OBJECTIVE: In this study, we retrospectively evaluate the surgical outcome of the cervical fracture-dislocation in order to define the criteria for the operative approach selection based on fracture characteristics. METHODS: Thirty one consecutive patients (29 males and 2 females) who underwent operation for the cervical fracture-dislocation between 1997 and 2001 at a single institute were included in this study. Plain X-ray, computed tomography, and magnetic resonance imaging studies were performed in all patients. Injuries were characterized using Denis's three-column plain X-ray model, Daffer's computed tomography, and Oner's magnetic resonance imaging classifications. The Frankel classification was used for neurological deficits. The mean postoperative follow-up period was 11.93 months (range 1-61 months). RESULTS: The anterior approach was performed in 14 and the posterior approach in 10 of the 31 patients, respectively. Both anterior and posterior fixation was performed electively in 7 of the 31 patients. Daffer and Oner's classification was found to be able to predict surgical failures by either the anterior or the posterior approach. Three-column injury was misinterpreted as two-column injury only by plain radiography. No differences in neurological outcome, pain relief, or bone fusion rate were observed between the anterior approach and the posterior approach. However, the posterior approach was associated more frequently with postoperative kyphosis and instability. CONCLUSION: Surgical approach is usually determined on the basis of whether the compression is ventral or dorsal. Anterior fixation only may be an alternative to both anterior and posterior fixation in three-column injury, but posterior fixation alone is not.
Classification ; Follow-Up Studies ; Humans ; Kyphosis ; Magnetic Resonance Imaging ; Male ; Radiography ; Retrospective Studies

BACKGROUNDAlthough previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis, two-stage surgery strategy (less invasive internal distraction followed by posterior correction and instrumentation) has never been reported in the treatment of patients with severe spinal deformity. This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.

METHODSA total of 15 patients with severe scoliosis, kyphoscoliosis or kyphosis who underwent two-stage surgeries (less invasive internal distraction followed by posterior correction and instrumentation) were studied based on hospital records. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.

RESULTSThe average major curve magnitude was 129.4° (range, 95° to 175°), reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery. The loss of correction during the interval between two surgeries was 7.1%. The total major coronal curve correction was 81.4° or 62.9%. At the final follow up, the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%. The average major sagittal curve magnitude was 80.3° (range, 30° to 170°), and the total major sagittal curve correction was 48.2°. Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 42.2°. Clinical complications were noted in the peri-operative and long-term periods.

CONCLUSIONSTwo-stage surgery was a safe and effective surgical strategy in this difficult population. Using two-small-incision technique, the first stage surgery was less invasive. No permanent neurologic deficit was noted in this series.

Adolescent ; Child ; Female ; Humans ; Kyphosis ; diagnostic imaging ; surgery ; Male ; Radiography ; Scoliosis ; diagnostic imaging ; surgery ; Treatment Outcome

BACKGROUND: Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients. METHODS: A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate. RESULTS: Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001). CONCLUSIONS Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.
Adult ; Humans ; Kyphosis/diagnostic imaging* ; Magnetic Resonance Imaging ; Middle Aged ; Radiography ; Retrospective Studies ; Spine/diagnostic imaging* ; Spondylitis, Ankylosing/diagnostic imaging*

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*

A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.
Aged ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Endoscopes ; Female ; Gallstones ; Humans ; Hypertension ; Kyphosis* ; Lasers, Solid-State ; Lithotripsy ; Lithotripsy, Laser* ; Radiography ; Thorax

