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1.
Ping Wu Chenke Luo Xiaoyang Pang Zhengquan Xu Hao Zeng Xiyang Wang 《Archives of orthopaedic and trauma surgery》2013,133(10):1341-1350
Purpose
To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach.Materials and methods
Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated.Results
Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22–41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°–25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°–27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6–9 months after surgery.Conclusions
One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis. 相似文献2.
Aim
Our aim was to evaluate the feasibility and efficiency of the application of posterior transpedicular debridement with instrumentation and fusion to the treatment of over 60-year-old patients with thoracic tuberculosis.Methods
Fifteen over 60-year-old patients with thoracic tuberculosis treated by posterior transpedicular debridement with instrumentation and fusion between August 2006 and November 2010, seven males and eight females in this study were reviewed, retrospectively. Their age ranged from 61 to 75 (mean age 63.4). The follow-up period ranged from 12 to 51?months (mean 30?months). The patients were evaluated based on vertebral body loss, kyphotic angle, fusion status of affected segment, visual analog scale (VAS) pain score, and Frankel’s classification.Results
A solid fusion was achieved in all 15 cases. No postoperative complications, chronic infection, sinus formation or significant loss of deformity correction was noted in these patients. Moreover, VAS score was reduced and Frankel’s grade was recovered in all patients and there was no recurrence of the tuberculous infection.Conclusions
Posterior transpedicular debridement with instrumentation and fusion is a feasible and effective procedure in the treatment for thoracic tuberculosis in patients over the age of 60. 相似文献3.
Xiyang Wang Xiaoyang Pang Ping Wu Chengke Luo Xiongjie Shen 《European spine journal》2014,23(4):830-837
Purpose
The aim of this study was to compare single posterior debridement, interbody fusion and instrumentation with one-stage anterior debridement, interbody fusion and posterior instrumentation for treating thoracic and lumbar spinal tuberculosis.Method
From January 2006 to January 2010, we enrolled 115 spinal tuberculosis patients with obvious surgical indications. Overall, 55 patients had vertebral body destruction, accompanied by a flow injection abscess or a unilateral abscess volume greater than 500 ml. The patients underwent one-staged anterior debridement, bone grafting and posterior instrumentation (group A) or single posterior debridement, bone grafting and instrumentation (group B). Clinical and radiographic results for the two groups were analyzed and compared.Results
Patients were followed 12–36 months (mean 21.3 months), Fusion occurred at 4–12 months (mean 7.8 months). There were significant differences between groups regarding the post-operative kyphosis angle, angle correction and angle correction rate, especially if pathology is present in thoracolumbar and lumbar regions. Operative complications affected five patients in group A, and one patient in group B. A unilateral psoas abscess was observed in three patients 12 months postoperatively. In one of them, interbody fusion did not occur, and there was fixation loosening and interbody absorption. All of them were cured by an anterior operation.Conclusion
Anterior debridement and bone grafting with posterior instrumentation may not be the best choice for treating patients with spinal tuberculosis. Single posterior debridement/bone grafting/instrumentation for single-segment of thoracic or lumbar spine tuberculosis produced good clinical results, except in patients who had a psoas abscess. 相似文献4.
Purpose
The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.Patients and methods
A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty-two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared.Results
The average follow-up period was 15 months (range 12–24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the two groups regarding neurological recovery, functional outcome and fusion rate.Conclusion
Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar Pott’s disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.5.
M. A. Erfani B. Pourabbas H. Nouraie I. Vadiee A. R. Vosoughi 《Musculoskeletal surgery》2014,98(2):107-114
Background
Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey.Methods
A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices.Results
There were 102 pediatric individuals, 61 boys and 41 girls, aged 3–17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12–81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly.Conclusions
Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes. 相似文献6.
