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

OBJECTIVE: Clinical, radiographic, and outcomes assessments, focusing on complications, were performed in patients who underwent pedicle subtraction osteotomy (PSO) to assess correction effectiveness, fusion stability, procedural safety, neurological outcomes, complication rates, and overall patient outcomes. METHODS: We analyzed data obtained from 13 consecutive PSO-treated patients presenting with fixed sagittal imbalances from 1999 to 2006. A single spine surgeon performed all operations. The median follow-up period was 73 months (range 41-114 months). Events during perioperative course and complications were closely monitored and carefully reviewed. Radiographs were obtained and measurements were done before surgery, immediately after surgery, and at the most recent follow-up examinations. Clinical outcomes were assessed using the Oswestry Disability Index and subjective satisfaction evaluation. RESULTS: Following surgery, lumbar lordosis increased from -14.1degrees +/- 20.5degrees to -46.3degrees +/- 12.8degrees (p < 0.0001), and the C7 plumb line improved from 115 +/- 43 mm to 32 +/- 38 mm (p < 0.0001). There were 16 surgery-related complications in 8 patients; 3 intraoperative, 3 perioperative, and 10 late-onset postoperative. The prevalence of proximal junctional kyphosis (PJK) was 23% (3 of 13 patients). However, clinical outcomes were not adversely affected by PJK. Intraoperative blood loss averaged 2,984 mL. The C7 plumb line values and postoperative complications were closely correlated with clinical results. CONCLUSION: Intraoperative or postoperative complications are relatively common following PSO. Most late-onset complications in PSO patients were related to PJK and instrumentation failure. Correcting the C7 plumb line value with minimal operative complications seemed to lead to better clinical results.
Animals ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Osteotomy ; Outcome Assessment (Health Care) ; Postoperative Complications ; Prevalence ; Spine

Sagittal spinal balance is an essential factor for not only the external appearance, but also for the spine's function. Fixed sagittal imbalance is the result of different causes, and this generally requires surgical treatment. Sagittal imbalance is mainly caused by decreased lumbar lordosis and increased thoracic kyphosis, and it can also be influenced by the pelvic incidence and flexion contracture of the hip and knee joints. So, a careful understanding and clinically considering the many factors and compensatory mechanisms that are associated with sagittal imbalance are needed. Proper surgical treatments provide a satisfactory outcome for these patients and good radiographic results. Correction of sagittal imbalance generally requires spinal osteotomy and long segment fusion. For the surgical treatment, we should consider the perioperative and postoperative complications of osteotomy and long segment fusion and then make proper decisions for the range of fusion of the proximal and distal sides and the selection of the correct method of osteotomy, the ideal correction angle and the best method of internal fixation. Problems such as loss of correction may occur postoperatively due to kyphotic change and pseudarthrosis of the proximal and distal sides. Therefore, we need to conduct a thorough analysis and make a detailed plan for the surgical approach. We should also study and understand the radiological factors when treating sagittal spinal balance because not only the spine, but also the pelvis, hip and knee joints are involved in forming the sagittal balance
Animals ; Contracture ; Hip ; Humans ; Incidence ; Knee Joint ; Kyphosis ; Lordosis ; Osteotomy ; Pelvis ; Postoperative Complications ; Pseudarthrosis ; Spine

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

BACKGROUND: This study was conducted to confirm the predictive power of preoperative pulmonary functions tests (PFTs) for intra- and post-operative cardiopulmonary complications during corrective surgery for scoliosis. METHODS: A retrospective review of hospital charts of patients who underwent surgical correction for scoliosis and/or kyphosis at our medical center between September 2002 and September 2008 was performed. RESULTS: A total of 141 patients were enrolled in this study. The overall intra- and post-operative cardiopulmonary complication rate was 33.3% (47/141). There were 32 and 19 complications related to pulmonary issues (22.7%) and cardiovascular complications (13.5%), respectively. The complication rate of neuromuscular scoliosis (NMS) was 47.3% (35/74), while that of non-neuromuscular scoliosis (NNMS) was 17.9% (12/67). The cardiopulmonary complication rates of groups with FEV1 volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 66.7% (18/27), 43.3% (13/30), 20.0% (7/35) and 18.4% (9/49), respectively. The group with FEV1 volumes below 1 L showed a significantly increased risk when compared to the group with FEV1 volumes over 2 L (P<0.05, Odds ratio = 5.15, multivariate logistic regression test). The cardiopulmonary complication rates of groups with FVC volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 70.8% (17/24), 37.5% (9/24), 33.3% (11/33) and 16.7% (10/60), respectively. Additionally, the group with FVC volumes below 1 L showed significantly increased risk when compared to a group with FVC volumes greater than 2 L (P<0.001, Odds ratio = 8.0, multivariate logistic regression). CONCLUSIONS: The correction for NMS carries a higher complication rate than NNMS. Intra- and post-operative cardiopulmonary complication rates of a group with FEV1 or FVC volumes below 1 L were higher than the rates of groups with FEV1 and FVC volumes greater than 2 L.
Humans ; Intraoperative Complications ; Kyphosis ; Logistic Models ; Odds Ratio ; Postoperative Complications ; Respiratory Function Tests ; Retrospective Studies ; Risk Factors ; Scoliosis

We report a case of insufficiency fracture of the sternum in a 70-year-old female patient with a review of the literature. She complained of sudden onset chest pain and aggravating dyspnea. She has been managed with corticosteroid due to chronic obstructive pulmonary disease for 15 years. Diagnosis of sternal insufficiency fracture presented with thoracic kyphosis was made on the basis of absence of trauma history, radiologic findings of lateral chest radiograph, bone scintigraphy and chest computed tomography. Thoracic kyphosis and osteoporosis secondary to menopause, corticosteroid therapy and limited mobility due to chronic obstructive pulmonary disease were considered as predisposing factors of the sternal insufficiency fracture in this patient.
Aged ; Case Report ; Female ; Fractures, Spontaneous/radiography ; Fractures, Spontaneous/diagnosis* ; Fractures, Spontaneous/complications ; Human ; Kyphosis/complications ; Lung Diseases, Obstructive/complications ; Osteoporosis, Postmenopausal/complications ; Sternum/radiography ; Sternum/injuries*

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