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Biomedical subjects

Robert B Winter

Publications and source records attributed to Robert B Winter.

17 recordsLinked to original sources
PubMed2006

Segmental spinal dysgenesis: case report of a 50-year follow-up after surgery at age 3 years: case report.

STUDY DESIGN: Case report with ultra long-term follow-up. OBJECTIVE: To show the long-term positive benefits of an arthrodesis at age 3 years. SUMMARY OF BACKGROUND DATA: To our knowledge, there have been no previous reports of a 50-year follow-up of a posterior spine fusion for severe congenital kyphosis and segmental spinal dysgenesis. METHODS: Chart and radiographic documentation of both the preoperative, postoperative, and 50-year follow-up. RESULTS: Solid arthrodesis was achieved after a pseudarthrosis repair. Major correction was achieved and paraplegia prevented. Despite a long fusion to the sacrum, there was no junctional or sacroiliac degeneration. CONCLUSIONS: Arthrodesis at age 3 years provided an optimal ultra long-term follow-up.

Female↗
PubMed2005

Pedicle anatomy in a patient with severe early-onset scoliosis: can pedicle screws be safely inserted?

OBJECTIVE: With the rapid increase in the use of pedicle screws in the thoracic spine for various pathologies, knowledge of the pedicle anatomy is critical. Previous authors, in discussing pedicle morphology, have usually reported their findings in nondeformed adult specimens. More recently, the use of pedicle screws in adolescent idiopathic scoliosis has been reported. METHODS: The authors studied the pedicle diameters in the spine of a patient with infantile idiopathic scoliosis who died at age 28 of cor pulmonale. The concave pedicles from T6 to L3 were measured both directly and with thin-section computed tomography (CT) scanning (the curve apex was T8-T11). RESULTS: By direct measurement, the concave pedicle width at its narrowest point (the isthmus) ranged from 2.9 (T9) to 6.7 (L1, L3) mm. Three apical concave pedicles (T8, T9, T10) had no cancellous cavity. By CT scan measurement, the four apical concave pedicles measured 3.4 (T8), 2.8 (T9), 2.6 (T10), and 3.4 (T11) mm, respectively. CONCLUSIONS: In conclusion, the authors confirm others' findings that the concave pedicles can be so small that pedicle screw insertion is impossible. We also found that these findings can be confirmed preoperatively with thin-section CT scanning. In such situations, extrapedicular screw placement should be considered.

Adult↗
PubMed2004

Congenital scoliosis due to unilateral unsegmented bar: posterior spine fusion at age 12 months with 44-year follow-up.

STUDY DESIGN: Retrospective case report. PURPOSE: Long-term follow-up. METHODS: A 44-year follow-up after surgery at the age of 1 year for congenital scoliosis with original and current information. BACKGROUND INFORMATION: This long a follow-up after so young a fusion has not previously been reported. Shorter follow-ups have not revealed the problems this patient has had subsequently. RESULTS: Low back pain began 22 years after surgery (age 23 years) and cervical pain began 24 years after surgery (age 25 years). Anterior cervical discectomy and fusion plus posterior fusion of two disc levels were necessary at the age of 36 years. Continued low back pain resulting from multilevel degeneration causes major disability. CONCLUSIONS: This patient had an excellent result from his posterior spine fusion at the age of 1 year, with no loss of curve correction, no "crankshafting," and minimal loss of vital capacity. Long-term follow-up did indicate major disabilities resulting from both cervical and lumbar degenerative disc disease.

Adult↗
PubMed2004

A tale of two brothers: ultra-long-term follow-up of juvenile idiopathic scoliosis.

OBJECTIVE: The aim of this work was to demonstrate the life-saving benefit of spine fusion for progressive juvenile idiopathic scoliosis. A follow-up of this duration (73 years) has never been previously reported. RESULTS: The properly treated patient is alive and well 73 years after surgery, but the brother whose curve was ignored died of cor pulmonale at age 45. CONCLUSIONS: Properly done spine fusion can save the life of children with progressive juvenile idiopathic scoliosis.

Aged↗
PubMed2003

Adolescent idiopathic scoliosis: case report with 63-year follow-up postsurgery.

