Objective To investigate the surgery tactics for ossification of ligamentum flavum (OLF) associated with dural ossification (DO) in the thoracic spine and the cl inical outcome. Methods Between June 2006 and December 2009, 98 patients with thoracic spinal stenosis secondary to OLF were treated, and DO was found in 18 cases during operation. There were 11 males and 7 females with a mean age of 58 years (range, 46-73 years). The disease duration ranged from 5 to 48 months (mean,20 months). All patients underwent surgical decompression because of recent neurological aggravation. Both DO and OLF were resected with octagonal decompression by dissecting pedicle flavum tunnel. The Japanese Orthopaedic Association (JOA) score, modified Oswestry Disabil ity Index (ODI), and the Cobb angle were used to evaluate the effectiveness. Results The initial symptoms were significantly alleviated postoperatively. All patients had transient cerebrospinal fluid (CSF) leakage postoperatively, the CSF leakage disappeared after 8-10 days of conservative treatment. All the incisions healed by first intention. There was no complication of neurologic function deterioration, meningitis, wound infection, or spinocutaneous fistula. Eighteen patients were followed up 20-60 months (mean, 49 months). No recurrence of spinal cord compression symptoms,or neurologic function deterioration was observed at last follow-up. The JOA scores and effectiveness and modified ODI scores were significantly improved after 1 month and 12 months of operation when compared with preoperative scores (P lt; 0.05). The Cobb angles of kyphosis of the involved vertebrae were (6.7 ± 1.6)° before operation and (8.0 ± 1.2)° after 12 months of operation, showing significant difference (t=4.000，P=0.001). Postoperative T2-weighted axial MRI, sagittal MRI scan, and short T1 inversion recovery MRI showed that compressed deformity of the spinal cord returned to normal. Conclusion The surgery tactics for thoracic spinal stenosis secondary to the OLF with DO is safe, and no patching dura mater tears is effective.
ObjectiveTo explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis.
MethodsBetween March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T4, 5 in 2 cases, T6, 7 in 5 cases, T7, 8 in 3 cases, T9, 10 in 2 cases, T10, 11 in 4 cases, and T11, 12 in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA).
ResultsThe mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases).
ConclusionIntertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.
Objective To explore the feasibil ity and efficacy of percutaneous kyphoplasty (PKP) for the treatment of severe osteoporotic vertebral compression fracture (OVCF), and to assess the cl inical result of the PKP technique. Methods From May 2006 to October 2007, 12 patients with severe OVCF affecting more than 2/3 of the original vertebral body height were treated by using domestic PKP and percutaneous vertebroplasty (PVP) tool systems. There were 3 malesand 9 females, with the age of 56-82 years and a mean disease course of 4.2 months (1-49 months). Eleven thoracic vertebra and 4 lumbar vertebra suffered from severe vertebral compression fractures, which included 3 extremely severe thoracic OVCF. Four thoracic vertebra and 3 lumbar vertebra had not severe OVCF. There were 4 cases of single vertebral compression fracture, 6 cases of double fractures, and 2 cases of triple fractures. Only single side PKP and PVP were performed via extrapedicular approach in thoracic vertebra, and via transpedicular approach in lumbar spine under fluoroscopic control. Eight patients with severe thoracic compression fractures and 4 with severe lumbar fractures were treated by PKP. Four patients with relatively mild thoracic compression fractures and 3 with lumbar fractures were treated by PVP. Results The operation was successfully, 3 patients with extremely severe thoracic compression fractures received no intervention. The maximum expansion pressure of balloon was (1 068 ± 298) kPa, and the volume was (3.1 ± 1.2) mL during operation. The average operative time of PKP was (44.9 ± 10.6) minutes per vertebra, while the average operative time of PVP was (36.5 ± 6.8) minutes per vertebra. The average volume of injected bone cement was (2.5 ± 0.6) mL per thoracic vertebra, and (3.6 ± 1.2) mL per lumbar vertebra. The mean hospitalization time were (3.7 ± 1.6) days. Twelve cases were followed up 5-18 months (mean 8.6 months). The visual analogue scale scoreswere (2.35 ± 0.61) points 2 days after operation and (2.89 ± 1.07) points at last follow-up, there were statistically significant differences when compared with before operation (8.27 ± 1.36) points (P lt; 0.01). Extravertebral leakage of the bone cement into the paravertebral tissue and/or disc occurred in 6 patients (9 vertebra) without significant symptom. Conclusion One side approach PKP is a safe and effective technique for treatment of severe OVCF with markedly rel ief of pain.
Objective To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). MethodsSeven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T1, 2 in 2 cases) and 5 patients with CCTDH (T1, 2 in 1 case, T7, 8 in 1 case, T10, 11 in 2 cases, T11, 12 in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. ResultsAll surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores (P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score (P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores (P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%.ConclusionUsing the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.
ObjectiveTo analyze the pressure change and distribution of the intervertebral disc of upper thoracic spine in vertical pressure and 5° flexion, extension, or lateral bending.
MethodsTwelve thoracolumbar spinal specimens were harvested from mini pigs and were divided into 2 groups (n=6). T1, 2, T3, 4, T5, 6, and T7, 8 segments were included in one group, and T2, 3, T4, 5, T6, 7, and T8, 9 segments were included in the other group. The data from both groups represented the complete upper thoracic vertebra data. Biomechanical machine and pressure sensitive film were used to measure the pressure on the vertebral columns under loadings of 100, 150, and 200 N in vertical pressures and 5° flexion, extension, or lateral bending. The pressure change of each intervertebral disc under different loads and in different movement conditions was analyzed.
