Transient fixation of L4 vertebra preserves lumbar motion and function in Lenke Type 5C and 6C scoliosis

AbstractThis study investigated the efficacy of a novel surgical method that relies on the transient fixation of L4 in Lenke Type 5C and 6C adolescent idiopathic scoliosis. Thirty-six transient surgically treated L4 fixation patients were retrospectively evaluated. The first surgery involved mechanical correction of scoliosis; the lowest instrumented vertebra (LIV) was L4. After an average of 1.3 years (range, 0.3–3.4), the second surgery to remove transient L4 pedicle screws was performed. Radiographic parameters and SRS-22 scores were measured. Cobb’s angle, coronal balance, LIV tilting angle, and LIV coronal disc angle clearly improved after the first surgery (p < 0.01). After the second surgery, the corrected Cobb angle (p = 0.446) and coronal balance were maintained (p = 0.271). Although L3/S1 lumbar lordosis decreased after the first surgery (p < 0.01), after removal of transient L4 pedicle screws, it recovered slightly (p = 0.03). Similarly, the preoperative L3/4 lateral disc mobility eventually recovered after transient L4 screw removal (p < 0.01). The function domain of the SRS-22 showed better scores after removal of transient L4 screws (p = 0.04). L4 transient fixation surgery is beneficial for Lenke Type 5C and 6C scolioses that do not fully satisfy LIV (L3) criteria. It preserves L3/4 disc motion, increases functional outcomes, and maintains spinal correction and coronal balance.

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Adolescent idiopathic scoliosis: sagital plane and low density pedicle screws

Coluna/Columna ◽

10.1590/s1808-18512014130100210 ◽

2014 ◽

Vol 13 (1) ◽

pp. 13-15

Author(s):

Rodrigo Augusto do Amaral ◽

Robert Meves ◽

Maria Fernanda Silber Caffaro ◽

Ricardo Shigueaki Galhego Umeta ◽

Luciano Antônio Nassar Pelegrino ◽

...

Keyword(s):

Medical Records ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Sagittal Plane ◽

Pedicle Screws ◽

Low Density ◽

Kyphosis Correction ◽

Pearson Coefficient ◽

Analysis Of Dispersion

OBJECTIVE: To examine the sagittal curves of patients treated with CD instrumentation using exclusively pedicle screws. METHODS: Image analysis of medical records of 27 patients (26 M and 1 F) with a minimum follow-up of 6 months, who underwent surgical treatment in our service between January 2005 and December 2010. The curves were evaluated on coronal and sagittal planes, taking into account the potential correction of the technique. RESULTS: In the coronal plan the following curves were evaluated: proximal thoracic (TPx), main thoracic (TPp), and thoracolumbar; lumbar (TL, L), and the average flexibility was 52%, 52%, and 92% and the capacity of correction was 51%, 72%, and 64%, respectively. In the sagittal plane there was a mean increase in thoracic kyphosis (CT) of 41% and an average reduction of lumbar lordosis (LL) of 17%. Correlation analysis between variables showed Pearson coefficient of correlation of 0.053 and analysis of dispersion of R2 = <0.001. CONCLUSION: The method has shown satisfactory results with maintenance of kyphosis correction in patients with normal and hyper kyphotic deformities.

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Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

Asian Spine Journal ◽

10.4184/asj.2017.11.4.513 ◽

2017 ◽

Vol 11 (4) ◽

pp. 513-519 ◽

Cited By ~ 1

Author(s):

Adem Cobden ◽

Akif Albayrak ◽

Yalkin Camurcu ◽

Hakan Sofu ◽

Temel Tacal ◽

...

Keyword(s):

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pedicle Screws ◽

Definitive Treatment ◽

Sacral Slope ◽

Complication Rates ◽

Level Of Evidence ◽

Radiological Results ◽

Lower Complication ◽

Clinical And Radiological Results

<sec><title>Study Design</title>Retrospective study (level of evidence: level 3).</sec><sec><title>Purpose</title>The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).</sec><sec><title>Overview of Literature</title>The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.</sec><sec><title>Methods</title>We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.</sec><sec><title>Results</title>Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<italic>p</italic><0.05).</sec><sec><title>Conclusions</title>The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.</sec>

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Early Outcomes Following Dorsal Denervation of the Midfoot for Management of Arthritic Pain

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00383 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Glenn G. Shi ◽

Arun Kumar ◽

Meredith A. Williams ◽

Benjamin K. Wilke ◽

Joseph L. Whalen ◽

...

