Lijin Zhou’s research while affiliated with Capital Medical University and other places

Background This study aimed to assess the efficacy of a novel spinal osteotomy technique, the posterior trans-intervertebral osteotomy with anterior support, in individuals diagnosed with ankylosing spondylitis. This study utilized computer software to simulate the osteotomy procedure, predict orthopedic outcomes, and assist in preoperative planning. Methods Four patients with ankylosing spondylitis underwent posterior trans-intervertebral osteotomy with anterior support that post-operative follow-up of more than 1 year. Osteotomy was performed using the intervertebral space approach with the cage placed anteriorly in the intervertebral space to improve the correction. Perioperative clinical symptoms, imaging data, and surgical factors were also documented. Results Patients who underwent posterior trans-intervertebral osteotomy with anterior support achieved good clinical results with favorable correction rates and minimal estimated blood loss. The average preoperative, postoperative and follow-up Cobb angles were 90.5° (range: 86–96°), 43.5° (range: 34–52°) and 46.25°(range: 37–55°), respectively. The average estimated blood loss was 500 mL (range: 300–800 mL). Patients with preoperative deficits improved their neurological status, and no complications were observed throughout the postoperative period. Pain, self-image, and mental health in the SRS-22 demonstrated significant improvement at the final follow-up compared to preoperative values. The satisfaction with management score was 3.25 ± 0.65. Conclusions Posterior trans-intervertebral osteotomy with an anterior support procedure was performed through the intervertebral space and subsequent implantation of a cage within the transpedicular space, effectively addressing the constraints associated with the conventional trans-intervertebral osteotomy method. Our preliminary findings indicate that posterior trans-intervertebral osteotomy with anterior support is potentially more secure than the conventional method for correcting ankylosing spondylitis kyphosis.

Background To assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status. Methods This study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT. Results A total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 ± 7.96 (range 12–29) years. Among them, 20 patients were aged ≤ 16 years. The traction weight started from 1.5 kg and raised to 45.2 ± 13.2% of body weight on average progressively, with the average traction duration of 129 ± 63 days. After traction, the main curve was corrected from an average of 120.66 ± 3.89° to 94.88 ± 3.35°, and to 52.33 ± 22.36° (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 ± 14.76% vs. 47.33 ± 16.04%, 41.87 ± 13.68% vs. 45.19 ± 15.57%, and 40.44 ± 15.87% vs. 45.24 ± 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 ± 5.43 g/L to 70.68 ± 6.98 g/L and 42.40 ± 3.44 g/L 45.72 ± 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction. Conclusions Halo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.

Background The surgical treatment of severe and complex adult spinal deformity (ASD) commonly required three-column osteotomy (3-CO), which was technically demanding with high risk of neurological deficit. Personalized three dimensional (3D)-printed guide template based on preoperative planning has been gradually applied in 3-CO procedure. The purpose of this study was to compare the efficacy, safety, and precision of 3D-printed osteotomy guide template and free-hand technique in the treatment of severe and complex ASD patients requiring 3-CO. Methods This was a single-centre retrospective comparative cohort study of patients with severe and complex ASD (Cobb angle of scoliosis > 80° with flexibility < 25% or focal kyphosis > 90°) who underwent posterior spinal fusion and 3-CO between January 2020 to January 2023, with a minimum 12 months follow-up. Personalized computer-assisted three-dimensional osteotomy simulation was performed for all recruited patients, who were further divided into template and non-template groups based on the application of 3D-printed osteotomy guide template according to the surgical planning. Patients in the two groups were age- and gender- propensity-matched. The radiographic parameters, postoperative neurological deficit, and precision of osteotomy execution were compared between groups. Results A total of 40 patients (age 36.53 ± 11.98 years) were retrospectively recruited, with 20 patients in each group. The preoperative focal kyphosis (FK) was 92.72° ± 36.77° in