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BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients often complain of walking discomfort. However, dynamic balance evaluation methods of gait in ASD have not been well established. DESIGN: Case series study. PURPOSE: Characterize the gait of ASD patients using a novel two-point trunk motion measuring device. PATIENT SAMPLE: Sixteen ASD patients scheduled for surgery and 16 healthy control subjects. OUTCOME MEASURES: Trunk swing width and track length of the upper back and sacrum. METHODS: Gait analysis was performed using a two-point trunk motion measuring device on 16 ASD patients and 16 healthy control subjects. Three measurements were taken for each subject, and the coefficient of variation was determined to compare measurement accuracy between the ASD and control groups. Trunk swing width and track length were measured in three dimensions for comparisons between the groups. The relationship among output indices, sagittal spinal alignment parameters, and quality of life (QOL) questionnaire scores was examined as well. RESULTS: No significant difference was found for the precision of the device between the ASD and control groups. Compared with controls, the walking style of ASD patients tended to have larger right-left swing of the trunk (+14.0 cm and +23.3 cm at the sacrum and upper back, respectively), larger horizontal plane movement of the upper body (+36.4 cm), less vertical movement (-5.9 cm and -8.2 cm up-down swing at the sacrum and upper back, respectively), and longer gait cycle (+0.13 sec). Regarding QOL in ASD patients, greater right-left/front-back swing of the trunk, greater movement in the horizontal plane, and longer gait cycle were associated with lower QOL scores. Conversely, greater vertical movement was associated with higher QOL. CONCLUSIONS: ASD patients had unique gait characteristics, the intensity of which were associated with diminished QOL. The two-point trunk motion measuring device may be reliable and useful for the clinical assessment of balance during gait in ASD patients.
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Marcha , Qualidade de Vida , Humanos , Adulto , Reprodutibilidade dos Testes , Caminhada , SacroRESUMO
BACKGROUND: Amyloidosis is a rare group of diseases in which fibrillar amyloid proteins are deposited in systemic organs to result in functional disorder. However, amyloidosis affecting the cervical spine is very rare. We herein describe a case of systemic amyloidosis including a combination of cervical myelopathy with amyloid deposition and cardiac dysfunction due to cardiac amyloidosis. CASE PRESENTATION: An 86-year-old man with cervical myelopathy accompanied with cardiac dysfunction due to cardiac amyloidosis underwent posterior cervical laminectomy from C3 to C4. We were able to identify the patient's cardiac amyloidosis and significant cardiac dysfunction before surgery and manage his perioperative treatment successfully. Preoperative cervical computed tomography (CT) showed multiple fine calcifications below the lamina, which were later confirmed by pathological analysis as amyloid deposition. CONCLUSIONS: This is a relatively rare report of systemic amyloidosis including a combination of cervical myelopathy with amyloid deposition and cardiac dysfunction from cardiac amyloidosis. CT findings of multiple fine calcifications suggest the possibility of amyloidosis and may warrant further examination of cardiac function.
