Clinical analysis of risk factors and preventive dissection of lymph node metastasis in central region of stage cN0 isthmus papillary thyroid carcinoma / 国际外科学杂志

Objective:To explore the risk factors affecting central lymph node metastasis in cN0 isthmus papillary thyroid carcinoma and the significance and feasibility of preventive dissection, so as to provide reference for clinical treatment.Methods:The clinical data of 108 patients with cN0 stage isthmus papillary thyroid cancer who underwent surgery in the General Surgery Department of Lianyungang Oriental Hospital from January 2014 to December 2021 were retrospectively analyzed. There were 32 males and 76 females, with an age range of 24 to 70 years, with a mean age of (46.0±12.7) years. Statistical analysis was performed using the SPSS 22.0 statistical software. Chi-square test and logistic regression were used to analyze the relationship between central lymph node metastasis and patients Relationship between clinical case factors.Explore the feasibility of preventive cleaning.Results:The positive rate of lymph node metastasis in central region of isthmic papillary thyroid carcinoma was 37.9% (41/108). Univariate analysis showed that central lymph node metastasis was associated with tumor diameter ( χ2=5.36, P=0.021), capsular infiltration ( χ2=7.69, P=0.006), and elevated thyroglobulin ( χ2=7.73, P=0.005). Multivariate analysis showed that capsular infiltration ( HR=2.75, P=0.037) and tumor diameter ( HR=4.454, P=0.004) were independent risk factors for central lymph node metastasis. The ROC curve of tumor diameter to predict central lymph node metastasis was drawn, and the AUC value of the area under the curve was calculated to be 0.720. When the diameter was 0.695 cm, the Youden index was 0.326, the sensitivity was 0.878, and the specificity was 0.448. 6 cases (5.56%) had temporary recurrent laryngeal nerve palsy, 13 cases (12.04%) had temporary hypoparathyroidism, no permanent complications occurred. Conclusions:cN0 stage PTCI has the risk of early occult lymph node metastasis. Prophylactic CLND can clarify the stage of the tumor, assess the risk, and guide the follow-up treatment of patients. CLND should be routinely performed for patients with tumor diameter >0.695 cm and capsular invasion.

Unstable Non-isthmic Spondylolisthesis Following Unilateral Biportal Endoscopy Assisted Unilateral Laminotomy for Bilateral Decompression: A Case Report

@#Lumbar decompressive laminectomy is a standard treatment for degenerative lumbar spinal stenosis, but in some cases, can lead to iatrogenic spondylolysis and delayed segmental instability. Iatrogenic spondylolysis occurs in most cases in pars interarticularis, but rare cases have also been reported, pediculolysis in pedicle and laminolysis in lamina. Minimally invasive spine surgery (MIS) is known to have a low risk of developing these iatrogenic spondylolyses, and unilateral biportal endoscopy is the MIS that has been drawing attention. We present a case of a 72-year-old female who was diagnosed with L4-5 unstable non-isthmic spondylolisthesis and severe right central disc extrusion 10 weeks after UBE assisted unilateral laminotomy for bilateral decompression (ULBD) at the consecutive segments of L3-4 and L4-5. Pre-operative imaging studies revealed severe central stenosis without spondylolisthesis at L3-L4 and L4- L5 along with L4-L5 facet tropism. She was managed by anterior lumbar interbody fusion and cement augmented pedicle screw fixation, which resulted in the complete resolution of her clinical and neurologic symptoms.

Effect of Wiltse approach pedicle screw-laminar hook internal fixation combined with autologous ilium transplantation for repairing single-segment lumbar spondylolysis / 解放军医学杂志

