Adult scoliosis.

Adult scoliosis is a complex and difficult area of modern orthopaedics. Thanks to modern techniques of both operative and nonoperative care, treatment is now possible for problems thought of as impossible only a few years ago. Most adult scoliosis problems require a great depth of evaluation and decision making before arriving at the best form of treatment.

Anterior strut-grafting for the treatment of kyphosis. Review of experience with forty-eight patients.

Anterior strut-grafting was used in forty-eight patients to treat structural kyphosis of the thoracic and lumbar spine. Forty patients had a combined anterior and posterior arthrodesis. Kyphosis was corrected from an average of 93 degrees preoperatively to an average of 59 degrees at follow-up.

Voluntary school screening for scoliosis in Minnesota.

School screening for scoliosis is a well accepted technique for the early detection of spinal deformities. We reviewed the experience in Minnesota over the past eight years, with an average of one-quarter of a million children being screened yearly. Of the children screened, 3.

Brain abscess as a complication of halo traction.

The occurrence of a brain abscess as a complication of halo traction and immobilization in the management of scoliosis is reported. Previous reports suggest that this complication is rare. Unique in this case is the development of an intracerebral abscess without skull perforation by the halo device and without evidence of contiguous spread of infection.

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients.

The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion.

Twenty-four patients with Scheuermann's kyphosis underwent correction of the deformity through a combined anterior and posterior spine fusion. All patients had a solid arthrodesis and most were relieved of their preoperative pain. Deformity was improved in all patients.

Neurologic deficits secondary to spinal deformity. A review of the literature and report of 43 cases.

Forty-three cases of neurologic complications of untreated spinal deformities are reviewed. Kyphosis, averaging 95 degrees, was present in all but one patient. The most common deformity was a congenital kyphosis, present in 17 patients.

Lumbosacral hemivertebrae. A review of twenty-four patients, with excision in eight.

Twenty-four cases of lumbosacral hemivertebrae are reviewed. The treatment groups consisted of observation, bracing, posterior spinal fusion with and without Harrington instrumentation, and two-stage hemivertebral excision. Clinical and radiographic spine decompensation was found to be an important parameter in following these patients.

Treatment of idiopathic scoliosis in the Milwaukee brace.

The results of treatment of idiopathic scoliosis with a Milwaukee brace were studied in 133 patients (127 girls and six boys) whose ages ranged from eight years and five months to sixteen years and two months at the beginning of treatment. These 133 patients had 192 separate curves (119 right thoracic, thirty-nine high lumbar, twelve thoracolumbar, and twenty-two high left thoracic). Of these patients, seventy-four with 109 curves were followed for five years or more after the brace was discontinued (average, eight years; range, five to thirteen years); twenty-nine patients were treated surgically because of a poor response to the brace or progression of the curve; and thirty patients were lost to follow-up.

Reconstructive surgery in the adult for failed scoliosis fusion.

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients.

Spine deformity in neurofibromatosis. A review of one hundred and two patients.

The natural history, associated anomalies, and response to operative and nonoperative treatment were reviewed in 102 patients with neurofibromatosis and spine deformity. Eighty patients were found to have curvatures associated with dystrophic changes in the vertebrae and ribs. The presence of dystrophic changes such as rib penciling, spindling of the transverse processes, vertebral scalloping, severe apical vertebral rotation, foraminal enlargement, and adjacent soft-tissue neurofibromas was found to be highly significant in prognosis and management.

Neurofibromatosis and hypertension. A case report.

The case of a 12-year-old boy with neurofibromatosis, kyphoscoliosis, and hypertension is reported. The association of neuroflibromatosis and kryphoscoliosis is well known. There are no reports on the association of neurofibromatosis and hypertension in the orthopaedic literature.

Post-laminectomy kyphosis.

Post-laminectomy spinal deformity occurs in 50% of children undergoing laminectomies for cord tumors. Kyphosis is the most frequent deformity found. The integrity of the facet joints appears to be one of the most important factors in the development of this kyphosis.

Techniques of anterior spinal surgery for the management of kyphosis.

Experience with the techniques of spinal surgery for the management of thoracic and lumbar kyphosis suggests that the anterior approach is useful for correcting fixed deformity (achieving solid arthrodesis and decompressing the spinal cord when necessary). The insertion of an anterior bone graft alone does not guarantee a solid arthrodesis. Meticulous technique, autologous bone, and efficient immobilization are essential for a satisfactory result.

Screening for spinal deformities in Minnesota schools.

Early detection of spine deformities by school screening has proven to be an effective mechanism for early diagnosis. The forward bending test is a simple rapid method of detection and has been used in the Minnesota State screening program. Screening in Minnesota began in 2 rural communities and spread to include the whole state.