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Objectives:To evaluate the values of sagittal CT image histogram features in the differential diagnosis of brucella spondylitis(BS)and pyogenic spondylitis(PS).Methods:The data of 40 BS patients[25 males,15 females;age:51.6±13.0 years old;body mass index(BMI):23(20,28)kg/m2,the BS group]and 33 PS patients[13 males,20 females;age:50.8±16.7 years old;BMI:23(20,26)kg/m2,the PS group]who underwent CT examination of the spine in our hospital and were confirmed through pathology and/or etiology were collected.The region of interest(ROI)was delineated on each level of the sagittal CT images of the two groups of patients by using the 3D Slicer platform and grayscale global histogram analysis was performed.The clinical data were compared using chi square test,independent sample t-test,and Mann Whitney U test between the two groups of patients;Univariate analysis,correlation analysis,and multivariate analysis were used in sequence to identify the histogram features with significant differences between the two groups(including 10%percentile,1%percentile,25%percentile,5%percentile,median,minimum,skewness,and variance);Logistic regression and the screened features were combined for modeling,and receiver operating characteristic(ROC)curves were drawn and areas under the curve(AUC)were calculated to compare the discriminative ability of each histogram feature.Results:There was no statistically significant difference in age,gender,and BMI between the two groups of patients(P>0.05).Among the histogram parameters,10%percentile value,1%percentile value,25%percentile value,5%percentile value,median,minimum value,skewness,and variance were statistically different between the two groups(P<0.05).The 10%percentile value displayed the best diagnostic performance,with an AUC value of 0.824 and a specificity of 0.893.The combined model had an AUC value of 0.860 and a specificity of 0.946.Conclusions:Based on 10%percentile value of CT grayscale histogram and joint model,PS and BS can be distinguished effectively,providing a basis for accurately distinguishing the two diseases in clinical practice.
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Objective:To elucidate the diagnostic utility of clinical features and radiomics characteristics derived from magnetic resonance imaging T2-weighted fat-suppressed images (T2WI-FS) in differentiating brucellosis spondylitis from pyogenic spondylitis.Methods:Clinical records of 26 patients diagnosed with Brucellosis Spondylitis and 23 with Pyogenic Spondylitis were retrospectively reviewed from Xinjiang Medical University First Affiliated Hospital between January 2019 and December 2021. Confirmatory diagnosis was ascertained through histopathological examination and/or microbial culture. Demographic characteristics, symptoms, clinical manifestations, and hematological tests were collected, followed by a univariate analysis to discern clinically significant risk factors. For the radiomics evaluation, preoperative sagittal T2WI-FS images were utilized. Regions of interest (ROIs) were manually outlined by two adept radiologists. Employing the PyRadiomics toolkit, an extensive array of radiomics features encompassing shape, texture, and gray-level attributes were extracted, yielding a total of 1,500 radiomics parameters. Feature normalization and redundancy elimination were implemented to optimize the predictive efficacy of the model. Discriminatory radiomics features were identified through statistical methods like t-tests or rank-sum tests, followed by refinement via least absolute shrinkage and selection operator (LASSO) regression. An integrative logistic regression model incorporated selected clinical risk factors, radiomics attributes, and a composite radiomics score (Rad-Score). The diagnostic performance of three models clinical risk factors alone, Rad-Score alone, and a synergistic combination were appraised using a confusion matrix and receiver operating characteristic (ROC) analysis.Results:The cohort comprised 49 patients, including 36 males and 13 females, with a mean age of 53.79±13.79 years. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) emerged as significant clinical risk factors ( P<0.005). A total of seven discriminative radiomics features (logarithm glrlm SRLGLE, exponential glcm Imc1, exponential glcm MCC, exponential gldm SDLGLE, square glcm ClusterShade, squareroot glszm SALGLE and wavelet.HHH glrlm Run Variance) were isolated through LASSO regression. Among these selected features, the square glcmClusterShade feature exhibited the best performance, with an area under the curve (AUC) value of 0.780. It demonstrated a sensitivity of 68.8%, specificity of 94.4%, accuracy of 82.4%, precision of 91.7%, and negative predictive value of 0.773. Furthermore, the logarithm glrlm SRLGLE feature had an AUC of 0.736, sensitivity of 68.8%, specificity of 72.2%, accuracy of 76.5%, precision of 72.2%, and negative predictive value of 0.812. The exponential glcm Imc1 feature had an AUC of 0.736, sensitivity of 50.0%, specificity of 94.4%, accuracy of 73.5%, precision of 88.9%, and negative predictive value of 0.680. Three diagnostic models were constructed: the clinical risk factors model, the radiomics score model, and the integrated model (clinical risk factors+radiomics score), which showed AUC values of 0.801, 0.818, and 0.875, respectively. Notably, the integrated model exhibited superior diagnostic efficacy. Conclusion:The amalgamation of clinical and radiomics variables within a sophisticated, integrated model demonstrates promising efficacy in accurately discriminating between Brucellosis Spondylitis and Pyogenic Spondylitis. This cutting-edge methodology underscores its potential in facilitating nuanced clinical decision-making, precise diagnostic differentiation, and the tailoring of therapeutic regimens.
