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1.
Med Sci Monit ; 26: e921507, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196483

RESUMO

BACKGROUND We compared the clinical and radiographic outcomes between interface fixation using absorbable screws and plate fixation in anterior cervical corpectomy and fusion (ACCF) to evaluate the effectiveness of these 2 fixation methods for the treatment of 2-level cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS From January 2014 to December 2016, a total of 220 patients who received 2-level ACCF were retrospectively collected. Among them, 108 patients were treated with interface fixation using absorbable screws (Group A) and 112 patients underwent plate fixation (Group B). Japanese Orthopedic Association (JOA) score and Neck Disability Index (NDI) score were employed to compare the clinical improvement. Operative time, blood loss, surgical cost, cervical lordosis, complications, and fusion rate were also evaluated. RESULTS The average follow-up time were 35.2±4.5 months in Group A and 35.9±3.9 months in Group B. There was no difference in operative time and blood loss for both groups. The JOA scores and NDI scores were similar in each follow-up (p>0.05 in all). Group A cost an average of 30% less than Group B for the operation. Both groups achieved 100% in the fusion rate with the same conditions in cervical lordosis. Group A (5/108) had a significantly lower complication rate than Group B (17/112) (p<0.05). CONCLUSIONS ACCF with interface fixation using absorbable screws achieved similar clinical outcomes compared to ACCF with plate fixation for 2-level CSM. Moreover, the interface fixation using absorbable screws presented far fewer complications and cost less for the operation.


Assuntos
Parafusos Ósseos , Discotomia/instrumentação , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Vertebroplastia/instrumentação , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fusão Vertebral/métodos , Espondilose/diagnóstico por imagem , Vertebroplastia/métodos
2.
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
3.
World Neurosurg ; 133: e653-e657, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568918

RESUMO

BACKGROUND: The C1 lateral mass and C2 pedicle screw with rod fixation system has been used commonly in recent years. Despite the numerous reports on this technique in the literature, there are no studies regarding the effect of the angle of the rod used. We investigated the effect of rod angle on subaxial lordosis, cervical sagittal balance, and pain scores. METHODS: Clinical records and radiologic images of 58 patients who underwent procedures between 2011 and 2016 at our clinic were assessed retrospectively. We recorded clinical findings, visual analog scale (VAS) scores, angles of cervical and segmental lordosis, and the distance between the C2 sagittal vertical axis (SVA) and the C7 posterior-superior corner. RESULTS: A total of 36 male and 22 female patients were enrolled. A negative correlation was found between the C1-C2 lordosis angle and the C2-C7 lordosis angle irrespective of surgical technique. In patients who were operated on using 30°-angled rods, there was a postoperative increase in C1-C2 lordosis degree and an improvement in C2 cervical SVA values. Postoperative month 6 VAS scores were significantly better in the patients who were operated on with angled rods compared with those who received straight rods. CONCLUSIONS: We believe this is because of the positive effect of the angled rod on sagittal balance. Nevertheless, prospective case-control studies should be conducted with larger groups of subjects. Furthermore, every patient should be evaluated considering the whole spinal sagittal balance.


Assuntos
Articulação Atlantoaxial/cirurgia , Pinos Ortopédicos , Lordose , Fusão Vertebral/instrumentação , Adulto , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/cirurgia , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Estudos Retrospectivos , Resultado do Tratamento
4.
World Neurosurg ; 133: e745-e750, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605853

RESUMO

BACKGROUND: Minimally invasive fusion of the sacroiliac (SI) joint has gained popularity for the treatment of refractory dysfunction. The purpose of this study was to compare the clinical outcomes of minimally invasive SI joint fusion between cylindrical threaded implants (CTIs) and triangular dowel implants (TDIs). METHODS: We retrospectively reviewed consecutive patients who underwent SI joint fusions with either CTIs or TDIs. Data collected included patient demographics, perioperative data, and all patient-reported outcomes (PROs) including postoperative visual analog scale (VAS), Oswestry Disability Index, and Short Form-12 at 6 months and 1 year. The change from baseline PROs between the cohorts was analyzed as the primary outcome. Secondary outcomes included revision rates and time to revision between the two cohorts. A P value <0.05 was considered significant. RESULTS: One hundred fifty-six consecutive patients underwent SI joint fusion, 74 patients with CTIs and 82 with TDIs. There was a significant difference in procedure length with CTI averaging 60.0 minutes (confidence interval: 55.7-64.3) and TDI averaging 41.2 minutes (confidence interval: 38.4-43.9, P < 0.0005). In both cohorts, there was a significant improvement in all PROs at 6 months when compared with preoperative values. However, when compared, there was no significant difference between the cohorts at 6-month follow-up or 1-year follow-up for either VAS-back, VAS-leg, Oswestry Disability Index, or Short Form-12. A 6.1% revision rate in the CTI cohort was observed compared with a 2.4% revision rate in the TDI cohort (P = 0.11). CONCLUSIONS: SI joint fusions with TDI or CTI offer a significant improvement in pain, disability, and quality of life. However, no difference was observed between devices to suggest superior clinical outcomes. Increased revision rates in the Rialto group warrants further investigation.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Articulação Sacroilíaca/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Próteses e Implantes , Estudos Retrospectivos , Titânio , Resultado do Tratamento
5.
World Neurosurg ; 133: e452-e458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526879

RESUMO

OBJECTIVE: The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage. METHODS: Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far. RESULTS: Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups. CONCLUSIONS: The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Adulto , Idoso , Antropometria , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Radiculopatia/epidemiologia , Amplitude de Movimento Articular , Fatores de Risco , Ciática/epidemiologia , Ciática/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia
6.
Bone Joint J ; 101-B(12): 1526-1533, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786998

RESUMO

AIMS: Chronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF). PATIENTS AND METHODS: A total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables. RESULTS: The number of patients with additional surgery were 32/183 (17%) in the PLF group, 229/1256 (18%) in the IPLF group, and 439/1435 (31%) in the IBF group. With the PLF group as a reference, the hazard ratio for additional lumbar surgery was 1.16 (95% confidence interval (CI) 0.78 to 1.72) for the IPLF group and 2.13 (95% CI 1.45 to 3.12) for the IBF group. All patient-reported outcomes improved after surgery (p < 0.001) but were without statistically significant differences between the groups at the one-, two- and 6.9-year follow-ups (all p ≥ 0.12). CONCLUSION: The addition of interbody fusion to posterolateral fusion was associated with a higher risk for additional surgery and showed no advantages in patient-reported outcome Cite this article: Bone Joint J 2019;101-B:1526-1533.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Reoperação , Fusão Vertebral/instrumentação , Resultado do Tratamento
7.
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
8.
BMC Musculoskelet Disord ; 20(1): 451, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615503

RESUMO

BACKGROUND: To compare the imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod. METHODS: Thirty-seven patients suffering from atlantoaxial dislocation underwent posterior reduction and internal fixation by pedicle screw and rod. We measured pre-operative and post-operative atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), sum of lateral mass interspace (SLMI) of the operation and the control group. ADI, CCA, CMA, and SLMI between the pre-operative and post-operative conditions of the operation group and the control group were compared. RESULTS: The ADI, CCA, CMA, and SLMI in the pre-operative condition of the operation group were 8.3 ± 4.3 mm, 130.2 ± 14.2°, 133.8 ± 16.7°, and 3.7 ± 1.3 mm, respectively, those in the post-operative condition of the operation group were 1.0 ± 0.9 mm, 148.5 ± 9.4°, 156.0 ± 8.2°, and 8.0 ± 2.7 mm, respectively, while those in the control group were 1.2 ± 0.3 mm, 152.7 ± 5.3°, 160.2 ± 6.3°, and 4.5 ± 1.0 mm respectively. Post-operative ADI, CCA, CMA, and SLMI were statistically different (p < 0.01) from pre-operative assessments. The SLMI has no significant difference between the pre-operative condition and the control group. Post-operative SLMI was statistically different from that of the control group. CONCLUSIONS: The lateral mass joints were widened after the anatomical reduction of atlantoaxial dislocation by pedicle screw and rod. Widening of the lateral mass exists in both atlantoaxial fusion and occipital-cervical fusion.


