Pub Date : 2019-11-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.21.003
Hua-zheng Wang, D. He, Bo Liu, Yuqing Sun
Objective To evaluate the accuracy of transarticular screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to evaluate the clinical outcomes of this treatment method. Methods Data of 56 patients(26 males and 30 females) with atlantoaxial instability who were treated by C1, 2 transarticular screw fixation using ITFN from November 2005 to October 2015 were retrospectively analyzed. The mean age of the patients was 44.5 years (range, 9-68 years). There were 44 cases with congenital malformation, 4 with old odontoid fracture, 7 with spontaneous dislocation, and 1 with rheumatoid arthritis. C2 isthmus width and height were measured on preoperatively obtained CT scans, and screw positioning was evaluated on postoperatively obtained CT scans, and classified into three types: ideal position (type I), acceptable position (type II) and unacceptable position (type III). A novel grading system is proposed based on previous study and grading system, and the difficulty of placing C1, 2 transarticular screw using ITFN was classified into three types: easy (total score 0), median (total score 1) and hard (total score 2, 3). Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom’s criteria. Results The isthmus width was 5.46±1.86 mm on the right side and 5.38±1.36 mm on the left side. The isthmus height was 4.89±1.33 mm on the right side and 4.97±1.17 mm on the left side. According to the grading system, 78, 11, and 23 of the sides were classified into easy, median and hard groups respectively. One hundred and seven transarticular screws were placed in 56 patients, and 71.03% of which were ideal screws, and 28.97% were acceptable screws. Five patients had unilateral screws placed. There was no significant difference in screw positioning among the three groups (χ2=0.46, 0.54, 1.18; P=0.50, 0.46,0.28). The mean follow-up period was 44.7 months (range, 6-120 months). At the latest follow-up, according to Nurick score, there are 30 patients scoring 0, 25 patients scoring 1, and 1 patient scoring 2. According to Odom’s criteria, outcomes were as follows: excellent, 66.1%; good, 26.8%; fair, 7.1%; and poor, 0%. All patients with preoperative neck pain had symptom relief or improvement, with more than 89.33% improvement in visual analogue scale scores. No dural laceration, injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted. Conclusion ITFN is a safe, accurate, and effective tool for transarticular screw placement in patients with atlantoaxial instability. Key words: Cervical atlas; Axis; Joint instability; Surgery, computer-assisted
{"title":"Intraoperative three-dimensional fluoroscopy based navigation assisted C1, 2 transarticular screw placement for the treatment of atlantoaxia instability","authors":"Hua-zheng Wang, D. He, Bo Liu, Yuqing Sun","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.21.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.21.003","url":null,"abstract":"Objective \u0000To evaluate the accuracy of transarticular screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to evaluate the clinical outcomes of this treatment method. \u0000 \u0000 \u0000Methods \u0000Data of 56 patients(26 males and 30 females) with atlantoaxial instability who were treated by C1, 2 transarticular screw fixation using ITFN from November 2005 to October 2015 were retrospectively analyzed. The mean age of the patients was 44.5 years (range, 9-68 years). There were 44 cases with congenital malformation, 4 with old odontoid fracture, 7 with spontaneous dislocation, and 1 with rheumatoid arthritis. C2 isthmus width and height were measured on preoperatively obtained CT scans, and screw positioning was evaluated on postoperatively obtained CT scans, and classified into three types: ideal position (type I), acceptable position (type II) and unacceptable position (type III). A novel grading system is proposed based on previous study and grading system, and the difficulty of placing C1, 2 transarticular screw using ITFN was classified into three types: easy (total score 0), median (total score 1) and hard (total score 2, 3). Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom’s criteria. \u0000 \u0000 \u0000Results \u0000The isthmus width was 5.46±1.86 mm on the right side and 5.38±1.36 mm on the left side. The isthmus height was 4.89±1.33 mm on the right side and 4.97±1.17 mm on the left side. According to the grading system, 78, 11, and 23 of the sides were classified into easy, median and hard groups respectively. One hundred and seven transarticular screws were placed in 56 patients, and 71.03% of which were ideal screws, and 28.97% were acceptable screws. Five patients had unilateral screws placed. There was no significant difference in screw positioning among the three groups (χ2=0.46, 0.54, 1.18; P=0.50, 0.46,0.28). The mean follow-up period was 44.7 months (range, 6-120 months). At the latest follow-up, according to Nurick score, there are 30 patients scoring 0, 25 patients scoring 1, and 1 patient scoring 