| Objective: To analyze the long-term results and the influence factors of spontaneous correction of unfused thoracic curves in anterior and posterior selective fusions in Lenke type 5C adolescent idiopathic scoliosis(AIS).Methods: From January 2005 to December 2011,89 Lenke type 5C AIS patients with a minimum of 5-year follow-up who underwent thoracolumbar/lumbar(TL/L)selective fusion in Spine Surgery of Nanjing Drum Tower Hospital were reviewed.Forty-three patients underwent anterior fusion(anterior group),while 46 underwent posterior fusion(posterior group).The following radiological parameters were measured and analyzed at pre-operation,post–operation,and latest follow-up: curve magnitude of primary thoracolumbar/lumbar and secondary thoracic curve,trunk shift,thoracic apical vertebral translation,upper instrumented vertebra tilt,thoracic kyphosis,proximal junctional angle,sagittal vertical axis.Independent sample t test was used to compare the above parameters between the two groups.Results: The two groups were homogeneous in demographic and preoperative radiographic data(P>0.05).Compared with those in posterior group,anterior group were found with less fusion levels(5.4±0.6 vs 5.9±0.8,P<0.001)and longer operation time [(276±28)min vs(186±36)min,P=0.001].Immediately after surgery,the spinal deformity was significantly corrected in the two groups.The mean spontaneous correction rates of the minor curve were 49.5% and 56.1% in anterior and posterior groups,respectively(P=0.140).At the final follow-up,the spontaneous correction rate of minor curve was maintained at 45.5% and 48.6%,respectively(P=0.484),with no significant correction loss.Other radiographic parameters were also stably maintained.According to the correlation analysis,the spontaneous correction rate was significantly correlated with upper instrumented vertebra(UIV)tilt in both groups (anterior: r=-0.526,P<0.001 vs.posterior: r=-0.399,P=0.016).No infection,vascular injury and neurologic complications were observed in both groups intraoperatively and during the follow-up.Conclusions: Both anterior and posterior selective fusion can achieve satisfactory spontaneous correction of unfused thoracic curves in Lenke type 5C AIS,with no significant difference between the two surgical approaches.UIV tilt is a key influence factor of spontaneous correction of thoracic curves.Objectives: To investigate the clinical outcomes of one-stage posterior correction surgery and second-stage anterior debridement and fusion in treating children with thoracic tuberculosis complicated with kyphoscoliosis.Methods: From January 2008 to December 2014,a total of 17 patients with thoracic vertebral tuberculosis complicated with kyphoscoliosis in our institution who underwent a second-stage posterior orthopedic anterior debridement and fusion surgery were included.There were 8 cases and 9 females with an average age of 7.7±3.6 years(5-14 years old).The tuberculosis lesions were located in the thoracic vertebrae,and the lesions ranged from 1 to 4 vertebral bodies with no jumping lesions.13 cases had symptoms of low fever,night sweats,anorexia,fatigue and other symptoms of tuberculosis and chest and back pain,limited mobility.All patients underwent posterior correction and anterior debridement and bone graft fusion surgery,followed by postoperative anti-tuberculosis treatment.The parameters included the presence or absence of recurrence of local lesions,correction of kyphoscoliosis,maintenance in the middle and long-term follow-up,and improvement of neurological function.The operation time,intraoperative blood loss,fusion segment,and number of screws were recorded.The following radiographic parameters were measured: Cobb angle of the coronal curve,regional kyphosis;thoracic kyphosis,lumbar lordosis and sagittal vertical axis.The incidence of complications during intraoperative and follow-up was recorded.Results: The average operation time was 4.1±0.8h,the average intraoperative blood loss was 526±275 ml,the average fixed segment was 7.6±2.3,and 173 pedicle screws were placed.The average implantation density was 72.3±7.8%.The preoperative coronal Cobb angle was 12.6±6.2°,the regional kyphosis was 67.2°±19.4°.After surgery,the coronal Cobb angle were corrected to 9.2±4.1°,the regional kyphosis was corrected to 21.7±8.5°,and the average correction rate was 66.7±17.5% and 76.6±16.6%.Global sagittal balance was also improved significantly.All patients were followed up for an average of 37.5±11.2 months.The radiographic parameters remained stable at the last follow-up(P>0.05).One patient developed dural tear during operation and was repaired intraoperatively.One patient developed postoperative subcutaneous cerebrospinal fluid leakage.One patient had pedicle screw displacement at T5 level.No recurrence of primary spinal tuberculosis was seen at the last follow-up of all patients.Conclusions: One-stage posterior correction and second-stage anterior debridement and fusion are an effective procedure for children with thoracic tuberculosis complicated with kyphoscoliosis.Significant postoperative deformity correction could be achieved with low complication rate.Solid fusion and satisfactory correction maintenance were observed at mid to long-term follow-up.Objective: To investigate the clinical outcome of long fusion correction surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy and tumor resection in adolescent.Methods: Records of 12 cases undergoing correction surgery of post-laminectomies thoracic(n=6)or thoracolumbar(n=6)kyphotic deformity were reviewed.Saggittal and coronal Cobb angles before surgery,immediately after surgery and at the final follow-up were measured to evaluate the correction of deformity and loss of correction.Neurological function was evaluated using the Frankel grading system.Back pain was assessed by using the visual analogue score(VAS).Disability status was evaluated by using the Oswestry Disability Index(ODI).Satisfaction to surgery was assessed by using the patient satisfactory index(PSI).Results: The mean kyphosis angle reduced from 76.1°±19.6° before surgery to 33.7°±17.6° immediately after surgery,and remained at 38.9°±17.1° at the final follow-up with the average correction rate of 58.6% and 51.0%,respectively.Seven patients with concomitant scoliosis,the mean coronal angle reduced from 51.6°±21.3° before surgery to 16.4°±9.3°immediately after surgery and 19.9°±9.3°at the final follow-up.The average corrective rate was 69.5% and 62.4%,respectively.The mean ODI improved from 19.9±7.5 to 10.8±8.0,whereas the mean VAS score improved from 5.3±2.0 to 1.5±1.4.The sagittal and coronal balance of the spine,Frankel grading,ODI and visual analogue score were improved.The PSI was 100%.One patient had inferior paraplegia and recovered to Frankel grade E after treatments.Conclusions: Ideal clinical outcomes could be achieved after long fusion surgery for thoracic or thoracolumbar kyphotic deformity secondary to laminectomy for spinal tumor.Due to the high incidence of kyphotic deformity in adolescent,internal fixation should be performed simultaneously with the resection of spinal tumor,especially in thoracic or thoracolumbar region. |
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