Assuntos
Articulação Atlantoaxial/lesões , Fixação Interna de Fraturas/instrumentação , Luxações Articulares/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Criança , Estudos Transversais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1151-1155, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512458

RESUMO

Objective: To investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up. Methods: A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C 4, 5, C 5, 6 in 12 cases and C 5, 6, C 6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C 2-C 7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence. Results: No complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up ( P<0.05), but there was no significant difference between 1 week after operation and last follow-up ( P>0.05). Conclusion: The application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.


Assuntos
Cetonas , Polietilenoglicóis , Fusão Vertebral , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Cetonas/normas , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/normas , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Resultado do Tratamento
11.
World Neurosurg ; 132: 273-281, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521758

RESUMO

OBJECTIVE: Although many risk factors for cage retropulsion (CR) after lumbar interbody fusion (LIF) have been described in the literature, they still remain controversial. The purpose of this study is to investigate the risk factors for CR after LIF. METHODS: The literature was searched in PubMed, Cochrane library, and Embase from October 2000 to October 2018. The key words and combinations used in the search included LIF, cage, retropulsion, posterior migration, and risk factors. Only studies with sufficient data to calculate odds ratio for CR were included. Odds ratio and 95% confidence interval were calculated for outcomes via RevMan5.3 and SPSS 22.0. RESULTS: A total of 10 studies were included in this study. Twelve risk factors were assessed by analyzing 4467 patients. The pooled results indicated that a pear-shaped disk and straight cage were significant risk factors for CR. However, factors that had no significant relation with CR were preoperative diagnosis (disk herniation, spinal stenosis, and spondylolisthesis); gender; surgical segments (from L2 to S1); multilevel fusion; and unilateral pedicle screws fixation. CONCLUSIONS: According to current evidence, a pear-shaped disk and straight cage are significant risk factors for CR. However, preoperative diagnosis, gender, multilevel fusion, surgical segments, and unilateral pedicle screws fixation are not the risk factors associated with CR. A revision surgery is needed when neurologic symptoms happen after CR. The conclusion should be consulted cautiously due to the limited number of included studies. Therefore larger-scale studies are still needed to investigate the risk factors for CR.


Assuntos
Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Fusão Vertebral/instrumentação , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Parafusos Pediculares , Reoperação , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia
12.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
13.
World Neurosurg ; 132: e333-e340, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476458

RESUMO

OBJECTIVE: We evaluated the technical feasibility and potential advantages of transcranial insertion of an atlas screw for atlantoaxial fixation. METHODS: From January 2016 to August 2018, the transcranial technique for atlas screw insertion was used in 6 patients. Conventional lateral mass atlantoaxial fixation was not possible because of the presence of a complex craniovertebral junctional abnormality and difficulty in direct exposure of the facet of the atlas. In all cases, severe basilar invagination and assimilation of the atlas was present. Of the 6 patients, 3 were male and 3 were female. The age range was 12-41 years (average, 23 years). The surgical technique involved a small suboccipital craniotomy in line with the facet of the axis. Extradural elevation of the cerebellum exposed the region of the occipital condyle and fused atlas. The screw was directed medially and inferiorly into the facet of the atlas. RESULTS: In all 6 patients, strong and successful atlantoaxial fixation was achieved. All patients showed clinical improvement after surgery. At an average follow-up period of 21 months, successful arthrodesis of atlantoaxial joint had been achieved in all 6 patients, with no complications. CONCLUSIONS: Transcranial insertion of atlas screw can be used as a salvage procedure when the conventional method of screw insertion is not possible because of technical difficulties.


