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Biomedical subjects

H L Shufflebarger

Publications and source records attributed to H L Shufflebarger.

10 recordsLinked to original sources
PubMed1992

Thoracolumbar osteotomy for postsurgical sagittal imbalance.

A prospective study of 12 patients with sagittal plane imbalance after multiple surgeries for scoliosis is reported. Reconstruction was attempted by posterior thoracolumbar junction osteotomy. Eighty-seven degrees of thoracic kyphosis (ending at L3) was improved to forty-one degrees (ending at T12). Lumbar lordosis was increased from 21 to 30 degrees, beginning at L1 afterward (L3 before). 8.7 cm posterior displacement of the sagittal weight-bearing axis was achieved. No permanent complications ensued. The procedure, without anterior surgery, corrects the deformity at the apical area. Cotrel-Dubousset instrumentation secured correction and fixation.

Adult↗
PubMed1991

Anterior and posterior spinal fusion. Staged versus same-day surgery.

Seventy-five patients who underwent combined anterior and posterior spinal fusion were compared to evaluate the results and safety of staged vs. continuous anterior and posterior spinal fusion. Thirty-five patients underwent two-stage anterior and posterior spinal fusion. The first stage consisted of anterior release; the second stage, which took place 7-10 days later, consisted of posterior spinal fusion and instrumentation. Forty patients underwent continuous anterior and posterior spinal fusion. This procedure consisted of anterior release followed by immediate posterior spinal fusion and instrumentation. The results show that 1) a continuous procedure is faster than the staged procedure; 2) there is less blood loss; 3) fewer days are spent in the hospital; and 4) better correction of the spinal deformity is achieved. Also, the complications were less frequent and less severe with the continuous procedure. It was concluded that the continuous procedure is safe and efficacious and has several advantages over the staged procedure.

Adult↗
PubMed1991

Prevention of the crankshaft phenomenon.

Factors favoring development of the crankshaft phenomenon after posterior spinal fusion include immaturity and large residual deformity. Eight patients at high risk to develop the crankshaft phenomenon underwent periapical anterior growth arrest and fusion before posterior instrumentation and fusion. With follow-up to skeletal maturity, 0% developed crankshaft phenomenon. Anterior growth arrest and fusion before a posterior procedure is recommended in scoliosis patients at high risk to develop the crankshaft phenomenon.

Child↗
PubMed1990

Fusion levels and hook patterns in thoracic scoliosis with Cotrel-Dubousset instrumentation.

This study reports the results of treatment of adolescents with King Types 2, 3, and 4 idiopathic curves using Cotrel-Dubousset instrumentation. Imbalance was seen in Types 2 and 4 curves when distraction direction hook patterns crossing the thoracolumbar junction were employed. Imbalance was not seen when a modified hook pattern employing compressing forces across the thoracolumbar junction was employed. No imbalance was observed in Type 3 curves using the basic right thoracic curve hook pattern. In Type 4 curves, a second modified hook pattern is required to obtain improved correction and balance. The mechanism of production of imbalance is explained by a three dimensional analysis of the deformity and of the forces generated by the Cotrel-Dubousset system.

Adolescent↗
PubMed1989

Cotrel-Dubousset instrumentation in neurofibromatosis spinal problems.

Cotrel-Dubousset (CD) instrumentation has been employed in 12 patients with neurofibromatosis with spinal deformity (ten regular scoliosis, one dysplastic kyphoscoliosis, and one multilevel laminectomy). The follow-up period averaged 33 months. In regular scoliosis frontal correction averaged 69%, axial derotation averaged 33%, and sagittal normalcy was produced without immobilization and without pseudoarthrosis. Successful arthrodesis was obtained in a dysplastic patient after initial failure via anterior concave struts and posterior CD instrumentation with immobilization. Stabilization and fusion of one patient with multiple-level thoracic laminectomy was achieved without immobilization. CD instrumentation is effective in the surgical management of neurofibromatous spinal abnormalities.

Adolescent↗
PubMed1988

Cotrel-Dubousset instrumentation.

Cotrel-Dubousset Instrumentation (CDI) presents a diversified posterior implant system applicable in any situation requiring posterior spinal instrumentation. It acts in the three dimensions of the spine, frontal-sagittal-axial. Correct hook site selection and direction provide spinal balance in three dimensions. The double major idiopathic scoliosis is an appropriate model on which to learn the principles of usage of CDI Results of CDI in a wide variety of spinal pathology have been excellent. There is a learning curve for CDI, hook placement being the most significant. Pitfalls and complications can be avoided.

Bone Screws↗
PubMed1987

Composite measurement of scoliosis: a new method of analysis of the deformity.

A method of calculation of biplanar spinal deformity in which the frontal Cobb angle is added to the deviation from normal sagittal alignment is presented. Three equivalent groups of adolescent idiopathic scoliosis treated by different surgical methods are presented. When only the frontal Cobb method of comparison was used, results were similar. When the composite measurement that takes into account sagittal changes was used, the Harrington instrumentation group showed significantly poorer results than the Luque rod and Cotrel-Dubousset rod groups. The composite measurement, considering sagittal alignment, is a significantly more valid method of description of the scoliotic deformity and of comparison of treatment methods.

Adolescent↗
PubMedDate not supplied

Spinal fusions to the pelvis augmented by Cotrel-Dubousset instrumentation for neuromuscular scoliosis.

Eighteen patients with spinal deformity secondary to a neuromuscular disorder were treated with posterior fusion using Cotrel-Dubousset instrumentation (CDI) to the pelvis. The mean frontal plane curve was 70 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 3 degrees at an average follow-up of 28 months. Pelvic obliquity improved in nine patients from a preoperative mean of 22 degrees to 11 degrees at follow-up. Lumbar lordosis was maintained with preoperative and postoperative means of -36 degrees. Complications included perioperative hardware failure in one case and one late, deep infection. There were no neurologic complications, pseudarthroses, or rod breakage. Posterior spinal fusion with CDI to the pelvis is an effective treatment for patients with neuromuscular scoliosis.

Adolescent↗
PubMedDate not supplied

The Milwaukee brace in idiopathic scoliosis: evaluation of 123 completed cases.

The Milwaukee Brace, as evaluated in 123 completed cases, is effective in controlling and correcting mild to moderate idiopathic scoliotic curves. The factors contributing to more correction include dorsal location, younger patients at onset of treatment, more flexible curves, and most important cooperative patients and parents. Less severe curves also achieved greater correction. Loss of correction after brace discontinuance is negligible, due to the fact that weaning and discontinuance were based on the stability of correction after 24 unbraced hours. Patients cooperative with the wearing and exercise program can expect approximately 25 per cent correction in dorsal curves and 20 per cent correction in lumbar curves. Cosmetic improvement can be expected in the majority of patients. Complications are negligible.

Adolescent↗