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Objective:To analyze risk factors for prolonged postoperative hospitalization in patients with Brucella spondylitis (BS).Methods:A total of 130 patients with BS who underwent surgical treatment in the Department of Spine Surgery, the First Affiliated Hospital of Xinjiang Medical University from June 2011 to December 2021 were retrospectively analyzed. There were 95 males and 35 females, aged 51.53±12.26 years (range, 20-76 years). The 75th percentile of patients' hospitalization time was used as the critical value, and hospitalization time≥75% quartile was defined as prolonged hospitalization time. Baseline data, clinical outcomes, laboratory test indices, and imaging findings were compared between patients with prolonged and normal length of stay. Indicators with statistically significant differences between the two groups were included in a binary logistic regression analysis to determine independent risk factors for prolonged postoperative hospitalization for BS. The receiver operating characteristic (ROC) curve was plotted for subjects with prolonged postoperative hospitalization, and the area under the curve (AUC) for each independent risk factor was calculated. Additionally, 95% confidence intervals (CI), sensitivity, and specificity were determined.Results:All patients were operated successfully. The length of hospitalization was 6.98±2.73 days (range, 6-20 days). The 75% quartile of the length of hospitalization was 9 days, so hospitalization time≤9 days was considered as normal length of hospitalization (normal group) and more than 9 days was considered as prolonged hospitalization (prolonged group), of which there were 99 cases in the normal group and 31 cases in the prolonged group. All patients were followed up for 12.3±3.2 months (range, 7-31 months). The results of univariate analysis showed elevated body mass index ( Z=901.00, P<0.001), recent wasting (χ 2=15.84, P<0.001), elevated erythrocyte sedimentation rate ( t=-4.82, P<0.001), elevated C-reactive protein ( Z=895.50, P<0.001), decreased albumin ( Z=2199.50, P<0.001), presence of epidural abscess on MRI (χ 2=10.45, P=0.001), and increased intraoperative blood loss (χ 2=8.81, P=0.003) may be risk factors for prolonged hospitalization after BS. Binary logistic regression analysis showed that increased body mass index ( OR=1.25, P=0.033), recent wasting ( OR=0.04, P=3.395), increased erythrocyte sedimentation rate ( OR=7.50, P<0.001), elevated C-reactive protein ( OR=4.71, P=0.008), and epidural abscess on MRI ( OR=3.69, P=0.033) were independent risk factors for prolonged postoperative hospital stay of BS, and the AUC of ROC was 0.70, 0.71, 0.71, 0.75, 0.66, respectively. The AUC of the combined prediction model was 0.89, and the prediction value was good. Conclusion:Elevated body mass index, recent wasting, elevated C-reactive protein, elevated erythrocyte sedimentation rate, and the presence of an epidural abscess on MRI are independent risk factors for prolonged postoperative hospitalization in patients with BS, and the combined prediction model has better predictive efficacy.
