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1.
Zhonghua Zhong Liu Za Zhi ; 42(12): 1056-1062, 2020 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-33342165

RESUMO

Objective: To analyze the safety and efficacy of percutaneous vertebroplasty combined with interstitial implantation (125)I of seeds (PVPI) in the treatment of thoracic vertebroplasty with posterior vertebra defect. Methods: A retrospective analysis of the clinical data of 64 patients with thoracic spine metastases admitted to Yunnan Cancer Hospital from November 2017 to May 2019 was conducted, including 32 patients with posterior vertebra defect (experimental group) and 32 cases without (control group). Forty-two vertebral bodies of 32 patients in the experimental group were treated with improved PVPI surgery, which performed with the secondary sealing method and inclined puncture needle injection bone cement rotary filling technology, to reduce leakage. The 54 vertebral bodies of 32 patients in control group underwent PVPI. The two groups of patients were followed up on the second day, one month, three months and six months after the operation, and the short-term efficacy, long-term efficacy and safety indicators of the two groups were compared. Results: All 64 patients successfully completed the surgical treatment. The visual analogue scores and Karnofsky scores of the experimental group and the control group were improved to varying degrees on the second day, 1 month, 3 months and 6 months after the operation. There was no statistically significant difference between the two groups (P>0.05). The amount of bone cement in the experimental group and control group was (2.36±0.20) ml and (2.39±0.17) ml, and the difference was not statistically significant (P=0.482). The amount of (125)I seed implantation was (30.63±0.91) and (32.56±0.68), respectively, the difference was not statistically significant (P=0.925). The partial response rates of the study group and the control group were 81.3% and 87.5%, the stable disease rates were 12.5% and 9.4%, the differences were not statistically significant (P>0.05). The median overall survival (mOS) of the study group was 13 months, and the median progression-free survival (mPFS) was 8 months. The mOS of the control group was 14 months, and the mPFS was 8 months. The differences were not statistically significant (P>0.05). In the experimental group, 6 (14.3%) vertebral bodies had cement leakage, of which 2 (4.8%) were cement leakage at posterior vertebra, 4 (9.5%) were paravertebral cement leakage. Seven (13.0%) paravertebral cement leakage occurred in the control group. There was no significant difference in bone cement leakage between the two groups (P=0.097). Bone cement leakage in both groups did not cause serious complications such as spinal cord injury and paraplegia. Conclusion: The application of PVPI in the treatment of thoracic metastatic tumor patients with posterior vertebra defect can acquire better clinical efficacy and safety through conduction of the improved intraoperative technology and paying more attention to the control of bone cement distribution and other issues.


Assuntos
Radioisótopos do Iodo , Neoplasias Torácicas , Vértebras Torácicas , Vertebroplastia , China , Humanos , Radioisótopos do Iodo/uso terapêutico , Metástase Neoplásica , Estudos Retrospectivos , Neoplasias Torácicas/patologia , Neoplasias Torácicas/terapia , Vértebras Torácicas/patologia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
2.
J Vet Sci ; 21(4): e52, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735091

RESUMO

BACKGROUND: Intradural-intramedullary intervertebral disc extrusion (IIVDE) is a rare condition of intervertebral disc disease. However, the diagnosis of IIVDE is challenging because the prognosis and imaging characteristics are poorly characterized. OBJECTIVES: We aimed to describe the clinical and imaging characteristics of tentatively diagnosed IIVDE in dogs to assess the prognostic utility of neurological grade and magnetic resonance imaging (MRI) findings. METHODS: Twenty dogs were included in this retrospective cohort study. RESULTS: Nonchondrodystrophic breeds (n = 16) were more predisposed than chondrodystrophic breeds. Most dogs showed acute onset of clinical signs. Neurological examination at admission showed predominant non-ambulatory paraparesis (n = 9); paresis (n = 16) was confirmed more frequently than paralysis (n = 4). Follow-up neurological examination results were only available for 11 dogs, ten of whom showed neurological improvement and 8 showed successful outcomes at 1 month. The characteristic MRI findings include thoracic vertebra (T)2 hyperintense, T1 hypointense, intramedullary linear tracts with reduced disc volume, and cleft of the annulus fibrosus. None of the MRI measurements were significantly correlated with neurological grade at admission. Neurological grade did not differ according to the presence of parenchymal hemorrhage, parenchymal contrast enhancement, and meningeal contrast enhancement. Neurological grades at admission showed a statistical correlation with those observed at the 1-month follow-up (r = 0.814, p = 0.02). CONCLUSIONS: IIVDE is a rare form of disc extrusion commonly experienced after physical activity or trauma and most frequently affects the cranial-cervical and thoracolumbar regions of nonchondrodystrophic dog breeds. Neurological score at admission emerged as a more useful prognostic indicator than MRI findings in dogs with suspected IIVDE.


