49 results on '"Jianxiong Shen"'
Search Results
2. Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis
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Yang Jiao, Haining Tan, Erwei Feng, Zhen Wang, Youxi Lin, Junduo Zhao, and Jianxiong Shen
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Adult ,Young Adult ,Spinal Fusion ,Treatment Outcome ,Rheumatology ,Scoliosis ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Thoracic Vertebrae ,Retrospective Studies - Abstract
Background The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis. Methods A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility Results A total of 41 patients were included, with an average age of 20 years (range, 12–49 years) and follow-up of 34 months (range, 24–58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure. Conclusion The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.
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- 2022
3. Neurofibromatosis Type 1 with Severe Dystrophic Kyphosis: Surgical Treatment and Prognostic Analysis of 27 Patients
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Yu Zhao, Guixing Qiu, Ye Tian, Jianguo Zhang, Jianxiong Shen, Siyi Cai, and Hong Zhao
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Adult ,Male ,medicine.medical_specialty ,Dystrophic curves ,Neurofibromatosis 1 ,Adolescent ,medicine.medical_treatment ,Kyphosis ,Scoliosis ,Spine deformity ,Surgical planning ,Thoracic Vertebrae ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Discectomy ,medicine ,Humans ,Orthopedics and Sports Medicine ,Lumbar kyphosis ,Neurofibromatosis ,Surgical treatment ,Child ,030222 orthopedics ,Clinical Article ,Lumbar Vertebrae ,business.industry ,Articular surface ,medicine.disease ,Prognosis ,Surgery ,Osteotomy ,Spinal Fusion ,Clinical Articles ,Female ,business ,030217 neurology & neurosurgery ,Neurofibromatosis type 1 - Abstract
Objective The aim of the present study was to explore the surgical treatment and prognosis of 27 cases of neurofibromatosis type 1 with severe dystrophic kyphosis. Methods We performed surgical treatment for scoliosis and kyphosis caused by dystrophic curves at Peking Union Medical College Hospital, Beijing, China from December 2015 to December 2017. The study included 21 patients with moderate to severe kyphosis, 12 males and 9 females, with an average age of 14.95 ± 6.05 years. All patients had kyphosis angles greater than 70° and had more than four skeletal developmental defects. A total of 6 patients with severe kyphosis, 2 males and 4 females, with an average age of 12.5 years, had more than five skeletal developmental defects with a kyphosis angle greater than 90° or a lumbar kyphosis angle greater than 40°. According to the patient's own situation, we adopted a low‐grade surgery scheme (grades 1 or 2) or a high‐grade surgery scheme (grades 3–6). The low‐grade surgery was mainly lower articular surface resection or pontodestomy, and the high‐grade surgery was mainly apical vertebral body or upper discectomy. All patients were followed up to determine their prognosis. Results Statistical analysis showed that there was a significant difference in preoperative and postoperative scores between the two groups (P 0.05). Conclusion Early identification of dysplastic scoliosis‐related deformities plays an important role in surgical planning and prognosis, and low‐level surgical procedures are more favorable for patients' prognosis., Surgical treatment had a significant effect on scoliosis kyphosis. Approximately 50% of complications after internal fixation were related to high‐level surgery. Gender, age, extent of resection, height, and body mass index had no significant effect on preoperative, postoperative, and prognostic indicators of patients.
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- 2020
4. Surgical treatment of spinal deformities in spinal muscular atrophy: a single-center experience from China
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Zhen Wang, Erwei Feng, Yang Jiao, Jiachen Lin, Junduo Zhao, Weiyun Chen, and Jianxiong Shen
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Muscular Atrophy, Spinal ,Sacrum ,China ,Treatment Outcome ,Spinal Fusion ,Adolescent ,Scoliosis ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Retrospective Studies ,Follow-Up Studies - Abstract
To report the clinical characteristics and surgical outcomes of scoliosis in patients with spinal muscular atrophy (SMA) from Mainland China.Nineteen patients were retrospectively analyzed. Demographic, anthropometric and respiratory parameters were collected preoperatively. Surgical program was analyzed. Radiographic data were measured perioperatively. Motor status, ventilation support, sitting ability and respiratory symptoms were evaluated preoperatively and at final follow-up.Age at surgery was 17.08 (12.83, 20.08) years. More than 40% of patients were diagnosed with low weight. Pulmonary dysfunction was observed in all patients. All patients received posterior spinal fusion (PSF). Sacroiliac fixation with sacral-2 alar iliac technique was used in 16 patients. Major curve correction rate was 54.87 ± 16.14%. Pelvic obliquity correction rate was 63.84 ± 23.70%. T1-T12 height, space-available-for-lung ratio and thoracic transverse diameter were increased (p 0.001). Percentage of patients capable of sitting independently increased from 26.32% preoperatively to 73.68% at final follow-up. Cumulative scores of sitting-related items in muscular dystrophy spine questionnaire improved from 19.11 ± 5.40 preoperatively to 26.21 ± 5.20 at final follow-up. Total scores of symptomatic domains in St. George's Respiratory Questionnaire decreased from 4 (2, 12) preoperatively to 1 (0, 3) at final follow-up.SMA patients in China always present severe scoliosis at late adolescence, accompanied with high proportion of low weight and pulmonary dysfunction. PSF is effective for the correction of scoliosis and pelvic obliquity and the improvement of thoracic morphology. Sitting ability and respiratory symptoms were improved postoperatively.
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- 2022
5. Risk factors of postoperative pulmonary complications after primary posterior fusion and hemivertebra resection in congenital scoliosis patients younger than 10 years old: a retrospective study
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Lulu Ma, Xuerong Yu, Jianguo Zhang, Jianxiong Shen, Yu Zhao, Shugang Li, and Yuguang Huang
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Male ,Research ,Congenital scoliosis ,Diseases of the musculoskeletal system ,Osteotomy ,Postoperative Complications ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,RC925-935 ,Rheumatology ,Risk Factors ,Child, Preschool ,Humans ,Female ,Orthopedics and Sports Medicine ,Thoracoplasty ,Child ,Postoperative pulmonary complication ,Retrospective Studies - Abstract
Background Postoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown. Methods A retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications. Results A total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications. Conclusions For congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.
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- 2022
6. Older fusion-surgery age in congenital scoliosis patients is a risk factor for extended length of stay, more estimated blood loss, longer fused segments and higher medical costs: a retrospective study
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Xiaolin Xu, Zhe Su, Xiaohan Ye, Guanfeng Lin, Yang Yang, Xiran Chai, Jianguo Zhang, Jianxiong Shen, Shengru Wang, and You Du
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Male ,medicine.medical_specialty ,Sports medicine ,medicine.medical_treatment ,Diseases of the musculoskeletal system ,Rheumatology ,Estimated blood loss ,Risk Factors ,Internal medicine ,Epidemiology ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Risk factor ,Aged ,Retrospective Studies ,Rehabilitation ,business.industry ,Genitourinary system ,Research ,Congenital scoliosis ,Retrospective cohort study ,Length of Stay ,Risk factor for fusion surgery ,Medical costs ,Spinal Fusion ,Treatment Outcome ,RC925-935 ,Scoliosis ,Orthopedic surgery ,business - Abstract
Background Contradictory opinions about whether early correction and fusion surgeries should be performed for congenital scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs. Methods We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs. Results Age at fusion (OR = 1.053; p p = 0.004) and thoracic deformity (OR = 1.519; p = 0.03) were risk factors for extended LOS. Age at fusion (OR = 1.117; p p p = 0.027) and failure of formation (OR = 1.718; p = 0.021) were risk factors for more EBL. Age at fusion (OR = 1.213; p p p = 0.004) were risk factors for higher medical costs. Conclusions We found that older age at fusion in CS patients is a risk factor for extended LOS, more EBL, longer fused segments and higher medical costs with the risk increasing by 5–21 % for each year of age. Other identified risk factors include thoracic deformity for extended LOS; longer fused segments, higher medical costs, and musculoskeletal defects for extended LOS; and CS type (FF and MD) and sex (male) for more EBL.
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- 2021
7. Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis
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Jianxiong Shen, Sen Liu, Nan Wu, Lianlei Wang, Ziquan Li, Chenxi Yu, Hong Zhao, Zhen Zhang, Shengru Wang, Sen Zhao, Keyi Yu, Yang Yang, Yuanqiang Zhang, You Du, Jiashen Shao, Lian Liu, Guixing Qiu, Terry Jianguo Zhang, Yu Zhao, Zhengye Zhao, and Zhihong Wu
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medicine.medical_specialty ,Adult non-degenerative scoliosis ,Diseases of the musculoskeletal system ,Scoliosis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Young adult ,Risk factor ,Retrospective Studies ,030222 orthopedics ,Univariate analysis ,Lumbar Vertebrae ,Cobb angle ,Perioperative complications ,business.industry ,Research ,Long-segment posterior instrumentation and fusion ,Perioperative ,medicine.disease ,Surgery ,Radiography ,Spinal Fusion ,Treatment Outcome ,RC925-935 ,Risk factors ,Orthopedic surgery ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Introduction Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied. Methods We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis. Results One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003). Conclusions Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.
- Published
- 2021
8. Modified PUMC classification for adolescent idiopathic scoliosis
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Hong Zhao, Yipeng Wang, Xi Zhou, Bin Yu, Jinqian Liang, Qianyu Zhuang, Yu Zhao, Qi-yi Li, Chang Xiao, Jianguo Zhang, Jianxiong Shen, Shugang Li, Siyi Cai, Guixing Qiu, and Shengru Wang
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Male ,medicine.medical_specialty ,Adolescent ,Interobserver reliability ,Radiography ,Idiopathic scoliosis ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Retrospective analysis ,Humans ,Orthopedics and Sports Medicine ,Prospective cohort study ,030222 orthopedics ,business.industry ,Intraobserver reliability ,Outcome measures ,Spinal Fusion ,Scoliosis ,Practice Guidelines as Topic ,Female ,Surgery ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Kappa - Abstract
BACKGROUND The original Peking Union Medical College (PUMC) classification of adolescent idiopathic scoliosis (AIS) is one system to combine each type with corresponding surgical fusion guidance, presenting comparable interobserver reliability, and reproducibility with Lenke classification. However, during its application in previous over 10 years, we found 2 main problems of this classification, which required modification. PURPOSE (1) To evaluate the interobserver and intraobserver reliability, (2) to assess the effects of the added fusion criteria of proximal thoracic (PT) curve on improving postoperative shoulder balance of the modified PUMC classification of AIS. STUDY DESIGN/SETTING Retrospective analysis of our AIS cohort and prospective validation of its effectiveness. PATIENT SAMPLE Fifty sets of preoperative radiographs of AIS patients were randomly chosen from our AIS database. Furthermore, 46 consecutive AIS cases with PT curve were enrolled who underwent surgeries in our center from July 2007 to July 2013, with at least 2-year follow-up. OUTCOME MEASURES The classification results of 50 sets of preoperative radiographs by 5 surgeons. The shoulder balance was evaluated using radiographic shoulder height. METHODS Five surgeons independently evaluated and classified presurgical radiographs of 50 AIS patients based on the modified PUMC classification. Inter- and intraobserver reliabilities were calculated. Furthermore, the post-op shoulder balance was investigated in 46 consecutive cases of AIS with PT curve who were treated strictly based on the modified PUMC classification. RESULTS The Kappa coefficients of inter- and intraobserver reliability of the overall modified PUMC classification are 0.889 and 0.865, respectively. The Kappa coefficients of inter- and intraobserver reliability for the type II are 0.791 and 0.746, respectively. In addition, the shoulder balance rate of the 46 AIS patients with PT curve at the final follow-up was 95.7%. CONCLUSIONS Modified PUMC classification presents incremental improvement compared to our original published version, with high interobserver and intraobserver reliability and better performance of postoperative shoulder balance. Furthermore, the modified PUMC classification provides corresponding surgical fusion guidance for each subtype. Multicenter prospective studies with larger samples are still needed to further improve this system.
