BACKGROUND: To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion. METHODS: This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated. RESULTS: One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041). CONCLUSIONS: The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.
Female ; Humans ; Lumbar Vertebrae/pathology/*surgery ; Male ; Middle Aged ; Prognosis ; Reoperation ; Spinal Diseases/pathology/surgery ; *Spinal Fusion ; Survival Analysis ; Thoracic Vertebrae/pathology/*surgery

OBJECTIVETo explore the imaging characteristics and operation outcomes of intramedullary schwannoma in thoracolumbar spine.

METHODSFrom June 2005 to December 2012,17 patients with intramedullary schwannoma in thoracolumbar spine were operated through posterior approach, including 11 males and 6 females with an average age of 53 years old ranging from 46 to 67 years old. The courses of disease ranged from 3 to 5 years (averaged 3.3 years). Thoracic patients manifested chest and back pain,numbness and inability on lower limb gradually, unsteady gait. Lumbar patients manifested low back pain,radiating pain and numbness on lower limb, intermittent claudication. Preoperative VAS score was 5 to 8 with an average of 6.12. Eleven patients suffered from never injury, 4 cases were grade C, 5 cases were grade D and 2 cases were grade E according to Frankel classification. Three patients were injured on thoracic segments, 5 patients were on thoracolumbar segments, 3 patients on lumbar segments and 6 patients on lumbosacral segment confirmed by CT and MRI. Five patients were epidural, 12 were intradural extramedullary. Six patients underwent spinal decompression and tumor resection simply, eleven patients underwent spinal decompression, tumor resection, internal fixation and bone graft fusion.

RESULTSNo injury of blood vessel or spinal cord occurred during operation, cutting healed well. All patients were followed up from 12 to 60 months with an average of 32 months. Chest and back pain, low back pain, radiating pain and numbness on lower limb were improved significantly. VAS score at final follow-up was 0 to 3 (averaged 1.5). According to Frankel classification, 5 cases were grade D, and 6 cases were grade E at final follow-up.

CONCLUSIONMRI is an effective method in diagnosis of intramedullary schwannoma in thoracolumbar spine. Operative method is choosed by imaging expression, and the aim is effectively decompression of spine, reconstruction of stability of spine.

Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurilemmoma ; pathology ; surgery ; Spinal Neoplasms ; pathology ; surgery ; Thoracic Vertebrae ; surgery

OBJECTIVETo compare the long-term influence of vertebral fixation through or across the affected vertebra on vertebral morphology.

METHODSClinical data of 48 patients with simple thoracic and lumbar spinal fractures who were admitted between Jan. 2008 and Dec. 2010 were analyzed retrospectively. Among them 36 cases (28 males and 8 females) were fixed through the injured vertebra (group A) and 12 cases (8 males and 4 females) were fixed across the injured vertebra (group B). All patients were followed up for 6-36 months (mean 11.5 months). The vertebral body height, endplate angle and neurofunction were compared between the two groups before surgery, a week after surgery and at the end of the follow-up period.

RESULTSThere was no statistically significant difference in vertebral body height,endplate angle and neurofunction before operation between group A and B (P > 0.05). Vertebral body height and endplate angle improved in both groups a week after operation and at the end of the follow-up period as compared with those before operation (P < 0.05), and the efficacy in group B was significantly better than that in group A (P < 0.05). There was no significant difference in neurofunction between the two groups (P > 0.05).

CONCLUSIONThe fixation method through the injured vertebra had a better reduction effect, more stable fixation, and a better long-term effect on vertebral morphology than that across the injured vertebra in the treatment of thoracolumbar vertebral fractures.

Adult ; Female ; Humans ; Lumbar Vertebrae ; injuries ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; pathology ; surgery

OBJECTIVETo investigate the safety and efficiency of spinal osteotomies for traumatic fixed kyphotic deformity of thoracolumbar spine with spinal cord injury.

