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

Adolescent ; Child ; Female ; Humans ; Male ; Marfan Syndrome ; complications ; diagnostic imaging ; Radiography ; Scoliosis ; diagnostic imaging ; surgery

Degenerative scoliosis is one of the important reasons of low back pain in middle-aged and elderly. The surgical treatment has been gradually paid more attention to in recent years. Pain and the quality of life are the key points of the surgical treatment. In addition to neurogenic compression,clinical symptoms and health-related quality of life are also closely related to the three-dimensional deformity of spine. Researchers try to employ different classifications of degenerative scoliosis to guide personalizedly surgical treatment. In the future,osteoporosis and complications may be the research highlights in the surgical treatment of degenerative scoliosis.
Aged ; Humans ; Low Back Pain ; etiology ; Middle Aged ; Osteoporosis ; etiology ; Quality of Life ; Scoliosis ; complications ; surgery ; Spine

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.
Adolescent ; Adult ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Scoliosis ; surgery ; Spine ; surgery

OBJECTIVETo analyze thoracic complications related to the convex thoracoplasty for the treatment of rib hump deformity in patients with thoracic scoliosis.

METHODSBetween December 2003 and September 2007, 548 patients with thoracic scoliosis underwent posterior spinal correction and the convex thoracoplasty. There were 167 male and 381 female, with an average age of 16.1 years (range, 12 to 38 years). The mean preoperative rib prominence was 35 degrees (range, 16 degrees to 50 degrees).

RESULTSThe mean number of resected ribs was 4.1. The mean rib prominence was 7 degrees (range 2 degrees to 17 degrees) after operation. No death happened. Thoracic complications related to the thoracoplasty consisted of respiratory insufficiency in 1 (0.2%) patient,intraoperative tear of parietal pleura in 29 (5.3%), with a subsequent pleural effusion in 6 and pneumothorax in 3. In the other patients, no obvious tear of parietal pleura was found during operation. However, 6 (1.1%) patients had pleural effusion after operati on.

CONCLUSIONThe thoracic complications related to convex thoracoplasty can be decreased by improving the surgical skill and using respiratory function monitoring.

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Thoracic Vertebrae ; surgery ; Thoracoplasty ; adverse effects

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

OBJECTIVETo explore the clinical effects of total vertebral column resection combined with anterior mesh cage support in treating severe congenital kyphoscoliosis.

METHODSFrom April 2008 to April 2012,21 patients with severe congenital kyphoscoliosis were treated with total vertebral column resection and internal fixation through posterior approach combined with anterior mesh cage support. There were 8 males and 13 females with an average age of 19.4 years old (ranged from 10 to 35). And 6 cases were thoracic segments deformity,13 cases were thoracolumbar segments and 2 cases were lumbar segments, of them, 2 cases were accompanied with Chairs deformity, 6 cases with diastematomyelia, 4 cases with syringomyelia,and 1 case with neurofibromatosis. According to the Frankel grade system, 3 cases were grade C, 5 cases grade D and 13 cases grade E. Blood loss, operative time, and perioperative complications were recorded. Coronal and sagittal Cobb angle, apical vertebral offset distance, sagittal offset, the relative height of shoulders, razor back deformities were measured and analyzed before and after operation.

RESULTSThe average operative time was 5.2 h (3.5 to 6.5 h) and blood loss was 2,500 ml (1,400 to 4,900 ml). The 2nd day after operation, apical vertebral offset distance, sagittal offset, the relative height of shoulders, razor back deformities had obviously improved than preoperative (P < 0.05). There was no significant difference in above items between postoperative on the 2nd day and final follow-up (P > 0.05). The corrective rate of kyphosis and scoliosis were (60.97 +/- 6.30)% and (62.24 +/- 5.82)%, respectively. On the first day after surgery,2 cases of Frankel grade E aggravated to grade D, and obtained recovery at 2 week after conservative treatment. And 1 case palinesthesia later,grade D aggravated to grade C and obtained recovery after revision surgery in time. One case complicated with permanent blindness of left eye, 1 case occurred injury of pleura and 2 cases had cerebrospinal fluid leak during operation. All patients were followed up from 9 to 31 months with an av- erage of 18.6 months. At final follow-up,all patients obtained bone union, Frankel grade D in 4 cases and grade E in 17 cases, no correction loss and internal fixation loosening was found.

CONCLUSIONTotal vertebral column resection combined with anterior mesh cage support can effectively correct kyphosis and scoliosis in severe congenital kyphoscoliosis and can avoid injury of spine cord by spinal crispation, but intraoperative position and neurologic complications should still be considered.

Adolescent ; Adult ; Child ; Female ; Humans ; Kyphosis ; complications ; congenital ; diagnostic imaging ; surgery ; Male ; Retrospective Studies ; Scoliosis ; complications ; congenital ; diagnostic imaging ; surgery ; Spine ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo evaluate the surgical results of selective thoracic fusion (STF) for scoliosis associated with syringomyelia.

METHODSFrom January 2001 to January 2009, 93 cases of scoliosis associated with syringomyelia were retrospectively reviewed. There were 11 cases who underwent STF and were followed up more than 2 years, which included 8 female and 3 male, the mean age was 14.9 years (9 - 21 years). Curve type, coronal and sagittal Cobb angle, apical vertebral rotation apical vertebral translation, flexibility, trunk shift were recorded and analyzed.