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Chiari malformation (CM) is a group of congenital cerebellar tonsillar hernia malformations involving the craniocervical junction. Chiari malformation type I (CMI) is the most common in clinic, however its pathogenesis is still unclear, and there is no consensus on the surgical treatment standard of CMI. At present, the most widely accepted is the theory of posterior fossa incompatibility, so doctors at home and abroad use posterior fossa decompression (PFD) and posterior fossa compression with duraplasty (PFDD) as the gold standard for surgical treatment, and have their own experience and technical improvement. However, the volume of the posterior cranial fossa in some patients is no different from that in healthy people, and about 30% of the patients with CMI have poor results after posterior cranial fossa decompression. As a result, this operation cannot treat all patients with CMI. In recent years, with the development of imaging, the progress of diagnostic technology and the deepening of understanding of CM, some studies have shown that CMI may be related to atlantoaxial instability, and proposed that CMI is the secondary factor of atlantoaxial instability, and atlantoaxial fusion is the standard of surgical treatment, which has caused great controversy in academic circles. Different clinical research results of scholars support or oppose this theory: some studies have shown that the clinical symptom relief rate of patients with CMI treated with atlantoaxial fusion is 96.9%; another study showed that 70% of patients with CMI underwent atlantoaxial fusion had improved neurological function, but the overall postoperative effect was not satisfactory. In short, CMI is related to many diseases and its clinical manifestations are complex. Therefore, individualized management and treatment should be carried out in combination with the clinical manifestations and auxiliary examination results of patients.
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Objective:To investigate the relationship between simple Chiari malformation type I (CMI) and atlantoaxial instability from the imaging point of view.Methods:A retrospective analysis were performed on 46 patients diagnosed with simple CMI from January 2014 to December 2020. Forty-six normal people matched for age and sex were selected as the normal control group, while 30 patients with atlantoaxial dislocation were selected as the dislocation group. The degree of atlantoaxial joint degeneration in each group was assessed according to Weishaupt degeneration grading; the atlantoaxial joint angulation angle was measured in the control group of patients with simple CMI; and the sagittal imaging parameters of cervical spine X-ray were measured, including C 0-C 1 Cobb angle, C 0-C 2 Cobb angle, C 1-C 2 Cobb angle, C 1-C 7 Cobb angle, C 2-C 7 Cobb angle, C 7 Slope, C 2 Tilt, spino cranial angle (SCA), and C 2-C 7 sagittal vertebral axis (SVA). All radiographic parameters were measured twice independently by two spine surgeons, and intraclass correlation coefficient (ICC) were determined to demonstrate intra- and inter-observer reliability. Results:ICC ranged between 0.842 and 0.974 in the current study, demonstrating "excellent" reliability of radiographic measurements. No significant difference was noted regarding age and the distribution of genders among the three groups. There were significant differences in the distribution of Weishaupt degeneration grading of atlantoaxial joints between simple CMI, normal and dislocation group ( H=53.68, P<0.001 on the left side; H=43.39, P<0.001 on the right side). There were significant differences in the degree of atlantoaxial joint degeneration between the normal group and dislocation group (left, Z=6.60, P<0.001; right, Z=6.29, P<0.001); There were significant differences in the degree of atlantoaxial joint degeneration between the normal group and simple CMI patients (left, Z=5.31, P<0.001; right, Z=4.13, P<0.001); There were significant differences in the degree of atlantoaxial joint degeneration between simple CMI and dislocation group (left, Z=3.20, P=0.001; right, Z=3.15, P=0.002). There were significant difference in the angulation angle of the atlantoaxial articular surface between the normal group and simple CMI patients (left, Z=3.32, P<0.001; right, Z=5.74, P<0.001). There were significant differences in C 0-C 1 Cobb angle ( t=2.41, P=0.018), C 1-C 7 Cobb angle ( t=2.88, P=0.005), C 2-C 7 Cobb angle ( t=3.29, P=0.001), and C 2-C 7 SVA ( t=2.87, P=0.005) between the normal group and simple CMI patients, but there was no significant difference in other parameters. Conclusion:The degree of atlantoaxial joint degeneration in patients with simple CMI is higher than that in normal people, the angulation angle is larger, and the cervical lordosis is larger, suggesting that there may be atlantoaxial joint instability. This study provides further evidence that Chiari malformation type I is associated with atlantoaxial instability.
