Posterior transpedicular stabilisation of the infected spine

BACKGROUND: Six men and seven women, aged 62 years, bedridden due to back pain from a septic spondylitis in the thoracolumbar region and not responding to conservative treatment, were operated on with transpedicular stabilisation of the affected segments to enhance mobilisation. All patients experienced immediately reduced back pain, allowing them to leave their bed and start mobilisation during the first postoperative day. At follow-up after a mean of 29 months (range 13-60 months) only one was using analgesics. RESULTS: Nine of the 11 patients with pathological neurology at surgery had improved, none had deteriorated, and all were ambulatory without bladder or bowel disturbances. Seven had achieved a solid interbody fusion, with a continued radiographic decrease in the spondylitic change in the rest, indicating that a progressive interbody fusion was in progress. Three individuals had increased kyphosis, a mean of 11 deg compared with the postoperative radiographs.     

Posterior decompression and stabilisation of a spondylodiscitis L4/5

European Spine Journal -     

同种异体骨移植重建四肢恶性骨肿瘤切除后骨缺损

[目的]探讨同种异体骨移植修复重建四肢恶性骨肿瘤切除后骨缺损的临床疗效。[方法] 2013年6月～2017年12月对本院收治的21例四肢恶性骨肿瘤切除后骨缺损病例进行大段同种异体骨移植重建,其中复合肿瘤型人工关节置换12例,单纯异体骨段移植9例。本组病例男13例,女8例;年龄11～51岁,平均(21.53±6.54)岁,均经过术前穿刺活检及术后病理确诊,Enneking分期ⅠB期4例,ⅡB期17例,其中骨肉瘤和尤文肉瘤患者术前均行2个疗程新辅助化疗及术后规范化疗。术后采用MSTS评分进行功能评价。[结果]所有患者获随访8～48个月,平均(29.64±11.22)个月,均未发生移植异体骨或假体周围骨折,无关节脱位及假体松动。其中19例肢体功能优良,MSTS功能评分16～28分,平均(22.82±4.47)分。[结论]异体骨移植联合肿瘤型人工关节复合置换,以及异体骨段移植重建长骨干缺损仍然是治疗四肢恶性骨肿瘤切除后骨缺损的一种有效重建方法。     

Posterior 360-degree stabilisation of the upper thoracic spine: a technical note

PURPOSE: To describe a technique involving posterior 360-degree stabilisation of the upper thoracic spine: spinal cord decompression, posterior vertebral body replacement, and then posterior instrumentation and intercostal posterolateral vertebral stabilisation. METHODS: Three men and 4 women aged 41 to 77 (mean, 58) years underwent posterior 360-degree stabilisation of the upper thoracic spine. Their indications for surgery were bone metastasis (n=5), burst fracture (n=1), and osteoporotic collapse with cord compression (n=1). Their clinical and radiological findings and treatment outcomes were retrospectively reviewed. RESULTS: Pain status of all patients improved after surgery: 4 had severe and 3 had mild pain preoperatively; in 3 pain became minimal and 4 had none postoperatively. All patients except one had Frankel/American Spinal Injury Association scores of E after surgery indicating complete recovery of sensory and motor function. There were no complications related to surgery or instrumentation construct. At the time of review, one patient had died of old age 8.6 years after surgery and another from local recurrence and lung metastasis 5.7 years after surgery. All other patients were living. CONCLUSION: One-stage posterior 360-degree stabilisation and vertebral body replacement is a useful technique for upper thoracic spine surgery.     

Use of a bioactive scaffold for the repair of bone defects in a novel reproducible vertebral body defect model

