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1.
Medicine (Baltimore) ; 100(11): e24220, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725928

RESUMO

INTRODUCTION: Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. PATIENT CONCERNS: A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year. DIAGNOSIS: Lumbar disc herniation (LDH). INTERVENTIONS: This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. OUTCOMES: The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. CONCLUSION: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.


Assuntos
Parafusos Ósseos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/instrumentação
2.
Medicine (Baltimore) ; 100(12): e25202, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761705

RESUMO

ABSTRACT: To introduce a novel technique of using individualized 3D printing occipitocervical fusion instrument (3D-OCF) for the treatment of upper cervical deformity with atlantoaxial joint dislocation.The surgery for deformity of the craniocervical junction area is a challenge in the field of spine. If the surgical deviation is too large to injure the spinal cord or vertebral artery, it will cause catastrophic damage to the patient. Therefore, it is controversial whether these patients should undergo surgical treatment. We provide a novel surgical approach for the challenging upper cervical surgery through 3D-OCF and a typical patient.We present a 54-year-old female patient, who suffered from dizziness and numbness in her limbs for 8 months. After the patient was admitted, we performed the three-dimensional CT scan, modeled using Mimics software 17.0, and designed customized occipitocervical fusion instrument. Besides, we repeatedly perform simulated surgery based on 3D-printed models before surgery.The operative time was 142 minutes and the intraoperative blood loss was 700 mL. X-ray showed reduction of atlantoaxial dislocation and accurate position of internal fixation. The patient's symptoms were significantly relieved: the sensation of dizziness and numbness of limbs was obviously relieved, and the sense of banding in chest, abdomen, and ankle was disappeared. At the last follow-up, imaging showed that 3D-OCF had bone-integration and Syringomyelia was disappeared. The patient's cervical JOA (Japanese Orthopaedic Association) score increased from 10 points to 17 points.Individualized 3D-OCF can improve the safety and accuracy of upper cervical surgery, reduce the operative time and the number of fluoroscopy. Our study provides a novel surgical approach for the challenging upper cervical surgery.


Assuntos
Articulação Atlantoaxial/anormalidades , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Osso Occipital/cirurgia , Impressão Tridimensional , Fusão Vertebral/instrumentação , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/patologia , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/patologia , Pessoa de Meia-Idade , Osso Occipital/diagnóstico por imagem , Duração da Cirurgia , Ossificação Heterotópica/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X
3.
Zhonghua Wai Ke Za Zhi ; 59(3): 216-221, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685056

RESUMO

Objectives: To establish a geometric model of the atlantoaxial dislocation and basilar invagination reduction,and examine its value for clinical application. Methods: A retrospective analysis of 35 patients with atlantoaxial dislocation and basilar invagination admitted to the Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University from May 2018 to May 2020 was conducted.There were 5 males and 30 females,aged (48±15) years(range: 19 to 69 years). The geometric model of the atlantoaxial reduction was established based on the mid-sagittal section of the cervical spine. The relevant data were calculated according to the geometric model before operation,and the fusion cage of the corresponding height was placed into C1-2 facet joint of patient for quantitative reduction. The theoretical reset value, actual reset value, postoperative symptoms and complications were collected. The paired t-test was used to compare the difference between theoretical and actual reset value to verify the reliability of the geometric model. Results: The theoretical vertical reduction distance of all patients was (5.79±2.96) mm(range:1.52 to 10.96 mm),and the actual vertical reduction distance was (7.43±2.96)mm(range: 1.40 to 12.77 mm),and there was no statistical difference between them(t=-1.96,P=0.069).The theoretical reduction angle was (10.80±2.24)°(range: 7.09 to 14.86°), the actual reduction angle was (10.64±7.00)°(range: 3.50 to 20.50°),and there was no statistical difference between them (t=0.09, P=0.933). At 6 months follow-up, 35 patients achieved satisfactory atlanto-axial joint fusion, and the symptoms were relieved. No internal fixation system displacement, fracture, wound infection and other complications occurred. Conclusion: This geometric model can estimate the vertical reduction distance and the reduction angle of the axial before operation,and provide a reference for the height of the fusion cage so as to avoid under or over-reduction.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Modelos Biológicos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto Jovem
4.
Bone Joint J ; 103-B(3): 536-541, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641409