STUDY DESIGN: This is a prospective study of 85 patients. OBJECTIVES: We wanted to identify the changes of ROM and sagittal alignment of the cervical spine after laminoplasty, and we wanted to determine the preoperative factors affecting the ROM and sagittal alignment of the cervical spine after laminoplasty. SUMMARY OF THE LITERATURE REVIEW: Cervical laminoplasty is an effective procedure for decompressing multilevel spinal cord compression. It has been reported that the ROM of the cervical spine was decreased after laminoplasty. It is well known that preoperative lordosis of the cervical spine is prerequisite for performing laminoplasty. Maintaining the postoperative lordosis of the cervical spine is also important for decompressing the spinal cord after laminoplasty. MATERIALS AND METHODS: Eighty-five patients who underwent open door laminoplasty from the C3 to C7 levels were prospectively studied. The minimum follow-up was two-years. The preoperative diagnosis was cervical spondylotic myelopathy (CSM) for 52 patients, ossification of the posterior longitudinal ligament (OPLL) for 29 patients and multilevel cervical disc herniation for 4 patients. Plain cervical spine lateral radiography in the neutral, flexion and extension positions was performed preoperatively and at the two-year follow-up. The cervical lordosis or kyphosis was measured by Cobb's method. The diagnosis, degree of preoperative lordosis in the neutral position, and the degree of preoperative sagittal alignment in flexion and extension were studied as the risk factors for postoperative kyphosis. RESULTS: The preoperative ROM of the cervical spine was 29.2 degrees and the postoperative ROM was 20.3 degrees. Therefore, 30.5% of the preoperative ROM was decreased after laminoplasty. A decreased ROM of more than 50% was found in 13 patients (15.3%). Their diagnosis was CSM in 11 patients (11/52, 21.1%) and OPLL in 2 patients (2/29, 6.9%). There were no significant differences in preoperative ROM between the two groups with decreased ROM being noted in more than 50% of the patients and decreased ROM being noted in less than 50% of the patients. The preoperative lordotic angle in the neutral position was 16.2 degrees and the postoperative lordotic angle was 11.4 degrees. Kyphosis (mean: 12.2 degrees) developed in 9 patients (9/85, 10.6%) after the surgery. Their preoperative diagnosis was CSM in all patients. The preoperative lordotic angle was significantly less in the kyphotic group than in the lordotic group. The preoperative flexion was 10.2 degrees greater and the preoperative extension was 10.3 degrees less in the kyphotic group than in lordotic group. The preoperative flexion angle was 19.3 degree kyphosis and the extension angle was 8.7 degree lordosis in the kyphotic group. CONCLUSIONS: The ROM of the cervical spine was decreased 30.5% after laminoplasty. Kyphosis developed in 10.6% of the patients. The preoperative factors affecting postoperative kyphosis were the diagnosis of CSM, a preoperative lordosis less than 10 degrees and a greater preoperative flexion angle than the extension angle. Therefore, kyphosis after laminoplasty was expected in a patient with the above three preoperative factors, so other treatment options such as instrumented fusion should be considered.
Animals ; Diagnosis ; Follow-Up Studies ; Humans ; Kyphosis ; Longitudinal Ligaments ; Lordosis ; Prospective Studies ; Radiography ; Range of Motion, Articular* ; Risk Factors ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine*

STUDY DESIGN: Observational cohort study. PURPOSE: To assess the surgical outcomes of posterior decompression and fusion for cervical myelopathy in patients with athetoid cerebral palsy. OVERVIEW OF LITERATURE: Patients with athetoid cerebral palsy demonstrate involuntary movements and develop severe cervical spondylosis with kyphosis. In these patients, surgery is often performed at an early age because of myelopathy. A few studies have reported about the long-term outcomes of surgical treatment; however, they contain insufficient information. METHODS: From 2003 to 2008, 13 patients with cervical myelopathy due to athetoid cerebral palsy underwent posterior fusion surgery and were included in this study. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), C2–7 angle on radiography, and need for additional surgical treatment were examined at 1 and 5 years postoperatively. RESULTS: The mean C2–7 angle was −10.5°±21.1° preoperatively and was corrected to −2.9°±13.5° immediately postoperatively. This improvement was maintained for 5 years. The JOA score was 9.5±2.5 preoperatively and 12.2±1.7 at the 5-year follow-up. NDI was 17±6.9 preoperatively and 16±7.5 at the 5-year follow-up. Patient satisfaction with surgery on a 100-point scale was 62.2±22.5 at the 5-year follow-up. Three patients needed additional surgery for loosening of screws. These results demonstrate good surgical outcomes for posterior fusion at 5 years. CONCLUSIONS: Posterior decompression and fusion should be considered a viable option for cervical myelopathy in patients with athetoid cerebral palsy.
Asian Continental Ancestry Group ; Cerebral Palsy* ; Cohort Studies ; Decompression ; Dyskinesias ; Follow-Up Studies* ; Humans ; Kyphosis ; Neck ; Patient Satisfaction ; Radiography ; Spinal Cord Diseases* ; Spine ; Spondylosis

OBJECTIVESTo evaluate the influence of thoracic kyphosis to sagittal alignment and balance of the lumbosacral vertebrae in thoracic adolescent idiopathic scoliosis patients.

