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1.
Bone Joint J ; 102-B(3): 376-382, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114809

RESUMO

AIMS: To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS). METHODS: We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence. RESULTS: A total of 179 patients were available for analysis. After matching, 124 patients remained (62 in each cohort). Restoration of thoracic kyphosis was significantly better in the sublaminar band group than in the pedicle screw group (from 23.7° to 27.5° to 34.0° versus 23.9° to 18.7° to 21.5°; all p < 0.001). When the preoperative thoracic kyphosis was less than 20°, sublaminar bands achieved a normal postoperative thoracic kyphosis, whereas pedicle screws did not. In the coronal plane, pedicle screws resulted in a significantly better correction than sublaminar bands at final follow-up (73.0% versus 59.7%; p < 0.001). CONCLUSION: This is the first study to compare sublaminar bands and pedicle screws for the correction of a thoracic AIS. We have shown that pedicle screws give a good coronal correction which is maintained at two-year follow-up. Conversely, sublaminar bands restore the thoracic kyphosis better while pedicle screws are associated with a flattening of the thoracic spine. In patients with preoperative hypokyphosis, sublaminar bands should be used to restore a proper sagittal profile. Cite this article: Bone Joint J 2020;102-B(3):376-382.


Assuntos
Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Parafusos Pediculares , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico , Vértebras Torácicas/diagnóstico por imagem
2.
Bone Joint J ; 102-B(3): 371-375, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114817

RESUMO

With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION) spinal surgery, we outline a number of measures which have been synthesised into a coherent operative technique. These include positioning, dissection, management of the reference frame, the grip, the angle of attack, the drill, the template, the pedicle screw, the wire, and navigated intrathecal analgesia. Optimizing techniques to improve accuracy allow an overall reduction of the repetition of the surgical steps with its associated productivity benefits including time, cost, radiation, and safety. Cite this article: Bone Joint J 2020;102-B(3):371-375.


Assuntos
Fluoroscopia/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Parafusos Pediculares , Escoliose/diagnóstico
3.
Zhongguo Gu Shang ; 33(2): 99-105, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133805

RESUMO

OBJECTIVE: To explore the application value of 3D printing technology in preoperative surgery plan and intraoperative auxiliary operation for adult kyphoscoliosis deformity. METHODS: The clinical data of 12 adult patients with kyphoscoliosis deformity treated from September 2017 to January 2019 were retrospectively analyzed. There were 3 males and 9 females, aged from 21 to 63 years old with an average of (47.67±13.32) years old. Among them, 4 cases were congenital kyphoscoliosis, 2 cases were old tuberculosis thoracolumbar kyphosis ; 2 cases were idiopathic kyphoscoliosis, 4 cases were degenerative kyphoscoliosis. The CT scan data of the patient's spine was imported into Mimics17.0 software to establish the three dimensional model of the spine, and the spine model was produced by 3D printer. Using the spine model simulated operation, preoperative surgery program planning and formulated a precise surgery, and further analysed postoperative imaging parameters improvement. All the patients were followed up for more than 1 year. Before and after operation and at the last follow-up, the scoliosis Cobb angle, maximum kyphosis Cobb angle, and coronal plane balance (distance between C 7 plumbline and center sacral vertical line, C7PL-CSVL), sagittal plane balance (sagittal vertical axis, SVA), pelvic parameters and other related imaging parameters were measured to further evaluate its orthopedic effect. RESULTS: Twelve patients with spine deformity were treated with different osteotomy and internal fixation fusion methods under the guidance of a 1∶1 spine model (pedicle screw placement of 4 patients with severe deformity were assisted by pedicle screw guide plates), nail placement and osteotomy have good effects, no major tissue damage such as blood vessels, nerves and spinal cord during and after surgery, no complications such as cerebrospinal fluid leakage and infection. Preoperative Cobb angle of scoliosis was (56.5±22.5) °, Cobb angle of kyphosis was (65.2±19.5) °, C7 PL-CSVL was (45.8±16.9) mm, SVA was (48.7±25.4) mm. Postoperative at 4 weeks, Cobb angle of scoliosis was (20.8±11.5) °, and Cobb angle of kyphosis was (22.0±6.6) °, with correction rates of (65.1±9.7)% and (64.6± 10.6)%, respectively ; C7 PL-CSVL was (22.3±8.9) mm, and SVA was (23.3±13.1) mm, all of which were significantly improved compared with preoperative results. The mean follow-up time was (18.5±7.9) months in 12 patients. At the last follow-up, the Cobb angles of scoliosis and kyphosis were (22.2±10.8) ° and (23.6±7.7) °, respectively, C7 PL-CSVL was (23.5±10.8) mm, and SVA was (24.7±12.5) mm. The results were statistically significant compared preoperative (P<0.05). There was no significant difference at the postoperative at 4 weeks and the last follow-up (P>0.05). CONCLUSION: The 3D print model can visually and clearly show the vertebral morphology and structure of adult kyphoscolisis and its spatial relationship with the adjacent vertebrae, blood vessels, and nerves, which provides a good and intuitive stereoscopic anatomical structure observation for the individualization of the surgical plan. Pre-simulation of operations to determine the internal fixation, fusion segment and osteotomy orthopedic way, may to provide a reference for actual clinical surgery, and can improve the accuracy and safety of surgery.


