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[PMID]:29384840
[Au] Autor:Jiang G; Zhang Y; Sun X
[Ad] Endereço:Department of Orthopedics, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang Province.
[Ti] Título:The relationship between the expression of TN and the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis.
[So] Source:Medicine (Baltimore);97(5):e9555, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study was conducted with the aim to investigate the relationship between Tetranectin (TN) and efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis. METHODS: Ninety-two patients with traumatic kyphosis admitted in our hospital from February 2014 to June 2016 were included whose serum TN levels were examined by ELISA. Using the mean level of TN as cut-off value, patients were classified into TN high level group (group I) and TN low level group (group II). The observation indexes, including operation time, intra-operational loss of blood, Cobb angle, postoperative complications and recurrence rate of kyphosis within post-operational 6 months were recorded for comparison. RESULTS: TN level was significantly higher in group I [(6.19 ±â€Š0.33) µmol/L] than that in group II [(5.29 ±â€Š0.34) µmol/L] (P < .05). There was no significant difference in average age, sex, lesion site and average time from injury to operation between the two groups (all P > 0.05). Compared to group II, operation time in group I was significantly shortened (5.02 ±â€Š1.15 VS 4.58 ±â€Š0.53, P = .023), the intra-operational loss of blood decreased (2418.56 ±â€Š362.06 VS 2235.84 ±â€Š325.63, P = .013), post-operational Cobb angle decreased (11.10 ±â€Š1.31 VS 6.93 ±â€Š1.04, P = .000), and the incidence of postoperative complications (nail-breaking, rod-breaking and looseness) and recurrence rate decreased (18.8% VS 4.5%, P = .036; 10.4% VS 0.0%, P = .028). CONCLUSION: Serum TN level is proved to be related to the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis, and may serve as a possible indicator for clinical treatment.
[Mh] Termos MeSH primário: Cifose/sangue
Cifose/cirurgia
Lectinas Tipo C/sangue
Vértebras Lombares/cirurgia
Osteotomia
Vértebras Torácicas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Biomarcadores/sangue
Perda Sanguínea Cirúrgica
Ensaio de Imunoadsorção Enzimática
Feminino
Seguimentos
Seres Humanos
Incidência
Cifose/diagnóstico por imagem
Cifose/etiologia
Vértebras Lombares/diagnóstico por imagem
Vértebras Lombares/lesões
Masculino
Duração da Cirurgia
Complicações Pós-Operatórias/sangue
Complicações Pós-Operatórias/epidemiologia
Recidiva
Vértebras Torácicas/diagnóstico por imagem
Vértebras Torácicas/lesões
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Lectins, C-Type); 109489-77-2 (tetranectin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009555


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[PMID]:29381917
[Au] Autor:Zhou L; Fan J; Cheng L; Jiang T; Yun B; Tang G; Yin J; Fang J; Yin G
[Ad] Endereço:Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University.
[Ti] Título:Changes of cervical sagittal alignments during motions in patients with cervical kyphosis.
[So] Source:Medicine (Baltimore);96(47):e8410, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Changes of cervical sagittal alignment during motion in cervical kyphosis patients have never been published before. This study was to investigate the changes and provide a better reference for orthopedic treatment.Randomized double-blind repeat trial was carried out on 60 patients with cervical kyphosis. On standard position, hyper flexion, and hyper extension sagittal radiographs, the following measurements were made: the C2-7 vertebral body spatial alignment angle (∠A), C2-7 vertebral lower terminal lamina tilt angle (∠B), C2/3 to C6/7 segmental intervertebral space angle (∠C), the distance from the posterior edge of odontoid to C7 vertebral body (D value), and the difference of angle A, B, and C between cervical flexion and extension movement. Another 60 healthy volunteers were enrolled, of whom the cervical curve apex was determined using Borden's method to compare change and distribution characteristics to patients with cervical kyphosis and C value.In standard lateral position, ∠A was positive and increased from C2 to C7. In hyper extension position, ∠A decreased with reducing amplitude from C2 to C7 compared with the standard position, whereas in hyper flexion position, the average value of ∠A increased with decreasing amplitude from C2 to C7. ∠B followed similar change regularities as ∠A with a larger mean value. In cervical flexion and extension movement, ∠A change of upper vertebral body (∠D) was almost equal to ∠A change of lower vertebral body and ∠C change between the adjacent 2 vertebral bodies (∠E). The curve apex distribution was almost between C4 and C5 in cervical kyphosis patients. A significant difference was observed between cervical kyphosis patients and normal people in C value and D value.The correction of the cervical kyphosis can be carried out from the apex of the cervical spine that provides a solid theoretical foundation for the correction of the cervical kyphosis.
