PubMed Health⌕ Search

Biomedical subjects

R B Winter

Publications and source records attributed to R B Winter.

At least 19 recordsLinked to original sources
PubMed1999

Scoliosis secondary to cerebrocosto-mandibular syndrome. A case report with surgical management.

STUDY DESIGN: A case report of scoliosis secondary to cerebrocosto-mandibular syndrome. OBJECTIVES: To bring about awareness of the scoliosis and respiratory problems associated with this rare syndrome. SUMMARY OF BACKGROUND DATA: Of the approximately 50 cases of this syndrome previously reported, only 3 involved scoliosis, and only 1 of these required surgery (but the patient expired). METHODS: A retrospective chart was made, and a radiologic review were done. RESULTS: A successful surgical outcome was achieved, despite severe preoperative curvature (112 degrees scoliosis) and diminished pulmonary function (21% vital capacity). CONCLUSION: This syndrome can be associated with progressive scoliosis but can be managed successfully with surgery.

Child↗
PubMed1999

Congenital scoliosis with posterior spinal arthrodesis T2-L3 at age 3 years with 41-year follow-up. A case report.

STUDY DESIGN: A case report. OBJECTIVES: To document the long-term effects of early fusion for progressive congenital scoliosis. SUMMARY OF BACKGROUND DATA: There is concern about fusion at an early age causing torso shortening and possible crankshaft phenomenon. METHODS: A review of medical and radiologic records. RESULTS: A 3-year old girl with progressive congenital scoliosis had posterior spinal arthrodesis in 1955. A pseudarthrosis was repaired at age 4, and at age 8 she had an osteotomy of the fusion mass because of bending of the fusion mass. In a follow-up 41 years after fusion, she has no back pain and no history of pulmonary problems. Despite the long fusion at a young age, her torso-to-leg ratio was remarkably good. The thoracic lordosis had improved to a normal thoracic kyphosis. CONCLUSION: Early arthrodesis was life saving and caused no long-term problems. Because significant spinal growth has occurred by age 3, no adverse effects on torso-leg ratio with an early long arthrodesis, and in addition the crankshaft phenomenon is rare in congenital scoliosis.

Child, Preschool↗
PubMed1998

Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern. A review of 67 consecutive cases having selective thoracic arthrodesis.

STUDY DESIGN: A retrospective study by an independent observer of a consecutive series of 67 cases of adolescent idiopathic scoliosis presenting with a King II curve pattern. OBJECTIVES: To demonstrate the validity of a selective thoracic fusion as a treatment of King II curves with special attention to immediate postoperative and long-term trunk balance in the coronal and sagittal planes. SUMMARY OF THE BACKGROUND DATA: The literature has been fairly controversial in terms of the recommended treatment of King II curve patterns in adolescent idiopathic scoliosis. The main confusion appears to be whether the thoracic curve alone or both curves should be instrumented and fused. METHODS: Sixty-seven patients were identified as having had a selective posterior thoracic spine fusion with instrumentation between 1961 and 1994. None of these cases had a fusion of the lumbar spine. Preoperative radiographs were analyzed for determination of the appropriate fusion level using the criteria of the stable and neutral vertebra. Follow-up radiographs were evaluated for balance in the coronal and sagittal planes using the central sacral line on posteroanterior radiograph and the C7 sacral promontory line on lateral film. RESULTS: At 2-year or greater follow-up, the unfused lumbar curve remained equal to or less than the corrected thoracic curve in 63 patients (94%). No patient required extension of fusion. Frontal plane balance analysis showed that 47 of the 67 patients had the T1 plumb line within 2 cm of the midline for an average decompensation of 8.7 mm. In no patient was the loss of balance greater than 3.8 cm. Sagittal plane balance analysis showed that only one patient had inferior junctional kyphosis greater than 10 degrees. This did not require extension of fusion. There were no cases of superior junctional kyphosis. CONCLUSIONS: The concept of selective thoracic fusion in the King II curve pattern appears to be valid. These findings suggest that arthrodesis of the lumbar spine can be avoided when this pattern is properly diagnosed and appropriately treated. Proper identification of the stable and neutral vertebra and of the appropriate level of fusion are important to achieve good postoperative balance. Successful preservation of lumbar motion segments is important to long-term satisfactory outcome in adolescent idiopathic scoliosis.

