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1.
Spine (Phila Pa 1976) ; 46(6): E374-E383, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33620182

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to make a thorough comparison of clinical and radiographic outcomes between ankylosing spondylitis (AS) patients with severe kyphosis who underwent one- or two-level pedicle subtraction osteotomy (PSO) and to determine the indications of one-level PSO. SUMMARY OF BACKGROUND DATA: Traditionally, one-level PSO was considered being able to obtain 35° to 40° correction. However, in our practice, one-level PSO might achieve satisfied clinical and radiographic outcomes in AS patients with severe thoracolumbar kyphosis defined as global kyphosis (GK) ≥80°. METHODS: Fifty-five AS-related severe thoracolumbar kyphosis patients undergoing one- or two-level PSO from January 2007 to November 2016 were reviewed. The radiographic parameters included thoracic kyphosis (TK), lumbar lordosis (LL), GK, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), sagittal vertical axis (SVA), and femoral obliquity angle (FOA). Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). RESULTS: The mean follow-up period was 39.7 ±â€Š20.2 months (range, 24-120 months). Patients who underwent one-level PSO have significantly smaller preoperative GK, SVA, FOA, and larger preoperative LL and SS compared to those who underwent two-level PSO (P < 0.05). The optimal cutoff points of preoperative radiographic parameters for selecting one-level PSO were: GK <94°, SVA <18.0 cm, and LL <18°. No significant difference was observed between the two groups with regard to preoperative ODI and VAS (P > 0.05), and the improvement of ODI and VAS (P > 0.05). Significantly more operative time, blood loss, and fusion levels were found in two-level PSO group (P < 0.05). CONCLUSION: One-level PSO might be appropriate for selected severe AS-related kyphosis patients with GK <94°, SVA <18.0 cm, and LL <18°. This finding might be beneficial for surgical decision-making in performing one-level PSO, a relatively less risky procedure, to reconstruct the ideal sagittal alignment in AS patients with severe thoracolumbar kyphosis.Level of Evidence: 2.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Satisfação do Paciente , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
2.
Neurosurgery ; 88(4): 864-883, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33548924

RESUMO

Adult cervical deformity management is complex and is a growing field with many recent advancements. The cervical spine functions to maintain the position of the head and plays a pivotal role in influencing subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. There are various types of cervical deformity and a variety of surgical options available. The major advancements in the management of cervical deformity have only been around for a few years and continue to evolve. Therefore, the goal of this article is to provide a comprehensive review of cervical alignment parameters, deformity classification, clinical evaluation, and surgical treatment of adult cervical deformity. The information presented here may be used as a guide for proper preoperative evaluation and surgical treatment in the adult cervical deformity patient.


Assuntos
Vértebras Cervicais/cirurgia , Fixação Ocular/fisiologia , Cifose/cirurgia , Lordose/cirurgia , Postura/fisiologia , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Cifose/classificação , Cifose/diagnóstico por imagem , Lordose/classificação , Lordose/diagnóstico por imagem , Masculino , Osteotomia/métodos , Fusão Vertebral/métodos , Resultado do Tratamento
3.
J Pediatr Orthop ; 41(3): 133-137, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33448725

RESUMO

PURPOSE: Congenital kyphosis is a rare condition. In this case series we sought to identify the outcomes and complications of posterior instrumented fusion and the resultant epiphysiodesis effect in uniplanar congenital kyphosis in pediatric patients. METHOD: Pediatric patients were included if treated for a uniplanar congenital kyphotic deformity treated with posterior instrumented spinal fusion between October 2006 and August 2017, with a minimum of 2 years of follow-up. Patients were excluded if a coronal deformity >10 degrees was present. RESULTS: Six patients met the inclusion criteria. Mean age at surgery was 3.6 years. The mean kyphotic deformity before surgery was 49.7 degrees. All patients underwent posterior instrumented fusion with autogenous iliac crest graft and a cast or brace postoperatively. One patient showed a loss of motor evoked potential on prone positioning which returned to normal on supine positioning. No patient showed any postoperative neurological deficits. One patient was diagnosed with a wound infection which was successfully treated with oral antibiotics.By a follow-up of 5.4 years (range, 2.2 to 10.9 y) there was no failure of instrumentation. An epiphysiodesis effect (a difference of ≥5 degrees in the kyphotic deformity measured between the immediate postoperative and final follow-up lateral whole spine XR) of 16.2 degrees (range, 7.2 to 30.9 degrees) was seen in 5 patients. The mean annual epiphysiodesis effect was 2.7 degrees (95% confidence interval, 1.4-4.1 degrees). No kyphosis proximal to the instrumentation was observed for the duration of follow-up. CONCLUSION: Posterior instrumented fusion and epiphysiodesis is safe and effective. The epiphysiodesis effect occurs in 5/6 of cases, and our data suggests that the procedure is associated with an acceptable blood loss and a low incidence of neurological complications.


