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1.
Unfallchirurg ; 123(2): 143-154, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32016493

RESUMO

Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.


Assuntos
Cifose , Fusão Vertebral , Traumatismos da Coluna Vertebral , Tratamento Conservador , Humanos , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares , Osteotomia , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento
2.
World Neurosurg ; 133: e233-e240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518735

RESUMO

BACKGROUND: Compensatory mechanisms for cervical kyphosis are unclear. Few alignment analyses have targeted ongoing cervical kyphosis and detailed the effects of compensatory alignment changes. METHODS: We analyzed the radiographic alignment parameters of 31 patients (21 men and 10 women) with postoperative kyphotic changes after anterior cervical corpectomy and fusion (ACCF) between 2006 and 2015. This analysis included lordotic angle of the fusion area, fusion area length, cervical lordosis angle (CL), O-C7 angle (O-C7a), and cervical sagittal vertical axis (cSVA) as basic parameters and occipito-C2 angle (O-C2a), adjacent cranial angle, adjacent caudal angle, and T1 slope as compensatory parameters at 2 time points after surgery. RESULTS: Alignment analysis revealed that CL was significantly decreased by 5.0 ± 7.7° (P < 0.01) and O-C7a was changed by only -0.2 ± 6.8° (P = 0.75). An inverse correlation was found between ΔCL and ΔO-C2a (ρ = -0.40), with a nearly 1:1 relationship in the scatter diagram. ΔT1 slope had no direct compensatory correlation with ΔCL (P = 0.28) but was strongly correlated with ΔcSVA (ρ = 0.78). The scatter diagram of ΔcSVA and ΔT1 slope showed compensatory relevance and a shifted point to its collapse as the T1 slope lost control of cSVA; thereafter, both parameters incessantly increased, and ΔT1 and ΔcSVA became positive. CONCLUSIONS: When CL decreased after ACCF, ΔO-C2 immediately compensated for the CL loss that could lead to failure to obtain horizontal gaze. If cSVA increased, Δcaudal adjacent angle and ΔT1 slope (extension below the kyphosis) compensated for the horizontal offset translation. The noncompensatory status (ΔcSVA and ΔT1 positive) may necessitate further correction surgery in which the caudal fused level is beyond T1.


Assuntos
Adaptação Fisiológica/fisiologia , Vértebras Cervicais/cirurgia , Cifose/etiologia , Complicações Pós-Operatórias/etiologia , Postura/fisiologia , Fusão Vertebral , Idoso , Antropometria , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem
3.
World Neurosurg ; 133: e342-e347, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562968

RESUMO

OBJECTIVE: This study was carried out to analyze the surgical effect of cervical spine sagittal alignment for patients with Hirayama disease (HD). METHODS: Forty-four subjects were retrospectively analyzed for the parameters of cervical spine sagittal alignment. The case group consisted of 23 patients with HD, whereas the control group consisted of 21 healthy adolescent subjects. Pre- and postoperative cervical spine sagittal parameters of the patients with HD were collected; the cervical sagittal parameters of the healthy adolescent subjects were also collected. Sagittal alignment parameters were compared between the patients with HD and the healthy adolescent subjects, and between the pre- and postoperative parameters for the patients with HD. RESULTS: Forty-four subjects completed the follow-up, with the average follow-up period being 18.0 months. No significant differences were detected between the HD and control groups for clinical parameters (P > 0.05). The preoperative HD group had smaller values compared with the control group in the sagittal parameters of C2-7 cervical lordosis (CL) angle, T1 slope, thoracic inlet angle (TIA), and cervical tilt angle (P < 0.05). For the patients with HD, the preoperative values were smaller compared with the postoperative HD values for the parameters of C2-7 CL angle, T1 slope, and cervical tilt angle (P < 0.05). We found no significant differences between the postoperative patients with HD and the healthy subjects, including C2-7 CL angle, C2-7 sagittal vertical axis, T1 slope, TIA, neck tilt angle, cervical tilt angle, and cranial tilt angle (P > 0.05). CONCLUSIONS: Patients with HD have sagittal imbalance of the cervical spine compared with age-matched healthy adolescent subjects, and surgical treatment could correct the sagittal imbalance.


