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Management of severe and rigid idiopathic scoliosis.

Teixeira da Silva LE, de Barros AG, de Azevedo GB - Eur J Orthop Surg Traumatol (2015)

Bottom Line: Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications.Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results.Neuromonitoring is essential during these procedures.

View Article: PubMed Central - PubMed

Affiliation: Center of Spine Diseases, Instituto Nacional de Traumatologia e Ortopedia - INTO, Av. Brasil 500, Rio de Janeiro, 20940-070, Brazil, luiscarelli@uol.com.br.

ABSTRACT
Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25% of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient's profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.

No MeSH data available.


Related in: MedlinePlus

11-year-old female with severe rigid juvenile idiopathic scoliosis. Patient underwent preoperative halo-gravitational traction followed by staged procedures. a–d Preoperative clinical and radiographic images. e, f First, posterior release and instrumentation and postoperative halo-gravitational traction. g Radiograph showing poor correction with traction. h–l Second-stage posterior vertebral column resection and thoracoplasty reconstruction with internal osteosynthesis (TRIO)
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Fig3: 11-year-old female with severe rigid juvenile idiopathic scoliosis. Patient underwent preoperative halo-gravitational traction followed by staged procedures. a–d Preoperative clinical and radiographic images. e, f First, posterior release and instrumentation and postoperative halo-gravitational traction. g Radiograph showing poor correction with traction. h–l Second-stage posterior vertebral column resection and thoracoplasty reconstruction with internal osteosynthesis (TRIO)

Mentions: Recently, believing in the benefits of osteosynthesis after the partial resection of rib, we developed a new strategy in the treatment of moderate and severe rib hump deformity for scoliosis patients. Thoracoplasty reconstruction with internal osteosynthesis (TRIO) consists of stabilization of rib stumps after partial costectomy using rib clips. Possible advantages of TRIO technique are better correction of rib prominence, lower postoperative impairment of pulmonary function, lower chest wall pain and less rib pseudoarthrosis [29] (Fig. 3).Fig. 3


Management of severe and rigid idiopathic scoliosis.

Teixeira da Silva LE, de Barros AG, de Azevedo GB - Eur J Orthop Surg Traumatol (2015)

11-year-old female with severe rigid juvenile idiopathic scoliosis. Patient underwent preoperative halo-gravitational traction followed by staged procedures. a–d Preoperative clinical and radiographic images. e, f First, posterior release and instrumentation and postoperative halo-gravitational traction. g Radiograph showing poor correction with traction. h–l Second-stage posterior vertebral column resection and thoracoplasty reconstruction with internal osteosynthesis (TRIO)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4488473&req=5

Fig3: 11-year-old female with severe rigid juvenile idiopathic scoliosis. Patient underwent preoperative halo-gravitational traction followed by staged procedures. a–d Preoperative clinical and radiographic images. e, f First, posterior release and instrumentation and postoperative halo-gravitational traction. g Radiograph showing poor correction with traction. h–l Second-stage posterior vertebral column resection and thoracoplasty reconstruction with internal osteosynthesis (TRIO)
Mentions: Recently, believing in the benefits of osteosynthesis after the partial resection of rib, we developed a new strategy in the treatment of moderate and severe rib hump deformity for scoliosis patients. Thoracoplasty reconstruction with internal osteosynthesis (TRIO) consists of stabilization of rib stumps after partial costectomy using rib clips. Possible advantages of TRIO technique are better correction of rib prominence, lower postoperative impairment of pulmonary function, lower chest wall pain and less rib pseudoarthrosis [29] (Fig. 3).Fig. 3

Bottom Line: Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications.Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results.Neuromonitoring is essential during these procedures.

View Article: PubMed Central - PubMed

Affiliation: Center of Spine Diseases, Instituto Nacional de Traumatologia e Ortopedia - INTO, Av. Brasil 500, Rio de Janeiro, 20940-070, Brazil, luiscarelli@uol.com.br.

ABSTRACT
Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25% of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient's profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.

No MeSH data available.


Related in: MedlinePlus