The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis
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Abstract Background: Ultrasonography has been used to predict the necessary endotracheal tube (ETT) size by measuring the cricoid cartilage diameter. The aim of this study was to determine the accuracy of ultrasound to predict ETT size for pediatric patients with congenital scoliosis. Methods: Fifty pediatric patients who underwent scoliosis surgery were included in the study. According to the position of the scoliosis, patients were divided into three groups: Group C (cervical lateral bending), Group T (thoracic scoliosis), and Group L (lumbar scoliosis). For all participants, the transverse diameter of the cricoid cartilage was measured with ultrasonography. The initial ETT size was chosen according to the measurements, then the leak test was used to determine the bestfit ETT size. The ETT size predicted by ultrasound and the bestfit ETT size were compared using Bland-Altman analysis. Results: There was a strong correlation between the bestfit ETT size and the ETT size predicted by ultrasound in Group T (r = 0.93, p < 0.001) and Group L (r = 0.94, p < 0.001) and a moderate correlation in Group C (r = 0.83, p < 0.001). Bland-Altman analysis showed that the ETT size was overestimated by ultrasound in pediatric patients with cervical lateral bending (bias = 0.73 mm, precision = 0.42 mm, limit of agreement = 0.08 to 1.38 mm). Conclusion: Ultrasound is a reliable tool to predict ETT size for pediatric patients with thoracic or lumbar scoliosis. However, pediatric patients with cervical lateral bending will need an ETT smaller than the size predicted by ultrasonography. Trial Registration: Chinese Clinical Trial Registry, TRN: ChiCTR1900023408, date of registration: 05.26.2019, 'retrospectively registered'.Keywords:
Endotracheal tube
The frequency and characteristics of definite lumbar scoliosis in an adult common low-back pain population (n = 671) were assessed by a clinical and radiologic prospective study. The prevalence was 7.5% [N = 50], increasing with age: 2% before 45 years; 15% after 60 years. Scoliosis was revealed by low-back pain in adult-hood in 86% of the cases. The mean Cobb angle was 21 pL 11.4o, A Cobb angle of more than 30o was noted in 16% of the scoliotics, thus 1% of the entire population. The proportion of women increased with the severity of the scoliosis. Right and left side scolioses were equally noted. A correlation between the Cobb angle and age was found (0.3o/Yr; P < 0.05). Rotatory olisthesis was noted in 34% of the cases, more often in right side curves (P < 0.01). The lumbar scoliotc patients were distinguished by a more advanced age (62 pL 12.4 Yr vs. 49.6 pL 15.5 Yr; P < 0.001), a greater proportion of women (72% vs, 48%; P < 0.01), and a more likely in volvement of L3 and L4 radicular pain (P < 0.05). Ridicular thigh pain was related to unstable curves (P < 0.01). The lumbar scoliotic patients thus constitute a subgroup within the low-back pain population.
Cobb angle
Radicular pain
Back Pain
CobB
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The article presents the results of morphofuntional changes of vertebral canal, submeningeal spaces and spinal cord in patients with severe forms of scoliotic deformity from superthoracic to lumbar part. It was proved that deformity of liquor spaces brings to disturbance of cerebrospinal fluid circulation. The degree of disturbance of liquor dynamics corresponds to depth and gravity of scoliotic deformity. Data of liquor spectrum analysis in patients with scoliosis help to see the changes in a form of increase of absorption spectrum even at early stages of the disease
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There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients.The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients (mean age 47.4 years) with adult idiopathic scoliosis, including thoracic kyphosis (TK), thoracolumbar junction kyphosis (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT) and C7 plumb line (C7PL). The patients were divided into three groups according to the age: 20 - 40 years, 41 - 64 years, and ≥ 65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis (AIS) patients. The relationship between all parameters as well as age and sagittal parameters were analyzed.The PI in patients with adult idiopathic scoliosis was 58.1° ± 13.0°, which was significantly higher than that in normal adults. The PT (19.9° ± 10.6°) was also higher than that in both normal adults and AIS patients, while the SS (38.1° ± 12.0°) was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL.PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.
