Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are v...Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.展开更多
Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the corr...Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity(flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.展开更多
BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few s...BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.展开更多
Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication c...Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication conditions and clinical pathways of above new technique. Materials and Methods: A total of 90 patients have severe angular kyphosis, 37 males and 53 females, with an average age of 47 years. All patients were treated with posterior bilateral pedicle screw and step tight closure for gradual shortening and orthopedic technology. Results: Average intraoperative blood loss was 2089 ml. Average operation time was 326 minutes. Kyphotic angle changed from 90.1° averagely preoperatively to 41.6° averagely postoperatively with an improvement rate of 65%. The distance from C<sub>7</sub> plumb line to posterior upper edge of the S<sub>1</sub> vertebral body was averagely 5.2 mm postoperatively, with a correction rate of 73%. Neurological complications occurred in 2 cases, accounting for 6%. Non-neurological complications occurred in 2 cases, accounting for 6%. Anatomical parameters were significantly improved postoperatively (P < 0.05). All patients were averagely followed up for 28 months. Segments undergoing osteotomy achieved bone fusion, without loss of orthopedic angle. Conclusions: The orthopedic technology of bilateral pedicle screw and step tight closure designed by human physiology and biomechanical principles can protect spinal cord cells from injury to the utmost. To choose an appropriate osteotomy plane during pre-surgical planning can make the repair results closer to the normal function of the spine. Intraoperative nerve root protection, full release and bone graft fusion are effective safeguards to ensure kyphosis correction and to avoid spine lateral offset.展开更多
Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and contro...Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and control group.Results:The postoperative Cobb angle of the observation group was(8.29±1.24)°better than that of the control group(15.68±2.73)°,P<0.05;The preoperative Cobb angle of the observation group was(49.78±4.15)°compared with that of the control group(50.11±4.23)°,P>0.05;The incidence of postoperative complications and recurrence rate in the observation group were 5.00%and 5.00%respectively,which were lower than 25.00%and 30.00%in the control group(P<0.05).Conclusion:Posterior V-osteotomy for traumatic kyphosis can improve Cobb angle,reduce the risk of postoperative complications and recurrence,which is safe and feasible.展开更多
Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surger...Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.017）. There were significant differences in LL, TLJA, TK, SS, and pelvic incidence （PI） between two groups. Conclusions：Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.展开更多
Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of...Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of effective techniques to prevent ST. The purpose of this study was to propose a pedicle subtraction osteotomy （PSO） with a cage as a method to prevent ST and to explore the efficacy and feasibility of this method in the treatment of kyphosis in AS. Methods： We retrospectively reviewed 89 consecutive patients with AS kyphosis who underwent a PSO （Group B, 46 patients） or a PSO with a cage （Group A, 43 patients） from February 2009 to December 2013. Pre- and post-operative radiographic results were reviewed. ST and complications were analyzed in both groups. Clinical assessment was performed using the Scoliosis Research Society-22 （SRS-22） outcomes metric. The patients were followed up for at least 2 years. Results： Group A achieved the same re-alignment of the kyphotic spine as Group B. Two （4.7%） of the 43 patients in Group A and 14 （30.4%） of the 46 patients in Group B had intraoperative ST （2＂2 = 10.020, P = 0.002）. Significant differences were identified between the two groups in the height change of the osteotomized column. SRS-22 scores improved significantly in both groups. Seven patients experienced neurologic complications （1 in Group A and 6 in Group B）. Eight patients had cerebrospinal fluid leakage （2 in Group A and 6 in Group B）. Conclusion： PSO with a cage significantly avoided ST during the osteotomy procedure and might represent a new, safe, and feasible choice tbr treating patients with AS kyphosis.展开更多