METHODSSingle-level vertebral osteotomies were performed on 3 groups of fresh-frozen human cadaveric lumbar spines. Group 1 underwent a conventional anterior opening-wedge or posterior closing-wedge osteotomy, Group 2 underwent a conventional decancellation posterior closing-wedge osteotomy, and Group 3 underwent the modified decancellation posterior closing-wedge osteotomy. Sagittal plane angulation as well as anterior height and distance of the spinal column were measured before and after osteotomy. In the clinical study, 26 cases of old thoracolumbar fractures with spinal cord injury, 36 years in average, were recruited in this study. The mean time from injury to this operation was 25 months ranging from 3 months to 11 years. Prior to the index surgery, 9 patients received conservative treatment, and 17 patients underwent surgical treatment. There were complete paraplegia in 10 cases and incomplete paraplegia in 14 cases (Frankel B 2 cases, C 10 and D 2). The patients suffered from the low back pain, the average score of VAS was 4.5 (2.5 - 6.0). The patients were found with remained kyphotic deformity of a mean 35 degrees (20 degrees - 75 degrees ). According to the deformity angles, conventional or modified decancellation posterior closing-wedge osteotomy was performed.

RESULTSOn 3 groups of fresh-frozen human cadaveric lumbar spines, the mean correction was (38.0 +/- 2.5) degrees for Group 1, (36.0 +/- 3.6) degrees for Group 2, and (49.0 +/- 2.0) degrees for Group 3. The mean change in anterior height and distance was (13.8 +/- 1.4) mm and (30.2 +/- 2.5) mm respectively for Group 1. For Groups 2 and 3 it was only 2 - 4 mm. In clinical trial, all cases were followed up for 10 months to 6 years, average 12.5 months. Successful decompression and satisfied correction of kyphosis was noticed. The post-operatively mean angle of kyphosis deformity was 10.8 degrees , ranging from 0 degrees to 40 degrees . Neurological functional recovery was noticed in 50% of all cases. For complete spinal cord injury, 30% of cases partially recovered (sensory function), whereas neurological function recovery was noted in 64.3% of cases with incomplete spinal cord injury, a statistical difference was showed between the incomplete and complete spinal cord injury cases (P < 0.01). The score of VAS was 2.3 (1.0 - 3.5) at last follow-up.

CONCLUSIONSThe traumatic fixed kyphotic deformity of thoracolumbar spine with spinal cord injury could be treated with conventional or modified decancellation posterior closing-wedge osteotomy, neurological function and low back pain were expectably recovered.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; surgery ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Thoracic Vertebrae ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo analyze the impact of thoracic and thoracolumbar angular kyphosis on pelvic shape and sagittal alignment.

METHODSFrom May 2002 to June 2010, the sagittal spino-pelvic parameters were analyzed in lateral standing radiographs of 32 patients (mean age 29.6 years) with thoracolumbar angular kyphosis. The parameters included Cobb angle of kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT) and sagittal vertical axis (SVA). All pelvic parameters in the patients were compared with those reported in historical normal subjects. All patients were treated by using kyphotic correction and fusion. The preoperative and postoperative parameters were compared. The pelvic parameters were also compared between the patients with kyphotic apex located at T(1-8) and those located at T(9-12) and thoracolumbar junction. The linear regression analysis was used to investigate the independent factors of PI.

RESULTSThe mean kyphosis was 90.1° (31° - 138°). The mean age of kyphosis occurrence was 6.1 years. The mean PI, SS and PT were 34.8°, 35.8° and -0.7° respectively. The PI and PT were significantly smaller (P < 0.001) in the patients than those in normal subjects while the SS was similar. The kyphosis was improved to 27.9° post-operatively. There was no difference in PI values between pre-operation and postoperation (P > 0.05). The PI and SS in patients whose kyphosis located at thoracic spine (T(1-8)) were significantly higher than those at T(9)-L(2). Instead of patients' age and LL, the preoperative Cobb angle of kyphosis and the levels where kyphosis located were two independent impact factors of PI.