Assuntos
Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Adulto , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Impressão Tridimensional , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Resultado do Tratamento , Adulto Jovem
4.
Zhongguo Gu Shang ; 33(2): 106-10, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133806

RESUMO

OBJECTIVE: To investigate the clinical effects of the Halo-pelvic traction combined with posterior instrumentation correction and internal fixation for the treatment of severe and rigid scoliosis. METHODS: From January 2015 to 2019 May, 16 patients with severe and rigid scoliosis were treated by the Halo-pelvic traction combined with posterior instrumentation correction. There were 7 males and 9 females, aged 14 to 28 years with an average of 17.6 years, Cobb angle was 90° to 140° with an average of (108.84±17.93) °. Including congenital scoliosis in 10 cases (6 cases of dyssegmented scoliosis, 3 cases of dysplasia, 1 case of mixed scoliosis), idiopathic scoliosis in 4 cases and neurofibromatosis in 2 cases. All patients in group had scoliosis corrected by Halo-pelvic distraction combined with posterior instrumentation correction and internal fixation. Among them, 7 cases were treated with self-made guide device for iliac bone puncture, and the other cases with traditional bare hands. The height, scoliosis Cobb angle, kyphosis Cobb angle and correction rate of 16 patients before and after surgery were observed. RESULTS: The body height was corrected from (144.88±6.32) cm to (154.56±7.87) cm ; Cobb angle of scoliosis was corrected from (108.84±17.93) ° to (42.12±7.29) °, Cobb angle of kyphosis was corrected from (64.18±16.39) ° to (33.81±6.06) °. After the Halo pelvic traction, the body height increase, Cobb angle of scoliosis and kyphosis were changed with the mean of (7.06± 5.65) cm, (41.50±9.09)%, (30.52±9.66)%, respectively. After the stage Ⅱ surgical correction, the body height increase, Cobb angle of scoliosis and kyphosis were changed with the mean of (2.63±1.78) cm, (32.47±10.80)%, (15.55±9.47)% (The baseline Cobb angle referenced by the correction rate was the Cobb angle of the previous treatment). The body height increase and correction rate of Cobb angle of scoliosis and kyphosis with staged traction combined with surgery was (9.69±5.42) cm, (61.09 ± 5.03)%, (46.07±8.60)%. There was significant difference in body height increase, correction rate of Cobb angle of scoliosis and kyphosis between before and after each period of treatment (P<0.05). CONCLUSION: Treatment of severe and rigid scoliosis with Halo-pelvic traction combined with stage Ⅱ surgical correction can significantly correct deformities and improve appearance, and has fewer surgical complications and strong clinical operability.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escoliose/cirurgia , Tração , Resultado do Tratamento , Adulto Jovem
5.
Zhongguo Gu Shang ; 33(2): 116-20, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133808

RESUMO

OBJECTIVE: To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS). METHODS: The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve. RESULTS: The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (P>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (P<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (P<0.05). CONCLUSION: The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Escoliose , Fusão Vertebral , Feminino , Seguimentos , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Escoliose/cirurgia , Resultado do Tratamento
6.
Zhongguo Gu Shang ; 33(2): 131-5, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133811

