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1.
J Bone Joint Surg Am ; 2024 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-39292794

RESUMO

BACKGROUND: Conventional surgical procedures for atlantoaxial instability or dislocation (AAI/D) have been associated with a high prevalence of postoperative occipitocervical pain and dysfunction, as well as substantial perioperative blood loss. We hypothesized that minimally invasive surgery for posterior atlantoaxial lateral mass joint fusion (MIS-PALF), a procedure that can largely avoid disruption of suboccipital musculature, would be superior to the standard Goel-Harms technique in terms of postoperative pain and perioperative blood loss. METHODS: This was a prospective cohort study of patients undergoing MIS-PALF for AAI/D at Peking University Third Hospital's Department of Orthopaedics from January 2021 to December 2021 and a historical control group of patients with the same diagnoses who were treated with the Goel-Harms technique. The duration of surgery, perioperative blood loss, postoperative length of hospital stay, postoperative body temperature, pain, supplementary use of narcotics, spinal cord function/improvement (assessed using the Japanese Orthopaedic Association [JOA] scores), reduction of AAI/D (determined based on radiographic parameters), rate of successful fusion, and complication rate were all compared between the 2 groups. RESULTS: No significant differences were noted between the groups (43 MIS-PALF cases, 86 control cases) regarding baseline data, operative time, spinal cord function or improvement, reduction of AAI/D, rate of successful fusion, and complication rate. MIS-PALF was associated with significantly less perioperative blood loss, a shorter postoperative hospital stay (decreased by 30.8%), lower intensity and frequency of postoperative pain (decreased by 10.6% and 61.9%, respectively), less need for supplementary narcotics, and less frequent postoperative fever (decreased by 48.7%). CONCLUSIONS: This was the first prospective cohort study of which we are aware on minimally invasive procedures for atlantoaxial fusion. Clinical efficacy (AAI/D reduction, rate of successful atlantoaxial fusion, JOA score improvement), efficiency (operative time), and safety (complications) of MIS-PALF appeared to be noninferior to those of the Goel-Harms technique. MIS-PALF was superior in terms of postoperative occipitocervical pain and length of hospital stay, both of which directly affect overall patient satisfaction and postoperative recovery of quality of life. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

2.
World Neurosurg ; 189: e69-e79, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38838937

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of patient-tailored 3D printed brace in the treatment of adolescent idiopathic scoliosis (AIS), and to compare the health-related quality of life (HRQoL) of patients treated with 2 different types of brace. MATERIALS AND METHODS: From September 2017 to August 2020, 103 AIS patients requiring non-operative management were prospectively recruited in this study. All patients were followed up every 6 months, clinical and radiologic examination were assessed at each follow-up time. Full-length anteroposterior radiographs of the spine in the standing position were obtained. At the last follow-up, each patient completed a standardized HRQoL questionnaire. Compliance is defined as that the patient insists on wearing the brace for ≥23 hours every day (full-time wearing) and follow-up every 6 months until bone maturity. The rate of major curve Cobb progression was defined that maximum Cobb angle of major curve greater than 6° compared with that at the initial diagnosis, or aggravated to more than 45° so that orthopedic surgery was recommended during treatment, which was defined as the rate of conversion to surgery. The effects of these 2 types of braces on the rate of major curve Cobb progression and HRQoL were analyzed by independent sample t test and χ2 test. RESULTS: The thickness was 4 mm for thoracolumbosacral orthosis (TLSO) and 3 mm for 3D-printed brace (3DPB). In addition, compared with the material used in TLSO, the weight (600-800 g) of the 3DPB materials with the same area is reduced by about 25% to 30%. In our sample, 55 patients (49.1%) and 48 patients (33.1%) were respectively included in the 3DPB cohort and the TLSO cohort. The maximum Cobb angle of major curve in the 3DPB cohort was significantly lower than those in the TLSO cohort at 6 months, 12 months, and the last follow-up (P < 0.01). The thoracic kyphosis (TK) and lumbar lordosis (LL) of the 2 cohorts at the last follow-up were lower than those before brace treatment, in addition, there was a significant difference in TK (P = 0.001) and LL (P = 0.004) between the 2 cohorts at the follow-up. The scores of physical function, pain, self-image, mental health, and treatment satisfaction in the Chinese version of the 22-item questionnaire of the Scoliosis Research Society in the 3DPB cohort were higher than those in the TLSO cohort (P < 0.01 and P < 0.05, respectively). The scores of the 3DPB cohort were significantly higher than those of the TLSO group in the 4 dimensions (P = 0.008, 0.013, 0.015, and 0.002, respectively) of the EuroQol-5D health description system except for mobility, and the overall health status of EuroQol-5D was higher for the 3DPB cohort (P < 0.001). At the last follow-up, 1 patient in the 3DPB cohort and 10 patients in the TLSO cohort had major curve Cobb progression of greater than 6°, and the rate of major curve Cobb progression in the 3DPB cohort was significantly lower than that in the TLSO cohort (OR 14.2, 95% CI 1.7∼115.8, P < 0.01). One patient in the 3DPB and 7 patients in the TLSO cohorts received subsequent surgery or were recommended for surgery, and the rate of conversion to surgery was significantly lower than in the 3DPB cohort (OR 9.2, 95% CI 1.1∼77.9, P < 0.05). CONCLUSIONS: A patient-tailored 3D-printed brace is lighter, thinner, and more comfortable than conventional braces in the treatment of AIS. It can substantially improve the HRQoL of patients and can significantly reduce the progression of major curve Cobb progression and rate of conversion of surgery.