[Abstract] Objective To analyze the characteristics of lumbar spondylolysis in military patients, and explore the clinical effect of Wiltse approach pedicle screw-laminar hook internal fixation combined with autologous ilium transplantation in repairing single-segment lumbar spondylolysis. Methods Thirty-three military patients with single-segment lumbar spondylolysis were admitted to the 940 Hospital of Joint Service Support Force of Chinese PLA from January 2016 to January 2019. The Wiltse approach pedicle screw-lamina hook internal fixation combined with autogenous ilium transplantation was performed to repair the lumber spondylolysis, the patients were then followed up to evaluate the visual analogue scale (VAS) and Oswestry dysfunction index (ODI) of lumbar pain, and compared with that before surgery. 3-D CT of lumbar spine was used to evaluate the bone graft fusion in the isthmus. Results The army patients accounted for 63.6% (21/33) of all the cases. The injured segments were located at L4 and L5 segment, with the L5 segment (84.8%, 28/33) being the most common. The operation time was 85-150 min, the intraoperative blood loss was 50-150 ml, postoperative drainage volume was 10-30 ml. VAS score of lower back pain decreased from 5.8±0.7 before surgery to 1.4±0.8 three months after surgery, and to 0.4±0.5 at the last follow-up, the difference was statistically significant (P<0.05). ODI decreased from 41.2%±5.8% before surgery to 12%±3.9% 3 months after surgery, and to 9.5%±2.6% at the last follow-up, the difference was statistically significant (P<0.05). At 3 months, 6 months and 12 months follow-up, the bone graft fusion rate was 18.2% (6/33), 48.5% (16/33) and 84.8% (28/33), respectively, and the average bone graft fusion time was 7.0±2.8 months. Conclusion Wiltse approach pedicle screw-laminar hook internal fixation combined with autogenous ilium transplantation is a feasible and effective minimally invasive solution for repairing single-segment lumbar spondylolysis of military patients with shorter bone graft fusion time.

History-indicated transvaginal cerclage: results from a single-centre

Background: Cervical incompetence occasionally results in mid-trimester pregnancy loss, preterm labour and increased foetal morbimortality. History-indicated cerclage is proposed when obstetric history suggests cervical incompetence. The aim of this study was to evaluate the maternal-foetal outcomes following prophylactic cervical cerclage.Methods: Retrospective study reviewing data of all women undergoing transvaginal history-indicated cerclage from January 1st, 2008 to December 31th, 2017 at Centro Hospitalar Universitário do Algarve - Faro. Primary outcome: gestational age <37weeks at birth. Secondary outcomes: neonatal morbimortality and intensive care unit (NICU) admission and maternal morbidity. Data were analyzed with IBM SPSS Statistics 23.Results: A total of 12 history-indicated cerclages were performed (9 women). At first cerclage, mean maternal age, gestity, parity and live children were 27.6, 2.44, 1.11 and 0.78 (87.7% preterm), respectively. At cerclage placement, mean gestational age and cervical length were 16.1 weeks and 27.5mm. Average hospital admission was 10.7 days. In all cases McDonald technique was performed. Four hospital readmissions occurred for threatened labour. Mean gestational age at cerclage removal was 36.9 weeks (83.3% in ambulatory) and 38.9 at delivery. Average time between cerclage removal and labour was 14.5 days. Spontaneous onset of labour occurred in 75% and vaginal delivery in 83.4%. There were no reports of preterm birth, foetal admission to NICU or maternal complications. Mean number of live children after procedure was 1.58.Conclusions: Prophylactic cervical cerclage seems to improve pregnancy outcome with minimal maternal risks. However, our data suggest over inclusion of women, with unnecessary procedures, emphasizing the importance of re-evaluating inclusion criteria.

Comparison of sagittal plane morphology of spine and pelvis in adolescents with L₅S₁ developmental spondylolisthesis and isthmic spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent.@*METHODS@#Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. 0.05).@*CONCLUSIONS@#Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.

Comparison of the effectiveness of vertebral arch replantation and laminectomy in the treatment of mild to moderate isthmic spondylolisthesis / 中国修复重建外科杂志

