus should be reserved for severe deformities when other means of correction or stabilization are inadequate.

Adolescent↗

PubMed1976

Batchelor's extra-articular subtalar arthrodesis. A report on sixty-four procedures in patients with poliomyelitic deformities.

Sixty-four feet of fifty-four patients treated with Batchelor's extra-articular subtalar arthrodesis for poliomyelitic deformities were reviewed after a minimum follow-up of four years. Early in the series the results were poor because of inexperience with the technique and poor selection of patients. The incidence of non-union, which appeared to be high in this series compared with other series in which the Grice technique was used, was attributed mainly to the more advanced age of our patients at the time of arthrodesis (average age, 9.9 years). A common factor in the cause of non-union was tightness of the heel cord. Redistribution of muscles to balance power in the foot did not appear to be necessary to achieve good results in feet with equinovalgus deformity, and conversely, energetic redistribution of muscle power in these feet did not result in late varus deformity.

Adolescent↗

PubMed1976

Triple tenodesis of the knee. A soft-tissue operation for the correction of paralytic genu recurvatum.

There are two types of genu recurvatum: one with bone deformity, which responds well to osteotomy, and one with posterior soft-tissue laxity with secondary bone changes. To date, no reliable treatment short of arthrodesis has been effective for the second type. An operation for this type of genu recurvatum (post-poliomyelitic) is described: a soft-tissue reconstruction of the lax tissues posterior to the knee joint done in three layers. The operation was done on sixteen knees in fourteen patients, with an average follow-up of four years and three months. The average recurvatum before surgery was 42 degrees and at the time of follow-up it was 6 degrees. Preliminary surgery is often required and precise surgical technique and prolonged bracing after surgery also are needed. All but one patient was made brace-free provided the limb operated on was not flail.

Adolescent↗

PubMed1975

Discography in paralytic scoliosis.

Observations are made on the progressive alterations of the intervertebral disc in paralytic scoliosis, demonstrated by discography.

Adolescent↗

PubMed1975

Paralytic pelvic obliquity. Its prognosis and management and the development of a technique for full correction of the deformity.

Thirty-nine patients with post-poliomyelitic scoliosis and pelvic obliquity were treated and followed for up to four years. The dominant pathological mechanism causing the pelvic obliquity was trunk-muscle imbalance. The natural history of untreated pelvic obliquity is progression, leading ultimately to dislocation of the hip. The functional abilities of the patient are then severely restricted. Our aim in treatment was to obtain the maximum possible correction of pelvic tilt and so to prevent subluxation of the femoral head. Total correction was obtained in fifteen patients; no loss of correction was seen in twenty-four patients. The best results were achieved by preliminary traction, Dwyer instrumentation distally to the fifth lumbar vertebra, and extensive posterior fusion extendind distally to the sacrum.

Female↗

PubMed1975

Stimulation of bone growth by periosteal stripping. A clinical study.

Periosteal stripping in the long lower limb bones of thirty children with shortening after poliomyelitis was performed. All have been followed up for five years. A relative increase in length attributable to the periosteal stripping procedure was seen in the majority. The conclusions are that this simple procedure is indicated in minor degrees of limb inequality in growing children, but that the haphazare response precludes any accurate estimation of the final outcome of such a procedure.

Adolescent↗

PubMed1975

Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. A long-term study.

Two hundred and forty-one consecutive anterior spine fusions for tuberculosis were reviewed to determine how often late progressive kyphosis occurred because of disproportionate growth of the posterior and anterior elements. Three of thirty-one patients with objective roentgenographic evidence of solid anterior fusion had an increase in kyphosis. Two of these had findings suggestive of growth retardation of the anterior ring epiphysis above the fusion mass. Posterior-element overgrowth in the third patient could not be excluded as a cause.

Child↗

PubMed1974