Bone defects in vertebral bodies (VB) usually occur after the reduction of fractures or are caused by bone disease. Besides the treatment of original disease, repair of the bone defect can restore the structure of VB and improve stabilization of the spine to protect the spinal cord nerves. To aid studies of the efficacy of bioengineering techniques for repair of VB, we developed a rat model with a critical size bone defect in VB. Air-motivated burrs were used to create two sizes of bone defect (2 × 3 × 1.5 mm; 2 × 3 × 3 mm) in the anterior part of VB in 6-month-old Fischer 344 rats. Quantitative CT analyses and histological assays demonstrated that neither defects self-repaired by 8 weeks post surgery. Moreover, the tendency of bone formation was monitored in the same animal by serial CT image evaluations, allowing us to demonstrate that there was significant bone growth during the 4- to 6-week period after the creation of the bone defect.We then implanted sintered poly(lactic-co-glycolic acid) (PLGA) microsphere scaffolds loaded with Matrigel with or without recombinant human bone morphogenetic protein 2 (rhBMP2; 2.0 µg rhBMP2/10 µL Matrigel/scaffold) into the bone defect (2 × 3 × 3 mm) in the VB. Bone formation was detected by quantitative analyses of serial CT images, which demonstrated bone growth in rats that received the rhBMP2 implant, in both surrounding areas and inside area of the scaffold. In addition to a rapid increase within 2 weeks of the operation, another significant bone formation period was found between 4 and 8 weeks after the implantation. By contrast, the control group that received the implant without rhBMP2 did not show similar bone formation tendencies. The results of CT analyses were confirmed by histological studies.This study suggests that a critical size bone defect of the anterior VB can be developed in a rat model. Characterization of this model demonstrated that 4 to 6 weeks after creation of the defect was a significant bone growth period for VB bone repair in rats. This animal model has further utility for the study of different biomaterials for VB bone repair. Implantation of a bioactive PLGA scaffold carrying rhBMP2 allowed more successful repair of the VB defect. Although further characterization studies are needed, the bioactive PLGA scaffold developed in this study will likely adapt easily to other in vivo osteogenesis applications.     

Posterior vertebral instrumentation for correction of scoliosis

One hundred and five patients were treated by instrumentation for various spinal conditions by means of the posterior route. There were 90 patients with scoliosis in this series. Of these, 61 cases (67.7%) were corrected by Harrington distraction rod and segmental wire fixation. The various degrees of deformity in these patients produced the correction figures of 36.4%-42.6% of the original. The complications were eight cases of displacement of the upper hook, two cases of superficial infection, and one case of late infection. There were no cases of neurologic injury. The discussion centers on the importance of the awake test, the estimation of expected correction before surgery, the Harrington distraction rod with segmental wire fixation as an effective method, and the measures to be taken for the prevention of displaced fractures at the site of the upper hook in kyphoscoliosis correction.     

僵硬性脊柱后凸畸形全脊椎切除

目的经后路全脊椎切除技术治疗僵硬性脊柱后凸畸形的手术需注意的问题及安全性探讨。方法回顾性分析2OO6年9月-2008年10月本院收治10例僵硬的脊柱后凸畸形患者。其中男7例,女3例;年龄为15～45岁,平均27.8岁。术前测量后凸Cobb角为35°～102°,平均71°,均采用单纯后路全脊椎切除技术治疗。结果后凸矫正率为75.8%,随访时间为6~18个月,患者的疼痛程度及发作频率较术前明显好转,植骨6个月后均达满意融合,内固定无松动或断钉。结论全脊椎切除术围手术期并发症发生率低,应用于矫形治疗重度僵硬后凸型脊柱侧凸不失为一种较为安全有效的方法。     

Posterior vertebral column resection in spinal deformity: a systematic review

Purpose

This study aimed to assess the amount of correction and risk of complications of posterior vertebral column resection (PVCR) in the treatment of spinal deformity.

Methods

A comprehensive research was conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews for published articles about PVCR in spinal deformity. Data from these included studies were pooled with the help of the Review Manager software from the Cochrane Collaboration and the R software. The amount of correction of PVCR was indicated with change of coronal and sagittal Cobb angle after operation. Risk of complications was demonstrated with prevalence.

Results

7 studies, a total of 390 patients, were included for analysis. The average operative time for PVCR was 430 min and the estimated blood loss was 2,639 ml. The mean amount of correction by PVCR was 64.1° in scoliosis and 58.9° in kyphosis, accounting a correction rate of 61.2 and 63.1 %, respectively. As to coronal and sagittal imbalance, data were limited. The overall prevalence of complications of PVCR was 32 % (95 % CI 12–54 %). The most common was neurologic complications, estimated to be 8 % (95 % CI 2–16 %). And risk of spinal cord injury was 2 % (95 % CI 0–3 %). The revision rate was 6 % (95 % CI 1–13 %). Incidence of infection was pooled to be 2 % (95 % CI 1–4 %). Complication rate related with implant was 2 % (95 % CI 0–6 %).

Conclusion

PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team.