Objective: To compare the effectiveness of vertebral arch replantation and laminectomy in the treatment of mild to moderate isthmic spondylolisthesis. Methods: The clinical data of 66 patients with isthmic spondylolisthesis treated with vertebral arch replantation or laminectomy between March 2014 and July 2016 were retrospectively analyzed. They were divided into trial group (34 cases, treated with complete replantation of vertebral arch, intervertebral fusion, and internal fixation) and control group (32 cases, treated with laminectomy with intervertebral fusion and internal fixation) according to different surgical methods. There was no significant difference in general data of gender, age, disease duration, lesion segment, Meyerding grade, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Japanese Orthopaedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, complications, vertebral arch fusion of trial group, and epidural scar formation of the two groups were recorded. The VAS score, JOA score, and ODI score were evaluated at preoperation, 3, 6, 12 months after operation, and at last follow-up. The effectiveness was evaluated according to HOU Shuxun's criteria. Results: All the patients successfully completed the surgery, without any aggravation of nerve injury, dural tear, infection, etc. There was no significant difference in the operation time between the two groups ( t=0.583, P=0.562), but the intraoperative blood loss was significantly lower in the trial group than that in the control group ( t=2.134, P=0.037). All the 66 patients were followed up 13-18 months (mean, 16.2 months). Postoperative clinical symptoms of all patients were significantly improved. In the control group, 7 cases were found to have symptoms of spinal canal stenosis with postoperative posture changes at 3 months after operation, and 5 cases showed mild lower limb numbness at 18 months after operation. No complication such as infection and nerve injury occurred in other patients. In the trial group, 34 cases of epidural scar tissue were completely blocked outside the replantation vertebral arch, while in the control group, 11 cases of epidural scar tissue invaded the spinal canal. At last follow-up, the fusion rate of intervertebral bone grafting and vertebral arch replantation in the trial group was 100%, and the fusion rate of intervertebral bone grafting in the control group was also 100%. The VAS score, ODI score, and JOA score were significantly improved at each time point after operation ( P0.05). According to HOU Shuxun's criteria, the excellent and good rate was 91.2% in the trial group and 84.4% in the control group, showing no significant difference ( χ2=1.092, P=0.573). Conclusion: Compared with laminectomy, vertebral arch replantation can better improve postoperative neurological symptoms, maximize the reconstruction of the bone spinal canal, restore the stability of the intraspinal environment, and it is a better surgical method for lumbar isthmic spondylolisthesis.

Cerclaje Cérvico-Ístmico transabdominal: experiencia de 30 años / Cervical-Isthmic transabdominal cerclage: experience of 30 years

RESUMEN Introducción: se define incompetencia cervical como la incapacidad del cuello uterino de retener una gestación en el segundo trimestre, en ausencia de contracciones uterinas. El cerclaje cervical es la intervención que ha demostrado utilidad en el tratamiento de la incompetencia cervical. La principal vía utilizada para cerclaje es la vaginal, sin embargo existe un grupo de pacientes en el que ésta no es posible y debe realizarse un abordaje transabdominal. Este trabajo muestra los resultados y experiencia de 30 años en la instalación de cerclaje por vía abdominal abierta. Se realiza una revisión de la literatura y se discuten sus indicaciones, resultados y complicaciones. Además se analiza la técnica quirúrgica, especialmente las variantes de ella y el momento de realizar la intervención. Métodos: se revisaron datos de 20 pacientes a las que se realizó cerclaje transabdominal, desde el año 1985 hasta la fecha. En todas las cirugías participó el autor principal de este artículo. Resultados: las intervenciones se realizaron entre las 8 y 18 semanas de gestación. Las causas principales fueron la imposibilidad de realizar un cerclaje por vía vaginal, debido a ausencia de cuello por conizaciones amplias o repetidas y amputaciones cervicales o fracaso de cerclajes por vía vaginal previos. Las 20 pacientes tuvieron 23 embarazos, 20 partos (16 mayores de 37 s. y 4 mayores de 34 s.) y 3 abortos. Se obtuvo un 87% de sobrevida fetal. Conclusiones: la utilización de esta técnica es útil en pacientes con imposibilidad de cerclaje por vía vaginal o en fracasos de cerclajes vaginales previos. La literatura revisada no muestra diferencias estadísticamente significativas entre los procedimientos realizados previos o durante la gestación, ni tampoco si se realiza mediante laparoscopía o cirugía abierta.

