ABSTRACT
Objective:To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of stiff kyphosis.Methods:From January 2016 to April 2018, 12 patients with stiff kyphosis in our department were treated with middle-column preserved pedicle subtraction closing-opening wedge osteotomy. The patients' operative time, intraoperative blood loss, postoperative drainage, surgical complications, low back pain and leg pain visual analogue scale (VAS), Oswestry dysfunction index (ODI) score, and SF-36 were recorded.These parameters were compared at preoperative, postoperative, and at the final follow-up. Coronal parameters included lumbar scoliosis Cobb angle, C 7 vertebral body center to humeral vertical line distance (C 7PL-CSVL), whilesagittal parameters includedlumbar Lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittalvertical axis (SVA). Results:All of 12 patients successfully completed the operation.The mean operation time was 238.20±65.95 min, the mean intraoperative blood loss was 440.50±133.60 ml.The patients’ODI score was 65.92%±6.96% at the preoperative, and 21.00%±3.19% at the final follow-up. The difference was statistically significant ( t=20.32, P<0.0001).The VAS score of back pain was 6.00±0.95 at preoperative, 2.33±0.89 at 3 months postoperatively, and 1.42±0.51 at the final follow-up. The VAS score of leg pain was 6.91±1.24 at preoperative, 2.50±1.00 at 3 months postoperatively, and1.50±0.52 at the final follow-up. There was significant difference in SF-36 at preoperative and at final follow-up ( P<0.05). The differences in LL, SS, PT and SVA at the preoperative and at final follow-up were statistically significant ( F=17.47, P<0.001; F=5.015, P=0.0125; F=14.66, P<0.001; F=81.11, P<0.001) . There was significant difference in lumbar scoliosis Cobb angle and C 7PL-CSVL at the preoperative and at final follow-up ( F=87.19, P<0.001; F=100.9, P<0.001) . Conclusion:The advantages of this surgical procedure includesimple operation, reducedsurgery time, and shorten intraoperative bleeding, which can effectively relief clinical symptoms, improve the quality of life, correctkyphosis, and maintain the patient's spinal-pelvic balance.
ABSTRACT
Objective:To investigate the effect of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of old thoracolumbar compression fractures combined with kyphosis deformity.Methods:A retrospective case series study was performed to analyze data of 27 patients with old thoracolumbar compression fractures combined with kyphosis deformity admitted in Taizhou Hospital from January 2010 to January 2017. There were 10 males and 17 females, with age range of 45-75 years (mean, 61.7 years). The injured segments and osteotomy segments included T 11 in 5 patients, T 12 in 10, L 1in 8 and L 2 in 4. Time from initial fracture to surgery was 9-120 months (mean, 23.2 months). According to the American Spinal Injury Association (ASIA) classification, neurological impairment symptoms were detected in 9 patients, including grade C in 1 and grade D in 8. All patients underwent one-level middle-column preserved pedicle subtraction osteotomy. Operation time, blood loss, and perioperative complications were recorded. Before operation, at 3 months after operation and at latest follow-up, kyphosis Cobb angle, sagittal vertical axis (SVA) and height of anterior column (AC) as well as posterior column (PC) were measured. Visual analogue scale (VAS) and Oswestry disability index (ODI) score were used to evaluate the clinical efficacy. American Spinal Injury Association (ASIA) score was used to assess neurological function. Results:All patients were followed up for average 18.1 months (range, 12-34 months). Operation time was (155.2±35.4)minutes (range, 130-250 minutes). Blood loss was (338.1±101.4)ml (range, 150-550 ml). No serious neurological or vascular complications occurred during perioperative period. Kyphosis Cobb angle was (6.0±3.1)° at postoperative 3 months compared to preoperative (46.5±8.5)°( P<0.05), and showed no significant loss at latest follow-up [(7.9±3.8)°] ( P>0.05). SVA was improved significantly from preoperative [42.7(25.5, 78.2)]mm to [5.5(1.2, 7.3)]mm at postoperative 3 months ( P<0.05). AC height was increased by average 16.3 mm at postoperative 3 months compared to the preoperative level ( P<0.05), with no significant change in PC height ( P>0.05). There was no significant difference in SVA, AC height and PC height at postoperative 3 months and latest follow-up ( P>0.05). There were significant differences in VAS [(1.7±0.8)points, (2.3±1.4)points] and ODI (17.3±7.5, 19.4±4.3) at postoperative 3 months and at latest follow-up compared to these before operation [(7.7±1.3)points, 61.4±6.2] ( P<0.05), with no significant differences in VAS and ODI at postoperative 3 months and latest follow-up ( P>0.05). No implant failure was noted during follow-up. The osteotomy surface was fused in all patients at postoperative 6 months. At latest follow-up, ASIA grade was improved from grade C to grade D in 1 patient and from grade D to grade E in 8 patients. Conclusion:Middle-column preserved pedicle subtraction closing-opening wedge osteotomy can effectively correct old thoracolumbar fractures with kyphosis, relieve pain and improve nerve function.
