ObjectiveTo summarize the research progress of surgical treatment for primary sacrum tumor. MethodThe domestic and foreign related literature about surgical treatment of primary sacrum tumor, and many aspects of its surgical procedures, intraoperative hemostasis, pelvic reconstruction, protection of sacral nerve, complications, and prognosis was summarized and analyzed. ResultsThe operation is the major therapy for primary sacrum tumor. However, surgical procedures, protection of sacral nerve, and the way of intraoperative hemostasis remain controversial. Meanwhile, the complexity of pelvic reconstruction, the diversity of complications, and prognosis related with many factors bring difficulties and challenges to the surgical treatment. ConclusionsIt is urgent need to develop an effective unified standard to conduct diagnosis and treatment of primary sacrum tumor.
ObjectiveTo summarize the research progress of one-stage posterior hemivertebra resection for congenital kyphoscoliosis. MethodsThe domestic and foreign related literature about spinal hemivertebra deformity,and many aspects of its operation mode,operation timing,the fixed segment,and operation complications were summarized and analysed. ResultsThe hemivertebra resection can remove teratogenic factors directly,and is favor by the majority of domestic and foreign physicians,but the procedure,indications,long-term effectiveness,and postoperative complications are still unconcern,and the operation timing and fixed-fused segment is still controversial. ConclusionThe operation timing and the fixed segment of one-stage posterior hemivertebra resection for congenital kyphoscoliosis need further research.
ObjectiveTo investigate the optimal surgical opportunity timing of posterior hemivertebra resection by comparing the outcomes of surgical treatment for congenital spinal deformity in patients at different ages. MethodsBetween January 2007 and Februay 2013, 36 cases of congenital hemivertebra scoliosis underwent one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion. There were 22 males and 14 females, with an average age of 16.8 years (range, 5-48 years). The patients were divided into 3 groups:group A (≤10 years, n=7), group B (10-20 years, n=22), and group C (>20 years, n=7). There was no significant difference in gender, segment, type, and complication among 3 groups (P>0.05). Anteroposterior and lateral X-ray films were taken before and after operation to measure the scoliosis Cobb angle, kyphosis Cobb angle, and C7 plumb line-center sacral vertical line (C7PL-CSVL). The improvement rate was calculated. And the perioperative and long-term complications were recorded. ResultsThe operation time of group A was significantly less than that of group C (P<0.05); the intraoperative blood loss of group B and group C were significantly more than that of group A (P<0.05); and the fixed segments of group B and group C were significantly more than those of group A (P<0.05). Thirty-six cases were followed up 7-62 months (mean, 31.3 months). No poor wound healing, pedicle cutting, pseudoarticulation formation, and other complications occurred during the follow-up. At last follow-up, 31 patients obtained a balance of double shoulders and double hips. The scoliosis Cobb angle, kyphosis Cobb angle, and C7PL-CSVL at immediate after operation and last follow-up were significantly improved when compared with preoperative ones in 3 groups (P<0.05). The scoliosis Cobb angle at last follow-up of group B was significantly larger than that of group C, the kyphotic correction rate at immediate after operation was significantly larger in groups A and C than in group B, the kyphotic correction rate of group B at last follow-up was significantly less than that of group C, and C7PL-CSVL correction rate of group A at immediate after operation was significantly larger than that of group B, all showing significant differences (P<0.05). ConclusionEarly one stage posterior hemivertebra resection is safe and effective, especially in patients who had no formation of structural compensatory bending and spinal stiffness, which can shorten the operation time and reduce the fixed segments and intraoperative hemorrhage. Influence on the growth and activity of the spine is relatively small.
ObjectiveTo investigate the changes and relationship of cervical spine sagittal alignment and other spinal-pelvic sagittal parameters in adolescent idiopathic scoliosis. MethodsBetween July 2011 and July 2014, 35 patients with idiopathic scoliosis who met the inclusion criteria underwent posterior pedicle screw instrumentation and fusion. There were 12 males and 23 females with a mean age of 16.2 years (range, 13-20 years), including 16 cases of Lenke type 1, 7 cases of Lenke type 2, 4 cases of Lenke type 3, 3 cases of Lenke type 4, 4 cases of Lenke type 5, and 1 case of Lenke type 6. The average follow-up time was 10.9 months (range, 5-36 months). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), T1 slope, C2 slope, C7 sagittal vertical axis (C7 SVA), C2-7 plumbline (cSVA) were measured on pre-and post-operative standing lateral X-ray film. Based on preoperative CL, the patients were divided into kyphosis group (CL>0°) and lordosis group (CL < 0°); after operation, the patients were divided into restored lordosis (group A), decreased kyphosis (group B), and increased lordosis (group C) after operation. All data about sagittal profile changes were analyzed. The relations between CL and other spinal-pelvic parameters in the kyphosis and lordosis groups before operation were determined via Spearman correlation coefficient. ResultsStatistically significant changes were observed in PT, PI, SS, and LL between at pre-and post-operation (P < 0.05), but no significant difference was found in the other parameters (P>0.05). There were 17 patients in lordosis group and 18 in kyphosis group before operation. Intra-group comparisons showed significant changes in PT, PI, SS, C2 slope, and C7 SVA in lordosis group, and in PT, PI, SS, LL, CL, TK, T1 slope, and C2 slope in kyphosis group (P < 0.05). Subgroup comparisons showed significant changes in CL, TK, C2 slope, C7 SVA, and T1 slope before operation (P < 0.05) and T1 slope at last follow-up between 2 groups (P < 0.05). In kyphosis group, 7 cases (group A) had restored lordosis, 7 cases (group B) had decreased kyphosis, and 4 cases had increased lordosis. In lordosis group, 9 cases (group C) had increased lordosis, 3 cases had decreased lordosis, and 5 cases had kyphotic cervical alignment after operation. Significant difference was found in LL, CL, T1 slope, C2 slope, and C7 SVA of group A, in TK and CL of group B, and in CL and cSVA of group C between pre-and post-operation (P < 0.05). There were significant differences in pre-and post-operative LL between groups A and B (P < 0.05). In lordosis group, there was a strong correlation between CL and C2 slope (P < 0.05) at pre-operation. CL had strong correlation with C2 slope and T1 slope (P < 0.05) at pre-operation in kyphosis group, and CL had moderate correlation with cSVA (P < 0.05). ConclusionCervical sagittal alignment plays an important role in the balance of the spine and pelvis. The change of cervical sagittal alignment has a certain correlation with the change of thoracic kyphosis. Attention to properly maintaining or restoring cervical sagittal lordosis alignment should be considered in preoperative evaluation of adolescent indiopathic scoliosis.