Assuntos
Vértebras Cervicais/patologia , Discotomia , Fusão Vertebral , Atrofias Musculares Espinais da Infância/cirurgia , Adolescente , Adulto , Antropometria , Placas Ósseas , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/patologia , Lordose/diagnóstico por imagem , Lordose/etiologia , Lordose/patologia , Masculino , Aparelhos Ortopédicos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Atrofias Musculares Espinais da Infância/complicações , Adulto Jovem
4.
Bone Joint J ; 101-B(11): 1370-1378, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674249

RESUMO

AIMS: The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. PATIENTS AND METHODS: This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. RESULTS: Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. CONCLUSION: Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370-1378.


Assuntos
Braquetes/efeitos adversos , Cifose/etiologia , Lordose/etiologia , Escoliose/terapia , Adolescente , Criança , Feminino , Humanos , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares , Masculino , Estudos Retrospectivos , Vértebras Torácicas
5.
J Pediatr Orthop ; 39(8): e597-e601, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393296

RESUMO

BACKGROUND: Prader-Willi syndrome (PWS) patients can present with scoliosis which can be treated with serial cast correction (SCC) or with growth friendly surgery (GFS). This study's purpose was to describe the results of SCC as well as GFS for PWS patients with early-onset scoliosis (EOS). METHODS: PWS patients were identified from 2 international multicenter EOS databases. Scoliosis, kyphosis, spine height (T1-S1), right/left hemithoracic heights/widths (RHTH, LHTH, RHTW, LHTW) were measured pretreatment, postoperation, and at 2-year follow-up. Complications were recorded. RESULTS: Overall, 23 patients with 2-year follow-up were identified. Pretreatment; patients treated with SCC (n=10) had mean age of 1.8±0.6 years; body mass index (BMI), 16±1.5 kg/m; scoliosis, 45±18 degrees; kyphosis, 56±9 degrees; T1-S1, 22.4±2.4 cm; RHTH, 8.0±2.0 cm; LHTH, 8.5±1.7 cm; RHTW, 6.6±1.3 cm; and LHTW, 8.0±1.0 cm. Patients treated with GFS (n=13) had mean age of 5.8±2.6 years; BMI, 21±5.4 kg/m; scoliosis, 76±14 degrees; kyphosis, 59±25 degrees; T1-S1, 24.1±3.6 cm; RHTH, 10.0±1.6 cm; LHTH, 10.6±1.6 cm; RHTW, 9.4±2.5 cm; and LHTW, 8.1±2.8 cm. At 2-year follow-up, patients treated with SCC had mean scoliosis 37±11 degrees (18% correction, P=0.06); kyphosis, 42±6 degrees (NS); T1-S1, 26.4±2.1 cm (P<0.01); RHTH, 9.0±1.1 cm (13%; P=0.30); LHTH, 10.0±1.5 cm (18%, P<0.01); RHTW, 7.4±1.1 cm (12%, P<0.01); and LHTW, 8.0±1.0 cm (0%, P=0.34). At 2-year follow-up, patients treated with GFS had mean scoliosis 42±13 degrees (45% correction, P<0.000001); kyphosis, 53±13 degrees (10%, P=0.19); T1-S1, 31.5±5.4 cm (P<0.00001); RHTH, 12.0±2.4 cm (20%; P<0.01); LHTH, 12.0±1.7 cm (13%; P<0.01); RHTW, 9.8±1.3 cm (4%; P=0.27); and LHTW, 7.9±2.3 cm (3%;P=0.11). As an entire group, patients with a BMI>17 kg/m² had more device-related than disease-related complications (P=0.09). Patients treated with SCC had 0.9 complications per patient. Patients treated with GFS had 2.2 complications per patient [≤5 y more often had ≥2 complications (P=0.05)]. CONCLUSIONS: At 2-year follow-up, SCC and GFS were both effective in treating EOS in PWS patients. Patients treated with SCC had significant improvements in spine height and LHTH. Patients treated with GFS had significant improvements in scoliosis magnitude, spine height, RHTH, and LHTH. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Moldes Cirúrgicos , Cifose/terapia , Procedimentos Ortopédicos , Síndrome de Prader-Willi/complicações , Escoliose/terapia , Índice de Massa Corporal , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Lactente , Cifose/diagnóstico por imagem , Cifose/etiologia , Masculino , Procedimentos Ortopédicos/efeitos adversos , Período Pós-Operatório , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Índice de Gravidade de Doença
6.
World Neurosurg ; 131: 154-158, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398526

