Humans ; Kyphosis ; etiology ; surgery ; Osteotomy ; methods ; Spondylitis, Ankylosing ; complications

Avascular necrosis of a vertebral body, a relatively uncommon entity, is caused by malignancy, infection, radiation, systemic steroid treatment, trauma, and the like.1 Vertebral osteonecrosis induced by trauma is called Kvmell's disease, because it was initially described by Hermann Kvmell of Germany in 1891.2 This paper reported a young female with posttraumatic vertebral osteonecrosis and analyzed the causes. She was treated by thoracoscopic surgery successfully.
Accidents, Traffic ; Adolescent ; Female ; Humans ; Kyphosis ; etiology ; Osteonecrosis ; complications ; surgery ; Spinal Diseases ; complications ; surgery ; Thoracoscopy

Humans ; Kyphosis ; complications ; surgery ; Osteotomy ; methods ; Scoliosis ; complications ; surgery ; Treatment Outcome

Humans ; Kyphosis ; etiology ; surgery ; Osteotomy ; methods ; Spondylitis, Ankylosing ; complications ; Treatment Outcome

BACKGROUND: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. METHODS: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. RESULTS: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9degrees +/- 11.7degrees with PSO, 14.3degrees +/- 8.4degrees with SPO, 38.3degrees +/- 12.7degrees with PVCR, and 19.3degrees +/- 7.1degrees with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%). CONCLUSIONS: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.
Adult ; Aged ; Female ; Humans ; Kyphosis/*complications/*surgery ; Male ; Middle Aged ; Osteotomy/*adverse effects/*methods ; Postoperative Complications ; Retrospective Studies ; Spondylitis, Ankylosing/*complications/*surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the safety and efficacy of asymmetrical osteotomy in treating elderly degenerative lumbar kyphoscoliosis.

METHODSFrom January 2010 to June 2012,17 elder patients with degenerative lumbar kyphoscoliosis were treated with asymmetrical osteotomy,their data were retrospectively analyzed. There were 6 males and 11 females with an average age of 61 years old (57 to 72). Total length spinal X-ray was performed for all patients before operation,and sagittal and coronal balance were analyzed. The follow-up time was 1 year at least. VAS score, thoracolumbar Cobb angle and pelvic parameters were analyzed.

RESULTSAll patients were operated successfully. The average operation time was 210 min (180 to 260) and intraoperative blood loss was 1,100 ml (750 to 2 200). At 1 year after operation, VAS score decreased from preoperative 7.0 +/- 1.5 to 1.1 +/- 0.6; lumbar lordosis (LL) corrected from (1.9 +/- 9.6) degrees to (35.2 +/- 6.7) degrees; thoracic kyphosis (TK) increased from (26.3 +/- 9.7) degrees to (32.5 +/- 11.2) degrees; lumbar scoliosis decreased from (25.1 +/- 11.0) degrees to (7.9 +/- 3.6) degrees; pelvic tilt (PT) restored from (33.0 +/- 10.1) degrees to (25.3 +/- 8.9) degrees; sacral slope (SS) increased from (13.9 +/- 9.7) degrees to (27.2 +/- 11.0) degrees; sagittal balance improved from (10.3 +/- 8.1) cm to (3.1 +/- 4.2) cm,and coronal balance improved from (3.5 +/- 2.1) cm to (1.3 +/- 1.1) cm. There was statistically significant difference above data between preoperation and postoperation.

CONCLUSIONAsymmetrical osteotomy can not only correct scoliosis deformity, but also restore lumbar lordosis, and may safely and effectively solve the problem of elderly degenerative lumbar kyphoscoliosis.

