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1.
BMC Musculoskelet Disord ; 22(1): 152, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546648

RESUMO

BACKGROUND: Patient compliance is essential to the effectiveness of brace treatment for adolescent idiopathic scoliosis (AIS) patients. Subjective measurements like questionnaires and inquiries proved to be arguably inaccurate. Although some scholars have applied temperature/force monitors to measuring patient compliance objectively, few studies to date could monitor patient compliance in real time. The objective of this study is to describe and evaluate a compliance real-time monitoring system of the brace usage in AIS patients. METHODS: A compliance real-time monitoring system (specifically consisting of a compliance monitor, a WeChat Mini Program, a cloud-based storage system and a website backstage management system) was designed to manage the brace treatment. Thirty patients receiving brace treatment were enrolled. They were told to upload the data at least once a day. Clinicians downloaded the compliance data and communicated with the patients online based on their analysis of data at least once every 3 months. The measured force, quality compliance (measured force / baseline force), measured time, and quantity compliance (measured time/ prescribed time) were used to evaluate patient compliance. Patients were also asked to rate their satisfaction at the final follow-up. RESULTS: Twenty-eight patients were included in the final analysis. The mean baseline force was 1.23 ± 0.28 N. The mean measured force was 0.79 ± 0.29 N. The mean quality compliance was 64.8 ± 22.2%. The prescribed time of all patients was 23 h. The mean measured time was 14.1 ± 2.9 h. The mean quantity compliance was 61.3 ± 12.6%. Both the quality and quantity compliance during the first 3 months of treatment was significantly lower than the latter 3 months. In this study, 96.4% (27/28) patients were satisfied with the use of the monitoring system, among whom 21.4% (6/28) are very satisfied and 75.0% (21/28) are somewhat satisfied. CONCLUSIONS: The compliance real-time monitoring system, without evaluating the clinical and radiographic outcomes for now, has already shown some feasibility and effectiveness for the management of the brace usage in AIS patients. This system, as a useful tool for online patient management and patient-clinician communication, would be potentially employed on a large scale in future for clinicians to improve the compliance and satisfaction of AIS patients who have received brace treatment.

2.
BMC Musculoskelet Disord ; 22(1): 144, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546654

RESUMO

PURPOSE: We previously reported anterior release, posterior internal distraction, and subsequent spinal fusion (ARPIDF) for the correction of severe scoliosis with a satisfactory correction rate. However, surgical procedures were completed in 2-3 stages. Here we compare Cobb angle of ≥90° in scoliosis correction between a novel posterior multiple screws distraction reducer (MSDR) system and ARPIDF. METHODS: Thirty-six patients with severe scoliosis treated by MSDR or ARPIDF (n = 18 in both groups). We retrospectively analyzed and compared outcome measures between the two groups over a minimum follow-up duration of 2 years. The following variables were compared between the two groups: age at surgery, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, operation time, estimated blood loss, hospitalization time, follow-up duration, various radiological parameters, complication rate, and Scoliosis Research Society-30 score. RESULTS: There were no significant between-group differences with respect to age, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, and follow-up duration. Further, there was no significant difference in terms of preoperative, postoperative, and final follow-up findings of the radiographic data. However, the ARPIDF group had longer operation and hospitalization times and greater blood loss. In the ARPIDF group, 4 patient developed complications (infection, intraoperative neuromonitoring changes, transient dyspnea); none of these events occurred in the MSDR group. CONCLUSION: The use of MSDR helped achieve greater scoliosis correction with a shorter operation time, lower blood loss, and lower complication rate than the use of ARPIDF. MSDR facilitates safer and easier correction of severe scoliosis without increasing surgical risk.

