Idiopathic scoliosis and pineal lesions in Australian children.

PURPOSE: To determine whether treatment of pineal lesions in children is associated with development of idiopathic scoliosis. METHODS: 38 boys and 10 girls with pineal lesions were identified. Their mean age at presentation was 10 years. The pineal pathology varied from cysts and epidermoid to teratoma, germinoma, pineocytoma, and glioblastoma. Treatment ranged from biopsy/extirpation to radiotherapy. RESULTS: 12 patients died. No scoliosis was found in any females or any of the deceased. Two boys had scoliosis: one had a 12-degree right upper thoracic curve with 32-degree kyphosis and the other had a 60-degree right thoracolumbar idiopathic curve, requiring a 2-stage arthrodesis. CONCLUSION: Pineal ablation is not related to the development of idiopathic scoliosis in humans.

Outcomes following treatment of metastatic spine tumors.

Fifty seven consecutive patients with metastatic spine tumors were assessed for their suitability for operative treatment or radiotherapy and/or chemotherapy using a modified version of the Nihon University scoring system. Using this scoring system 29 patients underwent surgery and 28 received radiotherapy/chemotherapy. The outcomes were assessed to determine if a modified scoring had any effect on patient survival. No statistical difference was found between the two groups, though a trend was noted--the group receiving surgery had a mean survival of 30 weeks compared to a mean survival of 16 weeks found in the non-surgical group.

The surgical management of degenerative lumbar scoliosis. Posterior instrumentation alone versus two stage surgery.

Twenty-one patients who underwent surgery for degenerative scoliosis were retrospectively reviewed. Eleven patients underwent staged anterior and posterior surgery. Ten patients had a single posterior procedure. Posterior instrumentation to the sacrum was done in all cases. Average length of follow-up was 3.8 years (range: 2 to 7 years). All patients were assessed by the Oswestry Disability Questionnaire and Low-Back Outcome Score. Additional questions included analogue scales for pain and quality of life, and self-rating of the outcome of treatment. Nine patients that had two stage surgery and 4 patients that had single posterior surgery considered their outcome to be good or excellent (p = 0.13). This correlated with better functional tolerance, specifically sleep, lifting, sitting, and social life. Although pain intensity was the same for both groups, only the staged group reported significant reduction in analgesic intake. Significant correction in scoliosis and the lumbosacral fractional curve was noted only following staged surgery. A solid spinal fusion determined a satisfactory outcome irrespective of the method of treatment. Staged anterior and posterior surgery for degenerative lumbar scoliosis resulted in a better fusion rate, greater correction of deformity, and more improvement in function than did posterior surgery alone.

Factors influencing wound healing after surgery for metastatic disease of the spine.

STUDY DESIGN: The study group consisted of 53 patients who underwent 75 operations for spine metastases. Patient and tumor demographic factors, preoperative nutritional status, and perioperative adjunctive therapy were retrospectively reviewed. OBJECTIVE: To determine the risk factors for wound breakdown and infection in patients undergoing surgery for spinal metastases. SUMMARY OF BACKGROUND DATA: Spinal fusion using spine implants may be associated with an infection rate of 5% or more. Surgery for spine metastases is associated with an infection rate of more than 10%. Factors other than the type of surgery performed may account for the greater infection rate. METHODS: Data were obtained by reviewing patient records. Age, sex, and neurologic status of the patient; tumor type and site; and surgical details were noted. Adjunctive treatment with corticosteroids and radiotherapy was recorded. Nutritional status was evaluated by determining serum protein and serum albumin concentrations and by total lymphocyte count. RESULTS: Wound breakdown and infection occurred in 15 of 75 wounds. No patient or tumor demographic factors other than intraoperative blood loss (P < 0.1) were statistically associated with infection. The correlation between preoperative protein deficiency (P < 0.01) or perioperative corticosteroid administration (P < 0.10) and wound infection was significant. There was no statistical correlation between lymphocyte count or perioperative radiotherapy and wound infection. CONCLUSIONS: The results indicate that preoperative protein depletion and perioperative administration of corticosteroids are risk factors for wound infection in patients undergoing surgery for spine metastases. Perioperative correction of nutritional depletion and cessation of steroid therapy may reduce wound complications.

Inappropriate secretion of antidiuretic hormone in postoperative scoliosis patients: the role of fluid management.

STUDY DESIGN: The present study examined the hypothesis that hypotonic saline therapy before surgery was a major factor in the development of the syndrome of inappropriate antidiuretic hormone secretion. OBJECTIVES: The influence of fluid therapy and its relationship to the syndrome of inappropriate antidiuretic hormone secretion was studied by measuring patient electrolyte and osmolar responses at given times after surgery. SUMMARY OF BACKGROUND DATA: Mild renal dysfunction and increased plasma antidiuretic hormone occurs after surgery. Occurrence of the syndrome of inappropriate secretion of antidiuretic hormone after spine surgery is rare. The development of the syndrome of inappropriate secretion hormone after surgery may be related to hypotonic fluid replacement during and after surgery. METHODS: Twelve patients undergoing surgery for correction of idiopathic scoliosis were assigned randomly to two groups. The control group (five patients) was given isotonic saline, and the trial group (seven patients) was given hypotonic saline. RESULTS: The trial group developed syndrome of inappropriate antidiuretic hormone secretion with a significant decrease in serum sodium and osmolarity. The control group did not develop syndrome of inappropriate antidiuretic hormone secretion. CONCLUSIONS: Hypotonic saline therapy predisposes to the development of syndrome of inappropriate antidiuretic hormone secretion, whereas isotonic saline protects patients from syndrome of inappropriate antidiuretic hormone secretion when undergoing surgery for scoliosis.