RESUMO

BACKGROUND: Proximal junctional failure (PJF) is a major and sometimes devastating problem following adult spinal deformity (ASD) correction surgery. Common consensus still lags on guidelines for preventing and managing these complications. Surgical treatment of scoliosis in the presence of osteogenesis imperfecta (OI) in the pediatric population is well described. The complication rates are unusually higher in this special subset of patients owing to poor quality of bone. There is a paucity of literature focusing on surgical techniques, strategies, and problems involved in the management of ASD associated with OI. CASE DESCRIPTION: We report a 59-year-old female with type 1 OI and adult scoliosis who underwent T10-to-pelvis fusion for ASD according to the principles of adult deformity correction. At a 1-year follow-up, she presented with asymptomatic proximal junctional kyphosis of 45° and 2 weeks later had PJF along with spinal cord injury after a fall. On computed tomography scan, kyphosis was increased to 60° at T9-T10. She underwent decompression and revision deformity correction using quadruple rods, with extension of instrumentation to T2 with soft landing using rib bands. At a 4-year follow-up, she had a good functional outcome after revision surgery. CONCLUSIONS: This is the first report of successful management of PJF following ASD correction in the presence of OI using this technique. Suboptimal hold of implants due to poor bone quality must be at the focus of any surgical planning for these patients. All possible strategies to prevent PJF must be considered when planning the deformity correction in adults with OI.


Assuntos
Cifose/cirurgia , Osteogênese Imperfeita/complicações , Complicações Pós-Operatórias/cirurgia , Escoliose/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/etiologia , Pessoa de Meia-Idade , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação , Escoliose/complicações , Escoliose/diagnóstico por imagem , Fusão Vertebral
7.
Iowa Orthop J ; 39(1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413678

RESUMO

Background: Vertebral fracture after posterior arthrodesis and instrumentation for idiopathic scoliosis is a rare occurrence with limited reported cases in the literature. Case Presentation: A 16-year-old female patient surgically treated for adolescent idiopathic scoliosis with T2-L1 posterior spinal fusion was in a low-energy fall resulting in fracture of L1 and new kyphosis and scoliosis of the thoracolumbar spine at the distal aspect of the fusion. The fracture was initially managed conservatively, however pain persisted and thus she was indicated for extension of the fusion and correction of the post-traumatic kyphosis. Conclusions: Fractures after posterior spinal fusion for idiopathic scoliosis are rare and evidence for the appropriate management remains limited in the literature.Level of Evidence: V.


Assuntos
Acidentes por Quedas , Cifose/cirurgia , Escoliose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Radiografia Torácica/métodos , Reoperação/métodos , Medição de Risco , Escoliose/diagnóstico , Escoliose/etiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
8.
Spine (Phila Pa 1976) ; 44(14): 996-1002, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31260422