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Amiloidose , Cardiopatias , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Masculino , Humanos , Idoso de 80 Anos ou mais , Traumatismos da Medula Espinal/patologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/patologia , Amiloidose/complicações , Amiloidose/diagnóstico , Amiloidose/patologia , Cardiopatias/complicações , Cardiopatias/patologiaRESUMO
STUDY DESIGN: Retrospective cohort study. PURPOSE: This study aimed to evaluate the relationship between C7 plumb line (C7PL) decompensation and the Scoliosis Research Society (SRS) 22-item patient questionnaire scores, including those related to self-image, preoperatively and 2 years after surgery. OVERVIEW OF LITERATURE: In the surgical treatment of adolescent idiopathic scoliosis (AIS), inferior trunk balance caused by C7PL decompensation can negatively affect patients' quality of life. However, there are few reports in the literature that describe or clarify how postoperative trunk imbalance affects each SRS-22 domain, including self-image domain scores. METHODS: A total of 120 patients with AIS who underwent posterior spinal fusion from August 2006 to March 2017 at our facility and were followed up for 2 years or more were included. Radiological parameters were measured on whole-spine anteroposterior and lateral radiographs. Revised SRS-22 (SRS-22r) values were also recorded. Coronal trunk imbalance was defined as a deviation of ≥2.0 cm between the C7PL and the central sacral vertical line. Patients with and without coronal trunk imbalance at 2 years after surgery were defined as D (+) (decompensation type) and D (-), respectively. Mean SRS-22r values, including function, pain, self-image, mental health, and subtotal were compared between the D (+) and D (-) groups. Logistic regression analysis was performed to detect the preoperative factors related to D (+) using predictors, including curve type, maximum Cobb angle, and coronal trunk imbalance. RESULTS: At 2 years after surgery, the D (+) group had a significantly lower self-image in the domain of SRS-22r scores compared with the D (-) group. Preoperative coronal trunk imbalance was significantly related to D (+) but not to significant changes in the postoperative SRS-22 score in any of the SRS-22 domains. CONCLUSIONS: Postoperative C7PL deviation lowers the self-image in patients with AIS. Patients with preoperative coronal trunk imbalance were significantly more likely to be D (+).
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BACKGROUND: To evaluate the surgical results of patients with cervical spondylotic myelopathy (CSM) with inconsistency between deep tendon reflex findings and cervical magnetic resonance imaging (MRI) findings and to analyze the differences between patients with good and poor surgical outcomes. METHODS: We evaluated 50 subjects with CSM (30 males, 20 females; mean age: 70.4 years) who underwent posterior surgery and were followed for at least 1 year postoperatively. Matched CSM was defined as a consistent preoperative neurological pattern determined by deep tendon reflex and cervical MRI T2-weighted high-signal intramedullary area or stenosis in the most cranial compression levels. A lack of consistency was classified as unmatched CSM. Recovery rate (RR) according to Japanese Orthopaedic Association (JOA) scoring preoperatively and at 1 year postoperatively were compared between the groups. RESULTS: The matched and unmatched CSM group included 27 subjects (13 males, 14 females; mean age: 68.2 years) and 23 subjects (17 males, 6 females; mean age: 72.8 years), respectively. RR was significantly higher in the matched CSM group (56.1 ± 3.7 % vs 36.8 ± 2.7 %; p = 0.002). Unmatched CSM was significantly associated with a lower RR independently of sex, patient age, surgical procedure, preoperative JOA score, diagnosis levels, and complication of diabetes. CONCLUSIONS: Postoperative JOA score RR was significantly diminished among unmatched CSM patients comprising of 46% of cases. Some patients with unmatched CSM had multiple levels of spinal canal stenosis, foraminal stenosis, and peripheral neuropathy, suggesting that surgical results were poorer than those of matched CSM.
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Doenças da Medula Espinal , Espondilose , Masculino , Feminino , Humanos , Idoso , Constrição Patológica/cirurgia , Reflexo de Estiramento , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/complicações , Imageamento por Ressonância Magnética/métodos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/patologia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Espondilose/complicações , Resultado do Tratamento , Descompressão Cirúrgica/métodosRESUMO
BACKGROUND: Patients with congenital heart disease (CHD) are associated with an increased incidence of scoliosis, often with severe progression. We report a case of hemoptysis caused by rapid scoliosis progression subsequent to surgery for CHD that was successfully managed by surgical curve correction following coil embolization. CASE PRESENTATION: A 14-year-old girl with scoliosis had undergone open heart surgery for CHD at the age of 1 year. She was first noted to have scoliosis at 12 years of age, which began to progress rapidly. At age 13, her main thoracic curve Cobb angle was 46°, and hemoptysis with high pulmonary vein pressure due to vertebral rotation was detected. Nine months after coil embolization, she received posterior spinal fusion from T5 to L2 for scoliosis correction. Postoperatively, her pulmonary vein diameter was enlarged, with no detectable signs of hemoptysis. CONCLUSIONS: We encountered a case of hemoptysis caused by advanced scoliosis after cardiac surgery that was successfully treated by correction of the scoliotic curve following coil embolization. Patients with secondary scoliosis after surgery for CHD should be carefully monitored for the possibility of cardiovascular system deterioration.