RESULTSThere were 9 double curves and 2 triple curves, the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases, Lenke B in 7 cases and Lenke C in 2 cases. The average coronal Cobb angle of thoracic curve before and after surgery were 62.6° and 19.0° respectively, and the average correction rate was 69.6%. The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36.1° and 11.6° respectively, and the average spontaneous correction rate was 67.9%. The followed up time ranged from 24 to 48 months (mean 29.5 months), the average loss of correction rate was 6.8%. Only one trunk decompensation was noted at final follow-up. Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery, no neurological complication was noted at final follow-up.

CONCLUSIONSSTF could be safely performed in scoliosis associated with syringomyelia. Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients. The satisfactory result could be achieved according to the STF criteria for IS.

Adolescent ; Child ; Female ; Humans ; Male ; Retrospective Studies ; Scoliosis ; complications ; surgery ; Spinal Fusion ; methods ; Syringomyelia ; complications ; surgery ; Thoracic Vertebrae ; surgery ; Young Adult

OBJECTIVETo summarize the clinical features and evaluate the surgical results of adolescent idiopathic scoliosis (AIS) with thoracolumbar kyphosis.

METHODSFour hundred and thirteen AIS patients were retrospectively reviewed between January 2001 and January 2007. Among them, 10 patients had thoracolumbar kyphosis, including 2 males and 8 females. The average age at surgery was 14.3 years old. There were 3 PUMC type IIb2, 4 PUMC IIc3, 1 PUMCIId2, 2 PUMC IIIb. Eight patients underwent posterior correction and spinal fusion with instrumentation, 2 patients underwent anterior release, posterior correction and spinal fusion with instrumentation. By reviewing the roentgenograms of patients, the curve type, Cobb angle, flexibility, apical rotation and translation, coronal and sagittal trunk shift and thoracolumbar kyphosis were measured and analyzed.

RESULTSEight patients had double curves and 2 patients had triple curves. Among them, the Cobb angles of thoracolumbar or lumbar curve were larger than 45 degrees in 7 patients, the flexibility index was less than 70% in 6 patients, the apical vertebral rotation was larger than II degrees in 9 patients and the apical vertebral translation was larger than 2 cm in all patients. All the surgical treatment strategy and fusion level followed the criteria of PUMC classification. The coronal Cobb angles of thoracic curve before and after surgery were 71.7 degrees and 37.4 degrees respectively, and the average correction rate was 47.8%. The coronal Cobb angles of thoracolumbar or lumbar curve before and after surgery were 65.0 degrees and 27.8 degrees respectively, and the average correction rate was 57.2%. The Cobb angles of thoracolumbar kyphosis before and after surgery were 35.5 degrees and 4.2 degrees respectively, and the average correction rate was 88.2%. No trunk decompensation was noted at final follow-up. All patients were followed-up from 12 to 72 months; the average follow up was 23.1 months.

CONCLUSIONSAIS patients with thoracolumbar kyphosis usually have double or triple curves. In these patients, thoracolumbar curves or lumbar curves are severe and have obvious rotatory deformity. Thoracolumbar curve or lumbar curve should be fused in idiopathic scoliosis patients with thoracolumbar kyphosis to avoid trunk decompensation or junctional kyphosis. By using criteria of PUMC classification, these patients can be well identified and corresponding fusion level can be followed as well.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; complications ; surgery ; Lumbar Vertebrae ; Male ; Retrospective Studies ; Scoliosis ; complications ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; Treatment Outcome

OBJECTIVETo investigate the clinical results of one stage surgical treatment in congenital scoliosis (CS) patients associated with split cord malformation (SCM).

METHODSBetween January 2007 and December 2010, 50 patients underwent one stage surgical treatment for CS associated with SCM. Among of them, 38 patients (13 male and 25 female) with an average age of (15 ± 6) years, who were followed up in the clinic at least 2 years longer, were include in the study. There were 12 patients with Type I SCM and 26 patients with Type II SCM Pre-operative, post-operative and the follow-up imaging data were collected and compared by paired t-test, while imaging data between Type I SCM group and Type II SCM group were compared by group t-test. Bony spur was first resected to the Type I SCM while nothing was done to the Type II SCM. Then, all patients were followed by posterior corrective procedure in one stage. Meanwhile, duraplasty were only applied in 5 patients whose dural cleft were more than 1 cm longer.

RESULTSThe average follow-up was 41 ± 13 months (range, 26-68 months). The average operation time was 491 ± 152 minutes (range, 105-780 minutes) and the average blood loss was (1 933 ± 1 516) ml (range, 1 000-8 000 ml). The mean major coronal curve was corrected from 70° ± 26° preoperatively to 312° ± 16° postoperatively with a correction rate of 57% ± 18%, and 33° ± 17° at the final follow-up with a correction rate of 54% ± 20%. The mean major sagittal curve was corrected from 43° ± 31° to 26° ± 16°, and 27° ± 15° at the final follow-up. The postoperative complication occurred in 2 patients (5.3%) with Type I SCM, including neurological deterioration in 1 patient (2.6%) and cerebrospinal fluid leakage in 1 patient (2.6%). There were no paralysis and other serious complications. The patients who suffered from neurological deterioration recovered to the preoperative neurological status at 30 months postoperatively and no further improvement at the final follow-up.

CONCLUSIONIt is safe and efficient to treat the CS associated with SCM by one stage surgery without increasing the risk of neurological complications postoperatively.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Neural Tube Defects ; complications ; surgery ; Retrospective Studies ; Scoliosis ; complications ; congenital ; surgery ; Treatment Outcome ; Young Adult