Spine
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We reviewed three-dimensional (3D) computed tomography (CT) images of congenital spinal deformities and proposed a new classification based on the information obtained. ⋯ The large volume of information that can be obtained by evaluating 3D CT images of congenitally deformed vertebrae can be a great help in developing a strategy for surgical treatment. We need to develop a new classification of congenital scoliosis based on the perspective of 3D imaging to understand the etiology and embryology, as well as to determine an operative strategy.
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Review of relevant literature including personal opinions. ⋯ Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.
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A focused review of the literature with regard to the important system abnormalities of patients with spinal deformities associated with exotic congenital syndromes with additional data from the author's own experience in assessment of patients with rare syndromes treated for thoracic insufficiency syndrome. ⋯ For optimal patient care, it is necessary to have a clear understanding of exotic congenital syndromes and how they may impact on both the presentation of spinal deformity and the response to treatment, as well as how they may introduce additional morbidity into standard treatment plans. It is clear that with this understanding that preoperative strategies can be employed to enhance the safety of spinal treatment for these unique children.
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Clinical Trial
The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion.
Prospective study of 31 patients who underwent anterior cervical fusion. ⋯ ACDF using the Solis cage packed with Grafton demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of the traditional ACDF using tricortical iliac crest grafts. Therefore, the results of this study suggest that the ongoing use of the PEEK cage packed with DBM and autologous bone chips in ACDF is a safe and effective alternative to the gold standard of autologous iliac bone grafts.
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To review diagnosis and treatment of neurogenic factors implicated in the development of progressive scoliosis. ⋯ Surveillance MRI should be undertaken for scoliosis when there are clinical indications consistent for a tethered cord, spinal cord tumor, or Chiari malformation and associated syringomyelia.