SUMMARY Introduction: cervical incompetence is defined as the inability of the cervix to retain a pregnancy in the second trimester, in the absence of uterine contractions. Cervical cerclage is the intervention that has proven its usefulness in the treatment of cervical incompetence. The main route used for cerclage is vaginal, however there is a group of patients in which this is not possible and a transabdominal approach must be performed. This work shows the results and experience of 30 years in the installation of cerclage by abdominal open route. A review of the literature is made and its indications, results and complications are discussed. In addition, the surgical technique is analyzed, especially it's variants and the moment of performing the intervention. Methods: data from 20 patients who underwent a transabdominal cerclage from 1985 to date were reviewed. In all the surgeries, the main author of this article participated. Results: the interventions were performed between 8 and 18 weeks of gestation. The main causes were the impossibility of performing a cerclage by vaginal route due to absence of the cervix by extensive or repeated conizations and cervical amputations or failure of previous cerclage by vaginal route. The 20 patients had 23 pregnancies, 20 deliveries (16 over 37 w. and 4 over 34 w.) and 3 abortions. 87% of fetal survival was obtained. Conclusions: the use of this technique is useful in patients with inability to cerclage vaginally or in failures of previous vaginal cerclages. The literature reviewed does not show statistically significant differences between the procedures performed before or during pregnancy, nor whether it is performed by laparoscopy or open surgery.

Vertebral three-dimensional motion characteristics of adjacent segments in patients with isthmic spondylolisthesis in vivo / 中国修复重建外科杂志

Objective: To observe vertebral three-dimensional motion characteristics of adjacent segments in patients with symptomatic L 4 isthmic spondylolisthesis (IS). Methods: Fourteen symptomatic L 4 IS patients who underwent surgery treatment (trial group) and 15 asymptomatic volunteers without back pain and other lesions of spine (control group) were recruited. There was no significant difference in gender, age, body mass index, and bone mineral density between the two groups ( P>0.05). The three-dimensional reconstruction model of lumbar spine was acquired from the thin slice CT of the lumbar spine of the subjects by combining dual-X-ray fluoroscopy imaging system with spiral CT examination. The model was matched to the double oblique X-ray fluoroscopy images captured by dual-X-ray fluoroscopy imaging system at different active positions of the lumbar spine to reproduce the three-dimensional instantaneous of lumbar spondylolisthesis at different state of motion. The motion and relative displacement of adjacent segments (L 3, 4 and L 5, S 1) of spondylolisthesis were measured quantitatively by establishing a three-dimensional coordinate system at the geometric center of the vertebral body. The results were compared with those of the control group. Results: When L 3, 4 in the control group were flexed flexion-extension, left-right twisting, and left-right bending, and when L 5, S 1 in the control group were flexed left-right twisting and left-right bending, the activity along the main axis of motion (main axis of motion) tended to increase compared with that along the corresponding coupled axis of motion (secondary axis of motion); however, this trend disappeared in the trial group, and the main and secondary movements were disordered. Because of the coronal orientation of the facet joints of L 5, S 1, the degree of motion along the main axis of motion decreased during flexion and extension, but this trend disappeared in the trial group. Compared with the control group, L 3, 4 in the trial group exhibited displacement instability in flexion-extension, left-right twisting, and left-right bending ( P0.05). Conclusion: Patients with symptomatic L 4 IS have disorders of primary and secondary movement patterns in adjacent segments, while IS showed significantly displacement instability in L 3, 4 and significantly decreased motion in L 5, S 1.

The clinical outcome of the treatment of isthmic spondylolysis with Smiley face rod fixation system / 中国脊柱脊髓杂志

Objectives:To investigate the clinical outcome of Smiley face rod fixation system for lumbar isthmic spondylolysis.Methods:From January 2016 to June 2017,18 patients with isthmic spondylolysis were treated with smiley face screw-rod fixation system.There were 13 males and 5 females,with an average age of 28.2±3.2(25-32) years old.The average disease duration was 16.3±5.7(7-24) months.L5 isthmic spondylolysis was involved in all cases.All patients had been followed up at 3 months and 1 year after surgery.The preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) were compared.The X-ray and CT scan were evaluated to analyze the change of range of motion in the lumber spine and the bony fusion rate.Results:The mean operation time was 90.0±24.1 minutes.The average blood loss was 140±15ml.The average follow-up was 18.5±5.0 (12-24) months.The VAS at 3 months after operation was 3.0±1.2,and the ODI was (17.2±4.5)％ respectively,which showed significant differences compared with the preoperative ones[7.3±2.5 and (67.0±15.1)％](P＜0.05).The VAS and ODI at 1 year after operation were 1.0± 0.6 and (9.1±5.3)％,which showed significant differences compared with 3 months postoperation(P＜0.05).The range of motion between L5 and S1 was 13.1°±2.1° and the incidence of lumbar instability was 83.3％(15/18) preoperatively;it was 9.3°±1.6° and 11.1％(2/18) postoperatively,and there was statistic difference(P＜0.05).All patients achieved bone fusion in the isthmic defect 1 year after operation.Conclusions:The Smiley face rod fixation is a reliable treatment for lumbar spondylolysis with the advantage of minimal invasive,less nerve interference,and to restore normal anatomical structure,maintain the lumbar spine stability.