ObjectiveTo identify the prevalence of distal adding-on phenomenon after posterior selective fusion in type Lenke 1A idiopathic scoliosis, to analyze its risk factors so as to find the reasonable choice for lowest instrumented vertebra (LIV). MethodsA retrospective study was made on the clinical data of 43 patients with type Lenke 1A idiopathic scoliosis undergoing posterior selection fusion with pedicle screw instrumentation between July 2011 and December 2015. There were 15 males and 28 females, aged 12-18 years (mean, 16 years). The preoperative Cobb angle was (50.1±11.3)°. The anteroposterior and lateral radiographs were taken at preoperation, immediate after operation, and last follow-up to measure the radiographic parameters. Forty-three patients were divided into adding-on group and control group according to whether or not the occurrence of distal adding-on phenomenon on anteroposterior radiographs of the spine at last follow-up. All the factors that maybe cause distsal adding-on were evaluated by statistical analysis. ResultsThe patients were followed up 12-50 months (mean, 26.5 months). At last follow-up, distal adding-on was observed in 10 of 43 patients (23.3%), including 2 males (13.3%) and 8 females (28.6%). Univariate analyses showed following several factors associated with adding-on:preoperative lumbar flexibility, preoperative pelvic tilt in coronal plane, preoperative LIV+1 deviation from center sacral vertical line, L4 subtype, the difference between LIV and last touching vertebra (LTV) (LIV-LTV), the difference between LIV and lower end vertebra (LEV) (LIV-LEV), and the difference between LIV and stable vertebra (SV) (LIV-SV). The risk factors above were brought into Logistic regression model, the results showed that preoperative LIV+1 deviation (deviation>10 mm, odds ratio=10.812, P=0.026), LIV-LTV (LIV-LTV<1, odds ratio=9.017, P=0.04), and L4 subtype (1A-R, odds ratio=9.744, P=0.047) were significantly associated with adding-on. ConclusionPreoperative LIV+1 deviation of >10 mm, L4 subtype (1A-R) and LIV-LTV of <1 are independent predictive factors of adding-on after surgery. As high risk of adding-on was closely related with the incorrect fusion level, it plays an important role for surgeons to decide the level of the fusion before surgery thoroughly. The LIV should be extended at least to LTV+1 to avoid adding-on phenomenon.
ObjectiveTo explore the risk factors of coronal imbalance after posterior long-level fixation and fusion for degenerative lumbar scoliosis.MethodsRetrospectivly analyzed the clinical records of 41 patients with degenerative lumbar scoliosis who had received posterior long-level fixation and fusion with selective transforaminal lumbar interbody fusion (TLIF) accompanied by Ponte osteotomy between August 2011 and July 2016. Patients were divided into imbalance group (group A, 11 cases) and balance group (group B, 30 cases) according to state of coronal imbalance measured at last follow-up. The radiographic parameters at preoperation and last follow-up were measured, and the variance of preoperative and last follow-up parameters were calculated. The radiographic parameters included coronal Cobb angle, coronal balance distance (CBD), apical vertebral translation (AVT), apical vertebral rotation (AVR), Cobb angle of lumbar sacral curve (LSC), and L5 tilt angle (L5TA). Univariate analysis was performed for the factors including gender, age, preoperative T value of bone mineral density, number of instrumented vertebra, upper and lower instrumented vertebra, segments of TLIF, decompression, and Ponte osteotomy, as well as the continuous variables of preoperative imaging parameters with significant difference were converted into two-category variables, obtained the influence factors of postoperative coronal imbalance. Multivariate logistic regression analysis was performed to verify the risk factors from the preliminary screened influence factors and the variance of imaging parameters with significant difference between the two groups.ResultsThe follow-up time of groups A and B was (3.76±1.02) years and (3.56±1.03) years respectively, there was no significant difference between the two groups (t=0.547, P=0.587). The coronal Cobb angle, AVT, LSC Cobb angle, and L5TA in group A were significantly higher than those in group B before operation (P<0.05), and all the imaging parameters in group A were significantly higher than those in group B at last follow-up (P<0.05). There was no significant difference between the two groups in parameters including the variance of coronal Cobb angle, AVT, and LSC Cobb angle before and after operation (P>0.05), and there were significant differences between the two groups in parameters including the variance of CBD, L5TA, and AVR (P<0.05). Univariate analysis showed that preoperative L5TA was the influencing factor of postoperative coronal imbalance (P<0.05). Multivariate logistic regression analysis showed that preoperative L5TA≥15° was an independent risk factor of postoperative coronal imbalance, and variance of pre- and post-operative AVR was a protective factor.ConclusionPreoperative L5TA≥15° is an independent risk factor for coronal imbalance in patients with degenerative lumbar scoliosis after posterior long-level fixation and fusion.