Keyword(s):

Pain Relief ◽

Functional Outcomes ◽

Nonoperative Management ◽

Short Form ◽

Safe Alternative ◽

Sf 36 ◽

The Mean ◽

Protective Sensation ◽

And Function ◽

Complications Rate

Category: Midfoot/Forefoot Introduction/Purpose: Debilitating midfoot arthritic pain is reported to affect up to 12% of adults over 50 years. After failure of nonoperative management, midfoot arthrodesis has been favored as the primary operative treatment producing acceptable outcomes with associated potentially long postoperative immobilization and 17% major complications rate. The aim of this study was to evaluate the pain and functional outcomes of dorsal midfoot surgical denervation by deep peroneal neurectomy as a safe alternative for management of dorsal midfoot pain. Methods: In this retrospective study, 18 patients (21 feet) who underwent dorsal denervation of the midfoot by deep peroneal neurectomy by a single surgeon were evaluated. There were 13 women and 5 men with mean age 70.4 (range, 47 to 88) at the time of surgery. Indications for the procedure include painful midfoot arthritis, lack of radiographic collapse, intact plantar protective sensation, failed nonoperative management for 6 months, and greater than 75% transient pain relief from preoperative diagnostic block of deep peroneal nerve. Preoperative and postoperative (3 months, 6 months) Visual Analog Scale (VAS), Short- Form 36 (SF-36), and Foot and Ankle Outcome Score (FAOS) were reviewed. Complications were recorded. Results: The mean VAS score improved from 7.4 +/-1.9 to 1.9 +/-1.9 at 3 months and 1.4 +/-1.9 at 6 months (p<0.001). Six patients reported being pain free (VAS=0) at 3 months. All subscales of FAOS showed significant improvement at both 3 and 6 months (Table 1). The mean SF-36 total score improved from 51.4 +/-17.9 to 72.5 +/-7.6 and 74.5 +/-7.5 at 3 and 6 months respectively (p<0.001). Available radiographs at 6 months showed no further collapse. Complications include one patient with delayed wound healing and another patient with inadequate pain relief. No patients reported symptomatic paresthesia. Conclusion: Deep peroneal neurectomy for dorsal midfoot denervation is a safe and effective alternative to arthrodesis for management of dorsal arthritic midfoot pain showing significant improvements in both pain and functional outcomes at early follow up. Our study demonstrated clinical and function outcomes similar to those previously reported for arthrodesis yet with the advantages of earlier postoperative weightbearing and lower complication rate.

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Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.185510 ◽

2016 ◽

Vol 7 (04) ◽

pp. 550-553 ◽

Cited By ~ 4

Author(s):

Sohail Rafi ◽

Naseem Munshi ◽

Asad Abbas ◽

Rabia Hassan Shaikh ◽

Imtiaz Hashmi

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Pedicle Screw ◽

Pedicle Screws ◽

Scoliosis Surgery ◽

Hybrid Instrumentation ◽

System Versus ◽

Cobb’S Angle

ABSTRACT Introduction: Adolescent idiopathic scoliosis is the most common type of scoliosis. A Cobb angle of 50° will progress beyond the age of spinal maturity. Surgery over bracing is advised at a Cobb angle above or equal to 50°. The aim of surgery is to bring the Cobb angle down below 50° to prevent reprogression as well as improve the quality of life. The objective of the study is to analyze the efficacy and significance in lifestyle improvement of pedicle screw-only fixation system versus the more common hybrid instrumentation system used for the surgical treatment of adolescent idiopathic scoliosis. Materials and Methods: A prospective cohort study was conducted involving two groups of patients were included in the study. One group was operated with pedicle screw-only method while the other with hybrid instrumentation system. The pre- and post-operative Cobb’s angles were taken across a follow-up of 4 years. An SRS-30 questionnaire was given in a yearly follow-up to assess the lifestyle improvement of the patient. Results: Pedicle screw-only method was significantly more effective in reducing Cobb’s angle (P = 0.0487). It was showed less loss of correction (P = 0.009) pedicle screw-only surgery was also better at reducing thoracic curves (P = 0.001). There seemed a better recovery time with pedicle screw surgery (P = 0.003). Conclusion: Pedicle screws are more effective and durable than hybrid systems at when treating adolescent idiopathic scoliosis.

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Comparative effectiveness of treatment options for displaced midshaft clavicle fractures

Bone & Joint Open ◽

10.1302/2633-1462.28.bjo-2021-0112.r1 ◽

2021 ◽

Vol 2 (8) ◽

pp. 646-654

Author(s):

John R. Martin ◽

Patrick E. Saunders ◽

Mark Phillips ◽

Sean M. Mitchell ◽

Michael D. Mckee ◽

...

