Songhua Xiao

Clinical use of the nanohydroxyapatite/polyamide mesh cage in anterior cervical corpectomy and fusion surgery

Purpose. This study was to report the clinical use of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA 66) mesh cages in anterior cervical corpectomy and fusion (ACCF) surgery. Method. 95 patients who underwent single level anterior cervical corpectomy and fusion for cervical spondylosis myelopathy (CSM) in our hospital were reviewed and divided into 2 groups according to using nanohydroxyapatite/polyamide mesh cage and titanium mesh cage (TMC). Demographic data of patients and surgical, clinical, and radiological data before operation and at last follow-up were collected and compared. Result. The operation time, surgical blood loss, complications, and Japanese Orthopaedic Association scores (JOA scores) of two groups were similar. At the last follow-up both the two groups obtained 100% solid bone fusion, but the TMC group had higher rate of severe cage subsidence than the n-HA/PA 66 group (27% versus 2%). Conclusion. Nanohydroxyapatite/polyamide 66 mesh cage is safe and effective in ACCF and can be a substitution to titanium mesh cage.

Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases.

Study Design. A retrospective analysis of patients undergoing spinal deformity correction surgery by the assistance of intraoperative computed tomography (iCT) with or without navigation system. Objective. To share our preliminary experience and analysis of the iCT navigation system applied to spinal deformity surgery. Summary of Background Data. The iCT navigation system has been shown to improve accuracy and safety in posterior instrumentation. It not only decreased the operation time but also prevented excessive radiation exposure to the medical staff. To date, there are only few reports about the application of the iCT navigation system in spinal deformity surgery. Methods. From April 2009 to September 2010, 59 patients who had a diagnosis of scoliosis, kyphosis, or scoliokyphosis and underwent iCT-assisted surgical correction were included. Without randomization, 28 patients were operated with the iCT-navigation system, and the other 31 patients were operated with standard procedure under iCT assistance. The detailed procedures, preoperative and intraoperative images were illustrated. The accuracy of screw placement, time for screw insertion, postoperative correction rate, and iCT scanning data were analyzed. Results. There were significant differences between 2 groups in (1) the preoperative Cobb angle (76.2° and 62.6° in the navigation and non-navigation groups), (2) the accuracy and the revision rate of thoracic pedicle screws and total pedicle screws, and (3) the average screw insertion time. The breach rate and the revision rate of thoracic pedicle screws and total pedicle screws were significantly lower and the average screw insertion time was significantly lesser in the navigation group than in the non-navigation group. There were no statistically significant difference in (1) the breach rate and the revision rate of lumbar pedicle screws, (2) the mean iCT scanning time and time-out, (3) the mean number of fusion segments, (4) the mean number of iCT scans, and (5) the postoperative correction rate. Complications were encountered in 2 patients in the non-navigation group but none in the navigation group. There was no reoperation due to implant malposition in both groups. Conclusion. The iCT navigation system provides desirable accuracy of posterior spinal instrumentation for patients during surgical correction of spinal deformity without radiation exposure to the medical staff, especially in thoracic spine instrumentation. Meanwhile, the iCT in itself is an effective means of assessing complex instrumentation of the spinal deformity.

Clinical report of cervical arthroplasty in management of spondylotic myelopathy in Chinese

ObjectivesTo investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively.Methods and materialsFrom 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odoms scale) and radiological (X-ray of flexion, extension; left and right bending position) follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels.ResultsAt least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsms scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9°) early postoperation and 8.12°(5.8°–13.6°) more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates (<1.5 mm) in 14/77 levels and (1.5~3 mm) in 4/77. heter-ossification was found in the replaced levels only in 2 cases.ConclusionByran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

Radiologic and clinical outcomes comparison between single- and two-level pedicle subtraction osteotomies in correcting ankylosing spondylitis kyphosis