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Cardiopatias Congênitas , Escoliose , Fusão Vertebral , Adolescente , Feminino , Cardiopatias Congênitas/complicações , Hemoptise/complicações , Hemoptise/terapia , Humanos , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna VertebralRESUMO
INTRODUCTION: Assessments of early postoperative bony union after posterior lumbar interbody fusion via computed tomography (CT) have revealed cases in which interbody fixation by bony union resulted in nonfusion due to bone absorption. The apparent bone union state reverted to a nonunion state several months later, exhibiting a so-called "fake union" phenomenon. Additionally, few reports have evaluated the effect of teriparatide on bony union. The present study aimed to evaluate the frequency of change in assessment from fusion to nonfusion in the postoperative follow-up of lumbar interbody fusion, compare the late postoperative bony union rates in groups with or without early postoperative fusion, and examine the effect of postoperative teriparatide in those groups. METHODS: Sixty-nine subjects enrolled from multiple hospitals were prospectively evaluated following single-level lumbar interbody fusion. The patients were randomly allocated into treatment with or without weekly postoperative teriparatide. The subjects were then classified as having bony union or nonfusion at 2 months postoperatively, and fusion rates at 6 months were compared. For the evaluation of bony union, blinded radiological examinations were performed via CT. Additional comparisons were made according to teriparatide use. RESULTS: The rate of nonunion at 6 months postoperatively in patients with fusion at 2 months postoperatively was 27.8%. Among subjects with bony union at 2 months postoperatively, the fusion rate at 6 months in those who received teriparatide was 93.3% (p=0.027) versus 57.1% in those who did not. CONCLUSIONS: The rate of nonunion at 6 months postoperatively in patients exhibiting union at 2 months after surgery was 27.8%. Postoperative weekly teriparatide treatment significantly reduced the rate of fake union.
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OBJECTIVE: In recent years, it has become possible to predict postoperative correction and residual deformity in adolescent idiopathic scoliosis (AIS) surgery based on the technique used and extent of fixation. However, the recommended degree of correction has not yet been established. In this study, the authors aimed to clarify the extent to which a residual postoperative deformity would be acceptable according to Scoliosis Research Society (SRS)-22r and satisfaction scores after AIS surgery. METHODS: Overall, 92 patients who underwent posterior spinal fusion for Lenke type 1 or 2 AIS were retrospectively included. The Patient Acceptable Symptom State (PASS) cutoff values for each SRS-22r domain were calculated using receiver operating characteristic (ROC) curves to obtain predictive values of treatment satisfaction 2 years after surgery. Multivariate logistic regression analysis was performed with deformity parameters and demographic data as explanatory variables, and achieving the PASS cutoff value of each SRS-22r domain and treatment satisfaction were objective variables. Cutoff values were calculated using ROC analysis. RESULTS: The PASS cutoff values for SRS-22r domains were 3.69 (area under the ROC curve [AUC] 0.86) for self-image, 4.25 (AUC 0.82) for mental health, and 4.22 (AUC 0.82) for the subtotal. The residual main thoracic Cobb angle was not remarkably related to SRS-22r or treatment satisfaction. The residual thoracolumbar/lumbar (TL/L) Cobb angle was significantly associated with treatment satisfaction, with a cutoff value of 12.5° (AUC 0.75). The parameters of deformity that were significantly associated with achieving the PASS cutoff value for self-image were the TL/L Cobb angle and main thoracic apical vertebral translation, although their respective AUCs were < 0.7. CONCLUSIONS: In patients with Lenke type 1 and 2 AIS, the residual postoperative TL/L Cobb angle was significantly associated with achieving the PASS cutoff values for self-image and treatment satisfaction. Satisfaction with treatment was more likely when the TL/L Cobb angle was ≤ 12.5°.