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the psychological changes and employment outcomes following corrective osteotomy in patients with ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: To date, no study has investigated the changes in psychological status and subsequent improvement in employment outcome after correction of kyphotic deformities in patients with AS. METHODS: This study included 48 patients with AS who underwent corrective osteotomy for severe kyphotic deformity. Sagittal alignment was assessed radiographically. Clinical status was evaluated using the Short Form-36 Health Survey, psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS), and employment outcomes were assessed using the Lam Employment Absence and Productivity Scale (LEAPS). The degree of postoperative sagittal alignment correction was measured, and changes in clinical and employment outcomes and psychological status were evaluated. The relationship between the degree of sagittal alignment correction and each evaluation item was analyzed. RESULTS: Following postoperative sagittal alignment correction, all patients could stand erect and look straight. Significant improvements were observed in the clinical and employment outcomes, as well as in patients' psychological status. The degree of sagittal vertical axis correction was significantly correlated with the HADS depression and the LEAPS total scores. The degree of correction of the chin-brow vertical angle was significantly correlated with the Short Form-36 mental health score, the HADS depression and anxiety scores, and the LEAPS total and productivity subscores. Notably, the improvement in the HADS depression score was significantly correlated with the LEAPS total score. CONCLUSION: This study demonstrated the psychological changes and subsequent improvement in employment outcomes after corrective osteotomy in patients with AS. The degree of sagittal alignment correction was correlated with improvements in psychological status and employment outcomes. LEVEL OF EVIDENCE: 4.


Assuntos
Emprego , Cifose/psicologia , Cifose/cirurgia , Espondilite Anquilosante/psicologia , Espondilite Anquilosante/cirurgia , Adulto , Emprego/psicologia , Feminino , Humanos , Cifose/etiologia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Osteotomia/psicologia , Estudos Retrospectivos
9.
Spine (Phila Pa 1976) ; 44(18): E1075-E1082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261269

RESUMO

STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVE: We aimed to investigate the long-term impacts of brace treatment for adolescent idiopathic scoliosis (AIS) on the musculoskeletal system. SUMMARY OF BACKGROUND DATA: Although full-time brace treatment is the mainstay of conservative treatment for AIS, the restrictive nature of brace treatment for lumbosacral motion might negatively affect the musculoskeletal system. METHODS: Of 319 patients treated nonoperatively for AIS, 80 patients completed clinical and imaging examinations. Body composition, including body fat mass, lean mass, fat percent, and muscle mass, was estimated via bioelectrical impedance analysis. Bone mineral density (BMD) was measured at the lumbar spine and left hip. In 73 patients, the measurement of cross-sectional area and fatty degeneration of paraspinal muscles at the superior endplate of L4 were performed using axial T2-weighted magnetic resonance imaging. Patients were divided into the full-time brace (FB; >13 hours per day) and nonfull-time brace (NFB; observation, part-time bracing, or drop out from FB within a year) groups. RESULTS: There were 44 patients in the FB group and 36 in the NFB group. Patients in the FB group were significantly younger at the initial visit (12.7 ±â€Š1.3 years) and older at the final follow-up (41.5 ±â€Š5.6 years) than those in the NFB group (14.2 ±â€Š3.2 and 37.4 ±â€Š7.1 years, respectively; P < 0.01). The rate of patients engaging in mild or moderate sports activity in adulthood tended to be higher in the FB group (47.7%) than in the NFB group (25%) (P = 0.11). However, there were no significant differences in body composition, paraspinal muscle morphology, and BMD between the two groups both before and after adjusting for age. CONCLUSION: Full-time brace wearing during adolescence did not have any negative impacts on the musculoskeletal system in adulthood. This information will be helpful for improving the compliance of full-time bracing. LEVEL OF EVIDENCE: 4.


Assuntos
Composição Corporal , Densidade Óssea , Braquetes , Músculos Paraespinais/patologia , Escoliose/terapia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares , Masculino , Músculos Paraespinais/diagnóstico por imagem , Estudos Retrospectivos
10.
World Neurosurg ; 130: e961-e970, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302275