Keyword(s):

Functional Outcomes ◽

Nonoperative Management ◽

Meta Analysis ◽

Treatment Options ◽

Nonoperative Treatment ◽

Cochrane Library ◽

Surgical Fixation ◽

Clavicle Fractures ◽

And Function ◽

Compression Plating

Aims The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures. Methods Initial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores. Results In all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47). Conclusion Surgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654.

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839 Early Ambulation After a Lower Limb Burn Is Associated with Reduced Length of Stay: A Quantitative Longitudinal Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.412 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S258-S259

Author(s):

Dale W Edgar ◽

Dana A Hince ◽

Dale O Edwick ◽

Fiona M Wood

Keyword(s):

Length Of Stay ◽

Phase I ◽

Phase Ii ◽

Lower Limb ◽

Functional Outcomes ◽

Burn Injury ◽

Unit Length ◽

Skin Grafting ◽

Early Ambulation ◽

And Function

Abstract Introduction A lower limb burn arguably has a significantly greater effect than an upper limb burn due to the detrimental impact on ambulation and return to daily roles and function. The patterns of functional recovery following a lower limb burn are poorly understood and has only been studied in small cohorts. It was hypothesized that patients, following an early ambulation pathway will have a reduced length of stay (LOS), and improved functional outcomes compared to patients with delayed ambulation after burn or after surgery. Methods The study aimed to explore if the timing of ambulation after lower limb burn and after skin grafting influenced acute LOS and functional outcomes. The study examined patients between 2011–2019 who sustained a lower limb burn injury in two phases. In Phase I, a preliminary sample (2011–2016) of 1209 lower limb burn patients with 1215 burn events was extracted and their date of ambulation confirmed retrospectively from the digital medical record. Phase II, in progress since 2017, prospectively collected the dates of ambulation. The definition of ‘early ambulation’ varies significantly and is poorly described in the literature. This study defined early and late ambulation through the categorization of four ambulatory pathways in surgically managed patients. The outcomes measured were acute LOS, and the Lower Limb Functional Index (LLFI-10) at six weeks after the burn. Conservatively managed patients were described as a reference only and not further analysed. Results Ambulatory data was available for 95% of cases, and the cohort had a mean age of 37.3 years; 65.6 % were male; and, 57% required surgery. Late ambulation was associated with TBSA; presence of a foot burn; and, when patients burn occurred in a rural area. Phase I results confirmed early ambulation, particularly after surgery, was significantly associated with reduced LOS (p< 0.001). Excluding ICU cases (n=33), median LOS increase was 2 days where ambulation was delayed after surgery. Phase I results indicated a similar trend in LLFI-10 data. The pooling and analysis of Phase I and Phase II data underway now, will substantially increase the sample size and allow definitive understanding of the influence of sub-groups such as ICU patients on the outcomes of interest. Conclusions Ambulation by 48 hours after lower limb grafting surgery is associated with reduced acute burn unit length of stay. Applicability of Research to Practice Where appropriate, achieving early ambulation within two days after surgery will assist patients to progress more rapidly on their journey towards desired participation goals.

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Posterior column osteotomy plus unilateral cage strutting for correction of lumbosacral fractional curve in degenerative lumbar scoliosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02011-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hui Wang ◽

Longjie Wang ◽

Zhuoran Sun ◽

Shuai Jiang ◽

Weishi Li

Keyword(s):

