The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial.

BACKGROUND: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. METHODS: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. RESULTS: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. CONCLUSION: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. TRIAL REGISTRATION: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018. LEVEL OF EVIDENCE: Therapeutic Level I.

The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting.

BACKGROUND: Recent studies suggest that routine postoperative laboratory tests are not necessary after primary elective total hip arthroplasty (THA). This study aims to evaluate the utility of routine postoperative laboratory tests in patients undergoing THA for hip fracture in a semi-urgent clinical setting. MATERIALS AND METHODS: This retrospective study included 213 consecutive patients who underwent primary unilateral THA for hip fractures. Patient demographics, clinical information, and laboratory tests were obtained from the electronic medical record system. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory test-related interventions. RESULTS: A total of 207 patients (97.18%) had abnormal postoperative laboratory results, which were mainly due to anemia (190/213, 89.20%) and hypoalbuminemia (154/213, 72.30%). Overall, 54 patients (25.35%) underwent a clinical intervention, 18 patients received blood transfusion, and 42 patients received albumin supplementation. Factors associated with blood transfusion were long operative time and low preoperative hemoglobin levels. Factors associated with albumin supplementation were long operative time and low preoperative albumin levels. Of the 33 patients with abnormal postoperative creatinine levels, 7 patients underwent a clinical intervention. For electrolyte abnormalities, sodium supplementation was not given for hyponatremia, three patients received potassium supplementation, and one patient received calcium supplementation. CONCLUSIONS: This study demonstrated a high incidence of abnormal postoperative laboratory tests and a significant clinical intervention rate in patients who underwent THA for hip fracture in a semi-urgent clinical setting, which indicates that routine laboratory tests after THA for hip fracture are still necessary for patients with certain risk factors. LEVEL OF EVIDENCE: Level III. Trial registration Clinical trial registry number ChiCTR1900020690.

Correlation between severity of adolescent idiopathic scoliosis and pulmonary artery systolic pressure: a study of 338 patients.

PURPOSE: Study of patients with adolescent idiopathic scoliosis. OBJECTIVE: To examine the correlation between pulmonary arterial pressure and coronal Cobb angle of idiopathic scoliosis. METHODS: A total of 338 patients (82.8 % female) with idiopathic scoliosis (average age 15.6 years; range 14-20 years) were included. Preoperatively, the coronal Cobb angle of curvature and the apex location and direction were determined from radiographic records. Tricuspid regurgitation velocity (TRV) and inferior vena cava diameter were also measured using Doppler echocardiography. Pulmonary arterial systolic pressure (sPAP) was calculated from the TRV according to the modified Bernoulli equation and correlations between sPAP and the features of scoliosis were identified by statistical analysis. RESULTS: Among the 338 patients, there were 305 thoracic curves, 276 (90.5 %) of which were right curves, and 265 thoracolumbar/lumbar curves. sPAP varied from 5.0 to 37.6 mmHg. Pulmonary hypertension could not be excluded in the case of one patient. A mild correlation (Spearman test, correlation coefficient = 0.187, P = 0.001) between sPAP and coronal Cobb angle of the main thoracic (MT) curves was identified. Correlations between sPAP and the degree of other curves were not significant. Patients with sPAP >20 mmHg also had larger thoracic curve angles (mean MT 42.16° vs. 52.45°; U test, P = 0.002). There were no differences in sPAP levels between patients with right and left thoracic curves. CONCLUSIONS: A mild positive correlation was identified between sPAP and the coronal Cobb angle of the MT curves. There was no relationship between sPAP and the direction of the curvature.

The effect of growing Rod treatment on coronal balance during serial lengthening surgeries in early onset scoliosis.

