Significant Difference In Cobb Angle Research Articles

A pilot study on the "ScoliBrace" in the treatment of adolescent idiopathic scoliosis.

Bracing for adolescents with idiopathic scoliosis (AIS) is a treatment option to prevent curve progression to surgical level. This study aimed to assess the efficacy of a 3D fully customized over corrective brace, "ScoliBrace," an orthosis treatment for AIS. This was a prospective pilot study of AIS female patients with inclusion criteria followed recommended Scoliosis Research Society (SRS) Guidelines. Cobb angles measured at: baseline (T0), 21months (T5-2), skeletal maturity (T6), 6months post-brace (T7), along with hours of brace wear using a thermal sensor and health-related quality of life (HRQoL) using the SRS-22r questionnaire. A total of 30 female AIS patients with mean age 11.85 ± 0.68years, predominantly Risser 0 (70%), and median Cobb angle 29° were recruited; 21 patients were included for the final analysis. Results showed significant difference in Cobb angle between T0 and T5-2 (median = 22.5° vs. 28.5°, p = 0.0082). 57.14% had reduction in Cobb angle by ≥ 5° at skeletal maturity. Cobb angle reduced 0.794° for each additional hour of dosage (p = 0.036, 95% CI = - 1.532°, - 0.056°). Although pain level was increased at T6 (4.37 ± 0.51vs.4.70 ± 0.41, p = 0.014), patients reported significantly greater satisfaction with management of their condition (3.90 ± 0.90vs.3.29 ± 0.88, p = 0.020). Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. Using "ScoliBrace" as a non-surgical treatment, maintained curves below surgical threshold and showed curve reduction, improving patient satisfaction with management.

A comparative study on the clinical efficacy of percutaneous endoscopic lumbar discectomy and conventional open surgery in the treatment of lumbar disc herniation.

To analyze the efficacy of single-channel percutaneous endoscopic lumbar discectomy (PELD) and conventional open surgery in the treatment of lumbar disc herniation (LDH). This is a retrospective study. A total of 66 patients with LDH admitted to Tianjin Medical University from June 2017 to June 2018 were divided into two groups: the observation group (single-channel PELD) and the control group (posterior lumbar interbody fusion), with 33 cases in each group. The two groups were compared in terms of visual analogue scale(VAS), oswestry disability index (ODI), Japanese Orthopaedic Association Score(JOA), perioperative indicators, clinical efficacy, postoperative complications, changes in inflammatory factors and serum T lymphocyte subsets. The operation time, incision length, intraoperative blood loss, time in bed, hospital stay in the observation group were all lower than those in the control group. At 7d after treatment, the improvement of ODI, VAS and JOA in the observation group were better than that in the control group. At the last follow-up, there was no significant difference in Cobb angle and lumbar lordosis angle between the two groups. The levels of serum IL-1, IL-6 and TNF-α in the observation group were lower than those in the control group. The degree of reduction of serum CD3+ and CD4+ in the observation group were higher than those in the control group. And the level of elevation of CD8+ in the observation group was lower than that in the control group. Moreover, there was no significant difference in CD4+/CD8+ level between the two groups. The excellent rate of surgical results in the observation group was higher than that in the control group. Complications occurred in both groups, with no significant difference between the two groups. Single-channel PELD can achieve superior clinical efficacy over conventional open surgery in the treatment of LDH.

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population.

ObjectiveThe study aimed to investigate the effect of the type of bone cement distribution on clinical outcomes following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) in the elderly.MethodsRetrospective analysis of 160 patients diagnosed with OVCF who underwent PVP treatment from March 2018 to December 2020. Based on the kind of postoperative bone cement distribution, bone cement was classified as types I, II, III, IV, and V. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height ratio, refracture rate of injured vertebrae, and incidence of adjacent vertebral fractures were compared for the five types before and after three days, and one year of operation.ResultsVAS and ODI at three days and one year postoperative were significantly lower than those preoperative (P < 0.05) for all five distribution types. VAS and ODI for types I, II, and III were lower at one year postoperatively than for types IV and V (P < 0.05). There was no significant difference in Cobb angle and anterior vertebral body height ratio between preoperative and three days postoperative groups (P < 0.05); however, there were significant differences between three days and one-year postoperative and preoperative groups (P < 0.05). Following one year of surgery, the Cobb angle and the anterior vertebral height ratio of types IV and V were significantly different from those of types I, II, and III (P < 0.05), and there was a statistically significant difference between types IV and V (P < 0.05). In terms of the incidence of injured vertebral refractures and adjacent vertebral fractures, the evenly distributed types I, II, and III were significantly lower than the unevenly distributed types IV and V, and the incidence of type V was higher (P < 0.05).ConclusionsThe clinical efficacy of cement distribution following PVP of types I, II, and III is better than that of types IV and V, which can better relieve pain with long-lasting efficacy and minimize the occurrence of refractures of injured vertebrae and adjacent vertebral body fractures.