[Mh] Termos MeSH primário: Vértebras Cervicais
Cabeça/fisiologia
Cifose/fisiopatologia
Amplitude de Movimento Articular/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Fenômenos Biomecânicos
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Meia-Idade
Movimento (Física)
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008410


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[PMID]:29382020
[Au] Autor:Zhang C; Wang G; Liu X; Li Y; Sun J
[Ad] Endereço:Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University,Shandong Province.
[Ti] Título:Failed percutaneous kyphoplasty in treatment of stage 3 Kummell disease: A case report and literature review.
[So] Source:Medicine (Baltimore);96(47):e8895, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Albeit it is rare, the authors report a stage 3 Kummell disease case. It is diagnosed by dynamic thoracic magnetic resonance imaging (MRI). Because there is no established strategy on stage 3 Kummell disease, we performed percutaneous kyphoplasty at first, but unfortunately made a revision surgery to remove the polymethylmethacrylate (PMMA) cement after the failure of percutaneous kyphoplasty. PATIENT CONCERNS: A 73-year-old lady with severe back pain due to osteoporosis vertebral fracture was admitted to our hospital on June 23, 2016. She underwent percutaneous kyphoplasty with the back pain improved shortly. Unfortunately, she went back to our hospital due to aggravated back pain and partial paralysis on July 25, 2016. DIAGNOSES: Kummell disease, lumbar stenosis, lacunar infarction. OUTCOMES: Specially, the compression of spinal cord was obvious in the hyperflexion position on dynamic MRI. Even though there was no improvement in muscle strength, the patient was satisfied with the back pain relief after percutaneous kyphoplasty. But, the same back pain reappeared after about 1 month. Then, we took out the PMMA cement and performed posterior vertebral column resection. At last, the back pain was relieved again but the muscle strength was improved not obviously after operation. At the same time, the kyphosis was corrected and the intravertebral stability was achieved. LESSONS: Dynamic MRI is helpful in Kummell disease with neurologic symptoms, even if there is no obvious compression in the neutral position. Furthermore, the intravertebral instability is probably the main reason of the neurologic symptoms in this case. Percutaneous kyphoplasty could not reconstruct the intravertebral stability. Stage 3 Kummell disease with obvious intravertebral instability should be treated by open surgery.
[Mh] Termos MeSH primário: Cifoplastia/efeitos adversos
Cifose/cirurgia
Reoperação/métodos
Fraturas da Coluna Vertebral/complicações
[Mh] Termos MeSH secundário: Idoso
Cimentos para Ossos
Feminino
Seres Humanos
Cifoplastia/métodos
Cifose/etiologia
Fraturas por Osteoporose/complicações
Polimetil Metacrilato
Falha de Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Bone Cements); 9011-14-7 (Polymethyl Methacrylate)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008895


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[PMID]:29245270
[Au] Autor:Miyazaki M; Kanezaki S; Notani N; Ishihara T; Tsumura H
[Ad] Endereço:Department of Orthopaedic Surgery, Oita University, Oita, Japan.
[Ti] Título:Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia: A case report.
[So] Source:Medicine (Baltimore);96(49):e8983, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. PATIENT CONCERNS: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. DIAGNOSES: Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. INTERVENTIONS: We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. OUTCOMES: No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. LESSONS: Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia.
[Mh] Termos MeSH primário: Acondroplasia/complicações
Cifose/cirurgia
Fusão Vertebral/métodos
Estenose Espinal/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Cifose/diagnóstico por imagem
Vértebras Lombares/diagnóstico por imagem
Vértebras Lombares/cirurgia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Estenose Espinal/diagnóstico por imagem
Vértebras Torácicas/diagnóstico por imagem
Vértebras Torácicas/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171225
[Lr] Data última revisão:
171225
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008983


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[PMID]:29245239
[Au] Autor:Zhang Z; Liu Z; Zhu Z; Qiu Y
[Ad] Endereço:Department of Spine Surgery, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
[Ti] Título:Predictors of ultimate postoperative cervical sagittal alignment in main thoracic adolescent idiopathic scoliosis: A long-term follow-up study.