BACKGROUND: Gaining and maintaining spinal balance after surgery is of great importance for early onset scoliosis (EOS). However, tendency of balance on the coronal plane after growing rod surgery has not been studied before. This study evaluated the effect of growing rod treatment on coronal balance (CB) during serial lengthening surgeries in EOS. METHODS: All EOS patients treated with growing rod technique in our hospital from August 2002 to June 2014 were retrospectively reviewed. Radiographic data before the sixth lengthening surgery were measured on the posteroanterior X-ray images, including global CB (C7 plumbline-central sacral vertical line, C7PL-CSVL), regional CB (apical vertebrae-CSVL), Cobb angle of the main curve and pelvic inlet width (PIW). Global CB index and regional CB index were calculated as dividing global CB and regional CB by PIW, respectively. The changes of these parameters during repeated lengthening surgeries were analyzed. RESULTS: Five hundred seventy Radiographs of 67 patients, including 134 images before and after growing rod insertion surgeries and 436 images pre- and post-lengthening surgeries were measured. Global CB and global CB index did not show significant differences between every two set points during lengthening procedures (P > 0.05). The percentage of patients with C7PL-CSVL distance more than 20 mm roughly ranged from 30 to 45 % during the lengthening process. With regards to regional CB and main curve Cobb angles, there were significant differences between every two adjacent set points during the first five lengthening surgeries (P < 0.05). CONCLUSIONS: Global CB did not significantly change during serial lengthening surgeries and C7PL-CSVL distances of greater than 20 mm comprised of over one third of patients during growing rod treatment. However, worsening regional CB and Cobb angles of the main curve during lengthening intervals were corrected by lengthening manipulation and maintained at a stable level.

Dual growing rod treatment in early onset scoliosis: the effect of repeated lengthening surgeries on thoracic growth and dimensions.

PURPOSE: To investigate changes in thoracic dimensions (TDs) following repeated lengthening surgeries after dual growing rod treatment of early onset scoliosis and thereby its effect on thoracic growth. METHODS: All EOS patients treated with dual growing rod technique in Peking Union Medical College Hospital from June 2004 to June 2014 were retrospectively reviewed. Thoracic spine height (T1-T12), total spine height (T1-S1), maximal coronal chest width and pelvic inlet width (PIW) were measured on the posteroanterior X-ray images after initial growing rod insertion surgery and after each lengthening surgery. Absolute TDs measurements were normalized by PIW. Changes of absolute and normalized TDs measurements with age and number of lengthening surgeries were analyzed. RESULTS: Radiographs of 229 surgeries of 53 EOS patients were measured, including 49 images after initial growing rod insertion surgery and 180 images of lengthening surgeries. Significant positive correlations between age and all three absolute TDs were found (P < 0.01) whereas significant negative correlations between age and all three normalized TDs (P < 0.01) were identified. Similarly, negative correlations were also identified between number of lengthening surgeries and the three normalized TDs (P < 0.01). Significant differences of normalized TDs were identified between initial surgery and the first lengthening through covariance analysis (P < 0.01). Yet, such differences were seldom seen between every two adjacent lengthening surgeries. CONCLUSIONS: Growing rod technique could maintain TDs growth through repeated lengthening procedures but the growth rate was compromised as the number of lengthening procedures increased.

Surgical treatment of tumor-induced osteomalacia: a retrospective review of 40 cases with extremity tumors.

BACKGROUND: Tumor-induced osteomalacia (TIO) is a rare syndrome typically caused by mesenchymal tumors. It has been shown that complete tumor resection may be curative. However, to our knowledge, there has been no report of a large cohort to exam different surgical approaches. This study was aimed to assess outcomes of different surgical options of patients with tumor-induced osteomalacia at a single institution. METHODS: Patients with extremity tumors treated in our hospital from January, 2004 to July, 2012 were identified. The minimum follow-up period was 12 months. Patient's demography, tumor location, preoperative preparation, type of surgeries were summarized, and clinical outcomes were recorded. Successful treatment was defined as significant symptom improvement, normal serum phosphorus and significant improvement or normalization of bone mineral density at the last follow-up. Differences between patients with soft tissue tumors and bone tumors were compared. RESULTS: There were 40 (24 male and 16 female) patients identified, with an average age of 44 years. The tumors were isolated in either soft tissue (25 patients) or bone (12 patients) and combined soft tissue and bone invasion was observed in 3 patients. For the primary surgery, tumor resection and tumor curettage were performed. After initial surgical treatment, six patients then received a second surgery. Four patients were found to have malignant tumors base on histopathology. With a minimum follow-up period of 12 months, 80% of patients (32/40) were treated successfully, including 50% of patients (2/4) with malignant tumors. Compared to patients with bone tumor, surgical results were better in patient with soft tissue tumor. CONCLUSIONS: Surgical treatment was an effective way for TIO. Other than tumor curettage surgery, tumor resection is the preferred options for these tumors.