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BACKGROUND CONTEXT: Posterior spinal fusion with pedicle screws is commonly used for the treatment of adolescent idiopathic scoliosis (AIS). To reduce radiation exposure, methods other than computed tomography (CT) are desirable for preoperative determination of pedicle diameter. PURPOSE: Investigate the differences between magnetic resonance imaging (MRI) and CT measurements of pedicle diameter. STUDY DESIGN: Cross-sectional research. PATIENT SAMPLE: Twenty-one AIS Lenke type 1 patients (19 female and 2 males, mean age at surgery: 15.4 years) who underwent posterior spinal fusion between April 2009 and October 2019. OUTCOME MEASURES: Gap between CT and MRI pedicle diameters. METHODS: The inner and outer diameters of the right and left pedicles from T1 to L3 were measured separately by two spine surgeons for statistical comparisons. RESULTS: The respective minimum and maximum CT-MRI values were -3.7 mm and 4.7 mm for inner diameter and -4.6 mm and 5.3 mm for outer diameter. Regarding inter-examiner error, the probability of a 2 mm difference in measurement was less than 5% for both modalities. The probability of a 1 mm difference was also less than 5%, and that of a 3 mm or more difference was 2.1% for the inner diameter and 2.9% for the outer diameter. Whereas low body weight was significantly associated with measurement differences, pedicle laterality was not. CONCLUSIONS: MRI does not have the reliability to measure pedicle size in AIS patients at present. However, with advancements in image processing technology, the accuracy of pedicle size measurement by MRI may soon improve.
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Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Adolescente , Estudos Transversais , Feminino , Humanos , Cifose/cirurgia , Imageamento por Ressonância Magnética , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective observational study. OBJECTIVE: This study aimed to determine the effect of reducing the radiation dose of intraoperative cone beam computed tomography (CBCT) during posterior spinal fusion (PSF) for pediatric scoliosis on the rate of pedicle screw (PS) violation. SUMMARY OF BACKGROUND DATA: Intraoperative CBCT for pediatric scoliosis improves the accuracy of PS insertion in PSF. However, few reports have addressed the PS perforation rate from reduced radiation doses in hybrid navigation. METHODS: We evaluated 855 PSs inserted into 58 pediatric scoliosis patients (11 male and 47 female, mean age: 16.6 yr) who underwent PSF using CBCT. A radiation dose of 1/3 or 1/5 of the normal dose (ND) was defined as a low dose (LD). After PS insertion, intraoperative CBCT images were reviewed to assess the degree of PS perforation. G2-3 (i.e., perforations of 4âmm or more) was defined as a violation. The PS violation rate was compared between the groups, and factors associated with violations were examined. RESULTS: A total of 567 and 288 screws were inserted in the ND group and LD group, respectively. The PS violation rate was comparable at 1.8% in the ND group and 1.7% in the LD group. Multiple logistic regression analysis showed that distance from the upper instrumented vertebra (UIV) was an independently associated factor of PS violation (+1 vertebra, operation room 0.73, P â = â0.038). In addition, the mean height of patients with PS violations (148.8â±â3.6âcm) was significantly shorter than that of patients without violations (157.9â±â1.2âcm) ( P â=â0.034). CONCLUSION: There was no increase in PS violation rate with lower doses of radiation for intraoperative navigation CBCT. Extra care is warranted for vertebrae close to the UIV and patients of shorter stature.Level of Evidence: 3.