the template group and 93.47° ± 33.91° in the non-template group, with a main curve Cobb angle of 63.35° (15.00°, 92.25°) and 64.00° (20.25°, 99.20°), respectively. Following the correction surgery, there were no significant differences in postoperative FK, postoperative main curve Cobb angle, correction rate of FK (54.20% vs. 51.94%, P = 0.738), and correction rate of main curve Cobb angle (72.41% vs. 61.33%, P = 0.101) between the groups. However, the match ratio of execution to simulation osteotomy angle was significantly greater in the template group than the non-template group (coronal: 89.90% vs. 74.50%, P < 0.001; sagittal: 90.45% vs. 80.35%, P < 0.001). The operating time (ORT) was significantly shorter (359.25 ± 57.79 min vs. 398.90 ± 59.48 min, P = 0.039) and the incidence of postoperative neurological deficit (5.0% vs. 35.0%, P = 0.018) was significantly lower in the template group than the non-template group. Conclusion Performing 3-CO with the assistance of personalized 3D-printed guide template could increase the precision of execution, decrease the risk of postoperative neurological deficit, and shorten the ORT in the correction surgery for severe and complex ASD. The personalized osteotomy guide had the advantages of 3D insight of the case-specific anatomy, identification of osteotomy location, and translation of the surgical planning or simulation to the real surgical site.

Background. Severe and rigid scoliosis poses significant challenges in surgical correction, and innovative approaches are continually sought to enhance effectiveness and ensure patient safety. Halo-gravity traction (HGT) continues to be a vital tool in managing severe spinal conditions, offering a nonsurgical or preoperative approach to address spinal deformities. However, the correction effect that HGT can achieve for severe and rigid spinal deformity is currently unclear and the impact of HGT on the selection of spinal osteotomy grade was still unknown. Methods. A retrospective matched-cohort study was conducted and a total of 74 patients from January 2018 to December 2021 in our institution were finally enrolled in this study, including 27 patients in the HGT group and 47 patients in the non-HGT group based on whether patients receive HGT or not. Comprehensive assessments including radiographic outcomes, surgical parameters, and clinical complications were collect and analyzed before and after correction surgery. Results. Of the patients included in the HGT group, 21 had thoracic curvature and 6 had thoracolumbar/lumbar curvature, compared with 38 and 9 in the non-HGT group, respectively (P=0.66). There was no significant difference in the etiologies of scoliosis between two groups (15/7/3/2 vs. 25/16/4/2, P=0.85). The main curve in HGT and non-HGT groups were corrected from an average of 113.69°–51.25° and 111.94°–63.79° (P<0.01). For the HGT group, the mean correction rate of focal kyphosis (FK) was 45.43%, which was significantly higher than those in the non-HGT group (33.98%, P<0.05). There were no statistically significant differences in preoperative parameters of sagittal vertical axis (SVA) (P=0.13) or thoracic kyphosis (TK) (P=0.07) between the two groups. Postoperatively, the HGT group showed significantly lower values in SVA (P=0.001) and TK (P=0.001) compared to the non-HGT group. However, there was no significant difference in the imaging parameters coronal vertical axis (CVA) and apical vertebral translation (AVT) between the two groups (P>0.05). In the preoperative surgical planning phase before HGT treatment, 26 patients were initially considered candidates for 3-column osteotomy (3CO), while one patient was evaluated as suitable for posterior column osteotomy (PCO). Following HGT treatment, the assessment changed with 11 patients identified as candidates for 3CO and 16 patients deemed suitable for PCO. The application proportion of 3CO was significantly higher in the non-HGT group than in the HGT group (P<0.05). The mean blood loss of the non-HGT group was significantly greater than that of the HGT group (666.67 ± 486.55 ml vs. 1024.47 ± 718.46 ml, P<0.05), but the surgical time showed no difference between the two groups (297.33 ± 66.89 mins vs. 299.15 ± 56.73 mins, P=0.90). The incidence of complications in the HGT group was 7.4%, which was significantly lower than that of the non-HGT group (P<0.05). Conclusion. This study showed that the use of HGT, as a feasible and safe strategy, has superior efficacy and safety for treating severe and rigid scoliosis and can reduce the level of osteotomy used during surgery to some extent.