2. According to Odom’s criteria, outcomes were as follows: excellent, 66.1%; good, 26.8%; fair, 7.1%; and poor, 0%. All patients with preoperative neck pain had symptom relief or improvement, with more than 89.33% improvement in visual analogue scale scores. No dural laceration, injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted. \u0000 \u0000 \u0000Conclusion \u0000ITFN is a safe, accurate, and effective tool for transarticular screw placement in patients with atlantoaxial instability. \u0000 \u0000 \u0000Key words: \u0000Cervical atlas; Axis; Joint instability; Surgery, computer-assisted","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1311-1319"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44114591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.002
B. Shi, Dun Liu, Zhen Liu, Ze-zhang Zhu, Xu Sun, Bin Wang
Objective To illustrate the surgical strategy of sequential correction in degenerative lumbar scoliosis (DLS) with type C coronal imbalance, and to evaluate the clinical outcomes and advances of sequential correction technique. Methods Twelve patients (2 males and 10 females) applying sequential correction technique from January 2015 to August 2017 were retrospectively reviewed. The ages of the cohort ranged 48-74 years and the average value was 52.3±8.4 years. The sequential correction technique was mainly applied in 3 steps: correction of local kyphoscoliosis with satellite rod on convex side of lumbar spine; correction of lumbosacral curve with L 4-S1 Intervertebral fusion and satellite rod on convex side of lumbosacral spine; correction of global deformity with bilateral long rods. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL), and the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were assessed at pre-operation, post-operationand last follow-up. The quality of life was evaluated using SF-36 questionnaire, and paired t test was used for the statistical analysis. Results The average follow-up period was 16.7±4.8 months. The Cobb angles at pre-operation and post-operation were 59.6°±18.7° and 25.6°±12.4° (t=3.705, P<0.001), respectively. At last follow-up, the average Cobb angle was 27.5°±13.0°, and there was no significant loss of correction (t=0.366, P=0.718). Post-operative C7PL-CSVL changed from 48.5±17.2 mm to 9.7±4.3 mm (t=5.842, P<0.001), of which the average value was 10.1±4.5 mm at last follow-up (t=0.223, P=0.826). At post-operation, 11 patients were with type A coronal imbalance, and 1 patient was still with type C coronal imbalance. The scores of bodily pain, general health, and social functioning were 8.4±1.9, 78.1±9.4 and 76.7±8.4 at pre-operation, 10.2±2.0 (t=2.260, P=0.034) , 89.5±7.6 (t=3.267, P=0.004) and 84.5±9.3 (t=2.156, P=0.042) at post-operation. In addition, there was no implant-related complications during follow-up. Conclusion The sequential correction technique could be well used in adult degenerative lumbar scoliosis patients with type C coronal imbalance, which can simplify the surgical procedure, decrease the rates of post-operative coronal imbalance, and obtain rigid internal fixation. Key words: Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Spinal fusion
目的探讨退行性腰椎侧凸伴C型冠状不平衡的顺序矫正手术策略，评价顺序矫正技术的临床效果和进展。方法回顾性分析2015年1月至2017年8月12例应用顺序矫正技术的患者(男2例，女10例)的临床资料。队列年龄48 ~ 74岁，平均值52.3±8.4岁。顺序矫正技术主要分为3步:腰椎凸侧卫星棒矫正局部后凸性脊柱侧凸;腰骶侧凸侧l4 - s1椎间融合术及卫星棒矫正腰骶曲线双侧长棒矫正全身畸形。术前、术后及末次随访时评估冠状面参数Cobb角、C7垂直线与骶正中垂直线距离(C7PL-CSVL)，矢状面参数全局后凸(GK)和矢状面垂直轴(SVA)。生活质量评价采用SF-36问卷，采用配对t检验进行统计分析。结果平均随访时间为16.7±4.8个月。术前、术后Cobb角分别为59.6°±18.7°、25.6°±12.4°(t=3.705, P<0.001)。末次随访时平均Cobb角为27.5°±13.0°，无明显矫正损失(t=0.366, P=0.718)。术后C7PL-CSVL由48.5±17.2 mm变为9.7±4.3 mm (t=5.842, P<0.001)，末次随访时平均为10.1±4.5 mm (t=0.223, P=0.826)。术后11例为A型冠状动脉不平衡，1例仍为C型冠状动脉不平衡。躯体疼痛、一般健康、社会功能评分术前分别为8.4±1.9、78.1±9.4、76.7±8.4，术后分别为10.2±2.0 (t=2.260, P=0.034)、89.5±7.6 (t=3.267, P=0.004)、84.5±9.3 (t=2.156, P=0.042)。随访期间无种植体相关并发症发生。结论顺序矫正技术可以很好地应用于成人退行性腰椎侧凸伴C型冠状位不平衡患者，简化手术程序，降低术后冠状位不平衡发生率，获得刚性内固定。关键词:成人;腰椎;椎间盘退变;脊柱侧弯;脊柱融合术
{"title":"Surgical strategy and clinical outcomes in degenerative lumbar scoliosis with type C coronal imbalance","authors":"B. Shi, Dun Liu, Zhen Liu, Ze-zhang Zhu, Xu Sun, Bin Wang","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.002","url":null,"abstract":"Objective \u0000To illustrate the surgical strategy of sequential correction in degenerative lumbar scoliosis (DLS) with type C coronal imbalance, and to evaluate the clinical outcomes and advances of sequential correction technique. \u0000 \u0000 \u0000Methods \u0000Twelve patients (2 males and 10 females) applying sequential correction technique from January 2015 to August 2017 were retrospectively reviewed. The ages of the cohort ranged 48-74 years and the average value was 52.3±8.4 years. The sequential correction technique was mainly applied in 3 steps: correction of local kyphoscoliosis with satellite rod on convex side of lumbar spine; correction of lumbosacral curve with L 4-S1 Intervertebral fusion and satellite rod on convex side of lumbosacral spine; correction of global deformity with bilateral long rods. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL), and the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were assessed at pre-operation, post-operationand last follow-up. The quality of life was evaluated using SF-36 questionnaire, and paired t test was used for the statistical analysis. \u0000 \u0000 \u0000Results \u0000The average follow-up period was 16.7±4.8 months. The Cobb angles at pre-operation and post-operation were 59.6°±18.7° and 25.6°±12.4° (t=3.705, P<0.001), respectively. At last follow-up, the average Cobb angle was 27.5°±13.0°, and there was no significant loss of correction (t=0.366, P=0.718). Post-operative C7PL-CSVL changed from 48.5±17.2 mm to 9.7±4.3 mm (t=5.842, P<0.001), of which the average value was 10.1±4.5 mm at last follow-up (t=0.223, P=0.826). At post-operation, 11 patients were with type A coronal imbalance, and 1 patient was still with type C coronal imbalance. The scores of bodily pain, general health, and social functioning were 8.4±1.9, 78.1±9.4 and 76.7±8.4 at pre-operation, 10.2±2.0 (t=2.260, P=0.034) , 89.5±7.6 (t=3.267, P=0.004) and 84.5±9.3 (t=2.156, P=0.042) at post-operation. In addition, there was no implant-related complications during follow-up. \u0000 \u0000 \u0000Conclusion \u0000The sequential correction technique could be well used in adult degenerative lumbar scoliosis patients with type C coronal imbalance, which can simplify the surgical procedure, decrease the rates of post-operative coronal imbalance, and obtain rigid internal fixation. \u0000 \u0000 \u0000Key words: \u0000Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Spinal fusion","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1232-1238"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44743724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS). Methods All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups. Results The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P 0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction. Conclusion Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spinal Stenosis; Surgical procedures, minimally invasive; Spinal fusion
目的比较微创经椎间孔腰椎椎体间融合术(MIS-TLIF)联合显微内镜椎间盘切除术(MED)与象限手术(Quadrant)治疗退行性腰椎管狭窄症(DLSS)的临床疗效。方法回顾2015年5月至2017年10月手术治疗的59例DLSS患者。根据手术方式将所有病例分为MED组(27例)和象限通道组(32例)。随访11 ~ 29个月，平均18.5个月。比较两组患者的手术时间、术中出血量、术后引流、术后卧床时间、术后肌酸激酶(CK)、融合率、肌肉纤维化程度，以及视觉模拟评分(VAS)评分和Oswestry功能障碍指数(ODI)评分。结果MED组手术时间明显长于象限组(161.7±22.4 min∶145.6±19.4 min, t=4.541, P < 0.05)。6个月和12个月时，MED组ODI低于象限组。MED组融合率为88.9%(24/27)，象限通道组为93.8%(30/32)。两组融合率比较，差异无统计学意义。MED组10例，象限组12例，术后1年行腰椎MRI检查。测量术后与术前复合肌面积萎缩比例。MED组下背部肌肉萎缩较轻(0.12±0.05∶0.22±0.04,t=-2.428, P<0.05)。术中术后并发症两组均发生硬膜囊破裂1例。立即用明胶海绵加纤维蛋白胶封堵，术后未见脑脊液漏。象限通道组1例皮肤切口边缘血供少，表皮坏死，1例脂肪液化。结论与Quadrant辅助相比，MIS-TLIF辅助MED出血量少，创伤小，恢复快，可减少术后切口并发症的发生率。关键词:腰椎;椎间盘退变;脊髓狭窄;外科手术，微创;脊柱融合术
{"title":"A comparison study of two channels during MIS-TLIF in degenerative lumbar spinal stenosis treatment","authors":"Shixue Li, Wei Zhang, Yapeng Sun, Fei Zhang, Haofei Cui, Yuan Gao, Liao Jiaqi, Zeyang Li","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.008","url":null,"abstract":"Objective \u0000To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS). \u0000 \u0000 \u0000Methods \u0000All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups. \u0000 \u0000 \u0000Results \u0000The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P 0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction. \u0000 \u0000 \u0000Conclusion \u0000Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication. \u0000 \u0000 \u0000Key words: \u0000Lumbar vertebrae; Intervertebral disc degeneration; Spinal Stenosis; Surgical procedures, minimally invasive; Spinal fusion","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1275-1284"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46095714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.005
Hai Wang, G. Qiu
Objective To evaluate the feasibility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) system to predict peri-operative risk in degenerative scoliosis patients scheduled for spinal surgery. Methods Clinical data of 227 cases with degenerative scoliosis (Male∶Female=57∶170, Mean age=66.2±7.7 years), who accepted the operation of instrumentation and fusion in our hospital from January 2013 to July 2017, were retrospectively reviewed according to the E-PASS system, including peri-operative complications. Both hospital stayand post-operative hospital staywere compared between the groups with and withoutthe complications using t test. All E-PASS scores, including Preoperative Risk Score (PRS), Surgical Stress Score (SSS) and Comprehensive Risk Score (CRS), were analyzed between the two groups using Mann-Whitney Utest.The relationship between complications and PRS, SSS and CRS were analyzed using Spearmancorrelation analysis. The predictiveaccuracy of PRS, SSS and CRS were analyzed using the area under the receiver operating characteristic (ROC) curve (AUC). Results There were a total of 47 patients (20.7%) suffering peri-operative complications, including 27 cases (11.9%) with complications at surgical sites and 23 cases (10.1%) with