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Parafusos Pediculares , Escoliose , Fusão Vertebral , Cirurgia Assistida por Computador , Adolescente , Criança , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Parafusos Pediculares/efeitos adversos , Doses de Radiação , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios XRESUMO
ABSTRACT: This study investigated whether postoperative rotational deformity in adolescent idiopathic scoliosis patients could be predicted by prone-position pre-operative angle of trunk rotation (ATR).Surgical rib hump correction is performed with the patient in a prone position. However, the association between pre-operative ATR in the prone position and postoperative ATR results is unknown.Thirty-four consecutive patients who underwent skip pedicle screw fixation for Lenke type 1 or 2 adolescent idiopathic scoliosis were retrospectively reviewed. All subjects were followed for a minimum of 1âyear. ATR measurements were taken for the standing-flexion position with a scoliometer before surgery and at 1âyear afterward. Pre-operative measurements were also taken for the prone position. Correlations between pre- and postoperative ATR were calculated by means of Pearson correlation coefficient. Associations between the correction angle from the standing-flexion position to prone position and postoperative standing-flexion correction angle were determined by linear regression analysis.Pre- and postoperative ATR for the standing-flexion position showed a moderate association (râ=â0.64, Pâ<â.01). A similar correlation was seen for pre-operative prone-position ATR and postoperative standing-flexion ATR (râ=â0.56, Pâ<â.01). In linear regression analysis, there was significant proportional error between the correction angle from the standing-flexion position to prone position and postoperative standing-flexion correction angle (ßâ=â0.40, Pâ<â.01).In conclusion, pre-operative ATR in either standing-flexion or prone position and postoperative standing-flexion ATR displayed moderate associations. Linear regression analysis revealed that ATR correction angle could be estimated by calculating the correction gains of 0.4° per 1° of correction angle in the prone position.
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Cifose , Parafusos Pediculares , Decúbito Ventral , Escoliose , Fusão Vertebral , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas , Resultado do TratamentoRESUMO
INTRODUCTION: In this study, we present "microscopic mini-open foraminotomy (MicroMOF)" as a new, less invasive method for posterior cervical foraminotomy. TECHNICAL NOTE: Using surgical microscope guidance, the spinous process is hemi-split, and the posterior muscle is detached from the laminar subperiosteal surface. Bony resection is then performed obliquely from medial posterior to lateral anterior under lateral-tilted surgical field exposure. MicroMOF has been performed successfully for cervical radiculopathy and cervical spondylotic amyotrophy, which achieved postoperative symptom improvement with few complications. CONCLUSIONS: The novel MicroMOF foraminotomy technique has been found to protect the nerve root and vertebral artery and help preserve muscle and cervical facet joint bone.
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BACKGROUND: Postoperative intracranial complications are rare in spine surgery not including cranial procedures. We describe an uncommon case of pseudohypoxic brain swelling (PHBS) and secondary hydrocephalus after transforaminal lumbar interbody fusion (TLIF) presenting as impaired consciousness and repeated seizures. CASE PRESENTATION: A 65-year-old man underwent L4-5 TLIF for lumbar spondylolisthesis and began experiencing generalized seizures immediately postoperatively. Computed tomography (CT) revealed diffuse cerebral edema-like hypoxic ischemic encephalopathy. He was transported to our hospital, at which time epidural drainage was halted and anti-edema therapy was commenced. His impaired consciousness improved. However, he suffered secondary hydrocephalus due to continuous bleeding from a dural defect and spinal epidural fluid collection 3 months later. Following the completion of dural repair and insertion of a ventriculoperitoneal shunt, his neurologic symptoms and neuroimaging findings improved significantly. CONCLUSIONS: PHBS can be considered in patients with unexpected neurological deterioration following lumbar spine surgery even with the absence of documented durotomy. This might be due to postoperative intracranial hypotension-associated venous congestion, and to be distinguished from the more common postoperative cerebral ischemic events-caused by arterial or venous occlusions-or anesthetics complications.