BACKGROUND CONTEXT Single pedicle subtraction osteotomy (PSO) has been used to correct ankylosing spondylitis (AS) kyphosis successfully, but this approach seems insufficient to correct severe kyphosis. Two-level PSO has been attempted to correct advanced kyphosis in recent years. However, studies have not yet compared outcomes between single and double PSOs, and the indications to perform two-level PSO are unclear. PURPOSE This study aimed to compare the radiologic and clinical outcomes between single- and two-level PSOs in correcting AS kyphosis. STUDY DESIGN This work is a retrospective cohort study. PATIENT SAMPLE Sixty patients were included. Thirty-seven underwent single-level PSO, and 23 underwent one stage two-level PSO. OUTCOME MEASURES The radiologic analysis included thoracic kyphosis, thoracolumbar junction, lumbar lordosis, pelvic index, chin-brow vertical angle (CBVA), sagittal vertical axis (SVA), and pelvic tilt (PT). Clinical assessment was performed with a Scoliosis Research Society-22 (SRS-22) outcomes instrument. The operative time, blood loss, and complications were also documented. METHODS All of the aforementioned measurements were recorded before surgery, after surgery, and at the last follow-up. The outcomes were compared between the two groups. RESULTS The operating time was 232±52 minutes for single- and 282±43 minutes for two-level PSOs. The blood loss was 1,240±542 mL (Level 1) and 2,202±737 mL (Level 2). The total spine correction was 43.2°±15.1° (Level 1) and 60.6°±19.1° (Level 2) (p<.001), the SVA correction was 13.2±10.6 cm (Level 1) and 23.6±10.2 cm (Level 2) (p<.001), and the PT correction was 10.1°±11.6° (Level 1) and 15.2°±10.8° (Level 2) (p<.001). The CBVA correction was 50.6°±17.8° (Level 1) and 51.4°±18.6° in (Level 2) (p>.05). All patients could walk with horizontal vision and lie on their backs postoperatively. The SRS-22 improved from 1.7±0.4 to 4.2±0.8 in the two-level group and 1.8±0.8 to 4.3±0.7 in the single-level group. The fusion of the osteotomy was achieved in each patient. The complications were similar in both groups. CONCLUSIONS Pedicle subtraction osteotomy is an effective method to correct kyphosis with AS. Most patients can be successfully treated by single PSO. In severe patients, two-level PSO may be preferable because its correction ability is greater and spine curvature is better than that of single-level PSO. However, two-level PSO requires an increased operating time and results in increased blood loss. Nevertheless, the complications were similar between the two groups.

Multilevel 3D Printing Implant for Reconstructing Cervical Spine With Metastatic Papillary Thyroid Carcinoma

Study Design. A unique case report. Objective. A three-dimensional (3D) printing technology is proposed for reconstructing multilevel cervical spine (C2–C4) after resection of metastatic papillary thyroid carcinoma in a middle-age female patient. Summary of Background Data. Papillary thyroid carcinoma is a malignant neoplasm with a relatively favorable prognosis. A metastatic lesion in multilevel cervical spine (C2–C4) destroys neurological functions and causes local instability. Radical excision of the metastasis and reconstruction of the cervical vertebrae sequence conforms with therapeutic principles, whereas the special-shaped multilevel upper-cervical spine requires personalized implants. 3D printing is an additive manufacturing technology that produces personalized products by accurately layering material under digital model control via a computer. Reporting of this recent technology for reconstructing multilevel cervical spine (C2–C4) is rare in the literature. Methods. Anterior-posterior surgery was performed in one stage. Radical resection of the metastatic lesion (C2–C4) and thyroid gland, along with insertion of a personalized implant manufactured by 3D printing technology, were performed to rebuild the cervical spine sequences. The porous implant was printed in Ti6AL4V with perfect physicochemical properties and biological performance, such as biocompatibility and osteogenic activity. Finally, lateral mass screw fixation was performed via a posterior approach. Results. Patient neurological function gradually improved after the surgery. The patient received 11/17 on the Japanese Orthopedic Association scale and ambulated with a personalized skull-neck-thorax orthosis on postoperative day 11. She received radioiodine I131 therapy. The plane x-rays and computed tomography revealed no implant displacement or subsidence at the 12-month follow-up mark. Conclusion. The presented case substantiates the use of 3D printing technology, which enables the personalization of products to solve unconventional problems in spinal surgery. Level of Evidence: 5

Stepwise Therapy for Treating Tuberculosis of the Upper Cervical Spine: A Retrospective Study of 11 Patients.

