Assessment of Quality of Life for Scheuermann’s Kyphosis Patients with Cobb’s Angle 50°–65° Treated Conservatively or Surgically in North Jordan: A Prospective Comparative Study

BackgroundScheuermann’s disease is the most common cause of hyperkyphosis of the thoracic spine during the adolescence period. It causes neck and lower back pain, restriction of lung expansion, traction of the spinal cord, increased vulnerability to vertebral fracture, and a hump. Patients with curves < 60° are treated conservatively, while surgery is used for patients with curves > 60°. The purpose of this prospective cohort study was to assess the quality of life and functional changes in conservatively or surgically treated Scheuermann’s disease patients with a curve size of 50°–65° in north Jordan.MethodsSixty-three adolescent patients with Scheuermann’s kyphosis (aged between 10 and 18 years) were treated at our hospital between January 2014 and August 2018. All patients were investigated clinically, radiologically (Cobb’s angle), and functionally (Oswestry Disability Index [ODI], Scoliosis Research Society 22 revision [SRS-22r] questionnaire, and pulmonary function test [PFT]) pre- and post-treatment (final follow-up). Patients were randomly selected for treatment method (conservative versus surgical).ResultsThere were 31 patients (mean age, 15.48 ± 2.50 years) and 32 patients (mean age, 16.19 ± 1.51 years) treated conservatively and surgically, respectively. Mean ± standard deviation of ODI, SRS-22r, and Cobb’s angle of the surgical group improved from 16.8% ± 14.3%, 3.5 ± 0.5, and 58.75° ± 3.59°, respectively, pre-surgery to 13.4% ± 10.8%, 4.2 ± 0.5, and 41.53° ± 3.94°, respectively, post-surgery, while those of the conservative group became worse from 12.6% ± 13.4%, 3.9 ± 0.7, and 56.1° ± 3.3°, respectively, to 20.1% ± 13.6%, 3.5 ± 0.7, and 58.8° ± 5.8°, respectively. The surgical group showed better improvement in all scores than the conservative group (p < 0.05), as well as in PFT.ConclusionsSurgical treatment of Scheuermann’s kyphosis with curves of 50°–65° resulted in better QOL, Cobb’s angle, and PFT than conservative treatment. This was because of lower patient cooperation in the conservative management group, which made the curve less flexible for exercises and bracing.     

The role of multi-modal intra-operative neurophysiological monitoring in corrective surgeries for thoracic tuberculosis with kyphosis

Objective: The aim of this study was to assess the performance and utility of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during corrective surgery for thoracic tuberculosis with kyphosis (TTK).Methods: 68 patients (mean age 31.7 ± 20.3 years) who underwent corrective surgery for TTK from 2012 to 2019 were included in this retrospective study. Patients were neurologicaly evaluated before and after surgery with systematic neurologic examinations. Intraoperative neurophysiological monitoring (IONM) with SSEP and MEP was carried out. A receiver operating characteristic (ROC) curve and area under ROC curve (AUC) were used to identify the diagnostic accuracy of potential recovery.Results: IONM alerting occurred in 12 surgeries (12/68, 17.6%), of which 6 were SSEP alerting, 2 MEP alerting, and 4 combinations of both SSEP and MEP. Among the 12 cases where there was IONM alerting, 3 (25%) had postoperative neurological deficits(PND), whereas one patient had PND without IONM alerting. IONM sensitivity and specificity were 0.75 (95% CI 0.22–0.99) and 0.86 (95% CI 0.74–0.93) respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 0.25 and 0.98 respectively. The AUC of evoked potential recovery in diagnosing PND was 0.884.Conclusion: Our study showed that multi-modal IONM with SSEP and MEP can effectively indicate a potential neural injury and predict PND during TTK corrective surgery.Level of Evidence: Level IV, Therapeutic Study     

颈椎椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸的中长期疗效

【摘要】 目的：观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效。方法：回顾性分析2008年3月~2019年9月，采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者，其中男11例，女7例，年龄52.3±8.1岁；颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）合并慢性颈脊髓病5例，脊髓型颈椎病13例。减压节段：17例为C3~C7，1例为C3~T1，术中固定融合3.8±1.0个椎体。12例患者出院时（术后2周左右）复查颈椎MRI，11例患者获得随访，随访时间2.1~13.5年（10.5±2.8年）。在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角，在颈椎MRI上测量脊髓前缘角及改良K线，末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况。术前及末次随访时进行JOA评分及颈痛VAS评分。结果：18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸，术后2周为3.8°±8.0°前凸，有显著性差异（P<0.01）； 术前C2~C7颈椎Cobb角为1.3°±9.4°前凸，术后2周为5.8°±7.0°前凸，无显著性差异（P＞0.05）。12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸，术后2周为1.3°±5.2°后凸，有显著性差异（P<0.01）；C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸，术后2周为1.1°±6.3°前凸，有显著性差异（P<0.01）。7例（39%）患者术后出现C5神经根麻痹，均在术后1~4个月内完全恢复。术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合，后凸矫形角度无丢失；颈椎MRI显示脊髓无受压，正中矢状位片显示脊髓前缘角无丢失。11例患者JOA评分术前8.0±2.8分，末次随访时15.6±0.9分，有显著性差异（P<0.01），JOA评分改善率（83±14）%；颈痛VAS评分术前为2.2±3.0分，末次随访时为1.1±1.2分，术前与末次随访时相比无显著性差异（P>0.05）。结论：对于合并有退变性颈椎后凸的多节段受压的慢性压迫性颈脊髓病，采用椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术可以获得长期稳定、良好的脊髓功能改善的效果。     