Background Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more impcrtant.Although posterior vertebra column resection has been incre...Background Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more impcrtant.Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity,no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region.Therefore,the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.Methods From May 2004 to May 2006,53 patients（38 male,1 5 female）at an average age of 37.6 years（range,24 to 66 years）,were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital.Among them,5 consecutive adult patients with severe post-traumatic kyphosis were included in this study.Operation time, blood lOSS and complications were noted in each case.Radiographic documentation was made on the basis of standing anterior-posterior（AP）and lateral views and three dimensional reconstruction images of computed tomography （CT） scans were used to further identify the apex region of a sharp angular deformity.Sagittal correction was assessed in terms of effective regional deformity（ERD）for the injury Ievel.Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan.Preoperative and postoperative clinical assessments were performed by using Oswestw disability index（ODI）, back pain was rated in all patients by the visual analog scale （VAS） preoperatively,postoperatively and at the latest follow-up.Results The mean operating time was 265 minutes（220-408 minutes）,with an average blood loss of 1 362 ml （870-2570 m1）.Each patient finished at least two years of follow-up.The average ERD significantly decreased from 69°（58°-86°）,preoperatively to 4°（1°-8°） after surgery （P=0.01 7）;with a mean correction of 65°.ERD averaged 1 0.4°（7°-1 7°）at the latest follow-up with a mean loss of 6.4°.VAS and ODI scores improved from preoperative 7.4（6.0-9.0） and 55.2（48.0-60.0） to 2.3（1.0-4.0） and 1 2.2（7.0-18.0）at the latest follow-up.Full bone fusion was achieved in all patients.Complications occurred in two patients：one had a transient weakness of the Ieft side lower extremity and the symptom improved spontaneously without further treatment within one month;the other patient suffered a deep wound infection three weeks after the operation,and recovered well by additional debridement,continuous perfusion and drainage.Conclusions Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region.Nevertheless,this challenging procedure should be performed by experienced spinal surgeon to minimize complications.展开更多
Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with c...Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design. Methods From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotmy with instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 cases underwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the oeteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method. Results The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such： 9 male and 7 female, the mean age was 49.2 years （range 38--70）, the kyphosis improved from an average of 30° （range 15°--45°） preoperatively to 4° （range -26°--30°） postoperatively, the kyphosis was corrected on average 2.5-0 per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2°. As a result, there was no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such： 5 male and 9 female, the mean age was 35.3 years old （range 15--57）, the kyphosis improved from an average of 64°- （range 34°--95°） preoperatively to 8.70 （range -10°--22°） postoperatively. The kyphosis was corrected on average of 6.2°- per 1 mm in the height of the psteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6°. There was also no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. Conclusions The therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach. The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5°- and the maximum angle of correction of 45°. The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per I mm of 6.2°. It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to held us constructing Preoperative desiqn.展开更多
Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes hav...Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.展开更多
背景:随着磁控制生长棒技术在治疗脊柱畸形领域的不断完善进步,已有大量的研究投入到该项领域当中,但主要研究现状、热点与发展趋势尚不够明确。目的:基于文献计量学探讨来自不同国家运用磁控制生长棒治疗脊柱畸形研究领域中文章的质量...背景:随着磁控制生长棒技术在治疗脊柱畸形领域的不断完善进步,已有大量的研究投入到该项领域当中,但主要研究现状、热点与发展趋势尚不够明确。目的:基于文献计量学探讨来自不同国家运用磁控制生长棒治疗脊柱畸形研究领域中文章的质量和数量,旨在阐明磁控制生长棒在全球发展趋势以及评估在世界范围内研究生产力、研究趋势与研究热点。方法:主要基于Web of Science核心集数据库对1998-2023年发表的文章进行检索。使用CiteSpace 5.8和VOSviewer 1.6.19软件对数据进行分析,并生成可视化知识图谱。对所有研究进行以下参数的评估:发表论文总数、中心性、h指数、国家、作者、期刊的贡献,通过文献共被引、高被引文献和文献关键词爆发等分析来进行趋势与热点的探究。结果与结论:①最终纳入138篇文献。在2009-2020年,该领域发表的文章数量逐渐增加。美国发文量最多(53篇,37.32%),同时美国的文章研究h指数及中心性最高。②关键词分析结果显示,排名前10位的关键词例如早发性脊柱侧弯、外科手术及并发症等,客观真实地反映了磁控制生长棒在治疗脊柱畸形领域的现状和热点;因磁控制生长棒例如锚钉拔出、植入失败和杆断裂等风险因素而导致的治疗失效、相应医学分级的精准运用、生活质量和大脑性瘫痪等并发症的监测治疗是该领域近年来的研究热点。③文献共被引结果显示,结合磁控制生长棒技术的创新性和有效性研究,对应脊柱畸形的分型应用以及相关并发症的监测治疗可能是该领域的研究趋势。④诸多高被引文献进一步强调了磁控制生长棒技术的治疗运用效果,为矫正脊柱畸形领域提供一种有效的治疗新思路与技术支持。⑤文献关键词爆发分析结果显示,磁控制生长棒应用的风险因素、医学分级、生活质量和大脑性瘫痪可能成为该领域的研究前沿。⑥文章结果证实,磁控制生长棒技术对脊柱畸形的分型运用以及相关并发症的深度研究是该领域的发展趋势,但要深入了解磁控制生长棒技术治疗脊柱畸形的有效性与安全性,还需要一个长期的随访证据;该领域整体研究水平近年来稳步提升,但也存在高质量文献数量较少及各地区研究发展不平衡等问题。展开更多
文摘Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.