Reliability of a novel Cobb protractor for measuring the Cobb angle of radiograph in scoliosis.

OBJECTIVE: To introduce a novel Cobb protractor and assess its reliability and rapidity for measuring Cobb angle in scoliosis patients. METHODS: The novel Cobb protractor had two endplate markers. A measurement was performed just to align the two markers to each endplate of the curve. The Cobb angle on the posteroanterior radiographs of 24 patients clinically diagnosed with adolescent idiopathic scoliosis was measured by three orthopedic surgeons with both standard Cobb method and the new technique, and the time of measurement was recorded. Intraclass correlation coefficients (ICCs) were calculated to assess the reliability of the new method. RESULTS: The time for a measurement with the new tool was approximately 10 seconds less than the time that used to finish a measurement with the standard method (P<0.05). The overall mean Cobb angle for the major curve of the 24 patients was 47.8°. The mean overall intraobserver and interobserver ICC was 0.971 and 0.971 for the Cobb method group, while the overall intraobserver ICC and the interobserver was 0.985 and 0.979 for the new tool group. CONCLUSIONS: The novel Cobb protractor could perform quick measurement and measure almost all forms of radiographs. The Cobb protractor might be an ideal instrument to measure the Cobb angle.

Meta-analysis of circumferential fusion versus posterolateral fusion in lumbar spondylolisthesis.

STUDY DESIGN: Literature review and meta-analysis. SUMMARY OF BACKGROUND DATA: Posterolateral fusion (PLF) and circumferential fusion (CF) were widely used in the treatment of lumbar spondylolisthesis. There was a great controversy over the preferred fusion method. OBJECTIVE: We performed a meta-analysis for determining which fusion method was better in lumbar spondylolisthesis. METHODS: A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library from January 1960 to December 2013. Comparative studies were selected according to eligibility criteria. Weighed mean differences (WMDs) and risk differences were calculated. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group. RESULTS: Eight comparative studies were identified. There was less evidence that no significant difference was found between CF and PLF for clinical satisfaction [odds ratio (OR), 0.63; 95% confidence interval (95% CI), 0.30, 1.32; P=0.22)] and for complication rate (OR, 0.64; 95% CI, 0.23, 1.76; P=0.39). The PLF was more effective than the CF for the reduction of complication rate for patients with isthmic spondylolisthesis (OR, 0.44; 95% CI, 0.23, 0.86; P=0.02). There was no significant difference for fusion rate, reoperation rate, operating time, and blood loss. Subanalysis showed that the CF can increase the fusion rate of patients with isthmic spondylolisthesis (OR, 0.12; 95% CI, 0.01, 1.00; P=0.05). PLF was more effective than CF for the reduction in operating time (WMD=-75.68; 95% CI, -99.00, -52.37; P<0.00001), and CF was more effective than PLF for the restoration of segment lordosis, disk height, and spondylolisthesis. CONCLUSIONS: There was really no difference for clinical satisfaction, complication rate, fusion rate, reoperation rate, operating time, and blood loss. PLF can reduce complication rate and operating time. CF can improve fusion rate for individuals with isthmic spondylolisthesis and restore lumbar alignment. The level of evidence was low.

