Hong Zhao

Zhejiang University, Hang-hsien, Zhejiang Sheng, China

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Publications (66)47.81 Total impact

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    ABSTRACT: A retrospective study of 1162 consecutive patients who underwent spinal deformity surgical procedures at our spine center from January 2010 to December 2013.
    Spine 11/2014; 39(24):E1425-32. · 2.16 Impact Factor
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    ABSTRACT: To investigate changes in thoracic dimensions (TDs) following repeated lengthening surgeries after dual growing rod treatment of early onset scoliosis and thereby its effect on thoracic growth.
    11/2014;
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    ABSTRACT: The aim of the present study was to summarize and analyze the complications of posterior vertebral column resection in patients with spinal tumors. The complications of 40 patients following surgery were recorded, and surgery-related parameters including segments, bleeding volume and surgical duration were recorded and analyzed. SPSS 12.0 software was used to analyze the correlation between the complications and these parameters retrospectively. A total of 36 complications were reported. The median follow-up duration of the patients was 14 months (range, 4-78 months). Transient late tracheal extubation was associated with higher intraoperative bleeding volume, lower preoperative forced vital capacity and forced expiratory volume in 1 sec. Replaced spinal segment subsidence was associated with increased duration of surgery, higher intraoperative bleeding volume and higher total blood transfusion volume. Thrombocytopenia was associated with increased duration of surgery and higher total blood transfusion volume. The majority of the complications were minor and did not affect the recovery of the patients. Active prevention is necessary to reduce the incidence of complications, in particular, major ones.
    Experimental and therapeutic medicine 11/2014; 8(5):1539-1544. · 0.34 Impact Factor
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    ABSTRACT: Background Although measures to reduce and treat degenerative changes after fusion are discussed, these are still controversial.MethodsA retrospective study was conducted on a consecutive series of 3,799 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 1999 and January 2009. A total of 28 patients with symptomatic adjacent segment degeneration surgery were identified. Another group of 56 matched patients with degenerative lumbar disease without symptomatic adjacent segment degeneration after spinal fusion were marked as the control group. These two groups were compared for demographic distribution and clinical and radiographic data to investigate the predictive factors of symptomatic adjacent segment degeneration surgery by logistic regression.ResultsThe overall incidence rate of symptomatic adjacent segment degeneration surgery was 0.74%. Strong risk factors for the development of a symptomatic adjacent segment degeneration requiring surgery were preoperative distance from L1 to S1 sagittal plumb line (p = 0.031), preoperative lumbar lordosis (p = 0.005), and preoperative adjacent disc height (p = 0.003). Mean postoperative lumbar lordosis was smaller (p = 0.000) in symptomatic adjacent segment degeneration surgery (SASDS) group compared with in the control group (33.3° vs. 39.8°). Postoperative adjacent disc height was also significantly lower in the former group compared with the latter group (p = 0.002). Logistic regression analysis showed that body mass index (BMI) (OR: 1.75; p = 0.006), preoperative adjacent disc degeneration (ADD) on MRI (OR: 13.52; p = 0.027), and disc bulge in preoperative CT examination (OR: 390.4; p = 0.000) maintained their significance in predicting likelihood of symptomatic adjacent segment degeneration surgery.Conclusions The occurrence of a symptomatic adjacent segment degeneration surgery is most likely multifactorial and is related to BMI, preoperative ADD on MRI, and disc bulge in preoperative CT examination.
