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Biomedical subjects

J H Moe

Publications and source records attributed to J H Moe.

At least 19 recordsLinked to original sources
PubMed1988

Treatment of symptomatic flatback after spinal fusion.

Fifty-five patients who had loss of lumbar lordosis after spinal fusion and subsequently had corrective osteotomies were studied. When they were first seen, fifty-two patients (95 per cent) were unable to stand erect and forty-nine (89 per cent) had back pain. The previous use of distraction instrumentation with a hook placed at the level of the lower lumbar spine or the sacrum was the factor that was most frequently identified as leading to the development of the flatback syndrome. Sixty-six extension osteotomies were performed in these fifty-five patients. Nineteen patients (35 per cent) had an associated anterior spinal fusion. Thirty-three patients (60 per cent) had one or more complications, including pseudarthrosis, a dural tear, failure of hardware, neurapraxia, and urinary tract infection. The results of the operation were evaluated at follow-up by review of clinical records, radiographs, and questionnaires. At an average follow-up of six years (range, two to fourteen years), most patients felt that they had benefited from the corrective osteotomies. However, twenty-six patients (47 per cent) continued to lean forward and twenty patients (36 per cent) continued to have moderate or severe back pain. The failure to restore sagittal plane balance led to a higher rate of pseudarthrosis, which was associated with recurrent deformity. Anterior spinal fusion combined with posterior osteotomy resulted in greater maintenance of correction. The prevention of flatback syndrome is important, since its treatment is difficult. When a spinal fusion must be extended to the level of the lower lumbar spine or the sacrum, the use of distraction instrumentation should be avoided in order to prevent this deformity.

Adolescent↗
PubMed1987

Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.

Twenty-six adults, ranging in age from nineteen to fifty-eight years old, were treated for idiopathic scoliosis by two-stage anterior and posterior spinal fusion. The goals of the combined procedure were to increase correction of the curve and decrease the rate of pseudarthrosis. Preoperatively, the major curves measured an average of 83 degrees, and on the best side-bend they averaged 59 degrees, a 29 per cent degree of flexibility. At the time of discharge from the hospital the curves had improved to an average of 44 degrees, a correction of the preoperative curve of 39 degrees or 47 per cent. At an average length of follow-up of forty-nine months, the major curves measured an average of 50 degrees, a 41 per cent correction compared with the initial curves. Twenty-three of the major curves were better than when they were measured on the preoperative radiograph of the best side-bend, by an average of 15 degrees, but eight curves were either the same or worse. No patient had pseudarthrosis or permanent neurological injury. It is our conclusion that a two-stage anterior and posterior fusion is of value for the treatment of the adult who has a rigid curve that requires maximum correction to allow the head, shoulders, and torso to be centered over the pelvis. We do not recommend the use of instrumentation for the anterior fusion as this did not increase the correction of the curve in this series of patients.

Adult↗
PubMed1986

Fusion to the sacrum for nonparalytic scoliosis in the adult.

This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis who had spinal fusion from T11 or above to the sacrum. This study was prompted by the frustrations of the treating surgeons in attempting long fusions from the thoracic spine to the sacrum. Of 25 patients treated with a single-stage posterior fusion only 28% had a good result with a single procedure. Failures were due to pseudarthrosis, decompensation, or loss of lumbar lordosis. Ten patients treated with posterior fusion and subsequent 6-month augmentation had a 70% success rate. Eight patients treated with anterior followed by posterior fusion had a 75% success rate. The ideal answer to this clinical problem has not yet been found.

Adult↗
PubMed1985

Spinal deformities in patients with arthrogryposis. A review of 16 patients.

