Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

Background Various bone grafting have been reported to achieve anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar tuberculosis. However, nonstructural bone grafting has been rarely studied. This study aimed to compare the efficacy of nonstructural bone grafting versus structural bone grafting in the treatment of lumbar tuberculosis.Patients and methods We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g. Visual Analog Scale for back pain, the Oswestry Disability Index) were collected before surgery and at follow-up.Results Both nonstructural and structural bone grafting were associated with significant improvements in the quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting resulted in the significantly less operation duration, blood loss and lower bone fusion rate than structural bone grafting group. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups. Conclusions Nonstructural bone grafting can achieve anterior column support with less surgical trauma and simpler surgical procedure than structural bone grafting, but the lower rate of grafted bone fusion should be taken into consideration when choosing nonstructural bone grafting. Key words Lumbar tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; Nonstructural bone grafting; Structural bone grafting

Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

[Background] Various bone grafting have been reported to achieve anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar tuberculosis. However, nonstructural bone grafting has been rarely studied. This study aimed to compare the efficacy of nonstructural bone grafting versus structural bone grafting in the treatment of lumbar tuberculosis.[Patients and methods] We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g. Visual Analog Scale for back pain, the Oswestry Disability Index) were collected before surgery and at follow-up. [Results] Both nonstructural and structural bone grafting were associated with significant improvements in the quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting resulted in the significantly less operation duration, blood loss and lower bone fusion rate than structural bone grafting group. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups.[Conclusions] Nonstructural bone grafting can achieve anterior column support with less surgical trauma and simpler surgical procedure than structural bone grafting, but the lower rate of grafted bone fusion should be taken into consideration when choosing nonstructural bone grafting.

Nonstructural versus structural bone grafting in the treatment of lumbar spinal tuberculosis combined with single-stage posterior debridement and instrumentation: a retrospective cohort study

Background Many types of bone grafting have been reported for successful use in achieving anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the feasibility of none-structural bone grafting from comparing the advantages and disadvantages with structural bone grafting in the treatment of lumbar spinal tuberculosis. Patients and methods We retrospectively reviewed patients with lumbar spinal tuberculosis who had undergone none-structural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for back pain, the Oswestry Disability Index were collated before surgery and at follow-up. Results Both none-structural and structural bone grafting were associated with significant improvements in quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was in both two groups, without any associated complications. The operation duration and blood loss in none-structural bone grafting group was significantly less. The bone fusion rate was higher in structural bone grafting group. There were three complications in the none-structural bone grafting and four complications in the structural bone grafting group; the incidence of complications between the two groups was not significantly different. Conclusions Based on single-stage posterior debridement and pedicle screws fixation, none-structural bone grafting can achieve anterior column support with reducing surgical trauma, simplifying surgical procedure and decreasing intraoperative hemorrhage, but the lower rate of grafted bone fusion should be taken into consideration when choosing the aforementioned method. Key words Lumbar spinal tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; None-structural bone grafting; Structural bone grafting

Vertebral column resection for severe kyphosis

Vertebral column resection is an excellent tool for the correction of sharp angular deformities. Preoperative planning is crucial, and a 3D model is helpful. The spinal column is stabilized before any resection is performed. The dorsal fusion mass holds the dura and spinal cord suspended with the adhesions while the anterior decompression is being performed. The correction is performed by shortening with compression, rod exchange, in situ bending, cantilever, and compression. The anterior column support is important. Multiple rods prevent early rod failure. The cord is covered with bone graft to prevent mechanical compression from muscle or a hematoma.The video can be found here: https://youtu.be/FlBE5SFa2Gw.