Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis.</p><p><b>DATA SOURCES</b>We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis."</p><p><b>STUDY SELECTION</b>The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies.</p><p><b>RESULTS</b>The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications.</p><p><b>CONCLUSIONS</b>MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.</p>

Selective thoracic fusion in the scoliosis associated with syringomyelia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical results of selective thoracic fusion (STF) for scoliosis associated with syringomyelia.</p><p><b>METHODS</b>From January 2001 to January 2009, 93 cases of scoliosis associated with syringomyelia were retrospectively reviewed. There were 11 cases who underwent STF and were followed up more than 2 years, which included 8 female and 3 male, the mean age was 14.9 years (9 - 21 years). Curve type, coronal and sagittal Cobb angle, apical vertebral rotation apical vertebral translation, flexibility, trunk shift were recorded and analyzed.</p><p><b>RESULTS</b>There were 9 double curves and 2 triple curves, the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases, Lenke B in 7 cases and Lenke C in 2 cases. The average coronal Cobb angle of thoracic curve before and after surgery were 62.6° and 19.0° respectively, and the average correction rate was 69.6%. The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36.1° and 11.6° respectively, and the average spontaneous correction rate was 67.9%. The followed up time ranged from 24 to 48 months (mean 29.5 months), the average loss of correction rate was 6.8%. Only one trunk decompensation was noted at final follow-up. Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery, no neurological complication was noted at final follow-up.</p><p><b>CONCLUSIONS</b>STF could be safely performed in scoliosis associated with syringomyelia. Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients. The satisfactory result could be achieved according to the STF criteria for IS.</p>

Pedicle screw fixation for cervical spine instability: clinical efficacy and safety analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reports of applying cervical pedicle screw (CPS) system in the posterior cervical spine surgeries are limited because of its inherent risk of neurovascular injury. The clinical results of cervical spine instability treated with CPS system were retrospectively analyzed, and the clinical efficacy and safety of this management were evaluated.</p><p><b>METHODS</b>Twenty-five patients with cervical spine instability undergoing posterior C3 - C7 single/double door laminoplasty and free-hand CPS fixation as well as graft fusion were investigated; of whom, 3 were due to trauma, and 22 degenerative cervical pathogenesis. One hundred and fifty in total, CPSs were implanted in 5 cervical segments for 1 patient, 4 for 2, 3 for 18, and 2 for 4. Japanese Orthopaedic Association (JOA) score and its improvement rate, neck disability index (NDI), segmental stability, pedicle cortex perforation rate and other complication-associated parameters were assessed.</p><p><b>RESULTS</b>The average follow-up was 16.6 (6 - 30) months. Compared with pre-operative values, JOA score improved by 4.10 +/- 0.84 points on average (P < 0.05) at 6 months post operation, with a mean improvement rate of 61%. While the pre-operative and 6-month post-operative NDI were 32.96 +/- 6.13 and 16.84 +/- 4.40 (P < 0.05), respectively. At 6-month post-operation and the final follow-up, fused segments were stable. Pedicle cortex perforation rate was 8.0%, with no neurovascular complications observed.</p><p><b>CONCLUSIONS</b>Anatomizing the pre-operative radiographic data facilitates the precise operative design prior to surgery; and CPS system is capable of offering safe and satisfying outcomes in the management of cervical spine instability.</p>

