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Methods@#We examined the data of AIS patients with Lenke type 1 curves who underwent posterior fusion surgery in a retrospective manner. PSI was defined as a 2-year postoperative absolute radiographic shoulder height (RSH) of ≥2 cm. Patients were divided into two groups based on the presence of PSI and the level of their upper instrumented vertebra (UIV) (UIV at T2 or T3 [U-UIV] or UIV below T3 [L-UIV]). The radiographic parameters and clinical outcomes were compared, and the cutoff values of risk factors were identified by multivariate analysis. @*Results@#Of 104 patients, 21 (20.2%) had left shoulder elevation PSI. The PSI group had a significantly greater preoperative RSH (−5.1 mm vs. −14.3 mm) and main thoracic (MT) curve correction rate (77.3% vs. 69.1%) than the non-PSI group. The PSI incidence did not differ between the U-UIV and L-UIV groups. Multivariate analysis identified preoperative RSH and the MT curve correction rate as independent risk factors for PSI. The receiver operating characteristic curve analysis identified the preoperative RSH cutoff value as −6.5 mm and MT curve correction rate cutoff value as 76.9%. @*Conclusions@#Even in AIS patients with Lenke type 1 curves, the incidence of PSI was relatively high (20.2%). Patients with preoperative lower right shoulder elevation (i.e., RSH >−6.5 mm) had a higher risk of PSI regardless of UIV level when the MT curve showed a higher correction rate (i.e., correction rate >76.9%).
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Methods@#Adult volunteers aged over 50 years were included in the study after participating in the screening program. Characteristic data and standing radiographic parameters were assessed. A propensity score model was established with adjustments for age and sex after a preliminary analysis, and cases were divided into DLS (Cobb angle >10°) and non-DLS (Cobb angle ≤10°) groups. @*Results@#There were significant differences in age, sex, C2 sagittal vertical axis (C2-SVA), C7-SVA, T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), PI minus LL (PI–LL), knee angle, ankle angle, pelvic shift, C7-center sacral vertical line, L4 tilt, femur-tibia angle, and hip-knee-ankle angle (all p <0.05) using a preliminary analysis of 261 cases (75 DLS and 186 non-DLS). A one-to-one propensity score-matched analysis was used after 70 pairs of cases were selected. There were no significant differences in the characteristic data for lower extremity parameters. There were still significantly higher values of C2-SVA, TPA, PI, PT, and PI–LL in DLS group than in non-DLS group (all p <0.05). @*Conclusions@#This study showed an important relationship between DLS and sagittal spinal deformity. However, DLS was not associated with the sagittal and coronal lower extremity alignments.
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Methods@#This retrospective study includes 295 corrective surgery patients with ASD. Subjects were divided into two groups after propensity age matching analysis: cranial malalignment (McGS 13) and normal cranial alignment (−8≤ McGS ≤13). Lumbar lordosis (LL), pelvic tilt (PT), TK, cervical lordosis (CL), and sagittal vertical axis (SVA) were evaluated between the two groups. @*Results@#SVA (95–56 mm) and PT (34°–25°) decreased and LL (19°–41°) increased 2 years after surgery (p <0.05), but McGS (−1.1° to −0.5°) and CL (21°–19°) did not change. Conversely, in the group with cranial malalignment, SVA (120–64 mm), PT (35°–26°), and LL (12°–41°) showed similar results to the normal cranial parameter group 2 years after surgery, but in contrast, McGS (−13° to −2°) and CL (24°–18°) improved significantly. @*Conclusions@#Severe ASD adversely affects to maintain horizontal gaze but can be improved by spinal corrective surgery.
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Methods@#This study prospectively examined nine T-OPLL patients who underwent posterior thoracic decompression with kyphosis correction and instrumented fusion at Hamamatsu University School of Medicine between 2017 and 2019. All underwent preoperative selective angiography to detect and evaluate the Adamkiewicz artery and ASA. Intraoperative neuromonitoring and Doppler ultrasonography were performed to analyze neurological complications and spinal cord blood flow. @*Results@#All nine patients showed ASA stenosis in the area of T-OPLL. In all patients, the Adamkiewicz artery was located between T7 and L2 and the area of ASA stenosis corresponded to the level of T-OPLL and greatest spinal cord compression; intraoperative Doppler ultrasonography confirmed the ASA defect at the same spinal level. The number of spinal levels from the Adamkiewicz artery to the most compressive OPLL lesion was greater in the two patients who developed postoperative neurological deficit compared to those who did not (5.5 vs. 2.3, p=0.014). @*Conclusions@#This is the first study to report detection of ASA stenosis in patients with T-OPLL. Maintaining spinal cord blood flow is important in these patients to avoid neurological deterioration.