METHODSStanding posteroanterior and lateral x-rays of a cohort of 55 patients with thoracic adolescent idiopathic scoliosis were obtained. The patients were classified according to their thoracic kyphosis, the first group TK < 10 degrees and the second group 10 degrees < or = TK < or = 40 degrees . The following parameters were measured: lumbar lordosis (LL), upper and lower arc of lumbar lordosis, sagittal vertical axis, sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT). Sagittal plane parameters were analyzed using t-test between two groups, with significance set at P < 0.05. Linear correlations between parameters were calculated using Pearson correlation coefficients, with significance set at P < 0.01.

RESULTSThere were smaller LL and upper arc of lumbar lordosis in the first group. Significant linear correlations were found between each single adjacent shape parameter. Significant correlations were also found between TK, LL and upper arc of lumbar lordosis, as well as between PT, SS and PI.

CONCLUSIONSSagittal alignment and balance of the lumbosacral vertebrae may influence the thoracic kyphosis in AIS patients. The mechanism of this influence may through the adaptation of upper arc of lumbar lordosis. This influence must be considered in thoracic adolescent idiopathic scoliosis patients who undergo selective posterior thoracic fusion.

Adolescent ; Adult ; Female ; Humans ; Kyphosis ; complications ; pathology ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; Male ; Radiography ; Sacrum ; diagnostic imaging ; pathology ; Scoliosis ; complications ; pathology ; Thoracic Vertebrae ; diagnostic imaging ; pathology

OBJECTIVE: To investigate the correlation between the changes of cervical curvature and atlantoaxial instability. METHODS: The correlation between the changes of cervical curvature and atlantoaxial instability was retrospectively studied in 50 outpatients with abnormal cervical curvature (abnormal cervical curvature group) from January 2018 to December 2019. There were 24 males and 26 females in abnormal cervical curvature group, aged from 18 to 42 years old with an average of(30.62±5.83) years. And 53 patients with normal cervical curvature (normal cervical curvature group) during the same period were matched, including 23 males and 30 females, aged from 21 to 44 years with an average of(31.98±6.11) years. Cervical spine X-ray films of 103 patients were taken in lateral position and open mouth position. Cervical curvature and variance of bilateral lateral atlanto-dental space(VBLADS) were measured and recorded, Pearson correlation coefficient analysis was used to study the correlation between the changes of cervical curvature and atlantoaxial instability. RESULTS: Atlantoaxial joint instability accounted for 39.6%(21/53) in normal cervical curvature group and 84.0%(42/50) in abnormal cervical curvature group. There was significant difference between two groups(P<0.01). VBLADS in abnormal cervical curvature group was (1.79±1.01) mm, which was significantly higher than that in normal cervical curvature group(0.55±0.75) mm(P<0.01). Pearson correlation coefficient analysis showed that the size of cervical curvature was negatively correlated with VBLADS. CONCLUSION Cervical curvature straightening and inverse arch are the cause of atlantoaxial instability, the smaller the cervical curvature, the more serious the atlantoaxial instability.
Adolescent ; Adult ; Atlanto-Axial Joint/diagnostic imaging* ; Cervical Vertebrae/diagnostic imaging* ; Female ; Humans ; Joint Instability/diagnostic imaging* ; Kyphosis ; Male ; Radiography ; Retrospective Studies ; Young Adult

BACKGROUND: Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. METHODS: To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. RESULTS: The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80degrees +/- 17.19degrees and 33.23degrees +/- 14.39degrees, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). CONCLUSIONS: The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.
Adolescent ; Adult ; Cerebral Palsy/complications ; Child ; Female ; Humans ; Kyphosis/radiography ; Lordosis/radiography ; Lumbar Vertebrae/radiography/surgery ; *Magnetic Resonance Imaging ; Male ; Muscular Dystrophy, Duchenne/complications ; Prospective Studies ; Scoliosis/complications/radiography/*surgery ; Severity of Illness Index ; Spinal Cord/*pathology ; Thoracic Vertebrae/radiography/surgery ; Young Adult