ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.
Objective To compare the surgical efficacy of different operating methods for treating old thoracolumbarfracture with spinal cord injury. Methods From September 2000 to March 2006, 34 cases of old thoracolumbar fractures with spinal cord injury were treated. Patients were divided into 2 groups randomly. Group A (n=18): anterior approach osteotomy, il iac bone graft and internal fixation were used. There were 10 males and 8 females with the age of 17-54 years. The apex level of kyphosis was T11 in 2 cases, T12 in 5 cases, L1 in 8 cases and L2 in 3 cases. The average preoperative Cobb angle of kyphosis was (36.33 ± 3.13)°, and the average preoperative difference in height between anterior and posterior of involved vertebra was (22.34 ± 11.61) mm. Neurological dysfunction JOA score was 10.44 ± 1.12. Group B (n=16): transpedicular posterior decompression and internal fixation were used. There were 8 males and 8 females with the age of 18-56 years. The apex level of kyphosis was T11 in 2 cases, T12 in 6 cases, L1 in 7 cases and L2 in 1 case. The preoperative Cobb angle of kyphosis was (38.55 ± 4.22)°, and the preoperative difference in height between anterior and posterior of involved vertebra was (20.61 ± 10.22) mm. Neurological dysfunction JOA score was 10.23 ± 2.23. Results All the patients were followed up for 9-46 months with an average of 13.5 months. Cobb angle was (12.78 ± 3.76)° in group A, which was improved by (24.23 ± 1.64)° campared to that of preoperation; and was (10.56 ± 4.23)° in group B, which was improved by (26.66 ± 1.66)°. JOA score was 14.21 ± 1.08 in group A, which wasimproved by 3.92 ± 1.33; and it was 13.14 ± 2.32 in group B, which was improved by 3.12 ± 1.95. The average postoperative difference between anterior height and posterior height of vertebral body in group A was (3.11 ± 1.06) mm, which was improved by (18.03 ± 2.14) mm; and it was (2.56 ± 1.33) mm in group B, which was corrected by (20.36 ± 3.78) mm. There were statistically significant differences in the above indexes between preoperation and postoperation in 2 groups (P lt; 0.01), but no significant differences between 2 groups (P gt; 0.05). In group A, pleural effusion occurred in 2 cases and local pulmonary collapse in 4 cases and intercostals neuralgia in 1 case. In group B, leakage of cerebrospinal fluid occurred in 3 cases. Conclusion Both anterior and posterior approach are capable of treating of the old thoracolumbar fracture with incomplete spinal cord injury and providing the satisfying result of deformation correction, neurological decompression and neurological functional recovery to a certain extent.
ObjectiveTo investigate the clinical outcome of Ponte osteotomy for old osteoporotic multi-segment vertebral fracture combined with thoracolumbar kyphosis in elderly. MethodsBetween April 2007 and December 2012, 11 elderly patients with thoracolumbar kyphosis caused by old osteoporotic multi-segment vertebral fracture received Ponte osteotomy. There were 4 males and 7 females, with an average age of 69 years (range, 62-76 years) and with an average disease duration of 4 years (range, 10 months to 7 years). A total of 51 vertebrae was involved in fracture, including T5 in 1, T8 in 1, T9 in 1, T10 in 5, T11 in 8, T12 in 11, L1 in 11, L2 in 10, and L3 in 3. Based on Frankel classification, there were 9 cases of grade E and 2 cases of grade D. The Cobb angle of thoracolumbar kyphosis and the distance of sagital plane between C7 plump line and the posterior superior corner of S1 (sagittal vertical axis distance, SVA) were measured at pre-operation, at 2 weeks after operation, and last follow-up. The effectiveness of the treatment was appraised by visual analogue scale (VAS). ResultsAll the operations were successfully completed. Cerebrospinal fluid leakage occurred in 3 cases, and was cured after symptomatic treatment. Eleven patients were followed up 22 months on average (range, 7-38 months). Back pain symptoms, the appearance, and the trunk balance were significantly improved after operation. Postoperatively neurological symptoms were not aggravated. In 2 cases of grade D, 1 case recovered to grade E, and 1 case had no improvement. Osseous fusion was observed at 6.7 months on average (range, 5-9 months) in 10 patients except 1 patient who had no complete fusion at 7 months after operation. There was no infection, failure of internal fixation, or other complications. At 2 weeks after operation and last follow-up, the VAS score, Cobb angle, and SVA were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 2 weeks and last follow-up (P>0.05). The correction rate of Cobb angle was 70.6%±2.2% at 2 weeks after operation and was 66.7%±1.3% at last follow-up, showing no significant difference (t=25.20, P=0.13). ConclusionPonte osteotomy is effective for old osteoporotic multi-segment vertebral fracture combined with thoracolumbar kyphosis in elderly. It can obtain satisfactory sagittal balance.
OBJECTIVE: To introduce a method to treat kyphosis with universal spine system (USS) and to evaluate its clinical effect. METHODS: From January 2000 to September 2002, 31 patients with kyphosis were treated with "one-stage total vertebral wedge-shaped osteotomy" and internal fixation of USS. The average follow-up time was 12 months (6-31 months). We observed the clinical effect with the spinal column Cobb before operation and after operation, and the osteotomy confluence rate. RESULTS: In 31 patients, the average angle (Cobb) was 89 degrees before operation and 74 degrees after operation; the average rate of correction was 83.15% and the average rate of osteotomy confluence was 96.77%. No screw and rod broke and loosened. CONCLUSION: The USS is the reliable internal fixation instrument for the treatment of kyphosis, can increase the osteotomy confluence rate and improve correcting rate.
Objective To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. Methods Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40 ° of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations. Results The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40º) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05). Conclusion The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosisdeformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracturedislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8years. The whole spine radiographs were taken pre-and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, acrohorizontal angle and distance between posterosuperior point of S1and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6±16.4° to 42.6±14.3°(P＜0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5±45.6 mm to 10.7±9.6 mm(P＜0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.
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 clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients. MethodsBetween January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T10 to L2, and the kyphotic Cobb angle was (28.79±5.04)° before operation. ResultsThe operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (t=8.542, P=0.000; t=9.826, P=0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (P < 0.05) and to (23.68±4.35)° at last follow-up (P < 0.05), but no significant difference was found between at immediate and last follow-up (P > 0.05). No loosening or breakage of internal fixation was observed during follow-up. ConclusionPosterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).