RESUMO

OBJECTIVE: To report the outcomes of severe kyphoscoliosis secondary to ankylosing spondylitis (AS) corrected with 3D-printed individualized guiding templates. METHODS: Computed tomography (CT) data of patients with severe kyphoscoliosis secondary to AS were used to reconstruct 3D models of the spine and to develop a surgical plan. An asymmetric wedge pedicle subtraction osteotomy (PSO) was simulated using medical computer design software. Before the actual surgery, continual surgical simulations were performed until the most suitable one was obtained, and personalized guiding templates were manufactured for the anticipated PSO. During operation, the osteotomy plane and trajectories for the pedicle screws were positioned by the designed patient-specific 3D-printed guiding templates. RESULTS: In this study, we reviewed 9 patients who underwent correction of kyphoscoliosis using a 3D-printed individualized guiding template and were followed for a median of 21.4 months (range, 9-36 months). The average correction at the site of osteotomy was 65.9°. No patient experienced severe complications, such as misplaced pedicle screws or neurologic complications. At the last follow-up, no patient exhibited implant dysfunction on radiography. CONCLUSIONS: Preoperative surgical simulation using 3D-printed templates is a viable technique that enables surgery to meet both patient- and surgeon-specific requirements for correction of severe thoracolumbar kyphoscoliosis. These 3D-printed templates can guide the performance of planned PSO to provide functional restoration of severe kyphoscoliosis secondary to AS.


Assuntos
Cifose/cirurgia , Medicina de Precisão/métodos , Impressão Tridimensional , Escoliose/cirurgia , Índice de Gravidade de Doença , Espondilite Anquilosante/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Masculino , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Resultado do Tratamento
11.
Medicine (Baltimore) ; 98(30): e16485, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348255

RESUMO

RATIONALE: Spondylometaphyseal dysplasia (SMD) is an extremely rare disorder of irregular development of spine and metaphyses of long tubular bones. Mutations in the collagen type X alpha 1 gene were found to underlie this condition. Previously reported mutations in the N-terminal non-collagenous NC2 domain and C-terminal non-collagenous NC1 domain failed to be identified in some specific patients. PATIENT CONCERNS: A 23-year-old male was referred to us for fixed, angular thoracolumbar kyphosis with semi-paralysis, numbness, and tremor on his left lower limb. Marked hypoplasia of thoracolumbar vertebra and spinal canal stenosis were observed on radiology. DIAGNOSES: He was diagnosed with spondylometaphyseal dysplasia (Type A4). Gene sequencing was performed using normalized targeted regions sequencing (TRS). A novel heterozygous missense variant p.Gly139Cys in the triple-helical region. Multiple lines of evidence imply this mutation to be pathogenic. INTERVENTIONS: Posterior instrumentation and vertebral column resection were given to correct his fixed, angular thoracolumbar kyphosis. OUTCOMES: The correction was satisfying and the functional outcomes were good. LESSONS SUBSECTIONS AS PER STYLE: The findings corroborated that type X collagen plays a critical role in the formation of the human spine as well as the long bones, and further expanded the range of type X collagenopathy. Surgical procedure could be considered for patients with severe malformation and neurological impairments.


Assuntos
Colágeno Tipo X/genética , Coxa Valga/complicações , Osteocondrodisplasias/complicações , Osteocondrodisplasias/genética , Coxa Valga/cirurgia , Humanos , Cifose/etiologia , Cifose/cirurgia , Masculino , Osteocondrodisplasias/cirurgia , Análise de Sequência de DNA , Adulto Jovem
12.
World Neurosurg ; 129: e522-e529, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31152888

RESUMO

BACKGROUND: This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). METHODS: A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9-L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. RESULTS: A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69-34.093). CONCLUSION: Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.


Assuntos
Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco
13.
J Am Acad Orthop Surg ; 27(12): e555-e567, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31170097

RESUMO

Cervical spinal deformity (CSD) in adult patients is a relatively uncommon yet debilitating condition with diverse etiologies and clinical manifestations. Similar to thoracolumbar deformity, CSD can be broadly divided into scoliosis and kyphosis. Severe forms of CSD can lead to pain; neurologic deterioration, including myelopathy; and cervical spine-specific symptoms such as difficulty with horizontal gaze, dysphagia, and dyspnea. Recently, an increased interest is shown in systematically studying CSD with introduction of classification schemes and treatment algorithms. Both major and minor complications after surgical intervention have been analyzed and juxtaposed to patient-reported outcomes. An ongoing effort exists to better understand the relationship between cervical and thoracolumbar spinal alignment, most importantly in the sagittal plane.