[So] Source:Medicine (Baltimore);96(49):e8799, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This is a retrospective study. The aim of this study was to access sagittal compensatory mechanism of the cervical spine in thoracic adolescent idiopathic scoliosis (T-AIS) before and after posterior spinal fusion and to identify preoperative or immediate postoperative radiographic parameters that can predict the ultimate cervical sagittal alignment (CSA) after long-term follow-up.A retrospective study was performed on 44 T-AIS patients treated with posterior spinal fusion and with at least 5 years of follow-up. Preoperative, immediate postoperative and latest follow-up radiographs were reviewed measuring cervical lordosis (CL), cervical sagittal vertical axis (CSVA), upper thoracic kyphosis (UTK), main thoracic kyphosis (MTK), global thoracic kyphosis (GTK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson correlation analysis, stepwise multilinear regression analysis, and receiver operator characteristic (ROC) curve were performed to define the relationship between ultimate CL and preoperative or immediate postoperative radiographic parameters.CL significantly improved from 6.6 ±â€Š8.8 degree kyphosis preoperatively to 3.8 ±â€Š8.7 degree kyphosis immediate postoperatively and to 0.5 ±â€Š7.3 degree lordosis at the latest follow-up. Pre- and postoperative CSVA showed no significant difference. Pearson correlation coefficient test showed that CL was only correlated to T1 slope and UTK before surgery, whereas it was correlated to T1 slope, UTK, and GTK after surgery. The following equation was developed to estimate the ultimate CL: ultimate CL = -2.792 + 0.510 × Preop CL + 0.531 × Postop T1 slope. Furthermore, ROC curve showed that preoperative CL ≥-4.5 degree was strongly predictive and postoperative T1 slope ≥11.3 degree was moderately predictive of lordotic cervical spine after long-term follow-up.For T-AIS patients, CL significantly increased after surgery with the restoration of the global and regional sagittal profile. The sagittal compensatory mechanism of the cervical spine before surgery is different from that after surgery. In these patients, preoperative CL and immediate postoperative T1 slope could be predictors of the ultimate CSA after long-term follow-up.
[Mh] Termos MeSH primário: Vértebras Cervicais/diagnóstico por imagem
Cifose/diagnóstico por imagem
Lordose/diagnóstico por imagem
Radiografia/métodos
Escoliose/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Vértebras Cervicais/cirurgia
Criança
Feminino
Seguimentos
Seres Humanos
Cifose/etiologia
Cifose/cirurgia
Lordose/etiologia
Lordose/cirurgia
Masculino
Pelve/diagnóstico por imagem
Período Pós-Operatório
Estudos Retrospectivos
Sacro/diagnóstico por imagem
Escoliose/complicações
Escoliose/diagnóstico por imagem
Fusão Vertebral/métodos
Vértebras Torácicas/diagnóstico por imagem
Vértebras Torácicas/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008799


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[PMID]:29245233
[Au] Autor:Li S; Li Z; Hua W; Wang K; Li S; Zhang Y; Ye Z; Shao Z; Wu X; Yang C
[Ad] Endereço:aDepartment of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologybDepartment of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Wuhan, China.
[Ti] Título:Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: Case report and literature review.
[So] Source:Medicine (Baltimore);96(49):e8770, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Thoracic-lumbar vertebral fracture is very common in clinic, and late post-traumatic kyphosis is the main cause closely related to the patients' life quality, which has evocated extensive concern for the surgical treatment of the disease. This study aimed to analyze the clinical outcomes and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation. PATIENT CONCERNS: All patients presented back pain with kyphotic apex vertebrae between T12 and L3. According to Frankel classification grading system, among them, 3 patients were classified as grade D, with the ability to live independently. DIAGNOSES: A systematic review of 12 case series of post-traumatic kyphosis after failed thoracolumbar fracture operation was involved. INTERVENTIONS: Wedge osteotomy was performed as indicated-posterior closing osteotomy correction in 5 patients and anterior open-posterior close correction in 7 patients.Postoperatively, thoracolumbar x-rays were obtained to evaluate the correction of kyphotic deformity, visual analog scales (VAS) and Frankel grading system were used for access the clinical outcomes. OUTCOMES: All the patients were followed up, with the average period of 38.5 months (range 24-56 months). The Kyphotic Cobb angle was improved from preoperative (28.65 ±â€Š11.41) to postoperative (1.14 ±â€Š2.79), with the correction rate of 96.02%. There was 1 case of intraoperative dural tear, without complications such as death, neurological injury, and wound infection. According to Frankel grading system, no patient suffered deteriorated neurological symptoms after surgery, and 2 patients (2/3) experienced significant relief after surgery. The main VAS score of back pain was improved from preoperative (4.41 ±â€Š1.08) to postoperative (1.5 ±â€Š0.91) at final follow-up, with an improvement rate of 65.89%. LESSONS: Surgical treatment of late post-traumatic kyphosis after failed thoracolumbar fracture operation can obtain good radiologic and clinical outcomes by kyphosis correction, decompression, and posterior stability.