Increase of TNFα-stimulated osteoarthritic chondrocytes apoptosis and decrease of matrix metalloproteinases 9 by NF-κB inhibition.

OBJECTIVE: To investigate the in vitro effect of caffeic acid phenethyl ester (CAPE), a NF-κB inhibitor, on the apoptosis of osteoarthritic (OA) chondrocytes and on the regulation of the gelatinases matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9). METHODS: Annexin V-FITC/propidium iodide (PI) labeling and western blotting were used to observe and determine the apoptosis in TNFα-stimulated primary cultured osteoarthritic chondrocytes. Also, gelatin zymography was applied to examine MMP-2 and MMP-9 activities in supernatants. RESULTS: It was confirmed by both flow cytometry and western blotting that chondrocytes from OA patients have an apoptotic background. Use of CAPE in combination with 10 ng/mL of TNFα for 24 h facilitated the apoptosis. MMP-9 in the supernatant could be autoactivated (from proMMP-9 to active MMP-9), and the physiologic calcium concentration (2.5 mmol/L) could delay the autoactivation of MMP-9. The activities of MMP-2 and MMP-9 in the fresh supernatant increased significantly in response to stimulation by 10 ng/mL of TNFα for 24 h. The stimulatory effect of TNFα just on proMMP-9 was counteracted significantly by CAPE. CONCLUSION: NF-κB could prevent chondrocytes apoptosis though its activation was attributed to the increase of proMMP-9 activity induced by TNFα (a pro-apoptotic factor). Therefore, therapeutic NF-κB inhibitor was a 'double-edged swords' to the apoptosis of chondrocytes and the secretion of MMP-9.

Drainage does not promote post-operative rehabilitation after bilateral total knee arthroplasties compared with nondrainage.

UNLABELLED: OBJECTIVE To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties (TKA). METHODS: A prospective study including 40 patients was conducted. These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team. A suction drainage was placed by randomization in only one knee for each patient, while the other knee as self-control. Pain visual analogue scale score, extremity swelling, wound healing, range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically. RESULTS: Each patient was followed up for 12 months. Placing drainage did not relieve the pain, extremity swelling, ecchymosis, or reduce the incidence of early complications (all P>0.05). CONCLUSIONS: Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA, compared with nondrainage. On the other hand, it might complicate the surgical operation, and increase the incidence of post-operative hemorrhage and retrograde infection. Thus we do not recommend suction drainage in unsophisticated TKA.

[Features of pelvic parameters in adolescent idiopathic scoliosis and their relationships with spinal sagittal parameters].

OBJECTIVE: To explore the features of pelvic parameters in patients with adolescent idiopathic scoliosis (AIS) and the relationships with spinal sagittal parameters and evaluate their roles in sagittal balance. METHODS: A total of 112 AIS patients from March 2007 to February 2011 were recruited. Six parameters were evaluated from lateral standing radiographs:pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK) and sagittal vertical axis (SVA). Pearson's correlation was used to determine the relationship between the above parameters and t-test applied to compare the differences between the subgroups: (1) by the major curve types in coronal plane (primary thoracic curve vs. primary lumbar curve); (2) by the value of SVA (positive vs. negative). RESULTS: The values of PI and SS in our cohort were 47.2° and 39.4° and they were lower than those in Caucasians as previously reported. PI was correlated with SS, PT and LL (r = 0.562, 0.773 and 0.278 respectively); TK not correlated with pelvic parameters (PI, PT and SS). SVA correlated with both spinal (TK, LL) and pelvic parameters (PI, PT). In the subgroup analyses, the values of PI and SS were significantly higher in the primary thoracic curve subgroup than those in the primary lumbar curve subgroup (49.4° vs 45.1°, 41.0° vs 38.0°). The values of PI and PT were distinctively higher in the positive SVA subgroup than those in the negative SVA subgroup (54.6° vs 45.6°, 14.3° vs 6.2°). CONCLUSION: Ethnic differences exist in the main pelvic parameters and their values are lower in Chinese than in Caucasians. There are also differences among different types of AIS. The values of main pelvic parameters are higher in AIS patients with a primary thoracic curve than in those with a primary lumbar curve. Pelvic parameters play an important role in maintaining a sagittal balance. The main pelvic parameters have influences on sagittal lumbar configuration but little on thoracic segment. A high PI value leads to a forward lean in torso with an increased PT as a result of compensation and vice versa. The alteration of PT is a major compensatory pattern of pelvis. The features of pelvic parameters should be considered during surgical planning.

