[The circumferential decompression by posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior iongitudinal ligament].

OBJECTIVE: To observe the efficacy of the circumferential decompression with posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior Iongitudinal ligament (T-OPLL). METHODS: From May 2012 to June 2015, 16 consecutive patients underwent posterior transpedicular osteotomy and segmental instrumentation with interbody fusion.Osteotomy range was depended by length and types of OPLL.Patient's data included level, clinical presentation, blood loss, length of surgery, complications, VAS, JOA, and Frankel grading system before and after the surgery. All data were collected, retrospectively. RESULTS: The follow-up period was (30±19) months (range from 12 to 50 months). The operation time was (261.6±51.3) min (range from 190 to 310 min). The blood loss was (980.3±370.5) ml (range from 600 to 2 100 ml). All patients were well treated with posterior compression and segmental instrumentation with interbody fusion.The VAS score was (4.2±0.2) in all patients at a week, improving to (2.7±0.1) points at 3 months, (2.4±0.2) at 1 year, and (2.0±0.1) at last fellow-up.The statistical analysis of the results showed a significant improvement of pain at 3 months (P<0.05) when compared to the preoperative status.The preoperative JOA score was (4.2±1.7) in all patients, improving to (7.8±2.5) points at 3 months, (8.5±2.7) at 1 year, and (9.0±1.0) at last fellow-up.The mean recovery rate for the total JOA score was (72%±8%). Differences in the overall JOA Scores showed significant postoperative improvement.Frankel grade improved by either 1 or 2 grades in 16 patients at the last follow-up.None of the patients showed any signs of instrument migration or failure during follow-up. CONCLUSION: The results suggested that the procedure achieved a total resection of the ossified posterior longitudinal ligament.The treatment method with posterior transpedicular osteotomy and circumferential decompression was found to be safe, effective, reliable, and technically feasible.

Resection hip arthroplasty as a feasible surgical procedure for periacetabular tumors of the pelvis.

AIMS: Surgical treatment of periacetabular tumors remains one of the most challenging problems in musculoskeletal oncology. The purpose of this study was to review the clinical and functional outcomes of resection hip arthroplasty and analyze its feasibility. METHODS: This study assesses twenty-seven patients with periacetabular tumors treated by resection hip arthroplasty between 1999 and 2010. The tumors were excised with wide margins and the residual intact femoral head placed underneath the resected ilium. Clinical, functional and oncological outcomes as well as complications were carefully evaluated. RESULTS: The average follow-up time was 55 months (range, 3-118) and the mean surgical time 170 min (range, 120-350) with an average blood loss 1200 ml (range, 600-2200). Six patients died in 6-33 months postoperatively; no other local recurrences or deaths occurred. The 1-year, 5-year, and 10-year disease-free survival rates were 96.3%, 77.8% and 77.8% respectively. The mean limb-length discrepancy was 5 cm (range, 2-7.5) and all patients required custom-made shoes with their heels heightened by 2-5 cm. At the last follow-up, the mean functional score was 75.6%. Twenty patients recovered normal ambulation function with custom-made shoes and seven had to walk with crutches. Wound healing problems were observed in nine patients and deep or superficial infection in none. CONCLUSIONS: Resection hip arthroplasty is recommended as a feasible surgical protocol for periacetabular tumors because it has few complications, good functional results, short surgical time and little blood loss.