Assuntos
Cifose/cirurgia , Fusão Vertebral/métodos , Pré-Escolar , Humanos , Cifose/congênito , Anormalidades Musculoesqueléticas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Inquéritos e Questionários , Resultado do Tratamento
4.
Medicina (Kaunas) ; 57(2)2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33494142

RESUMO

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.


Assuntos
Cifose , Lordose , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cifose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
5.
Spine (Phila Pa 1976) ; 46(4): 232-240, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475278

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types. SUMMARY OF BACKGROUND DATA: Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear. METHODS: Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured. RESULTS: In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P < 0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24-3.56), smaller quantity (OR: 1.03, 95% CI: 1.00-1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92-2.31) were independent predictors of postoperative PJK. CONCLUSION: Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.Level of Evidence: 3.


Assuntos
Cifose/classificação , Cifose/cirurgia , Vértebras Lombares/cirurgia , Músculos Paraespinais/patologia , Adulto , Idoso , Feminino , Humanos , Cifose/epidemiologia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prevalência , Radiografia , Estudos Retrospectivos , Fatores de Risco
6.
Spine (Phila Pa 1976) ; 46(4): 241-248, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475279

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to compare the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and clinical outcomes of patients who did and did not receive posterior ligament complex (PLC) augmentation using a semitendinosus allograft when undergoing long-segment posterior spinal fusion for adult spinal deformity. SUMMARY OF BACKGROUND DATA: Clinical research on the augmentation of the PLC to prevent PJK and PJF has been limited to small case series without a comparable control group. METHODS: From 2014 to 2019, a consecutive series of patients with adult spinal deformity who underwent posterior long-segment spinal fusion with semitendinosus allograft to augment the PLC (allograft) or without PLC augmentation (control) were identified. Preoperative and postoperative spinopelvic parameters were measured. PJK, PJF, and Oswestry Disability Index (ODI) scores were recorded and compared between the two groups. Univariate and multivariate analysis was performed. P ≤ 0.05 was considered significant. RESULTS: Forty-nine patients in the allograft group and 34 patients in the control group were identified. There were no significant differences in demographic variables or operative characteristics between the allograft and control group. Preoperative and postoperative spinopelvic parameters were also similar between the two groups. PJK was present in 33% of patients in the allograft group and 32% of patients in the control group (P = 0.31). PJF did not occur in the allograft group, whereas six patients (18%) in the control group developed PJF (P = 0.01). Postoperative absolute ODI was significantly better in the allograft group (P = 0.007). CONCLUSION: The utilization of semitendinosus allograft tendon to augment the PLC at the upper instrumented vertebrae in patients undergoing long-segment posterior spinal fusion for adult deformity resulted in a significant decrease in PJF incidence and improved functional outcomes when compared to a cohort with similar risk of developing PJK and PJFLevel of Evidence: 3.


Assuntos
Tendões dos Músculos Isquiotibiais/cirurgia , Cifose/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Tendões dos Músculos Isquiotibiais/patologia , Humanos , Incidência , Cifose/epidemiologia , Cifose/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coluna Vertebral/cirurgia
7.
Spine (Phila Pa 1976) ; 46(3): E174-E180, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399437

