Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review.

AIM: To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). METHODS: PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV). RESULTS: Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD - 2.72, 95% CI (- 4.69, - 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI-LL (WMD - 9.57, 95% CI (- 17.42, - 1.71), P = 0.02), larger follow-up PI-LL (WMD - 12.62, 95% CI (- 17.62, - 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD - 3.43, 95% CI (- 4.71, - 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (- 0.46, 0.60), P = 0.04), larger preoperative PT (WMD - 3.04, 95% CI (- 5.27, - 0.81), P = 0.008, larger follow-up PT (WMD - 3.69, 95% CI (- 6.66, - 0.72), P = 0.02) were identified as risk factors for PJK. CONCLUSION: Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.

Extraskeletal myxoid chondrosarcoma of the buttock: a case report and literature review.

Background: Extraosseous myxoid chondrosarcoma (EMC) is extremely rare, and the case we report is of a particular site with partial bone destruction. Case presentation: This case report can further strengthen the understanding of EMC and guide clinical treatment. The patient presented with a right buttock mass that was present for 1 year and that had gradually enlarged with tenderness for 6 months. The diagnosis was EMC. The interventions included puncture biopsy, surgical resection, and postoperative chemotherapy. The tumor was resected extensively, and the postoperative recovery was satisfactory. There was no recurrence or metastasis during the follow-up for 18-month. Case presentation: The case we reported occurred in the pelvic cavity, which has not been previously reported in the literature, and there was partial bone destruction. Complete resection of the tumor was performed, and a satisfactory prognosis was achieved.

[The Biomechanics Influence of unilateral laminectomy and discectomy surgery on the adjacent different grades of Disc Degeneration].

OBJECTIVES: To study the stress distribution of the adjacent different grades of disc degeneration underwenting unilateral laminectomy and discectomy surgery using non-linear finite element analysis. METHODS: Based on the lumbar CT scans, the finite element model (FEM) of lumbar spinal segment (L3-L5) was established. According to L3-L4 intervertebral disc degeneration, different grades of disc degeneration (healthy, mild, moderate and severe) models were established and unilateral laminectomy and discectomy surgery were also established. Physiological action such as flexion, extension, lateral bending and lateral rotation was simulated and the von Mises stress in the nucleus pulposus and annulus fibrosus matrix of L3-L4 disc was investigated. RESULTS: After unilateral laminectomy and discectomy surgery, the extremum value of von Mises stress of nucleus pulposus and annulus fibrosus matrix was maximum during extension and minimus left bending in the healthy intervertebral disc. Compared with healthy disc, the increment of extremum value was found during left bending in the mildly degenerated disc. When the value decreased in the moderately degenerated disc, but still higher than that in the healthy disc. When the adjacent disc is severely degenerated, the extremum value of nucleus pulposus decreased, in addition to axial rotation, and even lower than that of healthy disc. The value of annulus matrix decreased and still higher than that of healthy disc, especially during left bending. CONCLUSIONS: After unilateral laminectomy and discectomy surgery, avoiding lateral bending will reduce the abnormal stress in the degenerated disc and decreased the risk of accelerating disc degeneration.

Finite element analysis in adjacent segment degeneration after lumbar fusion.

BACKGROUND: Adjacent segment degeneration (ASD) following lumbar fusion has been well documented in recent years. However, the pathogenesis of ASD is not clear. To investigate this issue, we established a finite element model of segments L2-L5, simulated a single-segment posterior fixation in L3-L4 and investigated the stress variation and the effects of the instrumented lumbar posterior fixation on adjacent levels. METHODS: Models A, B and C of L2-L5 multisegment finite element intact models were established. In model A, segment L3-L4 was not fixed and was without disc degeneration in the adjacent segment (L2-L3, L4-L5); in model B there was posterior pedicle fixation in segment L3-L4 without disc degeneration in the adjacent segment (L2-L3, L4-L5); in model C there was posterior pedicle fixation in segment L3-L4 with a degenerated disc in the adjacent segment (L2-L3, L4-L5). Four levels of axial pressure, 0.3, 0.5, 1.0 and 2.0 MPa, were compared between each model of the stress variation on the discs of the adjacent segment (L2-L3, L4-L5). RESULTS: The maximum principal stress mean value of disc L2-L3 under four pressures in model A was determined. The statistical results showed that stress was not significant difference in disc L2-L3 between models A and B, but there was a significant difference in disc L2-L3 between models A and C and a significant difference between each group in disc L4-L5 under four pressure conditions. CONCLUSIONS: The preoperative degeneration of the adjacent segment of the disc is a significant risk factor for ASD.