共查询到20条相似文献，搜索用时 31 毫秒
1.
Zagra Antonino Scaramuzzo Laura Galbusera Fabio Minoia Leone Archetti Marino Giudici Fabrizio 《European spine journal》2015,24(7):924-930
Introduction
Aim of the study was to evaluate the biomechanical stability and the clinical efficacy of a lumbar interbody fusion obtained by single oblique cage implanted by a posterior approach.Method
Through the realization of three finite element models (FEMs), the biomechanics of POLIF was compared to PLIF and TLIF. Ninety-four patients underwent interbody fusion by POLIF with instrumented posterolateral fusion. Clinical and radiographic outcomes were evaluated at regular intervals for at least 6 months.Results
The FEMs showed no statistically significant differences in stability in compression and flexion–extension. Mean preoperative VAS score was 7.1, decreased to 2.1 at follow-up. Mean preoperative SF-12 value was 34.5 %, increased to 75.4 % at follow-up. All patients showed a good fusion rate and no hardware failure.Discussion
POLIF associated to instrumented posterolateral fusion is a viable and safe surgical technique, which ensures a biomechanical stability similar to other surgical techniques.2.
Purpose
To compare scoliosis progression in quadriplegic spastic cerebral palsy with and without intrathecal baclofen (ITB) pumps.Methods
A retrospective matched cohort study was conducted. Patients with quadriplegic spastic cerebral palsy, GMFCS level 5, treated with ITB pumps with follow-up >1 year were matched to comparable cases by age and baseline Cobb angle without ITB pumps. Annual and peak coronal curve progression, pelvic obliquity progression and need for spinal fusion were compared.Results
ITB group: 25 patients (9 female), mean age at pump insertion 9.4 and Risser 0.9. Initial Cobb angle 25.6° and pelvic tilt 3.2°. Follow-up 4.3 (1.0–7.8) years. Cobb angle at follow-up 76.1° and pelvic tilt 18.9°. Non-ITB group: 25 patients (14 female), mean age at baseline 9.2 and Risser 1.0. Initial Cobb angle 29.7° and pelvic tilt 7.1°. Follow-up 3.5 (1.0–7.5) years. Cobb angle at follow-up 69.1° and pelvic tilt 21.0°. The two groups were statistically similar for baseline age, Cobb angle and Risser grade. Mean curve progression was 13.6°/year for the ITB group vs 12.6°/year for the non-ITB group (p = 0.39). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable; ITB group 4.5°/year vs non-ITB 4.6°/year (p = 0.97). During follow-up 5 patients in the ITB group and 9 in the non-ITB group required spinal fusion surgery for curve progression (p = 0.35).Conclusions
Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population.3.
Faldini Cesare Di Martino Alberto Borghi Raffaele Perna Fabrizio Toscano Angelo Traina Francesco 《European spine journal》2015,24(7):887-892
Purpose
Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle measurements, but recently it has been demonstrated that sagittal spinopelvic alignment plays a critical role in determining the final outcome. The aim of this paper is to compare the clinical and radiological results of 81 patients affected by adult scoliosis, treated with short or long fusions, and followed for 2–5 year follow-up.Materials and methods
81 patients affected by degenerative lumbar scoliosis managed by posterior-only surgery were retrospectively evaluated. Fifty-seven patients underwent to a short fusion procedure, while 24 had a long fusion. Clinical and radiographic coronal and sagittal spinopelvic parameters were compared between the two groups.Results
Coronal Cobb angle was 24° preoperatively and passed to 12° in the short fusion group, while changed from 45° to 10° in the long fusion group. Lumbar lordosis was 45° preoperatively and 60° at final follow-up in the short fusion group passed from 24° to 55° in the long fusion group. Sacral slope passed from 25° to 45° in the short fusion group, while from 10° to 40° in the long fusion group. Pelvic tilt passed from 24° to 13° in the short fusion group, and from 28° to 23° in the long fusion group.Conclusion
Surgical treatment of degenerative lumbar scoliosis improved balance and alignment of the spine, and also the coronal plane in terms of Cobb angle. These results were associated to a consistent clinical improvement and an acceptable rate of complications.4.