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To investigate the association between Hounsfield units (HU) measured at the planned upper instrumented vertebra (UIV) and UIV+1 and proximal junctional kyphosis (PJK) in patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: PJK is a common complication following surgery for ASD and poor bone quality is noted to be one of the risk factors. HUs from standard computed tomography (CT) scans can be used for evaluating regional bone quality. METHODS: Sixty-three patients were included from a single institution. The demographic characteristics and radiographic parameters were recorded. Local vertebral HUs at the planned UIV and UIV+ 1 were measured using preoperative CT scans. The patients were divided into three groups: no PJK, non-bony PJK, and bony PJK. The risk factors between the three groups and the correlation between the mean HU and increase in the PJK angle were analyzed. RESULTS: The incidence of PJK was 36.5%. The mean HU was significantly lower in the bony PJK group (HU: 109.0) than in the no PJK group (HU: 168.7, P = 0.038), and the mean HU in the non-bony PJK group (HU: 141.7) was not different compared to the other two groups. There was a significant negative correlation between the mean HU values and the increase in the PJK angles (r = -0.475, P < 0.01). The cutoff value for the mean HU used to predict bony PJK was 120 and a HU value less than 120 was a significant risk factor for bony PJK (OR: 5.74, 95% CI [1.01-32.54], P = 0.04). CONCLUSIONS: We noted a significant inverse relationship between the mean HUs at the UIV and UIV+ 1 and increase in the PJK angles postoperatively. In ASD patients, the HUs may be used preoperatively to identify patients with a higher risk of bony PJK.Level of Evidence: 3.


Assuntos
Cifose/diagnóstico por imagem , Cifose/cirurgia , Cuidados Pré-Operatórios/métodos , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adulto , Idoso , Densidade Óssea/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
8.
Neurosurgery ; 88(3): 603-611, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33372223

RESUMO

BACKGROUND: Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE: To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS: The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS: The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION: SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Ossos Pélvicos/cirurgia , Sacro/cirurgia , Fusão Vertebral/tendências , Falha de Tratamento , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X
9.
J Pediatr Orthop ; 41(3): e204-e210, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370003

RESUMO

BACKGROUND: There are few reports on the surgical management of early-onset scoliosis (EOS) associated with Marfan syndrome (MFS). Affected patients tend to have more rapid curve progression than those with idiopathic EOS, and their course is further complicated by medical comorbidities. As surgical techniques and implants for growing spines become more widely applied, this study seeks to better delineate the safety and efficacy of growth-friendly spinal instrumentation in treating this population. METHODS: A prospective registry of children treated for EOS was queried for MFS patients treated between 1996 and 2016. Forty-two patients underwent rib-based or spine-based growing instrumentation and were assessed on preoperative, surgical, and postoperative clinical and radiographic parameters including complications and reoperations. Subgroup analysis was performed based on spine-based versus rib-based fixation. RESULTS: Patients underwent their index surgery at a mean age of 5.5 years, when the major coronal curve and kyphosis measured 77 and 50 degrees, respectively. Over half were treated with traditional growing rods. Patients underwent 7.2 total surgical procedures-4.7 lengthening and 1.9 revision surgeries not including conversion to fusion-over a follow-up of 6.5 (±4.1) years. Radiographic correction was greatest at index surgery but maintained over time, with a final thoracic height measuring 23.8 cm. Patients experienced a mean of 2.6 complications over the course of the study period; however, a small group of 6 patients experienced ≥6 complications while over half of patients experienced 0 or 1. Implant failures represented 42% of all complications with infection and pulmonary complications following. CONCLUSIONS: This is the largest report on patients with EOS and MFS. All subtypes of growth-friendly constructs reduced curve progression in this cohort, but complications and reoperations were nearly universal; patients were particularly plagued by implant failure and migration. Further collaborations are needed to enhance understanding of optimal timing and fixation constructs for those with MFS and other connective tissue diseases.


Assuntos
Síndrome de Marfan/cirurgia , Procedimentos Ortopédicos/instrumentação , Próteses e Implantes/estatística & dados numéricos , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Cifose/etiologia , Cifose/cirurgia , Masculino , Síndrome de Marfan/complicações , Procedimentos Ortopédicos/estatística & dados numéricos , Próteses e Implantes/efeitos adversos , Reoperação , Estudos Retrospectivos , Escoliose/etiologia , Fusão Vertebral , Resultado do Tratamento
10.
Spine (Phila Pa 1976) ; 46(1): E56-E64, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315363

