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1.
Commun Biol ; 2: 390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31667364

RESUMO

Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.

2.
World Neurosurg ; 127: e416-e426, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981802

RESUMO

BACKGROUND: Multimodal intraoperative neuromonitoring (IONM) has been proposed as an effective way to reduce permanent neurologic injury during spinal deformity surgery. However, few studies have reported evoked potential changes at different surgical stages of thoracic posterior vertebral column resection (PVCR). METHODS: A total of 82 cases with severe thoracic deformity (Yang's A type) treated by PVCR in a single institution between January 2010 and March 2015 were reviewed. Multimodal IONM including somatosensory evoked potential, motor evoked potential, and descending neurogenic evoked potential was performed for real-time assessment of spinal cord function during surgery. The risk factors of neuromonitoring events at different surgical stages were documented and analyzed. RESULTS: Multimodal IONM was successfully performed in all 82 cases. Thirty-nine neuromonitoring events presented in 27 (32.9%) cases. Neurologic monitoring events were more likely to occur in patients with larger scoliosis and kyphosis, longer osteotomy closure distance, more Halo gravity traction, more screw insertion, and higher PVCR segments. The reasons for monitoring changes included 6 events during screw insertion, 20 during osteotomy, 9 during osteotomy gap closure, and 4 during deformity correction. New postoperative neurologic deficits were observed in 11 (13.4%) cases including 1 incomplete paraplegia, 8 transient cord deficits, and 2 nerve root injuries. CONCLUSIONS: Multimodal IONM can effectively identify neurologic deficits throughout surgery. Osteotomy and osteotomy gap closure are the surgical stages with the highest neurologic risks during PVCR procedures. It is imperative to improve dexterity since the majority of neuromonitoring events are caused by surgical techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Escoliose/cirurgia , Medula Espinal/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Criança , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Procedimentos Neurocirúrgicos/métodos , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto Jovem
3.
Spine J ; 19(6): 1041-1047, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30529785

RESUMO

BACKGROUND CONTEXT: In-brace correction (IBC) plays an important role in curve progression of patients with adolescent idiopathic scoliosis (AIS) under brace treatment. We evaluated the coronal deformity angular ratio (C-DAR) as a potential predictor of IBC. Based on our experience, we postulated that a high C-DAR may result in low IBC. This relationship had not been previously studied. PURPOSE: To evaluate the relationship of C-DAR and IBC in patients with AIS. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: A total of 119 patients with AIS treated with a Gensingen brace in our scoliosis center from July 2015 to October 2017 were included. OUTCOME MEASURES: In-brace correction. METHODS: Data were collected before and upon brace placement. Correlation analyses between study variables and IBC were performed. A linear regression model was established on the basis of C-DAR. RESULTS: At brace fitting, the average age was 12.62±1.16 (range, 10-15) years and mean major curve Cobb angle was 32.14±4.66° (range, 25-40°). Mean IBC was 59.62%±22.03% (range, 16.2-100%). IBC had significant correlation with C-DAR (r=-0.69; 95% confidence interval, -0.77 to -0.61; p<.001). IBC was not significantly correlated with age, sex, height, weight, BMI, menstrual status, or Risser sign. A simple linear regression model established that in-brace correction=115.4-10.7×C-DAR. CONCLUSIONS: C-DAR has strong negative correlation with IBC and may estimate the expected IBC. The usage of C-DAR may obviate the need for flexibility radiographs, such as supine or supine lateral bending radiographs.

