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Dive into the research topics where R B Winter is active.

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Featured researches published by R B Winter.


Journal of Bone and Joint Surgery, American Volume | 1983

The selection of fusion levels in thoracic idiopathic scoliosis.

H A King; John H. Moe; D S Bradford; R B Winter

From the material and data reviewed in our study of 405 patients, it appears that postoperative correction of the thoracic spine approximately equals the correction noted on preoperative side-bending roentgenograms. Selective thoracic fusion can be safely performed on a Type-II curve of less than 80 degrees, but care must be taken to use the vertebra that is neutral and stable so that the lower level of the fusion is centered over the sacrum. The lumbar curve spontaneously corrects to balance the thoracic curve when selective thoracic fusion is performed and the lower level of fusion is properly selected. In Type-III, IV, and V thoracic curves the lower level of fusion should be centered over the sacrum to achieve a balanced, stable spine.


Journal of Bone and Joint Surgery, American Volume | 1979

Management of severe spondylolisthesis in children and adolescents.

D Boxall; D S Bradford; R B Winter; John H. Moe

Forty-three patients with a fifth lumbar-first sacral spondylolisthesis of 50 per cent or greater were reviewed. Four had been treated non-operatively; eleven, by arthrodesis; eighteen, by decompression and arthrodesis; and ten, by reduction and arthrodesis. The angle of slipping (measurement of the kyphotic relationship of the fifth lumbar to the first sacral vertebra) was found to be as important a measurement as the percentage of slipping in measuring instability and progression of slipping. Hamstring tightness did not correlate with neural deficit. Arthrodesis alone, even in the presence of minor neural deficits, tight hamstrings, or both, gave relief of pain and resolution of neural deficits and tight hamstrings. Our experience with a limited number of patients suggests that management by postoperative extension casts may achieve a significant reduction in percentage of slipping and in angle of slipping. Progression of the spondylolisthesis may occur following a solid arthrodesis.


Journal of Bone and Joint Surgery, American Volume | 1972

Avascular Necrosis of the Capital Femoral Epiphysis as a Complication of Closed Reduction of Congenital Dislocation of the Hip: A Critical Review Of Twenty Years' Experience At Gillette Children's Hospital

James R. Gage; R B Winter

In a retrospective study of 154 congenital dislocations of the hip treated by closed reduction with and without preliminary traction at Gillette Hospital during the period January 1, 1948, through December 31, 1967, the incidence of avascular necrosis was analyzed after follow-ups ranging from two to more than nineteen years. There were twenty-seven hips with complete necrosis and twenty-four with partial necrosis. Eight of the normal hips had shown Type-I changes previously described by Salter, Kostuik, and Dallas. An attempt was made to identify the factors responsible for avascular necrosis of the capital femoral epiphysis, either complete or partial. As a result of this study the following conclusions were reached: 1. The older the child is, the more frequent the complication of avascular necrosis, all other factors being equal. 2. There is a direct correlation between inadequate traction and the incidence of avascular necrosis of the femoral head. 3. There is a direct correlation between the Lorenz position and the incidence of avascular necrosis of the femoral head. 4. Avascular necrosis usually results in permanent deformity of the femoral head, but there is a spectrum of deformities which in all likelihood depend on the severity of the vascular insult. 5. A program of adequate traction, gentle reduction, and avoidance of the extreme Lorenz position reduced the incidence of total avascular necrosis from 34.8 per cent during the first five years of the study period to 4.5 per cent in the last five years. The incidence of partial necrosis, on the other hand, remained essentially the same.


Journal of Bone and Joint Surgery, American Volume | 1980

Treatment of idiopathic scoliosis in the Milwaukee brace.

