Objective To explore some operative problems of correcting paralytic scoliosis(PS) by using vertebral pedicle screwsrods system. Methods From May 2000 to May 2005, 18 patients with PS were corrected by screwsrods system which were made of titanium alloy.There were 10 males and 8 females, aging from 11 to 26 years. The primary disease included poliomyelitis in 13 patients and myelodysplasia (MS) in 5 patients (2 cases for second correction) with scoliosis of an average 85° Cobb angle (55-125°). The pelvic obliquity was found in all patients with an average 24° angle (355°).Of the 18 patients,3 cases were given perioperative halo-pelvic traction, 2 cases were given vertebral wedge osteotomy and correction and fixation, the other patients were purely underwent the treatment of pedicle screwrods system implants. Fusion segment at operation ranged from 6 to 15 sections, applied screws the most was 16,the fewest was 6. Results There were no wound infections and neurologic complications, all wounds healed by the first intention. Allscoliosis obtained obvious correction (P＜0.001), the correction rate averaged 52.95% (44%-81%); the majority of lumbar kyphosis and pelvic obliquity were apparently corrected. The average clinical follow-up (16 cases) was 21 months(6-36 months),there was no implants failure. One patient with MS had a worse Cobb magnitude, the other patients had no curve progression (P＞0.05). Conclusion The use of vertebral pedicle screwsrods fixation to multiple vertebral bodys and short segment fusion for PS, the treatment method is reliable and the outcome is satisfactory. While performing the correcting operative procedures, the spinal, pelvic and lower extremity deformities and functions should be all considered as a whole.
Objective To discuss the characteristics of delivery and anesthesia management of pregnant women with moderate to severe scoliosis, and to summarize the anesthesia implementation strategies for pregnant women with scoliosis. Methods Pregnant women with moderate to severe scoliosis admitted to West China Second University Hospital, Sichuan University between January 2020 and January 2022 were retrospectively included. The demography information, delivery mode, anesthesia implementation plan and other relevant data of the women were analyzed. Results A total of 9 women with moderate to severe scoliosis were included, with an average age of 29.9 years. The median (lower quartile, upper quartile) of the Cobb angle of the women was 42° (35°, 54°). There were 5 women with moderate to severe impairment of lung ventilation function, 1 woman with grade Ⅲ heart function, and 8 women with comorbidities. Among the 8 women who underwent cesarean section, 3 underwent general anesthesia, 4 underwent epidural block, and 1 underwent local anesthesia with enhanced sedation. One woman who chose vaginal delivery underwent epidural labor analgesia. All women passed the surgery or delivery period safely, with 5 transferred to the intensive care unit for further treatment after surgery, and 4 safely returned to the ward after surgery. All women recovered and were discharged. Eight fetuses survived, and 1 fetus underwent lethal induced abortion. Conclusions Pregnant women with moderate to severe scoliosis during pregnancy have poor tolerance to vaginal delivery due to severe malformations and organ dysfunction, especially cardiopulmonary dysfunction. Most of them terminate pregnancy through cesarean section. When making anesthesia decisions, it is important to carefully consider the women’s own condition and surgical risks.
Objective Currently, there are few researches on lordosis associated with scol iosis. To explore the effects of nickel-titanium memory alloy staple (Staple) on the growth of thoracic lordosis by observing the histological changes of cartilage cells in the osteoepiphysis of the thoracic vertebrates in goats. Methods Eighteen 2-3 months old female goats, weighing 8-12 kg, were randomly divided into long staple group (n=6), short staple group (n=6), and blank control group (n=6). Long staple (7 mm) and short staple (4 mm) were implanted into T6-11 segments of goats in long and short staplegroups by anterior approach, respectively. The blank control group was not treated. The X-ray examination was performedpre-operatively and at 3 months post-operatively to observe the changes of Cobb angle. Then the growth plates and inferior facet processes of the apex vertebral body were harvested to observe the histological grades of cartilage by HE staining, and to observe prol iferation and apoptosis of chondrocytes through immunohistochemistry double label ing staining with poly-ADPribose- polymerase-p85 and prol iferating cell nuclear antigen. Results At 3 months after operation, the T6-11 Cobb angles were significantly higher than those of pre-operation in short staple group and long staple group, which were significantly higher than those in blank control group (P lt; 0.05), but there was no significant difference between short staple group and long staple group (P gt; 0.05). The results of HE staining and immunohistochemistry double staining showed that the number of chondrocytes were reduced obviously with irregular columnar arrangement and increased volume ratio of surrounding extracellular matrix in prol iferative zone and hypertrophic zone of growth plate and inferior articular process in both long and short staple groups, and this tendency was more noticeable in long staple group. There were significant differences in the grades of prol iferation viabil ity of chondrocytes between 2 staple groups and blank control group (P lt; 0.05), but there was no significant difference tewteen long staple group and short staple group (P gt; 0.05). The prol iferation viabil ities of chondrocytes in growth plate and inferior articular process were significantly higher in blank control group than in 2 staple groups (P lt; 0.01), but there was no significant difference between long staple group and short staple group (P gt; 0.05). Conclusion The histological evidences prove that the Staple implantation by anterior approach can reduce prol iferation viabil ity of chondrocytes in growth plate and inferior articular process of the thoracic vertebrates in goats, which conduces the growth direction of thoracic vertebrates to kyphosis.
