Risk Factors ID’d for Massive Blood Loss in Scoliosis Surgery

For patients undergoing scoliosis surgery, the risk of massive blood loss is increased with preoperative Cobb angles bigger than 50 degrees and for those undergoing osteotomy or fusion of more than six levels, according to a study published in the Feb. 15 issue of Spine.
 

 For patients undergoing scoliosis surgery, the risk of massive blood loss is increased with preoperative Cobb angles bigger than 50 degrees and for those undergoing osteotomy or fusion of more than six levels, according to a study published in the Feb. 15 issue of Spine.

  

Include pre-op Cobb angle larger than 50 degrees, osteotomy, or fusion of more than six levels 




Xuerong Yu, M.D., from Peking Union Medical College Hospital in Beijing, and colleagues retrospectively analyzed data from patients undergoing scoliosis surgery, from June 1, 2011 to Oct. 31, 2011, based on their classification as having lost more than 30 percent of estimated blood volume (group A; 95 patients) and those who lost 30 percent or less of their blood volume (group B; 64 patients). Total blood loss was defined as the sum of intraoperative and postoperative estimated blood loss.

The researchers found that 59.7 percent of the patients had massive blood loss. There were significant differences between the groups with patients in group A shorter, with larger preoperative Cobb angles, more levels fused, and more osteotomies than patients in group B. Independent risk factors for massive blood loss included preoperative Cobb angle of more than 50 degrees (odds ratio [OR], 2.47), more than six levels fused (OR, 3.70), and osteotomy (OR, 4.64).
"In conclusion, patients with preoperative Cobb angle larger than 50 degrees or patients planning to undergo osteotomy or fusion of more than six levels have an increased risk of massive blood loss," write the authors. "This may contribute to an improved use of blood conservation strategy."

Source : Doctors Lounge ( 8th march 2013 )

Shalimar boy undergoes two surgeries to fix scoliosis

 

Tanner Dubose had to wear a halo before the first of his two surgeries. 

The first time Bill Dubose remembers his son Tanner showing him a lump on the left shoulder blade was about three years ago.
It wasn’t hurting his then 9-year-old son or keeping him from doing anything, so Dubose suggested they watch it and bring it up at his next doctor’s visit.
Just in the last six months the lump quickly worsened into life-threatening scoliosis. Tanner had a 127-degree curve in his spine that endangered his heart and lungs.
When a local doctor deemed Tanner’s case too severe for him to fix, his family in Shalimar began looking elsewhere.
“It crossed his mind that maybe no one could do anything,” Dubose said from Shriners Hospitals for Children in St. Louis, where Tanner has undergone two surgeries to straighten his spine. “I was devastated inside.”
Dubose and now 11-year-old Tanner have been at the hospital since January.
His first surgery Feb. 28 was the preparation for the second, more complicated one, Dubose said.
During the second surgery Thursday, part of Tanner’s vertebrae was removed and rods and plates were attached to the rest of his spine. Surgery on scoliosis as severe as Tanner’s is rare, so it was watched by more than 100 doctors through a live feed to an auditorium.
In six months to a year, Tanner’s spine and the equipment will fuse together. For now, Tanner won’t be able to lift more than 5 pounds for about a month.
“He’s going to get proficient in video games and homework,” his father joked.
Tanner will get a souvenir, however.
He’s taking home his “halo,” a horseshoe shaped piece of metal that was screwed to his skull for about two months before the surgeries. Weights were attached to the halo through a pulley system to help start straightening his spine and prepare him for the operations.
The only time Tanner went without the halo and weights was when he took a shower. Tanner’s always been a good sleeper, Dubose said, so only some extra fluffy pillows were needed.
“I think he’s grown a few inches,” Dubose said. “I think he has gotten straighter and not hunched over as much.”
Tanner said the halo hurt for about the first week, but then it became normal.
“I hardly noticed it,” he said.
Tanner walked on the treadmill for 30 minutes with the halo weights two times a day, five days a week before the surgeries. His perseverance inspired his father to work on his own health.
“If my son, who’s in this condition, can do this, I can do it,” Dubose said.
Tanner is taking it all in stride. In some ways, he is older than his 11 years, his father said.
“He likes normal kid stuff, but he also wakes up to watch The Weather Channel to learn how to prepare for that day,” he said.
Tanner was nervous when he first learned about the upcoming surgeries. And it’s been hard to be in St. Louis without his mom and three sisters, he said.
There is no timetable for him and his father to come home.
When Tanner does return, “I’ll go visit my friends and spend time with my family. Just do whatever I did before,” he said.