Sixteen patients with arthrogryposis having spinal deformities were reviewed. The age of diagnosis of scoliosis was from birth to 15 years. Many different curve patterns were seen. Five patients had decreased anterior-posterior thoracic diameter associated with decreasing vital capacity. One of them died at age 6 months of bronchopneumonia and one other at 16 years from cardiac arrest during surgery elsewhere. Eight patients had nonoperative treatment with an orthosis, and of these, three are still under orthotic care. For the remaining five, one had improved at the end of the treatment, and four had increased curvatures in the orthosis. Six patients underwent surgery, four from the group treated by bracing, and two having surgery as the primary treatment at this Center. One patient had posterior fusion without instrumentation, four had posterior fusion with instrumentation, and one had posterior instrumentation without fusion. Spinal problems can occur in arthrogryposis patients, are poorly controlled nonoperatively, and frequently require surgical treatment, especially if there is thoracic lordosis.

Adolescent↗
PubMed1985

The surgical treatment of congenital kyphosis. A review of 94 patients age 5 years or older, with 2 years or more follow-up in 77 patients.

Ninety-four patients with surgical treatment of congenital kyphosis have been reviewed. Of these, 77 had a follow-up of 2 years or more, with an average follow-up of 7 years. The average age at surgery was 15, and the average kyphosis was 75 degrees. Twenty-seven had posterior fusion only, and 48 had combined anterior and posterior fusion. (Two others had anterior fusion only). The average kyphosis in the two groups was the same, but the anterior and posterior group had a better correction and a better maintenance of correction than the posterior group alone. Kyphosis of less than 55 degrees in growing children often was stabilized successfully by posterior surgery only, but adults and patients with kyphosis greater than 55 degrees required both anterior and posterior fusion. Halo-femoral traction was responsible for two of the three paralyses in this review.

Adolescent↗
PubMed1984

Posterior spinal arthrodesis for congenital scoliosis. An analysis of the cases of two hundred and ninety patients, five to nineteen years old.

We analyzed the results of posterior arthrodesis of the spine for congenital scoliosis, with or without Harrington instrumentation, in 290 of 323 patients who were operated on between the ages of five and nineteen years and were followed for two years or more. The length of follow-up averaged six years and ranged from two to twenty-eight years. The average curve before surgery was 55 degrees (range, 13 to 155 degrees), the average curve at correction was 38 degrees (range, 5 to 102 degrees), and the average curve at final follow-up was 44 degrees (range, 5 to 103 degrees). Bending of the fusion mass of more than 10 degrees was seen in forty patients; pseudarthrosis, in twenty; and adding-on of vertebrae with an increase in the curve of more than 10 degrees, in seven patients. There were four deaths, only one of them in the last twenty-five years. One was due to intraoperative cardiac arrest; one, to intraoperative overtransfusion; one, to postoperative overtransfusion; and one, to gastrointestinal bleeding eight months postoperatively while the patient was in a Risser jacket. Two patients became paraplegic due to excessive distraction with the Harrington rod, and two others had a partial cranial-nerve lesion due to halo traction. Based on these results, we concluded that posterior arthrodesis of the spine is satisfactory for most patients with congenital scoliosis. The most common problem was bending of the fusion mass in growing children, which occurred in 14 per cent of the patients. Use of Harrington instruments allowed slightly better correction (36 per cent compared with 28 per cent) but was associated with the only cases of paraplegia and infection in the series.

Adolescent↗
PubMed1984

Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children.

In selected patients a method of rod insertion without fusion combined with use of a full-time external orthotic support, e.g., the Milwaukee brace, is effective. The orthopedic surgeon confronted with young children who have curves that do not respond to conservative treatment alone or in which bracing is contraindicated should find this procedure particularly suitable. The method allows for the expression of full growth potential while maintaining curve correction.

Adolescent↗
PubMed1983

Zielke instrumentation (VDS) for the correction of spinal curvature. Analysis of results in 66 patients.

Sixty-six patients who underwent anterior spinal fusion with Zielke instrumentation for thoracolumbar and lumbar curvatures were reviewed. Results compared favorably with reported series in which the Dwyer instrumentation system was used. The best corrections were obtained in the idiopathic single-curve group (45% correction of upper curve, 87% correction of lower curve, and 95% correction of instrumented curve) as compared with the double-curve group (33% correction of upper curve, 53% correction of lower curve, and 62% correction of instrumental curve). Vertebral body lateral translation (subluxation) was completely corrected in 87% of the patients. Instrumentation kyphosis can be prevented by placement of anterior wedge grafts in the intervertebral spaces. Complications were frequent but usually insignificant. The use of the Zielke instrumentation system offers the advantage of improved ability to derotate the spine while obtaining significant curve correction in a short fusion area.

