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Objective: Treating patients with large thoracic scoliosis (between 70° and 100°) poses technical challenges, particularly with traditional correction techniques (TCT). To address this, we developed a novel deformity correction manipulation system (DCMS) aimed at reducing surgical complexity and trauma. This study aims to assess the safety and effectiveness of DCMS in treating large thoracic scoliosis., Methods: From January 2016 to June 2021, 76 patients with large thoracic scoliosis were included in this retrospective study. The patients were divided into two groups: DCMS (n = 34) and TCT (n = 42). Basic patient data including age at surgery, sex, etiology, Risser sign, flexibility of the main thoracic curve, instrumented levels, number of screws, duration of hospital stay, and follow-up time were collected and analyzed. Radiographic and clinical outcomes, as measured by various radiographic parameters and Scoliosis Research Society-30 (SRS-30) scores, were retrospectively analyzed and compared between the two groups. Adverse events were also documented. Statistical analyses were performed using two-tailed independent t-tests, chi-square tests, and Fisher's exact test., Results: The DCMS group exhibited significantly shorter operative times, reduced blood loss, and shorter hospital stays compared to the TCT group. However, there were no significant differences between the two groups in terms of age at surgery, sex, etiology, Risser sign, flexibility of the main curve, instrumented levels, number of screws, and follow-up time. While preoperative major curves were statistically similar between the two groups, the DCMS group achieved a superior correction rate compared to the TCT group (74.2% ± 8.8% vs 68.1% ± 10.5%). No significant differences were observed in other radiographic parameters, SRS-30 scores, or the incidence of adverse events., Conclusion: The application of DCMS resulted in shorter operative times, reduced blood loss, shorter hospital stays, and greater curve correction compared to TCT. DCMS proves to be a safe and effective technique for treating large thoracic curves., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

The treatment of congenital hemivertebrae in the upper thoracic region is challenging. The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 80.2%. The total main curve was 44.1° before surgery and 11.6° at the last follow-up, with an average correction rate of 73.9%. The caudal compensatory curve was corrected from 20.2° to 7.1°, with an average correction rate of 64.9%. The segmental kyphosis was corrected from 30.9° to 8.9°, with an average correction rate of 65.5%. The total Scoliosis Research Society-22 score significantly improved in all patients at the last follow-up, mainly resulting from the improvement of the self-image, mental health, and satisfaction domains. The following complications were found: one pedicle fracture, two malpositioned screws, one transient neurologic deficit, one implant failure, and four postoperative curve progressions. Although good radiographic deformity correction and clinical results were achieved after surgery, the incidence rate of complications was high at 42.9%; great care should be taken to prevent them, especially for postoperative curve progression (19.0%).