Adolescent↗
PubMed1997

Adult spinal deformity and respiratory failure. Surgical results in 35 patients.

STUDY DESIGN: Retrospective chart and complementary study review. OBJECTIVES: To describe the features of adult patients with spinal deformity and respiratory failure and to analyze the results of surgical treatment. SUMMARY OF BACKGROUND DATA: Many authors have studied the relation between spinal deformities and cardiorespiratory failure, but there exists little information about the benefits of reconstructive surgery in severely compromised patients. METHODS: The charts and complementary studies of 35 adult patients surgically treated between January 1, 1978, and December 31, 1994, were reviewed. The patients were 18 years old or older (average age, 36 years). They had spinal deformity of any etiology with respiratory insufficiency as evidenced by vital capacity of less than 60% of predictive normal, PaO2 less than 80 mm Hg, or PaCO2 more than 45 mm Hg. All had reconstructive spinal surgery in an attempt to improve their respiratory problem. RESULTS: Seven patients died within the first postoperative year, and one patient was lost to follow-up at 6 months. The other 27 patients had a mean follow-up time of 72 months. The 34 patients were divided into three groups: good, fair, and poor evolution. The patients in the good evolution group had a better preoperative general condition, had more correction of their deformities, had more improvement in their respiratory function, and had fewer complications than those in the other groups. The patients in the poor evolution group were older, had more cardiac problems, and had less correction at surgery. CONCLUSION: The results of surgery varied from extremely good to extremely bad. The seven patients who died within the first year had no benefit, but the 27 others did very well, usually gaining significant improvement of their respiratory function. Because the alternative to surgical correction is death, this study shows that, under the right circumstances, correction of spinal deformity and, therefore, correction of respiratory function can be life-saving.

Adult↗
PubMed1997

Twenty-eight-year follow-up of anterior and posterior fusion for congenital kyphosis. A case report.

STUDY DESIGN: Case report and long-term follow-up. OBJECTIVES: To answer the question of whether the operation performed was worthwhile and lasting. SUMMARY OF BACKGROUND DATA: Congenital kyphosis due to defects of vertebral body formation has a high incidence of paraplegia if not surgically stabilized. Traditional posterior spine fusion failed for such problems. METHODS: Radiographic and photographic evidence of the patients's problem, the combined anterior and posterior surgery, and at a 28-year follow-up available. RESULTS: Surgery at age 13 prevented paraplegia, but also gave correction of deformity and permitted a normal life. CONCLUSIONS: Combined anterior and posterior spinal fusion is a good operation with lasting value for this condition.

Adolescent↗
PubMed1997

A study of functional spinal motion in women after instrumentation and fusion for deformity or trauma.

STUDY DESIGN: Photographs were used to measure the residual spine motion in 71 women who had undergone spine fusion and instrumentation for spinal deformity or trauma. OBJECTIVES: To accurately define the ability of the patient to flex, extend, and bend to the right and left, thus providing the surgeon some accurate information rather than speculation regarding spinal motion. METHODS: The 71 patients had undergone spine fusion with instrumentation for scoliosis, kyphosis, or spine trauma. The average age of the patient at surgery was 22 years, ranging from 11 years to 62 years. The average time since surgery was 6 years, ranging from 1 year to 32 years. Each patient had six views photographed: flexion, extension, right and left side bending from the front, and right and left side bending from the back. Each photograph was measured independently by two research assistants. A total of 852 photographs were analyzed. RESULTS: The average degree of right side bending was 22 degrees, that of left side bending was 23 degrees, that of flexion was 111 degrees, and that of extension was 30 degrees. For the 59 patients who underwent fusion of seven levels or more and who were fused down to T12, L1, L2, L3, or L4, there was no correlation of the range of motion with the lowermost level of fusion, except in patients with fusion to L4 who had significantly less motion. Flexion was primarily a function of hamstring tightness and was best in those who exercised regularly (aerobics, gymnastics, ballet), regardless of the number of levels fused or the lowermost level of fusion. CONCLUSION: Typical spine fusions for deformity produce a moderate loss of functional motion, except in patients who undergo fusion to L4 who lose much more. The technique of analysis was found to be highly accurate and reproducible.

Adolescent↗
PubMed1997

Neurologic safety in spinal deformity surgery.

