Biomedical subjects

Sigurd Berven

Publications and source records attributed to Sigurd Berven.

At least 19 recordsLinked to original sources

PubMed2007

The selection of operative versus nonoperative treatment in patients with adult scoliosis.

STUDY DESIGN: Retrospective case-control matched series. OBJECTIVE: The purpose of this study is to define factors that influence the patient and surgeon in the selection of surgical versus nonsurgical treatment for adult scoliosis. SUMMARY OF BACKGROUND DATA: There is no literature that specifically examines why adult scoliosis patients and/or their surgeons choose surgical versus nonsurgical treatment. METHODS: This study analyzes a prospective multicentered database for adult spinal deformity. A logistic regression technique was used to perform case-control matching. A total of 161 matched pairs were compared for radiographic characteristics, questionnaire responses, and standardized outcome measures. RESULTS: Nonsurgical patients had greater preoperative medical risk factors. Surgical patients had larger thoracic (51 degrees vs. 44 degrees, P = 0.006) and thoracolumbar/lumbar curves (55 degrees vs. 43 degrees, P = 0.000). Surgical patients had more frequent leg pain (47% vs. 35%, P = 0.04). They reported a higher mean level of daily back pain (P = 0.008) and more frequent moderate-to-severe back pain over the past 6 months (P = 0.03). There were also significant differences in perception of appearance and social function between the cohorts. CONCLUSIONS: This study emphasizes the complexity of surgical decision making for adult scoliosis patients. It also underscores the importance of patient-based health status measures in evaluating the adult scoliosis patient.

Adolescent↗

PubMed2006

A clinical impact classification of scoliosis in the adult.

STUDY DESIGN: Multicenter, prospective, consecutive clinical series. OBJECTIVES: To establish and validate classification of scoliosis in the adult. SUMMARY OF BACKGROUND DATA: Studies of adult scoliosis reveal the impact of radiographic parameters on self-assessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability. METHODS: A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated. RESULTS: Mean maximal coronal Cobb was 46 degrees and lumbar lordosis 46 degrees . Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected. CONCLUSIONS: A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.

Adult↗

PubMed2006

Nonsurgical resource utilization in adult spinal deformity.

STUDY DESIGN: The enrollment data were retrospectively reviewed for 1,061 patients entered into a prospective multicenter study of adult spinal deformity between January 2002 and June 2004. OBJECTIVE: The purpose of this study is to quantify and analyze the use of nonsurgical resources in patients with adult spinal deformity. SUMMARY OF BACKGROUND DATA: Limited data exist regarding the utilization of nonsurgical treatment methods for adult spinal deformity. METHODS: Demographic data, surgical history, symptom assessment, and nonsurgical treatment regimen were reviewed. Health status measures were the SF-12, SRS-29, and ODI. Nonsurgical patients were divided into low- and high-symptom subgroups based on age adjusted ODI score. Resource utilization was analyzed based on both patient and physician questionnaire responses. RESULTS: High- and low-symptom nonsurgical subgroups differed significantly on all reported health status measures (P < 0.0001). High-symptom patients used greater resources in terms of narcotics, epidural blocks, and physical agent methods (P < 0.001), analgesics (P < 0.01), pain management referral and bed rest (P < 0.02), strength training, nerve root blocks, and stabilization exercises (P < 0.05). CONCLUSIONS: The results of this study demonstrate that, within the population of adult deformity patients, distinct high- and low-symptom groups exist and can be clearly identified. While high-symptom patients used significantly greater resources, most low-symptom patients used nonsurgical resources as well.

Adult↗

PubMed2006

Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee.