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Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.
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Objective:To analyze the application and clinical efficacy of one-stage unilateral or bilateral fenestration, debridement, interbody fusion combined with posterior internal fixation for the treatment of lumbosacral brucellosis spondylitis.Methods:All patients with lumbosacral brucellosis spondylitis were retrospectively analyzed, who underwent fenestration, debridement, interbody fusion combined with posterior internal fixation from June 2013 to June 2019. A total of 48 patients were enrolled in this study. According to the surgical method, they were divided into two groups. Unilateral fenestration group: 27 cases of one-stage posterior unilateral fenestration, debridement, interbody fusion combined with posterior internal fixation were performed, 21 males and 6 females, aged 23-71 years; Bilateral fenestration group: 21 cases of one-stage posterior bilateral fenestration, debridement, interbody fusion combined with posterior internal fixation were performed, aged 26-58 years. There were 16 males and 5 females. The preoperative and postoperative clinical symptoms, neurological function, C-reactive protein, the surgery duration time, the blood loss, and erythrocyte sedimentation rate were observed. The internal fixation device was evaluated for looseness or fracture by imaging examination. The Bridwell classification criteria were used to evaluate the bone graft fusion. Postoperative complications were also assessed.Results:All patients completed the operation successfully, and the diseased tissues were sent for pathological examination during the operation, and all of them were diagnosed as brucellosis. All patients were followed up for 12-48 months (mean 23.7 ±6.3 months). C-reactive protein, erythrocyte sedimentation rate, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Scores (JOA) were significantly improved in both groups at different time points after operation. There was no significant difference in the general condition before operation between the two groups ( P>0.05). The mean operation time and mean blood loss were 120.5±34.1 min and 214.4±150.2 ml, in the unilateral fenestration group; 187.1±30.3 min and 455.8±250.5 ml in the bilateral fenestration group; and the difference was significant ( t=8.123, t=2.962, P<0.05) . The postoperative lumbar and leg pain were significantly relieved. There was no significant difference in C-reactive protein, erythrocyte sedimentation rate, VAS, ODI and JOA scores between the two groups at the same time point. In the bilateral fenestration group, one patient developed incision infection half a month after the operation, who underwent debridement and drainage, and finally cured. There was no significant difference in the time of bone graft fusion between the two groups ( t=0.542, P>0.05). At the last follow-up, all the patients were completely fused. Conclusion:Unilateral or bilateral fenestration, debridement and bone graft fusion and internal fixation for the treatment of lumbosacral brucellosis spondylitis can achieve good clinical results, and the former has the advantages of short operation time and low cost.
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Objective:To evaluated the indications, methods, outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods:Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016, including 1 male and 4 females. Initial surgery age were at1.7~5.4 years old, averaged (39.6±19.4) months and were 0.67-8 months, averaged (87.0±95.1) days. Disease duration ranged from 23 days to 8 months, with an average of 88 days. X-ray, CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression. Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre- and post- operation. During the follow-up, X-ray and CT were performed to assess the fusion condition of the grafted bone.Results:The duration of operation was ranged from 75-145 months, with an average of (101.0±20.7) months; Blood loss ranged from 50-100 ml, with an average of (70.0±21.2) ml; follow-up duration ranged from 6 to 48 months, with an average of (23.5±17.6) months. Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E. Among the five cases, two received satisfactory reduction, two cases received incomplete reduction, and one experienced failure reduction. The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery, with an average of (9.5±3.4) months. The physiological curvature of cervical remained well without bone resorption, nonunion, pseudoarthrosis, as well as screw loosening or broken. Internal fixation of 2 cases were removed.Conclusion:Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice. The detailed diagnosis of medical history, physical examination and comprehensive imaging evaluation. The posterior approach technique of C1-2 was feasible and effective, which could obtain decompression, reconstruction andstability all together.
