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2017| October-December | Volume 1 | Issue 3
December 18, 2017
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Strategies in early-onset scoliosis treatment
Michal Latalski, Marek Fatyga, Grzegorz Starobrat, Anna Danielewicz
October-December 2017, 1(3):45-49
Early-onset spinal deformities are still challenging to pediatric orthopedic surgeons. One still looks for the ideal treatment of these deformities. Preservation of thoracic motion, spine growth, and protection of cardiac and lung function are crucial to the success of the treatment.
The purpose of this review is to present the reader's brief description of available methods of treatment of early- onset scoliosis (EOS).
Authors searched the PubMed for locating and selecting the data. Extracting and synthesizing the data were done by orthopedic surgeons based on their knowledge and experience in the treatment of EOS patients.
The current treatment techniques include nonsurgical strategies, such as body cast or brace in younger patients with a smaller curve (<50°). Surgical treatment of spinal deformity should be considered when progression increases. Definitive fusion is rarely indicated in young patients. Strategies based on compression (staples or tethers), distraction (growing rods, vertical expandable prosthetic titanium rib), and growth guiding (Shilla, growth guidance system) are presented with their advantages and disadvantages. Repeated surgeries – planned and unplanned are burdensome for patients. Although technology improves, the complication rates in the treatment are still high.
Treatment of EOS is challenging. Although much is already known about the treatment of children with EOS, there is still no gold standard in proceedings.
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A very rare case of cauda equina syndrome due to lumbar disc prolapse in a pregnant woman in the second trimester
Murahari Penkulinti, Rajkiran Reddy Banala, Vinayak Santosh, G PV Subbaiah
October-December 2017, 1(3):56-58
Low back pain is a frequently encountered issue in pregnant women affecting >50%; incidence of low back pain secondary to lumbar disc herniation in pregnancies is low (1:10000). Cauda equina syndrome from lumbar disc herniation is a serious complication; delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disc herniation in pregnancy have been reported; however, cauda equina syndrome as a result of disc herniation is rare (2%). Here we are reporting a rare case of cauda equine syndrome in a pregnant woman at 16-week gestation is presented. We present a rare case of 30-year-old woman (G3P2L0) at 16-week gestation, presented initially at an emergency department at a district level hospital with low backache radiating to both the lower limbs treated with pain medications; 48 h later, the patient presented to us with bilateral foot drop with saddle anesthesia, urinary and fecal incontinence. On physical examination, the patient has bilateral foot drop with complete weakness of extensor hallucis longus and ankle inversion of both feet. The lumbar magnetic 'g (MRI) scan showed massive central disc herniation in L4–L5 level with severe central canal stenosis. After assessment by the anesthesiology and gynecology departments using a posterior approach under prone position, bilateral laminotomy and discectomy was performed at L4-L5 level. No complications were observed in the mother and the fetus during and after the surgery. Pain has subsided immediate post-op, three months after surgery, the patient was walking normally with minimal saddle hypoesthesia. The pregnancy proceeded normally, and she gave birth for full-term baby without any complications delivered by cesarean section. Clinical picture of low back pain is very frequent during pregnancy. However, we should perform an MRI scan for sudden onset of sciatica associated with loss of strength, bowel, and bladder disturbance. Patient diagnosed with cauda equina syndrome should undergo emergency surgery to minimize neurological sequelae.
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Frequent users of health-care services have worse outcomes of spinal surgery: Results from a web-based survey
Grzegorz Miekisiak, Dariusz Latka, Pawel Jarmuzek
October-December 2017, 1(3):51-55
Background and Objective:
Spinal surgery becomes ever safer and the success rate is constantly increasing. Nevertheless many patients present poor outcomes despite apparent technical success. Proper selection of patients is key, but it is virtually impossible to provide a clear algorithm as there are great many aspects to be considered. The purpose of this study was to assess the potential of anonymous web surveys as screening tools for factors predicting poor outcomes of surgery. The hypothesis was that frequent users of health-care services (FUOHS) are worse surgical candidates.
An open anonymous and interactive web surveys were placed within a web portal concerning the spinal health. It was comprised of three sections: first one focused on demographics and information regarding the surgery, second being the Core Outcome Measures Index questionnaire, and the third containing additional information.
A total of 425 subjects completed the questionnaire. After removing multiple entries, the final number of subjects included in the study was 411. The relative risk of an unfavorable outcome in a FUOHS group was 3.63 compared with the rest. Likewise, the relative risk of reporting complications in this group was 1.94 though it reached the statistical significance only in the subgroup of patients who had a surgery on a lumbar segment.
Discussion and Conclusions:
The web surveys can help identify factors that can predict bad outcomes of surgical treatment. In this case, it was shown that frequent visits to doctors' office for reasons other than spine-related is a negative prognostic factor for good outcome of spine surgery.
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