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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.
BMC Musculoskelet Disord ; 18(1): 322, 2017 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-28754114

RESUMO

BACKGROUND: Screw-rod constructs have been widely used to correct spinal deformities, but the effects of different screw-rod systems on anti-rotational torque have not been determined. This study aimed to analyze the biomechanical effect of different rod-screw constructs on anti-rotational torque. METHODS: Three conventional spinal screw-rod systems (Legacy, RF-F-10 and USSII) were used to test the anti-rotational torque in the material test machine. ANOVA was performed to evaluate the anti-rotational capacity of different pedicle screws-rod constructs. RESULTS: The anti-rotational torque of Legacy group, RF-F-10 group and USSII group were 12.3 ± 1.9 Nm, 6.8 ± 0.4 Nm, and 3.9 ± 0.8 Nm, with a P value lower than 0.05. This results indicated that the Legacy screws-rod construct could provide a highest anti-rotation capacity, which is 68% and 210% greater than RF-F-10 screw-rod construct and USSII screw-rod respectively. CONCLUSIONS: The anti-rotational torque may be mainly affected by screw cap and groove design. Our result showed the anti-rotational torque are: Legacy system > RF-F-10 system > USSII system, suggesting that appropriate rod-screw constructs selection in surgery may be vital for anti-rotational torque improvement and preventing derotation correction loss.


Assuntos
Parafusos Ósseos/estatística & dados numéricos , Procedimentos Ortopédicos/instrumentação , Escoliose/cirurgia , Humanos , Torque
9.
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
10.
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
11.
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
12.
Clin Spine Surg ; 30(4): E381-E389, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28437342

RESUMO

STUDY DESIGN: A retrospective review of data collected prospectively. OBJECTIVE: The study aimed to assess the possible effects of idiopathic scoliosis on left ventricular (LV) myocardial performance in children and adolescent patients. SUMMARY OF BACKGROUND DATA: Spine anomaly may impair cardiorespiratory function. It has been confirmed that respiratory function decreased in patients with scoliosis. However, limited study of the effect of scoliosis on heart function has been published, and no assessment of myocardial deformation of these patients has been reported to our knowledge. METHODS: Forty-one patients with a median age of 16 years and a median Cobb's angle of 75 degrees were studied. LV myocardial deformation was evaluated using 2-dimensional speckle-tracking echocardiography. The results were compared with those of 33 controls. The correlations between Cobb's angle and echocardiographic parameters in patients were also explored. RESULTS: Compared with controls, patients had significantly lower global LV longitudinal systolic strain in all 3 views (4 chamber, 2 chamber, and 3 chamber views), lower global radial and circumferential strains in mitral valve (MV) level and papillary muscle (PM) level; reduced LV longitudinal early diastolic strain rate (SRe) in all 3 longitudinal views and reduced radial SRe in MV level and reduced circumferential SRe in apical (AP) level; decreased LV longitudinal late diastolic strain rate in 4-chamber view and decreased radial ones in all 3 short-axis levels. Among patients, Cobb's angle correlated negatively with LV global radial strain of MV level (r=-0.37, P=0.02), global circumferential strain of MV level (r=-0.35, P=0.03), and global circumferential strain of PM level (r=-0.49, P=0.001), whereas positively with LV longitudinal SRa of 4-chamber view (r=0.46, P=0.003), longitudinal SRa of 2-chamber view (r=0.49, P=0.001), and circumferential SRa of AP level (r=0.35, P=0.02). CONCLUSIONS: LV mechanics are impaired in patients with idiopathic scoliosis, which correlate with the severity of scoliosis. Our findings suggest the need and provide a mechanical basis for further studies in these patients.


Assuntos
Ecocardiografia Doppler/métodos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Função Ventricular Esquerda , Adolescente , Adulto , Criança , Diástole , Feminino , Humanos , Masculino , Sístole , Adulto Jovem
13.
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
14.
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
15.
Clin Spine Surg ; 29(9): E452-E456, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27755202

RESUMO

STUDY DESIGN: To report a new technique. OBJECTIVE: To introduce a new method of precise correction controlling for ankylosing spondylitis kyphosis. SUMMARY OF BACKGROUND DATA: The exact angle method is excellent for calculating the pedicle subtraction osteotomy angle but is difficult to perform during surgery. In this study, the precise rod bending technique was proposed as a new method for precise correction controlling for ankylosing spondylitis kyphosis through illustrative cases. METHODS: A preoperative plan using the exact angle method, with exact osteotomy angle and level determined, was prepared using a whole-spine lateral x-ray film. Then a precise contoured rod imitating the predicted spine correction was obtained using the lateral spine x-ray film that was of the actual size of the trunk. This rod model was disinfected and used for precisely controlling kyphosis correction in ankylosing spondylitis patients with good cervical spine and hip joints. RESULTS: Four ankylosing spondylitis kyphosis patients were successfully corrected using the precise bending rod technique. Their mean age was 31 years, the mean operative time was 247 minutes (160-320 min), the mean volume of bleeding was 1482 mL (727-2700 mL), and the average follow-up period was 13.8 months (9-17 mo). All patients regained their sagittal balance (all C7-SSVL≤2 cm). The predicted ostetomy degree was accurate to within 2 degrees compared with the achieved degree at the osteotomy site. No complications occurred during or after surgery. CONCLUSIONS: The precise rod bending technique is a simple, effective method for precise correction of kyphosis caused by ankylosing spondylitis. The surgical result corresponded to the preoperative planning.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Parafusos Pediculares , Espondilite Anquilosante/cirurgia , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
16.
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
17.
Mol Med Rep ; 13(6): 4636-42, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27082501