[Mh] Termos MeSH primário: Fixação Interna de Fraturas/efeitos adversos
Cifose/cirurgia
Osteotomia/métodos
Complicações Pós-Operatórias
Reoperação/métodos
Fraturas da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Adulto
Dor nas Costas/etiologia
Dor nas Costas/cirurgia
Falha da Terapia de Resgate
Feminino
Fixação Interna de Fraturas/métodos
Seres Humanos
Cifose/etiologia
Vértebras Lombares/lesões
Vértebras Lombares/cirurgia
Masculino
Meia-Idade
Medição da Dor
Vértebras Torácicas/lesões
Vértebras Torácicas/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008770


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[PMID]:29069048
[Au] Autor:Kong L; Tian W; Cao P; Wang H; Zhang B; Shen Y
[Ad] Endereço:Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
[Ti] Título:Predictive factors associated with neck pain in patients with cervical disc degeneration: A cross-sectional study focusing on Modic changes.
[So] Source:Medicine (Baltimore);96(43):e8447, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The predictive factors associated with neck pain remain unclear. We conducted a cross-sectional study to assess predictive factors, especially Modic changes (MCs), associated with the intensity and duration of neck pain in patients with cervical disc degenerative disease.We retrospectively reviewed patients in our hospital from January 2013 to December 2016. Severe neck pain (SNP) and persistent neck pain (PNP) were the 2 main outcomes, and were assessed based on the numerical rating scale (NRS). Basic data, and also imaging data, were collected and analyzed as potential predictive factors. Univariate analysis and multiple logistic regression analysis were performed to assess the predictive factors for neck pain.In all, 381 patients (193 males and 188 females) with cervical degenerative disease were included in our study. The number of patients with SNP and PNP were 94 (24.67%) and 109 (28.61%), respectively. The NRS of neck pain in patients with type 1 MCs was significantly higher than type 2 MCs (4.8 ±â€Š0.9 vs 3.9 ±â€Š1.1; P = .004). The multivariate logistic analysis showed that kyphosis curvature (odds ratio [OR] 1.082, 95% confidence interval [CI] 1.044-1.112), spondylolisthesis (OR 1.339, 95% CI 1.226-1.462), and annular tear (OR 1.188, 95% CI 1.021-1.382) were factors associated with SNP, whereas kyphosis curvature (OR 1.568, 95% CI 1.022-2.394), spondylolisthesis (OR 1.486, 95% CI 1.082-2.041), and MCs (OR 1.152, 95% CI 1.074-1.234) were associated with PNP.We concluded that kyphosis curvature, spondylolisthesis, and annular tear are associated with SNP, whereas kyphosis curvature, spondylolisthesis, and MCs are associated with PNP. This study supports the view that MCs can lead to a long duration of neck pain.
[Mh] Termos MeSH primário: Vértebras Cervicais
Degeneração do Disco Intervertebral/complicações
Cervicalgia/etiologia
[Mh] Termos MeSH secundário: Adulto
Fenômenos Biomecânicos
Estudos Transversais
Feminino
Seres Humanos
Cifose/complicações
Modelos Logísticos
Lordose/complicações
Masculino
Meia-Idade
Análise Multivariada
Medição da Dor
Estudos Retrospectivos
Fatores de Risco
Doenças da Coluna Vertebral/complicações
Espondilolistese/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008447


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[PMID]:28963161
[Au] Autor:Wong YW; Samartzis D; Cheung KMC; Luk K
[Ad] Endereço:The University of Hong Kong, Room 516, 5th Floor, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
[Ti] Título:Tuberculosis of the spine with severe angular kyphosis: mean 34-year post-operative follow-up shows that prevention is better than salvage.
