scholarly journals Dandy-Walker Syndrome Associated with Scoliosis: Clinical Presentation, Preoperative Assessment, and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Athanasios I. Tsirikos ◽  
Sarah J. Wordie
Keyword(s):  
Skeletal Maturity ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Preoperative Assessment ◽  
Posterior Spinal Fusion ◽  
Postoperative Recovery ◽  
Uneventful Recovery ◽  
Scoliosis Correction ◽  
Assessment And Treatment ◽  
Cranial Fossa

Dandy-Walker syndrome (DWS) affects the posterior cranial fossa resulting in characteristic dysmorphic facial and body features. Scoliosis is not typically reported as an extracranial manifestation of this condition. We present a 12-year-old female patient who developed a right thoracic scoliosis measuring 60° with increased lumbar lordosis. Scoliosis correction was indicated to alleviate back pain, improve cosmesis, and prevent respiratory complications. A multidisciplinary preoperative assessment included cardiac, respiratory, anaesthetic, and neurology reviews. She underwent a posterior spinal fusion from T2 to L3 with pedicle hook/screw and rod instrumentation and a combination of locally harvested autologous and allograft bone. This resulted in excellent deformity correction and a balanced spine in the coronal and sagittal planes. The patient made an uneventful recovery and returned gradually to her normal level of activities. She was monitored in clinic until she completed her growth (4 years after surgery); the satisfactory surgical outcome was maintained at follow-up and was associated with high patient satisfaction. Scoliosis can occur in children with DWS with resemblance to adolescent idiopathic scoliosis in regard to type of coronal deformity, age at presentation, surgical techniques, and postoperative recovery. Early identification of scoliosis in patients with DWS can allow preoperative planning and prompt surgical management in order to reduce the risk of significant morbidity which can occur if the scoliosis is allowed to deteriorate. Excellent deformity correction can be achieved and maintained beyond skeletal maturity in order to improve physical appearance, as well as preserve level of function and quality of life.

An algorithmic strategy for selecting a surgical approach in cervical deformity correction

2014 ◽  
Vol 36 (5) ◽  
pp. E5 ◽  
Author(s):  
Shannon Hann ◽  
Nohra Chalouhi ◽  
Ravichandra Madineni ◽  
Alexander R. Vaccaro ◽  
Todd J. Albert ◽  
...  
Keyword(s):  
Surgical Management ◽  
Surgical Approach ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Preoperative Assessment ◽  
Cervical Kyphosis ◽  
Cervical Deformity ◽  
Category Type ◽  
Big Picture ◽  
Algorithmic Strategy

Adult degenerative cervical kyphosis is a debilitating disease that often requires complex surgical management. Young spine surgeons, residents, and fellows are often confused as to which surgical approach to choose due to lack of experience, absence of a systematic method of surgical management, and today's plethora of information regarding surgical techniques. Although surgeons may be able to perform anterior, posterior, or combined (360°) approaches to the cervical spine, many struggle to rationally choose an appropriate approach for deformity correction. The authors introduce an algorithm based on morphology and pathology of adult cervical kyphosis to help the surgeon select the appropriate approach when performing cervical deformity surgery. Cervical deformities are categorized into 5 different prevalent morphological types encountered in clinical settings. A surgical approach tailored to each category/type of deformity is then discussed, with a concrete case illustration provided for each. Preoperative assessment of kyphosis, determination of the goal for surgery, and the complications associated with cervical deformity correction are also summarized. This article's goal is to assist with understanding the big picture for surgical management in cervical spinal deformity.

scholarly journals Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
George I. Mataliotakis ◽  
Athanasios I. Tsirikos ◽  
Karen Pearson ◽  
Don S. Urquhart ◽  
Carolyn Smith ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pancreatic Enzyme ◽  
Deformity Correction ◽  
Posterior Spinal Fusion ◽  
Major Surgery ◽  
Scoliosis Surgery ◽  
Total Blood ◽  
Caucasian Girl ◽  
Postoperative Intensive Care ◽  
Scoliosis Correction

Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.

scholarly journals Surgical correction of proximal junctional kyphosis

2020 ◽  
Vol 2 (1) ◽  
pp. V11
Author(s):  
Jamal McClendon ◽  
Richard Shindell ◽  
Karl R. Abi-Aad ◽  
Ahmad Kareem Almekkawi ◽  
Tanmoy Maiti ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Surgical Techniques ◽  
Posterior Spinal Fusion ◽  
Proximal Junctional Kyphosis ◽  
First Case ◽  
Segmental Instrumentation ◽  
Scoliosis Correction ◽  
Individualized Approach ◽  
Full Correction ◽  
Junctional Kyphosis

