Background: This trial reports the 2-year and immediate postremoval clinical outcomes of a novel posterior apical short-segment (PASS) correction technique allowing for correction and stabilization of adolescent idiopathic scoliosis (AIS) with limited fusion. Methods: Twenty-one consecutive female AIS patients were treated at 4 institutions with this novel technique. Arthrodesis was limited to the short apical curve after correction with translational and derotational forces applied to upper and lower instrumented levels. Instrumentation spanned fused and unfused segments with motion and flexibility of unfused segments maintained. The long concave rods were removed at maturity. Radiographic data collected included preoperative and postoperative data for up to 2 years as well as after long rod removal. Results: All 21 patients are beyond 2 years postsurgery. Average age at surgery was 14.2 years (11-17 years). A mean of 10.5 ± 1 levels per patient were stabilized and 5.0 ± 0.5 levels (48%) were fused. Cobb angle improved from 56.1° ± 8.0° to 20.8° ± 7.8° (62.2% improvement) at 1 year and 20.9° ± 8.4°, (62.0% improvement) at 2 years postsurgery. In levels instrumented but not fused, motion was 26° ± 6° preoperatively compared to 10° ± 4° at 1 year postsurgery, demonstrating 38% maintenance of mobility in nonfused segments. There was no report of implant-related complications. Conclusions: PASS correction technique corrected the deformity profile in AIS patients with a lower implant density while sparing 52% of the instrumented levels from fusion through the 2-year follow-up.
- Publikační typ
- časopisecké články MeSH
STUDY DESIGN: A prospective, nonrandomized, multicenter study. OBJECTIVES: The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration. METHODS: This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery. RESULTS: Twenty-one female patients, mean age of 14.2 years (10.6-16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV. CONCLUSION: Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density. LEVEL OF EVIDENCE: 4.
- MeSH
- dítě MeSH
- fúze páteře přístrojové vybavení metody MeSH
- hrudní obratle diagnostické zobrazování patofyziologie chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- pedikulární šrouby MeSH
- prospektivní studie MeSH
- rentgendiagnostika MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů fyziologie MeSH
- skolióza diagnostické zobrazování patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Pacienti s adolescentnou idiopatickou skoliózou absolvujú počas liečby väčšie množstvo röntgenových snímok chrbtice. Opakovaná expozícia ionizujúcemu žiareniu má za následok vyššiu incidenciu karcinómu prsníka, štítnej žľazy a leukémií. Jednou z neradiačných alternatív röntgenových snímok je magnetické meranie chrbtice prístrojom Ortelius 800. Hodnotili sme presnosť prístroja u pacientov po operačnej liečbe skoliózy pedikulárnymi skrutkami a tyčami a aj prípadný vplyv hypertrofickej jazvy a prítomnosti implantátu na presnosť merania. Metodika Vyšetrili sme 13 pacientov po operačnej korekcii skoliózy. Údaje z Orteliusa boli porovnané s röntgenovými snímkami zhotovenými v ten istý týždeň. Výsledky Priemerná veľkosť meraného Cobbovho uhla na röntgenových snímkach bola 18,92°. Priemerný absolútny rozdiel medzi Orteliusom a RTG snímkami bol 4,53°. Rozdiel nebol štatisticky signifikantný (p=0,0698). Záver U pacientov po operačnej liečbe je Ortelius dostatočne presnou alternatívou RTG snímok. Titánový implantát nemá vplyv na presnosť merania, ale hypertrofická jazva môže v ojedinelých prípadoch znemožniť dokončenie vyšetrenia. Aj keď sa Ortelius zdá byť akceptabilnou alternatívou RTG snímok pri meraní Cobbovho uhla, neposkytuje všetky údaje o štruktúre kosti a postavení implantátu, ktoré zachytí len RTG snímka.