Ahmed Shawky Al-Moataz Abdel Razek Zohny Al-Sabrout Mohamed El-Meshtawy Khaled Mohamed Hasan Heinrich Boehm 《European spine journal》2013,22(10):2211-2218
Study design
This is a prospective observational study.Purpose
The aim of this study was to determine whether the combination of thoracoscopically assisted corpectomy with posterior percutaneous transpedicular instrumentation in prone position achieves treatment goals in burst thoracic or thoracolumbar fractures and minimizes the associated morbidities.Methods
Between December 2007 and December 2008, 26 patients with acute burst spinal fractures were operated upon in our hospital. Those patients underwent posterior percutaneous stabilization plus anterior thoracoscopically assisted corpectomy and fusion in prone position. Clinical and radiological outcomes of these patients were evaluated after a minimum follow-up period of 2 years. The Oswestry Disability Index (ODI) combined with clinical examination was used for clinical evaluation. Plain X-ray in two views was used for the radiological evaluation.Results
The mean operative time was 248 min. The average blood loss was 765 ml. Ten patients had preoperative neurological deficits ranging from Frankel A to D. One patient did not show any neurological improvement at the final follow-up. The mean ODI at final follow-up was about 7. The mean preoperative kyphosis angle was 25.58°, improved to 9.2° postoperatively and to 13.8° at the final follow-up. No cases of implant failure were reported at the final follow-up.Conclusions
Minimal invasive spinal techniques including thoracoscopic decompression and fusion and short segment posterior percutaneous instrumentation showed good clinical outcomes and can be considered as alternative to open procedures with decreased rates of morbidities in managing burst thoracic and thoracolumbar fractures. 相似文献7.
Weihu Ma Nanjian Xu Yong Hu Guoqing Li Liujun Zhao Shaohua Sun Weiyu Jiang Guanyi Liu Yongjie Gu Jiayong Liu 《European spine journal》2013,22(10):2232-2239
Study design
A retrospective study was conducted to evaluate anterior plate fixation of unstable atlas fractures using a transoral approach.Objective
To further investigate the safety and efficacy of this surgical technique, as there is currently a paucity of available data.Summary of background data
While most atlas fractures can be managed by external immobilization with favorable results, surgery is usually preferable in highly unstable cases. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1–C2 or C0–C2, but these techniques usually result in loss of joint function and cannot fully stabilize anterior arch fractures of the atlas. Although a transoral approach circumvents these issues, only nine cases were described in the literature to our knowledge.Methods
Twenty patients with unstable atlas fractures were treated with this technique during a 6-year period. Screw and plate placement, bone fusion, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, strength, pain levels, and signs of infection were assessed clinically upon follow-up.Results
There were no incidents of screw loosening or breakage, plate displacement, spinal cord injury, or vertebral artery injury. A total of 20 plates were placed and all 40 screws were inserted into the atlas lateral masses. CT scans demonstrated that two screws were placed too close to the vertebral artery canal, but without clinical consequences. Imaging demonstrated that bone fusion was achieved in all cases by 6 months postoperatively, without intervertebral instability. No plate-related complications were observed in any patients during the follow-up period.Conclusions
C1 anterior plate fixation using a transoral approach appears to be a safe, reliable, and function-preserving surgical method for the management of unstable atlas fractures. For this type of fracture, a transoral approach with anterior fixation should be considered as an alternative to posterior approaches or conservative treatments. 相似文献8.
