Related Experiment Videos
The lumbar theco-peritoneal shunt syndrome and its surgical management
Insights
Children treated for hydrocephalus with a theco-peritoneal shunt developed a severe orthopedic syndrome. This included progressive lumbar hyperlordosis, impacting gait and requiring surgical correction in some cases.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pediatric Neurology
Background:
- Idiopathic communicating hydrocephalus in infancy is often treated with theco-peritoneal shunts.
- Long-term complications of such treatments can include orthopedic syndromes.
- A characteristic syndrome involving spinal deformity has been noted in patients post-shunt.
Purpose of the Study:
- To describe the orthopedic syndrome associated with lumbar theco-peritoneal shunts for hydrocephalus.
- To detail the surgical correction methods for severe lumbar hyperlordosis in these patients.
- To report the outcomes of surgical intervention for this specific complication.
Main Methods:
- Case series of seven patients treated with lumbar theco-peritoneal shunts for hydrocephalus.
- Clinical assessment of orthopedic features including spinal curvature, straight leg raising, stance, and gait.
- Surgical intervention for severe hyperlordosis using a three-stage procedure: anterior osteotomy, 90-90 femoral traction, and posterior fusion with Harrington instrumentation.
Main Results:
- All seven patients presented with a characteristic orthopedic syndrome.
- This syndrome included severe, rigid, progressive lumbar hyperlordosis, restricted straight leg raising, and gait abnormalities.
- Four patients with curves >90 degrees underwent corrective surgery with good results and few complications.
Conclusions:
- Lumbar theco-peritoneal shunts for hydrocephalus can lead to a distinct orthopedic syndrome in childhood.
- Severe lumbar hyperlordosis is a significant complication requiring surgical correction.
- A multi-stage surgical approach offers effective correction for extreme spinal deformity with favorable outcomes.
Abstract:
Seven patients treated in infancy by a lumbar theco-peritoneal shunt for idiopathic communicating hydrocephalus presented later in childhood after developing a characteristic orthopaedic syndrome. This included a severe, rigid and progressive lumbar hyperlordosis, severe bilateral restriction of straight leg raising and abnormalities of stance and gait. Four of the patients, who had severe hyperlordotic curves of over 90 degrees, required operations to correct their extreme deformity. The recommended method of correction is a three-stage procedure: first, anterior wedge resection osteotomies at several levels in the lumbar spine, then a period of "90-90" femoral traction, and finally a posterior fusion and stabilisation using Harrington instrumentation. The results were good, with few complications.