Clinical features of adolescent idiopathic scoliosis with thoracolumbar kyphosis and its surgical treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical features and evaluate the surgical results of adolescent idiopathic scoliosis (AIS) with thoracolumbar kyphosis.</p><p><b>METHODS</b>Four hundred and thirteen AIS patients were retrospectively reviewed between January 2001 and January 2007. Among them, 10 patients had thoracolumbar kyphosis, including 2 males and 8 females. The average age at surgery was 14.3 years old. There were 3 PUMC type IIb2, 4 PUMC IIc3, 1 PUMCIId2, 2 PUMC IIIb. Eight patients underwent posterior correction and spinal fusion with instrumentation, 2 patients underwent anterior release, posterior correction and spinal fusion with instrumentation. By reviewing the roentgenograms of patients, the curve type, Cobb angle, flexibility, apical rotation and translation, coronal and sagittal trunk shift and thoracolumbar kyphosis were measured and analyzed.</p><p><b>RESULTS</b>Eight patients had double curves and 2 patients had triple curves. Among them, the Cobb angles of thoracolumbar or lumbar curve were larger than 45 degrees in 7 patients, the flexibility index was less than 70% in 6 patients, the apical vertebral rotation was larger than II degrees in 9 patients and the apical vertebral translation was larger than 2 cm in all patients. All the surgical treatment strategy and fusion level followed the criteria of PUMC classification. The coronal Cobb angles of thoracic curve before and after surgery were 71.7 degrees and 37.4 degrees respectively, and the average correction rate was 47.8%. The coronal Cobb angles of thoracolumbar or lumbar curve before and after surgery were 65.0 degrees and 27.8 degrees respectively, and the average correction rate was 57.2%. The Cobb angles of thoracolumbar kyphosis before and after surgery were 35.5 degrees and 4.2 degrees respectively, and the average correction rate was 88.2%. No trunk decompensation was noted at final follow-up. All patients were followed-up from 12 to 72 months; the average follow up was 23.1 months.</p><p><b>CONCLUSIONS</b>AIS patients with thoracolumbar kyphosis usually have double or triple curves. In these patients, thoracolumbar curves or lumbar curves are severe and have obvious rotatory deformity. Thoracolumbar curve or lumbar curve should be fused in idiopathic scoliosis patients with thoracolumbar kyphosis to avoid trunk decompensation or junctional kyphosis. By using criteria of PUMC classification, these patients can be well identified and corresponding fusion level can be followed as well.</p>

Management of cerebrospinal fluid leakage following cervical spine surgery / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the management and outcome of cerebrospinal fluid leakage (CSFL) after cervical surgery.</p><p><b>METHODS</b>Medical records of 642 patients who underwent cervical surgery between December 1999 and December 2005 at our hospital were retrospectively reviewed. Five patients complicated by CSFL after surgery were enrolled, of which 4 cases were complicated after ossified posterior longitudinal ligament or posterior vertebral osteophyte resection directly injuring the dura, and 1 case after posterior cervical double-door laminoplasty without observed dural injury during surgery. Of the 5 CSFL cases, 4 cases occurred at 1-3 days after operation and 1 case at 9 days after operation. All 5 postoperative CSFL cases were treated through wound drainage removal, wound sutures, prophylactic antibiotics, and continuous subarachnoid drainage in the elevated head position.</p><p><b>RESULTS</b>All 5 CSFL cases experienced leakage cessation within 1-3 days and wound healing within 4-8 days, and subarachnoid drainage lasted 11-16 days with an average volume of 320 mL (range, 150-410 mL). Four cases experienced headache, nausea and vomiting, 1 case suffered from somnolence and hyponatremia, and symptoms subsided after symptomatic treatment and intravenous fluid administration. All patients were followed up for an average of 32 months (range, 22-50 months). No occurrence of cerebrospinal fluid cyst or wound infection was observed. CSFL produced no significant negative effects upon neuromuscular function recovery.</p><p><b>CONCLUSION</b>Continuous subarachnoid cavity drainage in combination with elevated head position is a simple and safe non-surgical method in treatment of CSFL following cervical surgery.</p>

Analysis of Prognosis of Children with Non-Hodgkin′s Lymphoma / 实用儿科临床杂志

Objective To analyze the factors affecting prognosis of children with non-Hodgkin′s lymphomas(NHL).Methods Thirty patients of childhood NHL histologically proven in Shanghai children′s medical center from Jan.1996 to Dec.2000 were analyzed.The patients were divided into groups according to some clinical factors that may have predictive significance including age,gender,immunologic phenotype,general system symptom,the size of tumor bulk,bone marrow involvement,mediastinal involvement,hepatomegaly or liver involvement,splenomegaly or spleen involvement and early response to chemotherapy,then the difference of survival rate were compared between groups.Survival analysis was performed by the Kaplan-Meier method,and difference between groups were campared using the Log-rank test.Results The 3-year survival rate was better in patients without giant tumor bulk than that with giant tumor bulk(P0.05).Conclusions Bone marrow involvement and the size of tumor bulk have very significant influence on prognosis of childhood NHL,and splenomegaly or spleen involvement have significant influence on disease-free survival.It can′t be proven in childhood NHL in this study.