complications at non-surgical sites. Both hospital stay (t=-4.722, P<0.001)and post-operative hospital stay (t= -4.867, P<0.001) were increased because of the complications. All E-PASS scores, including PRS (P=0.005), SSS (P=0.003) and CRS (P<0.001) were significantly higher in patients with peri-operative complications and they were linearly correlated with the overall incidence of the complications(ρ=0.185-0.259). In particular, PRS was correlated with complications at non-surgical sites (ρ=0.162) and SSS with surgical site complications(ρ=0.162). The area under the receiver operating characteristic curve (AUC) for PRS and SSS was higher in patients with complications at non-surgical and surgical sites (AUC=0.655 and 0.650), respectively.The AUC for CRS exhibited good predictive power for both types of complications (AUC=0.662 and 0.631). Conclusion The peri-operative morbidity of spinal surgery for degenerative scoliosis was relatively higher. The E-PASS system could correctly predict the morbidity. Key words: Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Spinal fusion; Intraoperative complications; Postoperative complications
{"title":"Clinical study of E-PASS system for peri-operative morbidity of spinal surgery for degenerative scoliosis","authors":"Hai Wang, G. Qiu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.005","url":null,"abstract":"Objective \u0000To evaluate the feasibility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) system to predict peri-operative risk in degenerative scoliosis patients scheduled for spinal surgery. \u0000 \u0000 \u0000Methods \u0000Clinical data of 227 cases with degenerative scoliosis (Male∶Female=57∶170, Mean age=66.2±7.7 years), who accepted the operation of instrumentation and fusion in our hospital from January 2013 to July 2017, were retrospectively reviewed according to the E-PASS system, including peri-operative complications. Both hospital stayand post-operative hospital staywere compared between the groups with and withoutthe complications using t test. All E-PASS scores, including Preoperative Risk Score (PRS), Surgical Stress Score (SSS) and Comprehensive Risk Score (CRS), were analyzed between the two groups using Mann-Whitney Utest.The relationship between complications and PRS, SSS and CRS were analyzed using Spearmancorrelation analysis. The predictiveaccuracy of PRS, SSS and CRS were analyzed using the area under the receiver operating characteristic (ROC) curve (AUC). \u0000 \u0000 \u0000Results \u0000There were a total of 47 patients (20.7%) suffering peri-operative complications, including 27 cases (11.9%) with complications at surgical sites and 23 cases (10.1%) with complications at non-surgical sites. Both hospital stay (t=-4.722, P<0.001)and post-operative hospital stay (t= -4.867, P<0.001) were increased because of the complications. All E-PASS scores, including PRS (P=0.005), SSS (P=0.003) and CRS (P<0.001) were significantly higher in patients with peri-operative complications and they were linearly correlated with the overall incidence of the complications(ρ=0.185-0.259). In particular, PRS was correlated with complications at non-surgical sites (ρ=0.162) and SSS with surgical site complications(ρ=0.162). The area under the receiver operating characteristic curve (AUC) for PRS and SSS was higher in patients with complications at non-surgical and surgical sites (AUC=0.655 and 0.650), respectively.The AUC for CRS exhibited good predictive power for both types of complications (AUC=0.662 and 0.631). \u0000 \u0000 \u0000Conclusion \u0000The peri-operative morbidity of spinal surgery for degenerative scoliosis was relatively higher. The E-PASS system could correctly predict the morbidity. \u0000 \u0000 \u0000Key words: \u0000Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Spinal fusion; Intraoperative complications; Postoperative complications","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1257-1263"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46684990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.007
S. Xia, Dun Liu, B. Shi, Yang Li, B. Shi, Zhen Liu, Xu Sun, Y. Qiu
Objective To evaluate the radiographic and clinical outcomes of Scoliosis Research Society(SRS)-Schwab Grade IV osteotomy in type I congenital kyphosis. Methods All of 28 patients with type I congenital kyphosis who underwent SRS-Schwab Grade 4 osteotomy from June 2015 to June 2017 were retrospectively reviewed,including 21 males and 7 females aged 10 to 28 years old, with an average of 13.6±8.5 years. On standing wholespinal X-rays at pre-operation, post-operation and each follow-up, global kyphosis(GK), thoracic kyphosis(TK), lumbar lordosis(LL) and sagittal vertical axis(SVA) were measured. The intra-operative and post-operative complications were recorded for each patient. The Scoliosis Research Society-22 questionnaires(SRS-22) and visual analog scale(VAS) for back pain were collected from patients elder than 12 years old at pre-operation and last follow-up. The comparison analysiswasperformed by paired samples t test. Results At pre-operation, the