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Zhang J, Zhang C, Zhong W, Zhao Z, Han F, Han Z, Zhang H, Huang T, Luo X. Validity and reliability of a novel iPhone method to rapidly measure cervical sagittal parameters. Sci Rep 2022; 12:19579. [PMID: 36380107 PMCID: PMC9666521 DOI: 10.1038/s41598-022-21660-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
We introduced a novel method based on the iPhone's intrinsic photo edit function to measure sagittal parameters of the cervical spine. This study aimed to assess the validity of this new method compared with the picture archiving and communication system (PACS) method (the gold standard) and to test the reliability of this novel technique. One hundred consecutive patients admitted to our hospital diagnosed with cervical spondylotic myelopathy or cervical spondylotic radiculopathy were retrospectively reviewed. Four angles, including the C0-2 Cobb angle, C2-7 Cobb angle, T1S and neck tilt (NT), were assessed by iPhone and PACS. The validity and reliability were evaluated, and the time taken by both methods was compared. The ICCs of the validity of the C0-2 Cobb angle, C2-7 Cobb angle, T1S and NT were 0.960, 0.976, 0.980 and 0.946, respectively. The ICCs of the intraobserver reliability of the C0-2 Cobb angle, C2-7 Cobb angle, T1S and NT were 0.966, 0.983, 0.971 and 0.951, respectively. The ICCs of the interobserver reliability of the C0-2 Cobb angle, C2-7 Cobb angle, T1S and NT were 0.953, 0.972, 0.957 and 0.929, respectively. The Bland‒Altman plot of validity of the four angles revealed mean differences of 0.3, 0.2, 0.1, and 0.1 degrees with 95% CIs of 4.1, 4.1, 2.9, and 4.3 degrees, respectively. The iPhone measurement time (58.55 ± 4.17 s) was significantly less than that by the PACS (70.40 ± 2.92 s) when compared by the independent-samples T test (P < 0.001). This novel method using the iPhone's intrinsic photo edit function is accurate, reliable, fast and convenient when measuring cervical sagittal parameters.
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Affiliation(s)
- Jie Zhang
- grid.452206.70000 0004 1758 417XDepartment of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Chunyang Zhang
- Department of Orthopedic Surgery, People’s Hospital of Chongqing Banan District, Chongqing, 401320 People’s Republic of China
| | - Weiyang Zhong
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zenghui Zhao
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Fei Han
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zhenghan Han
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Hang Zhang
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Tianji Huang
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Xiaoji Luo
- grid.452206.70000 0004 1758 417XDepartment of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China ,grid.203458.80000 0000 8653 0555Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
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王 旭, 李 沐, 朱 宇, 朱 庆. [Application progress of implantation in surgical treatment of cervical tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:122-126. [PMID: 35038810 PMCID: PMC8844622 DOI: 10.7507/1002-1892.202107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/04/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review the characteristics and applications of different implantation in cervical tuberculosis surgery and the research progress of the new implantation. METHODS By consulting relevant domestic and foreign research literature on cervical tuberculosis, the classification, advantages, disadvantages, and prospects of implantations were analyzed and summarized. RESULTS The incidence of cervical tuberculosis has increased recently and has a high disability rate. Currently, the implantation in the surgical treatment of cervical tuberculosis are mainly divided into bone materials, metal materials, and bioactive materials; the above materials have their own advantages and disadvantages, for example, the amount of autologous bone is limited, the complications of allogeneic bone are common, and the bone fusion effect of metal materials is poor. With the development of science and technology, the implantation are also more diverse. CONCLUSION The choice of the implantation affects the bone fusion directly, furthermore, it affects the effectiveness of cervical tuberculosis, the development of new implantation provides a variety of options for the treatment of cervical tuberculosis.
