Curve flexibility in cerebral palsy-related neuromuscular scoliosis: does the intraoperative prone radiograph reveal more flexibility than preoperative radiographs?

Chaudry, Zubair; Anderson, John T.

doi:10.1186/s13013-017-0122-2

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…In addition, individualized orthosis design according to the prone flexibility rather than personal experience or general standard makes the orthosis planning process more evidence-based and patient-specific. As the prone position with manual correction or prone position under general anesthesia were reported to have potential predictability to the postoperative correction [ 22 , 23 ], future studies are deserved to explore the feasibility of using prone flexibility to assist surgical planning.…”

Section: Discussionmentioning

confidence: 99%

An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

Cheung

et al. 2017

PLoS ONE

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BackgroundSpinal flexibility is an essential parameter for clinical decision making on the patients with adolescent idiopathic scoliosis (AIS). Various methods are proposed to assess spinal flexibility, but which assessment method is more effective to predict the effect of orthotic treatment is unclear.ObjectiveTo investigate an effective assessment method of spinal flexibility to predict the initial in-orthosis correction, among the supine, prone, sitting with lateral bending and prone with lateral bending positions.MethodsThirty-five patients with AIS (mean Cobb angle: 28° ± 7°; mean age: 12 ± 2 years; Risser sign: 0–2) were recruited. Before orthosis fitting, spinal flexibility was assessed by an ultrasound system in 4 positions (apart from standing) including supine, prone, sitting with lateral bending and prone with lateral bending. After orthosis fitting, the initial in-orthosis correction was routinely assessed by whole spine standing radiograph. Comparisons and correlation analyses were performed between the spinal flexibility in the 4 positions and the initial in-orthosis correction.ResultsThe mean in-orthosis correction was 41% while the mean curve correction (spinal flexibility) in the 4 studied positions were 40% (supine), 42% (prone), 127% (prone with lateral bending) and 143% (sitting with lateral bending). The correlation coefficients between initial in-orthosis correction and curve correction (spinal flexibility) in the 4 studied positions were r = 0.66 (supine), r = 0.75 (prone), r = 0.03 (prone with lateral bending) and r = 0.04 (sitting with lateral bending).ConclusionsThe spinal flexibility in the prone position is the closest to and most correlated with the initial in-orthosis correction among the 4 studied positions. Thus, the prone position could be an effective method to predict the initial effect of orthotic treatment on the patients with AIS.

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Section: Discussionmentioning

confidence: 99%

An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

Cheung

et al. 2017

PLoS ONE

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“…Neuromuscular scoliosis can vary widely, from flexible to rigid. It is also possible to encounter mostly semirigid curves 14 . Congenital scoliosis involves only rigid curvatures.…”

Section: Discussionmentioning

confidence: 99%

“…It is also possible to encounter mostly semirigid curves. 14 Congenital scoliosis involves only rigid curvatures.…”

Section: Discussionmentioning

confidence: 99%

Corrective Maneuvers Used in Different Scoliosis Deformities With the Experience of 72 Operated Patients

Bayram,

Polat,

Karataş

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Purpose: This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content. Materials and Methods: Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated. Results: The mean follow-up was 42.5 (24–108) months, and the mean age was 15.8 (12–29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50–139) degrees, and the final follow-up was 15.6 (5–40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12–110) degrees, and the final follow-up was 41.2 (25–62) degrees. The mean surgical time was 293 (160–440) minutes. The mean hospitalization length was 5.8 (2–21) days. The blood delivered to patients during surgery and postoperative was 715 (300–1800) mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle (P=0.000). Conclusions: Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

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“…27 Preoperative supine traction radiographs are useful to determine spinal flexibility for patients with severe scoliosis. 28 Supine anteroposterior (AP) pelvis x-rays are also required to assess for the presence of hip displacement, both to identify a possible infra-pelvic cause of pelvic obliquity and to initiate early surgical treatment due to the adverse natural history (i.e., painful osteoarthritis) associated with untreated hip displacement (Figure 3). 29,30,31…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Management of Spinal Deformity in Cerebral Palsy

Howard

Sees

Shrader

2019

Journal of the Pediatric Orthopaedic Society of North America

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Scoliosis is common in cerebral palsy (CP), typified by rapidly progressive curves that impact patient function and quality of life. With age, these curves become rigid, with potential for sitting imbalance, decubitus ulcers, decreased socialisation, increased caregiver demands, and, in some cases, decreased pulmonary function. The use of bracing for scoliosis in CP is to support the collapsing spine rather than to prevent curve progression and should not be expected to alter natural history. Scoliosis correction surgery, however, is indicated for progressive curves greater than 40°-50°, with the primary surgical goals being achieved with a balanced spine over a level pelvis, allowing for a more stable sitting platform and improved quality of life. Hip displacement and scoliosis are often coincident in CP, but the order of surgical management remains controversial. The mainstay of treatment for scoliosis involves posterior instrumentation and fusion from the upper thoracic spine to the pelvis. Though several options are available, the best evidence to date would suggest that segmental pedicle screw fixation achieves better curve correction and an improved risk profile over other implant choices. Often proposed as a benefit of scoliosis surgery in CP, the true impact of curve correction on pulmonary function has not been well studied and is currently unknown. Substantial comorbidities increase the perioperative risk profile-including swallowing difficulties, aspiration risk, recurrent respiratory infections, epilepsy, and malnutrition -necessitating patient counseling and mitigating strategies to optimize surgical outcomes. Optimizing medical and nutritional management pre-and perioperatively is important to tip the balance in favor of benefits over risks.

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Curve flexibility in cerebral palsy-related neuromuscular scoliosis: does the intraoperative prone radiograph reveal more flexibility than preoperative radiographs?

Cited by 8 publications

References 6 publications

An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

Corrective Maneuvers Used in Different Scoliosis Deformities With the Experience of 72 Operated Patients

Management of Spinal Deformity in Cerebral Palsy

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