1.Early outcome of one-stage posterior transpedicular hemi-vertebra resection in the treatment of children with congenital scoliosis.
Yang YU ; Wen-Jun CHEN ; Yong QIU ; Bin WANG ; Bang-Ping QIAN ; Ze-Zhang ZHU ; Feng ZHU ; Xu SUN ; Wei-Wei MA
Chinese Journal of Surgery 2010;48(13):985-988
OBJECTIVETo evaluate the early outcomes of children with congenital scoliosis treated by one-stage transpedicular hemi-vertebra resection.
METHODSFrom July 2005 to June 2006, 27 consecutive cases of congenital scoliosis managed by one-stage transpedicular hemi-vertebra resection with instrumentation were investigated retrospectively. There were 11 girls and 16 boys, with a mean age of 5.5 years at surgery (range 1.3 - 10.0 years). Location of the hemi-vertebra was in the thoracic spine in 12 cases and in the lumbar spine in 15 cases. Radiographic evaluations were performed on the preoperative, postoperative, and latest follow-up standing posteroanterior and lateral radiographs.
RESULTSThe average operation time was 4 hours (range 3-6 hours), and the mean blood loss during operation was 750 ml (range 300 - 2200 ml). The mean fusion level was 2 to 7 segments, average 4.4 segments. The average follow-up period was 16 months (range 12 - 34 months). Mean Cobb angle of the total main curve was 40.0° before surgery, 12.6° after surgery, and 15.2° at latest follow-up. Mean Cobb angle of the segmental main curve was 35.6° before surgery, 11.6° after surgery, and 12.1° at latest follow-up. The trunk shift was improved from 16.5 mm before operation to that of 7.5 mm after the operation and 7.6 mm at the latest follow-up. Compensatory cranial curve improved from 19.4° before surgery to 8.9° after surgery, and compensatory caudal curve improved from 26.3° to 12.8°. The angle of segmental kyphosis was 26.4° before surgery and 14.6° after surgery in cases with thoracic hemivertebrae, and averaged 11.2° before surgery and 3.9° after surgery in cases with lumbar hemivertebrae. Peri-operative complications included two pedicle screws malpositioning and one case with pelvic tilt. There was no neurological complication.
CONCLUSIONOne-stage transpedicular hemi-vertebra resection with instrumentation has a good capability of correcting deformity on the frontal and sagittal planes, which is available in children with middle or lower thoracic or lumbar hemivertebrae.
Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Lumbar Vertebrae ; abnormalities ; surgery ; Male ; Retrospective Studies ; Scoliosis ; congenital ; surgery ; Thoracic Vertebrae ; abnormalities ; surgery ; Treatment Outcome
2.Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases.
Ye Soo PARK ; Hong Sik KIM ; Seung Wook BAEK ; Sang Hyun LEE
Clinics in Orthopedic Surgery 2013;5(3):225-229
Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.
Aged
;
*Bone Screws
;
Cohort Studies
;
Female
;
Humans
;
Ilium/surgery
;
Lumbar Vertebrae/*abnormalities/*surgery
;
Male
;
Middle Aged
;
Sacrum/surgery
;
Spinal Fusion/adverse effects/*instrumentation/methods
;
Treatment Outcome
3.Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review.
Farzad OMIDI-KASHANI ; Ebrahim Ghayem HASANKHANI ; Amir ASHJAZADEH
Asian Spine Journal 2014;8(4):521-530
Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain
;
Congenital Abnormalities
;
Constriction, Pathologic
;
Decompression
;
Failed Back Surgery Syndrome
;
Humans
;
Lumbar Vertebrae
;
Osteoarthritis
;
Radiculopathy
;
Spinal Fusion
;
Spinal Stenosis*
;
Spine
;
Spondylolysis
4.Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review.
Farzad OMIDI-KASHANI ; Ebrahim Ghayem HASANKHANI ; Amir ASHJAZADEH
Asian Spine Journal 2014;8(4):521-530
Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain
;
Congenital Abnormalities
;
Constriction, Pathologic
;
Decompression
;
Failed Back Surgery Syndrome
;
Humans
;
Lumbar Vertebrae
;
Osteoarthritis
;
Radiculopathy
;
Spinal Fusion
;
Spinal Stenosis*
;
Spine
;
Spondylolysis