Assuntos
Vértebras Cervicais/cirurgia , Cifose/etiologia , Cifose/cirurgia , Escoliose/etiologia , Escoliose/cirurgia , Artrite Reumatoide/complicações , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Fixação Ocular , Humanos , Doença Iatrogênica , Degeneração do Disco Intervertebral/complicações , Cifose/diagnóstico por imagem , Cervicalgia/etiologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Escoliose/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Espondilose/complicações , Transtornos da Visão/etiologia
14.
BMC Musculoskelet Disord ; 20(1): 305, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31253156

RESUMO

BACKGROUND: Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. METHODS: Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. RESULTS: A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. CONCLUSION: The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.


Assuntos
Dor nas Costas/cirurgia , Cimentos para Ossos/uso terapêutico , Cifose/cirurgia , Osteonecrose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Seguimentos , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem , Medição da Dor , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/instrumentação
15.
World Neurosurg ; 129: 363-366, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247357

RESUMO

BACKGROUND: Severe kyphosis is infrequently seen in neonates with myelomeningoceles. Spinal skeletal dysmorphology complicates repair, as local tissue may be insufficient to cover the dural repair. Although neonatal kyphectomy has been proposed as a potential solution to this problem, it carries significant potential risks that may not be acceptable to families. CASE DESCRIPTION: A neonate presented with a large myelomeningocele defect with associated severe lumbar kyphosis. Kyphectomy was both declined by the family owing to the potential surgical risks and deemed not appropriate by the surgeons based on the challenging anatomic considerations. Soft tissue closure was not possible with local tissue rearrangement. Acellular dermal matrix was used as a definitive soft tissue coverage option, with complete epithelialization noted at 8 weeks postoperatively. CONCLUSIONS: Acellular dermal matrix is a potentially useful adjunct for definitive reconstruction of complex neonatal soft tissue defects where local tissue is not available.


Assuntos
Derme Acelular , Cifose/etiologia , Meningomielocele/complicações , Meningomielocele/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Recém-Nascido , Vértebras Lombares
16.
J Clin Neurosci ; 66: 138-143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31088766

RESUMO

Short-segment temporary posterior spinal instrumentation has been widely used to treat thoracolumbar burst fractures. However, kyphosis recurrence without hardware failure has become a concern. Therefore, we investigated risk factors for kyphosis recurrence after short-segment temporary fixation for thoracolumbar burst fractures. Our prospective multicenter study involved 76 consecutive patients with thoracolumbar burst fractures who underwent short-segment temporary posterior fixation using ligamentotaxis with Schanz screws and without fusion. Patients were divided into two groups -kyphosis recurrence and no kyphosis recurrence- according to correction loss of the kyphotic angle. Clinical and radiographic data were examined to reveal the risk factors for postoperative kyphosis recurrence. After surgery, all patients experienced fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful. However, mean 9.1° loss of correction in kyphotic angle was observed. Statistical analysis revealed that a high ratio of canal compromise before surgery, as seen on computed tomography scanning, and a large preoperative kyphotic angle influenced kyphosis recurrence. In conclusion,short-segment temporary posterior fixation yields satisfactory results regarding reduction and maintenance of fractured vertebrae. However, correction loss after implant removal is associated with a high compromised canal ratio before surgery and a large preoperative kyphotic angle.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Cifose/etiologia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Falha de Equipamento , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Cifose/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
J Orthop Surg Res ; 14(1): 137, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31097011