Background: Spinal tuberculosis accounts for more than 50% of bone tuberculosis cases. This study compared clinical, radiological and functional outcomes between anterior and posterior approaches for treatment of middle or lower thoracic spinal tuberculosis in elderly patients., Methods: We retrospectively examined middle or lower thoracic spinal tuberculosis (T5-T12) in patients over 65 years. All procedures included debridement, decompression, autologous bone graft and fixation. Surgical procedure, surgical duration, estimated blood loss during surgery and laboratory results were recorded. Pleural effusion volume, thoracic cavity volume, Oswestry Disability Index score, neurological status, radiological parameters and complication rate were evaluated., Results: No significant difference was found in surgical duration, blood loss, kyphosis angle correction, loss of correction, thoracic cavity volume, or complication rate between the two groups (P > 0.05). Average postoperative pleural effusion volumes were 605.9 ± 209.5 mL (377-1074 mL) and 262.9 ± 228.1 mL (0-702.4 mL) in the anterior and posterior groups, respectively (P = 0.004). Average hospitalization durations were 26.4 ± 10.5 days (17-53 days) and 19.2 ± 5.0 days (14-30 days) (P = 0.04). Average postoperative serum albumin levels were 24.19 ± 3.84 g/L (19-29.5 g/L) and 28.24 ± 2.52 g/L (24.4-31.6 g/L) (P = 0.01). No relapse or reinfection was observed in either group at the final follow-up. Surgical revision was not required in either group., Conclusions: Both anterior and posterior surgeries can be used to treat middle or lower thoracic spinal (T5-T12) tuberculosis in elderly patients. In general, the posterior approach might be superior, especially for patients with poor general health., (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Extended fusion can be performed in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) with a large and relatively rigid thoracic curve. Progression of the thoracic curve is related to coronal imbalance. We aimed to determine the correlation between the upper instrumented vertebra choice and coronal balance in patients with Lenke 5C AIS., Methods: A total of 61 patients with Lenke 5C AIS underwent posterior fusion from 2009 to 2015 in a single institution with ≥2 years of follow-up data available. The extended fusion group (n = 32) and thoracolumbar/lumbar (TL/L) fusion group (n = 29) were compared for the correction rates for the main TL/L and thoracic curves, coronal balance, upper end vertebra (UEV) tilt, and Scoliosis Research Society-22 questionnaire score., Results: Both groups had excellent correction of the main TL/L curve, and the extended fusion group had a significantly greater correction rate of the thoracic curve than the TL/L fusion group (70.2% vs. 57.3%). The incidence of coronal imbalance was similar in both groups. The spontaneous change in UEV tilt was associated with the change in coronal balance from the first to the final follow-up examination. In the TL/L fusion group, the increase in UEV tilt from the first to final follow-up visit resulted in improved coronal balance at the final follow-up examination. Both groups had similar Scoliosis Research Society-22 questionnaire scores at 2 years postoperatively., Conclusions: In patients with Lenke 5C AIS, thoracic curve fusion results in better correction of the thoracic curve but no improvement in coronal balance. With TL/L fusion, a postoperative UEV tilt >5° leads to better coronal balance., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Lenke 5 AIS is a kind of three-dimensional deformity and literature reported it usually accompany with coronal or/and sagittal imbalance. However, the postoperative coronal and sagittal balance in these patients has rarely be analyzed previously and the predict factors for postoperative trunk balance are still unclear. To synthetically analysis coronal and sagittal balance of Lenke 5 AIS patients simultaneously and found out predict factors for postoperative coronal or/and sagittal imbalance., Methods: Fifty-six Lenke 5 AIS patients who underwent posterior surgery and be followed up more than 2 years were included in this study. Coronal parameters included main curve Cobb angle, lumbosacral hemi-curve Cobb angle, preoperative LEV/LIV tilt and translation and C7-CSVL distance; While sagittal parameters included pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), lumbar lordosis(LL), thoracic kyphosis(TK), and sagittal vertical axis(SVA). Coronal imbalance was defined as C7-CSVL> 20 mm, and sagittal imbalance defined as (1) SVA > 40 mm or (2) PT < 20% PI/2 or PT > 20° or (3) PI-LL > 10°. And relative parameters were compared between balance and imbalance group to find out predict factors., Results: All seven final coronal imbalance patients occurred in LIV = L5 group. Preoperative LIV tilt(11.4°) and translation(5.2 mm) in coronal imbalance group were abnormally lower than balance group (21.7° and 15.7 mm respectively). Eighteen patients performed final sagittal imbalance. The PI in these patients (37.7°) was significantly lower than balance group (48.0°). And most of finial sagittal imbalance patients also occurred in LIV = L5 group., Conclusions: LIV = L5 as a threshold point, represents higher risk of postoperative coronal and/or sagittal imbalance. Besides, large LEV-S1 curve in reduce-bending film and small PI is directly related to final coronal imbalance and sagittal imbalance respectively.

Objective: To evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture., Methods: Between April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T 8, 9 in 1 case, T 10, 11 in 2 cases, T 11 in 2 cases, T 12 , L 1 in 1 case, L 1, 2 in 1 case, and L 2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity., Results: The operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones ( P <0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation ( P <0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up ( P >0.05)., Conclusion: Posterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.

Rationale: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment., Patient Concerns: The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease., Diagnoses: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis., Interventions: Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting., Outcomes: Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived., Lessons: Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.