Assuntos
Doenças do Cão/diagnóstico , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Vértebras Torácicas/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem
3.
Acta Orthop Traumatol Turc ; 54(3): 287-292, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544064

RESUMO

OBJECTIVE: The aim of this study was to detect the relationship between the development of Schmorl's nodes (SNs) and bone mineral density (BMD) in young patients. METHODS: Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60 males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years) with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT sections by quantitative CT and then compared between the two groups. RESULTS: The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae. The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no significant relationship between the total number of SNs per patient and the mean BMD (p=0.156). CONCLUSION: Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in patients younger than 40 years. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Densidade Óssea , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Vértebras Torácicas , Adulto , Causalidade , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X/métodos
6.
Bone Joint J ; 102-B(4): 513-518, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228067

RESUMO

AIMS: Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. METHODS: A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression. RESULTS: Of the 95 patients, 71.6% (68) had a thoracic correction of > 60%. Most (97.8%) had metal density < 80%, while thoracic flexibility > 50% was found in 30.5% (29). Preoperative hypokyphosis (< 20°) was present in 25.3%. A postoperative thoracic hypokyphosis was four times more likely to occur in patients with thoracic correction ≥ 60% (odds ratio (OR) 4.08; p = 0.005), after adjusting for confounding variables. This association was not affected by metal density, thoracic flexibility, LIV, UIV, age, or sex. CONCLUSION: Our study supports the 'essential lordosis' hypothesis of Roaf and Dickson, i.e. with a greater ability to translate the apical vertebra towards the midline, there is a commensurate lengthening of the anterior column due to the vertebral wedging. Cite this article: Bone Joint J 2020;102-B(4):513-518.


Assuntos
Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/patologia , Escoliose/fisiopatologia , Curvaturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Adulto Jovem
7.
Spine Deform ; 8(4): 751-761, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32232747

RESUMO

STUDY DESIGN: Two-center retrospective cohort study. OBJECTIVE: The aim of this study is to investigate the clinical effectiveness and safety of the MCGR hybrid in terms of spinal growth, 3D correction, balance, and complications. The magnetic-controlled growing-rod (MCGR) growth instrumentation method has gained popularity for early onset scoliosis (EOS) treatment in the past years due to the non-invasiveness of the subsequent interval elongation procedures. To improve 3D correction and reduce the costs, we combined a single concave MCGR with a sliding rod on the convex side to control the apex. METHODS: A retrospective cohort study of 18 EOS children with an average 3-year follow-up (range 2.0-3.7) from two European spine centers treated with the single MCGR hybrid concept; 14 primary and 4 conversion cases. The primary and conversion cases were both evaluated preoperatively, postoperatively, 1 year, 2 years, and last follow-up. RESULTS: Mean age was 9.9 (SD ± 2.9 years). The average frontal Cobb angle was reduced from mean 65° to 30° postoperatively, and had increased to 37° at latest follow-up. Rotation of the apical vertebra improved from mean 27° to 20° postoperatively which was partially lost to 23°. Kyphosis and lordosis both increased by an average of 5° during the time of follow-up. Spinal balance was improved. The post-implantation T1-S1 spine growth rate averaged 10 mm/year at last follow-up. There were 13 implant-related complications in 6 out of 18 patients. No screw pull-outs and nor surgical site infections were registered. CONCLUSIONS: This is the first medium-term results of a single MCGR hybrid construct. Maintenance of correction and growth are reasonable, and the complication rate is relatively low as compared to bilateral MCGR application. LEVEL OF EVIDENCE: III.