Clinical Effect of Bone Filling Mesh Container Vertebroplasty in Osteoporotic Compression Fracture.

Objective To investigate the clinical application of bone filling mesh container vertebroplasty in osteoporotic vertebral compression fractures (OVCFs). Methods Patients with OVCF from October 2018 to April 2020 were selected. Patients in the control and study groups underwent percutaneous kyphoplasty (PKP) and bone filling mesh container vertebroplasty, respectively. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), visual analog scale (VAS) scores before and after surgery, and the incidence of complications were compared between the two groups. Results The operation time and fluoroscopy time of the study group were significantly lower than those of the control group (P < 0.05). There was no significant difference in the injection volume of bone cement between the study group and the control group (P > 0.05). There was no significant difference in Cobb angle between the two groups. Three months after the operation, the height of the anterior edge increased and the Cobb angle decreased in the two groups (P < 0.05), but there was no significant difference in the height of the anterior edge and the Cobb angle between the two groups (P > 0.05). The JOA scores increased, while the ODI and VAS scores decreased in both groups after surgery (P < 0.05). There was no significant difference in the total effective rate between the study group (96.15%) and the control group (92.31%) (P > 0.05). The incidence of complications in the study group (3.85%) was significantly lower than that in the control group (15.38%) (P < 0.05). Conclusions For the treatment of OVCFs, bone filling mesh container vertebroplasty is comparable to PKP in terms of functional recovery, but it can safely reduce operative time, fluoroscopy time, and complication rates.

Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis

To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis (DS). From June 2017 to September 2019, 120 patients with degenerative scoliosis were randomly divided into treatment group (60 cases) and control group(60 cases). The patients in treatment group were treated with chiropractic manipulation once every other day for 4 weeks. The patients in control group were treated with eperisone hydrochloride tablets combined with thoracolumbar orthopedic(TSLO)brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day. The course of treatment was 4 weeks. After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. The adverse reactions during the treatment were recorded. There were significant differences in VAS and ODI between two groups at each time point after treatment (P<0.001), VAS and ODI at 2 weeks after treatment (PVAS=0.025, PODI=0.032) and 3 weeks after treatment(PVAS=0.040, PODI=0.044) in treatment group were significantly different from those in control group, but there was no significant difference in VAS and ODI at other time points between treatment group and control group (P>0.05). There was significant difference in Cobb angle between treatment group(P=0.010) and control group(P=0.017) after treatment, but there was no significant difference in LL and SVA between treatment group and control group. There was no significant difference in Cobb angle, LL and SVA between two groups before and after treatment. During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group. Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

One-Stage Posterior Vertebral Column Resection in the Treatment of Adolescent Thoracic and Lumbar Tuberculosis Complicated With Severe Kyphotic Deformity

Our study aims to investigate the clinical outcome of 1-stage posterior vertebral column resection (PVCR) for adolescent thoracic and lumbar tuberculosis with severe kyphotic deformity (Cobb angle≥60°). Between January 2008 and January 2016, we recorded 16 (9 male, 7 female) adolescent cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity treated by 1-stage PVCR (average age: 15.38 ± 1.54 years; range: 13-18 years). The Cobb angle of kyphosis was 64.56° ± 3.41°. According to the American Spinal Injury Association (ASIA) classification, all patients were classified preoperatively. The lesions involved T4-T11 in 10 cases and T12-L2 in 6 cases. The mean follow-up time was 19.06 ± 11.42 months (range: 12-48 months). Based on ASIA classification, postoperative grades were significantly increased compared with preoperative grades (P < 0.05), The mean Cobb angle was significantly corrected to 20.25° ± 13.83° at 1 week after surgery, when compared with preoperative Cobb angle (P < 0.05). There was no significant difference in Cobb angle between 1-week after operation and the last follow-up (20.69° ± 13.83°) (P > 0.05). All the patients achieved bony fusion at a mean time of 14 months (range: 10-20 months) postoperatively. No fixation loosening, displacement, or fracture was observed during follow-up. One-stage PVCR is an effective surgical method for the treatment of adolescent thoracic and lumbar spinal tuberculosis with severe kyphotic deformity, which can completely remove the lesion, effectively correct the kyphosis deformity, and prevent related complications.

