Sagittal Plane Deformities in Children with SMA2 following Posterior Spinal Instrumentation.

This is a retrospective radiographic review to assess post-operative sagittal plane deformities in patients with Spinal Muscular Atrophy type 2 that had been treated with posterior spinal instrumentation. Thirty-two patients with a history of either spinal fusion (N = 20) or growing rods (N = 12) were identified with an average of 7.6 (2.1-16.6) years post-operative follow-up. Forty percent (13/32) of the patients were identified as having obvious "tucked chin" (N = 4), "tipped trunk" (N = 9), or both (N = 3). Sacral incidence was the only parameter that was statistically significant change between pre-operative or immediate post-operative measurements (66.9° vs. 55.2° p = 0.03). However, at final follow-up, the post-operative thoracic kyphosis had decreased over time in those that developed a subsequent sagittal deformity (24.2°) whereas it increased in those that did not (44.7°, p = 0.008). This decrease in thoracic kyphosis throughout the instrumented levels, resulted in a greater lordotic imbalance (30.4° vs. 5.6°, p = 0.001) throughout the instrumented levels in the group that developed the subsequent cervical or pelvic sagittal deformities. In conclusion, sagittal plane deformities commonly develop outside the instrumented levels in children with SMA type 2 following posterior spinal instrumentation and may be the result of lordotic imbalance that occurs through continued anterior growth following posterior instrumentation.

The incidence of spondylolysis and spondylolisthesis in children with osteogenesis imperfecta.

BACKGROUND: Spondylolysis and spondylolisthesis are common abnormalities of the lumbar spine. The incidence of these diagnoses is recognized in the healthy population. However, their incidence in osteogenesis imperfecta (OI) patients is less well defined. METHODS: This is a retrospective radiographic review of patients treated in the OI clinic from a single institution. Lateral radiographs were reviewed on all available patients to assess the incidence of spondylolysis and spondylolisthesis in this patient population. The morphology of the pedicle and pars interarticularis was also evaluated to identify any abnormalities or dysplasia of these structures. RESULTS: One hundred ten of the 139 patients treated in the OI clinic met the inclusion criteria for this study. Of these patients, 79% (87 of 110) were ambulatory. The overall incidence of spondylolysis in this pediatric OI population was found to be 8.2% (9 of 110) at an average age of 7.5 years. The incidence of spondylolisthesis was 10.9% (12 of 110) at an average age of 6.5 years with 75% (3 of 12) being isthmic type and 25% (3 of 12) dysplastic. The combined incidence of spondylolysis and spondylolisthesis was 19.2%. Incidentally, the pedicle length was noted to be elongated in 40.0% (44 of 110) of this OI population. CONCLUSIONS: This study found that the incidence of spondylolysis in a group of children with OI was much higher than in the normal pediatric population, which has been reported to be 2.6% to 4.0%. This incidence was also found to be higher than previously reported incidence of spondylolysis in OI patients (5.3%). The incidence of spondylolisthesis was also found to be much higher than that of the normal pediatric population (4.2%). It is important to recognize this higher incidence of these abnormalities and to anticipate future associated symptoms and potential worsening listhesis that can clinically affect the lifestyles of these children and potentially require surgical treatment. The clinical significance of these findings will necessitate long-term follow-up.

Functional outcomes of Denis zone III sacral fractures treated nonoperatively.

OBJECTIVES: The purpose of this study is to report the outcomes of nonoperative treatment in patients with Denis Zone III sacral fractures at a minimum of 2 years follow up. DESIGN: Retrospective review of prospectively collected data of a consecutive series of patients. SETTING: Level I trauma center. PATIENTS: A consecutive series of 15 patients (15-47 years old) with Denis Zone III sacral fractures treated nonoperatively from 1997 to 2002 was studied. Eleven patients were available for follow-up questionnaires; nine participated in a physical examination. Time to final follow up averaged 43 months (range, 25-67 months). INTERVENTION: Demographic data; mechanism of injury; injury-specific assessment of bowel, bladder, and sexual function; physical examination; and fracture pattern were collected from a prospectively collected database. MAIN OUTCOME MEASUREMENTS: At a minimum of 2-year follow up, evaluation of SF-36 scores, Roland Morris back pain questionnaire, and Gibbons classification was conducted. RESULTS: All fractures healed. Six patients had a postinjury increase in kyphosis (range, 1 degrees -17 degrees ) without a correlation to final outcomes. Mean SF-36 scores were all uniformly lower than the normalized general population and were biased by frequent associated injuries. Final Roland-Morris scores averaged 3.3 +/- 3.3. Gibbons classification scores initially averaged 2 +/- 1.2 and decreased to 1.5 +/- 0.8, each within their standard deviations. Eight had residual bowel, bladder, and/or sexual dysfunction. CONCLUSIONS: Nonoperative treatment of Denis Zone III sacral fractures yields consistent healing. Despite improvement in initial neurologic deficits, residual complaints were common.

11-month-old child refuses to sit up.

Discitis and vertebral osteomyelitis are rare in children and require a high index of suspicion for the timely diagnosis. The diagnosis should be considered in a child who develops a limp or in an infant who displays a postural or positional preference.

Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis.

STUDY DESIGN: A retrospective chart review was performed on all idiopathic scoliosis patients treated with instrumented spinal fusion over a 15-year period. OBJECTIVES: To provide an experience from a single institution over a prolonged time period. The goal was to determine the frequency of repeat surgical interventions following the "definitive" spinal fusion surgery and identify the factors responsible for these reoperations. SUMMARY OF BACKGROUND DATA: Instrumented spinal fusion remains the standard of care in the surgical management of idiopathic scoliosis. This surgery is considered a "definitive" procedure where, barring a complication, no additional surgical procedures are planned. Although many studies have reported the frequency of specific complications following spinal fusion, little information currently exists regarding the cumulative average of these repeat surgical interventions that occur following these "definitive" procedures. METHODS: Surgical logs were reviewed on all patients who had an instrumented spinal fusion for idiopathic scoliosis from January 1988 through December 2002. All subsequent surgical interventions on these patients were then identified from the logs through December 2004. Pertinent information was gleaned from surgical logs and patient charts to provide details for these reoperations. RESULTS: A total of 1,046 patients underwent an instrumented spinal fusion for idiopathic scoliosis: 809 had a posterior-only fusion, 228 had an anterior-only fusion, and 9 had a combined anterior/posterior spinal fusion. A total of 172 repeat surgical interventions were performed in 135 patients (12.9%). Of these 135 patients, 29 patients (21.5%) had two or more separate procedures performed. The most common reasons for reoperation were infection, symptomatic implant, and pseudarthrosis. Patients who had posterior fusions had a significantly higher rate of reoperation than patients who had anterior fusions (14.0% vs. 9.3%). Reoperations due to infections and symptomatic implants occurred with significantly higher frequency in the posterior spine fusion group compared with those with anterior spinal fusion. No differences in rates of reoperation for pseudarthrosis were noted between posterior and anterior fusion groups. CONCLUSIONS: Repeat surgical interventions are relatively common following these supposedly definitive surgical procedures. The most common reasons for return to surgery are infection, symptomatic implant, and pseudarthrosis.