文摘Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity(flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.
文摘BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.
文摘Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication conditions and clinical pathways of above new technique. Materials and Methods: A total of 90 patients have severe angular kyphosis, 37 males and 53 females, with an average age of 47 years. All patients were treated with posterior bilateral pedicle screw and step tight closure for gradual shortening and orthopedic technology. Results: Average intraoperative blood loss was 2089 ml. Average operation time was 326 minutes. Kyphotic angle changed from 90.1° averagely preoperatively to 41.6° averagely postoperatively with an improvement rate of 65%. The distance from C<sub>7</sub> plumb line to posterior upper edge of the S<sub>1</sub> vertebral body was averagely 5.2 mm postoperatively, with a correction rate of 73%. Neurological complications occurred in 2 cases, accounting for 6%. Non-neurological complications occurred in 2 cases, accounting for 6%. Anatomical parameters were significantly improved postoperatively (P < 0.05). All patients were averagely followed up for 28 months. Segments undergoing osteotomy achieved bone fusion, without loss of orthopedic angle. Conclusions: The orthopedic technology of bilateral pedicle screw and step tight closure designed by human physiology and biomechanical principles can protect spinal cord cells from injury to the utmost. To choose an appropriate osteotomy plane during pre-surgical planning can make the repair results closer to the normal function of the spine. Intraoperative nerve root protection, full release and bone graft fusion are effective safeguards to ensure kyphosis correction and to avoid spine lateral offset.
文摘Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and control group.Results:The postoperative Cobb angle of the observation group was(8.29±1.24)°better than that of the control group(15.68±2.73)°,P<0.05;The preoperative Cobb angle of the observation group was(49.78±4.15)°compared with that of the control group(50.11±4.23)°,P>0.05;The incidence of postoperative complications and recurrence rate in the observation group were 5.00%and 5.00%respectively,which were lower than 25.00%and 30.00%in the control group(P<0.05).Conclusion:Posterior V-osteotomy for traumatic kyphosis can improve Cobb angle,reduce the risk of postoperative complications and recurrence,which is safe and feasible.
文摘Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.017）. There were significant differences in LL, TLJA, TK, SS, and pelvic incidence （PI） between two groups. Conclusions：Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.
文摘Background： Sagittal translation （ST） is an accidental event that surgeons commonly encounter during a spinal osteotomy in the correction of kyphosis in ankylosing spondylitis （AS）. However, there is a paucity of effective techniques to prevent ST. The purpose of this study was to propose a pedicle subtraction osteotomy （PSO） with a cage as a method to prevent ST and to explore the efficacy and feasibility of this method in the treatment of kyphosis in AS. Methods： We retrospectively reviewed 89 consecutive patients with AS kyphosis who underwent a PSO （Group B, 46 patients） or a PSO with a cage （Group A, 43 patients） from February 2009 to December 2013. Pre- and post-operative radiographic results were reviewed. ST and complications were analyzed in both groups. Clinical assessment was performed using the Scoliosis Research Society-22 （SRS-22） outcomes metric. The patients were followed up for at least 2 years. Results： Group A achieved the same re-alignment of the kyphotic spine as Group B. Two （4.7%） of the 43 patients in Group A and 14 （30.4%） of the 46 patients in Group B had intraoperative ST （2＂2 = 10.020, P = 0.002）. Significant differences were identified between the two groups in the height change of the osteotomized column. SRS-22 scores improved significantly in both groups. Seven patients experienced neurologic complications （1 in Group A and 6 in Group B）. Eight patients had cerebrospinal fluid leakage （2 in Group A and 6 in Group B）. Conclusion： PSO with a cage significantly avoided ST during the osteotomy procedure and might represent a new, safe, and feasible choice tbr treating patients with AS kyphosis.