STUDY DESIGN: The Morbidity and Mortality database of the Scoliosis Research Society (SRS) was queried as to the incidence and type of complications as reported by its members for the treatment of adolescent idiopathic scoliosis (AIS) with spinal fusion and instrumentation procedures regarding surgical approach (anterior, posterior, or combined anterior-posterior) during a recent 3-year period. OBJECTIVE: To evaluate the incidence of surgeon-reported complications in a large series of spinal fusions with instrumentation for a single spinal deformity diagnosis and age group regarding surgical approach. SUMMARY OF BACKGROUND DATA: The SRS has been collecting morbidity and mortality data from its members since its formation in 1965 with the intent of using these data to assess the complications and adverse outcomes (death and/or spinal cord injury) of surgical treatment for spinal deformity. Surgical approaches to the management of treatment of AIS have a measurable impact on efficacy of correction, levels fused, and operative morbidity. However, there is a lack of consensus on the choice of surgical approach for the treatment of spinal deformity. METHODS: Of the 58,197 surgical cases submitted by members of the SRS in the years 2001, 2002, and 2003, 10.9% were identified as having had anterior, posterior, or combined spinal fusion with instrumentation for the diagnosis of AIS, and comprised the study cohort. All reported complications were tabulated and totaled for each of the 3 types of procedures, and statistical analysis was conducted. RESULTS: Complications were reported in 5.7% of the 6334 patients in this series. Of the 1164 patients who underwent anterior fusion and instrumentation, 5.2% had complications, of the 4369 who underwent posterior instrumentation and fusion, 5.1% had complications, and of the 801 who underwent combined instrumentation and fusion, 10.2% had complications. There were 2 patients (0.03%) who died of their complications. There was no statistical difference in overall complication rates between anterior and posterior procedures. However, the difference in complication rates between anterior or posterior procedures compared to combined procedures was highly significant (P < 0.0001). The differences in neurologic complication rates between combined and anterior procedures, as well as combined and posterior procedures were also highly statistically significant (P < 0.0001), but not between anterior and posterior procedures. CONCLUSIONS: This study shows that complication rates are similar for anterior versus posterior approaches to AIS deformity correction. Combined anterior and posterior instrumentation and fusion has double the complication rate of either anterior or posterior instrumentation and fusion alone. Combined anterior and posterior instrumentation and fusion also has a significantly higher rate of neurologic complications than anterior or posterior instrumentation and fusion alone.

Adolescent↗

PubMed2005

The impact of positive sagittal balance in adult spinal deformity.

STUDY DESIGN: This study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N = 352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index. OBJECTIVES: To examine patients with adult deformity with positive sagittal balance to define parameters within that group that might differentially predict clinical impact. SUMMARY OF BACKGROUND DATA: In a multicenter study of 298 adults with spinal deformity, positive sagittal balance was identified as the radiographic parameter most highly correlated with adverse health status outcomes. METHODS: Radiographic evaluation was performed according to a standardized protocol for 36-inch standing radiographs. Magnitude of positive sagittal balance and regional sagittal Cobb angle measures were recorded. Statistical correlation between radiographic parameters and health status measures were performed. Potentially confounding variables were assessed. RESULTS: Positive sagittal balance was identified in 352 patients. The C7 plumb line deviation ranged from 1 to 271 mm. All measures of health status showed significantly poorer scores as C7 plumb line deviation increased. Patients with relative kyphosis in the lumbar region had significantly more disability than patients with normal or lordotic lumbar sagittal Cobb measures. CONCLUSIONS: This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.

Cohort Studies↗

PubMed2005

Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation.

STUDY DESIGN: An in vitro biomechanical study of C1-C2 posterior fusion techniques using a cadaveric model. OBJECTIVES: To investigate the acute stability afforded across the atlantoaxial segment by a novel technique that uses intralaminar screws in C2, and to compare these results to the stability obtained using a C2 pedicle fixation technique. SUMMARY OF BACKGROUND DATA: There are numerous techniques available for rigidly coupling C1 and C2. It has been shown that screw techniques provide higher acute stability than wiring practices. However, many of these methods that use screw fixation in C2 can be technically difficult, especially in cases in which there is an aberrant vertebral artery course or if the C2 pedicle is not large enough to accommodate the instrumentation. A novel technique that uses intralaminar screws in C2 with C1 pedicle screws and bilateral longitudinal rods has been recently developed in an effort to overcome many of these issues. To date, there are no published reports as to whether this new technique provides equivalent (or better) fixation to the currently accepted methods. METHODS: Six fresh-frozen human cadaveric cervical spines (C0-C4) were used in this study. Specimens were tested in their intact condition after destabilization via odontoidectomy, and after implantation of 3 different fixation constructs: (1) the Harms technique, 2 pedicle screws in C2, (2) a single C2 pedicle screw and a single C2 intralaminar screw, and (3) a construct having bilateral intralaminar C2 screws. Pure moment loading in flexion/extension, lateral bending, and axial rotation was applied to the occiput. Subsequent relative intervertebral rotations were determined using a 3 camera system. Range of motion for the intact, destabilized, and 3 fixation scenarios was determined, and statistical analysis was performed using one-way analysis of variance Fisher least-significant-difference post hoc test for multiple comparisons. RESULTS: The data indicate that odontoidectomy significantly increased C1-C2 motion in flexion/extension and lateral bending. All 3 fixation techniques significantly reduced motion compared to the intact and destabilized cases. There were no statistically significant differences between the C2 intralaminar and pedicle screw techniques. CONCLUSIONS: The results clearly indicate the potential of the intralaminar screw technique to provide stability that is equivalent to methods currently used. Given the serious complications that can follow vertebral artery injury and the decreased likelihood of injury by avoiding placement of C2 pedicle screw(s) and C1-C2 transarticular screw(s), strong consideration should be given to using a construct that incorporates C2 intralaminar screw(s).

