Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0°±12.3° (range −30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7°±11.4° (range −24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over tim

MRI neurography and diffusion tensor imaging of a sciatic perineuroma in a child

Perineuroma, rare in children, presents as a painless mononeuropathy of a major nerve trunk. Resection of the lesion with end-to-end sural nerve grafting appears to be the treatment of choice. This technique is not recommended if the unhealthy segment of nerve is too long or if spinal roots are involved. However, in children, reports of direct MR evaluation of nerve trunks and of the exiting nerve roots are limited. We report a 7-year-old girl with an intramural sciatic nerve perineuroma in whom the diagnosis was made by MRI and confirmed by biopsy. The MR protocol combining 3-D T2-W STIR SPACE, fat-saturated gadolinium-enhanced T1-W images, and diffusion tensor imaging with tractography was a valuable tool for depicting peripheral nerve and roots in order to plan surgical treatmen

Arthrodèse de la colonne avec ou sans fixation du bassin oblique chez l'enfant neurologique et révision de la physiopathologie et du traitement de la scoliose neuromusculaire

Les enfants neurologiques ont un grand risque de développer des déformations spinales. La scoliose peut être aussi liée à un bassin oblique qui peut amener à des points d'appui ischiatiques et éventuellement à des escarres. Cette association donne beaucoup de difficultés pour la prise en charge chirurgicale et la question est de savoir si le bassin doit être pris dans la fixation de la colonne ou non. Sur 31 patients neurologiques opérés avec une spondilodèse à l'Hôpital Cantonal de Genève, on a eu 12% de correction du bassin oblique quand la fusion était faite jusque L5 et 54% quand elle était faite jusque à S1. Le bassin oblique résiduel est de 16,6° en moyenne et seulement 2 patients ont eu des difficultés liés à cette déformation. Le bassin oblique présentant des degrés d'obliquité plus importants doivent être acceptés dans ce groupe de patients

Spastic hip dysplasia in severe cerebral palsy: Review from the literature

Cerebral palsy is a neurodevelopmental condition that could be secondary to hypoxic–ischaemic brain injury during the perinatal period of development or congenital anomalies. Cerebral palsy is the most frequent cause of physical disability in development countries. These patients have motor impairment and also a high rate of mental health problems. Their motor impairments developed unbalanced hip contractures that can lead to silent hip dislocation. The incidence of this complication can be very high, from 15% to 60% (1). There is a relationship with the degree of physical disability and hip dislocation (2). Non-walking patients have a high chance to develop this deformity. The pathogenesis of the progressive hip subluxation from the acetabulum is related to muscular imbalance around the hip. They usually have strong adductors and flexors and unbalanced weak abductors and extensors. The natural history of the hip dislocation can develop pain, contractures and difficulties with hygiene. Surveillance programmes in cerebral palsy patients can help in detecting at-risk patients for hip dislocation, and early recognition enables early appropriate interventions. The surveillance should be performed with regular radiographic hip examination; because physical examination alone is not a reliable method to mesure hip dislocation . Most physicians agree that preventing hip dislocation is a good way to prevent future problems with hip pain and contracture, providing benefits to the family, caregivers and patient (2). Surgical and rehabilitative approaches, such as soft tissue lengthening and proximal femoral and pelvic osteotomies, can help to maintain hip reduce into the acetabulum. The rationale of this review is to evaluate recent literature for current trends in the surveillance and treatment of spastic hip problems in patients with cerebral palsy

Percutaneous pelvic osteotomy in non-ambulatory cerebral palsy patients

The aim of this study was to describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. Forty non-ambulatory children and adolescents (47 hips) were consecutively treated with percutaneous pelvic osteotomy. The mean preoperative Reimers' migration percentage improved from 66.2% to 4.9% at the final follow-up. The mean preoperative acetabular angle (AA) improved from 32.4° to 13.2° at last follow-up. Percutaneous pelvic osteotomy is a less invasive surgical approach and appears to be a valid option with similar outcomes to standard techniques.This method results in less muscle stripping and blood loss and a shorter operating time

Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature

We report 4 cases of nutcracker fractures of the cuboid resulting from equestrian sport in pediatric population. These lesions are often consistent with a trauma in forced abduction of the forefoot. The particular mechanism of the cuboid fracture due to horseback riding in children is discussed. The methods used to radiographically evaluate the compression fracture of the cuboid and its associated injuries are presented. Left untreated, these fractures can lead to severe alterations in foot mechanics and function, such as to severe pain. In addition, the surgical treatment to correct the nutcracker fracture of the cuboid in our patients is presented

Apophyseal avulsion fracture of the greater trochanter after slipped capital femoral epiphysis: a case report

A 13-year-old boy sustained an avulsion fracture of the left greater trochanter eight months after surgical stabilisation of a slipped capital femoral epiphysis on the same side. In this specific case, avulsion of the greater trochanter after slipping of the capital femoral epiphysis may have been facilitated by weakening of the trochanteric physis