Objective: To investigate the clinical outcome and preventive effect of polyetheretherketone(PEEK) rod hybrid surgery on proximal junction failure(PJF) after long-segment fusion of adult spinal deformity. Methods: A retrospective study was conducted to analyze patients with degenerative scoliosis/kyphosis who underwent long-segment decompression and fusion surgery at Department of Orthopedics, Peking University First Hospital from January 2017 to December 2021. A total of 75 patients were included in the study, including 14 males and 61 females, aged (67.2±6.8)years (range:55 to 84 years). According to the operation method chosen by the patients, the patients were divided into PEEK rod hybrid group (20 cases) and traditional titanium rod group (55 cases). The general information of the patients was collected, and the coronal and sagittal parameters of the spine were measured before operation, at 1 month after operation, and at the last follow-up. The clinical effect of surgery was judged by the visual analogue scale (VAS) and Oswestry disability index (ODI). Whether proximal junctional kyphosis (PJK) and PJF occurred during the follow-up and the time of occurrence were recorded. Comparisons between groups were performed using independent sample t test, Mann-Whitney U test, χ² test and Fisher's exact probability method. The data before and after surgery in the same group were compared using the paired sample t test and the Wilcoxon test. Results: There were no significant differences in age, gender, body mass index, bone mineral density, distal instrumented vertebrae, surgical segments, osteotomy method, operation time, and intraoperative bleeding between the two groups (all P>0.05). The follow-up time of the PEEK rod group was shorter(M(IQR)16.5(4.8) vs. 25.0(12.0),Z=-4.230,P<0.01). There were no significant differences in coronal, sagittal parameters, VAS and ODI between the two groups before operation (all P>0.05). Postoperative coronal Cobb angle, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, sagittal vertical axis (SVA), VAS and ODI were significantly improved in both groups(all P<0.05). At the last follow-up, the SVA of the PEEK rod hybrid group was(3.74±2.40)cm, which was significantly lower than that of the titanium rod group (6.28±4.06)cm (t'=-3.318, P=0.002). At the last follow-up, the ODI of the PEEK rod hybrid group was 30.7±6.1, significantly better than the titanium rod group 39.3±17.2(t=-3.203, P=0.046). PJK occurred in 2 patients (10.0%) in the PEEK rod hybrid group, and no PJF phenomenon was observed. In the titanium rod group, 18 patients (32.7%) developed PJK, and 11 patients (20.0%) developed PJF. There was a statistically significant difference in the incidence of PJF between the PEEK rod hybrid group and the titanium rod group (P=0.031). Conclusions: PEEK rod hybrid surgery can achieve good clinical results in the treatment of adult spinal deformities. Compared with traditional titanium rod surgery, it can significantly reduce the incidence of postoperative PJF and improve the clinical function of patients.
Male ; Female ; Animals ; Humans ; Adult ; Retrospective Studies ; Titanium ; Kyphosis/etiology* ; Sacrum ; Osteotomy/adverse effects* ; Spinal Fusion/methods* ; Lumbar Vertebrae ; Treatment Outcome ; Postoperative Complications/epidemiology*

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis.
 Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI).
 Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation.
 Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.
Back Pain ; surgery ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrospinal Fluid Leak ; epidemiology ; Female ; Follow-Up Studies ; Fractures, Bone ; complications ; surgery ; Humans ; Hypesthesia ; etiology ; Kyphosis ; etiology ; surgery ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Operative Time ; Osteotomy ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Surgical Wound Infection ; epidemiology ; Thoracic Vertebrae ; injuries ; surgery ; Treatment Outcome ; Urinary Tract Infections ; epidemiology

OBJECTIVETo evaluate the clinical effects of posterior spinal transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture in elderly.

METHODSFrom July 2009 to February 2014,26 patients with kyphosis caused by delayed osteoporotic vertebral fracture were treated with transpedicular wedge osteotomy. There were 10 males and 16 females,aged from 55 to 75 years old with an average of 67 years. There were 1 osteotomy in thoracic vertebra,21 osteotomies in thoracolumbar vertebrae and 4 in lumbar vertebrae. Total 29 vertebrae were involved, 23 cases with single vertebral fracture and 3 cases with double vertebral fractures. Preoperative Cobb angles were 32°~51° with the mean of (42.00 ± 4.75) ° and VAS scores were 6 to 9 points with an average of (8.40 ± 0.75) points. According to the Frankel grade of spinal cord function, 4 cases were grade D and 22 cases were grade E. Intraoperative bleeding, operation time and perioperative complications were recorded, and improvements of Cobb angle were evaluated by X-rays. VAS score and Frankel grade were respectively used to evaluate the pain and nerve function.