Atlanto-Axial Joint↗

PubMed2005

Correlation of radiographic parameters and clinical symptoms in adult scoliosis.

STUDY DESIGN: This study is a retrospective review of the initial enrollment data from a prospective multicentered study of adult spinal deformity. OBJECTIVES: The purpose of this study is to correlate radiographic measures of deformity with patient-based outcome measures in adult scoliosis. SUMMARY OF BACKGROUND DATA: Prior studies of adult scoliosis have attempted to correlate radiographic appearance and clinical symptoms, but it has proven difficult to predict health status based on radiographic measures of deformity alone. The ability to correlate radiographic measures of deformity with symptoms would be useful for decision-making and surgical planning. METHODS: The study correlates radiographic measures of deformity with scores on the Short Form-12, Scoliosis Research Society-29, and Oswestry profiles. Radiographic evaluation was performed according to an established positioning protocol for anteroposterior and lateral 36-inch standing radiographs. Radiographic parameters studied were curve type, curve location, curve magnitude, coronal balance, sagittal balance, apical rotation, and rotatory subluxation. RESULTS: The 298 patients studied include 172 with no prior surgery and 126 who had undergone prior spine fusion. Positive sagittal balance was the most reliable predictor of clinical symptoms in both patient groups. Thoracolumbar and lumbar curves generated less favorable scores than thoracic curves in both patient groups. Significant coronal imbalance of greater than 4 cm was associated with deterioration in pain and function scores for unoperated patients but not in patients with previous surgery. CONCLUSIONS: This study suggests that restoration of a more normal sagittal balance is the critical goal for any reconstructive spine surgery. The study suggests that magnitude of coronal deformity and extent of coronal correction are less critical parameters.

Adolescent↗

PubMed2005

The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability.

STUDY DESIGN: Prospective analysis of a consecutive cohort of adult spinal deformity patients queried over a 12-month period. OBJECTIVES: To assess the SRS-22 instrument compared with the SF-12 and Oswestry. SUMMARY OF BACKGROUND DATA: Very few reports in the literature have applied the SRS-22 to adult spinal deformity patients. METHODS: Consecutive adult spinal deformity patients were applied the SRS-22, SF-12, and Oswestry. Four analyses were done: 1) floor/ceiling effect; 2) Pearson's correlation coefficients between the SRS-22, SF-12, and Oswestry; 3) Cronbach's alpha analysis for internal consistency within the SRS-22; and 4) test/retest. RESULTS: Floor/ceiling range for the SRS-22 compared favorably with the SF-12 and Oswestry. The Pearson's coefficients correlating the two questionnaires relative to the SRS-22 were > 0.7. The Cronbach's alpha within each domain for the SRS-22 were > 0.7, except for pain (0.67). Test/retest correlation coefficients ranged from 0.84 to 0.95 for the subscales. CONCLUSIONS: The SRS-22 is a disease-specific instrument with the capacity to demonstrate change in health status more effectively than the SF-12 and in more domains than the Oswestry. The SRS-22 showed high criterion validity with the SF-12 and Oswestry based on Pearson's coefficients. High Cronbach's alpha scores suggested a high internal consistency within each domain of the SRS-22, except for pain (0.67). Test/retest reliability was excellent.