RESUMO

STUDY DESIGN: Prospective observational study. OBJECTIVE: The aim of this study was to investigate the improvement in gait parameters after surgery and whether corrective surgery for sagittal imbalance would be influenced by preoperative pelvic compensation. SUMMARY OF BACKGROUND DATA: There have been no other studies investigating the influence of preoperative pelvic compensation on surgical outcomes. METHODS: A total of 32 patients who were scheduled to undergo corrective surgery for sagittal plane deformity were included and were followed-up for 1 year after surgery. Radiological parameters were measured on biplanar full-body imaging. Before surgery and 6 months after surgery, three-dimensional motion analyses were performed to estimate center of gravity (CoG) deviation from the center of mass (CoM), mean trunk kyphosis (TK) angle, gait deviation index (GDI), and kinematic parameters. Before surgery, the patients were classified into CoG+ and CoG- groups. "+" and "-" representing increases and decreases in the distance of CoG from CoM of the pelvic segment from first to third trials, respectively. Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) were measured for 1 year after surgery. RESULTS: All radiological parameters improved significantly after surgery. For gait parameters, CoG from CoM, mean TK angle, and minimum angle of the hip and knee joints in the stance phase during walking were significantly decreased after surgery and GDI scores significantly improved after surgery. The mean changes of the CoG distance from the CoG and the mean TK from first to third trials of gait analysis significantly decreased postoperatively. There were no significant differences in ODI and EQ-5D scores over 1-year follow-up assessment between CoG+ and CoG- groups. CONCLUSION: Preoperative abnormal stooping gait, and progressive worsening of sagittal imbalance in patients with sagittal plane deformity improved after corrective surgery. Patients with preoperative dynamic sagittal imbalance could have similar surgical results to those without it after corrective surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Marcha , Cifose/cirurgia , Pelve , Adulto , Idoso , Feminino , Análise da Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Caminhada
11.
Sci Rep ; 10(1): 22420, 2020 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-33380733

RESUMO

Magnetically controlled growing rods (MCGR) are commonly implanted for the treatment of early-onset scoliosis. While most authors report favorable short-term results, little is known about long-term deformity correction. This prospective cohort study assesses spinal deformity control in a homogeneous spinal muscular atrophy (SMA) patient group treated with MCGR implants, a standardized lengthening protocol and a minimum follow-up of four years. 17 SMA patients with progressive scoliosis were treated with MCGR implanted parallel to the spine with rib-to-pelvis fixation. Radiologic measurements were performed before and after MCGR implantation and during external lengthening procedures. These included measurements of the scoliotic curve, kyphosis, lordosis, pelvic obliquity and the spinal length. Additional clinical data of the complications were also analyzed. 17 children (mean age 7.4 years) were surgically treated and underwent a total of 376 lengthenings. Complication rates were 3.5% in respect to all interventions or 41% of the patients had complications during 3.5% of the lengthening sessions. The initial implantation significantly reduced the main scoliotic curve by 59%, with the correction remaining constant throughout the follow-up. Pelvic obliquity was also significantly and permanently corrected by 72%, whereas kyphosis and lordosis were not influenced. The spinal length could be significantly increased mostly during the first year of treatment. Bilateral implantation of MCGRs for correction of spinal deformity in children with SMA showed no decrease of the lengthening potential during a four-year follow-up. Therefore, the previously described 'law of diminishing returns' could not be applied to this patient population.Level of Evidence/Clinical relevance: Therapeutic Level IV.


Assuntos
Alongamento Ósseo/instrumentação , Atrofia Muscular Espinal/cirurgia , Curvaturas da Coluna Vertebral/cirurgia , Alongamento Ósseo/métodos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Fixadores Internos , Cifose/etiologia , Cifose/patologia , Cifose/cirurgia , Lordose/etiologia , Lordose/patologia , Lordose/cirurgia , Magnetismo , Masculino , Atrofia Muscular Espinal/complicações , Atrofia Muscular Espinal/patologia , Pelve/cirurgia , Estudos Prospectivos , Próteses e Implantes , Costelas/cirurgia , Escoliose/etiologia , Escoliose/patologia , Escoliose/cirurgia , Curvaturas da Coluna Vertebral/etiologia , Curvaturas da Coluna Vertebral/patologia , Resultado do Tratamento
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1269-1274, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063492

