单纯后路多个全脊椎切除矫治严重脊柱侧、后凸畸形

目的评价严重脊柱侧、后凸畸形单纯后路多节段全脊椎切除,侧后凸畸形矫正技术的手术矫治效果和临床风险性。方法2003年1月~2001年1月,本院骨科收治38例严重脊柱侧、后凸畸形患者,全部病例均采用单纯后路多节段全脊椎切除的方法。全部病例手术前均行站立位X线脊柱全长片、核磁共振和三维CT重建等辅助检查,计算手术时间、出血量,观察手术前后侧后凸的矫正率、术中脊柱短缩,手术后整体平衡情况。结果本组患者均进行1.5~3个椎体的全脊椎切除,术中测量脊柱短缩42 mm(31~62 mm),手术平均用时348 m in(280~510 m in),手术中平均出血量2010 m l(1400~3200 m l)。全部病例经过1~2.5年的随访,侧凸畸形cobb角平均矫正率为56.3%(51.2%~64.2%);后凸畸形平均矫正率为75.6%(67.8%~81.4%)。所有患者躯干平衡良好,未发现失代偿现象。手术并发症包括3例出现一过性的脊髓损伤症状(1例一过性双侧下肢不全瘫、2例一过性单侧下肢不全瘫)和6例神经根性疼痛,未经特殊处理恢复正常,4例肠系膜上动脉综合症,经胃肠减压处理症愈。结论对于严重成人脊柱侧、后凸畸形患者,单纯后路顶椎附近多个椎体全脊椎切除技术三维矫正效果满意,安全有效。     

新型腰椎前凸计算回归方程对成人脊柱畸形矫形术后机械性并发症的预测作用

目的:探讨由骨盆入射角(pelvic incidence,PI)和胸椎后凸(thoracic kyphosis,TK)计算腰椎前凸的新型回归方程对成人脊柱畸形(adult spinal deformity,ASD)矫形术后机械性并发症的预测作用.方法:回顾性分析2011年1月～2019年3月于我科接受后路矫形的ASD患...     

胸腰椎骨折分型、损伤评分、后凸畸形及神经功能损伤的关联研究

目的 探究腰椎骨折损伤程度与骨折的分型、损伤评分、后凸畸形和神经功能损伤的关联.方法 将患者根据后方韧带复合体(PLC)损伤程度分为PLC完整组和PLC损伤组.通过评判两组患者的骨折分型、损伤评分、后凸畸形及神经功能损伤情况,研究他们与PLC损伤的关系.结果 PLC损伤租的载荷分享评分系统(LCS)评分(7.1士0.8)分和严重程度评分(TLICS) (8.2±0.6)分均比PLC完整组的LCS评分(5.7士0.5)分和TLICS(4.6±0.7)分高.PLC损伤组患者的Denis分型和AO分型亦更严重.PLC损伤组的Cobb角为29°,PLC完整组的Cobb角为19°.PLC损伤组的神经功能不全比例89％,PLC完整组的这一比例为60％.结论 胸腰椎骨折与后方韧带复合体关系密切.PLC损伤程度与骨折分型、损伤评分、后凸畸形和神经损伤程度呈正相关的关系.     

青少年特发性脊柱侧弯胸腰椎生理曲度的影像学研究

目的:探讨青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)胸腰椎生理曲度变化情况以及不同类型侧弯之间胸腰椎生理曲度的差异。方法:自2017年1月至2021年12月回顾性分析305例脊柱全长正侧位X线片的青少年患者,根据有无侧弯分为正常组和侧弯组。正常组179例,男79例,女100例;年龄10~18(12.84±2.10)岁。侧弯组126例,男33例,女93例;年龄10~18(13.92±2.20)岁。观察并比较两组Risser征、胸椎后凸角(thoracic kyphosis,TK)与腰椎前凸角(lumbar lordosis,LL),并分析比较不同性别、不同程度侧弯与不同节段侧弯TK值与LL值。结果:侧弯组在女性比率(P=0.001)、年龄(P<0.001)方面均明显高于正常组;Risser征方面,正常组低级别骨化程度比率明显高于侧弯组(P=0.038)。侧弯组TK值明显小于正常组(P<0.001),而两组LL值比较,差异无统计学意义(P=0.147)。男性与女性之间比较,TK值与LL值差异无统计学意义。轻度侧弯TK值明显大于中度侧弯(P<0.05),但LL值比较,差异无统计学意义(P>0.05)。不同节段侧弯之间TK值与LL值比较,差异均无统计学意义(P>0.05)。结论:胸椎与腰椎生理曲度均与性别无关;AIS患者胸椎生理曲度变小,但是腰椎生理曲度基本不变。轻度AIS患者的胸椎生理曲度大于中度AIS患者,但是腰椎生理曲度在轻中度患者之间几乎无差异,且与正常青少年相似。AIS患者胸腰椎生理曲度变化可能与脊柱前柱相对生长过快有关,其具体机制有待进一步研究。     

Pedicle Morphology of Lower Thoracic and Lumbar Spine in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis: A Comparison with Fracture Patients

ObjectiveThe pedicle morphology of ankylosing spondylitis (AS)‐related thoracolumbar kyphosis patients may be different from that of individuals with normal spine due to the ectopic ossification and kyphotic deformity. However, there was no literature analyzing the pedicle morphology of AS patients with thoracolumbar kyphosis. Therefore, the present study aimed to investigate the pedicle morphology of lower thoracic and lumbar spine (T9‐L5) in ankylosing spondylitis (AS)‐related thoracolumbar kyphosis patients.MethodsA retrospective review of AS patients with thoracolumbar kyphosis (AS group) and the patients with spinal or rib fracture (fracture group) who underwent CT scans of the lower thoracic and lumbar spine between February 2017 and September 2018 was performed. Patients with spinal tumor, spinal tuberculosis, severe degenerative spinal diseases including degenerative scoliosis, degenerative spondylolisthesis, degenerative spinal stenosis or history of previous spine surgery, or AS patients with pseudarthrosis which influenced the measurement of pedicle parameters were excluded. The measured parameters on CT images included transverse pedicle angle (TPA), transverse pedicle width (TPW), chord length (CL), pedicle length (PL), and sagittal pedicle angle (SPA). The intraclass correlation coefficient (ICC) was used to evaluate the agreement of radiographic parameters between observers. The independent sample t test was applied for the comparison of pedicle parameters between the two groups. The gender distribution between the two groups were compared using the Fisher''s exact test.ResultsA total of 1444 pedicles of 53 AS‐related thoracolumbar kyphosis patients and 30 patients with fracture were analyzed. TPA was significantly smaller in AS group (p < 0.05). Significantly larger TPW was found in AS group in the lumbar spine (p < 0.05). TPW ≥ 7.5 mm was observed in 95.3%–98.1% of the pedicles at the levels of L3‐L5 in AS group. The CL and PL were significantly larger in AS group at the levels of T9‐L5 (p < 0.05). The CL ≥ 50 mm was found in 84.0%–96.2% of the pedicles in mid‐to‐lower lumbar spine in AS group. Significantly smaller SPA was found in AS group at the levels from L3 to L5 (p < 0.05).ConclusionsPedicle screws with relatively large diameter of 7.5 mm and length of 50 mm could be used in mid‐to‐lower lumbar spine in the majority of AS‐related thoracolumbar kyphosis patients. Also, the insertion angle of pedicle screws in both the transverse and sagittal plane should be appropriately reduced in these patients. This study may help surgeons select the pedicle screws of appropriate size in AS patients.     

The efficacy of Theraband versus general active exercise in improving postural kyphosis

BackgroundThoracic kyphotic posture is accompanying increased biomechanical load of the backbone which is possibly problematic.ObjectiveThe current study aimed to examine the effects of general active exercise versus Theraband exercise on female kyphotic posture.MethodsAn experimental study was conducted at the biomechanical lab. in Physical Therapy College, Cairo University. Fourteen female volunteers with kyphotic posture aged from 18 to 30 years were selected and equally distributed into two groups; 1st group received Theraband exercises (neck retraction exercise, scapular retraction exercise, and resistive shoulder blade squeeze) and 2nd group received general active exercises (Thoracic stretching exercise, thoracic extension exercises, and extension in lying with cervical retraction exercises). Each exercise was conducted properly for 60 min in 3 sessions per week for 4 weeks (total of 12 sessions per week). The Index of kyphosis (IK) was calculated before and after treatment. Moreover, the percentage of back disability index questionnaire (PBDI) and pain score were also detected.ResultsMultivariate analysis of covariance (MANCOVA) was used to compare the post-treatment's means between the first and second groups and control the pre-treatment variables. No significant differences were found post-treatment (P > 0.05). Moreover, IK measures showed a statistically significant difference post-treatment (P < 0.05). The paired sample t-test showed statistically significant differences (P < 0.05) in all variables within the first and second groups.ConclusionThe current study demonstrated the positive effect of both techniques in reducing the IK, percentage of back disability index, and pain score with a more positive effect of Theraband in reducing the IK measures post-treatment.     