4.
World Neurosurg ; 121: e433-e440, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267947

RESUMO

BACKGROUND: The use of posterior vertebral column resection (PVCR) has extended the treatment of severe spinal deformity. However, the practice guidelines for anterior column support in patients treated by PVCR remain ill defined. The objective of the present study was to compare the clinical and radiographic outcomes of severe thoracic spinal deformity treated by PVCR with and without anterior column support (ACS). METHODS: We performed a prospective study of 57 patients with severe thoracic deformity (classified as Yang's A type) treated by PVCR with or without anterior column support from January 2010 to April 2015. The patient characteristics, radiographic parameters, intraoperative data, and complications were analyzed to clarify these 2 clinical series. RESULTS: The sex, age, diagnosis, curve magnitude, and curve type were similar between the PVCR with ACS group (n = 21) and non-ACS group (n = 36) preoperatively. Evaluation of the radiographic parameters, intraoperative data, and complications found no statistically significant intergroup differences, except for the osteotomy distance (non-ACS group, 4.0 cm; ACS group, 5.3 cm; P < 0.001) and shortening distance of the osteotomy gap (non-ACS group, 4.0 cm; ACS group, 3.5 cm; P = 0.005). CONCLUSIONS: The results of the present study have shown that PVCR without ACS seems to be a safe and effective technique for Yang's A type severe thoracic spinal deformity correction compared with PVCR with ACS. PVCR without ACS requires a relatively smaller osteotomy range and could potentially decrease the risk of implant failure due to bone to bone fusion.


Assuntos
Cifose/cirurgia , Procedimentos Neurocirúrgicos/métodos , Osteotomia/métodos , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adolescente , Adulto , Idoso , Criança , Potenciais Evocados/fisiologia , Feminino , Humanos , Cifose/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomógrafos Computadorizados , Adulto Jovem
5.
World Neurosurg ; 123: e597-e603, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30529518

RESUMO

OBJECTIVE: To identify the factors affecting in-brace correction in patients with adolescent idiopathic scoliosis (AIS). METHODS: We performed a retrospective analysis of patients with AIS receiving Gensingen brace treatment in our scoliosis center from July 2015 to October 2017 was performed. The selection of patients was in accordance with the Scoliosis Research Society inclusion criteria for a bracing study. Some radiographic and clinical parameters, including the Cobb angle, rib-vertebra angle difference, coronal and sagittal balance, lumbar-pelvic relationship (LPR), Risser sign, curve type, age, gender, height, weight, body mass index, and menstrual status were collected. The correlation and difference analyses were performed to identify the factors influencing in-brace correction. RESULTS: A cohort of 112 patients with AIS (94 girls and 18 boys) were included in the present study. The mean in-brace correction was 59.29% ± 22.33% (range, 16.22%-100.00%). In-brace correction showed a significantly negative correlation with the major curve Cobb angle, minor curve Cobb angle, total curve Cobb angle, and LPR (P < 0.05 for all). Sagittal and coronal imbalance could reduce the curve correction (P < 0.001 and P = 0.008, respectively). The remaining parameters were not related to in-brace correction. CONCLUSIONS: In-brace correction in the present study was 59.29% ± 22.33% (range, 16.22%-100.00%). Some factors, including the Cobb angle, sagittal and coronal balance, and LPR, have an effect on in-brace correction. The results from the present study can provide some useful information for brace design and fabrication.


Assuntos
Braquetes , Escoliose/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Resultado do Tratamento
6.
Neurosurgery ; 85(2): 211-222, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30060239

RESUMO

BACKGROUND: Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE: To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS: A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. RESULTS: The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. CONCLUSION: The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.

7.
World Neurosurg ; 123: e787-e796, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30579019

RESUMO

BACKGROUND: Three-column osteotomies were developed to treat severe spinal deformities but result in high neurologic complications and require further risk stratification. The present study investigated whether the combination of spinal cord function classification (SCFC) and deformity angular ratio (DAR) could further stratify the neurologic risks in the surgical correction of severe and stiff kyphoscoliosis. METHODS: The patients with kyphoscoliosis who had undergone posterior 3-column osteotomies at the spinal cord level were reviewed. Using our SCFC system, the preoperative neurologic function (type A, B, or C) was classified. The sagittal DAR (S-DAR), coronal, and total DARs were calculated. Intraoperative monitoring events and new neurologic deficits (NNDs) postoperatively were documented and analyzed using the SCFC and DAR or both combined. RESULTS: The NND rates increased significantly from type A to C (P = 0.000) and increased exponentially with an increase in S-DAR in types B and C but not type A. They also increased exponentially with aggravation of the SCFC in the medium and high but not low S-DAR group. All NNDs had recovered at 3 months for type A and most had recovered at 6 months for type B or C. CONCLUSIONS: The NNDs in type A SCFC usually experienced better recovery even with high S-DARs. Type B SCFC with an S-DAR >20° and type C SCFC with any S-DAR resulted in significantly greater intra- and postoperative neurologic risks. The combination of SCFC and S-DAR can further stratify the intra- and postoperative neurologic risks with these procedures.