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Objectives@#To investigate renal function during denosumab therapy using the estimated glomerular filtration rate based on cystatin C (eGFRcys) which is more accurate than creatinine (eGFRcr) for renal function. @*Methods@#Bone mineral densities (BMDs) of lumbar spine and hip regions, eGFRcys, eGFRcr, creatinine clearance (Ccr), and serum total homocysteine (S-Hcy) were measured during 2-year denosumab therapy in 53 women with osteoporosis naïve to anti-osteoporosis drugs (new group) and 64 women who were switched from long-term bisphosphonate treatment to denosumab therapy (switch group). @*Results@#There were no significant differences in age, eGFRcr, Ccr, eGFRcys, and S-Hcy levels at baseline between the groups. BMDs in the lumbar spine, femoral neck, and total hip increased significantly after 2-year denosumab therapy in both groups. eGFRcr decreased in the switch group, and Ccr decreased in both groups; however, eGFRcys and S-Hcy levels did not change significantly in either group. To investigate the causal factors associated with the decrease in eGFRcr and Ccr, multiple regression analysis was performed in all patients. Denosumab initiation within 3 months after fracture and eGFRcr or Ccr at baseline were independent factors for the decrease in eGFRcr or Ccr during the 2-year denosumab therapy. Decline in creatinine-based renal function could be reflected by increased muscle mass during the ongoing recovery from fracture. @*Conclusions@#Renal function was preserved in all patients, including those in the switch group during denosumab therapy. Creatinine-based renal function should be cautiously interpreted during denosumab therapy in patients with recent fractures.
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Methods@#As part of a 2016 health screening, 320 female volunteers underwent whole-spine radiographs. Age-matched healthy women were grouped according to the number of vaginal deliveries (0, 1–2, or ≥3). Demographic variables and spinopelvic parameters were compared among the three groups. @*Results@#Of the 320 volunteers, 213 were enrolled (mean age, 71.1±7.2 years). The mean number of vaginal deliveries was 2.2. The average pelvic incidence (PI) was 55.6°±11.1° and was significantly higher in the 90 women with three or more vaginal deliveries than in the other two groups (p<0.001). The average sacral slope was 33.4°±11.1° and was significantly higher in the women with three or more vaginal deliveries than in the 18 who did not deliver vaginally (p<0.001). The 105 women with one or two vaginal deliveries had significantly higher PIs and sacral slopes than did those who did not deliver vaginally (p<0.001). @*Conclusions@#This is the first study documenting an association between vaginal delivery and pelvic parameters. Bony birth canal realignment during vaginal delivery can affect postnatal PI. Our study helps in understanding the PI changes over a woman’s life span.
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Study DesignCombination of retrospective and prospective study.PurposeWe aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.Overview of LiteratureThe clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.MethodsWe analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.ResultsIn the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value p-value ConclusionsFor patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.
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Study DesignCombination of retrospective and prospective study.PurposeWe aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.Overview of LiteratureThe clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.MethodsWe analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.ResultsIn the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value p-value ConclusionsFor patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.
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STUDY DESIGN: Cross-sectional cohort study.PURPOSE: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals.OVERVIEW OF LITERATURE: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment.METHODS: In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50–92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50–64 years, 65–74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup.RESULTS: In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50–64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65–74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015).CONCLUSIONS: This study showed that hypertension was associated with forward-shifted global sagittal alignment.
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Aged , Animals , Female , Humans , Male , Cohort Studies , Hypertension , Incidence , Japan , Kyphosis , Lordosis , Mass Screening , Microcirculation , Multivariate Analysis , Muscle, Skeletal , Quality of Life , SpineABSTRACT
STUDY DESIGN: A retrospective study. PURPOSE: To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). OVERVIEW OF LITERATURE: Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. METHODS: Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. RESULTS: Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. CONCLUSIONS: The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.
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Adult , Female , Humans , Male , Bone Density , Congenital Abnormalities , Incidence , Kyphosis , Osteoporosis , Osteotomy , Retrospective Studies , SpineABSTRACT
BACKGROUND: Bone mineral density (BMD) is the indicator of bone quality in at-risk individuals. Along with the fracture risk assessment tool (FRAX), a quick assessment of BMD from routine radiographs may be useful in the case of lacking X-ray absorptiometry data. This study aimed to investigate the correlation of cortical thickness index (CTI) and canal flare index (CFI) with BMD and FRAX and to evaluate their ability to predict femoral neck BMD (nBMD) and FRAX in the general elderly population. METHODS: A total of 560 volunteers (age ≥ 50 years) who underwent hip-spine X-ray, BMD scanning and FRAX calculation were retrospectively reviewed. CTI and CFI were measured on anteroposterior radiographs and analyzed for their correlation with BMD and FRAX and for their ability to predict nBMD. The ability of CTI to predict osteoporosis status (OPS) and fracture risk status (FRS) was also investigated and the threshold values were calculated. All the analyses were performed separately on male and female subjects. RESULTS: Significant differences in CTI, CFI, nBMD and FRAX between males and females were observed. CTI and CFI demonstrated significant positive correlation with nBMD and FRAX (all p < 0.001) in both males and females. CTI, height, and weight significantly predicted nBMD. CTI statistically predicted OPS and FRS, and the values of 0.56 and 0.62 were computed as CTI thresholds for males and females, respectively. CONCLUSIONS: CTI was significantly correlated with nBMD and it predicted nBMD at good prediction levels. Therefore, CTI may be used as a supportive tool in the assessment of OPS and FRS besides BMD and FRAX in clinical practice.