Management of spinal osteomyelitis-associated deformity

Spinal osteomyelitis predominantly affects the anterior vertebral column. Pyogenic infection seldom results in significant deformity but rather the more insidious causes such as tuberculosis. The typical deformity is a single plane kyphosis, other than when the infection affects the more mobile and more loaded lumbar spine where facet subluxation may result in a three-dimensional torsional deformity. Management is dictated by whether the disease process is active versus healed disease, the skeletal maturity of the patient and whether there is ongoing spinal growth expected and associated neurological deficit. Surgical strategies may be anterior only, such as in the sub-axial cervical and thoracic active disease, combined anterior and posterior procedures at the cervico-thoracic and thoracic‐lumbar junctions, but the posterior circumferential vertebral column resection (VCR) is increasingly utilized for rigid healed disease, especially with late presenters and in those patients who have associated neurological impairment.     

Postoperative spino-pelvic stereoradiography to predict adjacent segment disease

PurposeThe purpose of this study was to identify sagittal spinopelvic parameters predictive of adjacent segment disease (ASD) on postoperative whole spine weight-bearing stereoradiography.Materials and methodsA total of 84 patients with previous spinal fusion surgery and documented radiological follow-up with early weight-bearing postoperative whole spine stereoradiography (EOS® Imaging System) were retrospectively included. A pathological group of 42 patients (9 men, 33 women; mean age, 63.1 ± 11.5 [SD] years) who developed documented ASD (mean follow-up, 76.75 months; range: 31.5–158.5 months) was compared with a control group of 42 asymptomatic patients (7 men, 35 women; mean age, 60.9 ± 11.8 [SD] years) (mean follow-up, 115 months; range: 60–197 months) based on sagittal balance evaluation and routinely used spino-pelvic parameters. Comparisons were made using uni- and multivariate analyses.ResultsAt univariate analysis, patients with ASD had an anteriorly displaced sagittal vertical axis (CAM plumb line) and an inadequate lumbar lordosis (LL) in reference to pelvic incidence (PI) compared to controls. They also had higher C7 slope and C2-C7 offset. At multivariate analysis, C2-C7 offset (OR = 1.152; 95% CI: 1.056–1.256; P = 0.001) and a lack of LL (OR = 5.063; 95% CI: 1.139–22.498; P = 0.033) were significantly associated with ASD.ConclusionAnterior cervical imbalance, reflected by an increase in C2-C7 offset and insufficient restoration of LL are postoperative predictive factors of ASD on stereoradiography.     

Spinal posture during pubertal growth

A cohort of children was followed-up annually from a mean age of 10.8-13.8 years to determine the development of their posture. Of the sample of 1060 children, 847 (79.9%) participated in the final examination. Thoracic kyphosis and lumbar lordosis were measured annually with a spinal pantograph. Those children whose thoracic kyphosis in pantography was more than 35^o at entry and 45^o or more at the final examination underwent a lateral standing radiograph. The 3-year incidence of Scheuermann's disease was 0.4%. The mean thoracic kyphosis increased and the mean lumbar lordosis decreased with age in both sexes, but these changes were not constant. Thoracic kyphosis was most pronounced at a mean age of 12.8 years and lumbar lordosis was least pronounced at a mean age of 13.8 years. In accordance with the literature, the wide individual variation found in this study for both thoracic kyphosis and lumbar lordosis during the pubertal growth period was mainly physiologic.     

Indications for surgery in so-called “regular” thoracic and thoracolumbar kyphosis

Idiopathic thoracic, thoracolumbar, and Scheuermann's kyphosis do not figure in the same global entity. We propose a classification for so-called regular kyphosis. This classification is based on the location of the most rigid curvature segment. Segmental kyphosis may be short, in which case we can distinguish between four types: high kyphosis (type I), middle kyphosis (type II), low or thoracolumbar kyphosis (type III), and segmental kyphosis, which can extend along the entire thoracic spine (type IV). The symptomatology and therapeutic indications are different for each type. We report a series of 15 patients (6 female, 9 male), aged between 18 and 33 years (average age 24 years). The mean kyphosis angle (Cobb angle) in type I patients (n = 3) was 75° in type II patients (n = 3) it was 82°, and in type III patients (n = 9) it was 78°. The pain was greater in type III patients. All patients were operated on using a double approach. As the first step, we performed an anterior approach, disc excision, and bone graft. Ten days later, a posterior approach with CD instrumentation was carried out on ten levels. The mean follow-up is 4 years (range 9 months in 7 years). We noticed no neurological complications and one case of late sepsis. Mean angular loss of correction was 6°. The correction obtained dependend on the type of kyphosis. We obtained a mean postoperative Cobb angle of 63° in type I curves, 55° in type II, and 45° in type III. The new classification allows a better understanding of regular kyphosis and helps to define clinical and therapeutic approaches. An analysis of the resulting surgical correction can also be made by comparing homogeneous groups of patients.Paper read at the ESDS Meeting, Birmingham, 1994, and selected for full publication.