Assuntos
Braquetes , Impressão Tridimensional , Qualidade de Vida , Escoliose , Humanos , Escoliose/terapia , Escoliose/cirurgia , Escoliose/diagnóstico por imagem , Adolescente , Feminino , Masculino , Estudos Prospectivos , Estudos de Coortes , Criança , Resultado do Tratamento , Seguimentos
3.
Heliyon ; 10(1): e23435, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38148803

RESUMO

Background: Difficult airway remains a great challenge in patients with atlantoaxial dislocation (AAD). Preoperative evaluation and reliable prediction are required to facilitate the airway management. We aimed to screen out reliable radiological indicators for prediction of difficult laryngoscopy in patients with AAD. Methods: A retrospective nested case-control study within a single center longitudinal AAD cohort was conducted to investigate the radiological indicators. All the patients with difficult laryngoscopy from 2010 to 2021 were enrolled as the difficult laryngoscopy group. Others in the cohort without difficult laryngoscopy were randomly selected as the non-difficult laryngoscopy group by individually matching with the same gender, same surgery year, and similar age (±5 years) at a ratio of 6:1. Radiological data on preoperative lateral X-ray images between the two groups were compared. Bivariate logistic regression model was applied to screen out the independent predictive indicators and calculate the odds ratios of indicators associated with difficult laryngoscopy. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. Results: A total of 154 patients were finally analyzed in this study. Twenty-two patients with difficult laryngoscopy and matched with 132 controls. Four radiological parameters showed significant difference between the two groups. Among which, ΔC1C2D (the difference of the distance between atlas and axis in the neutral and extension position), owned the largest AUC. Conclusions: ΔC1C2D could be a valuable radiologic predictor for difficult laryngoscopy in patients with AAD.

5.
J Bone Joint Surg Am ; 105(10): 771-778, 2023 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-36827380

RESUMO

BACKGROUND: Patients with "sandwich" fusion (concomitant C1 occipitalization and C2-C3 nonsegmentation), a subtype of Klippel-Feil syndrome, are at particular risk for developing atlantoaxial dislocation (AAD). However, the clinical and surgical characteristics of AAD in patients with sandwich fusion have not been clearly defined. METHODS: A retrospective case-control study with a large sample size and a minimum 2-year follow-up was performed. From 2000 to 2018, 253 patients with sandwich AAD underwent a surgical procedure; these patients constituted the case group, and a matching number of patients with non-sandwich AAD were randomly selected to form the control group. Clinical data from electronic medical records and various imaging studies were analyzed and compared. The Japanese Orthopaedic Association (JOA) scale was used to evaluate neurological function. RESULTS: Patients with sandwich AAD, compared with patients with non-sandwich AAD, had symptom onset at a younger age (34.8 compared with 42.8 years; p < 0.001) and had a higher likelihood for myelopathy (87.4% compared with 74.7%; p < 0.001). Patients with sandwich AAD had a higher incidence of lower cranial nerve palsy (7.9% compared with 0.0%; p < 0.001), a lower preoperative JOA score (13.4 compared with 14.2; p < 0.001), and higher incidences of accompanying Type-I Chiari malformation (20.9% compared with 1.2%; p < 0.001) and syringomyelia (21.3% compared with 1.6%; p < 0.001). Finally, patients with sandwich AAD had higher likelihoods of undergoing transoral release (28.5% compared with 5.1%; p < 0.001) and use of salvage fixation techniques (34.4% compared with 6.3%; p < 0.001), and had lower postoperative results for the JOA score (14.9 compared with 15.9; p < 0.001) and improvement rate (43.8% compared with 58.2%; p < 0.001). CONCLUSIONS: Patients with sandwich AAD demonstrated distinct clinical manifestations. Versatility involving the use of various internal fixation techniques and transoral release procedures was frequently required in the surgical management of these patients, and meticulous and personalized preoperative planning would be of paramount importance. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Lesões do Pescoço , Fusão Vertebral , Siringomielia , Humanos , Adulto , Seguimentos , Estudos Retrospectivos , Estudos de Casos e Controles , Luxações Articulares/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Fusão Vertebral/métodos , Resultado do Tratamento
6.
Acta Neurochir (Wien) ; 165(5): 1155-1160, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36534186

RESUMO

PURPOSE: To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among "sandwich" atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures. METHODS: The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1-Z4). RESULTS: There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (p < 0.05). Ninety-two ICAs (57.5%) were anteriorly located in Z3, 50 (31.3%) were located in Z4, 17 were located in Z2, and only one ICA was located in Z1 in all 80 patients. CONCLUSIONS: In "sandwich" AAD patients, particular attention should be paid to excessively medialized ICA to avoid ICA injury during trans-oral procedures, and the risk of injuring the ICA with more cranially and medially angulated C1LM screw placement was relatively less during posterior fixation procedures. A novel classification of ICA location was used to describe the relationship between ICA and LMA.