RESUMO

AIMS: The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques. METHODS: We retrospectively analyzed a series of 51 patients with a thoracic adolescent idiopathic scoliosis. There were 26 patients in the convex pedicle screw group who had screws implanted periapically (Group 2) and a control group of 25 patients with bilateral pedicle screws (Group 1). The patients' charts were reviewed and pre- and postoperative radiographs evaluated. Postoperative patient-reported outcome measures (PROMs) were recorded. RESULTS: The number of implants (14.5 vs 17.1) and the implant density (1.5 vs 1.9) were significantly lower in Group 2 (p < 0.001). Operating time was 27 minutes shorter in Group 2 than in Group 1, with a mean of 217 minutes (SD 50.5; 120 to 346). The duration of surgery per instrumented vertebra was reduced by 19% in Group 2 (p = 0.011). No statistical difference was found in the postoperative Cobb angle, vertebral rotation, the relative correction achieved, or postoperative PROMs. CONCLUSION: Despite a lower implant density and achieving correction through a convex rod, surgical correction of the Cobb angle and vertebral body rotation was similar in both groups. Periapical pedicle screws and primary correction on the concave side do not seem to be mandatory in order to achieve good surgical results in idiopathic thoracic scoliosis. The operating time was shorter in the group with lower implant density. In conclusion, the technique provided good results and has the potential to reduce complications and costs. Cite this article: Bone Joint J 2021;103-B(3):536-541.


Assuntos
Parafusos Pediculares , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Estudos Retrospectivos , Inquéritos e Questionários
5.
J Clin Neurosci ; 85: 84-91, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581796

RESUMO

BACKGROUND: The aim of this study was to compare surgical trauma and radiographic and clinical outcomes of stand-alone and instrumented lateral lumbar interbody fusion (LLIF) in the treatment of single-level low-grade lumbar spondylolisthesis. METHODS: Ninety-five patients with single-level low-grade lumbar spondylolisthesis, who underwent stand-alone LLIF (stand-alone group, [n = 54]) or LLIF plus percutaneous posterior fixation (instrumented group, [n = 41]) were enrolled in this study. Operative time, intraoperative blood loss, serum C-reactive protein (CRP) and creatine kinase (CK) levels, the length of postoperative bed rest time, and hospital stay were compared between the 2 groups. Disc height, the percent of slip, segment lordosis, lumbar lordosis, the visual analog scale score, the Oswestry Disability Index and complications were also compared. RESULTS: Operative and bed rest time were shorter, intraoperative blood loss was less, and postoperative CRP and CK levels were lower in the stand-alone group. During follow-up, 6 patients in stand-alone group underwent posterior fixation due to cage subsidence. Although satisfactory radiographic results were achieved in both groups, the maintenance of increased disc heights and segment lordosis was inferior in the stand-alone group at the final follow-up. Greater improvement in postoperative VAS scores and ODI were observed in the stand-alone group, although the rates of cage subsidence and revision were higher. CONCLUSION: Stand-alone LLIF was superior to instrumented LLIF in terms of tissue trauma for the treatment of single-level low-grade lumbar spondylolisthesis. However, stand-alone LLIF was inferior in the maintenance of disc height and segment lordosis, and the occurrence of cage subsidence and revision.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(7): e24675, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607805