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Idiopathic scoliosis
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We evaluated the radiographic results of posterior spinal arthrodesis with use of Cotrel-Dubousset instrumentation in seventy-six patients who had adolescent idiopathic scoliosis. At an average of six years (range, five to ten years) postoperatively, the fusion appeared to be solid in all patients. Comparison of radiographs that had been made immediately postoperatively with those that had been made at the time of the latest follow-up showed that no patient had lost any correction in the coronal plane at the levels with instrumentation and seventy-five had had no change in the thoracic or lumbar sagittal alignment at the levels with or without instrumentation. In the remaining patient, a kyphosis had developed at the junction of the segments with instrumentation and those without instrumentation, necessitating additional operative treatment. Sixty-three patients completed a questionnaire for assessment of the clinical status. Their responses were favorable with regard to function, cosmetic appearance, and general satisfaction with the operative result. Twenty-four (38 per cent) of the sixty-three patients reported occasional pain in the spine that did not interfere with work or school activities. Sixty-two patients stated that, given the hypothetical situation of reverting to the preoperative status, they would have the operation again.
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To explore the indications of fusion for degenerative lumbar spinal stenosis treated by "windows technique".From December 1999 to December 2005, 145 consecutive patients who were treated by primary decompression with "windows technique" laminoforaminotomy for degenerative lumbar spinal stenosis, a retrospective study, were divided into 3 groups (A and B and C) by preoperative lumbar conditions and surgical methods. In group A, 39 patients with spinal instability or degenerative lumbar spondylolisthesis or scoliosis underwent decompression and fusion; in group B, 31 patients with spinal instability or degenerative lumbar spondylolisthesis or scoliosis underwent decompression alone; In group C, 75 patients without spinal instability or degenerative lumbar spondylolisthesis or scoliosis were treated by decompression without fusion. On hospital medical records to review, they were followed up by telephone and out-patient referral. Statistics the duration of hospitalization, operative time, estimated blood loss; Observed recrudescence and reoperation and complication; and using Oswestry Disability Index and Visual Analog Scale and satisfaction rate for efficacy assessment, application SPSS 13.0 software.All 145 patients had at least a 3-year follow-up (ranging 37 to 108 months). In the group C, the duration of hospitalization less than in the group A or B (P < 0.05); In the group A, the operative time and estimated blood loss greater than in the group B or C (P < 0.05); The group B treated by decompression alone in the presence of instability or spondylolisthesis or scoliosis showed the worst results by the Oswestry Disability Index or Visual Analog Scale or ate of satisfaction (P < 0.05). The same good results can be obtained in the group A and C. There were not different about recrudescence or reoperation or complication in the three groups.Fusion should be performed on patients with instability or degenerative lumbar spondylolisthesis or scoliosis after primary decompression with "windows technique" laminoforaminotomy. The patient with simple lumbar spinal stenosis undergone primary surgery does not require fusion.
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Forty six patients with idiopathic scoliosis were treated according the Harrington method. The surgical treatment was done with the Harrington distraction rod, and vertebral arthrodesis with autogenous iliac bone graft. The patients wore a Risser-Cotrel body-cast for nine months but started walking two days after casting. Good clinical results were obtained in all the patients. Final curve correction was 40%. In this series of patients no pseudoarthrosis occurred.
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The aim of the study was the radiological evaluation of the three-dimensional asymmetric treatment of scoliosis in strict symmetric initial positions.152 Patients (137 F and 15 M) with idiopathic progressive scoliosis (85 single scoliosis cases and 67 double-major) with proven curve progression were retrospectively analysed on the basis of radiological evaluation in the period of years 1999-2004. Mean age of assessed group was 14.22 years (range 7/21, SD=2.57), mean time of observation 31.80 months (range 18/63, SD=10.75). All children were treated with Dobosiewicz method of three-dimensional asymmetric correction in strict symmetric initial positions and with rigid Cheneau brace when indicated.Mean initial value of Cobb angle was 25.92 degrees (range 9/62, SD=10.59), mean initial rotation of apical vertebra was 9.55 degrees (range 0/30, SD=7.66). The outcome values were 31.04 degrees (range 5/76, SD=13.96) and 12.97 degrees (range 0/35, SD=8.41), respectively. Mean progression of Cobb angle during entire period of observation was 5.12 degrees (range -21 / +38, SD=9.62), mean progression of apical vertebra rotation was 3.42 degrees (range -21 / +25, SD=6.03). Further multi-factor analysis is discussed in full text. Results are also presented in the form of radiograms.The radiological results demonstrated prevalent stabilisation of scoliotic curves in children treated with Dobosiewicz method between October 1999 and December 2004.
