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Rib Hump in Adolescent Idiopathic Scoliosis - Assessment of Its Flexibility and the Need for Thoracoplasty
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S 137. Selective Posterior Decompression and Short Segmental Fusion of Degenerative Lumbar Scoliosis Yong Hai, MD, Xianglong Meng, MD; Orthopedic Surgery Department, Chaoyang Hosptial, Capital Medical University, Beijing, China BACKGROUND CONTEXT: Degenerative lumbar scoliosis (DLS) is commonly present in older adult patients with spinal pain. The extent of fusion for degenerative lumbar scoliosis has not yet been determined. PURPOSE: The purpose of this study is to analyze the surgical results of short segmental fusion after selective decompression for degenerative lumbar scoliosis. STUDY DESIGN/SETTING: This is a retrospective study. PATIENT SAMPLE: 42 patients with DLS complaining of lower extremities pain treated surgically in our hospital from January 2004 to June 2007 were reviewed. 15 males and 27 females, averaged 65.6 years old, were included. The follow-up time ranged from 1 to 3.5 years postoperatively. OUTCOME MEASURES: VAS and ODI was utilized to evaluate the clinical outcome. METHODS: The selective posterior decompression and short segmental fusion with pedicle screws were employed, and fusion levels were limited within scoliosis curves. The fusion level, blood loss, operation time and perioperative comorbidity and complication were recorded. Preoperative and postoperative cobb angles, lumbar lordotic angles, VAS and ODI were evaluated, and statistical difference was analyzed. RESULTS: The difference between preoperative and follow-up VAS score is statistically significant, and statistical difference also found in ODI score. The statistical difference was not found between preoperative and follow-up cobb angles, and it was not found in lordotic angle, either. Early complication occurred to 23 percent of patients, including urinary infection, ileus et al. No major complications happened during perioperative period, and no screw failures, compression fracture occurred during the follow-up period. CONCLUSIONS: Selective posterior decompression and short segmental fusion is an effective way to treat degenerative lumbar scoliosis with main complaint of lower limbs discomforts. The surgical results are related with lumbar canal and foraminal decompression, but not related with change of cobb angles. The surgical treatment can reduce surgical injuries and leave more mobile levels for degenerated lumbar spine in old patients. Local stability was also preserved in this procedure. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
63S
OUTCOME MEASURES: Clinical measurement of rib prominence using scoliometer. METHODS: The magnitude of the rib humps before and after the operation were measured using Bunnell’s scoliometer with the patient in Adam’s forward bending posture. The flexibility of the rib hump was assessed clinically before the operation by asking the patient to perform Adam’s forward bending position with the legs apart, and then to laterally flex and rotate the spine by asking the patient to hold the opposite ankle with the two hands without bending the knees. This maneuver reduces the rib hump and the magnitude of the residual hump is measured with the scoliometer. This is then compared to the magnitude of the rib hump present with the patient in Adams forward bend position after the operation at three months’ follow-up. RESULTS: All seven patients were girls. The mean age was 15.8 years (range 14 - 17 years). The magnitude of the curve improved from a mean preoperative Cobb angle of 53.6 +/- 11.2 degrees (range 45.3 - 72.5 degrees) to a mean postoperative Cobb angle of 7.8 +/- 9.3 degrees (range 0.4 - 17.6 degrees). The mean preoperative magnitude of the rib hump was 12.3+/- 6.9 degrees (range 5 - 20 degrees) as measured using the Bunnell’s scoliometer with the patient in Adam’s forward bend position. This rib hump was then corrected to a mean magnitude of 1.3 +/- 2.2 degrees (range 0 - 5 degrees) by performing the above described technique. The mean postoperative magnitude of the rib hump was 3.0 +/- 3.1 degrees (range 0 - 8 degrees) with the patient in Adam’s forward bend position. There was positive correlation between the postoperative residual rib hump and the reduced rib hump measured preoperatively using our described technique (Pearson’s correlation coefficient r50.81, p50.05). CONCLUSIONS: This flexion derotation test is a useful test in assessing the amount of postoperative persistent rib hump after posterior correction of adolescent idiopathic scoliosis using pedicle screw instrumentation with derotation technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.171
Friday, October 8, 2010 7:25–8:25 AM General Session: Best Papers
doi: 10.1016/j.spinee.2010.07.170
138. Rib Hump in Adolescent Idiopathic Scoliosis - Assessment of Its Flexibility and the Need for Thoracoplasty Palaniappan Lakshmanan, MS (Orth), FRCS (Orth), Sami Hassan, MD, BMedSci (Hons), MBCHB, Conal Quah, MD, MRCS, MBCHB, Iona E. Collins, FRCS (Orth); Queens Medical Centre, Nottingham, United Kingdom BACKGROUND CONTEXT: Numerous articles are available regarding the assessment of flexibility of the curve in adolescent idiopathic scoliosis and their relation to the postoperative correction. However, there is none available to assess the rib hump flexibility to assess preoperatively as to the need for subsequent thoracoplasty. PURPOSE: We described a technique of measuring the flexibility of the rib prominence clinically before surgery, and aimed to analyze the results in patients with adolescent idiopathic scoliosis who underwent posterior surgical correction with pedicle screw instrumentation. STUDY DESIGN/SETTING: Prospective study/University Hospital. PATIENT SAMPLE: This prospective study included seven consecutive patients with adolescent idiopathic scoliosis who underwent posterior surgical correction with pedicle screw instrumentation. All the patients included had Lenke Type I curve.