Source : nwf daily news 

Rare Kyphoscoliosis spine surgery performed in Tirupur

The Tirupur-based Revathi Medical Centre has claimed to have performed a rare surgery to correct Kyphoscoliosis, an abnormal curvature of the spine, on a 23-year-old woman M.Manimeghalai who hails from The Nilgiris district. 

The surgery that lasted 12 hours was performed by spine surgery team comprising Gurusamy Nachimuthu, K. Dhanasekar, R. Raja and R. Eswaramurthi. 

Mr. Eswaramurthi, managing director of Revathi Medical Centre, told reporters that the deformity to the spine of the girl was found progressing over the period and she had severe pain that restricted her movements.

“She has been admitted to the hospital with twisted spine, short trunk and early myelopathy (ie nerve dysfunctions),” he said. The surgery was performed only after briefing the patient as well as her parents of the risks in the surgery like its long duration, possibilities of paralysis and massive blood loss.

Post surgery, the spine curvature of the girl has returned to near normal range. The patient, according to the hospital sources, can return to normal activities after six months. 

“If patient has come at an earlier stage, the magnitude of the surgery could have been much lesser,” Dr. Eswaramurthi said. 

Source : The Hindu , Tirupur , 7th March 2013 

School girl with the 'worst spinal curvature' doctors had ever seen can do the splits again after 11-hour operation

Emily Crosby, 13, had one of the worst cases of scoliosis doctors had seen

Her lungs were being crushed by her ribs and risked being punctured

Had an 11-hour operation in which a titanium rod was fitted to her spine

A teenage girl is celebrating after undergoing an 11-hour operation to correct a snake-like double curve in her spine.

Emily Crosby's spine curved at a 90 degree angle at the top before twisting 50 degrees in the opposite direction further down - sticking out like a ‘shark's fin’ when she bent forward.

The 13-year-old's dance teacher initially spotted that her back was misaligned in January last year. Her mother Jackie took Emily to a walk-in clinic who referred them to the James Cook Hospital.

Here doctors diagnosed her with one of the worst cases of scoliosis - or curvature of the spine - they had ever seen. 

Emily trains with her local dance academy 

 

efore her operation, Emily's spine had a double curve (left). She underwent an 11 hour operation to fit a titanium rod to her spine (right)

It was so curved that her lungs became crammed in between her ribs and if doctors hadn't discovered the condition, the teenager's lungs could have been punctured. The schoolgirl underwent surgery in June to have a titanium rod inserted into her back to straighten the bones.

Emily’s mother, Jackie, 45, said: ‘She went down to surgery at 7am and she didn't get back until 7.45pm.
‘I am in awe of them and I can't praise them enough.

At one point during the extensive operation, surgeons were forced to stop after a machine monitoring Emily's progress delivered a reading of paralysis - but thankfully it was a false alarm.
The mother-of-three from Seaton Carew, near Hartlepool, Cleveland, said:  ‘They had to pick me off the floor when they told me.

‘It was awful. We thought the doctor was showing us an X-ray of the worst case scenario but it was actually my daughter's spine on the screen. 



Before the operation (left) Emily's ribs were crushing her lungs. Now (right) she has recovered sufficiently to take part in a netball tournament in Italy

We thought we were just going in for an initial check but the doctor had already booked the operation in.

