Acute colonic pseudo-obstruction (Ogilvie's syndrome)

Summary In addition to the presentation of 14 of our own patients, this study analyzes 1027 cases with acute colonic pseudo-obstruction reported in the literature from 1948 to 1987. Principal associated diseases are cardiopulmonary insufficiencies, postoperative conditions, and systemic disorders. The syndrome is related to a disturbance of colonic autonomic innervation resulting in gross dilatation of the cecum and the right hemicolon. Therapeutic measures include conservative management, colonoscopic decompression, and surgical procedures. The latter have been associated with high morbidity and mortality. Our data support a nonoperative approach to this condition, including conservative measures and colonscopic decompression as the initial therapy of choice with few complications and high efficacy.     

Delayed anterior spinal artery syndrome following posterior scoliosis correction

The authors report two cases of delayed post-operative anterior spinal artery syndrome (ASAS) following posterior correction with Cotrel Dubousset (CD) instrumentation for adolescent idiopathic scoliosis. Sensory pathways were continuously monitored from skin incision to awakening. In both cases intraoperative SEPs were normal and the wake-up test revealed no neurological deficit.Both patients were presented with incomplete paraplegia (no sensory impairment) three and ten hours after surgery. Without delay, both patients underwent revision surgery, and the CD instrumentation was removed. Immediately after surgery, both patients motor power in their lower extremities improved rapidly. In cases with delayed ASAS after posterior scoliosis correction, the removal of the instrumentation system was shown to be sufficient to regain full motor recovery caudal to the level of impairment.None of the authors has received any financial support for this case report Each author certifies that his or her institution has approved the reporting of this case report     

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Objective

To evaluate the clinical and economic impact of a novel postoperative pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS).

Methods

Patient charts were reviewed for demographic data and to determine length of surgery, implant density, use of osteotomies, estimated blood loss, American Society of Anesthesiologists (ASA) score, length of hospital stay, and any subsequent complications. Hospital charges were divided by charge code to evaluate potential savings.

Results

Two hundred and seventy-nine of 365 patients (76.4 %) treated with PSF carried a diagnosis of AIS and had completed 6 months of clinical and radiologic follow-up, a period of time deemed adequate to assess early complications. There was no difference between groups in age at surgery, sex, number of levels fused, or length of follow-up. Patients managed under the accelerated discharge (AD) pathway averaged 1.36 (31.7 %) fewer days of inpatient stay. Operative time was associated with a shorter length of stay. There was no difference in complications between groups. Hospital charges for room and board were significantly less in the AD group ($1.885 vs. $2,779, p < 0.001).

Conclusions

A pathway aimed to expedite discharge following PSF for AIS decreased hospital stay by nearly one-third without any increase in early complication rate. A small but significant decrease in hospital charges was seen following early discharge. Early discharge following PSF for AIS may be achieved without increased risk of complications, while providing a small cost savings.     

Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases

We present the transient long thoracic nerve (LTN) injury during instrumented posterior spinal arthrodesis for idiopathic scoliosis. The suspected mechanism of injury, postoperative course and final outcome is discussed. The LTN is susceptible to injury due to its long and relatively superficial course across the thoracic wall through direct trauma or tension. Radical mastectomies with resection of axillary lymph nodes, first rib resection to treat thoracic outlet syndrome and cardiac surgery can be complicated with LTN injury. LTN injury producing scapular winging has not been reported in association with spinal deformity surgery. We reviewed the medical notes and spinal radiographs of two adolescent patients with idiopathic scoliosis who underwent posterior spinal arthrodesis and developed LTN neuropraxia. Scoliosis surgery was uneventful and intraoperative spinal cord monitoring was stable throughout the procedure. Postoperative neurological examination was otherwise normal, but both patients developed winging of the scapula at 4 and 6 days after spinal arthrodesis, which did not affect shoulder function. Both patients made a good recovery and the scapular winging resolved spontaneously 8 and 11 months following surgery with no residual morbidity. We believe that this LTN was due to positioning of our patients with their head flexed, tilted and rotated toward the contralateral side while the arm was abducted and extended. The use of heavy retractors may have also applied compression or tension to the nerve in one of our patients contributing to the development of neuropraxia. This is an important consideration during spinal deformity surgery to prevent potentially permanent injury to the nerve, which can produce severe shoulder dysfunction and persistent pain.     