CONCLUSIONSThe kyphosis occurred at childhood may influence pelvic shape and alignment significantly. The lower kyphotic apex located and the bigger kyphosis, the greater impact on the pelvic morphology. The surgery can improve the kyphosis, but can not change the sagittal pelvic morphology. Early treatment of thoracolumbar angular kyphosis is beneficial not only to reconstruction of spine alignment but also to the formation of sagittal pelvic morphology.

Adolescent ; Adult ; Female ; Humans ; Kyphosis ; pathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pelvis ; pathology ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Young Adult

OBJECTIVETo analyze the influence of thoracic kyphosis on the sagittal compensatory mode of the spine in idiopathic thoracic scoliosis after the selective thoracic fusion.

METHODSNinety AIS patients (mean age 14.5 years old) who received selective thoracic fusion from February 1999 to December 2005 in one institution with at least 24-month follow-up were evaluated. Forty-one patients underwent anterior spinal fusion and forty-nine patients underwent posterior spinal fusion. And then the patients were divided into two subgroups according to the magnitude of preoperative thoracic kyphosis (TK): Group A, TK less than 10 degrees ; and Group B, TK more than 10 degrees . The radiological parameters were measured including: thoracic and lumbar curve magnitude, TK, lumbar lordosis (LL), thoracolumbar junction kyphosis (T(10)-L(2), TJK), distal junctional kyphosis (DJK), sagittal vertical axis (SVA).

RESULTSAt final follow-up, TK, TJK and DJK increased significantly compared with preoperative Cobb angle in subgroup A patients who underwent anterior spinal fusion (P < 0.05). Generally, there was a lordosis loss of TJK and DJK during follow-up. While in subgroup B, TJK at final follow-up increased apparently compared with preoperative Cobb angle (P < 0.05). And there was a increased trend of DJK in spite of no significant difference, however, there was no obvious change of TK in subgroup B. At the final follow-up, TK and TJK increased significantly in subgroup A patients who underwent posterior spinal fusion (P < 0.05). And there was a increased tendency of DJK during follow-up, although there was no significant difference. And there was no obvious change of TK, TJK and DJK in subgroup B. There was a increased trend of LL in spite of no significant difference in group A patients who underwent anterior or posterior spinal fusion. The sagittal balance maintained well during follow-up in both groups.

CONCLUSIONSFor AIS patients with thoracic hypokyphosis, normal TK and LL could be achieved during follow-up with selective thoracic instrumentation. However, the increase of DJK and TJK may occur during the follow-up, and the risk factors may be the anterior short segmental fusion and the reconstruction of the sagittal profile in the hypokyphosis patients.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Perioperative Period ; Retrospective Studies ; Scoliosis ; pathology ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; pathology ; surgery

OBJECTIVETo evaluate the clinical outcome of posterior total vertebral resection in treating thoracic vertebrae tumor in order to provide a safe and effective method in rebuilding spine stability.

METHODSFrom 2002.1 to 2007.12, 18 patients with thoracic spine tumor underwent posterior total vertebral resection and internal fixation. Among the patients, 10 patients were male and 8 patients were female, ranging in age from 45 to 78 years, with an average of 56 years. The course of the diseases ranged from 2 to 13 months. After the operation, the tumor reccurence was monitored by X-ray, and the tumor markers were detected.

RESULTSAll the patients were followed up for a period ranging from 12 to 60 months, averaged 29 months. All the patients showed a postoperative neurologic improvement, as well as showed radiographic evidence of solid fusion in the follow-up examinations during 3 to 9 months, with an average of (8 +/- 1.4) months.

CONCLUSIONPosterior total vertebral resection for the treatment of thoracic spine tumor is safe and effective.

Aged ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Spinal Neoplasms ; pathology ; surgery ; Thoracic Vertebrae ; pathology ; surgery ; Treatment Outcome

OBJECTIVESTo explore the clinical significance of the transverse thoracic pedicle diameters measurement and thoracic pedicles classification in thoracic adolescent idiopathic scoliosis patients.