Assuntos
Articulação Atlantoaxial/cirurgia , Craniotomia/métodos , Fusão Vertebral/métodos , Adolescente , Adulto , Articulação Atlantoaxial/anormalidades , Parafusos Ósseos , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Fusão Vertebral/instrumentação , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia , Adulto Jovem
14.
World Neurosurg ; 132: e193-e201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493594

RESUMO

OBJECTIVE: To evaluate the effect of screw-rod fixation and selective axial loosening in the treatment of atlantoaxial instability or dislocation (including reducible and irreducible) caused by os odontoideum (OO) via a single posterior approach. METHODS: A consecutive series of patients with OO surgically treated in our hospital were retrospectively analyzed. For atlantoaxial instability and reducible atlantoaxial dislocation, C1-C2 screw-rod fixation and fusion were performed. OO combined with irreducible atlantoaxial dislocation was reduced after posterior axial loosening, followed by screw-rod fixation and fusion. The general information, clinical data, and radiographic data were compared between the 2 different procedures. RESULTS: There were 41 patients with an average age of 40.6 ± 21.7 years. All the patients underwent posterior reduction and C1-2 screw rod fixation, 6 with axial loosening and 35 without axial loosening. The clinical manifestations and radiographic data significantly improved after the operation with a low rate of complications. Except for clivus-canal angle and visual analogue score of cervical pain, there were no differences in clinical and radiographic data between the 2 procedures. CONCLUSIONS: Posterior screws-rod fixation and selective axial loosening is appropriate for treating OO complicated with atlantoaxial instability or dislocation (including reducible and irreducible) without the need for anterior decompression.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebra Cervical Áxis/cirurgia , Fusão Vertebral/métodos , Adulto , Parafusos Ósseos , Criança , Feminino , Humanos , Fixadores Internos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Processo Odontoide/patologia , Processo Odontoide/cirurgia , Estudos Retrospectivos , Fusão Vertebral/instrumentação
15.
Clin Orthop Surg ; 11(3): 291-296, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475049

RESUMO

Background: The purpose of this study was to determine whether restoration of range of motion (ROM) could be achieved by implant removal after natural bone healing and consolidation of fractured vertebrae and examine whether early removal of the implant could maximize restoration of ROM. Methods: This study included 30 cases of thoracolumbar fractures without neurological deficit requiring surgery (nine cases of flexion-distraction injuries and 21 cases of burst fractures). Percutaneous pedicle screw fixation (PPSF) was performed at the fractured vertebrae and one level above and one level below the fracture level. Pedicle screws were removed at an average of 12 months after surgery upon healing of fractured vertebrae. The following radiological and clinical findings were evaluated: restoration of anterior vertebral height ratio (AVHR), Cobb angle (CA), ROM, and complications. Sixteen patients who were checked for ROM were divided into two groups based on the time of implant removal: nine patients within 12 months and seven patients after 12 months. Restoration of vertebral height loss and ROM were compared between the two groups. Results: At the final follow-up, significant pain relief and restoration of AVHR and CA were achieved in patients who underwent PPSF. Patients who had implant removed within 12 months after surgery had better ROM recovery than those who had implant removed after 12 months postoperatively. There were no significant differences in AVHR and CA between the two groups. Conclusions: PPSF followed by implant removal after healing of fractured body appears to be effective in achieving restoration of ROM. In our study, early removal of implant within 12 months after surgery was associated with better achievement of ROM than removal after 12 months. In addition, there were no significant differences in restoration of vertebral height between the two groups.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Idoso , Remoção de Dispositivo , Feminino , Consolidação da Fratura , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Fraturas da Coluna Vertebral/fisiopatologia , Fusão Vertebral/métodos , Vértebras Torácicas/lesões , Vértebras Torácicas/fisiopatologia , Fatores de Tempo , Adulto Jovem
16.
BMC Musculoskelet Disord ; 20(1): 405, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484526