RESUMO

BACKGROUND: In the present study, we aimed to evaluate the effects of pulmonary rehabilitation on respiratory functions after the surgery on the basis of early radiological findings, pain degree, function, and satisfaction scores in operated patients with adolescent idiopathic scoliosis (AIS). METHODS: Thirty patients with AIS were included in the present study, who were divided into 2 groups. Scoliosis surgery and diaphragmatic breathing and pursed lip exercises were applied in Group 1 (n = 15), whereas merely scoliosis surgery was applied in Group 2 (n = 15). Pulmonary functions, arterial blood gas analysis, Cobb and kyphosis angles, apical vertebral rotation, and apical vertebral translation were measured before and 1st and 6th months after the surgery. Using the SRS-30 test, the psychosocial statuses of the patients and their satisfaction degrees with surgery applied were measured before and after the surgery. RESULTS: Six months after the surgery, the values of Cobb and kyphosis angles and apical vertebral rotations, and apical vertebral translation of the patients were determined to be significantly ameliorated, which is consistent with the literature. Forced vital capacity (l) and forced expiratory volume in the first second (l/s) were observed to be significantly improved in both groups after the surgery (respectively, P = .001, P = .014, P = .001, P = .005). In addition, the partial pressure of oxygen (pO2) value was found to be significantly increased 6 months after the surgery compared with that before the surgery in Group 2 (P = .022). SRS-30 showed that most of the scores in Group 1 were dramatically increased; a significant difference between the groups was not recorded. CONCLUSION: Patients with AIS have been found to be satisfied with the surgery. Conversely, pulmonary rehabilitation has been shown to slightly improve the respiratory functions in the patients with AIS, 1 and 6 months after the surgery.


Assuntos
Pulmão/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Gasometria/métodos , Estudos de Casos e Controles , Criança , Diafragma , Feminino , Volume Expiratório Forçado , Humanos , Cifose/diagnóstico por imagem , Masculino , Radiografia/métodos , Respiração , Testes de Função Respiratória/estatística & dados numéricos , Escoliose/fisiopatologia , Fusão Vertebral/métodos , Resultado do Tratamento , Capacidade Vital , Adulto Jovem
7.
Medicine (Baltimore) ; 100(5): e24005, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592856

RESUMO

ABSTRACT: Although transforaminal lumbar interbody fusion (TLIF) is a widely accepted procedure, major complications such as cage retropulsion (CR) can cause poor clinical outcomes. Endplate injury (EI) was recently identified as a risk factor for CR, present in most levels developing CR. However, most EIs occurred in non-CR levels, and the features of EIs in CR levels remain unknown.The aim of this study was to identify risk factors for CR following TLIF; in particular, to investigate the relationship between EIs and CR, and to explore the features of EIs in CR.Between October 2010 and December 2016, 1052 patients with various degenerative lumbar spinal diseases underwent bilateral instrumented TLIF. Their medical records, radiological factors, and surgical factors were reviewed and factors affecting the incidence of CR were analyzed.Twenty-one patients developed CR. Nine had back pain or leg pain, of which six required revision surgery. A pear-shaped disc, posterior cage positioning and EI were significantly correlated with CR (P < .001, P = .001, and P < .001, respectively). Computed tomography (CT) scans revealed the characteristics of EIs in levels with and without CR. The majority of CR levels with EIs exhibited apparent compression damage in the posterior part of cranial endplate on the decompressed side (17/18), accompanied by caudal EIs isolated in the central portion. However, in the control group, the cranial EIs involving the posterior part was only found in four of the total 148 levels (P < .001). Most of the injuries were confined to the central portion of the cranial or caudal endplate or both endplates (35 in 148 levels, 23.6%). Additionally, beyond cage breaching into the cortical endplate on lateral radiographs, a characteristic appearance of coronal cage misalignment was found on AP radiographs in CR levels with EIs.A pear-shaped disc, posterior cage positioning and EI were identified as risk factors for CR. EI involving the posterior epiphyseal rim had influence on the development of CR. Targeted protection of the posterior margin of adjacent endplates, careful evaluation of intraoperative radiographs, and timely remedial measures may help to reduce the risks of CR.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares , Complicações Pós-Operatórias , Falha de Prótese/efeitos adversos , Fusão Vertebral , Espondilolistese , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Medição de Risco/métodos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
8.
J Pediatr Orthop ; 41(3): 133-137, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33448725

RESUMO

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


Assuntos
Cifose/cirurgia , Fusão Vertebral/métodos , Pré-Escolar , Humanos , Cifose/congênito , Anormalidades Musculoesqueléticas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Inquéritos e Questionários , Resultado do Tratamento
9.
Bone Joint J ; 102-B(11): 1560-1566, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135451

RESUMO

AIMS: To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). METHODS: We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. RESULTS: A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted. CONCLUSION: Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: Bone Joint J 2020;102-B(11):1560-1566.