RESUMO

OBJECTIVE: To analyze the effectiveness and safety of one stage three column osteotomy in treatment of scoliosis with split spinal cord malformation. METHODS: The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed. There were 17 males and 24 females with average age of (25.14±4.51) years old and the average weight of (65.14±9.11) kg. According to the classification of longitudinal spina bifida, 15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B. The general situations of two groups were recorded ; preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated ; the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated ; the complication of two groups was recorded. RESULTS: All 41 patients were followed up for more than 12 months. The operation time, intraoperative blood loss, and perioperative blood transfusion volume in group A were (610.14±115.02) min, (4 001.12±1 014.33) ml, (3 951.14±1 021.55) ml, respectively, and group B were (520.12±101.14) min, (2 701.57±1 021.45) ml, (2 565.77±880.47) ml, the difference between the two groups was statistically significant (P<0.05). The postoperative hospital stays in the group A and B were (9.45±4.21) days and (9.14±3.01) days, respectively, and there was no significant difference (P>0.05). There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups (P>0.05). Immediately after surgery and 12 months after surgery, there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups (P>0.05). Six patients in group A had complications, which was higher than that in group B of 1 case (χ2=4.885, P< 0.05). CONCLUSION: One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good balance of the trunk. However, for patients with typeⅠsplit spinal cord malformation, they will face longer operation time, more intraoperative bleeding volume, large amount of perioperative blood transfusion and higher risk of complications, and the safety is not as good as that of typeⅡpatients. Therefore, in the actual treatment of scoliosis, especially for those with typeⅠsplit spinal cord malformation, a more reasonable surgical plan should be developed in combination with the actual situations of the patients, so as to improve the safety of the operation.


Assuntos
Escoliose , Fusão Vertebral , Adulto , Feminino , Humanos , Masculino , Osteotomia , Estudos Retrospectivos , Escoliose/cirurgia , Medula Espinal , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 99(3): e18845, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011501

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effectiveness and safety of long fusion (LF) versus short fusion (SF) for the treatment of degenerative scoliosis (DS). METHODS: We will search MEDLINE, EMBASE, PubMed, the Cochrane Library, and Web of Science to collect the randomized and non-randomized controlled studies that compared LF with SF in the treatment of DS from inception to June 1, 2019. The quality of the included studies will be assessed by 2 evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies will be analyzed using RevMan 5 (version 5.3.3). RESULTS AND CONCLUSION: The study will compare the efficacy and safety of LF and SF in the treatment of DS and provide more reliable, evidence-based data for clinical decision making. PROSPERO REGISTRATION NUMBER: CRD42019137646.


Assuntos
Metanálise como Assunto , Escoliose/cirurgia , Fusão Vertebral/métodos , Humanos , Projetos de Pesquisa , Resultado do Tratamento
8.
Bone Joint J ; 102-B(2): 261-267, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009441

RESUMO

AIMS: It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis. METHODS: In all, 91 nonambulatory patients with neuromuscular scoliosis were included. All underwent surgery using bilateral, segmental, pedicle screw instrumentation. A total of 40 patients underwent fusion to L5 and 51 had their fixation extended to the pelvis. The two groups were assessed for differences in terms of clinical and radiological findings, as well as complications. RESULTS: The main curve (MC) was a mean of 90° (40° to 141°) preoperatively and 46° (15° to 82°) at two-year follow-up in the L5 group, and 82° (33° to 116°) and 19° (1° to 60°) in the pelvic group (p < 0.001 at follow-up). Correction of MC and pelvic obliquity (POB) were statistically greater in the pelvic group (p < 0.001). There was no statistically significant difference in the operating time, blood loss, or complications. Loss of MC correction (> 10°) was more common in patients fixated to the pelvis (23% vs 3%; p = 0.032), while loss of pelvic obliquity correction was more frequent in the L5 group (25% vs 0%; p = 0.007). Risk factors for loss of correction (either POB or MC) included preoperative coronal imbalance (> 50 mm, odds ratio (OR) 11.5, 95%confidence interval (CI) 2.0 to 65; p = 0.006) and postoperative sagittal imbalance (> 25 mm, OR 11.0, 95% CI1.9 to 65; p = 0.008). CONCLUSION: We found that patients undergoing pelvic fixation had a greater correction of MC and POB. The rate of complications was not different. Preoperative coronal and postoperative sagittal imbalance were associated with increased risks of loss of correction, regardless of extent of fixation. Therefore, we recommend pelvic fixation in all nonambulatory children with neuromuscular scoliosis where coronal or sagittal imbalance are present preoperatively. Cite this article: Bone Joint J 2020;102-B(2):261-267.


Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Limitação da Mobilidade , Parafusos Pediculares , Estudos Retrospectivos , Escoliose/complicações , Fusão Vertebral/instrumentação , Resultado do Tratamento
9.
Zhonghua Yi Xue Za Zhi ; 100(3): 192-196, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008285

RESUMO

Objectives: To evaluate the effect of minimally invasive lateral lumbar interbody fusion (LLIF/OLIF) on the sagittal balance of adult degenerative scoliosis. Methods: From January 2014 to June 2017, a total of 23 patients with degenerative scoliosis underwent staged minimally invasive surgery in Shanghai Ruijin Hospital. All patients were implanted with LLIF or OLIF cage from the lateral approach first, and was followed by the posterior percutaneous pedicle screw fixation or pedicle screw fixation via Wiltse approach. If the sagittal deformity correction was not satisfactory after the first surgery, a posterior osteotomy can be performed during the second stage operation. A biplanar X-ray of the whole spine was taken with the EOS imaging system before and after surgery. The EOS software was used to measure and evaluate the patient's sagittal balance parameters including pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), the sagittal vertical axis (SVA) and the coronal Cobb angle. The visual analogue scale (VAS) score for low back pain, the Oswestry Disability Index (ODI) score were evaluated before and after surgery. Paired t test or repeated measures ANOVA was used to compare the data before and after surgery. Results: There were 6 males and 17 females with a mean age of (72±4) years (62-79 years). Nine patients were treated with LLIF and 14 patients with OLIF. Sixteen cases were implanted with three cages, five with two cages and two with four cages. The mean follow-up period was 24.2 months (15-42 months). After the first operation, the Cobb angle of the patient was significantly improved (18°±7° vs 33°±8°, t=13.2, P<0.01). All the parameters for sagittal balance, including PI-LL (20°±8° vs 31°±8(o)), SVA ((5.3±2.0) cm vs (8.2±3.5) cm), PT (16°±6° vs 23°±4°) were all significantly improved as well (t=6.8, 4.5, 9.0, ALL P<0.01). At the last follow-up, the VAS score of low back pain (3.4±1.1 vs 6.3±1.0) and ODI scores (27.3%±3.0% vs 47.1%±5.9%) were also significantly improved (t=11.3, 17.8, both P<0.01). No major complications occurred in this group. Conclusions: Minimally invasive LLIF/OLIF can significantly improve the coronal and sagittal balance of adult degenerative scoliosis. Staged minimally invasive surgery can significantly alleviate pain and improve function in these patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , China , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares , Masculino , Estudos Retrospectivos , Escoliose/patologia , Resultado do Tratamento , Escala Visual Analógica
10.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
11.
J Pediatr Orthop ; 40(1): e37-e41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30973475