文摘Background Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more impcrtant.Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity,no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region.Therefore,the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.Methods From May 2004 to May 2006,53 patients（38 male,1 5 female）at an average age of 37.6 years（range,24 to 66 years）,were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital.Among them,5 consecutive adult patients with severe post-traumatic kyphosis were included in this study.Operation time, blood lOSS and complications were noted in each case.Radiographic documentation was made on the basis of standing anterior-posterior（AP）and lateral views and three dimensional reconstruction images of computed tomography （CT） scans were used to further identify the apex region of a sharp angular deformity.Sagittal correction was assessed in terms of effective regional deformity（ERD）for the injury Ievel.Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan.Preoperative and postoperative clinical assessments were performed by using Oswestw disability index（ODI）, back pain was rated in all patients by the visual analog scale （VAS） preoperatively,postoperatively and at the latest follow-up.Results The mean operating time was 265 minutes（220-408 minutes）,with an average blood loss of 1 362 ml （870-2570 m1）.Each patient finished at least two years of follow-up.The average ERD significantly decreased from 69°（58°-86°）,preoperatively to 4°（1°-8°） after surgery （P=0.01 7）;with a mean correction of 65°.ERD averaged 1 0.4°（7°-1 7°）at the latest follow-up with a mean loss of 6.4°.VAS and ODI scores improved from preoperative 7.4（6.0-9.0） and 55.2（48.0-60.0） to 2.3（1.0-4.0） and 1 2.2（7.0-18.0）at the latest follow-up.Full bone fusion was achieved in all patients.Complications occurred in two patients：one had a transient weakness of the Ieft side lower extremity and the symptom improved spontaneously without further treatment within one month;the other patient suffered a deep wound infection three weeks after the operation,and recovered well by additional debridement,continuous perfusion and drainage.Conclusions Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region.Nevertheless,this challenging procedure should be performed by experienced spinal surgeon to minimize complications.
文摘Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design. Methods From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotmy with instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 cases underwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the oeteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method. Results The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such： 9 male and 7 female, the mean age was 49.2 years （range 38--70）, the kyphosis improved from an average of 30° （range 15°--45°） preoperatively to 4° （range -26°--30°） postoperatively, the kyphosis was corrected on average 2.5-0 per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2°. As a result, there was no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such： 5 male and 9 female, the mean age was 35.3 years old （range 15--57）, the kyphosis improved from an average of 64°- （range 34°--95°） preoperatively to 8.70 （range -10°--22°） postoperatively. The kyphosis was corrected on average of 6.2°- per 1 mm in the height of the psteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6°. There was also no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. Conclusions The therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach. The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5°- and the maximum angle of correction of 45°. The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per I mm of 6.2°. It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to held us constructing Preoperative desiqn.
文摘Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.
文摘背景:随着磁控制生长棒技术在治疗脊柱畸形领域的不断完善进步,已有大量的研究投入到该项领域当中,但主要研究现状、热点与发展趋势尚不够明确。目的:基于文献计量学探讨来自不同国家运用磁控制生长棒治疗脊柱畸形研究领域中文章的质量和数量,旨在阐明磁控制生长棒在全球发展趋势以及评估在世界范围内研究生产力、研究趋势与研究热点。方法:主要基于Web of Science核心集数据库对1998-2023年发表的文章进行检索。使用CiteSpace 5.8和VOSviewer 1.6.19软件对数据进行分析,并生成可视化知识图谱。对所有研究进行以下参数的评估:发表论文总数、中心性、h指数、国家、作者、期刊的贡献,通过文献共被引、高被引文献和文献关键词爆发等分析来进行趋势与热点的探究。结果与结论:①最终纳入138篇文献。在2009-2020年,该领域发表的文章数量逐渐增加。美国发文量最多(53篇,37.32%),同时美国的文章研究h指数及中心性最高。②关键词分析结果显示,排名前10位的关键词例如早发性脊柱侧弯、外科手术及并发症等,客观真实地反映了磁控制生长棒在治疗脊柱畸形领域的现状和热点;因磁控制生长棒例如锚钉拔出、植入失败和杆断裂等风险因素而导致的治疗失效、相应医学分级的精准运用、生活质量和大脑性瘫痪等并发症的监测治疗是该领域近年来的研究热点。③文献共被引结果显示,结合磁控制生长棒技术的创新性和有效性研究,对应脊柱畸形的分型应用以及相关并发症的监测治疗可能是该领域的研究趋势。④诸多高被引文献进一步强调了磁控制生长棒技术的治疗运用效果,为矫正脊柱畸形领域提供一种有效的治疗新思路与技术支持。⑤文献关键词爆发分析结果显示,磁控制生长棒应用的风险因素、医学分级、生活质量和大脑性瘫痪可能成为该领域的研究前沿。⑥文章结果证实,磁控制生长棒技术对脊柱畸形的分型运用以及相关并发症的深度研究是该领域的发展趋势,但要深入了解磁控制生长棒技术治疗脊柱畸形的有效性与安全性,还需要一个长期的随访证据;该领域整体研究水平近年来稳步提升,但也存在高质量文献数量较少及各地区研究发展不平衡等问题。
