Factors that influence in-brace derotation effects in patients with adolescent idiopathic scoliosis: a study based on EOS imaging system.

OBJECTIVE: To investigate the effects of bracing on apical vertebral derotation and explore the factors that influence in-brace derotation effects in adolescent idiopathic scoliosis (AIS) patients. For patients with AIS, vertebral rotation causes cosmetic appearance abnormalities and acts as an indicator for curve progression. However, there have been few studies investigating the precise derotation effects of bracing for apical vertebra. The application of EOS imaging system enables quantitative evaluation of vertebral rotation in the axial plane in a standing position. METHODS: There were 82 eligible patients enrolled in current study, who underwent EOS imaging evaluation before and immediately after bracing. The clinical demographic data (age, gender, Risser sign and menstrual status) were recorded. The correlation analyses between derotation effects and key parameters (age, pre-brace Cobb angle, thoracic kyphosis, lumbar lordosis, vertebral rotation, pelvis axial rotation and apical vertebral level) were performed. The in-brace derotation effects stratified by gender, Risser sign, apical vertebral level, menarche status, coronal balance and sagittal balance were also analyzed. RESULTS: The rotation of apical vertebra was decreased from 8.8 ± 6.0 degrees before bracing to 3.8 ± 3.3 degrees immediately after bracing (p < 0.001), and the derotation rate was 49.2 ± 38.3%. The derotation degrees in brace was significantly correlated with major curve Cobb angle (r = 0.240, p = 0.030), minor curve Cobb angle (r = 0.256, p = 0.020) and total curve Cobb angle (r = 0.266, p = 0.016). Both the pre-brace apical vertebral rotation and apical vertebral level were significantly correlated with derotation effects in brace (p < 0.001). Patients with thoracic major curve showed worse derotation effects than those with lumbar major curve (p < 0.001). In addition, patients with coronal balance showed better in-brace derotation effects than those with coronal decompensation (p = 0.005). CONCLUSIONS: A satisfactory apical vertebral derotation rate (approximately 50%) could be obtained immediately after bracing in AIS patients. Pre-brace Cobb angle of curve, pre-brace apical vertebral rotation, apical vertebral level and coronal balance exhibited close associations with in-brace derotation effects of apical vertebra.

Perioperative complications of en bloc resection and anterior column reconstruction for thoracic and lumbar spinal tumors.

PURPOSE: To evaluate the perioperative clinical outcomes of en bloc resection and anterior column reconstruction for thoracolumbar spinal tumors. METHODS: This study conducted a retrospective analysis of prospective data collection of 86 consecutive patients, including 40 males and 46 females, with an average age of 39 years (ranged from 10 to 71 years). There were 35 cases of a malignant primary tumor,42 cases of an aggressive benign tumor, and nine cases of metastases. The main lesions were located in 65 cases of thoracic spine, 17 cases of lumbar spine, and 4 cases of thoracolumbar spine. Tumors involved one level in 45 patients, two levels in 12 patients, three levels in 21 patients, four levels in five patients, five levels in two patients, and six levels in one patient. RESULTS: According to the Weinstein-Boriani-Biagini surgical staging system, all patients achieved en bloc resections, including 74 cases of total en bloc spondylectomy and 12 cases of sagittal resections. The mean surgical time was 559 min (210-1208 min), and the mean total blood loss was 1528 ml (260-5500 ml). A total of 122 complications were observed in 62(72.1%) patients, of which 18(20.9%) patients had 25 major complications and one patient (1.2%) died of complications. The combined approach (P = 0.002), total blood loss (P = 0.003), staged surgery (P = 0.004), previous surgical history (P = 0.045), the number of involved vertebrae (P = 0.021) and lumbar location (P = 0.012) were statistically significant risk factors for major complication. When all above risk factors were incorporated in multivariate analysis, only the combined approach (P = 0.052) still remained significant. CONCLUSIONS: En bloc resection and anterior column reconstruction is accompanied by a high incidence of complications, especially when a combined approach is necessary.

Measurement of distances and locations of thoracic and lumbar vertebral bodies from CT scans in cases of spinal deformation.