Assuntos
Articulação Atlantoaxial , Lesões das Artérias Carótidas , Luxações Articulares , Lesões do Pescoço , Fusão Vertebral , Humanos , Masculino , Feminino , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Fusão Vertebral/métodos , Vértebras Cervicais/cirurgia , Parafusos Ósseos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia
7.
Front Oncol ; 12: 1016258, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36387088

RESUMO

Background context: Patients with spinal metastases always have a poor health-related quality of life (HRQoL) and disease- and treatment-related adverse outcomes. The Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) has been verified and validated in English for patients with spinal metastases but not in Chinese. Purpose: This paper aimed to complete the cross-cultural adaptation of the Chinese version of the SOSGOQ, to verify its reliability and validity, and to report on the HRQoL of Chinese patients with spinal metastases. Study design/setting: This is a single-center, prospective, observational cross-sectional study. Patient sample: Seventy-six patients were enrolled in this study. Outcome measures: The SOSGOQ is made up of five HRQoL domains (physical function, neurological function, pain, mental health, social function) and post-therapy questions. The EQ-5D 3L questionnaire covers five items in mobility, self-care, usual activities, pain discomfort, and anxiety-depression, each with three answer options. The SF-36 comprises 36 items divided into eight domains. Methods: A single-center, prospective, observational cross-sectional study involving patients with spinal metastases who underwent surgery was conducted. HRQoL was evaluated using the Chinese version of the SOSGOQ, the Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36), and the EuroQol 5-Dimension questionnaire (EQ-5D). Demographic, tumor, symptom, and treatment data, as well as Eastern Cooperative Oncology Group (ECOG) information, were collected. Internal consistency reliability, convergent validity, concurrent validity, and clinical validity were used to evaluate reliability. A Spearman's correlation analysis was used to analyze the relationship between variables. Results: This study enrolled 76 patients, with a mean age of 55.8 years. The kidney was the most common primary tumor site, and the thoracic spine was the most affected. The internal consistency of the overall SOSQOQ (0.907) was higher than the EQ-5D (0.819), and all items of the SOSQOQ had a high convergent validity (>0.40). The SOSGOQ was significantly correlated with the EQ-5D in respective domains (p < 0.001) and overall score (p < 0.001), whereas the SF-36 was related to the overall SOSGOQ score and most domains. Total SOSGOG was significantly sensitive to changes in ECOG (p = 0.017), prior surgery (p = 0.001), and tumor type (p = 0.026). Conclusions: The SOSGOQ is a reliable and effective tool for evaluating HRQoL in patients with spinal metastases, with high sensitivity and specificity. Surgical treatment can significantly improve patients' HRQoL.

8.
BMJ Open ; 12(2): e053846, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-35168975

RESUMO

INTRODUCTION: Preoperative autologous blood donation (PABD) can be used to reduce the exposure of allogeneic blood transfusion in patients undergoing elective surgery. Better blood management to avoid anaemia and reduce allogeneic blood transfusion after spine surgery become increasingly important with development of enhanced recovery after surgery. We present here the design of a randomised controlled trial with three groups to verify the clinical effectiveness of PABD in patients at high risk of transfusion for lumbar fusion surgery and explore the optimal timing of autologous blood donation. METHOD AND ANALYSIS: Patients (age 18-70 years) who will receive lumbar fusion surgery for degenerative disease with haemoglobin over 110 g/L and 'high risk' of allogeneic blood transfusion are eligible, unless they refuse participation or are diagnosed with malignant metastases, infection, cardiovascular and cerebrovascular diseases, haematological disorders or relevant drug history and critical illnesses. A total of 1200 patients will be recruited and randomised into three groups. Patients in group A will not receive PABD and be regarded as control group. PABD will be performed for patients in groups B and C. Blood donation will be finished at 1 week (±3 day) before surgery in group B and 2 weeks (±3 day) before surgery in group C. Primary outcome measures will include haemoglobin decline, incidence and amount of allogeneic blood transfusion. Secondary outcome measures will include days of hospitalisation after surgery, haematocrit level and incidence of complications. This study is a single-centre and open-label randomised controlled trial. The sample size is calculated with reference to the retrospective data and previous studies. ETHICS AND DISSEMINATION: This trial has been approved by the Peking University Third Hospital Medical Science Research Ethic Committee (no: 2020-262-02). Results of the trial will be submitted for publication in a peer-reviewed journal and as conference presentations. TRIAL REGISTRATION NUMBER: ChiCTR2000039824, preresults.