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Objective:To compare the clinical efficacy and complications of combined anterior and posterior approach and simple posterior release reduction and internal fixation in the treatment of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) .Methods:The medical records of 47 patients with basilar invaginationdepression complicated with refractory atlantoaxial dislocation who received surgical treatment from July 2000 to December 2017 were retrospectively analyzed. The patients were divided into anterior and posterior combined approach group (23 cases) and posterior approach group (24 cases). Key observation indicators include: Chamberlain line (CL), Wackenheim line (WL), McGae line (ML), atlantodens interval (ADI), cervicomedullary angle (CMA), clivus-canal angle (CCA), JOA scores (Japanese Orthopedic Association, JOA) and Ranawat grade.Results:The average follow-up was 48.7±31.2 months in the A-P group and 44.4±33.4 months in the P group. The average preoperative JOA score of the A-P group was 8.20±2.75 points and 14.98±1.05 points at the last follow-up, and the improvement rate was 77.35%±11.35%. The average preoperative JOA score of the P group was 8.06±2.52 points, and the last follow-up was 14.71±0.62 points, and the improvement rate was 74.38%±10.52%. There was no statistically significant difference between the two groups in JOA score ( t=0.877, P=0.262) and improvement rate ( t=1.478, P=0.206) at the last follow-up. The preoperative CL, WL, ML, ADI, CMA and CCA angles of the A-P group were 13.12±5.76 mm, 6.94±3.55 mm, 7.04±4.57 mm, 9.75±2.06 mm, 110.85°±13.6°, 95.32°±18.3°, respectively. The last follow-up was 1.68±2.53 mm, -2.76±2.26 mm,-1.52±2.43 mm, 1.12±1.55 mm, 149.26°±12.6°, and 141.42°±13.7°, respectively, with statistically significant differences from preoperative. The preoperative CL, WL, ML, ADI, CMA and CCA angles of P group were 12.52±5.17 mm, 6.59±3.04 mm, 6.94±4.32 mm, 9.88±1.93 mm, 115.35°±12.4°, 97.25°±16.4°, respectively. The results of the last follow-up were 2.00±3.67 mm, -3.06±1.85 mm, -1.76±2.88 mm, 1.17±1.18 mm, 146.76°±11.4° and 137.56°±10.4°, respectively, which were statistically significant compared with the preoperative results. There was no significant difference between the two groups in preoperative and final follow-up. The average bone graft fusion time of the A-P group was 9.2±4.9 months, and the average bone graft fusion time of the P group was 9.5±4.7 months. There was no statistically significant difference in the bone graft fusion time between the two groups ( t=0.547, P=0.382). Postoperative complications occurred in a total of 8 cases in the two groups, including 6 cases (21.7%) in the combined approach group and 2 cases (8.3%) in the posterior approach group. The incidence of complications in the posterior approach group was significantly lower than that in the combined approach group. Conclusion:The clinical and imaging results of the treatment of basilar depression with atlantoaxial dislocation by one-stage posterior release reduction and internal fixation are basically the same as those obtained by the anterior and posterior combined approach, but the complication rate of the posterior approach is significantly lower than that of the anterior and posterior combined approach.
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Objective@#To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance.@*Methods@#The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method.@*Results@#Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000).@*Conclusion@#Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance.
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Objective To discuss the clinical efficacy and surgical indications of one-stage posterior debridement,Smith-Petersen osteotomy(SPO), compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis. Methods All of 32 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one-stage posterior debridement,SPO, compressive fusion and instrumentation from March 2010 to October 2016,including 23 males and 9 females,aged 2 to 77 years old,average(39.2±17.8)years.All patients were treated by preoperative quadruple anti-tuberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months.Preoperative and postoperative changes in clinical symptoms,nervous func-tion,the situation of the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)with strict follow-up,as well as other re-lated complications were observed.The spinal fusion rate and fusion situation,changing of the physiological curvature,as well as loosening or breaking of the internal fixation device were detected through regular imaging examination.Results The surgery du-ration time was 90-150 min,average(120±19.6)min,and the blood loss was 150-600 ml,average(320±88.9)ml.Postoperative follow-up time was 1 to 3 years,average 2.3 years.The symptoms of tuberculosis poisoning in all patients were obviously relieved and the nutritional status was improved gradually. The visual analogue scale(VAS) improvement rate was about 92%. The VAS score in the preoperative and the last follow-up was statistically significant.All patients'ESR and CRP returned to normal levels at the last follow-up.The Kirkaldy-Willis function score showed that the total fine rate was 93.75%.9 patients with spinal neurologi-cal impairment were postoperative improved significantly.Except 1 patient's Asia grade improved from the B to C,others returned to normal condition.30 cases recovered.Pleural effusion was observed in 3 cases treated with closed thoracic drainage and antibi-otics.The drainage tube was removed after 5-7 d.Incision fistula were observed in 1 patient at 1 month after discharge and recov-ered after debridement and drugs adjustment.Internal fixation loosening was found in 1 elderly patient after 6 months after surgery which was treated with hyperextended brace and anti-osteoporosis drugs.No tuberculosis recurrence was found.Conclusion One-stage posterior debridement, SPO, compressive fusion and instrumentation is a simple, effective and safety surgical approach, which has great application value for surgical treatment of patients with thoracolumbar spinal tuberculosis.
