[Show abstract][Hide abstract] ABSTRACT: A comparable retrospective study.
To compare the clinical outcomes of surgical treatment by posterior only and anterior video-assisted thoracoscopic surgery for thoracic spinal tuberculosis (TSTB).
145 patients with TSTB treated by two different surgical procedures in our institution from June 2001 to June 2014 were studied. All cases were retrospectively analyzed and divided into two groups according to the given treatments: 75 cases (32F/43M) in group A performed single-stage posterior debridement, transforaminal thoracic interbody fusion and instrumentation, and 70 cases (30F/40M) in group B underwent anterior video-assisted thoracoscopic surgery (VATS). Clinical and radiographic results in the two groups were analyzed and compared.
Patients in group A and B were followed up for an average of 4.6±1.8, 4.4±1.2 years, respectively. There was no statistically significant difference between groups in terms of the operation time, blood loss, bony fusion, neurological recovery and the correction angle of kyphotic deformity (P>0.05). Fewer pulmonary complications were observed in group A. Good clinical outcomes were achieved in both groups.
Both the anterior VATS and posterior approaches can effectively treat thoracic tuberculosis. Nevertheless, the posterior approach procedure obtained less morbidity and complications than the other.
PLoS ONE 03/2015; 10(3):e0119759. DOI:10.1371/journal.pone.0119759 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tuberculous spondylitis (TS, also called Spinal tuberculosis, Pott's spine or Pott's disease) is a common extrapulmonary manifestation of tuberculosis (TB), but multilevel, noncontiguous TS cases are rare.
Physical examination, CT, MRI imaging, percutaneous biopsy and other lab tests were used to confirm the diagnosis.
we report a rare case of atypical, multilevel and noncontiguous TS in a 50-year-old woman. We found four noncontiguous osteolytic lesions in her spine that affected the Intervertebral joints of T10/11, L1/2, L3/4 and L5/S1. Patient was then treated conservatively with anti-TB drugs and was followed-up for about 1 year. The treatment turned out to be successful.
The conservative anti-TB treatment was enough at least for this particular patient.
International Journal of Clinical and Experimental Medicine 01/2015; 8(2):3006-9. · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury.
A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly.
Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup.
Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.
Indian Journal of Orthopaedics 11/2014; 48(6):568-73. DOI:10.4103/0019-5413.144219 · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study Design: This was a retrospective clinical study. Objective: The aim of this study was to assess the efficacy of a combined anterior and posterior approach, or single-stage posterior extensive approach for resection of large abdominally involved dumbbell tumor in the lumbar region. Background: Resection of the large spinal-retroperitoneal involved dumbbell tumor is particularly controversial and challenging because of unique exposure requirements. Methods: From June 2006 to October 2011, 18 consecutive patients suffering from large dumbbell tumors in the lumbar region were involved. In the initial 8 patients, a combined posterior and anterior surgical approach was applied. The remaining 10 patients were surgically treated with a single posterior extensive approach to excise both the intraspinal and intra-abdominal tumors. Reconstruction with bone or mesh grafts was also performed simultaneously in 3 of the 10 patients in this group. Results: The perioperative period was uneventful for 7 of 8 patients who underwent combined surgery. However, 1 patient encountered right nephrectomy because of a ruptured renal vein and refractory bleeding during anterior tumor exposure. Histopathology revealed the presence of schwannoma (n=4), neurofibroma (n=3), and neuroblastoma (n=1). With the mean of 52 months of follow-up, metastasis occurred in 1 patient with neuroblastoma. In the 10 patients with only the posterior approach, histopathology demonstrated schwannoma (n=5), neurofibroma (n=3), small round cell mesenchymal tumor (n=1), and benign fibrous histiocytoma (n=1). No recurrence was detected at the mean follow-up of 24 months. Conclusions: The posterior extensive approach is safe and effective to remove the large abdominally involved dumbbell tumors, and also facilitates simultaneously reconstruction of the vertebral body, as compared with the combined posterior and anterior approach.
[Show abstract][Hide abstract] ABSTRACT: Retrospective study.