K.-H. Frosch R. Akoto T. Drenck M. Heitmann C. Pahl A. Preiss 《Operative Orthopadie und Traumatologie》2016,28(3):193-203
Objective
An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.Indications
Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.Contraindications
Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.Surgical technique
Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.Postoperative management
Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.Results
In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).Conclusion
Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.5.
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.6.
Yu-Xiang Wang Hong-Qi Zhang Weiwei Liao Ming-xing Tang Chao-feng Guo Ang Deng Jian-Huang Wu Jin-Yang Liu 《International orthopaedics》2016,40(6):1117-1124
Purpose
Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion.Methods
From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60–71 years). The mean follow-up was 46.5 months (range 38–70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle.Results
Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°–22.5°) and became 29.4° (range 27.1°–32.5°) at final follow-up.Conclusions
Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability.7.
Purpose
This study aimed to evaluate the clinical and radiological results in patients with unstable Denis type B thoracolumbar burst fractures treated by modified one-stage posterior/anterior combined surgery.Methods
Thirty-one patients with unstable Denis type B thoracolumbar burst fractures were enrolled in this study. The patients underwent one-stage posterior/anterior combined surgery with posterior instrumentation using pedicle screws and anterior monosegmental reconstruction utilizing titanium mesh cages. The mean follow-up period was 38.3 months. Clinical outcomes, radiological parameters, and treatment-related complications were assessed.Results
The mean age of the patients was 36.4 years. The mean operative time and blood loss were 230 min and 645 ml, respectively. The VAS pain score was significantly improved after surgery, and the improvement was maintained until the final follow-up. In 23 patients with neurologic dysfunction, 20 (87 %) patients had improvement after surgery. By the final follow-up, 27 patients had returned to work; 18 of the 27 patients returned to a similar job. The mean sagittal kyphosis was corrected from 21.2° preoperatively to 2.5° postoperatively, which increased slightly to 4.3° at the final follow-up. Minimal subsidence and tilt of the titanium mesh cage were observed during the follow-up period. Solid bony fusion was achieved in all patients. One patient developed a posterior surgical site infection, which was resolved by antibiotic treatment and surgical debridement.Conclusion
Modified one-stage posterior/anterior combined surgery for Denis type B unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.8.
Yasser Allam Tarek El-Fiky Mahmoud Yasser Farghally Sameh Al-Sabagh Ahmed Ezzat Siam 《European spine journal》2016,25(2):444-449
Purpose
The purpose of this study was to compare Cobb angle measurements performed using an Oxford Cobbmeter and digital Cobbmeter in a series of 20 adolescent idiopathic scoliosis (AIS) patients.Methods
Four observers measured major Cobb angles on 20 standing postero-anterior radiographs of AIS patients with both Oxford Cobbmeter and digital Cobbmeter (iPhone Cobbmeter Application). The measurements were repeated a week after the original measurements.Results
The mean Cobb angle in this study was 43.6° ± 23.62°. The mean measurement time for an observer to measure the 20 Cobb angles was 24.9 min for the smart phone compared with 25.6 min for the Oxford Cobbmeter. The 95 % confidence interval for differences between smart phone and Oxford Cobbmeter measurements on the same radiograph was ±3.68°. The intra-observer variability of the smart phone is equivalent to the Oxford Cobbmeter. The 95 % confidence intervals for inter-observer error were ±5° and ±5.8° for the smart phone and Oxford Cobbmeter, respectively.Conclusions
We conclude that the smart phone with integrated Tiltmeter and Cobbmeter application is an equivalent Cobb measurement tool to the Oxford Cobbmeter. The advantages of smart phone are the accuracy of determining the most inclined vertebrae and accordingly more precise Cobb angle measurement. The new smart phones with these integrated applications may be really helpful to the spine surgeons, especially in hospitals where PACS or Oxford Cobbmeter is not available.9.