ResultsIn flexion, the anterior annulus pressure of the upper thoracic vertebra increased (P < 0.05), whereas the posterior annulus pressure showed no significant change (P > 0.05) or an increasing trend (P < 0.05). In extension, the anterior annulus pressure of the upper thoracic vertebra decreased (P < 0.05), whereas the posterior annulus pressure decreased (P < 0.05) or had no obvious change (P > 0.05). In lateral bending, the pressure on the concave side of the annulus increased significantly (P < 0.05).
ConclusionThe upper thoracic vertebra has unique biomechanical characteristics under different loadings; moreover, the posterior vertebral structure plays an important role in the movement of the upper thoracic vertebral segment and pressure distribution. In lateral bending of the upper thoracic vertebra, the concave side pressure will increase significantly, which suggests that asymmetrical force is an important cause of scoliosis progression. Gravity plays an important role in the progression of scoliosis.
Objective
To investigate the effectiveness of multilevel Ponte osteotomies on maintenance and restoration of thoracic kyphosis in idiopathic scoliosis (IS) surgery.
Methods
Between March 2008 and February 2010, 42 patients with thoracic IS (Lenke type 1 curves) were corrected with posterior pedicle screw system. Multilevel Ponte osteostomies for posterior release was performed in 17 cases (group A), and the 3 segments near the apical vertebrae were selected as the osteotomy site; simple posterior soft tissue release was given in 25 cases (group B). There was no significant difference in sex, age, disease duration, lesion segments, coronary Cobb angle, thoracic kyphosis, Risser index, and bending flexibility between 2 groups (P gt; 0.05). The anteroposterior and lateral standing radiographs of the spine were taken to compare the effectiveness between 2 groups.
Results
Operation was successfully completed in all patients. The operation time and blood loss in group A were significantly greater than those in group B (P lt; 0.05). Spine dural injury and leakage of cerebrospinal fluid occurred in 1 case of group A, which was cured after compression on local area of the wound; the other patients had no intraoperative complications. The patients were followed up 2-4 years (mean, 2.8 years); no nerve injury, infection, or internal fixation failure occurred. No obvious correction loss was observed and the appearance and trunk balance were significantly improved. The coronal Cobb angles at 1 week and 2 years after operation were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05). There was no significant difference in the coronal Cobb angle and correction rate between 2 groups at 1 week and 2 years after operation (P gt; 0.05). Group A was significantly better than group B in the thoracic kyphotic angle and angle changes at 1 week and 2 years after operation (P lt; 0.05).
Conclusion
The posterior approach surgery with multilevel Ponte osteotomies can restore the thoracic kyphosis in IS, but it has no effect on coronal correction in Lenke type 1 curves.
ObjectiveTo investigate the clinical application of three-dimensional (3D) printing technique combined with a new type of thoracic pedicle screw track detector in thoracic pedicle screw placement.MethodsAccording to the characteristics of thoracic pedicle and common clinical screw placement methods, a new type of thoracic pedicle screw track detector was independently developed and designed. The clinical data of 30 patients with thoracic vertebrae related diseases who underwent posterior thoracic pedicle screw fixation between March 2017 and January 2020 were retrospectively analysed. Among them, there were 18 males and 12 females with an average age of 56.3 years (range, 32-76 years). There was 1 case of thoracic disc herniation, 4 cases of thoracic canal stenosis, 2 cases of ossification of posterior longitudinal ligament of thoracic vertebra, 16 cases of thoracic trauma, 2 cases of thoracic infection, and 5 cases of thoracic canal occupation. Three-dimensional CT of the thoracic vertebra was routinely performed preoperatively, and the model of the patient’s thoracic vertebra was reconstructed and printed out. With the assistance of the model, preoperative simulation was performed with the combination of the new type thoracic pedicle screw track detector, and detected no nails after critical cortical damage. During operation, one side was randomly selected to use traditional hand screws placement (control group), and the other side was selected to use 3D printing technique combined with new type thoracic pedicle screw track detector to assist thoracic pedicle screws placement (observation group). The single screw placement time, adjustment times of single screw, and blood loss during screw placement were compared between the two groups. The accuracy of screw placement in the two groups was evaluated according to postoperative CT imaging data.ResultsThe single screw placement time, adjustment times of single screw, and blood loss during screw placement in the observation group were significantly less than those in the control group (P<0.05). Postoperative CT examination showed that the observation group had 87 screws of grade 1, 3 screws of grade 2, and the acceptable screw placement rate was 100% (90/90); the control group had 76 screws of grade 1, 2 screws of grade 2, 11 screws of grade 3, and 1 screw of grade 4, and the acceptable screw placement rate was 86.7% (78/90); showing significant difference in screw placement between the two groups (χ2=12.875, P=0.001). All patients were followed up 6-18 months, with an average of 11.3 months. There was no complication of vascular, nerve, spinal cord, or visceral injury, and screws or rods broken, and no patient was revised.ConclusionThe 3D printing technique combined with the new type of thoracic pedicle screw track detector assisted thoracic pedicle screw placement is convenient, and significantly improves the accuracy and safety of intraoperative screw placement, and overall success rate of the surgery.