BACKGROUND: Spinal deformations, except for acute injuries, are among the most frequent reasons for visiting an orthopaedic specialist and musculoskeletal treatment in adults and adolescents. Data on the morphology and anatomical structures of the spine are therefore of interest to orthopaedics, physicians, and medical scientists alike, in the broad field from diagnosis to therapy and in research. METHODS: Along the course of developing supplementary methods that do not require the use of ionizing radiation in the assessment of scoliosis, twenty CT scans from females and males with various severity of spinal deformations and body shape have been analysed with respect to the transverse distances between the vertebral body and the spinous process end tip and the skin, respectively, at thoracic and lumbar vertebral levels. Further, the locations of the vertebral bodies have been analysed in relation to the patient's individual body shape and shown together with those from other patients by normalization to the area encompassed by the transverse body contour. RESULTS: While the transverse distance from the vertebral body to the skin varies between patients, the distances from the vertebral body to the spinous processes end tips tend to be rather similar across different patients of the same gender. Tables list the arithmetic mean distances for all thoracic and lumbar vertebral levels and for different regions upon grouping into mild, medium, and strong spinal deformation and according to the range of spinal deformation. CONCLUSIONS: The distances, the clustering of the locations of the vertebral bodies as a function of the vertebral level, and the trends therein could in the future be used in context with biomechanical modeling of a patient's individual spinal deformation in scoliosis assessment using 3D body scanner images during follow-up examinations.

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach.

BACKGROUND: Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases. METHODS: We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis. RESULTS: Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18. CONCLUSION: T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation. TRIAL REGISTRATION: retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022.

Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery: A prospective, randomized, placebo-controlled clinical trial.

BACKGROUND: This study evaluates the efficacy of dexmedetomidine (DEX) in reducing postoperative delirium (POD) and modulating pro-inflammatory cytokines in elderly patients undergoing thoracolumbar compression fracture surgery. METHODS: In this randomized, double-blind, placebo-controlled trial conducted from October 2022 to January 2023 at Anting Hospital in Shanghai, 218 elderly patients were randomized into DEX (n = 110) and normal saline (NS, n = 108) groups. The DEX group received 0.5 µg/kg/h DEX, and delirium incidence was assessed using the Confusion Assessment Method (CAM) on days 1 to 3 post-surgery. Levels of interleukins IL-1ß, IL-6, and tumor necrosis factor-α (TNF-α) were measured pre-operation (T0) and on postoperative days 1 (T1) and 3 (T3). Preoperative (T0) and postoperative day 1 (T1) cerebrospinal fluid (CSF) samples were treated with varying concentrations of olanzapine or DEX to observe their regulatory effects on the expression of Phospho-ERK1/2 and Phospho-JNK. RESULTS: Dexmedetomidine significantly lowered the incidence of POD to 18.2%, compared to 30.6% in the NS group (P = .033). While all patients showed an initial increase in cytokine levels after surgery, by T3, IL-6 and TNF-α levels notably decreased in the DEX group, with no significant change in IL-1ß levels across groups. The adverse events rate was similar between groups, demonstrating the safety of DEX in this population. In postoperative CSF samples, treatment with 0.5 mM DEX significantly downregulated Phospho-JNK and upregulated Phospho-ERK1/2 expression, demonstrating a dose-dependent modulation of inflammatory responses. CONCLUSION: Dexmedetomidine is effective in reducing early POD in elderly patients post-thoracolumbar compression fracture surgery. It also decreases IL-6 and TNF-α levels, indicating its potential in managing postoperative inflammatory responses. Treatment with 0.5 mM DEX significantly modulated Phospho-ERK1/2 and Phospho-JNK expressions in postoperative CSF samples, indicating a dose-dependent effect on reducing inflammation. This study contributes to understanding DEX's role in improving postoperative outcomes in elderly patients.

Thoracolumbar fractures patients undergoing posterior pedicle screw fixation can benefit from drainage.

