Protection of L1 nerve roots by pre-relieve tension in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

Abstract Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to June 2017, 10 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO at T12 or L1, the mean kyphosis and scoliosis correction rates reached 77.4± 8.5% and 76.6± 6.8%, respectively and the intraoperative estimated blood loss was 1990±1010 mL, and the mean operative time was 7.12± 3.88 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 60 ± 30, 47 ± 33, 44 ± 30, 32 ± 18, 50 ±30, 46 ± 29, 26 ± 40 and 52 ± 20 at baseline to 81 ± 16, 69 ± 19, 73 ± 11, 66 ± 21, 74 ± 16, 74 ± 24, 63 ± 37 and 76 ± 12 one year after surgery, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by lower limb weakness and inner thigh numbness on knee extension and hip flexion, which was further confirmed by electromyography. Conclusions : PEO is easier to operate, and the spinal cord and nerve root are under direct vision and can effectively and safely correct severe rigid thoracolumbar spine deformity with satisfactory clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery.

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Protection of L1 nerve roots in vertebral osteotomy for severe rigid thoracolumbar spine deformity

10.21203/rs.2.15567/v1 ◽

2019 ◽

Author(s):

Hang Liao ◽

Houguang Miao ◽

Peng Xie ◽

Yueyue Wang ◽

Ningdao Li ◽

...

Keyword(s):

Nerve Root ◽

Bodily Pain ◽

Thoracolumbar Spine ◽

Operation Time ◽

Clinical Results ◽

Spine Deformity ◽

Nerve Roots ◽

Limb Weakness ◽

Nerve Root Injury ◽

Scoliosis Correction

Abstract Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to June 2017, 10 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO performed at T12 or L1, the kyphosis and scoliosis correction rates reached averages of 77.4 ± 8.5% and 76.6 ± 6.8%, intraoperative bleeding 1990 ± 1010 ml, operation time 7.12 ± 3.88 h. One year after surgery, the SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health from 60 ± 30, 47 ± 33, 44 ± 30, 32 ± 18, 50 ±30, 46 ± 29, 26 ± 40 and 52 ± 20 to 81 ± 16, 69 ± 19, 73 ± 11, 66 ± 21, 74 ± 16, 74 ± 24, 63 ± 37 and 76 ± 12, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by knee extension and hip flexion of lower limb weakness and inner thigh numbness, which further confirmed by electromyography. Conclusions : The parallel endplate osteotomy is simple, results in less bleeding, spinal cord and nerve root under direct vision and can effectively and safely correct severe rigid thoracolumbarspine deformity with better clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery. Key words: Thoracolumbar deformity, Nerve roots injury, L1 nerve roots, Parallel endplate osteotomy

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Protection of L1 nerve roots by pre-relieve tension in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

10.21203/rs.2.20867/v3 ◽

2020 ◽

Author(s):

Hang Liao ◽

Houguang Miao ◽

Peng Xie ◽

Yueyue Wang ◽

Ningdao Li ◽

...

Keyword(s):

Nerve Root ◽

Bodily Pain ◽

Thoracolumbar Spine ◽

Spine Deformity ◽

Nerve Roots ◽

Limb Weakness ◽

Nerve Root Injury ◽

Estimated Blood Loss ◽

Scoliosis Correction ◽

The Mean

Abstract Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity.Methods: From July 2016 to January 2019, 12 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied.Results: Following PEO at T12 or L1, the mean kyphosis and scoliosis correction rates reached 77.0 ± 8.9% and 75.5 ± 8.0%, respectively and the intraoperative estimated blood loss was 1950 ± 1050 mL, and the mean operative time was 6.98 ± 4.02 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 63 ± 28, 50 ± 25, 50 ± 30, 34 ± 19, 53 ± 28, 45 ± 30, 30 ± 36 and 54 ± 18 at baseline to 83 ± 18, 69 ± 19, 72 ± 12, 66 ± 21, 75 ± 15, 72 ± 22, 66 ± 34 and 76 ± 12 at one year postoperatively , 83 ± 8, 68 ± 32, 83 ± 17, 73 ± 17, 82 ± 18, 76 ± 26, 70 ± 37 and 88 ± 12 at 18 months postoperatively, 86 ± 6, 83 ± 33, 90 ± 16, 81 ± 16, 89 ± 14, 88 ± 25, 83 ± 17 and 94 ± 10 at 24 months postoperatively, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by lower limb weakness and inner thigh numbness on knee extension and hip flexion, which was further confirmed by electromyography.Conclusions: PEO is easier to operate, and the spinal cord and nerve root are under direct vision and can effectively and safely correct severe rigid thoracolumbar spine deformity with satisfactory clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery.