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- 2019
9. Vertebral Growth Around Distal Instrumented Vertebra in Patients With Early-Onset Scoliosis Who Underwent Traditional Dual Growing Rod Treatment
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Chong Chen, Jianxiong Shen, Haining Tan, Jianguo Zhang, Shugang Li, Tianhua Rong, Youxi Lin, Zheng Li, Yahan Wang, and Kenny Kwan
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Male ,Scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Prospective Studies ,Age of Onset ,Child ,Retrospective Studies ,030222 orthopedics ,Bone Development ,Lumbar Vertebrae ,business.industry ,Longitudinal growth ,medicine.disease ,Vertebra ,Vertebral body ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Child, Preschool ,Vertebral height ,Female ,Neurology (clinical) ,Growing rod ,Early onset scoliosis ,business ,Nuclear medicine ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Study design Retrospective radiographic study. Objective To investigate the growth of the vertebrae around distal instrumented vertebra (DIV) in patients with early-onset scoliosis (EOS) who underwent dual growing rod (DGR) treatment. Summary of background data Previous studies indicated that DGR was likely to preserve or even stimulate the spinal growth. However, report pertaining to the effect of growing rod on the growth of individual vertebral body is rare. Methods The EOS patients treated with DGR who had at least four lengthenings and 5-year follow-up were enrolled. Spine radiographs at index surgery and final follow-up were reviewed. The height, width, and depth of vertebral body from DIV-2 to DIV+2, and the height of the adjacent intervertebral space (IVS) were measured. The percentage of growth was calculated. Results Thirty-one patients (mean age, 6.2 ± 2.5 years old) met the inclusion criteria, 74.2% (23/31) of whom were female. The average follow-up was 6.2 years (range, 5.0-10.4 yr). The measured vertebrae were divided into DIV group (n = 65), DIV- group (DIV-1 and DIV-2, n = 60), and DIV+ group (DIV+1 and DIV+2, n = 47). There were 33, 90, and 78 measured IVSs in DIV, DIV-, and DIV+ group, respectively. The total percentage growth of vertebral height was significantly higher in DIV- group than that in DIV and DIV+ groups (56.6 ± 20.3% vs. 45.6 ± 18.0% and 42.7 ± 16.2%, respectively, P ≤ 0.001). The vertebrae in DIV- group also had the highest annual height growth rate (8.7 ± 2.6% vs. 7.0 ± 2.4% and 6.6 ± 2.0%, respectively, P ≤ 0.001). A significant decrease of IVS height was observed in DIV- and DIV groups (P ≤ 0.001). Conclusion Traditional DGR with periodical distraction stimulated the longitudinal growth of the two segments immediately above DIV in patients with EOS. DGR technique had a negative effect on the development of intervertebral discs within distracted levels. Level of evidence 3.
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- 2019
10. Comparison between surgical fusion and the growing-rod technique for early-onset neurofibromatosis type-1 dystrophic scoliosis
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Liqiang Cui, Siyi Cai, Jianguo Zhang, Jianxiong Shen, and Guixing Qiu
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medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Growing rod ,Neurofibromatosis 1 ,Sports medicine ,Posterior fusion ,Scoliosis ,Pulmonary function testing ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Neurofibromatosis ,Retrospective Studies ,Dystrophic early-onset scoliosis ,030222 orthopedics ,Neurofibromatosis type-1 ,business.industry ,Prostheses and Implants ,medicine.disease ,Trunk ,Surgery ,Spinal Fusion ,Treatment Outcome ,Sample size determination ,Orthopedic surgery ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Spinal deformities constitute one of the most common types of manifestations of neurofibromatosis type-1 (NF-1), which can lead to either dystrophic or non-dystrophic early-onset scoliosis (EOS). Surgical treatment for EOS with NF-1 is challenging, and the outcomes have rarely been reported. The anterior-posterior procedure is widely used, but posterior-only fusion is theoretically easier and safer to perform. Is it possible that a new surgery that accommodates growth is a better choice? A direct comparison between posterior fusion and growth-friendly surgery in terms of surgical outcomes has not yet been conducted in dystrophic EOS with NF-1 patients. Methods Baseline information was extracted from the NF-1 database at our institute with approval from the local ethics committee. All enrolled patients were diagnosed with NF-1. Clinical and radiographic data were recorded preoperatively, after the initial surgery, and at the final follow-up. Implant-related, alignment, neurological complication and unplanned revision surgery data were recorded. We compared the outcomes of these two groups in terms of curve correction, growth parameters, complications and unplanned revision surgeries. Results There were eight patients in the PF group and eight patients in the GR group, with a mean follow-up of 51.0 ± 17.5 months. The main curve size was similar (PF 67.38° ± 17.43° versus GR 75.1° ± 26.43°, P = 0.501), and there were no significant differences in the initial surgery correction rate or the rate of correction. However, the patients in the GR group exhibited more T1-S1 growth during the follow-up overall and per year than did those in the PF group. The operative time was significantly longer for the PF group than for the GR group (PF, 4.39 ± 1.38 vs. GR, 3.00 ± 0.42 h; p = 0.008). Significantly fewer segments were involved in the PF group (8.25 ± 3.20) than in the GR group (13.00 ± 1.60). Conclusion For the initial treatment of dystrophic EOS in patients with NF-1, the GR technique is possibly a more appropriate treatment than is the PF technique in terms of trunk growth. However, the repeated procedures required for GR may be a considerable disadvantage. More studies with direct measurement of pulmonary function must be conducted to determine the effect of GR on pulmonary development. More studies with larger sample sizes and longer follow-up periods are needed to fully assess the treatment strategies.
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- 2020
11. Surgical Scoliosis Correction in Chiari-I Malformation with Syringomyelia Versus Idiopathic Syringomyelia
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Zheng Li, Jianguo Zhang, Haining Tan, Jinqian Liang, Tianhua Rong, Erwei Feng, Youxi Lin, Jianxiong Shen, and Yang Jiao
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Male ,medicine.medical_specialty ,Adolescent ,Radiography ,medicine.medical_treatment ,Matched-Pair Analysis ,Scoliosis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Syrinx (medicine) ,Child ,Retrospective Studies ,Cobb angle ,business.industry ,General Medicine ,medicine.disease ,Sagittal plane ,Syringomyelia ,Surgery ,Arnold-Chiari Malformation ,medicine.anatomical_structure ,Spinal Fusion ,Treatment Outcome ,030220 oncology & carcinogenesis ,Coronal plane ,Spinal fusion ,Case-Control Studies ,Female ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Both patients with Chiari-I malformation (CIM) with syringomyelia and those with idiopathic syringomyelia (ISm) have a syrinx and can have scoliosis as well. However, there is no literature regarding differences between CIM and ISm in terms of radiographic outcomes and surgical complications after posterior fusion, to our knowledge. The aim of the present study was to compare radiographic features, clinical outcomes, and surgical complications after posterior spinal fusion between patients with CIM-associated scoliosis and those with ISm-associated scoliosis. Methods One hundred and twenty patients with syringomyelia-associated scoliosis were retrospectively analyzed. Twenty-one patients with scoliosis secondary to CIM were enrolled and matched by sex, age, and the Cobb angle of the scoliotic curve with 21 patients with scoliosis secondary to ISm. All patients underwent 1-stage posterior fusion surgery. Coronal and sagittal radiographic parameters were evaluated before surgery, immediately after surgery, and at the final follow-up (at least 2 years). We also collected data regarding syringeal features, neurological deficits, intraoperative neuromonitoring, and complications. Results Sex, age, preoperative coronal/sagittal scoliosis parameters, and neurological deficits were similar between the matched CIM and ISm groups. On average, the CIM group had a longer syrinx (12.3 ± 3.6 versus 8.9 ± 4.5 vertebral levels, p = 0.010) than the ISm group. The CIM and ISm groups showed similar correction rates for primary curves (70.9% ± 10.6% versus 69.5% ± 16.3%, p = 0.739). There were no significant differences in coronal/sagittal correction, intraoperative neuromonitoring abnormalities, surgical complications, or Scoliosis Research Society-22 questionnaire scores between the 2 groups. Conclusions Despite matched demographic and scoliotic coronal parameters, patients with CIM had longer syrinxes compared with patients with ISm. One-stage posterior fusion achieved comparable clinical and radiographic outcomes for both CIM- and ISm-associated scoliosis without significant differences in neurological complications. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2020
12. Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis
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Yu Zhao, Guixing Qiu, Jianguo Zhang, Jianxiong Shen, Yipeng Wang, Siyi Cai, Zhengyao Li, and Hong Zhao
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medicine.medical_specialty ,Neurofibromatosis 1 ,Posterior fusion ,medicine.medical_treatment ,Scoliosis ,Neurofibromatosis ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Early-onset scoliosis ,Long-term ,medicine ,Humans ,Stage (cooking) ,Child ,Retrospective Studies ,030222 orthopedics ,Surgical outcome ,business.industry ,Instrumented fusion ,lcsh:RJ1-570 ,lcsh:Pediatrics ,medicine.disease ,Surgery ,Spinal Fusion ,Treatment Outcome ,Spinal fusion ,Pediatrics, Perinatology and Child Health ,Orthopedic surgery ,Cohort ,business ,Early onset scoliosis ,030217 neurology & neurosurgery ,Follow-Up Studies ,Research Article - Abstract
BackgroundThe mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients.MethodsA retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, the age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up.ResultsThe average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6 cm/year during the follow-up.ConclusionsPosterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.
- Published
- 2019
13. Posterior Correction Without Rib-head Resection for Patients With Neurofibromatosis Type 1, Dystrophic Scoliosis, and Rib-head Protrusion Into the Spinal Canal
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Guixing Qiu, Siyi Cai, Hong Zhao, Jianxiong Shen, Xisheng Weng, and Jianguo Zhang
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Male ,medicine.medical_specialty ,Neurofibromatosis 1 ,Adolescent ,Rotation ,medicine.medical_treatment ,Kyphosis ,Neuroimaging ,Ribs ,Scoliosis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pedicle Screws ,medicine ,Humans ,Orthopedics and Sports Medicine ,Spinal canal ,Longitudinal Studies ,Neurofibromatosis ,Child ,Retrospective Studies ,030222 orthopedics ,Rib cage ,Cobb angle ,business.industry ,medicine.disease ,Surgery ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Spinal fusion ,Coronal plane ,Female ,Neurology (clinical) ,business ,Spinal Canal ,030217 neurology & neurosurgery - Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The objective of this study is to report the result of patients with neurofibromatosis type 1(NF-1), dystrophic scoliosis, and rib-head protrusion into the spinal canal who received posterior scoliosis correction surgery without rib-head resection. SUMMARY OF BACKGROUND DATA A total of 124 patients with NF-1 and dystrophic scoliosis were treated at our institution during the study period. Eight patients with a median age of 12 years had rib-head protrusion into the spinal canal and received surgery and were included in the analysis. METHODS All 8 patients (6 male, 2 female) were treated from 2003 to 2013 and received posterior correction with a pedicle screw-rod 3-dimensional correction system or screw-hook hybrid system. Scoliosis correction rate and percentage of spinal canal occupied by the rib head were analyzed. RESULTS The median patient age, number of segments fused, and follow-up duration were 12 years, 10.5, and 22.5 months, respectively. There were no surgery-related complications, and symptoms in all patients improved after surgery. The median postoperative and 1-year follow-up sagittal kyphotic angles were significantly smaller as compared with the preoperative value (28.5 and 31 vs. 62.5 degrees, P=0.012). The median postoperative coronal Cobb angle of the main thoracic curve was significantly smaller compared with the preoperative value (29 vs. 64.5 degrees, P=0.012). The median percentage of the spinal canal occupied by the intraspinal rib was significantly lower at 1-year follow-up compared with the preoperative value (23.1% vs. 28.6%, P=0.018). CONCLUSIONS Posterior correction without rib-head excision can provide good outcomes for patients with NF-1 and dystrophic scoliosis and rib-head protrusion into the spinal canal.
- Published
- 2017
14. Kyphoscoliosis with Klippel-Trenaunay syndrome: a case report and literature review
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Haining Tan, Jiliang Zhai, Min-Er Zhong, Zheng Li, and Jianxiong Shen
- Subjects
Klippel-Trenaunay-Weber Syndrome ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Klippel-Trenaunay syndrome ,Adolescent ,Kyphosis ,Case Report ,Kyphoscoliosis ,Scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,medicine ,Humans ,Orthopedics and Sports Medicine ,Subacute thyroiditis ,030203 arthritis & rheumatology ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Recovery of Function ,medicine.disease ,Trunk ,Surgery ,Capillary malformations ,Spinal Fusion ,Treatment Outcome ,Venous varicosities ,Female ,lcsh:RC925-935 ,business ,Syringomyelia ,Limb hypertrophy ,Rare disease - Abstract
Background Klippel-Trenaunay syndrome (KTS) is a rare congenital syndrome characterized by the triad of venous varicosities, capillary malformations and limb hypertrophy. However, KTS may rarely occur in combination with kyphoscoliosis. Case presentation We presented an 18-year-old female with KTS and kyphoscoliosis. Hypertrophy of bone and soft tissue affected her left face, trunk and lower limb. Moreover, the patient is associated with subacute thyroiditis, vitamin D deficiency and iron deficiency anemia, high level of D-dimer, swollen tonsil, kyphoscoliosis and Chiari-I-malformation without syringomyelia. A posterior correction and spinal fusion from T10 to L5 levels were performed for this patient. The lumbar curve was corrected from 105° to 60° and the kyphosis improved from 58° to 26°. The distance of trunk shift decreased from 10 cm to 1.4 cm. There were no thrombotic events occurred. At the 8th month follow-up, there was no significantly change of the curve in the coronal and sagittal radiographs. During the 31-month follow-up, the patient did not experience any discomfort. And her general appearance did not have any change until the last follow-up. However, she refused to take radiograph for worrying about radiation. Conclusions KTS is a rare disease with classic clinical triad. However, it can also have other different features, including kyphoscoliosis, elevated D-Dimer, vitamin D deficiency and iron-deficiency anemia. These issues should be taken into consideration when planning treatment for kyphoscoliosis in KTS patients.
- Published
- 2019
15. Lenke 5C Curves in Adolescent Idiopathic Scoliosis
- Author
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Hong Zhao, Xisheng Weng, Jianguo Zhang, Jianxiong Shen, Guixing Qiu, and Yulei Dong
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Male ,medicine.medical_specialty ,Adolescent ,Radiography ,Operative Time ,Idiopathic scoliosis ,Selective fusion ,Preoperative care ,Thoracic Vertebrae ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Blood loss ,medicine ,Humans ,Retrospective Studies ,030222 orthopedics ,Lumbar Vertebrae ,Posterior fusion ,business.industry ,Retrospective cohort study ,Lumbar Curve ,Surgery ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background The optimal treatment of Lenke 5C curves in adolescent idiopathic scoliosis is still unclear. Objective To compare the outcomes and the spontaneous correction behavior between anterior and posterior selective fusion techniques in a large case series. Methods Demographic and surgical data for patients with Lenke 5C curves treated with anterior or posterior fusion were collected from July 2002 to September 2011. Clinical assessment and radiographic parameters were compared preoperatively and postoperatively and at a minimum of 2 years of follow-up. Results Fifty-three Lenke 5C adolescent idiopathic scoliosis cases with an average follow-up of 4 years (range, 2-9.6 years) were included. The clinical scores were similar between the 2 groups. Postoperative major thoracic curvature changes were similar. The minor thoracic curve demonstrated a higher spontaneous correction rate in the posterior group. At follow-up, the minor thoracic curve showed a greater loss of correction in the posterior group, and finally both groups were comparable. Surgical time, intraoperative blood loss, and complications were comparable. A total of 5 patients had a final thoracic curve larger than the preoperative degrees. Conclusion Selective fusion of the major thoracolumbar/lumbar curve in Lenke 5C adolescent idiopathic scoliosis can be achieved by anterior and posterior techniques. The spontaneous correction of the unfused thoracic curve was comparable after an average of 4 years follow-up.
- Published
- 2016
16. Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study
- Author
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Jianguo Zhang, Zheping Zhang, Guixing Qiu, Jianxiong Shen, and Hai Wang
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,medicine.medical_treatment ,American standards association (ASA) classification ,Logistic regression ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Rheumatology ,Epidemiology ,Degenerative scoliosis ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,Perioperative complication ,Retrospective cohort study ,Perioperative ,Odds ratio ,Operation duration (OD) ,Length of Stay ,Middle Aged ,Confidence interval ,Surgery ,Spinal Fusion ,Risk factors ,Scoliosis ,Spinal fusion ,Orthopedic surgery ,Female ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Backgrounds Rare study has been conducted to detect risk factors of perioperative complications, which are closely related to preoperative status of the patients and surgical stress. The aim of this study is to detect these relationships in degenerative scoliosis (DS) patients. Methods Perioperative complications of 226 cases with DS (56 males and 170 females; 65.5 ± 8.1 years old), who accepted posterior fusion in our hospital from January, 2013 to July, 2017, were retrospectively reviewed. Potential risk factors were first compared between patients with or without perioperative complications using student t test or Chi-squared test. Then, the unevenly distributed variables between the two groups were analyzed with binary logistic regression model. Results All patients separately underwent decompression with short limited instrumentation (116, 51.3%) or with long instrumentation for correction (110, 48.7%). The mean operation duration (OD) was 216.9 ± 64.2 min and the average amount of bleeding was 587.4 ± 357.2 ml. 44 cases (19.5%)suffered from the complications during the perioperative phase, including incision complications (5.3%), urinary infection (3.5%), dura tears/cerebrospinal fluid (CSF) leakages (3.5%) and new neurological deficits (2.7%). Hospital stay was significantly extended for the complications (p 2 (p = 0.011) and RBC transfusion≥4 U(p = 0.028) were associated with these complications. Multivariate logistic regressions revealed that only ASA grade > 2(p = 0.011, Odds Ratio[OR] = 4.104, 95% Confidence Interval[CI] = 1.413~ 11.917) and OD (p = 0.013, OR = 2.697, 95% CI = 1.233~ 5.899) were the independent risk factors. Conclusions The high morbidity of perioperative complications for posterior spinal fusion would significantly extend hospital stay of DS patients. It was independently related to higher ASA grade and longer OD.
- Published
- 2018
17. Spinal growth modulation with posterior unilateral elastic tether in immature swine model
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Jiaming Liu, Jianxiong Shen, Xuhong Xue, and Zheng Li
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Lordosis ,Swine ,Context (language use) ,Lumbar vertebrae ,Scoliosis ,Thoracic Vertebrae ,medicine ,Animals ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Fixation (histology) ,Lumbar Vertebrae ,business.industry ,Anatomy ,medicine.disease ,Sagittal plane ,Radiography ,Spinal Fusion ,medicine.anatomical_structure ,Epiphysis ,Coronal plane ,Models, Animal ,Surgery ,Neurology (clinical) ,business - Abstract
Background context Fusionless scoliosis surgery is frequently performed in children. Many studies have analyzed the effects of spinal growth modulation by tethering the anterior and anterolateral aspects of the spine in animal models. However, few studies have reported the disc health and spinal motion in spines with posterior unilateral elastic tethering. Purpose To analyze the regional radiography, biochemistry, and histology of spinal motion segments fixed by posterior unilateral elastic tethering. Study design A randomized controlled trial. Outcome measures Preoperative and postoperative radiographs of the spines were taken. After an 8-week recovery period, the spines were harvested en bloc and underwent radiographic, biochemical, and histologic analyses. Methods Fifteen 3-month-old swine were randomly divided into three groups. Instrumentation was performed posteriorly in the swine. In the elastic fixation (EF) group, five swine were instrumented on the left side of the lumbar vertebrae from L1 to L5 with pedicle screws that were connected with a unilateral elastic tether with tension to produce a curve on the spine. The same surgery was performed in the five animals of the metal rod fixation (MF) group, in which the screws were connected with metal rods and curves were established. In the control group, five animals were instrumented with five screws with no connecting cable. Results Scoliosis and lordosis were created in the coronal and sagittal planes in both the EF and MF groups. On average, the Cobb angles were 12.16°±1.37° and 9.10°±2.02° (p=.023) in the coronal plane and 17.44°±11.29° and 5.32°±3.06° (p=.049) in the sagittal plane in the two groups, respectively. The vertebrae and discs wedged on the tethered side in the two groups showed no significant differences (p>.05). The thickness of end-plate epiphysis on the fixed side was significantly decreased in the two groups (p=.032 and p=.024). No apparent change was found in the gross morphology of the discs in the two groups. The distribution of collagen types I and II decreased and that of matrix metalloprotease-3 (MMP-3) increased in both the EF and MF groups. Additionally, the proteoglycan synthesis decreased in the two groups. Conclusions Unilateral elastic tethering resulted in vertebral wedging and scoliosis. Although changes in collagen and MMP-3 distribution, proteoglycan synthesis, end-plate epiphysis, and disc thickness were observed, the tethered discs and end plates did not demonstrate gross morphologic signs of degeneration.
- Published
- 2015
18. The Effect of Unfused Segments in Coronal Balance Reconstitution After Posterior Selective Thoracolumbar/Lumbar Fusion in Adolescent Idiopathic Scoliosis
- Author
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Yipeng Wang, Jianxiong Shen, Hong Zhao, Shigong Guo, Guixing Qiu, Jianguo Zhang, Zhi-jian Sun, and Yu Zhao
- Subjects
Male ,Adolescent ,Radiography ,medicine.medical_treatment ,Idiopathic scoliosis ,Thoracic Vertebrae ,Young Adult ,Lumbar ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Child ,Retrospective Studies ,Balance (ability) ,Fusion ,Lumbar Vertebrae ,business.industry ,Torso ,Anatomy ,Trunk ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Spinal fusion ,Coronal plane ,Female ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
STUDY DESIGN A retrospective radiographical analysis. OBJECTIVE To assess the effect of unfused segments in the reconstitution of coronal balance after posterior selective thoracolumbar/lumbar (TL/L) curve fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Current literature suggests that compensatory changes occur after selective TL/L curve fusion surgery. Hitherto, the roles of the unfused levels in coronal balance reconstitution have not been fully understood. METHODS Radiographical data of patients with idiopathic scoliosis who underwent selective posterior TL/L curve fusion Peking Union Medical College Hospital before October 2011 with a minimum of 2 years of follow-up period were retrospectively analyzed. Changes of coronal trunk shift during the follow-up period were studied and multiple linear regression analysis was performed to determine its correlation with changes of upper and lower curve of unfused thoracic segments, instrumented segments angle, distal unfused segments angle, and coronal sacral inclination. RESULTS A total of 43 patients were included in this study. Preoperative and first erect radiographs demonstrated trunk shifts of 21.1 mm and 18.7 mm respectively, showing no significant differences (P = 0.205). At the last follow-up, it compensated to 9 mm, which showed significant differences (P < 0.01). Regression analysis of all patients showed that coronal trunk shift changes only correlated with distal unfused segment angle changes. Subgroup analysis based on the magnitude of preoperative thoracic curve found that only distal unfused segments had an impact on coronal balance reconstitution. However, subgroup analysis based on the flexibility of preoperative thoracic curve showed that both proximal unfused thoracic segments and distal unfused lumbar segments contributed to coronal balance compensation in patients with a thoracic curve flexibility rate of more than 70%. CONCLUSION The reconstitution of coronal balance was mainly compensated by distal unfused segments after selective posterior fusion of TL/L idiopathic scoliosis. The effect of unfused thoracic segments in coronal balance reconstitution mainly depended on its flexibility.
- Published
- 2014
19. Surgical correction of hyperlordosis in facioscapulohumeral muscular dystrophy: A case report
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Chong Chen, Fan Feng, Jianxiong Shen, Youxi Lin, Zheng Li, and Haining Tan
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Adolescent ,Hyperlordosis ,lcsh:Surgery ,Case Report ,Scoliosis ,Preoperative examination ,03 medical and health sciences ,0302 clinical medicine ,Spine surgery ,Facioscapulohumeral muscular dystrophy ,medicine ,Humans ,030222 orthopedics ,business.industry ,Sitting posture ,General Medicine ,lcsh:RD1-811 ,Surgical correction ,medicine.disease ,Wheelchair-dependent ,Muscular Dystrophy, Facioscapulohumeral ,Surgery ,nervous system diseases ,Spinal Fusion ,Treatment Outcome ,Spinal deformity ,Physical therapy ,Lordosis ,Quality of Life ,Female ,business ,030217 neurology & neurosurgery - Abstract
Background Hyperlordosis is common in facioscapulohumeral muscular dystrophy (FSHD), which cannot be controlled by bracing. While the surgical treatment is neither reported nor recommended in previous studies, we report the first corrective surgery for hyperlordosis in one wheelchair-dependent FSHD patient. Case presentation A 15-year-old, wheelchair-dependent girl complaining of hyperlordosis and lower extremity weakness was diagnosed as FSHD. Preoperative examination showed hyperlordosis of 116° with scoliosis of 44°. Posterior correction and bone graft fusion was performed. Postoperatively, the hyperlordosis was corrected to 72° and better sitting posture was gotten. 12 months’ follow-up showed favorable correction with improvement in SF-36 and ODI score. Conclusions The correction for hyperlordosis in FSHD is controversial. We report the first successful case of operative treatment by corrective spine surgery in these rare and demanding patient collective. Corrective surgery for spinal deformity, such as hyperlordosis and scoliosis, could do some help in posture and improve the quality of life especially in wheelchair-dependent patients.
- Published
- 2017
20. Evaluation of Quality of Life in Adolescent Idiopathic Scoliosis With Different Distal Fusion Level
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Zheng Li, Jinqian Liang, Jianxiong Shen, Guixing Qiu, and Ran Ding
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Male ,medicine.medical_specialty ,Adolescent ,Visual analogue scale ,Bone Screws ,Idiopathic scoliosis ,Scoliosis ,Surgical methods ,Quality of life ,Surveys and Questionnaires ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Kyphosis ,Pain Measurement ,Retrospective Studies ,Lumbar Vertebrae ,Cobb angle ,business.industry ,Retrospective cohort study ,medicine.disease ,Oswestry Disability Index ,Spinal Fusion ,Treatment Outcome ,Case-Control Studies ,Quality of Life ,Physical therapy ,Female ,Surgery ,Neurology (clinical) ,business - Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE The aim of this study was to assess patients' quality of life with different fusion levels in posterior pedicle screw correction of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA No previous study has demonstrated differences in health-related quality of life (HRQoL) between patients fused to L3 versus L4. MATERIALS AND METHODS A retrospective study was conducted on 30 scoliotic patients fused to L3 using complete pedicle screw instruments. Thirty age-matched and sex-matched scoliotic patients fused to L4 were in the control group. Radiologic parameters were assessed before surgery and at latest follow-up between the 2 groups. These 2 groups were compared for the Scoliosis Research Society 22 questionnaire (SRS-22), Oswestry Disability Index (ODI), visual analogue scale (VAS), and Short Form-36 (SF-36) questionnaires, which were administered preoperatively and at final follow-up. RESULTS There were no significant differences in sex, age, follow-up duration, the distribution of curve patterns, the postoperative residual Cobb angle of the main curve, complications, or surgical method between the L3 and L4 groups (P>0.05). Preoperative scores were statistically similar in the L3 and L4 groups for all domains of all questionnaires. There was no difference between the L3 and L4 groups for ODI (P=0.527) and VAS (P=0.518). There were no significant differences in the scores on function/activity, self-image/appearance, pain, mental health, or satisfaction with treatment domains between the 2 groups. No significant differences between the 2 groups were found at the final follow-up in the SF-36 subscales/domain scores. CONCLUSIONS This study attempted to elucidate the correlation between the length of fusion and functional outcome; however, it could not identify any difference between different fusion levels. On the basis of short-term results, there were no significant differences in the questionnaire scores between the 2 groups.
- Published
- 2014
21. How to Deal With Cerebrospinal Fluid Leak During Pedicle Screw Fixation in Spinal Deformities Surgery With Intraoperative Neuromonitoring Change
- Author
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Bin Feng, Guixing Qiu, Xi Zhou, Jinqian Liang, Jianguo Zhang, and Jianxiong Shen
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Leak ,Adolescent ,Bone wax ,Bone Screws ,Thoracic Vertebrae ,Young Adult ,Cerebrospinal fluid ,Monitoring, Intraoperative ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Kyphosis ,Pedicle screw fixation ,Child ,Aged ,Retrospective Studies ,Cerebrospinal fluid leak ,business.industry ,Middle Aged ,medicine.disease ,Internal Fixators ,Subdural Effusion ,Osteotomy ,Vertebra ,Surgery ,Scoliosis surgery ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Scoliosis ,Child, Preschool ,Anesthesia ,Concomitant ,Female ,sense organs ,Neurology (clinical) ,business - Abstract
Study design A retrospective study. Objective To analyze the cerebrospinal fluid (CSF) leak during the thoracic pedicle screw fixation in spinal deformities, the relative intraoperative neuromonitoring changes and the strategy for management. Summary of background data CSF leak may occur during the preparation of trajectory of thoracic pedicle screws in scoliosis surgery. The strategy for management of such situation is controversial. There is limited literature about the CSF leak and concomitant neuromonitoring change. Methods A total of 695 patients with spinal deformity subjected to correction by posterior instrumentation using thoracic pedicle screw fixation from 2008 January to 2010 December and followed up for more than 2 years were retrospectively analyzed for CSF leak during pedicle screw placement and the concomitant neuromonitoring changes. The cases with CSF leak and with complete information about neuromonitoring were reviewed. Results A total of 7284 thoracic pedicle screws were inserted in the thoracic level (10.4 screws/patient). All the procedures were performed under the intraoperative neuromonitoring. There were 8 cases of CSF leak with the rate of 0.11% during the screw trajectory preparation. Seven of the screws located at the concave side. Five cases presented with concomitant positive intraoperative neuromonitoring changes. The holes were sealed for 3 of them, and patients presented with reversible monitoring changes and intact neurological function. Negligence of the CSF leak and screw insertion caused the deterioration of neuromonitoring even neurological deficit that needed revision surgery. Three cases presented without intraoperative monitoring changes and woke up without neurological deficit. Conclusion The factors impacting the safety of screw placement for CSF leak included screw position, segment of vertebra, and concomitant neuromonitoring changes. Commonly, it was not necessary to repair the dural tear and sealing the pedicle hole with bone wax for the case with reversible neuromonitoring changes was all that needed. A lateral entry point to the initial one could be used and to continue the screw placement when neuromonitoring demonstrate reversible positive changes. Level of evidence 4.
- Published
- 2014
22. Safety of surgical treatment for patients with scoliosis and surgically corrected congenital cardiac malformations: a comparison with patients with scoliosis and normal hearts
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Ran Ding, Jianxiong Shen, Jinqian Liang, Zheng Li, and Sooyong Chua
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Blood transfusion ,Adolescent ,medicine.medical_treatment ,Scoliosis ,Young Adult ,Postoperative Complications ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Child ,Retrospective Studies ,business.industry ,Postoperative complication ,Retrospective cohort study ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,Cardiac surgery ,Spinal Fusion ,Case-Control Studies ,Anesthesia ,Predictive value of tests ,Spinal fusion ,Female ,business - Abstract
Object The safety of spinal fusion has been poorly studied in children with surgically corrected congenital cardiac malformations (CCMs). The objective of this study was to evaluate the safety of spinal fusion in patients with CCMs following cardiac surgery. Methods A retrospective study was conducted on 32 patients with scoliosis who received surgical treatment for their CCMs (CCM group). Sixty-four age- and sex-matched patients with scoliosis and normal hearts who received spinal fusion served as the control group. These 2 groups were compared for demographic distribution, blood loss, transfusion requirements, and incidence of postoperative complications. Results The ages, curve pattern distributions, and number of levels fused were similar between the 2 groups before spinal fusion. Overall, a total of 7 patients in the CCM group (21.9%) and 5 (7.8%) in the control group had documented postoperative complications. The perioperative allogenic blood transfusion rate and mean red blood cell transfusion requirement in the CCM group were significantly higher than those found in patients in the control group (68.7% vs 28.1%, respectively, p = 0.000; and 2.68 ± 2.76 units/patient vs 0.76 ± 1.07 units/patient, respectively, p = 0.011). In the CCM group, a preoperative major curve magnitude ≥ 80° was the most accurate indicator of an increased risk for a major complication (p = 0.019), whereas no statistically significant correlation was noted between postoperative complications and age, type of congenital heart disease, operative duration, and estimated blood loss during the operation and transfusion. Conclusions Spinal fusion subsequent to prior cardiac surgery is relatively safe and effective in correcting the spinal deformity for patients with scoliosis and surgically corrected CCMs. A preoperative major curve magnitude ≥ 80° may be a risk factor in predicting postoperative complications in scoliotic patients with surgically corrected CCMs.
- Published
- 2013
23. Surgical Scoliosis Correction in Chiari-I Malformation with Syringomyelia Versus Idiopathic Syringomyelia.
- Author
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Haining Tan, Youxi Lin, Tianhua Rong, Jianxiong Shen, Jianguo Zhang, Erwei Feng, Yang Jiao, Jinqian Liang, Zheng Li, Tan, Haining, Lin, Youxi, Rong, Tianhua, Shen, Jianxiong, Zhang, Jianguo, Feng, Erwei, Jiao, Yang, Liang, Jinqian, and Li, Zheng
- Subjects
ORTHOPEDIC braces ,SCOLIOSIS ,SYRINGOMYELIA ,SURGICAL complications ,SPINAL fusion ,HUMAN abnormalities ,RETROSPECTIVE studies ,PAIRED comparisons (Mathematics) ,RADIOGRAPHY ,CASE-control method ,TREATMENT effectiveness ,ARNOLD-Chiari deformity ,LONGITUDINAL method ,DISEASE complications - Abstract
Background: Both patients with Chiari-I malformation (CIM) with syringomyelia and those with idiopathic syringomyelia (ISm) have a syrinx and can have scoliosis as well. However, there is no literature regarding differences between CIM and ISm in terms of radiographic outcomes and surgical complications after posterior fusion, to our knowledge. The aim of the present study was to compare radiographic features, clinical outcomes, and surgical complications after posterior spinal fusion between patients with CIM-associated scoliosis and those with ISm-associated scoliosis.Methods: One hundred and twenty patients with syringomyelia-associated scoliosis were retrospectively analyzed. Twenty-one patients with scoliosis secondary to CIM were enrolled and matched by sex, age, and the Cobb angle of the scoliotic curve with 21 patients with scoliosis secondary to ISm. All patients underwent 1-stage posterior fusion surgery. Coronal and sagittal radiographic parameters were evaluated before surgery, immediately after surgery, and at the final follow-up (at least 2 years). We also collected data regarding syringeal features, neurological deficits, intraoperative neuromonitoring, and complications.Results: Sex, age, preoperative coronal/sagittal scoliosis parameters, and neurological deficits were similar between the matched CIM and ISm groups. On average, the CIM group had a longer syrinx (12.3 ± 3.6 versus 8.9 ± 4.5 vertebral levels, p = 0.010) than the ISm group. The CIM and ISm groups showed similar correction rates for primary curves (70.9% ± 10.6% versus 69.5% ± 16.3%, p = 0.739). There were no significant differences in coronal/sagittal correction, intraoperative neuromonitoring abnormalities, surgical complications, or Scoliosis Research Society-22 questionnaire scores between the 2 groups.Conclusions: Despite matched demographic and scoliotic coronal parameters, patients with CIM had longer syrinxes compared with patients with ISm. One-stage posterior fusion achieved comparable clinical and radiographic outcomes for both CIM- and ISm-associated scoliosis without significant differences in neurological complications.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]- Published
- 2020
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24. X-Ray assessment of the effect of pedicle screw on vertebra and spinal canal growth in children before the age of 7 years
- Author
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Jianguo Zhang, Jianxiong Shen, Guixing Qiu, Shugang Li, Yipeng Wang, and Xuhong Xue
- Subjects
Male ,musculoskeletal diseases ,medicine.medical_treatment ,Bone Screws ,Lumbar vertebrae ,Thoracic Vertebrae ,medicine ,Humans ,Orthopedics and Sports Medicine ,Spinal canal ,Child ,Pedicle screw ,Retrospective Studies ,Orthodontics ,Lumbar Vertebrae ,business.industry ,Follow up studies ,Infant ,Reproducibility of Results ,Anatomy ,equipment and supplies ,musculoskeletal system ,Spine ,Vertebra ,Radiography ,Bone screws ,Spinal Fusion ,surgical procedures, operative ,medicine.anatomical_structure ,Child, Preschool ,Spinal fusion ,Thoracic vertebrae ,Female ,Original Article ,Surgery ,business ,Spinal Canal ,Follow-Up Studies - Abstract
To determine the reliability of pedicle screws placed in children younger than 7 years of age, and to evaluate the effect of pedicle screw insertion on further growth of the vertebra and spinal canal.A retrospective study of 35 consecutive patients through Jan 2003-Dec 2010 for congenital scoliosis in7 years children was performed at one spine center. Patients undergoing pedicle screw instrumentation of at least two levels, which had been followed-up for at least 24 months were included. Measurements were performed in instrumented and adjacent non-instrumented levels. The effect of pedicle screw insertion on further growth was evaluated.The average age at surgery was 4.4 year (53 months, range, 23-84 months). 190 segments in 35 patients met the inclusion criteria. 77 segments had no screws and 113 had at least one screw. There was a significant difference between the pre-operative and final follow-up values of the measurement of spinal canal and vertebral body parameters (P0.001). No significant difference existed between growth rates of vertebral bodies and the sagittal diameters of spinal canal with or without screws. The growth rates of vertebral bodies in lumbar spine were higher than in thoracic spine in both instrumented and adjacent groups.Pedicle screw instrumentation does not cause a retardation effect on the development of vertebral bodies and the spinal canal in children at an early age. It is a safe and reliable procedure to achieve a stable fixation.