    Journal of Orthopaedic Surgery and Research 10/2014; 9(1):97. · 1.01 Impact Factor
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    ABSTRACT: Study Design. A retrospective radiographic analysis.Objective. To assess the effect of unfused segments in the reconstitution of coronal balance after posterior selective thoracolumbar/lumbar (TL/L) curve fusion for adolescent idiopathic scoliosis.Summary of Background Data. Current literature suggests that compensatory changes occur after selective TL/L curve fusion surgery. Hitherto the roles of the unfused levels in coronal balance reconstitution have not fully understood.Methods. Radiographic data of idiopathic scoliosis patients that underwent selective posterior TL/L curve fusion at our hospital before October 2011 with a minimum of 2 years follow-up period was retrospectively analyzed. Changes of coronal trunk shift during the follow-up period were studied and multiple linear regression analysis was performed to determine its correlation with changes of upper and lower curve of unfused thoracic segments, instrumented segments angle, distal unfused segments angle and coronal sacral inclination.Results. A total of 43 patients were included in this study. Pre-operative and first erect radiographs demonstrated trunk shifts of 21.1mm and 18.7mm respectively, showing no significant differences (P = 0.205). At the last follow-up, it compensated to 9mm, which showed significant differences (P<0.01). Regression analysis of all patients showed that coronal trunk shift changes only correlated with distal unfused segments angle changes. Subgroup analysis based on the magnitude of preoperative thoracic curve found that only distal unfused segments had an impact on coronal balance reconstitution. However, subgroup analysis based on the flexibility of preoperative thoracic curve showed that both proximal unfused thoracic segments and distal unfused lumbar segments contributed to coronal balance compensation in patients with a thoracic curve flexibility rate of more than 70%.Conclusions. The reconstitution of coronal balance was mainly compensated by distal unfused segments after selective posterior fusion of TL/L idiopathic scoliosis. The effect of unfused thoracic segments in coronal balance reconstitution mainly depended on its flexibility.
    Spine 09/2014; · 2.16 Impact Factor
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    ABSTRACT: Study Design. Retrospective Case SeriesObjective. The objectives of this study were to 1) determine the rate of POUR in a series of patients undergoing lumbar spine surgery 2) compare length of stay between patients who developed POUR and patients who did not, and 3) identify the patient and surgical factors associated with the development of POUR.Summary of Background Data. Although post-operative urinary retention (POUR) is a common complication in many surgical subspecialties, sparse literature is present regarding development of POUR after posterior lumbar surgical procedures.Methods. A retrospective review was conducted of all posterior lumbar surgery cases performed at single institute from July 2008 to July 2012. Data collected included demographic variables (age, sex, BMI), length of stay, comorbid medical conditions, and surgical data. Wilcoxon rank sum test with continuity correction was used to compare length of stay between patients who developed POUR and patients who did not. A multivariate logistic regression model was created using all patient and surgical factors and systematically pruned of variables not improving overall predictive power.Results. 647 patients (291 decompression, 356 decompression and fusion) were included in the study. 36 of 647 patients had urinary retention after lumbar spine surgery (5.6%). Patients who developed POUR had a longer length of stay compared to patients who did not develop POUR (3.94 days vs. 2.34 days, p = 0.005). Male gender, BPH, age, diabetes, and depression were significantly associated with development of POUR (OR: 3.05, 9.82, 1.04, 3.32, and 2.51, respectively). Smoking was inversely associated with the development of POUR (OR: 0.45).Conclusions. The risk of developing POUR following posterior lumbar spine surgery is approximately 5%. Male gender, BPH, age, diabetes, and depression were significantly associated with the POUR group. Patients who developed POUR had a greater length of stay.
    Spine 09/2014; · 2.16 Impact Factor
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    ABSTRACT: To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.
    Experimental and therapeutic medicine 07/2014; 8(1):25-30. · 0.34 Impact Factor
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    ABSTRACT: To determine: (1) the relationship of thoracic cage parameters and preoperative pulmonary function tests (PFTs) in congenital scoliosis (CS) patients. (2) if patients with rib deformity have greater impairment of PFTs than those without rib deformity. A total of 218 patients with CS and pulmonary dysfunction (FVC < 80 %) were conducted in one spine center between Jan 2009 and Mar 2013. The demographic distribution, medical records, PFTs and radiographs of all patients were collected. The association of PFTs and thoracic cage deformities was analyzed. In total, 143 patients (65.6 %) had a clinically relevant impairment of pulmonary function. They had smaller BMI, larger thoracic transverse and anteroposterior diameter, more thorax height, scoliotic angle and number of involved vertebra than no clinically impairment. PFTs were negative correlation significantly with scoliotic angle, number of involved vertebra and thoracic sagittal diameter, while thorax height is significant positive. The T1-12 height was significant positive correlation with age, stature, weight, thoracic transverse and sagittal longitudinal diameter, while negative correlation with scoliotic curve, number of involved vertebra, as well as kyphotic angle. PFTs do not correlate with T1-12 height, but significantly associated with the rib anomalies. The FVC and FEV1 were significantly lower in patients with rib anomalies than without rib anomalies. There was no association between the pulmonary function and the location of rib deformities. PFTs correlate significantly with scoliotic angle, number of involved vertebra, thoracic sagittal diameter, and thorax height. PFTs were significantly lower in patients with rib anomalies, particular to the patients with fused rib.
    European Spine Journal 05/2014; · 2.47 Impact Factor
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    ABSTRACT: To explore the correlation between the stability of lumbar vertebrate and pelvic indices of pelvic incidence (PI), lumber lordosis (LL), pelvic tilt (PT) and sacrum slope (SS).
    Zhonghua yi xue za zhi. 05/2014; 94(17):1338-41.
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    ABSTRACT: No recent studies have analyzed the rates of or reasons for unanticipated revision surgery within 30 days of primary surgery in spinal deformity patients. Our aim was to examine the incidence, characteristics, reasons, and risk factors for unplanned revision surgery in spinal deformity patients treated at one institution. All patients with a diagnosis of spinal deformity presenting for primary instrumented spinal fusion at a single institution from 1998 to 2012 were reviewed. All unplanned reoperations performed within 30 days after primary surgery were analyzed in terms of demographics, surgical data, and complications. Statistical analyses were performed to obtain correlations and risk factors for anticipated revision. Of 2758 patients [aged 16.07 years (range, 2-71), 69.8% female] who underwent spinal fusion surgery, 59 (2.1%) required reoperation within 30 days after primary surgery. The length of follow up for each patient was more than 30 days. Of those that required reoperation, 87.0% had posterior surgery only, 5.7% had anterior surgery, and 7.3% underwent an anteroposterior approach. The reasons for reoperation included implant failure (n = 20), wound infection (n = 12), neurologic deficit (n = 9), pulmonary complications (n = 17), and coronal plane imbalance (n = 1). The risk factors for reoperation were age, diagnosis, and surgical procedure with osteotomy.
    PLoS ONE 01/2014; 9(3):e87172. · 3.53 Impact Factor
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    ABSTRACT: Retrospective review. To identify the incidence and characteristics of rib anomalies in patients with congenital scoliosis (CS) in a Chinese population. Rib deformities and intraspinal anomalies often coexist in individuals with CS. Rib deformities may assist in diagnosing occult anomalies in these patients. The incidence of rib anomalies and the relationship between rib and vertebral abnormalities in Chinese patients with CS have not been reported. A total of 382 patients operated on at Peking Union Medical College Hospital during January 2010 to October 2012 were identified from a single institutional database. The demographic distribution, clinical and radiographical data were collected to investigate the incidence of rib anomalies, and the vertebral and intraspinal abnormalities associated with it. A total of 192 patients (50.3%) were documented with rib anomalies including numerical variation (46.4%) and structural changes (72.4%). Missing ribs was the most commonly seen anomaly in these patients, accounting for 43.8% of the rib anomalies. Of the patients with rib anomalies, a slightly higher proportion of patients had simple anomalies, 106 (55.2%) versus 86 (44.8%). Rib changes were most common in patients with thoracic or thoracolumbar vertebral anomalies, and occurred most frequently on the concave side (65.5%) or in the lower thoracic spine (36.5%). The overall incidence rate of intraspinal anomalies was 40.1% (153/382), and these were most commonly seen in patients with thoracic vertebral anomalies or with upper and middle thoracic rib anomalies. The incidence of rib anomalies was 50.3% in surgical patients with CS. The rib anomalies vary with the location and type of vertebral anomalies. The incidence of intraspinal anomalies was significantly higher in patients with rib anomalies than in those without rib anomalies.Level of Evidence: 4.