Introduction Patients with adolescent idiopathic scoliosis have to undergo multiple full-length spinal x-rays. Repeated exposure to ionizing radiation leads to higher incidence of breast cancer, thyroid cancer and leukemia. One of the radiation-free methods that try to replace the x-rays is magnetic measurement of the spine with Ortelius 800. We assessed the accuracy of this method in patients after surgical correction with pedicular screws and rods and possible influence of incision scar and presence of the implant on measurement accuracy. Methods 13 patients with adolescent idiopathic scoliosis after surgical correction were measured with Ortelius. Data from Ortelius were compared with standard spinal x-rays taken the same week. Results The average Cobb’s angle measured by x-ray was 18.92 degrees. The average absolute difference between Ortelius and x-rays was 4.53 degrees. The difference was not statistically significant (p= 0.0698). Conclusion Ortelius is accurate alternative to X-rays measurement of scoliosis patients after surgical correction. The titanium implant has no influence on measurement accuracy. Hypertrophic scar can occasionally prevent the patient to be examined with Ortelius. Although Ortelius seems to be an acceptable alternative to x-rays in Cobb’s angle measurement, it does not provide all the information regarding bone structure that only the x-ray does.
- MeSH
- diagnostické zobrazování * škodlivé účinky trendy MeSH
- dospělí MeSH
- elektromagnetické jevy MeSH
- elektromagnetické záření MeSH
- fyzikální vyšetření metody přístrojové vybavení MeSH
- lidé MeSH
- mladiství MeSH
- pooperační období MeSH
- prospektivní studie MeSH
- skolióza * diagnóza radiografie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- MeSH
- akademický sbor lékařské fakulty dějiny MeSH
- lidé MeSH
- nemocniční oddělení * dějiny MeSH
- ortopedie * dějiny MeSH
- traumatologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- biografie MeSH
PURPOSE OF THE STUDY To evaluate the effect of complications on the quality of life in patients after elective stabilisation surgery on the lumbar spine. MATERIAL AND METHODS Between January 2005 and June 2007, 208 patients (120 women and 88 men) were included in the prospective study carried out at our department. These patients were undergoing elective surgery for lumbar spinal disease, namely, central and lateral stenosis, degenerative disc disease and degenerative and isthmic spondylolisthesis. All patients were treated by transpedicular fixation and fusion involving transforaminal lumbar interbody fusion (TLIF) in 165 patients, anterior lumbar interbody fusion (ALIF) in five and posterolateral fusion (PLF) in 38 patients. Satisfaction of the patients with surgery outcomes was assessed on a three-point scale, using the Visual Analogue Scale (VAS), and the Short Form health survey questionnaire (SF-36v2) for life quality evaluation. The follow-up period ranged from 6 months to 2 years. The results were statistically analysed using the chi-square test and t-test. RESULTS A total of 30 complications were recorded in 28 patients (13.5%). Revision surgery was necessary in 18 patients (8.7%). Pedicle screw misplacement was found in eight patients and permanent neurological deficit with paresis of the unilateral lower limb in three patients. Carbon cage break-down during surgery occurred in one patient, misinsertion of the cage was in one patient. The dural sac was damaged in five patients, superficial and deep wound infection was found in four and two patients, respectively. Broken screws were detected in seven patients. Donor-site pain persisted in two patients. The patients free from complications were more satisfied (partial or full satisfaction in 86 %) than the patients with complications, who reported satisfaction in 78 %. However, the difference was not statistically significant. The complications had no significant effect on either any of the SF-36v2 health domains or the total physical and mental score or pain intensity. The ALIF procedure was associated with no complications, PLF with three (13 %) and TLIF with 23 (14 %) complications, but the differences were not statistically significant. DISCUSSION Complications and revision surgery were relatively frequent in our group, but not excessive compared with the published data which report their occurrence from 3% to 30 %. This large range is related to an ambiguous definition and specification of complications. A significantly fewer complications have been reported in the studies supported by companies, or in those in which the author/s participate in instrumentation development. Some studies suggest that novel and more complex techniques bring about a higher risk of complications and repeat surgery, others report better results and fewer reoperations following a 360-degree fusion than after PLF. The difference in complications between TLIP and PLF in our group was not significant. CONCLUSIONS Complications are a serious issue of spinal surgery. The majority of complications in our group were associated instrumentation - most frequently with incorrect screw misinsertion. On the whole, the complications did not significantly influence the quality of life and pain intensity after surgery. Most of them were treated successfully with no permanent consequences, the permanent neurological deficit in three patients, because of the small number, had no effect on the whole group results. A reduction in the number of complications would not produce any expected improvement of functional outcome.
- MeSH
- bederní obratle chirurgie MeSH
- dospělí MeSH
- fúze páteře škodlivé účinky MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci páteře chirurgie MeSH
- pooperační komplikace MeSH
- reoperace MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
