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Biomedical subjects

K D Leatherman

Publications and source records attributed to K D Leatherman.

18 recordsLinked to original sources
PubMed1988

Zielke instrumentation in idiopathic scoliosis: late effects and minimizing complications.

Sixty-eight patients with idiopathic scoliosis treated with Zielke instrumentation are reviewed. Comparison of Groups A and B demonstrates a statistically significant reduction in the incidence of rod fracture by modifying preoperative selection criteria and operative technique as described. Only one-half of the cases with broken implants had an unfavorable clinical course, and those rod fractures with curve progression were associated with significant pain. Average kyphosis was 9.7 degrees, and did not correlate with the subjective result. Analysis of Group A showed that thoracic progression was rare, and tended to occur in patients who were out of balance. Seventy-two percent of patients operated on for severe pain report significant relief at 4.2 years average follow-up, many reporting continued improvement between 1 and 3 years after surgery.

Equipment Failure↗
PubMed1983

Two-stage resection and spinal stabilization for aneurysmal bone cyst. A report of two cases.

Two cases of aneurysmal bone cyst of the dorsal lumbar spine are presented with four- and seven-year follow-up periods. The lesion in each case involved the vertebral bodies and posterior elements and extended to contiguous bony structures. Both anterior and posterior staged procedures were required for maximal excision, rendering the spine extremely unstable at the involved levels. Anterior strut grafting with autogenous iliac bone was done during the first stage after the vertebral bodies had been curetted. Three weeks later the remaining dorsal elements and associated tumor were removed through a posterior approach, and the spine was stabilized with the Harrington compression-distraction system and posterior autogenous iliac crest grafts. Both patients were neurologically normal after operation, and the spines in both were stable and solidly fused. Both have remained symptom-free and have had no evidence of recurrence.

Adult↗
PubMed1979

Two-stage corrective surgery for congenital deformities of the spine.

Sixty patients with congenital deformities of the spine were operated upon in the past fifteen years using a two-stage procedure. In the fifty patients with scoliosis half of the deformities were due to hemivertebrae and half to unilateral bars. The average correction of the deformity was 47 per cent. Early neurological signs observed in two patients with a diastematomyelia resolved. Of the ten patients with kyphosis nine had neurological signs of impending paraplegia and one was completely paraplegic before operation; all improved markedly. Posterior spinal fusion alone in the rapidly progressing congenital deformity may not prevent further progression, particularly in those cases iwth unilateral bars. Anterior resection of the vertebral body with later posterior fusion with Harrington instrumentation is safe and effective.

Adolescent↗
PubMed1978

Spinal injuries in child abuse: case report.

Injuries of the spine have been seen in cases of child abuse. These injuries can be identified by careful skeletal survey. In the case described, a young boy was originally diagnosed as having dorsolumbar kyphus with no previous trauma, but the injury was later found to be related to parental abuse. The most important condition to rule out is spinal infection. The parental behavioral history is important, and social work consultation is recommended.

Child Abuse↗
PubMed1978

Occurrence of cold agglutinins in congenital scoliosis.

Eighty-seven patients undergoing spinal surgery for a variety of conditions were surveyed for the presence of cold agglutinins. Patients with congenital scoliosis or metastatic lesions of the spine were found to have a frequency of cold agglutinins that was 250 to 1000 times greater than that in the general population. This greater frequency was independent of ABO blood group, sex, or age. Pre-admission screening of congenital scoliosis patients is urged.

ABO Blood-Group System↗
PubMed1978

Idiopathic and congenital scoliosis in twins.

This report contains a case presentation of monozygotic twins who had concordant right thoracic scoliosis of differing severities. One twin also had an associated congenital left lumbar scoliosis and urologic abnormalities. This report would suggest that the genetic basis of scoliosis may occur at multiple gene loci.

Abnormalities, Multiple↗
PubMed1978

Cotrel traction, exercises, casting in the treatment of idiopathic scoliosis. A pilot study and prospective randomized controlled clinical trial.

A pilot study of ten individuals with adolescent-onset idiopathic scoliosis demonstrated that a week of Cotrel traction and exercises did not improve curve correction obtained by the application of an elongation, derotation, flexion (EDF) cast. There was, however, a significant improvement on lateral bending correction during this period. A prospective, randomized, controlled clinical trial showed that the exercise programme and not the traction was responsible for rendering the spine less rigid.

Casts, Surgical↗
PubMed1978

Congenital kyphosis in myelomeningocele. Vertebral body resection and posterior spine fusion.

The deforming mechanisms in the congenital lumbar kyphosis of myelomeningocele are situated anteriorly. Posterior wedge resection with local fusion therefore will not prevent progression of the deformity. Nonetheless, this procedure may be the only method of affording sac closure, or providing continuity of the ulcerated integument. Definitive corrective surgery will be required later and must combat the anterior deforming forces. Resection of the apical vertebral body followed by posterior fusion with Harrington instrumentation provides a solid straight spine.