Short-segment pedicle instrumentation (SSPI) is widely used to treat thoracolumbar junction fracture. Implant failure is the most common complication of SSPI and often necessitates revision surgery. The stand-alone anterior technique for failed SSPI provides excellent decompression and anterior column reconstruction but it is incapable of restoring normal stability. High rate of complications is solely attributable to the anterior approach. Thus, the reconstruction of the anterior column with posterior compression instrumentation is the strategy of choice. In this study, we use a modified pedicle subtraction osteotomy (PSO) technique through a single posterior approach as the salvage method for the failed SSPI.
Thirteen patients with failed SSPI after thoracolumbar fracture were included and followed up at regular intervals. Revision indications include intractable pain, deteriorating neurological deficits and progressive deformity. The modified pedicle subtraction osteotomy (PSO) was performed. After osteotomy, anterior cortex thinned and the anterior longitudinal ligament was also preserved to maintain stability during correction. Autograft inserted into osteotomy gap to increase stability and fusion rate. The correction has been achieved with closure. We evaluated the patients' clinical symptoms, Segmental kyphosis correction, Bony fusion time, and complications.
Segmental kyphosis correction was from preoperative average 20.9°(range 9.5° to 38.5°) to 3.0° (range 1° to 5.5°) immediately after operation and 6.1° (range 3° to 8° at the last follow-up. Bony fusion was confirmed on radiographs in all patients at average 9.9 months (range 7.5-12 mo) after revision surgery. There was no implant failure in any of the 13 patients. Average preoperative VAS was 6.5 (range 5-9) and reduced to 3.7 (range 2-5) at the last follow-up. There was also a significant decrease in mean preoperative ODI from 55.2 (range38-76) to 32.8 (16-56). No patients suffered any neurological deterioration related to revision surgery. Complication was encountered in 6 patients (46.1%), including 4 with CSF leak and 2 with superficial wound infection. All these complications were managed conservatively and none of them underwent re-operation.
We conclude that modified PSO possesses the advantages of excellent kyphosis correction safe and reliable salvage alternative for revision of SSPI failure.
Journal of Spinal Disorders & Techniques 01/2014; Publish Ahead of Print:1. DOI:10.1097/BSD.0000000000000093 · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To confirm whether implanting pedicle-screw at the level of fractured vertebra increases adverse effects on fracture healing. MATERIAL and
CT follow-up was conducted for 28 patients who sustained thoracic or lumbar burst fracture and underwent posterior pedicle-screw instrumentation and reduction including implanting screws into the fractured vertebra at the same time. The time for follow-up CT scan ranged from 1 to 3 years postoperatively.
28 patients underwent final CT scan 1 to 3 years after surgery which revealed good bony fusion within each fractured vertebra and no screw or rod breakage; kyphosis was also not detected.
Implanting pedicle-screw at the level of fractured vertebra does not have a negative influence on bone healing.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation.
Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85 %) of all 20 animals. The positive rate for bacteria presence was 45 % by culture and 80 % by pyrosequencing method.
Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals.
Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the "culprit" for the persistence or recurrence of infection.
European Spine Journal 10/2013; 23(4). DOI:10.1007/s00586-013-3061-5 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: : This was a retrospective clinical study.
: To evaluate the safety and accuracy of pedicle screw placement in very young children and to observe its influence on vertebral and spinal canal growth.
: Although widely used, it is not known if pedicle screw fixation is safe and effective in very young children.
: Sixteen children, with an average age of 34 months, had received pedicle screw fixation from January 2003 to January 2010. Candidates for surgery were those patients who had hemivertebra deformity (11 patients), eosinophilic granuloma disease with spinal cord compression, and neurological deficit (2 patients), or spinal tuberculosis accompanied with kyphotic deformity (3 patients). The location of involved vertebrae was between T2 and L5. A total of 74 pedicle screws were implanted using a modified free-hand technique. The safety and accuracy of this method, and the influence on vertebral growth, was evaluated using postoperative x-ray and computer tomography scans.
