Thomas S. Renshaw

Vertebral Osteophytosis and Dysphagia: TWO CASE REPORTS OF THE SYNDROME RECENTLY TERMED ANKYLOSING HYPEROSTOSIS

Large, painless anterior cervical hyperostoses produced dysphagia and aspiration in this series of two cases. Both patients exhibited ossification of the anterior longitudinal ligament of the spine. The literature pertinent to the arthrogenic causes of dysphagia is reviewed and the pathological anatomy, etiologies of osteophytic conditions, analysis of previously reported cases and a rational diagnostic approach to the problem are discussed. Surgical excision of the offending osteophytes is indicated in those patients who do not respond satisfactorily to conservative therapy.

Screening school children for scoliosis.

Idiopathic scoliosis can be detected by early screening of school children in school clinics, a method which improves the detection rate. By early detection, many curves that would require surgical treatment can be prevented from reaching that severe magnitude. Much valuable data regarding the natural history of idiopathic scoliosis have been derived from screening programs. On the other hand, costs of screening are not inconsequential, and costs involved in follow-up procedures are high. Vast numbers of small, nonprogressive curves are discovered and followed. Several questions remain. (1) At what ages should school children be screened? (2) Should boys be screened? (3) What should be the criteria for referral or treatment? (4) What is a reasonable follow-up program? (5) How effective is nonoperative treatment? Careful study of the natural history and treatment of idiopathic scoliosis will help to answer these questions.

Preliminary traction in the treatment of developmental dislocation of the hip.

The benefit of preliminary traction in the treatment of developmental dislocation of the hip has not been clearly demonstrated. We retrospectively analyzed the results of traction treatment of 90 dislocated hips in 72 patients. After a 3-week course of traction, patients underwent attempted closed reduction. Fifty-two hips (58%) were managed successfully by closed reduction, whereas 38 hips (42%) required primary open reduction, x2 analysis revealed no significant difference in either the rate of successful closed reduction or the incidence of avascular necrosis compared to recently published series in which preliminary traction was not used. On the basis of presentation radiographs and arthrograms, we were unable to identify a subgroup of patients that clearly benefited from the use of traction in the treatment of developmental dislocation of the hip.

The Management of Hallux Valgus in Cerebral Palsy

A review of 11 cerebral‐palsied patients with 14 hallux valgus deformities treated at Newington Childrens Hospital between 1962 and 1977 indicates that traditional principles of bunion management may not be suitable for such patients. The results of 17 surgical procedures on these patients (three McBride soft‐tissue, five Mitchell osteotomy, nine McKeever arthrodeses), followed for an average of 54 months, were compared. The results indicate that solid bony arthrodesis of the metatarso‐phalangeal joint is necessary to prevent recurrence of the deformity. A hypothesis for the pathomechanics of hallux valgus in cerebral palsy is presented.

Studies of an L-rod sublaminar wire spinal fusion

The spine of a 25-year-old man with Duchenne muscular dystrophy was studied postmortem, 8 years after spine fusion with L-rods and sublaminar wires. The fusion was solid. Instrumentation appeared to have had no adverse effects on the spinal cord or meninges or in the epidural space. When wire removal from the spinal canal and fusion mass was studied, increased penetration of the wires into the spinal canal was noted.

The thoracic suspension orthosis.

Five years experience with the thoracic suspension orthosis at Newington Childrens Hospital has shown it to be an effective and very useful adjunct in the management of neuromuscular spinal deformity. The orthosis converts the thorax into a weight-bearing structure, thereby reducing the vertical load on the spine and allowing the abdomen and pelvis to act as a corrective distraction force. Fifty-nine of the 64 patients reported here have successfully used the orthosis to control spinal deformity and improve their functional status. Analysis of these 59 patients and the 5 treatment failures has resulted in identification of the specific indications, prerequisites, techniques, precautions, and contraindications necessary for the achievement of stated treatment objectives, often with dramatic success.