OBJECTIVETo obtain the spinal anatomic data of children for the development of implants used for scoliosis correction in children.

METHODSTwelve children cadaver spines (C(3)-L(5)) were separated into single vertebrae after CT scanning of the specimens. The transverse and sagittal pedicle length, transverse and sagittal pedicle angle, pedicle length versus spinal level were measured with either electronic vernier caliper or on reconstructed 3D model of the spine.

RESULTSThe transverse pedicle length, sagittal pedicle length, transverse pedicle angle, sagittal pedicle angle and pedicle length were significantly different among cervical, thoracic and lumbar groups, and these data suggest significant differences of children's pedicle from the documented adult spine data.

CONCLUSIONThe measurement can provide basic anatomic data for the development of the implant for scoliosis correction in children.

Child ; Female ; Humans ; Male ; Prostheses and Implants ; Scoliosis ; pathology ; surgery ; Spine ; anatomy & histology ; surgery

OBJECTIVETo study the local infiltration length of spinal bone giant cell tumor and chordoma in various para-tumorous tissues.

METHODSSurgical specimens from 7 patients with bone giant cell tumor and 10 patients with chordoma were divided into 6 groups: cortical bone group (CBG, para-tumorous tissue is bone cortex with periosteum), cartilage group (CG, para-tumorous tissues contain intervertebral disc, cartilage endplate and facet joint cartilage), trabecular bone group (TBG), paraspinal muscle tissue group (MTG), adipose tissue group (ATG) and scar tissue group (STG). Macroscopically margin (MSM) in the fresh specimens, histological margin (HLM) in the H&E sections and molecular margin (MCM) in the immunohistochemical staining sections were measured respectively. Three types of the margins of each group and MSM-HLMs, and MSM-MCMs among all groups were compared.

RESULTSAnalysis of Variance comparing MSM, HLM and MCM within each group showed that there were significant differences in all groups (P < 0.05) except for CBG and CG. MSMs were significantly longer than HLMs and MCMs in TBG and MTG (P < 0.05), and MSMs were significantly longer than MCMs in ATG and STG (P < 0.05). MSM-HLMs and MSM-MCMs of TBG and ATG were significantly larger than those of CG and CBG. MSM-HLMs and MSM-MCMs of MTG and STG were significantly larger than those of CG; in addition, MSM-MCM of STG was significantly larger than CBG's. The maximum of tumor infiltration length in CBG, MTG, ATG and STG were 11.68 mm, 13.08 mm, 8.64 mm and 9.98 mm respectively.

CONCLUSIONSEach vertebra can be seen as a compartment, so total spondylectomy is an optimal procedure when bone giant cell tumor and chordoma localized in the compartment. To achieve a wide resection, a 1.3 cm wide margin in para-tumorous cancellous bone, a 1.5 cm wide margin in para-tumorous muscle and 1.0 cm wide margin in adipose tissues are necessary. First-time resection should be more aggressive and avoid tumor cell contamination. The surgical extent of salvage revision should contain para-tumorous scar tissue with the margin no less than 1.0 cm.

Adolescent ; Adult ; Aged ; Chordoma ; pathology ; surgery ; Female ; Giant Cell Tumor of Bone ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Spinal Neoplasms ; pathology ; surgery ; Spine ; pathology

OBJECTIVETo ascertain the correlation between histological grades (HGs) of vertebral growth plates and Risser grades in idiopathic scoliosis (IS) patients; to identify whether digital skeletal age (DSA) is a reliable indicator for accurate evaluation of the spinal residual growth potential.

METHODSTwenty eight Chinese female patients were available for this study. Superior and inferior growth plates were obtained at each level when anterior approach surgeries were performed. Histological examinations were conducted after the specimens were processed. The patients were evaluated by DSA stages in this study. Correlations between histological grades, menarchal status, and chronological age were analyzed.

RESULTSThere was a negative correlation between the following: HGs and DSA stages in 28 cases (r = -0.541, P = 0.003), and HGs and menarchal status in patients in DSA stage III (r = -0.591, P = 0.006). Statistical significance of growth activity of growth plates was found between patients in DSA-stage II and those in DSA-stage III (P = 0.014).

CONCLUSIONSDSA may be a reliable indicator for predicting the spinal residual growth potential in IS patients, but it should be correlated with menarchal status and chronological ages.

