Clinical Effect of Vertebral Column Decancellation Osteotomy Combined with Ponte Osteotomy in Elderly Patients with Old Thoracolumbar Fracture Combined with Kyphosis Deformity

Objective. The purpose of this study was to investigate the clinical effect of vertebral column decancellation (VCD) osteotomy combined with Ponte osteotomy in elderly patients withold thoracolumbar fracture combined with kyphosis deformity.Methods.36 elderly patients with old thoracolumbar fracture combined with kyphosis deformity admitted to our hospital from August 2015 to November 2018 were selected as the study subjects, and all of them were treated with VCDosteotomy combined with Ponte osteotomy.The Cobb angle of thoracolumbar kyphosis, sagittal vertical axis (SVA), visual analog scale (VAS) score.Oswestry disability index (ODI) and life quality were compared at 1 week before and after surgery as well as at the last follow-up. Results. ® All the 36 patients underwent the surgery successfully without serious complications, with the average duration of surgery of (5.13±0.62) h, average blood loss of (821.58±142.67) ml and average hospital stay of (14.02±2.43) d. (2) The Cobb angle of thoracolumbar kyphosis and SVA at 1 week after surgery and at the last follow-up were smaller than those at 1 week before surgery (P < 0.01), but the Cobb angle of thoracolumbar kyphosis and SVA at the last follow-up were slightly larger than those at 1 week after surgery (P < 0.01). (3) The VAS score and ODI score at 1 week after surgery and at the last follow-up were lower than those before surgery (P < 0.01), and the VAS score and ODI score at the last follow-up were lower than those at 1 week after surgery (P < 0.01). @ The scoliosis research society 22-item (SRS-22) score at the last follow-up was higher than that before surgery (P < 0.01). Conclusion. VCD osteotomy combined with Ponte osteotomy in the treatment of old thoracolumbar fracture combined with kyphosis deformity in the elderly can reduce the Cobb angle of thoracolumbar kyphosis, improve sagittal balance, reduce pain symptoms and functional disorders, and improve patents’ life quality, having a good clinical effect.

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Background To assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery. Methods Data of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients’ demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed. Results In this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT. Conclusions Method of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT. Level of evidence Level III.

CORRECTION OF SCOLIOSIS IN CHILDREN WITH CONGENITAL HEART DEFECTS

ABSTRACT Objective: The purpose of this study was to evaluate the results of treatment in patients with deformities of the spine and congenital heart defects. Methods: Eighty-seven children aged 10 to 18 years old (27 males and 60 females) were treated surgically due to scoliosis. Results: The minimum angle of the curvature arc was 68°. The deformity parameters were evaluated on the basis of the spine x-ray. In patients with combined and rigid forms of scoliosis, correction was performed using dorsal segmental instrumentation. Where there was rigid deformity and it was not possible to perform a front release according to the somatic indications, a one-stage dorsal correction was performed in conditions of halo traction in combination with SPO or Ponte osteotomy. In patients with moderate impairment of blood circulation in the presence of rigid curvature of the main arch, two-stage surgery was performed, with ventral release at the apex of deformation, followed by halo traction. As a second stage, dorsal correction and stabilization of the spine was performed. In the operated patients, the mean correction with dorsal instrumentation was 64.2%. An average of 12 vertebrae were included in fusion. The degree of apical vertebral body derotation was found to be up to 30% of the initial rotation. With the use of hybrid and hook systems, the average degree of derotation was 18%. According to the physical examination within one year, the parameters of the function of external respiration and bronchial permeability increased significantly, from 10% to 30%, which indicates the functional nature of changes in cardiorespiratory disorders. Level of evidence IV, Case series.

Triple Curve Scoliosis Presented with Developmental Dysplasia of the Left Hip in Marfan Syndrome

Introduction: Marfan syndrome is an autosomal dominant disorder of connective tissue, and skeletal system involvements are the cardinal features. Triple rigid large major curve in conjunction with developmental dysplasia of the hip in Marfan syndrome is rare then sagittal and coronal imbalance correction on this case is challengingCase Presentation: We reported a case of 12 years old female with Marfan syndrome presented triple rigid large Major curve scoliosis on left cervico-thoracal, right main thoracal and left thorakolumbal, also developmental dysplasia of the left hip has been done correction surgery consist of open reduction following cast immobilization of the left hip, multiple ponte osteotomy and asymetrical pedicle substraction osteotomy to correct sagittal and coronal imbalance.Discussion: the treatment of scoliosis in patients with Marfan syndrome parallels that in patients with idiopathic scoliosis and spinal fusion and instrumentation should be considered for curves greater than 45 to 50 degrees. Posterior technique, Ponte osteotomy correct 10 to 20 degrees and pedicle substraction osteotomy correct 30 to 40 degrees at each segment are effective for managing sagittal and coronal imbalance in scoliosis. Open reduction developmental dysplasia of the hip to overcome complicated coronal balance correction.Conclusion : Detailed planning scoliosis surgery is needed to correct a rare the sagittal and coronal imbalance due to scoliosis complicated with developmental dysplasia of the hip in Marfan syndrome.