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Affiliation(s)
- 旭 王
- 吉林大学中日联谊医院骨科(长春 130033)Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun Jilin, 130033, P. R. China
| | - 沐风 李
- 吉林大学中日联谊医院骨科(长春 130033)Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun Jilin, 130033, P. R. China
| | - 宇航 朱
- 吉林大学中日联谊医院骨科(长春 130033)Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun Jilin, 130033, P. R. China
| | - 庆三 朱
- 吉林大学中日联谊医院骨科(长春 130033)Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun Jilin, 130033, P. R. China
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Ma S, Yu H, Zhou Z, Wu C, Liu Z, Deng W, Cao K. Case Report of Angular Post-Tuberculotic Kyphosis Corrected Through Pedicle Subtraction Osteotomy Above C7. Oper Neurosurg (Hagerstown) 2022; 22:e53-e57. [PMID: 34982923 DOI: 10.1227/ons.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Angular cervical kyphosis and its association with syringomyelia were rarely described. Correcting this kind of deformity from the front is extremely difficult or even impossible. Meanwhile, no study has made a report about correcting angular cervical kyphosis through pedicle subtraction osteotomy (PSO) above C7 because of the special anatomy of the vertebral artery. This is the first case of cervical deformity correction through PSO above C7. CLINICAL PRESENTATION We present the case of a 52-yr-old man who previously underwent debridement, decompression, and skull traction for cervical tuberculosis at age 6 yr. The sequelae of right-hand weakness occurred after surgery, and cervical kyphosis formed gradually. The patient recently started to complain of a severe neck pain. X-rays showed a cervical sagittal malalignment due to the angular kyphosis. Computed tomography scans revealed a fused angular kyphosis at C6-7, and MRI showed a long syringomyelia distal to the kyphosis. The definite diagnosis of the patient was post-tuberculotic cervical angular kyphosis, and because of the extremely narrow surgery corridor from the front, we decided to perform the surgery in a posterior approach. Hence, the patient was treated with the PSO with a long-segment pedicle screw fixation from C3 to T5 and received satisfactory angular kyphosis correction. CONCLUSION PSO above C7 to correct angular cervical kyphosis is feasible and reasonable when there is no other better solution, and it can achieve a satisfactory kyphotic deformity correction.
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Affiliation(s)
- Shengbiao Ma
- Orthopaedics Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Yuan B, Zhao Y, Zhou S, Wang Z, Chen X, Jia L. Treatment for tuberculosis of the subaxial cervical spine: a systematic review. Arch Orthop Trauma Surg 2021; 141:1863-1876. [PMID: 32776174 DOI: 10.1007/s00402-020-03572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/02/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To systematically review the clinical manifestations and treatment outcomes of patients with subaxial cervical spinal tuberculosis (SCS-TB) and evaluate the current evidence for surgical or nonsurgical treatment. METHOD A systematic review was performed using the PubMed, ScienceDirect, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies published in English from January 2000 to December 2018 were included in the search. A reference lists search of relevant articles was also conducted for other potential references. The risk of bias was assessed with the 13-item criteria recommended by the Cochrane Back and Neck Group and the Methodological Index for Non-Randomized Studies. RESULTS Fifteen articles were included with a total of 456 patients, of which only 1 study was randomized and fourteen were nonrandomized. The most common symptom reported was neck pain and stiffness, and the most common segment involved was C5. Of the 456 patients, 329 (72.1%) were treated surgically. Most experienced neurologic recovery after surgery. Instrumentation resulted in maintenance of the correction of alignment throughout the follow-up period. The use of radical debridement is still in debate. CONCLUSIONS Anti-TB therapy is necessary for all SCS-TB patients, including those underwent surgical management. For patients with neurological dysfunction, the surgical method with decompression and instrumentation could provide better cervical spinal alignment and stability. For adult, the radical debridement remains in debate, while for children, radical debridement may cause the development of progressive kyphosis during growth. Larger randomized comparative studies with longer follow-up times are needed.
