Application of back-forward Bending CT localization image in the prediction of proximal junctional kyphosis after spinal deformity surgery in adults / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators.@*METHODS@#A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T 5 in 1 case, T 6 in 1 case, T 9 in 13 cases, T 10 in 12 cases, and T 11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L 1 in 3 cases, L 2 in 3 cases, L 3 in 10 cases, L 4 in 7 cases, L 5 in 5 cases, and S 1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T 2-L 5 hyperextension C 7-vertebral sagittal offset (hC 7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC 7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK.@*RESULTS@#All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient's PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups ( P>0.05). Imaging measurements showed that the LL recovery value and T 8-L 3 vertebral hC 7-VSO in the PJK group were significantly higher than those in the non-PJK group ( P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T 2-T 7, L 4, L 5 vertebral hC 7-VSO ( P>0.05). T 8-L 3 vertebral hC 7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC 7-L 2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%.@*CONCLUSION@#Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient's T 8-L 2 vertebral hC 7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC 7-L 2, and the cut-off value is 2.54 cm.

Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease / 中国修复重建外科杂志

Objective: To compare the effectiveness of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease. Methods: A clinical data of 44 patients with stage Ⅲ Kümmell disease met the selection criteria between January 2014 and December 2017 was retrospectively analyzed. Eighteen cases were treated with short-segment bone cement-augmented fixation combined with vertebroplasty (short-segment group) and 26 cases were treated with long-segment bone cement-augmented fixation combined with vertebroplasty (long-segment group). There was no significant difference in gender, age, disease duration, fracture segment, bone mineral density (T value), Frankle grading, and preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior edge height of injured vertebrae, kyphosis Cobb angle, and thoracolumbar kyphosis (TLK) between the two groups ( P>0.05). The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK were compared between the two groups. Results: The operation time and the intraoperative blood loss in the short- segment group were significant lower than those in the long-segment group ( P0.05). All patients were followed up 12-36 months, with an average of 24.4 months. The VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK significantly improved at 1 week after operation and last follow-up in the two groups ( P0.05). At last follow-up, the neurological function of the two groups recovered, and there was no significant difference in Frankle grading between the two groups ( P>0.05). There were 3 cases (16.67%) of non-surgical vertebral fractures in the short-segment group and 6 cases (23.08%) in the long-segment group, showing no significant difference between the two groups ( P>0.05). Bone rejection occurred in 1 case in the short-segment group, and neither internal fixation failure nor collapse of the injured vertebrae occurred during follow-up. Conclusion: Both short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty can achieve good effectiveness in treatment of stage Ⅲ Kümmell disease, and can maintain the height of the injured vertebra and prevent the collapse of the injured vertebra. Compared with long-segment fixation, short-segment fixation has the advantages of shorter operation time and less intraoperative bleeding.

Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: A meta-analysis / 中国组织工程研究

BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference. OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis. METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.

Comparison of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture: A finite element study / 中国组织工程研究

BACKGROUND: Pedicle screw fixation combined with cement-augmented is an effective method for the treatment of severe osteoporotic vertebral fractures, but there is no uniform standard. The range of fixed segments is one of the focus of clinical controversy. OBJECTIVE: To establish a three-dimensional finite element model of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture, and to analyze the biomechanical characteristics of adjacent segment structures, fractured vertebral bodies and internal fixation devices. METHODS: The T 9 -L 5 segment of a volunteer without obvious degenerative disease was selected for CT scan. The CT images of Dicom format were obtained, and the engineering software was imported to establish a finite element geometric model to simulate the thoracolumbar fracture and the short-segment and long-segment cement-augmented pedicle screw fixation models. The relevant material parameters were set and the biomechanical characteristics of the two groups were compared and analyzed. RESULTS AND CONCLUSION: (1) The stress on the vertebrae was mainly concentrated on the periphery of the vertebral body and the small facet of the attachment. In the four directions flexion, extension, left-sided and right-sided curvature, the maximum stress of the proximal and distal adjacent vertebrae in the long-segment group was greater than that in the short-segment group. The stress of the intervertebral disc was mainly concentrated in the peripheral annulus. The maximum stress of the proximal and distal adjacent intervertebral discs was greater in the short -segment than in the long-segment, but the high stress area of the long-segment was larger than that of the short-segment. Therefore, long-segment fixation might accelerate the degeneration of adjacent segments.(2) The vertebral bodies of the long-segment group and the short-segment group were displaced to different extents, and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short- segment group.and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long- segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long- segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.