GK, TK, LL and SVA were 47.0°±4.9°, 16.8°±3.7°, 36.6°±7.7°, (-31.9±13.6) mm, respectively. At 3 months post-operation, the average values improved to 3.7°±2.3°, 36.8°±4.0°, 46.5°±4.4°, 4.0±19.1 mm, respectively. Significant differences were found in all parametersbetween pre- and post-operation. The post-operative follow-up was 12 to 24 months, with an average of 13.2±5.2 months. At the last follow-up, the GK, TK, LL and SVA were 4.0°±2.4°, 38.0°±6.0°, 45.9°±5.4°, 7.6±15.3 mm, and no significant correction loss was found during follow-up. The scores of each domain of SRS-22 questionnaire improved at different level during follow-up, of which the improvement in self-imagewas statistically significant (P<0.001). The scores of VAS for back pain improved significantly after operation (P<0.001). One patient hadabnormal intra-operative monitoringwhile no neurological defectwas detected at post-opera tion. Proximal junctional kyphosis occurred in 2 patients at 3 months follow-up while no patients needed revision surgery. There wereno implant-related complicationsduring follow-up. Conclusion The SRS-Schwab Grade 4 osteotomycould provide satisfying correction with relatively low rates of complications in type I congenital kyphosis. Thus, the SRS-Schwab Grade IV osteotomy is a safe strategy for type I congenital kyphosis. Key words: Thoracic vertebrae; Lumbar vertebrae; Congenital Abnormalities; Kyphosis; Osteotomy; Quality of life
{"title":"Application of SRS-Schwab grade IV osteotomy in the treatment of type I congenital kyphosis","authors":"S. Xia, Dun Liu, B. Shi, Yang Li, B. Shi, Zhen Liu, Xu Sun, Y. Qiu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.007","url":null,"abstract":"Objective \u0000To evaluate the radiographic and clinical outcomes of Scoliosis Research Society(SRS)-Schwab Grade IV osteotomy in type I congenital kyphosis. \u0000 \u0000 \u0000Methods \u0000All of 28 patients with type I congenital kyphosis who underwent SRS-Schwab Grade 4 osteotomy from June 2015 to June 2017 were retrospectively reviewed,including 21 males and 7 females aged 10 to 28 years old, with an average of 13.6±8.5 years. On standing wholespinal X-rays at pre-operation, post-operation and each follow-up, global kyphosis(GK), thoracic kyphosis(TK), lumbar lordosis(LL) and sagittal vertical axis(SVA) were measured. The intra-operative and post-operative complications were recorded for each patient. The Scoliosis Research Society-22 questionnaires(SRS-22) and visual analog scale(VAS) for back pain were collected from patients elder than 12 years old at pre-operation and last follow-up. The comparison analysiswasperformed by paired samples t test. \u0000 \u0000 \u0000Results \u0000At pre-operation, the GK, TK, LL and SVA were 47.0°±4.9°, 16.8°±3.7°, 36.6°±7.7°, (-31.9±13.6) mm, respectively. At 3 months post-operation, the average values improved to 3.7°±2.3°, 36.8°±4.0°, 46.5°±4.4°, 4.0±19.1 mm, respectively. Significant differences were found in all parametersbetween pre- and post-operation. The post-operative follow-up was 12 to 24 months, with an average of 13.2±5.2 months. At the last follow-up, the GK, TK, LL and SVA were 4.0°±2.4°, 38.0°±6.0°, 45.9°±5.4°, 7.6±15.3 mm, and no significant correction loss was found during follow-up. The scores of each domain of SRS-22 questionnaire improved at different level during follow-up, of which the improvement in self-imagewas statistically significant (P<0.001). The scores of VAS for back pain improved significantly after operation (P<0.001). One patient hadabnormal intra-operative monitoringwhile no neurological defectwas detected at post-opera tion. Proximal junctional kyphosis occurred in 2 patients at 3 months follow-up while no patients needed revision surgery. There wereno implant-related complicationsduring follow-up. \u0000 \u0000 \u0000Conclusion \u0000The SRS-Schwab Grade 4 osteotomycould provide satisfying correction with relatively low rates of complications in type I congenital kyphosis. Thus, the SRS-Schwab Grade IV osteotomy is a safe strategy for type I congenital kyphosis. \u0000 \u0000 \u0000Key words: \u0000Thoracic vertebrae; Lumbar vertebrae; Congenital Abnormalities; Kyphosis; Osteotomy; Quality of life","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1268-1274"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44274490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.006
Ze-zhang Zhu, H. Bao, Zhen Liu
Based on the coronal balance classification for adult spinal deformity established by our center, a new surgical technique for adult spinal deformity was further proposed, namely Sequential Correction. Spine deformity was classified as thoracolumbar/lumbar type and lumbosacral type according to the driver of the deformity. A short rod was firstly installed to correct the driver, followed by another short rod installed on the other side, and two long rods were installed at last. The incidence of postoperative coronal imbalance was significantly reduced using sequential correction, and the correction rate was significantly improved compared with the traditional technique.
