Objective To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS). Methods Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P gt; 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter’s standard and the correction of Cobb angle was assessed by X-ray films. Results All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P gt; 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (χ2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter’s standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= — 1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P lt; 0.05), but there was no significant difference between 1 week and last follow-up (P gt; 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957). Conclusion Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.
Objective To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor. Methods Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. Results The operation time of group A was significantly longer than that of group B (P lt; 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P lt; 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (χ2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (χ2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= — 0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P gt; 0.05). Conclusion MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.
【Abstract】 Objective To study the short-term effects of thoracoscopic anterior spine release combined with posterior correction on the pulmonary function in patients with idiopathic scoliosis (IS). Methods Between April 2004 and June 2008, 21 cases of IS underwent thoracoscopic anterior spine release combined with posterior correction. There were 9 males and 12 females with a mean age of 15.6 years (range, 12 to 24 years). Of 11 patients, 2 had left protrusion deformity and 19 had right protrusion deformity, including 12 cases of Lenke type I and 9 cases of Lenke type II, with an average coronal Cobb’s angle of 79.6° (range, 65-125°). The disease duration ranged from 1 year and 6 months to 9 years (mean, 2.5 years). The results of pulmonary function tests (PFTs) were compared between pre-operation and postoperative 6th month, including lung capacity, ventilation function, and thoracic compliance. Results The opening time of the chest was 90 to 150 minutes (mean, 127 minutes) at the thoracoscopic anterior spine release and all incisions healed by first intention with no chest cavity infection. All the patients were followed up from 6 to 36 months (mean, 13.5 months). The average coronal Cobb’s angle was 43.7° (range, 36-75°) at 1 week after posterior correction. At 6 months after operation, the vital capacity and total capacity were significantly increased (P lt; 0.05), but no significant change was observed in the percentage of actual value and expected one when compared with pre-operation (P gt; 0.05). The functional residual capacity and the percentage of actual value and expected one of residual volume was significantly decreased when compared with those at pre-operation (P lt; 0.05). The forced expiratory volume in one second (FEV1) and FEV1/FEV were not significantly improved (P gt; 0.05) , but the maximum ventilatory volume was significantly increased when compared with the preoperative value (P lt; 0.05). In addition, the Raw Total, Raw Insp, and Raw Exp decreased significantly after operation (P lt; 0.05). Conclusion Although the thoracoscopic anterior spine release combined with posterior correction might disturb the function of the thoracic cavity, the PFTs of the patients could be improved at different aspects because of the shape changes of the thoracic cavity, and the pulmonary function still needed further observation.
Objective To investigate the effectiveness of multilevel Ponte osteotomies on maintenance and restoration of thoracic kyphosis in idiopathic scoliosis (IS) surgery. Methods Between March 2008 and February 2010, 42 patients with thoracic IS (Lenke type 1 curves) were corrected with posterior pedicle screw system. Multilevel Ponte osteostomies for posterior release was performed in 17 cases (group A), and the 3 segments near the apical vertebrae were selected as the osteotomy site; simple posterior soft tissue release was given in 25 cases (group B). There was no significant difference in sex, age, disease duration, lesion segments, coronary Cobb angle, thoracic kyphosis, Risser index, and bending flexibility between 2 groups (P gt; 0.05). The anteroposterior and lateral standing radiographs of the spine were taken to compare the effectiveness between 2 groups. Results Operation was successfully completed in all patients. The operation time and blood loss in group A were significantly greater than those in group B (P lt; 0.05). Spine dural injury and leakage of cerebrospinal fluid occurred in 1 case of group A, which was cured after compression on local area of the wound; the other patients had no intraoperative complications. The patients were followed up 2-4 years (mean, 2.8 years); no nerve injury, infection, or internal fixation failure occurred. No obvious correction loss was observed and the appearance and trunk balance were significantly improved. The coronal Cobb angles at 1 week and 2 years after operation were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05). There was no significant difference in the coronal Cobb angle and correction rate between 2 groups at 1 week and 2 years after operation (P gt; 0.05). Group A was significantly better than group B in the thoracic kyphotic angle and angle changes at 1 week and 2 years after operation (P lt; 0.05). Conclusion The posterior approach surgery with multilevel Ponte osteotomies can restore the thoracic kyphosis in IS, but it has no effect on coronal correction in Lenke type 1 curves.
Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. Methods Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n=46) and non-osteotomytechnique (non-osteotomy group, n=53) separately. There was no significant difference in sex, age, Cobb angle of scol iosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P gt; 0.05). The operation time and blood loss were recorded; the Cobb angle of scol iosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. Results The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P lt; 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scol iosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P lt; 0.05). There was no significant difference in Cobb angle of scol iosis and the rate of correction between 2 groups (P gt; 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P lt; 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P lt; 0.05). Conclusion There is no signifcant difference in scol iosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood losswould increase greatly.
