Coronal Correction Using Kickstand Rods for Adult Thoracolumbar/Lumbar Scoliosis: Case Series With Analysis of Early Outcomes and Complications

2020 ◽  
Vol 19 (4) ◽  
pp. 403-413 ◽  
Author(s):  
Thomas J Buell ◽  
Peter A Christiansen ◽  
James H Nguyen ◽  
Ching-Jen Chen ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Adult Spinal Deformity ◽  
Case Series ◽  
Wound Dehiscence ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Complication Rates ◽  
Iliac Screw ◽  
Coronal Correction

Abstract BACKGROUND The “kickstand rod technique” has been recently described for achieving and maintaining coronal correction in adult spinal deformity (ASD). Kickstand rods span scoliotic lumbar spine from the thoracolumbar junction proximally to a “kickstand iliac screw” distally. Using the iliac wing as a base, kickstand distraction produces powerful corrective forces. Limited literature exists for this technique, and its associated outcomes and complications are unknown. OBJECTIVE To assess alignment changes, early outcomes, and complications associated with kickstand rod distraction for ASD. METHODS Consecutive ASD patients treated with kickstand distraction at our institution were retrospectively analyzed. RESULTS The cohort comprised 19 patients (mean age: 67 yr; 79% women; 63% prior fusion) with mean follow-up 21 wk (range: 2-72 wk). All patients had posterior-only approach surgery with tri-iliac fixation (third iliac screw for the kickstand) for mean fusion length 12 levels. Three-column osteotomy and lumbar transforaminal lumbar interbody fusion were performed in 5 (26%) and 15 (79%) patients, respectively. Postoperative alignment improved significantly (coronal balance: 8 to 1 cm [P < .001]; major curve: 37° to 12° [P < .001]; fractional curve: 20° to 10° [P < .001]; sagittal balance: 11 to 4 cm [P < .001]; pelvic incidence to lumbar lordosis mismatch: 38° to 9° [P < .001]). Pain Numerical Rating Scale scores improved significantly (back: 7.2 to 4.2 [P = .001]; leg: 5.9 to 1.7 [P = .001]). No instrumentation complications occurred. Motor weakness persisted in 1 patient. There were 3 reoperations (1-PJK, 1-wound dehiscence, and 1-overcorrection). CONCLUSION Among 19 ASD patients treated with kickstand rod distraction, alignment, and back/leg pain improved significantly following surgery. Complication rates were reasonable.

The “kickstand rod” technique for correction of coronal imbalance in patients with adult spinal deformity: initial case series

2020 ◽  
Vol 32 (3) ◽  
pp. 415-422
Author(s):  
Melvin C. Makhni ◽  
Ying Zhang ◽  
Paul J. Park ◽  
Meghan Cerpa ◽  
Ming Yang ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinous Process ◽  
Case Series ◽  
Wound Dehiscence ◽  
Contralateral Side ◽  
Coronal Imbalance ◽  
Iliac Screw ◽  
The Mean ◽  
Coronal Correction

OBJECTIVEThe objective of this study was to describe and evaluate a new surgical procedure for the correction of coronal imbalance (CI) in adult spinal deformity patients, called the “kickstand rod” technique.METHODSThe authors analyzed the records of 24 consecutive patients with pediatric and adult spinal deformity and CI treated between July 2015 and October 2017 with a long-segment fusion and a kickstand rod. For the kickstand rod technique, an iliac screw was placed on the ipsilateral side of the trunk shift and connected proximally through a side-by-side domino link to the thoracolumbar junction; this rod was distracted to promote coronal plane balancing. Distraction occurred with the rod on the contralateral side locked in order to preserve sagittal correction. Radiographic and clinical analyses were conducted to evaluate the outcomes and possible complications of the kickstand rod technique.RESULTSThe mean age of the patients was 55 years (range 14–73 years). Eighteen of the 24 patients were female. CI preoperatively was a mean of 63 mm, and the mean measurement at the final follow-up (mean duration 1.4 years) was 47 mm. There were no neurological, vascular, or implant-related complications in any of the patients. One patient developed wound dehiscence that was successfully treated without implant removal, and one developed proximal junctional kyphosis requiring extension of the construct proximally. One patient also returned to the operating room for excision of a spinous process. There were no complaints about screw prominence, kickstand construct failure, or significant worsening of CI after surgery.CONCLUSIONSThe kickstand rod technique is safe and effective for the correction of CI in spinal deformity patients. This technique was found to provide marked coronal correction and additional strength to the overall construct without significant adverse consequences.

scholarly journals Outcomes of Surgical Treatment for One Hundred and Thirty-Eight Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-Up