​Functional Analysis of Effectiveness of Short Segment with Index Vertebra Fixation as Compared with Long-segment Fixation in the Management of Thoracolumbar Spinal Injuries

Background: Dorsolumbar fractures are unstable mostly which requires surgical spinal stabilization to maintain anatomicalreduction and stability and also to promote early bony fusion and mobilization. Posterior short-segment pedicle screw fixation isusually done for burst fractures. Even though early clinical results of this surgery are usually satisfactory, a high failure rate andprogressive kyphosis remain a concern. To overcome this, in addition to short-segment fixation, the pedicle screw is insertedat the fracture site. Long-segment fixation is usually done for fracture dislocations.Materials and Methods: A total of 25 patients with dorsolumbar spinal injuries admitted in Government Rajaji Hospital andMadurai Medical College were selected for the study and followed for a period of 24 months. Of these, four patients were lostfollow–up, and hence, 21 cases were included in the study and followed for a period of 2 years.Results: A total of 25 patients were selected for the study. Our results showed good to excellent in long segment, 72.7% of thepatients were good (eight cases), and in short segment, 70% of the cases were good (seven cases). In long segment, 27.7%of the patients were fair (three cases), and in short segment, 30% of the cases were fair (three cases). In our study, the meanof Oswestry Disability Index in long segment is 32.31 and mean in short segment is 31.99. In our study, only one patient hadrod breakage, but the patient had no pain and no neurological deficit, and functional outcome is good.Conclusion: We conclude that short-segment fixation with index vertebra fixation provides as good results as long-segmentfixation with reduction in cost and time of surgery in the treatment of thoracolumbar spinal injuries.

Application of Laparoscopic and Robotic Ileal Uureteral Replacement Feasibility and Clinical Efficacy / 昆明医科大学学报

Ileal ureter is a suitable treatment option for patients with long ureteric strictures. Minimally invasive techniques have been shown to be as safe as open techniques but superior in terms of lesser trauma, less bleeding and less postoperative recovery time. In order to evaluate the feasibility and clinical efficacy of laparoscopic ileal ureter replacement, review of related literatures, indications, contraindications, surgical method, postoperative results combined with experience of our center has been done. Total 20 cases of laparoscopic ileal ureteral operation have been reviewed, the mean operation time was 195480 and blood loss was 50 ～ 375 ml and 7 Robotic ileal ureter replacement were reviewed median surgery time was 320720 min and bleeding is less then 10 ml100 ml. The operation complications include urinary leakage, intestinal obstruction, anastomotic site leakage, transient azotemia, urinary tract infection and so on. Postoperative renal function of all patients was improved in different degrees. Laparoscopic and Robotic ileal ureter replacement is feasible and can be used as an effective treatment for long ureteral injuries, although the curative effect is same as that of traditional open surgery, but Comparatively laparoscopic and robotic postoperative morbidity is less and have advantages such as it reduces surgical trauma, intraoperative bleeding, postoperative complications, less surgical scar and recovery time.The cases in the reports are limited, more cases need to be studied, and long-term results need to be assessed to establish and standardize these technique.

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Modification of End-to-End Anastomosis for Long-Segment Coarctation of the Aorta / 日本心臓血管外科学会雑誌