Localization and treatment of familial malignant nonfunctional paraganglioma with iodine-131 MIBG: report of two cases.

Two cases of familial, malignant, nonfunctional paraganglioma are reported. Uptake of iodine-131 metaiodobenzylguanidine ([131I]MIBG) by the tumors and metastases was demonstrated. In the first case, with multicentric and locally invasive disease, [131I]MIBG correctly localized a right carotid body paraganglioma which had been missed arteriographically. In the second case, with widespread, symptomatic metastatic disease, a therapeutic dose of [131I]MIBG produced palliation of bone pain after the failure of radio- and chemotherapy. Uptake of [131I]MIBG by paragangliomas does not correlate with catecholamine secretory activity. Iodine-131 MIBG should be considered as a therapeutic option in unresectable, malignant paragangliomas which take up this radiopharmaceutical.

The management of acute ligamentous injuries of the knee; experience with 116 patients.

One hundred and eighteen acute complete ligamentous injuries of the knee in 100 males and 16 females presented in the years 1974 to 1976. Stress analysis under anaesthesia was considered an important step in the clinical evaluation, while radiological evidence of articular fractures justified a high index of suspicion with ligamentous lesions. Eighty-eight of the injuries were treated by early operative repair of all damaged structures. The remaining knees were considered on preselected criteria, to be suitable for conservative treatment. At review twelve months following injury, 73% of the knees were considered to have good results. In general, late review showed no deterioration in stability, but an increasing proportion had pain. Unsatisfactory results were due to combined cruciate and collateral ligament instability.

Spinal fractures and dislocations in children and adolescents.

During the years 1962 through 1978 a total of 42 children under the age of 15 years with fractures or dislocations of the spine were admitted to the Royal Brisbane Hospital Complex. Sixty-three percent of these children were males. The predominate causes of injury were fall/jump (40%), road traffic accidents (29%), and water-related injuries (19%). Half the injuries occurred to the cervical spine, while injuries at more than one level occurred in 35% of patients. Cord injuries occurred in 14% of patients, while skeletal and head injuries occurred in over half of the spinal injuries associated with road trauma. The response of the immature spine following trauma differs from that of the adult, especially in respect to a growth potential, ultimate vertebral stability, and neurologic function.

Stress radiography in acute ligamentous injuries of the knee.

Stress radiography was performed on 60 acute ligamentous injuries of the knee under general anaesthesia using a simple standard technique. Laxity on angular stress in extension was evident when the posterior cruciate ligament was torn in association with a collateral capsular tear. The same test repeated in 20-30 degrees of flexion was abnormal when the collateral capsule alone was abnormal when the collateral capsule alone was torn and laxity always exceeded 5 degrees. Where both cruciate ligaments were torn the laxity exceeded 10 degrees. Lateral stress radiographs in the presence of an isolated capsular tear demonstrated rotatory laxity with a glide rarely exceeding 10 mm. The addition of a torn anterior cruciate ligament resulted in sagittal laxity greater than 7 mm and a tear of the posterior cruciate ligament, irrespective of the associated pathology, resulted in a laxity exceeding 12 mm.

Inferior dislocation of the outer end of the clavicle.

A case of inferior dislocation of the outer end of the clavicle is reported. The clavicle was found beneath the coracoid process and posterior to the intact tendons of the short head of biceps and coracobrachialis. Reduction was achieved by operative lateral retraction of the scapula. Open reduction appears to be the treatment of choice, especially if late, since traction may result in neurologic injury.

Scoliosis in symptomatic spondylolisthesis.

The association between spondylolisthesis and scoliosis was studied in 84 patients who presented during a 30-year period with symptomatic spondylolisthesis. The incidence of scoliosis was 42 per cent, the majority of cases being lumbar or thoracolumbar curves of less than 15 degrees. The incidence was highest in the group of patients with spondylolisthesis at L4--5 where all except one had scoliosis. Scoliosis was present in 47 per cent of patients with dysplastic spondylolisthesis at the lumbosacral junction; in this group, the incidence of scoliosis was greater where the displacement exceeded 25 per cent. The lowest incidence (25 per cent) was found in the group with isthmic spondylolisthesis at the lumbosacral junction. There appeared to be no relationship between excessive lumbar lordosis or tightness of the hamstrings and scoliosis.

Reduction of severe spondylolisthesis. A preliminary report.

This report describes the development of a technique for reduction and fusion of spondylolisthesis that includes posterior mobilization with alartransverse fusion, halo-femoral traction with the patient in some extension, and finally, anterior interbody fusion of the lumbosacral joint. The report emphasizes the technique, which has been employed in the care of 8 patients thus far.