Adolescent ; Adult ; Age Determination by Skeleton ; Female ; Finger Phalanges ; diagnostic imaging ; Growth Plate ; growth & development ; pathology ; surgery ; Humans ; Menarche ; Scoliosis ; pathology ; physiopathology ; surgery ; Spine ; growth & development ; pathology ; surgery

OBJECTIVE: To evaluate the curative effect of percutaneous vertebroplasty (PVP) for senile osteoporotic vertebral compressive fractures with posterior vertebral defect and spinal canal compromise.
 METHODS: A total of 50 patients with osteoporotic vertebral compressive fractures (50 vertebrae) underwent PVP from July, 2010 to October, 2013. Subsequent visual analogue scale (VAS) rating, analgesic utilization and mobility were recorded before and after the surgery.
 RESULTS: A total of 42 patients were followed up completely. The median VAS, analgesic administration score and patients' mobility score was significantly decreased at the 2nd hour, the 3rd day, the 1st month, the 3rd month, the 6th month and the 1st year after the surgery compared with those at the pre-operation (P<0.01). Five recurrence fractures were observed after PVP.
 CONCLUSION PVP is safe and effective and it is worthy for clinical popularization and application.
Fractures, Compression ; surgery ; Humans ; Osteoporotic Fractures ; surgery ; Pain Measurement ; Spinal Canal ; pathology ; Spinal Fractures ; surgery ; Spine ; pathology ; surgery ; Treatment Outcome ; Vertebroplasty

OBJECTIVETo investigate the morphology of the growth plates in anterior and posterior spinal column in adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) respectively.

METHODSSeventeen AIS patients (mean age 13.6 years, ranged 10 to 17 years) were recruited in this study and 10 patients with CS (mean age 9.3 years, ranged 6 to 12 years) were selected as control group. Growth plates were harvested during anterior and posterior surgery and then were paraffin embedded, sectioned at the thickness of 6 microm, and stained with Heametoxylin and Eosin. Quantitative histomorphometric analysis was made to measure the area and height of proliferative and hypertrophic zones by image analysis system.

RESULTSIn AIS, the hypertrophic and proliferative zones were significantly larger and/or higher in anterior column than those in posterior column (P < 0.05). The sizes of different subtype zones were similar in anterior and posterior columns in CS.

CONCLUSIONThe histological difference between anterior and posterior spinal column may exist in patients with AIS. The overgrowth of the anterior spinal column may predispose to lordotic instability and development of spine deformity.

Adolescent ; Child ; Female ; Growth Plate ; pathology ; Humans ; Male ; Osteogenesis ; Scoliosis ; pathology ; physiopathology ; surgery ; Spine ; pathology ; surgery ; Thoracic Vertebrae ; growth & development ; pathology

Scoliosis is a complex spinal three-dimensional malformation with complicated pathogenesis, often associated with complications as thoracic deformity and shoulder imbalance. Because the acquisition of specimen or animal models are difficult, the biomechanical study of scoliosis is limited. In recent years, along with the development of the computer technology, software and image, the technology of establishing a finite element model of human spine is maturing and it has been providing strong support for the research of pathogenesis of scoliosis, the design and application of brace, and the selection of surgical methods. The finite element model method is gradually becoming an important tool in the biomechanical study of scoliosis. Establishing a high quality finite element model is the basis of analysis and future study. However, the finite element modeling process can be complex and modeling methods are greatly varied. Choosing the appropriate modeling method according to research objectives has become researchers' primary task. In this paper, the author reviews the national and international literature in recent years and concludes the finite element modeling methods in scoliosis, including data acquisition, establishment of the geometric model, the material properties, parameters setting, the validity of the finite element model validation and so on.
Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Humans ; Scoliosis ; physiopathology ; surgery ; Spine ; pathology

OBJECTIVETo explore the effect of reduction on spino-pelvic balance in treating high-grade lumbar spondylolisthesis.

METHODSFrom Augest 2008 to Augest 2011, the data of 16 patients with high-grade lumbar spodylolisthesis (Meyerding grade III or more than grade III) underwent reduction treatment through posterior approach were retrospectively analyzed. There were 9 males and 7 females, aged from 24 to 65 years old with an average of 44 years. Preoperative, postoperative at 2 weeks and final follow-up, spino-pelvic parameters of all patients were measured and compared by total legth lateral X-rays, and spino-pelvic parameters included sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL) and sagittal vertical axis (SVA); the informations of intervertebral bone fusion was observed by CT and postoperative complications were recorded; clinical effects were assessed according to clinical Oswestry score (CODI).

RESULTSAll patients were followed up from 12 to 24 months with an average of 18 months. Four cases reduced anatomically, 8 cases reduced to grade I .4 cases reduced to grade II. There was statistically significant differences in sacral slope (SS), pelvic tilt (PT), lumbar lordosis angle (LL) and sagittal vertical axis (SVA) between before operation and two weeks after operation (P < 0.05), while pelvic incidence (PI) no statistically significant differences was found between before operation and two weeks after operation (P > 0.05). There was no statistically significant differences in SS, PT, LL, SVA, PI between two weeks after operation and final follow-up (P > 0.05). CODI had decreased from preoperative 36.6 ± 4.2 to 14.7 ± 4.0 at final follow-up (P < 0.05). One year after operation, all patients obtained bone fusion and can find the union of bone trabeculae by three-dimensional reconstruction CT. Three cases occurred transient nerve root pain, and recovered after medicinal treatment. No infection and internal fixation loosening and breakage were found.