RESUMO

BACKGROUND: We looked at long-term follow-up of spine stapling with Nitinol Staples. This was a cohort of all adolescent idiopathic scoliosis (AIS) patients with curves at high risk to progress based on curve magnitude, premenarchal status in all females, failure of brace treatment, and skeletal immaturity. METHODS: This is a single surgeon retrospective review of consecutive AIS patients treated with Nitinol staples for progressive scoliosis. Fourteen patients, 16 curves from 2005 to 2008 were eligible. Minimum curve for stapling was 30 degrees. Standard preoperative, intraoperative, and postoperative data were collected. All patients were followed for a minimum of 36 months and to skeletal maturity. Three groups were: improved (group 1), correction of any amount; minimal progression (group 2), progression ≤10 degrees; and failure (group 3), ≥10 degrees of progression. RESULTS: A total of 13 thoracic curves and 2 compensatory lumbar curves met the inclusion criteria (94%). Average follow-up was 61 months. The mean preoperative main thoracic curve was 35 degrees. All but 1 patients progressed at least 9 degrees in a brace prior to stapling. Females were all premenarchal, 10 patients were Risser 0 and 3 Risser 1. The average number of vertebrae stapled per curve was 6. Group 1 included 6 curves (40%). Group 2, 5 curves (33%). Group 3, 4 curves (27%). Three patients went on to uncomplicated fusion. Final curve measurement at the end of follow-up or before fusion (P=0.0037), curve progression (P≤0.001), and percentage of coronal correction on first postoperative standing radiograph (P=0.042) were the significant differences between groups 1+2 (successful) versus group 3 (failures). In total, 73% of this group either progressed ≤10 degrees or improved. CONCLUSIONS: This is the first study that follows AIS patients treated with spine stapling to skeletal maturity. Staples likely changed natural history in some of our patients. Initial percentage of correction on first standing postoperative PA x-rays was the only predictor of success. Stapling was safe without any long-term complications. LEVEL OF EVIDENCE: Level III-retrospective study.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Grampeamento Cirúrgico , Vértebras Torácicas/cirurgia , Adolescente , Assistência ao Convalescente , Ligas , Desenvolvimento Ósseo , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Radiografia , Reoperação , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral , Fatores de Tempo , Resultado do Tratamento
12.
J Pediatr Orthop ; 40(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815861

RESUMO

BACKGROUND: Several authors mentioned surgical outcome for scoliosis associated with neurofibromatosis type 1 (NF-1). However, no studies have summarized long-term surgical outcomes after surgical treatment of early-onset scoliosis (EOS) with NF-1. The purpose of this study is to evaluate the long-term surgical outcome after early definitive spinal fusion for EOS in NF-1 patients. METHODS: We performed a retrospective review on a cohort of 11 patients diagnosed with EOS associated with NF-1 between 1990 and 2009 in our hospital. The study included 7 male and 4 female NF-1 patients with a mean age at fusion surgery of 8 years 4 months who underwent early definitive spinal fusion for EOS. We reviewed radiographs, computed tomography and magnetic resonance images for each patient. The data collected included type of NF-1, Cobb angles, kyphotic angle, spinal length (T1-S1), and pulmonary function. We also evaluated progression of the dystrophic change through radiographs and computed tomography during the follow-up period. RESULTS: The mean follow-up duration was 14 years (5 y 10 mo to 25 y). All patients underwent anterior and posterior fusion surgeries in either 1 or 2 stages. Seven cases had subtotal tumor resection from the concave side followed by rib strut grafting. The mean preoperative Cobb angle of the primary curve was corrected from 71.2 to 24.1 degrees and was maintained at the final follow-up at 23.5 degrees. Mean values for preoperative and final follow-up T1-S1 heights were 30.7 and 36.2 cm, respectively. Mean values for preoperative and final follow-up % forced vital capacity (the present/the predicted) were 75.0% and 74.4%, respectively. The dystrophic change progressed in all cases during the long-term follow-up. CONCLUSIONS: Our goals for NF-1 scoliosis are to obtain deformity correction, to achieve stable instrumentation by using longer fusion levels and to attain a solid fusion mass that can tolerate continual erosion during the long-term follow-up. We achieve this by using a circumferential approach for EOS associated with NF-1. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Neurofibromatose 1/complicações , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral , Adolescente , Adulto , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Imagem por Ressonância Magnética , Masculino , Neurofibromatose 1/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Fusão Vertebral/métodos , Fatores de Tempo , Tomografia por Raios X , Resultado do Tratamento , Capacidade Vital , Adulto Jovem
13.
Bone Joint J ; 101-B(12): 1563-1569, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787003