Assuntos
Doadores de Sangue , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto , Idoso , Transfusão de Sangue , Transfusão de Sangue Autóloga/métodos , Hemoglobinas , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Adulto Jovem
9.
J Clin Transl Res ; 8(6): 594-601, 2022 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-36683652

RESUMO

Background and Aim: The modified Japanese Orthopaedic Association (mJOA) scale is one of the primary measures of neurological function used on patients with degenerative cervical myelopathy (DCM). Contrary to some reports, the mJOA is not based on patient-reported outcomes as it is an assessment conducted by physicians, allied health professionals, or trained staff. To date, the accuracy of post-operative recall by DCM patients of their pre-operative neurological function, as assessed by the mJOA scale, has not been examined. This study, therefore, aimed to evaluate recall accuracy in DCM patients using the mJOA scale. Methods: This study analyzed recall capacity of DCM patients who had undergone anterior cervical discectomy and fusion by a single surgeon at a large academic spine center between February 2012 and August 2017. Patient recall of neurological function pre-surgery was assessed at 3, 12, and 24 months post-surgery using the mJOA scale. Actual mJOA scores were also determined at each follow-up. Recall error (RE) was defined as the difference between recalled mJOA score at each post-operative visit and the actual baseline score. Age, gender, surgical segments, hospital length of stay, actual mJOA scores at follow-up, and actual rate of improvement in mJOA score were analyzed as predictors of recall accuracy. Descriptive statistics were collected to profile the characteristics of patients enrolled in the study cohort. All statistical computing and graphing were performed with R software and generalized estimating equation (GEE) model fitting was done using geepack package. Results: A total of 105 patients (56.2% of males and 43.8% of females) were enrolled in the study. The median ± SD (range) age at the pre-surgical baseline measurement was 50 ± 8 (25 - 78) years. The recalled mJOA scores at the three follow-up time points were lower than the actual mJOA scores. The recall accuracy gradually decreased over time. Estimated coefficients showed that all variables in the GEE model except for surgical fusion segments were significant (P < 0.05). The pre-operative actual baseline mJOA score was inversely associated with RE. An increasing actual mJOA score over time had a significant positive influence on RE. Greater RE was found in males compared to females. Unexpectedly, age was inversely associated with RE. Conclusions: The RE increases with the time interval between pre-surgical measurement and post-surgical follow-up and is more prominent in male DCMs patients following upper spine surgery. Relevance for Patients: It is necessary to select post-operative patients who need to pay attention according to the three factors of post-operative time, gender, and age, that is, patients with large RE should be given early or timely psychological counseling and treatment concerns, so as to reduce the occurrence of potential medical disputes and improve the level of medical safety.

10.
Front Surg ; 9: 1011100, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36684347

RESUMO

Objectives: To evaluate the survival and medium to long term health-related quality of life (HRQoL) of patients with primary cervical spinal tumors in a cross-sectional study and to identify any significant associations with demographic or clinical characteristics. Methods: Patients diagnosed with primary cervical spinal tumors were retrospectively enrolled and their clinical, radiologic, and follow-up data (specifically the EQ-5D questionnaire) were collected. Univariate and multivariate Cox time-dependent regression analyses were performed to examine the significance of certain variables on overall survival. Univariate and multivariate logistic regression analyses were conducted to identify variables significant for overall HRQoL and each dimension of the EQ-5D. Results: A total of 341 patients were enrolled in the study with a mean follow-up of 70 months. The diagnosis was benign in 246 cases, malignant in 84, and unconfirmed in 11. The 5-year overall survival rate was 86% and the 10-year overall survival rate was 65%. Multivariate analysis suggested that surgical treatment (P = 0.002, hazard ratio [HR] = 0.431, 95% CI. [0.254, 0.729]), benign and malignant tumors [P < 0.001, HR = 2.788, 95% CI. (1.721, 4.516)], tumor and surrounding normal tissue boundary [P = 0.010, HR = 1.950, 95% CI. (1.171, 3.249)], and spinal instability [P = 0.031, HR = 1.731, 95% CI. (1.051, 2.851)] still had significant effects on survival. Conclusions: In this cross-sectional study, we evaluated the survival period and medium and long-term health-related quality of life of patients with primary tumors of the cervical spine, and analyzed the significant related factors of tumor clinical characteristics. Surgery, myelopathy, malignancy, spinal pain relieved by lying down or supine position, and tumor infiltration on MRI were significant predictors for overall survival. Enneking stage and age were significant predictors for HRQoL.

