Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection?

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim was to evaluate the relationships of Cobb angle and pulmonary function tests (PFTs) changes in severe spinal deformity and underwent posterior vertebral column resection (PVCR). SUMMARY OF BACKGROUND DATA: No previous study focused on the correlation of deformity correction and PFTs changes in patients with cobb angle >90 degrees. METHODS: PFTs values [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and percent-predicted values FVC%, FEV1%] were evaluated preoperative and at 2 years after PVCR. FVC% <80% were defined as restrictive ventilation dysfunction (RVD), the severity of RVD were divided into mild (FEV1% ≥70%), moderate (70% > FEV1% ≥50%) and severe (FEV1% <50%). The relationships among PFTs values improvements and all possible impact factors (mainly correction cobb angle) collected in this study were analyzed. PFTs data were compared among the 3 RVD subgroups (mild vs. moderate vs. severe) and between residual >30 versus <30 degrees. RESULTS: A total of 53 cases (28 male/25 female, mean ages 18.9 Y) underwent PVCR in one center from 2004 to 2016 were enrolled cobb angle. When 2 years after PVCR, average PFTs values showed significant improvements. PFTs values changes showed no correlation with correction rate and correction angle. The only significant impact factor in this study for FVC, FVC%, FEV1 improvements was preoperative FVC% and the only impact factor for FEV1% improvement was preoperative FEV1%, the relationships were negative. In accordance with the regression analysis, PFTs values improvements among the 3 RVD subgroups from high to low was severe>moderate>mild. However, patients with residual cobb angle <30 degrees had less PFTs values improvements than patients with residual cobb angle >30 degrees. CONCLUSIONS: Two years after PVCR, PFTs values were significantly improved. There is no linear correlation between cobb angle change and PFTs values improvements. Lower preoperative FVC% and FEV1% indicate more PFTs values improvements at 2 years post-PVCR. LEVEL OF EVIDENCE: Level III.

Mid- and Long-Term Comparison Analysis of Two Approaches for the Treatment of Level III or Higher Lenke-Silva Adult Degenerative Scoliosis: Radical or Limited Surgery?

OBJECTIVE: As the population in general is living longer, less invasive adult degenerative scoliosis (ADS) surgery that balances risks and benefits requires long-term clinical outcomes to determine its strengths and weaknesses. We design a retrospective study to compare the postoperative mid- and long-term outcomes in terms of efficacy, surgical complications, and reoperation rate of patients with ADS treated with two different surgical approaches (long-segment complete reconstruction or short-segment limited intervention). METHODS: In this retrospective study, 78 patients with ADS (Lenke-Silva levels III or higher), who accepted surgical treatment at our hospital between June 2012 and June 2019 were included. These patients were assigned to the long-segment radical group (complete decompression with deformity correction involves ≥3 segments) and the short-segment limited group (symptomatic segment decompression involves <3 segments). In addition, general information such as age, gender, fixed segment number, efficacy, radiographic parameters, and reoperation rate of patients in the two groups were compared and analyzed. RESULTS: There were no significant differences between the two groups with regard to gender, follow-up time, long-term surgical complications and reoperation rate (P > 0.05). The mean age of patients in the long-segment strategy group was 57.1 ± 7.9 years, with a mean number of fixed segments of 7.9 ± 2.4. The mean age of patients in the short-segment strategy group was 60.8 ± 8.4 years, with a mean number of fixed segments of 1.4 ± 0.5. At the final follow-up visit, the long-segment radical group showed better results than the short-segment limited group with regard to coronal Cobb angle, lumbar lordosis angle and sagittal balance (P < 0.05). The long-segment strategy group had a higher implant-related complication rate (P = 0.010); the adjacent segment-related complication in the two groups showed no significant difference (P = 0.068). CONCLUSION: Considering the risk, rehabilitation pathway and costs of long-segment radical surgery, short-segment limited intervention is a better strategy for patients who cannot tolerate the long-segment surgery, improving symptoms and maintaining efficacy in the mid- and long-term, and not increasing the reoperation rate.

Posterior Vertebral Column Resection for Severe Spinal Deformity Correction: Comparison of Pediatric, Adolescent, and Adult Groups.

We compared the pre-, intra-, and postoperative characteristics among three groups of patients who underwent posterior vertebral column resection (PVCR) to clarify age-related characteristics and to guide patient management, surgical planning, and complication avoiding. We compared and analyzed the etiology, surgical events, outcomes, and complications among pediatric, adolescent, and adult patients who underwent PVCR in a single-center database retrospectively. Patients were categorized into pediatric (0-12 yr), adolescent (13-19 yr), and adult (>20 yr) cohorts. Demographics, surgical events, clinical and radiographic results, and major complications were compared between groups. A total of 87 patients with a mean follow-up 42 (24-96) months were identified. Pediatric group (14) had a high frequency of congenital vertebral and cardiac abnormal, adolescents (47) presented more intracanal malformations, and idiopathic was common in the adult group (26). Although pediatric patients had shorter fusion levels than adolescent and adult, their mean resected vertebrae (1.91), percentage of blood loss (estimated blood loss per total blood volume) (201.9%), and operative time were much higher. The coronal/sagittal correction rate was significantly higher in the pediatric group (73.6%/72.3%). Overall, surgical complications were more frequent in adults, particularly neuromonitoring alert and implant failure. However, more severe complications were noted in younger patients. For pediatric patients with PVCR, poor physiological conditions and frequent comorbidities indicated cautious patient selection and sufficient preoperative preparation. The higher correction rate may be due to the excellent compliance of the spinal cord. For adult patients, preoperative traction and adjusting the tension of the spinal cord during surgery could contribute to neurological safety.

Serum insulin-like growth factor 1 level and nutritional assessment in nondialytic patients with chronic renal failure.

AIM: In order to understand the nutritional status of nondialytic patients with chronic renal failure (CRF), nutritional assessment was made in 20 nondialytic patients (15 males and 5 females; mean age 43.7 +/- 15.1 years). METHODS: Twenty CRF inpatients were selected for nutritional assessment, and 20 normal subjects served as controls. The serum insulin-like growth factor 1 (IGF-1) concentration was measured by ELISA. Serum albumin, prealbumin, and transferrin levels were also determined. RESULTS: The mean IGF-I and transferrin levels in the CRF patients were significantly lower than those in normal subjects (IGF-1: 176.2 +/- 92.5 microg/l vs. 266.7 +/- 101.7 microg/l, p < 0.01; transferrin: 2.57 +/- 0.58 g/l vs. 3.18 +/- 0.27 g/l, p < 0.05). The IGF-1 levels in 7 patients with a serum albumin concentration <40.0 g/l were significantly lower than those in 13 patients with a serum albumin concentration >40.0 g/l (95.6 +/- 42.4 microg/l vs. 219.6 +/- 82.7 microg/l, p < 0.01). The IGF-1 levels in cases treated with alpha-ketoacid were higher than in those without alpha-ketoacid treatment. The IGF-1 levels were positively correlated with creatinine clearance (r = 0.7066, p < 0.01) and serum transferrin concentration (r = 0.5347, p < 0.05). CONCLUSIONS: The fact that serum IGF-1 was correlated with serum transferrin and creatinine clearance suggests that IGF-1 may be a good indicator for assessing the nutritional status of CRF patients. The serum IGF-1 level in CRF patients is probably lower than that in normal subjects and could be improved by nutritional therapy.