The safety and efficacy of Isola-Galveston instrumentation and arthrodesis in the treatment of neuromuscular spinal deformities.

BACKGROUND: Implant systems that realign and stabilize a deformed spine continue to evolve. The purpose of the study of this case series was to determine the safety and effectiveness of a system designed to integrate hook, wire, screw, and post anchors for the treatment of a wide spectrum of neuromuscular disorders associated with pelvic deformity or the potential for deformity. METHODS: Forty-seven consecutive patients who had a spinal deformity that was due to cerebral palsy or an upper motor-neuron cerebral palsy-like disease (thirty-one patients), myelomeningocele (nine), Duchenne muscular dystrophy (four), or other disorders (three) were managed with Isola-Galveston instrumentation and arthrodesis. The average age at the time of the operation was fourteen years and three months (range, five years and four months to twenty-three years and nine months). Eight patients (17 percent) had an additional anterior discectomy and arthrodesis without instrumentation, and three (6 percent) had an additional decancellation egg-shell osteotomy. The forty-seven patients were followed for an average of forty-seven months (range, twenty-four to 100 months). The complications were tabulated to assess the safety of the procedure, and the correction of each deformity was calculated to determine the efficacy. RESULTS: There were no deaths, acute wound infections, or serious neurological problems. Reoperation was necessary in five patients (11 percent). One reoperation was performed because of a delayed deep wound infection; one, because of delayed sterile drainage; and one, for a pseudarthrosis repair. The remaining two reoperations were done for removal of an implant because the cephalad portion had become prominent. In addition to the pseudarthrosis that required a reoperation, there were three possible pseudarthroses that did not require a reoperation (overall prevalence of pseudarthrosis, 9 percent). Postoperative bracing was used for eleven patients (23 percent); it did not influence the rate of pseudarthrosis or possible pseudarthrosis. The average preoperative scoliosis of 70 degrees was corrected to 24 degrees (a 66 percent correction) at the time of the latest follow-up, and the average preoperative pelvic obliquity of 27 degrees was corrected to 5 degrees (an 81 percent correction). A survey of the patients, parents, and caregivers indicated that 96 percent of them were satisfied or very satisfied with the result of the operation. CONCLUSIONS: Isola-Galveston instrumentation seems as safe and effective as other types of instrumentation that have been studied in comparable series in the literature. Isola-Galveston instrumentation is probably more effective for the correction of pelvic obliquity and the maintenance of correction. Only a posterior procedure is used, and the instrumentation appears to decrease the need for an additional anterior approach. Spinal hook, wire, screw, and post anchors have been successfully integrated into one posterior spinal implant system.

Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms.

STUDY DESIGN: A radiographic evaluation of standing cervical and global sagittal alignment in 100 adult volunteers with no neck or radicular arm symptoms was undertaken. OBJECTIVES: To document and define cervical standing lateral alignment and balance in a volunteer population without cervical problems. SUMMARY OF BACKGROUND DATA: Minimal data exist on cervical segmental sagittal alignment distributions in stance. METHODS: Radiographic measures of spinal alignment were collected and statistically analyzed. RESULTS: Data were categorized into two age- and sex-matched groups. Group 1 had no cervical or lumbar symptoms. Group 2 had no cervical symptoms, but had lumbar symptoms. Mean total and segmental cervical alignment distributions were not statistically different between groups. Mean total cervical lordosis in stance for the entire group was -40.0 +/- 9.7 degrees. Thoracic and lumbar alignment were within previously reported measures and not statistically different between groups. Plumb line markers at C7 and sacral reference points were not statistically different between groups. Pearson correlations revealed that cervical sagittal plane alignment vaired inversely with thoracic alignment. Independent orthopedists noted cervical osteoarthritis was present in 17% of each group of volunteers with substantial kappa agreement (0.73) between observers. Intraobserver and interobserver reliability of sagittal alignment measures of 30 randomly remeasured radiographs revealed strong correlation between observations. CONCLUSIONS: No differences in total cervical lordosis were noted between cervical asymptomatic volunteers with or without low back pain. Most cervical lordosis occurred at the C1-C2 level in stance, whereas only 6 degrees (15%) occurred at the lowest three cervical levels (C4-C7). Changes in cervical lordosis correlated inversely with changes in thoracic alignment.

Muscle fiber composition and length-tension relationships in rats chronically exposed to alcohol.

Adult Fischer 344 rats were fed an alcohol diet (7-9 g/kg/day) for 12 weeks and were compared to pair-fed controls with regard to the contraction and fiber characteristics of the gastrocnemius and plantaris muscles of the leg. Muscles were isolated in situ with blood and nerve supplies intact. The muscles were stretched by 1 mm increments and were stimulated at each muscle length with a voltage (1 msec pulse) that had been observed to produce maximal twitch force at the initial muscle length. Maximal twitch tension was found to be only 10% less in alcohol than pair-fed rats and the increase in force resulting from stretching was approximately 15% less in alcohol than pair-fed rats. No significant changes in sciatic nerve conduction velocities were produced by alcohol exposure. Moreover, no significant differences in muscle weight or the number and size of Type I, Type IIa or Type IIb muscle fibers were observed. Although the 12 weeks of alcohol exposure affected muscle physiology and histology in the direction of increased impairment, the differences were not large enough to be statistically significant.