Escoliosis idiopática del adolescente, análisis postoperatorio. Serie de casos / Idiopathic adolescent scoliosis, post-operative analysis. Case Series

Introducción La escolisis es una deformidad tridimencional de la columna vertebral. El objetivo principal del tratamiento es evitar la progresión, lograr la máxima corrección y la artrodesis del menor numero de segmentos, con buen balance coronal y sagital que permita una fusión indolora. El objetivo del estudio es evaluar los resultados de los pacientes operados por escolisis idiopática del adoelscente en nuestro centro. Materiales y Métodos se realizó un estudio tipo serie de casos, se incluyeron pacientes operados entre 2011 y 2017; en ellos se estudiaron: los datos demografícos, el tipo de curva, la densidad de tornillos utilizados, el porcentaje de reducción lograda al año y las complicaciones. Resultados Se obtuvieron datos de 27 pacientes. Pedominaron las curva Lenke 1B. El ángulo de Cobb preoperatorio promedio fue de 66,5o con un postoperatorio de24,4o. La densidad de tornillo presentó un promedio de 1,4. Presentaron complicaciones el 25,6% de los pacientes, siendo la más frecuente la infección. En el cuestionario SRS-22 se obtuvieron buenas resultados. Discusión Se ha reportado una densidad de 0,8-1,69 tornillos por vértebra fusionada con un porcentaje de corrección de 64-70%. En nuestro resultados la densidad de tornillos por vertebra fusionado fue de 1,4 lográndose una reduccion de 64,1%. Aumentar el número de tornillos no aumentó el grado de corrección de las curvas. En concordancia con la literatura la complicación mas frecuente fue la infección, con baja incidencia de lesión neurológica. Concluimos que la técnica de artrodesis utilizada en nuestro centro, con tornillos pediculares de tercera generación, obtiene buenos resultados de reducción, con porcentaje de complicaciones similares a los reportados previamente.

Background Scoliosis is a three-dimensional deformity of the spine. The main objective of treatment is to avoid progression, achieve maximum correction and arthrodesis of the least number of segments, with good coronal and sagittal balance that allows a painless fusion. The aim of the study is to evaluate the results of patients who underwent to surgical fusion for adolescent idiopathic scoliosis. Material and Methods A case series study was conducted by analyzing medical records of patients who underwent to surgical fusion for adolescent idiopathic scoliosis. between 2011 through 2017.An analysis of demographic data, the type of curve, the density of screws used, the percentage of reduction achieved after one year, and complications was performed. Results Data of 27 patients was included. Lenke 1B curves were predominant. The mean preoperative Cobb angle was 66.5o with a postoperative 24.4o. Screw density presented an average of 1.4. Complications were presented in 25.6% of the patients, the most frequent being infection. Good results were obtained in the SRS-22 questionnaire. Discussion A density of 0.8-1.69 screws per fused vertebra has been reported with a correction percentage of 64-70%. In our results, the density of screws per fused vertebra was 1.4, achieving a reduction of 64.1%. Increasing the number of screws did not increase the degree of correction of the curves. In accordance with the literature, the most frequent complication was infection, with a low incidence of neurological injury. We conclude that the arthrodesis technique used in our center, with third-generation pedicle screws, obtains good reduction results, with a percentage of complications similar to those previously reported.

Iphone app use to Cobb angle in adolescent idiopathic scoliosis: Does this apply? / Uso de aplicativo de iphone para ângulo de Cobb na escoliose idiopática do adolescente: É aplicável? / Uso de aplicaciones móviles para Iphone para el ángulo de Cobb en la escoliosis idiopática del adolescente: ¿es aplicable?

To validate a new method of measuring the Cobb angle for scoliosis from the mobile app CobbMeter to facilitate the evaluation and measurement in clinical practice.

Validar um novo método de medida do ângulo de Cobb para escoliose a partir do aplicativo para aparelho telefônico celular CobbMeter para facilitar a avaliação e medição na prática clínica.