Lumbar Lordosis ◽

Vertical Axis ◽

Posterior Column ◽

Degenerative Lumbar Scoliosis ◽

Sagittal Vertical Axis ◽

Lumbar Scoliosis ◽

Coronal Balance ◽

Bone Fusion ◽

Cage Subsidence

Abstract Background Inadequate release of the posterior spinal bone elements may hinder the correction of the lumbosacral fractional curve in degenerative lumbar scoliosis, since the lumbosacral junction tends to be particularly rigid and may already be fused into an abnormal position. The purpose of this study was to evaluate the surgical outcome and complications of posterior column osteotomy plus unilateral cage strutting technique on lumbosacral concavity for correction of fractional curve in degenerative lumbar scoliosis patients. Methods Thirty-two degenerative lumbar scoliosis patients with lumbosacral fractional curve more than 15° that were surgically treated by posterior column osteotomy plus unilateral cage strutting technique were retrospectively reviewed. The patients’ medical records were reviewed to identify demographic and surgical data, including age, sex, body mass index, back pain, leg pain, Oswestry Disability Index, operation time, blood loss, and instrumentation levels. Radiological data including coronal balance distance, Cobb angle, lumbosacral coronal angle, sagittal vertical axis, lumbar lordosis, and lumbosacral lordotic angle were evaluated before and after surgery. Cage subsidence and bone fusion were evaluated at 2-year follow-up. Results All patients underwent the operation successfully; lumbosacral coronal angle changed from preoperative 20.1 ± 5.3° to postoperative 5.8 ± 5.7°, with mean correction of 14.3 ± 4.4°, and the correction was maintained at 2-year follow-up. Cobb’s angle and coronal balance distance decreased from preoperative to postoperative; the correction was maintained at 2-year follow-up. Sagittal vertical axis decreased, and lumbar lordosis increased from preoperative to postoperative; the correction was also maintained at 2-year follow-up. Lumbosacral lordotic angle presented no change from preoperative to postoperative and from postoperative to 2-year follow-up. Postoperatively, there were 8 patients with lumbosacral coronal angle more than 10°, they got the similar lumbosacral coronal angle correction, but presented larger preoperative Cobb and lumbosacral coronal angle than the other 24 patients. No cage subsidence was detected; all patients achieved intervertebral bone fusion and inter-transverse bone graft fusion at the lumbosacral region at 2-year follow-up. Conclusion Posterior column osteotomy plus unilateral cage strutting technique on the lumbosacral concavity facilitate effective correction of the fractional curve in degenerative lumbar scoliosis patients through complete release of dural sac as well as the asymmetrical intervertebral reconstruction by cage.

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Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1709493 ◽

2020 ◽

Vol 36 (07) ◽

pp. 507-513

Author(s):

Chang Ryul Yi ◽

Woo Shik Jeong ◽

Tae Suk Oh ◽

Kyung S. Koh ◽

Jong-Woo Choi

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Speech Therapy ◽

Tongue Cancer ◽

Postoperative Radiotherapy ◽

Postoperative Chemotherapy ◽

Radiotherapy Group ◽

Tongue Reconstruction ◽

And Function ◽

Tip Of The Tongue

Abstract Background Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. Methods Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. Results Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. Conclusion We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

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Summary of Oncologic and Functional Outcomes

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0039-3402778 ◽

2020 ◽

Vol 33 (03) ◽

pp. 150-156 ◽

Cited By ~ 1

Author(s):

Roel Hompes ◽

Marta Penna

Keyword(s):

Functional Data ◽

Functional Outcomes ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Short Term ◽

Oncological Outcomes ◽

Randomized Controlled ◽

Collaborative Studies ◽

And Function

AbstractLarge cohort and collaborative studies to date have shown that the short-term oncological outcomes appear to be at least as good as traditional laparoscopic surgery. These results need confirmation in randomized controlled trials, which are currently underway (GRECCAR 11 and COLOR III). The functional data on transanal total mesorectal excision is still very scarce and more mature data on quality of life and function outcomes are eagerly awaited.

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Sagittal curve and high metal density in adolescent idiopathic scoliosis

Coluna/Columna ◽

10.1590/s1808-18512014130200229 ◽

2014 ◽

Vol 13 (2) ◽

pp. 104-107 ◽

Cited By ~ 1

Author(s):

Fabio Araújo Fernandes ◽

João Paulo Machado Bergamaschi ◽

Luciano Antonio Nassar Pellegrino ◽

Ricardo Shigueaki Galhego Umeta ◽

Maria Fernanda Silber Caffaro ◽

...

Keyword(s):

Retrospective Study ◽

Cobb Angle ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pedicle Screws ◽

Lateral View ◽

Radiographic Evaluation ◽

Anteroposterior Radiograph ◽

High Metal

Objectives: To analyze radiographically the postoperative kyphosis from patients undergoing surgical treatment for AIS with pedicle screws in all vertebrae included in the arthrodesis. Methods: Retrospective study. The following measurements were evaluated: Cobb angle in anteroposterior radiograph of the three curves (proximal thoracic, main thoracic, and lumbar), Cobb angle in the lateral view of the two curves: thoracic kyphosis (T5-T12) and lumbar lordosis (T12-S1). Results: Of the 25 patients evaluated preoperatively, four (16%) were hypokyphotic, 20 patients (80%) were normokyphotic and only one (4%) was hyperkyphotic. For hypokyphotic and hiperkyphotic patients a satisfactory correction of thoracic kyphosis was obtained in 100% of cases, which was preserved in the final result. The same pattern of thoracic kyphosis was observed for all normokyphotic patients throughout the follow-up. Conclusion: Radiographic evaluation of thoracic kyphosis in patients with AIS treated surgically with pedicle screws in all vertebrae showed satisfactory results with respect to the correction of thoracic kyphosis.

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