    Spine 12/2013; 38(26):E1656-61. · 2.16 Impact Factor
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    ABSTRACT: To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis. We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years (3-50 years).Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson's χ(2) test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies. A total of 57 (48.3%) patients were found to have intraspinal abnormalities.Split cord deformities were identified to be the most common intraspinal anomaly (32.2%), followed by syringomyelia (21.2%).Sixty-nine patients (58.5%) had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation (χ(2) = 14.05, P < 0.01). The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation (χ(2) = 27.50, P < 0.01).Intraspinal anomalies occurred in 42 of 69 patients (60.9%) with rib anomalies and 15 of 49 patients (30.6%) without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without rib anomalies in congenital scoliosis (χ(2) = 10.5, P < 0.01). The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intraspinal abnormalis.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 08/2013; 51(8):732-736.
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    ABSTRACT: Pedicle subtraction osteotomy (PSO) is a spinal realignment technique of correcting the sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal correction. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been fully elucidated. The purpose of this study was to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Retrospective analysis was conducted for 34 patients undergoing PSO surgery for ankylosing spondylitis. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar lordosis, thoracic kyphosis), pelvic parameters of pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) and global balance of sagittal vertical axis (SVA). And the correlations between PSO parameters (level and degree) and spinopelvic parameters were analyzed. There were significant changes in spinopelvic parameters including decreased thoracic kyphosis, increased lumbar lordosis, decreased SVA, decreased PT and increased SS. The decreased SVA were 3.94 ± 3.38 and 3.97 ± 1.91 in lumbar/thoracic osteotomy respectively (P > 0.05). The decreased values of PT were 9.71 ± 6.46 and 5.20 ± 2.74 respectively (P < 0.05). Larger degree of osteotomy (≥ 22°) had greater SVA and PT decreases (P < 0.05). PSO is a quite useful technique of restoring spinal alignment. Lumbar and larger degrees of osteotomy have greater effects on spinopelvic parameters.
    Zhonghua yi xue za zhi 04/2013; 93(15):1138-41.
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    ABSTRACT: BACKGROUND: Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy that is associated with mutations in mitochondrial DNA (mtDNA), however, no study of myocardium mtDNA of LVNC patients has been reported. To identify novel candidate mtDNA variants that may be responsible for the pathogenesis of LVNC, myocardial specimens were examined to investigate pathogenic mtDNA variants. MATERIALS AND METHODS: Samples from six patients who were diagnosed with LVNC and underwent heart transplantation were analyzed. The sequence and copy number of mtDNA from these samples were determined by Sanger sequencing and fluorescence-based quantitative polymerase chain reaction, respectively. RESULTS: Myocardial mtDNA sequences analysis revealed 227 substitution variants, including 157 coding variants and 70 non-coding variants. An m.9856T>C (Ile217Thr) mutation in MT-CO3 from one LVNC patient was found to be a non-haplogroup associated variant, and was rare in the mtDB Human Mitochondrial Genome Database, suggesting that the variant may be pathogenic. And there was statistically significant difference in mtDNA copy number between LVNC patients and normal control subjects. Electron microscopy (EM) of left ventricular myocardium showed abnormality in mitochondrial morphology and disordered sarcomeric organization. CONCLUSION: The identification of mtDNA sequence variants in myocardial specimens may be helpful for further investigation of the underlying pathogenic implications of myocardial mtDNA mutations in LVNC. However, measurement of mtDNA copy number showed that there was lower mtDNA content in myocardium of LVNC patients than in normal controls (P<0.01). Lower mtDNA copy number and morphological abnormalities of mitochondria suggested mitochondrial dysfunction that may be associated with etiology of LVNC.