[Study of rat lumbar vertebral endplate via micro computed tomography].

OBJECTIVE: To reconstruct the 3-dimensional (3D) models of vertebral endplate and internal canal structure based upon the micro computed tomography (MicroCT) scanning data and clarify the structural characteristics and changes of bone, canals and lumbar vertebral endplates with advancing age in SD rats. METHODS: Lumbar spines from male SD rats aged 3, 9 and 16 months (n = 15 each) were subjected to MicroCT scan. Mimics software was used to reconstruct the 3D models of lumbar vertebral endplate and internal canal structure. The bone volume fraction (BV/TV) of endplate was measured by CTAn software. RESULTS: The rebuilt 3D models of vertebral endplate showed that lumbar endplate was a thin layer of bone and the canals within vertebral endplate formed a ring-shaped canal network after reconstruction. Communicating branches existed between the adjacent canals. Every ring-shaped canal connected with trunk canals lying in the ventral and dorsal portions of endplate. The BV/TV of endplate in the ventral portion was lower than that in dorsal portion (ventral side: 79.9% ± 7.3%; dorsal side: 90.6% ± 6.2%, P < 0.05) and BV/TV increased with advancing age. CONCLUSION: The canals within rat lumbar vertebral endplate are not haphazard, but regularly arrayed to form a ring-shaped network of many circular canals, communicating branches and ventral and dorsal trunk canals. This canal network provides channels for blood vessels within endplate. The ratio of older rat canals decreases in endplate.

[Advances in minimally invasive spine surgery in treatment of adolescent idiopathic scoliosis and adult scoliosis].

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.

[Analysis of clinical results and complications of growing rod technique for congenital scoliosis].

OBJECTIVE: To evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis. METHODS: From August 2002 to October 2009, 34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients. Four patients underwent posterior correction surgeries with single growing rod (single growing rod group), 30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group). The average age at initial surgery was 6.9(2-13) years. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation including scoliosis, trunk translation, length of T1-S1, thoracic kyphosis and lumbar lordosis was conducted. RESULTS: The follow-up was 40.5 (24-110) months. In single growing rod group, the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up. T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery, and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year. The space available for lung ratio(SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up. Three patients reached final fusion. Four complications occurred in 3 of the 4 patients. In dual growing rod group, the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion. T1-S1 length increased from (25 ± 5) cm to (29 ± 5)cm after initial surgery and to (33 ± 5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year. The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications. CONCLUSIONS: Growing rod technique is a safe and effective choice for young children of long, complex congenital scoliosis. It maintains correction achieved at initial surgery while allowing spinal growth to continue. Implants-related complications remain the biggest challenge.

[Analysis of ribs and intraspinal anomalies in congenital scoliosis].

OBJECTIVE: To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis. METHODS: We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years (3-50 years).Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson's χ(2) test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies. RESULTS: A total of 57 (48.3%) patients were found to have intraspinal abnormalities.Split cord deformities were identified to be the most common intraspinal anomaly (32.2%), followed by syringomyelia (21.2%).Sixty-nine patients (58.5%) had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation (χ(2) = 14.05, P < 0.01). The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation (χ(2) = 27.50, P < 0.01).Intraspinal anomalies occurred in 42 of 69 patients (60.9%) with rib anomalies and 15 of 49 patients (30.6%) without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without rib anomalies in congenital scoliosis (χ(2) = 10.5, P < 0.01). CONCLUSIONS: The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intraspinal abnormalis.

