Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

Abstract Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.

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Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

10.21203/rs.3.rs-31598/v1 ◽

2020 ◽

Author(s):

hongheng lin ◽

Xiaoting Ou ◽

Wenchao Li ◽

Minyuan Chen ◽

Caijun Liu ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Operation Time ◽

Clinical Results ◽

Radiographic Evaluation ◽

Correction Loss ◽

Short Segment ◽

Significant Correction ◽

Short Segment Fixation

Abstract BackgroundThis is a retrospective study to evaluate the efficacy of percutaneous short segment fixation (PSSF) with or without intermediate screws in Magerl A3 thoracolumbar (TL) fractures accompanied with low bone mineral density (BMD).Methods From January 2017 to December 2018, 30 patients diagnosed with Magerl A3 TL fractures having a BMD between 0.5/cm2 and 1g/cm2 in the lumbar vertebrae with intact neurological functions and a history of major trauma who underwent PSSF with or without intermediate screws were enrolled in this study. The patients were divided into two groups of those with intermediate screws (group F) or without (group S). The operation time and intra-operation blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) were employed as clinical assessments and quantified. Radiographic follow-up assessed according to the Cobb angle (CA), Vertebral wedge angle (VWA), and anterior vertebral body height (AVBH).ResultsLoose screws were observed in 4 of the 30 enrolled patients. Significant differences were observed in operation time and intra-operative blood loss between the two groups. The enrolled patients’ clinical results (VAS and ODI scores) were good, however, no significant differences during all follow-up periods were present between the two groups. Radiographic evaluation (CA, VWA and AVBH) improved immediately after surgery, but significant correction loss was observed in the follow-up periods, especially in the first month. Radiographic evaluation demonstrated no significant differences between the two groups.Conclusion Although the patients’ clinical results were satisfactory, PSSF could not resist the correction loss in Magerl A3 TL fractures accompanied with BMD below 1g/cm2. Accordingly, the use of intermediate pedicle screws may be unnecessary due to their limited ability in resisting correction loss and increasing operation time as well as intra-operation blood loss.

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Transpseudarthrosis Osteotomy with Interbody Fusion for Kyphotic Spinal Pseudarthrosis in Ankylosing Spondylitis by a Single Posterior Approach: A Retrospective Study and a Brief Relevant Literature Review

BioMed Research International ◽

10.1155/2017/4079849 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Erzhu Yang ◽

Liangliang Cao ◽

Guowang Zhang ◽

Xiaofeng Lian ◽

Jianguang Xu

Keyword(s):

Ankylosing Spondylitis ◽

Blood Loss ◽

Posterior Approach ◽

Interbody Fusion ◽

Operative Time ◽

Relevant Literature ◽

Clinical Results ◽

Average Operative Time ◽

Single Posterior Approach

Objective. To explore the safety and efficacy of transpseudarthrosis osteotomy with interbody fusion in the treatment of Ankylosing Spondylitis (AS) patients with kyphotic spinal pseudarthrosis by a single posterior approach. Methods. Twelve consecutive patients with spinal pseudarthrosis underwent transpseudarthrosis osteotomy and interbody fusion with a polyetheretherketone (PEEK) cage by a single posterior approach. The operative time, intraoperative blood loss, and complications were recorded. Radiographic and clinical results were assessed preoperatively and at the final follow-up. Results. The average operative time was 201.9 min and the mean blood loss was 817.5 ml. The visual analogue scale (VAS) improved significantly from 6.7 preoperatively to 1.1 at the final follow-up. The average correction of the segmental kyphosis at the level of the pseudarthrosis was 22.3°. Bony fusion was achieved in all patients, and there was no obvious loss of correction at follow-up. Conclusion. Transpseudarthrosis osteotomy at the level of the pseudarthrosis can be safely performed and surgical repair of pseudarthrosis with interbody fusion by a single posterior approach was feasible.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04348-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fangning Hu ◽

Xi Liu ◽

Fanxiao Liu ◽

Honglei Jia ◽

Xiaolong Lv ◽

...

Keyword(s):

Blood Loss ◽

Rating Scale ◽

Clavicle Fracture ◽

Operation Time ◽

Clinical Results ◽

Intraoperative Blood Loss ◽

Traditional Group ◽

Significant Difference ◽

Clavicle Fractures ◽

Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

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Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

10.21203/rs.3.rs-273357/v1 ◽

2021 ◽

Author(s):

Hao Cheng ◽

Guo-dong Wang ◽

Tao Li ◽

Xiao-yang Liu ◽

Jian-min Sun

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Sagittal Balance ◽

Rating Scale ◽

Clinical Results ◽

Spinal Alignment ◽

Thoracolumbar Kyphosis ◽

Kummell’S Disease ◽

Kümmell’S Disease

Abstract Background: To evaluate the short to mid-term radiographic and clinical outcomes of the restoration of normal spinal alignment and sagittal balance in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods: Between February 2016 and May 2018,30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into two groups (A and B) according to whether the kyphosis was combined with neurological deficits.All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance.And the radiographic outcomes and clinical results of these 30 patients were retrospectively evaluated.The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS)of the whole spine before operation,immediately after operation,and the last follow-up of each group were measured and evaluated.The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups .Results: The average follow-up period of group A and B were 34.2 and 38.7 months respectively.The parameters of both groups such as SVA,TLK,and thoracolumbar Cobb angle after surgery and at the last follow-up were significantly improved compared with those before surgery.The ODI and the NRS of the two groups at the last follow-up were also significantly improved. Conclusion: In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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Is It Necessary to Reduce Thoracolumbar Compression Fractures with Intermediate Screws in the Fractured Vertebra?