单纯后路松解原位弯棒技术治疗重度僵硬的脊柱侧凸

目的 探讨单纯后路松解原位弯棒技术对重度僵硬的非角状脊柱侧凸的治疗效果.方法 采用后路松解、原位弯棒技术治疗包括各种病因导致的重度僵硬的非角状脊柱侧凸畸形14例,依据患者的影像学资料、并发症的发生情况等评估临床效果.结果 脊柱侧凸的主弯平均Cobb角为86.3°(70～97°),柔韧性为21.3%(8%～28%),术后...     

Comparison of anterior and posterior vertebral column resection versus anterior and posterior spinal fusion for severe and rigid scoliosis

Background Context

Many different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior and posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion, was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis.

Unusual presentation of osteoblastoma in a patient with idiopathic scoliosis after posterior spinal fusion

BACKGROUND CONTEXT: Few studies have described the diagnosis of osteoblastoma of the spine as a cause of scoliosis. These reports have described the tumor in conjunction with initial presentation of painful scoliosis. This case report presents a case of osteoblastoma 9 years removed from diagnosis and fusion of idiopathic scoliosis in the thoracic spine. PURPOSE: To report the late presentation of an osteoblastoma of the thoracic spine 9 years after posterior spinal fusion for scoliosis. STUDY DESIGN: Case report. METHODS: A 25-year-old man presented with thoracolumbar back pain and progressive neurological deficit 9 years after posterior spinal fusion for idiopathic scoliosis. Magnetic resonance imaging of the thoracic spine indicated the presence of a mass in the spinal canal causing cord compression. The patient underwent decompression with resection of the mass which was found to be an aggressive osteoblastoma. RESULTS: The patient enjoyed a full neurological recovery and has subsequently developed a recurrence at 13 months. CONCLUSIONS: We present osteoblastoma as a possible cause of low back pain and neurological deficit postfusion that should be considered in a differential diagnosis.     

Sagittal spinopelvic changes after posterior spinal fusion in adolescent idiopathic scoliosis

PurposeThis article examines if longer posterior spinal fusions with instrumentation (PSFI) into the lumbar spine (L3/4) alter spinopelvic parameters compared with selective fusions to T12/L1/L2 in adolescent idiopathic scoliosis (AIS) patients.MethodsWe analysed radiographs of 84 AIS patients, 58 (69%) females and 26 (31%) males, who underwent PSFI at an mean age of 15 years ± 2.5 years, range 10 years to 21 years, between 1st January 2007 and 31st December 2014. Radiographic parameters were measured pre- and post-operatively at most recent follow-up (range 2 years to 8.2 years): pelvic incidence (PI), lumbar lordosis (LL, L1–S1 and L4–S1), sagittal vertical alignment (SVA), scoliosis angle and proximal junctional kyphosis (PJK). PI–LL was calculated. Data was analysed using t-tests or Wilcoxon rank-sum tests.ResultsIn total, 32 patients underwent a selective fusion with lowest instrumented vertebra (LIV) T12–L2, and 52 patients underwent a fusion with LIV L3–L4. In both groups, scoliosis angle was significantly corrected at follow-up (p < 0.005).Pre-operatively, both groups had similar LL (L1–S1) and PI–LL. Post-operatively, LL increased in the L3–4 fusion group (p < 0.005) but did not change in the selective fusion group (p = 0.116). This change in LL in the L3–4 fusion group affected the post-operative PI–LL (T12–L2 fusion -4.9° versus L3–4 fusion -13.6°, p = 0.002). No differences were seen in PI, SVA or LL L4–S1 between groups. Radiographic PJK occurred in seven of the L3–4 patients with and without PJK (noPJK –8.8° versus PJK –25.8°, p = 0.026).ConclusionsIn patients who underwent a fusion ending at L3 or L4, LL was increased. This altered the PI–LL relationship, and appeared to increase the risk of PJK.Level of evidenceIII     

Increased blood loss during posterior spinal fusion for idiopathic scoliosis in an adolescent with Fontan physiology

A 15-year-old patient with Fontan physiology experienced major blood loss during posterior spinal fusion for idiopathic scoliosis. Contributing factors for the increased blood loss and potentially useful measures to limit blood loss in patients with Fontan physiology are discussed.     