Adolescent↗
PubMed1983

The selection of fusion levels in thoracic idiopathic scoliosis.

From the material and data reviewed in our study of 405 patients, it appears that postoperative correction of the thoracic spine approximately equals the correction noted on preoperative side-bending roentgenograms. Selective thoracic fusion can be safely performed on a Type-II curve of less than 80 degrees, but care must be taken to use the vertebra that is neutral and stable so that the lower level of the fusion is centered over the sacrum. The lumbar curve spontaneously corrects to balance the thoracic curve when selective thoracic fusion is performed and the lower level of fusion is properly selected. In Type-III, IV, and V thoracic curves the lower level of fusion should be centered over the sacrum to achieve a balanced, stable spine.

Adolescent↗
PubMed1982

Surgical treatment of paralytic scoliosis associated with myelomeningocele.

The spines of forty patients with myelomeningocele and paralytic scoliosis were surgically stabilized at the Twin Cities Scoliosis Center between 1960 and 1979. Treatment with posterior spine fusion and Harrington instrumentation extending to the sacrum, combined with anterior fusion using either Dwyer or Zielke instrumentation, gave the best results, correcting scoliosis by an average of 45 degrees (comparing preoperative values with those at the last visit), lordosis by an average of 20 degrees, torso decompensation by an average of 5.7 centimeters, and pelvic obliquity by an average of 7 degrees. This combined fusion method reduced the rate of pseudarthrosis to 23 per cent (compared with 46 per cent when only posterior fusion and instrumentation were used). Prophylactic antibodies (selected on the basis of preoperative cultures of urine) reduced the infection rate to 8 per cent. Posterior fusion or anterior fusion alone was inadequate, even with instrumentation. Early mobilization wearing a bivalved polypropylene body jacket minimized osteoporosis, pressure sores, and social isolation. Unsolved technical problems remain, however, especially in relation to obtaining fusion across the lumbosacral joint.

Bone Transplantation↗
PubMed1982

The results of spinal arthrodesis for congenital spinal deformity in patients younger than five years old.

We reviewed the results of spinal arthrodesis for congenital spinal deformity in forty-nine patients who were younger than five years old. The minimum follow-up was five years, and eleven patients had completed their growth. Posterior arthrodesis alone was found to be effective in most scoliotic patients. There was minimum bending of the fusion mass in most patients, almost no creation of lordosis, and minimum effect on torso-lower limb relationships. For congenital kyphosis, posterior arthrodesis was highly effective, giving better eventual correction than when both anterior and posterior arthrodesis was done.

Adolescent↗
PubMed1982

Anterior strut-grafting for the treatment of kyphosis. Review of experience with forty-eight patients.

Anterior strut-grafting was used in forty-eight patients to treat structural kyphosis of the thoracic and lumbar spine. Forty patients had a combined anterior and posterior arthrodesis. Kyphosis was corrected from an average of 93 degrees preoperatively to an average of 59 degrees at follow-up. Eight patients underwent anterior cord decompression, five of whom showed improvement of neural function at follow-up. Ten patients had a loss of correction averaging 19 degrees. In four patients a pseudarthrosis developed at the strut graft-vertebral body junction. The strut graft fractured in five of nine patients in whom the graft was four centimeters or more from the apical vertebra. Complications were frequent, but for the most part they were thought to have been preventable. Anterior strut-grafting appears to be a valid and logical technique for managing structural kyphosis.