3.
BMC Musculoskelet Disord ; 22(1): 185, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588805

RESUMO

BACKGROUND: The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI. METHODS: Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire. RESULTS: The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P < 0.001). The incidence of PJK in Lenke 5 AIS was 18.6 %, 21.9 % (7/32) in the low PI group (PI < 45°) and 15.8 % (6/38) in the high PI group (PI ≥ 45°), and there was no statistical difference between the two groups (χ2 = 0.425, P = 0.514). For low PI patients, there is no significant difference where the UIV is located with regards to the TK apex between the PJK and Non-PJK subgroups (χ2 = 1.103, P = 0.401). For high PI patients, PJK was more likely to occur when UIV was cephalad to than caudal to the TK apex (31.25 % vs. 4.7 %, P = 0.038). There was no significant difference in the selection of LIV between the two groups. CONCLUSIONS: There is no difference in the incidence of PJK between the Lenke 5 AIS patients with low PI (< 45°) and high PI (≥45°), but the main risk factor of PJK should be different. For patients with low PI, overcorrection of LL should be strictly avoided during surgery. For patients with high PI, the selection of UIV should not be at or cephalad to the apex of thoracic kyphosis to retain more mobile thoracic segments.

4.
J Transl Med ; 19(1): 14, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407627

RESUMO

BACKGROUND: Currently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD). METHODS: Twenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores. RESULTS: There was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively. CONCLUSIONS: In patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

5.
BMC Musculoskelet Disord ; 22(1): 54, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422037

RESUMO

BACKGROUND: PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). METHODS: Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. RESULTS: Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA <90° in predicting dysphagia reached 88.5%. CONCLUSIONS: PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia. TRIAL REGISTRATION: This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019.

6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 33-38, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448196

RESUMO

Objective: To compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF). Methods: Between April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF. Results: Dysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group ( χ 2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS ( P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up ( P>0.05). The differences in O-EAa and nPAS were significant ( P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group ( P>0.05); the difference in the O-C2a was significant ( t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant ( P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups ( P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS ( P<0.05). The dO-C2a≤-5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia ( P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤-5° with a significant OR of 14.4. Conclusion: The dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.


Assuntos
Transtornos de Deglutição , Luxações Articulares , Fusão Vertebral , Adolescente , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Adulto Jovem
7.
Sci Adv ; 6(50)2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33310848

RESUMO

Osteoporotic fractures are prevalent in society, and their incidence appears to be increasing as the worldwide population ages. However, conventional bone repair materials hardly satisfy the requirements for the repair of pathological fractures. Here, we developed a biomimetic polyetherketoneketone scaffold with a functionalized strontium-doped nanohydroxyapatite coating for osteoporotic bone defect applications. The scaffold has a hierarchically porous architecture and mechanical strength similar to that of osteoporotic trabecular bone. In vitro and in vivo studies demonstrated that the scaffold could promote osteoporotic bone regeneration and delay adjacent bone loss via regulating both osteoblasts and osteoclasts. In addition, the correlations between multiple preimplantation and postimplantation parameters were evaluated to determine the potential predictors of in vivo performance of the material. The current work not only develops a promising candidate for osteoporotic bone repair but also provides a viable approach for designing other functional biomaterials and predicting their translational value.

8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1468-1473, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191708

RESUMO

Objective: To review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery. Methods: The mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years. Results: TXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range. Conclusion: The effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.


Assuntos
Antifibrinolíticos , Ácido Tranexâmico , Adolescente , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Humanos , Período Pós-Operatório , Ácido Tranexâmico/uso terapêutico
9.
Neurosurg Rev ; 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097988

RESUMO

The pathophysiology behind the instigation and progression of scoliosis in Chiari malformation type I (CMI) patients has not been elucidated yet. This study aims to explore the initiating and progressive factors for scoliosis secondary to CMI. Pediatric patients with CMI were retrospectively reviewed for radiological characteristics of tonsillar herniation, craniocervical anomaly, syrinx morphology, and scoliosis. Subgroup analyses of the presence of syrinx, scoliosis, and curve progression were also performed. A total of 437 CMI patients were included in the study; 62% of the subjects had syrinx, and 25% had scoliosis. In the subgroup analysis of 272 CMI patients with syrinx, 78 of them (29%) had scoliosis, and multiple logistic regression analysis showed that tonsillar herniation ≥ 10 mm (OR 2.13; P = 0.033) and a clivus canal angle ≤ 130° (OR 1.98; P = 0.025) were independent risk factors for scoliosis. In the subgroup analysis of 165 CMI patients without syrinx, 31 of them (19%) had scoliosis, and multiple logistic regression analysis showed that a clivus canal angle ≤ 130° (OR 3.02; P = 0.029) was an independent risk factor for scoliosis. In the subgroup analysis of curve progression for 97 CMI patients with scoliosis, multiple logistic regression analysis showed that anomalies of the craniocervical junction and syrinx were not risk factors for curve progression. Many complex factors including craniocervical angulation, tonsillar herniation, and syrinx might participate in the instigation of scoliosis for CMI patients, and the relationship between craniocervical angulation and scoliosis deserves further study.

