ABSTRACT
Congenital insensitivity to pain with anhidrosis (CIPA) is associated with Charcot arthropathy and is a rare clinical syndrome, with limited treatment options. Through a decade-long follow-up of a single case, we aim to provide new insights for clinicians regarding the choice of surgical strategies and postoperative complications. The diagnosed patient exhibited congenital insensitivity to pain and anhidrosis, accompanied by severe Charcot arthropathy affecting the spine. Multiple postoperative complications, including implant displacement, adjacent segment pathology, and pedicle screw loosening, occurred after surgical intervention, leading to five subsequent revision surgeries. Considering the limited experience in managing CIPA-related Charcot spinal arthropathy in the literature, surgical correction remains the preferred treatment. Among the 16 cases reviewed, common postoperative complications included implant displacement, adjacent segment pathology, and pedicle screw loosening. Based on current experience, we do not recommend extensive resection and reconstruction after removing the affected vertebral body, as this may increase the risk of implant displacement. Instead, a 360° long-segment fusion may help reduce the risk of adjacent segment degeneration. Additionally, we discuss potential reasons for revision surgery after Charcot spinal arthropathy surgery and perioperative management strategies for such cases. Meticulous care, appropriate rehabilitation exercises, and metabolic therapy for bone mineralization are crucial components of the treatment for this condition.
ABSTRACT
Objective To analyze the clinical results of 360° fusion for spondylolisthesis.Methods Data of 76 patients from March 2005 to November 2012,including 26 males and 50 females with a mean age of 54.3 years were retrospectively analyzed.All patients had undergone modified 360° fusion.The clinical outcomes were evaluated by the Japanese Orthopaedic Association scores (JOA) and visual analogue scale (VAS).The fusion status and loss of correction were assessed by CT and plain radiographs.Results All patients had been successfully followed up for at least one year.Post-operative reduction rate was 96.8％,with a mean loss rate of 1.1％ at six months and 0.8％ at one year follow-up separately,but the difference was not significant.Postoperative percentage of slip,lumbar lordosis,intervertebral disc height and slip angle had significant differences,compared with those of the pre-operative,but the difference between one week post-operative,six months follow-up and one year follow-up were not significant.The fusion rate was 76.3％ at six months follow-up and 98.7％ at one year follow-up,and there were significant differences.Both JOA and VAS score at six months and one year follow-up indicated significant differences in contrast to that of preoperative.Dural injury was found in one patient,and subsidence was found in one patient.One received a second operation at 3 months after the surgery due to screw loose.Conclusions Modified 360° fusion shows great clinical outcome and fusion rate,which can be a dominant procedure for treating spondylolisthesis.
ABSTRACT
Objective To introduce a new spinal surgery navigation system based on structured light scanning(structured light navigation system,SLNS),and to compare accuracy of pedicle screw placement using SLNS,CT based navigation system and free hand technique.Methods Thirty-two calf vertebral pedicles,40 and 32 were placed with pedicle screws using SLNS,CT navigation system,and free hand technique,respectively.The pedicle breakage ratio,transverse section angle (TSA),sagittal section angle (SSA),screw offset deviation of each screw were detected according to CT images.Results The pedicle breakage ratio of pedicle screws in SLNS group,CT navigation group and free hand group were 6%(2./32),5%(2/40),25%(8/32),respectively.The difference between each of the two navigation groups and free hand group were statistically significant regarding frequency of screw misplacement.The difference between the two navigation systems was not obvious.The average SSA error and TSA error in SLNS group were 2.58°±2.74° and 4.26°±5.20°.For CT navigation group,they were 2.95°±2.61° and 3.13°±-2.75°.There was no statistical difference between the two navigation methods for the SSA or TSA error.There was no statistical difference in offset deviation among SLNS group,CT navigation group and free hand group.Conclusion The SLNS is a new and practical navigation system,which has similar accuracy with CT navigation system.