Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic locatio...Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.展开更多
Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scol...Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.展开更多
文摘Background Cervicothoracic junction spinal tuberculosis （CJST） in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children. Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months. Results The patients were followed-up for an average of 26 months （range, 15-32 months）. There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° （range, 30-52°） before the operation to 18° （range, 12-26°） post-operation. Neurological function was improved in all patients. Conclusions Combined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.
文摘Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.