Validar un nuevo método de medición del ángulo de Cobb para la escoliosis a partir de la aplicación móvil CobbMeter, para facilitar la evaluación y la medición en la práctica clínica.

Síndrome 3-M: descripción clínica-radiológica: caso clínico / 3-M syndrome: clinical and radiological description. Case report

Introducción: El síndrome 3M combina retardo de crecimiento prenatal y postnatal severo, dismorfias faciales (semeja facies "melancólica") y anomalías radiológicas. Es una enfermedad infrecuente de la que hasta el momento se han descrito alrededor de 200 casos. "3M" se refiere a las iniciales de los tres autores que describieron este síndrome. Los rasgos faciales característicos son: cabeza relativamente grande, dolicocefalia, abombamiento frontal, cara triangular, mentón prominente, nariz antevertida, labios gruesos, cejas gruesas, surco nasolabial largo e hipoplasia de tercio medio de cara. Los hallazgos radiológicos, que van apareciendo con la edad son costillas y huesos largos finos y delgados, y cuerpos vertebrales altos. El síndrome 3M se transmite como un rasgo autosómico recesivo y es genéticamente heterogéneo. Objetivo: Descripción del caso clínico de una nina actualmente de 10 años de edad en el que se confirmó este síndrome. Caso clínico: Nina referida a Genética a los 15 meses de vida, por talla baja severa, dismorfias y malformaciones. Su seguimiento clínico y radiológico permitió plantear y confirmar este diagnóstico. Conclusión: En ocasiones sólo el seguimiento longitudinal de pacientes con talla baja severa permite que se evidencien alteraciones sugerentes de un diagnóstico específico. La certificación del diagnóstico favorece un adecuado manejo clínico y consejería genética a los padres.

Introduction: 3M syndrome combines severe prenatal and postnatal growth delay, facial dysmorphism (resembles melancholy facies) and radiological abnormalities. It is a rare disease with 200 cases reported so far. "3M" refers to the initials of the three authors who first described this syndrome. The characteristic facial features are: relatively large head, dolichocephaly, frontal bossing, a triangular face, pointed chin, upturned nose, full lips, full eyebrows, long philtrum and hypoplastic midface. radiological findings which appear with age, include slender long bones and ribs and tall vertebral bodies. 3M syndrome is transmitted as an autosomal recessive trait and is genetically heterogeneous. Objective: Report the clinical case of a girl, now 10 years of age, diagnosed with the syndrome. Case report: An infant girl, 15 months old, was referred to Genetics Clinic due to severe short stature, dysmorphic features and malformations. Her clinical and radiological follow-up led to propose and confirm this diagnosis. Conclusion: Sometimes only longitudinal monitoring of patients with severe short stature evidence abnormalities suggesting a specific diagnosis. The right diagnosis results in suitable clinical care and genetic counseling to parents.

Posterior Epidural Migration of Lumbar Ruptured Disc: Report of Two Cases

Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.

Unilateral Fusion of the Odontoid Process with the Atlas in Klippel-Feil syndrome: A Case Report

Klippel-Feil syndrome (KFS) displays congenital fusion of the cervical vertebrae; it is a relatively common condition and has many associated malformations such as Sprengel's deformity, scoliosis, rib anomalies, congenital defects of the brain or spinal cord, renal anomalies, congenital heart disease, deafness, cleft palate, cranial and facial asymmetry, and enteric cysts. There are various types of cervical fusion observed in KFS. However, fusion of the odontoid process with the atlas is a very rare finding. We report here on a 4-year-old boy with unilateral fusion of a separated odontoid process with the lateral mass of the atlas, and this was associated with a spontaneously closed ventricular septal defect, a small patent ductus arteriosus and a horseshoe kidney.

