scholarly journals One-stage anterior focus debridement, interbody graft using titamium mesh cages, and anterior instrumentation and fusion in the surgical treatment of short segment thoracic tuberculosis

2020 ◽  
Author(s):  
huijun zhang ◽  
zenghui lu ◽  
lin wei ◽  
chao ding ◽  
junsong yang
Keyword(s):  
Internal Fixation ◽  
Bone Graft ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Short Segment ◽  
Anterior Debridement ◽  
Thoracic Spinal ◽  
Imaging Results ◽  
Thoracic Tuberculosis

Abstract Study design:This is a retrospective studyObjective:The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis. MethodsWe performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.ResultsAll patients underwent operation successfully. The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and all the patients got bony spinal fusion within 4 to 8 months after surgery judging by spinal x-ray film.The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 18.2± 4.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients. Neurologic status of the 16 patients with preoperative neurologic defcit was 3 with grade A recovered to normal; 4 with grade B recovered to normal; 4 with grade C recovered to normal; 3 with grade A recovered to grade D; 1 with grade B recovered to grade D;1 with grade C recovered to D.ConclusionThe clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia or incomplete paralysis can be an effective and feasible treatment method.

scholarly journals One-stage anterior focus debridement, interbody graft using titamium mesh cages, and anterior instrumentation and fusion in the surgical treatment of short segment thoracic tuberculosis with paraplegia

2020 ◽  
Author(s):  
huijun zhang ◽  
zenghui lu ◽  
lin wei ◽  
chao ding ◽  
junsong yang
Keyword(s):  
Internal Fixation ◽  
Bone Graft ◽  
Clinical Manifestations ◽  
Short Segment ◽  
Anterior Debridement ◽  
Bone Fusion ◽  
Thoracic Spinal ◽  
Imaging Results ◽  
Thoracic Tuberculosis

Abstract Purpose The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia.Methods We performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB with paraplegia who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.Results All patients underwent operation successfully. The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 30.7 ± 7.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients.The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and bone fusion was achieved at the final follow-up.Conclusion The clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of segmental thoracic tuberculosis with paraplegia were satisfactory.

scholarly journals The efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis

2020 ◽  
Author(s):  
Jiao Zhou ◽  
Quanyi Li ◽  
Yongchun Zhou ◽  
Qichun Song
Keyword(s):  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Clinical Manifestations ◽  
Adult Patients ◽  
Thoracic Spinal ◽  
Imaging Results ◽  
Single Posterior Approach ◽  
Posterior Debridement ◽  
Thoracic Spinal Tuberculosis

Abstract Background: The aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was conducted on 88 adult patients with thoracic spinal tuberculosis between June 2013 and September 2017. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imaging results of the approach were subsequently analysed. Results: All patients were followed up for 40.6 ± 4.1 m (range, 36–48 m). Bony fusion was achieved in all bone grafts. The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). The postoperative and final-follow-up kyphosis angles were both significantly smaller than the pre-operative kyphosis angles (P<0.05). The postoperative angle correction rate reached 81.5%, and the postoperative angle loss only reached 4.1%. At the last follow-up, ASIA improvement was significant compared with the preoperative levels (P<0.05). Conclusion: The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

2014 ◽  
Vol 20 (1) ◽  
pp. 30-40 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
David F. Bauer ◽  
Thomas A. Moore ◽  
Patrick R. Pritchard ◽  
Mark N. Hadley
Keyword(s):  
Thoracic Myelopathy ◽  
Short Segment ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Signal Change ◽  
Long Term Follow Up ◽  
Outcome Comparison ◽  
Thoracic Cord

Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

scholarly journals Temporary occipital fixation in young children with severe cervical-thoracic spinal deformity

2017 ◽  
Vol 43 (4) ◽  
pp. E11
Author(s):  
Brian J. Kelley ◽  
Anas A. Minkara ◽  
Peter D. Angevine ◽  
Michael G. Vitale ◽  
Lawrence G. Lenke ◽  
...  
Keyword(s):  
Young Children ◽  
Bone Graft ◽  
Craniovertebral Junction ◽  
Spinal Instability ◽  
Long Term Effects ◽  
Partial Restoration ◽  
Thoracic Spinal ◽  
Flexion Extension ◽  
Upper Thoracic

OBJECTIVEThe long-term effects of instrumentation and fusion of the occipital-cervical-thoracic spine on spinal growth in young children are poorly understood. To mitigate the effects of this surgery on the growing pediatric spine, the authors report a novel technique used in 4 children with severe cervical-thoracic instability. These patients underwent instrumentation from the occiput to the upper thoracic region for stabilization, but without bone graft at the craniovertebral junction (CVJ). Subsequent surgery was then performed to remove the occipital instrumentation, thereby allowing further growth and increased motion across the CVJ.METHODSThree very young children (15, 30, and 30 months old) underwent occipital to thoracic posterior segmental instrumentation due to cervical or upper thoracic dislocation, progressive kyphosis, and myelopathy. The fourth child (10 years old) underwent similar instrumentation for progressive cervical-thoracic scoliosis. Bone graft was placed at and distal to C-2 only. After follow-up CT scans demonstrated posterior arthrodesis without unintended fusion from the occiput to C-2, 3 patients underwent removal of the occipital instrumentation.RESULTSFollow-up cervical spine flexion/extension radiographs demonstrated partial restoration of motion at the CVJ. One patient has not had the occipital instrumentation removed yet, because only 4 months have elapsed since her operation.CONCLUSIONSTemporary fixation to the occiput provides increased biomechanical stability for spinal stabilization in young children, without permanently eliminating motion and growth at the CVJ. This technique can be considered in children who require longer instrumentation constructs for temporary stabilization, but who only need fusion in more limited areas where spinal instability exists.