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Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.
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Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.
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Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2%.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.
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Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94%) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11%) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11%) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41%) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82%).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.
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BACKGROUND:Cervical single-door laminoplasty for chronic compressive myelopathy has obtained exact effects. To reduce the occurrence of related complications, different doctors have proposed different improvement programs, and have achieved a certain effect, but the effect on postoperative complications is not very wel. OBJECTIVE:To evaluate the effect of modified open-door laminoplasty with steel implantation and preservation of bilateral semispinalis. METHODS: We retrospectively analyzed the data of 30 cases of multilevel cervical spondyiotic myelopathy who underwent modified open-door laminoplasty from October 2013 to March 2014. Internal fixation material was Centerpiece titanium plate fixation system. Visual Analogue Scale score, Japanese Orthopaedic Association score (17-score method), neck disability index, range of motion of cervical vertebra, and cervical curvature were compared before treatment and during folow-up. Axial symptom severity was assessed after treatment. RESULTS AND CONCLUSION:The patients were followed up for 12-24 months. No complications appeared during repair, including postoperative spinal cord injury, cerebrospinal fluid leakage, infection or C5 nerve root palsy. Only one patient suffered from axial pain, but there was no need for oral medication. The improvement rate of Japanese Orthopaedic Association score was (76.96±17.61)%. Neck disability index decreased from 12.29±3.82 preoperatively to 8.24±2.86 in final follow-up. Range of motion of cervical vertebra (47.41±17.33)° in final follow-up, accounting for (93.0±4.2)% of preoperative data. Cervical curvature decreased from (13.47±10.54)° preoperatively to (12.88±8.56)° in final follow-up. These findings confirm that modified open-door laminoplasty with preservation of bilateral semispinalis can reserve cervical rear structure to maximum extent, is conducive to early functional exercise after rehabilitation, and reduces the incidence of axial symptoms and loss of cervical curvature.
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BACKGROUND: At present, more and more scholars pay attention to the influence of spine and pelvis sagittal balance on the quality of life of patients. Postoperative changes in spine imaging parameters fol owing corrective osteotomy for lumbar degenerative kyphosis have not been reported. OBJECTIVE: To evaluate postoperative changes in sagittal balance fol owing corrective osteotomy for lumbar degenerative kyphosis. METHODS: We retrospectively analyzed 35 consecutive lumbar degenerative kyphosis patients treated with posterior osteotomy fixation in the First Affiliated Hospital of Xinjiang Medical University from February 2012 to December 2014. Imaging parameters were measured before fixation, immediately after fixation and during final fol ow-up. RESULTS AND CONCLUSION: (1) There were significant differences between preoperative and postoperative parameters except for pelvic incidence angle (P < 0.05). (2) There were significant differences between postoperative and last fol ow-up parameters except for Cobb angle, pelvic incidence angle, thoracic kyphosis angle and the thoracolumbar kyphosis (P < 0.05). (3) Pelvic tilt angle was negatively correlated with lumbar lordosis after fixation (r=-0.610, P < 0.001). Thoracic kyphosis was positively correlated with lumbar lordosis (r=0.598, P < 0.001). (4) Results suggested that lumbar sagittal contour can be significantly improved by corrective osteotomy for lumbar degenerative kyphosis. Simultaneously, reciprocal changes in the adjacent areas such as thoracic spine and pelvis occur to adapt to the new sagittal balance.