    Molecular Genetics and Metabolism 02/2013; · 2.83 Impact Factor
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    ABSTRACT: To investigate the safety and effectiveness of one-stage posterior correction of scoliosis associated with little symptomatic syringomyelia. A total of 19 cases diagnosed as scoliosis with little symptomatic syringomyelia between January 2003 and November 2010 were included in this study (study group), the patients underwent one-stage posterior correction and instrumentation without neurosurgery for the syringomyelia. At the same time, 9 cases with severe symptomatic syringomyelia were included as the control group, the patients underwent neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting. All patients underwent posterior pedicle screw or screw-hook hybrid instrumentation. The preoperative, postoperative and the last follow-up of the Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The perioperative and the last follow-up complications of neurological injury were recorded. The surgical outcome and postoperative complications between the 2 groups were compared with the t student and chi-square statistics methods. There were no significant differences in gender, age, the location, length and diameter of the syringomyelia of the 2 groups (P > 0.05). The follow-up period ranged from 6 to 45 months, with a mean of 28.6 months. The average preoperative Cobb angles of coronal main curves of the 2 groups were 71° ± 23° and 68° ± 19°, the postoperative Cobb angles were 27° ± 20° and 25° ± 16°, and the last follow-up Cobb angles were 29° ± 17° and 32° ± 20°. The coronal correction rate was 66% ± 19% in the study group and 65% ± 21% in the control group (t = 0.136, P = 0.893). There was no significant difference at the last follow-up(t = 0.210, P = 0.837). The average preoperative Cobb angles of thoracic kyphosis of the 2 groups were 35° ± 18° and 32° ± 19°, the postoperative Cobb angles were 25° ± 10° and 23° ± 9°, and the last follow-up Cobb angles were 24° ± 4° and 28° ± 8°. The mean sagittal correction rate of the 2 groups were 50% ± 58% and 57% ± 53% (t = -0.303, P = 0.764). There was also no significant difference at the last follow-up time (t = 0.769, P = 0.490). There were no significant difference, in terms of the postoperative of the apical vertebra translation, apical vertebra rotation and trunk shift between the 2 groups (P > 0.05). One case in the study group complicated with a pedicle screw breaking the anterior cortex of the vertebra and one in the control group complicated with a hook loosening, postoperatively. At the last follow-up time, the neurological symptoms of the 2 groups got no aggravating. One-stage posterior correction of scoliosis associated with little symptomatic syringomyelia may be effective and safe.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 08/2012; 50(8):714-8.
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    ABSTRACT: Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS. A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques. The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb's angle (P > 0.05), or in the pre-operative sagittal Cobb's angle between both groups (P > 0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P < 0.01), but not in the sagittal plane (P > 0.05). The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P < 0.05). The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.
    Chinese medical journal 08/2012; 125(16):2862-6. · 0.90 Impact Factor
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    ABSTRACT: To summarize and analyze the complications of posterior vertebral column resection in the treatment of spinal tumors. The complications of 31 patients were recorded and categorized into primary and secondary complications. Many factors such as segment, bleeding volume and surgical duration were reviewed. The SPSS 12.0 software was used to analyze the relations between the complications and these factors retrospectively. Two primary and 30 secondary complications were identified. A definite relation existed between the delayed removal of endotracheal intubation and bleeding volume. And a definite relation existed also between transient thrombocytopenia and operative duration. There was no relation between prosthetic subsidence and various factors (including follow-up period). Most complications are secondary and have basically no effect on the recovery of patients. And preventions are feasible in most cases. So a thorough plan should be devised to prevent the occurrences of potential complications, especially primary ones. For any occurrence, active treatment should be offered to improve the surgical safety.
    Zhonghua yi xue za zhi 06/2012; 92(23):1587-90.
