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Orthopaedic complications of lumboperitoneal shunts
J McIvor1, J I Krajbich, H Hoffman
1Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Lumboperitoneal shunts for hydrocephalus can cause lower limb neurologic deficits and spinal deformities due to arachnoiditis. This study reviewed 375 children, finding significant rates of these complications.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Spinal Surgery
Background:
- Lumboperitoneal (LP) shunts are used to treat communicating hydrocephalus.
- Potential complications include neurologic deficits and spinal deformities, often attributed to arachnoiditis.
Purpose of the Study:
- To investigate the incidence of shunt-induced neurologic deficits and spinal deformities in children who underwent LP shunts.
- To analyze the types and prevalence of these complications.
Main Methods:
- Retrospective chart review of 375 pediatric patients who received LP shunts between 1960 and 1981.
- Data collection focused on documented neurologic deficits and spinal deformities.
Main Results:
- 63 out of 375 patients (16.8%) showed evidence of shunt-induced neurologic deficits.
- Common deficits included back pain (34 patients), hamstring tightness (45 patients), and foot deformities (40 patients).
- Spinal deformities such as lumbar hyperlordosis, lordoscoliosis, and scoliosis were observed in 49 patients.
Conclusions:
- LP shunts in children may lead to significant neurologic and spinal complications.
- Arachnoiditis involving the conus medullaris and lower lumbar roots is the suspected cause of these deformities.
Abstract:
Lumboperitoneal (LP) shunts performed for communicating hydrocephalus have been reported to lead to neurologic deficits in the lower limbs and spinal deformities as a result of arachnoiditis. A chart review of 375 children who underwent LP shunts between 1960 and 1981 at The Hospital For Sick Children in Toronto was undertaken. Of the 375 charts reviewed, evidence of shunt-induced neurologic deficits was seen in 63 patients. Thirty-four patients had back pain with or without sciatica, 45 patients had hamstring tightness, and 40 patients had foot deformities. Forty-nine patients had lumbar hyperlordosis, lordoscoliosis, and scoliosis. These deformities are postulated to be the result of arachnoiditis involving the conus medullaris and lower lumbar roots.