Assuntos
Pinos Ortopédicos , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Fatores Etários , Criança , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem
10.
Medicine (Baltimore) ; 99(40): e22186, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019393

RESUMO

This study aimed to verify the relationship between the number of fusion level and the risk of screw loosening by using cortical bone trajectory (CBT) screws in patients with lumbar degenerative disease.We retrospectively reviewed the serial plain radiograph images of lumbar degenerative disease patients who had undergone posterior fixation and fusion surgery with CBT from 2014. All included patients should have been followed-up with computed tomography scan or plain radiograph for at least 6 months after operation. We individually evaluated the prevalence of screw loosening according to each vertebral level. We also determined whether the number of screw fixation affected the prevalence of screw loosening and whether S1 fixation increased the risk of screw loosening.The screw-loosening rates were high at the S1 level. Moreover, although fixation involved to S1, the loosening rates evidently increased (Fisher exact test, P = .002). The screw-loosening rate was 6.56% in 2 level fusion. However, it increased with the number of fusion levels (3 level: 25.00%, 4 level: 51.16%, and 5 level: 62.50%). To investigate if the number of fusion level affected the S1 screw loosening, we classified the cohort of patients into either involving S1 (S1+ group) or not (S1- group) according to different fusion levels (). The screw loosening between 2 group in 2 (5.56% vs 6.98%) and 3 fusion level (26.32% vs 22.73%) did not exhibit any significant difference. Interestingly, significantly high screw loosening was found in 4 fusion level (60.00% vs 15.38%), indicating that the higher fusion level (4 level) can directly increase the risk of S1 screw loosening.Our data confirmed that the screw-loosening rate increases rate when long segment CBT fixation involves to S1. Therefore, in case of long-segment fixation by using CBT screw, surgeons should be aware of the fusion level of S1.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fusão Vertebral/instrumentação , Osso Cortical/diagnóstico por imagem , Análise de Falha de Equipamento/métodos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Clinics (Sao Paulo) ; 75: e1824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935824

RESUMO

OBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Sacro , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Criança , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Zhonghua Wai Ke Za Zhi ; 58(9): 707-712, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878418

RESUMO

Objective: To evaluate the feasibility of placement of S(2) alar iliac screw (S(2)AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods: Eighteen patients with Lumbar Degenerative Scoliosis treated by S(2)AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People's Liberation Army and Department of Orthopedics, 89th hospital of People's Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C(7) plumb line -center sacral vertical line (C(7)PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S(2)AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results: All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° (t=41.142, P<0.01) and C(7)PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm (t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° (t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° (t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° (t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° (t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm (t=3.052, P=0.01) .ODI decreased from 0.58(0.40) (M(Q(R))) to 0.18 (0.15) (Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S(2)AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions: Free-hand technique of S(2)AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S(2)AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.


Assuntos
Ílio/cirurgia , Sacro/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Idoso , Animais , Parafusos Ósseos , Estudos de Viabilidade , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(35): e22026, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871958

RESUMO

BACKGROUND: The objective of this meta-analysis was to summarize and identify the available evidence from these studies to estimate which device was better for multilevel cervical spondylotic myelopathy (MCSM). And provides clinicians with evidence on which to base their clinical decision making. METHODS: This review will include all studies comparing the new Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion (ACDF) for the treatment of MCSM. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the July, 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is operative time, blood loss, clinical function outcome, radiologic outcomes, and complications. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS: This study will summarize current evidence to assess the efficacy and safety of Zero-profile versus cage-plate interbody fusion system in ACDF for the treatment of MCSM. CONCLUSION: The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as comparing the 2 devices in ACDF for MCSM REGISTRATION NUMBER:: INPLASY202070095 (DOI number: 10.37766/inplasy2020.7.0095).


Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
14.
Spine (Phila Pa 1976) ; 45(15): E892-E902, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675599

RESUMO

STUDY DESIGN: A multicenter, randomized, open-label, parallel-group trial. OBJECTIVE: To investigate interbody bone fusion rates in titanium-coated polyetheretherketone (TiPEEK) and polyetheretherketone (PEEK) cages after posterior lumbar interbody fusion (PLIF) surgery. SUMMARY OF BACKGROUND DATA: Previous clinical studies have not revealed any significant difference in bone fusion rates between TiPEEK and PEEK cages. METHODS: During one-level PLIF surgery, 149 patients (84 men, 65 women, mean age 67 yr) were randomly allocated to use either a TiPEEK cage (n = 69) or PEEK cage (n = 80). Blinded radiographic evaluations were performed using computed tomography and assessed by modified intention-to-treat analysis in 149 cases and per-protocol analysis in 143 cases who were followed for 12 months. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Oswestry Disability Index. RESULTS: The interbody union rate at 12 months after surgery was 45% owing to a very strict definition of bone fusion. The rates of bone fusion were significantly higher at 4 and 6 months after surgery in the TiPEEK group than in the PEEK group in the unadjusted modified intention-to-treat analysis and were significantly higher at 6 months in the unadjusted per-protocol analysis. Binary logistic regression analysis adjusted for sex, age, body mass index, bone mineral density, and surgical level showed that using a TiPEEK cage (odds ratio, 2.27; 95% confidence interval: 1.09-4.74; P = 0.03) was independently associated with bone fusion at 6 months after surgery. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Oswestry Disability Index results improved postoperatively in both groups. CONCLUSION: Using the TiPEEK cage for PLIF enabled the maintenance of better bone fusion to the endplate than using the PEEK cage at 6 months after the surgery. Our findings suggest the possibility of an earlier return to rigorous work or sports by the use of TiPEEK cage. LEVEL OF EVIDENCE: 1.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Fixadores Internos , Cetonas/administração & dosagem , Vértebras Lombares/cirurgia , Polietilenoglicóis/administração & dosagem , Fusão Vertebral/métodos , Titânio/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Lactente , Fixadores Internos/tendências , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fusão Vertebral/instrumentação
15.
Jt Dis Relat Surg ; 31(2): 201-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584715

RESUMO

OBJECTIVES: This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann's kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. PATIENTS AND METHODS: This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. RESULTS: There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. CONCLUSION: The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.


Assuntos
Parafusos Pediculares , Implantação de Prótese/instrumentação , Doença de Scheuermann/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Feminino , Humanos , Masculino , Parafusos Pediculares/efeitos adversos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Doença de Scheuermann/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Spine Deform ; 8(5): 1117-1130, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32451975

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVES: To assess final outcomes in patients with early-onset scoliosis (EOS) who underwent growth-preserving instrumentation (GPI). Various types of growth-preserving instrumentation (GPI) are frequently employed, but until recently had not been utilized long enough to assess final outcomes. METHODS: GPI "graduates" with multi-level congenital curves were identified. Graduation was defined as a final fusion or 5 years of follow-up without planned future surgeries. Outcomes included radiographic parameters and complications. RESULTS: 26 patients were included. 11 had associated diagnoses; eight had fused ribs. 17 were treated with traditional growing rods, seven with vertically expandable prosthetic ribs, and two with Shilla procedures. The mean GPI spanned 12.3 levels including 10.7 motion segments, age at index surgery was 5.5 years, treatment spanned 7.5 years, and follow-up was 9.2 years. 24 patients underwent final fusion. Mean major curve decreased from 73° to 49° with index surgery (p < 0.01) and remained unchanged through a final follow-up. Final major curve was < 40° in 9 patients (35%), 40°-60° in 11 patients (42%), and > 60° in 6 patients (23%). None worsened throughout treatment. Mean T1-T12 height increased 2.4 cm with index surgery (p = 0.02) and 5.4 cm total (p < 0.01). T1-T12 height increased in all patients and was ultimately < 18 cm in 10 patients (38%), 18-22 cm in 10 patients (38%), and > 22 cm in 6 patients (23%). On average, there were 2.6 complications per patient, including 1.7 implant failures. 12 patients (46%) experienced ≥ 3 complications; four patients (15%) experienced none. CONCLUSION: We observed successful prevention of deformity progression but substantial residual deformity among GPI graduates with multi-level congenital EOS. Most coronal curve correction was attained during GPI implantation; thoracic height improved throughout treatment. While some favorable results were found, treatment strategies allowing improved deformity correction would be valuable for this challenging population. LEVEL OF EVIDENCE: Therapeutic-III.


