Complications analysis of posterior vertebral column resection in 40 patients with spinal tumors

Surgical Outcome Comparison of Posterior Vertebral Column Resection with or without Anterior Column Support in Treatment of Yang's Type A Severe Thoracic Spinal Deformity

BACKGROUND

The use of posterior vertebral column resection (PVCR) has extended the treatment of severe spinal deformity. However, the practice guidelines for anterior column support in patients treated by PVCR remain ill defined. The objective of the present study was to compare the clinical and radiographic outcomes of severe thoracic spinal deformity treated by PVCR with and without anterior column support (ACS).

METHODS

We performed a prospective study of 57 patients with severe thoracic deformity (classified as Yang's A type) treated by PVCR with or without anterior column support from January 2010 to April 2015. The patient characteristics, radiographic parameters, intraoperative data, and complications were analyzed to clarify these 2 clinical series.

RESULTS

The sex, age, diagnosis, curve magnitude, and curve type were similar between the PVCR with ACS group (n = 21) and non-ACS group (n = 36) preoperatively. Evaluation of the radiographic parameters, intraoperative data, and complications found no statistically significant intergroup differences, except for the osteotomy distance (non-ACS group, 4.0 cm; ACS group, 5.3 cm; P < 0.001) and shortening distance of the osteotomy gap (non-ACS group, 4.0 cm; ACS group, 3.5 cm; P = 0.005).

CONCLUSIONS

The results of the present study have shown that PVCR without ACS seems to be a safe and effective technique for Yang's A type severe thoracic spinal deformity correction compared with PVCR with ACS. PVCR without ACS requires a relatively smaller osteotomy range and could potentially decrease the risk of implant failure due to bone to bone fusion.

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°

Objective

The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°.

Methods

The medical records of 17 patients (mean age 17.9 (range, 9–27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24–64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs.

Results

The mean preoperative localized kyphosis angle was 121.8° (range, 101°–149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient.

Conclusion

PVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°.

Level of evidence

Level IV, therapeutic study.

Rare blood donors screening by multiplex PCR methods in Chinese Zhuang and Dong population and pedigree analysis

There are little data available regarding the frequencies of the blood group antigens other than ABO and RhD in the Chinese Zhuang and Dong population. Knowledge of the antigen frequencies is important to assess risk of antibody formation and to guide the probability of finding antigen-negative donor blood, which is especially useful when blood is required for a patient who has multiple red cell alloantibodies. The aim of this study is sought to massively screen for rare blood donors with antigen-negative (e.g. Fy (a-), s-, k-, Di (b-) and Js (b-)) in an ethnic Zhuang and Dong population of China, for providing precious rare blood type materials which can be used to improve the capability of compatible infusion and reduce the transfusion reactions. Finally, inheritance of the Fy (a-), s-, k-, Di (b-) and Js (b-) phenotypes was investigated by pedigree analysis. We screened for Fy (a-), s-, k-, Di (b-) and Js (b-) phenotypes in blood donors by multiplex polymerase chain reaction. The rare phenotypes Fy (a-), s-, k-, Di (b-) and Js (b-) were verified by flow cytometry and sequencing analysis. The results indicated that there are five Fy (a-), three s (-), two Di (b-) in 4490 Zhuang random samples and three Fy (a-) in 1927 Dong random samples. In conclusion, this study is the first small step to create a rare donor data bank for Chinese Zhuang and Dong population and to prepare antigen negative compatible blood to patients with multiple alloantibodies.