Total hip replacement in Jehovah's Witnesses under spinal anesthesia without transfusion.

Ninety patients who were Jehovah's Witnesses underwent 107 total hip replacements without transfusion; all procedures were performed under spinal anesthesia. Of these 90, 87 had not previously undergone hip replacement surgery. They sustained an average intraoperative blood loss of 300 mL, which was a significant reduction compared with that in controlled groups of patients reported by other authors. Factors other than spinal anesthesia that aided in reducing blood loss were posterior surgical exposure of the hip without capsulectomy or removal of the greater trochanter, hemostasis without electrocauterization, and rapidly performed surgery. There were three operative complications and one death, none of which were related to spinal anesthesia.

Transverse traction in the treatment of scoliosis. A preliminary report.

Nineteen scoliotic patients were treated with the standard Harrington distraction rod supplemented with transverse traction. The latter consists of a compressive device (either Harrington';s or Cotrel's) applied to the convex side of the curve to correct disc space wedging and then drawn toward the distraction rod with a simple traction apparatus. Intraoperative roentgenograms were taken with the Harrington distraction rod alone after maximal distraction was applied. This was followed by postoperative roentgenograms with the transverse traction added. The 50.3% correction by distraction rod alone is increased to 66% with the addition of transverse traction. Detailed analysis of each curve, segment by segment, showed that the correction was augmented, not only in the center of the curve, where the compression corrected disc space wedging, but in the ends of the curve as well. This series uses each patient as his or her own control in demonstrating increased correction added by transverse traction.

The operative treatment of congenital scoliosis. A report of 23 patients.

Spinal fusion was performed in 23 patients with congenital scoliosis. Various procedures were used including posterior fusion and without instrumentation. No surgical procedure proved to be superior for obtaining correction regardless of the use of supplemental instrumentation. The use of Knodt or Harrington Instrumentation could not be correlated with a lower pseudoarthrosis rate, shorter postoperative immunobilization period, or a decrease in postoperative loss of correction. The morbidity associated with these surgical procedures was high (48%). Thoracic curves were more prone to lengthen or develop kyphoses postoperatively. A high incidence of varied congenital anomalies was found in association with congenital scoliosis. A through work-up including an intravenous pyelogram and myelogram is strongly recommended prior to the operative treatment of congenital scoliosis.

Operative treatment of spine deformity in osteogenesis imperfecta.

There has been little mention in the literature of scoliosis associated with osteogenesis imperfecta. The purpose of this study was to investigate the problem of spine deformity in a series of osteogenesis imperfecta patients and to review the operative treatment of 8 patients. A series of 49 patients (ranging in age from 8 months to 57 years, average 12 years) with osteogenesis imperfecta were studied. Thirty-five (71%) of these patients had scoliosis ranging from 7 degrees to 105 degrees (average 42 degrees). The more severely involved patients (OIC and OITI groups) demenostrated a higher incidence (80%) of scoliosis and a greater average degree of curvature (42 degrees) as compared to the mildly involved (OITII) group with a 50% incidence of scoliosis with an average curvature of 26 degrees. Attempts to control these curves by bracing have been difficult and usually had to be abandoned. Eight of these patients underwent spine stabilization in an attempt to control curve progression. All 8 patients had posterior spine fusions. One of these patients had an anterior fusion preceding the posterior fusion because of a significant kyphotic deformity. Harrington instrumentation was used in 5 patients. One patient could not be instrumented secondary to severe osteoporosis while the remaining 2 patients were treated by the Risser technique. Postoperatively, either cast or brace protection was used. Only minimal improvement in the curves was achieved. Spine stabilization rather than curve correction is the goal of spine fusion in osteogenesis imperfecta. An important finding was that there was no change in the pre- and postoperative activity and ambulatory status in these patients. Preliminary follow-up (9-12 months) in all 8

Anterior fibular strut grafting in the treatment of kyphosis.

An intact segment of autologous fibula provides a strong, physiologic, anterior support in the surgical treatment of short segment kyphosis. In this series of 20 patients, only 3 had no signs of spinal cord injury. Correction averaged 20 degrees. At an average follow-up of 2.2 years, 9 degress of the previously obtained correction were maintained, including 3 patients with non-union and marked loss of correction. Twenty-four complications were noted in association with traction, surgery, and immobilization. The results suggest that attempts at correction should remain secondary to those of stabilization and relief or prevention of neurologic problems. Supplementary posterior spinal fusion is necessary to increase the strength of the stabilized segment as well as decrease the incidence of pseudoarthrosis and loss of correction.

Stabilization of the collapsing spine in duchenne muscular dystrophy.

Of 41 patients with Duchenne muscular dystrophy, no ambulatory patient had scoliosis greater than 19 degrees. Non-ambulatory patients were prophylactically placed in body jackets, which kept the spine flexible and provided adequate support for sitting in the majority of patients. Ten patients had posterior spine fusion for progressive spinal collapse. The procedure was extensive with significant blood loss but boney fusion was achieved in every case. Pulmonary complications were minimized by performing preoperative tracheostomy on all patients who had vital capacities less than 40% and or non-functional coughs. Spinal fusion permitted long-term sitting stability despite the progression of the disease.