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Aged , Female , Humans , Male , Absorptiometry, Photon , Bone Density , Diagnosis , Femur Neck , Femur , Hip Fractures , Osteoporosis , Retrospective Studies , Risk Assessment , VolunteersABSTRACT
STUDY DESIGN: Prospective physical measurement of the sagittal vertical axis (SVA). PURPOSE: To evaluate a simple method for measuring SVA by analyzing its relationship with radiographic measurements and clinical appearance. OVERVIEW OF LITERATURE: No studies have examined physical measurements using the cranial center of gravity (CCG) in a relaxed standing position. METHODS: The physical measurement of the horizontal distance between CCG and spina iliaca posterior superior (CCG-SIPS) was measured using a straight ruler in 252 healthy volunteers and 56 patients with adult spinal deformity. Health-related quality of life (HRQOL) was evaluated using the Oswestry disability index (ODI), and clinical symptoms were assessed according to standing status and the presence of gastroesophageal reflux disease (GERD). RESULTS: CCG-SIPS increased with age in the volunteer group and strongly correlated with radiographic SVA in the patient group (r=0.984). Differences increased between CCG-SIPS in patients in the relaxed position and radiographic SVA with an increase in sagittal malalignment (r=0.692, p120 mm) was significantly larger in the patient group than in the group with low sagittal malalignment (59.9±18.8 vs. 45.1±17.0; p=0.004); these patients (CCG-SIPS>120 mm) needed crutches or walkers for standing. The patient group with GERD had significantly larger sagittal malalignment than the group without GERD (160.3 mm vs. 81.0 mm). CONCLUSIONS: The CCG-SIPS correlated with age and strongly reflected radiographic SVA and HRQOL in the patients. Moreover, it reflects a relaxed posture without a backward shift in the radiographic position even in patients with severe sagittal malalignment. The critical limit of CCG-SIPS can be relevant to clinical appearance, including standing assistance (>120 mm) and the existence of GERD (>150 mm). Thus, it will be a useful predictor of true SVA in clinical practice before radiographic evaluation.
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Adult , Humans , Congenital Abnormalities , Crutches , Gastroesophageal Reflux , Gravitation , Healthy Volunteers , Methods , Posture , Prospective Studies , Quality of Life , Volunteers , WalkersABSTRACT
STUDY DESIGN: Large cohort study. PURPOSE: To clarify spinal sagittal alignment and health-related quality of life (HRQOL) according to sex in volunteers aged >50 years with cervical deformity (CD). OVERVIEW OF LITERATURE: Adult spinal deformities, especially those associated with lumbosacral lesions, are more frequent in females; however, CD is observed to a greater extent in males. METHODS: We divided 656 volunteers (263 males, 393 females; age, 50–89 years [mean, 73 years]) as follows: males with CD (CDM; 82 patients); males without CD (NCDM, 181); females with CD (CDF, 36); and females without CD (NCDF, 357). CD was defined as C2–7 sagittal vertical axis (SVA) ≥40 mm. We measured pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI−LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 SVA, and C2–7 SVA. HRQOL was evaluated using EuroQOL five dimensions questionnaire (EQ-5D). RESULTS: In CDM, NCDM, CDF, and NCDF groups, the respective parameters were as follows: PT: 15°, 14°, 26°, and 21°; PI−LL: 7°, 5°, 16°, and 10°; C2–7 SVA: 49, 24, 46, and 20 mm; C7 SVA: 61, 40, 75, and 47 mm; and EQ-5D: 0.82, 0.88, 0.78, and 0.81. PT and PI−LL were significantly greater in the CDF group than in the NCDF group (p < 0.05) but were not significantly different between CDM and NCDM groups. The CDF group already showed deterioration of spinopelvic alignment, although it was maintained in the CDM group. EQ-5D in showed significantly greater deterioration the CDM group than in the NCDM group; deterioration of lumbopelvic parameters had less influence in males (p < 0.05). CONCLUSIONS: Sagittal spinal deformity may have different mechanisms in males and females. The deterioration of spinal sagittal alignment in males may originate from the cervical spine, and CD may be associated with HRQOL.