W A Carr; John H. Moe; R B Winter; John E. Lonstein

The results of treatment of idiopathic scoliosis with a Milwaukee brace were studied in 133 patients (127 girls and six boys) whose ages ranged from eight years and five months to sixteen years and two months at the beginning of treatment. These 133 patients had 192 separate curves (119 right thoracic, thirty-nine high lumbar, twelve thoracolumbar, and twenty-two high left thoracic). Of these patients, seventy-four with 109 curves were followed for five years or more after the brace was discontinued (average, eight years; range, five to thirteen years); twenty-nine patients were treated surgically because of a poor response to the brace or progression of the curve; and thirty patients were lost to follow-up. More than 80 per cent of the seventy-four patients followed for five years or more showed some increase of their curves after the brace was discontinued. The average correction at follow-up compared with the original curve was 2 degrees for thoracic curves (range, -18 to 24 degrees) and 4 degrees for the thoracolumbar and lumbar curves (range, -11 to 17 degrees). The brace was more effective for curves of less than 40 degrees. More than one-third of the patients with curves of 40 degrees or more eventually required surgical treatment. Age, curve pattern, and status of the iliac and ring epiphyses did not correlate withe response to brace treatment. The best guideline for prediction of the results of brace treatment was the response of the curve to the brace, especially during the first year of treatment. If the curve is reduced in the brace to less than 50 per cent of its initial measurement, there is a good chance of obtaining significant permanent correction.


Journal of Bone and Joint Surgery, American Volume | 1984

Posterior spinal arthrodesis for congenital scoliosis. An analysis of the cases of two hundred and ninety patients, five to nineteen years old.

R B Winter; John H. Moe; John E. Lonstein

We analyzed the results of posterior arthrodesis of the spine for congenital scoliosis, with or without Harrington instrumentation, in 290 of 323 patients who were operated on between the ages of five and nineteen years and were followed for two years or more. The length of follow-up averaged six years and ranged from two to twenty-eight years. The average curve before surgery was 55 degrees (range, 13 to 155 degrees), the average curve at correction was 38 degrees (range, 5 to 102 degrees), and the average curve at final follow-up was 44 degrees (range, 5 to 103 degrees). Bending of the fusion mass of more than 10 degrees was seen in forty patients; pseudarthrosis, in twenty; and adding-on of vertebrae with an increase in the curve of more than 10 degrees, in seven patients. There were four deaths, only one of them in the last twenty-five years. One was due to intraoperative cardiac arrest; one, to intraoperative overtransfusion; one, to postoperative overtransfusion; and one, to gastrointestinal bleeding eight months postoperatively while the patient was in a Risser jacket. Two patients became paraplegic due to excessive distraction with the Harrington rod, and two others had a partial cranial-nerve lesion due to halo traction. Based on these results, we concluded that posterior arthrodesis of the spine is satisfactory for most patients with congenital scoliosis. The most common problem was bending of the fusion mass in growing children, which occurred in 14 per cent of the patients. Use of Harrington instruments allowed slightly better correction (36 per cent compared with 28 per cent) but was associated with the only cases of paraplegia and infection in the series.


Journal of Bone and Joint Surgery, American Volume | 1981

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

S Swank; John E. Lonstein; John H. Moe; R B Winter; D S Bradford

We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients. The average age of the patients when first seen was 30.7 years. The indications for operation were pain, progression of the curve, magnitude of the curve, and cardiopulmonary symptoms. Preoperative traction, including halo-femoral traction, did not result in increased correction when compared with the initial supine side-bending roentgenogram. A one-stage fusion was performed in 174 patients and multiple-stage procedures, in forty-eight patients. At an average follow-up of 3.6 years the average loss of correction was 6.2 degrees, 68 per cent of the patients were free of pain, and a solid fusion had been obtained in all but six patients. Complications developed in 53 per cent of the patients, the most common problems being pseudarthrosis, urinary tract infection, wound infection, instrumentation problems, a pulmonary disorder, and loss of lumbar lordosis. Paraplegia occurred in one patient. The over-all mortality rate was 1.4 per cent. Complications increased with age, and the highest mortality rate was in patients with congenital scoliosis who had cor pulmonale.


Journal of Bone and Joint Surgery, American Volume | 1979

Spine deformity in neurofibromatosis. A review of one hundred and two patients.

