ABSTRACT
La escoliosis idiopática del Adolescente (EIA) es una deformidad tridimensional de la columna vertebral que aqueja de diversas formas la condición de vida de quien la padece, afectando el desarrollo físico y psicológico del paciente. Proponemos evaluar el resultado clínico, radiológico y el componente de calidad de vida de pacientes tratados quirúrgicamente con EIA, en el servicio de Neurocirugía, Hospital Jesús Yerena del Lídice. Se evaluó patrón de la curva, clasificación según Lenke, ángulo de Cobb pre y postquirúrgico, edad de tratamiento quirúrgico, gradode corrección, calidad de vida según cuestionario SRS-22 pre y postquirúrgica, valoración funcional mediante la escala de discapacidad de Oswestry (ODI) y complicaciones postoperatorias. Se estudiaron 22 casos (95 % femenino), el principal grupo etario fue de 11-14 años (55 %), la escoliosis tipo 1 fue la predominante (60 %), el ángulo de Cobb inicial fue mayor a 50° (50 %) y la madurez esquelética principal fue Risser 3 (55 %). La edad de resolución quirúrgica predominante fue entre 15-18 años (60 %), el grado de corrección postoperatorio fue de 75-100 % (73 %) y la densidad de los tornillos pediculares fue de 1.4-1.7 (64 %). En el cuestionario SRS-22, hubo mayor afectación en las dimensiones de autoimagen con una media de 1.8 y la valoración por ODI mostró un índice de incapacidad mínima, que fue mejorando en los controles sucesivos. Nuestra principal complicación fueron las infecciones (36 %). Concluimos que la cirugía correctiva temprana en la EIA ofrece a una mejoría clínica, radiológica y de la calidadde vida de estos paciente(AU)
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that affects the living condition of those who suffer from it in various ways, affecting the physical and psychological development of the patient. We propose to evaluate the clinical and radiological outcome and the quality-of-life component of patients treated surgically with EIA, in the Neurosurgery Service, Hospital Jesús Yerena del Lídice. Curve pattern, Lenke classification, pre-and post-surgical Cobb angle, age at surgical treatment, degree of correction, quality of life according to pre-and post-surgical SRS-22 questionnaire, functional assessment using the Oswestry Disability Scale (ODI) and postoperative complications were evaluated. 22 cases were studied (95% female), the main age group was 11-14 years (55%), type 1 scoliosis was predominant (60%), the initial Cobb angle was greater than 50° (50%) and the main skeletal maturity was Risser 3 (55%). The predominant age of surgical resolution was between 15-18 years (60%), the degree of postoperative correction was 75-100% (73%) and the density of pedicle screws was 1.4-1.7 (64%). In the SRS-22 questionnaire, there was greater impairment in the self-image dimensions with a mean of 1.8 and the ODI assessment showed aminimal disability index, which improved in successive controls. Our main complication was infections (36%). We conclude that early corrective surgery in AIS offers clinical, radiological and quality of life improvement for these patient(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , ScoliosisABSTRACT
Objective To study correlation between the deformation and displacement trend of the lumbosacral vertebra (L1-S1) for two typical scoliosis spine under vertical load, so as to provide the mechanical basis of treatment and prevention of scoliosis in clinic. Methods The X-ray computed tomography (CT) imaging of two typical scoliosis spine (Lenke-4AN type and Lenke- 5CN type) were converted into 3D models，and their finite element models were then established and verified. The internal stress distribution and displacement variation of the models were calculated by the finite element software; the correlation between the lumbosacral vertebral structure and displacement of the spine was analyzed. Results Under the same boundary conditions and load cases, the stress and displacement for two kinds of lumbosacral vertebral models showed different trends. Due to its left-leaning and forward convex bending deformation as well as relatively large lordosis angle(60°) and smaller left-leaning angle (17.37°), the Lenke-4AN type lumbosacral spine produced slightly small forward convex displacement(8.18 mm) and relatively large left-leaning displacement (0.97 mm). The Lenke- 5CN type lumbosacral spine showed left-leaning and forward convex bending deformation as well, with relatively large lordosis angle (59°) and left-leaning angle (26.97°), so it produced more severe left-leaning (20.65 mm) and forward deformation (9.22 mm). Conclusions The deformation trend of lumbosacral vertebra is closely related to its structural characteristics, and different scoliosis lumbosacral vertebral structures will cause corresponding deformation trend. The research findings are important for the prevention and treatment of scoliosis.