Intradural Cervical Disc Herniation: A Case Report

Intradural cervical disc herniation is an extremely rare condition and its pathogenesis is not certain. We experienced a case of intradural cervical disc herniation at the C4-5 level in a 56-year-old man. The preoperative sagittal T1- and T2- weighted images revealed an intradural iso-intensity lesion, with the spinal cord behind the posterior longitudinal ligament at the C4-5 disc level. The post-contrast T1-weighted image revealed a peripheral enhanced intradural lesion. We report here on a case of an intradural cervical disc herniation that was diagnosed by radiological examination, and we include a review of the related literature.

Oblique Coronal MRI in the Evaluation of Bony Stenosis of the Cervical Foramina: Objectiveness and Correlation with Radiograph

PURPOSE: To determine the utility of oblique coronal MR (OMR) imaging in the evaluation of bony foraminal narrowing of the cervical spine by comparison of its findings with those of combined axial and sagittal MR (CMR) imaging and correlation with the findings of oblique radiography. MATERIALS AND METHODS: One hundred and eight cervical neural foramina in 18 patients formed the basis of this study. Three radiologists working in a blind fashion independently graded the degree of bony narrowing of the foramina seen on OMR and CMR images and on oblique radiographs (0=none, 1=stenosis below 25% of AP dimension, 2=stenosis exceeding 25% of AP dimension). Inter-observer variance was measured for each modality, and for each of these and for each foramen, consensus was reached as to whether of CMR or OMR showed better correlation with radiographs. RESULTS: Inter-observer variance in OMR was less (kappa=0.88) than in CMR (kappa=0.41). Correlation between the findings of OMR and radiography was also better (kappa=0.63) than between those of CMR and radiography (kappa=0.41). CONCLUSION: OMR can be a useful supplement in evaluating foraminal stenosis, especially when oblique radiographs and CMR images show discrepancies.

Clinical Significance of Nerve Root Enhancement in Contrast-Enhanced MR Imaging of the Postoperative Lumbar Spine

PURPOSE: To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. MATERIALS AND METHODS: Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. RESULTS: Of 26 cases(22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms(87.2% and 88.6%, respectively). CONCLUSION: In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant.

Interdural Cyst of the Thoracolumbar Region

Spinal interdural cyst is an extremely rare lesion, the wall of which consists of a dura-like layer without arachnoid. This report describes two cases in which patients with interdural cysts of the thoracolumbar spine presented with atypical neurologic signs and symptoms, including lower back pain and radiating pian in both lower extremities. Plain radiographs, CT myelograms and magnetic resonance images were obtained, but the cysts could not be differentiated from extradural arachnoid cyst. Surgical intervention revealed a dura-like layer of cyst wall, and within the cyst, a fluid resembling cerebrospinal fluid was present. In one case, microscopic examination showed that fragments of connective tissue without an arachnoid lining formed a thin fibrous cystic wall, a finding consistent with meningeal cyst.

Unilateral and Bilateral Lumbosacral Transitional Vertebrae: Comparison of the Incidence of Combined Diseases

PURPOSE: The purpose of this study was to evaluate the radiologic findings of lumbosacral transitional verte-brae (LSTV), as seen on plain radiographs and MRI, and to compare the incidence of combined diseases be-tween unilateral and bilateral groups. MATERIALS AND METHODS:We retrospectively evaluated the plain radiographs and MR images of 63 patients with LSTV, classifying its type according to Castellvi 's criteria, and evaluated disc herniations, facet joint os-teoarthritic change, scoliosis, and spondylolisthesis. We then compared the incidence of each combined diseases between unilateral and bilateral groups, and as a control group, 63 patients without LSTV were also eval-uated. RESULTS: Forty of 63 cases of LSTV (63.5%) were bilateral, and 23 (36.5%) unilateral. According to Castellvi 's criteria, the incidence of type I was 41.3% (unilateral 7 cases, bilateral 19), type III30.2% (unilateral 8 cases, bilateral 11), type II23.8% (unilateral 8 cases, bilateral 7), and type IV 4.8% (unilateral 0 cases, bilateral 3).With combined diseases, the incidence of disc herniation was 66.7% (unilateral 15 cases, bilateral 27), moderate to severe facet joint osteoarthritic change 28.6% (unilateral 11 cases, bilateral 7), scoliosis 27.0% (unilateral 9 cases, bilateral 8), and spondylolisthesis 9.5% (unilateral 2 cases, bilateral 4). The incidence of facet joint os-teoarthritic change was significantly higher in the unilateral group (47.8%) than in the bilateral group (17.5%) (p=0.02), and scoliosis occurred at a higher rate in the unilateral group (39.1%) than in the bilateral group (20.0%) (p=0.18). There was, however, no significant difference in the incidence of disc herniation and spondylolisthesis between the two groups (unilateral group: 65.2% and 8.7%; bilateral group: 67.5% and 10.0%, respectively). CONCLUSION: With LSTV, the incidence of facet joint osteoarthritic change was significantly higher in the unilat-eral group than in the bilateral group, and scoliosis also showed a higher rate of occurrence in the unilateral group.