Assuntos
Anormalidades Múltiplas , Desenvolvimento Ósseo , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Vértebras Torácicas/crescimento & desenvolvimento , Vértebras Torácicas/cirurgia , Adolescente , Idade de Início , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
17.
Spine Deform ; 8(5): 1131-1134, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32451977

RESUMO

STUDY DESIGN: Case report and review of literature. OBJECTIVE: To illustrate the importance of "dynamic spinal cord mapping" (DSCM) in locating the site of neurophysiologic data loss during severe spinal deformity correction. During marked correction of severe spinal deformities, intra-operative neuromonitoring remains of paramount importance. This case illustrates the importance of a unique type of monitoring, particularly useful when obtaining correction at multiple sites. METHODS: A patient with symptomatic, progressive, severe kyphoscoliosis underwent multiple periapical posterior column osteotomies, partial T8 and complete T9 vertebral column resections and T2 to L3 posterior segmental instrumented fusion. During correction maneuvers, complete loss of spinous process descending neurogenic evoked potentials occurred. A flexible epidural catheter was placed at different spinal levels to dynamically stimulate the spinal cord and map out the site of data loss corresponding to the area of neural compromise. RESULTS: Using DSCM, the site of data loss was identified to the apex of the proximal thoracic region cephalad to the VCR site. This was rectified by releasing correction at the proximal end of the construct, and neurophysiologic data promptly returned to baseline. Postoperatively the patient was neurologically intact. CONCLUSION: Dynamic spinal cord mapping helps map areas of neurophysiologic data loss permitting focused attention to the site of compromise to reverse the offending agent. This improves the chance for return of baseline data, avoiding the potential for permanent neurologic catastrophe for the patient. LOE: IV.


Assuntos
Monitorização Neurofisiológica Intraoperatória/métodos , Cifose/cirurgia , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Medula Espinal/fisiologia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Cateteres , Espaço Epidural , Potenciais Evocados , Feminino , Humanos , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Índice de Gravidade de Doença , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Resultado do Tratamento
18.
Spine Deform ; 8(5): 983-989, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32405718

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To validate whether fusions that end proximal to the sagittal stable vertebrae are at risk for developing distal junctional kyphosis in adolescent idiopathic scoliosis. BACKGROUND: Posterior spinal fusion is routinely used for the treatment of patients with adolescent idiopathic scoliosis. Fusions that end in either the lower thoracic or upper lumbar spine have the advantage of preserving motion segments. However, fusions ending proximal to the sagittal stable vertebrae has been shown to be at higher risk for developing distal junctional kyphosis. METHODS: A multi-center database of prospectively enrolled subjects was queried for patients with adolescent idiopathic scoliosis that had Lenke type 1, 2 and 3 curves treated with posterior pedicle screw instrumentation. PA (posterior-anterior) and lateral full-length scoliosis films were obtained on each patient. PA radiographs were viewed to determine the coronal deformity and lateral radiographs to determine the sagittal deformity. Distal junctional kyphosis was defined as a greater than 10° increase in segmental kyphosis between the LIV and the LIV + 1 vertebra. RESULTS: 346 patients were included with 85% being female and mean age of cohort 14.2 [Formula: see text] 2.08 years. At 5 years postoperatively, there was significant difference occurrence of distal junctional kyphosis dependent on whether the LIV relative to SSV with only 2.2% of fusions below the SSV developing DJK compared to 6.5% for fusions ending at the SSV and 15% for fusions with LIV above the SSV (p < 0.001). There was no statistical difference in revision rates based on the relationship of LIV to SSV. CONCLUSION: There is an increased risk for development of DJK in patients with AIS treated with posterior fusion where the LIV was chosen proximal to the SSV. LEVEL EVIDENCE: Level III.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Estudos de Coortes , Feminino , Humanos , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Risco , Escoliose/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/diagnóstico por imagem
19.
Spine Deform ; 8(5): 1059-1067, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32378040