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BACKGROUND CONTEXT: The minimally invasive (MI) approach in posterior lumbar interbody fusion (PLIF) minimizes the muscle-stripping posterior exposure of the lumbar spine; therefore, it is hypothesized that such benefits would reduce adjacent segment pathology (ASP) development. OBJECTIVE: This study aimed to estimate the incidence of ASP following MI-PLIF. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: A total of 100 patients who had undergone single-level PLIF at the L4/5 level for lumbar degenerative spondylolisthesis were retrospectively studied (MI-PLIF group: 68 patients; conventional open PLIF [O-PLIF] group; 32 patients; average follow-up period: 100.5 months). OUTCOME MEASURES: Incidence of ASP. METHODS: Patients were considered to have operative ASP (OASP) if adjacent segments manifested degenerative lesions that caused clinically significant symptoms requiring surgery. Survival curves were estimated for each group using the Kaplan-Meier method. The study was not externally funded. The authors have no conflicts of interest to declare. RESULTS: Four (5.9%) of the 68 patients in the MI-PLIF group and 6 (18.8%) of the 32 patients in the O-PLIF group experienced OASP during the follow-up period. Kaplan-Meier analysis predicted a disease-free OASP survival rate of 98.5% (95% confidence interval [CI], 95.5%-100%) in the MI-PLIF group and 90.6% (95% CI, 81.1%-100%) in the O-PLIF group at 5 years, and 93.7% (95% CI, 86.8%-100%) in the MI-PLIF group and 71.8% (95% CI, 52.9%-97.5%) in the O-PLIF group at 10 years. MI-PLIF achieved a significantly higher survival rate in OASP than did O-PLIF (p=.04). O-PLIF was associated with a 3.97 times higher risk (odds ratio 3.97, 95% CI, 1.02-15.48; p=.04) of developing OASP in our cohort. CONCLUSIONS: Following MI-PLIF, the rate of OASP was predicted to be 1.5% at 5 years and 6.3% at 10 years. MI-PLIF had a lower incidence of OASP and more favorable clinical outcomes than did O-PLIF.
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Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: For instrumented correction surgery for adolescent idiopathic scoliosis (AIS), surgeons are increasingly switching from titanium (Ti) alloy rods to stiffer cobalt-chromium (CoCr) rods. The authors conducted the first multicenter randomized controlled clinical trial to investigate whether these materials affect the outcomes in terms of spine correction and quality of life (QOL). This trial was registered at UMIN Clinical Trials Registry on September 3, 2012, under the identifier UMIN000008838 (level of evidence 1). METHODS: Female AIS patients (Lenke types 1-3, patient age 10-19 years) were recruited at 5 Japanese institutions and randomized into two cohorts: 6.0-mm-diameter Ti rods were placed in one group, and 6.0-mm-diameter CoCr rods were placed in the other. Patients were followed up at 2 weeks and 3, 6, and 12 months with radiographic examination to quantify the sagittal and coronal correction (Cobb angle, thoracic kyphosis, rib hump, and apical vertebral rotation). Patients completed questionnaires (Scoliosis Research Society-22r, 12-Item Short-Form Health Survey, and Scoliosis Japanese Questionnaire-27) at 6 and 12 months to assess QOL. RESULTS: A total of 69 AIS patients were randomized to the demographically similar Ti (n = 37) or CoCr (n = 32) cohort. Four adverse events were recorded, two in each cohort, but these were not related to the rod material. At the final follow-up, both Ti and CoCr cohorts showed significant improvement in spinal correction, including the Cobb angle, thoracic kyphosis, and rib hump size. The correction rates were 68.4% and 67.1% for the Ti and CoCr cohorts, respectively. No parameters differed significantly between the cohorts at any time. Survey data showed improved but similar outcomes in both cohorts. CONCLUSIONS: Both treatments (Ti and CoCr) produced similar results and were efficient in engendering clinically significant spine corrections. Clinical trial registration no.: UMIN000008838 (UMIN Clinical Trials Registry).