Adolescent↗
PubMed1981

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients. The average age of the patients when first seen was 30.7 years. The indications for operation were pain, progression of the curve, magnitude of the curve, and cardiopulmonary symptoms. Preoperative traction, including halo-femoral traction, did not result in increased correction when compared with the initial supine side-bending roentgenogram. A one-stage fusion was performed in 174 patients and multiple-stage procedures, in forty-eight patients. At an average follow-up of 3.6 years the average loss of correction was 6.2 degrees, 68 per cent of the patients were free of pain, and a solid fusion had been obtained in all but six patients. Complications developed in 53 per cent of the patients, the most common problems being pseudarthrosis, urinary tract infection, wound infection, instrumentation problems, a pulmonary disorder, and loss of lumbar lordosis. Paraplegia occurred in one patient. The over-all mortality rate was 1.4 per cent. Complications increased with age, and the highest mortality rate was in patients with congenital scoliosis who had cor pulmonale.

Adult↗
PubMed1980

Long-term follow-up of scoliosis fusion.

One hundred and ten scoliotic patients underwent correction and spine fusion by one of us (J. H. M.) at Gillette Children's Hospital between 1947 and 1957. Sixty-one of these patients were evaluated in 1977 for this follow-up study. The evaluation consisted of physical and roentgenographic examination, photographs, and a detailed psychosocial analysis. The aims of the study were to evaluate: (1) the long-term stability of the fusion; (2) the incidence and severity of low-back pain; and (3) the degree of integration of the patient into society. The results showed that a solid fusion had no significant loss of correction with time. Eighty-four per cent of the patients lost only zero to 5 degrees of correction during an average follow-up of twenty-six years. Low-back pain was found to be no more frequent than in the normal population in this age group, and there was less low-back pain than in a comparable series of scoliotic patients without fusion. There was no correlation between the occurrence of low-back pain and the length or magnitude of the fused curve or the lowest extent of the fusion. An unexpected finding was the high incidence of neck pain, the cause of which is unknown. Psychosocial analysis revealed that the patients were productive, active, stable persons who were working and contributing members of society.

Adolescent↗
PubMed1980

The lumbosacral curve in idiopathic scoliosis. Its significance and management.

In 850 consecutive patients with idiopathic scoliosis, no primary lumbosacral curve with only secondary curves above it was found. Forty-four patients with double structural thoracic and lumbar, single structural thoracic, and single structural lumbar curves showed progressive loss of flexibility in the lumbosacral area. Of these, five patients had correction and fusion of the lumbosacral curve and seventeen had correction and fusion of the major curve above the third or fourth lumbar segment without surgical treatment of the lumbosacral area. The results were better in the latter group. Correction and fusion in the lumbosacral area was difficult to achieve. No patient had a permanent list when only curves above the lumbosacral curve were corrected and fused. Lumbosacral fusion should be reserved for primary lumbosacral curves associated with congenital anomalies or spondylolisthesis.

Adolescent↗
PubMed1980

Treatment of idiopathic scoliosis in the Milwaukee brace.

The results of treatment of idiopathic scoliosis with a Milwaukee brace were studied in 133 patients (127 girls and six boys) whose ages ranged from eight years and five months to sixteen years and two months at the beginning of treatment. These 133 patients had 192 separate curves (119 right thoracic, thirty-nine high lumbar, twelve thoracolumbar, and twenty-two high left thoracic). Of these patients, seventy-four with 109 curves were followed for five years or more after the brace was discontinued (average, eight years; range, five to thirteen years); twenty-nine patients were treated surgically because of a poor response to the brace or progression of the curve; and thirty patients were lost to follow-up. More than 80 per cent of the seventy-four patients followed for five years or more showed some increase of their curves after the brace was discontinued. The average correction at follow-up compared with the original curve was 2 degrees for thoracic curves (range, -18 to 24 degrees) and 4 degrees for the thoracolumbar and lumbar curves (range, -11 to 17 degrees). The brace was more effective for curves of less than 40 degrees. More than one-third of the patients with curves of 40 degrees or more eventually required surgical treatment. Age, curve pattern, and status of the iliac and ring epiphyses did not correlate withe response to brace treatment. The best guideline for prediction of the results of brace treatment was the response of the curve to the brace, especially during the first year of treatment. If the curve is reduced in the brace to less than 50 per cent of its initial measurement, there is a good chance of obtaining significant permanent correction.

Adolescent↗