A retrospective comparative study of clinical efficacy of percutaneous short segment pedicle screw fixation with or without screwing of the fractured vertebra with O-arm navigation

ObjectiveTo retrospectively analyze the short and long-term efficacies of O-arm-navigated percutaneous short segment pedicle screw fixation, with or without screwing of the fractured vertebra.MethodsA total of 42 patients who underwent O-arm-navigated percutaneous short segment pedicle screw fixation for the treatment of thoracolumbar fractures from February 2015 to December 2018 were selected for analysis. The patients were divided into two groups according to the surgical intervention they received: Group A received percutaneous short segment pedicle screw fixation with screwing of the fractured vertebra and Group B received percutaneous short segment pedicle screw fixation without screwing of the fractured vertebra. Radiographic analysis included Cobb angles and percentage of anterior vertebral height (AVH%). Clinical functional outcomes were assessed using the visual analog scale (VAS) for back pain and the oswestry disability index (ODI) scores.ResultsNo significant differences were observed in the operation time and intraoperative blood loss between the two groups (P > 0.05). The length of incision was statistically significantly different between the two groups (P < 0.05). There was no significant difference in Cobb angle and AVH% between the two groups before and after the surgery (P > 0.05). However, the Cobb angle and AVH% were both significantly larger in Group A than Group B at the final follow-up (P < 0.05). In terms of clinical outcomes, there were no statistically significant differences in VAS and ODI scores between the two groups (P > 0.05).ConclusionIn the short term, both minimally invasive treatments were safe and effective in treating thoracolumbar fracture. Although there was significant difference between the two groups in Cobb angle and vertebral body height at the last follow-up, the difference was small. Therefore, these specific parameters will be an important outcome measure in further investigations.

Intervertebral disc injury is the mainspring for the postoperative increase in Cobb Angle after thoracolumbar burst fracture.

A single-institution retrospective study of a cohort of patients who underwent internal fixation spine surgery for thoracolumbar burst fracture (TLBF). To observe the imaging manifestations of intervertebral disc changes in TLBF, to analyze the relationship between the degree of disc injury and the Cobb angle increase. We retrospectively analyzed the data of patients who underwent short-segment pedicle screw instrumentation in the spinal surgery department of a single hospital between January 2014 and December 2017 (n = 90). According to the magnetic resonance imaging characteristics of the superior intervertebral disc tissue of the injured vertebrae before the operation, the intervertebral disc injury was divided into three types, which was used for group allocation: group A, uninjured intervertebral disc group; group B, mild intervertebral disc injury group; and group C, severe intervertebral disc injury group. The main imaging results of the three groups Cobb, IVA, IHI, AHIV, and VAS were compared among groups. Ninety patients were included in the study (n = 38, 32, and 20, in groups A, B, and C, respectively). There was no statistically significant difference in demographics among the three groups (p > .05). 1-year post-surgery, the Cobb angle in group C differed significantly from that in groups A and B (p < .01). There was a significant difference in Cobb angle between groups A and B after internal fixation was removed for 6 months. At 1-year post-surgery, the IHI group C differed significantly from groups A and B (p < .01), while groups A and B were similar (p = .102); however, at 6 months after the internal fixation was removed, the IHI differed significantly between these two groups, also the AHIV between groups A and B was statistically significant (p < .01). The VAS pain score was similar among the three groups. Pearson's test showed that the increase in the Cobb angle was moderately correlated with IVA and IHI, and weakly correlated with AHIV. For TLBF with an intervertebral disc injury, the presurgical degree of intervertebral disc injury is the main reason for the post-surgery increase in the Cobb angle. Thus, diagnosis and treatment of this kind of patient require attention to the risk of spinal deformity.

