Impact of early surgical correction of curves in paralytic scoliosis

The purpose of this investigation was to investigate the advantages of early surgery in patients suffering from neuromuscular scoliosis. Between January 1992 and January 1998, 20 patients with paralytic scoliosis, with an average age of 15 years, were treated surgically in the Department of Orthopedic Surgery, University Hospital, Feiburg, Germany. The parameter investigations included correction of the scoliosis independent of preoperative curves, operation time independent of Cobb angles, complications and blood loss. Surgery included a dorsal semi rigid instrumentation with pedicle screws in the lumbo-sacral region and sublaminar wiring in the thoracic area. The preoperative scoliotic curve measured 73.1°, the postoperative curve 24.5°, the mean correction was 66.4%. The thoracic kyphosis could be corrected from 13.9-25.7°. The operation time was longer and the correction was less if high Cobb angles were found preoperatively. Two wound infections were observed. Rod breakage following a pseudarthrosis occurred in one patient, a refusion was necessary. Cobb angles alone should not be the standard to indicate surgery in neuromuscular scoliosis. If a decreased functional ability, pelvic obliquity or trunk decompensation with reduced vital capacity are found, surgery is more dangerous while the obtained correction is less. Therefore, we recommend early surgery

Treatment of tuberculous spondylitis at the cervicothoracic junction. Clinical impact of surgery by means of sternotomy

The operative treatment of tuberculous spondylitis remains a challenge with regard to the surgical approach to the cervicothoracic junction. In addition, it is difficult to restore the resected vertebral bodies. Two cases of tuberculous spondylitis in this area are presented. The first case concerns a 25-year-old African patient suffering from the effects of tuberculous spondylitis: Destruction of vertebral bodies dorsal [D]1, D2, and D3, kyphosis coupled with compression of the spinal cord, as well as incomplete motor and sensory paraplegia [Frankel grade C]. The operative treatment of tuberculous spondylitis that is described, approached the cervicothoracic junction by means of a sternotomia. Corpectomy of vertebral bodies D1 through D3 were followed by their restoration with the help of a titanium cage. As a result, the paraplegia disappeared. Ventral decompression was followed by dorsal instrumentation. The results of the operation are decompression of the spinal cord, correction of the kyphosis, and stable fusion followed by restitution of the paraplegia. Primary stability was provided by the use of a titanium cage and dorsal instrumentation. There was no need for an external brace. There was no loss of correction 3 years after the operation. The 2nd case concerns a 49-year-old European patient suffering from thoracic pain radiating around the chest. A partial destruction of D2 and D3 with kyphosis and compression of the spinal cord because of a tuberculous spondylitis were detected, neurological deficits were not found. The corpectomy of D2 and D3 were proceeded by means of a sternotomy, the defect was restored with the help of a titanium cage. Due to the use of a ventral Morscher plate an additional dorsal instrumentation was not necessary. The patient was fixed in a minerva plaster for 3 months. There was no loss of correction 2 years after the operation. Both patients are manual workers and postoperatively adapted to their former work