{"title":"Sequential correction: a reliable and simple technique for complex spine deformity","authors":"Ze-zhang Zhu, H. Bao, Zhen Liu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.006","url":null,"abstract":"Based on the coronal balance classification for adult spinal deformity established by our center, a new surgical technique for adult spinal deformity was further proposed, namely Sequential Correction. Spine deformity was classified as thoracolumbar/lumbar type and lumbosacral type according to the driver of the deformity. A short rod was firstly installed to correct the driver, followed by another short rod installed on the other side, and two long rods were installed at last. The incidence of postoperative coronal imbalance was significantly reduced using sequential correction, and the correction rate was significantly improved compared with the traditional technique.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1264-1267"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43960748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.004
Jie Cheng, Tao Xu, Mamat Mardan, Hai-long Guo, J. Sheng, Mamat Polat, Q. Deng, C. Xun, Jian Zhang, W. Liang, Rui Cao
Objective To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. Methods The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. Results Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.
{"title":"The application of a new intraoperative assessment method of coronal balance in surgical treatment of scoliosis","authors":"Jie Cheng, Tao Xu, Mamat Mardan, Hai-long Guo, J. Sheng, Mamat Polat, Q. Deng, C. Xun, Jian Zhang, W. Liang, Rui Cao","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.004","url":null,"abstract":"Objective \u0000To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. \u0000 \u0000 \u0000Methods \u0000The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. \u0000 \u0000 \u0000Results \u0000Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1249-1256"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48288122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.20.009
Yanjun An, Lingjiang Li
Objective To develop a calculation model for normal sagittal diameter (SD) of bulbo-medullary junction with the change of distance above the measurement baseline(the line connecting the anterior lower margin of the C2 vertebral body and the posterior upper margin of the C3 vertebral body), and to investigate its calculation error. Methods All of 164 patients with cervical disc herniation or cervical spinal stenosis who underwent cervical MRI between April 2018 and August 2018 in Beijing Jishuitan Hospital were included in this study. The normal bulbo-medullary junction was divided into two parts from top to bottom, and the dividing line was defined factitiously (the line parallel to the measurement baseline and through the lower margin of cancellous bone of the anterior arch of atlas). On the middle sagittal MRI images of 100 cases of normal bulbo-medullary junction, the change rate of the SD along the distance above the measurement baseline was counted on the upper and lower segments separately. The calculation model for SD of bulbo-medullary junction was established, with the SD of spinal cord at level of the lower margin of axis and the distance above the measurement baseline as independent variables. After setting-up of the calculation model, the actual SD at the lower margin of the C1 anterior arch and 10 mm above and below it was measured on other 64 cases of normal bulbo-medullary junction. The actual SD and calculation value were compared for calculating the error and error rate. The SD at the dividing line was estimated using the substituted estimation (the actual SD at level of the lower margin of axis) and mean-value estimation (the mean SD of the first 100 cases). Calculation value, substituted estimation and mean-value estimation were compared, and their calculation error and the occurrence rate of significant error (no less than 1 mm) were also compared. Results Calculation formula for SD of bulbo-medullary junction: (below the dividing line) SD=sagittal diameter at level of the lower margin of axis (SDA)+0.0472×height above the measurement baseline (HAB), (above the dividing line) SD=SDA+0.0472×height of dividing line above the measurement baseline (HDL)+0.298×(HAB-HDL). The error of calculation model increased with the distance above the measurement baseline. The error at the topmost level was 1.06±0.72 mm, and the error rate was 10.52%± 8.26%. Compared with the estimation method using the mean value, the calculation model was accompanied with a significantly lower ratio of significant error (Z=-3.527, P<0.001). Compared with the estimation method using a substitute, the error of the calculation model was significantly smaller (Z=-4.88, P<0.001) and the ratio of significant errors was significantly lower (Chi-Square= 6.015, P=0.024). Conclusion The SD calculation model could accurately estimate the SD of a normal bulbo-medullary junction, and has great significance for the quantitative imaging assessment and dec