- Published
- 2013
25. Comparison Between Subcutaneous Closed-suction Drainage and Conventional Closed-suction Drainage in Adolescents Idiopathic Scoliosis Patients Undergoing Posterior Instrumented Spinal Fusion
- Author
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Sooyong Chua, Guixing Qiu, Jianxiong Shen, and Jinqian Liang
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Idiopathic scoliosis ,Suction ,law.invention ,Subcutaneous Tissue ,Randomized controlled trial ,Blood loss ,law ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Drainage ,Child ,Prospective cohort study ,business.industry ,Surgery ,Scoliosis surgery ,Spinal Fusion ,Scoliosis ,Spinal fusion ,Anesthesia ,Female ,Suction drainage ,Neurology (clinical) ,business - Abstract
Prospective, randomized controlled clinical study.To evaluate the efficacy of subcutaneous closed-suction drainage in reducing blood loss as compared with conventional closed-suction drainage in adolescent idiopathic scoliosis cases undergoing posterior instrumented spinal fusion.Subcutaneous closed-suction drainage is reported to be a reasonable alternative to intra-articular indwelling closed-suction drainage and to that of no usage of any drainage system in knee arthroplasty. However, little is reported about the use of subcutaneous closed-suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion.A total of 105 adolescent idiopathic scoliosis patients undergoing posterior instrumented spinal fusion were randomized into 2 groups of either a subcutaneous drainage or a conventional closed-wound suction drainage system. These 2 groups were compared for demographic distribution, blood loss (hemoglobin/hematocrit changes, transfusion requirements), and incidence of wound problems (requirements for dressing reinforcement, oozing, subcutaneous hematoma, ecchymosis, infection).Mean drainage volume was less (P=0.000) in the subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (42 vs. 631 mL). The groups were statistically similar in terms of hemoglobin and hematocrit values obtained on the third postoperative day (10.60 vs. 9.52 g/dL, P=0.110; 30.85% vs. 27.82%, P=0.226), on discharge (10.90 vs. 9.75 g/dL, P=0.114; 31.10% vs. 28.13%, P=0.147), transfusion requirements (31.2% vs. 45.6%, P=0.133), and incidence of wound problems. However, the core temperature values were higher in subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (P=0.001), and the duration of fever was longer in the former compared with the latter (P=0.008).The data suggest that subcutaneous closed-suction drainage offers a reasonable alternative to closed-wound suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion.
- Published
- 2013
26. Evaluation of vertical traction radiography for predicting the outcome of moderate to severe rigid scoliosis correction
- Author
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Ye Li, Xiang Li, Yipeng Wang, Yu Jiang, Hong Zhao, Yu Zhao, Guixing Qiu, Jianxiong Shen, and Chang Xiao
- Subjects
musculoskeletal diseases ,Moderate to severe ,Orthodontics ,medicine.medical_specialty ,business.industry ,Radiographic imaging ,Radiography ,medicine.medical_treatment ,Scoliosis correction ,Scoliosis ,Traction (orthopedics) ,musculoskeletal system ,medicine.disease ,Sagittal plane ,Surgery ,medicine.anatomical_structure ,Spinal fusion ,medicine ,Orthopedics and Sports Medicine ,sense organs ,business - Abstract
Objective: To determine the efficacy of imaging patients in a state of traction (“traction imaging”) for selection of upper and lower vertebrae to undergo instrumentation (UIV and LIV, respectively) to correct moderate to severe, rigid scoliosis. Methods: Twenty-seven patients aged 11–21 years (average, 15.5 years) who had been treated at our institution for scoliosis of the thoracic spine between 2004 and 2008 were retrospectively analyzed. All patients were treated with the third multiple hook-screw and rod instrumentation system. Standardized radiographic measurements (anteroposterior, sagittal, bending, fulcrum, traction) were taken and Cobb's angles, apical vertebra translation (AVT), and traction-stable vertebrae determined. Results: All patients were followed for 6–36 months (average, 14.7 months). The Cobb's angles under preoperative vertical traction correlated positively with those measured postoperatively in standing anteroposterior film (P 0.05). Conclusions: Traction radiographic imaging is an effective, feasible preoperative assessment for determining which vertebrae are stable, designing the surgical strategy and choosing the UIV and LIV for correcting moderate to severe, rigid scoliosis.
- Published
- 2012
27. Scoliosis in a Patient With Gilbert Syndrome: A Case Report and Review of the Literature
- Author
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Zheng Li, Jianxiong Shen, and Jinqian Liang
- Subjects
Gilbert Syndrome ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Scoliosis ,Thoracic Vertebrae ,Lumbar ,Medicine ,Gilbert Disease ,Humans ,Clinical Case Report ,Hyperbilirubinemia ,Lumbar Vertebrae ,business.industry ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Spinal Fusion ,Spinal fusion ,Thoracic vertebrae ,Female ,Liver function ,business ,Research Article - Abstract
Gilbert syndrome (GS) is mainly characterized by intermittent unconjugated hyperbilirubinemia in the absence of hepatocellular disease or hemolysis. Little data are available on operative outcomes in GS patients with spinal deformity surgery. This study has presented a case of GS occurring in the patient with scoliosis. The patient was a 30-year-old female with scoliosis and GS. She was taken a correction form Thoracic 2 to Lumbar 1) levels by using the USS-II spinal system. At 2 years follow-up, the patient was well balanced and pain free. Plain radiographs demonstrated spine solid fusion without correction loss. Although complex scoliosis surgery can be performed safely in these patients with GS, careful perioperative managements including liver function and coagulation function are required.
- Published
- 2015
28. Advances in nonfusion techniques for the treatment of scoliosis in children
- Author
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Jia-ming Liu and Jianxiong Shen
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Wedge osteotomy ,Scoliosis ,musculoskeletal system ,medicine.disease ,Osteotomy ,Surgery ,Spinal fusion ,Deformity ,medicine ,Spinal deformity ,Orthopedics and Sports Medicine ,medicine.symptom ,business ,Orthopedic Procedures ,Pedicle screw - Abstract
Scoliotic deformity in young children is a challenge for the spinal surgeon. Though traditional spinal correction and fusion techniques can improve these deformities, they inhibit growth of the spine. Nonfusion technologies are an effective approach to this problem. They not only correct the spinal deformity, but also allow the spine to keep growing and developing. These techniques include the growing rod, stapling, pedicle screw tethering, the vertical expandable prosthetic titanium rib (VEPTR), and multi-vertebrae wedge osteotomy. This is a review of advances in nonfusion techniques for the treatment of scoliosis in children.
- Published
- 2010
29. Predictive Factors of Postoperative Pulmonary Complications in Scoliotic Patients With Moderate or Severe Pulmonary Dysfunction
- Author
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Shugang Li, Jinqian Liang, Jianguo Zhang, Jianxiong Shen, Guixing Qiu, Yipeng Wang, and Hong Zhao
- Subjects
Lung Diseases ,Male ,medicine.medical_specialty ,Adolescent ,Vital Capacity ,Treatment outcome ,MEDLINE ,macromolecular substances ,Pulmonary Dysfunction ,Young Adult ,Risk Factors ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Postoperative Period ,Young adult ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Scoliosis surgery ,Surgery ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Echocardiography ,Regression Analysis ,Female ,Neurology (clinical) ,business - Abstract
Retrospective clinical study.To evaluate the predictive factors of postoperative pulmonary complications in unselected scoliotic patients with moderate or severe pulmonary dysfunction.Many scoliotic patients with moderate or severe pulmonary dysfunction develop postoperative pulmonary complications during hospitalization. However, little is reported about the postoperative pulmonary complication events in this population at the first visit to the hospital.A total of 88 scoliotic patients with moderate or severe pulmonary dysfunction were identified. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of immediate postoperative pulmonary complications by logistic regression.A total of 16 (18.2%) patients were documented with postoperative pulmonary complications including increased requirement of postoperative ventilatory support (6.3%), atelectasis (31.3%), pneumothorax (6.3%), pneumonia (12.5%), and hypoxemia (43.8%). There were no statistical differences in age, sex, body mass index, abnormal echocardiogram, and prior symptoms between the 2 groups (P0.05). Of the patients with postoperative pulmonary complications, a slightly higher proportion of patients underwent anterior approach, 2 (12.5%) versus 2 (2.8%) (P=0.091). The Cobb angle before surgery was 102.1+/-25.5 degree with postoperative pulmonary complications versus 87.7+/-23.8 degree without postoperative pulmonary complications (P=0.034). Forced vital capacity was 47.0+/-10.5% versus 52.4+/-9.0% (P=0.037). Number of levels fused was 13.7+/-2.3 versus 13.1+/-2.2 (P=0.319). Operation time was 376.8+/-125.6 minutes versus 350.4+/-97.8 minutes (P=0.357). Anesthesia time was 415.3+/-126.8 minutes versus 388.0+/-97.5 minutes (P=0.341). Estimated blood loss was 1050.0+/-769.4 mL versus 777.8+/-460.9 mL (P=0.065), respectively. Logistic regression analysis showed that thoracoplasty correlated with postoperative pulmonary complications (odds ratio 3.81, 95% confidence interval 1.11-13.16).Thoracoplasty is the only independent predictor of postoperative pulmonary complications. However, the abnormal echocardiogram, prior symptoms, forced vital capacity, and other clinical characteristics play a less relevant role in the prediction of postoperative pulmonary complications.