Assuntos
Cifose/cirurgia , Escoliose/cirurgia , Doenças da Medula Espinal/etiologia , Medula Espinal/fisiologia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Eletromiografia , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Cifose/patologia , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteotomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Fatores de Risco , Escoliose/patologia , Escoliose/fisiopatologia , Medula Espinal/cirurgia , Doenças da Medula Espinal/fisiopatologia , Adulto Jovem
8.
Spine J ; 17(12): 1803-1811, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28602981

RESUMO

BACKGROUND CONTEXT: Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. PURPOSE: This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis. STUDY DESIGN/SETTING: A retrospective study was carried out. PATIENT SAMPLE: Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included. OUTCOME MEASURES: General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding. METHODS: The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed. RESULTS: The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with ST being or more than grade I (33.3%) was significantly higher than that with ST being less than grade I (9.8%). No linear correlations were found between spine shortening distance, deformity correction rate, and the degree of translation. CONCLUSIONS: The 3D translations are common in posterior three-column spinal osteotomies regardless of anterior strut graft placement. The increase of translation will increase neurologic risks, with GT or FT less than grade II and ST less than grade I being relatively safe.


Assuntos
Cifose/cirurgia , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
World Neurosurg ; 104: 723-728, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28532908

RESUMO

OBJECTIVE: To assess the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) without anterior support in treatment of Yang type A severe rigid thoracic kyphoscoliosis. METHODS: The records of 27 Yang type A severe thoracic kyphoscoliosis patients treated with PVCR without anterior support from January 2010 to September 2013 were analyzed retrospectively. Intraoperative multimodal neurophysiological monitoring was conducted in all patients. The 6 modes were somatosensory evoked potential, motor evoked potential, descending neurogenic evoked potential, spinal cord evoked potential, and electromyography (both triggered and free run). Radiographic parameters and complications were used to evaluate the clinical outcomes. RESULTS: PVCR without anterior support was conducted successfully in all 27 patients. Intraoperative monitoring events occurred in 3 patients (3/27); of these, 1 patient (1/27) showed postoperative spinal cord injury, but completely recovered within 9 months after the operation (Frankel level E). The number and osteotomy space of vertebrae resection were mean 1.33 levels and 3.7 cm, respectively. All cases achieved good coronal and sagittal curve correction. No implant related complications occurred until the latest follow-up. The average follow-up was 40.1 months (range, 24-59 months). CONCLUSIONS: In this study, we found that posterior vertebral column resection (PVCR) without any anterior support with a mean 3.7 cm shortening of the spinal column is safe, if close and unyielding contact of end plates can be obtained. A comprehensive understanding of the technique and intensive intraoperative neuromonitoring is mandatory to perform these challenging and complex spine deformity correction procedures safely.


Assuntos
Cifose/cirurgia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Criança , Eletroencefalografia , Eletromiografia , Potenciais Evocados/fisiologia , Feminino , Seguimentos , Humanos , Cifose/diagnóstico , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/fisiopatologia , Medula Espinal/fisiopatologia , Coluna Vertebral/fisiopatologia , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento , Adulto Jovem
10.
Spine (Phila Pa 1976) ; 42(23): E1371-E1379, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28441314