[Comparison of two techniques in hemivertebra resection: anterior- posterior approach versus posterior approach].

OBJECTIVE: To Compare the two techniques in the treatment of congenital kypho-scoliosis caused by fully-segmented hemivertebra. METHODS: 44 consecutive cases, 21 males and 23 females. The average age at surgery was 11.4 years ranging from 2 to 17 years, 20 patients underwent one-stage anterior and posterior hemivertebra resection and instrumentation. 24 patients underwent one-stage posterior hemivertebra resection and instrumentation. Long cassette standing radiographs were taken before and after surgery and at the final follow-up. The apical translation, the Cobb's angle in the coronal and sagittal plane were measured and analyzed. The medical records were reviewed and the complications were recorded. RESULTS: The average follow-up was 39.2 months ranging from 24 to 72 months. The 2 groups did not demonstrate any significant differences in gender, age at surgery, preoperative and postoperative Cobb angle, blood loss, or fusion segments (all P > 0.05). However, the anterior and posterior group demonstrated a less curve flexibility and longer operative time compared with the posterior groups (all P < 0.05). COMPLICATIONS: the anterior and posterior group included pedical cutting in 1 case, lumber curve decompensation in 1 case and crankshaft phenomenon in 2 cases. The posterior group included pedical cutting in 1 case and length of instrumentation in 1 case. CONCLUSIONS: Two techniques are safe and effective procedure for the congenital kypho-scoliosis. Anterior and posterior hemivertebra resection is indicated to rigid deformity, and anterior epiphysiodesis is needed to avoid crankshaft phenomenon for patients at an earlier skeletal age. Posterior hemivertebra resection can save operation time and is less invasive compared with anterior-posterior approach.

[Surgical treatment of scoliosis associated with syringomyelia].

OBJECTIVE: To explore the clinical manifestations and surgical strategies of scoliosis associated with syringomyelia. METHODS: A total of 50 cases diagnosed as scoliosis with syringomyelia between January 2003 and November 2010 were recruited. They were divided into 2 groups: Group A, neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting; Group B, one-staged posterior correction and instrumentation without previous neurosurgery. The preoperative, postoperative and last follow-ups of Cobb angle of coronal main curve and thoracic kyphosis were measured. Also the preoperative and postoperative apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The surgical efficacies and complications of correction were compared between 2 groups. RESULTS: All patients underwent posterior pedicle screw instrumentation and had a mean follow-up period of 32.1 months. Among them, 42 patients had clinical symptoms or signs preoperatively and 3 patients improved postoperatively. The mean correction of coronal curve was 65.7% and a mean loss of correction 6.4% during the follow-up. The mean correction of apical vertebra translation and apical vertebra rotation were 63.0% and 60.0% respectively. However, the trunk shift increased 0.4 cm. There were no statistically significant differences for the correction efficacies and complications between 2 groups (P > 0.05). CONCLUSION: Scoliosis associated with syringomyelia may be effectively managed if a surgeon manipulates carefully intraoperatively and perioperative spinal monitoring is practiced. Furthermore syrinx will not increase the incidence of postoperative complications without prophylactic neurosurgery.

[The mid-term effects of Bryan cervical disc prosthesis on sagittal alignment of overall cervical spine and the functional spinal unit].