R B Winter; John H. Moe; D S Bradford; John E. Lonstein; C V Pedras; A H Weber

The natural history, associated anomalies, and response to operative and nonoperative treatment were reviewed in 102 patients with neurofibromatosis and spine deformity. Eighty patients were found to have curvatures associated with dystrophic changes in the vertebrae and ribs. The presence of dystrophic changes such as rib penciling, spindling of the transverse processes, vertebral scalloping, severe apical vertebral rotation, foraminal enlargement, and adjacent soft-tissue neurofibromas was found to be highly significant in prognosis and management. Brace treatment of dystrophic curves was unsuccessful. Posterior fusion, with or without internal fixation, was the procedure of choice for problems due purely to scoliosis. Patients with dystrophic kyphoscoliosis required both anterior and posterior fusion to achieve stability. Sixteen patients had compression of the spinal cord or cauda equina.


Journal of Bone and Joint Surgery, American Volume | 1987

Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment.

B Sachs; D S Bradford; R B Winter; John E. Lonstein; John H. Moe; S Willson

From 1960 through 1978, a total of 274 patients who had a diagnosis of Scheuermann kyphosis were treated with a Milwaukee brace at the Twin Cities Scoliosis Center. We analyzed the long-term results in 120 patients who had used the Milwaukee brace and had been followed for at least five years after the completion of treatment. The average age of the patients at the initiation of treatment was twelve years and five months, the average age at the completion of treatment was sixteen years and one month, and the average age at the last follow-up examination was twenty-four years. Of the patients who wore the brace consistently, seventy-six showed improvement in the kyphosis between the initial evaluation and the evaluation at final follow-up, while twenty-four showed worsening and ten were unchanged. Seven of the twenty-four patients who were worse had had surgery before the review for this study. The indication for surgery was a kyphosis of more than 60 degrees that was increasing and was not controlled by the brace. Ten patients were inconsistent in their use of the brace. Two of the ten patients had improvement and eight had worsening of the kyphosis; three of the latter eight had a spinal fusion. This study showed that the Milwaukee brace is usually an effective method of treatment for patients who have Scheuermann kyphosis; however, four of fourteen patients who had an initial kyphosis of more than 74 degrees required a spinal fusion.


Journal of Bone and Joint Surgery, American Volume | 1987

Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.

J A Byrd; P V Scoles; R B Winter; D S Bradford; John E. Lonstein; John H. Moe

Twenty-six adults, ranging in age from nineteen to fifty-eight years old, were treated for idiopathic scoliosis by two-stage anterior and posterior spinal fusion. The goals of the combined procedure were to increase correction of the curve and decrease the rate of pseudarthrosis. Preoperatively, the major curves measured an average of 83 degrees, and on the best side-bend they averaged 59 degrees, a 29 per cent degree of flexibility. At the time of discharge from the hospital the curves had improved to an average of 44 degrees, a correction of the preoperative curve of 39 degrees or 47 per cent. At an average length of follow-up of forty-nine months, the major curves measured an average of 50 degrees, a 41 per cent correction compared with the initial curves. Twenty-three of the major curves were better than when they were measured on the preoperative radiograph of the best side-bend, by an average of 15 degrees, but eight curves were either the same or worse. No patient had pseudarthrosis or permanent neurological injury. It is our conclusion that a two-stage anterior and posterior fusion is of value for the treatment of the adult who has a rigid curve that requires maximum correction to allow the head, shoulders, and torso to be centered over the pelvis. We do not recommend the use of instrumentation for the anterior fusion as this did not increase the correction of the curve in this series of patients.


Journal of Bone and Joint Surgery, American Volume | 1980

The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion.

D S Bradford; K B Ahmed; John H. Moe; R B Winter; John E. Lonstein

Twenty-four patients with Scheuermanns kyphosis underwent correction of the deformity through a combined anterior and posterior spine fusion. All patients had a solid arthrodesis and most were relieved of their preoperative pain. Deformity was improved in all patients. Significant loss of correction did not occur in the fusion area but it did occur below the posterior arthrodesis in five patients.

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John H. Moe

University of Minnesota

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D S Bradford

University of Minnesota

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John E. Lonstein

Letterman Army Medical Center

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Alexander S. Cass

Boston Children's Hospital

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L Lutter

Boston Children's Hospital

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B A Bloom

Boston Children's Hospital

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D A Hanscom

Boston Children's Hospital

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Davitt Felder

Boston Children's Hospital

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G. Dean Macewen

Boston Children's Hospital

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Hoger J. Vitko

Boston Children's Hospital

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