RÉSUMÉ
Objective:To explore the optimal match degree between thoracolumbar kyphosis (TLK) and lower lumbar lordosis (LLL) in adult spinal deformity (ASD) after correction surgery.Methods:Data of 119 ASD patients (male: 28, female: 91), belonging to the Affiliated Hospital of Jining Medical University (19 cases), the Affiliated Hospital of Shandong University of Traditional Chinese Medicine (11 cases), and the First Medical Center of Chinese PLA General Hospital (89 cases) were reviewed and documented from March 2019 to March 2020. All patients (age, 64.48±8.88 years; range, 45-79 years) underwent the surgical procedure of thoracolumbar fusion with instrumentations were followed up over 24 months (51.68±15.60 months; range, 24-87 months) after surgery. Postoperative proximal interface failure, Oswestry disability index (ODI) score and Scoliosis Research Society-22 (SRS-22) score were recorded for all patients. The immediate match of TLK to LLL postoperatively was calculated as follows: TLM=TLK/LLL. The data of those individuals with excellent improvements in the ODI (>50%) at the final follow-up were recorded and analyzed. Then the mean value and the 95% CI of TLM in those individuals were calculated. All participants were subdivided into three groups according to the 95% CI value of TLM. After the receiver operating characteristic curve (ROC) analyzing, the area under the ROC curve (AUC) was the best cutoff value of TLM. The association of proximal junctional failure (PJF) developing with the abnormal TLM postoperatively was analyzed with logistic regression, and the odds ratio (OR) was calculated. Results:62 patients had significant improvements in ODI (>50%) at the final follow-up, and the mean TLM in those individuals was 0.41 [95% CI (0.2, 0.5)]. All patients were divided into three groups: TLM<0.2 (35 cases), 0.2≤TLM≤0.5 (48 cases) and TLM>0.5 (36 cases). The preoperative TLK (13.87°±16.61°) and T 1 pelvic angle (19.69°±10.55°) in the those patients with TLM<0.2 were the smallest, and those were the largest in those with TLM>0.5 (30.59°±16.68°, 28.30°±14.46°). The individuals with TLM<0.2 still had the smallest TLK (2.89°±1.78°), however, those with TLM>0.5 had the largest TLK (17.13°±12.13°) and the smallest LLL (-26.16°±11.02°) accordingly. Additionally, the ODI and SRS-22 for those with 0.2≤TLM≤0.5 at the final follow-up were the best ( P<0.05). ROC curve analysis results showed that the best cutoff value of TLM was 0.4 (sensitivity=78.9%, specificity=76.2%; AUC=0.802, 95% CI (0.708, 0.896) , P<0.001). During the follow-up after orthopedic surgery, there were 19 patients with postoperative proximal junction failure, including 16 patients in the mismatched group (6 patients in the TLM<0.2 group, 10 patients in the TLM>0.5 group) and 3 patients in the matched group (0.2≤TLM≤0.5 group), with the incidence of 23% (16/71) and 6% (3/48), respectively. The difference was statistically significant (χ 2=5.66, P=0.017). Thoracolumbar mismatch was significantly associated with proximal borderline failure after orthosis [ OR=4.35, 95% CI (1.196, 15.924)]. Conclusion:The abnormal correction in thoracolumbar kyphosis and lower lumbar lordosis may result in mismatch between thoracolumbar segments, which would undermine the quality of life, and increase the incidence of proximal junctional failure developing in those ASD patients underwent long-fusion surgeries. The match between TLK and LLL should be 0.2 to 0.5.
RÉSUMÉ
Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.
RÉSUMÉ
Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.
RÉSUMÉ
Objective To explore the influence factor of the stability of L5S1 fusion and the relationship between the stability of sacrum fusion and the clinical outcome for degenerative lumber scoliosis with long-segment fusion.Metheds Fifty patients with degenerative lumber scoliosis who underwent the long-segment fusion from June 2010 to January 2015 were included in this retrospective study.Based on post-operative L5S1 fusion,patients were divided into two groups.There were 15 patients(30％,9 male and 6 female patients) with a failing sacrum fusion whose average age 60±7.6 years (range from 58 to 78 years).6 patients had the situation at T12-S1,7 at L1-S1 and 2 at L2-S1.There were 35 patients (70％,26 male and 9 female patients) with a satisfying sacrum fusion whose average age 58.4±4.8 years (range from 50 to 80 years).Among them,16 were at T12-S1,12 at L1-S1 and 7 at L2-S1 levels.The interbody fusion rate and accuracy of pedicle screws were evaluated by anteroposterior and lateral spine radiographs in standing and CT scanning during the postoperative follow-up.The age,body mass index (BMI),bone mineral density,Cobb's angel,lumbar lordosis (LL),sagittal vertical axis (SVA),thoracic kyphosis (TLK),sacral slope (SS),pelvic inclination (PI) and pelvic tilt (PT) were compared between the 2 groups to analysis the relevant factor of the failing L5S1 fusion.Oswestry disability index (ODI) and visual analogue scale (VAS) were compared between the 2 groups in the postoperative follow-up.Results There were no statistically significant difference between the 2 groups preoperative in the age,BMI,lumbar Cobb angel,LL,SVA,TLK,SS,PI and PT.But there was a significant difference between the bone mineral density of 2 groups.LL were-40.5°± 8.7° vs.-41.2°±7.9°;TLK were 1.7°±7.4° vs.1.8°±6.7°;SS were 32.1°±5.6° vs.32.4°±5.5°;PT were 18.7°±10.5° vs.19.5°± 10.1°;PI were 42.3°±4.4° vs.40.1°±5.2°;SVA were 9.2±3.5 cm vs.9.5±3.1 cm;T value were-2.7±1.1 vs.-1.2±1.4.There were no statistically significant difference between the 2 groups in the ODI and VAS in the postoperative follow-up.Oswestry disability index were 8.2％±5.2％ vs.7.8％±4.5％;VAS value were 3.4±2.6 vs.3.1±2.1.Conclusion The smaller the bone mineral density of the patients with DS,the higher the incidence of the fusion failure L5S1 fusion.And when the failing L5S1 of fusion happened,the clinical outcome will not always be poor.