Paralysis following surgery to correct spinal deformity can be a catastrophic problem. Surgeons must be aware that there are a multitude of risk factors related to the etiology and pattern of deformity and that there are a multitude of events and actions in the operating room and after the surgery that influence the development of paralysis. Patients and families need to know that although paralysis can occur, it is rare, and that it can occur despite the very best efforts of the surgeon. This is a review of the available literature on the subject and some personal experiences of the author.

Humans↗
PubMed1997

The treatment of progressive kyphoscoliosis in camptomelic dysplasia.

STUDY DESIGN: This study evaluated the different forms of treatment of camptomelic dysplasia, a rare form of short-limbed dwarfism. OBJECTIVES: To determine the most efficacious form of management of spinal deformities in camptomelic dysplasia. SUMMARY OF BACKGROUND DATA: The literature on treatment of spinal deformities in camptomelic dysplasia is sparse. One report advocates aggressive surgical treatment to prevent curve progression and prevent already compromised respiratory function. METHODS: Eight patients with camptomelic dysplasia and progressive spinal deformity underwent a retrospective chart and radiographic review by an independent observer. Follow-up averaged 3 years and 9 months. RESULTS: Five of eight patients initially were treated with bracing and six of eight patients eventually required surgery. Average initial kyphosis was 114 degrees and scoliosis 61 degrees, compared with 99 degrees kyphosis and 52 degrees scoliosis at follow-up. Complications included pseudarthrosis (50%) and neurologic problems (33%). CONCLUSIONS: The authors advocate anterior/posterior uninstrumented fusion and halo cast immobilization postoperatively to prevent curve progression and avoid the potentially fatal sequelae associated with this disorder.

Braces↗
PubMed1997

The long-term follow-up of patients with Klippel-Feil syndrome and congenital scoliosis.

STUDY DESIGN: This study evaluated the long-term results of Klippel-Feil syndrome in patients with congenital scoliosis. OBJECTIVES: To determine the incidence of cervical and cervical-related symptoms of patients who have Klippel-Feil syndrome associated with congenital scoliosis. SUMMARY OF BACKGROUND DATA: Many authors have described the association of Klippel-Feil syndrome and congenital scoliosis. In this population of patients, cervical lesions often are discovered incidentally. The significance of these lesions is unknown. METHODS: Thirty-two patients with congenital scoliosis and Klippel-Feil syndrome were observed for more than 10 years. They were questioned specifically about cervical and cervical-related symptoms. All patients had sequential cervical radiographs and physical examinations. RESULTS: Despite rather dramatic radiographic appearances, only seven (22%) of the 32 patients had cervical or cervical-related symptoms, with two patients requiring surgery for their cervical lesions. The extent of the deformities and the average number of cervical vertebrae fused and cervical fusion-patterns were statistically similar between the symptomatic and asymptomatic groups. Patients fused to the cervicothoracic junction for management of their deformities had a significantly increased incidence of cervical symptoms. Also, patients with congenital stenosis had a significantly greater incidence of upper extremity pain. CONCLUSIONS: Only a small number of patients with Klippel-Feil syndrome and congenital scoliosis developed cervical symptoms. No fusion pattern that placed the patient at greater risk for developing symptoms could be identified. Factors that did lead to a greater incidence of cervical symptoms were fusion to the cervicothoracic junction and congenital cervical stenosis.

Adult↗
PubMed1997

Magnetic resonance imaging evaluation of the adolescent patient with idiopathic scoliosis before spinal instrumentation and fusion. A prospective, double-blinded study of 140 patients.

STUDY DESIGN: This was a prospective, double-blinded study of the magnetic resonance imaging findings in the neural axis of 140 neurologically normal typical adolescents with idiopathic scoliosis who were scheduled for scoliosis surgery. OBJECTIVE: To detect the prevalence of spinal cord and neural axis abnormalities in this select population. SUMMARY OF BACKGROUND DATA: No similar study exists, although a few related studies were published. METHODS: Full-length neural axis magnetic resonance imaging studies were reviewed independently by two radiologists who specialize in the spine. RESULTS: Only four patients had a definite abnormality-one a small thoracic syrinx and the other three with a Chiari malformation. None of these required neurosurgery. All 140 patients had their scoliosis surgery without necrologic compromise. CONCLUSION: Routine magnetic resonance imaging evaluation of neurologically normal, typical adolescents with idiopathic scoliosis is not warranted, based on this study.