RESUMO

AIMS: The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management. PATIENTS AND METHODS: A retrospective review of two prospective multicentre EOS databases identified 33 children with skeletal dysplasia and EOS (major curve ≥ 30°) who were treated with growth-friendly instrumentation at younger than ten years of age, had a minimum two years of postoperative follow-up, and had undergone three or more lengthening procedures. From the same registries, 33 matched controls with idiopathic EOS were identified. A total of 20 children in both groups were treated with growing rods and 13 children were treated with vertical expandable prosthetic titanium rib (VEPTR) instrumentation. RESULTS: Mean preoperative major curves were 76° (34° to 115°) in the skeletal dysplasia group and 75° (51° to 113°) in the idiopathic group (p = 0.55), which were corrected at final follow-up to 49° (13° to 113°) and 46° (12° to 112°; p = 0.68), respectively. T1-S1 height increased by a mean of 36 mm (0 to 105) in the skeletal dysplasia group and 38 mm (7 to 104) in the idiopathic group at the index surgery (p = 0.40), and by 21 mm (1 to 68) and 46 mm (7 to 157), respectively, during the distraction period (p = 0.0085). The skeletal dysplasia group had significantly worse scores in the physical function, daily living, financial impact, and parent satisfaction preoperatively, as well as on financial impact and child satisfaction at final follow-up, than the idiopathic group (all p < 0.05). The domains of the 24-Item Early-Onset Scoliosis Questionnaire (EOSQ24) remained at the same level from preoperative to final follow-up in the skeletal dysplasia group (all p > 0.10). CONCLUSION: Children with skeletal dysplasia gained significantly less spinal growth during growth-friendly management of their EOS and their health-related quality of life was significantly lower both preoperatively and at final follow-up than in children with idiopathic EOS. Cite this article: Bone Joint J 2019;101-B:1563-1569.


Assuntos
Doenças do Desenvolvimento Ósseo/complicações , Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Escoliose/etiologia , Coluna Vertebral/crescimento & desenvolvimento , Coluna Vertebral/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(51): e18061, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860955

RESUMO

Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction drains in adolescent patients who had undergone idiopathic scoliosis surgery. We evaluated the outcomes of patients with and without closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery.We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). We evaluated the wound drainage (wound oozing), need for transfusion, preoperative and postoperative hemoglobin levels, length of hospital stay, and postoperative blood loss from closed suction drains. Patients' scoliosis was categorized according to the Lenke Classification System for Scoliosis. The level of instrumentations was also evaluated.The median postoperative hemoglobin level was lower in group A than in group B. Postoperatively, group A underwent more blood transfusions than group B. Postoperative hospital stay was also significantly longer in group A than in group B. There was no statistical difference in the infection rate between the two groups.Using drains after AIS surgery increases hospital stay duration, blood transfusion rate and patients' anxiety of drain tube removal. Thus, closed suction drainage may not be suitable after AIS surgery.


Assuntos
Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Sucção/efeitos adversos , Sucção/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Adolescente , Estudos de Coortes , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Escoliose/diagnóstico por imagem , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Infecção da Ferida Cirúrgica/epidemiologia
15.
Zhonghua Yi Xue Za Zhi ; 99(41): 3249-3254, 2019 Nov 05.
Artigo em Chinês | MEDLINE | ID: mdl-31694121

RESUMO

Objective: To investigate the clinical outcomes of one-stage posterior correction surgery and second-stage anterior debridement and fusion in treating children with thoracic tuberculosis complicated with kyphoscoliosis. Methods: From January 2008 to December 2014, a total of 17 children with thoracic vertebral tuberculosis complicated with kyphoscoliosis who underwent a one-stage posterior correction and second-stage anterior debridement and complementary fusion were included. There were 8 males and 9 females with an average age of (8±4) years (5-14 years). All patients underwent posterior correction and anterior debridement and bone graft fusion surgery. The neurological function was determined by Frankel grade. The operation time, estimated blood loss (EBL), levels fused and numbers of screws were recorded. The following radiographic parameters were measured: Cobb angle of the coronal curve, regional kyphosis and sagittal vertical axis (SVA). The incidence of intraoperative and postoperative complications was recorded. The data before and after the operation were compared with paired sample t test. Results: The tuberculosis lesions located in the thoracic vertebrae, and the abscess involved 2 to 4 vertebral segments. The average operation time was (4.1±0.8) h, the EBL was (526±275) ml, the levels fused were 7.6±2.3, and 173 pedicle screws were placed. The preoperative coronal curve averaged 12.6°±6.2°, and it was corrected to 4.2°±1.9° postoperatively (t=4.628, P<0.01), the regional kyphosis was 67.2°±19.4°, and it was corrected to 15.7°±8.2° postoperatively (t=8.192, P<0.01). The SVA improved from (8.1±5.0) mm to (3.0±1.7) mm postoperatively. The mean duration of follow-up for all the patients were (38±11) months. At final follow-up, SVA was reduced to (2.4±2.0) mm and the other parameter kept stable. Thirteen patients had more than one grade improvement of Frankel grade. The VAS score for all patients improved from 4.7±2.8 to 2.2±0.5 postoperatively (t=3.973, P=0.01), and improved to 0.5±0.5 at final follow-up (t=-7.880, P<0.01). No recurrence of primary spinal tuberculosis was seen at final follow-up of all patients. Conclusions: One-stage posterior correction and second-stage anterior complementary debridement and fusion is an effective procedure for children with thoracic tuberculosis complicated with kyphoscoliosis. Significant postoperative deformity correction could be achieved with satisfactory improvement of neurological function. Solid fusion and satisfactory correction maintenance were observed at mid-to long-term follow-up.