Ahmed Shawky Mohamed El-Meshtawy Heinrich Boehm 《European orthopaedics and traumatology》2014,5(3):299-303
Background context
Traumatic thoracolumbar discoligamentous injuries and partial burst fractures are commonly managed through posterior-only stabilization. Many cases present later with failure of posterior implant and progressive kyphotic deformities that necessitates major surgeries. Anterior interbody fusion saves the patients unnecessary long-segment fixation and provides a stable definitive solution for the injured segment.Purpose
The purpose of this study is to assess the clinical and radiographic outcomes of combined minimal invasive short-segment posterior percutaneous instrumentation and anterior thoracoscopic-assisted fusion in thoracolumbar partial burst fractures or discoligamentous injuries.Study design
Prospective observational study.Patient sample
Thirty patients with acute thoracic or thoracolumbar injuries operated upon between December 2007 and January 2009.Outcome measures
Oswestry Disability Index (ODI), clinical and neurological examination for clinical assessment. Plain X-ray for radiological evaluation.Methods
Preoperative evaluation included clinical and neurological examination, plain X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Posterior short-segment percutaneous stabilization plus anterior thoracoscopically assisted fusion in prone position were done. The minimum follow-up period was 2 years (range 24–48 months).Results
The mean age was 44 years. The commonest affected segment was between T10 and L1 (22 patients, 73 %). The mean total operative time was 103 min. The mean operative blood loss was 444 ml. Interbody fusion cage was used in 28 patients while iliac graft in two cases. Fusion rate at the final follow-up was 97 % (29 patients); one patient did not show definitive fusion although he was clinically satisfied. The mean final follow-up ODI was 12 %. The mean preoperative kyphosis angle was 22° improved to 6.5° postoperatively and was 7.5° at final follow-up. There were no major intraoperative or postoperative complications.Conclusion
Combined anterior thoracoscopic fusion and short-segment posterior percutaneous instrumentation showed good clinical and radiographic outcomes in cases of thoracolumbar injuries through limiting the instrumented levels and preventing progress of posttraumatic kyphosis. 相似文献9.
Hong Qi Zhang Jin Song Li Shu Shan Zhao Yu Xiong Shao Shao Hua Liu Qi Gao Min Zhong Lin Jin Yang Liu Jian Huang Wu Jing Chen 《Archives of orthopaedic and trauma surgery》2012,132(12):1717-1723
Purpose
To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly.Materials and methods
This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B.Results
All patients were followed up for an average of 35.1?±?5.8?months (range 26?C45?months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10?months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups.Conclusion
Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis. 相似文献10.
Xin Hua Yin Shao Hua Liu Jin Song Li Yong Chen Xiong Ke Hu Ke Feng Zeng Hong Gui Yu Zhen Hai Zhou Hong Qi Zhang 《European spine journal》2016,25(4):1047-1055
Purpose
We present a retrospective study of patients with multilevel contiguous tuberculous spondylitis of thoracic region that underwent single-stage posterolateral debridement and fusion and following posterior instrumentation.Methods
From June 2000 to March 2009, 870 consecutive spinal tubercular patients including 36 patients who were diagnosed and treated as multilevel contiguous thoracic spinal tuberculosis in our institution. Apart from five patients being treated conservatively, the 31 cases received surgery by single-stage posterolateral debridement, fusion, following posterior instrumentation and postural drainage. The patients were evaluated based on the Frankel scoring system, kyphotic Cobb angle, and visual analog scale (VAS) pain score.Results
The mean duration of postoperative follow-up was 79.2 ± 9.9 months (range 62–98 months). Neither mortalities nor any major complications were found. Solid bony fusion was achieved in all patients. No patients with neurological deficit deteriorated postoperatively. According to Frankel scoring system, 7 cases were rated as Grade D, 24 cases as Grade E at last follow-up. The average preoperative Cobb’s angle was 32° (range 21°–39°). The average early postoperative Cobb’s angle was 23° (range 15°–32°). The mean latest postoperative Cobb’s angle was 26° (range 20°–32°), with a small loss of correction at last follow-up. Pre-op VAS was 8.8 ± 0.7 (range 7–10) and final follow-up was 1.8 ± 1.1. There was a significant difference of VAS between preoperation and the final follow-up.Conclusions
One-stage surgical treatment for multilevel contiguous spinal tuberculosis by posterolateral debridement, fusion, posterior instrumentation can be an effective and feasible treatment method.11.