Adolescent↗

PubMed2005

The effect on anterior column loading due to different vertebral augmentation techniques.

BACKGROUND: Vertebral compression fractures are a significant cause of morbidity amongst the elderly, resulting in pain, kyphosis, decreased mobility, and often depression. The two most popular operative treatments of compression wedge fractures are vertebroplasty and kyphoplasty, however, which method leads to restoration of normal spinal loading is unknown. METHODS: A cadaveric thoracolumbar spine model was fractured and then treated using one of two techniques: vertebroplasty or kyphoplasty. Three non-destructive loading regimes were applied to the intact, fractured and treated cases. Sub-adjacent nuclear pressure, used as a measure of anterior column loading, was determined for each experimental variant and loading case. FINDINGS: The data indicate that nuclear pressure was substantially reduced after the spine was fractured. These pressures were minimally increased after treatment, however, not to the level of the pre-fractured condition. In all loading cases, there were no significant differences between the two treatment types. INTERPRETATION: While our data show that both vertebroplasty and kyphoplasty allow the disc to generate higher nuclear pressures, neither treatment increased nucleus pulposus pressure above the level of the intact state. This directly relates to the clinical condition in that adjacent segment fractures sustained subsequent to either treatment is likely the result of overall disease progression, and not a direct result of the intervention.

Adult↗

PubMed2004

Intervertebral disc cell therapy for regeneration: mesenchymal stem cell implantation in rat intervertebral discs.

This study explores the use of mesenchymal stem cells (MSCs) for intervertebral disc regeneration. We used an in vivo model to investigate the feasibility of exogenous cell delivery, retention, and survival in the pressurized disc space. MSC injection into rat coccygeal discs was performed using 15% hyaluronan gel as a carrier. Injections of gel with or without MSCs were performed. Immediately after injection, fluorescently labeled stem cells were visible on sections of cell-injected discs. Seven and 14 days after injection, stem cells were still present within the disc, but their numbers were significantly decreased. At 28 days, a return to the initial number of injected cells was observed, and viability was 100%. A trend of increased disc height compared to blank gel suggests an increase in matrix synthesis. The results indicate that MSCs can maintain viability and proliferate within the rat intervertebral disc.

Animals↗

PubMed2003

Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity.

STUDY DESIGN: Observational study of patients with scoliosis and matched controls. OBJECTIVES: To determine the validity and reliability of the modified Scoliosis Research Society Outcomes Instrument (SRS-22) for use in the assessment of deformity in adults. To demonstrate the discriminate validity of the SRS-22 in differentiating between affected and unaffected adults. SUMMARY OF BACKGROUND DATA: Spinal deformity has an important impact on the general health status of adults. The magnitude of this impact has been difficult to measure and reported variably in the literature. The development of disease-specific outcomes tools permits improved sensitivity and specificity in measuring the patient's self-assessment of health status. An instrument for measuring disease-specific health status in adults with scoliosis has not been validated. MATERIALS AND METHODS: Observational study comparing the health status of adults affected by scoliosis and unaffected controls, matched for age, gender, and socioeconomic status. Pearson correlation analysis was used to determine the relationship of each domain within the SRS-22 and SF-36 with radiographic parameters including sagittal balance, coronal balance, and major curve correction. Discriminate validity of the modified SRS instrument was determined by a comparison of means between affected and unaffected cohorts. The validation of the SRS-22 was determined by criterion validity, using correlation analysis with comparable domains of the SF-36. The reliability of the SRS-22 was demonstrated using test-retest parity and Cronbach's alpha test for internal consistency. RESULTS: One hundred eighty adults were included in the study, 146 with scoliosis and 34 without. Adults with scoliosis scored significantly lower than unaffected controls on every domain of the SRS-22 and the SF-36. The floor and ceiling effect of the SRS-22 were less than observed in the SF-36 instrument. Pearson correlation analysis demonstrated no significant correlation between any radiographic process measure and any specific domain within the SRS-22 or the SF-36 (r < 0.25). Comparison of similar domains in the SRS-22 and the SF-36 demonstrates high correlation between the instruments. Test-retest analysis similarly demonstrates a high degree of reproducibility in each domain (r = 0.83-0.94). Cronbach's alpha test of internal consistency within each domain demonstrates intercorrelation values greater than 0.75 within each domain of the SRS-22. CONCLUSIONS: Adult scoliosis has a significant and measurable impact on affected patients compared with controls. There is a poor correlation between radiographic parameters of outcome and patient self-assessment of health status. The SRS-22 is a reliable instrument in adults as demonstrated by a high degree of internal consistency and reproducibility. The SRS-22 is a valid instrument for use in adult deformity as demonstrated by the criterion validity assessment with the SF-36. The study supports the use of the SRS-22 in the adult spinal deformity population.