Assuntos
Desbridamento , Cifose , Escoliose , Fusão Vertebral , Tuberculose da Coluna Vertebral , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Cifose/cirurgia , Vértebras Lombares , Masculino , Estudos Retrospectivos , Escoliose/cirurgia , Vértebras Torácicas , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 44(22): 1564-1570, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689252

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction. SUMMARY OF BACKGROUND DATA: Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction. METHODS: The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed. RESULTS: An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span. CONCLUSION: Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences. LEVEL OF EVIDENCE: 3.


Assuntos
Escoliose , Fusão Vertebral , Hospitalização , Humanos , Estudos Retrospectivos , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
17.
Spine (Phila Pa 1976) ; 44(22): 1578-1584, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689253

RESUMO

STUDY DESIGN: Retrospective review with qualitative phone interview. OBJECTIVE: This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. METHODS: A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. RESULTS: Mean Cobb angle at first specialist review was 49.5°â€Š±â€Š14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. CONCLUSION: In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. LEVEL OF EVIDENCE: 4.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Escoliose , Adolescente , Humanos , Entrevistas como Assunto , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/epidemiologia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Austrália Ocidental
18.
Spine (Phila Pa 1976) ; 44(23): 1630-1637, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725685

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVES: To analyze the outcomes at skeletal maturity of patients treated with a single traditional growing rod (GR). To compare results of patients according to whether posterior spinal fusion (PSF) was performed at treatment completion. SUMMARY OF BACKGROUND DATA: Few studies examined the end results of GRs at skeletal maturity. There is no agreement on requirement of PSF at GR treatment completion. METHODS: Clinical and radiological analysis of consecutive patients with severe and/or progressive scoliosis treated initially with traditional single GR. Group comparisons of patients with PSF and without fusion surgery at treatment completion. RESULTS: Thirty-four patients underwent traditional single GR implantation at a median age of 11.7 years. Median follow-up was 6.5 years. At last follow-up, T1-S1 distance was increased by a median 116 mm (P < 0.001) and median major curve Cobb angle was changed from 55° preoperatively to 30° (P < 0.001). Complications included 26 rod fractures, 1 implant prominence, 4 proximal junctional kyphosis, 2 proximal hook dislodgments, and 2 wound infections. At the beginning our experience, PSF was performed systematically in 17 patients. Relying on spinal ankylosis, 17 patients were subsequently not fused at GR treatment completion (single GR removed N = 2, single GR retained N = 7, dual GR surgery N = 8). There were no statistical differences between groups in improvements of radiological parameters from preoperative GR insertion to last follow-up. No GR fracture occurred after dual GR surgery. CONCLUSION: Single GR allows curve control and promotes spinal growth. Dual GR is, however, recommended for rod fracture prevention and better correction maintenance. In patients with satisfactory deformity correction at skeletal maturity, one may consider retaining dual GR instead of performing PSF. LEVEL OF EVIDENCE: 4.