Objective Degenerative lumbar scol iosis and spinal stenosis are more common in elderly patients. Because of many factors, treatment choices are more complex. To investigate the step treatment strategy of degenerative lumbarscol iosis and spinal stenosis. Methods Between January 2005 and December 2009, 117 patients with degenerative lumbar scol iosis and spinal stenosis were treated with step treatment methods, including conservative therapy (43 cases), posterior decompression alone (18 cases), posterior short segment fusion (1-2 segments, 41 cases), and posterior long segment fusion ( ≥ 3 segments, 15 cases). Step treatment options were made according to patient’s will, the medical compl ications, the degree of the symptoms of low back and lower extremity pain, the size of three-dimensional lumbar scol iosis kyphosis rotating deformity, lumbar spine stabil ity (lateral sl ip, degenerative spondylolysis), and the overall balance of the spine. The visual analogue scale (VAS) score of low back and lower extremity pain, Oswestry disabil ity index (ODI), lumbar lordosis angle, and scol iosis Cobb angle were measured and compared before and after treatments. Results Seventy-two cases were followed up more than 12 months, and there was no death or internal fixation failure in all patients. Of them, 19 patients underwent conservative treatment; the mean follow-up period was 19.3 months (range, 1-5 years); no symptom deterioration was observed; VAS score of low back and lower extremity and ODI were significantly decreased at last follow-up (P lt; 0.05); and lordosis angle was decreased and scol iosis Cobb angle was increased, but there was no significant difference (P gt; 0.05). Twelve cases underwentposterior decompression alone; the average follow-up was 36 months (range, 1-5 years); VAS score of lower extremity and ODI were significantly decreased at last follow-up (P lt; 0.05); and scol iosis Cobb angle was increased and lordosis angle was decreased, but there was no significant difference (P gt; 0.05). Thirty-one patients underwent posterior short segment fusion; the mean follow-up period was 21.3 months (range, 1-3 years); postoperative hematoma, poor wound heal ing, cerebrospinal fluid leakage, and superficial infection occurred in 1 case, respectively, and were cured after symptomatic treatment; VAS score of low back and lower extremity and ODI were significantly decreased (P lt; 0.05); and postoperative lumbar scol iosis Cobb angle and lordosis angle were significantly improved at last follow-up (P lt; 0.05). Ten patients underwent posterior long segment fusion; the mean follow-up period was 17.1 months (range, 1-3 years); postoperative symptoms worsened in 1 case and was cured after physical therapy and drug treatment for 3 months, and deep infection occurred in 1 case and was cured after debridement and continuous irrigation drainage; VAS score and ODI were significantly decreased (P lt; 0.05); and postoperative scol iosis Cobb angle and lordosis angle were improved significantly at last follow-up (P lt; 0.05). Conclusion The treatment of degenerative lumbar scol iosis and spinal stenosis should be individual and step. Surgery treatment should be rely on decompression while deformity correction subsidiary. Accurate judgment of the responsible segment of symptoms, scol iosis and lordosis can prevent the operation expansion and increase safety of surgery with active control bleeding.
Objective To explore some operative problems of correcting paralytic scoliosis(PS) by using vertebral pedicle screwsrods system. Methods From May 2000 to May 2005, 18 patients with PS were corrected by screwsrods system which were made of titanium alloy.There were 10 males and 8 females, aging from 11 to 26 years. The primary disease included poliomyelitis in 13 patients and myelodysplasia (MS) in 5 patients (2 cases for second correction) with scoliosis of an average 85° Cobb angle (55-125°). The pelvic obliquity was found in all patients with an average 24° angle (355°).Of the 18 patients,3 cases were given perioperative halo-pelvic traction, 2 cases were given vertebral wedge osteotomy and correction and fixation, the other patients were purely underwent the treatment of pedicle screwrods system implants. Fusion segment at operation ranged from 6 to 15 sections, applied screws the most was 16,the fewest was 6. Results There were no wound infections and neurologic complications, all wounds healed by the first intention. Allscoliosis obtained obvious correction (P＜0.001), the correction rate averaged 52.95% (44%-81%); the majority of lumbar kyphosis and pelvic obliquity were apparently corrected. The average clinical follow-up (16 cases) was 21 months(6-36 months),there was no implants failure. One patient with MS had a worse Cobb magnitude, the other patients had no curve progression (P＞0.05). Conclusion The use of vertebral pedicle screwsrods fixation to multiple vertebral bodys and short segment fusion for PS, the treatment method is reliable and the outcome is satisfactory. While performing the correcting operative procedures, the spinal, pelvic and lower extremity deformities and functions should be all considered as a whole.