: The average follow-up was 30.6 months. No patient had any neurological or radicular symptoms related to the placement of pedicle screws. Postoperative computer tomography scans demonstrated a malposition of 5 of the 74 pedicle screws (6.8%). Two screws breached the anterolateral cortical bone of the vertebral body. One screw breached the lateral cortical bone of the pedicle, 1 passed through the anterior vertebral margin by 3 threads, and a third was so laterally placed that it entered into disk space. There was no vessel, visceral complications, or any other adverse effects resulting from these misplacements. No screw was placed so medially that injured the spinal cord. No retardation of vertebral growth was observed in 7 patients who were followed up for at least 3 and up to 7 years.
: The results indicate that in very young children, pedicle screws can be safely implanted using a modified free-hand implantation technique.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to validate the efficacy and safety of single-stage posterior instrumentation and anterior debridement for treatment of active spinal tuberculosis with kyphotic deformity.
From January 2005 to January 2009, 13 males and 24 females were enrolled in this retrospective study. All patients underwent single-stage posterior instrumentation and fusion, combined with anterior radical debridement and bone grafting. Clinical and radiographic results were analysed.
Patients were followed-up for 33.6 months on average. Bony fusion was achieved at six- to nine-month follow-up in all patients. The respective average kyphosis at the pre-operative and the last follow-up was 53.5° and 12.6°, with a mean correction of 40.9° (78.5%). Neurologic recovery averaged 1.5 grades on the Frankel scale. No recurrence of tuberculosis or instrumentation failure occurred.
Single-stage posterior instrumentation and anterior debridement with fusion was demonstrated to be a safe and effective method to achieve spinal decompression and kyphosis correction in patients with Pott's disease.
International Orthopaedics 02/2012; 36(2):373-80. DOI:10.1007/s00264-011-1389-1 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cervical kyphosis is an uncommon but potentially debilitating and challenging condition. We reviewed the etiology, presentation, clinical and radiological evaluation, and treatment of cervical kyphosis. Based on the current controversy as to the ideal mode of surgical management, we paid particular attention to the available surgical strategies. There are three approaches for cervical kyphosis: the anterior, posterior or combined procedures. The principal indication for the posterior strategy is a flexible kyphosis or kyphosis caused by ankylosing spondylitis. The main point of debate is between the choice of the anterior or the combined strategy. The two strategies were compared with regard to clinical outcome, correction of deformity, rate of fusion, complications, revision surgery, and mortality. The combined strategy appears to result in a greater degree of correction than the anterior-alone strategy, and it is more likely to improve the cervical alignment to achieve a lordosis. However, the procedure carries a higher rate of postoperative neurological deterioration, complications, revision surgery, and mortality. Although the anterior-alone strategy achieves a smaller reduction of cervical kyphosis, it has a lower rate of postoperative neurological deterioration, complications, revision surgery, and mortality. We recommend that the surgical treatment of cervical kyphosis should be planned on an individual basis. A multicenter, prospective, randomized controlled study would be necessary to determine the ideal mode of treatment for complex cervical kyphosis.
European Spine Journal 10/2010; 20(4):523-36. DOI:10.1007/s00586-010-1602-8 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyphotic deformity (kyphotic angle >or= 45 degrees).
From January 2004 to January 2008, 30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study, including 8 male and 22 female. The average age was 35 years (range, 7 - 60 years), with average angle of kyphosis of 58 degrees (range, 45 degrees - 70 degrees). There were 28 patients complicated with intraspinal abscess, of which 10 patients presented with incomplete paraplegia. According to the Frankel's scoring system, there were 2 patients with Frankel Grade B, 6 with Grade C, 2 with Grade D. After antituberculous chemotherapy (HREZ) for at least 2 weeks, all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction, and then received anterior debridement, decompression and supportive bone grafting, all of which were completed in the same day. The postoperative standardized chemotherapy was 6HREZ/6-12HRE. The angle of kyphosis, curve correction after surgery, and recovery of paraplegia were analyzed. Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease.