New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children

Progressive scoliosis in young children has been treated with "spinal instrumentation without fusion" to avoid interference with spinal growth. Patients have to undergo a series of operations to have instruments exchanged for maintaining the correction. We have developed a newly designed remote-controlled growing-rod spinal instrumentation system proposed for the treatment of progressive scoliosis in young children. It can be used to stretch and correct the spinal deformities repeatedly and non-surgically, by means of a remote controller, after the first instrumentation operation. The purpose of this study is to describe the possible clinical application of this system for the treatment of progressive scoliosis in young children. To this end, we used the system in five beagle dogs with induced scoliotic deformities. The maximum distraction force of the instrument was 194 N. Correction of 1 cm was performed non-surgically in awake animals 3 weeks after the instrumentation operation, and then correction of 1 cm was carried out again 6, 9, and 12 weeks after the operation. The average initial Cobb's angle of the induced scoliotic deformities was 25°; this was corrected to 20°, 15°, 8°, and 3°, after the distractions at 3, 6, 9, and 12 weeks, respectively, postoperatively. All corrections were performed non-surgically without apparent complications. By repetitive distractions with the use of our new system, we may be able to reduce the number of operations required in young scoliotic children. Received for publication on March 6, 1998; accepted on July 9, 1998     

退变性腰椎侧凸长节段融合术后远端交界性问题分析

目的 :探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)长节段固定融合术后远端交界性问题(distal junctional problem,DJP)的发生率、危险因素及对患者生活质量的影响。方法 :2009年4月～2017年10月在我院确诊为DLS、年龄≥40岁、行长节段(≥4个节段)固定融合手术、随访时间≥1年的患者132例,将随访时出现DJP的13例患者纳入DJP组,未出现任何机械性并发症的41例患者纳入对照组。对个体因素[手术时的年龄、性别、体重指数(body mass index,BMI)、骨密度(bone mineral density,BMD)和T值、合并糖尿病和高血压情况、美国麻醉医师学会(ASA)分级等因素]、手术因素[固定融合节段数、远端固定椎(lowest instumented vertebra,LIV)位置、截骨操作和椎间融合情况]以及术前和术后影像学参数[侧凸Cobb角、顶椎的旋转程度(Nash-Moe)、顶椎偏移距离(apical vertebral translation,AVT)、冠状位平衡(coronal vertical axis,CVA)、胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、矢状位平衡(sagittal vertical axis,SVA)、T1骨盆角(T1 pelvic angle,TPA)、躯干整体倾斜角(global tilt,GT)等]进行单变量和多变量分析。比较两组术前和随访时的腰痛视觉模拟(visual analog scale,VAS)评分、下肢痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科学会(Japanese Orthopaedic Association,JOA)-29评分、脊柱研究学会(Scoliosis Research Society-22,SRS-22)评分和健康状况调查简表(short form 36 health survey questionnaire,SF-36)评分。结果 :本组患者DJP的发生率为9.8%(13/132),其中6例(46.2%)患者进行了翻修手术。DJP组患者骨密度T值显著低于对照组,DJP患者骨量减少及骨质疏松的比例显著高于对照组(P0.05),其他个体因素无显著性差异。两组手术因素均无显著性差异。与对照组相比,DJP组患者术前TLK较大、PT较小、SVA70mm的比例较高(53.85%vs 19.51%,P=0.040);术后即刻TLK、SVA显著大于对照组,矢状位失衡患者比例显著高于对照组(46.15%vs 14.63%,P=0.046),其他影像学参数无显著性差异。Logistic回归分析提示骨质疏松(OR=8.90,95%CI=1.95～40.51,P=0.005)、术后即刻矢状位失衡(OR=5.82,95%CI=1.15～29.42,P=0.033)发生DJP的风险分别增加了7.9倍、4.8倍。两组患者术前各项健康相关生活质量评分均无统计学差异;对照组患者术后各项健康相关生活质量评分较术前均有显著性提高(P0.05),而DJP组患者ODI、JOA评分、SF-36精神健康较术前无明显提高(P0.05);与对照组比较,DJP组随访时腰痛VAS评分、ODI、JOA评分、SRS疼痛、SRS功能状况、SRS亚总分、SRS治疗满意度、SF-36生理健康评分、SF-36精神健康评分更差。结论:DLS长节段固定融合术后9.8%的患者发生了远端交界性问题,严重影响患者术后生活质量改善;骨质疏松和术后即刻矢状位失衡是发生DJP的独立危险因素。     