PURPOSE: To explore whether it is necessary to put drain tubes after posterior pedicle screw fixation of thoracolumbar fractures. METHODS: From April 2020 to January 2023, a total of 291 patients with recent thoracolumbar fractures (AO type-A or type-B) who received the pedicle screw fixation operation were enrolled retrospectively. In 77 patients, drain tubes were used in the pedicle screw fixation surgery, while no drain tubes were placed in the other group. After gleaning demographic information and results of lab examination and imageology examination, all data were put into a database. Independent-sample t-tests, Pearson Chi-Square tests, Linear regression analysis, and correlation analysis were then performed. RESULTS: Compared to the control group, the drainage group had significantly lower postoperative CRP levels (P = 0.047), less use of antipyretics (P = 0.035), higher ADL scores (P = 0.001), and lower NRS scores (P < 0.001) on the 6th day after surgery. Other investigation items, such as demographic information, operation time, intraoperative blood loss, body temperature, and other preoperative and postoperative lab results, showed no significant differences. CONCLUSIONS: The use of a drain tube in the pedicle screw fixation of thoracolumbar fractures is correlated with the improvement of patients' living and activity ability and the reduction of inflammation, postoperative fever and pain.

Changes in thoracic radio density after living donor liver transplantation.

BACKGROUND: The outcomes after liver transplantation have greatly improved, which has resulted in greater focus on improving non-hepatic outcomes of liver transplantation. The present study aimed to evaluate thoracic spine radio density in children and adolescents after liver transplantation. METHODS: A total of 116 patients who underwent living donor liver transplantation were retrospectively analyzed. The radio density at the eleventh thoracic vertebra was measured using computed tomography scan performed preoperatively then annually for 5 years postoperatively and subsequently every 2 or 3 years. RESULTS: The mean thoracic radio density of male recipients of male grafts had the lowest values during the study. The radio density of patients receiving a graft from a female donor was higher than in recipients with grafts from males. Total mean radio density decreased for first 5 years postoperatively and then increased. Changes in radio density were equally distributed in both steroid withdrawal and no steroid withdrawal groups for 5 years, after which patients with steroid withdrawal had a greater increase. Changes in radio density were equally distributed in both the steroid withdrawal and no steroid withdrawal groups up to age 20, after which patients in the steroid withdrawal group had a greater increase. CONCLUSIONS: Gender differences may affect the outcome of radio density changes after transplantation. Given the moderate association between thoracic radio density and bone mineral density in skeletally mature adults and further studies are needed to validate this relationship between thoracic radio density and bone mineral density changes in pediatric liver transplantation.

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.

The efficacy of machine learning models in forecasting treatment failure in thoracolumbar burst fractures treated with short-segment posterior spinal fixation.

BACKGROUND: Although short-segment posterior spinal fixation (SSPSF) has shown promising clinical outcomes in thoracolumbar burst fractures, the treatment may be prone to a relatively high failure rate. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF. METHODS: A retrospective review of 332 consecutive patients with traumatic thoracolumbar burst fractures who underwent SSPSF at our institution between May 2016 and May 2023 was conducted. Patients were categorized into two groups based on treatment outcome (failure or non-failure). Potential risk factors for treatment failure were compared between the groups. Four MLMs, including random forest (RF), logistic regression (LR), support vector machine (SVM), and k-nearest neighborhood (k-NN), were employed to predict treatment failure. Additionally, LR and RF models were used to assess factors associated with treatment failure. RESULTS: Of the 332 included patients, 61.4% were male (n = 204), and treatment failure was observed in 44 patients (13.3%). Logistic regression analysis identified Load Sharing Classification (LSC) score, lack of index level instrumentation, and interpedicular distance (IPD) as factors associated with treatment failure (P < 0.05). All models demonstrated satisfactory performance. RF exhibited the highest accuracy in predicting treatment failure (accuracy = 0.948), followed by SVM (0.933), k-NN (0.927), and LR (0.917). Moreover, the RF model outperformed other models in terms of sensitivity and specificity (sensitivity = 0.863, specificity = 0.959). The area under the curve (AUC) for RF, LR, SVM, and k-NN was 0.911, 0.823, 0.844, and 0.877, respectively. CONCLUSIONS: This study demonstrated the utility of machine learning models in predicting treatment failure in thoracolumbar burst fractures treated with SSPSF. The findings support the potential of MLMs to predict treatment failure in this patient population, offering valuable prognostic information for early intervention and cost savings.

[Current status of surgical treatment for angular kyphosis in spinal tuberculosis].