10.
Artigo em Inglês | MEDLINE | ID: mdl-33079914

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the "apical vertebra deviation ratio (AVDR)" as a predictor of pulmonary function impairment. SUMMARY OF BACKGROUND: The pulmonary function of AIS is one of the key focuses of clinicians' attention. Early identification of AIS patients who are at risk of developing impaired pulmonary function is important for improving patient management. METHODS: Preoperative pulmonary function and radiographic examination data of 108 patients with thoracic AIS were collected. The following thoracic morphology data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between pulmonary function and thoracic morphology measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the thoracic morphology measurements could predict pulmonary function. RESULTS: The costophrenic angle distance (CAD), T1-diaphragm, and T1-T12 height were significantly positively correlated with FVC, FEV1, VC, and TLC (r = 0.54-0.74, p < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = -3.46 + CAD (cm)*0.27 (R = 0.54). If T1-T12 height is included, the correlation is further enhanced (R = 0.68). There was a significant negative correlation between the apical vertebra deviation ratio (AVDR) and FVC%, FEV1%, VC%, and TLC% (r = -0.46 to -0.52, p < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70-99.73*AVDR (R = 0.272). CONCLUSIONS: The two novel, 2-dimensional thoracic morphology measurements, CAD and AVDR, can be used as moderate to strong predictors of pulmonary function outcome in statistical terms. An AVDR greater than 0.2 suggests that the patient may suffer from moderate or severe pulmonary function damage. LEVEL OF EVIDENCE: 4.

11.
Spine J ; 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33049411

RESUMO

BACKGROUND CONTEXT: Tranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction. PURPOSE: The primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects. STUDY DESIGN: Prospective, double-blinded, randomized controlled trial. PATIENT SAMPLE: A total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study. OUTCOME MEASURES: The primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL. METHODS: Patients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo. RESULTS: The mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1-786.1 mL, p<0.001; 515.6 mL, 95% CI, 267.6-763.6 mL, p<.001]; (36.11%, p=.029, p=.013). Meanwhile, the mean TBL, maximum Hb decrease, and volume of drainage were also significantly lower in group A and B than in group C. IL-6 and CRP in group A and B were significantly lower than in group C from postoperative days 1 to 3. All these differences were not significant between groups A and B. No drug-related complications were observed in any patient. Multiple regression showed that the application of postoperative TXA and number of screws were significant parameters affecting PBL. CONCLUSIONS: A multiple-dose regimen of TXA, either by oral or intravenous application, could be a safe and effective means of controlling PBL and decreasing the postoperative transfusion rate in patients with AIS who underwent scoliosis surgery. In addition, it could inhibit postoperative inflammatory response.

12.
Front Bioeng Biotechnol ; 8: 559387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33123512

RESUMO

Objective: To build a model for proximal junctional kyphosis (PJK) prognostication in Lenke 5 adolescent idiopathic scoliosis (AIS) patients undergoing long posterior instrumentation and fusion surgery by machine learning and analyze the risk factors for PJK. Materials and Methods: In total, 44 AIS patients (female/male: 34/10; PJK/non-PJK: 34/10) who met the inclusion criteria between January 2013 and December 2018 were retrospectively recruited from West China Hospital. Thirty-seven clinical and radiological features were acquired by two independent investigators. Univariate analyses between PJK and non-PJK groups were carried out. Twelve models were built by using four types of machine learning algorithms in conjunction with two oversampling methods [the synthetic minority technique (SMOTE) and random oversampling]. Area under the receiver operating characteristic curve (AUC) was used for model discrimination, and the clinical utility was evaluated by using F1 score and accuracy. The risk factors were simultaneously analyzed by a Cox regression and machine learning. Results: Statistical differences between PJK and non-PJK groups were as follows: gender (p = 0.001), preoperative factors [thoracic kyphosis (p = 0.03), T1 slope angle (T1S, p = 0.078)], and postoperative factors [T1S (p = 0.097), proximal junctional angle (p = 0.003), upper instrumented vertebra (UIV) - UIV + 1 (p = 0.001)]. Random forest using SMOTE achieved the best prediction performance with AUC = 0.944, accuracy = 0.909, and F1 score = 0.667 on independent testing dataset. Cox model revealed that male gender and larger preoperative T1S were independent prognostic factors of PJK (odds ratio = 10.701 and 57.074, respectively). Gender was also at the first place in the importance ranking of the model with best performance. Conclusion: The random forest using SMOTE model has the great value for predicting the individual risk of developing PJK after long instrumentation and fusion surgery in Lenke 5 AIS patients. Moreover, the combination of the outcomes of a Cox model and the feature ranking extracted by machine learning is more valuable than any one alone, especially in the interpretation of risk factors.