The smartphone scoliosis screening software for measuring the Cobb angle of adolescent idiopathic scoliosis: a reliability study

ObjectiveTo investigate the accuracy and repeatability of the software that we developed in measuring the adolescent idiopathic scoliosis (AIS) Cobb angle. MethodsFifty patients with AIS were included in the study. Three independent surveyors measured the Cobb angle of coronal main curve, thoracic kyphosis angle (TK), thoracolumbar kyphosis angle (TLK) and lumbar kyphosis angle (LL) by using protractor, scoliosis screening software and picture archiving and communication system (PACS). The measurement was repeated after an interval of 2 weeks. The measurement time of software method and protractor method were compared by Paired t-test. Taking the Cobb angle measurement results of the PACS as the reference standard. The repeatability of the surveyor and the consistency between the surveyors are compared by the intraclass correlation coefficient (ICC). ResultsAmong the 50 patients, there were 18 males and 32 females, aged from 10 to 18 years (mean age of 14.4 years). The time of measuring Cobb angle by software method was significantly shorter than that by protractor method (94.7 ​± ​8.5s versus 217.9 ​± ​24.1s, t ​= ​−60.536, P ​< ​0.05). There was no significant difference in Cobb angle measured by software method and PACS method (all P ​> ​0.05). The reliability analysis showed that the three surveyors used software to measure the Cobb angle of the coronal main curve, TK, TLK and LL were all in good consistency (ICC>0.90). The repeatability and consistency of the software method used by the three surveyors were higher than that of the protractor method (ICC> 0.90). ConclusionsCompared with traditional protractor, the smartphone scoliosis screening software has shorter time, higher efficiency, higher accuracy and repeatability in measuring Cobb angle of AIS, so as to widely screen the diagnosis of scoliosis patients.

Comparison of corrective and clinical effects between SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

To compare the corrective and clinical effects between Scoliosis Research Society (SRS)-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis. Twenty-four cases of old thoracolumbar osteoporotic fractures with kyphosis treated by grade IV osteotomy in Sichuan Provincial Orthopedic Hospital from January 2018 to December 2019 were reviewed. Eleven cases were treated with grade IV osteotomy combined with the interbody fusion cage (group A), and 13 cases were treated with grade IV osteotomy alone (group B). Operation time, blood loss, and perioperative conditions of the 2 groups were recorded. After operation and the last follow up, the kyphosis angle (Cobb angle) and sagittal vertical axis (SVA) were measured by whole-spine splicing X-ray; clinical effect was analyzed by visual analog score (VAS) and Oswestry disability index (ODI). All operations were successful. Operation time was 239.5±29.0 min in group A and 179.2±22.7 min in group B (P<0.05). Intraoperative blood loss in group A was 1,560.9±378.6 mL and 1,242.3±339.0 mL in group B (P<0.05). Cerebrospinal fluid leakage occurred in 3 cases in group A and 1 case in group B (P<0.05). There were 3 cases of transient neurological symptoms in group A and 1 case in group B (P<0.05). There was no significant difference in Cobb angle and SVA between the 2 groups (P>0.05). There was no significant difference in ODI and VAS between the 2 groups (P>0.05). There were no complications, such as spinal cord injury, internal fixation loosening and fracture, or orthopedic loss. SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy can achieve good short-term orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. Corrective and clinical effects of the two groups are equivalent, but the operation time of grade IV osteotomy combined with the interbody fusion cage is longer, the amount of intraoperative blood is greater, and the incidence of complications is higher.

Application of open-door laminoplasty with ARCH plate fixation in cervical intraspinal tumors

BackgroundThe open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors.MethodsThis was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test.ResultsA total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P < 0.01). The JOA score was improved from 9.9 ± 1.5 to 15.5 ± 0.6 (t = − 18.36, P < 0.01), and the mean JOA recovery rate was 79% ± 11% at 24 months after the operation. There was no significant difference in Cobb angle between pre-operation and 24 months after the operation, which was 9.8 ± 2.6 and 10.3 ± 3.1 respectively (t = − 0.61, P > 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up.ConclusionsOpen-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors.

An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity.

To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique. This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position. The study cohort underwent intraoperative, laterally placed correction using a distractor placed between two upper ribs and the ipsilateral greater trochanter while the control cohort did not. The 24 study patients were compared to 22 control patients. Preoperative comparisons identified significant differences in Cobb angle, preoperative flexibility, and pelvic obliquity with the study group having larger, stiffer deformities with greater obliquity. There were no differences in pre-operative sagittal plane deformity. Mean post-operative upright Cobb angle correction was 67.3° ± 14.8° in the study and 55.3° ± 9.9° in the control group, representing a 66% and 60% correction, respectively. No neurological or other complications were noted from the use of this technique. The use of a laterally placed distraction device from upper ribs to ipsilateral greater trochanter allowed gradual lateral un-bending of large stiff neuromuscular spine deformities with greater correction than that of standard technique. In this small series, the technique allowed load-sharing during correction, with hips remaining in a functional sitting position, and without neurological complications. Level III-retrospective cohort study.