RESUMO

Objective: To introduce a self-designed adjustable operation frame and explore the feasibility and safety in the treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy. Methods: Between March 2016 and May 2018, 7 cases of severe kyphosis secondary to ankylosing spondylitis were treated with posterior osteotomy using self-designed adjustable operation frame with prone position. There were 5 males and 2 females with an average age of 49.4 years (range, 40-55 years). The disease duration was 10-21 years (mean, 16.7 years). The apical vertebrae of kyphosis were located at T 11 in 2 cases, T 12 in 1 case, L 1 in 1 case, and L 2 in 3 cases. Among the 7 cases, 2 were classified as typeⅠ, 4 as type ⅡB, and 1 as type ⅢA according to 301 classification system. There was no neurological deficit of all cases; but 1 case suffered bilateral hip joints ankylosed in non-functional position. The parameters of chin-brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA) were measured; and the operation time, the intraoperative blood loss, and the complications were also collected and analyzed. Results: All operations completed successfully. The operation time was 310-545 minutes (mean, 409.7 minutes) and the intraoperative blood loss was 1 500-2 500 mL (mean, 1 642.9 mL). There were 2 cases treated with one-level osteotomy of sagittal translation, 1 case of radiculopathy symptom of L 3, and 3 cases of tension of abdominal skin. All patients were followed up 20-35 months (mean, 27.9 months). There were significant differences in CBVA, GK, TLK, LL, and SVA between pre- and post-operation ( P<0.05); but no significant difference between 1 week after operation and last follow-up ( P>0.05). All the osteotomies and bone grafts fused well and no complications of loosening and breakage of internal fixator occurred during the follow-up. Conclusion: In the posterior osteotomy for correction of severe kyphosis secondary to ankylosing spondylitis, the self-designed adjustable operation frame is convenient for the patient to be placed in prone position. It is safe, feasible, and effective to perform osteotomy correction with the aid of the self-designed adjustable operation frame.


Assuntos
Cifose , Espondilite Anquilosante , Adulto , Feminino , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia , Resultado do Tratamento
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 875-880, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047722

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. METHODS: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12-48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. RESULTS: The average traction time of 24 cases was (2.5±1.1) weeks (1-5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136-176 cm) respectively, showing significant difference (P < 0.05), and the increased height was (12.4±4.6) cm (4-20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°ï¼158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°ï¼92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P < 0.05). The traction's coronal correction rate was 37.2%±10.9% (11.9%-51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°ï¼163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°ï¼92°)] and post-surgery [39.0°±16.8°(10°ï¼68°)](P < 0.05). The traction's sagittal correction rate was 40.0%±10.7%(16.7%-55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%-87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P < 0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P < 0.05). CONCLUSION: The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.


Assuntos
Cifose , Escoliose , Adolescente , Adulto , Feminino , Humanos , Cifose/cirurgia , Masculino , Estudos Retrospectivos , Escoliose/cirurgia , Tração , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 99(37): e22204, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925797

RESUMO

Many surgical procedures have been developed for the treatment of post-traumatic thoracolumbar kyphosis. But there is a significant controversy over the ideal management. The aim of this study was to illustrate the technique of modified grade 4 osteotomy for the treatment of post-traumatic thoracolumbar kyphosis and to evaluate clinical and radiographic results of patients treated with this technique.From May 2013 to May 2018, 42 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of modified grade 4 osteotomy, and their medical records were retrospectively collected. Preoperative and postoperative sagittal Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) were recorded. The average follow-up period was 29.7 ±â€Š14.2 months.The operation time was 185.5 ±â€Š26.8 minutes, the intraoperative blood loss was 545.2 ±â€Š150.1 mL. The Cobb angles decreased from 38.5 ±â€Š3.8 degree preoperatively to 4.2 ±â€Š2.6 degree 2 weeks after surgery (P < .001). The VAS reduced from 6.5 ±â€Š1.1 preoperatively to 1.5 ±â€Š0.9 at final follow-up (P < .001), and the ODI reduced from 59.5 ±â€Š15.7 preoperatively to 15.9 ±â€Š5.8 at final follow-up (P < .001). Kyphotic deformity was successfully corrected and bony fusion was achieved in all patients. Neurologic function of 7 cases was improved to various degrees.Modified grade 4 osteotomy, upper disc, and upper one-third to half of pedicle are resected, is an effective treatment option for post-traumatic thoracolumbar kyphosis. However, the long-term clinical effect still needs further studies.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Escala Visual Analógica
15.
Medicine (Baltimore) ; 99(32): e21579, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769906

RESUMO

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ±â€Š86 perfusion unite (PU), and the SCBF decreased to 228 ±â€Š68 PU after VCR (P = .008). The SCBF increased to 296 ±â€Š102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ±â€Š65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.