Adolescent↗

PubMed2003

Treatment of thoracic pseudarthrosis in the adult: is combined surgery necessary?

In deformity surgery in adults, pseudarthrosis remains an important cause of progressive deformity and postoperative pain. Revision surgery for pseudarthrosis in the lumbar spine is a difficult challenge with failure rates of as much as 50% using posterior surgery alone. Treatment of pseudarthrosis of the thoracic spine has not been well-described. The purpose of the current study was to review the long-term clinical and radiographic results of posterior-only surgery for the treatment of pseudarthrosis in the thoracic spine. Using a posterior extension osteotomy through the identified pseudarthrosis with reinstrumentation and autogenous bone grafting, an improvement of regional sagittal balance was shown and reliable clinical outcomes were obtained. A single-stage posterior revision surgery with extension osteotomies through the regions of pseudarthrosis coupled with rigid internal fixation and autogenous bone grafting is an effective technique for treatment of pseudarthrosis of the thoracic spine. This technique improves regional sagittal deformity and leads to reliable arthrodesis. Combined anterior and posterior surgery was not necessary for effective treatment of thoracic pseudarthrosis in this series.

Adolescent↗

PubMed2002

Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis.

STUDY DESIGN: A retrospective evaluation of radiographs in patients with idiopathic scoliosis was undertaken to assess predictors of flexibility. OBJECTIVE: To evaluate potential predictors of flexibility in patients with thoracolumbar and lumbar scoliosis. SUMMARY OF BACKGROUND DATA: Curve flexibility is an important consideration in the operative management of idiopathic scoliosis. Flexibility of the major curve is a useful predictor of expected surgical correction, and flexibility of compensatory curves determines whether they are structural or nonstructural. An accurate assessment of curve flexibility has important implications on surgical approaches and planning for deformity correction. The role of age and curve magnitude in predicting curve flexibility has not been well defined. A quantitative assessment of changes in curve flexibility with age and progression of deformity may yield important insight into the change in surgical management options over time. METHODS: A retrospective review of 75 patients with idiopathic thoracolumbar and lumbar scoliosis (age range 13-78 years) was undertaken. Preoperative standing and side-bending radiographs of thoracolumbar and lumbar curves were evaluated. Cobb angles of structural and fractional curves, curve flexibility, presence of lateral listhesis, and axial and radicular pain were documented. Predictors of structural and fractional curve flexibility were evaluated with correlation and regression analysis. Correlation analysis was used to demonstrate an association between radiographic findings and the clinical presentation. RESULTS: Seventy-five patients had an average major curve magnitude of 56 degrees (range 34-82 degrees ) with flexibility averaging 55% (range 20-93%). Structural curve flexibility was highly inversely correlated with both curve magnitude (r = -0.7; P< 0.001) and with age (r = -0.6; P< 0.001). Lumbar fractional curve (L4-S1) flexibility showed a high inverse correlation with age (r = -0.65; P< 0.001) but did not show correlation with Cobb angle. Thoracic compensatory curves showed a moderate correlation with Cobb angle (r = 0.53). Structural and fractional curve flexibility showed high correlation with each other (r = 0.5-0.66). Regression analysis yielded a formula to predict the flexibility of the structural curve (FSC): FSC = 130 - (Cobb + Age/2). Axial pain was correlated with age (r = 0.63); however, it was not correlated with curve magnitude. CONCLUSION: We have shown that curve magnitude and patient age are the main predictors of structural flexibility. Every 10 degrees increase in curve magnitude over 40 degrees results in a 10% decrease in flexibility; every 10-year increase in age decreases flexibility of the structural curve by 5% and the lumbosacral fractional curve by 10%. Curve magnitude and age of the patients are significant predictors of curve flexibility. The demonstration of this association offers useful information in estimating how surgical options for deformity correction may change over time.

