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ABSTRACT: STUDY DESIGN: A retrospective case review. INTRODUCTION: To evaluate the safety and efficacy of the non-fusion technique in achieving and maintaining the proper correction for congenital spinal deformity (CSD) and allowing normal spinal growth in patients with split spinal cord malformation (SSCM). MATERIALS AND METHODS: Seven patients who had CSD and SSCM were adopted, with a mean age of 8 years. All the patients in this study received Halo-gravity traction (HGT) prior to expansion of the spine and instrumentation with vertical expandable titanium prosthetic rib, growing rod or their hybrid. Five of them underwent opening wedge thoracoplasty simultaneously. And the two patients with type I SSCM underwent bony spur excision in the initial surgery before corrective manipulation. Then all the patients received a lengthened operation every six months. Changes of their major curve and length of T1-S1 spine were measured, and complications, neurological status were recorded. All the patients were followed up with an average of 32.6 months. RESULTS: Their mean major curve improved from 90.1° to 58.6° with a correction rate of 34.9 %. The T1-S1 length increased from 26.3 to 34.7 cm at final follow-up. Especially, one of the type I SSCM patients whose neurological deterioration was found preoperatively was significantly improved. CONCLUSION: Preoperative Halo-gravity traction followed by non-fusion and growing instrumentation may be effective and safe for young children of CSD associated with SSCM. But it is an ongoing study and additional large multicenter studies are necessary to further assess the safety and efficacy of non-fusion and growing instrumentation.
European Spine Journal 04/2013; · 1.97 Impact Factor
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ABSTRACT: INTRODUCTION: Adolescent scar contracture kyphoscoliosis is a very rare disease. METHODS AND RESULTS: Here, we present the case of a 21-year-old man who was scalded due to ebullient water when he was 10 years old. Moreover, kyphoscoliosis was found when he was 12 years old and developed rapidly. Thereafter, no management was proposed before his consultation at our center. On examination, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view, extensive contractured scar presented on the right side of the back, abdomen, chest wall, hip, right thighs and armpit anterior, especially in the right flank. A one-stage correction was deemed too risky, we therefore released contractured scar during the first stage with the defect of soft tissue protected by vaccum sealing drainage and then performed skeletal traction with halo and bilateral femoral pins. A reasonable correction was achieved without any neurological deficits 1 month after traction. Next, a second-stage operation was taken to translate a free anterolateral thigh myocutaneous flap to overlay the extensive defect of soft tissue. 1.5 months later, a third posterior segmental pedicle screw instrumented fusion with Smith-Peterson osteotomy between T9 and L2 was performed. Postoperative recovery was uneventful and as there were no complications, he was discharged 10 days after the third surgery. At 2-year follow-up the patient's outcome is excellent with balance and correction of the deformity. CONCLUSION: Based this grand round case and relevant literature, we discuss the different options for the treatment of adolescent scar contracture scoliosis.
European Spine Journal 10/2012; · 1.97 Impact Factor
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ABSTRACT: Study Design. Retrospective clinical study.Objective. The aim of this study is to retrospectively evaluate the safety and efficacy of one-stage surgical treatment for 45 consecutive patients, who had progressive congenital spinal deformity (CSD) associated with split spinal cord malformation (SSCM).Summary of Background Data. Correction of progressive CSD with SSCM has been reported that all SSCM should be operated firstly before any orthopedic intervention and then the second surgery for correction and stabilization of the spinal deformity 3 to 6 months later. Recently, more different viewpoints have been approved. The common belief of treatment for these 2 associated conditions is needed to be revised.Methods. Patients had one stage surgery; after exposure of the determined levels and placement of instruments, bony spur was resected in the patients of type I; in patients of type II we did nothing to the SSCM. In the corrective stage of surgery, posterior fusion surgery was performed in 38 patients; non-fusion surgery was performed in 7 patients.Results. 36 female and 9 male patients formed the basis of the study. The mean age was 14 years and the mean follow-up period was 31 months. Type I SSCM in 15 patients and type II in 30 patients. Seven patients had progressive neurologic deteriorations preoperatively. The mean major curves were corrected from an average of 73.7 to 33.5 with a correction rate of 54.5%. The overall complication was transient, including 2 patients of neurological compromise and 1 patients of cerebrospinal fluid leakage. The average loss of correction at final follow-up was 2.5 for major curves.Conclusion. The one-stage surgical treatment for CSD associated with SSCM provides a satisfactory option to effectively improve the spinal deformity without significant complications. Neurosurgical interventions are recommended to patients with Type I SSCM before spinal deformity surgery; however, patients with Type II SSCM can be treated safely without a need of neurosurgical intervention.
Spine 05/2012; · 2.08 Impact Factor