RESUMO

BACKGROUND: Pedicle subtraction osteotomy (PSO) and vertebral column decancellation (VCD) are frequently used methods for correction of thoracolumbar kyphosis resulting from ankylosing spondylitis (AS). However, there are limited reports performed to evaluate the difference of loss of correction and the effectiveness of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. OBJECTIVE: To retrospectively estimate the effectiveness of correction and loss of correction of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. METHODS: We performed a retrospective review of 61 consecutive AS kyphosis patients undergoing PSO or VCD surgery from March 2012 to April 2015. The patients were divided into PSO group (n = 25) and VCD group (n = 36) according to the types of osteotomies. Measurement of the radiographic parameters was performed and the change was analyzed. RESULTS: Mean loss of correction in the global kyphosis was 2.31° in the PSO group and 2.29° in VCD group at the last follow-up, respectively, with no significant difference. Progressive junctional kyphosis occurred in both groups. VCD obtained a significantly larger correction than PSO while sharing a similar incidence of complications. No serious complications were observed in the two groups. CONCLUSION: The PSO osteotomy and VCD osteotomy are both safe and effective methods in treating thoracolumbar kyphosis secondary to AS. Mild loss of correction mainly occurred in the global kyphosis in both techniques with no significant difference.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteotomia/instrumentação , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
World Neurosurg ; 128: e245-e251, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31026652

RESUMO

BACKGROUND: Sagittal translations (STs) secondary to osteotomy for the correction of ankylosing spondylitis (AS) kyphosis have drawn great attention, which is considered closely related to neurologic deficits and terrible fusion. Despite being discussed in several cases, there were no relevant reports about the transformation of ST and the spinal canal remodeling in AS patients. METHODS: Retrospective analysis was conducted on 16 patients with ST for the treatment of AS kyphosis through pedicle subtraction osteotomy during January 2011 to December 2014 in our hospital. Full-length free-standing spinal radiographs were available for all patients before and after surgery and also at the final follow-up. Radiologic parameters including global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA), and ST were measured. Rates of ST transformation after the surgery and at 1-year follow-up were compared. RESULTS: The average follow-up was 22 months, ranging from 12-36 months. There was no internal fixation failure during this period. The preoperative GK was 59.9 ± 21.0°, TLK was 38.0 ± 13.0°, LL was 7.4 ± 26.5°, and SVA was 27.2 ± 8.6 mm. The postoperative GK was 15.7 ± 2.1°, TLK was 5.6 ± 2.6°, LL was -36.1 ± 2.9°, and SVA was 6.1 ± 4.3 mm. ST was 7.1 ± 2.7 mm after surgery and 1.2 ± 1.0 mm at 1-year follow-up. The difference was statistically significant (P < 0.05). The rate of ST transformation was 84.9% ± 9.7%. According to Scoliosis Research Society surveys, the preoperative and the final follow-up satisfaction score was 1.6 ± 0.3 and 4.7 ± 0.4 respectively (P < 0.05). Remodeling of the spinal canal happened to all the patients with different degrees. CONCLUSIONS: All patients with ST after pedicle subtraction osteotomy for AS kyphosis occurred with spontaneous remodeling of the spinal canal at 1-year follow-up, by which ST can decrease in different degrees or even disappear, and favorable fusion can be achieved even without bone grafting into the osteotomy vertebra.


Assuntos
Remodelação Óssea , Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia/métodos , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Feminino , Humanos , Hipestesia/epidemiologia , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Canal Vertebral/diagnóstico por imagem , Espondilite Anquilosante/complicações , Vértebras Torácicas/diagnóstico por imagem
20.
J Orthop Surg Res ; 14(1): 98, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971275

RESUMO

INTRODUCTION: Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. METHODS: A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. RESULTS: All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. CONCLUSIONS: The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.


Assuntos
Vértebras Cervicais/lesões , Tratamento Conservador/efeitos adversos , Fraturas por Compressão/terapia , Cifose/etiologia , Traumatismos da Medula Espinal/terapia , Fraturas da Coluna Vertebral/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Vértebras Cervicais/diagnóstico por imagem , Tratamento Conservador/métodos , Progressão da Doença , Fraturas por Compressão/diagnóstico por imagem , Humanos , Cifose/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Radiografia , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
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