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BACKGROUND: Due to the limited number of reports comparing posterior fusion with posterior decompression alone for retro-odontoid pseudotumor, there remains no consensus on treatment preference, especially in older patients. This study compared posterior fusion (with or without additional decompression) with posterior decompression alone for treating spinal cord pressure from non-inflammatory retro-odontoid pseudotumor with atlanto-axial subluxation (AAS). METHODS: Forty-one patients (27 male and 14 female; mean age, 73.0 ± 11.4 years) who underwent either posterior cervical fusion or decompression alone for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS and were observed for more than 1 year between September 2009 and July 2019 were enrolled. Thirty-two patients (23 male and 9 female; mean age: 71.8 ± 10.9 years) received posterior fusion surgery (fusion group) and 9 patients (4 male and 5 female; mean age: 77.2 ± 12.5 years) underwent decompression alone (non-fusion group). We compared pre- and postoperative Japanese Orthopaedic Association (JOA) scores and preoperative cervical alignment parameters between the groups. RESULTS: In the fusion group, the mean preoperative JOA score was significantly improved from 9.0 ± 3.2 points to 11.7 ± 3.2 points at the final follow-up (p = 0.0002). Similarly in the non-fusion group, the mean preoperative and final follow-up JOA scores were 8.2 ± 3.5 points and 11.7 ± 3.8 points, respectively (p = 0.003). The recovery rate at the final follow-up was 22.6% in the fusion group and 43.4% in the non-fusion group, which were statistically comparable (p = 0.23). We observed no remarkable correlations between cervical sagittal spinal alignment parameters and JOA score recovery rate in the cohort, nor was any significant subluxation progression seen. CONCLUSION: Compared with fusion surgery, surgical decompression alone may be a suitable and less invasive option for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS, especially in elderly patients.
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Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4°, 23.4°, 25.8°, and 25.60°, respectively, and was significantly improved at all post-surgical time points (all p < 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores.
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BACKGROUND: Goldenhar syndrome sometimes displays progressive scoliosis and other spinal deformities that require treatment. However, few reports exist on scoliosis correction in Goldenhar syndrome. We described the rare radiological outcomes of a patient with Goldenhar syndrome who received brace treatment for scoliosis. CASE PRESENTATION: A 4-year-old boy was diagnosed as having Goldenhar syndrome and referred to our hospital for scoliosis treatment. The deformity deteriorated gradually, and left convex scoliotic angle was 26 degrees (T3-L2) at 11 years of age. Unexpectedly during treatment with an orthopedic brace, the curve had reversed to 21 degrees (T5-L2) at 7 months of therapy. After another adjustment of the brace, his right convex scoliotic angle improved to 13 degrees (T4-L2) at 15 months of treatment. CONCLUSIONS: Curve reversal may occur during brace treatment for scoliosis in Goldenhar syndrome. Clinicians may opt to periodically check curve correction despite the risk of increased radiation exposure.
