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1.
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
2.
Medicine (Baltimore) ; 99(33): e20955, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871974

RESUMO

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ±â€Š10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.


Assuntos
Discotomia , Laminoplastia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Tempo de Internação , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos , Resultado do Tratamento
3.
Bone Joint J ; 102-B(10): 1368-1374, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993336

RESUMO

AIMS: Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann's kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion. METHODS: A retrospective review of patients treated surgically for Scheuermann's kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples t-tests, and z-tests of proportions analyses where applicable. RESULTS: There were six postoperative infections in the two-stage anteroposterior group compared with three in the one-stage posterior-only group. A total of four patients in the anteroposterior group required revision surgery, compared with six in the posterior-only group. There was a significantly higher incidence of junctional failure associated with the one-stage posterior-only approach (12.9% vs 0%, p = 0.036). Proximal junction kyphosis (anteroposterior fusion (74.2%) vs posterior-only fusion (77.4%); p = 0.382) and distal junctional kyphosis (anteroposterior fusion (25.8%) vs posterior-only fusion (19.3%), p = 0.271) are common postoperative complications following both surgical approaches. CONCLUSION: A two-stage anteroposterior fusion was associated with a significantly greater correction of the kyphosis compared with a one-stage posterior-only fusion, with a reduced incidence of junctional failure (0 vs 3). There was a notably greater incidence of infection with two-stage anteroposterior fusion; however, all were medically managed. More patients in the posterior-only group required revision surgery. Cite this article: Bone Joint J 2020;102-B(10):1368-1374.


Assuntos
Doença de Scheuermann/cirurgia , Fusão Vertebral/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doença de Scheuermann/diagnóstico por imagem
4.
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
5.
Medicine (Baltimore) ; 99(38): e21973, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957316

RESUMO

OBJECTIVE: The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. METHODS: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS: We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26-1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394-2.343), operative time (WMD: 80.399, 95%CI: 44.397-116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008-520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006-0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82-1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. CONCLUSION: Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação
6.
Medicine (Baltimore) ; 99(37): e22069, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925743

RESUMO

OBJECTIVE: Long-segment spinal fusion surgery was associated with substantial perioperative blood loss which may increase hospitalization expenses and mortality rates. Substantial studies have reported that tranexamic acid (TXA) could reduce blood products and cost after joint arthroplasty surgery. However, there still exists controversy regarding the efficacy of TXA in long-segment spinal fusion surgery. We performed this protocol to design a randomized controlled study to evaluate the efficacy of TXA in decreasing transfusion rate of allogeneic blood products and transfusion cost in degenerative lumbar scoliosis patients. METHODS: This study was carried out as a double-blinded, randomized clinical trial on patients with degenerative lumbar scoliosis who prepared for long-segment spinal fusion surgery from December 2018 to December 2019. It was authorized via the Institutional Review Committee in Southwest Medical University (ky2019225). Eighty patients were divided randomly into 2 groups (Experimental group = 40, control group = 40). The patients in the experimental group received 1000 mg of TXA mixed in 100 mL normal saline as a single dose intravenously over 20 minutes before the skin incision was made. Control group received equivalent normal saline without TXA. Primary outcomes included total blood loss, estimated intraoperative blood loss, hematocrit and hemoglobin decline, postoperative drain amount, intra-/postoperative allogeneic transfusion amount and rate, and total transfusion cost. Secondary outcomes included surgical time, thrombotic complications including deep vein thrombosis and pulmonary embolism. All the needed analyses were implemented through utilizing SPSS for Windows Version 20.0. RESULTS: Table showed the relevant clinical outcomes between experimental group and control group. CONCLUSION: We hypothesized that TXA was effective and safe in reducing blood transfusion and cost in long-segment spinal fusion surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5854).