RESUMO

BACKGROUND: Postoperative neck tilt (PNT) is a phenomenon in adolescent idiopathic scoliosis (AIS) patients which is distinct form shoulder imbalance. There were scarce studies performed to explore the risk factors for PNT in Lenke 1 and 2 AIS patients, and whether it can be predicted after surgery remains unknown. The objective of this study is to explore the prevalence and risk factors for PNT, and introduce an index for prediction of PNT in Lenke 1 and 2 AIS patients after correction surgery. METHODS: Medical records of Lenke 1 and 2 AIS patients who received correction surgery were reviewed from February 2013 to February 2015. Posteroanterior films were evaluated before surgery and at 2 years' follow-up. Patients were divided into two groups according to whether PNT occurred at the 2 years' follow-up. Risk factors of PNT were analyzed, and PNT Index was proposed and verified. RESULTS: One hundred two Lenke 1 and 2 AIS patients were recruited in this study. The prevalence of PNT after correction was 40.2%. According to the postoperative CAT (Cervical Axis Tilt), patients were divided into two group: PNT group (CAT≧5°, n = 41) and non-PNT group (CAT< 5°, n = 61). Postoperative T1 tilt, preoperative proximal thoracic curve (PTC), postoperative PTC and postoperative coronal balance (CB) were significantly different between two groups. Logistic regression showed that postoperative PTC and postoperative CB were the primary risk factors for PNT, which could be predicted by the regression equation: PNT Index = 1.1 x postoperative PTC (degrees) - 0.9 x postoperative CB (millimeters). On the basis of ROC curve, if PNT Index was more than 10, the occurrence rate of PNT was 86%. On the contrary, the rate of no PNT phenomenon was 80%. CONCLUSION: Postoperative PTC and postoperative CB were the important factors for PNT in Lenke 1 and 2 AIS patients. Sufficient correction of PTC and moderate correction of CB should be recommended when operating on Lenke1 and 2 AIS patients.


Assuntos
Pescoço/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Parafusos Pediculares , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Equilíbrio Postural/fisiologia , Período Pré-Operatório , Prevalência , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Resultado do Tratamento , Adulto Jovem
17.
J Orthop Surg Res ; 14(1): 304, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488181

RESUMO

BACKGROUND: Lateral lumbar interbody fusion (LLIF) and bilateral percutaneous pedicle fixation are valuable, minimally invasive lateral approaches used to treat symptomatic degenerative disc disease. In the current procedure, the patient's position on the operating table is changed after LLIF surgery from the lateral decubitus to the prone position. The ability to perform both approaches with the patient in the same position should reduce operation time. Use of a guide wire is problematic during percutaneous pedicle screw (PPS) insertion using fluoroscopy with the patient in the lateral decubitus position. A new guide wire-less PPS system may solve this problem and reduce operation time. Here, we evaluated the operative data and efficacy for this technique. METHODS: This study included 30 patients (aged 70.8 ± 8.5 years; 17 men, 13 women) who underwent a combined operation (indirect decompression) using extreme lateral interbody fusion (XLIF) with only a single level for lumbar spinal canal stenosis and lumbar degenerative spondylolisthesis. Patient demographics and operative data were compared between two groups: patients who remained in the lateral decubitus position for pedicle screw fixation (L group) and those turned to the prone position (P group). Radiographic assessment was performed using pre- and postoperative anteroposterior and lateral lumbar films with measurement of lumbar lordosis, segmental lordosis, and segmental translation. RESULTS: We analyzed 18 patients in the P group and 12 in the L group. Age, sex, height, body weight, body mass index, estimated blood loss, and length of stay did not differ between groups. The operation time was 34 min shorter for the L group (P group 111.9 ± 25.0 vs. L group 77.5 ± 22.2 min, p < 0.01). Pre- and postoperative lordosis, segmental lordosis, and segmental translation did not differ significantly between groups. CONCLUSIONS: A single position after XLIF surgery is a feasible modification to the standard procedure when used with fluoroscopy and a guide wire-less PPS system. The time saved is the main advantage of inserting the PPS with the patient in the lateral decubitus position without repositioning. Use of the lateral PPS with a guide wire-less technique may help improve operative efficiency and reduce cost.


Assuntos
Fios Ortopédicos , Posicionamento do Paciente/métodos , Parafusos Pediculares , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação
18.
Zhonghua Wai Ke Za Zhi ; 57(10): 63-68, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510735

RESUMO

Objective: To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Methods: Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test. Results: The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(t=6.2,P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. Conclusions: The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.