Adult thoracolumbar and lumbar scoliosis treated with long vertebral fusion to the sacropelvis: a comparison between new hybrid selective spinal fusion versus anterior-posterior spinal instrumentation

Background contextCombined anteroposterior spinal fusion with instrumentation has been used for many years to treat adult thoracolumbar/lumbar scoliosis. This surgery remains a technical challenge to spine surgeons, and current literature reports high complication rates.PurposeThe purpose of this study is to validate a new hybrid technique (a combination of single-rod anterior instrumentation and a shorter posterior instrumentation to the sacrum) to treat adult thoracolumbar/lumbar scoliosis.Study designThis study is a retrospective consecutive case series of surgically treated patients with adult lumbar or thoracolumbar scoliosis.Patient sampleThis is a retrospective study of 33 matched pairs of patients with adult scoliosis who underwent two different surgical procedures: a new hybrid technique versus a third-generation anteroposterior spinal fusion.Outcome measuresPreoperative and postoperative outcome measures include self-report measures, physiological measures, and functional measures.MethodsIn a retrospective case-control study, 33 patients treated with the hybrid technique were matched with 33 patients treated with traditional anteroposterior fusion based on preoperative radiographic parameters. Mean follow-up in the hybrid group was 5.3 years (range, 2–11 years), compared with 4.6 years (range, 2–10 years) in the control group. Operating room (OR) time, estimated blood loss, and levels fused were collected as surrogates for surgical morbidity. Radiographic parameters were collected preoperatively, postoperatively, and at final follow-up. The Scoliosis Research Society Patient Questionnaire (SRS-22r) and Oswestry Disability Index (ODI) scores were collected for clinical outcomes.ResultsOperating room time, EBL, and levels fused were significantly less in the hybrid group compared with the control group (p<.0001). The postoperative thoracic Cobb angle was similar between the hybrid and control techniques (p=.24); however, the hybrid technique showed significant improvement in the thoracolumbar/lumbar curves (p=.004) and the lumbosacral fractional curve (p<.0001). The major complication rate was less in the hybrid group compared with the control group (18% vs. 39%, p=.01). Clinical outcomes at final follow-up were not significantly different based on overall SRS-22r scores and ODI scores.ConclusionThe new hybrid technique demonstrates good long-term results, with less morbidity and fewer complications than traditional anteroposterior surgery select patients with thoracolumbar/lumbar scoliosis. This study received no funding. No potential conflict of interest-associated bias existed.     

氨甲环酸在腰椎退变性侧凸患者截骨矫形长节段固定术中的应用

目的 :探讨氨甲环酸在腰椎退变性侧凸(DLS)患者截骨矫形长节段固定融合手术中的有效性及安全性。方法:本研究回顾性纳入101例行长节段(≥4节段)固定融合截骨矫形的DLS患者,术中使用氨甲环酸(TXA)的患者纳入氨甲环酸组(TXA组),术中未使用TXA的患者输入等量生理盐水并纳入对照组(Placebo组)。比较两组患者术前和术后6周内的相关资料,包括患者的基本信息、并发症、手术相关资料、术中出血量(IBL)、术后引流量、总出血量(TBL)、围术期输血量和输血率、输血费用以及围手术期并发症。采用多元回归分析的方法,探讨围术期总出血量、异体输血量和输血成本的独立危险因素。结果:41例患者纳入氨甲环酸组,对照组60例患者,两组之间的基线数据、影像学参数、术前凝血指标和肝肾功能无统计学差异。TXA组患者术中出血量(TXA组1245.22±770.61ml vs对照组1633.65±962.49ml, P=0.021)、术后引流量(TXA组1205.68±367.76 ml vs对照组1412.83±538.45ml,P=0.035)及总出血量(TXA组2450.90±1022.69ml vs对照组3046.48±1274.02ml,P=0.011)均显著小于对照组患者。TXA组术中自体血回输量为400.44±267.80ml,对照组为526.22±339.96ml,二者之间具有统计学显著性(P=0.031),TXA组患者术中异体输血量及输血率也均显著小于对照组(TXA组468.29±391.43ml vs 723.33±462.99ml,P=0.009;TXA组68.29%vs对照组86.67%,P=0.025)。TXA组围术期总输血量为746.34±460.49ml,显著小于对照组(1143.33±669.02ml)。TXA组患者围术期输血费为969.76±840.24元,而对照组输血费为1460.67±1029.51元,使用TXA可明显减少围术期输血费(P=0.005)。多因素回归分析结果提示,在其他因素不变的情况下,术中使用1g TXA可减少围术期出血689.89ml,减少异体输血390.26ml,减少输血费用549.11元。使用TXA没有发现明显并发症或副作用。结论:在腰椎退变性侧凸患者行截骨矫形长节段固定融合手术中使用TXA是有效、安全,并可以显著降低医疗费用成本。     