Background One-stage scoliosis correction surgery is safe for adolescent idiopathic scoliosis (AIS), but it is not yet known whether it is safe for presumed AIS (PAIS). This study sought to investigate the safety and efficacy of one-stage scoliosis correction surgery for PAIS associated with syringomyelia from multiple perspectives by conducting an analysis of 10-year consecutive cases. Methods A retrospective study of all consecutive cases of patients diagnosed with PAIS associated with syringomyelia or AIS from January 2011 to January 2020 was performed. The main radiographic parameters and clinical function scores before, immediately after, and at the last follow-up were collected or measured. Three-dimensional (3D) models of spinal canal length were generated, refined, measured, and compared between the PAIS and AIS groups. Results In total, 318 patients with AIS and 47 patients with PAIS associated with syringomyelia were included in the study. There were no significant differences between the two groups in terms of changes in the Cobb angle of the main curve (MC), thoracic kyphosis (TK), coronal balance (CB), sagittal vertical axis (SVA), Oswestry disability index (ODI), Scoliosis Research Society-22 (SRS-22) score, cervical and thoracolumbar spinal canal length, and whole spinal canal length before and after the surgery (P>0.05). The changes in the thoracolumbar and whole spinal canal length were significantly positively correlated with the improvement rate of the MC (P<0.05), but were not significantly correlated with the improvement rate of TK, the SRS-22 score, and the ODI (P>0.05). Conclusions In relation to the main radiologic parameters, clinical function scores, and 3D biomechanics, one-stage posterior correction surgery was found to be safe and effective for patients with PAIS associated with syringomyelia.

Background The purpose of the present study was to evaluate changes in pulmonary function, caused by preoperative halo-pelvic traction (HPT) for the treatment of extremely severe and rigid kyphoscoliosis, with use of 3-dimensional computed tomography (3D-CT) reconstruction and pulmonary function tests (PFTs). Methods Twenty-eight patients with severe and rigid scoliosis (Cobb angle, >100°) underwent preoperative HPT and staged posterior spinal fusion. CT, radiographic assessment, and PFT were performed during pre-traction and post-traction visits. The changes in total lung volume were evaluated with use of 3D-CT reconstruction, and the changes in pulmonary function were evaluated with PFTs at each time point. Differences were analyzed with use of 2-tailed paired Student t tests, and correlations were analyzed with use of Spearman rank tests. Results None of the patients had pulmonary complications during traction, and all radiographic spinal measurements improved significantly after HPT. The main Cobb angle was corrected from 143.30° ± 20.85° to 62.97° ± 10.83° between the pre-traction and post-traction evaluations. Additionally, the C7-S1 distance was lengthened from 280.48 ± 39.99 to 421.26 ± 32.08 mm between the pre-traction and post-traction evaluations. Furthermore, 3D lung reconstruction demonstrated a notable increase in total lung volume (TLV) (from 1.30 ± 0.25 to 1.83 ± 0.37 L) and maximum lung height (from 176.96 ± 27.44 to 202.31 ± 32.45 mm) between the pre-traction and post-traction evaluations. Moreover, PFTs showed that total lung capacity (TLC) improved between the pre-traction and post-traction evaluations (from 2.06 ± 0.32 to 2.98 ± 0.82 L) and that the changes in T1-T12 distance and maximum lung height were correlated with changes in TLV (p = 0.0288 and p = 0.0007, respectively). Conclusions The application of HPT is a safe and effective method for improving pulmonary function in patients with extremely severe and rigid scoliosis before fusion surgery. The TLV as measured with CT-based reconstruction was greatly increased after HPT, mainly because of the changes in thoracic height. Level of Evidence Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Background context: Standard partial facetectomies, [Smith-Petersen Osteotomy, (SPO)], (Schwab-grade-I) and complete facet resection also known as Ponte osteotomy, [PO], (Schwab-grade-II) are narrowly akin and collectively appreciated as posterior