The Natural History of Scoliosis in Myelomeningocele

Banta, John V.; Slakey, Joseph B.; Thomson, Jefrey

doi:10.1007/978-4-431-68373-5_76

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…41,42 In 40.7% of patients pelvic obliquity was observed. Nine per cent of these showed no spine deformity at the last control, a fact that suggests a di erent aetiology for pelvic obliquity.…”

Section: Discussionmentioning

confidence: 99%

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

1999

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The aim of the study was to analyze the present status of neurologic abnormalities, major orthopaedic deformities and ambulatory status in a large myelomeningocele population. Patients and methods: Cross-sectional study based on the clinical and radiographic records of 322 patients treated and followed-up from 1967 ± 1995. The setting was a multidisciplinary spina bi®da unit within a third-level university hospital, which serves as the referral centre for these patients in Catalonia (Spain). We collected information on diagnosis, central nervous system, musculoskeletal system (spinal and hip deformities) and functional level in each patient. To study relationships among the variables, the Mann-Whitney U and the Chisquared tests were applied. Results were considered to be statistically signi®cant at P levels of 40.05. Results: Mean age was 15.9 years. 78.1% of patients had mid-lumbar, low-lumbar or sacral neurological levels; 97.5% had hydrocephalus and 68.8% were shunted. Prevalence of spine deformities was 45.3%; 38.8% had dislocation of one or both hips. Median age of walking onset was 37.1 months and 74.8% of patients were ambulatory. Median age at which ambulation ceased was 128 months (10 years and 8 months). The bivariate analysis showed statistically signi®cant relationships between neurological level and all the variables studied (P50.001, P50.02) except body mass indexes and intelligence quotient. Conclusions: Neurological level was the main factor that determined neurological abnormalities, major orthopaedic deformities and ambulatory status.

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Section: Discussionmentioning

confidence: 99%

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

1999

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“…Although the more rostral extent of neurological impairment in patients with myelomeningocele has been strongly correlated with the risk of scoliosis development, that association has not been consistently reproduced among patients with SCI. 2,4,16,18,24,26,30,31 Furthermore, patients with myelomeningocele represent a congenital developmental process as opposed to SCI, which is a postdevelopmental injury. Modi et al compared pedicle screw constructs in neuromuscular scoliosis cases and noted a 58% correction from 82° to 34°.…”

Section: Discussionmentioning

confidence: 99%

Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

Hwang

Safain

King

et al. 2015

SPI

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OBJECT Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw–only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution. Methods Medical records and radiographs from Shriner's Hospital for Children–Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed. Results Thirty-seven patients, whose mean age at the index surgery was 14.91 ± 3.29 years, were identified. The cohort had a mean follow-up of 33.2 ± 22.8 months. The mean preoperative coronal Cobb angle was 65.5° ± 25.7°, which corrected to 20.3° ± 14.4°, translating into a 69% correction (p < 0.05). The preoperative coronal balance was 24.4 ± 22.6 mm, with a postoperative measurement of 21.6 ± 20.7 mm (p = 1.00). Preoperative pelvic obliquity was 12.7° ± 8.7°, which corrected to 4.1° ± 3.8°, translating into a 68% correction (p < 0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2° ± 8.4°, which corrected to 2.7° ± 3.1° (67% correction, p < 0.05). Preoperatively, thoracic kyphosis measured 44.2° ± 23.7° and was 33.8° ± 11.5° postoperatively. Thoracolumbar kyphosis was 18.7° ± 12.1° preoperatively, reduced to 8.1° ± 7.7° postoperatively, and measured 26.8° ± 20.2° at the last follow-up (p < 0.05). Preoperatively, lumbar lordosis was 35.3° ± 22.0°, which remained stable at 35.6° ± 15.0° postoperatively. Conclusions Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.

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“…2,9,11,[14][15][16] In a cohort study of 118 children with myelomeningoceles receiving modern neurosurgical care, 49% had scoliosis. 4 In our series, 43% of the patients with available diagnostic images had scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Correlation between shunt series and scoliosis radiographs in children with myelomeningoceles

Thomas

Hwang

Blumberg

et al. 2012

SPI

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Object Over 85% of patients with myelomeningoceles require placement of a ventriculoperitoneal shunt for hydrocephalus, and between 25% and 85% of these patients develop scoliosis. Although most patients undergo repeated shunt series radiography to evaluate for device malfunction, scoliosis radiographs are less consistently obtained. The authors sought to determine if a correlation exists between these 2 radiographic techniques for a given patient, as shunt series are obtained with the patient supine, whereas scoliosis radiographs are acquired with the patient standing upright. The authors also endeavored to study if shunt series radiographs can reliably detect significant scoliosis. Methods The authors retrospectively reviewed a single institution's series of 593 patients with myelomeningoceles and identified all patients in whom a shunt series and scoliosis radiographs were obtained within a 6-month period. They reviewed the medical records and radiographs of these patients for demographic and radiographic parameters. They then applied a linear regression model and determined shunt series curve cutoffs to detect scoliotic curves greater than 20° and 50°. Results Of the 593 patients identified, 116 did not have radiographs available for interpretation. Of the remaining 477 patients, 201 had radiographic evidence of scoliosis (42%), and 66 had both a shunt series and a scoliosis radiographs acquired within a 6-month interval. In 4 patients, both end vertebrae of the scoliotic curve could not be visualized on a single radiograph. The mean age of the remaining cohort was 10.6 ± 5.2 years and the mean curve magnitude was 58° ± 37°. Using identical end vertebrae, the mean shunt series curve magnitude was 49° ± 35°. The mean interval between both radiographs was 2.3 ± 3.3 months. The regression model showed a strong linear association between shunt series and scoliosis series curves. A curve greater than 19° on shunt series radiographs would detect significant curves of greater than 20° on scoliosis series with 91% sensitivity and 78% specificity. A shunt series curve greater than 37° had 100% sensitivity and 93% specificity in identifying significant scoliotic curves greater than 50°. Conclusions Although shunt series radiographs may not precisely depict scoliotic curve magnitude because the impact of gravity is negated, they may be useful in helping to confirm clinical suspicion of scoliosis. The authors' results suggest a strong correlation between both types of radiographs.

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The Natural History of Scoliosis in Myelomeningocele

Cited by 9 publications

References 11 publications

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

Correlation between shunt series and scoliosis radiographs in children with myelomeningoceles

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