This 3D video showcases the surgical techniques for patients with proximal junctional kyphosis. The surgical repair for patients with proximal junctional kyphosis is an individualized approach depending on patient history and imaging with adequate surgical measurements. This video will shed light on two cases with proximal junctional kyphosis and the method taken for their repair. The first case is of an 11-year-old female known to have osteogenesis imperfecta and status post T5–L3 posterior spinal fusion with segmental instrumentation. The patient underwent change of older instruments and scoliosis repair, with full correction on postoperative x-ray. The second patient is a 16-year-old male known to have cerebral palsy and kyphoscoliosis status post spinal fusion. The patient underwent scoliosis repair surgery with replacement of old instrumentation and scoliosis correction.The video can be found here: https://youtu.be/f5iLwqbU26Q.

scholarly journals Stromal tumor of duodenal autonomous nerves (plexosarcoma)

2007 ◽  
Vol 135 (5-6) ◽  
pp. 330-334
Author(s):  
Radoje Colovic ◽  
Marjan Micev ◽  
Vladimir Radak ◽  
Nikica Grubor ◽  
Natasa Colovic ◽  
...  
Keyword(s):  
Mesenteric Artery ◽  
Rare Case ◽  
Postoperative Recovery ◽  
Stromal Tumor ◽  
Uneventful Recovery ◽  
Back Wall ◽  
The Third ◽  
Great Vessels ◽  
Arterial Pulsation ◽  
Arterial Anastomosis

Gastrointestinal tumors arising from autonomous nerves of Meisner?s or Auerbach?s plexus (plexomas and plexosarcomas) are rare tumors in only 87 cases described in the literature up to 2001. We present a very rare case of gastrointestinal stromal tumor (plexosarcoma) of the third and fourth portion of the duodenum, 130x98x87 mm in diameter, arising from its back wall, with central necrosis of the well circumscribed tumor, which communicated with the duodenum through an ulceration of 15x7mm in diameter, spreading towards the great vessels of the retroperitoneum. It was gradually and carefully removed, together with 17 cm of the duodenum and few centimeters of the jejunum with end-to-end duodenojejunostomy below the Vater?s papilla. During the removal of the tumor, the superior mesenteric artery, being within the tumor?s capsule, was accidentally ligated but not transsected. In spite of the removal of the ligature, the artery became thrombosed due to damage of the intima by ligature so that it had to be resected and reanastomosed. After otherwise uneventful recovery, except for a mild pus discharge through the drain, not far from the arterial anastomosis, the patient suddenly started bleeding on the 13th day after surgery. At emergency reoperation, a rupture of the mesenteric artery above the thrombosed anastomosis was found. In spite of absence of the arterial pulsation within the mesentery, the bowel looked vital and the back flow from the artery was satisfactory. The arterial rereconstruction was not possible, so the artery was ligated. The postoperative recovery was surprisingly uneventful. The patient was discharged ten days after surgery and has stayed symptom-free so far. .

scholarly journals P081 CHRONIC GROIN PAIN IN SPORTSMEN. EVIDENCE-BASED IN EXPERIENCE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Osvaldo Santilli ◽  
Hernán Santilli ◽  
Rodolfo Scaravonati ◽  
Nicolás Nardelli ◽  
Hernán Etchepare
Keyword(s):  
Groin Pain ◽  
Treatment Algorithm ◽  
Postoperative Recovery ◽  
Chronic Groin Pain ◽  
Total Recovery ◽  
Ultrasound Findings ◽  
Common Causes ◽  
Assessment And Treatment ◽  
Sportsman’S Hernia ◽  
Low Sensitivity

Abstract Aim The main objective of this study is to describe and analyze the assessment and treatment of chronic groin pain (CGP) based on the experience collected in 20 years. Material and Methods Descriptive, observational, and retrospective study. It is a multidisciplinary team formed by surgeons, physiotherapists, orthopedists, and imaging specialists. That had developed an assessment, diagnosis, and treatment algorithm for (CGP), which have been implemented for more than 20 years. Follow-up included a record of clinical examination findings, clinical entities diagnosed, ultrasound findings, physiotherapy treatment, operation notes, and postoperative recovery, time to return to sporting activity, and complications. Results In the period between August 2000 and August 2020, we assessed 9996 patients with CGP. (91%) men and (9%) women with a mean age of 30 (SD: 11.21). The most frequently practiced sports were: football (43%), rugby (25%), tennis (12%). The most frequent clinical entities registered were tendinopathies (69%): iliopsoas-pectineus- related (36%) and adductor-related (33%). Tendinopathy sports rehabilitation treatment: (95.7%) presented total recovery in 45 days; 260 patients (4.3%)intra-tissue percutaneous electrolysis was used with favorable recovery. Only 16 patients required tenotomies The ultrasound has been used to detect signs of adductor tendinopathy (92%) and sportsman hernia, but has low sensitivity in iliopsoas-pectineus tendinopathy (21%). Conclusions The algorithm used has proven to be safe and successful. Tendinopathies and Sportsman's hernia are the most common causes of chronic groin pain in sportsmen, presenting together in 82% of the cases. TAPP hernioplasty repair, followed by physical rehabilitation offered excellent results to treat sportsman hernia.