CONCLUSIONSurgical reduction for high-grade lumbar spondylolisthesis can improve spino-pelvic balance and acquire satisfactory outcomes.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pelvis ; pathology ; Retrospective Studies ; Spinal Fusion ; Spine ; pathology ; Spondylolisthesis ; pathology ; surgery

Adult ; Bone Cysts, Aneurysmal ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; pathology ; Humans ; Osteosarcoma ; pathology ; Radiography ; Spinal Diseases ; diagnostic imaging ; pathology ; surgery ; Spinal Neoplasms ; pathology ; Spine ; diagnostic imaging ; pathology ; surgery

BACKGROUND: We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors. METHODS: The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred. RESULTS: The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r2 = 0.75, p = 0.010, Nurick's grade; r2 = 0.69, p = 0.019). One case of schwannoma recurred. CONCLUSIONS: The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.
Adult ; Aged ; Female ; Humans ; Laminectomy/methods ; Magnetic Resonance Imaging ; Male ; Meningioma/diagnosis/pathology/surgery ; Middle Aged ; Neurilemmoma/diagnosis/pathology/surgery ; Prognosis ; Retrospective Studies ; Spinal Neoplasms/diagnosis/pathology/*surgery ; Spine/pathology/surgery

OBJECTIVETo compare the therapeutic effects of debris spondylectomy, piecemeal spondylectomy, total en bloc spomdylectomy in treating lumbar metastatic tumors.

METHODSThe clinical data of 20 patients with lumbar metastatic tumors treated from January 2008 to October 2013 were retrospectively reviewed. There were 8 males and 12 females, aged from 35 to 65 years old with an average of (49.50 ± 9.97) years. All patients had single solitary metastases. Four cases were in L1,5 cases in L2,4 cases in L3,4 cases in L4, and 3 cases in L5. According to the type of Tomita, type II had in 4 cases, type III in 6 cases, type IV in 6 cases, type V in 4 cases. Tokuhashi score was 12.50 ± 1.97. All patients complained with back or leg pain, VAS score was 8.13 ± 0.85. Among patients, 7 cases were treated with debris spondylectomy (group A), 7 cases with piecemeal spondylectomy (group B), 6 cases with total en bloc spondylectomy (group C). Statistical analysis was used to compare the three groups with respect to surgical trauma (including operative time, transoperative bleeding, and intraoperative blood transfusion), clinical symptoms (by VAS score at 1 week after operation), surgical procedures conditions (by AP and lateral X-rays), and long-term results (by recurrence and death information).

RESULTSAll patients were followed up from 6 to 36 months with an average of (16.50 ± 7.88) months. Operative time for debris spondylectomy was (6.14 ± 0.68) h, intraoperative bleeding was (3 457.14 ± 399.40) ml, and intraoperative blood transfusion was (2 771.43 ± 423.14) ml. Operative time for piece-meal spondylectomy was (4.93 ± 0.61) h, intraoperative bleeding was (1 942.86 ± 378.51) ml, and intraoperative blood transfusion was (1 500.00 ± 336.65) ml. Operative time for total en bloc spondylectomy was(4.17 ± 0.67) h, intraoperative bleeding was (1 341.67 ± 361.13) ml, and intraoperative blood transfusion was (916.67 ± 321.66) ml. There was significant differences in operative time, intraoperative blood loss, and intraoperative blood transfusion between three groups (P < 0.05). In terms of these factors, total en bloc spondylectomy had the best outcome followed by piecemeal spondylectomy. All pains had released, VAS score decreased obviously at 1 week after operation (P < 0.05), and there was no significant differences between three groups (P > 0.05). Surgical effects were well with these methods according to the evaluation of AP and lateral X-rays . At final follow-up, group A had 4 recurrences (2 with breast cancer, 1 with prostate cancer,and 1 with thyroid cancer) and 3 deaths (2 with lung cancer and 1 with thyroid cancer); group B had 2 recurrences (1 with breast cancer and 1 with prostate cancer) and 3 deaths (1 with lung cancer, 1 with breast cancer and 1 with kidney cancer);group C had no recurrences and 2 deaths for lung cancer. There was significant differences in recurrence and death between three groups (P < 0.05). In terms of these factors, total en bloc spondylectomy had the best outcome in three methods.

CONCLUSIONThree kinds of operation method can relieve pain, improve nerve function, increase the spinal stability, control the local lesions, improve the patient's quality of life in treating lumbar metastatic tumors, but total en bloc spendylectomy, respect to operative time, transoperative bleeding, intraoperative blood transfusion, tumor recurrence and death is clearly superior to other two methods.

Adult ; Aged ; Blood Transfusion ; Female ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; Operative Time ; Retrospective Studies ; Spinal Neoplasms ; pathology ; surgery ; Spine ; surgery