Assessment of Clinical and Radiological Parameters in Spinal Tuberculosis: Comparison between Human Immunodeficiency Virus-Positive and Human Immunodeficiency Virus-Negative Patients.

Study DesignProspective comparative study.Purppse: A prospective comparative analysis of 30 patients with spinal tuberculosis (15 human immunodeficiency viruses [HIV] positive and 15 HIV negative). We compared the clinical and radiological parameters of the two groups.Overview of LiteratureWith the increasing incidence of HIV and tuberculosis co-infection, spinal tuberculosis is increasing globally, especially in developing countries. The diagnosis of spinal tuberculosis presents a challenge due to nonspecific constitutional symptoms and late presentation.MethodsA prospective study was conducted of 30 patients with spinal tuberculosis (15 HIV positive and 15 HIV negative) from August 2014–July 2016 for assessment of clinical and radiological parameters. Neurological assessment was done by classification of tuberculous paraplegia, and the amount of kyphosis was assessed by Cobb angle on a plain radiograph. Abscess size in anterior epidural space, the number of vertebral bodies involved and collapsed, and skip lesions were noted on magnetic resonance imaging. ResultsIn the prospective analysis of 30 patients, HIV positive (n=15) and HIV negative (n=15), there was no significant difference in neurological grading between the two groups. The amount of vertebral body destruction and degree of kyphosis was significantly greater in HIV-negative patients as compared with HIV-positive patients. There was a significant difference in Cobb angle between the two groups. The amount of anterior epidural space abscess formation was greater in HIV-positive patients as compared with HIVnegative patients.ConclusionsHIV-negative patients had greater vertebral body destruction and resultant kyphosis as compared with HIV-positive patients, who had greater anterior epidural abscess formation.

Surgery treatment of neurofibromatosis associated severe cervical kyphotic deformity: mid- and long-term follow-up and efficacy analysis

Objective: To investigate the surgical strategy and mid-and long-term outcomes of neurofibromatosis associated cervical kyphotic deformity. Methods: Thirteen patients with neurofibromatosis associated cervical kyphotic deformity operated in Shanghai Changzheng Hospital from January 1998 to December 2015 were analyzed retrospectively. There were 7 males and 6 females in this group, aged from 12 to 61 years, with an average age of (28±15) years. Eight patients were treated with anterior surgery (Group A) and 5 patients were treated with combined anterior and posterior surgery (Group A+P). Cobb angle correction of cervical kyphosis and improvement of clinical symptoms were followed up. Clinical efficacy between the two groups was compared and analyzed. Chi-square test, Fisher exact test and independent sample t test were used for comparative analysis between the two groups. Results: All patients were operated successfully and finished follow up. The follow-up period was from 42 to 128 months ((80±22) months). After the surgery, neurological symptoms and pain were significantly improved in all patients. Compared with preoperative values, Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score for pain at the last follow-up were significantly improved (t=7.63, -5.19, 8.63, -4.75, all P<0.01). Cervical kyphosis was significantly improved in all patients after surgery. In group A, the Cobb angle was improved from 64°±24° preoperatively to 12°±11° at the last follow-up, and the average correction rate of Cobb angle was 82.6%. In group A+P, the Cobb angle was improved from 55°±10° preoperatively to 7°±9° at the last follow-up, and the average correction rate of Cobb angle was 88.3%. The operation time, intraoperative blood loss and length of stay in group A were all significantly lower than those in group A+P (t=-6.32, -11.92, -6.52, all P<0.01). At the last follow-up, there was no significant difference in Cobb angle, JOA score and VAS score between the two groups (t=0.89, 0.94, 1.02, all P>0.05). Conclusions: Mid-and long-term results of anterior and combined anterior and posterior surgery for neurofibromatosis associated severe cervical kyphosis are satisfactory. Moderate correction strategy for cervical kyphosis is safe and effective. The incidence of complications of nerve injury can be reduced.