Assuntos
Desenvolvimento Ósseo , Próteses e Implantes/tendências , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/tendências , Adolescente , Desenvolvimento Ósseo/fisiologia , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento
19.
Spine (Phila Pa 1976) ; 44(23): 1647-1652, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725687

RESUMO

STUDY DESIGN: Retrospective review of a prospectively collected multicenter database. OBJECTIVE: The aim of this study was to investigate factors associated with low preoperative SRS pain scores. SUMMARY OF BACKGROUND DATA: The prevalence of preoperative pain in patients with adolescent idiopathic scoliosis (AIS) has become increasingly evident and is a primary concern for patients and families. Greater preoperative pain is associated with more postoperative pain; however, less is understood about what contributes to preoperative pain. METHODS: A prospectively collected, multicenter database was queried for patients with AIS. Patients were divided into 2 cohorts based on preoperative SRS pain scores: ≤ 3 (Pain cohort), 4 to 5 (No Pain cohort). Univariate analysis was performed identifying which factors were associated with a low preoperative SRS score and used for a CART analysis. RESULTS: Of 2585 patients total, 2141 (83%) patients had SRS pain scores of 4 to 5 (No Pain) and 444 (17%) had SRS pain scores ≤3 (Pain). Female sex, older age, greater % body mass index, larger lumbar curves, greater T5-12 kyphosis, and lower mental health scores were associated with greater preoperative pain. In multivariate CART analysis, lower mental health SRS scores (P = 0.04) and older age (P = 0.003) remained significant, with mental health scores having the greatest contribution. In subdividing the mental health component questions, anxiety-related questions appeared to have the greatest effect followed by mood/depression (SRS Question 13: OR 2.04; Q16: OR 1.35; Q7: OR 1.31; Q3: OR 1.20). CONCLUSION: Anxiety and mood are potentially modifiable risk factors that have the greatest impact on pre- and postoperative pain. These results can be used to identify higher-risk patients and develop preoperative therapeutic protocols to improve postoperative outcomes. LEVEL OF EVIDENCE: 3.


Assuntos
Saúde Mental , Medição da Dor/psicologia , Dor Pós-Operatória/psicologia , Cuidados Pré-Operatórios/psicologia , Escoliose/psicologia , Escoliose/cirurgia , Adolescente , Estudos de Coortes , Depressão/diagnóstico , Depressão/psicologia , Depressão/cirurgia , Feminino , Humanos , Masculino , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Estudos Retrospectivos , Escoliose/diagnóstico , Resultado do Tratamento , Adulto Jovem
20.
Medicine (Baltimore) ; 98(47): e18048, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764829

RESUMO

STUDY DESIGN: Retrospective review. BACKGROUND: Inferior facetectomies, with the utilization of segmental pedicle screw constructs for corrective fixation, can provide adequate flexibility and post less risk of neural tissue and blood loss. We analyzed outcomes of surgical treatment for adolescent idiopathic scoliosis (AIS) using inferior facetectomies and segmental pedicle screw constructs. We hypothesized that adequate main curve correction and suitable surgical outcomes would be observed using this technique. METHODS: We reviewed 38 AIS patients who underwent inferior facetectomies and segmental pedicle screw constructs by 2 surgeons at a single institution between May 2014 and December 2016. Coronal and sagittal radiographic measurements were evaluated over 1-year follow-up by 2 trained observers not associated with the surgeries. Surgical details, complications, and hospital length of stay (LOS) were also recorded. RESULTS: Mean fusion levels were 11.0 ±â€Š1.7. The mean Cobb angle of main AIS curves improved from 48.6±â€Š10.1 degree preoperatively to 11.8±â€Š6.2 degree postoperatively and 12.4±â€Š6.2 degree at 1-year follow-up, which percentage correction was 75.9% and 74.6%, respectively. The mean thoracic kyphosis (T5-12) angle was 20.7±â€Š11.6 degree preoperatively, 17.4±â€Š8.0 degree postoperatively, and 16.8±â€Š8.4 degree at 1-year follow-up. The mean surgical time, estimated blood loss, and LOS were 232.4 ±â€Š35.7 minutes, 475.0 ±â€Š169.6 mL, and 3.5 ±â€Š1.3 days. Twelve patients received blood transfusion. There were no neurological or wound complications. CONCLUSIONS: This case series demonstrated adequate correction of main AIS curves, acceptable thoracic kyphosis and blood loss, and short surgical time and LOS in AIS patients treated with inferior facetectomies and segmental pedicle screw constructs, potentially indicating that inferior facetectomies are adequate and suitable for AIS surgery when segmental pedicle screw constructs are utilized.


Assuntos
Procedimentos Ortopédicos/métodos , Parafusos Pediculares , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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