Assuntos
Antifibrinolíticos/uso terapêutico , Transfusão de Sangue , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Ácido Tranexâmico/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/prevenção & controle , Embolia Pulmonar , Fusão Vertebral/efeitos adversos , Trombose Venosa
7.
Medicine (Baltimore) ; 99(37): e22145, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925770

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both the effective techniques in treatment of cervical spondylosis. The purpose of this present retrospective cohort research was to assess the efficacy and safety of ACDF and CDA in treating the symptomatic cervical spondylosis over the 6-year follow-up. METHODS: From our registry database, we identified retrospectively patients who received CDA or ACDF in our academic institutions from 2012 to 2015. The study was approved by the Institutional Review Board in Zigong No.4 People's Hospital (Z10058072). All the subjects who participated in this trial were informed consent in writing. The inclusion criteria were the degenerative disc diseases between C3-7 resulting in myelopathy or radiculopathy, which was unresponsive to the conservative treatment. The clinical results were determined via Short Form-36, and neck disability index, numerical scoring scales for complications, arm pain and neck pain. The radiographic assessment contained the cervical lordosis, and the motion range of the functional spinal unit and total cervical spine. The routine follow-up was performed to collect the data of radiographic and clinical assessment at 6, 12, 24, 48, and 72 months before and after the surgery. RESULTS: This study had limited inclusion and exclusion criteria and a well-controlled intervention. It was assumed that both techniques could obtain the similar postoperative effects. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5878).


Assuntos
Artroplastia/métodos , Discotomia/métodos , Fusão Vertebral/métodos , Espondilose/cirurgia , Humanos , Cervicalgia , Medição da Dor , Projetos de Pesquisa , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(32): e21720, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769940

RESUMO

The surgical treatment of congenital scoliosis under 10 years is difficult as it involves resecting vertebrae. Moreover, patient follow-up after surgery is extremely important because the patient is a child whose growth has not been completed. However, there are very few long-term follow-up studies after surgical treatment of congenital scoliosis. Therefore, this study is designed to evaluate surgical outcomes after posterior hemivertebra resection in children under 10 years and its long-term effects.Twenty-one patients with congenital scoliosis who were younger than 10 years at the time of the surgery and received posterior hemivertebra resection and fusion using pedicle screw fixation were included in this study.There were significant improvements in the main curve, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis after surgery (P < .001, .021, .047, .043, .006, respectively). Coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis remained within the normal range during the follow-up period; however, main curve deteriorated significantly (P = .005). Trunk appearance of perception scale improved significantly after surgery (P = .031) and was maintained during the follow-up period (P = .078).In conclusion, posterior hemivertebra resection and fusion using pedicle screw fixation in patients under 10 years old with congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction. Complete resection of the hemivertebra is important for deformity correction and prevention of curve progression, and careful long-term follow-up is necessary.


Assuntos
Escoliose/cirurgia , Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Fixadores Internos , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Escoliose/complicações , Escoliose/fisiopatologia , Curvaturas da Coluna Vertebral/classificação , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(30): e21221, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791696

RESUMO

To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS.From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up.The mean visual analog score for back pain decreased from 6.1 ±â€Š2.0 preoperatively to 2.1 ±â€Š0.7 at 2-year follow-up (P < .05), and the mean visual analog score for leg pain reduced from 8.1 ±â€Š0.6 preoperatively to 1.3 ±â€Š0.8 at 2-year follow-up (P < .05). The Oswestry disability index scores improved from 65.4 ±â€Š16.3% preoperatively to 18.3 ±â€Š5.6% at 2-year follow-up (P < .05). The mean Cobb angle was 22.1 ±â€Š6.2° preoperatively, and 13.8 ±â€Š6.8° at 2-year follow-up (P < .05). The lumbar lordosis changed from -40.4 ±â€Š14.8° to -43.5 ±â€Š11.2° at 2-year follow-up (P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well.The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.