RESULTSThe average operation time were 155 min (ranged, 120 to 175) and the mean intraoperative bleeding were 1 100 ml (ranged,800 to 1 500). Postoperative at 2 days, Cobb angle and VAS score were (9.60 ± 2.50) ° and (4.00 ± 1.00) points, respectively, ranged from 5° to 15° and 1 to 5 points. VAS score and Cobb angle improved obviously compared with preoperative (P < 0.05), and the improvement rate of Cobb angle was 76%. Frankel grade of 1 case changed from grade E to C, and the others did not become worse. The follow-up period ranged from 3 to 24 months with an average of 16.4 months. At the final follow-up, Cobb angles and VAS score were (11.00 ± 3.50)° and (4.40 ± 1.25) points, respectively, ranged from 5° to 19° and 1 to 6 points. The patient whose Frankel grade E changed to C at 2 days after surgery and changed to grade D at the latest follow-up. Vertebral body fracture below the fusion level happened in 1 case at 3 months after surgery, vertebral body fracture above the fusion level happened in 1 case at 5 months after surgery, and their chest pain symptoms were relieved after symptomatic treatment and anti osteoporosis treatment. All osteotomy levels obtained fusion which confirmed by X-ray and no internal fixation loosening and breakage were found.

CONCLUSIONThe clinical effect of posterior transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture was satisfactory, but manipulation during the operation should be cautious and prevent adjacent vertebral body fracture should be pay attention to prevent.

Aged ; Female ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteoporotic Fractures ; complications ; surgery ; Osteotomy ; methods ; Spinal Fractures ; complications ; surgery ; Visual Analog Scale

OBJECTIVETo investigate the incidence and causes of neurologic deficits complications in the treatment of spinal deformity with posterior spinal osteotomy.

METHODSFrom January 2007 to December 2010, 321 cases of scoliosis or kyphosis patients were treated with posterior spinal osteotomy. There were 124 male and 197 female with an average age of (19 ± 11) years (2 - 56 years). The average preoperative main Cobb angle was 108° ± 33° (48° - 175°), the average kyphotic angle was 74° ± 29° (53° - 170°) before operation. Pedicle subtraction osteotomy was used in 226 cases, 95 cases with vertebral column resection. Pedicle screw-rod system was used for fixation. The patients were monitored by Somatosensory-evoked potentials monitoring and Stagnara wake-up test.

RESULTSThere were 11 cases with varying degrees of new neurologic deficits and the total incidence was 3.4%. The causes were as followed, spinal translation in 2 cases, compromised by close of resected areas in 2 cases, residual bone compression in 1 case, inadvertent operation in 2 cases, screw malposition in 1 case, hematoma compression in 1 case and spine elongation in 2 cases. There was significant difference between the patients with preexisting neurologic deficits (20.0%) and the patients with intact neurologic function (2.6%) (χ(2) = 13.060, P = 0.011), no significant differences in different classes of the age, etiology, deformity, osteotomy type and surgical type (P > 0.05). But the incidence of neurologic deficits was 4.6% in congenital scoliosis, 7.1% in neuromuscular scoliosis, 5.1% in kyphosis, 5.9% in adult deformity and 5.9% in Cobb angle more than 100°, which was higher than other classes. All the 11 cases were given emergent Methylprednisolone, neurotrophic drugs and hyperbaric oxygen therapy, 4 cases were underwent surgical exploration again. After treatment, 7 cases recovered completely, 2 cases recovered partially and 2 cases failed to improve at the last follow-up.

CONCLUSIONSSevere spinal deformity could be effectively treated with posterior spinal osteotomy. But the procedure is technical demanding and risky for neurologic deficits. The high risk factor is preexisting neurologic deficits.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; surgery ; Male ; Middle Aged ; Nervous System Diseases ; etiology ; Osteotomy ; adverse effects ; methods ; Postoperative Complications ; etiology ; Retrospective Studies ; Scoliosis ; surgery ; Young Adult

OBJECTIVETo observe the results of posterior osteotomy and correction in the surgical treatment of old tuberculous kyphosis.