11.
BMC Musculoskelet Disord ; 22(1): 121, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514363

RESUMO

BACKGROUND: Treatment of atlantoaxial dislocation is aimed at reduction and stabilization of the atlantoaxial joint. 3D printing refers to a process where additive manufacturing is achieved under precise computer control. Literature on its utilization in anterior atlantoaxial fixation and fusion is rare. This study is the first report on a 3D-printed locking cage used in the anterior procedure for atlantoaxial dislocation. METHODS: A middle-aged male in his 40s presented with weakness and numbness of his extremities for 3 years and could only walk slowly with assistance. Imaging studies revealed severe anterior migration of C1, irreducible atlantoaxial dislocation, and severe cervical-medullary compression. A preoperative plan consisting of trans-oral soft tissue release and fixation using tailor-designed 3D-printed cages was devised. Following fluoroscopic confirmation of reduction of the atlantoaxial joints, two customized 3D-printed cages made of titanium alloy were inserted into the bilateral facet joints, which were then locked by six screws into the lateral masses of C1 and C2. The microstructure of the inserted cages was optimized for improved biomechanical stability and enhanced osseo-integration, without the need for bone grafting. In addition, a biomechanical test was performed on seven human cadaveric specimens comparing the novel implant with the conventional C1 lateral mass-C2 pedicle screw construct in three modes of motion (flexion-extension, lateral bending, axial rotation). RESULTS: Improvement of neurologic function in the patient was evident immediately after surgery. He was able to walk independently 1 month post-operatively. At the 12-month follow-up, coronal reconstruction of CT demonstrated properly-positioned 3D-printed cages, evidence of osseo-integration at the bone-implant interface, and no subsidence or displacement of the implant. Eighteen months out of surgery, the mJOA score improved to 15, and lateral X-ray confirmed reduction of atlanto-axial dislocation. Additionally, the new construct provided strong fixation comparable to that conferred by conventional constructs as there was no significant difference observed between the two groups in all three directions of motion. CONCLUSIONS: The novel implant represents a new option in the treatment of irreducible atlantoaxial dislocation. It can provide strong anterior support for solid fixation and fusion with a low profile and a microstructure that obviates the need for bone grafting.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Parafusos Pediculares , Fusão Vertebral , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Fenômenos Biomecânicos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Impressão Tridimensional
12.
Neurospine ; 18(4): 770-777, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35000331

RESUMO

OBJECTIVE: To summarize the vertebral artery (VA) pattern of 96 "sandwich" atlantoaxial dislocation (AAD) patients and to describe the strategies of reducing the injury of VA during surgery. METHODS: From 2009 to 2020, we retrospectively reviewed the 3-dimensional computed tomography angiography data of 96 AAD patients combined with atlas occipitalization and C2-3 fusion, which were diagnosed as "sandwich" AAD and 96 patients as control group patients who were without atlas occipitalization, C2-3 fusion and any other cervical bone deformity at our institution. The variations of each side of VA were described in 3 different parts (C0-1, C1-2, and C2-3) according to the characteristics of the 3-part pathological structures in "sandwich" subgroup. RESULTS: One hundred ninety-two sides of VAs in every group of patients were analyzed and every VA was described separately at 3 different level regions. There were different variations in these 3 different regions: 4 variations in the upper fusion region, 5 variations in the sandwiched region, and 6 variations in the lower fusion region in sandwich AAD patients. And the rate of VA deformity in sandwich AAD patients was much higher and more types of VA variations existed. CONCLUSION: In "sandwich" AAD patients, deformities of vertebral arteries in craniovertebral junction are more common, and the same VA may have deformities at different levels that severely affect surgical procedures. Therefore, preoperative imaging examination of VA for "sandwich" AAD patients is vital of guiding surgeons to avoid injury of VA during surgery.

13.
Clin Spine Surg ; 34(3): E172-E176, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32969871

RESUMO

STUDY DESIGN: This is a single-center, retrospective, cohort study. OBJECTIVE: The objective of this study was to propose a surgical classification algorithm guiding the choice of surgical approaches for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine based on the characteristics of each patient's specific pathology. SUMMARY OF BACKGROUND DATA: Surgical decision-making in this OPLL patient population requires balancing a more definitive decompression of the thoracic spinal cord through direct decompression against a higher risk of significant complications. MATERIALS AND METHODS: Patients with a primary diagnosis of thoracic OPLL who received surgical decompression in a tertiary spine center between May 2009 and June 2015 were included. Surgical planning was guided by our classification algorithm according to the location and the extent of OPLL in each patient. Patient demographics, neurological function using the 11-point Japanese Orthopaedic Association scale, length of procedure, estimated blood loss, the occurrence of major complications, etc., were extracted from the database of electronic medical record system. The Kruskal-Wallis test and Fisher exact test were used when data were not normally distributed. RESULTS: A total of 115 patients (33 men and 82 women) were included in this study, among whom 108 had a follow-up of at least 12 months (average: 51.7±22.2 mo, range: 12-100 mo). On the basis of our classification algorithm, 11 patients were type I, 26 were type II, 60 were type III, 11 were type IV, and the choice of surgical decompression techniques used in each patient followed that recommended by the algorithm in all cases. On average, the Japanese Orthopaedic Association score improved from 5.0±1.8 preoperatively to 8.7±1.7 postoperatively, with a Hirabayashi improvement rate of 63.6%. CONCLUSION: A new surgical classification algorithm guiding the choice of approach for decompression of OPLL in the thoracic spine was validated in a series of 108 patients through an analysis of their clinical outcomes and surgical complications. LEVEL OF EVIDENCE: Level III.