13.
World Neurosurg ; 144: e916-e925, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32987173

RESUMO

BACKGROUND: Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. METHODS: We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. RESULTS: Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°-11.58°) and kyphosis of fixed segments (8.50°-9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser's grade with larger scoliosis might be risk factors for correction loss. CONCLUSIONS: Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.

14.
BMC Surg ; 20(1): 195, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883265

RESUMO

BACKGROUND: The windswept lower limb deformity describes valgus deformity in one leg with varus deformity in the other. It is mostly seen in young children with metabolic bone diseases (such as rickets) and may lead to leg length discrepancy (LLD) and Degenerative scoliosis (DS) in older age. To the best of our knowledge, there was no report of the spinal surgery in patient with severe DS associated with windswept deformity. The objective of this study is to report the unique case of a 60-year-old woman with severe degenerative scoliosis (DS) associated with windswept deformity caused by rickets who underwent a posterior correction and fusion surgery in spine. CASE PRESENTATION: The patient was diagnosed as rickets windswept lower limb deformity for 50 years but never went through routine treatment. Then, she performed lumbar scoliosis for more than 20 years and suffered from severe back pain for 4 years. After overall clinical evaluation and radiographic measures, we performed a posterior surgical correction and fusion from T9-L5. With this surgery, the main thoracolumbar curve Cobb angle corrected from 72.5° to 21.0°, the coronal balance from 0 cm to 2.0 cm while the sagittal vertical axis (SVA) from 1.5 cm to - 1.0 cm. At 2 years postoperative follow-up, her back pain has almost completely relieved with a satisfied fixation and bone fusion showed on CT scans. However, a coronal imbalance was found with C7-CSVLdistance equal to 4.0 cm. This coronal imbalance was highly correlated to the untreated LLD and pelvic obliquity, and should be improved by standing posture or shoe lifts. CONCLUSIONS: For such patient, the pure spinal correction and fusion surgery, in spite of lower limbs deformity, can achieve good relieve of back pain symptom, however may accompany by the complication of coronal imbalance due to the unimproved pelvic obliquity and LLD. However, longer follow-up is necessary to observe the long-term outcome of this patient's postoperative coronal imbalance.

15.
Spine J ; 20(11): 1761-1769, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615327

RESUMO

BACKGROUND CONTEXT: Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. PURPOSE: To compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system. STUDY DESIGN/SETTING: Retrospective comparative study. PATIENT SAMPLE: Ninety-one patients who underwent unilateral open-door laminoplasty. OUTCOME MEASURES: Clinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle. METHODS: Between April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared. RESULTS: Both groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p<.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p<.05). CONCLUSIONS: Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.

