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Xu HF, Li C, Ma ZS, Wu ZX, Sha J, Diwu WL, Yan YB, Liu ZC, Fan ZZ, Huang LY. Closing-opening wedge osteotomy for the treatment of congenital kyphosis in children. J Orthop Surg (Hong Kong) 2022; 30:10225536221118600. [PMID: 36120861 DOI: 10.1177/10225536221118600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To evaluate the safety and effectiveness of posterior closed-open wedge osteotomy for treatment of congenital kyphosis in children. METHODS Imaging and clinical data from January 2010 to December 2019 of posterior closed-open wedge osteotomy of congenital kyphosis with at least 2-year follow up was analyzed retrospectively. Perioperative indicators such as operation time, osteotomy site, osteotomy method and occurrence of complications, and imaging indicators were observed. The 3D printed models were used to measure the expanded distance of anterior edge vertebra and closed length of spinal canal line. The clinical effect was evaluated through SRS-22 questionnaires. RESULTS There were 15 CK patients in this study. The osteotomy segments and details are as follows: 1 case each for T6-9 and L2, 2 cases at T11, 3 cases at T12, and 6 cases at L1. The average operation time was 314 min, the average blood loss was 970 mL, the average fusion range was 6.3 segments, and the average time of follow up was 70.5 months. The Cobb angle of local kyphosis was corrected from 65.6 ± 18.8° to 11.3 ± 7.1°(p < .001). The range of kyphosis correction was 40-90°, and average correction rate was 83.2% (67.7-95.7%). The correction was stable in follow-up, and the kyphotic angle was 11.0 ± 7.6 (p = .68). The preoperative SVA was 31.5 ± 21.8 mm, and the postoperative recovery was 18.0 ± 15.5, while the last follow-up was 9.1 ± 7.9. The p values were 0.02 and 0.07 respectively. By using 3D printed models, the expanded distance of anterior edge vertebra and closed length of spinal canal line were 14.5 ± 7.5 mm and 24.5 ± 8.0 mm respectively. Self-image and satisfaction in SRS-22 improved significantly. There was no recurrence of deformity and junctional kyphosis. CONCLUSIONS The posterior closing-opening wedge osteotom for treatment of congenital kyphosis in children is satisfactory, if selected appropriately. During the longitudinal follow-up, the patients could achieve solid fusion and the correction could be well maintained.Evidence of Confidence: IVa.
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Affiliation(s)
- Hui-Fa Xu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Chao Li
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zhen-Sheng Ma
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zi-Xiang Wu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jia Sha
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Wei-Long Diwu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ya-Bo Yan
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zhi-Chen Liu
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Zong-Zhi Fan
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lu-Yu Huang
- Department of Orthopedics, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
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Koepke LG, Weiser L, Stangenberg M, Dreimann M, Heuer A, Strahl A, Viezens L. Outcome after Posterior Vertebral Column Resection in Patients with Severe Osteoporotic Fractures—A Retrospective Analysis from Two Centers. Medicina (B Aires) 2022; 58:medicina58020277. [PMID: 35208600 PMCID: PMC8879154 DOI: 10.3390/medicina58020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: In osteoporotic fractures of the spine with resulting kyphosis and threatening compression of neural structures, therapeutic decisions are difficult. The posterior vertebral column resection (pVCR) has been described by different authors as a surgical treatment in a single-stage posterior procedure. The aim of this study is to evaluate midterm outcomes of patients treated by pVCR due to severe osteoporotic fractures. Materials and Methods: Retrospective data analysis of all the patients treated for osteoporotic fractures by pVCR from 2012–2020 at two centers was performed. Demographic data, visual analog scale (VAS), Frankel scale (FS), Karnofsky performance status (KPS), radiological result and spinal fusion rates were evaluated. Results: A total of 17 patients were included. The mean age was 70 ± 10.2 y. The mean VAS decreased significantly from 7.7 ± 2.8 preoperatively to 3.0 ± 1.6 at last follow-up (p < 0.001) and the segmental kyphosis decreased from 29.4 ± 14.1° to 7.9 ± 8.0° (p < 0.001). The neurologic function on the FS did not worsen in any and improved in four of the patients. The median KPS remained stable over the whole observation period (70% vs. 70%). Spinal fusion was observed in nine out of nine patients who received CT follow-up >120 days after index surgery. Conclusions: This study showed that pVCR is a safe surgical technique with few surgical complications and no neurological deterioration considering the cohort. The patients’ segmental kyphosis and VAS improved significantly, while the KPS remained stable.