RESUMO

The aim of the present study was to evaluate the different expression levels of thyroid hormone responsive (THRSP; Spot14)/S14 related, Mig12 (S14R) during bone marrow mesenchymal stem cell (BM-MSC) adipogenesis in adolescent idiopathic scoliosis (AIS) patients. MSCs were retrospectively isolated from AIS patients and controls, and adipogenic differentiation was induced. Total RNA was extracted for Affymetrix 3'­IVT expression profiling microarrays and compared with the results from healthy controls. The results were confirmed by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) validation and the protein expression levels of Spot14 and its paralogous gene S14R by western blotting and immunohistochemistry. A total of 300 significantly altered mRNAs were detected (111 upregulated and 189 downregulated) and confirmed by RT­qPCR. The mRNA expression levels of seven genes, including Spot14, were altered by >2­fold in AIS patients. Spot14/S14R was selected for further investigation. The results of the western blotting demonstrated that mRNA and protein expression levels of Spot14/S14R were significantly higher in AIS patients than the controls (P<0.05). Immunohistochemistry demonstrated Spot14 was expressed in 85% (17/20 cases) in adipose tissue samples from AIS patients and 23.1% (3/13 cases) of adipose tissue samples from controls. The positive ratio of Spot14 in adipose tissue samples from AIS was significantly higher than the controls (P<0.001). The results of the present study indicated that Spot14/S14R were differently expressed in MSC adipogenesis in AIS patients, and they may be important in the abnormal adipogenic differentiation in AIS.


Assuntos
Adipogenia/genética , Diferenciação Celular/genética , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Proteínas Nucleares/genética , Escoliose/genética , Fatores de Transcrição/genética , Adolescente , Células Cultivadas , Criança , Análise por Conglomerados , Feminino , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Masculino , Proteínas Nucleares/metabolismo , Escoliose/metabolismo , Fatores de Transcrição/metabolismo
18.
Clin Spine Surg ; 29(3): E157-61, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27007792

RESUMO

STUDY DESIGN: This was a retrospective study. OBJECTIVE: The aim of this study was to compare radiographic outcomes of Lenke 5C adolescent idiopathic scoliosis (AIS) patients treated by vertebral column manipulator (VCM) or simple rod derotation (SRD) maneuver. SUMMARY OF BACKGROUND DATA: The direct vertebral rotation (DVR) technique has demonstrated better rotational and coronal correction than SRD, but clinical radiographic outcomes for Lenke 5C AIS following DVR using a VCM derotational device have not been described. MATERIALS AND METHODS: A retrospective study was carried out in 39 Lenke 5C AIS patients treated by VCM (n=20) or SRD (n=19) techniques between April 2008 and June 2011. All patients had complete clinical record and radiographic data. Nine radiographic variables were collected and compared at 3 time points (preoperative, immediate postoperative, and minimum 2-year follow-up) between both groups. RESULTS: Scoliosis was successfully corrected in both groups. All patients obtained good coronal and sagittal balance, and no severe complications occurred. The postoperative apical rotation corrective rate of the VCM and SRD groups were 55.1% and 25.5%, respectively (P < 0.05). Lowest instrumented vertebra and stable vertebra (LIV-SV) was statistically significant between the VCM and SRD groups, the mean values were 1.2 ± 0.4 level and 0.7 ± 0.5 level (P < 0.05). The main curve corrective rates and LIV-tilt angle correction rates were not significantly different between groups, but it showed a spontaneous correction for the coronal LIV-tilt angle for both groups at the last follow-up. CONCLUSIONS: VCM improved postoperative apical axial rotational correction and lessened the lumbar fusion segment compared with the SRD technique, which might have a potential trend to reserve lumbar mobility.


Assuntos
Manipulação da Coluna/instrumentação , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Lordose/diagnóstico por imagem , Lordose/fisiopatologia , Lordose/cirurgia , Masculino , Período Pós-Operatório , Rotação , Coluna Vertebral/fisiopatologia
19.
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
20.
Cardiol Young ; 25(5): 976-83, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25215628

RESUMO

OBJECTIVES: This study sought to evaluate left ventricular, right ventricular, and left atrial mechanics and their interactions in patients with congenital scoliosis without clinical heart failure. METHODS: A total of 23 patients with a median age of 14 years and a median Cobb's angle of 61° were studied. Ventricular and atrial myocardial deformation was measured using speckle tracking echocardiography. The results of the patients were compared with 22 controls. RESULTS: Compared with controls, the patients had a significantly greater annular a velocity (p=0.04) and lower e/a ratio (p=0.03); the left ventricular deformation significantly decreased in radial global (p=0.04) and segmental systolic strain and early diastolic strain rate (p=0.03); the left atrial deformation showed a significantly lower positive strain (p=0.02), greater negative strain (p=0.01), and active contractile strain rate (p=0.01). For the patients, the Cobb's angle was negatively correlated with the left ventricular global radial systolic strain (r=-0.65, p=0.001), left atrial positive strain (r=-0.68, p<0.001), and the left atrial negative strain was positively correlated with the left ventricular circumferential late diastolic strain rate (r=0.46, p=0.01). The left atrial conduit strain rate was positively correlated with the left ventricular circumferential early diastolic strain rate (r=0.42, p=0.03). The left atrial active contractile strain rate was positively correlated with the left ventricular longitudinal late diastolic strain rate (r=-0.4, p=0.03). CONCLUSIONS: Impaired left ventricular and altered left atrial mechanics occur relatively early in patients with congenital scoliosis, and are correlated with the severity of their scoliosis. Our findings provide evidence of preclinical heart dysfunction in patients with this disorder.


Assuntos
Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Escoliose/complicações , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adulto Jovem
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