Assuntos
Fixadores Internos , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Fatores Etários , Idade de Início , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Rotação , Escoliose/diagnóstico por imagem , Escoliose/patologia , Fusão Vertebral/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 102(6): e133-e135, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233849

RESUMO

Ganglioneuroma is a rare benign neoplasm. Patients with ganglioneuroma show no symptoms. We describe a rare case of giant ganglioneuroma with scoliosis in a 35-year-old woman, who presented to our hospital for haemoptysis. We combined with neurosurgeons to remove the tumour successfully. After 16 months of follow-up, there is no evidence of tumour recurrence.


Assuntos
Ganglioneuroma/cirurgia , Hemoptise/etiologia , Neoplasias do Mediastino/cirurgia , Escoliose/diagnóstico , Vértebras Torácicas/cirurgia , Adulto , Feminino , Ganglioneuroma/complicações , Ganglioneuroma/diagnóstico , Ganglioneuroma/patologia , Humanos , Imagem por Ressonância Magnética , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Invasividade Neoplásica/diagnóstico por imagem , Escoliose/complicações , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
9.
Vet Surg ; 49(5): 923-929, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32166794

RESUMO

OBJECTIVE: To describe median manubriotomy to access the ventral aspect of the caudal cervical and cranial thoracic spine and report the outcomes in dogs with lesions affecting the spinal cord at C6-T2 vertebral bodies. To evaluate possible complications of this technique and clinical outcomes. STUDY DESIGN: Cadaveric study and short case series. STUDY POPULATION: Two cadavers and nine dogs with lesions affecting the spinal cord at C6, C7, T1 or T2 vertebral bodies or corresponding intervertebral spaces. METHODS: Two cadavers were used for demonstration purposes. Medical records (2013-2019) were reviewed for dogs undergoing median manubriotomy to facilitate access to the ventral aspect of C6-T2 vertebral bodies and/or corresponding intervertebral disc spaces. Data on preoperative and postoperative neurological status and diagnostic imaging, surgical technique, and complications were retrieved. RESULTS: Indications for surgery included C7-T1 disc extrusions in five dogs, caudal cervical misalignment in three dogs, and C7-T1 and T1-T2 disc protrusions in one dog. The vertebral bodies of C6 to T2 were consistently visualized after median manubriotomy. Preoperative clinical signs resolved in five dogs and improved in two dogs. One dog was euthanized for lack of improvement, and one dog died of pulmonary thromboembolism. CONCLUSION: Median manubriotomy improved the surgical access to the ventral aspect of caudal cervical and cranial thoracic spine without related complications. CLINICAL SIGNIFICANCE: Median manubriotomy can be considered in dogs undergoing ventral decompression and/or stabilization of C7-T1 and T1-T2 intervertebral disc spaces.


Assuntos
Doenças do Cão/cirurgia , Deslocamento do Disco Intervertebral/veterinária , Manúbrio/cirurgia , Complicações Pós-Operatórias/veterinária , Animais , Vértebras Cervicais/patologia , Cães , Feminino , Deslocamento do Disco Intervertebral/patologia , Masculino , Vértebras Torácicas/patologia
10.
Spine Deform ; 8(4): 771-779, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32162196

RESUMO

STUDY DESIGN: Cross sectional OBJECTIVES: The purpose of this study is to evaluate the association between thoracic height and health-related quality of life (HRQoL) at skeletal maturity in patients with EOS. Current literature suggests a minimum thoracic height of 18 cm to 22 cm to avoid poor pulmonary function and related health outcomes. METHODS: Patients with EOS who reached skeletal maturity from 2005 to 2018 were identified in two registries including 32 centers. Thoracic height from T1 to T12 at skeletal maturity and Early Onset Scoliosis 24 Item Questionnaire (EOSQ-24) scores were collected. The EOSQ-24 domains included HRQoL of patients, parental impact, financial impact and patient and parental satisfaction. RESULTS: 469 patients (mean age: 14.9, female: 77.4%) were identified. 29% patients were of congenital etiology, 20.3% neuromuscular, 13.6% syndromic, 34.8% idiopathic, and 2.3% other. When patients were grouped by thoracic height at skeletal maturity, all EOSQ-24 domains increased after a threshold of 18 cm. When stratified by etiology, the 18 cm cutoff held for patients with congenital, neuromuscular and syndromic EOS. The cutoff for idiopathic EOS was 20 cm. For all patients, after the threshold was met, HRQoL continued to improve with increases in thoracic height at skeletal maturity. A subset of 169 patients for which arm span measurements were available was also identified and their thoracic heights were normalized. When grouped by the percentage of expected thoracic height attained, EOSQ-24 domains increased after a threshold of 80%. CONCLUSIONS: Once 18 cm of actual thoracic height or 80% of expected thoracic height is achieved, HRQoL continues to improve as thoracic height increases in skeletally mature patients with non-idiopathic EOS. Patients with idiopathic EOS had a higher threshold, possibly due to their larger average size and higher care giver expectations for HRQoL. LEVEL OF EVIDENCE: Level III.


