Search Results (4)

Background/Objectives: Spinal muscular atrophy (SMA) is a neuromuscular disorder frequently associated with progressive scoliosis requiring posterior spinal fusion (PSF). While Nusinersen offers significant clinical benefit, its intrathecal administration is challenging in patients with extensive spinal instrumentation and solid fusion. This study aimed to evaluate the safety, feasibility, and patient acceptance of lumbar laminectomy as a method to restore intrathecal access for repeated Nusinersen delivery in this population. Methods: A retrospective review was conducted in eleven patients with SMA who underwent lumbar laminectomy following prior PSF and confirmed radiographic fusion. Surgical data, injection outcomes, and patient-reported experiences were collected. A structured questionnaire assessed technical success, imaging requirements, sedation, functional response, and satisfaction. Results: Nine out of eleven patients (81.8%) successfully initiated intrathecal Nusinersen therapy through the laminectomy window, receiving a mean of 11.7 injections (range: 10–14). Imaging guidance was used in five cases; three required sedation or anesthesia. Intraoperative dural tears occurred in three patients and were managed without complications. Eight out of nine treated patients reported subjective motor improvement and expressed willingness to undergo the procedure again. No hardware revisions or major adverse events were observed during a mean follow-up of 48.8 months. Conclusions: Lumbar laminectomy is a viable and well-tolerated technique to establish intrathecal access in SMA patients with prior PSF. This approach enables sustained drug delivery and may remain clinically relevant as new intrathecal therapies emerge. Full article

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation. Full article

The advancement of medical prognoses hinges on the delivery of timely and reliable assessments. Conventional methods of assessments and diagnosis, often reliant on human expertise, lead to inconsistencies due to professionals’ subjectivity, knowledge, and experience. To address these problems head-on, we harnessed artificial intelligence’s power to introduce a transformative solution. We leveraged convolutional neural networks to engineer our SCOLIONET architecture, which can accurately identify Cobb angle measurements. Empirical testing on our pipeline demonstrated a mean segmentation accuracy of 97.50% (Sorensen–Dice coefficient) and 96.30% (Intersection over Union), indicating the model’s proficiency in outlining vertebrae. The level of quantification accuracy was attributed to the state-of-the-art design of the atrous spatial pyramid pooling to better segment images. We also compared physician’s manual evaluations against our machine driven measurements to validate our approach’s practicality and reliability further. The results were remarkable, with a p-value (t-test) of 0.1713 and an average acceptable deviation of 2.86 degrees, suggesting insignificant difference between the two methods. Our work holds the premise of enabling medical practitioners to expedite scoliosis examination swiftly and consistently in improving and advancing the quality of patient care. Full article

Hemivertebra is a common cause of congenital scoliosis and results from a lack of formation of one-half of the vertebral body. This condition is very rare and can present as solitary or as a syndrome component: i.e., the split notochord syndrome, which often implies vertebral defects, from a bifid vertebra to hemivertebrae, or fused vertebrae. We describe a case of supernumerary lateral hemivertebra detected prenatally at 12 weeks of gestation and the ultrasonography specifics that lead to early and accurate diagnosis, monitoring during pregnancy, and follow-up at the 4-year period. The case is presented to specify the importance of an early assessment of fetal spine and diagnosis of various conditions, including hemivertebrae, considering the significant association with other anomalies (cardiovascular, urinary, skeletal, gastrointestinal, and central nervous systems), which are most commonly involved. Moreover, the need to counsel future parents on the risks implied by this anomaly is important for the obstetrician. We underline the inclusion of these types of congenital conditions in high-risk pregnancy because of the frequent association with high cesarean delivery rates, growth restriction, delivery before term, and higher morbidity rates. Full article