Regional Disc Change in Segmental Hypoplasia of the Lumbosacral Vertebral Bodies: MR Findings

PURPOSE: To classify types of vertebral hypoplasia and to investigate the prevalence and patterns of associated disc degeneration. MATERIALS AND METHODS: Defining vertebral hypoplasia as occurring when the AP diameter of a lower vertebral body is smaller than that of an upper ones, we retrospectively reviewed the MR images obtained in 34 cases of this condition invloving young adults. Two major types and two subtypes, a total of four different entities were classified as follows; type I: hypoplasia involving a single vertebral body; type II: hypoplasia in-volving serial lower segmental vertebral bodies; subtype a: hypoplastic body located anteriorly along the anterior spinal line; subtype b: hypoplastic body located posteriorly along the posterior spinal line. We also investigated each type of vertebral hypopla-sia and patterns of associated disc changes. RESULTS: Three different types were observed. In type IIa(n= 29), posterior disc occurred in 8/29 cases, diffuse degeneration in 21/29 patients, and posterior disc herniation in all. All type Ia cases(3/3) showed diffuse disc degeneration at both upper and lower disc levels, with posterior disc herniation, while both type IIb cases(2/2) showed diffuse disc degeneration, with bidirectional disc herniation. CONCLUSION: By identifying the exact patterns of vertebral hypoplasia, we were able to predict which portion of the disc was likely to degenerate.

MR Imaging Findings of Lumbar Scheuermann's Disease: Correlation with Disk Pathologies

PURPOSE: To describe the MR imaging findings of lumbar Scheuermann's disease and to determine therelationship between various MR imaging findings of this disease and disk pathologies. MATERIALS AND METHODS: Weretrospectively evaluated the MR imaging findings of 13 patients under the age of 20 with lumbar Scheuermann'sdisease. One hundred and four vertebral bodies and 91 intervertebral disks were included in the study. The imagingfindings were analyzed with particular emphasis on the wedging of vertebral bodies, Schmorl's nodes, and theheight of intervertebral disks. The relationship between these findings and disk degeneration or herniation wasevaluated. RESULTS: Lumbar Scheuermann's disease was classified into two types according to Blumenthal'sclassification. Seven patients were type I and six were type II. Disk degeneration and herniation were identifiedin 28.6% (26/91) and 20.9% (19/91), respectively, of intervertebral disks. In type I, wedging of the vertebralbodies was noted in 48.2% of cases(27/56) and degeneration and herniation of adjacent disks were identified in24.1% (7/29) and 13.8% (4/29), respectively. Central Schmorl's nodes were identified in 29.5% (33/112) ofend-plates and degeneration and herniation of adjacent disks in 34.8% (8/23) and 17.4% (4/23), respectively. Intype II, anterior Schmorl's nodes were found in 11.5% (11/96) of end-plates and degeneration and herniation ofadjacent disks in 100% (10/10) and 70% (7/10), respectively. Decreased height of intervertebral disks was notedadjacent to the anterior Schmorl's nodes ; all were related to disk degeneration and 70% (7/10) to diskherniation. There was statistically significant correlation between anterior Schmorl's node, decreased height ofintervertebral disk and adjacent disk pathologies (p0.05). CONCLUSION: In lumbar Scheuermann's disease, anterior Schmorl's nodeand decreased height of an intervertebral disk are related to disk degeneration and herniation. MR is useful forthe evaluation of disk pathologies as well as changes in vertebral bodies.