ABSTRACT
Objective To study the correlation between the deformation and displacement trend of the lumbosacral vertebra (L1-S1) for two typical scoliosis spines under vertical loads,so as to provide the mechanical basis of treatment and prevention of scoliosis in clinic.Methods The X-ray computed tomography (CT) images of two typical scoliosis spines (Lenke-4AN type and Lenke-5CN type) were converted into 3D models,and their finite element models were then established and verified.The internal stress distribution and displacement variation of the models were calculated by the finite element software;the correlation between the lumbosacral vertebral structure and displacement of the spine was analyzed.Results Under the same boundary conditions and load cases,the stress and displacement for two kinds of lumbosacral vertebral models showed different trends.Due to its leftleaning and forward convex bending deformation as well as the relatively large lordosis angle (60°) and smaller left-leaning angle (17.37°),the Lenke-4AN type lumbosacral spine produced slightly small forward convex displacement (8.18 mm) and relatively large left-leaning displacement (0.97 mm).The Lenke-5CN type lumbosacral spine showed left-leaning and forward convex bending deformation as well,with relatively large lordosis angle(59°) and left-leaning angle (26.97°),so it produced more severe left-leaning displacement (20.65 mm) andforward convex displacement (9.22 mm).Conclusions The deformation trend of lumbosacral vertebra is closelyrelated to its structural characteristics,and different scoliosis lumbosacral vertebral structures will cause the corre-sponding deformation trend.The research findings are important for the prevention and treatment of scoliosis.
ABSTRACT
Objective To study the correlation between the deformation and displacement trend of the lumbosacral vertebra (L1-S1) for two typical scoliosis spines under vertical loads,so as to provide the mechanical basis of treatment and prevention of scoliosis in clinic.Methods The X-ray computed tomography (CT) images of two typical scoliosis spines (Lenke-4AN type and Lenke-5CN type) were converted into 3D models,and their finite element models were then established and verified.The internal stress distribution and displacement variation of the models were calculated by the finite element software;the correlation between the lumbosacral vertebral structure and displacement of the spine was analyzed.Results Under the same boundary conditions and load cases,the stress and displacement for two kinds of lumbosacral vertebral models showed different trends.Due to its leftleaning and forward convex bending deformation as well as the relatively large lordosis angle (60°) and smaller left-leaning angle (17.37°),the Lenke-4AN type lumbosacral spine produced slightly small forward convex displacement (8.18 mm) and relatively large left-leaning displacement (0.97 mm).The Lenke-5CN type lumbosacral spine showed left-leaning and forward convex bending deformation as well,with relatively large lordosis angle(59°) and left-leaning angle (26.97°),so it produced more severe left-leaning displacement (20.65 mm) andforward convex displacement (9.22 mm).Conclusions The deformation trend of lumbosacral vertebra is closelyrelated to its structural characteristics,and different scoliosis lumbosacral vertebral structures will cause the corre-sponding deformation trend.The research findings are important for the prevention and treatment of scoliosis.
ABSTRACT
Objective To study the correlation between the deformation and displacement trend of the lumbosacral vertebra (L1-S1) for two typical scoliosis spines under vertical loads,so as to provide the mechanical basis of treatment and prevention of scoliosis in clinic.Methods The X-ray computed tomography (CT) images of two typical scoliosis spines (Lenke-4AN type and Lenke-5CN type) were converted into 3D models,and their finite element models were then established and verified.The internal stress distribution and displacement variation of the models were calculated by the finite element software;the correlation between the lumbosacral vertebral structure and displacement of the spine was analyzed.Results Under the same boundary conditions and load cases,the stress and displacement for two kinds of lumbosacral vertebral models showed different trends.Due to its leftleaning and forward convex bending deformation as well as the relatively large lordosis angle (60°) and smaller left-leaning angle (17.37°),the Lenke-4AN type lumbosacral spine produced slightly small forward convex displacement (8.18 mm) and relatively large left-leaning displacement (0.97 mm).The Lenke-5CN type lumbosacral spine showed left-leaning and forward convex bending deformation as well,with relatively large lordosis angle(59°) and left-leaning angle (26.97°),so it produced more severe left-leaning displacement (20.65 mm) andforward convex displacement (9.22 mm).Conclusions The deformation trend of lumbosacral vertebra is closelyrelated to its structural characteristics,and different scoliosis lumbosacral vertebral structures will cause the corre-sponding deformation trend.The research findings are important for the prevention and treatment of scoliosis.
