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  • ISSN: 2373-9312
    Volume 5, Issue 3
    Research Article
    Oheneba Boachie-Adjei* and KwadwoYankey
    Introduction: Children with severe kyphosis are prone to developing neurologic compromise, poor respiratory function and possible early death. Early identification and surgical intervention has proven to be effective. However they carry the highest surgical risk of all the spine deformities.
    Objectives: To present the surgical results and complications of patients with severe kyphosis treated at the Foundation of Orthopedic and complex Spine (FOCOS) orthopedic hospital in Ghana with a combination of prolonged Halo gravity traction, Vertebral Column resection (VCR) and spinal stabilization.
    Methods: A consecutive series of 20 consecutive pediatric patients with severe kyphotic deformities were treated with Halo gravity traction and Vertebral column resection at a single center. We gathered the following demographic and clinical data: age, gender, BMI, diagnosis, procedure, Intraoperative monitoring (IOM) events, post operative complications.
    Results: 2 groups of 20 patients, 7 Early onset patients under 10 years with congenital kyphosis < 180 degrees (Group 1 N=7) and 13 adolescents patients with Kyphosis exceeding 180 degrees (Group 2 N=13). All the patients were treated with VCR. Group 1 averageage 7.7 +/- 3 years; BMI 17.7 +/- 2.8). Kyphosis averaged 85 degrees (70-150) and improved to 41 post op.(30-100). 50% (n=7) had intra-operative monitoring (IOM) changes that improved with corrective maneuvers and blood pressure elevation. 3 out of 5 patients with proximal junctional kyphosis (PJK) required a re-operation, one of whom also had additional procedure for infection.
    Group 2 patients included Congenita-11patients and Neurofibromatosis -2 patients. Average age: 17.8years; Sagittal deformity average 211deg and corrected to 53deg (74% correction). Intra-op spinal cord monitoring alerts occurred in 8 patients and post operative neurologic deficits occurred in 5 patients (1 permanent paraplegia) and 1 Post op mortality.
    Conclusions: Severe kyphosis ofcongenital or Neurofibromatosis in early onset or adolescents patients can be safely treated with vertebral column resection. Prolonged Halo gravity traction is helpful to obtain partial deformity correction prior to definitive surgery. Surgery provides excellent outcomes but with a high complication rate. Half of these cases had some neuro-monitoring changes that ultimately improved without lasting neurologic deficit. Proximal junctional kyphosiswas the most common complication requiring reoperation among the early onset group of patients.
    Chang Chia-Hui, Shuju Lee, Huahui Chiou, and Ishien Li*
    The results of this study indicate the critical role of parents' emotion-related beliefs in toddlers' development of effortful control (EC). We assessed EC and negative affectivity characteristics of 94 Taiwanese children through their parents' reports on the scales of the Early Childhood Behavior Questionnaire at two different points in time: at 24 and 30 months of age. When the children were 24 months old, we also assessed their parents' emotion-related beliefs through the Parent's Beliefs about Children's Emotions (PBACE) questionnaire. The PBACE predicted the change in EC six months later, controlled for the children's EC and negative affects at 24 months old. Three different aspects of PBACE significantly predicted the development in EC: parental beliefs about the value of /acceptance of children's negative emotions, manipulative nature of the emotions of children, and autonomy of children's emotions (non-supportive meta-emotions). While parental beliefs about the manipulative nature and autonomy of children's emotions decreased the growth of EC, valuing and/or accepting children's negative emotions positively predicted an increase in EC. In seeking to promote young children's development of EC, it is important for parental and care giving educators to point out the importance of supportive emotion-related beliefs, whereas non-supportive meta-emotions may hinder the growth of emotion regulatory capability in early childhood.
    Case Report
    Erica L. McGrath and Ping Wu*
    Zika virus is a flavivirus known to cause microcephaly during development. The mechanism underlying Zika virus-induced neuropathogenesis is still poorly understood. Recent studies have utilized the cutting edge cell culture and animal model technologies to elucidate factors contributing to Zika virus-associated microcephaly. While future work is needed, current studies have suggested three main factors that contribute to Zika virus pathology: viral lineage, host immunity, and pregnancy stages. This mini review will focus on some of the recent findings that advanced our knowledge in Zika virus-associated microcephaly.
    Teddy Ajero* and Daniel Tuckey
    The following case report illustrates the significance of patient history and always having a broad differential diagnosis. A four-year-old boy presented in our clinic with the solitary symptom of intermittent shoulder spasms. The patient's mother described frequent episodes of twitching lasting twenty to thirty seconds and occurring ten times per day, which concerned her for a possible tic disorder. During his examination, the patient had a single episode of the reported dystonia, which was felt to be choreoathetoid in nature. We were suspicious of an atypical presentation of acute rheumatic fever (ARF), and subsequent laboratory findings revealed a mildly elevated Anti-streptolys in O Antibody (ASO) titer. Focused history-taking uncovered that the patient had a febrile illness and a self-limiting rash one month prior to his presentation for which he did not seek care. After consultation with a pediatric infectious disease specialist, Group A Beta-Hemolytic Streptococcus (GABHS) prophylaxis was started, and he was referred to cardiology. His cardiologist performed an echocardiogram which demonstrated mild mitral regurgitation that was felt to be highly unusual for a child his age. He was diagnosed by his cardiologist with mitral valvulitis, and it was recommended that he continue Bicillin intramuscular injections for Streptococcal prophylaxis. The ultimate outcome of this case was the diagnosis of ARF in a patient whose only presentation was Sydenham's chorea. The main take-away from this case was the importance of always considering ARF in a patient who presents with only chorea as his or her primary symptom.
    Oheneba Boachie-Adjei*, Rufai M. Mahmud, and KwadwoYankey
    Introduction: Tuberculosis of the spine and its sequelae constitute a major burden on healthcare systems in the developing world and requires meticulous attention to detail, the appropriate surgical skill and good perioperative support systems to optimize surgical outcomes
    Objectives: To highlight the peculiar challenges associated with managing complex spine deformities arising from post TB infection in the developing world.
    Methodology: A comprehensive review of three pediatric patients with severe post TB kyphosis treated with Posterior vertebral column resection (VCR), fusion and instrumentation. Posterior VCR involves complete resection of a vertebra undertaken from a posterior approach. In the thoracic spine it involves a costo transversectomy, careful dissection of lateral and anterior margins of vertebral body, resection of body of vertebra while providing support for the spinal cord with rods placed across it in pedicle screws. This is followed by laminectomy. The opposing cartilaginous endplates of the vertebral bodies above and below resected vertebra is excised. A structural graft is then placed anterior to the spinal cord. A description of the presentation and treatment protocol was outlined.
    Results: The kyphotic deformities were first subjected to Halo gravity traction in an attempt to decrease the deformity while improving the nutritional status in one severely malnourished patient. A post-operative infection occurred in one patient requiring revision surgery. A second patient had persistent psoas abscess which required a second operation with anterior drainage, debridement and fusion. All three patients have had excellent recovery with fusion two years post op.
    Conclusion: Post TB kyphosis is a common sequela of Tuberculosis of the spine which can lead to paralysis. Surgical intervention requires a complex resection and fusion which can be successfully achieved in the properly selected patient.
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