Objective:To investigate the impact and clinical outcomes of intraoperative prone-position lumbar anteroposterior (AP) fluoroscopy under anesthesia on the selection of the lowest instrumented vertebra (LIV) in the patients with adolescent idiopathic scoliosis (AIS) plus structural lumbar curves.Methods:A retrospective analysis was conducted of the clinical data of 35 patients (29 females and 6 males) with AIS who had undergone surgical posterior correction and fusion at Scoliosis Center, The Third Affiliated Hospital, Sun Yat-sen University between January 2020 and October 2023. The mean age was (17.9±5.7) years. Lenke's classification: 6 cases of type 3, 12 cases of type 4, 7 cases of type 5 and 10 cases of type 6. Preoperatively, all patients underwent standing AP and lateral radiographs of the full-length spine, left and right bending radiographs of the spine, and full-spine CT. Intraoperatively, all patients underwent prone-position lumbar AP fluoroscopy under anesthesia. The criteria for LIV selection were: (1) it should be the most cephalad vertebra touched by the central sacral vertical line (CSVL); (2) its rotation should be ≤ grade Ⅱ by the Nash-Moe classification; (3) its tilt angle should be <25°. The preoperative and postoperative LIV rotation angles were compared, and the number of lumbar fusions was compared between preoperative planning and actual surgery. Comparisons were also made between preoperation, postoperation and the final follow-up, examining Cobb angle of the major curve, Cobb angle of the minor curve, LIV inclination, coronal balance distance (CBD), sagittal vertical axis (SVA), and distance between CSVL and LIV (CSVL-LIV). The correction rates of the major curve and the minor curve, and change in LIV inclination were compared between postoperation and the final follow-up.Results:The patients were followed for (18.0±3.0) months. The LIV rotation decreased from 8.34°±4.95° preoperatively to 5.03°±2.99° postoperatively. The intraoperative fluoroscopy reduced at least one segment fusion for 57.1% (20/35) of the patients so that the number of lumbar fusions decreased significantly from 4.2±0.7 in preoperative planning to 3.6±0.8 after actual surgery ( P<0.05). The Cobb angles of the major and minor curves, LIV inclination, and CSVL-LIV at postoperation and the final follow-up were significantly lower than the preoperative values ( P<0.05), but there were no significant differences between the final follow-up and postoperation in the Cobb angle of the major cure, Cobb angle of the minor curve, or LIV inclination ( P>0.05). None of the patients required surgical revision for distal junctional complications. Conclusions:In the surgical treatment of AIS patients with structural lumbar curves, compared to the preoperative X-rays using the same criteria, intraoperative prone-position lumbar AP fluoroscopy under anesthesia can not only be a safe and effective method for LIV selection but also effectively reduce the number of lumbar fusions to preserve more lumbar mobility.

Objective:To investigate the impact and clinical outcomes of intraoperative prone-position lumbar anteroposterior (AP) fluoroscopy under anesthesia on the selection of the lowest instrumented vertebra (LIV) in the patients with adolescent idiopathic scoliosis (AIS) plus structural lumbar curves.Methods:A retrospective analysis was conducted of the clinical data of 35 patients (29 females and 6 males) with AIS who had undergone surgical posterior correction and fusion at Scoliosis Center, The Third Affiliated Hospital, Sun Yat-sen University between January 2020 and October 2023. The mean age was (17.9±5.7) years. Lenke's classification: 6 cases of type 3, 12 cases of type 4, 7 cases of type 5 and 10 cases of type 6. Preoperatively, all patients underwent standing AP and lateral radiographs of the full-length spine, left and right bending radiographs of the spine, and full-spine CT. Intraoperatively, all patients underwent prone-position lumbar AP fluoroscopy under anesthesia. The criteria for LIV selection were: (1) it should be the most cephalad vertebra touched by the central sacral vertical line (CSVL); (2) its rotation should be ≤ grade Ⅱ by the Nash-Moe classification; (3) its tilt angle should be <25°. The preoperative and postoperative LIV rotation angles were compared, and the number of lumbar fusions was compared between preoperative planning and actual surgery. Comparisons were also made between preoperation, postoperation and the final follow-up, examining Cobb angle of the major curve, Cobb angle of the minor curve, LIV inclination, coronal balance distance (CBD), sagittal vertical axis (SVA), and distance between CSVL and LIV (CSVL-LIV). The correction rates of the major curve and the minor curve, and change in LIV inclination were compared between postoperation and the final follow-up.Results:The patients were followed for (18.0±3.0) months. The LIV rotation decreased from 8.34°±4.95° preoperatively to 5.03°±2.99° postoperatively. The intraoperative fluoroscopy reduced at least one segment fusion for 57.1% (20/35) of the patients so that the number of lumbar fusions decreased significantly from 4.2±0.7 in preoperative planning to 3.6±0.8 after actual surgery ( P<0.05). The Cobb angles of the major and minor curves, LIV inclination, and CSVL-LIV at postoperation and the final follow-up were significantly lower than the preoperative values ( P<0.05), but there were no significant differences between the final follow-up and postoperation in the Cobb angle of the major cure, Cobb angle of the minor curve, or LIV inclination ( P>0.05). None of the patients required surgical revision for distal junctional complications. Conclusions:In the surgical treatment of AIS patients with structural lumbar curves, compared to the preoperative X-rays using the same criteria, intraoperative prone-position lumbar AP fluoroscopy under anesthesia can not only be a safe and effective method for LIV selection but also effectively reduce the number of lumbar fusions to preserve more lumbar mobility.

Objective:To analyze the efficacy of percutaneous variceal embolization (PTVE) in children with portal hypertension at high risk of esophageal variceal bleeding.Methods:Clinical data of 14 children undergoing PTVE in Children's Hospital Affiliated to Chongqing Medical University from October 2018 to May 2023 were retrospectively analyzed, including 9 males and 5 females, with a median age of 1 years and 11 months, ranging from 7 months to 12 years and 10 months. The causes of portal hypertension were portal vein spongiosis in 5 cases, portal vein anastomotic stenosis after liver transplantation in 7 cases and decompensated cirrhosis in 2 cases. PTVE was performed in all patients. The surgical approach, intraoperative portal vein pressure, complications, prognosis, and gastrointestinal bleeding were analyzed.Results:The portal vein pressure was (21.3±4.1) mmHg (1 mmHg=0.133 kPa), ranging from 15.8 to 28.6 mmHg. PTVE was successfully completed in all cases, with 11 cases by hepatic approach and 3 cases by splenic approach. All patients were embolized without puncture bleeding. Among the 5 cases with portal vein spongiosis, Meso-Rex was performed in 4 cases from 1 to 27 months after PTVE, and liver transplantation was performed in 1 case 11 months after PTVE for there was no indication of Meso-Rex. Balloon dilatation was performed during embolization in 7 patients with portal vein anastomotic stenosis after liver transplantation. Two cases of decompensated cirrhosis underwent liver transplantation at 3 months and 7 months after embolization, respectively. All children were followed up for 5 to 60 months, and no death occurred, two cases had gastrointestinal bleeding.Conclusion:PTVE could be an effective minimally invasive treatment for children with portal hypertension at high risk of esophageal and gastric varices bleeding, and the incidence of posttreatment gastrointestinal bleeding rate is low.