Assuntos
Desenvolvimento Ósseo , Qualidade de Vida , Escoliose/patologia , Escoliose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Adolescente , Adulto , Idade de Início , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Escoliose/etiologia , Inquéritos e Questionários , Adulto Jovem
11.
Spine Deform ; 8(4): 605-611, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32162197

RESUMO

STUDY DESIGN: Retrospective chart review. OBJECTIVES: The aim of this study is to assess the role of insurance type, geographic socioeconomic status, and ethnicity in AIS disease severity in a state with mandated scoliosis screenings. Early detection of adolescent idiopathic scoliosis (AIS) is associated with reduced curve progression, surgical treatment, and long-term sequelae. Type of insurance, ethnicity, and socioeconomic status are important determinants in healthcare access. METHODS: Data were obtained for 561 AIS patients aged 10-18 years, living within a single county, and presenting to a single healthcare system for initial evaluation of AIS between 2010 and 2016 that met inclusion criteria. Demographic data including gender, age, self-reported ethnicity, insurance, and zip code were collected. Outcome measures included Cobb angle, curve severity, and referral delay. A single fellowship-trained pediatric orthopedic surgeon calculated presenting Cobb angle for each case. Zip code was used as a proxy for household income level. Independent sample t tests, analysis of variance and covariance, and χ2 analysis were used to determine the significant differences and correlations. RESULTS: Female patients (n = 326, CA = 22.4°) had significantly greater Cobb angle measurements compared with male patients (n = 117, CA = 18.1°). Patients with government-supported insurance had significantly higher Cobb angles (CA = 22.1°) than privately insured patients (CA = 19.2°) but were both classified within the "mild" range clinically, and are likely not clinically significant. There was no correlation between income level and Cobb angle. Referral delay and Cobb angle severity did not vary by age, income, or insurance. A χ2 analysis showed no association between Cobb angle and race. CONCLUSIONS: Cobb angle severity was not influenced by SES factors, including ethnicity and household income. LEVEL OF EVIDENCE: Level-II.


Assuntos
Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Resultados Negativos , Escoliose/patologia , Classe Social , Vértebras Torácicas/patologia , Adolescente , Fatores Etários , Criança , Grupos de Populações Continentais , Diagnóstico Tardio , Feminino , Humanos , Seguro Saúde , Masculino , Estudos Retrospectivos , Escoliose/etnologia , Escoliose/cirurgia , Índice de Gravidade de Doença , Fatores Sexuais
12.
World Neurosurg ; 138: 291-296, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32201295

RESUMO

BACKGROUND: Grade V thoracic spondylolisthesis secondary to neurofibromatosis type 1 (NF-1), especially combined with vertebral fusion, is rare. We reported a case of a 26-year-old female diagnosed with grade V T2spondylolisthesis and T2-T5 autofusion secondary to NF-1, which caused severe kyphotic deformity and neurologic deficits, and she was treated with posterior decompression, internal fixation, and fusion. CASE DESCRIPTION: The right-handed patient admitted to the clinic due to weakness of her legs. An eye examination documented a sign of Lisch nodules in the iris. Café-au-lait macules, dermal neurofibroma of multiple forms, and rubbery bumps of varying sizes could be observed on her skin. Paresis with muscle strength of 2/5 in both lower extremities with increased muscle tone and decreased muscle mass could be observed. Radiographic results indicated grade V thoracic spondylolisthesis with vertebral fusion from T2-T5 level. To alleviate neurologic dysfunction, posterior decompression, internal fixation, and fusion were performed. She reported marked improvement in lower limb motor and sensory functions during the follow-up, and her muscle strength recovered to 5/5. CONCLUSIONS: Grade V thoracic spondylolisthesis combined with vertebral fusion on T2-T5 level in NF-1 is rare. Early surgical intervention of posterior spinal decompression with internal fixation and fusion yielded satisfactory clinical outcomes.