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Affiliation(s)
- Bo Yuan
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Zhiwei Wang
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China.
| | - Lianshun Jia
- Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
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Pan Z, Cheng Z, Wang JC, Zhang W, Dai M, Zhang B. Spinal Tuberculosis: Always Understand, Often Prevent, Sometime Cure. Neurospine 2021; 18:648-650. [PMID: 34610698 PMCID: PMC8497242 DOI: 10.14245/ns.2142788.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zhimin Pan
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zujue Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wei Zhang
- Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Dai
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Sagittal balance of the cervical spine: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1411-1439. [PMID: 33772659 DOI: 10.1007/s00586-021-06825-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/26/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls. METHODS Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively. RESULTS A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001). CONCLUSION The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.
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Midterm surgical results of the lamina with spinous process in treating one-level thoracic or lumbar tuberculosis: a retrospective study. Sci Rep 2020; 10:22036. [PMID: 33328557 PMCID: PMC7745010 DOI: 10.1038/s41598-020-79209-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 12/06/2020] [Indexed: 11/09/2022] Open
Abstract
A retrospective study investigated the results of the lamina with spinous process (LSP) as a bone graft in one-level thoracic or lumbar spinal tuberculosis with the one-stage posterior approach of debridement, fusion and internal instrumentation. Data from 35 patients from January 2013 to December 2015 were analysed. Surgery time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All of the patients were followed up for a mean 43.90 ± 10.39 months. The mean age, surgery time, blood loss, hospitalization time, hospital cost and drainage volume were 33.65 ± 11.06 years, 182.40 ± 23.82 min, 280.80 ± 76.82 mL, 14.05 ± 3.58 days, 74,382.00 ± 11,938.00 yuan, and 340.00 ± 167.20 mL, respectively. VAS and ODI were significantly improved at the final FU. The ESR and CRP recovered to normal. The mean angle of 24.35 ± 5.74°preoperatively showed a significant difference between 1 week, postoperatively and final FU. Although there were the loss of angle at final FU comparing with the 1 week postoperatively, it still maintain the good alignment and the segmental stability. All patients achieved bony fusion with a mean time of 12.90 ± 3.91 months. In conclusion, the LSP as a structural bone graft is reliable, safe and effective for segmental stability reconstruction, which could be one choice for surgical management of thoracic or lumbar spinal TB.
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Lee SH, Hyun SJ, Jain A. Cervical Sagittal Alignment: Literature Review and Future Directions. Neurospine 2020; 17:478-496. [PMID: 33022153 PMCID: PMC7538362 DOI: 10.14245/ns.2040392.196] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the '5W1H' framework; "WHO" are related?, "WHY" important?, "WHAT" to evaluate and "WHAT" is normal?, "HOW" to evaluate?, "WHEN" to apply sagittal balance?, and "WHERE" to go in the future?
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Affiliation(s)
- Sang Hun Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Seung-Jae Hyun
- Department of Neurological Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Garg B, Mehta N, Vatsya P. Surgical strategy for correction of severe, rigid, post-tubercular cervical kyphosis: an experience of two cases. Spine Deform 2020; 8:801-807. [PMID: 32185728 DOI: 10.1007/s43390-020-00104-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Case series. OBJECTIVES To describe a novel surgical strategy for severe, rigid post-tubercular cervical kyphosis with treatment outcomes in two patients. BACKGROUND DATA Spinal tuberculosis is a common cause of kyphotic deformity in the developing world with 3-5% of non-operatively managed patients ending up with kyphosis exceeding 60°. Ventral, dorsal and combined approaches have been described for cervical kyphosis, but there is no established surgical strategy for severe, rigid post-tubercular cervical kyphosis. METHODS We operated on two girls with severe, rigid cervical kyphosis with preoperative kyphosis measuring 98° and 62°. Our surgical strategy included a three-step approach in the same sitting-(1) An anterior approach to osteotomize the fused vertebral body mass, decompress the spinal cord ventrally and place a temporary cage to stabilize the spine, (2) A posterior approach to osteotomize the fused facets and decompress the cord dorsally. With the completion of the osteotomy, a combination of pedicle screws and lateral mass screws was used to correct the deformity via an anterior opening, posterior closing type of osteotomy. This was followed by, (3) An anterior approach to replace the corpectomy cage with a larger one supplemented with an anterior cervical plate. RESULTS Our 540° approach achieved a substantial improvement in each of the clinical and radiological parameters we measured, viz. C2-C7 lordosis angle, C2-C7 sagittal vertical axis, neck tilt and Neck Disability Index. CONCLUSION For severe, rigid post-tubercular cervical spine kyphosis, a three-step, anterior-posterior-anterior procedure can be used for achieving acceptable correction, improving symptoms and avoiding further progression. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Pulak Vatsya
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Hajiaheman Y, Yang Y, Shayilanbieke N, Jin G. Mycobacterium culturing and drug resistance of osteoarticular tuberculosis in Xinjiang, China. Medicine (Baltimore) 2020; 99:e19697. [PMID: 32311949 PMCID: PMC7220655 DOI: 10.1097/md.0000000000019697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to elucidate the strains and drug resistance of mycobacterium isolated from osteoarticular tuberculosis (OATB) patients and provide a reference for the diagnosis and treatment of OATB.Sixty-nine clinically diagnosed and surgically treated OATB patients were collected in time period of January 2017 to December 2018 at the First Affiliated Hospital of Xinjiang Medical University. The BACTEC MGIT 960 system was used for mycobacteria culturing, strain identification, and drug susceptibility testing, and the mycobacteria culture positive rate, species distribution, and drug resistance were analyzed.Within 4 weeks, 24 (34.78%) isolates of mycobacteria culture were positive; 40 (57.97%) isolates were positive, when culturing time was expanded to 8 weeks, and the difference was statistically significant (P < .05). Among the 40 isolates, 24 (60%) were identified as mycobacterium tuberculosis (MTB), 10 (25%) were Mycobacterium bovis, and 6 (15%) were non-tuberculous mycobacteria (NTM). Among total 69 isolates, 40 were enrolled in drug sensitivity test, and 15 (37.5%) isolates were confirmed drug resistant strains, in which 5 isolates were MTB, 4 isolates were M. bovis, and 6 isolates of NTM.The pathogen of clinically diagnosed OATB was mainly MTB. However, M. bovis and NTM also accounted for a considerable proportion, and their drug resistance rate was higher. Extending the culturing time appropriately could improve the culture positive rate. NTM was a drug resistant strain, and mycobacteria culturing, strain identification, and drug resistance analysis should be carried out to serve as a guide for individual treatment.
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Tang K, Li J, Huang T, Zhong W, Luo X, Quan Z. Clinical efficacy of three types of autogenous bone grafts in treatment of single-segment thoracic tuberculosis: A retrospective cohort study. Int J Med Sci 2020; 17:2844-2849. [PMID: 33162812 PMCID: PMC7645334 DOI: 10.7150/ijms.47309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/27/2020] [Indexed: 01/29/2023] Open
Abstract
A retrospective study investigated and compared the results of lamina with spinous process (LSP), transverse process strut (TPS) and iliac graft (IG) as bone graft in thoracic single-segment spinal tuberculosis(TB) with the one-stage posterior approach of debridement, fusion and internal instrumentation. 99 patients treated from January 2012 to December 2015 were reviewed. LSP was performed in 35 patients (group A), TPS was undertaken in 33 patients (group B), and IG was carried out in 31 patients (group C). Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, intervertebral height and bone fusion time were compared between preoperative and final FU. All the patients were followed up for a mean 43.90±10.39 months in group A, 45.30±6.20 months in group B, 44.32±7.17 months in group C without difference(P>0.05). The mean age was younger, the blood loss was less, the hospitalization time and the surgical time were shorter in group A than those in group B and C (P<0.05). The drainage volume was less in group A than that in group B and group C. The CRP, ESR, VAS, and ODI were significantly decreased and there were no significant difference among the groups at the final FU. The neurological function after surgery was improved compared with preoperation among the groups. The bony fusion at a mean time 12.90±3.91 months in group A was longer than that in group B (6.75±1.55 months) and group C (5.52±1.64 months) (P<0.05). No significant difference was found at the mean segmental angle, mean intervetebral height of preoperation and final FU among the groups (P>0.05). In conclusion, the LSP and TPS as bone graft are reliable, safe, and effective for single-segment stability reconstruction for surgical management of thoracic TB and TPS could be new bone graft methods.