column shortening osteotomies (PCOs). The former is considered a gentler osteotomy grade than the latter. The spine literature provides very little information on their comparison regarding perioperative complications and major curve correction rate outcomes. Purpose: To determine whether Schwab-grade-I PCO (SPO) and Schwab-grade-II PCO (PO) are comparably safe in the surgical management of severe rigid scoliosis or kyphoscoliosis patients. Study design/setting: Retrospective single-center comparative clinical study. Patient sample: A total of 38 patients with severe rigid scoliosis or kyphoscoliosis were propensity score matched in this study, [SPO-treated]; n=21 (55.30%) and [PO-treated]; n=17 (44.70%), who underwent primary spinal deformity corrective surgery, respectively. Outcome measures: Outcomes included demographics, baseline pulmonary functional outcomes, perioperative complications incidence, hospital costs, Oswestry disability index (ODI), and scoliosis research society-22 (SRS-22) questionnaire scores. Methods: Following approval by the institutional review board (IRB) of Beijing Chaoyang Hospital-Affiliated Capital Medical University in Beijing, out of a total of 82 consecutive surgical patients with complete data demonstrating severe and/or rigid spinal deformity, a pool of 38/82 (46.3%) propensity-matched adults (≥18 years) with severe rigid scoliosis or kyphoscoliosis patients defined with a preoperative major curve magnitude of ≥80 degrees on anteroposterior plain radiographs, and flexibility of <25% on bending plain radiographs who underwent primary spinal deformity corrective surgery were retrospectively evaluated. The patients were dichotomized into two (2) osteotomy groups: standard (partial) facetectomy (SPO-treated), n=21 with an average age of 24.67 years, (i.e., Schwab-grade-I PCO) and complete facet excision, (PO-treated), (i.e., Schwab-grade-II PCO), n=17 with an average age of 23.12 years. The minimum follow-up period was 2 years. Primary outcomes included baseline and clinical features. Secondary outcomes included perioperative [intraoperative, immediate, and at 2-year postoperative] complication rates. Tertiary outcomes included perioperative ODI and SRS-22 scores. Statistical analyses were carried out by Student t-test and Pearson's Chi-squared test (Fisher's Exact Test), through Python statistical software package. Statistical significance was set at (p<0.05). Results: Of the 38 matched severe rigid scoliosis or kyphoscoliosis patients, 55.30% (n=21) were SPO-treated and 44.70% (n=17) were PO-treated patients, respectively. The overall average age of patients was 23.97 years, with a female incidence of 76.32%. Major curve correction rates were 49.19% and 57.40% in SPO-treated and PO-treated patients, respectively, (p>0.05). Immediately following surgery, comparable overall complication rates of 28.57% (n=6/21) vs 29.41% (n=5/17) were observed in the SPO-treated and PO-treated patients, respectively, (p=0.726). We observed incidences of 9.52%, (n=2/21) vs 5.88%, (n=1/17) for surgical intensive care unit (SICU) admission, and incidences of 4.76%, (n=1/21) vs 5.88%, (n=1/17) for cardiopulmonary events in SPO-treated versus PO-treated patients after surgery, respectively, (p>0.05). The incidences of neurological deficits in the SPO-treated and PO-treated patients were respectively, 14.29%, (n=3/21) vs 17.65%, (n=3/17) immediately following surgery, (p>0.05), and 0.00%, (n=0/21) in SPO-treated vs 14.28%, (n=3/21) in PO-treated patients at ≥2 years postoperative, (p<0.05). Among the 3 patients that reported neurological deficits in the PO-treated group at ≥2 years postoperative, 2 patients had preexisting baseline neurological deficits. The ODI score in the PO-treated group was significantly inferior at a minimum 2-year follow-up, (p<0.05). Conclusions: In the current study, both SPO-treated and PO-treated patients demonstrated statistically comparable surgical complications immediately following corrective surgery. Severe rigid kyphoscoliosis patients with preexisting baseline neurological deficits were more inclined to sustain neurological morbidity following corrective surgery. PCO corrective techniques are warranted as safe options for treating patients with severe rigid spine deformity phenotypes.