RESUMO

STUDY DESIGN: Multicenter retrospective. OBJECTIVE: To determine the long-term complication rate associated with surgical treatment of spondylolisthesis in adolescents. There is limited information on the complication rate associated with posterior spinal fusion (PSF) of spondylolisthesis in the pediatric and adolescent population. METHODS: Patients who underwent PSF for spondylolisthesis between 2004 and 2015 at four spine centers, < 21 years of age, were included. Exclusion criteria were < 2 years of follow-up or anterior approach. Charts and radiographs were reviewed. RESULTS: 50 patients had PSF for spondylolisthesis, 26 had PSF alone, while 24 had PSF with trans-foraminal lumbar interbody fusion (TLIF). Mean age was 13.9 years (range 9.6-18.4). Mean follow-up was 5.5 years (range 2-15). Mean preoperative slip was 61.2%. 20/50 patients (40%) experienced 23 complications requiring reoperation at a mean of 2.1 years (range 0-9.3) for the following: implant failure (12), persistent radiculopathy (3), infection (3), persistent back pain (2), extension of fusion (2), and hematoma (1). In addition, there were 22 cases of radiculopathy (44%) that were transient. Rate of implant failure was related to preoperative slip angle (p = 0.02). Reoperation rate and rates of implant failure were not associated with preoperative % slip (reoperation: p = 0.42, implant failure: p = 0.15), postoperative % slip (reoperation: p = 0.42, implant failure: p = 0.99), postoperative kyphosis of the lumbosacral angle (reoperation: p = 0.81, implant failure: p = 0.48), change in % slip (reoperation: p = 0.30, implant failure: p = 0.12), change in slip angle (reoperation: p = 0.42, implant failure: p = 0.40), graft used (reoperation: p = 0.22, implant failure: p = 0.81), or addition of a TLIF (reoperation: p = 0.55, implant failure: p = 0.76). CONCLUSION: PSF of spondylolisthesis in the adolescent population was associated with a 40% reoperation rate and high rate of post-operative radiculopathy. Addition of a TLIF did not impact reoperation rate or rate of radiculopathy.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiculopatia/epidemiologia , Radiculopatia/etiologia , Reoperação/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Adolescente , Criança , Falha de Equipamento , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Cifose/epidemiologia , Cifose/etiologia , Cifose/cirurgia , Masculino , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/cirurgia , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Fatores de Tempo , Resultado do Tratamento
20.
Spine Deform ; 8(4): 569-576, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32430793

RESUMO

STUDY DESIGN: Finite-element analysis. OBJECTIVES: Intraoperative contouring of rods is a common procedure for spine surgeons to match the native curvature of the spine, but it may lead to premature weakening of the rod. This study investigated the effect of different bending methods on rod fatigue performance. Rod failure in the cervical spine is of clinical concern, particularly when spanning the cervicothoracic region and when considering corrective osteotomies for deformity correction and global spinal alignment. METHODS: Finite-element models were developed to simulate rod bending (3.5 mm D, 40 mm L) to achieve a 23° angle with 3 different bending methods: French single, multiple bending, and in situ bending. Simulations were conducted in 4 steps: rod bending, rod spring back, residual stress relaxation, and F1717 mechanical test simulation. RESULTS: French single bending resulted in the highest residual stress concentrations for both titanium (TiAlV) and cobalt chrome (CoCr) at 783 MPa and 507 MPa, respectively. During F1717 test simulation, the French single bent rod had its highest tensile stress in the middle, with 917 MPa and 623 MPa, respectively, for TiAlV and CoCr, compared to in situ (580 MPa and 586 MPa for TiAlV and CoCr) and the French multiple bent rod (765 MPa and 619 MPa for TiAlV and CoCr). The computational model found that CoCr rods made the construct least prone to deformation. CONCLUSIONS: French single bend with TiAlV rods put the construct at highest risk of failure. CoCr rods led to minimal physical changes in microstructure while showing evidence of flattening.


Assuntos
Vértebras Cervicais/cirurgia , Fixadores Internos , Fusão Vertebral/instrumentação , Fenômenos Biomecânicos , Ligas de Cromo , Simulação por Computador , Análise de Elementos Finitos , Humanos , Microscopia Eletrônica de Varredura , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio
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