Adolescent↗

PubMed2002

Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation.

STUDY DESIGN: A retrospective study of adults with long fusion to the sacrum using three different fixations was performed. OBJECTIVE: To compare the long-term clinical results and complications associated with three methods of lumbosacral fixation for adult spine deformities: Luque-Galveston, combined iliac and sacral screws, and sacral screws. SUMMARY OF BACKGROUND DATA: The preferred technique for long fusion to the sacrum is controversial, and surgery for adult deformity is fraught with significant technical difficulties and high complication rates. No clinical study compares the long-term outcome of long fusion to the sacrum using these different methods of lumbosacral fixation. METHODS: This study included 54 consecutive patients who underwent elective combined anterior and posterior surgical reconstruction for adult spine deformity with a minimum follow-up period of 2 years. The patients were divided into three groups on the basis of the surgical method used for the posterior spine instrumentation. Group 1 consisted of 11 patients with smooth L-rod and segmental sublaminar wire instrumentation (Luque-Galveston technique). Group 2 consisted of 36 patients with posterior Isola segmental instrumentation and combined iliac and sacral screws. Group 3 consisted of 12 patients with Isola segmental instrumentation using bicortical sacral screws. Five patients were revised to another fixation group, giving a total of 59 cases. Radiographic, clinical results, and long-term outcome data were obtained using the modified Scoliosis Research Society (SRS) outcome instrument. RESULTS: There were 26 late complications. Pseudarthrosis developed in 10 patients, requiring revision surgery: 4 (36%) in the Group 1, 5 (14%) in Group 2, and 1 (8.5%) in Group 3. Comparison of the modified SRS outcomes showed no difference among the groups. The average SRS grand total score was 73.4% for Group 1, 70.9% for Group 2, and 62.6% for Group 3. Overall, 76% of the patients were satisfied with their outcome. The presence of perioperative complications or pseudarthrosis significantly correlated with a lower satisfaction score (P = 0.012 and P = 0.048, respectively). Sagittal plane decompensation significantly correlated with a higher pain score (P = 0.035). Patients with prior surgeries scored lower on the self-image questions than patients with no prior surgery (P = 0.007). CONCLUSIONS: Attention to sagittal balance is critical in these patients. Revision surgery is as safe and effective as primary surgery. According to the current findings, the Luque-Galveston fixation technique has an unacceptably high rate of pseudarthrosis, and this method is not recommended for adult deformities. Currently, the authors are using bicortical and triangulated sacral screws with an anterior interbody support in patients with good bone stock, but only when the spine balance is restored. Otherwise, they recommend using iliac fixation, although there is a higher rate of painful hardware, requiring removal.

Adult↗

PubMed2002

Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults?