Objective To review the King-types Ⅲ and Ⅳ patients treated by the CD hybrid technique and evaluate clinical results on the shorter fusion levels. Methods Fifty-eight patients with idiopathic scoliosis were treated by the CD hybrid method from March 2000 to January 2003, among whom 40 were grouped as Kingtype Ⅲ and 18 as Kingtype Ⅳ; 41 were female and 17 were male. The Cobb angle of the thoracic curve was averaged 64°(range 50-83°), and the curve flexibility was 62%. The compensative lumbarcurve was averaged 37°（range 16-48°）, and the curve flexibility was 105%. With the neutral rotational vertebrae as a basis to select the low instrumentation vertebrae, the neutral rotational vertebrae or the vertebrae at 1 or 2 levelsproximal to the neutral rotational vertebrae were selected as the low instrumentation vertebrae in all the patients. Standing AP and lateral radiographs were taken respectively at the discharge, during the follow-up after discharge, and at the final follow-up. Results The patients were followed up for an average of 2.4 years (range 1.8-3.2). The corrected curves lost an average of 3.1°（range -1-5°）and the correction rate of the thoracic curve was 68% at the final follow-up.The plumbline from C7 was parallel to the sacral midline in 56 patients. The lumbar curves were corrected to an average of 8°（2-13°）automatically. The lumbosacral angle was corrected automatically by 53% and the low instrumentation vertebrae in 48 patients turned into stable vertebrae. The low instrumentation vertebrae lost 1.4 segments on average compared with the Harrington principle. No spinal imbalance was clinically observed in all the patients. Conclusion The choice of the low instrumentation vertebrae as the neutral rotational vertebrae can have a good result in the clinical practice. It can be applied in the CD hybrid technique in treatment of idiopathicthoracic curves.
Objective To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L1–4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group (P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group (P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy (P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers (P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers (P<0.05). Conclusion The polymorphism of IL-6 genepromoter region-174 locus wasn’t correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.
【Abstract】 Objective To summarize the current development of the correction of severe and rigid scol iosis. Methods Recent l iterature concerning the correction of severe and rigid scol iosis at home and abroad was extensively reviewed, and current developments of the correction of severe and rigid scol iosis were summarized. Results The correction of severe and rigid scol iosis shows developments as follows: the application of Halo-gravity traction increase and Halo-femoral traction is applied in posterior correction surgery. Fixation and correction technique with all pedicle screws was gradually popularized. The applications of posterior vertebral column resection, one-stage anterior and posterior surgery, and posterior-only correction surgery increase. Conclusion The developments of all kinds of correction techniques improve the correction effects of severe and rigid scol iosis. Now there is no standardized treatment protocol for severe and rigid scol iosis. Greater development can be expected in the future.
ObjectiveTo observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. MethodsBetween March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years (range, 14-25 years). The average disease duration was 13.6 years (range, 3-24 years). All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type Ⅱ, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T6 in 1 case, at T7 in 3 cases, at T8 in 7 cases, at T9 in 13 cases, and at T10 in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22 (SRS-22) questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation (AVT), C7 plumb line-center sacral vertical line (C7PL-CSVL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) at pre-and post-operation. ResultsThe average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 mL; and total hospitalization cost was (14.7±1.4)×104 yuan RMB. The coronal plane Cobb angle of major curve was (55.7±16.5)°, and the TK was (43.2±16.2)° after first distraction. The patients were followed up 2-5 years (mean, 3.8 years). Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was found. The coronal plane Cobb angel of major curve, TK, and AVT after fusion and at last follow-up were significantly lower than preoperative ones (P<0.05), but no significant difference was found between at post-fusion and last follow-up (P>0.05). There was no significant difference in C7PL-CSVL and SVA between at pre-and post-operation (P>0.05). At last follow-up, SRS-22 questionnaire scores were 4.32±0.42 for active degree, 4.54±0.58 for mental health, 3.97±0.76 for self-image, 4.09±0.64 for pain, and 4.03±0.83 for satisfaction degree. ConclusionAnterior release internal distraction can provide satisfactory correction results for severe and rigid scoliosis with higher safety and lower incidence of complication.
Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.
Objective To review the research progress of upper instrumented vertebra (UIV) selection strategy for long-segment fixation (LSF) in adult degenerative scoliosis (ADS). Methods The relevant domestic and foreign literature in recent years was reviewed, and the selection strategy of sagittal and coronal UIV for LSF in ADS patients, the relationship between UIV selection and proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), the impact of minimally invasive spine surgery on the selection strategy of UIV were summarized. Results LSF can restore the biomechanical balance of the spine and reconstruct the physiological curve of the spine for ADS patients. LSF should be selected for ADS patients with severe scoliosis, vertebral rotation, and severe sagittal imbalance. For patients with poor general condition, UIV can choose the thoracic and lumbar vertebrae to reduce the operation time and intraoperative bleeding, which is conducive to early mobilization and reduce complications; for patients with good general condition, the upper thoracic vertebrae can be considered if necessary, in order to achieve satisfactory long-term effectiveness. However, the lower thoracic vertebra (T9、10) should be selected as much as possible to reduce postoperative complications such as PJK and PJF. In recent years, a new reference marker, the first coronal reverse vertebra was proposed, to guide the selection of UIV. But a large-sample multicenter randomized controlled study is needed to further verify its reliability. Studies have shown that different races and different living habits would lead to different parameters of the spine and pelvis, which would affect the selection of UIV. Minimally invasive surgeries have achieved satisfactory results in the treatment of ADS, but the UIV selection strategy in specific applications needs to be further studied. Conclusion The selection strategy of UIV in LSF has not yet been unified. The selection of UIV in the sagittal plane of the upper thoracic spine, the lower thoracic spine, or the thoracolumbar spine should comprehensively consider the biomechanical balance of the spine and the general condition of the patient, as well as the relationship between the upper horizontal vertebra, the upper neutral vertebra, and the upper end vertebra on the coronal plane.