Application of operation bed and C-arm digital metrology adjustment in the percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures

To explore the application effect of operation bed and C-arm digital metrology adjustment in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures. Ninty-four patients with osteoporotic thoracolumbar vertebral fractures admitted to our hospital from February 2015 to February 2017 were divided into control group and observation group according to random number table method, with 47 cases in each group. Control group adjusted C-arm and operating bed based on experience. For observation group surgical bed and C arm were measured and adjusted digitally and metrologically during percutaneous vertebroplasty. The operation time, times of fluoroscopy, hidden blood loss and bone cement volume were recorded in two groups. The clinical efficacy of two groups was observed by visual analogue score (VAS) and Oswestry Disability Index(ODI). Cobb angle and height of injured vertebrae before and after surgery were analyzed by imaging data. The operation time, times of fluoroscopy, and hidden blood loss were significantly lower in observation group than in control group (P<0.05), but there was no significant difference in bone cement volume between two groups (P>0.05); VAS and ODI of observation group were significantly lower than that of the control group(P<0.05); there was no significant difference in Cobb angle and height of injured vertebrae before and after operation between two groups. There were 3 cases of cement leakage, 1 case of urinary tract infection, 1 case of pulmonary infection, 2 cases of bedsore in observation group with complication rate was 14.89%(7/47); there were 8 cases of cement leakage, 2 cases of spinal nerve injury, 1 case of urinary tract infection, 3 cases of pulmonary infection, 2 cases of bedsore in control group with complication rate was 34.04% (16/47). The incidence of complications in observation group was significantly lower than that of control group (P<0.05). Operation bed and C-arm digital metrology adjustment can improve the surgical effect in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures and promote rapid recovery.

Can I Stop Bracing Now? Utilizing Hand X-rays as Standalone Criterion for Discontinuation of Bracing in Adolescent Idiopathic Scoliosis

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Chronic Illness, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Purpose The purpose of this study is to determine if Sanders maturation stage 7 can be utilized as a stand-alone criteria for discontinuation of a thoracolumbosacral orthosis (TLSO) in adolescent idiopathic scoliosis (AIS). Background TLSO, or “bracing,” is a common treatment modality offered to skeletally immature patients with AIS. Maturation markers such as Risser sign on pelvis x-ray, growth velocity, time from first menses and curve stability are common factors utilized to determine end of brace treatment. However, these methods can be fraught with variability. The Sanders classification is a simplified, reliable bone age classification system that correlates strongly with the behavior of idiopathic scoliosis. Methods Inclusion criteria consisted of brace treatment in AIS measuring between 25 and 40 degrees, main cobb curve remaining Results Seventy-five patients (71 female [94.7%]; mean age 12.72 years) met the criteria. Main Cobb angle at brace application was 28.60°±4.38°. Forty-two patients had at least a one-year minimum follow up post treatment. One year after discontinuing the brace, eight patients (19%) increased 5 or more degrees (5°, 6°, 7°, 8°) above their largest curve measurement during treatment. Mean progression one-year post brace discontinuation was 2.28°±1.23°. Final mean Cobb angle measured 32.07° for the group. Two patients in the group had a Cobb measurement above 40° at one year after treatment. No significant difference in Cobb angle was found between pre brace measurements and end of brace treatment, nor between the end of brace treatment and at final follow up. No patient in the group progressed to surgical intervention. Discussion Eight patients (19%) increased more than 4° one year after the end of brace treatment, but no patient progressed to a curve that necessitated surgical intervention. Sanders maturation stage 7 may be useful as a stand-alone criterion for termination of brace treatment in AIS.

Application of small incision approach in anterior surgery of thoracic and lumbar spinal tuberculosis

To investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis. A clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups ( P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard. The length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B ( P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference ( χ 2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up ( P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups ( Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation ( P<0.05); the VAS score in group A was significantly lower than that in group B ( t=-2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups ( t=-0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle ( P<0.05); but there was no significant difference between 1 day after operation and last follow-up ( P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation ( P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up ( P>0.05). At last follow-up, all patients cured, and no recurrence occurred. In the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.

Comparison of short-term effectiveness of structural and non-structural bone graft fusion in treatment of single segment thoracic tuberculosis

To compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis. The data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments ( P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A ( t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups. Compared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences ( P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] ( t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation ( P<0.05); the CRP of group B was significantly higher than that of group A ( t=-2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups ( P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups ( Z=-1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference ( χ 2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation ( t=-2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up ( t=-1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups ( t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A ( t=4.824, P=0.000). Non-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.

A strategy of combining posterior occipitocervical angle with occipital-C 2 angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion

To assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C 2 (O-C 2) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion. The clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C 2 angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C 2 angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C 2 angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C 2 angle, and lower cervical curvature (Cobb angle). All 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones ( t=15.870, P=0.000; t=6.587, P=0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C 2 angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones ( P<0.05); but no significant difference was found in POCA and O-C 2 angles between at 3 days after operation and at last follow-up ( P>0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation ( P>0.05). The strategy of combination POCA and O-C 2 angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.