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake-up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence-based approaches covered in this review.     

伴有侧凸畸形的腰椎管狭窄症的外科治疗

目的总结后路一期减压、内固定、融合手术治疗伴有腰椎侧凸畸形的腰椎管狭窄症患者的效果。方法自1998年1月-2005年10月,治疗伴有腰椎侧凸畸形的腰椎管狭窄症患者38例,腰椎侧凸畸形角度平均31°,术前 JOA评分平均11分,均采用腰椎后路一期减压、矫形、内固定、融合治疗。结果 32例得到随访,随访时间1-4年,平均2．5年,矫正角度平均13°。矫正角度丧失1°-5°,平均3°。截骨融合率100％。随访时JOA评分平均23分,患者对手术效果满意。结论后路一期减压、内固定、融合手术是治疗伴有腰椎侧凸畸形的腰椎管狭窄症的有效手段。     

骨移植在青少年特发性脊柱侧凸后路矫形术的应用研究

[目的]通过不同植骨在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用比较,探讨其临床应用效果.[方法]回顾性分析2000年～2005年行后路钉-棒系统矫形手术的71例青少年特发性脊柱侧凸患者,其中自体骨移植21例(A组),同种异体骨移植23例(B组),自体骨混合同种异体骨移植27例(C组),比较随访第3、9、15、36个月的融合率、Cobb's角丢失率及假关节发生率.[结果]A组平均融合节段7个,B组平均融合节段7.6个,C组平均融合节段8个.随访的第3个月,融合率、Cobb's角丢失率及假关节发牛率A组、B组、C组无显著性差异(P＞0.05).第9个月,A组融合率高于B、C两组,A组与B、C组有显著性差异(P＜0.05),B、C组间无显著性差异(P＞0.05),Cobb's角丢失率及假关节发生率A、B、C组无显著性差异(P＞0.05).第15、36个月,融合率、Cobb's角丢失率及假关节发牛率A、B、C组无显著性差异(P＞0.05).[结论]同种异体骨移植、自体骨混合同种异体骨移植与自体骨移植在青少年特发性脊柱侧凸后路矫形手术中对维持矫形效果可取得相近的近远期临床效果.     

重度脊柱侧凸的后路手术矫治

目的评价后路矫形内固定术治疗重度脊柱侧凸的疗效。方法重度脊柱侧凸患者16例,进行后路矫形内固定术治疗,术前主弯Cobb角71°-110°（84°±11°）,其中矢状面异常患者11例。结果手术时间3．4—5．1（4．1±0．6）h,出血量570—1120（778±178）ml,平均融合节段11（9—13）个椎体,术后主弯Cobb角24°-44°（31°±5°）,11例矢状面异常患者重新恢复了胸椎生理性后凸和腰椎生理性前凸,未发生感染、血气胸和神经系统等并发症。终末随访时,主弯Cobb角27°-45°（33°±5°）,矫正丢失率为0—13％（7％±5％）,固定范围内植骨全部融合,未发生术后失代偿和假关节形成。结论后路矫形内固定术是治疗重度脊柱侧凸安全有效的方法。