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BACKGROUND: Studies showed that both anterior cervical disc replacement and anterior cervical decompression and fusion can achieve good clinical result in cervical spondylosis. However, it is not conclusive about which kind of surgical method has an advantage in avoiding the adjacent segment degeneration. OBJECTIVE: To compare the effect on adjacent segment degeneration of single segment cervical disc herniation treated with anterior cervical decompression and fusion and anterior cervical disc replacement. METHODS: We col ected clinical data of 178 patients with cervical disc herniation and receiving anterior cervical disc replacement or anterior cervical decompression and fusion from January 2009 to December 2012. A retrospective analysis was performed. There were 116 cases in the anterior cervical decompression and fusion group and 62 cases in the anterior cervical disc replacement group. RESULTS AND CONCLUSION: (1) Evaluation: visual analogue scale score, Japanese Orthopaedic Association Scores and neck disability index were improved significantly in both groups during final fol ow-up compared with that pre-treatment (P 0.05). At 3 months after surgery, in the anterior cervical decompression and fusion group, surgical segment was confluent, and range of motion lost. During final fol ow-up, range of motion of adjacent upper segment and adjacent lower segment was significantly increased, and the increased range of motion in the upper segment was bigger than that of the lower segment (P < 0.05). (3) During final fol ow-up, X-ray films and MRI images revealed the number of degenerated adjacent segment was more in the anterior cervical decompression and fusion group than in the anterior cervical disc replacement group (P <0.05). The number of degenerated middle and upper segments was more than that of the lower segment in both groups (P < 0.05). (4) The findings confirmed that anterior cervical disc replacement or anterior cervical decompression and fusion for treating cervical disc herniation could effectively relieve nerve symptoms of patients. However, compared with the anterior cervical disc replacement, adjacent segment degeneration occurs more commonly after anterior cervical decompression and fusion.
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Objective To evaluate the effect of treatment of the intervertebral infection via single?stage posterior midline incision and bilateral muscle gap approach. Methods A retrospective of 39 cases (male 25 cases, female 14 cases) of lumbar in?tervertebral infected patients from October 2012 to December 2014 who were treated by posterior debridement, interbody fusion using allograft and posterior instrumentation through paraspinal muscle gap approach were analyzed, whose mean age was 48 years (range 11-70 years). According to the confirming diagnosis, patients underwent postoperatively anti?inflammatory or chemotherapy treatment. The disease controlling statues were evaluated based on laboratory results of ESR, CRP;Imaging examinations were tak?en to evaluate the fusion of vertebral body;Clinical effects were evaluated using the Visual Analog Scale (VAS) and the JOA score of lumbar function. Results In these 39 cases of intervertebral infection patients, 8 cases ware diagnosed as pyogenic infec?tious, 25 cases were diagnosed as tuberculosis infections, 2 cases were diagnosed as unknown infections, and brucellosis infec?tious was found in 4 cases. All patients' symptoms were significantly improved. The lower back VAS score: average 8.22±0.93 points before operation, average 2.21 ± 0.88 points one week after operation, and an average score of 0.80 ± 0.58 points by the last follow?up time. The lower extremity VAS score: average 2.32 ± 1.82 points before operation, average 1.89 ± 0.62 points one week after operation, and an average score of 0.61±0.47 points by the last follow?up time. All patients were followed up for 12-18 months (average 13 months), One patient with pyogenic infectious occurred wound infection 1 week postoperatively, and healed after a repeatedly surgery. No internal fixation loosening, fracture, or segmental collapse was observed ,and good fusion was present in all patients after 12 months. JOA lumbar function score: all patients were effective after operation, the improve?ment rate was excellent in 76.9%, good in 17.9%, and passable in 5.2%. Comparing with preoperation, the excellent and good rate was 94.8%. Conclusion The treatment of lumbar intervertebral infection via single?stage posterior midline incision and bi?lateral muscle gap approach was clinically effective, which can completely remove the lesion, and achieve rigid internal fixation.
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Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.