- Published
- 2010
30. Anterior Spinal Fusion Versus Posterior Spinal Fusion for Moderate Lumbar/Thoracolumbar Adolescent Idiopathic Scoliosis
- Author
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Jianxiong Shen, Hong Zhao, Chia I. Lee, Hai Wang, Yipeng Wang, Guixing Qiu, Qi Fei, Jianguo Zhang, Suomao Yuan, and Yu Zhao
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Lordosis ,medicine.medical_treatment ,Bone Screws ,Kyphosis ,Scoliosis ,Lumbar vertebrae ,Thoracic Vertebrae ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Child ,Lumbar Vertebrae ,business.industry ,Health Care Costs ,Length of Stay ,medicine.disease ,Internal Fixators ,Surgery ,Radiography ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,Spinal fusion ,Thoracolumbar kyphosis ,Female ,Neurology (clinical) ,business ,Risser sign - Abstract
STUDY DESIGN A prospective study. OBJECTIVE Comparison study of radiologic and clinical outcomes, efficiency, and cost between anterior spinal fusion (ASF) and posterior spine fusion (PSF) in surgical treatment of moderate lumbar/thoracolumbar adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA ASF and PSF indicated for lumbar and thoracolumbar adolescent idiopathic scoliosis surgical treatment have respective advantages and disadvantages. However, up until today, a related prospective AIS comparative study has rarely been reported. METHODS Thirty-two cases in this prospective study with patients enrolled in either method A or B alternately in a sequence were divided into 2 groups. Group A underwent ASF with single solid rod and single screw constructs, and group B underwent PSF with segmental total pedicle screw system. Inclusion criteria were: (1) AIS diagnosis; (2) diagnosis classification as Lenke5CN type; (3) Cobb angles 35 degrees-60 degrees on anteroposterior view radiographs. Exclusion criteria were: (1) a history of spinal surgery; (2) age younger than 10 years; (3) Risser sign 0 degree; (4) lumbar/thoracolumbar kyphosis. All patients were observed with 2-year minimum follow-up (24-46 months). Clinical and radiologic outcomes of both groups A and B were analyzed. RESULTS Statistical t test or Mann-Whitney U test demonstrated no significant difference in preoperative age (P = 0.380), Risser sign (P = 0.733), magnitude (P = 0.936), flexibility (P = 0.815), apical vertebra rotation (AVR, P = 0.756), and apical vertebra translation (AVT, P = 0.355) of the lumbar/thoracolumbar curves, trunk shift (TS, P = 0.448), sagittal kyphosis from T5-T12 (P = 0.792) and sagittal lordosis from L1-L5 (P = 0.299). Average coronal correction of thoracolumbar/lumbar curves was 83% after surgery and 77% at follow-up in group A and 87% after surgery and 82% at follow-up in group B (P = 0.236 and P = 0.138). No significant differences were observed regarding correction of sagittal alignment, TS, AVT, AVR and hospitalization days on last follow-up between both groups (P > 0.05). No pseudarthrosis, reoperation, neurologic complications, infection, and no other problems were observed. Excellent clinical fusion results were present in all patients on their last follow-up. However, significant differences were evident in group A in regards to reduced operative time (P = 0.046), reduced estimated blood loss (P = 0.003), decreased blood transfusion (P = 0.006), reduced implants cost and hospitalization expenses (P = 0.000). Additionally, group A had shorter fusion levels than group B (p50 = 4 vs. p50 = 5, P = 0.003). CONCLUSION ASF versus PSF comparison in treating moderate lumbar/thoracolumbar AIS did not show significant differences in regards to safety or efficacy but demonstrated shorter fusion levels, reduced surgical trauma and costs in ASF.
- Published
- 2008
31. Comparison of 1-Stage Versus 2-Stage Anterior and Posterior Spinal Fusion for Severe and Rigid Idiopathic Scoliosis–A Randomized Prospective Study
- Author
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Yipeng Wang, Guixing Qiu, Yu Zhao, Jianxiong Shen, and Zhihai Zhang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Scoliosis ,Severity of Illness Index ,Thoracic Vertebrae ,Pulmonary function testing ,Central nervous system disease ,Severity of illness ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Child ,Prospective cohort study ,business.industry ,Retrospective cohort study ,Perioperative ,medicine.disease ,Surgery ,Spinal Fusion ,Spinal fusion ,Female ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
STUDY DESIGN A randomized prospective study. OBJECTIVE To compare safety, efficacy, and cost between 1-stage and 2-stage anterior and posterior spinal fusion in treating rigid thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Retrospective study issued different outcomes comparing 1-stage with 2-stage surgical procedures in treating neuromuscular and congenital scoliosis. A randomized prospective study in AIS has rarely been reported. METHODS.: Twenty-four patients were randomly divided into 2 groups. Group A underwent a 2-stage procedure, group B a 1-stage procedure. Inclusion criteria were: (1) AIS; (2) rigid single thoracic curve, > or =90 degrees on anteroposterior and > or =60 degrees on side bending view; and (3) pulmonary function tests, vital capacity > or =500 mL or FEV1 > or =50%. Exclusion criteria were: (1) curves either
- Published
- 2006
32. Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis. Clinical article
- Author
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Xuhong Xue, Jianxiong Shen, Zheng Li, Jinqian Liang, Haiquan Yu, and Guixing Qiu
- Subjects
Adult ,Male ,medicine.medical_specialty ,China ,Adolescent ,medicine.medical_treatment ,Population ,Operative Time ,Blood Loss, Surgical ,Scoliosis ,Predictive Value of Tests ,Risk Factors ,Medicine ,Humans ,Surgical Wound Infection ,In patient ,Risk factor ,Surgical treatment ,education ,Child ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Spinal Fusion ,Treatment Outcome ,Spinal fusion ,Case-Control Studies ,Female ,business ,Erythrocyte Transfusion ,Body mass index ,BMI - Body mass index - Abstract
Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.
- Published
- 2014
33. Unplanned Reoperation within 30 Days of Fusion Surgery for Spinal Deformity
- Author
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Yu Zhao, Jianguo Zhang, Hong Zhao, Haiquan Yu, Guixing Qiu, Shugang Li, Jianxiong Shen, Zheng Li, Yipeng Wang, Jinqian Liang, Lijuan Zhao, and Xisheng Weng
- Subjects
Marfan syndrome ,Male ,Anatomy and Physiology ,Non-Clinical Medicine ,Epidemiology ,medicine.medical_treatment ,Orthopedic Surgery ,lcsh:Medicine ,Osteotomy ,Cohort Studies ,Risk Factors ,Clinical Epidemiology ,Achondroplasia ,lcsh:Science ,Child ,Musculoskeletal System ,Musculoskeletal Anatomy ,Multidisciplinary ,Statistics ,Implant failure ,Middle Aged ,Scoliosis ,Spinal fusion ,Child, Preschool ,Medicine ,Female ,Paraplegia ,Research Article ,Adult ,Reoperation ,medicine.medical_specialty ,Adolescent ,Clinical Research Design ,Biostatistics ,Spinal Curvatures ,Young Adult ,medicine ,Humans ,Statistical Methods ,Retrospective Studies ,Aged ,Health Care Policy ,business.industry ,lcsh:R ,Health Risk Analysis ,medicine.disease ,Reconstructive Surgery ,Surgery ,Spinal Fusion ,Coronal plane ,lcsh:Q ,business ,Mathematics - Abstract
No recent studies have analyzed the rates of or reasons for unanticipated revision surgery within 30 days of primary surgery in spinal deformity patients. Our aim was to examine the incidence, characteristics, reasons, and risk factors for unplanned revision surgery in spinal deformity patients treated at one institution. All patients with a diagnosis of spinal deformity presenting for primary instrumented spinal fusion at a single institution from 1998 to 2012 were reviewed. All unplanned reoperations performed within 30 days after primary surgery were analyzed in terms of demographics, surgical data, and complications. Statistical analyses were performed to obtain correlations and risk factors for anticipated revision. Of 2758 patients [aged 16.07 years (range, 2-71), 69.8% female] who underwent spinal fusion surgery, 59 (2.1%) required reoperation within 30 days after primary surgery. The length of follow up for each patient was more than 30 days. Of those that required reoperation, 87.0% had posterior surgery only, 5.7% had anterior surgery, and 7.3% underwent an anteroposterior approach. The reasons for reoperation included implant failure (n = 20), wound infection (n = 12), neurologic deficit (n = 9), pulmonary complications (n = 17), and coronal plane imbalance (n = 1). The risk factors for reoperation were age, diagnosis, and surgical procedure with osteotomy.
- Published
- 2014
34. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?
- Author
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Yipeng Wang, Zhi-jian Sun, Guixing Qiu, Jianxiong Shen, Jianguo Zhang, and Yu Zhao
- Subjects
musculoskeletal diseases ,Male ,Adolescent ,Radiography ,Idiopathic scoliosis ,Selective fusion ,Thoracic Vertebrae ,Young Adult ,Lumbar ,Pedicle Screws ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pedicle screw ,Child ,Retrospective Studies ,Posterior fusion ,Lumbar Vertebrae ,business.industry ,Follow up studies ,Anatomy ,musculoskeletal system ,Vertebra ,medicine.anatomical_structure ,Spinal Fusion ,Scoliosis ,Surgery ,Female ,business ,Follow-Up Studies - Abstract
To determine fusion necessity to one level below lower-end vertebra (LEV+1) in selective posterior fusion of moderate thoracolumbar/lumbar (TL/L) idiopathic scoliosis.A total of 37 patients with moderate TL/L idiopathic scoliosis (Cobb angle of TL/L curve between 30° and 60°) were identified and three patients with TL/L curve Cobb angle more than 60° were excluded. And the follow-up period was at least 2 years. Lowest instrumented vertebra (LIV) was one level proximal to LEV in three patients, LEV in 22 patients and LEV+1 in 12 patients. The three patients with TL/L Cobb angle more than 60° were all fused to LEV+1. Clinical and various radiographic measurements were collected before surgery, post-surgery and during last follow-up, and analytical comparisons were made between LIV = LEV patients and LIV = LEV+1 patients.No significant difference was observed regarding clinical and radiographic parameters between LEV group and LEV+1 group preoperatively except LIV disc angle and LIV translation. The correction rate of unfused thoracic curve and TL/L curve was 52.7 and 79.9 % in LEV group and 52.5 and 83.7 % in LEV+1 group at the last follow-up, indicating no significant difference (P = 0.976 and P = 0.415, respectively). Coronal balance and sagittal alignments were also comparable between the two groups. LIV translation was slightly less in LEV+1 group (P = 0.028) at the last follow-up on the basis that LEV+1 was less translated than LEV preoperatively.Our analysis almost showed no benefit for fusing to LEV+1 in moderate TL/L idiopathic scoliosis patients undergoing posterior selective fusion with pedicle screws. For patients with TL/L Cobb angle more than 60°, the distal fusion level probably needs to be LEV+1.
- Published
- 2013
35. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study
- Author
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Yu Fan, Jianxiong Shen, Jinqian Liang, Sooyong Chua, Jiliang Zhai, Si-Yi Cai, Xuhong Xue, Zheng Li, and Bin Feng
- Subjects
Male ,medicine.medical_specialty ,Blood transfusion ,Adolescent ,medicine.medical_treatment ,Scoliosis ,law.invention ,Blood Transfusion, Autologous ,Young Adult ,Randomized controlled trial ,law ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Prospective cohort study ,Child ,Aged ,Retrospective Studies ,business.industry ,Operative Blood Salvage ,Retrospective cohort study ,medicine.disease ,Surgery ,Spinal Fusion ,Spinal fusion ,Anesthesia ,Cohort ,Multivariate Analysis ,Female ,Neurosurgery ,business - Abstract
To determine the safety and efficacy of intraoperative cell salvage system in decreasing the need for allogeneic transfusions in a cohort of scoliosis patients undergoing primary posterior spinal fusion with segmental spinal instrumentation.A total of 110 consecutive scoliosis patients undergoing posterior instrumented spinal fusion were randomized into two groups according to whether a cell saver machine for intraoperative blood salvage was used or not. Data included age, body mass index, perioperative hemoglobin levels, surgical time, levels fused, perioperative estimated blood loss, perioperative transfusions and incidence of transfusion-related complications. A Chi-square test and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates to investigate the predictive factors of perioperative transfusion.Perioperative allogenic blood transfusion rate was lower in the cell saver group (14.5 versus 32.7%, p = 0.025). Mean intraoperative red blood cell transfusion requirement was also lower (0.21 U/pt versus 0.58 U/pt, p = 0.032). A multivariate analysis demonstrated that no. of fused segments (OR: 1.472; p = 0.005), preoperative hemoglobin level (OR: 0.901; p = 0.001), and the use of cell saver system (OR: 0.133; p = 0.003) had a trend toward significance in predicting likelihood of transfusion.Cell saver use significantly reduces the need for allogeneic blood in spine deformity surgery, particularly in patients with low preoperative hemoglobin or longer operation time. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for scoliosis patients.
- Published
- 2013
36. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center
- Author
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Guixing Qiu, Ye Tian, Shugang Li, Jianxiong Shen, Jianguo Zhang, Yipeng Wang, Weiqiang Liang, Hong Zhao, Bin Yu, and Yu Zhao
- Subjects
Male ,Vertebrae ,Pulmonology ,Pleural effusion ,Fistula ,medicine.medical_treatment ,Kyphosis ,lcsh:Medicine ,Pathology and Laboratory Medicine ,Osteotomy ,Nervous System Procedures ,0302 clinical medicine ,Medicine and Health Sciences ,Child ,lcsh:Science ,Musculoskeletal System ,030222 orthopedics ,Multidisciplinary ,Middle Aged ,Hemothorax ,Child, Preschool ,Spinal fusion ,Female ,Anatomy ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Surgical and Invasive Medical Procedures ,Ribs ,Spinal Curvatures ,Young Adult ,03 medical and health sciences ,Signs and Symptoms ,Rheumatology ,Diagnostic Medicine ,medicine ,Humans ,Skeleton ,Fistulas ,Aged ,Surgical Resection ,business.industry ,lcsh:R ,Biology and Life Sciences ,Chylothorax ,medicine.disease ,Spine ,Surgery ,Pleural Effusion ,Spinal Fusion ,Logistic Models ,lcsh:Q ,business ,Pleurodesis ,030217 neurology & neurosurgery - Abstract
Objectives To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery. Methods The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression. Results Among the 28 patients with postoperative pleural effusion, 24 (85.7%) suffered from hemothorax, 2 (7.1%) from chylothorax, and 2 (7.1%) from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%), on the concave side in 4 patients (14.3%), and on both sides in 4 patients (14.3%). One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old), congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery. Conclusions The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325), and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old), congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.