{"title":"Setting-up of the calculation model for sagittal diameter of bulbo-medullary junction","authors":"Yanjun An, Lingjiang Li","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.20.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.20.009","url":null,"abstract":"Objective \u0000To develop a calculation model for normal sagittal diameter (SD) of bulbo-medullary junction with the change of distance above the measurement baseline(the line connecting the anterior lower margin of the C2 vertebral body and the posterior upper margin of the C3 vertebral body), and to investigate its calculation error. \u0000 \u0000 \u0000Methods \u0000All of 164 patients with cervical disc herniation or cervical spinal stenosis who underwent cervical MRI between April 2018 and August 2018 in Beijing Jishuitan Hospital were included in this study. The normal bulbo-medullary junction was divided into two parts from top to bottom, and the dividing line was defined factitiously (the line parallel to the measurement baseline and through the lower margin of cancellous bone of the anterior arch of atlas). On the middle sagittal MRI images of 100 cases of normal bulbo-medullary junction, the change rate of the SD along the distance above the measurement baseline was counted on the upper and lower segments separately. The calculation model for SD of bulbo-medullary junction was established, with the SD of spinal cord at level of the lower margin of axis and the distance above the measurement baseline as independent variables. After setting-up of the calculation model, the actual SD at the lower margin of the C1 anterior arch and 10 mm above and below it was measured on other 64 cases of normal bulbo-medullary junction. The actual SD and calculation value were compared for calculating the error and error rate. The SD at the dividing line was estimated using the substituted estimation (the actual SD at level of the lower margin of axis) and mean-value estimation (the mean SD of the first 100 cases). Calculation value, substituted estimation and mean-value estimation were compared, and their calculation error and the occurrence rate of significant error (no less than 1 mm) were also compared. \u0000 \u0000 \u0000Results \u0000Calculation formula for SD of bulbo-medullary junction: (below the dividing line) SD=sagittal diameter at level of the lower margin of axis (SDA)+0.0472×height above the measurement baseline (HAB), (above the dividing line) SD=SDA+0.0472×height of dividing line above the measurement baseline (HDL)+0.298×(HAB-HDL). The error of calculation model increased with the distance above the measurement baseline. The error at the topmost level was 1.06±0.72 mm, and the error rate was 10.52%± 8.26%. Compared with the estimation method using the mean value, the calculation model was accompanied with a significantly lower ratio of significant error (Z=-3.527, P<0.001). Compared with the estimation method using a substitute, the error of the calculation model was significantly smaller (Z=-4.88, P<0.001) and the ratio of significant errors was significantly lower (Chi-Square= 6.015, P=0.024). \u0000 \u0000 \u0000Conclusion \u0000The SD calculation model could accurately estimate the SD of a normal bulbo-medullary junction, and has great significance for the quantitative imaging assessment and dec","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1285-1292"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44190790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.19.009
Yuxuan Zhang, Hongli Wang, Xiaosheng Ma
Oblique lateral interbody fusion (OLIF) surgery uses the retroperitoneal gap between the abdominal aorta and left psoas as the surgical approach to perform discectomy and interbody fusion. It has the advantages of shorter operation duration and hospital stay, less blood loss, lighter postoperative pain and quicker recovery compared with traditional lumbar interbody fusion surgery. OLIF surgery has been gradually applied in treating degenerative diseases of the lumbar spine. However, the complications, such as the injury of blood vessels, sympathetic nerves, lumbosacral plexus, peritoneum and ureteral, cannot be negligible. Previous studies reported that the overall incidence of complications about OLIF surgery was 3% to 53.1% with an average of 15.5%, which can be divided into intraoperative and postoperative complications. The incidence of iliac vascular injury was found to be 0.3%-15.4% in OLIF at the L5S1 segments. The anatomy about vascular in this area is complex because the aorta is branched into the left and right iliac artery. The surgical approach in L5S1 segments is also different from the traditional OLIF but similar to the lateral anterior lumbar interbody fusion, which could increase the risk of vascular injury. The other complications which do not show significant segmental difference were based on the previous literatures. The incidence of abdominal aortic injury is 0.1%, which is related to direct damage caused by the narrow operation window of OLIF. The incidence of lumbar segmental arterial injury was 0.7% to 5%, which may be caused by the anatomical variation of L4, 5 lumbar segmental artery. The incidence of lumbar sympathetic nerve injury is 1.7%. More attention should be paid to protect the lumbar sympathetic trunk which lying in the front of the psoas muscle. The incidence of cage-related complications ranges from 2.9% to 13.4%, which perhaps is associated with older age, osteoporosis and use of large-sized cages. Although the incidence of ureteral injury is 0.3% to 1.6%, care should also be taken due to not obvious injury without urinary tube.