Assuntos
Neurofibromatose 1/complicações , Espondilolistese/etiologia , Espondilolistese/cirurgia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Fusão Vertebral/métodos
13.
BMJ Case Rep ; 13(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32060112

RESUMO

Parsonage Turner syndrome (otherwise known as PTS, neuralgic amyotrophy or acute brachial neuritis) is a rare, but clinically significant cause of atraumatic shoulder girdle pain and weakness. Diagnosis is primarily clinical and can be challenging due to its heterogeneous presentation. A case of PTS following systemic infection from Staphylococcus aureus spondylodiscitis is presented. Timely consideration of the diagnosis prevented unnecessary investigation and allowed effective rehabilitation. This is the first case of PTS preceded by S. aureus infection. PTS should be considered in those presenting with acute, atraumatic shoulder dysfunction after systemic infection.


Assuntos
Neurite do Plexo Braquial/etiologia , Discite/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus , Idoso , Diagnóstico Diferencial , Humanos , Vértebras Lombares/patologia , Masculino , Vértebras Torácicas/patologia
14.
Spine Deform ; 8(2): 205-211, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026437

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare clinical outcomes and radiographic parameters between patients treated with a posterior spinal fusion that had a lower instrumented vertebra at T11, T12, and L1. BACKGROUND: Posterior instrumented fusions are well established for treating patients with adolescent idiopathic scoliosis (AIS). Fusions limited to the thoracic spine can adequately correct a spinal deformity while preserving lumbar segmental mobility. However, fusions that end at the thoracolumbar junction have been proposed to cause adjacent segment complications. Studies comparing outcomes between patients who were treated with fusions that end at the thoracolumbar junction with varying LIVs are limited. METHODS: A multicenter database was queried for patients with AIS that had Lenke Type 1 and 2 curves treated with a fusion that had an LIV at T11, T12, or L1. Coronal curve magnitude, degree of junctional kyphosis, C7-central sacral line, thoracic apical translation, and sagittal stable vertebrae were measured. Clinical and functional outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire and lumbar flexibility testing. RESULTS: The lower instrumented level was below the sagittal stable vertebrae in 22.7%, 40%, and 66.2% of patients in the LIV-T11, T12, and L1 groups, respectively (p < 0.001). The 5-year postoperative lumbar curve magnitudes were 20.3°, 16.3°, and 14.0° for T11, T12, and L1-LIV, respectively (p < 0.001). No patients in the T11 group (0%), two patients in the T12 group (2.5%), and one patient in the L1 (0.8%) group developed distal junctional kyphosis (p = 0.5). The 5-year postoperative total SRS-22 scores were 4.21, 4.50, and 4.38 (p = 0.029). Lumbar flexion decreased by 0.78 cm in the T11-LIV group, increased by 0.01 cm in the T12-LIV group, and decreased by 0.15 cm in the L1-LIV group (p = 0.434). CONCLUSION: There was no significant difference in SRS-22 scores, development of distal junctional kyphosis or loss of lumbar mobility between patients treated with a spinal fusion that had an LIV at T11, T12, or L1. LEVEL OF EVIDENCE: Level III.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Cifose , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/patologia , Escoliose/fisiopatologia , Inquéritos e Questionários , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento
15.
Spine Deform ; 8(2): 303-309, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026442

RESUMO

STUDY DESIGN: Retrospective, comparative, multicenter. OBJECTIVES: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increase in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. METHODS: Patients with idiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2-L5, L6-L10) were evaluated with primary outcome of T1-T12 SSL. RESULTS: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p < 0.05), kyphosis 39° (50° RB vs. 34° SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p < 0.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p < 0.05); L2-L5, 50° RB vs. 27° SB (p < 0.05); L6-L10, 56° RB vs. 26° SB (p < 0.05). SSL increased for both groups from preoperative to the tenth lengthening (p < 0.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the tenth lengthening (p < 0.05). After ten lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p < 0.05). CONCLUSION: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. LEVEL OF EVIDENCE: Level III.