METHODSFrom June 2004 to December 2008, 31 cases of old tuberculous kyphosis with posterior osteotomy and correction technique were treated. There were 12 cases of male and 19 cases of female. The average age was 33.4 years. Pedicle subtraction osteotomy or vertebral column resection were applied in surgery. The kyphosis angle, lumbar lordosis angle and sagittal balance condition of the spine were measured before and after surgery, as well as follow-up. The Frankel grading system for neurological function of lower extremities, the Oswestry disability index (ODI) for life quality, and patient satisfactory index (PSI) for satisfaction of surgery were applied before surgery and at follow-up.

RESULTSThe average kyphosis angle was 94° ± 27°, the average lumbar lordosis angle was 71° ± 20°, and the average sagittal C(7) plumb line was (-15 ± 44) mm away from the balance region before surgery. The average kyphosis angle decreased to 26° ± 11° in one week after surgery, with an improvement rate of 71.4%. The average follow-up time was 22.5 months. The average kyphosis angle was 28° ± 12° at the final follow-up, with an improvement rate of 70.0%. The average lumbar lordosis angle was 46° ± 11°, with an improvement rate of 35.1%. The postoperative kyphosis angle and lumbar lordosis angle were significantly different with that of pre-operation (for kyphosis angle: t = 16.3, P < 0.05; for lumbar lordosis angle: t = 8.1, P < 0.05). The average sagittal C(7) plumb line was (-4 ± 22) mm away from the balance region at the final follow-up, with an improvement rate of 73.4%. The Frankel grading were E in 13 cases, D in 13 cases, and C in 5 cases before surgery, and were E in 20 cases, D in 8 cases, and C in 3 cases at the final follow-up. The average ODI was 13 ± 12 before surgery, and was 7 ± 8 at the final follow-up, with an improvement rate of 45.2%. The PSI results showed a satisfied rate of 90.3%.

CONCLUSIONGood results can be achieved by applying proper posterior osteotomy and correction technique according to the severity of old tuberculous kyphosis.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Spinal Fusion ; methods ; Treatment Outcome ; Tuberculosis, Spinal ; complications ; Young Adult

OBJECTIVETo evaluate the clinical outcomes of posterior surgical corrective methods for ankylosing spondylitic kyphosis.

METHODSFrom June 2003 to June 2008, 21 cases of ankylosing spondylitic kyphosis received posterior surgical correction. There were 17 male and 4 female, and the average age was 39.5 years (range, 20 to 57 years). The total spine X-ray and CT were used to evaluate sagittal balance and thoracolumbar spine kyphosis angle, and chin brow-vertical angle was obtained from clinical lateral photograph. The surgical goal was to correct sagittal imbalance and chin brow-vertical angle. The simulated osteotomy was performed in computer before surgery to determine the correction methods. The surgical methods included: 16 cases of monosegmental closing osteotomy correction, 3 cases of anterior opening-posterior closing osteotomy correction, and 2 cases of combined pedicle subtraction osteotomy in thoracolumbar spine and Smith-Peterson osteotomy in lumbar spine. All patients were followed up after surgery, and the improvement of sagittal imbalance, chin brow-vertical angle and thoracolumbar spine kyphosis angle were assessed. The symptoms relief and satisfied rate were also evaluated.

RESULTSThe average operation time was 4.4 hours, and the average blood loss was 1770 ml. Before surgery, the average thoracolumbar kyphosis angle was 62.1°, the average anterior shift of C(7) plumb line was 172.9 mm, and the average chin brow-vertical angle was 34.9°. The average follow-up was 28.8 months after surgery. The average correction rate of thoracolumbar kyphosis angle was 60%, the average improvement rate of anterior shift of C(7) plumb line was 64%, and the average correction rate of chin brow-vertical angle was 98%. The improvement rate of back pain was 64% during follow-up. The total surgical satisfactory rate was 95%.

CONCLUSIONBased on the simulated osteotomy in computer before surgery, according to the characteristics of ankylosing spondylitic kyphosis, different posterior osteotomy and correction methods can achieve good results.

Adult ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Spondylitis, Ankylosing ; complications ; Treatment Outcome ; Young Adult

Humans ; Kyphosis ; etiology ; surgery ; Osteotomy ; methods ; Spondylitis, Ankylosing ; complications ; Treatment Outcome

Humans ; Kyphosis ; etiology ; surgery ; Osteotomy ; methods ; Spondylitis, Ankylosing ; complications

OBJECTIVETo evaluate the outcome of posterior trans-pedicle + disc osteotomy in patients with post-traumatic thoracolumbar kyphosis.