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Justin K Scheer ◽  
Lawrence Lenke ◽  
Justin S Smith ◽  
Peter G Passias ◽  
Han Jo Kim ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Short Form ◽  
Adult Spinal Deformity ◽  
Plumb Line ◽  
Leg Pain ◽  
Complication Rates ◽  
Sagittal Vertical Axis ◽  
Sagittal Deformity

Abstract INTRODUCTION Operative treatment of ASD can be very challenging with high complication rates. It's well established that pts benefit from such treatment. However, the surgical outcomes for pts with severe sagittal deformity have not been reported. METHODS Retrospective review of a prospective, multicenter adult spinal deformity (ASD) database. Inclusion criteria: operative patients age = 18, SVA = 15 cm, PI-LL = 30 degrees, and/or lumbar kyphosis = 5 degrees with a minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores: Oswestry Disability Index (ODI), Short form-36 (SF36), Scoliosis Research Society (SRS22), back/leg pain numerical rating scale (NRS) and min clinically important difference (MCID)/substantial clinical benefit (SCB) for patients eligible to meet it. Radiographic values: max coronal cobb angle, coronal C7 plumb line, pelvic tilt, mismatch between pelvic incidence and lumbar lordosis, thoracic kyphosis, C7 sagittal vertical axis. Demographic, frailty, surgical, and complication data were also collected. Comparisons between 2 yr postop and baseline HRQOL/radiographic data were made. P < .05 was significant. RESULTS About 138 patients were included from 502 operative patients (54.3% females, average age 63.3 ± 11.5 yr). Averege baseline frailty score was 4.1 ± 1.4, indicating that patients were frail. A total of 71 (51.4%) of the patients had a prior fusion. A total of 89.9% patients had posterior fusion only, with an average 11.5 ± 4.1 post levels fused. About 44.9% had 3-column osteotomy. Two standard deviations was considered for for SVA = 14.8 cm. All 2-yr postop radiographic parameters were significantly improved compared to baseline (P < .05) except coronal C7 plumb line (P > .05). All 2-yr HRQOL measures were significantly improved compared to baseline (P < .004). About 46.6% to 73.8% of patients met either MCID or SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had a minimum 1 major complication, and 42 (30.4%) had a postop revision. CONCLUSION Patients with a severe sagittal malalignment benefit from surgical correction at 2 yr postop both radiographically and clinically despite having a high complication rate.

Global coronal decompensation and adult spinal deformity surgery: comparison of upper-thoracic versus lower-thoracic proximal fixation for long fusions

2021 ◽  
pp. 1-13
Author(s):  
Thomas J. Buell ◽  
Christopher I. Shaffrey ◽  
Han Jo Kim ◽  
Eric O. Klineberg ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Spinal Deformity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Adult Spinal Deformity ◽  
Leg Pain ◽  
Sagittal Vertical Axis ◽  
Upper Thoracic ◽  
The Impact

OBJECTIVE Deterioration of global coronal alignment (GCA) may be associated with worse outcomes after adult spinal deformity (ASD) surgery. The impact of fusion length and upper instrumented vertebra (UIV) selection on patients with this complication is unclear. The authors’ objective was to compare outcomes between long sacropelvic fusion with upper-thoracic (UT) UIV and those with lower-thoracic (LT) UIV in patients with worsening GCA ≥ 1 cm. METHODS This was a retrospective analysis of a prospective multicenter database of consecutive ASD patients. Index operations involved instrumented fusion from sacropelvis to thoracic spine. Global coronal deterioration was defined as worsening GCA ≥ 1 cm from preoperation to 2-year follow-up. RESULTS Of 875 potentially eligible patients, 560 (64%) had complete 2-year follow-up data, of which 144 (25.7%) demonstrated worse GCA at 2-year postoperative follow-up (35.4% of UT patients vs 64.6% of LT patients). At baseline, UT patients were younger (61.6 ± 9.9 vs 64.5 ± 8.6 years, p = 0.008), a greater percentage of UT patients had osteoporosis (35.3% vs 16.1%, p = 0.009), and UT patients had worse scoliosis (51.9° ± 22.5° vs 32.5° ± 16.3°, p < 0.001). Index operations were comparable, except UT patients had longer fusions (16.4 ± 0.9 vs 9.7 ± 1.2 levels, p < 0.001) and operative duration (8.6 ± 3.2 vs 7.6 ± 3.0 hours, p = 0.023). At 2-year follow-up, global coronal deterioration averaged 2.7 ± 1.4 cm (1.9 to 4.6 cm, p < 0.001), scoliosis improved (39.3° ± 20.8° to 18.0° ± 14.8°, p < 0.001), and sagittal spinopelvic alignment improved significantly in all patients. UT patients maintained smaller positive C7 sagittal vertical axis (2.7 ± 5.7 vs 4.7 ± 5.7 cm, p = 0.014). Postoperative 2-year health-related quality of life (HRQL) significantly improved from baseline for all patients. HRQL comparisons demonstrated that UT patients had worse Scoliosis Research Society–22r (SRS-22r) Activity (3.2 ± 1.0 vs 3.6 ± 0.8, p = 0.040) and SRS-22r Satisfaction (3.9 ± 1.1 vs 4.3 ± 0.8, p = 0.021) scores. Also, fewer UT patients improved by ≥ 1 minimal clinically important difference in numerical rating scale scores for leg pain (41.3% vs 62.7%, p = 0.020). Comparable percentages of UT and LT patients had complications (208 total, including 53 reoperations, 77 major complications, and 78 minor complications), but the percentage of reoperated patients was higher among UT patients (35.3% vs 18.3%, p = 0.023). UT patients had higher reoperation rates of rod fracture (13.7% vs 2.2%, p = 0.006) and pseudarthrosis (7.8% vs 1.1%, p = 0.006) but not proximal junctional kyphosis (9.8% vs 8.6%, p = 0.810). CONCLUSIONS In ASD patients with worse 2-year GCA after long sacropelvic fusion, UT UIV was associated with worse 2-year HRQL compared with LT UIV. This may suggest that residual global coronal malalignment is clinically less tolerated in ASD patients with longer fusion to the proximal thoracic spine. These results may inform operative planning and improve patient counseling.

Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 547-554 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
J Tanner McMahon ◽  
Alexander Greven ◽  
Casey L Anthony ◽  
...  
Keyword(s):  
Head Trauma ◽  
Facial Pain ◽  
Rating Scale ◽  
Oral Surgery ◽  
Treatment Options ◽  
Case Series ◽  
Lead Contamination ◽  
Complication Rates ◽  
Trial Period ◽  
Trigeminal Stimulation

Abstract BACKGROUND Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with &gt;50% pain relief during trial stimulation received permanent implantation of the stimulation system. RESULTS Successful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation. CONCLUSION TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.

scholarly journals The Use of a Dynamic Elastomeric Fabric Orthosis in Supporting the Management of Athletic Pelvic and Groin Injury

2016 ◽  
Vol 25 (2) ◽  
pp. 101-110 ◽  
Author(s):  
Leanne Sawle ◽  
Jennifer Freeman ◽  
Jonathan Marsden
Keyword(s):  
Outcome Measures ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Preliminary Investigation ◽  
Case Series ◽  
Baseline Period ◽  
Numerical Rating ◽  
Straight Leg Raise ◽  
Type Of Injury ◽  
Groin Injury

Context:Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury.Objectives:To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury.Design:A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo.Settings:Community and university.Participants:8 athletes presenting with pelvic or groin injury confirmed through clinical screening.Intervention:A bespoke DEFO.Main Outcome Measures:Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0–10) at rest and during an active straight-leg raise and a broad jump.Results:In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing.

scholarly journals Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Hyeong-Jin Lee ◽  
Jin-Sung Kim ◽  
Kyeong-Sik Ryu
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Rating Scale ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Leg Pain ◽  
Spinal Diseases ◽  
Single Cage ◽  
Unilateral Approach ◽  
The Mean

Background. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely accepted surgical procedure. But there are only a few reports of MIS-TLIF using the unilateral approach and single cage in elderly patients. Objective. The study investigated the clinical and radiological outcomes of MIS-TLIF using the unilateral approach and single cage in the patients over 65 years of age. Methods. Thirty-eight patients were followed for a mean of 15.5±11.61 months. Radiological data include fusion rate, change of disc height, and central canal area. The numeric rating scale (NRS) and Oswestry disability index (ODI) were used to assess clinical outcomes. Results. The mean age of these patients at operation was 71.82±4.71 years (range, 65–82 years). Evidence of fusion was observed radiologically in 64.71% at 6 months and 87.5% at 12 months after surgery, giving a final fusion rate of 100%. The mean NRS scores for back and leg pain and ODI scores improved significantly at the final follow-up. Conclusions. Clinical and radiologic outcomes of MIS-TLIF using unilateral approach and single cage in elderly patients indicate an acceptable method for the treatment of various kinds of lumbar spinal diseases.