Aged ; Female ; Humans ; Kyphosis ; complications ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Pain ; complications ; Scoliosis ; complications ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To evaluate the clinical outcome of one stage posterior vertebral column resection in patients with spinal tuberculosis combined with kyphotic deformity. METHODS: Thirty-six patients with spinal tuberculosis combined with kyphotic deformity underwent posterior one-stage vertebral column resection reducing tension on the spinal cord from 1998 to 2006. The patients were mobilized with a thoracolumbar orthosis for 3 months. All patients had a minimum of a 2-year follow-up, and clinical examinations and radiographs were obtained at 6-month intervals. RESULTS: No perioperative mortality occurred. The average duration of surgery was 208 (145 approximately 385) min. The kyphotic Cobb angle improved from the preoperative average of 57.2 degree(17 degree approximately 86 degree) to a postoperative average of 8.9 degree(-6 degree approximately 27 degree). The average horizontal distance between C(7) and S(1) was 13.6 (8 approximately 19) mm preoperatively and 3.6 (-11 approximately 9) mm postoperatively. Nineteen patients had preoperative neurological deficits. Of them, 89.5% (17/19) showed a postoperative neurologic improvement. Perioperative complications occurred in 3(8.5%) of the 36 patients with pneumonias and superficial infections. Twenty-five patients (69.4%) showed radiographic evidence of solid fusion in the follow-up examinations. In the follow-up, 25% (9/36) patients rated their results as excellent, 66.7% (24/36) as good, 2 as fair, and 1 as poor. CONCLUSION One stage posterior vertebral column resection for the treatment of spinal tuberculosis with kyphotic deformity is safe and effective. Because this procedure is highly technical, the surgeon must be familiar with the pathoanatomy and the operation must be carefully done.
Adolescent ; Adult ; Female ; Humans ; Kyphosis ; etiology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Spine ; surgery ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; complications ; surgery

OBJECTIVETo evaluate the clinical effects of posterior spinal transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture in elderly.

METHODSFrom July 2009 to February 2014,26 patients with kyphosis caused by delayed osteoporotic vertebral fracture were treated with transpedicular wedge osteotomy. There were 10 males and 16 females,aged from 55 to 75 years old with an average of 67 years. There were 1 osteotomy in thoracic vertebra,21 osteotomies in thoracolumbar vertebrae and 4 in lumbar vertebrae. Total 29 vertebrae were involved, 23 cases with single vertebral fracture and 3 cases with double vertebral fractures. Preoperative Cobb angles were 32°~51° with the mean of (42.00 ± 4.75) ° and VAS scores were 6 to 9 points with an average of (8.40 ± 0.75) points. According to the Frankel grade of spinal cord function, 4 cases were grade D and 22 cases were grade E. Intraoperative bleeding, operation time and perioperative complications were recorded, and improvements of Cobb angle were evaluated by X-rays. VAS score and Frankel grade were respectively used to evaluate the pain and nerve function.

RESULTSThe average operation time were 155 min (ranged, 120 to 175) and the mean intraoperative bleeding were 1 100 ml (ranged,800 to 1 500). Postoperative at 2 days, Cobb angle and VAS score were (9.60 ± 2.50) ° and (4.00 ± 1.00) points, respectively, ranged from 5° to 15° and 1 to 5 points. VAS score and Cobb angle improved obviously compared with preoperative (P < 0.05), and the improvement rate of Cobb angle was 76%. Frankel grade of 1 case changed from grade E to C, and the others did not become worse. The follow-up period ranged from 3 to 24 months with an average of 16.4 months. At the final follow-up, Cobb angles and VAS score were (11.00 ± 3.50)° and (4.40 ± 1.25) points, respectively, ranged from 5° to 19° and 1 to 6 points. The patient whose Frankel grade E changed to C at 2 days after surgery and changed to grade D at the latest follow-up. Vertebral body fracture below the fusion level happened in 1 case at 3 months after surgery, vertebral body fracture above the fusion level happened in 1 case at 5 months after surgery, and their chest pain symptoms were relieved after symptomatic treatment and anti osteoporosis treatment. All osteotomy levels obtained fusion which confirmed by X-ray and no internal fixation loosening and breakage were found.

CONCLUSIONThe clinical effect of posterior transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture was satisfactory, but manipulation during the operation should be cautious and prevent adjacent vertebral body fracture should be pay attention to prevent.

Aged ; Female ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteoporotic Fractures ; complications ; surgery ; Osteotomy ; methods ; Spinal Fractures ; complications ; surgery ; Visual Analog Scale

OBJECTIVETo explore the clinical effects of total vertebral column resection combined with anterior mesh cage support in treating severe congenital kyphoscoliosis.

