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ABSTRACT: To evaluate the clinical outcome of posterior corrective operation for degenerative scoliosis and analyze the possible reasons for its late complications and their proper management.
Thirty-five patients with degenerative scoliosis, who were treated by posterior pedicle screw fixation and interbody fusion with cage implantation from September 1997 to September 2002, were reviewed. Their clinical outcomes were determined according to Oswestry Disability Index (ODI). The fusion area and its adjacent segments were evaluated through radiographic measurements of coronal Cobb angle, lumbar lordosis and coronal balance of the spine. The association of late complications, spinal alignment, and range of fusion was analyzed.
At final follow-up, ODI was 17.8 - 62.2 (average 34.7). Late complications occurred in 13 patients, accounting for 37.1%. Among the 13 cases, 10 were symptomatic and 6 received revision surgery. The late complications were proximal junctional scoliosis in 4 patients, proximal junctional kyphosis in 4 patients, proximal compressed vertebral fracture in 1 patient, pseudarthrosis in 1 patient, pedicle screw loosening in 1 patient, and distal segment degeneration in 1 patient. Junctional kyphosis had no obvious relationship with abnormality of spinal alignment. Adjacent segment degeneration occurred more commonly in the cases with the proximal ultimate vertebra below L1 (9/ 18) than above T12 (4/17).
The rate of late complications is relatively high after posterior corrective operation for degenerative scoliosis. Spinal alignment should be evaluated carefully in preoperative planning. The proximal ultimate vertebra should be extended to the level above T12 to avoid late complications.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2008; 46(7):484-7.
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ABSTRACT: To evaluate the clinical results of treatment of cervical spondylotic myelopathy by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches, and to study the methodology to prevent operative complications.
28 consecutive cases with cervical spondylotic myelopathy, aged 65.3 (49 ~ 73) were treated by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches from December 2001 to December 2005. The surgical methods included decompression of spinal canal, spinal fusion, and internal fixation with the combination of anterior and posterior approaches. The patients were followed up for 16 months (6 ~ 52 months). The clinical results and complications were analyzed retrospectively. The clinical effects were evaluated by the Japanese Orthopedic Association (JOA) scoring system and Odom's criteria. The outcome of cervical spinal fusion was evaluated by X-ray plate.
There were no neural injury and wound healing problems in all patients. All postoperative patients ambulated three days after the operation. CSF leak occurring in 3 cases was cured by conservative treatment. The recovery rate by the JOA scoring system was 50% when the patients were discharged. According to the Odom scoring system, 83.3% of the patients had excellent and good effects. No evidence of implant failure was found according to the Brantigan's criteria. Interbody fusion was achieved in 3 approximately 6 months after operation in all followed-up patients. No additional operation was needed for the involved segments, the spinal cord function of the patients had been improved in a certain extent, and the surgical outcomes could be maintained.
Decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches is necessary and effective in the treatment of severe and multi-level cervical spondylotic myelopathy, but the operative trauma is relatively serious, surgeons must carefully design the operative plan and pay enough attention to the methods to prevent operative complications, especially for the elderly patients.
Zhonghua yi xue za zhi 01/2007; 87(1):28-31.
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ABSTRACT: To investigate the indications and surgical techniques of reoperative lumbar spinal surgery using posterior lumbar interbody fusion cage.
Seventeen cases underwent reoperative lumbar spinal surgery using posterior lumbar interbody fusion cage. The surgical methods included decompression of lumbar canal, dural and radicular conglutination release, discectomy, posterior insertion of lumbar interbody fusion cage, pedicle screw instrumentation, posterolateral lumbar fusion. Periodical follow-up was conducted for 18 months (12 - 43 months). The clinical effect was evaluated by the Macnab's criterion, and the outcome of lumbar interbody fusion was evaluated according to the Brantigan's criterion.