Faldini Cesare Traina Francesco Perna Fabrizio Borghi Raffaele Martikos Konstantinos Greggi Tiziana 《European spine journal》2015,24(7):893-897
Purpose
To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuermann’s Kyphosis (SK).Methods
We analyzed 20 patients affected by SK and subjected to posterior correction of the kyphosis by facetectomy, Ponte osteotomy, fusion and multilevel instrumentation with pedicle screw system. Four spinal and three pelvic parameters were measured: sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT). Analysis of changes in postprocedural SSPs compared to preoperative values was performed.Results
TK passed from 78.6° preoperatively to 45.8° (p = 0.003). LL passed from 74.5° preoperatively to 53.5° (p = 0.01). No significant changes occurred in SVA, SS, PT and PI compared to preoperative values.Conclusion
We confirm the positive effect of surgery by Ponte osteotomy and posterior spinal fusion on TK and LL in patients with SK. In our experience, pelvic parameters did not change after surgery.10.
Background
The choice of surgical methods for lumbosacral tuberculosis is controversial due to the complex anterior anatomy and peculiar biomechanics of the lumbosacral junction. The objective of this study was to explore the clinical effect of posterior intervertebral space debridement with annular bone graft fusion and fixation for the treatment of lumbosacral tuberculosis.Methods
We retrospectively analysed data from 23 patients with lumbosacral tuberculosis who had undergone posterior intervertebral space debridement with annular bone fusion and fixation between January 2008 and September 2014. The mean age of the patients was 49.0 years (range, 27–71), and the mean duration of disease until treatment was 10.2 months (range, 6–20). The lumbosacral angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, American Spinal Injury Association (ASIA) grade and Social Functioning-36 (SF-36) score were determined to ascertain the clinical effects of the treatment.Results
All patients underwent follow-up observation. The mean follow-up time was 34.2 months (range, 18–45), the mean operation time was 167.0 min (range, 130–210) and the mean blood loss was 767.4 ml (range, 500–1150). The lumbosacral angle was 21.0°?±?2.1° before operation, rising to 28.8°?±?1.7° after operation (p?<?0.05) and being maintained thereafter. The mean VAS score before operation was 8.1?±?0.6, decreasing to 1.2?±?0.5 (p?<?0.05) at the final follow-up. The mean ESR and CRP values were 49.1?±?5.6 mm and 64.9?±?11.9 mg/L, respectively, before operation, decreasing to normal at the final follow-up. The preoperative ASIA grade was C in 6 patients, D in 12 and E in 5. At the final follow-up, all patients had an ASIA grade of E except for one patient with a grade of D. For all patients, the SF-36 score at the final follow-up was higher than the preoperative and postoperative scores.Conclusions
Posterior intervertebral space debridement with annular bone graft fusion and fixation is an effective treatment for lumbosacral spine tuberculosis.11.
Purpose
Bone substitutes’ advantage is enhancing arthrodesis biologic support without further autologous bone graft harvested from other skeleton sites, as from posterior iliac crests; however, in our experience, bone substitutes’ integration is often incomplete.Methods
From 2012 to 2017, we operated 108 patients by posterior instrumented vertebral arthrodesis in adolescent idiopathic scoliosis (AIS) correction, mean main curve 80° Cobb, and mean age 12 years and 6 months, with all pedicle screws instrumentation in main curve/curves area and hooks at upper tip of implant; bone graft has been harvested only at vertebral level, without bone substitutes or autologous graft from other patient sites or allogenic bone graft. We matched this group with 98 patients previously operated in which we used calcium triphosphate.Results
At 3 year mean follow-up, all patients in group treated with autologous bone graft only have complete and stable arthrodesis without loss of correction (mean curve 27° Cobb) or instrumentation failure. At 6 year mean follow-up in the group treated with autologous bone graft augmented by calcium triphosphate, 96 patients have stable arthrodesis without loss of correction (mean curve 24°), 1 case has implant break, and 1 case has 8° Cobb loss of correction.Conclusion
Bone substitutes are a further cost in arthrodesis surgery and suboptimal integration leaves foreign bodies on vertebras. Our experience shows that all pedicle screw instrumentation and bracing after surgery obtain stable correction showing in time a solid arthrodesis with autologous bone only, harvested at local site, without bone substitutes or further bone graft.Graphical abstract
12.
