Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
Arthritis, Rheumatoid/blood/complications/*pathology/radiography ; Female ; Fractures, Compression/etiology/radiography/surgery ; Humans ; Lumbar Vertebrae/*pathology/radiography ; Middle Aged ; Thoracic Vertebrae/*pathology/radiography ; Vertebroplasty

BACKGROUND: To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. METHODS: Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. RESULTS: The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar. CONCLUSIONS: When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disk Degeneration/*surgery ; Lordosis/*radiography ; Lumbar Vertebrae/pathology/*radiography/surgery ; Male ; Middle Aged ; Prosthesis Implantation ; Retrospective Studies ; *Spinal Fusion ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery

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

OBJECTIVETo study the treatment of spinal fractures in ankylosing spondylitis.

METHODSNineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively.

RESULTSAll of 19 cases were up to the diagnosis standards of ankylosing spondylitis. Eleven patients had cervical fracture and 8 had thoracolumbar fracture. Of the patients with cervical fracture, fractures occurred at C(5 - 7) in 9 patients. Of the patients with thoracolumbar injury, stress fractures were seen in 7 patients and all of seven fractures occurred at T(10)-L(2). Sixteen of the 19 patients sustained fractures through three columns of the spine. Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture. All of the 19 patients were treated operatively. Four different surgical procedures were used in patients with cervical fracture; decompression, fusion and stabilization with instrumentation by anterior approach were performed in 9 patients. Of the patients with thoracolumbar fractures, four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases. Eighteen patients had an average follow-up period of 46.6 months. Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1. Radiographic evidence of fusion was observed in all of the 18 patients. Two patients suffered neurological deterioration during surgery. One patient died from cerebrovascular infarction. Two patients had pneumonia after the operative procedure.

CONCLUSIONSSpinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury. Shearing fracture usually occurs at the lower cervical spine (C(5 - 7)) and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine. Surgical intervention may be indicated in this injury. Fracture union and neurological improvement can be achieved in most patients treated by operation. We suggest that, fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture, and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture. Complications is not rare after surgery and appropriate preventive measures are necessary for these patients.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; complications ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; Postoperative Care ; Postoperative Complications ; prevention & control ; Radiography ; Retrospective Studies ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.

METHODSFrom April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups. Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion. The two groups were compared for clinical and radiological outcomes.

RESULTSAll patients were followed up for 12 to 72 months. In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24). Two cases suffered from residual symptoms. Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%. No infection or neurological complication occurred in this group. In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21). One case suffered from residual symptoms. Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%. Four cases of infection or neurological complication occurred in this group. Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up. But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.

CONCLUSIONSThe first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion. Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fusion ; methods ; Spinal Stenosis ; diagnostic imaging ; pathology ; surgery ; Spondylolisthesis ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo have a retrospective review of the patients undergoing anterior lumbar interbody fusion (ALIF) with clinical and radiological assessment, and observe changing of graft after procedure and assess correlation between graft collapse and recurrence of radiculopathy.

METHODSSixty-seven consecutive patients undergoing ALIF only at L(4 - 5) with autologous iliac crest graft for intervertebral disc prolapse were followed-up for an average of 14 (2.5 - 32) years. The effect of the fusion was examined by the existence of radiolucent lines and bony continuity on plain radiographs and tomographs, or mobility on flexion-extension radiographs. The disc height was also measured. Lower limb radiculopathy was assessed based on the symptom and examination. Paired samples t-test was used for statistical analysis.

RESULTSSixty-four patients with successful fusion were analyzed (fusion rate: 96%). All measurements in this study were completed by the same author, and the measurement error of more than 2 mm was statistically significant. According to this, graft collapse occurred in 55 patients (86%) and 9 patients (14%) had no graft collapse. In these 55 cases, the original disc height was (12.1 +/- 2.9) mm, increased immediately after the surgery to (16.2 +/- 1.9) mm, however re-narrowed to (12.9 +/- 2.7) mm at the first observation of solid fusion (a mean of 9 months, ranging from 5 to 14 months), which was not significant different compared to the original. There was no significant change in disc height after solid fusion and the disc space at the final follow-up was (12.6 +/- 2.3) mm. There was no radiculopathy observed in 52 cases (95%) during the follow-up.

CONCLUSIONDisc space re-narrowing was observed in most cases after single level ALIF of L(4 - 5), however it was rarely less than the initial and unlikely to result in recurrence of radiculopathy.

Adult ; Equipment and Supplies ; Female ; Follow-Up Studies ; Humans ; Low Back Pain ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Lumbosacral Region ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Recurrence ; Spinal Fusion ; methods ; Spinal Osteophytosis ; surgery ; Time Factors ; Transplantation, Autologous ; methods ; Treatment Outcome

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

BACKGROUND: We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. METHODS: Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. RESULTS: For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. CONCLUSIONS: PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.
Adult ; Aged ; Blood Loss, Surgical ; Bone Transplantation/*methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disk Degeneration/*radiography/*surgery ; Lumbar Vertebrae/pathology/*radiography/*surgery ; Male ; Middle Aged ; Prosthesis Implantation/methods ; Retrospective Studies ; Spinal Fusion/*methods ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery ; Time and Motion Studies ; Treatment Outcome

BACKGROUND: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. METHODS: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. RESULTS: The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). CONCLUSIONS: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.
Aged ; Aged, 80 and over ; Bone Density Conservation Agents/*therapeutic use ; Diphosphonates/*therapeutic use ; Female ; Humans ; Imidazoles/*therapeutic use ; Lumbar Vertebrae/drug effects/pathology/radiography/surgery ; Male ; Middle Aged ; Osteoporosis/drug therapy ; Pain Measurement ; Pain, Postoperative ; Quality of Life ; Retrospective Studies ; Spinal Fusion/adverse effects/*methods ; Spinal Stenosis/pathology/radiography/*surgery ; Treatment Outcome

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery