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BMC Musculoskeletal Disorders Nov 2023The efficacy of anterior fusion with overcorrection in the instrumented vertebra for Lenke 1 AR type curves has been reported, but how to achieve overcorrection and how...
Anterior fusion surgery with overcorrection in the treatment of adolescent idiopathic scoliosis with Lenke 1 AR curve type: how to achieve overcorrection and its effect on postoperative spinal alignment.
BACKGROUND
The efficacy of anterior fusion with overcorrection in the instrumented vertebra for Lenke 1 AR type curves has been reported, but how to achieve overcorrection and how overcorrection affects spinal alignment are unclear. The purpose of this study was to identify the factors that cause overcorrection, and to investigate how overcorrection affects postoperative spinal alignment in the surgical treatment of Lenke 1 AR type curves.
METHODS
Patients who had anterior surgery for a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) type scoliosis and minimum 2-year follow-up were included. The radiographic data were measured at preoperative, postoperative 1 month, and final follow-up. The UIV-LIV Cobb angle was determined as the Cobb angle between the upper instrumented vertebra (UIV) and the lower instrumented vertebra (LIV), and a negative number for this angle was considered overcorrection. The screw angle was determined to be the sum of the angle formed by the screw axis and the lower and upper endplates in the LIV and UIV, respectively. The change (Δ) in the parameters from postoperative to final follow-up was calculated. The relationships between the UIV-LIV Cobb angle and other radiographic parameters were evaluated by linear regression analyses.
RESULTS
Fourteen patients met the inclusion criteria. Their median age was 15.5 years, and the median follow-up period was 53.6 months. The median UIV-LIV Cobb angle was -1.4° at postoperative 1 month. The median screw angle was 4.7°, and overcorrection was achieved in 11 (79%) cases at postoperative 1 month. The screw angle (r = 0.42, p = 0.012) and Δ FDUV-CSVL (the deviation of the first distal uninstrumented vertebra from the central sacral vertical line, r = 0.53, p = 0.003) were significantly correlated with the UIV-LIV Cobb angle.
CONCLUSIONS
Screw placement in the UIV and LIV not parallel to the endplate, but angled, was an effective method to facilitate overcorrection in the instrumented vertebrae. The results of the present study suggest that overcorrection could bring spontaneous improvement of coronal balance below the instrumented segment during the postoperative period.
Topics: Humans; Adolescent; Scoliosis; Thoracic Vertebrae; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion; Radiography; Kyphosis; Postoperative Period; Treatment Outcome; Follow-Up Studies
PubMed: 37936125
DOI: 10.1186/s12891-023-06989-4 -
BMC Musculoskeletal Disorders Feb 2022Improper occipitocervical alignment after occipitocervical fusion (OCF) may lead to devastating complications, such as dysphagia and/or dyspnea. The occipital to C2...
BACKGROUND
Improper occipitocervical alignment after occipitocervical fusion (OCF) may lead to devastating complications, such as dysphagia and/or dyspnea. The occipital to C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa) have been used to evaluate occipitospinal alignment. However, it may be difficult to identify the inferior endplate of the C2 vertebra in patients with C2-3 Klippel-Feil syndrome (KFS). The purpose of this study aimed to compare four different parameters for predicting dysphagia after OCF in patients with C2-3 KFS.
METHODS
There were 40 patients with C2-3 KFS undergoing OCF between 2010 and 2019. Radiographs of these patients were collected to measure the occipital to C3 angle (O-C3a), O-C2a, occipito-odontoid angle (O-Da), occipital to axial angle (Oc-Axa), and narrowest oropharyngeal airway space (nPAS). The presence of dysphagia was defined as the patient complaining of difficulty or excess endeavor to swallow. Patients were divided into two groups according to whether they had postoperative dysphagia. We evaluated the relationship between each of the angle parameters and nPAS and analyzed their influence to the postoperative dysphagia.
RESULTS
The incidence of dysphagia after OCF was 25% in patients with C2-3 KFS. The Oc-Axa, and nPAS were smaller in the dysphagia group compared to non-dysphagia group at the final follow-up (p < 0.05). Receiver-operating characteristic (ROC) curves showed that dO-C3a had the highest accuracy as a predictor of the dysphagia with an area under the curve (AUC) of 0.868. The differences in O-C3a, O-C2a, O-Da, and Oc-Axa were all linearly correlated with nPAS scores preoperatively and at the final follow-up within C2-3 KFS patients, while there was a higher R value between the dO-C3a and dnPAS. Multiple linear regression analysis showed that the difference of O-C3a was the only significant predictor for dnPAS (β = 0.670, p < 0.001).
CONCLUSIONS
The change of O-C3a (dO-C3a) is the most reliable indicator for evaluating occipitocervical alignment and predicting postoperative dysphagia in C2-3 KFS patients. Moreover, dO-C3a should be more than - 2° during OCF to reduce the occurrence of postoperative dysphagia.
Topics: Cervical Vertebrae; Deglutition Disorders; Humans; Klippel-Feil Syndrome; Postoperative Complications; Postoperative Period; Spinal Fusion
PubMed: 35130887
DOI: 10.1186/s12891-022-05072-8 -
Turkish Journal of Medical Sciences 2023Craniocervical junction (CCJ) can be involved in inflammatory arthritis. We aimed to define types of CCJ involvement in rheumatoid arthritis (RA), spondyloarthritis...
BACKGROUND/AIM
Craniocervical junction (CCJ) can be involved in inflammatory arthritis. We aimed to define types of CCJ involvement in rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) and compare them with patients without inflammatory arthritides.
MATERIALS AND METHODS
In this retrospective analysis, cervical CT or MRIs of patients with RA, SpA, or PsA, taken for any reason between 2010 and 2020, according to ICD-10 codes, were scanned. Demographic data of the patients were recorded. CCJ involvements (atlantoaxial, vertical, or subaxial subluxation, odontoid process involvement) were reevaluated by an experienced radiologist. The control group consisted of consecutive patients without inflammatory arthritis.
RESULTS
Exactly 459 patients (204 RA, 200 SpA, and 55 PsA) and 78 patients in the control group were included in the study. CCJ involvement was detected in 101 (49.5%) RA, 53 (26.5%) SpA, 10 (18.2%) PsA, and 4 patients (5.1%) in the control group (p < 0.001). The odontoid process was one of the main targets, especially in RA patients (69 (33.8%)), which was significantly higher than in the SpA, PsA, and control groups. Although vertical subluxation (VS) was numerically higher in the RA and SpA groups compared to the control group, VS-related brainstem compression was relatively uncommon: 6 (2.9%) in RA, 1 (0.5%) in AS, and none in the PsA and control groups.
CONCLUSION
CCJ involvement can often be detected in patients with inflammatory arthritis, especially in RA and SpA patients. The odontoid process is the main target of inflammation.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Arthritis, Rheumatoid; Adult; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Spondylarthritis; Aged; Arthritis, Psoriatic; Atlanto-Axial Joint; Cervical Vertebrae; Odontoid Process
PubMed: 38813511
DOI: 10.55730/1300-0144.5740 -
Global Spine Journal May 2023Comparative cohort study.
STUDY DESIGN
Comparative cohort study.
OBJECTIVE
Factors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear.
METHODS
A prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared.
RESULTS
Forty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, = 0.004). The PT group had a larger correction of cSVA (-7.7 vs 0.7 mm, = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up.
CONCLUSIONS
The selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.
PubMed: 34013765
DOI: 10.1177/21925682211017478 -
Scientific Reports Feb 2024Lumbo-sacral transitional vertebrae (LSTV) are frequent congenital variances of the spine and are associated with increased spinal degeneration. Nevertheless, there is a...
Lumbo-sacral transitional vertebrae (LSTV) are frequent congenital variances of the spine and are associated with increased spinal degeneration. Nevertheless, there is a lack of data whether bony alterations associated with LSTV result in reduced segmental restoration of lordosis when performing ALIF. 58 patients with monosegmental stand-alone ALIF in the spinal segment between the 24th and 25th vertebra (L5/S1)/(L5/L6) where included. Of these, 17 patients had LSTV and were matched to a control population by age and sex. Pelvic incidence, pelvic tilt, sagittal vertical axis, lumbar lordosis, segmental lordosis, disc height and depth were compared. LSTV-patients had a significantly reduced segmental lordosis L4/5 (p = 0.028) and L5/S1/(L5/L6) (p = 0.041) preoperatively. ALIF resulted in a significant increase in segmental lordosis L5/S1 (p < 0.001). Postoperatively, the preoperatively reduced segmental lordosis was no longer significantly different in segments L4/5 (p = 0.349) and L5/S1/(L5/6) (p = 0.576). ALIF is associated with a significant increase in segmental lordosis in the treated segment even in patients with LSTV. Therefore, ALIF is a sufficient intervention for restoring the segmental lordosis in these patients as well.
Topics: Humans; Lordosis; Lumbar Vertebrae; Retrospective Studies; Pelvis; Lumbosacral Region; Spinal Fusion
PubMed: 38302558
DOI: 10.1038/s41598-024-53179-w -
BMC Musculoskeletal Disorders Aug 2022The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to...
BACKGROUND
The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis.
METHODS
A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae.
RESULTS
A total of 41 patients were included, with an average age of 20 years (range, 12-49 years) and follow-up of 34 months (range, 24-58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure.
CONCLUSION
The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.
Topics: Adult; Humans; Kyphosis; Retrospective Studies; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome; Young Adult
PubMed: 35964038
DOI: 10.1186/s12891-022-05732-9 -
Medicine Nov 2019It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures.
METHODS
A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle-Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot.
RESULTS
Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18-0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34-0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19-9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78-1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73-7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot.
CONCLUSION
Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.
Topics: Age Factors; Aged; Aged, 80 and over; Conservative Treatment; Fracture Fixation; Humans; Length of Stay; Odontoid Process; Patient Satisfaction; Postoperative Complications; Spinal Fractures
PubMed: 31689741
DOI: 10.1097/MD.0000000000010281 -
Neurology India 2023Atmaram bone (C2 axis vertebra) is usually handed over to the family of the deceased on the next day after cremation during the ''Asthi sanchaya '' commemoration....
Atmaram bone (C2 axis vertebra) is usually handed over to the family of the deceased on the next day after cremation during the ''Asthi sanchaya '' commemoration. ''Asthi visarajan'' involves the practice of immersing the bones and ashes of the deceased in the Holy Ganges river as per Hindu beliefs. Atmaram bone, which usually does not burn during cremation, is handed over to the family of the departed (asthi sanchaya) after cremation which is then immersed in the holy Ganges river ( asthi visarajan). Atma means soul, Ram means Lord and Atmaram combined means the one who is Lord of his own soul." Worshiping of Lord Shiva (while living) and Asthi sanchaya-Asthi visarajan (of the departed) are two religious venerations in Hinduism. Atmaram bone was handed over to me for immersion in the holy Ganges on November 6, 2020, after conducting the asthi sanchaya of my mother during the coronavirus disease 2019 (COVID-19) pandemic. Atmaram bone looked like a Shivalinga statue to most who looked at it, whereas it resembled the image of the axis vertebrae (C2 vertebra) to me when I saw it that sacred day. Atmaram bone, the Shivalinga, and the C2 axis vertebra are among the most precious and sacred objects that humans can handle as relatives, as devotees, and as neurosurgeons, respectively. Asclepius, possibly a skilled war surgeon/neurosurgeon, was worshipped at Asclepieia. Trephination surgery in neurosurgery and religion are intertwined historically. Though there is no published literature, neurosurgeons in various parts of the world do offer religious prayers prior to major neurosurgical operations. In line with the religious veneration of worshipping Shiva Ling or immersion of bones of the departed soul in the Holy Ganges river, we believe it is the sacred responsibility of the operating neurosurgeon to perform surgery in complex craniovertebral junction. As neurosurgeons, we cannot ignore the axis in the living, the odontoid fracture in the injured, and the Atmaram in the deceased.
Topics: Humans; Neurosurgeons; Odontoid Process; Cross-Cultural Comparison; Cremation; COVID-19
PubMed: 37322753
DOI: 10.4103/0028-3886.378664 -
Acta Ortopedica Mexicana 2020The is a variable oval or round ossicle with a smooth cortical border, which partially corresponds to the odontoid process, without having continuity with the rest of...
The is a variable oval or round ossicle with a smooth cortical border, which partially corresponds to the odontoid process, without having continuity with the rest of C2 bone. The multifactorial etiology causes instability and clinically translates into pain and compression data into neural structures. The treatment of choice is surgical and techniques have been developed that focus on preserving the stability of the segment. We present the case of a 23-year-old female patient, who begins to suffer at 8 years of age, refers to moderate to severe cervicalgia, which develops with paresthesias in the left hemisphere and later paresis of the left thoracic limb. Physical examination showed hypoaesthesia of the left hemisphere, as well as paresis of the left thoracic limb. Extension studies demonstrate chronic axonal lesion from C1 to C3, predominantly left, imaging studies showing axial instability and magnetic resonance bulbar compression. The patient receives surgical treatment consisting of posterior fixation C1-C2, evolving satisfactorily.
Topics: Adult; Atlanto-Axial Joint; Axis, Cervical Vertebra; Female; Humans; Joint Instability; Odontoid Process; Spinal Fusion; Young Adult
PubMed: 33535281
DOI: No ID Found -
American Journal of Veterinary Research Nov 2023To investigate the feasibility of using shape memory alloy (SMA) implants for atlantoaxial joint stabilization using a rabbit model as a substitute for canines.
OBJECTIVE
To investigate the feasibility of using shape memory alloy (SMA) implants for atlantoaxial joint stabilization using a rabbit model as a substitute for canines.
ANIMALS
20 rabbit cadavers.
METHODS
We prepared rabbit cadavers from the middle of the skull to the third cervical vertebra. The vertebral body and canal sizes of the atlas and axis were compared using CT data from rabbits, normal dogs, and dogs with atlantoaxial instability (AAI) to assess the feasibility of using rabbits as substitutes for toy-breed dogs. The shape memory alloy (SMA) implants were designed to stabilize the atlantoaxial joint without compromising the spinal canal passage for safety and were classified into SMA-1 and SMA-2 based on their design. To evaluate the strength, the ventrodorsal force was measured with atlantoaxial ligaments intact, after removing the ligaments, and after applying conventional wire or SMA implants to stabilize the atlantoaxial joint. The time taken for implant application was measured.
RESULTS
No significant difference in vertebral body size of the atlas and axis was observed. A significant difference in vertebral canal size was observed between the animals. In biomechanical testing, the SMA-2 implant provided more stabilization, while the SMA-1 implant had lower strength than the conventional method using wires. The application time of wire was the longest, while that of SMA-1 was the shortest.
CLINICAL RELEVANCE
SMA implants provide comparable strength and demonstrate superior efficacy compared to conventional dorsal wire fixation of atlantoaxial stabilization. Therefore, SMA implants can be an effective surgical option for AAI.
Topics: Rabbits; Dogs; Animals; Shape Memory Alloys; Atlanto-Axial Joint; Joint Instability; Ligaments; Cadaver; Dog Diseases
PubMed: 37591491
DOI: 10.2460/ajvr.23.07.0158