Sagittal Pelvic Radius in Low-Grade Isthmic Lumbar Spondylolisthesis of Chinese Population

OBJECTIVE: To investigate the variation of pelvic radius and related parameters in low-grade isthmic lumbar spondylolisthesis. METHODS: Seventy-four patients with isthmic lumbar spondylolisthesis and 47 controls were included in this study. There were 17 males and 57 females between 30 and 66 years of age, including 30 with grade I slippages and 44 grade II slippages; diseased levels included 34 cases on L4 and 40 cases on L5. Thoracic kyphosis (TK), the pelvic radius (PR), the pelvic angle (PA), pelvic morphology (PR-S1), and total lumbopelvic lordosis (PR-T12) were assessed from radiographs. RESULTS: Statistically significant differences were found for the PA, PR-T12, and PR-S1 (24.5±6.6°, 83.7±9.8°, and 25.4±11.2°, respectively) of the patients with spondylolisthesis and the healthy volunteers (13.7±7.8°, 92.9±9.2°, and 40.7±8.9°, respectively). The TK/PR-T12 ratios were between 0.15 and 0.75. However, there were no differences in all the parameters between the L4 and L5 spondylolysis subgroups (p>0.05). The TK and PR-S1 of grade II were less than grade I, but the PA was greater. The PR-T12 of female patients were less than male patients, but the PA was greater (p<0.05). CONCLUSION: Pelvic morphology differed in patients with low-grade isthmic lumbar spondylolisthesis compared to controls. Gender and the grade of slippage impacted the sagittal configuration of the pelvis, but the segment of the vertebral slip did not. Overall, the spine of those with spondylolisthesis remains able to maintain sagittal balance despite abnormal pelvic morphology.

Replacement of Vertebral Lamina (Laminoplasty) in Surgery for Lumbar Isthmic Spondylolisthesis: 5-Year Follow-Up Results

STUDY DESIGN: A review of clinical and radiological outcomes of lumbar laminoplasty (LL) for the treatment of isthmic spondylolisthesis (ISL). PURPOSE: The single session performance of posterior lumbar interbody fusion with allograft in the anterior column and providing the realignment of the vertebrae was presented as a preliminary report earlier. OVERVIEW OF LITERATURE: Long-term surgical outcome of cervical laminoplasty in patients has been reported. But, outcome of LL in patients is unclear. METHODS: The long-term (5 years) year follow-up results of the LL technique are reported in this retrospective study. All patients underwent preoperative and postoperative direct X-ray, computed tomography, and magnetic resonance imaging. The patients that did not respond to conservative treatment were operated. Twenty-one (52.5%) female and 19 (47.5%) male patients were included. RESULTS: Mean age was 43,5 years (ranges, 22-57 years). The most common symptoms were low back pain (89%), pelvic and leg pain (69%) and reduction in walking distance (65%). A total of 180 pedicle screws were inserted in 40 patients; posterior lumbar interbody fusion and laminoplasty with reduction was performed in 20 patients for L4-L5, 12 patients for L5-S1, 4 patients for L3-L4-L5 and 4 patients for L4-L5-S1. Ten (25%) patients with ILL had accompanying spinal stenosis. The difference between preoperative and postoperative sagittal plane rotation and dislocation degrees and disc space heights were statistically significant in all patients (p<0.05). Solid grade 4 fusion was observed in 38 patients; in only 2 patients grade 2 pseudoarthrosis developed (5%), but these patients were asymptomatic. Visual analog scale, Prolo economical and functional scale was examined with an average follow-up 5.5 years. CONCLUSIONS: LL technique has the advantages of shorter duration of operation, lack of graft donor site complications, protection of posterior column osseoligamentous structures and achievement of high fusion rates in one session.

