Rubinstein-Taybi syndrome with scoliosis

<p>Abstract</p> <p>Study Design</p> <p>Case report.</p> <p>Objective</p> <p>The authors present the case of a 14-year-old boy with Rubinstein-Taybi syndrome (RSTS) presenting scoliosis.</p> <p>Summary of Background Data</p> <p>There have been no reports on surgery for RSTS presenting scoliosis.</p> <p>Methods</p> <p>The patient was referred to our hospital for evaluation of a progressive spinal curvature. A standing anteroposterior spine radiograph at presentation to our hospital revealed an 84-degree right thoracic curve from T6 to T12, along with a 63-degree left lumbar compensatory curve from T12 to L4. We planned a two-staged surgery and decided to fuse from T4 to L4. The first operation was front-back surgery because of the rigidity of the right thoracic curve. The second operation of lumbar anterior discectomy and fusion was arranged 9 months after the first surgery to prevent the crankshaft phenomenon due to his natural course of adolescent growth. To avoid respiratory complications, the patient was put on a respirator in the ICU for several days after both surgeries.</p> <p>Results</p> <p>Full-length spine radiographs after the first surgery revealed no instrumentation failure and showed that the right thoracic curve was corrected to 31 degrees and the left lumbar curve was corrected to 34 degrees. No postoperative complications occurred after both surgeries.</p> <p>Conclusions</p> <p>We succeeded in treating the patient without complications. Full-length spine standing radiographs at one year after the second operation demonstrated a stable bony arthrodesis with no loss of initial correction.</p

Clinical Results of Posterior Lumbar Interbody Fusion Using Titanium Intervertebral Spacers in Elderly Patients over 70 Years

Study Design : Retrospective study. Objective: To report the clinical and radiological results of posterior lumbar interbody fusion (PLIF)using titanium intervertebral spacers in elderly patients over 70 years. Summary of Background Data : PLIF with intervertebral spacers has been introduced to treat degenerative lumbar disorders. However, in the elderly patients, it is concerned that there are several possible complications that can be associated with the use of interbody support in anterior column reconstruction under weak bone quality. There were few reports about the results of PLIF using titanium intervertebral spacers in elderly patients. M ethods : Twenty-six patients with mean age of 73 years(range,70-78)underwent one or two-level PLIF using titanium intervertebral blocks combined with posterior instrumentation,with minimum 2-year follow-up (average 49 months; range, 25-88). Radiographic and clinical outcomes analysis was performed. Results : The sagittal alignment (regional lordosis) of the operative segments averaged 7.4°before surgery, 12.7°at discharge, 11.1°post-op 1-year, and 11.8°at the final follow-up. The percentage of posterior disc height was 14.1％ before surgery,and was significantly improved after the surgery to 26.9％ at discharge and 21.8％ at the final follow-up. In 18 patients with spondylolisthesis, the percentage of slip averaged 18.9％ before surgery, and was significantly improved after the surgery to 6.8％ at discharge and maintained until the final follow-up. All patients had radiographic fusion at the follow-up. The average JOA score was 12.6 points before surgery,and increased significantly to 23.1 points at the final follow-up. Conclusion : Posterior lumbar interbody fusion using titanium spacers is valuable even in the elderly patients. The preservation of bony endplate of vertebral body, and the insertion of spacers as antero-lateraly as possible in the intervertebral space, are important for successful fusion