Assuntos
Ossificação do Ligamento Longitudinal Posterior , Fusão Vertebral , Algoritmos , Estudos de Coortes , Descompressão Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 21(1): 821, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33287792

RESUMO

BACKGROUND: In the setting of congenital C1 occipitalization and C2-3 fusion, significant strain is placed on the atlantoaxial joint. Vertebral fusion both above and below the atlantoaxial joint (i.e., a "sandwich") creates substantial instability. We retrospectively report on a case series of "sandwich fusion" atlantoaxial dislocation (AAD), describing the associated clinical characteristics and detailing surgical treatment. To the best of our knowledge, the present study is the largest investigation to date of this congenital subgroup of AAD. METHODS: Seventy consecutive patients with sandwich fusion AAD, from one senior surgeon, were retrospectively reviewed. The clinical features and the surgical treatment results were assessed using descriptive statistics. No funding sources or potential conflict of interest-associated biases exist. RESULTS: The mean patient age was 42.2 years (range: 5-77 years); 36 patients were male, and 34 were female. Fifty-eight patients (82.9%) had myelopathy, with Japanese Orthopaedic Association (JOA) scores ranging 4-16 (mean: 12.9). Cranial neuropathy was involved in 10 cases (14.3%). The most common presentation age group was 31 to 40 years (24 cases, 34.3%). Radiological findings revealed brainstem and/or cervical-medullar compression (58 cases, 82.9%), syringomyelia (16 cases, 22.9%), Chiari malformation (12 cases, 17.1%), cervical spinal stenosis (10 cases, 14.3%), high scapula deformity (1 case, 1.4%), os odontoideum (1 case, 1.4%), and dysplasia of the atlas (1 case, 1.4%). Computed tomography angiography was performed in 27 cases, and vertebral artery (VA) anomalies were identified in 14 cases (51.9%). All 70 patients underwent surgical treatment, without spinal cord or VA injury. Four patients (5.7%) suffered complications, including 1 wound infection, 1 screw loosening, and 2 cases of bulbar paralysis. In the 58 patients with myelopathy, the mean JOA score increased from 12.9 to 14.5. The average follow-up time was 50.5 months (range: 24-120 months). All 70 cases achieved solid atlantoaxial fusion at the final follow-up. CONCLUSIONS: Sandwich fusion AAD, a unique subgroup of AAD, has distinctive clinical features and associated malformations such as cervical-medullar compression, syringomyelia, and VA anomalies. Surgical treatment of AAD was associated with myelopathy improvement and minimal complication occurrence.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Fusão Vertebral , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais , Criança , Pré-Escolar , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Adulto Jovem
15.
BMJ Open ; 10(11): e038373, 2020 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-33247008

RESUMO

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Brace treatment is effective for eligible patients with AIS and the effectiveness is significantly correlated with the average brace-wear time per day. Three-dimensional (3D) printing technology is a recent advancement that offers unique opportunities for biomedical applications, and customisation of scoliosis braces might lead to greater patient satisfaction and improved compliance. We present here the design of a randomised controlled trial on the clinical effectiveness of 3D-printed braces versus thoracolumbosacral orthoses (TLSO) for patients with AIS. METHODS AND ANALYSIS: Patients with AIS (age 10-16 years) with Risser sign 0-II, Cobb angle of main curve of 20°-40°, premenarchal or no more than 1-year postmenarchal (for women), and no history of treatment are eligible, unless they are unable to tolerate the treatment or refuse participation. A total of 88 patients will be randomised into either the 3D group or TLSO group on a 1:1 basis. Participants in the 3D group will choose between a 3D-printed brace and TLSO, according to the Zelen's design of the trial. Primary outcome measures will include the average brace-wear time per day, health-related quality of life and Cobb angle progression of the primary curve. Secondary outcome measures will include immediate in-brace correction of Cobb angle of the primary curve, rate of conversion to surgery and incidence of any adverse events. This study is designed as a single-centre, two-arm, superiority and open-label randomised controlled trial. The sample size is calculated with reference to the preliminary study and based on the sample size calculation formula. ETHICS AND DISSEMINATION: This study was approved by the Peking University Third Hospital Medicine Science Research Ethics Committee (No: 2019-017-02). Results of the trial will be submitted for publication in a peer-reviewed journal and as conference presentations. TRIAL REGISTRATION NUMBER: ChiCTR1900027379, pre-results.