Ayse Livanelioglu Fatma Kaya Vugar Nabiyev Gokhan Demirkiran Tüzün Fırat 《European spine journal》2016,25(2):476-482
Purpose
Radiological measurement has been accepted as the gold standard for evaluating scoliosis for many years. However, exposure of children to X-ray constitutes a major limitation of the radiological methods. Spinal Mouse (SM) is a safe, practical and easy to perform measurement of curvature in scoliosis, but its validity and reliability have not been investigated. The aim of this study was to investigate the validity and reliability of Cobb angle and SM measurements in children with adolescent idiopathic scoliosis (AIS).Methods
Fifty-one patients with AIS who were followed up conservatively were included in the study. The mean age of the patients was 14.4 years (9–18 years). Frontal plane curvatures were evaluated with SM by 2 physiotherapists and the results were compared with radiological measurements. Radiological measurements were performed by 2 orthopedists.Results
All the measurements were of the thoraco-lumbar curve and the mean value was 35.08° according to Cobb angle measurement. There was no difference between the interobserver measurements of SM (p = 0.256) while the Cobb degrees measured by the 2 orthopedists was different (p = 0.0001). We did not find a statistically significant difference between Cobb measurements and the SM measurements of observer 1 and 2 (p = 0.505). The interobserver and intraobserver agreement of the Cobb and SM measurements was excellent (ICC = 0.872–0.962). When the differences between the evaluations were compared, the interobserver SM differences were seen to be lower than the interobserver Cobb angle differences (p = 0.003). The agreement between the Cobb and SM measurements was higher for curves over 40°. We found a strong or very strong relationship between measurements made with the Cobb and SM methods (p < 0.0001).Conclusions
We conclude that SM can be used for research and patient follow-up in the clinic as a safe, reliable, quick, and easy to use method with no side effects although it cannot be the only factor to consider when determining the treatment plan of AIS patients.13.
Purpose
To evaluate the safety and efficacy of a superelastic shape-memory alloy (SNT) rod used in the treatment of adolescent idiopathic scoliosis (AIS).Methods
AIS Patients with Lenke 1 curves undergoing fusion surgery were randomized (1:1) at the time of surgery to receive either the SNT or a conventional titanium alloy (CTA) rod. Radiographs were obtained preoperatively and postoperatively up to 5 years of follow-up. Parameters assessed included coronal and sagittal Cobb angles, and overall truncal and shoulder balance. Sagittal profiles were subcategorized into Types A (<20°), B (20–40°), and C (>40°).Results
Twenty-four patients with mean age of 15 years were recruited. A total of 87.0% of subjects were followed up till postoperative 5 years, but all patients had minimum 2 years of follow-up. The fulcrum-bending correction index for the SNT group was 113% at postoperative day 4 and 127% at half-year, while the CTA group was 112% at postoperative day 4 and only 106% at half-year. In terms of sagittal profile, the SNT group moved toward type B profile at half-year follow-up with a mean correction of 7.6°, while no significant change was observed in the CTA group (?0.7°). Nickel levels remained normal, and there were no complications.Conclusions
This is the first randomized clinical trial of a novel SNT rod for treating patients with AIS, noting it to be safe and has potential to gradually correct scoliosis over time. This study serves as a pilot and platform to properly power future large-scale studies to demonstrate efficacy and superiority.14.
Background
Surgical site infection is a catastrophic complication after spinal surgery, which seriously affects the progress of rehabilitation and clinical outcome. Currently the clinical reports on spinal surgical site infections are mostly confined to the surgical segment itself and there are few reports on adjacent segment infections after spinal surgery.Study design
Case report.Objective
To report a clinical case with adjacent level infection after spinal fusion.Methods
We report the case of a 68-year-old woman who underwent posterior lumbar 4?5 laminectomy, posterolateral fusion and internal fixation. The patient showed signs of surgical site infection, such as surgical site pain, high fever and increase of the inflammatory index 1 week after the operation. Magnetic resonance imaging (MRI) confirmed the diagnosis of adjacent intervertebral disc infection. The patient received early combined, high-dose anti-infection treatment instead of debridement.Results
After the conservative treatment, the infection was controlled and the patient subsequently enjoyed a normal daily life.Conclusion
Adjacent level infections can occur after spinal surgery. Early diagnosis and anti-infection treatment played an important role in the treatment of this kind of complication.15.