     

单纯后路脊椎切除治疗僵硬型角状脊柱后凸畸形

目的 探讨单纯后路脊椎切除治疗僵硬型角状脊柱后凸畸形的临床疗效.方法 2001年5月至2007年12月,对41例僵硬型角状脊柱后凸患者行单纯后路脊椎切除术前脊柱后凸Cobbb角平均43.8°,26例同时伴有脊柱侧凸畸形,侧凸Cobb角平均39.1°.7例有不同程度的神经受损症状,Frankel分级C级2例,D级5例.通过术前、术后脊柱正、侧位X线片,神经功能Frankel分级,评价矫形效果、神经功能,观察手术并发症,分析临床疗效.结果 41例患者均获随访,随访时间1年4个月～7年3个月,平均3年11个月,术中出现2例椎弓根骨折,3例椎弓根螺钉拔出现象,术后出现1例气胸,2例局部感染,6例神经系统并发症.术后2周后凸C0bb角平均9.8°,矫正率77.6%,术后2周侧凸Cobb角平均10.°,矫正率为74.4%,畸形角度与躯干平衡情况较术前获得明显改善,与术前相比差异有统计学意义(P<0.001).术后6个月复查,所有病例固定融合节段均获骨性融合,所有病例矫形效果均无明显丢失,与术后2周比较差异无统计学意义(P>0.05).7例具有神经症状患者中,4例好转,2例无变化,1例加重;Frankel分级E级3例,D级3例,B级1例.结论 采用单纯后路脊椎切除治疗僵硬型角状脊柱后凸畸形能直接去除致病因素,可获得良好的矫形效果,临床疗效满意.     

Metallic plate stabilisation of bone grafts in craniofacial surgery

The use of Champy miniplates to stabilise bone grafts in osseous defects following craniofacial and orbital osteotomies is discussed. The advantages of these methods are decrease in operating time, accurate fit of the bone graft and the fixation of the bone graft in the plane of the plate, thus placing it exactly into the correct position in relation to the osteotomy. Total stability is obtained and, in maxillary advancement, intermaxillary fixation may not be necessary. This is useful in children and at all ages adds to the postoperative safety. There may be less relapse with this rigid internal fixation. Long term follow-up will be required to determine whether this statement is true. Although the plates are expensive, it is felt that the reduction in operating time outweighs this.     

Reconstruction of anterior chest wall defect with ceramic bone grafts--a case of localized malignant mesothelioma

The reconstruction of an anterior chest wall defect was performed on a 61-year-old male after resecting a localized malignant mesothelioma. The tumor was resected with body of the sternum, the anterior portion of the bilateral second, third and fourth ribs, muscles, subcutaneous tissue and skin. The defect was 12.5 cm x 9.5 cm in size. The reconstruction of the defect was made with Marlex mesh, two ceramic bone grafts and a latissimus dorsi musculocutaneous flap. Double Marlex mesh was sewn under the edges of the ribs and the intercostal muscles of the defect by interrupted sutures. In order to fit the ceramic bone graft to the defect transversely, two pieces of ceramic bones (Iliac crest spacers) were selected from various sizes. They were connected by a stainless steel wire through the holes which were originally made at the edge for fixation, and the connected portion was covered with methyl methacrylate. Two ceramic bone grafts were fixed to each of the stumps of the bilateral third and fourth ribs by monofilament threads. A musculocutaneous pedicle flap made from the right latissimus dorsi covered the operative filed. There were no postoperative wound infection and no extrusion of the prostheses seven months after the operation.     

后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效分析

目的探讨经后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效。方法回顾性分析2017年6月至2019年10月河南省人民医院脊柱外科收治的28例胸腰段椎体成形术椎再骨折患者资料。男7例,女21例;年龄61~76岁,平均62.4岁;骨折椎体:T115例,T129例,L111例,L23例;既往手术方法:经皮椎体成形术治疗17例,经皮椎体后凸成形术治疗11例。手术方法:后路切除棘突、椎板,经侧方切除关节突、横突,部分切除椎体、骨水泥及上下椎间盘,神经减压,椎体间人工椎体固定,后路钉棒矫形固定。记录手术时间及术中出血量,比较患者术前和末次随访时后凸cobb角评价矫形效果;比较患者术前和末次随访时疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分评价脊柱功能改善情况。结果本组患者手术时间平均为182.1 min,术中出血量平均为996.2 mL。28例患者术后随访8~29个月(平均19.8个月),无明显神经功能损伤及其他严重并发症发生。cobb角由术前的41.3°±10.3°改善为末次随访时的6.4°±2.5°,VAS评分由术前的(7.3±1.8)分改善为末次随访时的(2.5±1.0)分,JOA评分由术前的(8.4±2.3)分改善为末次随访时的(21.3±2.5)分,以上比较差异均有统计学意义(P<0.05)。结论经后路椎体次全切治疗胸腰段椎体成形术椎再骨折,可一期进行骨水泥清除、椎管减压、椎间植骨融合,重建脊柱稳定性,有很好的疗效。