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Affiliation(s)
- Leon-Gordian Koepke
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
- Correspondence: ; Tel.: +49-17632605843
| | - Lukas Weiser
- Clinic for Trauma, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-Universität, 37075 Göttingen, Germany;
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
| | - Annika Heuer
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - André Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
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Enz A, Kostuj T, Warnke P, Osmanski-Zenk K, Mittelmeier W, Klinder A. Intraoperative damage to surgical gloves during various operations on the musculoskeletal system: a multicenter study. Arch Orthop Trauma Surg 2022; 142:57-65. [PMID: 32862266 PMCID: PMC8732942 DOI: 10.1007/s00402-020-03594-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Various orthopedic surgical procedures cause mechanical stress for gloves. In some cases, sharp-edged objects impact on the glove surfaces. The systematic description of lesions is still missing. METHODS 2289 gloves from 409 surgeries [primary hip and knee arthroplasties (PA), revisions arthroplasties (RA) and arthroscopic shoulder, hip and knee surgery (AY)] from 3 clinics were examined for lesions using water tightening test according to the European norm EN 455-1. RESULTS Arthroscopies showed the lowest rate of operations with damaged gloves (6.9%). Depending on clinic, 32.7% and 59.2% of PA surgeries generated damaged gloves, while in RA, these numbers rose to 76.0% and 72.8%, respectively. In PA and RA, the most affected finger was the index finger, whereas in arthroscopies, more damage occurred on the middle finger and the thumb. The size of the lesions was rather small with the vast majority being 1 mm or 2 mm in size. CONCLUSION All investigated interventions led to glove lesions. With increasing mechanical stress, the number of glove defects increased. EN 455 does not account for the intraoperative tear risk. Stricter requirements for gloves should be introduced. Glove change intervals should be defined and implemented, and new materials should be developed.
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Affiliation(s)
- Andreas Enz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany.
| | - Tanja Kostuj
- Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm, Hamm, Germany
| | - Philipp Warnke
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock, Rostock, Germany
| | - Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | - Annett Klinder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Pehlivanoglu T, Erdag Y, Oltulu I, Akturk UD, Korkmaz E, Yildirim K, Sarioglu E, Gun K, Ofluoglu E, Aydogan M. Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures' Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients. Neurospine 2021; 18:319-327. [PMID: 33657776 PMCID: PMC8255769 DOI: 10.14245/ns.2040812.406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain.
Methods One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically.
Results Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p = 0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p < 0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately.
Conclusion Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures’ sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.
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Affiliation(s)
- Tuna Pehlivanoglu
- Yeni Yuzyil University, Faculty of Health Sciences, Istanbul, Turkey.,Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Yigit Erdag
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ismail Oltulu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | | | - Emre Korkmaz
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Kerem Yildirim
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ender Sarioglu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Kerem Gun
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ender Ofluoglu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Mehmet Aydogan
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
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[Minimally invasive posterior and anterior stabilization of the thoracolumbar spine after traumatic injuries]. Unfallchirurg 2020; 123:752-763. [PMID: 32902669 DOI: 10.1007/s00113-020-00860-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Injuries of the thoracolumbar junction are the most common fractures of the spine due to their anatomical position and load. Common classification systems differentiate between stable and unstable injuries and thus also between operative and conservative therapy. The majority of injuries can be treated conservatively; however, unstable injuries require surgical treatment for a variety of reasons. In the grey area between stable and unstable injuries, a clinical decision based on clinical experience is necessary in order to select the best treatment. A wide variety of parameters must be included and a change in strategy from conservative to operative may also be necessary. Posterior instrumentation is the most common procedure; purely anterior stabilization is rarely used. The length of the instrumentation/spondylodesis depends on bone quality, age of the patient, and fracture. The decision as to whether anterior operative treatment should be performed depends on fracture morphology, success of reduction, and the resulting stability. The open surgical procedure is increasingly being replaced by minimally invasive procedures in posterior and anterior techniques but can be an advantage in complex injuries (B and C injuries according to AO). Hybrid procedures are also possible. This also applies to the treatment of osteoporotic fractures, since a clear assignment between traumatic and osteoporotic cause is not always easy and possible. This article describes the principles, the possible indications, and limitations of minimally invasive posterior and anterior stabilization.
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[Posttraumatic deformity of the thoracolumbar spine]. Unfallchirurg 2020; 123:143-154. [PMID: 32016493 DOI: 10.1007/s00113-019-00764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic kyphotic deformities of the thoracolumbar spine may result in significant clinical complaints. If conservative treatment is not successful, surgical correction of the kyphosis becomes an option. In contrast to degenerative deformities, posttraumatic kyphotic deformities are usual limited to few segments and can be treated with shorter constructs. The surgical strategy depends on the rigidity and the localization of the posttraumatic kyphotic deformity. In this respect purely posterior approaches and combined posteroanterior surgical approaches are available each with different advantages and disadvantages.
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