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Protection of L1 nerve roots by pre-relieve tension in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

10.21203/rs.2.20867/v2 ◽

2020 ◽

Author(s):

Hang Liao ◽

Houguang Miao ◽

Peng Xie ◽

Yueyue Wang ◽

Ningdao Li ◽

...

Keyword(s):

Nerve Root ◽

Bodily Pain ◽

Thoracolumbar Spine ◽

Spine Deformity ◽

Nerve Roots ◽

Limb Weakness ◽

Nerve Root Injury ◽

Estimated Blood Loss ◽

Scoliosis Correction ◽

The Mean

Abstract Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to January 2019, 12 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO at T12 or L1, the mean kyphosis and scoliosis correction rates reached 77.0 ± 8.9% and 75.5 ± 8.0%, respectively and the intraoperative estimated blood loss was 1950 ± 1050 mL, and the mean operative time was 6.98 ± 4.02 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 63 ± 28, 50 ± 25, 50 ± 30, 34 ± 19, 53 ± 28, 45 ± 30, 30 ± 36 and 54 ± 18 at baseline to 83 ± 18, 69 ± 19, 72 ± 12, 66 ± 21, 75 ± 15, 72 ± 22, 66 ± 34 and 76 ± 12 at one year postoperatively , 83 ± 8, 68 ± 32, 83 ± 17, 73 ± 17, 82 ± 18, 76 ± 26, 70 ± 37 and 88 ± 12 at 18 months postoperatively, 86 ± 6, 83 ± 33, 90 ± 16, 81 ± 16, 89 ± 14, 88 ± 25, 83 ± 17 and 94 ± 10 at 24 months postoperatively, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by lower limb weakness and inner thigh numbness on knee extension and hip flexion, which was further confirmed by electromyography. Conclusions : PEO is easier to operate, and the spinal cord and nerve root are under direct vision and can effectively and safely correct severe rigid thoracolumbar spine deformity with satisfactory clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery. Key words: Thoracolumbar deformity, Nerve roots injury, L1 nerve roots, Parallel endplate osteotomy

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Spine

Goodman's Neurosurgery Oral Board Review ◽

10.1093/med/9780190055189.003.0009 ◽

2020 ◽

pp. 103-120

Author(s):

Allan D. Levi

Keyword(s):

New Technologies ◽

Thoracolumbar Spine ◽

Spinal Instrumentation ◽

Pedicle Screws ◽

Metastatic Lesion ◽

Oral Exam ◽

Spine Deformity ◽

Thoracic Disc ◽

Cervical Plating ◽

Invasive Techniques

Spine cases form a significant component of the neurosurgery Oral Board Examinations. A familiarity with the common cases is essential in preparing for the boards. Spine includes cases that span from the skull base to the sacrum. Another component of spine includes an understanding of spine stability as well as the use of spinal instrumentation such as cervical plating and pedicle screws. These techniques are now a standard part of the neurosurgical armamentarium. Current new technologies or approaches to the spine whether minimally invasive techniques or surgery for deformity are actively used and will continue to form a larger part of the oral exam. The following cases are discussed in this chapter: bilateral cervical facet dislocation with spinal cord injury, central calcified thoracic disc herniation, L5 congenital spondylolysis with spondylolisthesis, metastatic lesion, and a thoracolumbar spine deformity.

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Segmental Spinal Dysgenesis

Neurosurgery ◽

10.1227/00006123-198804000-00021 ◽

1988 ◽

Vol 22 (4) ◽

pp. 739-744 ◽

Cited By ~ 31

Author(s):

R. Michael Scott ◽

Samuel M. Wolpert ◽

Louis E. Bartoshesky ◽

Seymour Zimbler ◽

Lawrence Karlin

Keyword(s):

Computed Tomography ◽

Spinal Cord ◽

Lower Limb ◽

Thoracolumbar Spine ◽

Spinal Column ◽

Neurological Deficits ◽

Spinal Instability ◽

Nerve Roots ◽

Limb Deformities ◽

Focal Abnormality

Abstract Segmental spinal dysgenesis is characterized by focal agenesis or dysgenesis of the lumbar or thoracolumbar spine, with focal abnormality of the underlying spinal cord and nerve roots. Children are symptomatic at birth with lower limb deformities and neurological deficits that may be segmental. Myelography and computed tomography disclose hypoplastic or absent vertebrae and atrophic or absent neural elements adjacent to the bony deformity; the spinal column distal to the abnormality may be partially bifid, but is otherwise normal. Spinal ultrasonography was a helpful diagnostic adjunct in one patient. Surgery may be helpful in decompressing partially functioning spinal cord or nerve roots, but may exaggerate the tendency toward spinal instability. The embryology of this abnormality is not clear, but two children had other anomalies suggesting a spinal dysraphic syndrome, and its cause is probably related to a segmental maldevelopment of the neural tube.

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