16.
Clin Neurol Neurosurg ; 196: 106014, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32593045

RESUMO

OBJECTIVES: It remains unclear which subgroups of scoliotic patients with CMI and syringomyelia are more likely to undergo unplanned neurosurgery after spinal deformity correction. The purpose of this study is to explore risk factors of unplanned neurosurgery for scoliotic patients with CMI and syringomyelia after spinal deformity correction. PATIENTS AND METHODS: This cohort consisted of 62 scoliotic patients with CMI and syringomyelia who underwent spinal deformity surgery with a mean follow-up of 4.3 year. 14 of them underwent unplanned neurosurgery (the NN group), and the other 48 patient underwent single spinal correction surgery (the SS group). The radiological parameters were compared between the two groups, and multivariate logistic regression analysis and Kaplan-Meyer survival curves were used to identify potential risk factors of unplanned neurosurgery. RESULTS: The incidence of unplanned neurosurgery after spinal deformity surgery was 22.28 % (14/62), and delayed headache was the most common reason for unplanned neurosurgery with five patients (36 %) and follow by neck pain with three patients (21 %). Significantly increased tonsil ectopia (9.7 ± 3.8 vs. 6.9 ± 2.9; P = 0.021), syrinx/cord width ratio (0.62±0.11 vs. 0.45±0.13; P<0.001), and syrinx/cord area ratio (0.45 ± 0.11 vs. 0.26 ± 0.15; P<0.001) were found in the NN group. While, there were no significant differents in pBC2 line, clivus canal angle, and syrinx length between the two groups. The logistic regression analysis indicated that tonsil ectopia≥10 mm (P = 0.019; OR=6.440; 95 %CI = 1.361 to 30.467) and syrinx/cord area ratio ≥ 0.4 (P = 0.006; OR=7.664; 95 %CI = 1.819 to 32.291) were independent risk factors of unplanned neurosurgery. Kaplan-Meyer survival curves showed cumulative unplanned neurosurgery for patients with tonsil ectopia ≥ 10 mm (P < 0.001) and syrinx/cord area ratio ≥ 0.4 (P = 0.001) after spinal deformity correction. CONCLUSION: After spinal deformity correction, 78 % of the patients did not require later neurosurgery and those that needed it had a delay of more than nine months. Tonsil ectopia ≥ 10 mm and syrinx/cord area ratio ≥ 0.4 were independent risk factor of unplanned neurosurgery after spinal deformity correction. It is reasonable to perform spinal corrective surgery in patients with minimal symptoms and signs without the need for prior neurosurgical intervention.

17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 275-284, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174070

RESUMO

Objective: To summarize the research progress of hydrogels for the regeneration and repair of degenerative intervertebral disc and to investigate the potential of hydrogels in clinical application. Methods: The related literature about the role of hydrogels in intervertebral disc degeneration especially for nucleus pulposus was reviewed and analyzed. Results: Hydrogels share similar properties with nucleus pulposus, and it plays an important role in the regeneration and repair of degenerative intervertebral disc, which can be mainly applied in nucleus pulposus prosthesis, hydrogel-based cell therapy, non-cellular therapy, and tissue engineering repair. Conclusion: Hydrogels are widely used in the regeneration and repair of intervertebral disc, which provides a potential treatment for intervertebral disc degeneration.


Assuntos
Hidrogéis/uso terapêutico , Degeneração do Disco Intervertebral/terapia , Disco Intervertebral , Núcleo Pulposo , Regeneração , Humanos
18.
Neurol India ; 68(2): 299-304, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32189709

RESUMO

Background: The treatment of the syrinx prior to correction of the scoliosis in syringomyelia-associated scoliosis (SMS) patients remains controversial. The aim of this study is to evaluate the role of the syrinx size in the management of SMS patients. Materials and Methods: This was a retrospective study of 36 SMS patients. They were divided into 2 groups: Group A (26 with a small syrinx, syrinx(S)/spinal cord(C) ratio ≤0.7) and Group B (10 with a large syrinx, S/C ratio >0.7). Patients with a large syrinx accepted prophylactic neurosurgery prior to scoliosis surgery. They were evaluated at baseline, 1-week and last follow-up after correction surgery for changes in curve correction, global coronal balance, thoracic kyphosis (TK), sagittal vertical axis (SVA), and Scoliosis Research Society (SRS)-22 scores. Results: The syrinx size of patients in Group A was significantly smaller than that of in Group B. The syrinx size was significantly decreased after prophylactic neurosurgery in Group B. The radiographic parameters of scoliosis at baseline, 1-week and last follow-up after scoliosis surgery were comparable between two groups. No abnormal signal was detected during the process of neuromonitoring in both groups. Pre- and postoperative SRS-22 scores were similar between two groups. Conclusions: Prophylactic neurosurgery may be beneficial for decreasing the risk of correction surgery in SMS patients with large syrinx (S/C ratio >0.7). After the intervention of syrinx prior to scoliosis correction, SMS patients with large syrinx could obtain similar clinical and radiographic outcomes of treatment with pedicle-screw-based spinal instrumentation and fusion compared to the patients with small syrinx.