STUDY DESIGN: Retrospective case report. PURPOSE: To provide true outcome analysis by a 63-year follow-up. MATERIAL AND METHODS: A 16-year-old girl had a posterior spine fusion for adolescent idiopathic scoliosis in 1939 and has been followed ever since. Both original photographs and radiographs as well as current material are available. BACKGROUND INFORMATION: A follow-up of this duration has not previously been reported. RESULTS: She had a solid T9-L3 arthrodesis and had no problems until age 50 when degenerative changes at L3-L4 required extension of the fusion to L4. When seen in 2002 at age 79, she had problems with degenerative disc disease at L4-S1 with spinal stenosis symptoms. CONCLUSIONS: The original fusion area remained solid and without symptoms for 63 years. Distal degenerative changes began 34 years after her original surgery and are still present at the 63-year follow-up. These degenerative changes at L4-L5 and L5-S1 are often thought to be secondary to the arthrodesis to L4, but because they are extremely common in persons of this age who do not have scoliosis or a fusion mass to L4, it is not possible to imply a cause and effect relationship. True outcome results cannot be ascertained at a 2-year or even 10-year follow-up.

Adolescent↗
PubMed2003

A meta-analysis of the literature on the issue of selective thoracic fusion for the King-Moe type II curve pattern in adolescent idiopathic scoliosis.

STUDY DESIGN: Meta-analysis of available literature. OBJECTIVE: To attempt to clarify the confusion existing about the "King II" idiopathic scoliosis curve pattern. SUMMARY OF BACKGROUND DATA: Since the 1983 publication by King et al, surgeons have been confused as to when to include or exclude the lumbar curve in double curve patterns. METHODS: The available literature was reviewed for relevant publications, which contained specific data analysis. Publications without adequate follow-up were excluded as were "commentary" publications unsupported by research data. RESULTS: This literature review confirms the original publication by King et al that properly identified King II curve pattern patients need selective thoracic fusion only. The fusion should end at the thoracolumbar junction. CONCLUSION: Selective thoracic fusion is the procedure of choice for properly selected King II curves.

Adolescent↗
PubMed2003

The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients.

STUDY DESIGN: Retrospective chart and radiographic reviews were conducted. OBJECTIVE: To identify the incidence of and any possible risk factors for the crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis. SUMMARY OF BACKGROUND DATA: Studies have shown the crankshaft problem to be common after posterior arthrodesis for infantile and juvenile idiopathic scoliosis, but the few reports available show it to be much less common for congenital scoliosis. METHODS: This study chose children fused before the pubertal growth spurt, all classified as Risser 0 and with open triradiate cartilages. These children were followed to the end of their growth (mean follow-up period 12 years). Several measurement parameters were used for evaluation. RESULTS: The crankshaft problem, measured as a Cobb angle increase of more than 10 degrees, was seen in 15% of the 54 patients. There was a positive correlation with earlier surgery and larger (>50 degrees) curves. No other positive correlations could be identified. CONCLUSIONS: Crankshafting was observed in 15% of the patients, more often with larger curves and earlier fusions.

Adolescent↗
PubMed2002

Treatment of severe postburn kyphosis with combined plastic surgery and milwaukee bracing.

STUDY DESIGN: A case is reported in which severe postburn kyphosis is treated with combined plastic surgery and Milwaukee bracing. OBJECTIVES: To demonstrate that severe kyphosis can develop secondary to burn scars and that spine surgery can be avoided. SUMMARY OF BACKGROUND DATA: Nothing is available in the literature on this subject. METHODS: A 14-year-old boy had severe burns of the arms, anterior neck, and anterior torso with a resulting 90 degrees stiff kyphosis. RESULTS: The patient was treated by multiple plastic surgery procedures combined with a Milwaukee brace, which corrected his kyphosis to a normal alignment. CONCLUSIONS: Spine surgery was avoided with quality plastic surgery and Milwaukee brace management.

Adolescent↗
PubMed2002

Flail chest secondary to excessive rib resection in idiopathic scoliosis: case report.

STUDY DESIGN: Case report. OBJECTIVES: To report a previously undescribed complication of scoliosis surgical treatment. SUMMARY OF BACKGROUND DATA: None available. METHODS: Clinical case analysis. RESULTS: Excessive rib resection resulted in a permanent "flail" chest. CONCLUSION: Rib resection ("costoplasty") is a valuable procedure for obtaining bone graft and for esthetic reduction of rib prominence, but excessive removal and especially done twice can produce major disability.

Adolescent↗
PubMed2002

Long multiple struts for severe kyphosis.

The treatment of severe structural kyphosis poses a difficult problem. The use of an anterior fusion has proven to be an integral part of the surgical treatment of any kyphosis. In addition, the use of multiple struts has helped solve the treatment problem in severe kyphosis. The use of multiple struts and the role of vascularized grafts, technical details, complications, and errors and how to prevent them are discussed in the current study.

Adolescent↗