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Affiliation(s)
- Ke Tang
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianxiao Li
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianji Huang
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiyang Zhong
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoji Luo
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxue Quan
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liang XJ, Zhong W, Tang K, Quan Z, Luo XJ, Jiang DM. One-stage posterior debridement with transverse process strut as bone graft in the surgical treatment of single-segment thoracic tuberculosis: A retrospective single-center study. Medicine (Baltimore) 2019; 98:e18022. [PMID: 31764819 PMCID: PMC6882565 DOI: 10.1097/md.0000000000018022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This retrospective study investigated the effect of the novel bone graft transverse process strut (TPS) in single segmental thoracic spinal tuberculosis (TB) with the one-stage posterior approach of debridement, fusion, and internal instrumentation. Thirty patients treated in our department from March 2014 to October 2016 were retrospectively analyzed. Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All the patients were followed for a mean 50.10 ± 25.10 months; the mean age, surgical time in minutes, blood loss, hospitalization time, and drainage volume were 46.23 ± 17.20 years, 195.08 ± 24.0 minutes, 280.77 ± 189.90 mL, 17.31 ± 4.23 days, 436.92 ± 193.81 mL, respectively. VAS and ODI scores were significantly improved at the final FU. The ESR and CRP returned to normal. All patients achieved bony fusion with a mean time of 5.85 ± 1.82 months and a mean segmental angle of 18.77 ± 2.49° preoperatively, which significantly decreased to 9.31 ± 1.54° at the final FU (P < .05). No complications, such as bone graft failure, pleural effusion, fistula, or wound infection were recorded except for cerebrospinal fluid leakage (one case), water electrolyte imbalance (5 cases), superficial infection (1 case), and mild intestinal obstruction (1 case). TPS as a bone graft is reliable, safe, and effective for segmental stability reconstruction for surgical management of single-segment thoracic spinal TB.
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Affiliation(s)
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxue Quan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Ji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dian-Ming Jiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Li Z, Wu W, Chen R, Huang Y, Chen X, Lin J. Could Allograft Bones Combined with Poly-Ether-Ether-Ketone Cages or Titanium Mesh Cages be an Alternative Grafting Method in the Management of Cervical Spinal Tuberculosis? World Neurosurg 2019; 128:e653-e659. [PMID: 31054342 DOI: 10.1016/j.wneu.2019.04.226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effectiveness of allograft bones combined with poly-ether-ether-ketone (PEEK) cages or titanium mesh cages (TMCs) in the management of cervical spinal tuberculosis. METHODS A total of 16 patients with cervical spinal tuberculosis who underwent anterior debridement, reconstruction with allograft bones combined with PEEK cages or TMCs, and anterior plate fixation between 2013 and 2016 were retrospectively studied. Neck pain, neurologic status, operating time, intraoperative blood loss, cervical spine alignment, bony fusion, and self-reported clinical outcomes were reviewed. RESULTS Six patients underwent 1 level reconstruction using PEEK cages and 10 patients received TMCs reconstruction. Patients received a mean follow-up time of 45.9 ± 13.1 months. Neck pain was greatly relieved, as visual analog scale scores decreased from 4.6 ± 1.3 preoperatively to 0.7 ± 0.5 at the final follow-up (P < 0.05). Neurologic status was improved in all patients with neurologic deficits, with 9 patients improving by 1 grade and 1 patient by 2 grades. Kyphosis angle was corrected from 1.3 ± 12.0 degrees preoperatively to -5.4 ± 10.2 degrees postoperatively (P < 0.05) and remained at -3.6 ± 9.6 degrees at the final follow-up (P < 0.05). Bony fusion was achieved in all patients, with a mean time to the fusion of 3.8 ± 1.3 months. There was no implant failure or signs of cervical spinal tuberculosis recurrence. Excellent results, good results, and fair results were reported in 37.5%, 56.25%, and 6.25% of patients, respectively. CONCLUSIONS Allograft bone combined with PEEK cages and TMCs could bring about favorable clinical results in patients with cervical spinal tuberculosis. This method could be an alternative to autologous bone grafting method in the management of certain cases.