OBJECTIVE: To investigate the mid-term radiological outcome of sagittal alignment of overall cervical spine and the functional spinal unit after replacement surgery with Bryan cervical disc prosthesis. METHODS: Eighteen patients with cervical disc disorder were performed cervical disc replacement with 20 Bryan discs from November 2005 to May 2010, including single-level 16 cases and bi-level 2 cases. The patient consisted of 13 males and 5 females with age ranging from 38 to 59 years (average, (47 ± 6) years). Fourteen cases with overall cervical lordotic alignment and segmental lordotic alignment per-operatively (group 1) and 4 others with segmental kyphotic alignment and overall cervical kyphotic alignment per-operatively (group 2). The overall sagittal alignment (C(2-7)) and segmental sagittal alignment were measured pre-operatively, post-operatively and at final follow-up to evaluate the outcome. RESULTS: All cases obtained the follow-up with an average of (24 ± 5) months (range 12 to 53 months). To the mean overall cervical alignment, there were 9.9° ± 1.9° per-operatively, 12.8° ± 2.1° post-operatively and 11.6° ± 1.8° at final follow-up in group 1 and -1.8° ± 0.8° per-operatively, 7.3° ± 1.3° post-operatively and 5.0° ± 2.1° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively (t = -2.987 and -5.058, P < 0.05) and no statistical significance between post-operatively and final follow-up (P > 0.05) in both groups. To the mean segmental alignment there were 2.6° ± 0.8° per-operatively, 5.4° ± 1.0° post-operatively and 4.3° ± 0.9° at final follow-up in group 1 and -3.0° ± 0.8° per-operatively, 3.8° ± 1.3° post-operatively and 0.3° ± 2.8° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively in both groups (t = -3.829 and -4.086, P < 0.05) and between post-operatively and final follow-up in group 1 (t = 2.630, P < 0.05)but not in group 2 (P > 0.05). CONCLUSIONS: The Bryan cervical disc prosthesis has a good mid-term outcome for maintaining sagittal alignment of overall cervical spine and the functional spinal unit. Long-term follow-up should be needed to assess the long-term functionality of the prosthesis.

[The efficacy of one-stage posterior correction surgery for scoliotic patients with little symptomatic syringomyelia].

OBJECTIVE: To investigate the safety and effectiveness of one-stage posterior correction of scoliosis associated with little symptomatic syringomyelia. METHODS: A total of 19 cases diagnosed as scoliosis with little symptomatic syringomyelia between January 2003 and November 2010 were included in this study (study group), the patients underwent one-stage posterior correction and instrumentation without neurosurgery for the syringomyelia. At the same time, 9 cases with severe symptomatic syringomyelia were included as the control group, the patients underwent neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting. All patients underwent posterior pedicle screw or screw-hook hybrid instrumentation. The preoperative, postoperative and the last follow-up of the Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The perioperative and the last follow-up complications of neurological injury were recorded. The surgical outcome and postoperative complications between the 2 groups were compared with the t student and chi-square statistics methods. RESULTS: There were no significant differences in gender, age, the location, length and diameter of the syringomyelia of the 2 groups (P > 0.05). The follow-up period ranged from 6 to 45 months, with a mean of 28.6 months. The average preoperative Cobb angles of coronal main curves of the 2 groups were 71° ± 23° and 68° ± 19°, the postoperative Cobb angles were 27° ± 20° and 25° ± 16°, and the last follow-up Cobb angles were 29° ± 17° and 32° ± 20°. The coronal correction rate was 66% ± 19% in the study group and 65% ± 21% in the control group (t = 0.136, P = 0.893). There was no significant difference at the last follow-up(t = 0.210, P = 0.837). The average preoperative Cobb angles of thoracic kyphosis of the 2 groups were 35° ± 18° and 32° ± 19°, the postoperative Cobb angles were 25° ± 10° and 23° ± 9°, and the last follow-up Cobb angles were 24° ± 4° and 28° ± 8°. The mean sagittal correction rate of the 2 groups were 50% ± 58% and 57% ± 53% (t = -0.303, P = 0.764). There was also no significant difference at the last follow-up time (t = 0.769, P = 0.490). There were no significant difference, in terms of the postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift between the 2 groups (P > 0.05). One case in the study group complicated with a pedicle screw breaking the anterior cortex of the vertebra and one in the control group complicated with a hook loosening, postoperatively. At the last follow-up time, the neurological symptoms of the 2 groups got no aggravating. CONCLUSION: One-stage posterior correction of scoliosis associated with little symptomatic syringomyelia may be effective and safe.