Replacement of Vertebral Lamina (Laminoplasty) in Surgery for Lumbar Isthmic Spondylolisthesis: 5-Year Follow-Up Results

STUDY DESIGN: A review of clinical and radiological outcomes of lumbar laminoplasty (LL) for the treatment of isthmic spondylolisthesis (ISL). PURPOSE: The single session performance of posterior lumbar interbody fusion with allograft in the anterior column and providing the realignment of the vertebrae was presented as a preliminary report earlier. OVERVIEW OF LITERATURE: Long-term surgical outcome of cervical laminoplasty in patients has been reported. But, outcome of LL in patients is unclear. METHODS: The long-term (5 years) year follow-up results of the LL technique are reported in this retrospective study. All patients underwent preoperative and postoperative direct X-ray, computed tomography, and magnetic resonance imaging. The patients that did not respond to conservative treatment were operated. Twenty-one (52.5%) female and 19 (47.5%) male patients were included. RESULTS: Mean age was 43,5 years (ranges, 22-57 years). The most common symptoms were low back pain (89%), pelvic and leg pain (69%) and reduction in walking distance (65%). A total of 180 pedicle screws were inserted in 40 patients; posterior lumbar interbody fusion and laminoplasty with reduction was performed in 20 patients for L4-L5, 12 patients for L5-S1, 4 patients for L3-L4-L5 and 4 patients for L4-L5-S1. Ten (25%) patients with ILL had accompanying spinal stenosis. The difference between preoperative and postoperative sagittal plane rotation and dislocation degrees and disc space heights were statistically significant in all patients (p<0.05). Solid grade 4 fusion was observed in 38 patients; in only 2 patients grade 2 pseudoarthrosis developed (5%), but these patients were asymptomatic. Visual analog scale, Prolo economical and functional scale was examined with an average follow-up 5.5 years. CONCLUSIONS: LL technique has the advantages of shorter duration of operation, lack of graft donor site complications, protection of posterior column osseoligamentous structures and achievement of high fusion rates in one session.

Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Does Not Correalte with Slip Reduction and Neural Foraminal Dimension

STUDY DESIGN: Prospective nonrandomized study. PURPOSE: To find a possible correlation between clinical outcome and extent of lumbar spondylolisthesis reduction. OVERVIEW OF LITERATURE: There is no consensus in the literature concerning whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis. METHODS: Forty six patients with a mean age of 37.5 years (age, 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF). Clinical outcome was measured using visual analogue score (VAS) and Oswestry disability index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and 1 year after surgery and changes were compared. Radiographic fusion was judged with computed tomography scans at 1 year. RESULTS: Ninety percent of the patients had good or very good clinical results with fusion and instrumentation. Baseline and one-year postoperative mean VAS score was 6.33 (range, 5–8) and 0.76 (range, 0–3), respectively (p=0.004). Baseline and one-year postoperative, mean ODI score was 48 (range, 32–62) and 10 (range, 6–16), respectively (p<0.001). A mean spondylolisthesis slip of 32.1% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, vertical foraminal dimension), and foraminal) diameter improved from 9.8 to 11.7 mm (p=0.005), 4.5 to 5.8 mm (p=0.004), 11.3 to 12.6 mm (p=0.002), and 18.6 to 20.0 mm (p<0.001), respectively. The fusion rate was 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction. CONCLUSIONS: Neural decompression and interbody fusion can significantly improve pain and disability but the clinical outcome does not correlate with radiological improvement in the neural foraminal dimension.