Dennis S. Meredith MD Christopher K. Kepler MD MBA Russel C. Huang MD Vishal V. Hegde 《HSS journal》2013,9(1):25-31
Background
Previous studies have demonstrated the distinct advantages of thoracoscopically assisted spinal fusion compared to traditional open thoracotomy. However, these techniques are limited by a steep learning curve, prolonged operative time, and lack of three-dimensional visualization of the surgical field.Objective
The objective of this study was to describe our initial experience with an adaptation of the extreme lateral interbody fusion (XLIF) technique allowing access to the anterior aspect of the thoracic and thoracolumbar spine with specific reference to (1) early pulmonary complications, (2) non-pulmonary complications, and (3) ability of this technique to successfully achieve spinal decompression and fusion at the operative level.Methods
Clinical and radiographic data were reviewed for the entire perioperative period. A total of 18 patients (72% females; mean age, 56.8 years) underwent a thoracic XLIF procedure for spinal pathologies including disc herniation, fracture, tumor, pseudoarthrosis, and proximal junctional kyphosis. A total of 32 levels were treated, with the majority located at the thoracolumbar junction. Twelve of the procedures were done as part of a combined anterior/posterior surgery.Results
The mean estimated blood loss was 577 ml and the mean length of stay was 12 days. At a mean follow-up of 14 months, all patients except for one (who died of widely metastatic disease) had achieved radiographic evidence of fusion. Two patients developed pulmonary effusions requiring medical intervention. Six patients had seven non-pulmonary complications: incidental durotomy (two), infection (one), instrumentation pullout (one), cardiac arrhythmia (two), and death from metastatic disease (one).Conclusions
The XLIF technique can be utilized for access to the anterior column of the thoracic and thoracolumbar spine. The advantages of this minimally invasive technique include avoidance of the need for an access surgeon and for lung deflation during surgery as well as excellent visualization of the spinal pathology. 相似文献12.
Purpose
Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction.Methods
Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8–56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria).Results
Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1–4) days in ICU and were able to walk unaided 1.6 (1–2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1–18) degrees, with loss of correction of 4 (0–19) degrees at final follow-up.Conclusions
Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery. 相似文献13.
Li M Fang X Sun Y Wang X Wang L Liu H He S Zhu X Zhou L Su H Liu H Ni J 《Archives of orthopaedic and trauma surgery》2011,131(10):1375-1381
Introduction
Spontaneous thoracic curve correction may occur following selective anterior spinal fusion in patients with adolescent idiopathic scoliosis (AIS). However, a few reports have described outcomes in patients following selective posterior fusion. The aim of this retrospective study was to assess curve correction in AIS patients with major lumbar curves and secondary thoracic curves after selective posterior fusion of the major curve.Methods
The records of 42 AIS patients with major lumbar and minor thoracic curves who had received selective posterior lumbar fusion with segmental pedicle screw fixation were examined. Preoperative and follow-up radiographs were examined and the following were determined: curve flexibility, Cobb angle measurements of the major and minor curves, thoracolumbar/lumbar and thoracic Cobb measurements. Also, thoracolumbar/lumbar to thoracic Cobb ratios were determined. Minimum follow-up was 2?years. Patients were compared with respect to whether final thoracic curve improvement was (group A) or was not (group B) apparent. Improvement was indicated by a final thoracic curve that was less than the preoperative thoracic curve.Results
Thoracic curve improvement was apparent in 32 of 42 patients after surgery. The mean preoperative thoracic curve in group A was 22.5° and 15.0° at follow-up, while corresponding values in group B were 35.0° and 39.8°. There were no cases in group A and eight cases in group B in which the preoperative thoracic curve was >30°. All patients in group B had preoperative thoracic curves on lateral bending >20°. Thoracic curvature at final follow-up was strongly correlated with preoperative thoracic curvature (r?=?0.911) and thoracic curvature on lateral bending (r?=?0.948).Conclusions
Selective posterior fusion with segmental pedicle screw fixation in patients with major lumbar AIS resulted in curve correction in the majority of cases. Preoperative thoracic curvature and thoracic curvature on lateral bending were strongly correlated with the final thoracic curvature. 相似文献14.