Assuntos
Osteogênese por Distração/métodos , Escoliose/cirurgia , Vértebras Torácicas/crescimento & desenvolvimento , Vértebras Torácicas/cirurgia , Idade de Início , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Escoliose/patologia , Escoliose/fisiopatologia , Vértebras Torácicas/patologia
16.
Spine Deform ; 8(3): 387-396, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026444

RESUMO

STUDY DESIGN: Retrospective analysis of consecutive cases. OBJECTIVES: To identify clinically relevant three-dimensional (3D) sub-groups for adolescent idiopathic scoliosis (AIS). Classifications for AIS are developed to assist surgeons in surgical planning and therapeutic management. However, current systems are based on two-dimensional (2D) parameters that do not completely describe the 3D deformity. Hence, variations in surgical results based on pre-operative 2D classifications may be attributed to the lack of 3D description. METHODS: Subjects from a multicenter database of AIS patients were included in this study. All patients had bi-planar radiographs and 3D reconstruction of the entire spine. A clustering algorithm based on fuzzy c-means was utilized to identify sub-groups based on the following ten parameters measured on 3D reconstructions of the spine: Cobb angle, orientation of the plane of maximum curvature of the proximal thoracic, mid-thoracic (MT) and thoracolumbar (TLL) levels, axial rotation of the apical vertebra of the MT and TLL segments, T4-T12 thoracic kyphosis, and L1-S1 lumbar lordosis. Da Vinci views were also generated and analyzed for each patient in the study. A panel of four experienced spine surgeons from the SRS 3D Scoliosis Committee reviewed and evaluated each group to determine if cluster groups were clinically distinct from each other. RESULTS: The clustering algorithm was able to detect 11 sub-groups. The population size for each cluster varied from 11 to 290. Statistically significant differences were seen between the parameters for each group. Four spine surgeons reviewed the three most representative cases of each group and unanimously agreed that each cluster group represents a sub-group that was not defined in current classifications. CONCLUSIONS: This study presents a new method of classifying AIS based on a fuzzy clustering algorithm using parameters describing the 3D characteristics of the deformity. Further clinical validation is needed to confirm the usefulness of this classification system. LEVEL OF EVIDENCE: IV.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Radiografia , Escoliose/classificação , Escoliose/diagnóstico por imagem , Adolescente , Análise por Conglomerados , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Estudos Retrospectivos , Escoliose/patologia , Escoliose/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia
17.
Spine Deform ; 8(2): 285-293, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32030643

RESUMO

STUDY DESIGN: Reproducibility study. OBJECTIVES: Assess the agreement and reliability of the classification of early onset scoliosis (C-EOS). C-EOS is a promising tool for patients with early onset scoliosis (EOS). However, the reliability has only been examined without measuring radiographs and not including the annual progression rate (APR) modifier. METHODS: We included a single-center consecutive cohort of patients diagnosed with EOS seen in our outpatient clinic. Patients had no previous spine surgery. Four raters rated 60 cases. Two anterior-posterior full-spine radiographs, taken minimum 6 months apart, and one sagittal radiograph were measured twice by all raters in a blinded test-retest setup. Results were assessed using crude frequency of overall agreement (OA), intra- and inter-rater Fleiss kappa (κ) statistics, and intraclass correlation coefficient (ICC). We calculated the 95% limits of agreement (LOA) for major curve angle (MCA), kyphosis, and APR using a linear mixed-effects model. Inter- and intra-rater LOA were analyzed for each etiology separately. RESULTS: Mean age was 8.7 ± 3.4 years and the etiology were congenital/structural (n = 20), idiopathic (n = 19), neuromuscular (n = 13), or syndromic (n = 8). For etiology, OA was 75.8% and κ = 0.80. For major curve angle, OA was 84.2%, κ = 0.86, ICC = 0.97, and LOA = 12.8°. For kyphosis, OA was 55.8%, κ = 0.52, ICC = 0.87, and LOA = 20.6°. For APR, OA was 76.7%, κ = 0.61, ICC = 0.77, and LOA = 17.4°/year. Inter- and intra-rater LOA were generally largest for neuromuscular and smallest for idiopathic patients. CONCLUSIONS: We found substantial agreement for etiology, however, with disagreement in certain cases. The reliability of MCA was excellent; however, somewhat lower for kyphosis and APR with less accuracy. The measurement errors of MCA, kyphosis, and APR depended largely on the etiology. Regarding APR, LOA exceeded the 10°/year increments proposed in the C-EOS, suggesting a revision of this optional modifier. LEVEL OF EVIDENCE: Diagnostic study level 1.