Radiologic Findings of Intraspinal Epidural Arachnoid Cyst

PURPOSE: To evaluate the radiologic findings of intraspinal epidural arachnoid cyst. MATERIALS AND METHODS: Six pateuts with surgically proven intraspinal epidural arachnoid cyst were included in this study. Four were freeof specific past history, but two had a history of trauma. All underwent examination by plain radiography,CT-myelography and MRI, and the following aspects were retrospectively analysed : vertebral pressure erosion,interpedicular distance, enlargement of neural foramina, as seen on plain radiograph, contrast-filling and lateralbulging of lesions through neural foramina on CT-myelograph, and signal intensity, size and shape of margin andepidural fat pattern, as seen on MRI. RESULTS: Three of four congenital intraspinal epidural arachnoid cysts weresingle in the thoracolumbar region, while in the other case, there were multiple cysts in the mid- and lowerthoracic regions. Cysts were equivaleut in size to between four and six vertebral bodies. Plain radiographicfindings of pedicular pressure erosion, widened interpedicular distance, and bilateral neural foraminalenlargement of several contiguous vertebrae were observed in all four cases. One showed posterior vertebralscalloping. On CT-myelograph, a contrast-filled cystic lesion occupying the posterior epidural space, with lateralbulging through neural foramina and anterior displacement of the contrast-filled thecal sac, was seen. On MRI,longitudinally elongated, well-demarcated cysts were seen to be present in the posterior epidural space; theirsignal intensity was the same as in CSF. An epidural fat cap pattern enveloping the upper and lower ends of thecysts was apparent in all cases. In two cases, traumatic intraspinal epidural arachnoid cysts were situated in thethoracolumbar and lumbosacral region, respectively, near a previously injured region and were smaller (equivalentto the height of three vertebral bodies). CT-myelograph and MRI showed that their effect on the thecal sac wascompressive only. CONCLUSION: When pressure erosion of vertebral odies and pedicles of contiguous severalvertebrae in the thoracic or thoracolumbar region is recognized on plain radiograph, intraspinal epiduralarachnoid cyst should be included in differential diagnosis, and for accurate evaluation, CT-myelograph and/or MRIare needed.

Schmorl's Nodes of the Lumbar Spine: Are They Simply Normal

PURPOSE: To evaluate the accompanying abnormal findings of Schmorl's nodes(SN), a normal variants of thelumbar spine. MATERIALS AND METHODS: Seventy-five patients with one or more SN, as seen on lumbar spine MRI werestudied. Using a 1.5T MR unit, the number and location of SN, their site of the end plate, adjacent disc changesand lesion associated and not associated with SN, and accompanying associated bony spinal stenosis wereretrospectively investigated. RESULTS: Among the 75 patients, 230 SN were noted in 375 vertebral bodies; theywere relatively frequently located on the second(65, 28.2%) and third(65, 28.2%) lumbar vertebrae. The most commonend-plate site of SN was the posterior one-third portion(160;69.6%). In 450 discs of these 75 patients, 172lesions were noted;those associated with SN(76/167, 45.5%) was more common than those not thus associated (96/283,33.9%)(p <0.05), and those associated with SN were relative frequently located on intervertebral disc L2-3 orL3-4(p <0.05). Thirty-seven SN (16.1%) were associated with bony spinal stenosis. CONCLUSION: Because it isfrequently associated with disc lesions and bony spinal stenosis, SN of the lumbar spine may be a pathologiccondition rather than a normal variant.