Wilson Z. Ray Khaled M. Krisht Andrew T. Dailey Meic H. Schmidt 《Acta neurochirurgica》2013,155(7):1179-1186
Background
There is significant controversy surrounding the ideal management of thoracolumbar burst fractures. While several treatment and management algorithms have been proposed, the ideal treatment strategy for these fractures remains unsettled. The authors review their experience with short-segment posterior fusion followed by anterior thoracoscopic corpectomy for the treatment of unstable thoracolumbar burst fractures.Methods
We identified all patients treated by a single surgeon at our institution from 2002 to 2009 with short-segment posterior fusion followed by anterior thoracoscopic corpectomy for unstable thoracolumbar junction burst fractures. Demographic data, mechanism of injury, classification of fracture, Cobb angle, American Spinal Injury Association score, associated injuries, tobacco use, follow-up duration, and radiographic studies were all collected. Outcomes were assessed for fracture alignment (preoperative, postoperative, and long-term follow-up kyphosis), rate of fusion, neurological outcome, and treatment complications.Results
Thirty-two patients with burst fracture of the thoracolumbar junction defined as T10 to L1 were included. At a mean follow-up of 20.4 months, 90 % of patients had demonstrated radiographic evidence of fusion and 91 % retained the correction of their kyphotic deformity. There were three complications in the series.Conclusions
Short-segment posterior fusion with thoracoscopic anterior corpectomy represents an alternative to traditional open treatment of thoracolumbar burst fractures. A thoracoscopic approach allows for a short-segment posterior fusion, reducing the loss of adjacent motion segments, minimizes morbidity associated with traditional open anterior approaches, allows for anterior and posterior column stabilization, and is associated with a high rate of bony fusion. 相似文献15.
16.
Background
The purpose of the study was to evaluate the clinical and radiological follow-up of patients suffering from fixed post-traumatic and postinflammatory kyphotic deformities of the thoracic and lumbar spine and treated by posterior transpedicular wedge resection osteotomy of the spine.Methods
A total of 28 patients received a posterior transpedicular wedge resection osteotomy. A prospective follow-up was performed preoperatively, postoperatively and after 3, 6 and 12 months. The kyphotic angle of the fractured segment was evaluated as well as the clinical parameters the self-reported visual analog scale (VAS) and the Oswestry score.Results
The median pain scores (VAS) and the Oswestry disability scores (p<0.05) decreased significantly from pretreatment to post-treatment. Postoperatively a significant correction of the kyphotic angle could be achieved with a mean of 28° (range 14-44°). In the follow-up after 1 year there was a 7° increase in kyphosis.Conclusions
Transpedicular wedge resection osteotomy of the thoracic and lumbar spine offers a safe surgical technique for the treatment of fixed postinflammatory kyphotic deformities. 相似文献17.
Kei Watanabe Lawrence G. Lenke Keith H. Bridwell Yongjung J. Kim Marsha Hensley Linda Koester 《Journal of orthopaedic science》2010,15(6):720-730
Background
There have been no standardized surgical options for severe scoliotic curvatures ≥100°. Halo-gravity traction is a viable option for surgical treatment of severe scoliosis. The aim of this study was to evaluate the efficacy and safety of perioperative halo-gravity traction for scoliosis curves ≥100° with respect to radiographic outcomes and clinical complications.Methods
A total of 21 scoliosis patients with ≥100° curves (average 118.7°; range 100°-158°) with a minimum 2-year follow-up (average 41.8 months; range 24.0-97.0 months) who underwent spinal instrumented fusion using perioperative halo-gravity traction were analyzed. Diagnoses were neuromuscular scoliosis (n = 10), idiopathic (n = 9), and congenital (n = 2). In all, 15 patients were treated by the anterior release procedure followed by final posterior fusion and 6 patients by posterior fusion alone. Six patients had only preoperative traction preceding posterior fusion alone, 6 patients only staged traction between anterior release and final posterior fusion, and 9 patients had both preoperative traction preceding anterior release and staged traction preceding final posterior fusion. The average overall traction period in all patients was 67 days (range 10–78 days).Results
Radiographic outcomes demonstrated 51.3% correction of the major Cobb angle, 40 mm correction of apical vertebral translation, 76 mm increase of T1-S1 length, and 20.7% increase of space available for lungs at the ultimate follow-up (all comparisons P < 0.05). Preoperative traction demonstrated 27.5% correction of the major curve Cobb angle, 51.5 mm increase of T1-S1 length, 14.9% increase of space available for the lungs (all comparisons P < 0.05). Staged traction after anterior release demonstrated 37.2% correction of the major curve Cobb angle, 26.1 mm correction of apical vertebral translation, 56.5 mm increase of T1-S1 length, 14.2% increase of space available for the lungs (all comparisons P < 0.05). There were only two patients with a pin-site problem, and one required débridement. There were no neurological deficits or clinical complications.Conclusions
Scoliosis patients with ≥100° curves can be managed successfully by corrective fusion surgery concomitant with perioperative halo-gravity traction without significant complications. 相似文献18.