修正矢状位年龄校正评分对国人成人脊柱畸形术后发生PJK/PJF预测能力的研究

【摘要】 目的：评价矢状位年龄校正评分（sagittal age-adjusted score，SAAS）和以国人年龄匹配脊柱为基线修正的SAAS评分（M-SAAS）预测国人成人脊柱畸形（adult spinal deformity，ASD）术后发生近端交界性后凸/失败（proximal junctional kyphosis/failure，PJK/PJF）的能力。方法：收集来自我院影像学系统66例年龄匹配脊柱-骨盆序列的受试者资料，其中男性28例，女性38例，年龄54.7±6.2岁，测量骨盆入射角（pelvic incidence，PI）、腰椎前凸角（lumbar lordosis，LL）、骨盆倾斜角（pelvic tilt，PT）以及T1骨盆角（T1-pelvic-angle，TPA）并统计分析年龄与PI-LL、PT以及TPA的线性回归方程，将公式记为M-SAAS。回顾性分析68例于2017～2021年在我院行脊柱矫形术的ASD患者病历资料，其中男性10例，女性58例，年龄64.0±8.1岁，术后PJK/PJF发生12例。测量PI、LL、PT以及TPA，计算SAAS评分并观察PJK/PJF发生率与评分的匹配程度。将68例ASD患者术后影像学参数代入M-SAAS，计算M-SAAS评分并观察PJK/PJF发生率与评分的匹配程度。结果：SAAS评分为1.9±2.6分（-4~6分），术后即刻评估为“矫正不足”“匹配”及“过度矫正”的患者分别为5例（7.4%）、25例（36.7%）和38例（55.9%），PJK/PJF发生率分别为40.0%（2/5）、20.0%（5/25）和13.2%（5/38），匹配组PJK/PJF发生率与另两组差异无统计学意义。依据正常脊柱-骨盆序列得M-SAAS线性回归方程为：理想PI-LL=0.47×（年龄-55）+0.3、理想PT=0.44×（年龄-55）+14和理想TPA=0.37×（年龄-55）+9。ASD患者最终M-SAAS分数为0.2±2.8分（-5~5分），术后即刻被评估为“矫正不足”“匹配”及“过度矫正”的患者分别为17例（25.0%）、31例（45.6%）和20例（29.4%），术后PJK/PJF发生率分别为11.8%（2/17）、6.5%（2/31）和40.0%（8/20），“过度矫正”组PJK/PJF发生率高，与“匹配”组差异有统计学意义（P=0.008）。结论：SAAS不适用于对国人ASD患者术后发生PJK/PJF的预测评价，根据国人中老年年龄匹配脊柱-骨盆序列参数关系修正的M-SAAS可预测ASD患者术后发生PJK/PJF的概率。     

强直性脊柱炎胸腰椎后凸畸形患者不同体位下主动脉相对椎体位置变化的MRI观察

目的：在MRI上探究强直性脊柱炎（ankylosing spondylitis,AS）胸腰椎后凸畸形患者不同体位下（仰卧位与侧卧位）主动脉相对椎体位置的解剖关系。方法：纳入2020年5月～2022年12月在我院行单节段经椎弓根椎体截骨术（pedicle subtraction osteotomy,PSO）治疗的AS胸腰椎后凸畸形患者33例。男29例，女4例；年龄38.3±8.8岁（22～54岁）。收集性别、年龄及顶椎位置等基线资料。在术前站立位全脊柱侧位片上测量全脊柱整体后凸角（global kyphosis,GK）。获取仰卧位与侧卧位MRI并测量以下参数：（1）主动脉-椎体角度（θ）;(2)主动脉-椎体距离（d1）;(3)主动脉外壁-椎体前缘间隙（d2）。为探究左、右侧卧位对主动脉相对椎体位置的影响，根据侧卧位拍摄MRI的方向分为左侧卧位与右侧卧位两组以比较两组患者在仰卧位与（左或右）侧卧位时主动脉相对椎体位置的差异。根据AS患者的后凸畸形程度，将所有患者分为低后凸畸形组（GK≤70°）及高后凸畸形组（GK>70°）以探究AS患者后凸畸形程度对主动脉相对椎体位置的影响，并通过不...     

重度颈椎后凸畸形病人平衡悬吊牵引的护理

目的 总结重度颈椎后凸畸形病人平衡悬吊牵引的护理措施,探讨平衡悬吊牵引的护理经验与体会.方法 回顾性分析2017年3月至2020年7月,术前接受平衡悬吊牵引预矫形的17例重度颈椎后凸畸形病人的临床资料.牵引过程中,对病人采取不良反应的观察与处理、平衡悬吊牵引管理、心理疏导和舒适护理等系统的护理干预措施.观察病人牵引前后...