The Clinical Value of Measurement of Normal Fetal Aortic Isthmus Systolic Index with Prenatal Ultrasound / 中国医科大学学报

Objective To obtain the fatal aortic isthmic systolic index(ISI)with prenatal ultrasound,and to establish reference ranges for normal live fatal aortic isthmic systolic index(ISI). Methods A total of 251 normal fetuses at 18?37 gestation weeks were collected and underwent Dop?pler ultrasound examination to obtain the fatal aortic isthmus waveforms. Peak systolic velocity(PSV)and systolic nadir(NS)were measured on the waveforms. ISI was derived from the ratio NS/PSV,and its relationship with gestational weeks was analyzed. Results ISI value was between 0.19 and 0.21,from 18 to 24 gestational weeks. As the gestational weeks increasing,PSV increased;however,NS decreased gradually. At about 28 weeks,a brief end?systolic deceleration wave was observed on the aortic isthmus waveforms,and this trend led to ISI towards a mean value of zero at about 30 weeks. At the end of pregnancy,ISI was about-0.33. The curve equations were established regarding the gestational age as the independent variable X,PSV,NS and ISI as the dependent variable Y respectively. Y∧=-69.116+9.542X-0.139X2,R2=0.96,P<0.001;Y∧=-99.881+10.331X-0.232X2,R2=0.99,P<0.001;Y∧=-0.671+0.086X-0.02X2,R2=0.99,P<0.001. Conclusion Prenatal ultrasound can measure the fetal aortic isthmic systolic index,which is helpful in the diagnosis of fetal cardiovascular anomalies and evaluation of fetal intrauterine status.

Importance of wide canal sign in the MR diagnosis of lumbar isthmic spondylolisthesis / 实用放射学杂志

Objective To evaluate the importance of wide canal sign (increased anteroposterior diameter of the spinal canal at L5) in the MR diagnosis of lumbar isthmic spondylolisthesis.Methods One hundred cases of bilateral isthmic spondylolisthesis at L5 confirmed with conventional radiography and/or CT were randomly collected.Another age and sex matched 100 cases without spon-dylolisthesis were collected as control group.The sagittal canal diameters at the L1 and L5 levels were measured and analyzed for all 100 cases of bilateral isthmic spondylolisthesis and 100 control subjects.For each group,the sagittal canal ratio(defined as the maxi-mum anteroposterior diameter of the canal at L5 level divided by the diameter of the canal at L1 )was calculated and compared be-tween the two groups ,and anylyzed with ROC curve.Results The mean midline sagittal anteroposterior diameter was (22.3 ± 1.34)mm at L5 in patients with lumbar isthmic spondylolisthesis,and (18.8±1.57)mm in the control subjects.The sagittal canal ratio was 1.32 in the isthmic spondylolisthesis group and 1.12 in the control subjects,which was different significantly.ROC curve illustrated that the sagittal canal ratio 1.25 was a most meanful point with 88% sensitivity and 90% specificity.Conclusion The sag-ittal canal ratio at L5 is bigger than 1.25 meaning abnormally increased sagittal canal diameter (wide canal sign),which specifically indicates the presence of bilateral pars interarticularis defects.Using this sign can help to make correct MR diagnosis and differential diagnosis of isthmic spondylolisthesis .

Successful pregnancy by direct intraperitoneal insemination in an infertile patient with failure of recanalization of isthmic stenosis after laparoscopic radical trachelectomy

Radical trachelectomy is a promising fertility-sparing treatment for patients with early stage cervical cancer who want to preserve their fertility. However, isthmic stenosis occurs frequently in patients who received radical trachelectomy and it is one of the causes of infertility following radical trachelectomy. Moreover, despite the treatment for recanalization of isthmic stenosis, recanalization can fail or isthmic stenosis can recur. Herein we report a successful pregnancy and birth by direct intraperitoneal insemination in an infertile woman with failure of recanalization of isthmic stenosis after laparoscopic radical trachelectomy.

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

BACKGROUND: The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. METHODS: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 +/- 6.1 years, and group B included 52 patients with a mean age of 47.3 +/- 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. RESULTS: The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. CONCLUSIONS: Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

Modified Jaslow technique for treatment of adult double-level isthmic spondylolisthesis / 第二军医大学学报

