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Zhou L, Zhang H, Yang H, Li Z, Han C, Zhang Y, Hai Y. Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction. J Bone Joint Surg Am 2023; 105:1793-1800. [PMID: 37733922 DOI: 10.2106/jbjs.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate changes in pulmonary function, caused by preoperative halo-pelvic traction (HPT) for the treatment of extremely severe and rigid kyphoscoliosis, with use of 3-dimensional computed tomography (3D-CT) reconstruction and pulmonary function tests (PFTs). METHODS Twenty-eight patients with severe and rigid scoliosis (Cobb angle, >100°) underwent preoperative HPT and staged posterior spinal fusion. CT, radiographic assessment, and PFT were performed during pre-traction and post-traction visits. The changes in total lung volume were evaluated with use of 3D-CT reconstruction, and the changes in pulmonary function were evaluated with PFTs at each time point. Differences were analyzed with use of 2-tailed paired Student t tests, and correlations were analyzed with use of Spearman rank tests. RESULTS None of the patients had pulmonary complications during traction, and all radiographic spinal measurements improved significantly after HPT. The main Cobb angle was corrected from 143.30° ± 20.85° to 62.97° ± 10.83° between the pre-traction and post-traction evaluations. Additionally, the C7-S1 distance was lengthened from 280.48 ± 39.99 to 421.26 ± 32.08 mm between the pre-traction and post-traction evaluations. Furthermore, 3D lung reconstruction demonstrated a notable increase in total lung volume (TLV) (from 1.30 ± 0.25 to 1.83 ± 0.37 L) and maximum lung height (from 176.96 ± 27.44 to 202.31 ± 32.45 mm) between the pre-traction and post-traction evaluations. Moreover, PFTs showed that total lung capacity (TLC) improved between the pre-traction and post-traction evaluations (from 2.06 ± 0.32 to 2.98 ± 0.82 L) and that the changes in T1-T12 distance and maximum lung height were correlated with changes in TLV (p = 0.0288 and p = 0.0007, respectively). CONCLUSIONS The application of HPT is a safe and effective method for improving pulmonary function in patients with extremely severe and rigid scoliosis before fusion surgery. The TLV as measured with CT-based reconstruction was greatly increased after HPT, mainly because of the changes in thoracic height. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lijin Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, Mesregah MK, Ghanem KM, Storlie NR, Huang WH, Chen WC, Bartels-Mensah M, Chen XY, Ye Z, Zhang Y, Pan A, Kim SS, Lonner B, Alanay A, Hai Y. Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1646-1657. [PMID: 36548436 PMCID: PMC10448105 DOI: 10.1177/21925682221146502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. METHODS Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P < .05). RESULTS Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P = .006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P = .04)]. CONCLUSION Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.
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Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | | | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | | | | - Wei-Hsun Huang
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
| | - Wei-Cheng Chen
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
| | | | - Xin Yuan Chen
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
| | - Ziyang Ye
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Sunny Sik Kim
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - International Spinal Deformity Review Study Group (ISDRSG)
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
- Creighton University School of Medicine, Omaha, NE, USA
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
- University of Debrecen School of Medicine, Hungary
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
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Han C, Hai Y, Zhou C, Yin P, Guo R, Wang H, Wang W, Cha T, Li G. Investigation of in vivo three-dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis. JOR Spine 2021; 4:e1151. [PMID: 34611586 PMCID: PMC8479520 DOI: 10.1002/jsp2.1151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the three-dimensional (3D) changes of the spinal canal length (SCL) after corrective surgeries and their association with the radiographic and clinical outcomes of idiopathic scoliosis patients. The length of the spinal cord has been demonstrated to be strongly correlated with the SCL. Understanding the changes in SCL could help determine the morphologic changes in the spinal cord to prevent spinal cord injury. METHODS Twenty-seven scoliotic patients' 3D spinal canal were investigated using computed tomography images. The SCL between the upper and lower end vertebrae (U/L-EV) was measured at five locations. The radiographic parameters of each patient and the patient-reported outcomes (PROs) scores were also collected. The correlations of the changes of the SCLs with the other factors were analyzed. RESULTS The SCL between the U/L-EV changed non-uniformly at different locations. The post-operative SCLs were significantly elongated by 7.5 ± 3.5 mm (6.0 ± 2.5%, P < .001) at the concave side and compressed by -2.6 ± 2.6 mm (-1.9 ± 1.9%, P < .001) at the convex side. The elongations of the SCL at the concave and posterior locations were correlated with the radiographic parameters including the pre-operative main Cobb angles (r = .511, P = .006; r = .613, P = .001) and apical vertebral translation (AVT) (r = .481, P = .011; r = .684, P = .000). No PRO scores were found to correlate with the SCL changes. CONCLUSION The corrective surgeries elongated the spinal canal mainly at the concave side and compressed at the convex side. The main thoracic Cobb angle, the changes of AVT, and Cobb angles were moderately associated with the changes of the SCLs, but no PRO score was found to associate with the changes of the SCLs. The data could be instrumental for the improvement of corrective surgeries that are aimed to maximize the correction of scoliosis and minimize the negative effect on the spinal cord to prevent neurological complications.
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Affiliation(s)
- Chaofan Han
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
| | - Yong Hai
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Chaochao Zhou
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
| | - Peng Yin
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Runsheng Guo
- First Affiliated Hospital of Nanchang UniversityNanchangChina
| | | | | | - Thomas Cha
- Orthopaedic Spine CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Guoan Li
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
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