Qin S.H.,Beijing Chuiyangliu Hospital
Zhonghua wai ke za zhi [Chinese journal of surgery] | Year: 2010
To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida. The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed. One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment. Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.
Xing Z.-J.,Beijing Chuiyangliu Hospital
National Medical Journal of China | Year: 2011
Objectives: To study the stress distribution of the adjacent different grades of disc degeneration underwenting unilateral laminectomy and discectomy surgery using non-linear finite element analysis. Methods: Based on the lumbar CT scans, the finite element model (FEM) of lumbar spinal segment(L3-L5) was established. According to L3-L4 intervertebral disc degeneration, different grades of disc degeneration (healthy, mild, moderate and severe) models were established and unilateral laminectomy and discectomy surgery were also established. Physiological action such as flextion, extension, lateral bending and lateral rotation was simulated and the von Mises stress in the nucleus pulposus and annulus fibrosus matrix of L3-L4 disc was investagated. Results: After unilateral laminectomy and discectomy surgery, the extremum value of von Mises stress of nucleus pulposus and annulus fibrosus matrix was maximum during extension and minimus left bending in the healthy intervertebral disc. Compared with healthy disc, the increment of extremum value was found during left bending in the mildly degenerated disc. When the value decreased in the moderately degenerated disc, but still higher than that in the healthy disc. When the adjacent disc is severly degenerated, the extremum value of nucleus pulposus decreased, in addition to axial rotation, and even lower than that of healthy disc. The value of annulus matrix decreased and still higher than that of healthy disc, especially during left bending. Conclusions: After unilateral laminectomy and discectomy surgery, avoiding lateral bending will reduce the abnormal stress in the degenerated disc and decreased the risk of accelerating disc degeneration. © 2011 by the Chinese Medical Association.
Du W.,Hebei Medical University |
Wang L.,Hebei Medical University |
Shen Y.,Hebei Medical University |
Zhang Y.,Hebei Medical University |
And 2 more authors.
European Spine Journal | Year: 2013
Purpose: To investigate the long-term impacts of different posterior operations on curvature, neurological improvement and axial symptoms for multilevel cervical degenerative myelopathy (CDM), and to study the relationship among loss of cervical lordosis, recovery rate and axial symptom severity. Methods: We retrospectively reviewed 98 patients with multilevel CDM who had undergone laminoplasty (Group LP, 36 patients), laminectomy (Group LC, 30 patients), or laminectomy with lateral mass screw fixation (Group LCS, 32 patients) between January 2000 and January 2005. Loss of curvature index (CI) was measured according to the preoperative and final follow-up radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. Axial symptom severity was quantified by Neck Disability Index (NDI). Results: Analysis of final follow-up data showed significant differences among the three groups regarding loss of CI (F = 41.46, P < 0.001) between preoperative and final follow-up JOA scores (P < 0.001), final follow-up JOA score (F = 7.81, P < 0.001), recovery rate (F = 12.98, P < 0.001) and axial symptom severity (χ 2 = 18.04, P < 0.001). Loss of CI showed negative association with neurological recovery (r = -0.555, P < 0.001) and positive correlation with axial symptom severity (r = 0.696, P < 0.001). Conclusions: Excellent neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while loss of CI in groups LP and LC caused a high incidence of axial symptoms. Loss of CI was correlated with poor neurological recovery and axial symptom severity. Lateral mass screw fixation can effectively prevent loss of postoperative cervical curvature and reduce incidence of axial symptoms. © 2013 The Author(s).