Objective To assess the surgical outcomes of double-level isthmic spondylolisthesis in adults. Methods From Mar. 2006 to Nov. 2010, 30 patients with double-level lumbar isthmic spondylolisthesis were treated with modified Jaslow technique combined with posterior lumbar interbody fusion. Clinical outcomes were assessed by Japanese Orthopedic Association (JOA) score; the functional disability was quantified by Oswestry Disability Index (ODI); the Lenke grading system was used to assess the spinal fusion; and theHenderson grading system, the intervertebral height index, and the Taillard index were used to assess the clinical outcome. Results All the 30 patients achieved reduction of different degrees, with the mean reduction rate being (43. 60±25. 29) %. The intervertebral height index was (17. 68±6. 67)% before operation, increased to (50. 99 ± 4. 94) % at 1 week after operation and (44. 37 ±5. 84) % at the last follow-up. The Taillard index was (20. 91 ± 7. 11) % before operation, (10. 23 ± 2. 16) % at1 week after operation, and (11. 87±2. 73) % at the last follow-up. The height index and the Taillard index before operation were significantly different from those of the other two time points (1 week after operation and final follow-up, P<0. 01). The bone fusion was grade A in 49 levels and grade B in 11 levels. The JOA score increased from 9. 60 ± 1. 89 before operation to 22. 40±2. 06 at 6 months after operation and 22. 70±1. 63 at the final follow-up. ODI was 34. 90±5. 56 before operation, which was decreased to 11. 80±1. 81 at 6 months after operation and 10. 70±1. 33 at the last follow-up. The JOA score and the ODI index before operation were significantly different from those of 6 months after operation and those at the final follow-up (P<0. 01). The Henderson clinical outcome was excellent in 19 cases, good in 8 cases, and poor in 3 cases. Conclusion Complete decompression, reduction of isthmic spondylolisthesis by modified Jaslow technique, pedicle screw fixation, and posterior lumbar interbody fusion can achieve satisfactory clinical results for adults with double-level isthmic spondylolisthesis.

Difference of Sagittal Spinopelvic Alignments between Degenerative Spondylolisthesis and Isthmic Spondylolisthesis

OBJECTIVE: The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. METHODS: Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. RESULTS: There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL (42+/-13degrees) was significantly lower than that of the control group (48+/-11degrees; p=0.029), but that of ISPL (55+/-6degrees) was significantly greater than a control group (p=0.004). The SVA of DSPL (55+/-49 mm) was greater than that of a control group (<40 mm), but that of ISPL (21+/-22 mm) was within 40 mm as that of a control group. The PT of DSPL (24+/-7degrees) and ISPL (21+/-7degrees) was significantly greater than that of a control group (11+/-6degrees; p=0.000). CONCLUSION: Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

The influence on isthmic spondylolisthesis from lumbar vertebras facet joint orientation variation / 中国医师进修杂志

Objective To explore the influence on isthmic spondylolisthesis (IS) from lumbar vertebras facet joint orientation (FJO) variation. Methods The lumbar vertebras of 60 patients scanned by 16-slices spiral CT were collected, 30 cases with IS was defined as isthmic group;30 cases with normal lumbar vertebras was defined as control group, the FJO at L3-4, L4-5 and L5-S1 were measured in two groups. The difference between two groups were compared at three levels, the difference between both sides of the facet joint orientation also was compared;the measured data and the data of 60 patients from foreign literature were compared at three levels. Results The FJO in isthmic group were (47.9±6.3)° ,(37.5±7.3)° , (37.9±7.7)° at the right of L3-4, L4-5, L5-S1 levels respectively,the FJO in control group were (53.1 ± 7.3)° , (40.5±6.3)° , (38.5±7.3)° respectively, the FJO in isthmic group were (48.1±6.0)° , (37.9 ± 7.4)° , (37.6 ± 7.6)° at the left of L3-4, L4-5, L5-S1 levels respectively, the FJO in control group were (52.3 ± 7.6)° , (41.6 ± 6.0)° , (38.2 ± 7.2)° respectively. The significant difference was found at L3-4 and L4-5 levels (P < 0.05), the orientation was similar at L5-S1 level (P > 0.05). The difference between the both sides FJO of lumbar vertebras was not found at L3-4,L4-5 and L5-S1 levels (P >0.05). The same as the measured data and the corresponding data from foreign literature(P > 0.05 ). Conclusions It seems possible that the coronal FJO may be the phenotypic representation of the familial etiology of IS. It is helpful for the measurement of lumbar vertebras FJO to find IS early,it is important to reduce and release the IS.