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Adult , Animals , Female , Humans , Male , Cohort Studies , Congenital Abnormalities , Incidence , Kyphosis , Lordosis , Quality of Life , Sex Characteristics , Spine , VolunteersABSTRACT
STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the relationship between tumor location and clinical characteristics. OVERVIEW OF LITERATURE: Hemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma's location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI. METHODS: We analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group. RESULTS: The average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups. CONCLUSIONS: Age may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI.
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Humans , Central Nervous System , Demography , Diagnosis , Hemangioblastoma , Magnetic Resonance Imaging , Rare Diseases , Retrospective StudiesABSTRACT
STUDY DESIGN: Retrospective. PURPOSE: This study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS). OVERVIEW OF LITERATURE: Although PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures. METHODS: We retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, 4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time. RESULTS: Inaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes. CONCLUSIONS: Minimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle, as a result of pedicle morphology and the PPS pathway. Oblique fluoroscopic views, based on CT measurement, may allow accurate PPS insertion with a shorter fluoroscopy time.
Subject(s)
Humans , Fluoroscopy , Pedicle Screws , Radiation Exposure , Retrospective Studies , Spinal Fusion , SpineABSTRACT
STUDY DESIGN: A prospective, randomized, controlled study. PURPOSE: The objective of this study was to evaluate the effectiveness of two techniques of skin preparation with povidone-iodine. OVERVIEW OF LITERATURE: Preoperative skin preparation is important for preventing surgical site infection by reducing the bacteria in the surgical area. Povidone-iodine is a commonly used agent for preoperative skin preparation, and further decrease in surgical site infections can be expected by understanding how to apply it more effectively. METHODS: Eighty-nine spine surgery patients were randomly allocated to two groups. In group A, povidone-iodine was applied to the surgical site just before starting the operation; in group B, povidone-iodine was applied several minutes prior to starting the operation and was allowed to dry. We collected samples from the wound edge before suturing, and we compared the rates of positive culture between the two groups. RESULTS: The rate of positive culture was 30.2% (13 out of 43 patients) in group A, and 6.5% (3 out of 46 patients) in group B. This indicates that there was a significant difference in postoperative infection rates between group A and group B. CONCLUSIONS: Because bacteria on the skin appeared significantly reduced by allowing povidone-iodine to dry for several minutes prior to surgery, we recommend this approach to reduce the incidence of postoperative infections.
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Humans , Bacteria , Incidence , Povidone-Iodine , Prospective Studies , Skin , Spine , Wounds and InjuriesABSTRACT
A recurrent laryngeal nerve injury is known as a complication referring to an anterior cervical spine surgery. However, hypoglossal nerve injury is not well known yet. Herein we report a rare case of a 39-years-old male with a hypoglossal nerve injury after C3/4 osteophyte resection with Smith-Robinson approach. In this case there appeared difficulties of articulation and tongue movement with deviation of the tongue to the left side after the surgery and we diagnosed a hypoglossal nerve injury due to retraction against the nerve during the operation. During the operative approach to the upper cervical spine we had to retract the internal carotid artery and the soft tissue to reach the vertebrae. This retract was the cause of the hypoglossal nerve injury. A gently traction and intermittent release is important to avoid a hypoglossal nerve damage.
Subject(s)
Female , Humans , Male , Carotid Artery, Internal , Cervical Vertebrae , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Osteophyte , Recurrent Laryngeal Nerve Injuries , Spine , Tongue , TractionABSTRACT
STUDY DESIGN: Case series. PURPOSE: The objective of this study was to investigate the change in pulmonary function in adult patients with a spinal deformity who underwent spinal corrective surgery. OVERVIEW OF LITERATURE: Degenerative lumbar and/or thoraco-lumbar deformities are is often prominent in adult spinal deformity cases, whereas a thoracic deformity involving the chest wall is inconspicuous. A lumbar spine deformity could affect the pulmonary function; however, few reports have investigated pulmonary function in adult patients with a spinal deformity. METHODS: This study included 14 adult patients with a spinal deformity who underwent posterior corrective fusion (3 males, 11 females; mean age, 67.4 years). We measured percent vital capacity (%VC) and percent forced expiratory volume in 1 second (%FEV1) before surgery and six months after surgery. We investigated the change in pulmonary function after corrective surgery and the correlation between radiographic parameters and pulmonary function. RESULTS: Mean preoperative %VC and %FEV1 values were 99.9% and 79.3%, respectively. Two cases were diagnosed with restrictive impairment, and two cases were diagnosed with obstructive impairment before surgery. %VC improved in the restrictive impairment cases six months after surgery. However, %FEV1 did not improve significantly after surgery in the obstructive impairment cases. CONCLUSIONS: Restrictive impairment was improved in adult patients with a spinal deformity by corrective spinal surgery. However, spinal surgery did not improve obstructive impairment.