{"title":"Advances in research on complications of oblique lateral interbody fusion","authors":"Yuxuan Zhang, Hongli Wang, Xiaosheng Ma","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.009","url":null,"abstract":"Oblique lateral interbody fusion (OLIF) surgery uses the retroperitoneal gap between the abdominal aorta and left psoas as the surgical approach to perform discectomy and interbody fusion. It has the advantages of shorter operation duration and hospital stay, less blood loss, lighter postoperative pain and quicker recovery compared with traditional lumbar interbody fusion surgery. OLIF surgery has been gradually applied in treating degenerative diseases of the lumbar spine. However, the complications, such as the injury of blood vessels, sympathetic nerves, lumbosacral plexus, peritoneum and ureteral, cannot be negligible. Previous studies reported that the overall incidence of complications about OLIF surgery was 3% to 53.1% with an average of 15.5%, which can be divided into intraoperative and postoperative complications. The incidence of iliac vascular injury was found to be 0.3%-15.4% in OLIF at the L5S1 segments. The anatomy about vascular in this area is complex because the aorta is branched into the left and right iliac artery. The surgical approach in L5S1 segments is also different from the traditional OLIF but similar to the lateral anterior lumbar interbody fusion, which could increase the risk of vascular injury. The other complications which do not show significant segmental difference were based on the previous literatures. The incidence of abdominal aortic injury is 0.1%, which is related to direct damage caused by the narrow operation window of OLIF. The incidence of lumbar segmental arterial injury was 0.7% to 5%, which may be caused by the anatomical variation of L4, 5 lumbar segmental artery. The incidence of lumbar sympathetic nerve injury is 1.7%. More attention should be paid to protect the lumbar sympathetic trunk which lying in the front of the psoas muscle. The incidence of cage-related complications ranges from 2.9% to 13.4%, which perhaps is associated with older age, osteoporosis and use of large-sized cages. Although the incidence of ureteral injury is 0.3% to 1.6%, care should also be taken due to not obvious injury without urinary tube.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1222-1228"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46099559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2019.19.003
Jie Yu
Objective To analyze the relationship between cervical alignment and the development of dysphagia after anterior and posterior cervical spine surgery (AC and PC). Methods A total of 354 patients were reviewed in the present study, including 172 patients who underwent the AC procedure and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. The preoperative and postoperative neutral lateral cervical spine radiographs were evaluated. The C2-C7 angles were measured twice by the same researcher, independently, using the same methods. The change in C2-C7 angle (dC2-C7 angle) was equal to the difference between postoperative and preoperative. Results There were 12.8% AC (22/172) and 9.3% PC (17/182) patients reported dysphagia after cervical surgery. Of them, 12 patients could be graded as "mild", 8 patients as "moderate", and 2 patients as "severe" dysphagia in AC group, following the dysphagia grading system defined by Bazaz. There were 11 patients graded as "mild", 5 patients as "moderate", and 1 patient as "severe" dysphagia in PC group. No statistical significance was found between AC and PC group (χ2=0.513, P=0.545). Logistic regression analysis revealed that the dC2-C7 angle had considerable impact on postoperative dysphagia (OR=1.141, P=0.001). The chance of developing postoperative dysphagia in patients with dC2-C7 angle larger than 5 degree (64.1%) was significantly greater than that with lower than 5 degree (34.9%, χ2=10.831, P=0.001). Age, gender, BMI, operative time, blood loss, procedure type, revision surgery, most cephalic operative level and number of operative levels did not significantly influence the incidence of postoperative dysphagia (P>0.05). No relationship was found between the dC2-C7 angle and the degree of dysphagia (RR=-0.012, P=0.516). Conclusion Postoperative dysphagia is a common complication after cervical surgery. The dC2-C7 angle may play an important role in development of dysphagia in both AC and PC surgery. Over-enlargement of cervical lordosis should be avoided in order to reduce the rate of development of postoperative dysphagia. Key words: Deglutition disorders; Cervical vertebrae; Diskectomy; Spinal fusion; Postoperative complications
{"title":"The role of C2-C7 angle in the development of dysphagia after anterior and posterior cervical spine surgery","authors":"Jie Yu","doi":"10.3760/CMA.J.ISSN.0253-2352.2019.19.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2019.19.003","url":null,"abstract":"Objective \u0000To analyze the relationship between cervical alignment and the development of dysphagia after anterior and posterior cervical spine surgery (AC and PC). \u0000 \u0000 \u0000Methods \u0000A total of 354 patients were reviewed in the present study, including 172 patients who underwent the AC procedure and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. The preoperative and postoperative neutral lateral cervical spine radiographs were evaluated. The C2-C7 angles were measured twice by the same researcher, independently, using the same methods. The change in C2-C7 angle (dC2-C7 angle) was equal to the difference between postoperative and preoperative. \u0000 \u0000 \u0000Results \u0000There were 12.8% AC (22/172) and 9.3% PC (17/182) patients reported dysphagia after cervical surgery. Of them, 12 patients could be graded as \"mild\", 8 patients as \"moderate\", and 2 patients as \"severe\" dysphagia in AC group, following the dysphagia grading system defined by Bazaz. There were 11 patients graded as \"mild\", 5 patients as \"moderate\", and 1 patient as \"severe\" dysphagia in PC group. No statistical significance was found between AC and PC group (χ2=0.513, P=0.545). Logistic regression analysis revealed that the dC2-C7 angle had considerable impact on postoperative dysphagia (OR=1.141, P=0.001). The chance of developing postoperative dysphagia in patients with dC2-C7 angle larger than 5 degree (64.1%) was significantly greater than that with lower than 5 degree (34.9%, χ2=10.831, P=0.001). Age, gender, BMI, operative time, blood loss, procedure type, revision surgery, most cephalic operative level and number of operative levels did not significantly influence the incidence of postoperative dysphagia (P>0.05). No relationship was found between the dC2-C7 angle and the degree of dysphagia (RR=-0.012, P=0.516). \u0000 \u0000 \u0000Conclusion \u0000Postoperative dysphagia is a common complication after cervical surgery. The dC2-C7 angle may play an important role in development of dysphagia in both AC and PC surgery. Over-enlargement of cervical lordosis should be avoided in order to reduce the rate of development of postoperative dysphagia. \u0000 \u0000 \u0000Key words: \u0000Deglutition disorders; Cervical vertebrae; Diskectomy; Spinal fusion; Postoperative complications","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"39 1","pages":"1180-1185"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43455699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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