Surgical repair of the mitral valve

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Transoesophageal Echocardiography ◽  
Degenerative Disease ◽  
Systolic Anterior Motion ◽  
Mitral Repair ◽  
Assessment And Treatment ◽  
Secondary Mitral Regurgitation ◽  
Characteristic Features

Chapter 9 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. In the first part of the chapter, the indications for MV repair are reviewed, and areas of controversy are highlighted. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for repair of degenerative disease. Considerations for minimally invasive mitral repair are briefly reviewed. The bulk of the chapter is given over to TOE assessment prior to, and following, surgical repair. Characteristic features of, and associated complications encountered with, different mitral pathologies are presented. In particular, the risk factors for post-operative systolic anterior motion (SAM) in patients with degenerative disease and failure of a reduction annuloplasty in patients with secondary mitral regurgitation are described. The final section of the chapter details the post-repair assessment, with an emphasis on the features of an optimal repair, quantifying residual mitral regurgitation, mechanisms of repair failure, and assessment and treatment of post-operative SAM.

scholarly journals A Systematic Review of Treatment Strategies for the Prevention of Junctional Complications After Long-Segment Fusions in the Osteoporotic Spine

2020 ◽  
pp. 219256822093990 ◽  
Author(s):  
Murray Echt ◽  
William Ranson ◽  
Jeremy Steinberger ◽  
Reza Yassari ◽  
Samuel K. Cho
Keyword(s):  
Systematic Review ◽  
Thoracolumbar Spine ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Compression Fracture ◽  
Deformity Correction ◽  
Preventive Treatment ◽  
Cement Augmentation ◽  
Mineral Density ◽  
Junctional Kyphosis

Study Design: Systematic review Objectives: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-known complications after long-segment fusions in the thoracolumbar spine of osteoporotic patients. Recent advances in anti-resorptive and anabolic medications, instrumentation, surgical technique, and cement augmentation have all aided in the avoidance of junctional kyphosis. In this article, current literature on the prevention of PJK and PJF in the osteoporotic spine is reviewed. Methods: A systematic literature review was conducted using the PubMed/MEDLINE and Embase databases in order to search for the current preventive treatment methods for PJK and PJF published in the literature (1985 to present). Inclusion criteria included (1) published in English, (2) at least 1-year mean and median follow-up, (3) preoperative diagnosis of osteoporosis, (4) at least 3 levels instrumented, and (5) studies of medical treatment or surgical techniques for prevention of junctional kyphosis. Results: The review of the literature yielded 7 studies with low levels of evidence ranging from level II to IV. Treatment strategies reviewed addressed prophylaxis against ligamentous failure, adjacent vertebral compression fracture, and/or bone-implant interface failure. This includes studies on the effect of osteoporosis medication, cement augmentation, multi-rod constructs, and posterior-tension band supplementation. The role of perioperative teriparatide therapy maintains the highest level of evidence. Conclusions: Perioperative teriparatide therapy represents the strongest evidence for preventive treatment, and further clinical trials are warranted. Use of cement augmentation, sublaminar tethers, and multi-rod constructs have low or insufficient evidence for recommendations. Future guidelines for adult spinal deformity correction may consider bone mineral density–adjusted alignment goals.

Powered Instrumentation in Functional Endoscopic Sinus Surgery II: A Comparative Study

1996 ◽  
Vol 75 (1) ◽  
pp. 42-44 ◽  
Author(s):  
John H. Krouse ◽  
Dewey A. Christmas
Keyword(s):  
Comparative Study ◽  
Endoscopic Sinus Surgery ◽  
Middle Turbinate ◽  
Surgical Techniques ◽  
Postoperative Recovery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Surgical Results ◽  
Standard Techniques

The present paper compares the use of the microdebrider as a form of powered instrumentation for endoscopic sinus surgery with traditional endoscopic surgical techniques. A group of 250 patients undergoing surgery with the microdebrider was compared with a group of 225 patients undergoing traditional procedures in order to evaluate their postoperative recovery, healing, and incidence of complications. The use of the microdebrider demonstrated faster healing with less crusting than standard techniques, as well as decreased bleeding, synechia formation, lateralization of the middle turbinate, and ostial reocclusion. The microdebrider offers excellent surgical results with fewer complications and faster healing than traditional techniques in functional endoscopic sinus surgery.

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