<p>Several problems have been reported following coarctectomy, especially in cases involving long-segment coarctation (COA). Although residual COA, proximal arch kinking, and airway compression may occur after coarctectomy, avoiding the use of artificial materials provides a better chance for the subsequent growth of the aorta. We successfully performed a modified end-to-end anastomosis with subclavian flap aortoplasty for a two-month-old boy with COA. A two-month-old boy was admitted to our hospital for nocturnal tachypnea and a feeding disorder. The initial echocardiography showed a preductal long COA beyond the left subclavian artery. A perimembranous VSD, a patent foramen ovale, and a patent ductus arteriosus were also noted. The left ventricular function was mildly depressed with an ejection fraction of 59%. Enhanced CT revealed a long-segment COA with a length of 15 mm. The blood pressure gradient between the upper and lower limbs was 40 mmHg. The operation was performed at the age of 2 months. The 4th intercostal space was opened through a posterolateral left thoracotomy incision. The distal end of the isthmus was so ligated as to maintain blood perfusion to the lower body through the PDA. The arch was clamped between the left carotid and the left subclavian artery (LSCA). The LSCA and the isthmus were divided as distally as possible, and the two distal ends were longitudinally incised and sutured to each other in a side-to-side fashion using a 7-0 polypropylene continuous suture. After complete resection of the ductal tissue, a newly created distal arch was anastomosed to the descending aorta. The left ventricular ejection fraction was increased to 74% at discharge. Catheterizations 3 years after the surgery did not reveal any stenosis or deformity in the aorta at normal PA pressure. The patient has been doing well and is free of complications 7 years after the surgery. At present, end-to-end anastomosis and aortic arch advancement with or without cardiopulmonary bypass are widely used procedures for coarctectomy ; however, a modified end-to-end anastomosis is still a viable option for cases involving long-segment coarctation.</p>

Posterior short segment and long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture:Meta analysis / 中国综合临床

Objective To systematically evaluate the efficacy and safety of posterior short segment and long segment pedicle screw internal fixation in the treatment of thoracolumbar burst fracture. Methods By searching the database, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, a comprehensive study was carried out to make a comparison between the posterior short segment and the long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture, and Meta analysis was performed. Results A total of 14 related studies and 658 patients were enrolled in the study, including 320 patients in short segment group and 338 cases in long segment group, and Meta analysis was performed. The results suggested that there was no significant difference between the short segment group and the long segment group in terms of the deformity angle of the injured vertebra measured after operation and at the last follow?up, and sagittal index at the last follow?up ( MD=-0. 22,95%CI -2. 73,2. 28,P=0. 86;MD=-0. 28,95%CI -2. 23,1. 67, P=0. 78;MD=0. 47, 95%CI -3. 45, 4. 39, P=0. 81 ) . Besides, both groups had no statistical difference in post?operative COBB angle,anterior vertebral height and compression rate of injured vertebrae ( MD=0. 21,95%CI -0. 65,1. 06,P=0. 64; MD=-0. 46,95%CI -1. 40,0. 49,P=0. 34; MD=0. 47,95%CI -2. 28, 3. 21, P= 0. 74 ) , while the differences in COBB angle, anterior vertebral height, compression rate, correction loss were statistically significant at the last follow?up (MD=5. 11,95%CI 2. 81,7. 40,P<0. 0001;MD=-11. 89,95%CI-15. 28,-8. 50,P<0. 00001;MD=6. 46,95%CI 3. 85,9. 07,P<0. 00001) . There was no significant difference in VAS scores and the ODI scores between the two groups at the last follow?up ( MD =0. 01,95%CI -0. 15,0. 17,P=0. 9; MD=-0. 47,95%CI -2. 68,1. 74,P=0. 86),while the two groups showed statistically significant difference in fixation failure ( RR = 0. 08, 95%CI 0. 01, 0. 15, P = 0. 02 ) . Conclusion Posterior long segment pedicle screw internal fixation is more effective in treating thoracolumbar burst fracture than short segment surgery. It can reduce the COBB angle,restore the anterior height of the injured vertebra,and decrease the anterior vertebral pressure.

Ileal ureteric replacement for bilateral long segment ureteric injuries: a case report and literature review / 中华泌尿外科杂志

Objective To report a ileal ureteric replacement surgery for bilateral long segment ureter injury.Methods Data from a patient suffered bilateral long segment uretercic stenosis was reviewed.A 32-year-old female,who underwent radical surgery of cervical cancer and postoperative radiotherapy 1 year ago,complained intermittent low back pain for 11 months and was found renal function abnormality for 3 months.Ultrasound showed bilateral hydronephrosis,and the CT urography showed bilateral middle-lower ureteral stenosis.Preoperative diagnosis was bilateral hydronephrosis with bilateral ureteral obstruction.The patient underwent bilateral ileal ureteric replacement under general anesthesia.Results The surgical procedure was successful and the postoperative recovery was favorable.The operation time was 180 min,and blood loss was 100 ml.The abdominal cavity drainage tube was removed 8 days and the urinary catheter was removed 9 days postoperatively.During 8 months' follow up,the patient showed resolved flank pain with stable serum creatinine.No complication was reported.The CTU 2 months postoperatively showed the hydronephrosis was relieved with normal functioning kidneys.Conclusion Bilateral ileal ureteric replacement surgery might be an effective procedure and viable option for bilateral long segment ureteric injuries.