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Síndrome de Goldenhar , Procedimentos Ortopédicos , Escoliose , Braquetes , Pré-Escolar , Síndrome de Goldenhar/complicações , Síndrome de Goldenhar/diagnóstico por imagem , Síndrome de Goldenhar/terapia , Humanos , Masculino , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Escoliose/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Musculocontractural Ehlers-Danlos syndrome caused by pathogenic variants in CHST14 (mcEDS-CHST14) is a recently delineated connective tissue disorder characterized by multisystem congenital malformations and progressive connective tissue fragility-related manifestations. With only 2 cases of mcEDS-CHST14 containing precise information on surgical spinal correction being reported to date, there remains no consensus on treatment standards. This study describes the detailed clinical and radiologic outcomes of the third known patient with mcEDS-CHST14 who successfully underwent surgery for severe kyphoscoliosis. CASE DESCRIPTION: The patient was a 19-year-old girl with mcEDS-CHST14 who suffered from low back pain and decreased daily activities caused by progressive kyphoscoliosis. She underwent posterior spinal fusion with an all-pedicle screw construct from T4 to L4 for a preoperative main curve Cobb angle of 69 degrees and kyphotic angle of 27 degrees. Postoperative Cobb angle of the main curve and kyphotic angle were 26 and 6 degrees, respectively. Although sufficient correction was achieved without disseminated intravascular coagulation or other serious sequelae, a large amount of blood (2600 g) was lost due to tissue fragility. Her low back pain was decreased at 1 year after surgery. CONCLUSIONS: On the basis of the present and 2 earlier reported cases, posterior spinal fusion may be a reasonable surgical option for severe progressive spinal deformities in patients with mcEDS-CHST14. However, careful attention is needed for possible massive blood loss from tissue fragility.
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Síndrome de Ehlers-Danlos/cirurgia , Cifose/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Síndrome de Ehlers-Danlos/complicações , Feminino , Humanos , Cifose/genética , Escoliose/genética , Adulto JovemRESUMO
STUDY DESIGN: A retrospective single-center and single-surgeon study. OBJECTIVE: This study investigated the screw perforation rate according to main curve flexibility in pedicle screw fixation using a computed tomography (CT) guidance for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND: The authors have been using a CT-based navigation system during pedicle screw insertion for AIS to avoid serious neurovascular or visceral structure injury but suspect that high main curve flexibility may account for some breaches. DATA: Seventy-two consecutive patients with AIS Lenke type 1 or 2 who had undergone pedicle screw fixation using a CT-based navigation system between February 2008 and April 2018 were retrospectively reviewed. MATERIALS AND METHODS: The authors evaluated the perforation rate of pedicle screws inserted into the main thoracic curve between the upper-end and lower-end vertebrae for factors associated with screw violations using multivariate logistic regression mixed models. RESULTS: A total of 723 pedicle screws were inserted into the T4-T12 vertebrae with the aid of CT-based navigation. The respective grade 3 perforation rates according to main curve flexibility were 0%-30%: 3.2%; 30%-55%: 1.1%; 55%-75%: 5.2%; and 75%-100%: 5.5%. Main curve flexibility of ≥55% was significantly associated with grade 3 screw perforations (P=0.02). CONCLUSIONS: Main curve flexibility of ≥55% was significantly related to screw violation in AIS surgery. Greater care is thus advised for screw insertion using CT navigation in AIS with main curve flexibility ≥55%.
Assuntos
Parafusos Pediculares , Escoliose , Fusão Vertebral , Cirurgia Assistida por Computador , Adolescente , Humanos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Spinal deformity is a characteristic feature of Loeys-Dietz syndrome (LDS). Surgical correction in LDS is indicated when the deformity is progressive to avoid neurological deficits, respiratory impairment, and back pain. However, few reports exist on the surgical treatment of spinal deformity in LDS, and no therapeutic standards have been established. We described the clinical and radiological outcomes of a patient with LDS receiving surgery for severe kyphoscoliosis. A 21-year-old male patient with LDS underwent posterior spinal fusion with an all-pedicle screw construct from T10 to L5 for a preoperative main curve Cobb angle of 70 degrees and kyphotic angle of 49 degrees. The postoperative Cobb angle of the main curve and kyphotic angle improved to 36 and 8 degrees, respectively. Correction surgery was performed with frequent motor evoked potential testing, taking care not to cause motor paralysis. Ameliorated low back pain and improvements in clinical questionnaire scores were noted at 21 months after surgery. No perioperative complications were reported. Based on the present case, posterior spinal fusion represents a good correction option for severe spinal deformity in LDS with syringomyelia. Careful preoperative examination and treatment for neurovascular and neurological lesions is advised to prevent severe complications.