Twenty-seven cages were implanted into twenty-three disc spaces (cage at L(3 - 4) in 5 cases, cage at L(4 - 5) in 8 cases, and cage at L(5)-S(1) in 4 cases). All postoperative patients ambulated after two weeks. No wound healing problems and nerve injury were found. Dural rupture occurred in 5 cases, but without occurrence of cerebrospinal fluid leakage. According to the Macnab's criterion, the preoperative lower extremity radicular symptoms and neurogenic claudication were effectively relieved in 15 cases (88.2%), and the outcomes were good or excellent in 15 cases (88.2%). According to the Brantigan's criterion no evidence of implant failure was found, and interbody fusion could be achieved about 6 months in all patients. No additional operation was needed for involved segments, and the surgical outcomes could be maintained.
A good and effective method, use of posterior lumbar interbody fusion cage in reoperative lumbar spinal surgery eliminates neural compression and the discogenic pain, restore the lumbar alignment, and accomplish the internal fixation and anterior column fusion of lumbar vertebrae simultaneously.
Zhonghua yi xue za zhi 08/2006; 86(25):1748-51.
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ABSTRACT: To study the effectiveness and advantages of transforaminal lumbar interbody fusion (TLIF) in the treatment of upper lumbar disc herniation.
Eighteen cases with upper lumbar disc herniation, 12 males and 6 females, aged 21 - 67, underwent TLIF. Follow-up was conducted for 19.8 months (12 - 54 months). The surgical process, outcomes, and complications were reviewed retrospectively. In TLIF operation, pedicle screw fixation was performed first, unilateral or bilateral facet joints were then excised. Disc removal and titanium mesh or fusion cage insertion were completed via transforaminal approach.
Unilateral TLIF was performed in 14 cases and bilateral TLIF was accomplished in 4 cases. The mean operation time was 82.4 minutes and the intraoperative blood loss was 323 ml. No injury of spinal cord or nerve roots happened during the operation. The follow-up showed that the operation results were excellent in 11 cases, good in 4 cases, and fair in 3 cases. No worsening or relapse of preoperative symptoms was observed. Disc spaces and lumbar lordosis were restored satisfactorily. No internal fixation failure was found.
Able to excise disc completely, restore physiological lumbar curve effectively and prevent postoperative instability, TLIF is one of effective surgical treatments for upper lumbar disc herniation for selected patients.
Zhonghua yi xue za zhi 08/2006; 86(25):1740-2.
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ABSTRACT: To investigate the techniques and indications of treatment of degenerative scoliosis.
The clinical data of 45 degenerative scoliosis patients, 18 males and 27 females, aged 41 - 77, all suffering from severe low back pain, were analyzed. Twenty of them underwent posterior lumbar interbody fusion with pedicle screws combined with correction of scoliosis. Sixteen patients underwent depression of vertebral canal and pure internal fixation and fusion of pedicle. Eight patients underwent pure depression, such as laminectomy or incision of intervertebral foramen. The corrective effects of scoliosis, condition of intervertebral fusion, and complications were observed.
All operations were performed successfully and all the patients made a remarkable recovery. During the 13 months' follow-up, 88% of the patients showed remarkable relief from pain and claudication and improved life quality. No loss in correction angle and height of disc space was found among the patients who had undergone internal fixation and interbody fusion. The residual symptom of low back pain was more manifest in the patients who had not undergone internal fixation than in those who had.
Posterior lumbar interbody fusion with pedicle screws is safe and effective in the treatment of severe degenerative scoliosis.
Zhonghua yi xue za zhi 07/2003; 83(12):1066-9.
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ABSTRACT: To investigate clinical results of posterior pedicle screw system and interbody fusion in the treatment of degenerative scoliosis.
From September 1997 to June 2002, 32 cases with degenerative scoliosis were analyzed for operative effect, postoperative complication and follow-up results.
The average correcting ratio of scoliosis was 47.9%, and pain relief ratio 90.6%. There was one case of pseudoarthritis and one case of brain vessel embolism. After an average 15-month (6-57 months) follow-up, there was no loss of correction and height of disc spaces and there was no shift of interbody cages.
Posterior pedicle screw combined with interbody fusion is one of safe and effective treatments of degenerative scoliosis.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 05/2003; 35(2):163-5.