Assuntos
Cifose/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Escoliose/cirurgia , Medula Espinal/irrigação sanguínea , Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Cifose/complicações , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Escoliose/complicações , Medula Espinal/cirurgia , Coluna Vertebral/fisiopatologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(29): e20982, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702838

RESUMO

To explore the effectiveness of posterior vertebral column resection for failed thoracolumbar anterior instrumented fusion.Ten patients with anterior fusion with refractory pain, progressive neurological deficits, and kyphosis were recruited. Anterior removal of the implant and posterior vertebral column resection were performed. The mean operating time, intraoperative blood loss, kyphosis angle, visual analog scale pain score, Oswestry disability index, bone fusion time, and complications were assessed in a minimum 18-month follow-up.The mean operating time was 323.5 ±â€Š63.6 minutes, with a mean blood loss of 1189 ±â€Š253.4 mL. The mean preoperative kyphosis angle of 54.6°â€Š±â€Š8.0° immediately decreased to 4.8°â€Š±â€Š1.5° after revision surgery and eventually to 6.8°â€Š±â€Š1.3° at the final follow-up. The mean bone fusion time was 6.8 ±â€Š1.2 months. All patients had satisfactory sagittal and coronal balance with no implant failure at the last follow-up. The average visual analog scale score was 6.2 ±â€Š1.0 preoperatively, and it decreased to 2.6 ±â€Š0.5 at the last follow-up. No patient suffered from neurological deterioration. The Oswestry disability index decreased from 39.8% ±â€Š4.6% preoperatively to 24.5% ±â€Š4.7% at the final follow-up. Complications occurred in 4 patients: 3 experienced tearing of the lung, and 1 had a superficial wound infection.Anterior removal of the implant and posterior vertebral column resection constituted a safe and effective revision surgery for patients with prior anterior fusion with rigid postsurgical deformities.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Feminino , Humanos , Cifose/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Falha de Tratamento , Escala Visual Analógica , Adulto Jovem
17.
Spine (Phila Pa 1976) ; 45(15): E943-E949, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675609

RESUMO

STUDY DESIGN: Retrospective observational study. OBJECTIVE: The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD. SUMMARY OF BACKGROUND DATA: Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown. METHODS: Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained. RESULTS: Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD- group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery. CONCLUSION: GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time. LEVEL OF EVIDENCE: 3.


Assuntos
Refluxo Gastroesofágico/diagnóstico por imagem , Cifose/diagnóstico por imagem , Cifose/cirurgia , Cuidados Pós-Operatórios/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Inquéritos e Questionários , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Fatores de Tempo
18.
Spine (Phila Pa 1976) ; 45(15): E950-E958, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675610

RESUMO

STUDY DESIGN: Case-control study from a continuous series. OBJECTIVES: To study the impact of perioperative sitting radiographs in adult spinal deformity (ASD) patients and determine whether proximal junctional kyphosis (PJK) can be prevented using preoperative sitting radiograph. SUMMARY OF BACKGROUND DATA: Radiographic analysis of ASD comprises standing whole-spine radiography which cannot evaluate the relaxed posture without head-to-foot compensation. METHODS: Preoperative and postoperative whole-spine standing and sitting radiographs and proximal mechanical complications in surgically treated spinal disorders with a minimum of 1-year follow-up were studied. Whole-spinal alignment was defined by cervical lordosis (CL), sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and level of kyphotic apex (KA). Proximal mechanical complication was described as a PJK (proximal junctional angle >20°) or reoperation due to proximal junctional failure. RESULTS: Surgically treated 113 patients were prospectively investigated. Patients were divided into either the ASD (thoracic to ilium posterior corrective fusion), or non-ASD groups. In the ASD group, 10 patients had postoperative PJK, and three revision surgeries were carried out due to PJF with neurological deficit. Comparing standing with sitting positions, CL, TK, and PT became larger, SVA became frontal, LL and SS became smaller, and KA became caudal particularly in the ASD group. Logistic regression analysis demonstrated that the most influenced plumb line for PJK was the upper instrumented vertebra (UIV) to C2 plumb line distance, with a cutoff value of 115 mm for predicting PJK. CONCLUSION: Our findings highlight the usefulness of sitting spinal alignment evaluation, particularly in ASD patients, with maximum effort of thoracic spine and lower extremity compensation at standing. Mechanical complications such as PJK could be predicted using the distance from the planned UIV to the C2 plumb line in preoperative sitting radiographs. LEVEL OF EVIDENCE: 3.