Operative time was 4 to 6 hours (average 5.2 h), blood loss was 600 to 900 ml (average 760 ml). No perioperative severe complications occurred. The kyphotic angle was corrected to 0 degrees - 10 degrees, and the maximum corrected angle was 65 degrees . The average follow-up duration was 18 months (range, 12 - 48 m). All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up. Neurologic deficits were improved: 2 patients from B to D, 6 patients from C to E, 2 patients from D to E. No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up.
Combined posterior instrumentation and anterior debridement, fusion surgery in one stage is proved to be successful in treating spinal tuberculosis, correcting the kyphosis, and providing solid fusion.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2010; 48(8):597-600.
[Show abstract][Hide abstract] ABSTRACT: To investigate the surgical treatment for cervical dumbbell tumors.
Clinical manifestation, surgical type and stage, and surgical method of 36 consecutive patients with cervical dumbbell tumor were retrospectively studied.
The tumors in 35 patients were completely resected once, and the other one patient underwent subtotal resection. Signs and symptoms of all patients were recovered to different degrees, without significant complications and tumor recurrence.
According to the type and stage of dumbbell tumors, we could adopt surgical methods through posterior or posterior combined with anterior approach, together with instruments and fusion, which could completely resect tumors and prevent complications.
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences 09/2009; 34(9):898-901.
[Show abstract][Hide abstract] ABSTRACT: To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis (AS) and the effect of combined anterior and posterior operation.
Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel's score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach.
There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up.
The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.
Chinese Journal of Traumatology (English Edition) 07/2009; 12(3):148-52. DOI:10.3760/cma.j.issn.1008-1275.2009.03.005
[Show abstract][Hide abstract] ABSTRACT: To establish a 3-dimensional finite element model.
The coordinate data of the vertebras were obtained from the CT scan images of Chinese 50th percentile healthy male adult volunteers' cervical spine, converted into point cloud data, and stored as ASCII file using Mimics software. CATIA software was used to preprocess and Geomagic software was used to establish the geometry model of the C0 approximately C7 cervical spine. The geometry model was meshed by Hypermesh software. Mapped mesh method was used to mesh cortical bone, trabecular bone, intervertebral disk, ligaments, etc. Some material parameters were defined from other available material parameters using proportion and function scale method.
The model had 22 512 solid elements and 14 180 shell/membrane elements. The model was validated by the cervical spine drop test.
The model has good biofidelity and can be used to study the dynamic response and injury mechanism of the cervical spine in the car accidents.
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences 06/2008; 33(5):410-4.
[Show abstract][Hide abstract] ABSTRACT: To discuss the pathological characteristics of cervical spinal fracture of ankylosing spondylitis (AS), and surgical effect by combined anterior and posterior operation.
Eighteen AS patients with traumatic cervical fracture-dislocation were treated from January 2000 to January 2006. The symptom duration of AS was 14.5 years in average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D in Frankel's score. All patients underwent surgical procedures by combined anterior and posterior approach.
There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage. There were some extent neurological improvement in 14 incompletely paraplegic patients, no improvement in 4 complete paraplegia patients. The follow-up period was 21.2 months in average and the bone fusion was 3.6 months. There were 4 complications during perioperative period and 1 in long term follow-up.
The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is the reasonable surgical strategy in the treatment of cervical spinal fracture-dislocation with AS.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2007; 45(6):373-5.
[Show abstract][Hide abstract] ABSTRACT: To discuss the diagnosis and treatment of cauda equina syndrome.
Thirty-four cases of cauda equina syndrome from 1993 to 2005 were analysed retrospectively. Its clinical representation, pathology character and clinical outcome were observed.
At follow-ups of 3 to 102 months after the treatment (averagely 43 months), the muscle strength and function of the constrictor began to resume to different degrees. Muscle strength resumed gradually one week after the operation, resumed faster 3 months after the operation, and resumed completely more one year later. Function of the constrictor began to resume 3 days after the operation, and resumed mostly six months or so after the operation. Sense resumed slowly.
Clinical outcome of cauda equina syndrome is good. Resumption after the operation obviously correlates to the time of operation. One week after the operation, the kinetic function resumes best, function of the constrictor resumes well and the sense function of the saddle area resumes not very well.
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences 09/2006; 31(4):599-600, 606.