Management of Orthopaedic Sequelae of Congenital Spinal Disorders

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Presentation transcript:

Management of Orthopaedic Sequelae of Congenital Spinal Disorders by Michael Akbar, Bjoern Bresch, Thorsten M. Seyler, Wolfram Wenz, Thomas Bruckner, Rainer Abel, and Claus Carstens J Bone Joint Surg Am Volume 91(Supplement 6):87-100 November 1, 2009 ©2009 by The Journal of Bone and Joint Surgery, Inc.

A nine-year-old child with myelomeningocele and severe thoracolumbar scoliosis. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph showing the neurogenic thoracolumbar scoliosis of the child in Figure 1. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

A five-year-old patient with a myelomeningocele at the thoracic level. A five-year-old patient with a myelomeningocele at the thoracic level. The spinal brace is used to stabilize the trunk. The use of a brace is only a temporary conservative treatment option that can permit the delay of surgery until the child is eight or nine years old. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Radiographs showing progression of deformity of a c-shaped thoracolumbar scoliosis during conservative treatment in a spinal brace. Radiographs showing progression of deformity of a c-shaped thoracolumbar scoliosis during conservative treatment in a spinal brace. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing a lumbar kyphosis with rigid components. Photograph showing a lumbar kyphosis with rigid components. The kyphosis exceeded 80° at the time of the child's birth. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Three-dimensional computed tomography reconstruction of a lumbar kyphosis in an eleven-year-old child with myelomeningocele. Three-dimensional computed tomography reconstruction of a lumbar kyphosis in an eleven-year-old child with myelomeningocele. The kyphosis is associated with compensatory hyperlordosis of the adjacent thoracic spine and the sacrolumbar junction. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing a child with myelomeningocele and severe rigid lumbar kyphosis. Photograph showing a child with myelomeningocele and severe rigid lumbar kyphosis. The lower portion of the rib cage has come to rest against the anterior aspect of the thighs. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Implant failure. Implant failure. Rod penetration through the sacrum. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Implant failure. Implant failure. Rod breakage and dislocation. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing calcaneal deformity of the foot with development of heel pads. Photograph showing calcaneal deformity of the foot with development of heel pads. The patient walks on his heels. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Left: Radiograph showing the indication for the Lambrinudi osteotomy to increase dorsiflexion in a foot with an equinus deformity and talotibial impingement (arrow). Left: Radiograph showing the indication for the Lambrinudi osteotomy to increase dorsiflexion in a foot with an equinus deformity and talotibial impingement (arrow). Right: Radiograph showing the indication for inverse Lambrinudi osteotomy to limit dorsiflexion (arrow) in a foot with a paralytic calcaneus deformity. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

A and B: The clinical (A) and radiographic (B) appearance of a calcaneal deformity of the foot in a patient with myelomeningocele. A and B: The clinical (A) and radiographic (B) appearance of a calcaneal deformity of the foot in a patient with myelomeningocele. C and D: Implantation of a bone wedge between the talus and the calcaneus limits dorsiflexion. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Postoperative result after performance of an inverse Lambrinudi osteotomy and tendon transfer to the Achilles tendon in the patient depicted in Figure 11. Postoperative result after performance of an inverse Lambrinudi osteotomy and tendon transfer to the Achilles tendon in the patient depicted in Figure 11. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Neurogenic clubfoot in a patient with myelomeningocele. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Pathological fracture of the distal part of the femur in a child with a myelomeningocele at the thoracic level. Pathological fracture of the distal part of the femur in a child with a myelomeningocele at the thoracic level. Note the exuberant callus formation. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.

Photographs showing treatment of a small sacral pressure sore with a fasciocutaneous flap. Michael Akbar et al. J Bone Joint Surg Am 2009;91:87-100 ©2009 by The Journal of Bone and Joint Surgery, Inc.