METHODSThirty thoracic idiopathic scoliosis patients who were hospitalized during October 2008 and July 2009 and 20 non-scoliosis adolescents who were adopted during August 2008 and July 2009 were included in this study. Successive CT thoracic vertebrae scanning of all subjects were obtained. All participants' transverse pedicle diameters of the thoracic vertebrae were measured with the software of PACS Client. Classified the pedicle into 4 types according to the transverse pedicle diameters. In control group, the transverse pedicle diameters of bilateral thoracic vertebrae were compared using paired-t test. In AIS group, the transverse pedicle diameters of concave and convex side thoracic vertebrae were compared using paired-t test. The distribution of pedicle types were compared using Chi-Square test between the control group and AIS group.

RESULTSThe transverse pedicle diameters showed a decreasing trend from T(1) to T(4) followed by an increasing trend from T(5) to T(12) in both groups. The bilateral transverse pedicle diameters had no significant difference in the control group. The transverse pedicle diameters of the concave side at the apex of thoracic curve were found to be significantly thinner than those of convex side. The ratio of Type 4 was higher in thoracic adolescent idiopathic scoliosis patients than the controls, and the ratio of Type 1 was smaller in thoracic adolescent idiopathic scoliosis patients than the controls.

CONCLUSIONSThe thoracic pedicles in thoracic adolescent idiopathic scoliosis patients are often rather thinner. Preoperative CT measurement of thoracic pedicle in the treatment of idiopathic scoliosis is suggested helpful in deciding the correct strategy of pedicle screw insertion and decreasing the risk of clinically relevant neurovascular complications.

Adolescent ; Child ; Female ; Humans ; Male ; Radiography ; Scoliosis ; diagnostic imaging ; pathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Young Adult

OBJECTIVESTo quantify the changes of the spatial relations between the vertebral body and the thoracic aorta in main right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior instrumentation and fusion.

METHODSTwenty-nine patients with main right thoracic AIS were divided into 2 groups. Group A included 13 females and 1 male with an average age of 14.3 years old and average main thoracic Cobb angle of 44.9 degrees, these patients underwent mini-incision thoracic anterior spinal fusion. Group B included 12 females and 3 males with an average age of 14.2 years old and average main thoracic Cobb angle of 46.4 degrees, all of them were treated with posterior spinal fusion. Patients underwent CT scanning from T5 to T12 Pre-and post-operatively. Five parameters pertaining to the spatial relations between the vertebral body and the thoracic aorta including the angle for safety screw placement (gamma), the angle of the aorta relative to the vertebral body (beta), vertebral rotation angle (gamma), distance from the aorta to the closest point of the vertebral body cortex (a) and distance from the posterior wall of the aorta to the anterior edge of the left rib head (b) were analyzed and were correlated with the curve correction.

RESULTSIn Group A, the alpha angle and 3 angle increased while gamma decreased after curve correction, and significant difference were found at T8 and T9 levels (P < 0.05); the a value decreased and b value increased after curve correction and reached significant difference at T9 (P < 0.05). No significant change of these parameters was found in Group B post-operatively. In Group A, the increment of alpha angle, beta angle and b value show great correlation with the decrement of gamma angle (P < 0.01). At the periapical the increment of alpha angle, beta angle and b value show great correlation with decrement of apical vertebral translation, while decrement of a value show great correlation with increment of kyphosis from T5 to T12 (P < 0.01).

CONCLUSIONSUnder anterior instrumentation and correction, the aorta moved anteromedially toward vertebral body on CT scanning. The factors contributing to the aorta shifting included releasing of aorta from vertebrae, vertebral derotation and curve correction.

Adolescent ; Aorta, Thoracic ; pathology ; Bone Screws ; Child ; Female ; Humans ; Male ; Scoliosis ; pathology ; surgery ; Spinal Fusion ; instrumentation ; methods ; Thoracic Vertebrae ; pathology ; surgery

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