Adolescent↗
PubMed1996

Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis.

STUDY DESIGN: A study was done to evaluate the use of voluntary supine side bending radiographs and Risser table traction radiographs in adolescent patients undergoing posterior spinal fusion for idiopathic scoliosis. OBJECTIVES: To compare the usefulness of supine side bending and traction radiographs in assessing curve flexibility and determining fusion levels in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Supine side bending radiographs have been used in the preoperative evaluation of idiopathic scoliosis to determine curve flexibility and fusion area. Traction films have been used to determine the flexibility of large curves and neuromuscular curves where active side bending is not possible. No study to date has compared the use of these films in patients with adolescent idiopathic scoliosis undergoing surgery. METHODS: Seventy-five patients with more than a 2-year follow-up period after surgery were included in this study. Preoperative radiographs included a standing posteroanterior and lateral film and both supine maximal voluntary side bending films and a traction film done on a Risser table. A preoperative review of these radiographs was done to determine curve flexibility and fusion levels. At follow-up evaluation, the patients were examined for any evidence of decompensation or "adding-on" of levels. RESULTS: For curves less than 60 degrees, side bending radiographs showed greater curve correction than traction radiographs, whereas the opposite was true for curves greater than 60 degrees. For King I and II curves, side bending radiographs were superior for determination of lumbar curve flexibility and for distinguishing these two types of curves. On traction radiographs, the stable vertebra was 1.4 vertebral levels higher than on the standing film. When the fusion level was moved proximally because of the traction radiograph, decompensation or "adding-on" commonly occurred. CONCLUSIONS: Supine bending radiographs are superior to traction radiographs for assessing curve flexibility except for curves more than 60 degrees. The selection of the distal extent of fusion based on the traction radiograph gave a large number of poor results. The selection of fusion levels in adolescent Idiopathic scoliosis is best determined by a combination of standing posteroanterior and lateral radiographs and the supine maximum voluntary bend films.

Adolescent↗
PubMed1996

Paraplegia resulting from vessel ligation.

STUDY DESIGN: This is a retrospective review of clinical records for evidence of paraplegia specifically resulting from segmental vessel ligation during anterior spinal surgery. OBJECTIVES: To determine the precise risk rate, and to potentially identify risk factors. SUMMARY OF BACKGROUND DATA: Although many authors have alluded to this risk, the exact risk rate and risk factors have never been identified. METHODS: All patients having an anterior approach involving T1-L3 were reviewed. The two reviewers were not involved in any of the surgeries. The 1197 cases were consecutive from 1967 to 1991. RESULTS: There were no paralyses. CONCLUSIONS: There would appear to be virtually no risk to segmental vessel ligation provided: 1) vessel ligation is unilateral, 2) done on the convexity of a scoliosis, 3) ligated at midvertebral body level, and 4) hypotensive anesthesia is avoided. Soft clamping with somatosensory-evoked potential monitoring does not appear justified.

Adult↗
PubMed1996

Congenital spine deformity, congenital stenosis, diastematomyelia, and tight filum terminale in a workmen's compensation patient: a case report.

STUDY DESIGN: This case report concerns a patient injured at work who was denied adequate evaluation and treatment by a Workman's Compensation Commission, resulting in nearly complete paraplegia. OBJECTIVES: For a patient with a congenital spine deformity, a diastematomyelia, a tight filum terminale, and a congenital stenosis, denial of magnetic resonance imaging evaluation and appropriate surgery cannot be justified. SUMMARY OF BACKGROUND DATA: This 35-year-old man injured his knee and back in a fall at work but was able to work for 1 week. Progressive neurologic deterioration was documented, but magnetic resonance imaging evaluation was denied. When it finally obtained and the lesion identified, appropriate neurosurgery was denied. METHODS: When seen by the authors more than 3 years after his injury, he had a nearly complete paraplegia. Despite neurosurgical decompression and spine stabilization, no significant recovery occurred. RESULTS: A nearly complete paraplegia resulted from this combination of lesions coupled with intolerable delay in diagnosis and therapy, both the result of "foot-dragging" by a Workmen's Compensation Commission. CONCLUSIONS: In an effort to be "cost-conscious" and to avoid "unnecessary low back surgery," a Workmen's Compensation Commission has caused a patient to become paraplegic. Such management is neither cost-effective nor of adequate quality.

Adult↗