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Duke orthopaedics presents wheeless' textbook of orthopaedics site map search site by word home advertising info editorial board contact us my account orthopaedic manifestations of myelomeningocele - discussion of myelodysplasia - spinal deformities:     - vertebral column development:     - scoliotic & kyphosis in myelomeningocele may be either congenital or paralytic, or combination of both;     - scoliosis in myelomenigocele:     - kyphosis in myelomenigocele:          - need to distinguish between 2 distinct types of kyphosis both of which are centered over mid lumbar segment;                - c shaped curve w/o rigid segment;                - more progressive s shape curve w/ rigid kyphosis which often has vertebral anomalies;          - pts less than 1 yr of age w/ a curve less than 90 deg can be expected to progress 8 deg / yr;          - pts older than 1 yr w/ curves greater than 90 deg may progress 13 deg / yr;          - radiographs:                - need to measure cobb angle on lateral radiographs;                - need to measure distance of kyphosis from line connecting c1 to s1;          - indications for treatment: (resection of kyphotic segment);                - increasing spinal deformity;                - respiratory deformity or crowding of abdominal contents;                - failure of skin ulcerations to heal;          - treatment:                - surgery should be delayed as long as possible inorder to delay recurrence;                - patent shunt is essential to prevent acute hydrocephalus, which can result from spinal sac excision usually necessary with kyphectomy;                - resection of kyphosis w/ local fusion or fusion to pelvis may be required;                - kyphectomy for severe congenital kyphosis in pts with thoracic-level myelomeningocele is indicated for sitting imbalance or w/ skin problems occur over the apex;                - cordotomy:                        - in the report by lalonde f and jarvis j (1999), the authors performed a cordotomy as a part of spinal correction in myelomeningocele patients at an avg age of 9 years;                               - cordotomy was performed at or below the level of the kyphosis;            . Viagra uk paypal buy viagra without prescription viagra canada prescription pfizer viagra buy online no prescription side effects of viagra and grapefruit juice cheap viagra pills for sale generic viagra online without prescription generic viagra online http://medicaresupplementspecialists.com/pfz-cheap-viagra-no-prescription-sy/ pfizer viagra buy online no prescription cheap viagra yahoo mail viagra spam viagra uk reviews extra cheap viagra pfizer viagra buy online no prescription Memoirs viagra salesman cheap viagra online viagra o viagra mejor buy viagra in usa online Buy online viagra review viagra super active vs regular viagra buy viagra online

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