Objective: To review current status of surgical treatment for angular kyphosis in spinal tuberculosis and provide reference for clinical treatment. Methods: The literature on the surgical treatment for angular kyphosis of spinal tuberculosis in recent years was extensively reviewed and summarized from the aspects of surgical indications, surgical contraindications, surgical approach, selection of osteotomy, and perioperative management. Results: Angular kyphosis of spine is a common complication in patients with spinal tuberculosis. If kyphosis progresses gradually, it is easy to cause neurological damage, deterioration, and delayed paralysis, which requires surgical intervention. At present, surgical approaches for angular kyphosis of the spine include anterior approach, posterior approach, and combined anterior and posterior approaches. Anterior approach can be performed for patients with severe spinal cord compression and small kyphotic Cobb angle. Posterior approach can be used for patients with large kyphotic Cobb angle but not serious neurological impairment. A combined anterior and posterior approaches is an option for spinal canal decompression and orthosis. Osteotomy for kyphotic deformity include Smith-Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO), vertebral column resection(VCR), vertebral column decancellation (VCD), posterior vertebral column resection (PVCR), deformed complex vertebral osteotomy (DCVO), and Y-shaped osteotomy. SPO and PSO are osteotomy methods with relatively low surgical difficulty and low surgical risks, and can provide 15°-30° angular kyphosis correction effect. VCR or PVCR is a representative method of osteotomy and correction. The kyphosis correction can reach 50° and is suitable for patients with severe angular kyphosis. VCD, DCVO, and Y-shaped osteotomy are emerging surgical techniques in recent years. Compared with VCR, the surgical risks are lower and the treatment effects also improve to varying degrees. Postoperative recovery is also a very important part of the perioperative period and should be taken seriously. Conclusion: There is no consensus on the choice of surgical treatment for angular kyphosis in spinal tuberculosis. Osteotomy surgery are invasive, which is a problem that colleagues have always been concerned about. It is best to choose a surgical method with less trauma while ensuring the effectiveness.

Comparison Clinical Outcomes of Posterior Short Segment Transpedicular Fixation with or without Injured Vertebra Fixation in Thoracolumbar Burst Fracture: A Retrospective Study.

AIM: To evaluate and compare clinical outcomes between the posterior short-segment pedicle fixation with injured vertebra fixation (PSPFI) and fixation without injured vertebra fixation (PSPF) for thoracolumbar burst fracture (TLBF). MATERIAL AND METHODS: In this retrospective study, a total of 78 patients with TLBF were included and assigned to PSPFI (n=46) and PSPF (n=32) groups. The operative time, blood loss, perioperative complications, Oswestry disability index (ODI), and visual analog pain score (VAS) were examined immediately after surgery, 1 month, 3 months, and 1 year after surgery. Moreover, the postoperative vertebral height correction rate and postoperative Cobb angle correction rate were examined immediately and 1 year after surgery, as well as the corrected vertebral height loss rate and Cobb angle correction loss rate. RESULTS: No significant difference was identified in terms of operative time, blood loss, perioperative complications, ODI, and VAS after surgery (p > 0.05) between the PSPFI and PSPF groups. Moreover, the postoperative vertebral height correction rate and postoperative Cobb angle correction rate showed no difference between the groups as well. However, the PSPFI group had a significantly lower loss rate in terms of corrected vertebral height loss rate and Cobb angle correction loss rate than the PSPF group 1 year after surgery (p < 0.05). CONCLUSION: PSPFI and PSPF achieve similar clinical outcomes. However, posterior short-segment pedicle fixation with injured vertebra significantly maintains vertebral height correction rate and Cobb angle correction rate, which serve as a better choice for the treatment of TLBF.

[Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury].

Objective: To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Methods: Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T 11, 7 cases of T 12, 9 cases of L 1, and 11 cases of L 2. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. Results: The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences ( P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one ( Z=-4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up ( P<0.05). There was no significant difference between different time points after operation ( P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up. Conclusion: The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization.

Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report.

INTRODUCTION: Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis. CASE PRESENTATION: A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits. DISCUSSION: Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.

[Development and clinical application of lateral segmental positioning plates of the body surface spine].

