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

BACKGROUNDThis study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotomy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design.

METHODSFrom April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotomy with instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 cases underwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the osteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method.

RESULTSThe distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such: 9 male and 7 female, the mean age was 49.2 years (range 38-70), the kyphosis improved from an average of 30 degrees (range 15 degrees-45 degrees) preoperatively to 4 degrees (range -26 degrees-30 degrees) postoperatively, the kyphosis was corrected on average 2.5 degrees per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2 degrees. As a result, there was no significant difference (P > 0.05) when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such: 5 male and 9 female, the mean age was 35.3 years old (range 15 - 57), the kyphosis improved from an average of 64 degrees (range 34 degrees-95 degrees) preoperatively to 8.7 degrees (range -10 degrees-22 degrees) postoperatively. The kyphosis was corrected on average of 6.2 degrees per 1 mm in the height of the osteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6 degrees . There was also no significant difference (P > 0.05) when comparing the measurement collected with the result simulated from the geometric model.

CONCLUSIONSThe therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach. The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5 degrees and the maximum angle of correction of 45 degrees . The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per 1 mm of 6.2 degrees . It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to help us constructing preoperative design.

Adult ; Aged ; Female ; Humans ; Kyphosis ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Osteotomy ; Thoracic Vertebrae ; surgery

Humans ; Kyphosis ; surgery ; Lumbar Vertebrae ; surgery ; Osteotomy ; adverse effects ; methods ; Thoracic Vertebrae ; surgery

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

OBJECTIVETo summarize the clinical characteristics of severe adolescent idiopathic cervical kyphosis and the operation method.

METHODSA retrospective study was performed in 12 adolescent patients with severe cervical kyphosis treated from July 2003 to January 2007. Preoperative the Cobb angle of kyphosis range from 55 degrees to 73 degrees (average 61 degrees ). According to the angles between the posterior vertebral body tangents at every involved level on lateral cervical radiograph in extension, the osteotomy angles and range of lamina and facet were decided. The anterior release and posterior osteotomy were performed firstly. Then skull traction was maintained in order to correct the deformity as long as possible, fusion and internal fixation was completed after 7-10 days. The cervical coronal and sagittal planes X-rays and the MR were hold after operation 3 days, 3 months, 6 months, 1 year and 2 years. At the same time the treatment result, bone fusion and the instrumentation were followed up, and the symptoms were compared between pre-operation and post-operation.

RESULTSThe defect appearance of the patients was improved significantly, with the total disappearance of neck pain and improvement of nerve function. Post-operational cervical spine MR showed that the physiological curve of cervical spine was restored, cerebral spinal fluid line was clear in the kyphosis area and no spinal cord compression was found. X-ray imaging of post-operation 3 d showed that Cobb angle ranged from -12.3 degrees to 11.2 degrees with an average of -2.0 degrees . Beside one patient's AISA score was D, other patient's AISA score was E.

CONCLUSIONSThe severe adolescent idiopathic cervical kyphosis has its own clinical manifestation. It is an ideal treatment to completely assess the deformity, have staging operation and skull traction between two operations.

Adolescent ; Cervical Vertebrae ; surgery ; Female ; Humans ; Kyphosis ; surgery ; Male ; Retrospective Studies ; Spinal Fusion ; methods

OBJECTIVETo evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis.

METHODSFrom August 2002 to October 2009, 34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients. Four patients underwent posterior correction surgeries with single growing rod (single growing rod group), 30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group). The average age at initial surgery was 6.9(2-13) years. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation including scoliosis, trunk translation, length of T1-S1, thoracic kyphosis and lumbar lordosis was conducted.

RESULTSThe follow-up was 40.5 (24-110) months. In single growing rod group, the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up. T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery, and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year. The space available for lung ratio(SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up. Three patients reached final fusion. Four complications occurred in 3 of the 4 patients. In dual growing rod group, the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion. T1-S1 length increased from (25 ± 5) cm to (29 ± 5)cm after initial surgery and to (33 ± 5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year. The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications.

CONCLUSIONSGrowing rod technique is a safe and effective choice for young children of long, complex congenital scoliosis. It maintains correction achieved at initial surgery while allowing spinal growth to continue. Implants-related complications remain the biggest challenge.

Humans ; Kyphosis ; Lordosis ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; Spine ; surgery

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

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

OBJECTIVE: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. METHODS: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12－48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. RESULTS: The average traction time of 24 cases was (2.5±1.1) weeks (1－5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136－176 cm) respectively, showing significant difference (P < 0.05), and the increased height was (12.4±4.6) cm (4－20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°－158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°－92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P < 0.05). The traction's coronal correction rate was 37.2%±10.9% (11.9%－51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°－163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°－92°)] and post-surgery [39.0°±16.8°(10°－68°)](P < 0.05). The traction's sagittal correction rate was 40.0%±10.7%(16.7%－55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%－87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P < 0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P < 0.05). CONCLUSION The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.
Adolescent ; Adult ; Female ; Humans ; Kyphosis/surgery* ; Male ; Retrospective Studies ; Scoliosis/surgery* ; Traction ; Treatment Outcome ; Young Adult

BACKGROUNDThe advantages of video assisted thoracoscopic anterior correction for scoliosis are minimal invasion and relatively short-time instrumentation; however the relatively steep learning curve cannot be ignored. Small incision, thoracotomic anterior correction for idiopathic thoracic scoliosis could be another choice because of less demanding technique. We compared the outcomes of these two techniques.

METHODSForty-nine patients with idiopathic right thoracic scoliosis were randomly divided into two groups. Group A was 12 girls with mean age 14.9 years, mean Cobb angle 52 degrees and Risser signs "+++" to "++++". Ten patients received video assisted thoracoscopic anterior correction with Eclipse rectification and two with Frontier instrumentation. Group B was 4 boys and 33 girls with mean age 14.1 years, mean Cobb angle of 56 degrees and Risser signs "++" to "++++". These patients underwent small incision, thoracotomic anterior instrumentation. The operation time, blood loss, postoperative drainage, instrumented levels, curve correction and early loss of correction of both groups were analyzed.

RESULTSGroup A had average operation time of (390+/-82) minutes, intraoperative blood loss of (600+/-155) ml, instrumented level of 7.4+/-1.3, postoperative drainage of (500+/-160) ml, correction rate of (65+/-16)% and loss of correction during the 18-36 month followup of (8.6+/-2.9)%. Group B had average operative time of (220+/-80) minutes, intraoperative blood loss of (320+/-120) ml, instrumented level of 7.8+/-0.9, postoperative drainage of (210+/-90) ml, curve correction rate of (70+/-12)% and loss of correction during the 18-36-month followup of (4.6+/-3.9)%. The curve correction rates of the two groups were not statistically significant (P>0.05). However, the operative time, blood loss, postoperative drainage, and early loss of correction showed statistical significance (P<0.05).

CONCLUSIONBoth video assisted thoracoscopic anterior correction and small incision thoracotomic anterior correction are safe and effective in correcting the idiopathic thoracic scoliosis.

Adolescent ; Adult ; Child ; Female ; Humans ; Kyphosis ; surgery ; Male ; Scoliosis ; surgery ; Thoracic Surgery, Video-Assisted ; methods ; Thoracic Vertebrae ; surgery ; Thoracotomy ; methods