Assuntos
Discotomia/métodos , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
10.
Bone Joint J ; 102-B(8): 1003-1009, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731818

RESUMO

AIMS: There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision. METHODS: Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis. RESULTS: Prior lumbar fusion surgery was associated with increased risk of prosthetic dislocation (hazard ratio (HR) = 2.393, p < 0.001) and revision (HR = 1.528, p < 0.001). Head components larger than 28 mm were associated with lower dislocation rates compared to the 28 mm head (32 mm: HR = 0.712, p < 0.001; 36 mm: HR = 0.700, p < 0.001; 38 mm: HR = 0.808, p < 0.140; and 40 mm: HR = 0.421, p < 0.001). Heads of 38 mm (HR = 1.288, p < 0.001) and 40 mm (HR = 1.367, p < 0.001) had increased risk of revision compared to the 28 mm head. CONCLUSION: Lumbar fusion surgery was associated with higher rate of hip prosthesis dislocation and higher risk of revision surgery. Femoral head component of 32 mm (or larger) associates with lower risk of dislocation in patients with previous lumbar fusion. Cite this article: Bone Joint J 2020;102-B(8):1003-1009.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Fusão Vertebral/efeitos adversos , Idoso , Artroplastia de Quadril/métodos , Estudos de Coortes , Feminino , Cabeça do Fêmur/cirurgia , Finlândia , Humanos , Estimativa de Kaplan-Meier , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fusão Vertebral/métodos , Resultado do Tratamento
11.
Bone Joint J ; 102-B(8): 1062-1071, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731831

RESUMO

AIMS: To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine. METHODS: A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion. RESULTS: The mean changes in segmental lordosis and global lordosis were 7.1° (SD 6.7°) and 2.9° (SD 9.9°) respectively for the interbody fusion group, and 0.8° (SD 5.1°) and -0.4° (SD 10.1°) respectively for the posterolateral fusion-only group. Segmental lordosis (ρ = 0.794, p < 0.001) corrected by interbody fusion correlated best with prone traction radiographs. Global lumbar lordosis (ρ = 0.788, p < 0.001) correlated best with the interbody fusion group and preoperative lateral standing radiographs. The least difference in slip distance (-0.3 mm (SD 1.7 mm), p < 0.001), slip angle (0.9° (SD 5.2°), p < 0.001), and disc height (0.02 mm (SD 2.4 mm), p < 0.001) was seen between prone traction and postoperative radiographs. Regression analyses suggested that prone traction parameters best predicted correction of slip distance (Corrected Akaike's Information Criterion (AICc) = 37.336) and disc height (AICc = 58.096), while correction of slip angle (AICc = 26.453) was best predicted by extension radiographs. Receiver operating characteristic (ROC) cut-off showed, with 68.3% sensitivity and 64.5% specificity, that to achieve a 3.0° increase in segmental lordotic angle, patients with a prone traction disc height of 8.5 mm needed an interbody fusion. CONCLUSION: Prone traction radiographs best predict the slip distance and disc height correction achieved by interbody fusion for lumbar degenerative spondylolisthesis. To achieve this maximum correction, interbody fusion should be undertaken if a disc height of more than 8.5 mm is attained on preoperative prone traction radiographs. Level of Evidence: Level II Prognostic Study Cite this article: Bone Joint J 2020;102-B(8):1062-1071.


Assuntos
Fusão Vertebral/métodos , Espondilolistese/diagnóstico por imagem , Espondilolistese/terapia , Tração/métodos , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Decúbito Ventral , Curva ROC , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Bone Joint J ; 102-B(8): 981-996, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731832

RESUMO

AIMS: Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. METHODS: Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom's criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger's and Begg's tests, meta-regression, and sensitivity analyses were performed. RESULTS: In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom's scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. CONCLUSION: Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981-996.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/métodos , Substituição Total de Disco/métodos , Adulto , Idoso , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Japão , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/cirurgia , Medição da Dor , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(28): e21064, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664123

RESUMO

BACKGROUND: Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement. METHODS: All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss. RESULTS: The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals. CONCLUSION: We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement. TRIAL REGISTRATION NUMBER: PROSPERO 2020 CRD42020172087.