139. SPORT Intervertebral Disc Herniation: Indications Matter Most Adam M. Pearson, MD, MS, Jon Lurie, MD, MS, Tor Tosteson, ScD, Wenyan Zhao, MS, William Abdu, MD, MS, Sohail Mirza, MD, MPH, James N. Weinstein, DO, MS; Dartmouth Hitchcock Medical Center, Lebanon, NH, USA BACKGROUND CONTEXT: The treatment effect of surgery (TE) may vary with specific patient and disease characteristics. While SPORT demonstrated a significant advantage for discectomy at 4 years for the ‘‘average’’ patient meeting specific inclusion criteria (radiculopathy with neurological findings and corresponding lesion on imaging), we hypothesized that certain subgroups might benefit more or less from surgery. PURPOSE: To determine if TE varied across subgroups in order to identify patients with specific characteristics that could predict TE and aid in decision making. STUDY DESIGN/SETTING: As-treated analysis of combined randomized and observational cohorts performed at 13 spine centers in 11 states. PATIENT SAMPLE: 1,192 patients with radiculopathy, neurological findings and intervertebral disc herniation (IDH) confirmed with crosssectional imaging. OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: IDH patients underwent discectomy (n5788) or received exclusively nonoperative care (n5404) and were analyzed according to
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
63S
OUTCOME MEASURES: Clinical measurement of rib prominence using scoliometer. METHODS: The magnitude of the rib humps before and after the operation were measured using Bunnell’s scoliometer with the patient in Adam’s forward bending posture. The flexibility of the rib hump was assessed clinically before the operation by asking the patient to perform Adam’s forward bending position with the legs apart, and then to laterally flex and rotate the spine by asking the patient to hold the opposite ankle with the two hands without bending the knees. This maneuver reduces the rib hump and the magnitude of the residual hump is measured with the scoliometer. This is then compared to the magnitude of the rib hump present with the patient in Adams forward bend position after the operation at three months’ follow-up. RESULTS: All seven patients were girls. The mean age was 15.8 years (range 14 - 17 years). The magnitude of the curve improved from a mean preoperative Cobb angle of 53.6 +/- 11.2 degrees (range 45.3 - 72.5 degrees) to a mean postoperative Cobb angle of 7.8 +/- 9.3 degrees (range 0.4 - 17.6 degrees). The mean preoperative magnitude of the rib hump was 12.3+/- 6.9 degrees (range 5 - 20 degrees) as measured using the Bunnell’s scoliometer with the patient in Adam’s forward bend position. This rib hump was then corrected to a mean magnitude of 1.3 +/- 2.2 degrees (range 0 - 5 degrees) by performing the above described technique. The mean postoperative magnitude of the rib hump was 3.0 +/- 3.1 degrees (range 0 - 8 degrees) with the patient in Adam’s forward bend position. There was positive correlation between the postoperative residual rib hump and the reduced rib hump measured preoperatively using our described technique (Pearson’s correlation coefficient r50.81, p50.05). CONCLUSIONS: This flexion derotation test is a useful test in assessing the amount of postoperative persistent rib hump after posterior correction of adolescent idiopathic scoliosis using pedicle screw instrumentation with derotation technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.171
Friday, October 8, 2010 7:25–8:25 AM General Session: Best Papers
doi: 10.1016/j.spinee.2010.07.170
138. Rib Hump in Adolescent Idiopathic Scoliosis - Assessment of Its Flexibility and the Need for Thoracoplasty Palaniappan Lakshmanan, MS (Orth), FRCS (Orth), Sami Hassan, MD, BMedSci (Hons), MBCHB, Conal Quah, MD, MRCS, MBCHB, Iona E. Collins, FRCS (Orth); Queens Medical Centre, Nottingham, United Kingdom BACKGROUND CONTEXT: Numerous articles are available regarding the assessment of flexibility of the curve in adolescent idiopathic scoliosis and their relation to the postoperative correction. However, there is none available to assess the rib hump flexibility to assess preoperatively as to the need for subsequent thoracoplasty. PURPOSE: We described a technique of measuring the flexibility of the rib prominence clinically before surgery, and aimed to analyze the results in patients with adolescent idiopathic scoliosis who underwent posterior surgical correction with pedicle screw instrumentation. STUDY DESIGN/SETTING: Prospective study/University Hospital. PATIENT SAMPLE: This prospective study included seven consecutive patients with adolescent idiopathic scoliosis who underwent posterior surgical correction with pedicle screw instrumentation. All the patients included had Lenke Type I curve.
139. SPORT Intervertebral Disc Herniation: Indications Matter Most Adam M. Pearson, MD, MS, Jon Lurie, MD, MS, Tor Tosteson, ScD, Wenyan Zhao, MS, William Abdu, MD, MS, Sohail Mirza, MD, MPH, James N. Weinstein, DO, MS; Dartmouth Hitchcock Medical Center, Lebanon, NH, USA BACKGROUND CONTEXT: The treatment effect of surgery (TE) may vary with specific patient and disease characteristics. While SPORT demonstrated a significant advantage for discectomy at 4 years for the ‘‘average’’ patient meeting specific inclusion criteria (radiculopathy with neurological findings and corresponding lesion on imaging), we hypothesized that certain subgroups might benefit more or less from surgery. PURPOSE: To determine if TE varied across subgroups in order to identify patients with specific characteristics that could predict TE and aid in decision making. STUDY DESIGN/SETTING: As-treated analysis of combined randomized and observational cohorts performed at 13 spine centers in 11 states. PATIENT SAMPLE: 1,192 patients with radiculopathy, neurological findings and intervertebral disc herniation (IDH) confirmed with crosssectional imaging. OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: IDH patients underwent discectomy (n5788) or received exclusively nonoperative care (n5404) and were analyzed according to
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.