[So] Source:Bone Joint J;99-B(10):1381-1388, 2017 Oct.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: To address the natural history of severe post-tuberculous (TB) kyphosis, with focus upon the long-term neurological outcome, occurrence of restrictive lung disease, and the effect on life expectancy. PATIENTS AND METHODS: This is a retrospective clinical review of prospectively collected imaging data based at a single institute. A total of 24 patients of Southern Chinese origin who presented with spinal TB with a mean of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria were reviewed. Plain radiographs were used to assess the degree of spinal deformity. Myelography, CT and MRI were used when available to assess the integrity of the spinal cord and canal. Patient demographics, age of onset of spinal TB and interventions, types of surgical procedure, intra- and post-operative complications, and neurological status were assessed. RESULTS: All except one of the 24 patients were treated with anti-TB chemotherapy when they were first diagnosed with spinal TB. They subsequently received surgery either for neurological deterioration, or deformity correction in later life. The mean follow-up was 34 years (11 to 59) since these surgical interventions. Some 16 patients (66.7%) suffered from late neurological deterioration at a mean of 26 years (8 to 49) after the initial drug treatment. The causes of neurological deterioration were healed disease in nine patients (56.2%), re-activation in six patients (37.5%) and adjacent level spinal stenosis in one patient (6.3%). The result of surgery was worse in healed disease. Eight patients without neurological deterioration received surgery to correct the kyphosis. The mean correction ranged from 97° to 72°. Three patients who were clinically quiescent with no neurological deterioration were found to have active TB of the spine. Solid fusion was achieved in all cases and no patient suffered from neurological deterioration after 42 years of follow-up. On final follow-up, six patients were noted to have deceased (age range: 47 years to 75 years). CONCLUSION: Our study presents one of the longest assessments of spinal TB with severe kyphosis. Severe post-TB kyphosis may lead to significant health problems many years following the initial drug treatment. Early surgical correction of the kyphosis, solid fusion and regular surveillance may avoid late complications. Paraplegia, restrictive lung disease and early onset kyphosis might relate to early death. Clinically quiescent disease does not mean cure. Cite this article: 2017;99-B:1381-8.
[Mh] Termos MeSH primário: Previsões
Cifose/prevenção & controle
Vértebras Lombares
Osteotomia/métodos
Fusão Vertebral/métodos
Vértebras Torácicas
Tuberculose da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seguimentos
Seres Humanos
Cifose/diagnóstico
Cifose/etiologia
Masculino
Meia-Idade
Período Pós-Operatório
Radiografia
Estudos Retrospectivos
Resultado do Tratamento
Tuberculose da Coluna Vertebral/complicações
Tuberculose da Coluna Vertebral/diagnóstico
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171001
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B10.BJJ-2017-0148.R1


  9 / 5171 MEDLINE  
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[PMID]:28885330
[Au] Autor:Chang DG; Yang JH; Suk SI; Suh SW; Kim JH; Lee SJ; Na KH; Lee JH
[Ad] Endereço:aDepartment of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University bDepartment of Orthopedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University cDepartment of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, Catholic University of Korea dDepartment of Orthopedic Surgery, Kyung Hee Hospital, College of Medicine, Kyung Hee University, Seoul, Korea.
[Ti] Título:Fractional curve progression with maintenance of fusion mass in congenital scoliosis: An 18-year follow-up of a case report.
[So] Source:Medicine (Baltimore);96(36):e7746, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The management of congenital scoliosis concentrates on early diagnosis and proper surgical treatment before the development of severe deformities. Decision making regarding the appropriate fusion levels, proper surgical treatment, and reduction amount of kyphoscoliosis is very important but difficult in the treatment of congenital scoliosis, especially in young children. PATIENT CONCERNS: We report an 11-year follow-up of revision surgery for fractional curve progression after combined anterior and posterior fusion without hemivertebra resection using pedicle screw fixation (PSF) in congenital kyphoscoliosis at age 4 years (a total 18-year follow-up). A T12 hemivertebra was documented in a 4-year-old girl and was treated by combined anterior and posterior fusion in two stages with PSF. The fusion mass was maintained but the distal compensatory curve progressed during the follow-up period. The patient underwent a posterior vertebral column resection (PVCR) with extended posterior fusion at the age of 11, 7 years after initial surgery. OUTCOMES: Eleven years after the revision surgery with PVCR, the patient showed satisfactory results and her spine was well balanced. LESSONS: The cause of revision surgery for the curve progression may include inappropriate fusion level, incomplete hemivertebra resection, or failure of anterior and posterior fusion. Especially, inappropriate fusion level may result in deterioration of the compensatory curve even without progression of the fusion mass. CONCLUSION: Appropriate selection of fusion levels, complete resection of hemivertebra, and satisfactory reduction of scoliosis and kyphosis are important factors for deformity correction and prevention of progression of both main and compensatory curves (adding-on of structural curve or progression of compensatory curve) as well as reducing the influence of adjacent vertebral growth using as short a fusion as possible.