‘I cried a lot. Emily is very fit and active so we never knew anything was wrong, she never felt any pain.

‘But when we got to the hospital and the doctor asked her to bend forward I just couldn't believe what I was seeing.

Emily Crosby (right, pictured with her mother, left) underwent an 11 hour operation to straighten her spine

‘Her spine was sticking out like a shark's fin. I was so nervous when she went into theatre.

‘It sounds awful to say, but one slip of the knife and she's paralysed. That's all it takes.’

But just days after the operation last June, Emily was recovering well and was even doing the splits two weeks later.

Emily is now back to full fitness and is taking part in a netball tournament in Italy at the end of the month.

She has just finished a stint performing in a pantomime and also trains with the Seaton Academy of Dance.

Mrs Crosby, who is also mother to Alex, 11, and Jack, nine, said: ‘We are so proud of her. She is so positive.’

She added: ‘Even though her operation was serious, she was determined to show other children with the same condition that you can still be active and enjoy life.’

Mrs Crosby is so proud of her daughter she has nominated her for a Pride of Hartlepool award.

She said: ‘She has made a tremendous recovery and is an inspiration to her family and friends. She has so much determination.’


Source : DailyMail ( 28th Feb 2013 ) 

Hope Against Hope !

     My Major  Spine surgery done in Jan 2012 at Manipal Hospital, Bangalore  under the supervision of one of the expert spinal surgeon in India ' Dr VidhayaDhara S' , who not only a Good Surgeon but also a very good human being too  and he was the only person who gave me confidence and  suggested to go for this surgery without any fear as surgery was the only hope in front of me as i was completely on the last stage of life .

This miracle surgery detail now published at Bangalore Manipal Hospital Weekly Magazine this week and i am uploading the same  article on it   !!

Note : Be Remember ! Scoliosis  is Mostly Idiopathic with no Pain  and affect females more in comparsion to male  . When you notice  any unnatural curve in the spine , Unbalance Shoulder or Hips , then  do Approach  to the Scoliois  Expert  !

Life is the Name of fight

!!! So Fight and Love yourself till Your Last Breathe !!!!!


My Pain is Mine ,
My Love is Divine ,
I can roam , I Can run ,
Does'nt matter , if I have bend spine ,
My Limbs are weak but grips are strong ,
My Motto is clear , to bring sunshine ,
I laugh in pain , and challenging hurdles ,
I find solutions , whether difficulties are Nine ,
Fighting from life , fighting for breathing
Fighting for dignity , fighting from illness,
Its my Luck , what god written for me ,
Accepting happily , Without regret
When Seeing in the sky , listening slow sound as God Saying !
That Day will come , when You will recover from All such !!!!
Just Believe on me , and Be happy forever !!
And Do the things , On Your terms and Conditions !!
Nothing will go Wrong !!!

With Regards :
Mohd Faisal Nawaz

   

Bokaro General Hospital introduces modern treatment for spinal ailments

Bokaro General Hospital has introduced an advance treatment for those suffering from spinal problems.
A team of doctors in the neurosurgery department of Bokaro General Hospital (BGH) performed vertebroplasty a few months ago for the first time on a 58-year-old woman, Noor Jahan, who was suffering from osteoporosis, after medical treatment yielded no result. "She is leading a normal life now," said BGH sources.

Vertebroplasty is a modern treatment for vertebral compression fractures which are not responsive to conventional medicines. Doctors say it is one of the minimal invasive procedures to correct deformity of spinal cords.

Anand Kumar, the neurosurgeon who led the team that performed vertebroplasty, said they went for intensive diagnosis after medicines failed to pacify Noor Jahan's pain. "Spinal cord is a vital part (of the body) and damage of any form may lead to complete paralysis for life," he said.