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To evaluate whether radiologic parameters affect spine surgeon's osteotomy choice in patients with severe and stiff thoracic kyphoscoliosis. SUMMARY OF BACKGROUND DATA: Three-column osteotomies were developed to address severe and stiff kyphoscoliosis. Current choice on osteotomies is based on the morphology of kyphosis, global balance, and locations of the main curvature; however, quantitative basis for decision making is still lacking. METHODS: Sixty patients with severe and stiff thoracic kyphoscoliosis who underwent three-column osteotomy in the thoracic spine were classified into four groups according to the grade of osteotomy. The radiologic parameters including maximum scoliosis, maximum kyphosis, deformity angular ratio (DAR; maximum Cobb angle divided by number of vertebrae involved), apical vertebral translation, coronal balance, and sagittal balance were measured and compared. Correlation analysis between the radiologic parameters and the osteotomy grades was conducted. Perioperative and long-term complications were reviewed. RESULTS: The overall scoliosis was corrected from a mean preoperative Cobb angle of 129.1° (range, 90-174°) to 56.4° (range, 14-100°), and overall kyphosis was corrected from 124.3° (range, 64-180°) to 54.3° (range, 11-95°). As the osteotomy grades increased, the mean preoperative maximum kyphosis increased from 104.5° to 151.8° and the mean sagittal DAR (S-DAR) increased from 16.4 to 24.9. Statistically significant between-group differences were found for preoperative maximum kyphosis (P = 0.001), S-DAR (P = 0.045), and total DAR (P = 0.033). Significant correlations were observed between the preoperative maximum kyphosis and the osteotomy grade (r = 0.454, P < 0.001). The S-DAR significantly correlated with the osteotomy grade (r = 0.322, P = 0.012). CONCLUSION: The preoperative maximum kyphosis and the S-DAR may affect the surgeon's decision on the grade of osteotomies. This may enrich the theoretical basis on preoperative planning and help with patient counseling. LEVEL OF EVIDENCE: 4.


Assuntos
Cifose/diagnóstico por imagem , Osteotomia/métodos , Escoliose/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Criança , Tomada de Decisão Clínica , Feminino , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Escoliose/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
11.
Spine (Phila Pa 1976) ; 42(14): 1050-1057, 2017 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-28187068

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVES: This study is to measure and analyze the changes of three-dimensional (3D) distances of spinal column and spinal canal at the three-column osteotomy sites and address their clinical and neurologic significance. SUMMARY OF BACKGROUND DATA: Three-column osteotomies were developed to treat severe and stiff spine deformities with insufficient understanding on the safe limit of spine shortening and the relationship between the shortening distance of the spinal column and that of the spinal canal. METHODS: Records of 52 continuous patients with severe and stiff scoliosis treated with three-column spine osteotomies at our institution from July 2013 to June 2015 were reviewed. The preoperative spinal cord function classification were type A in 31 cases, type B in 10 cases, and type C in 11 cases. The types of osteotomies carried out were extended pedicle subtraction osteotomy in nine patients and posterior vertebral column resection in 43 patients. Multimodality neuromonitoring strategies were adopted intraoperatively. 3D pre- and postoperative spine models were reconstructed from the computed tomography (CT) scans. The distances of convex and concave spinal column and the spinal canal shortening were measured and analyzed. RESULTS: The spinal column shortening distance (SCSD) measured on the 3D models (27.8 mm) were statistically shorter than those measured intraoperatively (32.8 mm) (P < 0.05); however, they were strongly correlated statistically (r = 0.82). The central spinal canal shortening distance (CCSD) was significantly shorter than the convex SCSD (P < 0.05). The convex SCSD and CCSD were significantly shorter in cases with anterior column strut graft than in those with bone-on-bone fusion (P < 0.05). CONCLUSION: The shortening distance of the convex spinal column cannot represent that of the central spinal canal in patients with severe scoliosis. The spinal column shortening procedure in appropriately selected patient groups with bone-on-bone fusion is a viable option with the CCSD being significantly shorter than the convex SCSD. LEVEL OF EVIDENCE: 4.