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[corrected] Three-dimensional surgical correction of scoliosis was introduced in the 1980s by Cotrel-Dubousset. Initially only laminar and pedicular hooks, two rods (correcting and stabilizing), and transverse links joining both rods were used to correct and stabilize the spine. When implant systems had been developed and modernized, transpedicular screws in the lumbar segment were used, followed by titanium implants. The aim of our study was to evaluate the outcome after surgical correction of scoliosis using the three-dimensional correction method with spondylodesis.We studied 171 patients with scoliosis treated surgically by the three-dimensional method of correction in the years 1992-2002. These were patients with idiopatic scoliosis not exceeding 70-80 degrees , depending on the degree of correction in extension tests. In 28 cases, titanium implants were used. In most cases, transpedicular screws were used in the lumbar spine, on the convex side of the scoliosis. Tytanium implants were used to enable diagnosis by CT or MRI after surgery.The mean angle of scoliosis before surgery was 56 degrees (range 40 degrees -90 degrees ). After surgical correction the mean angle was 16 degrees (range 5 degrees -37 degrees ); however, in long-term follow-up, the mean angle had increased slightly to 18 degrees (range 8 degrees -50 degrees ). The observation period was 2 to 16 years. There were complications in 9.3% of these cases, mainly late sterile negative tissue reactions to steel implants. Infectious and neurological adverse reactions were not observed.The best outcome after surgical treatment was achieved in grade II scoliosis. The scale of correction amounted to an average 70%. Transpedicular screws in the lumbar spine enabled a reduced range of stabilization. Titanium implants enabled radiological diagnosis by MRI and CT after surgery.
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To investigate the clinical effects of limited decomression, fixation, and fusion in treating degenerative scoliosis with spinal stennosis.From June 2002 to January 2009, 26 patients of degenerative scoliosis with spinal stenosis were treated with limited decomression, fixation, and fusion. There were 6 males and 20 females with an average age of 61.3 years (ranged, 51 to 72 years). Course of disease of spinal stenosis was from 11 months to 6 years with an average of 36 months. X-ray, CT, MRI examination were performed preoperatively for all the cases and myelography was performed for 6 cases. Preoperative Cobb's angle,focal lordosis angle,the distance between C7 plumb line (C7PL) and upper edge of S1 vertebral body (SVA), and the distance between C7PL and center sacral vertical line (CSVL) were (22.0 +/- 10.1) degrees, (21.6 +/- 10.2) degrees, (7.6 +/- 6.4) cm, (6.8 +/- 5.6) cm respectively. Measured Cobb's angle, focal lordosis angle, SVA, CSVL after operation and final follow-up were compared with preoperative data. JOA score system were used to evaluate clinical effects.The operative time All the patients were followed up from 1.3 to 5 years with an average of 2.5 years. Postoperative and final follow-up, Cobb's angle was (10.5 +/- 8.2) degrees, (8.8 +/- 5.2) degrees, respectively; focal lordosis angle was (25.4 +/- 14.2) degrees, (31.6 +/- 13.2) degrees, respectively; SVA was (0.6 +/- 3.3) cm, (-1.2 +/- 2.5) cm,respectively; CSVL was (2.8 +/- 1.3) cm, (1.6 +/- 1.2) cm, respectively. There was significant difference in data before and after operation. Preoperative, instantly postoperative, final follow-up, JOA score was 11.0 +/- 1.7, 22.4 +/- 2.4, 24.0 +/- 2.1, respectively; 13 cases obtained excellent results, 8 good, 3 fair, 2 poor. Loss of correction occurred in one case. No collapse of intervertebral space, nerve injury, breakage of fixation system were found.Surgical treatment with limited decompression, pedicle screw fixation and fusion is effective method for degenerative scoliosis with spinal stenosis, individualized surgery design should be made according to clinical symptoms, signs and imaging features.
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Treatment of scoliosis under 30 degrees Cobb in growing patients remains controversial. Different orthopaedic devices have been developed and used with satisfactory results, alone or in combination with a variety of physiotherapy programs. The F.E.D. method is a dynamic three-dimensional therapy consisting in the application of derotational forces under spine stretching. This method offers some advantages over conventional conservative treatment for scoliosis: shorter treatment period, no use of plasters in many cases, better psychological tolerance, etc.In this work, the results of the F.E.D. method were compared to other conservative treatment techniques in scoliosis under 30 degrees Cobb angle and Risser 3 or less.Both the F.E.D. group and the group of patients treated by traditional orthopaedic methods included 30 children. Patients were divided on the basis of the type of scoliotic deformity: thoracic, thoracolumbar or lumbar. SUMMARY OF RESULTS AND FINDINGS: The results obtained showed that patients treated with the F.E.D. method had a significantly better outcome than the other methods in terms of angle correction and shorter period of treatment necessary to reach correction.The F.E.D. method can be considered as the elective treatment in growing adolescents with scoliosis under 30 degrees.
Conservative Treatment
Cobb angle
Idiopathic scoliosis
Spinal Deformity
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