Assuntos
Classificação/métodos , Escoliose/classificação , Escoliose/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Reprodutibilidade dos Testes , Escoliose/diagnóstico por imagem , Escoliose/patologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia
18.
Medicine (Baltimore) ; 99(2): e18202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914013

RESUMO

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/patologia , Cinética , Dor Lombar/patologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Espondilose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Suporte de Carga , Adulto Jovem
19.
Mol Med Rep ; 21(1): 191-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31939624

RESUMO

Thoracic ossification of the posterior longitudinal ligament (T­OPLL) is one of the most common factors that causes thoracic spinal stenosis, resulting in intractable myelopathy and radiculopathy. Our previous study reported that the rs201153092 polymorphism present in the collagen 6A1 (COL6A1) gene was a potentially pathogenic locus for the development of T­OPLL. The present study aimed to determine whether the rs201153092 mutation causes abnormal expression of COL6A1 in Han Chinese patients with T­OPLL, and to examine the effects of this mutation on osteogenesis by establishing a model of osteogenic differentiation. COL6A1 gene mutant and wild­type mouse 3T3­E1 embryonic osteoblast models were constructed to induce the differentiation of these cells into osteoblasts. The potential of the mutation site to induce abnormal expression of the COL6A1 gene and osteogenic markers was assessed via reverse transcription­quantitative PCR and western blot analyses. The results demonstrated that the rs201153092A mutation site resulted in significantly increased COL6A1 gene expression levels in the OPLL tissues obtained following clinical surgery. This mutation was shown to play an important role in the development of T­OPLL by regulating the overexpression of the COL6A1 gene and significantly increasing the expression levels of osteogenic markers. The findings of the present study suggested that the rs201153092A mutant variant could increase the expression levels of COL6A1 and consequently play a role in the pathogenesis of T­OPLL.


Assuntos
Colágeno Tipo VI/genética , Ligamentos Longitudinais/metabolismo , Ossificação do Ligamento Longitudinal Posterior/genética , Osteogênese/genética , Idoso , Animais , Grupo com Ancestrais do Continente Asiático , Linhagem Celular , Colágeno Tipo VI/metabolismo , Feminino , Estudos de Associação Genética , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/metabolismo , Ossificação do Ligamento Longitudinal Posterior/patologia , Osteoblastos , Polimorfismo de Nucleotídeo Único , Vértebras Torácicas/metabolismo , Vértebras Torácicas/patologia
20.
World Neurosurg ; 136: e586-e592, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958587

RESUMO

OBJECTIVE: The purpose of this study was to examine the thoracic inlet angle (TIA) and its related parameters in the cervical and cervical-thoracic vertebrae in patients with degenerative cervical spondylosis (DCS) and explore the association of the TIA, tilt angle of the neck, and tilt angle of the first thoracic spine with the cervical degeneration score. METHODS: Patients with DCS were included from January 2014 to December 2017. The relevant parameters were assessed on T2-weighted magnetic resonance imaging. The association of cervical parameters with the cervical degeneration score was examined by multiple linear regression model. RESULTS: A total of 204 patients (126 men) were eligible and enrolled, with a mean age of 55-56 years. Men had significantly higher thoracic inlet parameters than women (all P < 0.05). Thoracic inlet parameters were positively correlated with age (all P < 0.05). After adjustment for age and sex, the significant association between the TIA and cervical or cervical-thoracic spine degeneration scores was not observed in all vertebrae. Meanwhile, men had higher vertebral height (VH) and intervertebral disk height (IVDH) than women. Only the VHs of C7, T1, and T2 and the IVDHs of C6-7, T1-2, and T2-3 were significantly and positively associated with the TIA (all P < 0.05). CONCLUSIONS: Age was positively correlated with thoracic inlet parameters in patients with DCS. Men had significantly higher thoracic inlet parameters than women because the men had higher VHs and IVDHs. However, the TIA was not associated with the level of cervical disk degeneration. The clinical relevance of these findings has not been established.


Assuntos
Vértebras Cervicais/patologia , Degeneração do Disco Intervertebral/patologia , Espondilose/patologia , Vértebras Torácicas/patologia , Fatores Etários , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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