The Analysis of the Outcome of Short- and Long-Segment Posterior Instrumentation for Thoracolumbar Bursting Fractures

STUDY DESIGN: A retrospective study. SUMMARY OF THE LITERATURE REVIEW: The reports comparing short- and long-segment instrumentation are insufficient. OBJECTIVES: To determine the postoperative results and to analyze relative factors affecting results between short- and long-segment instrumentation in thoracolumbar fractures. MATERIALS AND METHODS: From March 2006 to March 2012, 97 patients with thoracolumbar fracture were treated with posterior instrumentation. They were divided into 2 groups, the short- (Group I) and long-segment groups (Group II). To analyze factors affecting results, several factors including age, anterior column height (ACH), and the kyphotic angle were reviewed. For radiologic evaluation, postoperative and follow-up radiographs were evaluated by measuring the kyphotic angle and ACH. Additionally, the presence of complications was reviewed. RESULTS: Groups I and II consisted of 45, 52 cases and had mean ages of 50.3, 55.8 years, respectively. In Group I, the ACH increased from 44.2% to 75.3% postoperatively, and remained 72.8% at follow-up. The kyphotic angle decreased from 19.4degrees to 10.6degrees postoperatively, and remained at 12.8degrees at follow-up. In Group II, the ACH recovered from 41.6% to 76.4% postoperatively, and was 74.8% at follow-up. The kyphotic angle decreased from 21.6degrees to 12.6degrees postoperatively, and was 13.9degrees at follow-up. The canal compromise, age, and comminution were not directly related with results. However, the mean age of the 7 cases showing complications was 72 years, and the 7 cases had severe comminuted fractures. CONCLUSIONS: The short- and long-segment instrumentations of thoracolumbar fractures are not significantly different with respect to the results attained. However, in order to decrease complications, we should pay attention to age and fracture comminution.

Long-segment Posterolateral Fusion with Instrumentation of the Multi-level Spinal Stenosis: Long-term Followup over the 5 Years / 대한정형외과학회잡지

PURPOSE: To evaluate the long-term results, and to analyze the clinical and radiological results of long-segment posterolateral fusion with instrumentation in multi-level spinal stenosis. MATERIALS AND METHODS: A retrospective review was carried out on 62 patients, who had undergone long-segment posterolateral fusion with instrumentation for the treatment of multi-level spinal stenosis from June, 1990 to May, 1998 with a minimal follow up of 5 years. The clinical outcomes were evaluated using the Katz's classification and the Oswestry disability scoring system (ODI). The radiological results were evaluated by monitoring the changes in the adjacent segments and the Lenke's grade for bony union. RESULTS: The mean follow-up duration was 94 (61-156) months. There were 14 males and 48 females. The mean age was 58.7 (37-78) years. The mean number of fused segments per person were 3.97 (3-8) and the fusion techniques used in this study were either the fixed fusion for 60 cases or floating fusion for 2. 48 (77.4%) cases showed results beyond 'satisfaction'. The mean ODI was 30.0 (6-88%), which means moderate disability. The ODI according to the number of fusion segments was checked for good results. Good results were observed in 25.8%, 33.6%, and 25.9% of patients with 3, 4 or more than 5 fusion segments, respectively. There was no statistical difference. Regarding the changes in the adjacent segments, disc space narrowing, traction spur, endplate sclerosis and vacuum phenomenon was observed in 25 (40.3%), 26 (41.9%), 22 cases (35.5%) and 7 cases (11.3%), respectively. 34 (55.0%) cases had more than one change in the adjacent segments but the ODI was 38.0% for "good results" and 25 (74.0%) cases were "satisfied". In all cases except for one, bony union showed Lenke's A or B degree by radiographs. Pseudarthrosis was detected in 1 (1.6%) case. CONCLUSION: In the analysis of long-term clinical and radiological results for multi-level spinal stenosis treatment, posterolateral fusion with instrumentation might be good results irrespective of the fusion level and the change in adjacent segment.