scholarly journals Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

2019 ◽  
Author(s):  
Yongchun Zhou ◽  
Weiwei Li ◽  
Liqun Gong ◽  
Jiao Zhou ◽  
Jing Luo
Keyword(s):  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Operation Time ◽  
Anterior Debridement ◽  
Thoracic Spinal ◽  
Group A ◽  
Group B ◽  
Posterior Debridement ◽  
Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

scholarly journals Late Radiation–Related Toxicities in Patients Treated for Early-Stage Cervical Carcinoma by Surgery and Adjuvant Radiotherapy: A Retrospective Imaging Study

2021 ◽  
Vol 27 ◽  
Author(s):  
Katarina Nadova ◽  
Miroslava Burghardtova ◽  
Klara Fejfarova ◽  
Klaudia Reginacova ◽  
Hana Malikova
Keyword(s):  
Cervical Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Inclusion Criteria ◽  
Imaging Results ◽  
The Mean ◽  
Risk Of Cancer ◽  
Tomography Scan

Surgical treatment is preferred therapy of early-stage cervical carcinoma. In the risk of cancer recurrence surgery is often followed by adjuvant radiotherapy. In our retrospective study we aimed at identifying late (≥6 months) and very late (≥5 years) radiation adverse effects on imaging scans as CT, PET/CT and MRI in patients who underwent successful treatment for cervical carcinoma by radical surgery combined with radiotherapy ± chemotherapy. We correlated imaging results with clinical manifestations. We selected young and middle-aged patients with long life expectancy, as late radiation-related toxicities may significantly affect their quality of life. Patients were selected from those who were primary diagnosed and treated between the years 1987–2011 and regularly visited our Oncology department in years 2011–2012. Following inclusion criteria were applied: age ≤55 years at diagnosis, clinical follow-up ≥5 years and at least one tomography scan ≥3 years after finished treatment. One hundred and three subjects were reviewed: 73 patients met all inclusion criteria, while 30 patients fulfilled the inclusion criteria except for available tomography scan ≥3 years after therapy. The mean imaging follow-up was 11.2 ± 7.6 years and the mean clinical follow-up was 15.0 ± 6.9 years. In 20 (27%) subjects 27 cases grade I radiation-related toxicities were found; 9 (33%) of those 27 cases were clinically silent. In 14 (19%) females only grade I toxicities were observed. Grade III-IV toxicities were found in 5 (6.8%) subjects. No grade V toxicities were observed. We concluded that severe late side effects caused by radiotherapy were exceedingly rare in females successfully treated for early-stage cervical carcinoma, only 1 bilateral osteonecrosis, 2 cases of ileus, and 2 potentially radiation-induced tumors were found. The majority of radiation-related comorbidities found on imaging scans were clinically silent.

scholarly journals Clinical effect of combined anterior and posterior approach surgery for cervical spondylotic myelopathy

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Yanzhou Jiang ◽  
Liancong Fu ◽  
Yunshan Mu
Keyword(s):  
Internal Fixation ◽  
Bone Graft ◽  
Clinical Efficacy ◽  
Posterior Approach ◽  
Cervical Vertebra ◽  
Clinical Effectiveness ◽  
Fusion Rate ◽  
Effective Rate ◽  
The Difference

<p>Objective: To evaluate the clinical efficacy of combined anterior and posterior approach surgery for patients with spinal type. Methods: Randomly selected from January 2013 to December 2015 in our hospital 96 cases of cervical spondylosis patients treated in our hospital from January 2013 to December 2015 , the technical way of the operation of these 96 cases of loyalty if they were randomly divided into A, B, C three groups. A group of 32 cases were treated by combined anterior and posterior approach in treatment of cervical myelopathy. B group of 32 cases patients with anterior cervical corpectomy decompression and bone graft fusion internal fixation surgery to treat cervical vertebra disease, C treatment group of 32 patients used conventional posterior decompression and fusion surgery for lateral mass screw fixation. Postoperative follow-up, the three groups of X-ray intervertebral stability and fusion, neurological function JOA score and clinical efficacy of the effective date were compared. Results: three group of patients after half a year, the JOA scores were improved, the patients of the A group after a year of score(16.3±1.83)，the scores of B and C two groups were respectively (15.7±1.15）、（15.59±1.21）, there was statistically differences between the three groups （ P ＜ 0.05). After one year’s follow-up, the bone graft and internal fixation material had no loosening, displacement and subsidence, the fusion rate of A group reached 90.6%, the fusion rate of B group was 53.1%, the fusion rate of C group was 56.25%, and the difference was statistically significant (P＜0.05）. For clinical effectiveness is divided into apparent, effective, fair, invalid. the effective rate of group A was 87.5%, and the effective rate was 50% in group B, the difference was statistically significant（P＜0.05）. Conclusion: the treatment effect of A group was better than that of B and C two groups before and after operation, and the effect was significant.</p>

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