Assuntos
Articulação Atlantoaxial/cirurgia , Descompressão Cirúrgica/métodos , Luxações Articulares/cirurgia , Platibasia/cirurgia , Fusão Vertebral/métodos , Adolescente , Adulto , Idoso , Vértebras Cervicais/anormalidades , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Luxações Articulares/complicações , Masculino , Pessoa de Meia-Idade , Osso Occipital/anormalidades , Osso Occipital/cirurgia , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Adulto Jovem
19.
J Pediatr Orthop ; 39(8): 400-405, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393297

RESUMO

BACKGROUND: The Shilla procedure was designed to correct and control early-onset spinal deformity while harnessing a child's remaining spinal growth. It allows for controlled axial skeletal growth within the construct, avoiding the need for frequent surgeries to lengthen implants. We hypothesized that curve characteristics evolve over time after initial apex fusion and placement of the Shilla implants. The purpose of this study was to identify trends in curve evolution after Shilla implantation and understand how these changes influence ultimate outcome. METHODS: A single-center, retrospective review of all patients with Shilla implants in place for ≥5 years yielded 21 patients. Charts and radiographs were reviewed to compare coronal curve characteristics preoperatively, postoperatively, and at last follow-up to note changes in the apex of the primary curve. Also noted were the development of adjacent compensatory curves, the overall vertical spinal growth, and the need for definitive spinal fusion once skeletal maturity was reached. RESULTS: Of the 21 patients, the curve apex migrated caudally in 12 patients (57%) and cephalad in 1 patient (5%), with a mean migration of 2.7 vertebral levels. Two patients (10%) developed new, significant compensatory curves (1 caudal and 1 cephalad). All patients demonstrated spinal growth in T1-S1 length following index surgery (mean, 45 mm). At skeletal maturity, 10 patients underwent definitive posterior spinal fusion and instrumentation, and 3 underwent implant removal alone. CONCLUSIONS: This study constitutes the longest follow-up of Shilla patients evaluating curve and implant behavior. Results of this review suggest that the apex of the fused primary curve shifts in approximately 62% of patients, with nearly all of these (92%) involving a distal migration. Compensatory curves did develop after Shilla placement as well. Overall, these findings represent adding-on distal to the apex after Shilla instrumentation rather than a crankshaft phenomenon about the apex. A better understanding of spinal growth mechanics and outcomes after Shilla placement may improve our ability to appropriately select patients and instrumentation levels. LEVEL OF EVIDENCE: Level III.


Assuntos
Escoliose , Fusão Vertebral , Coluna Vertebral , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Próteses e Implantes , Radiografia/métodos , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Resultado do Tratamento
20.
World Neurosurg ; 132: 421-428.e1, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31398524

RESUMO

BACKGROUND: Grade II spondylolisthesis remains a complex surgical pathology for which there is no consensus regarding optimal surgical strategies. Surgical strategies vary regarding extent of reduction, use of instrumentation/interbody support, and anterior versus posterior approaches with or without decompression. Here we provide the first report on the efficacy of robotic spinal surgery systems in support of the treatment of grade II spondylolisthesis. METHODS: Using 2 illustrative cases, we provide a technical report describing how robotic spinal surgery platform can be used to treatment grade II spondylolisthesis with a novel instrumentation strategy. RESULTS: We describe how the "reverse Bohlman" technique to achieve a large anterior fusion construct spanning the pathological level and buttressed by the adjacent level above, coupled with a novel, high-fidelity posterior fixation scheme with transdiscal S1-L5 and S2 alar iliac (S2AI) screws placed in a minimally invasive fashion with robot guidance allows for the best chance of fusion in situ. CONCLUSIONS: The reverse Bohlman technique coupled with transdiscal S1-L5 and S2AI screw fixation accomplishes the surgical goals of creating a solid fusion construct, avoiding neurologic injury with aggressive reduction, and halting the progression of anterolisthesis. The use of robot guidance allows for efficient placement of these difficult screw trajectories in a minimally invasive fashion.


Assuntos
Parafusos Ósseos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Coluna Vertebral/cirurgia , Espondilolistese/cirurgia , Idoso , Feminino , Humanos , Fixadores Internos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Sacro/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Espondilolistese/diagnóstico por imagem , Resultado do Tratamento
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