Jiao S.F.,Beijing Chuiyangliu Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2012
To study surgical strategies for ankle and foot deformities secondary to spina bifida and treatment methods for different types of deformities. From January 1990 and July 2009, 107 patients with ankle and foot deformities secondary to spina bifida were retrospectively analyzed. There were 44 males and 63 females, with an average age of 17.7 years (rangd from 1.3 to 52 years). Among the patients, 58 patients had double ankle deformities, 49 patients had unilateral deformities (22 cases on the left side, 27 cases on the right). Ninety-nine patients with equinus deformities were treated by achilles tendon lengthening and tendon transfering; 25 patients with talipes were treated by release of anterior tendon of ankle and tendon transfer; 17 patients with valgus and varus deformities were treated by tendon transfer and calcaneal osteotomy; 15 patients with flail deformities were managed treated by bone fusion between calcaneus and talus and shortening of achilles tendon; 9 patients with claw toe deformities were treated by bone fusion of interphalangeal joint or Ilizarovs distraction. AOFAS (American Orthopaedic Foot & Ankle Society) comprehensive scoring system was used to evaluate subjective pain and objective functional. Seventy-nine (127 feet) of 107 patients were followed up, and the duration ranged from 48 to 180 months (averaged, 64 months). According to AOFAS scoring system, the results were rated as excellent in 89 feet, good in 26 feet, moderate in 9 feet and poor in 3 feet. Treatment strategies for ankle-foot deformities mainly included four principles, deformity correction, muscular balance, joint stability and reservation of foot elasticity. Different combined procedure was applied for different foot deformities and received good therapeutic effects.
Du W.,Hebei Medical University |
Zhang P.,Hebei Medical University |
Shen Y.,Hebei Medical University |
Zhang Y.-Z.,Hebei Medical University |
And 2 more authors.
Spine Journal | Year: 2014
Background context Either an anterior approach or a posterior approach, which aims to decompress the spinal cord and restore the sagittal alignment, has been adopted to treat multilevel cervical degenerative myelopathy (CDM) associated with kyphosis. However, there is controversy on the optimal surgical strategy for the treatment of multilevel CDM with kyphotic deformity because of the complications of each surgical approach. Purpose The purpose of this study was to investigate the surgical efficacy of enlarged laminectomy (removing the inside edge of facet joints and decompressing the nerve foramina) and lateral mass screw fixation for the treatment of multilevel CDM associated with kyphosis. Study design A retrospective radiographic and clinical study to access the efficacy of enlarged laminectomy with lateral mass screw fixation in the treatment of multilevel CDM related to kyphosis. Patient sample A total of 43 patients (28 men and 15 women; average age, 59.6 years) with multilevel CDM correlated to kyphosis were obtained in the study. Outcome measures All radiological data were recorded on computer-based measurement from preoperative or postoperative X-ray, magnetic resonance imaging (MRI), and computed tomography. All neurological parameters were accessed in each patient. Methods Analysis consisted of: Japanese Orthopedic Association (JOA) score, recovery rate, curvature index (CI), the expansion degree and drift-back distance of the spinal cord, axial symptom severity, and C5 root palsy. The recovery rate based on the JOA score was calculated for each patient. Cervical CI as well as the expansion degree and drift-back distance of the spinal cord was measured using MRI. Axial symptom severity was quantified by a visual analog scale (VAS). Statistical analysis was performed using paired t test with significance set at p<.05. Results Enlarged laminectomy was performed over a mean of 3.97 levels (range, 3-5 levels). Follow-up information was obtained at a mean of 2.8 years (range, 1.5-5 years) after surgery. Analysis of the final follow-up data showed significant differences before and after surgery in the JOA score (t=24.17, p<.001), CI improvement (t=21.89, p<.001), the anteroposterior diameter at the level of maximum compression of the spinal cord (t=9.54, p<.001), and VAS score (t=13.30, p<.001). The mean spinal cord posterior shift was 4.72±1.10 mm (range, 0-6.71 mm). X-rays confirmed that bone grafts were completely fused at a mean of 3 months after surgery. During the follow-up period, only two patients (4.7%) did not obtain complete recovery, four patients (9.3%) experienced axial symptoms; there were no C5 root palsy and instrument failures noted in this series. Conclusion Enlarged laminectomy with fixation for the management of multilevel CDM is demonstrated to be an effective strategy for improving neurological function, restoring the normal cervical lordosis, and decreasing the incidence of axial symptoms and C5 root palsy, but there is a need for randomized controlled studies with long-term follow-up to confirm and clarify these results. © 2014 The Authors. Published by Elsevier Inc. All rights reserved.