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Affiliation(s)
- Zhechen Li
- Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian, China
| | - Wence Wu
- The First Clinical Medical School, Fujian Medical University, Fujian, China
| | - Ruomiao Chen
- Department of Plastic Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian, China
| | - Yunpeng Huang
- Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian, China
| | - Xuanwei Chen
- Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian, China.
| | - Jianhua Lin
- Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, Fujian, China
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Du X, Ou YS, Zhu Y, Zhao ZH, Luo W, He B, Peng QQ, Hu JY. One stage posterior debridement, non-structural bone graft in the surgical treatment of single segment thoracic tuberculosis: A retrospective single-center cohort study. Int J Surg 2019; 65:134-139. [PMID: 30974185 DOI: 10.1016/j.ijsu.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the clinical efficacy of non-structural with structural bone graft in the surgical treatment of single segment thoracic tuberculosis after one stage posterior debridement. METHODS 61 patients with single segment thoracic tuberculosis treated by one stage posterior debridement, bone graft fusion and internal fixation were retrospectively analyzed. Among them, 35 cases were admitted from 2015 to 2017 in the non-structural bone graft group and 26 cases were admitted from 2011 to 2015 in the structural bone graft group. The visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), neurological function, operation time, operative blood loss, hospital stay, correction and loss of Cobb angle, bone graft fusion time and complications were recorded and analyzed. RESULTS Compared with structural bone graft group, the operation time of non-structural bone graft group was shorter and the operative blood loss was less, but the hospital stay was longer (P < 0.05). With the follow-up of 14-44 months, the VAS score, ESR, CRP and neurological function in the two groups were both improved (P < 0.05). The correction and loss of Cobb angle in the non-structural bone graft group were both smaller than those in the structural bone graft group (P < 0.05). The bone graft fusion time of the non-structural bone graft group was significantly shorter than the structural bone graft group (P < 0.05). No significant difference was found in the incidence of complications between the two groups (n.s.). CONCLUSION Non-structural bone graft has less surgical trauma and shorter bone fusion time compared with structural bone graft in the surgical treatment of single segment thoracic tuberculosis. The two methods may achieve comparable clinical efficacy in alleviating symptoms, correcting kyphosis and improving neurological function for appropriate cases.
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Affiliation(s)
- Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yun-Sheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zeng-Hui Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Qi-Qi Peng
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jian-Yu Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Boody BS, Tarazona DA, Vaccaro AR. Evaluation and Management of Pyogenic and Tubercular Spine Infections. Curr Rev Musculoskelet Med 2018; 11:643-652. [PMID: 30280287 PMCID: PMC6220010 DOI: 10.1007/s12178-018-9523-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection. RECENT FINDINGS Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.