ABSTRACT
OBJECTIVE: To investigate the expression of Toll-like receptor 4 (TLR4)/myeloid differentiation factor (MyD88)/nuclear factor-κB (NF-κB) pathway genes and related inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-12, IL-6 in patients with secondary spinal cord injury (SSCI) and the correlations with prognosis. METHODS: The clinical data of 105 SSCI patients and 40 healthy subjects were reviewed. According to Frankel's classification of spinal cord injury, the patients were divided into complete injury group and incomplete injury group, and according to the improvement of Japanese Orthopedic Association (JOA) scores, the patients were divided into good prognosis group and poor prognosis group. The expression of TLR4, MyD88, NF-κB in peripheral blood mononuclear cells (PBMC) and serum TNF-α, IL-12, IL-6 levels were compared between SSCI patients and healthy controls, between patients with complete and incomplete injury, between patients with poor and good prognosis. Logistic regression analysis was used to analyze the risk factors leading to poor prognosis of SSCI, and Pearson's correlation analysis was used to analyze the correlation between JOA score and the above indicators. RESULTS The expressions of TLR4, MyD88, NF-κB in PBMC and serum TNF-α, IL-12, IL-6 levels in SSCI patients were significantly higher than those in healthy subjects (all P<0.01), those in complete injury group were higher than those in incomplete injury group, and those in poor prognosis group were higher than those in good prognosis group (all P<0.01). The proportions of patients with Frankel grade A, spinal cord edema or hemorrhage, spinal cord injury length longer than 4 cm in poor prognosis group was significantly higher than those in good prognosis group (all P<0.01). Logistic regression analysis showed that Frankel grade, spinal cord edema or hemorrhage, length of spinal cord injury, relative expressions of TLR4, MyD88, NF-κB in PBMC, serum levels of TNF-α, IL-12 and IL-6 were risk factors for poor prognosis in SSCI patients (P<0.05 or P<0.01). Pearson's correlation analysis showed that JOA improvement rate was negatively correlated with the relative expressions of TLR4, MyD88, NF-κB mRNA in PBMC and serum TNF-α, IL-12, IL-6 levels (P<0.05 or P<0.01). CONCLUSIONS The activation of TLR4/MyD88/NF-κB pathway and the up-regulation of the expression of related inflammatory factors TNF-α, IL-12 and IL-6 are involved in the progression of SSCI, which are closely related to the neuroinflammatory injury, and can be used as reference indexes for evaluating prognosis in SSCI patients.