Background
Current methods of measuring vertebral rotation by plain radiographs rely on anatomic landmarks that are not present in the postoperative spine or require advanced imaging. Furthermore, there are few studies on the incidence of crankshaft with modern pedicle instrumentation.Questions/Purposes
We sought to (1) describe and validate a method of vertebral rotation measurement using plain radiographs and (2) measure postoperative rotation in a series of patients treated for adolescent idiopathic scoliosis.Methods
Patients with adolescent idiopathic scoliosis treated with surgery over a 6-year period were reviewed. Patients with computed tomography (CT) scans and radiographs within 60 days of another were included. Vertebral rotation was calculated by radiographic measurements and measured directly by CT scan. As an internal control, patients with two apical pedicle screws on all radiographs were analyzed. Rotation was measured for all patients with at least 1 year of radiographic follow-up.Results
Three thousand five hundred fifty-two instrumented spinal levels in 308 consecutive patients were reviewed. Ten patients with 93 screws were analyzed by CT and radiographs. The average discrepancy between computed tomography (CT) and radiographs was 3.3?±?1.9°, with 81.7% (76/93) within 5°. Intra- and inter-rater reliabilities for measured axial rotation were excellent (intra-class correlation coefficient (ICC)?=?0.879 and 0.900, respectively). One hundred swventy-eight patients were eligible with an average follow-up of 2.3?±?1.2 years; 84.8% (151/178) had screw(s) visible on all images at the major curve apex. The average postsurgical rotation was 3.5?±?2.9°; 19.2% (29/151) were measured to have a rotation over 5°, and 4.0% (6/151) demonstrated a rotation over 10°. Only 4.6% (7/151) of patients demonstrated a postoperative Cobb angle change over 10°.Conclusions
Most major curves have apical pedicle screw instrumentation that can be followed by radiographs alone to measure rotation. Vertebral rotation measurement requires only plain radiographs and is a more sensitive determination for subtle postoperative crankshaft than change in Cobb angle.16.
E. Crespo Romero R. Peñuela Candel S. Gómez Gómez A. Arias Arias A. Arcas Ordoño J. Gálvez González R. Crespo Romero 《Musculoskeletal surgery》2017,101(2):167-172
Background
This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of hallux valgus.Materials and methods
A prospective study of 108 patients, with hallux valgus deformity, who underwent PFS was conducted. The minimum clinical and radiological follow-up was two years (mean 57.3 months, range 22–112).Results
Preoperative mean visual analog scale was 6.3 ± 1.5 points, and AOFAS scores were 50.6 ± 11 points. At the last follow-up, both scores improved to 1.9 ± 2.4 points and 85.9 ± 1.83 points, respectively. Mean hallux valgus angle changed from 34.3° ± 9.3° preoperatively to 22.5° ± 11.1° at follow-up. At follow-up, 76.5% of the subjects were satisfied or very satisfied. Recurrence of medial 1st MT head pain happened in 22 cases (16.7%).Conclusions
PFS, in our study, does not improve the radiological and patient satisfaction rate results compared with conventional procedures. The main advantage is a low postoperative pain level, but with an insufficient HVA correction.Level of evidence
II, prospective study.17.