Child↗
PubMedDate not supplied

Experience with an intraoperative autogenous blood recovery system in scoliosis and spinal surgery.

A clinical trial of an intraoperative autogenous blood recovery system shows that while the method is safe, the cost in spinal surgery is quite high. The unit was used in 20 procedures in 18 patients thought to have increased risk of intraoperative bleeding (mature idiopathic, congenital, myelomeningocele, Marfan's, and irradiation scolioses and late spinal fractures). Collection in four procedures was either insufficient for use of contaminated. In the remaining 16 cases, 20% of the blood loss was recovered. A total of ten units of blood was recovered, at a cost of $283/unit; this is four times the current cost for a unit of blood in the local blood bank. The method would be more beneficial if a huge blood loss were anticipated, as most of its cost is incurred in the setup, and the higher the blood loss at surgery, the higher the percentage of the yield might be. The method may be useful with rate blood types and for patients with religious objections to transfusions.

Adolescent↗
PubMedDate not supplied

Benefits of the Harrington compression system in lumbar and thoracolumbar idiopathic scoliosis in adolescents and adults.

Adolescent and adult scoliosis exhibits deformity present in all three planes of orientation, but the principal correcting effect of the Harrington distraction system is in the frontal plan. Sagittal and horizontal deformity was addressed by adding the compression system. Twenty patients were treated with combined apparatus. The mean preoperative frontal curve was 52 degrees, and the mean postoperative curve was 16 degrees. The average preoperative tilt angel was 31 degrees, and the average postoperative angle was 8 degrees. Thoracolumbar kyphosis was reduced, and lumbar lordosis was maintained. The combined apparatus addresses the triplanar curvature more effectively than the single distraction system.

Adolescent↗
PubMedDate not supplied

Effect of the Harrington compression system on the correction of the rib hump in spinal instrumentation for idiopathic scoliosis.

To analyze the effect of the Harrington compression system on the rib hump in thoracic idiopathic scoliosis, intraoperative measurements were made on 21 cases during correction with the distraction system and after addition of the compression system. The data show that the compression system makes a major contribution to the correction of total rib deformity in over two-thirds of the patients, and the correction of the rib valley is much more significant than correction of the rib hump. Analysis of postoperative spine roentgenograms seems to indicate that the extent of the rib correction does not correlate with spine derotation as measured by the system of Nash and Moe. The improvement in rib correction achieved by addition of the compression system appears to result from changes centered about the costovertebral joints.

Adolescent↗
PubMedDate not supplied

Anterior decompression of the spinal cord for neurological deficit.

With newer radiographic methods for defining abnormalities affecting the spine, and improved surgical techniques, anterior decompression has proved effective in improving neurologic return when pressure on the cord is directed from anteriorly. Twenty-five patients undergoing anterior decompression for partial neurologic deficit fit into one of four categories: 1) fracture, 2) tumor, 3) infection, and 4) congenital scoliosis. Operative procedures were performed over a period of 15 years with the longest follow-up being 15 years. Of the 25 patients, 19 have been followed for greater than two years. No patient in this series showed worsening of his neurologic status on a permanent basis. The most dramatic improvement was noted in the fracture cases, although in cases of infection and tumor were almost as exciting. In the congenital cases recovery was slow and in some cases not as dramatic; however, progression of neurologic deficit in all cases was halted. In those cases showing a progressive deficit the deterioration was halted. With our present surgical skills and our increased armamentarium of diagnostic techniques and conservative treatment, hopeful waiting for return of neurologic function should no longer be tolerated where the lesion is exerting anterior pressure on the spinal cord.

Adult↗
PubMedDate not supplied

A new orthosis for immediate postoperative bracing in idiopathic scoliosis.

The "crutch-type scoliosis brace" and the KSO are leather covered aluminum braces, which have been successfully used in treating scoliosis patients at the Kosair Spinal Deformity Center both nonoperatively and postoperatively. This report defines the measurements, materials, and construction details for effective use of these braces and reports the very encouraging results of the KSO in a group of instrumented idiopathic scoliotic patients.

Adolescent↗
PubMedDate not supplied

Current status of anterior spine surgery for scoliosis.

The greatest need for anterior spine surgery is for those cases that have neurological involvement with pressure or stress forces exerted on the spinal cord. With anterior decompression excising anomalous bone, shortening the spine with posterior osteomies, and correction with Harrington instrumentation, many of these cases were protected against neurological sequelae as well as correction of the deformity. Anterior spine reconstruction is a 2-stage procedure. The procedure protects against damage to the blood supply, untethers the spinal cord, corrects deformity, and stabilizes the spinal column. As more cases that can benefit from anterior spine correction of scoliosis are recognized, the expertise to deal with these lesions continues to grow.

Adolescent↗