Assuntos
Fluoroscopia/métodos , Parafusos Pediculares , Projetos de Pesquisa , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
14.
Medicine (Baltimore) ; 99(27): e20323, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629626

RESUMO

BACKGROUND: The goal of this study was to review relevant randomized controlled trials in order to determine the efficacy of decompression and lumbar interbody fusion in the treatment of lumbar spinal stenosis. METHOD: Using appropriate keywords, we identified relevant studies in PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through July 2019 were considered for inclusion. For each study, we assessed odds ratios, mean difference, and 95% confidence interval to assess and synthesize outcomes. RESULT: Twenty-one randomized controlled trials were eligible for this meta-analysis with a total of 3636 patients. Compared with decompression, decompression and fusion significantly increased length of hospital stay, operative time and estimated blood loss. Compared with fusion, decompression significantly decreased operative time, estimated blood loss and overall visual analogue scale (VAS) scores. Compared with endoscopic decompression, microscopic decompression significantly increased length of hospital stay, and operative time. Compared with traditional surgery, endoscopic discectomy significantly decreased length of hospital stay, operative time, estimated blood loss, and overall VAS scores and increased Japanese Orthopeadic Association score. Compared with TLIF, MIS-TLIF significantly decreased length of hospital stay, and increased operative time and SF-36 physical component summary score. Compared with multi-level decompression and single level fusion, multi-level decompression and multi-level fusion significantly increased operative time, estimated blood loss and SF-36 mental component summary score and decreased Oswestry disability index score. Compared with decompression, decompression with interlaminar stabilization significantly decreased operative time and the score of Zurich claudication questionnaire symptom severity, and increased VAS score. CONCLUSION: Considering the limited number of included studies, we still need larger-sample, high-quality, long-term studies to explore the optimal therapy for lumbar spinal stenosis.


Assuntos
Descompressão Cirúrgica/estatística & dados numéricos , Vértebras Lombares/cirurgia , Fusão Vertebral/estatística & dados numéricos , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Duração da Cirurgia , Fusão Vertebral/métodos
16.
J Am Acad Orthop Surg ; 28(17): 693-699, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618681

RESUMO

The management of idiopathic scoliosis in the skeletally immature patient can be challenging. Posterior spinal fusion and instrumentation is indicated for severe scoliosis deformities. However, the skeletally immature patient undergoing posterior fusion and instrumentation is at risk for developing crankshaft deformities. Moreover, bracing treatment remains an option for patients who are skeletally immature, and although it was found to be effective, it does not completely preclude deformity progression. Recently, fusionless treatment options, such as anterior vertebral body growth modulation, have been developed to treat these patients while avoiding the complications of posterior rigid fusion. Good results have been shown in recent literature with proper indications and planning in the skeletally immature patient.


Assuntos
Braquetes , Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Desenvolvimento Ósseo , Criança , Feminino , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Vértebras Lombares/crescimento & desenvolvimento , Masculino , Dispositivos de Fixação Ortopédica/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/prevenção & controle , Fusão Vertebral/métodos , Coluna Vertebral/crescimento & desenvolvimento
17.
Spine (Phila Pa 1976) ; 45(14): E839-E846, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609468