Objective To review the King-types Ⅲ and Ⅳ patients treated by the CD hybrid technique and evaluate clinical results on the shorter fusion levels. Methods Fifty-eight patients with idiopathic scoliosis were treated by the CD hybrid method from March 2000 to January 2003, among whom 40 were grouped as Kingtype Ⅲ and 18 as Kingtype Ⅳ; 41 were female and 17 were male. The Cobb angle of the thoracic curve was averaged 64°(range 50-83°), and the curve flexibility was 62%. The compensative lumbarcurve was averaged 37°（range 16-48°）, and the curve flexibility was 105%. With the neutral rotational vertebrae as a basis to select the low instrumentation vertebrae, the neutral rotational vertebrae or the vertebrae at 1 or 2 levelsproximal to the neutral rotational vertebrae were selected as the low instrumentation vertebrae in all the patients. Standing AP and lateral radiographs were taken respectively at the discharge, during the follow-up after discharge, and at the final follow-up. Results The patients were followed up for an average of 2.4 years (range 1.8-3.2). The corrected curves lost an average of 3.1°（range -1-5°）and the correction rate of the thoracic curve was 68% at the final follow-up.The plumbline from C7 was parallel to the sacral midline in 56 patients. The lumbar curves were corrected to an average of 8°（2-13°）automatically. The lumbosacral angle was corrected automatically by 53% and the low instrumentation vertebrae in 48 patients turned into stable vertebrae. The low instrumentation vertebrae lost 1.4 segments on average compared with the Harrington principle. No spinal imbalance was clinically observed in all the patients. Conclusion The choice of the low instrumentation vertebrae as the neutral rotational vertebrae can have a good result in the clinical practice. It can be applied in the CD hybrid technique in treatment of idiopathicthoracic curves.
ObjectiveTo investigate the influence and management of blood pressure on intraoperative cortex somatosensory evoked potential (CSEP) in the surgery of severe scoliosis. MethodsFrom June 2009 to March 2012, CSEP monitoring during surgery of severe scoliosis were performed on 43 patients, in whom 4 had abnormal CSEP while blood pressure decline. There were 2 males and 21 females. The average age was 16.1 years. The average preoperative Cobb angle was 96.1° (88.7-107.5°). Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. The arterial blood pressure (ABP) was used to evaluate the intraoperative blood pressure. ResultThe incidence rate of bilateral CSEP wave abnormalities after blood pressure decline was 9.3% in the surgery of severe scoliosis. One case of CSEP abnormality occurred during the installing of pedicle screws; two cases during the Smith-Petersen osteotomy, and one case during the bone graft after correction. With the ABP dropping to about 92/57 mm Hg (1 mm Hg=0.133 kPa), the amplitude decreased 80% in 24-33 minutes. After the ABP increased to 113/75 mm Hg by treatment, the index was backed up normally in 5-10 minutes. There was no neurological complication after surgery. ConclusionA high incidence rate and significantly decreased amplitude of CSEP abnormality after blood pressure decline in the surgery of severe scoliosis are found. Intraoperative stable blood pressure should be maintained for patients with severe scoliosis. When the amplitude of CSEP decreases followed with blood pressure decline, blood pressure should be actively corrected by treatment, so that the CSEP may get back to normal as soon as possible.
ObjectiveTo explore the surgical indications,decompression and fusion method,and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. MethodsBetween April 2000 and November 2011,46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above).Of 46 cases,25 were male and 21 were female,with a mean age of 70.2 years (range,65-81 years) and with a mean disease duration of 6.4 years (range,4 years and 6 months to 13 years).X-ray films showed that the lumbar Cobb angle was (26.7±10.0)°,and the lumbar lordotic angle was (20.3±8.8)°.The lumbar CT and MRI images showed three-segment stenosis in 24 cases,four-segment stenosis in 17 cases,and five-segment stenosis in 5 cases.A total of 165 stenosed segments included 12 L1,2,34 L2,3,43 L3,4,45 L4,5,and 31 L5 and S1.Visual analogue scale (VAS) score,Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. ResultsThirteen patients had leakage of cerebrospinal fluid during operation,and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively,who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change,adequate drainage,debridement and suture.No death,paralysis,central nervous system infection,or other complication was observed in these patients.Forty-six cases were followed up 12-72 months (mean,36.2 months).Lumbago and backache and intermittent claudication of lower extremity were obviously improved.During follow-up,no screw incising,loosening and broken screws,or pseudarthrosis was noted under X-ray film and CT scanning.At last follow-up,the lumbar Cobb angle was reduced to (9.8±3.6)°,while the lumbar lordotic angle was increased to (34.1±9.4)°,which were significantly improved when compared with preoperative ones (t=16.935,P=0.000;t=15.233,P=0.000).At last follow-up,VAS,ODI,and JOA scores were 3.2±1.2,35.5%±14.0%,and 26.6±5.7 respectively,showing significant differences when compared with preoperative scores (8.0±2.2,60.8%±13.3%,and 12.9±3.4) (t=19.857,P=0.000;t=16.642,P=0.000;t=15.922,P=0.000). ConclusionMulti-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms,rebuild spinal balance,and improve the life quality of the patients.It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.