Ahmed Ezzat Siam Hesham El Saghir Heinrich Boehm 《Journal of orthopaedics and traumatology》2016,17(1):41-51
Background
This is the first case series to describe adjacent segment infection (ASI) after surgical treatment of spondylodiscitis (SD).Materials and methods
Patients with SD, spondylitis who were surgically treated between 1994 and 2012 were included. Out of 1187 cases, 23 (1.94 %) returned to our institution (Zentralklinik Bad Berka) with ASI: 10 males, 13 females, with a mean age of 65.1 years and a mean follow-up of 69 months.Results
ASI most commonly involved L3–4 (seven patients), T12–L1 (five) and L2–3 (four). The mean interval between operations of primary infection and ASI was 36.9 months. All cases needed surgical intervention, debridement, reconstruction and fusion with longer instrumentation, with culture and sensitivity-based postoperative antimicrobial therapy. At last follow-up, six patients (26.1 %) were mobilized in a wheelchair with a varying degree of paraplegia (three had pre-existing paralysis). Three patients died within 2 months after the ASI operation (13 %). Excellent outcomes were achieved in five patients, and good in eight.Conclusions
Adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication (1.94 %). It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Possible explanations are: haematomas of repeated micro-fractures around screw loosening, haematogenous spread, direct inoculation or a combination of these factors. ASI may also lead to proximal junctional kyphosis, as found in this series. We suggest early surgical intervention with anterior debridement, reconstruction and fusion with posterior instrumentation, followed by antimicrobial therapy for 12 weeks.Level of evidence
Level IV retrospective uncontrolled case series.18.
Hongda Bao Peng Yan Mike Bao Yong Qiu Zezhang Zhu Zhen Liu Jack C. Y. Cheng Bobby K. W. Ng Feng Zhu 《European spine journal》2016,25(8):2416-2422
Purpose
To investigate the change of pulmonary function in adult scoliosis patients with respiratory dysfunction undergoing HGT combined with assisted ventilation.Methods
21 adult patients were retrospectively reviewed with a mean age of 26.2 years. Inclusion criteria were as follows: age over 18 years old; coronal Cobb angle greater than 100°; with respiratory failure; and duration of HGT more than 1 month. All patients underwent respiratory training.Results
The Cobb angle averaged 131.21° and was reduced to 107.68° after HGT. Significantly increased mean forced vital capacity (FVC) was found after HGT (P = 0.003) with significantly improved percent-predicted values for FVC (P < 0.001). Meanwhile, significantly increased forced expiratory volume in 1 s (FEV1) was also observed (P < 0.001) with significantly improved percent-predicted values for FEV1 (P = 0.003) after HGT.Conclusion
The results of our study revealed that combined HGT and assisted ventilation would be beneficial to pulmonary function improvement in severe adult scoliosis cases, most of which were young adults.19.
Philippe M. Tscholl Patrick O. Zingg Claudio Dora Eric Frey Stefan Dierauer Leonhard E. Ramseier 《Journal of children's orthopaedics》2016,10(1):25-30
Purpose
Mild slipped capital femoral epiphyses (SCFE) nevertheless show significant femoral head–neck deformities which may put cartilage and acetabular labrum at risk. Whether this deformity can be restored to normal has not yet been described in the literature.Methods
In a prospective follow-up study, 14 patients with mild SCFE underwent in situ fixation with a single 6.5-mm cancellous, partially threaded screw. In 14 patients arthroscopic osteochondroplasty was performed, and in 13 patients pre- and postoperative measurements of the α-angle were made using antero-superior radial magnetic resonance imaging.Results
After arthroscopic osteochondroplasty, the mean α-angle decreased from 57° (range 50°–74°) to 37° (range 32°–47°; p < 0.001). Six patients showed beginning degenerative intra-articular changes (four antero-superior cartilage and three antero-superior labrum lesions) at the time of hip arthroscopy. No intra-operative complications occurred. In one patient, arthroscopic debridement was necessary due to arthrofibrosis and persistent pain.Conclusion
Arthroscopic osteochondroplasty can successfully correct the antero-superior α-angle in patients with mild SCFE to normal values. Clinical randomized controlled studies with long-term follow-up are required to find evidence of improved functional and radiographic mid- and long-term outcome compared to in situ fixation alone.20.
Kevin A. Reinard Diana M. Cook Hesham M. Zakaria Azam M. Basheer Victor W. Chang Muwaffak M. Abdulhak 《European spine journal》2016,25(7):2068-2077