scholarly journals Addition of Fusion to Decompression for Grade I Degenerative Lumbar Spondylolisthesis is Associated With Greater Patient-Reported Outcome Improvements at Twenty-Four-Month Follow-Up: A Multicenter Study Using the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jian Guan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Mohammed A Alvi ◽  
Steven D Glassman ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Primary Outcome Measure ◽  
Patient Reported Outcome ◽  
Leg Pain ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-mo outcomes for patients undergoing decompression alone vs decompression and fusion. METHODS Patients undergoing single-level surgery from 7/1/2014 to 6/30/2016 were identified. The primary outcome measure, 24-mo Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed. RESULTS Of the 608 patients (85.5% with at least 24-mo follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-mo change in ODI was significantly greater in the fusion group than the decompression-only group (−25.8 ± 20.0 vs −15.2 ± 19.8, P < .001). Fusion remained independently associated with 24-mo ODI change in our multivariable model (B = −7.05, 95% CI 10.70-3.39, P = < .001). Patients in the fusion group were significantly more likely to reach minimal clinically important difference (MCID, 12.8 points) in ODI at 24 mo (73.3% vs 56.0%, P = < .001), and to experience significantly greater NRS back pain improvement at 24-mo follow-up (3.8 ± 3.1 vs −1.8 ± 3.9, P < .001). Fusion was also independently associated with achieving MCID for ODI at 24 mo in our logistic regression model (OR 1.767, 95% CI 1.058-2.944, P = .029). CONCLUSION The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 mo. Longer-term follow-up is warranted to assess whether this effect is sustained.

Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up

2019 ◽  
Vol 30 (5) ◽  
pp. 635-643 ◽  
Author(s):  
James H. Nguyen ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Jeffrey P. Mullin ◽  
Marcus D. Mazur ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Wound Dehiscence ◽  
Adult Patients ◽  
Complication Rates ◽  
Related Complication ◽  
Screw Head ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw

OBJECTIVERecent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors’ objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up.METHODSOf 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors’ institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed.RESULTSTwenty patients (7.7%) had iliac screw–related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5–S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw–related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction–related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001).CONCLUSIONSPrevious studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.

Outcomes of Surgical Treatment for One Hundred Thirty-Eight Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series

2021 ◽  
Author(s):  
Justin K Scheer ◽  
Lawrence G Lenke ◽  
Justin S Smith ◽  
Darryl Lau ◽  
Peter G Passias ◽  
...  
Keyword(s):  
Adult Spinal Deformity ◽  
Case Series ◽  
Major Complication ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Complication Rates ◽  
Sagittal Vertical Axis ◽  
Estimated Blood Loss ◽  
Sagittal Deformity

Abstract BACKGROUND Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported. OBJECTIVE To report the outcomes of patients undergoing surgical correction for severe sagittal deformity. METHODS Retrospective review of a prospective, multicenter ASD database. Inclusion criteria: operative patients age ≥18, sagittal vertical axis (SVA) ≥15 cm, mismatch between pelvic incidence and lumbar lordosis (PI-LL) ≥30°, and/or lumbar kyphosis ≥5° with minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores including minimal clinically important difference (MCID)/substantial clinical benefit (SCB), sagittal and coronal radiographic values, demographic, frailty, surgical, and complication data were collected. Comparisons between 2 yr postoperative and baseline HRQOL/radiographic data were made. P &lt; .05 was significant. RESULTS A total of 138 patients were included from 502 operative patients (54.3% Female, Average (Avg) age 63.3 ± 11.5 yr). Avg operating room (OR) time 386.2 ± 136.5 min, estimated blood loss (EBL) 1829.8 ± 1474.6 cc. A total of 71(51.4%) had prior fusion. A total of 89.9% were posterior fusion only. Mean posterior levels fused 11.5 ± 4.1. A total of 44.9% had a 3-column osteotomy. All 2 yr postoperative radiographic parameters were significantly improved compared to baseline (P &lt; .001 for all). All 2yr HRQOL measures were significantly improved compared to baseline (P &lt; .004 for all). A total of 46.6% to 73.8% of patients met either MCID/SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had minimum 1 major complication, and 42(30.4%) had a postop revision. CONCLUSION Patients with severe sagittal malalignment benefit from surgical correction at 2 yr postoperative both radiographically and clinically despite having a high complication rate.

scholarly journals Therapeutic Effects of Saireito (Chai-Ling-Tang), a Traditional Japanese Herbal Medicine, on Lymphedema Caused by Radiotherapy: A Case Series Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Aiko Nagai ◽  
Yuta Shibamoto ◽  
Keiko Ogawa
Keyword(s):  
Herbal Medicine ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Case Series ◽  
Tumor Control ◽  
Therapeutic Effects ◽  
Case Series Study ◽  
Custom Made ◽  
Japanese Herbal Medicine ◽  
Series Study

Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50%) showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study.

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