Assuntos
Osteotomia/efeitos adversos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Pesos e Medidas Corporais , Feminino , Humanos , Imagem Tridimensional , Masculino , Osteotomia/métodos , Estudos Retrospectivos , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
12.
Int J Surg Case Rep ; 30: 218-221, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28089323

RESUMO

INTRODUCTION: Intraoperative neurophysiological monitoring (IONM) has proven to help reduce the probability of postoperative neurological deficit for spinal deformity correctional surgeries. However, in rare cases new deficits may still happen. We report a surgical case in which the patient had postoperative paralysis. We would like to call for more case reports with postoperative neurological deficits as they present difficult clinical cases. PRESENTATION OF CASE: A 61-year-old male patient with severe thoracolumbar kyphoscoliosis underwent posterior spinal correction and fusion with segmental T10-L5 pedicle screws and rods instrumentation with IONM. The only intraoperative event was a pedicle breach at left L3 which was detected by triggered electromyography (EMG) testing, and the pedicle screw was repositioned. Left lower extremity paralysis was observed upon patient awakening. He received rehabilitation treatment and had limited recovery of muscle strength. Partial lumbar nerve root injury was likely the cause of the paralysis. DISCUSSION: This is a case with new lumbar nerve root deficit, with positive EMG signal change, but negative somatosensory evoked potential (SSEP) and motor evoked potential (MEP) findings. We discuss the different neurophysiological modalities for monitoring lumbar spinal nerve root function. We review journal articles from the past two decades which reported lumbar root deficits, and list neuromonitoring events during the surgeries. CONCLUSION: Multimodality monitoring with spontaneous and electrically triggered EMG combined with SSEP and MEP may provide the best chance to detect lumbar nerve root injuries.

13.
J Back Musculoskelet Rehabil ; 30(3): 559-563, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27911281

RESUMO

STUDY DESIGN: A retrospective study in Chinese Han people. PURPOSE: To explore whether promoter polymorphisms of matrix metalloproteinases-3 (MMP-3) (rs3025058) and interleukin-6(IL-6) (rs1800795) genes are associated to AIS gender bias. METHODS: A total of 200 patients (100 boys and 100 girls) with AIS and 200 healthy age-matched adolescents were recruited from July 2008 to August 2013 in our scoliosis center. All AIS patients had Cobb angles larger than 20°, average 43 ± 3.6° (range 24-72°). A case-control study using genotypic technique was conducted to explore whether promoter polymorphisms of MMP-3 and IL-6 were associated to AIS gender bias. In addition, to confirm the association between gene variants of MMP-3 and IL-6 and AIS. Statistical analysis of genotype frequencies between AIS patients and normal controls was performed by X^2 test. RESULTS: The frequency of 5A/5A genotype of MMP-3 gene in patients with AIS was higher than in controls (19% versus 9.5% p= 0.007), in the sub-divided groups depend on gender, no significant difference was found between AIS girls and boys in the frequency of 5A/5A genotype of MMP-3 (20% in girls versus 18% in boys p= 0.718). No significant difference was found between AIS and controls in the frequency of G/G genotype of IL-6 (97.5% versus 98%). In the sub-divided groups depend on gender, no significant difference was found between AIS girls and boys in the frequency of G/G genotype of the IL-6 gene (98% in girls versus 97% for boys). CONCLUSIONS: The promoter polymorphism of the MMP-3 gene was confirmed to have an association with AIS and the promoter polymorphism of the IL-6 gene was lack of association with AIS. Besides, both gene variants of MMP-3 and IL-6 were not associated to AIS gender bias.