10.21203/rs.3.rs-542387/v1 ◽

2021 ◽

Author(s):

ZeJun Xing ◽

Shuai Hao ◽

XiaoFei Wu

Keyword(s):

Blood Loss ◽

Body Height ◽

Pedicle Screws ◽

Operation Time ◽

Short Segment ◽

Compression Fractures ◽

Significant Difference ◽

Before And After ◽

Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

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Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study

10.21203/rs.2.15560/v2 ◽

2019 ◽

Author(s):

Yiliang Cui ◽

Xingyi Hua ◽

Florian Schmidutz ◽

Jian Zhou ◽

Zongsheng Yin ◽

...

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Functional Outcomes ◽

Operation Time ◽

Tibial Shaft ◽

Shaft Fractures ◽

Significant Difference ◽

Special Surgery ◽

Tibial Shaft Fractures

Abstract Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach. Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss. Results: A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM. Conclusions: Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.

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Regrowth of the adenoids after adenoidectomy down to the pharyngobasilar fascial surface

The Journal of Laryngology & Otology ◽

10.1017/s0022215115001437 ◽

2015 ◽

Vol 129 (7) ◽

pp. 662-665 ◽

Cited By ~ 5

Author(s):

L Wei ◽

M Wang ◽

N Hua ◽

K Tong ◽

L Zhai ◽

...

Keyword(s):

Surgical Technique ◽

Blood Loss ◽

Success Rate ◽

Operation Time ◽

Early Complications ◽

Estimated Blood Loss ◽

Endoscopic Guidance ◽

Pharyngobasilar Fascia

AbstractObjectives:This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.Methods:Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.Results:In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.Conclusion:Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.

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Clinical Effect of Vertebral Column Decancellation Osteotomy Combined with Ponte Osteotomy in Elderly Patients with Old Thoracolumbar Fracture Combined with Kyphosis Deformity

Tobacco Regulatory Science ◽

10.18001/trs.7.5.1.160 ◽

2021 ◽

Vol 7 (5) ◽

pp. 3878-3887

Author(s):

Tongtong Zhang ◽

Chao Kong ◽

Xiangyao Sun ◽

Wei Wang ◽

Shudong Jiang ◽

...

Keyword(s):

Elderly Patients ◽

Cobb Angle ◽

Vertebral Column ◽

Clinical Effect ◽

Life Quality ◽

Thoracolumbar Fracture ◽

Thoracolumbar Kyphosis ◽

Ponte Osteotomy ◽

Vas Score

Objective. The purpose of this study was to investigate the clinical effect of vertebral column decancellation (VCD) osteotomy combined with Ponte osteotomy in elderly patients withold thoracolumbar fracture combined with kyphosis deformity.Methods.36 elderly patients with old thoracolumbar fracture combined with kyphosis deformity admitted to our hospital from August 2015 to November 2018 were selected as the study subjects, and all of them were treated with VCDosteotomy combined with Ponte osteotomy.The Cobb angle of thoracolumbar kyphosis, sagittal vertical axis (SVA), visual analog scale (VAS) score.Oswestry disability index (ODI) and life quality were compared at 1 week before and after surgery as well as at the last follow-up. Results. ® All the 36 patients underwent the surgery successfully without serious complications, with the average duration of surgery of (5.13±0.62) h, average blood loss of (821.58±142.67) ml and average hospital stay of (14.02±2.43) d. (2) The Cobb angle of thoracolumbar kyphosis and SVA at 1 week after surgery and at the last follow-up were smaller than those at 1 week before surgery (P < 0.01), but the Cobb angle of thoracolumbar kyphosis and SVA at the last follow-up were slightly larger than those at 1 week after surgery (P < 0.01). (3) The VAS score and ODI score at 1 week after surgery and at the last follow-up were lower than those before surgery (P < 0.01), and the VAS score and ODI score at the last follow-up were lower than those at 1 week after surgery (P < 0.01). @ The scoliosis research society 22-item (SRS-22) score at the last follow-up was higher than that before surgery (P < 0.01). Conclusion. VCD osteotomy combined with Ponte osteotomy in the treatment of old thoracolumbar fracture combined with kyphosis deformity in the elderly can reduce the Cobb angle of thoracolumbar kyphosis, improve sagittal balance, reduce pain symptoms and functional disorders, and improve patents’ life quality, having a good clinical effect.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

10.21203/rs.3.rs-37318/v1 ◽

2020 ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background Surgical management of lumbar disc herniation in the hidden zone is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce a safe and effective technique named microscopic extra-laminar sequestrectomy (MELS) for treatment of hidden zone lumbar disc herniation and present clinical outcomes within a two year follow-up period. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with hidden zone lumbar disc herniation were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and herniated fragment were visually exposed using this extra-laminar approach. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 months, ranging from 18 to 24 months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is a safe and effective method in the management of hidden zone lumbar disc herniation. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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