The Changes of Adjacent Segments after Long Segment Posterolateral Fusion: Comparative Study of 3 year versus over the 7 year Follow-up Patients / 대한정형외과학회잡지

PURPOSE: To compare the 3 year and over the 7 year results after long-segment posterolateral fusion and to analyze the changes of adjacent segments and the changes according to the segmental lordosis angle of the fusion segments. MATERIALS AND METHODS: A retrospective review was carried out 62 patients of long segment fusion for 7 years follow up and compared that of the 3 year and over the 7 year results. The changes of adjacent segments were evaluated by simple radiography for disc space narrowing, traction spur, endplate sclerosis and vacuum phenomenon.In last follow-up, segmental lordosis angle of fusion level was evaluated by Gelb's criteria and clinical results were analyzed by Katz's classification. RESULTS: In the changes of adjacent segments, disc space narrowing was increased 27.4% to 38.7%, traction spur was 22.6% to 35.5%, endplate sclerosis was 19.4% to 32.2% and vacuum phenomenon was 8.1% to 12.9%. The changes of adjacent segments were observed that from 3.4% to 20.7% in physiologic group and from 33.3% to 90.9% in un-physiologic group. The clinical results showed 83.9% satisfaction and 16.1% un-satisfaction. CONCLUSION: In long-term follow up of long-segment posterolateral fusion, physiologic segmental lordosis angle should be preserved for decrease of changes of adjacent segments in long-segment posterolateral fusion.

Treatment of Thoraco-Lumbar Bursting Fractures According to Load-Sharing Classification

PURPOSE: To determine optimal levels of posterior fixation in thoraco-lumbar bursting fractures according to the Load-sharing classification. MATERIALS AND METHODS: From Aug. 1999 to Aug. 2003, 50 patients who had been operated with the posterior fixation in one-body thoraco-lumbar bursting fracture were selected. They were divided into two groups, group I, 6 points and below in the Load-sharing score and group II, 7 points and above. And also, each groups subdivided into two subgroups, A (short segment fixation including below and above one body) and B (long segment fixation including below and upper two body). So patients subdivided into I-A, I-B, II-A, II-B. Change of the corrected kyphotic angle was measured and compared with each subgroups. RESULTS: The loss of the corrected kyphotic angle was measured average 1.7degrees in group I and 4.1degrees in group II, and there was significant difference between two groups (p>0.05). The loss of the corrected kyphotic angle in the subgroups was average 1.8degrees in I-A, 1.6degrees in I-B, 3.5degrees in II-A and 4.9degrees in II-B. And there was significant difference statistically in I-A and II-A (p>0.05). CONCLUSION: In the thoraco-lumbar bursting fracture with 6 points and below of the Load-sharing score, the fixation of the short segment is a useful method. But in the fracture with 7 points and above, the fixation of the short segment is not enough, and these findings be required the further evaluation for some cause of the loss of corrected angle and treatment modalities including the fixation of the long segment.

The Results of Long Segment Posterolateral Fusion in Degenerative Lumbar Spinal Disorders / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the safety and the validity of the long level posterolateral fusion with pedicle screw augmentation in the surgical treatment of degenerative lumbar spinal disorders in older patients. MATERIALS AND METHODS: A radiological evaluation such as fusion rate, the changes of lordotic angle, metal failure and junctional problem, and clinical results about a 33 patients older than 50 years of age in whom a posterolateral fusion has been performed on more than three segments were analyzed. RESULTS: Arthrodesis was obtained in 23 cases and the changes in the lordotic angle was 7.9+/-5.2degrees. Satisfactory results were obtained in 20 cases, fair in 8 and poor in 5 cases. Satisfactory results were obtained in 12 of the 16 cases in which S1 was included in the arthrodesis and 8 of the 17 cases in which S1 was not included in the arthrodesis. The post-surgical complications encountered were as follows: Wound infection in 5 cases, metal loosening or failure in 12, bone graft donor site problem in 2 and junctional problems in 8 cases. Revision surgery was performed in 9 cases. CONCLUSION: Long segment fusion in degenerative lumbar spinal disorders should be considered carefully in old age because of the high rate of post-surgical complications and unsatisfactory clinical outcomes.