Assuntos
Interleucina-6/genética , Metaloproteinase 3 da Matriz/genética , Escoliose/genética , Adolescente , Estudos de Casos e Controles , Criança , China , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Cifose , Masculino , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Estudos Retrospectivos , Caracteres Sexuais , Adulto Jovem
14.
Medicine (Baltimore) ; 95(19): e3289, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27175629

RESUMO

Longer spinal fusions have been shown to result in improved deformity correction; however, loss of normal flexibility in the fusion area should not be ignored. Current consensus was to achieve a shorter fusion in primary surgery, with the goal of preserving as much of the distal motion segment as possible. However, the correlation between the length of fusion and functional outcome remains controversial. To the best of our knowledge, a previous study has demonstrated the function outcomes and the differences in HRQoL with specific fusion levels.In this cross-sectional study, 172 patients (mean age, 17.8 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 29.7 mo) were included to measure lumbar spine mobility and quality of life using validated outcome instruments in the study population. Patients were assigned to 5 groups according to the lower instrumented vertebra (LIV) level: group A (fusion above L2) 26 patients; group B (fusion to L2) 21 patients; group C (fusion to L3) 46 patients; group D (fusion to L4) 53 patients; and group E (fusion to L5) 26 patients. At each follow-up, patients were asked to complete the Scoliosis Research Society 22 (SRS-22) Questionnaire. Lumbar mobility was assessed using a dual digital inclinometer.Average spinal range of motion (ROM) was 41.4 degrees (SD, 20.7), forward flexion was 29.2 degrees (SD, 15.0), and backward extension was 12.2 degrees (SD, 9.5). The total spinal range of motion and forward flexion dropped noticeably as the LIV got more distal. Statistically significant between-group differences (1-way ANOVA) were found for ROM (P < 0.001), forward flexion (P < 0.001), or backward extension (P < 0.001). The motion segments preserved significantly correlated with ROM (r = 0.76, P < 0.001), ROMF (r = 0.76, P < 0.001), and ROME (r = 0.39, P < 0.001). However, no significant between-group differences was found for each domain of SRS-22 questionnaire.The motion segments preserved strongly correlated with lumbar mobility. Less fusion levels can preserve better lumbar flexibility by keeping more motion segments.


Assuntos
Qualidade de Vida , Escoliose/cirurgia , Fusão Vertebral , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Amplitude de Movimento Articular , Escoliose/fisiopatologia , Escoliose/psicologia , Fusão Vertebral/métodos , Fusão Vertebral/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
15.
Eur Spine J ; 25(6): 1821-9, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26769035

RESUMO

PURPOSE: Spinal cord function classification systems are not useful for guiding surgery in patients with severe spinal deformities. The aim of this study is to propose a classification system for determining a surgical strategy that minimizes the risk of neurological dysfunction in patients with severe spinal deformities. METHODS: The records of 89 patients with severe spinal deformities treated with vertebral column reconstruction from 2008 to 2013 were retrospectively analyzed. Based on neurophysiological monitoring, magnetic resonance imaging, and neurological symptoms patients were categorized into three groups: group A, normal spinal cord, normal evoked potentials and no neurological symptoms; group B, spinal cord abnormalities and/or abnormal evoked potentials but no neurological symptoms; group C, neurological symptoms with or without spinal cord abnormalities/abnormal evoked potentials. Outcomes and complications were compared between the groups. RESULTS: A total of 89 patients (51 male, 38 female) were included with 47 (52.8 %), 16 (18.0 %), and 26 (29.2 %) patients in groups A, B and C, respectively, and a mean follow-up 34.5 months. There were no differences in age, gender, average preoperative scoliosis, and kyphosis among three groups, but there were differences with respect to the causes of severe spinal deformity and the corrective rate of scoliosis and kyphosis. Changes in intraoperative evoked potentials were different in these three types according to this new classification, and the recovery rates of changes in the three groups were 71.1, 50.0, and 14.1 %, respectively. Postoperative spinal cord injury was positively related to intraoperative changes of evoked potentials. CONCLUSION: The classification system may be useful for guiding surgical decisions in patients with severe spinal deformities to minimize the risk of neurological complications.


Assuntos
Monitorização Intraoperatória , Procedimentos Ortopédicos , Medula Espinal , Doenças da Coluna Vertebral , Adolescente , Adulto , Criança , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Masculino , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Estudos Retrospectivos , Medula Espinal/fisiologia , Medula Espinal/fisiopatologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Adulto Jovem
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