- Published
- 2016
37. Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary results of a single center
- Author
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Shengru, Wang, Jianguo, Zhang, Guixing, Qiu, Yipeng, Wang, Shugang, Li, Yu, Zhao, Jianxiong, Shen, and Xisheng, Weng
- Subjects
Male ,Adolescent ,Prostheses and Implants ,Spine ,Osteotomy ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Child, Preschool ,Humans ,Female ,Kyphosis ,Child ,Retrospective Studies - Abstract
Retrospective study.To evaluate clinical outcomes of dual growing rod (GR) technique in treating children with congenital scoliosis (CS).Published reports on the dual GR technique results of early-onset scoliosis demonstrate it to be safe and effective. However, the use of GR in congenital spinal deformities is controversial, and there have been no reports on the results and complications of dual GR technique for CS with large series of patients.During 2004 to 2009, a total of 30 patients with CS underwent dual GR procedures. Of the 159 total procedures conducted within the treatment period, 125 were lengthenings with an average of 4.2 lengthenings per patient. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographical evaluation was conducted.The mean scoliosis improved from 72.3° to 34.9° after initial surgery and was 35.2° at the last follow-up or after final fusion. T1-S1 length increased from 25.42 to 29.03 cm after initial surgery and to 33.32 cm at last follow-up or after final fusion with an average T1-S1 length increase of 1.49 cm per year. The space available for lung ratio in patients with thoracic curves improved from 0.84 to 0.96 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications.The dual GR technique is safe and effective in the treatment of selected cases of long, complex CS. It maintains correction achieved at initial surgery while allowing spinal growth to continue. And it has an acceptable rate of complications. The osteotomy at the apex vertebra with short segmental fusion of the severe rigid scoliosis or the patients with kyphosis could help to improve the correction and decrease the implant failures, with little influence on the length of the spine.
- Published
- 2012
38. The position of the aorta relative to the spine for pedicle screw placement in the correction of idiopathic scoliosis
- Author
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Hong Zhao, Shugang Li, Jianxiong Shen, Yipeng Wang, Guixing Qiu, Jiaming Liu, and Jianguo Zhang
- Subjects
Male ,medicine.medical_specialty ,Lamina ,Adolescent ,medicine.medical_treatment ,Bone Screws ,Idiopathic scoliosis ,Aorta, Thoracic ,Scoliosis ,Thoracic Vertebrae ,Young Adult ,medicine.artery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pedicle screw ,Child ,Aorta ,business.industry ,Anatomy ,medicine.disease ,Surgery ,Position (obstetrics) ,Spinal Fusion ,Spinal fusion ,Female ,Neurology (clinical) ,Tomography ,business ,Tomography, X-Ray Computed - Abstract
Study design An analysis of computed tomography (CT) images of patients with adolescent thoracic idiopathic scoliosis for posterior pedicle screw placement. Objective To evaluate the relative position of the aorta to the spine by the axial CT scans in patients with right thoracic idiopathic scoliosis, and to discuss the safe trajectory and screw length for posterior pedicle screw placement. Summary of background data Posterior pedicle screw instrumentation and fusion are widely used in the correction of scoliosis. Pedicle screw placement in the thoracic spine implies risk of injuring the aorta. Literatures on the relative position of the aorta to the spine are mostly focused on the anterior surgery. However, few are reported about the posterior surgery. Methods A total of 47 patients with adolescent right thoracic idiopathic scoliosis who underwent CT scan of total spine before surgery were included in this study. Transverse plane including bilateral pedicles, lamina, and transverse process was selected for measurement from T4 to T12. We defined a new coordinate system, and 5 parameters were measured in each vertebral body from T4 to T12 of the patients. The point where the left pedicle axial line and the base of the left transverse process intersected was defined as the origin of the coordinate system. A line connecting bilateral intersection was defined as x-axis. y-axis perpendicular to the x-axis is drawn ventrally from the origin. The left pedicle-aorta angle (α), the left aorta angle (β), the left pedicle-aorta distance (PAD), the aorta-x-axis distance (AXD), and the vertebral rotation angle (γ) were measured. Results The values of angles α and β had a tendency of first increasing and then decreasing, and increasing again from T4 to T12. The lowest value of angle α occurred at T10 (7.45±6.10 degrees), followed by T4 (8.89±6.49 degrees), T11 (9.13±7.59 degrees), and T9 (9.74±6.11 degrees). PAD and AXD values had a tendency of decreasing first and then increasing from T4 to T12. The lowest values of PAD and AXD occurred at T6; 25.94±5.33 and 23.64±6.53 mm, respectively. From the cephalad to the caudal spine, angle γ increased first and then decreased. The highest value occurred at T7 (2.32±6.83 degrees), which rotated to the right side. The second largest value occurred at T8 (2.23±7.76 degrees). Statistical analysis indicated that the apical vertebral translation and vertebral rotation angle were significantly positively correlated to angles α and β (P Conclusions The highest risk of injuring the aorta when placing pedicle screw during posterior scoliosis surgery was at T10, followed by T4, T11, and T9 in right thoracic idiopathic scoliosis. Taking a spine CT scan and evaluating the relative position of the aorta to the thoracic spine before surgery are significant in precise and safe pedicle screw placement.
- Published
- 2012
39. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation
- Author
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Jianguo Zhang, Bin Yu, Hong Zhao, Jianxiong Shen, Xin-yu Yang, Guixing Qiu, Yu Zhao, and Yipeng Wang
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Bone Screws ,Idiopathic scoliosis ,Scoliosis ,Concave side ,Thoracic Vertebrae ,medicine ,Internal fixation ,Humans ,Decompensation ,Pedicle screw ,Child ,Postural Balance ,Retrospective Studies ,business.industry ,Lumbosacral Region ,General Medicine ,Lumbar Curve ,medicine.disease ,Spine ,Surgery ,Radiography ,Spinal Fusion ,Coronal plane ,Female ,business - Abstract
To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion,By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed,Totally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8 degrees and 47.4 degrees, respectively. After surgery, they were corrected to 13.7 degrees and 6.8 degrees, respectively. At final follow-up, they were 17.0 degrees and 9.5 degrees, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6 degrees and 35.2 degrees, respectively. After surgery, they were corrected to 8.6 degrees and 8.3 degrees, respectively. At final follow-up, they were 10.3 degrees and 11.1 degrees, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P = 0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1 degrees and 1.8 degrees, 2.4 degrees and 2.4 degrees, respectively. No significant difference was noted (both P0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P0.05).Both all pedicle screws and hybrid instrumentation can offer good correction results of the thoracic curve and lumbar curve in posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. While with all pedicle screws, the correction results of the thoracic curve and lumbar curve are both better than those with hybrid instrumentation without increased decompensation rate.
- Published
- 2009
40. The changes of the interspace angle after anterior correction and instrumentation in adolescent idiopathic scoliosis patients
- Author
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Yipeng Wang, Jia-yi Li, Guixing Qiu, Bin Yu, Jianguo Zhang, Xisheng Weng, Qi Fei, Qi-yi Li, and Jianxiong Shen
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musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Case Study ,business.industry ,medicine.medical_treatment ,Idiopathic scoliosis ,Lumbar Curve ,musculoskeletal system ,Caudal vertebra ,Vertebra ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Spinal fusion ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Instrumentation (computer programming) ,lcsh:RC925-935 ,business - Abstract
Background In idiopathic scoliosis patients, after anterior spinal fusion and instrumentation, the discs (interspace angle) between the lowest instrumented vertebra (LIV) and the next caudal vertebra became more wedged. We reviewed these patients and analyzed the changes of the angle. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients underwent anterior spinal fusion and instrumentation, Cobb angle of the curve, correction rate, coronal balance, LIV rotation, interspace angle were measured and analyzed. Results There were total 30 patients included. The mean coronal Cobb angle of the main curve (thoracolumbar/lumbar curve) before and after surgery were 48.9° and 11.7°, respectively, with an average correction rate of 76.1%. The average rotation of LIV before surgery was 2.1 degree, and was improved to 1.2 degree after surgery. The interspace angle before surgery, on convex side-bending films, after surgery, at final follow up were 3.2°, -2.3°, 1.8° and 4.9°, respectively. The difference between the interspace angle after surgery and that preoperatively was not significant (P = 0.261), while the interspace angle at final follow-up became larger than that after surgery, and the difference was significant(P = 0.012). The interspace angle after surgery was correlated with that on convex side-bending films (r = 0.418, P = 0.022), and the interspace angle at final follow-up was correlated with that after surgery (r = 0.625, P = 0.000). There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007). Conclusion The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up. The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.
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- 2007
41. Congenital Scoliosis in Smith–Magenis Syndrome
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Jinqian Liang, Lin Sheng, Jianxiong Shen, and Zheng Li
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Scoliosis ,Smith–Magenis syndrome ,medicine.disease ,Short stature ,Surgery ,Obstructive sleep apnea ,Spinal fusion ,Agenesis ,medicine ,Craniofacial ,medicine.symptom ,business ,Tetralogy of Fallot - Abstract
The Smith–Magenis syndrome (SMS) is a complex and rare congenital condition that is characterized by minor craniofacial anomalies, short stature, sleep disturbances, behavioral, and neurocognitive abnormalities, as well as variable multisystemic manifestations. Little is reported about spinal deformity associated with this syndrome. This study is to present a case of scoliosis occurring in the setting of SMS and explore the possible mechanisms between the 2 diseases. The patient is a 13-year-old Chinese female with congenital scoliosis and Tetralogy of Fallot, mental retardation, obstructive sleep apnea, hypertrophy of tonsil, conductive hearing loss, and agenesis of the epiglottis. An interphase fluorescent in situ hybridization at chromosome 17p11.2 revealed a heterozygous deletion, confirming a molecular diagnosis of SMS. She underwent a posterior correction at thoracic 1-lumbar 1 (T1-L1) levels, using the Moss-SI spinal system. At 6-month follow-up, the patient was clinically pain free and well balanced. Plain radiographs showed solid spine fusion with no loss of correction. Congenital cardiac disease, immunodeficiency, and severe behavioral problems can affect the surgical outcome following spine fusion and need to be taken into consideration for the surgeon and anesthesiologist. Scoliosis is not uncommon among patients with SMS, and there is a potential association between congenital scoliosis and SMS. The potential mechanisms in the pathogenesis of congenital scoliosis of SMS included retinoic acid-induced 1 (RAI1) microdeletion and RAI1 gene point mutation.