OBJECTIVE: To investigate the clinical efficacy of body-surface guide plates for lateral segmental positioning in the thoracolumbar spine. METHODS: From March 2018 to March 2021, 768 gerontal patientss underwent percutaneous vertebroplasty with balloon dilatation due to thoracolumbar compression fracturess, 356 males and 412 females. aged from 64 to 92 years old with an average of (77.9±13.5) years old. All patients were treated in hospital within 1 week after injury. All patients underwent preoperative localization, and were divided into localization plate group and locator group according to different localization methods. There were 390 patients in the localization plate group, 180 males and 210 females, aged from 64 to 92 years old, with an average age of (78.4±14.3) years old. There were 378 patients in the locator group, 176 males and 202 females, aged from 64 to 90 years old, with an average age of (77.5±13.4) years old. After preliminary positioning with the above two methods, skin markers were made, cloth was routinely disinfected, and the spinal lateral position was fluoroscopically examined after the fine needle was inserted into the marked point and the vertical body at the near tail end. The accuracy of the original positioning method was evaluated. The number of times, time and accuracy of positioning of the two groups of patients were compared and analyzed. RESULTS: The specific data of patient positioning in the two groups were collected for statistical analysis. The number of times of fluoroscopy in the positioning plate group and the locator group was(3.3±0.5) times and (5.0±1.2) times, and the positioning time was (60.4±9.4) s and (105.0±30.9) s, respectively. The accuracy of fluoroscopy was 97.5% (380/390) and 85.7% (324/378), respectively, with statistical significance (P<0.05). CONCLUSION: The lateral segmental positioning plate of the body surface spine has the advantages of simple operation, accurate positioning, and reducing X-ray radiation for patients, which is worthy of clinical application.

Aggressive vertebral hemangiomas contain no adipose tissue resulting in thoracic spine kyphosis: A case report.

RATIONALE: Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very aggressive behavior was attributable to its significant vascular component and contained no adipose tissue. PATIENT CONCERNS: We report a case of thoracic spine kyphosis of AVHs with multiple vertebral bodies and intervertebral disc destruction in a 45-year-old woman. DIAGNOSES: Based on the imaging studies, the patient underwent surgical removal of this lesion and spinal reconstruction. Histopathology consistent with vertebral hemangioma and contained no adipose. INTERVENTIONS: The patient underwent surgical removal of the lesion and spinal reconstruction. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, the laminae of the T5-7 vertebrae were removed and exposing the lesion. The lesion was soft and showed cystic changes, completely curetted and autogenous bone was implanted. Vertebroplasty was performed through T3-T9 pedicles bilaterally. Pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES: After 9 days of operation, the incision healed cleanly and free of pain. She was discharged in good general condition. The patient remained asymptomatic after follow-up 6 months of postoperative. LESSONS: AVHs destroy multiple vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare.

Comparison of Outcomes between Single-Level and Double-Level Corpectomy in Thoracolumbar Reconstruction: A Retrospective Study of 16 Patients Using Expandable Cages.

BACKGROUND Reconstruction surgery using titanium vertebral body replacements aids in spinal stability after damage. Functional evaluation includes Nurick and ASIA grading systems. This study compares outcomes of single and double-level corpectomy in patients treated with thoracolumbar reconstruction. MATERIAL AND METHODS Records of 16 patients who underwent vertebral reconstruction with expandable cages after single (n=9) and double (n=8) corpectomy were analyzed retrospectively. Thoracal and lumbar cases were approached posteriorly (n=14). Clinical evaluation was performed by neurological examination, Nurick Scale, American Spinal Injury Association (ASIA) Neurological Scores, and Visual Analog Scale (VAS). Preoperative and postoperative 3-month scores were recorded. Radiological evaluation was performed by calculation of regional angulation and postoperative recovery of vertebral body height. RESULTS Preoperatively, 2 patients had no motor or functional sensory deficits (ASIA grade E) and 6 patients were ASIA grade D. Immediately after surgery, 4 of the ASIA grade D patients improved to ASIA grade E, while 2 patients remained ASIA grade D during follow-up. Four patients were ASIA grade A; their conditions showed no improvement postoperatively. Preoperative and postoperative 3-month Nurick grade was statistically significant (P=0.022). Postoperative Cobb angle improved by a mean of 5.4° (P=0.001). Improvement by at least 1 grade in neurological recovery was observed in 6 (38%) of the cases. Pain scores analyzed using the VAS changed from a mean of 7 to a mean of 2.63 (P<0.001). CONCLUSIONS In our experience, expandable cages are useful in the restoration of different pathologies of the thoracolumbar trunk with low complication and revision rates. With expandable cages it is possible to achieve restoration of the Cobb angle, improvement in Nurick Grade and effective pain palliation.