Purpose: We aimed to analyze the cervical sagittal alignment change following the growing rod treatment in early-onset scoliosis (EOS) and identify the risk factors of sagittal cervical imbalance after growing-rod surgery of machine learning. Materials and Methods: EOS patients from our center between 2007 and 2019 were retrospectively reviewed. Radiographic parameters include the cervical lordosis (CL), T1 slope, C2-C7 sagittal vertical axis (C2-7 SVA), primary curve Cobb angle, thoracic kyphosis (TK), C7-S1 sagittal vertical axis (C7-S1 SVA) and proximal junctional angle (PJA) were evaluated preoperatively, postoperatively and at the final follow-up. The parameters were analyzed using a t-test and χ2 test. The machine learning methodology of a sparse additive machine (SAM) was applied to identify the risk factors that caused the cervical imbalance. Results:138 patients were enrolled in this study (96 male and 42 female). The mean thoracic curve Cobb angle was 67.00±22.74°. The mean age at the first operation was 8.5 ±2.6yrs. The mean follow-up was 38.48±10.87 months. CL, T1 slope, and C2-7 SVA increased significantly in the final follow-up compared with the pre-operative data. (P<0.05). The CL and T1 slope increased more significantly in the group of patients who had proximal junctional kyphosis (PJK) compared with the patients without PJK (P<0.05). The location of the upper instrumented vertebrae (UIV) and single/dual growing rod had no significant influence on the sagittal cervical parameters (P>0.05). According to the SAM analysis of machine learning algorithms, Postoperative PJK, more improvement of kyphosis, and T1 slope angle were identified as the risk factors of cervical sagittal imbalance during the treatment of growing rod surgery. Conclusions: The growing rod surgery in EOS significantly affected the cervical sagittal alignment. Postoperative PJK and more improvement of kyphosis and T1 slope angle would lead to a higher incidence of cervical sagittal imbalance.

(1) Background: The three-dimensional printing (3DP) technique has been reported to be of great utility in spine surgery. The purpose of this study is to report the clinical application of personalized preoperative digital planning and a 3DP guidance template in the treatment of severe and complex adult spinal deformity. (2) Methods: eight adult patients with severe rigid kyphoscoliosis were given personalized surgical simulation based on the preoperative radiological data. Guidance templates for screw insertion and osteotomy were designed and manufactured according to the planning protocol and used during the correction surgery. The perioperative, and radiological parameters and complications, including surgery duration, estimated blood loss, pre- and post-operative cobb angle, trunk balance, and precision of osteotomy operation with screw implantation were collected retrospectively and analyzed to evaluate the clinical efficacy and safety of this technique. (3) Results: Of the eight patients, the primary pathology of scoliosis included two adult idiopathic scoliosis (ADIS), four congenital scoliosis (CS), one ankylosing spondylitis (AS), and one tuberculosis (TB). Two patients had a previous history of spinal surgery. Three pedicle subtraction osteotomies (PSOs) and five vertebral column resection (VCR) osteotomies were successfully performed with the application of the guide templates. The main cobb angle was corrected from 99.33° to 34.17°, and the kyphosis was corrected from 110.00° to 42.00°. The ratio of osteotomy execution and simulation was 97.02%. In the cohort, the average screw accuracy was 93.04%. (4) Conclusions: The clinical application of personalized digital surgical planning and precise execution via 3D printing guidance templates in the treatment of severe adult rigid deformity is feasible, effective, and easily generalizable. The preoperative osteotomy simulation was executed with high precision, utilizing personalized designed guidance templates. This technique can be used to reduce the surgical risk and difficulty of screw placement and high-level osteotomy.