ABSTRACT
OBJETIVO: Identificar los factores de riesgo de descompensación distal postoperatoria (D.D.P.) y definir una estrategia quirúrgica segura en curvas tipo Lenke 1A tratadas con tornillos pediculares. MÉTODO: Estudio radiológico retrospectivo de 63 pacientes con escoliosis Lenke 1A, con un seguimiento mínimo de un año. Se evaluó, edad, sexo, grados Cobb, signo de Risser, relación de la vértebra distal instrumentada (V.D.I.) con la vértebra distal de la curva (V.D.), vértebra estable (V.E.) y con la vértebra, cuya distancia a la línea central vertical al sacro (L.V.S.) era superior a 10 mm "distancia vertebral" (D.V.). RESULTADOS: 8 casos (12,7%) desarrollaron D.D.P. El signo de Risser fue 0 en 2 pacientes (25%) y I en 2 pacientes (25%). Relación de V.D.I. con V.D.: 4 pacientes (50%) mismo nivel (V.D. +0), 4 pacientes (50%) un nivel caudal (V.D. (+1); relación V.D.I. con V.E.: 5 pacientes (62,5%) 2 niveles cefálicos (V.E -2), 3 pacientes (37,5%) 1 nivel cefálico (V. E.-1); relación V.D.I. con D.V.: 5 pacientes (62,5%) un nivel cefálico D.V. (-1), 3 pacientes mismo nivel (D.V.+ 0). CONCLUSIONES: Riesgo de descompensación distal postoperatoria: V.D.I. mismo nivel V.D. (V.D. + 0), 2 niveles cefálicos V.E. (V.E.-2), 1 nivel cefálico D.V. (D.V. -1). Estrategia quirúrgica curvas Lenke 1A: V.D.I: 1/2 niveles caudales a V.D. (V.D. +1/+2), un nivel cefálico a V.E. (V.E -1), mismo nivel D.V. (D.V. +0).
OBJETIVO: Identificar os fatores de risco de descompensação distal pós-operatória (DDP) e definir estratégia cirúrgica de segurança em curvaturas de Lenke 1A, tratadas com parafusos pediculares. MÉTODO: Estudo radiológico retrospectivo de 63 pacientes com escoliose Lenke 1A, com acompanhamento mínimo de um ano. Os parâmetros avaliados foram idade, sexo, graus do ângulo de Cobb, sinal de Risser, relação da vértebra distal instrumentada (VDI) com a vértebra distal da curvatura (VD), com a vértebra estável (VE) e com a vértebra cuja distância da linha central vertical até o sacro (LVS) era superior a 10 mm de "distância vertebral" (DV). RESULTADOS: 8 casos (12,7%) desenvolveram DDP. O sinal de Risser foi 0 em 2 pacientes (25%) e 1 em 2 pacientes (25%). Relação VDI/VD: 4 pacientes (50%) mesmo nível (VD +0), 4 pacientes (50%) nível caudal (VD +1); relação VDI/VE: 5 pacientes (62,5%) 2 níveis cefálicos (VE -2), 3 pacientes (37,5%) 1 nível cefálico (VE -1); relação VDI/DV: 5 pacientes (62,5%) um nível cefálico DV (-1), 3 pacientes mesmo nível (DV +0). CONCLUSÕES: Risco de descompensação distal pós-operatória:VDI mesmo nível VD (VD +0), 2 níveis cefálicos VE (VE -2), 1 nível cefálico DV (DV -1). Estratégia cirúrgica nas curvaturas Lenke 1A: VDI: 1/2 níveis caudal até VD (VD +1/+2), um nível cefálico até VE (VE -1), mesmo nível DV (DV +0).
OBJECTIVE: To identify risk factors for postoperative distal decompensation (PDD) and safe surgical strategy in curvatures Lenke type 1A, treated with pedicle screws. METHOD: Retrospective radiographic study of 63 patients with scoliosis Lenke 1A, with follow-up of at least one year. The parameters evaluated were age, sex, degrees of Cobb's angle, Risser sign, relationship of distal instrumented vertebra (DIV) to the distal vertebra (DV) of the curvature, to the stable vertebra (SV) and to the vertebra which distance to the central vertical line to the sacrum (VLS) was greater than 10 mm of "vertebral distance" (VD). RESULTS: 8 cases (12.7%) developed DDP. The Risser sign was 0 in 2 patients (25%) and 1 in 2 patients (25%). DIV/DV relationship: 4 patients (50%) same level (DV +0), 4 patients (50%) caudal level (DV +1); DIV/SV ratio: 5 patients (62.5%) 2 cephalic levels (VD -2), 3 patients (37.5%) 1 cephalic level (SV -1); DIV/VD relationship: 5 patients (62.5%) 1 cephalic level (VD -1), 3 patients the same level (VD +0). CONCLUSIONS: Risk of postoperative distal decompensation: DIV same level DV (DV +0), 2 cephalic levels SV (SV -2), 1 cephalic level VD (VD -1). Surgical strategy in Lenke 1A curvatures: DIV: 1-2 levels caudal to DV (DV +1/+2), 1 cephalic level to SV (SV -1), the same level VD (VD +0).