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Year : 2002  |  Volume : 36  |  Issue : 4  |  Page : 262-266

Evaluation and management of complex spinal deformities in developing countries - a critical analysis of 127 operated cases

PD Hinduja National Hospital, Mumbai, India

Correspondence Address:
S Y Bhojraj
Spine Clinic, PD Hinduja National Hospital, Veer Savarkar Marg, Mumbai 400016
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Source of Support: None, Conflict of Interest: None

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Over an 8 years study period, the author had an opportunity to evaluate a large number of patients with complex thoracic and thoracolumbar deformities of varied etiology. Of these 127 were treated surgically [scoliosis: 78 and hyperkyphosis :49]. These deformities were operated for a variety of indications, viz: relentless progression, risk of future neurological deficit, progressive cardiorespiratory compromise, and cosmesis. The various etiologies of these cases, along with their treatment protocols have been analyzed and presented in this paper. Various approaches and implants that we used in the surgery of these patients have also been discussed. A specific protocol for management was devised based on the following variables:
  1. The etiopathology of the deformity and its natural history [viz: idiopathic, congenital, neuromuscular, nerofibromatosis, etc].
  2. The timing of surgery.[emergency, semi- elective, elective, etc],
  3. The appropriate surgical approach [anterior, posterior or combined]
  4. The implant and instrumentation: which implant design would be the ideal one in terms of user friendliness, simplicity of design and affordability,
  5. The fusion: the technique, the mandatory fusion levels, choice of grafts and bone substitutes if any?
  6. The postoperative protocol for mobilization and role of bracing.
  7. The safety factor: surgery for complex spinal deformities although rewarding is extremely "high risk" and could result in unforgiving neurological compromise either transient or permanent. This specific factor needs to be extensively discussed, preoperatively, with the patient and his family in the true context of the risk benefit ratio, before assuming responsibility for its management. Use of pre and intraoperative spinal cord monitoring [somatosensory evoked potentials] has been extremely helpful in this regard.

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