RESUMO
Objective To explore the risk factors related to the development and progression of lumbar degenerative spondylolisthesis (LDS).Methods A total of 71 patients with LDS or degenerative spinal stenosis (DSS) were retrospectively.Thirty-six patients with LDS (group LDS) and 35 patients with DSS (group DSS) were enrolled.Spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), regional lumbopelvic lordosis angles (PR-LI, PR-L2, PR-L3, PR-L4, PR-L5), pelvic morphology (PR-S1), lumbar 4 slope (L4 S) and lumbar 5 slope (L5 S) were assessed on whole spine lateral radiographs in a standing position.All the parameters from LDS will compared with those of DSS and normal population respectively, Student's t-test was used to compare each parameter among the LDS, DSS and normal population.Results PI [ (57.67±11.78) °], SS [ (37.83±9.17) °] and LL [ (54.65±11.45) °] in group LDS were significantly greater than those of group DSS [ (44.47±8.75) °, (28.18±9.02) °, (38.97±15.59) °] and normal reference value [ (44.75±9.01) °, (33.57±7.64) °, (48.75±10.03) °] (P＜0.05).L4 S [ (8.18±9.98) °] and L5 S [ (19.96±8.33) °] in group LDS were greater than the group DSS[ (3.32±7.95) °, (10.87±8.02) °] (P＜0.05).The PR-L4 [ (57.63±13.44) °], PR-L5 [ (45.76±10.92) °] and PR-S1 [ (27.91±10.41) °] in group LDS were significantly smaller than those of group DSS [ (65.48±10.70) °, (56.33±9.15) °, (38.63±7.29) °] (P＜0.05).Conclusion Greater PI may lead to the development and progression of lumbar degenerative spondylolisthesis.L5 S is a parameter that can be used to predict the risk of LDS.The lower regional lumbopelvic lordosis angles in LDS were smaller than those of DSS.
RESUMO
Objective To discuss the clinical efficacy of surgical treatment of pathologic vertebral surgery for thoracic and lumbar tuberculosis. Methods All of 322 cases of thoracic and lumbar spinal tuberculosis patients from December 2003 to June 2014 were retrospectively analyzed in our department. All patients were underwent debridement, fusion and nerve decompres?sion surgery. According to different fixed methods, patients were divided into pathologic vertebral surgery group (fixation complet?ed within lesions invaded motion unit) including 91 males and 100 females, with an average age of 41.53 years, and non?pathologic vertebral surgery group (long segments or short segment fixation) including 61 males and 70 females, with an average age of 42.72 years. We observed the tuberculosis cure rate, degrees of deformity, pain and neurological recovery, operative time, blood loss and complications by follow?up. Results The average follow?up time was 75.52 months in pathologic vertebral surgery group and 76.21 months in non?pathologic vertebral surgery group. The total number of pathologic vertebras in pathologic vertebral surgery group and non?pathologic vertebral surgery group were 277 and 218 respectively, and the average was 1.45 and 1.66. The total number of fixed segments was 277 in pathologic vertebral surgery group and 485 in non?pathologic vertebral surgery group, and the average fixed segments was 1.45 and 3.70. The cure rate was 85.86%in pathologic vertebral surgery group and 85.49%in non?pathologic vertebral surgery group at 6 months postoperatively, and 98.95%and 98.47%at the last follow?up time, with no signifi?cant difference between groups. Graft fusion rate was 89.00%in pathologic vertebral surgery group and 89.31%in non?pathologic vertebral surgery group 6 months postoperatively, 98.38%and 98.47%at the last follow?up time, without significant difference. In lumbar spine, the average correction of Cobb's angle was 12.4° in pathologic vertebral surgery group and 13.1° in non?pathologic vertebral surgery group, and the average angle loss was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average correction of Cobb’s angle was 10.9°in pathologic vertebral surgery group and 11.1°in non?pathologic vertebral surgery group, and the average angle loss was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average correction of Cobb's angle was 10.2° in pathologic vertebral surgery group and 12.7° in non?pathologic vertebral surgery group, and the average angle loss was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in pathologic verte?bral surgery group and 210.45 min in non?pathologic vertebral surgery group, with significant difference. The average blood loss was 726.12 ml in pathologic vertebral surgery group and 726.12 ml in non?pathologic vertebral surgery group, with significant dif?ference. The complication rate was 11.51%in pathologic vertebral surgery group and 11.45%in non?pathologic vertebral surgery group, with no significant difference. Conclusion Pathologic vertebral surgery surgery is a safe, effective and feasible method of operation for treatment of thoracic and lumbar tuberculosis, which can effectively preserve adjacent normal vertebral motion unit features. The thoracic surgery was less satisfactory than the lumbar and thoracolumbar surgery.