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Affiliation(s)
- Barrett S Boody
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Daniel A Tarazona
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Zhong J, Pan Z, Chen Y, Yao H, Cheng Z, Liu Q, Zeng Z, Li Z, Duan P, Chen J, Li H, Huang S, Han Z, Kim KN, Ha Y, Cao K. Postoperative Cervical Sagittal Realignment Improves Patient-Reported Outcomes in Chronic Atlantoaxial Anterior Dislocation. Oper Neurosurg (Hagerstown) 2018; 15:643-650. [PMID: 30445658 DOI: 10.1093/ons/opy035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic atlantoaxial anterior dislocation (AAD) not only results in myelopathy, but dislocation-related kyphosis also results in cervical malalignment, which permanently affects neck function and patient-reported outcomes (PROs). OBJECTIVE To investigate the effect of kyphotic correction on realigning cervical spine and independent cervical alignment parameters, which may be correlated with an improvement of PROs. METHODS The study included 21 patients with chronic AAD-related kyphosis who underwent C1-2 reduction and correction surgery. Radiographic parameters were measured to assess cervical realignment preoperatively and postoperatively. Neck disability index (NDI), short form 12 physical component summary (SF-12 PCS), and Japanese Orthopaedic Association (JOA) scores were recorded to reveal changes in PROs. The independent parameters correlated with the improvements of PROs were analyzed. RESULTS Of the radiographic parameters, the C1-2 Cobb angle, the C2-7 Cobb angle, thoracic inlet angle, cervical tilt, and T1 slope were significantly changed from -4.0° ± 16.2°, -29.2° ± 11.2°, 73.1° ± 13.3°, 30.4° ± 8.5°, and 29.1° ± 8.8° preoperatively to -13.5° ± 8.1° (P = .005), -18.0° ± 12.0° (P < .001), 67.1° ± 11.6° (P = .042), 23.1° ± 10.3° (P = .007), and 24.0° ± 7.0° (P = .011) at last follow-up, respectively. NDI, JOA, and SF-12 PCS scores were significantly improved postoperatively. The C1-2 Cobb angle was an independent parameter correlated with the improvements in SF-12 PCS, NDI, and JOA scores. CONCLUSION Correction and reduction surgery can realign cervical spine in chronic AAD patients. The C1-2 Cobb angle was an independent parameter correlated with the improvements of PROs.
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Affiliation(s)
- Junlong Zhong
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhimin Pan
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yiwei Chen
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haoqun Yao
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zujue Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Quanfei Liu
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaoxun Zeng
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhiyun Li
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pingguo Duan
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiangwei Chen
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hu Li
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Sheng Huang
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhimin Han
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kai Cao
- Spine Surgery, Department of Ortho-paedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
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One-Stage Wedge Osteotomy Through Posterolateral Approach for Cervical Postlaminectomy Kyphosis with Anterior Fusion. World Neurosurg 2018; 119:45-51. [PMID: 30064029 DOI: 10.1016/j.wneu.2018.07.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Osteotomy through anterior exposure is challenging with severe complications for upper cervical kyphosis (CK), especially for cases with previous anterior fusion. A novel technique comprising 1-stage osteotomy via a posterolateral-only approach is introduced for treatment of CK secondary to C2-4 laminectomy for neurofibroma removal and subsequent anterior fusion. METHODS A 42-year-old man presented with progressive numbness and weakness of upper and lower limbs. As an adolescent, he underwent posterior laminectomy and neurofibroma excision without effective fixation and anterior C2-4 vertebra fusion 6 years later. Sagittal computed tomography indicated that Cobb angle between C2 and C6 was 68° with complete fusion between C2 and C4 vertebral bodies. Secondary CK was diagnosed based on medical history and radiographic findings, and modified Japanese Orthopaedic Association scale score was 10. Piezosurgery was used for osteotomy by shortening the vertebral height through posterolateral approach after cervical pedicle screw placement. Occipitocervical fusion was performed with compression between C2 and C4. RESULTS Cobb angle was adjusted to 8° postoperatively. Modified Japanese Orthopaedic Association score increased to 14 with obvious muscle strength improvement. The 6-month postoperative x-ray indicated good position of C2-4 vertebrae and occipitocervical fixation system. No neurologic complications or local recurrence was found at final follow-up at 8 months. The patient returned to work in his full capacity. CONCLUSIONS Preliminary outcomes reveal wedge osteotomy via piezosurgery through a posterolateral-only approach is feasible and effective in revision surgery for upper CK with previous anterior fusion.
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