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To elucidate factors that determine segmental lordosis after lateral retroperitoneal lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation. SUMMARY OF BACKGROUND DATA: LLIF has been widely used in degenerative lumbar spine surgery. However, the detailed mechanisms that determine segmental lordosis are still unknown. METHODS: A total of 69 patients who underwent LLIF with posterior pedicle screw fixation without posterior osteotomy were analyzed. Computed tomography was performed before and within 2 weeks after surgery, and segmental lordotic angle (SLA) after surgery (Post-SLA) was predicted using multiple regression analysis. Explanatory factors considered in this study included SLA before surgery (Pre-SLA), disc height before surgery (DiscH), cage position (CageP; distance between the center of the cage and the center of the disc, where a positive value indicates an anterior cage position), cage angle (CageA), cage height (CageH), CageH-DiscH (amount of lift up), previous decompression surgery, and level fused. RESULTS: A total of 102 levels were analyzed. Multiple regression analysis revealed that the Post-SLA can be predicted with three independent variables, CageP, Pre-SLA, and CageH-DiscH and the adjusted R was 0.70. In cases when the cage was located anteriorly (CageP > 3 mm), Post-SLA was greater with larger CageH, larger CageA, and larger Pre-SLA. When the cage was located in the middle (3 mm ≤CageP ≤-1 mm), Post-SLA was greater with larger CageP, larger Pre-SLA, and without previous decompression surgery. If the cage was located posteriorly (CageP < -1 mm), Post-SLA was greater with smaller CageH-DiscH and greater Pre-SLA. CONCLUSION: To gain maximum segmental lordosis in LLIF, the cage should be located anteriorly. Furthermore, if the cage can be located anteriorly, a thicker cage with proper angle cage will gain segmental lordosis. If the cage is located posteriorly, a thin cage should be selected. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Humanos , Lordose , Postura/fisiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
18.
Orthop Clin North Am ; 51(3): 339-343, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498952

RESUMO

Pediatric spine trauma presents unique management challenges. These injuries are often the result of high-energy mechanisms and are associated with other serious injuries that can complicate surgical and nonsurgical approaches. The pediatric population presents a host of challenges related to patient compliance, healing challenges, and patient tolerance of therapy. Percutaneous pedicle screw instrumentation, temporary fixation without fusion, continues to expand in its role of pediatric spine fracture treatment. Compared with open instrumentation and fusion, this technique addresses many of the previously mentioned challenges. Additional study is needed to evaluate the clinical utility of this approach in pediatric spinal fractures.


Assuntos
Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares , Resultado do Tratamento
19.
Orthop Clin North Am ; 51(3): 423-425, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498960

RESUMO

When the guidelines of the North American Spine Society concerning deep venous thrombosis (DVT) prophylaxis were followed, only 2 (0.63%) of 315 patients with minimally invasive transforaminal lumbar interbody fusions developed DVT complications over a 9-year period. Based on these findings, mechanical DVT prophylaxis appears to be adequate in patients undergoing elective spinal surgery, with no current support for pharmacologic prophylaxis.


Assuntos
Vértebras Lombares/cirurgia , Embolia Pulmonar/terapia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Trombose Venosa/terapia , Idoso , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Fatores de Risco , Fusão Vertebral/métodos , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
20.
Medicine (Baltimore) ; 99(23): e20014, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501966

RESUMO

To date, no studies have evaluated the outcomes of lumbar interbody fusion using the anterior to psoas (ATP) approach in patients with spondylolisthesis at L5/S1. We; therefore, aimed to evaluate short-term surgical outcomes of interbody fusion using the ATP approach combined with posterior fixation in these patients.We performed a retrospective analysis of 9 patients with grade I spondylolisthesis at L5/S1 who were treated with fusion and posterior fixation using the ATP approach at our hospital from April to July 2018. The recorded parameters included operation time, intraoperative blood loss, complications, intervertebral fusion rate, radiological intervertebral height, intervertebral foramen height, intervertebral foramen width, pain, visual analog scale, and Oswestry disability index.Four men and 5 women at an average age of 57.8 years (range: 46-71 years) were enrolled in the study. The average operation time was 152.8 ±â€Š22.9 minutes, and the average blood loss during surgery was 165 ±â€Š27.5 mL. All patients confirmed the relief of their low back pain, and there were no serious complications. The follow-up time was more than 6 months. The visual analog scale and Oswestry disability index scores 3 days postoperatively and at the last follow-up were significantly lower than those before surgery (P < .05). At the last follow-up, the intervertebral space of the surgical segment showed bony fusion in all patients, and the intervertebral height and intervertebral foramen height and width were significantly increased compared with those before surgery (P < .05).The ATP approach was safe and effective for the treatment of spondylolisthesis at L5/S1. It showed low vascular injury and cage shift rates and was technically easy to perform. We recommended that surgeons identify the vessels in the surgical field preoperatively so that they can be secured or safely ligated during surgery.


Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Idoso , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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