[Mh] Termos MeSH primário: Cifose/cirurgia
Vértebras Lombares
Reoperação/métodos
Escoliose/cirurgia
Fusão Vertebral/métodos
Vértebras Torácicas
[Mh] Termos MeSH secundário: Adolescente
Progressão da Doença
Feminino
Seres Humanos
Parafusos Pediculares
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007746


  10 / 5171 MEDLINE  
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[PMID]:28885125
[Au] Autor:Nori S; Iwanami A; Yasuda A; Nagoshi N; Fujita N; Hikata T; Yagi M; Tsuji T; Watanabe K; Momoshima S; Matsumoto M; Nakamura M; Ishii K
[Ad] Endereço:Departments of 1 Orthopedic Surgery and.
[Ti] Título:Risk factor analysis of kyphotic malalignment after cervical intramedullary tumor resection in adults.
[So] Source:J Neurosurg Spine;27(5):518-527, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE A number of studies have reported that surgery for cervical intramedullary tumors via the posterior approach can result in postoperative sagittal malalignment of the cervical spine; however, the risk factors remain unclear. The purpose of this study was to investigate the changes in cervical spinal alignment after surgery for cervical intramedullary tumors in adults and to elucidate the risk factors for cervical spinal sagittal misalignment. METHODS Data for the period from April 2001 to December 2011 for all adults who had undergone surgery for cervical intramedullary spinal cord tumors at a single institution were retrospectively analyzed to determine the postoperative changes in cervical spine alignment. Patients younger than 20 years of age and those who required postoperative radiotherapy were excluded from the study. Patients were divided into 2 groups according to tumor location: upper tumor (U) group, in which the central region of the tumor was above the C-5 level; and lower tumor (L) group, in which the central region of the tumor was at or below the C-5 level. Changes in alignment of the cervical spine were measured on plain lateral radiographs. Data on atrophy of the deep extensor muscles (DEMs), tumor location, detachment of the DEMs from the C-2 spinous process, the C2-7 angle before surgery, patient age at surgery, tumor histology, patient sex, tumor size, and number of laminae affected were reviewed for each patient, and the correlation of each of these factors with cervical spinal malalignment was evaluated using statistical analysis. RESULTS The 54 adults eligible for analysis had a mean age of 49.1 years. Ependymoma was the most common cervical intramedullary tumor (63.0%) in this series. In the tumor location U group, the kyphotic angle of the C2-7 spinal segments increased after surgery (-5.8° ± 2.8°). In contrast, in the L group, the C2-7 lordotic angle increased after surgery (6.4° ± 2.6°). In the univariate analysis, atrophy of the DEMs, detachment of the DEMs from the C-2 spinous process, and an upper cervical location of the tumor were identified as factors significantly correlated with the development of cervical spinal kyphosis after surgery. Multiple linear regression analysis revealed the following as risk factors for kyphotic change of the cervical spine after surgery: 1) atrophy of the DEMs after surgery (ß = -0.54, p < 0.01), and 2) detachment of the DEMs from the C-2 spinous process (ß = -0.37, p < 0.01). CONCLUSIONS Atrophy of the DEMs after surgery and detachment of the DEMs from the C-2 spinous process are directly related to the risk of cervical spinal kyphosis after surgery for cervical intramedullary tumors in adults. Therefore, preservation of the DEMs, especially those attached to the C-2 spinous process, is important for the prevention of kyphotic malalignment of the cervical spine after surgery for intramedullary tumors.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Cifose/etiologia
Complicações Pós-Operatórias
Neoplasias da Medula Espinal/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Vértebras Cervicais/diagnóstico por imagem
Ependimoma/diagnóstico por imagem
Ependimoma/cirurgia
Feminino
Seres Humanos
Cifose/diagnóstico
Cifose/epidemiologia
Modelos Lineares
Lordose/diagnóstico
Lordose/epidemiologia
Lordose/etiologia
Masculino
Meia-Idade
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/epidemiologia
Estudos Retrospectivos
Fatores de Risco
Neoplasias da Medula Espinal/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.3171/2017.4.SPINE16956



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