Gordon C. Robin

Scoliosis in the Elderly: A Follow-up Study

A follow-up x-ray study of 554 subjects aged between 50 and 84 years has been carried out to determine the appearance, presence, and progression of scoliosis in the elderly and its relationship to osteoporosis and back pain. The subjects were chosen from a population group of 3600 subjects examined 7 to 13 years previously in the same laboratory by the same investigators. Some degree of scoliosis was found in 70% of the subjects, and curves of 10° or more in approximately 30%. Ten percent of the subjects had developed scoliosis de novo during the follow-up period. There was no direct relationship between the presence or progression of scoliosis and osteoporosis. There was no direct relationship between scoliosis and back pain or between scoliosis and degenerative changes in the spine. Since scoliosis in the elderly seldom becomes a clinical problem of significance, there would appear to be no valid reason for a more extensive study of the condition at this time.

Studies on spinal and peripheral muscles from patients with scoliosis.

This report describes part of a wider study on muscles from patients with adolescent idiopathic scoliosis. The aim of the study was to clarify if there exists a side-related pathology in the spinal musculature and if extraspinal muscles are abnormal in scoliosis patients. In scoliotic patients, both spinal and peripheral muscles showed frequent abnormalities when examined morphologically and histometrically by light and electron microscopy. Idiopathic scoliosis patients differed from the others. Morphologic pathology seemed worse on the concave side. A mild Type I fiber atrophy occurred in spinal muscles on the concave side and in the deitoids. A generalized tendency towards small myofibers was also noted. The findings suggest that there is a generalized specific neuromuscular disorder causing idiopathic scoliosis.

Eosinophilic Granuloma of the Spine

Twenty patients treated for eosinophilic granuloma of the spine were studied. Only 40% demonstrated the classical radiographic picture of vertebra plana. In 60% a lytic lesion of the vertebral body or the posterior elements was found. Seven patients underwent surgery; the indications were neurological involvement or failure of the biopsy to disclose the diagnosis. At an average follow-up period of 7 years, 17 patients are well and alive with no residual spinal pain, neurological compromise, recurrent disease, or extraskeletal involvement. Vertebral body collapse underwent some regeneration but did not regain full body height. In several patients this resulted in a local deformity. In patients with unifocal spinal eosinophilic granuloma, watchful observation with no treatment other than spinal support is warranted. In patients with neural involvement or multifocal lesions, a more active treatment, including surgery, may be indicated.

Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment.

In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.

Growth rate analysis of lung metastases from histologically benign giant cell tumor of Bone

A growth rate analysis of lung metastaws of benign gaint cell tumor (GCT) Of Bone, Histologically Indistinguishable from the Primary benign tumor, is presented. The doubling time (DT) was 186 days in the first 13 months of growth, and 465 days in the last 4 months. These Dts are much longer than DT of lung metastases of any other tumors, and have a good correlation with a long survival time. Backward extrapolation showed that the lung metastases began to develop years before the primary tumor was diagnosed and treated. If this can be confirmed in a larger number of patients, it could be concluded that there will be no indication for amputation as a treatment for benign GCT whether or not lung metastases are present. The growth rate analysis supports the concept that these metastases might represent a benign process, and as such are a unique histologic and clinical phenomenon.

Equalization of lower limbs by epiphysiodesis: results of treatment.

Equalization of lower limb length was achieved by epiphysiodesis in 20 children. During the period under review the Phemister procedure was replaced by percutaneous epiphysiodesis, and orthoroentgenogram was superseded by computed tomography (CT) scanning. In five children with anisomelia, whose expected discrepancy was 4.5 cm, the results at maturity showed an average discrepancy of 0.7 cm. In 10 girls with limb-length discrepancy (LLD) caused by ischemic necrosis with congenital dislocation of the hip, the average LLD at maturity was 0.6, whereas the expected LLD was 4 cm. In five children with LLD caused by infection, the average discrepancy was 3.8 cm at the time of epiphysiodesis, whereas at maturity it was 0.5 cm. A good result was achieved in 90% of the patients. We recommend the Moseley straight-line graph, CT scanography, and percutaneous epiphysiodesis.