METHODSFrom April 2008 to April 2012,21 patients with severe congenital kyphoscoliosis were treated with total vertebral column resection and internal fixation through posterior approach combined with anterior mesh cage support. There were 8 males and 13 females with an average age of 19.4 years old (ranged from 10 to 35). And 6 cases were thoracic segments deformity,13 cases were thoracolumbar segments and 2 cases were lumbar segments, of them, 2 cases were accompanied with Chairs deformity, 6 cases with diastematomyelia, 4 cases with syringomyelia,and 1 case with neurofibromatosis. According to the Frankel grade system, 3 cases were grade C, 5 cases grade D and 13 cases grade E. Blood loss, operative time, and perioperative complications were recorded. Coronal and sagittal Cobb angle, apical vertebral offset distance, sagittal offset, the relative height of shoulders, razor back deformities were measured and analyzed before and after operation.

RESULTSThe average operative time was 5.2 h (3.5 to 6.5 h) and blood loss was 2,500 ml (1,400 to 4,900 ml). The 2nd day after operation, apical vertebral offset distance, sagittal offset, the relative height of shoulders, razor back deformities had obviously improved than preoperative (P < 0.05). There was no significant difference in above items between postoperative on the 2nd day and final follow-up (P > 0.05). The corrective rate of kyphosis and scoliosis were (60.97 +/- 6.30)% and (62.24 +/- 5.82)%, respectively. On the first day after surgery,2 cases of Frankel grade E aggravated to grade D, and obtained recovery at 2 week after conservative treatment. And 1 case palinesthesia later,grade D aggravated to grade C and obtained recovery after revision surgery in time. One case complicated with permanent blindness of left eye, 1 case occurred injury of pleura and 2 cases had cerebrospinal fluid leak during operation. All patients were followed up from 9 to 31 months with an av- erage of 18.6 months. At final follow-up,all patients obtained bone union, Frankel grade D in 4 cases and grade E in 17 cases, no correction loss and internal fixation loosening was found.

CONCLUSIONTotal vertebral column resection combined with anterior mesh cage support can effectively correct kyphosis and scoliosis in severe congenital kyphoscoliosis and can avoid injury of spine cord by spinal crispation, but intraoperative position and neurologic complications should still be considered.

Adolescent ; Adult ; Child ; Female ; Humans ; Kyphosis ; complications ; congenital ; diagnostic imaging ; surgery ; Male ; Retrospective Studies ; Scoliosis ; complications ; congenital ; diagnostic imaging ; surgery ; Spine ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo study retrospectively the efficacy and complications of combined pedicle subtraction osteotomy (PSO) and polysegmental closing wedge osteotomy for correction of the severe rigid thoracolumbar kyphotic deformity in ankylosing spondylitis (AS).

METHODSA total of 8 consecutive male patients with AS and severe thoracolumbar kyphotic deformity (mean age 32 years, range 28 - 46) were involved in this study from August 2004 to June 2007. The average preoperative Cobb angle of thoracic spine (T(1)-T(12)) was 96 degrees (range, 80 degrees - 112 degrees ), the mean preoperative angle of lumbar lordosis (L(1)-S(1)) was 10 degrees (5 degrees - 15 degrees ). The mean chin-brow angle was 47 degrees (range, 40 degrees - 58 degrees ). The average gaze angle was 43 degrees (range, 32 degrees - 50 degrees ). After preoperative assessment, single-level PSO was performed in L(3) vertebrae and two-level polysegmental closing wedge osteotomy was performed in thoracolumbar vertebrae (T(12)-L(1), L(1-2)). Radiographic and clinical results and complications were assessed.

RESULTSThe surgical time was (298.1 +/- 20.7) minutes and blood loss during the procedure was (1588.8 +/- 171.6) ml. The follow-up period was (11.5 +/- 7.7) months. The postoperative angle and the amount of correction of the thoracic and lumbar spine were 76.1 degrees +/- 9.6 degrees , 20.3 degrees +/- 1.1 degrees and 48.4 degrees +/- 4.7 degrees , 38.4 degrees +/- 4.7 degrees respectively. The postoperative chin-brow and gaze angle was 16.5 degrees +/- 4.6 degrees and 73.0 degrees +/- 5.2 degrees , respectively. The amount of correction for sagittal balance was (12.3 +/- 1.6) cm. No nerve, vascular injury, stress fracture and coronal decompensation occurred in the patients.

CONCLUSIONSCombined PSO and polysegmental closing wedge osteotomy by posterior approach only is safe and effective for correction of the severe rigid thoracolumbar kyphotic deformity in AS. The visual field is significantly improved after surgery.

Adult ; Follow-Up Studies ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Retrospective Studies ; Spondylitis, Ankylosing ; complications ; Treatment Outcome