Surgical management of a multilevel thoracolumbar aneurysmal bone cyst.

Aneurysmal bone cysts (ABCs) are primary bone tumours that rarely occur in the spine and generally affect one vertebral level in adolescents. Here, we present an unusual case of a multilevel thoracolumbar ABC, which presented a unique surgical challenge due to its infiltrative and destructive nature. A teenage male presented with back pain, paresthesias and a mildly spastic gait. MRI of the thoracolumbar spine revealed an expansive, multicystic mass extending from the left T12-L1 vertebral bodies into adjacent musculature. The patient underwent a two-stage surgical approach with decompression of the spinal cord and instrumentation to stabilise the vertebral column. The first stage involved posterior decompression, laminectomy and facetectomies, followed by pedicle-based instrumentation from T10 to L3. This was followed by a vertebrectomy and anterior stabilisation with an expansile cage from T11 to L2. A gross total resection was achieved with the patient maintaining full neurological function.

Capillary Hemangioma of the Spinal Cord: Case Report and Systematic Review of Literature.

BACKGROUND: Capillary hemangiomas are rare vascular lesions that rarely affect the central nervous system. When they present within the spinal canal, they are typically confined intradurally, with intramedullary extension rare. We present a rare case of spinal intramedullary capillary hemangioma, with a systematic review of the literature. METHODS: Medical records and imaging data were retrospectively reviewed using the health record software EPIC (Verona, Wisconsin, USA) and the radiology management software system RIS/PACS (Radiology Information System/Picture Archiving and Communication System; QREADS). The report was written in accordance with the CARE (case reports) guidelines. We also performed a systematic review of the literature on all cases of intramedullary spinal capillary hemangiomas in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. RESULTS: We report a case of a 54-year-old man who presented with progressive paraplegia and sensory deficits in the lower extremities. Spinal magnetic resonance imaging showed an intramedullary enhancing lesion centered at T11 with associated spinal cord compression. He underwent thoracic laminectomy and gross total resection of the lesion without complications and subsequent improvement on his neurological examination. Histological examination showed findings consistent with a capillary hemangioma. The literature review also documented 21 studies with a combined total of 38 cases of intramedullary spinal capillary hemangioma. CONCLUSIONS: Purely intramedullary capillary hemangiomas are unusual spinal lesions with only a few cases reported in the literature. These should be considered in the differential diagnosis of intramedullary tumors. Surgical management remains the first line of treatment for symptomatic patients.

Clinical Features and Surgical Management of Intramedullary Schwannoma of the Spinal Cord.

BACKGROUND: Intramedullary schwannoma is a relatively rare tumor with only a few literature reports. This study was aimed to report the clinical characteristics of intramedullary schwannoma and discuss imaging findings and treatment strategies. METHODS: The inclusion criterion was consecutive patients with intramedullary schwannomas who were surgically treated in our institution between 2017 and 2022. Data included clinical characteristics, radiologic features, surgical management, and prognosis. Clinical and follow-up details of all cases were collected and reviewed. RESULTS: This study included 3 male and 8 female patients. The mean age was 45 years (range 26-77 years). Cervical spine (4 cases, 36.4%), thoracic spine (4 cases, 36.4%), and lumbosacral spine (3 cases, 27.3%) involvement was found. Weakness, numbness and pain of limbs were the main symptoms at administration. Preoperative magnetic resonance imaging demonstrated lesion with spinal cord medullary invasion and well demarcated margins. The postoperative histologic examination showed benign lesions and confirmed the schwannoma. CONCLUSIONS: This article presented a series of 11 cases of intramedullary schwannoma with sharp margins and well-enhanced features. Prognosis and functional recovery were good after gross total resection.