METHODSBetween June 2000 and June 2003, 26 adult patients, 16 male and 10 female, average 30.6 years old (21 - 42 y), of post-traumatic thoracolumbar kyphosis were corrected by means of single posterior trans-pedicle + disc osteotomy technique. Operation time, blood loss, and surgical complication were counted. Back pain Visual Analog Scale (VAS) Oswestry score and Frankel neurological grade were used to for clinical evaluation. All the radiographic and clinical data were requested at 3 time points (before operation, directly postoperatively, and at final follow-up).

RESULTSNo severe complications were found in this group. Local kyphosis (T(10)-L(2) Cobb angle) was corrected from average 22.3 degrees +/- 3.5 degrees to 2.2 degrees +/- 2.1 degrees (corrective rate 90.1%). Intraoperative average blood loss was (680.0 +/- 31.5) ml and average operational time was (186.0 +/- 22.8) min. All the patients finished at least 3 - 5 years follow-up, Neural improvement achieved in this group (before operation Frankel D 12 cases, Frankel C 6 cases and Frankel B2 cases; 3 years postoperation Frankel E 14 cases, Frankel D 2 cases Frankel C1 case and Frankel B 1 case), postoperative back pain was reduced from preoperative 8.6 +/- 1.3 to 2.2 +/- 0.5 in VAS and Oswestry score improved from (62.5 +/- 8.6)% to (16.2 +/- 4.3)% at last follow up.

CONCLUSIONSingle posterior trans-pedicle + disc osteotomy technique is suitable to thoracolumbar post-traumatic kyphosis.

Adult ; Female ; Humans ; Kyphosis ; etiology ; surgery ; Lumbar Vertebrae ; injuries ; Male ; Osteotomy ; methods ; Spinal Fractures ; complications ; Thoracic Vertebrae ; injuries ; Treatment Outcome ; Young Adult

OBJECTIVETo study retrospectively the efficacy and complications of combined pedicle subtraction osteotomy (PSO) and polysegmental closing wedge osteotomy for correction of the severe rigid thoracolumbar kyphotic deformity in ankylosing spondylitis (AS).

METHODSA total of 8 consecutive male patients with AS and severe thoracolumbar kyphotic deformity (mean age 32 years, range 28 - 46) were involved in this study from August 2004 to June 2007. The average preoperative Cobb angle of thoracic spine (T(1)-T(12)) was 96 degrees (range, 80 degrees - 112 degrees ), the mean preoperative angle of lumbar lordosis (L(1)-S(1)) was 10 degrees (5 degrees - 15 degrees ). The mean chin-brow angle was 47 degrees (range, 40 degrees - 58 degrees ). The average gaze angle was 43 degrees (range, 32 degrees - 50 degrees ). After preoperative assessment, single-level PSO was performed in L(3) vertebrae and two-level polysegmental closing wedge osteotomy was performed in thoracolumbar vertebrae (T(12)-L(1), L(1-2)). Radiographic and clinical results and complications were assessed.

RESULTSThe surgical time was (298.1 +/- 20.7) minutes and blood loss during the procedure was (1588.8 +/- 171.6) ml. The follow-up period was (11.5 +/- 7.7) months. The postoperative angle and the amount of correction of the thoracic and lumbar spine were 76.1 degrees +/- 9.6 degrees , 20.3 degrees +/- 1.1 degrees and 48.4 degrees +/- 4.7 degrees , 38.4 degrees +/- 4.7 degrees respectively. The postoperative chin-brow and gaze angle was 16.5 degrees +/- 4.6 degrees and 73.0 degrees +/- 5.2 degrees , respectively. The amount of correction for sagittal balance was (12.3 +/- 1.6) cm. No nerve, vascular injury, stress fracture and coronal decompensation occurred in the patients.

CONCLUSIONSCombined PSO and polysegmental closing wedge osteotomy by posterior approach only is safe and effective for correction of the severe rigid thoracolumbar kyphotic deformity in AS. The visual field is significantly improved after surgery.

Adult ; Follow-Up Studies ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Retrospective Studies ; Spondylitis, Ankylosing ; complications ; Treatment Outcome