Assuntos
Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Postura Sentada , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Cifose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Radiografia/métodos , Radiografia/tendências , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Vértebras Torácicas/cirurgia , Adulto Jovem
19.
BMC Surg ; 20(1): 133, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532269

RESUMO

BACKGROUND: The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis. METHODS: We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded. RESULTS: All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6 ± 9.3°. The Cobb angle was reduced to 10.6 ± 2.6° postoperatively and was found to be 11.4 ± 3.1° at the final follow-up. The mean angle correction was 23.0 ± 8.9°, and the correction rate was 66.2 ± 12.2%. The mean angle lost was 0.8 ± 0.9°, and the lost rate was 5.8 ± 5.4% at the final follow-up. CONCLUSIONS: Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.


Assuntos
Transplante Ósseo/métodos , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Desbridamento/métodos , Feminino , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
J Pediatr Orthop ; 40(6): 261-266, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501899

RESUMO

BACKGROUND: Proximal junctional kyphosis (PJK) is a major complication after posterior spinal surgery. It is diagnosed radiographically based on a proximal junctional angle (PJA) and clinically when proximal extension is required. We hypothesized that abnormal spinopelvic alignment will increase the risk of PJK in children with early-onset scoliosis (EOS). METHODS: A retrospective study of 135 children with EOS from 2 registries, who were treated with distraction-based implants. Etiologies included 54 congenital, 10 neuromuscular, 37 syndromic, 32 idiopathic, and 2 unknown. A total of 89 rib-based and 46 spine-based surgeries were performed at a mean age of 5.3±2.83 years. On sagittal radiographs, spinopelvic parameters were measured preoperatively and at last follow-up: scoliosis angle (Cobb method, CA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope and PJA. Radiographic PJK was defined as PJA≥10 degrees and PJA≥10 degrees greater than preoperative measurement. The requirement for the proximal extension of the upper instrumented vertebrae was considered a proximal junctional failure (PJF). Analysis of risk factors for the development of PJK and PJF was performed. RESULTS: At final follow-up (mean: 4.5±2.6 y), CA decreased (P<0.005), LL (P=0.029), and PI (P<0.005) increased, whereas PI-LL (pelvic incidence minus lumbar lordosis) did not change (P=0.706). Overall, 38% of children developed radiographic PJK and 18% developed PJF. Preoperative TK>50 degrees was a risk factor for the development of radiographic PJK (relative risk: 1.67, P=0.04). Children with high postoperative CA [hazard ratio (HR): 1.03, P=0.015], postoperative PT≥30 degrees (HR: 2.77, P=0.043), PI-LL>20 degrees (HR: 2.92, P=0.034), as well as greater preoperative to postoperative changes in PT (HR: 1.05, P=0.004), PI (HR: 1.06, P=0.0004) and PI-LL (HR: 1.03, P=0.013) were more likely to develop PJF. Children with rib-based constructs were less likely to develop radiographic PJK compared with children with spine-based distraction constructs (31% vs. 54%, respectively, P=0.038). CONCLUSIONS: In EOS patients undergoing growth-friendly surgery for EOS, preoperative TK>50 degrees was associated with increased risk for radiographic PJK. Postoperative PI-LL>20 degrees, PT≥30 degrees, and overcorrection of PT and PI-LL increased risk for PJF. Rib-based distraction construct decreased the risk for radiographic PJK in contrast with the spine-based constructs. LEVEL OF EVIDENCE: Level III.


Assuntos
Cifose , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Escoliose , Coluna Vertebral/cirurgia , Idade de Início , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Cifose/etiologia , Cifose/cirurgia , Masculino , Período Pós-Operatório , Radiografia/métodos , Risco Ajustado/métodos , Fatores de Risco , Escoliose/diagnóstico , Escoliose/epidemiologia , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia
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