Kei Ando Shiro Imagama Zenya Ito Ryoji Tauchi Akio Muramoto Hiroki Matsui Tomohiro Matsumoto Naoki Ishiguro 《Journal of orthopaedic science》2013,18(3):380-387
Background
The purpose of this study was to evaluate the surgical results of the single-stage surgery only from posterior approach for the management of thoracic dumbbell tumor and to discuss its usefulness and limitations.Methods
Sixteen cases of large thoracic dumbbell tumor (11 men and 5 woman, mean age, 44 years) were analyzed retrospectively. Pathologic findings included schwannoma in 10 patients, neurofibroma in 2 patients (Recklinghausen in 1 patient), meningioma in 2 patients, myxolipoma in 1 and ganglioneuroma in 1. They underwent single-stage removal of dumbbell tumor using the posterior approach followed by laminectomy and often costotransversectomy combined with instrumentation. Clinical and radiologic outcomes are reviewed.Results
The mean follow-up period for clinical and radiographic outcome variables was 66 months (range, 24–120 months). Operative time ranged from 185 to 420 min (mean, 320 min), with estimated blood loss ranging from 71 to 1830 ml (mean, 540 ml). Postoperative complications were pleural injury during the enucleation of paravertebral tumors, which could be repaired, and the chest tube was detained to prevent postoperative pneumothorax. Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. One patient underwent both posterior and anterior surgery because of attachment to and compression of an artery. We were not able to diagnose this case preoperatively, although a biopsy had been performed.Conclusions
Single-stage surgery may be a useful method for removing thoracic dumbbell tumors without the combined anterior approach, unless they are attached to and compressing the artery and the diagnosis cannot be made preoperatively. 相似文献19.
Hyuk Hur Jung-Kil Lee Jae-Won Jang Tae-Sun Kim Soo-Han Kim 《European spine journal》2014,23(8):1641-1647
Purpose
The goal of this study was to evaluate the results and feasibility of primary anterior cervical discectomy and fusion (ACDF) with plating for unstable traumatic spondylolisthesis of the axis, the so-called hangman’s fracture, via the standard anterior retropharyngeal approach.Methods
The clinical and radiological records of 17 patients (14 males and 3 females, mean age: 51 years, range 17–73 years) with unstable hangman’s fracture who were treated between January 1996 and June 2012 were reviewed retrospectively. ACDF with plating at C2–3 level was performed in all patients (type II fracture: 12 patients, type IIA fracture: 3 patients and type III fracture: 2 patients, based on the Levine and Edwards classification). Combined morbidity, complications, neurological improvement and fusion rate were assessed.Results
Seventeen patients underwent fusion surgery via the standard anterior retropharyngeal approach. Four patients required an additional posterior arthrodesis to augment the anterior procedure. Patients wore a Philadelphia collar for 4–6 weeks and fusion at C2–3 was achieved in all patients. Two cases of complications were observed during treatment, comprising of one case of non-union and one case of transient dysphagia that resolved after 3 months. However, none of the patients experienced worsening of the neurological function post-operatively. There were no cases of permanent nerve injury or infection.Conclusions
Treatment of the hangman’s fracture is dependent on the stability of the injury. Although the treatment for unstable hangman’s fracture is still controversial, we carefully suggest that primary ACDF with plating via the standard anterior retropharyngeal approach may be a feasible treatment option. It provides immediate stability and allows for early ambulation while promoting a stable bone union with minimal morbidity. 相似文献20.