ABSTRACT
Objective@#To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors.@*Methods@#From October 2009 to March 2018, 17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up.@*Results@#There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred.@*Conclusion@#Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
ABSTRACT
Objective To explore the clinical effect of reduction and reconstruction of the removed bony structure after one?stage posterior resection of high cervical tumors. Methods From October 2009 to March 2018,17 patients including 10 males and 7 females of high cervical tumors who underwent one?stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posteri?or arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Ortho?paedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X?ray before the operation and at the last follow?up. Results There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow?up pe?riod was 29.1±28.2 months. No recurrence was found during the follow?up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow?up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow?up in X?ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell?shape tumors is a demanding surgery with high in?cidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
ABSTRACT
Objective To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closingopening wedge osteotomy for the treatment of ankylosing spondylitis (AS)-related thoracolumbar kyphosis.Methods From January 2010 to December 2016,eleven patients (9 males and 2 females) who underwent one-level middle-column preserved pedicle subtraction osteotomy with an average age of 40.8 years (21-68 years) were reviewed.The average thoracolumbar kyphosis angle (TLK) was 50.5°±9.6° and the average lumbar lordosis angle was-2.5°±24.1°.The thoracolumbar kyphosis,sagittal vertical axis (SVA),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,Scoliosis Research Society (SIRS) 22,Oswestry disability index (ODI) score,the length of anterior column and posterior column at the pre-and post-operation,operation time,perioperative blood loss and complications were recorded.Results The osteotomy sites of 11 cases included 7 in L2,2 in L3 and 2 in T12.Theaverage operation time was 156.8 min (120-220 min).The average blood loss was 604.5 ml (350-900 ml).The average time of followup was 24 months (12-42 months).Complications were encountered in 2 patients.There were 1 casewith transient neurological deficits,another case with incision infection.No serious neurological or vascular complications occurred in all cases.The thoracolumbar kyphosis (TLK),lumbar lordosis,pelvic tilt,sacral slope,thoracic kyphosis,SRS 22 and ODI score were improved significantly.The preoperative TLK cobb was 50.5° (36°-66°),which improved to 5.1 ° (1 °-11°) at the final follow-up with a mean correction rate of 89.9％.Sagittal migrationwas improved from 184.6 mm preoperatively to 79.2 mm atthe final follow-up with an average correctionrate of 49.3％.The differences of the length of posterior column of osteotomy site after operation showed no statistical significance.All patients had solid fusion at osteotomy site and no instrumentational failure and loosening were found over the follow up.Conclusion Middle-column preserved pedicle subtraction closing-openingwedge osteotomy is safe and effective for correction of the thoracolumbar kyphosis deformity occurring in ankylosing spondylitis,resulting in satisfactory out comes with acceptable complications.
ABSTRACT
Objective To investigate the treatment of the complications of puncture lapsus after the percutaneous vertebroplasty (PVP) for osteoporotic fractures.Methods From December 2011 to November 2014,3 female patients with postoperative complications of PVP which were treated for osteoporotic fractures,aged from 71 to 82 years (average,78 years old) were involved.Each of them performed a revision surgery in our hospital.One of them was performed with PVP of the 12th thoracic vertebral due to the osteoporotic thoracic vertebral compression fracture.However,bone cement was leaked into spinal canal after PVP,and the patient suffered from left abdominal constriction and impaired of sensation in left inguinal region.She underwent anterior approach of decompression,cement removal and internal fixation one year after the first operation.The second case was performed with PVP of the 1st lumbar vertebral due to the osteoporotic lumbar vertebral compression fracture.In this case,bone cement was leaked into spinal canal after PVP,and the patient suffered from abdominal and lower extremity pain,paralysis,and hypoesthesia of lower limbs.This patient was treated with posterior approach of decompression,cement removal and internal fixation.The third case was performed with the 12th thoracic vertebral PVP due to the osteoporotic thoracic vertebral compression fracture.Subdural hemorrhage happened after PVP,and the patient suffered from paralysis and sensory loss of the two lower limbs.This patient was treated with posterior approach of laminotomy,hemostasis in the spinal canal and evacuation of hematoma.We performed a follow up from 21 to 29 months (average,24.7 months),to observe the recovery of the patients.Results one case' s abdominal constriction eliminated and the inguinal region pain improved after the revision surgery,and there's no internal fixation loosening with the follow-up of 21 months.The other case's abdominal and lower limb pain relieved,the lower limb muscle strength recovered to grade 4,and the tactile of lower limb recovered to normal after the revision surgery.There' s no internal fixation loosening with the follow-up of 29 months.One case of patients with slightly recovered of lower extremity muscle strength and feeling after surgery,and remained lower limb pain,died two years after the surgery.Conclusion Complications of spinal cord compression after percutaneous vertebroplasty (PVP) for osteoporotic fractures can get good outcomes by using appropriate revision surgeries,although revision surgery is difficult and risky.