Assuntos
Braquetes , Escoliose , Adolescente , Criança , Feminino , Humanos , Impressão Tridimensional , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Escoliose/diagnóstico por imagem , Escoliose/terapia , Resultado do Tratamento
16.
Ann Transl Med ; 8(17): 1070, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33145289

RESUMO

BACKGROUND: This was a prospective randomized cohort study aiming at examining the safety and efficacy of artificial vertebral body (AVB) fabricated by electron beam melting (EBM) in comparison to conventional titanium mesh cage (TMC) used in single-level anterior cervical corpectomy and fusion (SL-ACCF). METHODS: Forty patients with cervical spondylotic myelopathy (CSM) underwent SL-ACCF using either the EBM-AVB or the TMC. Patients were evaluated for their demographics, radiological characteristics, neurologic function [using the Japanese Orthopaedic Association (JOA) scale], and health-related quality-of-life (HRQoL) aspects [using the Short Form 36 (SF-36)] before and after the surgery and comparison was made between the two groups both at baseline and the last follow-up. The Student t-text, paired-sample t-text, and Fisher's exact test were used when appropriate to detect any statistical significance at the level of α=0.05. RESULTS: Post-operative recovery was uneventful for all patients and no revision surgery was required. There were no significant differences between the EBM-AVB group and the TMC group at baseline. Patients in both groups demonstrated significant improvement in cervical alignment, JOA score, and SF-36 score after the surgery. Six months post-operatively, patients in the EBM-AVB group were found to have significantly less loss of fusion height and lower incidence for severe implant subsidence compared with the TMC group. Patients in the two groups were comparable at the last follow-up regarding their rate of fusion, cervical alignment, JOA recovery rate, SF-36 score, and by Odom's criteria. CONCLUSIONS: For CSM patients undergoing SL-ACCF, the EBM-AVB group demonstrated comparable outcomes regarding patient cervical alignment, neurologic function, and HRQoL in comparison with the TMC group. Furthermore, the use of EBM-AVB was associated with decreased loss of the height of the fusion mass and a lower rate for severe implant subsidence.

17.
Ann Transl Med ; 8(6): 332, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32355776

RESUMO

BACKGROUND: Reconstruction following resection of the primary tumors of the upper cervical spine is challenging, and conventional internal implants develop complications in this region. 3D printing, also known as additive manufacturing, can produce patient-specific porous implants in a particular shape for bone defect reconstruction. This study aimed to describe the clinical outcomes of upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. METHODS: Patients with primary tumors involving C2 who were treated in our institution between July 2014 and November 2018 were enrolled. A two-stage intralesional spondylectomy was performed using the posterior-anterior approach. Anterior reconstruction was accomplished using a customized 3D-printed vertebral body, which was fabricated by successive layering of melted titanium alloy powder using electron beam melting. No bone graft was used. RESULTS: Nine patients (2 males and 7 females) were included in the study with a mean age of 31.4 years (12 to 59 years). Seven patients demonstrated tumors located in C2 and 2 showed involvement of C2 and C3. During a mean follow-up of 28.6 months (range, 12-42 months), 1 patient died of systemic metastasis and 1 had local tumor recurrence, the other 7 patients were alive and functional in their daily living until the last follow-up without evidence of disease. The 3D-printed vertebral bodies were all stable with no sign of displacement or subsidence, evidence of implant osseointegration was observed on the imaging studies. For the posterior instrumentation systems, no screw loosening or rod breakage was found. CONCLUSIONS: Spinal reconstruction in the upper cervical region using customized 3D-printed vertebral body is reliable. The tailored shape matching with the contact surfaces and the porous structure conductive to osseointegration provide both short- and long-term stability to the implant.

18.
BMC Musculoskelet Disord ; 21(1): 83, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32033548

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old. MRI plays an important role in the diagnosis and evaluation of CSM, which can directly demonstrate the correlation between disc, spinal cord, posterior structures and abnormal signal in spinal cord. Static MRI can only show the static and neutral position of spinal cord, which is not enough to understand the pathogenesis of CSM. Dynamic MRI demonstrating the extension and flexion position of spinal cord can be a better tool for the treatment of CSM, especially the surgical decision making. METHOD: A total of 180 CSM patients who have indications for surgery will be recruited in outpatient of Peking University Third Hospital and assigned to three groups (Group A, B and C) based on their static MRI after consent. Group A (incomplete dura compression) means the signal of cerebral spinal fluid (CSF) is still visible. Group B (complete dura compression) means no CSF signal and no shape change of spinal cord. Group C (spinal cord compression) means shape change of spinal cord. Two surgical plans will be made for each participant by one professional surgeon according to the static MRI and dynamic MRI respectively and we will randomly choose one to perform via a random number system. Follow-up will be maintained at 3, 6, and 12 months after surgery through outpatient or telephone interview, including mJOA score, 10-s G&R (grip and release) and 10-s step test, SF-36 score, radiographic examination and complications. Finally, data collection and statistical analysis will be finished by researchers who are blinded to recruitment and treatment. DISCUSSION: This study will help us to explore the indication of dynamic MRI and the value of dynamic MRI in the treatment of CSM, especially the surgical decision making. Dynamic MRI can be a useful tool in the treatment of CSM patients. TRIAL REGISTRATION: ChiCTR1900023014. Registered on May 7th, 2019.