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    ABSTRACT: To evaluate the safety and effectiveness of correction of scoliosis associated with tethered cord without releasing it. Twenty-two cases diagnozed as scoliosis with tethered cord between December 2005 and January 2011 were investigated retrospectively in the study. There were 8 males and 14 females. The age was from 6 to 51 years, averaged 17.7 years. There were 7 patients with clinical symptoms before surgery. All the patients underwent posterior deformity correction and instrumentation by pedicle screws directly without releasing the tethered cord. Spinal cord monitoring was conducted in all the cases. The preoperative and postoperative Cobb angle of the coronal main curve and thoracic kyphosis were measured. Also, the preoperative and postoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The incidence of perioperative complications were recorded. A total of 20 patients were followed up. The follow-up time was from 6 to 52 months, mean 23.5 months. The average Cobb angle of the coronal main curve were 68° ± 20° before surgery and 38° ± 21° after surgery with a mean correction of 48.1%. The difference was significant (t = 13.9, P < 0.05). The mean kyphosis was 65° ± 18° preoperatively and 28° ± 11° postoperatively, with a correction of 56.7%. The difference was also significant (t = 8.81, P < 0.05). The preoperative values of the apical vertebra translation, apical vertebra rotation and trunk shift were (5.4 ± 2.5) cm, 2.3° ± 0.6° and (2.0 ± 1.8) cm, respectively, which were corrected to (3.2 ± 1.8) cm, 1.2° ± 0.5° and (1.5 ± 1.1) cm after the surgery. Compared to the preoperative values, the difference were significant in the apical vertebra translation (t = 5.69, P < 0.05) and apical vertebra rotation (t = 10.07, P < 0.05). However, there was no difference in trunk shift. Postoperative complications occurred in 3 patients, including transient numbness of the lower extremity in 1 patient and hydrothorax in 2 patients. No neurological and instrumentation complications occurred during the follow-ups. Patients with clinical symptoms before surgery got no serious during the surgery and follow-ups. If there are no symptoms of tethering in scoliosis patients with tethered cord, the corrective surgeries may be safe and effective when spinal cord monitoring conducted without spinal cord untethering. But more cases are needed to confirm it.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2012; 50(4):333-7.
  • Applied Mechanics and Materials 03/2012;
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    ABSTRACT: Retrospective review. To evaluate the efficacy of multimodal intraoperative neuromonitoring for predicting iatrogenic neurological injury during surgical correction of a spine deformity and evaluate the potential risk factors for neurological monitoring changes. Single modal intraoperative neuromonitoring is insufficient to predict neurological injury during surgical correction of spine deformity. Multimodal monitoring can provide more accuracy. Some risk factors were reported to be correlated with high rates of neurological deficits during scoliosis correction. But few studies have reported on the risk factors for neurological monitoring changes (NMCs). The records of 176 consecutive patients who underwent surgery for the treatment of spinal deformities were reviewed. The patients were monitored using transcranial electric motor-evoked potential (MEP) and/or somatosensory-evoked potential (SEP). Alterations with the MEP wave amplitude decreasing more than 75% and SEP amplitude decreasing more than 50%, as compared with the baseline, were diagnosed as positive changes. Risk factors related to NMCs were evaluated, in light of preoperative neurological deficits, comorbidity of spinal cord deformity, procedure of osteotomy, main curve Cobb angle, and a diagnosis of kyphosis. Combined MEP/SEP monitoring was successfully achieved in 175 of 176 cases. Eleven cases were presented with true NMCs according to MEPs. One patient had an irreversible neurological deficit and 4 patients had transient neurological deficits after waking up from the operation. SEP lagged MEP for an average of 15 minutes when both were presented with positive changes. The sensitivity and specificity of MEP were 91.7% and 98.8%, respectively. Solo SEP were 50% and 95.2%. Combined MEP and SEP were 92.9% and 99.4%. The procedure of osteotomy, curve Cobb angle more than 90 degrees, and preoperative kyphosis were correlated with a higher incidence of NMCs. Multimodal intraoperative monitoring provides higher sensitivity for monitoring during spine deformity surgery and can predict events of neurological injury. The detection of NMCs and adjustment of surgical strategy may prevent irreversible neurological deficits. The possible risk factors for NMCs during spine deformity surgery include an osteotomy procedure, kyphosis correction, and preoperative Cobb angle more than 90 degrees.
    Journal of spinal disorders & techniques 02/2012; 25(4):E108-14. · 1.21 Impact Factor

Publication Stats

56 Citations
47.81 Total Impact Points

Institutions

  • 2008–2014
    • Zhejiang University
      • • State Key Lab of Diagnosis and Treatment of Infectious Diseases
      • • School of Medicine
      Hang-hsien, Zhejiang Sheng, China
  • 2003–2014
    • Peking Union Medical College Hospital
      Peping, Beijing, China
  • 2010
    • State Key Laboratory of Medical Genetics of China
      Ch’ang-sha-shih, Hunan, China
  • 2002
    • Peking Union Medical University
      Peping, Beijing, China