19.
Eur Spine J ; 29(8): 1981-1992, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32219596

RESUMO

PURPOSE: To investigate airway development and airway resistance by computed tomographic three-dimensional (3D) reconstruction of the bronchial tree in patients with adolescent idiopathic scoliosis (AIS). We evaluated factors predicting postoperative respiratory complications to provide timely treatment, prevent complications, and improve operative and anesthetic safety. METHODS: From August 2015 to August 2017, 53 AIS patients with a mean age of 15.4 years (range 10-20 years) were included in this study. Scoliotic parameters on radiographs were analyzed. Airway resistance was obtained by pulmonary function testing. All patients' pulmonary bronchial trees were 3D-reconstructed via chest thin layer computed tomography to explore the correlation between the spinal-thoracic deformity parameters and airway resistance. RESULTS: Correlations between scoliotic parameters and airway development parameters were not statistically significant (P > 0.05). The scoliotic parameters such as Cobb angle, apical vertebral translation, rotation angle to sagittal plane, rotation angle to middle line, and apical vertebral body-rib ratio (AVB-R) were positively correlated with tracheal bifurcation angle (R2: 0.429, 0.374, 0.430, 0.504, and 0.414, respectively; P < 0.05). Cobb angle, rib hump, and apical vertebral body-rib ratio (AVB-R) were positively correlated with left principal bronchus length to right principal bronchus length (PBL-R) (R2: 0.373, 0.503, and 0.377, respectively; P < 0.05). Superficial area of bronchial tree (SABT) and narrow cross section of trachea (NCT) were negatively correlated with plethysmography Pre-Ref resistance ratio (Pre/Ref) (R2: - 0.365 and - 0.452, respectively; P < 0.05). SABT and NCT were negatively correlated with respiratory impedance (Zrs) (R2: - 0.327 and - 0.436, respectively; P < 0.05). CONCLUSIONS: Pulmonary bronchial development in patients with AIS is affected by spinal-thoracic deformity. Comprehensive assessment of preoperative pulmonary function, especially airway resistance, is necessary in patients with AIS whether the thoracic scoliosis is severe or mild-to-moderate. These slides can be retrieved under Electronic Supplementary Material.

20.
World Neurosurg ; 137: e1-e8, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31476470

RESUMO

OBJECTIVE: To investigate the changes in the sagittal parameters of the cervical spine and the clinical efficacy of C2∼3 anterior cervical discectomy and fusion (ACDF) combined with internal fixation for unstable hangman's fractures. METHOD: The clinical data of 46 patients with unstable hangman's fractures treated with both C2∼3 ACDF combined with internal fixation between May 2012 and May 2017 were analyzed retrospectively. The upper cervical angle (C0∼2), the forward translation of the C2 vertebral body (C2-T), C2∼3 local kyphosis angle (C2∼3 LK), C2∼7 cervical curvature (C2∼7 CC), C2 sagittal vertical axis (C2-SVA), and T1 slope angle (T1S) were compared preoperatively, postoperatively, and at the last follow-up to evaluate the clinical therapeutic effects. RESULTS: A total of 46 patients were followed-up for an average of 16 months. No aggravation of the spinal cord, nerve injury, cerebrospinal fluid leakage, or other complications occurred. Six patients had American Spinal Injury Association (ASIA) grade C preoperatively; 4 improved to grade E, and 2 improved to grade D postoperatively. Twelve patients with ASIA grade D preoperatively improved to grade E postoperatively. C0∼2, C2-T, C2∼3 LK, C2∼7 CC, and C2-SVA measurements were significantly improved postoperatively and at the last follow-up, but there was no significant change in T1S between preoperative and postoperative values. CONCLUSIONS: For patients with unstable hangman's fractures, C2∼3 ACDF combined with internal fixation can achieve immediate stability of the upper cervical vertebrae, effectively correct the forward displacement and angulation of C2, and restore the sagittal balance of the cervical spine. The rate of osseous intervertebral fusion is high, and there are few complications. This method can effectively promote the recovery of spinal nerve function and preserve the motor function of the cervical vertebrae.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Adolescente , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
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