The woman was diagnosed with osteoporosis of spinal cord, caused by calcium deficiency. Aatin Jaiswal, an orthopaedist, and Kumar then consulted doctors in the radiology department where senior consultants Y P Bhattacharya and Vipin Pathak conducted advance MRI and spotted the weak bone.

While explaining the procedure, Kumar said unlike other surgeries which are done in operation theatres, vertebroplasty can be performed in the radiology room under fluoroscopy, an advance X-ray technique.
Every month, over 30 patients with spinal ailments visit BGH. The 910-bed hospital is the only facility in the district to have the modern equipment for vertebroplasty.

By this operative procedure a lot of patients of spinal fractures due to disease or trauma, patients of old age with spinal collapse and patients of end stage cancer with severe pain due to spinal causes will be benefited.
However, analyzing all the factors he alongwith his team which includes doctor Sushil and others decided to go for vertebroplasty to cure the patient. Unlike other operations which are performed in Operation Theatre, they performed this surgery in Digital Subtraction Angiography (DSA) room of Radiology Department under fluoroscopy guidance. Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures through fluoroscope.

What is vertebroplasty?

Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the US in 1994.
In this surgery, doctors make a tiny hole (about tip of a pen) on backbone from where bone cement is injected through a needle between the spaces of the damaged bone of the cord. Which gradually solidifies and takes normal shape of the bone and thus pain is reduced. It needs immense concentration and perfection.



Source : TOI , Ranchi  ( 23rd Feb 2013 ) 

Researchers Present Polyethylene/Carbon Scoliosis Brace

Researchers from France have developed a carbon bracing system for patients with scoliosis that has high compliance rates and reduces the impact on vital capacity (VC)—the maximum amount of air a percent can expel from the lungs after a maximum inhalation—which researchers deem is a quality-of-life improvement over the more familiar and more rigid Lyon brace. They also said the carbon brace can be used at a very young age without disrupting the chest growth, but should be kept for reducible scoliosis in older teenagers, whereas the Lyon brace treatment can only be started around puberty. The Corset Monocoque Carbone respectant la Respiration (CMCR), which translates as “monoshell carbon brace respecting breathing,” treats progressive thoracic, thoracolumbar, or combined scoliosis.




The brace was presented online February 14 in the journal Scoliosis. The article includes, among other things, summaries of prior studies, a description of the brace; theoretical principles; how to prescribe, build, and fit the brace; and protocols.
The CMCR monoshell is made of polyethylene and reinforced with prestressed carbon fiber braids that create support forces on the system of adjustable and mobile brace pads. This support keeps some mobility during movements, especially in respiratory ones, while also providing a permanent pressure, which varies depending on ribs and spine movements. In contrast, the Lyon brace is made of plexidur, a thermoplastic, and structured with metal reinforcements and adjustable but fixed localized support pads.
Summaries of the CMCR usage studies follow: In the first retrospective study of 115 patients, French-published in the Annals of Physical Medicine and Rehabilitation (2005), the CMCR brace stabilized moderate scoliosis, decreased the VC of 13 percent compared to the VC without the brace, and did not have sufficient impact on the hump reduction. Treatment had better results when started at Risser 3 or 4 than Risser 0, 1, or 2. The brace was then modified to increase the dorsal pad pressure and the location of correction forces was defined more precisely through the use of three-dimensional (3D) analysis. The second study, published in Scoliosis (2011), mainly focused on the impact on VC at brace setup and followed a cohort of 90 patients treated with the CMCR. Girls as well as boys increased VC during treatment, and at brace definitive removal, VC had increased 21 percent from the initial value, whereas the theoretical VC at the same time rose by 18 percent.
The researchers offered the CMCR as an alternative to rigid braces and concluded that the CMCR brace is innovative for, among other reasons, the materials used prevent chest movements while preserving respiratory capacity during brace usage, the mobile pads used to gradually correct scoliosis conform to stiffness areas that will appear throughout patient growth, and the orthosis is designed to partly maintain spine and chest mobility.


Source : OandP ( 21st feb 2013 )