1,721,666 research outputs found
Eosinophilic Granuloma (Vertebra Plana) Chapter 35
No full textEosinophilic granuloma is a benign form of Langerhans cell histiocytosis.
It is usually a solitary lesion that can affect any bone of the skeleton. Spine involvement may progress to vertebra plana which is characterized by the almost complete loss of anterior and posterior vertebral body height. Brace treatment is generally sufficient to allow spontaneous remodeling and reconstitution
of the vertebral height and shape although the process may take a long time.
Observation alone or biopsy to confirm the diagnosis of EG has also been recommended as a treatment strategy. Spinal lesions at risk of instability (rare) may benefit from surgical stabilization
Cervical Kyphosis in Neurofibromatosis Type I Chapter 23
No full textChildren with neurofibromatosis type I can develop cervical kyphosis. Severe cervical kyphosis in the setting of neurofibromatosis type I is a rare manifestation of the disease in the pediatric population, and it is often associated with vertebral dysplasia. Patients with a progressive deformity or neurological symptoms should be managed surgically. However, the presence of coexisting paraspinal and spinal cord tumors increases the risk of hemorrhaging and spinal
cord injury during corrective surgery. Close follow-up is extremely important because complications and progression of the deformity are frequent
Postural Kyphosis Chapter 21
No full textPostural kyphosis is a benign condition, and it is the most common type of increased thoracic kyphosis (greater than 40°); it is defined as an abnormal rounding of the thoracic spine characterized by the lack of rigidity in the spine, and the lack of structural abnormalities of the vertebral bodies on radiographs.
The treatment of postural kyphosis in children aims to prevent the curve from
worsening and to restore normal posture. The goal of physical therapy is to strengthen the back and abdominal muscles in order to relieve pressure on the spine, to improve posture and to reduce discomfort/pain. In skeletally immature
patients with more severe deformity and a significant amount of remaining
growth (Risser 0–2), a brace is indicated to support the spine growing into the correct posture
Late Onset Neuromuscular Scoliosis Chapter 20
No full textAbstract Patients with neuromuscular disorders tend to develop scoliosis at younger
ages than patients with idiopathic scoliosis; a large proportion of NMS are progressive and often non-responsive to orthotic management. Unlike idiopathic scoliosis, NMS can progress beyond skeletal maturity, particularly in wheelchair-bound patients, and be associated with pelvic obliquity. Also, NMS is often characterized by a greater decrease in lung volumes compared to idiopathic curves, which, in contrast, have normal muscle function.
In patients with NMS, bracing is usually not effective, and surgery is the primary treatment option; in case of the pelvic obliquity, fusion to the pelvis is recommended
Disc Bulging and Herniation in Children and Adolescents Chapter 26
No full textIn bulging discs, the nucleus pulposus remains contained within the annulus fibrosus, while in herniated discs, the nucleus pulposus extrudes through the fibers of the annulus fibrosus.
Compared to adult patients, children (in particular) and adolescents often have less specific complaints of pain or other symptoms, which leads to a longer
duration before diagnosis. Importantly, children and adolescents are less often
seen with neurological symptoms such as numbness and weakness.
Surgery has a good short-term prognosis, but up to 28% of patients may require repeated surgical treatment later in life; moreover, degenerative changes are still possible in adulthood
Progression Risk of Adolescent Idiopathic Scoliosis During Puberty and Natural History Chapter 17
No full textAdolescent idiopathic scoliosis affects about 3% of the general population. Most children will not have curves progressing beyond 20° and do not require active treatment. However, almost all curves progress during puberty; in particular,
thoracic curves have the highest risk of progression. The risk of progression is
related to the severity of the deformity at the onset of the pubertal growth spurt, which is the turning point in the natural history of idiopathic scoliosis.
The scoliotic risk varies with growth, and it is proportional to both the amount of remaining growth and the severity of the deformity. As a rule of thumb,
deformities less than 45° at skeletal maturity tend to remain stable during adulthood, while those over 50° tend to progress, and surgery is generally recommended during adolescence
Postsurgical Spinal Infection Chapter 66
No full textAccording to the surgical site and the time since surgery, postoperative spine infections can be divided into superficial (above the fascial layer) or deep (below the fascial layer) and acute (early-onset; within 3–4 weeks since surgery) or
chronic (late-onset; more than 4 weeks after surgery).
The development of a postoperative infection puts the patient at increased risk
for pseudoarthrosis, chronic pain, adverse neurological sequelae, return to the
operating room, worsened long-term outcomes, and—in most severe cases—even death.
A high index of suspicion is needed to make an early diagnosis; if treated
promptly through debridement and lavage in association with targeted antibiotic therapy (according to deep culture results), the outcome is generally good
Rare injuries of the elbow: fracture capitulum humeri, coronoid process and humeral troclea
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