STUDY DESIGN: Retrospective review of cases in which a single solid rod was used for the anterior correction of thoracolumbar and lumbar idiopathic scoliosis in adults. OBJECTIVES: To evaluate the efficacy and outcomes in these patients. SUMMARY OF BACKGROUND DATA: Anterior spinal fusion with instrumentation has been found to be kyphogenic in the treatment of scoliosis. Recent reports have shown an extremely high rate of pseudarthrosis and implant failure even in adolescents who have undergone anterior spinal fusion with a single flexible or rigid rod. METHODS: Fifteen consecutive adult patients with (average age, 37.5 years) had undergone anterior spinal fusion with a rigid rod were included in this study. One was lost to follow-up, leaving 14 patients with a complete radiographic follow-up of 44 months and clinical follow-up of 61 months. Patients were sent the Modified Scoliosis Research Society (SRS) Outcomes Instrument, charts were reviewed, and preoperative, postoperative, and final follow-up films of the entire spine were evaluated by independent reviewers uninvolved in the care of the patients. RESULTS: The average preoperative major curve was 50 degrees, which improved to 16 degrees at follow-up (a 66% correction). The average correction of the upper compensatory curve and lower fractional curve were 40% and 61%, respectively. The thoracolumbar sagittal plane alignment was maintained or improved in all patients (i.e., this surgery did not induce kyphosis in any patient). On average 0.9 levels were "saved" compared with levels chosen by the authors for posterior surgery. All patients achieved a solid fusion. Follow-up Modified SRS questionnaires revealed a satisfaction score 4.5 out of a possible score of 5, a pain score of 4.1 out of 5, a self-image score of 4.1 out of 5, a function score of 4.1 out of 5, and a mental health score of 4.0 out of 5, with an overall score of 82%. All patients but one were satisfied or extremely satisfied with the results of surgery. There was no incidence of implant breakage. CONCLUSIONS: The results of anterior spinal fusion using a single solid rod in adults with idiopathic scoliosis in this series are excellent, with 100% fusion rate, no development of kyphosis, and no incidence of hardware failure.

Adult↗

PubMed2002

Clinical outcome in chordoma: utility of flow cytometry in DNA determination.

STUDY DESIGN: A retrospective review of 100 patients with chordoma of the lumbar spine and sacrum. Twenty-three patients had flow cytometry data available and a minimum follow-up period of 5 years. OBJECTIVES: To determine whether DNA content and cell cycle analysis were associated with patient outcome. SUMMARY OF BACKGROUND DATA: DNA flow cytometry has been shown to be predictive for biologic behavior of various tumors. Chordoma has been evaluated in very small numbers of patients using DNA flow cytometric analysis, and the utility of DNA patterns in predicting outcome has not been clearly demonstrated. METHODS: Between January 1979 and December 1995, 100 patients underwent surgical resection for chordoma, and 23 had a minimum follow-up period of 5 years with flow cytometry data. DNA content and cell cycle analysis were determined by enzymatically staining cells with propidium iodide dye and passing them through a flow cytometer. DNA histograms were generated. Survivorship and freedom from local recurrence curves were constructed by the Kaplan-Meier method and compared by the log-rank test. RESULTS: The mean follow-up period was 7.3 years. For this group of 23 patients, mortality was 61% (14 patients) and local recurrence was 78% (18 patients). Eleven patients had tumors with diploid DNA content, and 12 patients had tumors with aneuploid DNA content. Metastases occurred in 4 of the 11 patients with a diploid pattern and 6 of the 12 with an aneuploid pattern. Six of the 11 patients with the diploid pattern died, in comparison with 8 of 12 patients with the aneuploid pattern. The Kaplan-Meier estimated survivorship (95% confidence interval) was 78% (66-90%) at a follow-up period of 5 years and 36% at a follow-up period of 10 years (22-50%), and no significant differences were found between patients with diploid and aneuploid patterns. CONCLUSIONS: Patients in whom metastases did not develop had a more favorable clinical outcome. DNA pattern was not associated with local recurrence or survival.

Adult↗

PubMed2002

Neuromuscular scoliosis: causes of deformity and principles for evaluation and management.

Scoliosis is commonly associated with a variety of neuromuscular disorders including conditions affecting upper and lower motor neurons as well as myopathies. Contained herein is a discussion of the spectrum of neuromuscular disorders that have been associated with scoliosis and related spinal deformities. Management, including surgical treatment in such patients, is summarized including indications, expectations, and impact on trunk balance, pulmonary function, and appearance.

Adult↗

PubMed2002

The lumbar zygapophyseal (facet) joints: a role in the pathogenesis of spinal pain syndromes and degenerative spondylolisthesis.

The zygapophyseal joints in the lumbar spine are important structural components contributing to the stability of the lumbar motion segments. Pathology of the zygapophyseal joints in the lumbar spine may be a significant cause of low back pain and segmental instability within the lumbar spine. Management of pathology related to the zygapophyseal joints remains a difficult challenge for the physician caring for patients with spinal disorders. Future investigations with tissue engineering, ligamentous reconstructions, and intervertebral disc replacement or regeneration may have useful applications in the treatment of zygapophyseal joint pathology.

Female↗