ABSTRACT
The present study reported the case of a patient with degenerative lumbar scoliosis who suffered from postoperative hemorrhage due to lumbar artery injury in corrective osteotomy. The patient presented with decline of blood pressure, extremely low hemoglobin, even after blood transfusion and fluid infusion. Digital subtraction angiography showed lumbar artery injury. Successful control of bleeding and gradually stable vital signs were observed after vascular embolisation. Severe and complex spinal deformity, severe osteophytes in the anterior edge of vertebral body, hypertension, and angiosclerosis were the risk factors of large vascular injuries in spinal osteotomy. Lumbar artery injury should be highly suspected when unknown and progressively aggravating abdominal or back pain, abdominal distention, neurological symptoms of lower limbs, decline of blood pressure, increase of heart rate, decrease of hemoglobin level, continuously bloody drainage or incision bleeding occurred. Vascular embolisation was effective and safe in the management of iatrogenic lumbar artery injury.
ABSTRACT
The present study reported the case of a patient with degenerative lumbar scoliosis who suffered from post?operative hemorrhage due to lumbar artery injury in corrective osteotomy. The patient presented with decline of blood pressure, extremely low hemoglobin, even after blood transfusion and fluid infusion. Digital subtraction angiography showed lumbar ar?tery injury. Successful control of bleeding and gradually stable vital signs were observed after vascular embolisation. Severe and complex spinal deformity, severe osteophytes in the anterior edge of vertebral body, hypertension, and angiosclerosis were the risk factors of large vascular injuries in spinal osteotomy. Lumbar artery injury should be highly suspected when unknown and progressively aggravating abdominal or back pain, abdominal distention, neurological symptoms of lower limbs, decline of blood pressure, increase of heart rate, decrease of hemoglobin level, continuously bloody drainage or incision bleeding oc?curred. Vascular embolisation was effective and safe in the management of iatrogenic lumbar artery injury.
ABSTRACT
Objective To report the application of C7T1extensive osteotomy and C7pedicle subtraction osteotomy(PSO) in the correction of cervicothoracic deformity secondary to ankylosing spondylitis(AS)and to investigate the efficacy and safety of the techniques.Methods Between April 2006 and August 2017,eight male patients with cervicothoracic deformity undergoing C7T1extensive osteotomy(3 cases)or C7PSO(5 cases)were retrospectively reviewed.The mean age was 31.3±14.9 years(range, 14-60 years).C2-T1kyphosis,C2-T1scoliosis and C2-T1sagittal vertical axis(SVA)were measured on the lateral cervical radio-graphs and chin-brow vertical angle(CBVA)was measured on clinical photographs preoperatively and at the final follow-up.The operative time, blood loss and complications were recorded. Results The average follow-up duration was (11.3 ± 7.9) months (range,3-48 months).In C7T1extensive osteotomy group,the mean operative time was 305 min(300-310 min)and the average blood loss was 1 250 ml(1 000-1 500 ml).Preoperative and postoperative C2-T1kyphosis were 17.0°±16.3°and-13.3°±20.2°,re-spectively.The preoperative CBVA was 20.0°±4.5°,which improved to 4.7°±5.9°at the final follow-up with a mean correction rate of 76.5%.C2-T1SVA was improved from(6.9±4.0)cm preoperatively to(3.5±1.8)cm at the final follow-up with an average correc-tion rate of 49.3%.In C7PSO group,the mean operative time was 536 min(375-730 min)and the average blood loss was 2 450 ml (700-4 200 ml).There were four patients with concomitant scoliosis and kyphosis.Preoperative and postoperative C2-T1kyphosis were 22.8°±10.5°and-13.5°±10.0°,respectively.The preoperative C2-T1scoliosis was 24.8°±12.7°,which improved to 5.0°±3.5° at the final follow-up with a mean correction rate of 79.8%.CBVA was improved from 60.5°±10.2°preoperatively to 14.3°±8.6°at the final follow-up with an average correction rate of 76.4%.C2-T1SVA was corrected to(6.4±2.5)cm at the final follow-up from(10.4 ± 4.3) cm preoperatively. One patient was presented with severe cervicothoracic scoliosis and the C2-T1scoliosis was im-proved to 10°from 33°with a 69.7% correction rate.No neurological complications,infection,or implant-related complications were observed both intraoperatively and during the follow-up period.One patient who underwent C7PSO experienced intraopera-tive subluxation of the osteomized vertebra.Fortunately,there was no neurological deficit.Solid bony fusion was observed after six-month Halo-vest immobilization.Conclusion Both C7T1extensive osteotomy and C7PSO are effective in the correction of cervico-thoracic deformity secondary to AS with acceptable complication rate.C7PSO is particularly suitable for the correction of severe and complicated biplanar cervicothoracic deformity.