Assuntos
Discotomia/efeitos adversos , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/epidemiologia , Compressão da Medula Espinal/diagnóstico , Espondilose/diagnóstico , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/patologia , Espondilose/cirurgia
19.
World Neurosurg ; 135: e106-e115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31756507

RESUMO

OBJECTIVE: The present study investigated the risk factors for instrumentation failure (IF) after total en bloc spondylectomy (TES) of thoracic and lumbar spine tumors using a titanium mesh cage (TMC) for anterior reconstruction. METHODS: The data from patients who had undergone TES for thoracic and lumbar spine tumors in our institution were retrospectively reviewed. Anterior reconstruction was performed using a TMC filled with morcelized allograft or morcelized autograft. Posterior reconstruction was performed using pedicle fixation. Survival analysis from TES to IF was conducted. The Kaplan-Meier method was used for univariate analysis. Factors of statistical significance were included in the multivariate analysis using Cox regression analysis. RESULTS: A total of 30 patients (20 men and 10 women), with a mean age of 37.1 ± 14.3 years (range, 14-65 years) were included. The mean follow-up period was 41.8 ± 21.3 months (range, 13-120 months). Bone fusion was achieved in 23 patients (76.7%). IF occurred in 8 patients. The mean interval from TES to the first IF was 31.8 ± 15.1 months (range, 13-64 months). On univariable analysis, a body mass index >28 kg/m2, perioperative radiotherapy, and the TMC in an oblique position were associated with IF. On multivariable analysis, these 3 factors were entered into the Cox regression model and were also significant. CONCLUSIONS: The use of TES can achieve durable oncological control. However, IF, a not uncommon late complication that leads to reoperation, should be a cause for concern. We found perioperative radiotherapy, a TMC in an oblique position, and a body mass index >28 kg/m2 were significant predictive factors for IF.


Assuntos
Vértebras Lombares/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Telas Cirúrgicas , Titânio , Adulto , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Reoperação , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas/efeitos adversos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Adulto Jovem
20.
Spine J ; 19(5): 803-815, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30447326

RESUMO

BACKGROUND CONTEXT: An anteroposterior combined approach has been used for the treatment of congenital cervical or cervicothoracic scoliosis. However, its outcomes and surgical risks have not been clarified. PURPOSE: We analyzed the characteristics of congenital cervical and cervicothoracic scoliosis and evaluated the outcomes of an anteroposterior combined approach for its treatment. STUDY DESIGN: We carried out a retrospective clinical study of prospectively collected data. PATIENT SAMPLE: Sixteen patients were treated between 2009 and 2013. Their average age was 9.2years. OUTCOME MEASURES: Radiographic and surgical outcomes were measured and recorded. We compared morphological parameters and preoperative and postoperative results. METHODS: All patients underwent surgery with a combined approach. The following radiographic parameters were measured: head tilt (HT), mandible incline (MI), shoulder balance (SB), structural and compensatory curves, cervical lordosis, C7 central sacral vertical line (C7-CSVL) ratio, C7 sagittal vertical axis (C7-SVA) ratio, C2-C7 SVA ratio, the angle between the upper endplate of the T2 vertebra and a horizontal line (T2 tilt), gravity line ratio. Demographic and surgical data were also collected. RESULTS: On average, the duration of follow-up was 68.0 months, surgical blood loss was 675mL, and the duration of surgery was 400.5 minutes. The average correction rate was 64.9% in the structural curve and 29.5% in the compensatory curve. Statistical analysis showed that MI significantly correlated with HT and SB (p<.05). The C7-CSVL ratio correlated with the HT, MI, and SB (p<.05). The C7-SVA ratio correlated with the structural curve and cervical lordosis (p<.05), and the gravity line ratio correlated with the structural and compensatory curve, cervical lordosis, and C7-SVA ratio (p<.05). Moreover, there were correlations between the structural and compensatory curves as well as between the structural curve and cervical lordosis (p<.05). There were significant differences before and after surgery in HT, MI, and structural and compensatory curves. Four patients developed nerve root palsy after surgical correction and totally recovered by 6 months of follow-up. CONCLUSION: The combined approach is an effective surgical option for congenital cervical or cervicothoracic scoliosis. The resection of the hemivertebra cannot only improve head-neck aesthetic appearance but can also maintain the growth potential of the neck.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Vértebras Cervicais/cirurgia , Criança , Feminino , Humanos , Masculino , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/cirurgia
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