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- 2015
42. A new operative classification of idiopathic scoliosis: a peking union medical college method
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Guixing Qiu, Jianguo Zhang, Yipeng Wang, Hongguang Xu, Jia Zhang, Xisheng Weng, Jin Lin, Yu Zhao, Jianxiong Shen, Xinyu Yang, Keith DK Luk, Duosai Lu, and William W. Lu
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Male ,medicine.medical_specialty ,China ,Supine position ,Adolescent ,Radiography ,Scoliosis ,Surgical planning ,Hospitals, University ,Cohen's kappa ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective cohort study ,Reliability (statistics) ,Retrospective Studies ,Observer Variation ,business.industry ,Reproducibility of Results ,Retrospective cohort study ,medicine.disease ,Spine ,Surgery ,Spinal Fusion ,Female ,Neurology (clinical) ,Radiology ,business - Abstract
Study design A retrospective radiographic study on the type of surgically treated idiopathic scoliosis, with a prospective study on the reliability of the type-related fusion guide. Objectives To identify and classify surgically treated idiopathic scoliosis, and define its related fusion levels by a new classification system. Summary of background data Some classification methods for idiopathic scoliosis have been suggested. However, poor intraobserver reproducibility and interobserver reliability were experienced in these studies, and were not appropriate for guiding surgical planning. Methods A total of 427 surgically treated idiopathic scoliosis cases were reviewed. Preoperative and postoperative standing anteroposterior, lateral, and preoperative supine side-bending radiograph were analyzed using the Scoliosis Research Society definition of scoliosis and curve apex. The resulting classification was tested for intraobserver reliability and interobserver reliability, and by 6 surgeons. Apical frequencies were determined for each type, and prospective surgical testing of the new type and its related fusion guide was performed. Results Three major types and 13 subtypes were identified, of which the Peking Union Medical College type I accounted for 56.62%, type II 42.16%, and type III 1.22%. The interobserver reliability testing was 85% (kappa coefficient 0.832), while intraobserver reproducibility was 91% (kappa coefficient 0.898). Each type had its corresponding fusion levels. A prospective study of 152 cases was performed according to the classification. All of these cases were followed over 18 months, and no postoperative decompensation was noted. Conclusion The Peking Union Medical College classification of idiopathic scoliosis is one system to combine each type with its corresponding fusion level, and it had much higher interobserver reliability and intraobserver reproducibility than the King system. Further prospectivestudies would help to clarify and expand this system.
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- 2005
43. Anterior spinal fusion with TSRH instrumentation for scoliosis
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Jianxiong, Shen, Guixing, Qiu, Xisheng, Weng, Hong, Zhao, Jin, Jin, Yipeng, Wang, Qibin, Ye, and Jin, Lin
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Adult ,Male ,Lumbar Vertebrae ,Adolescent ,Bone Screws ,Internal Fixators ,Thoracic Vertebrae ,Radiography ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Humans ,Female ,Child ,Follow-Up Studies ,Retrospective Studies - Abstract
To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.
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- 2003
44. Congential scoliosis in Wilson’s disease: case report and review of the literature
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Jianxiong Shen, Jinqian Liang, Zheng Li, and Xin Yu
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Case Report ,Disease ,Lumbar vertebrae ,Scoliosis ,Thoracic kyphosis ,Thoracic Vertebrae ,Hepatolenticular Degeneration ,medicine ,Humans ,education ,Child ,education.field_of_study ,Lumbar Vertebrae ,business.industry ,General Medicine ,medicine.disease ,Wilson’s disase ,Surgery ,Wilson's disease ,medicine.anatomical_structure ,Spinal Fusion ,Spinal fusion ,Thoracic vertebrae ,Congential scoliosis ,Female ,business - Abstract
Background Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism, which leads to the accumulation of this metal in liver, brain, cornea and kidney. Little is reported about spinal deformity associated with this syndrome. This study is to present a case of thoracic kyphosis occurring in the setting of Wilson’disease and explore the possible association between the two diseases. Case presentation Case report and literature review. A previously unreported thoracic kyphosis in Wislon’s disease is decribed. The patient was a 7-year-old Chinese female that underwent a posterior correction, using the Moss-SI spinal system performed at Thoracic 9-Lumbar 1 (T9-L1) levels. At 16-month follow-up, the patient was clinically pain free and well balanced. Plain radiographs showed solid spine fusion with no loss of deformity correction. After evaluating 211 WD patients referred to Peking Union Medical College Hospital from February 1991 to February 2012, the prevalence of congential scoliosis among patients with WD was 5.21% (11/211), much higher than that among general population (1/1000). Conclusions To the best of our knowledge, this is the first report of WD with thoracic kyphosis. During sugery, surgeons and anesthesiologists must pay particular attention to the abnormal liver and brain function associated with WD. The prevalence of scoliosis is much higher among patients with WD, indicating a potential association between congential scoliosis and WD. However, the exact mechanism how copper-chelating agents induce scoliosis is unclear.
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- 2014
45. Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation: It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status.
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Jianxiong Shen, Jianguo Zhang, Fan Feng, Yipeng Wang, Guixing Qiu, Zheng Li, Shen, Jianxiong, Zhang, Jianguo, Feng, Fan, Wang, Yipeng, Qiu, Guixing, and Li, Zheng
- Subjects
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SCOLIOSIS treatment , *CONGENITAL disorders , *SPINAL surgery , *HEALTH outcome assessment , *SPINAL cord abnormalities , *THERAPEUTICS , *SCOLIOSIS complications , *SPINAL cord surgery , *LONGITUDINAL method , *NEURAL tube defects , *SCOLIOSIS , *SPINAL fusion , *SURGICAL complications , *TREATMENT effectiveness , *DISEASE complications - Abstract
Background: The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction.Methods: This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering.Results: On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p < 0.05). In the type-I group, the correction rate was 48.9% at 1 week postoperatively and 42.2% at the last follow-up. In the type-II group, the correction rate was 54.7% at 1 week postoperatively and 47.9% at the last follow-up. Eleven (5.1%) of the patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up.Conclusions: Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological intervention. For such patients with intact or stable neurological status, prophylactic detethering prior to scoliosis surgery may not be necessary.Level Of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]- Published
- 2016
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46. Surgical correction of hyperlordosis in facioscapulohumeral muscular dystrophy: A case report.
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Haining Tan, Fan Feng, Youxi Lin, Chong Chen, Zheng Li, Jianxiong Shen, Tan, Haining, Feng, Fan, Lin, Youxi, Chen, Chong, Li, Zheng, and Shen, Jianxiong
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LORDOSIS ,FACIOSCAPULOHUMERAL muscular dystrophy ,BRACING (Structural engineering) ,SCOLIOSIS ,SURGERY ,PATIENTS ,THERAPEUTICS ,HEALTH surveys ,MUSCULAR dystrophy ,QUALITY of life ,QUESTIONNAIRES ,SPINAL fusion ,TREATMENT effectiveness - Abstract
Background: Hyperlordosis is common in facioscapulohumeral muscular dystrophy (FSHD), which cannot be controlled by bracing. While the surgical treatment is neither reported nor recommended in previous studies, we report the first corrective surgery for hyperlordosis in one wheelchair-dependent FSHD patient.Case Presentation: A 15-year-old, wheelchair-dependent girl complaining of hyperlordosis and lower extremity weakness was diagnosed as FSHD. Preoperative examination showed hyperlordosis of 116° with scoliosis of 44°. Posterior correction and bone graft fusion was performed. Postoperatively, the hyperlordosis was corrected to 72° and better sitting posture was gotten. 12 months' follow-up showed favorable correction with improvement in SF-36 and ODI score.Conclusions: The correction for hyperlordosis in FSHD is controversial. We report the first successful case of operative treatment by corrective spine surgery in these rare and demanding patient collective. Corrective surgery for spinal deformity, such as hyperlordosis and scoliosis, could do some help in posture and improve the quality of life especially in wheelchair-dependent patients. [ABSTRACT FROM AUTHOR]- Published
- 2017
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47. Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves
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Yipeng Wang, Jianguo Zhang, Yang Yang, Yanbin Zhang, Jianwei Guo, Jianxiong Shen, Shengru Wang, and Guanfeng Lin
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Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Thoracolumbar or lumbar ,Maximal correction ,Adolescent ,Radiography ,Idiopathic scoliosis ,Selective fusion ,Thoracic Vertebrae ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Pedicle Screws ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Pedicle screw ,Retrospective Studies ,030222 orthopedics ,Fusion ,Lumbar Vertebrae ,business.industry ,General Medicine ,Orthopaedic Surgery ,Surgery ,Indication ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Disc wedging ,Orthopedic surgery ,Female ,business ,Nuclear medicine ,030217 neurology & neurosurgery - Abstract
Introduction Posterior selective thoracolumbar or lumbar (TL/L) fusion with pedicle screw constructs for adolescent idiopathic scoliosis (AIS) has been studied in a few researches. However, few studies have discussed the indication for selective TL/L fusion and the behaviors of its adjacent disc angle. The present study aims to discuss the indication for posterior selective TL/L fusion and the behavior of the adjacent disc angle. Methods 45 consecutive cases of AIS undergoing posterior selective TL/L fusion were retrospectively evaluated, with an average follow-up of 36 months. Radiographs were reviewed to determine the coronal curve magnitude and the sagittal alignment preoperatively, postoperatively and at final follow-up. Thoracic curves in groups A had a correction loss of more than 5°, while thoracic curves in group B had a correction loss of not more than 5°. Results The coronal curve magnitude of the TL/L curve averaged 44° preoperatively and it was corrected to 6° immediately with a correction rate of 84.8 %. At final follow-up it was 9° with a correction loss of 3°. The minor thoracic curve was 26° preoperatively, and the convex side bending curve magnitude averaged 8° with a flexibility of 72.7 %. It was corrected to 13° immediately with a spontaneous correction of 48.5 %. At final follow-up it was 14° with a correction loss of 1°. UIVA decreased from 4° to 2° after surgery, and it was 2° at final follow-up. LIVA decreased from 7° to 4° after surgery, and it was 5° at final follow-up. Maximal correction of TL/L curves in group A is significantly less than that in group B. 1 patient received revision surgery to fuse the progressive thoracic curve. Conclusion Posterior selective TL/L fusion with pedicle screw constructs allows for spontaneous thoracic correction and maintains coronal and sagittal balance during the follow-up. Maximal correction instead of undercorrection was recommended for moderate Lenke 5C curves. Disc wedging could be improved after surgery and well maintained during the follow-up.
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48. The effect of growing Rod treatment on coronal balance during serial lengthening surgeries in early onset scoliosis
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Yu Zhao, Shugang Li, Jianxiong Shen, Wenjing Li, Zhi-jian Sun, Jianguo Zhang, Hong Zhao, Yipeng Wang, Shigong Guo, and Guixing Qiu
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Male ,medicine.medical_specialty ,Growing rod ,Adolescent ,Radiography ,Pelvic inlet ,Coronal balance ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Balance (ability) ,030222 orthopedics ,Cobb angle ,business.industry ,Early onset scoliosis ,Lengthening surgery ,Internal Fixators ,Surgery ,medicine.anatomical_structure ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Coronal plane ,Child, Preschool ,Orthopedic surgery ,Female ,business ,Nuclear medicine ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Gaining and maintaining spinal balance after surgery is of great importance for early onset scoliosis (EOS). However, tendency of balance on the coronal plane after growing rod surgery has not been studied before. This study evaluated the effect of growing rod treatment on coronal balance (CB) during serial lengthening surgeries in EOS. Methods All EOS patients treated with growing rod technique in our hospital from August 2002 to June 2014 were retrospectively reviewed. Radiographic data before the sixth lengthening surgery were measured on the posteroanterior X-ray images, including global CB (C7 plumbline-central sacral vertical line, C7PL-CSVL), regional CB (apical vertebrae-CSVL), Cobb angle of the main curve and pelvic inlet width (PIW). Global CB index and regional CB index were calculated as dividing global CB and regional CB by PIW, respectively. The changes of these parameters during repeated lengthening surgeries were analyzed. Results Five hundred seventy Radiographs of 67 patients, including 134 images before and after growing rod insertion surgeries and 436 images pre- and post-lengthening surgeries were measured. Global CB and global CB index did not show significant differences between every two set points during lengthening procedures (P > 0.05). The percentage of patients with C7PL-CSVL distance more than 20 mm roughly ranged from 30 to 45 % during the lengthening process. With regards to regional CB and main curve Cobb angles, there were significant differences between every two adjacent set points during the first five lengthening surgeries (P
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49. Anterior Spinal Fusion Versus Posterior Spinal Fusion for Moderate Lumbar/Thoracolumbar Adolescent Idiopathic Scoliosis: A Prospective Study.
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Yipeng Wang, Qi Fei, Guixing Qiu, Lee, Chia I., Jianxiong Shen, Jianguo Zhang, Hong Zhao, Yu Zhao, Hai Wang, and Suomao Yuan
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SPINAL fusion , *SCOLIOSIS , *ARTHRODESIS , *SPINAL surgery , *SURGERY - Abstract
The article discusses the results of a study which compared radiologic and clinical outcomes, efficiency and cost between anterior spinal fusion (ASF) and posterior spine fusion (PSF) in surgical treatment of moderate lumbar/thoracolumbar adolescent idiopathic scoliosis (AIS). The study found shorter fusion levels and reduced surgical trauma and costs in ASF.
- Published
- 2008
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