Aims: Tuberculosis of the upper cervical spine is a rare occurrence with serious consequence, and its optimal treatment protocol remains inconclusive. This study aims at investigating the clinical characteristics and management outcomes of the stepwise therapy for different stages of tuberculosis of the upper cervical spine. Methods: We conducted a retrospective analysis of 11 patients with tuberculosis of the upper cervical spine who received anti-tuberculosis chemotherapy for 15 months. Two infants were treated by individualized chemotherapy, while 9 patients with retropharyngeal abscess were first treated with CT-guided percutaneous puncture, and the catheter was used to administer local chemotherapy. Two of these 9 patients continued to receive posterior instrumentation due to atlantoaxial subluxation. Patients were followed up clinically and radiologically for an average period of 60 months. Results: Two patients underwent catheter change due to catheter falling off and blockage, 2 patients had gastrointestinal side effects, and 2 patients had drug-induced hepatitis derived from the chemotherapy. Mean erythrocyte sedimentation rate was 10.27 mm/h (range 4-16 mm/h) and average visual analogue scale score was 2.55. A total of 11 cases underwent routine anti-tuberculosis chemotherapy for 15 months. 9 of 11 cases received supplementary surgical therapy, and all patients were cured at the final follow-up. Conclusion: Standard anti-tuberculosis chemotherapy is the cornerstone of stepwise therapy for tuberculosis of the upper cervical spine. Local chemotherapy is effective and minimally invasive for patients with severe local symptoms without spinal cord compression. Just as in patients with atlantoaxial instability, open fixation and bone grafting are necessary.

Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients.

The aim of this study was to evaluate the efficacy of minimally invasive spinal decompression combined with local chemotherapy in treating patients with thoracic/lumbar tuberculosis (TB) and abscess compression of the spinal canal. Clinical data of 31 patients with thoracic/lumbar TB and spinal epidural abscess, admitted to our hospital between December 2005 and June 2014 were retrospectively analyzed. All patients received initial conservative treatment but achieved unsatisfactory results and then underwent minimally invasive spinal canal decompression, focus debridement and catheter drainage through a posterior interlaminar approach. Postoperatively, a short-course (1-2months) of local chemotherapy was given. The patients were followed up on a regular basis. The neurologic status was graded according to the American Spinal Injury Association (ASIA) score system. Kyphotic deformity was evaluated using Cobb angle measurement. Patients were followed up for an average of 37months (range: 12-96months). At the last follow-up, ASIA scores were improved in all patients, and there was a mild increase in the Cobb angle, but satisfactory spinal stabilization was achieved. Hepatorenal function, erythrocyte sedimentation rate and C-reactive protein levels all returned to normal. One complication was observed, where the patient had worsened deficit postoperatively but achieved a satisfactory recovery (from Grade C to Grade E) one year after a second surgery. Minimally invasive spinal canal decompression combined with local chemotherapy appears to be an effective treatment for patients with thoracic/lumbar TB and abscess compression in the spinal canal.

En bloc spondylectomy combined with chest wall excision for spinal tumor via a modified posterior approach: a retrospective study on 21 patients

OBJECTIVE This study was to investigate the feasibility and efficacy of total en bloc spondylectomy (TES) combined with chest wall excision through a modified posterior approach in treating the patients with thoracic spinal tumor and posterior chest wall invasion. METHODS Clinical data of 21 consecutive patients (7 males, 14 females; average age: 41.5, range: 20-69) who underwent the combined TES and chest wall excision through a modified posterior approach from 08/2005 to 01/2014 were retrospectively analyzed. Reconstruction of the spinal defect following TES was accomplished by dorsal stabilization and carbon cage interposition. All resected specimens were examined histologically. Radiotherapy and chemotherapy were performed according to the results of the surgery and histological examination. All patients were followed up on a regular basis. RESULTS The surgery was successfully performed in all patients. Histological analysis revealed primary malignant tumors in 16 patients and solitary vertebral metastases in 5 patients. Three patients with preoperative neurologic deficits of Frankel D recovered to Frankel E 1-3 weeks postoperatively. After the mean follow-up of 31 months (9-70), the 16 patients (16/21, 76.2%) with primary bone tumors were free of recurrence and present no evidence of disease. Four cases (4/21, 19%) with metastatic tumor developed recurrence or distant metastases. Three patients presented with cerebrospinal fluid leakage and one patient suffered pneumonia; they were soon recovered after treatment. No other complications were observed. CONCLUSION The results suggest that the combined TES with chest wall excision via a modified posterior approach seems feasible and effective for treating patients with thoracic spinal tumor and posterior chest wall invasion.

Posterior Vertebral Column Decancellation (VCD) for Severe Rapid Spinal Deformities

Identification of a kyphotic or kyphoscoliotic deformity in various pathologic conditions on radiographs does not necessarily imply the need for treatment, either operative or nonoperative. However, patients with sharp angular spinal deformity usually have neurologic symptoms, such as late-onset paraplegia and low back pain, and also have cosmetic problems and psychological implications. Surgery may be the suitable option for the management of these patients [1]. Corrective spinal osteotomy may be considered to realign the patient’s deformed spine and to decompression. These patients with a severe rigid spinal deformity present a formidable challenge to the spine surgeon, because most of these patients need spinal osteotomy to achieve adequate correction.