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RISS 인기검색어
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- 저자 : Kanna Rishi Mukesh (검색결과 2 건)
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Shanmugasundaram Sivaraj,Viswanathan Vibhu Krishnan,Shetty Ajoy Prasad,Rai Nimish,Hajare Swapnil,Kanna Rishi Mukesh,Rajasekaran Shanmuganathan 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.1
Study Design: Retrospective cohort.Purpose: The current study was planned to evaluate deformity characteristics, assess relationship between morphology of syrinx/Arnold Chiari malformation (ACM) and deformity, analyze effect of posterior fossa decompression (PFD), and evaluate outcome.Overview of Literature: Scoliosis in ACM-I and syringomyelia (SM) is uncommon, and deformity characteristics differ from those seen in idiopathic scoliosis.Methods: Data regarding patients, who underwent PFD for ACM-I presenting with SM and scoliosis between January 2009 and December 2018, were retrospectively collected. Only patients with 2-year follow-up were included. Sagittal/coronal deformity and sagittal spinopelvic parameters were examined. Symmetry and extent of tonsillar descent, as well as morphology (configuration/variation) and extent of syrinx were determined.Results: A total of 42 patients (20 females; age: 14.2±5.8 years) were included; 35 patients (83.3%) had atypical curves. Mean preoperative coronal Cobb was 57.7°±20.9°; and 12 (28.6%) had significant coronal imbalance. Tonsillar descent was classified as grade 1, 2, and 3 in 16 (38.1%), 11 (26.2%), and 15 (35.7%) patients; 35 patients (83.3%) had asymmetric tonsillar descent; 17 (40.4%), 3 (7.1%), 16 (38.1%), and 6 (14.4%) had circumscribed, moniliform, dilated, and slender syrinx patterns; and 9 (21.4%), 12 (28.6%), and 21 (50%) of syrinx were right-sided, left-sided, and centric. There was no significant relationship between side of tonsillar dominance (<i>p</i> =0.31), grade of descent (<i>p</i> =0.30), and convexity of deformity. There was significant association between side of syrinx and convexity of scoliosis (<i>p</i> =0.01). PFD was performed in all, and deformity correction was performed in 23 patients. In curves ≤40°, PFD alone could stabilize scoliosis progression (<i>p</i> =0.02). There was significant reduction in syrinx/cord ratio following PFD (<i>p</i> <0.001).Conclusions: ACM-I+SM patients had atypical curve patterns in 83% of cases, and the side of syrinx deviation correlates with scoliosis convexity. Syrinx shrinks significantly following PFD. PFD may not stabilize scoliosis in curves >40°.
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Ajoy Prasad Shetty,Rajesh Rajavelu,Vibhu Krishnan Viswanathan,Kota Watanabe,Harvinder Singh Chhabra,Rishi Mukesh Kanna,Jason Pui Yin Cheung,Yong Hai,Mun Keong Kwan,Gabriel Liu,Gabriel Liu,Saumajit Bas 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4
Study Design: Multicenter validation study.Purpose: To evaluate the inter-rater reliability of Rajasekaran’s kyphosis classification through a multicenter validation study.Overview of Literature: The classification of kyphosis, developed by Rajasekaran, incorporates factors related to curve characteristics, including column deficiency, disc mobility, curve magnitude, and osteotomy requirements. Although the classification offers significant benefits in determining prognosis and management decisions, it has not been subjected to multicenter validation.Methods: A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations.Results: The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte’s (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6).Conclusions: Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.
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