Abnormalities of aggregation, thromboxane A2 synthesis, and 14C serotonin release in platelets of patients with idiopathic scoliosis.

Platelet functions were investigated in 16 patients with idiopathic scoliosis (IS), in seven patients with congenital scoliosis (CS), and in 12 healthy individuals who served as a control group. All were females, aged 11 to 22 years. Platelet aggregation anomalies were observed in all IS patients. These constituted an impaired platelet-release reaction when aggregation was induced with ADP or epinephrine, but not with collagen or arachidonic acid. A decreased thromboxane A2 synthesis and impaired 14C-serotonin release were also observed when platelets were stimulated with ADP or epinephrine. Platelet from CS patients and the controls did not show any functional abnormalities when stimulated with the above four aggregating agents. The platelet function anomaly in IS patients was not associated with prolongation of the bleeding time, spontaneous occurrence of hemorrhagic episodes, or increased bleeding during invasive procedures, including major spinal surgery. The above findings and the recently described platelet structural anomalies in IS may imply that the pathological process operative in idiopathic scoliosis involves not only the axial skeleton, but also cellular blood elements. The similarity between blood platelets and muscle cells, and the anomalies that have been found in both systems in IS, support the notion that a muscle disorder may be involved in the pathogenesis of the disease.

Platelet aggregation abnormalities in idiopathic scoliosis.

Platelet aggregation studies were performed in 22 adolescent girls with idiopathic scoliosis. Impaired ADP-induced platelet aggregation was found in washed platelets of the 22 patients with idiopathic scoliosis when compared with the controls (76.5% of control values; p < 0.01). Furthermore, platelets from patients with progressive curves showed a greater degree of abnormality than platelets from those with nonprogressive curves, e.g., 57.6 ± 22% of control values (p < 0.001). No significant differences in aggregation could be detected when platelets were aggregated with the ionophore A-23187 in either the absence or the presence of calcium. Platelet aggregation studies in patients with other spinal deformities did not differ from the healthy controls. Because platelets share similar contractile proteins as muscles, the present study suggests that a muscle disorder may play an important pathogenic role in idiopathic scoliosis.

Human Facet Cartilage: Swelling and Some Physicochemical Characteristics as a Function of Age: Part 2: Age Changes in Some Biophysical Parameters of Human Facet Joint Cartilage

This study was aimed at investigating, in relating to aging, some of the biochemical and biophysical characteristics of the facet cartilage that determine the functional behavior of this tissue. In addition, facets and discs from the same segment were graded according to their macroscopic appearance. The proportion of severely degenerate discs was low in young subjects and increased with age; by contrast, the proportion of coarsely fibrillated and/or ulcerated facets was high in spines from young adults and remained constant throughout adulthood. Unlike discs, facets do not show an age-related loss of proteoglycans or a consequent decrease in the resistance to a compressive load. However, even in relatively young age groups (30-50 years) a high hydration was observed more often in facet joints than in cartilage from other joints studied. These characteristics are known to accompany damage of the collagen network and cartilage degeneration. Unlike normal femoral head cartilage, facet cartilage does not show a rise in fixed charge density with age. The cartilage from the superior processes (concave) is thicker than that from the inferior processes (convex) and has a higher fixed charge density. At the same time it has a higher water content, which indicates that damage occurs more frequently.

Hydatid Disease of the Spine Causing Paraplegia: The Combined Treatment by Surgical Drainage and Mebendazole: A Case Report

Hydatid disease of the spine is a rare disease with a poor prognosis. Paraplegia is a severe complication and has a low chance for recovery. Surgical drainage and decompression has been the treatment of choice although success was limited. Medical treatment with mebendazole was introduced in 1977 for cystic and alveolar Hydatid disease of the liver. In this paper, a case with Hydatid disease with complete paraplegia is presented. He was treated by combined surgical and medical treatment that included several surgical drainages, decompression, and fusion procedures, accompanied by high dose mebendazole for three years. Recovery from the paraplegia was complete except for the persistence of a neurogenic bladder. Neither clinical nor laboratory evidence of activity of the disease existed after six years of follow-up. This case must encourage further clinical trials in such cases, combining surgical treatment with mebendazole.