Surgical Experience with Pull-through Operation in Hirschsprung's Disease of the Descending Colon

Leveling colostomy with a frozen-section biopsy in a Hirschsprung's disease is an important factor for a successful procedure. Two neonatal cases of Hirschsprung's disease in the descending colon are reported. In both cases, loop ileostomy was established because of the unavailability of frozen-section biopsy on an emergency basis. At the time of definitive procedure of the first case, transition zone at the splenic flexure was noted and was compatible with the frozen section biopsy. In the second case, an unexpected longer resection at a higher level than transition zone was required because of the poor vascularity after dissection. In conclusion, a leveling colostomy should be selected as a choice in long-segment Hirschsprung's disease. Confirming preservation of the marginal artery of Drummond is particularly important in case of Hirschsprung's disease in the descending colon.

Huge Schwannoma Extended from Craniocervical Junction to Upper Thoracic Spine

We report a case of 16 centimeter long schwannoma extended from craniocervical junction to upper thoracic spine that was successfully resected by posterior laminoplasty. However the patient developed postoperative kyphotic deformity at 3 months postoperatively, and it was corrected by anterior corpectomy and plate fixation.

Comparisons of endoscopic and pathological characteristics between long and short segment Barrett's esophagus / 中华消化杂志

Objective To investigate the similarities and differences of endoscopic and pathological char- acteristics between long and short segment Barrett's esophagus.Methods One hundred and twenty-eight cases of Barrett's esophagus identified both by endoscopy and pathology were enrolled in this retrospective study. Among them,40 cases were long segment Barrett's esophagus (LSBE) and 88 were short segment Barrett's esophagus (SSBE).The age distribution,sex distinction,endoscopic manifestations and pathological changes were assessed.Data were statistically analyzed by t-test or u-test.Results There were no differences in age distribution and sex distinction between LSBE and SSBE groups (P＞0.05).The ring pattern was the most prominent type accounting for 62.5% in LSBE group.The island pattern was the most prominent type accounting for 85.2% in SSBE group.There were significant differences in the rates of specialized intestinal metaplasia between LSBE and SSBE groups(47.5% vs 14.8%,P＜0.01).Moreover,among the special- ized intestinal metaplasia,low grade (15.0% vs 4.5%),medium grade (12.5% vs 3.4%) and high grade dysplasia (5.0% vs 0.0%) between LSBE and SSBE groups also had statistical differences (all P＜0.05).Conclusions LSBE may have more tendency in dysplasia than that of SSBE.We should pay attention to the importance of endoscopic manifestations and pathological diagnosis.

A Clinical Analysis of Long Segment Fusion with Pedicle Screw in Degenerative Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To identify complications of long segment fusion with pedicular screw fixation of lumbosacral spine and analyze causative factors of complications. SUMMARY OF LITERATURE REVIEW: An unexpected high rate of complication has been observed in pedicle screw fixations used in long segment fusion for degenerative lumbar diseases. Adjacent problem, fixation problem due to osteoporosis, insufficient bone stock may cause implant failure and pseudarthrosis. MATERIALS AND METHODS: From January 1991 to March 1998, 62 patients underwent long segment fusion more than 3 segments for degenerative lumbar diseases, such as degenerative spinal stenosis, associated spondylolisthesis, spinal deformity(kyphoscoliosis), etc. 50 of them followed for more than one year after operation, average follow up period was 21.9 months(range: 12 to 58 months). 17 of them were male and 33 were female and average age was 59.76 years(range : 50 to 76 years). In all cases, pedicle screw fixation was performed with or without additional anterior/posterior lumbar interbody fusion. The number of fused segment was 25 three levels, 14 four levels, 6 five levels, 5 more than six levels. RESULTS: Problem in implant was noted in 19 patients, of which 16(33 screws) showed screw loosening and 3(4 screws) showed screw breakage. 25 of 33 loosened screws were in most distal segment and 21 of them were sacral screws. All the screw breakages developed in sacrum. The problem of screw was associated with the number of fused segment(p=0.009) and sagittal imbalance(p=0.043). Pseudarthrosis rate was 20%(10 patients) and was associated with screw failure(p=0.030). On clinical results, 66% of good to excellent results were obtained, and revision rate of complicated cases was 24%. CONCLUSIONS: In long segment fusion of degenerative lumbar spine, we need to restore more adequate sagittal balance, and need additional sacral fixation and anterior fusion to avoid implant failure and pseudarthrosis.

Long Segmental Fixation for unstable Thoracolumbar Fracture Without Severe Neurologic Involvement / 대한정형외과학회잡지

Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.