Objectives: There are many different systems recommending upper instrumented vertebra (UIV) for Lenke type 2 adolescent idiopathic scoliosis (AIS), several of which suggest that all Lenke type 2 AIS patients should be fused to the second thoracic vertebra (T2). However, all previously proposed UIV selecting systems do not accurately predict postoperative shoulder balance. We investigated whether fusing to T2 could prevent postoperative shoulder imbalance and identified circumstances under which to fuse up to T2., Patients and Methods: We retrospectively collected all patients with typical Lenke type 2 AIS who received surgery by one spine surgeon in our hospital from 2010 to 2014. Lateral shoulder balance was assessed utilizing radiographic shoulder height difference (RSH), coracoid height difference (CHD), clavicle-rib intersection difference (CRID), and clavicle angle (CA). Medial shoulder balance was assessed by T1 tilt angle and first rib angle (FRA). Lateral shoulders were considered to be level if the absolute value of RSH was less than 10 millimeters. All patients were divided into two groups as follows: 1) T2 group: UIV of T2 (n=49); and 2) below-T2 group: UIV of T3 (n=24) or T4 (n=6). Patients were assessed before surgery and at final follow-up with a minimum follow-up duration of 24 months., Results: Seventy-nine typical Lenke type 2 AIS patients were identified. Preoperative CHD and CA were significantly associated with postoperative lateral shoulder imbalance (both p=0.045), whereas the UIV level was not significantly associated with it. Both fusing to T2 and to below T2 could improve RSH (p<0.001 and p=0.001, respectively). Fusing to T2 slightly worsened CHD, CRID, and CA at last follow-up (all p<0.001), while fusing to below T2 improved these lateral shoulder balance parameters (p=0.042, p<0.001, and p=0.007, respectively). For medial shoulder balance, fusing to below T2 worsened T1 tilt angle and FRA at last follow-up (p=0.025 and p<0.001, respectively), while fusing to T2 effectively kept these medial shoulder parameters in balance. In addition, for patients with an elevated left border of T1, the T2 group had worse preoperative T1 tilt angle but gained better postoperative T1 tilt angle than the below-T2 group (p<0.001 and p=0.040, respectively)., Conclusion: Preoperative lateral shoulder balance, more so than the UIV level, can strongly influence postoperative lateral shoulder balance. Fusing to T2 can only effectively improve medial shoulder balance, not lateral shoulder balance (CHD, CRID, and CA). Moreover, a positive T1 tilt angle is an indicator for fusing to T2 to improve medial shoulder balance., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: One-stage posterior hemivertebral resection has been proven to be an effective, reliable surgical option for treating congenital scoliosis due to a single hemivertebra. To date, however, no studies of treating unbalanced multiple hemivertebrae have appeared. This study evaluated the efficacy and safety of one-stage posterior hemivertebral resection for unbalanced multiple hemivertebrae., Patients and Methods: Altogether, we studied 15 patients with unbalanced multiple hemivertebrae who had undergone hemivertebral resection using the one-stage posterior approach with at least 2 years of follow-up. Clinical outcomes were assessed radiographically and with the Scoliosis Research Society-22 (SRS-22) score. Related complications were also recorded., Results: The mean Cobb angle of the main curve was 62.4° (46°-98°) before surgery and 18.2° (9°-33°) at the most recent follow-up (average correction 73.3%). The compensatory cranial curve was corrected from 28.5° (11°-52°) to 9.1° (0°-30°) (average correction 70.0%). The compensatory caudal curve was corrected from 31.6° (14°-54°) to 6.9°(0°-19°) (average correction 79.1%). The segmental kyphosis/lordosis was corrected from 41.1° (-40° to 98°) to 12.3° (-25° to 41°) (average correction 65.5%). The mean growth rate of the T1-S1 length in immature patients was 9.8mm/year during the follow-up period. Health-related quality of life (SRS-22 score) had significantly improved. Complications include one wound infection and one developing deformity., Conclusion: One-stage posterior hemivertebral resection for unbalanced multiple hemivertebrae provides good radiographic and clinical outcomes with no severe complications when performed by an experienced surgeon. Longer follow-up to detect late complications is obligatory., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Several studies have explored cervical kyphosis (CK) in adolescent idiopathic scoliosis (AIS) patients. However, few studies have evaluated the cervical alignment in these patients according to their coronal curve type. The aim of this study was to analyze the radiological features of cervical sagittal alignment in Lenke 1 AIS patients before and after surgery., Methods: This is a retrospective study enrolled 50 patients. Preoperative and postoperative standing full-length radiographs (at last follow-up after operation) were used to measure the coronal and sagittal parameters. Main sagittal parameters included C2-C7 angle, thoracic inlet angle (TIA), T1 slope, proximal thoracic kyphosis (PTK, T1-5 kyphosis) and thoracic kyphosis (TK, T5-12 kyphosis)., Results: The TIA of patients with CK was significantly smaller than that of patients with CL (63.0° vs. 76.3°, p < 0.05) and the cutoff value was 71°. The TIA of patients with CK after surgery was significantly smaller than that of patients with CL postoperatively (62.5° vs. 74.6°, p < 0.05) and the cutoff value was 62°. In patients with postoperative CL, there was a significant increase in their PTK and a reduction in their TK, regardless of preoperative CL or CK. In patients whose CL deteriorated to CK after surgery, both their PTK and TK significantly decreased after surgery., Conclusions: Patients with TIA less than 71° were more likely to have CK. And patients with TIA less than 62° would lead to the postoperative uncorrected or new onset of CK. The increased PTK after operation could have a beneficial effect on the improvement of CL.

Purpose: To discuss the cause and clinical efficacy of revision surgery for secondary deformity after treatment of spinal tuberculosis with debridement, instrumentation, and fusion., Methods: From September 2007 to March 2013, 15 patients with postoperative secondary deformity after treatment of spinal tuberculosis were enrolled. Constitutional symptoms, laboratory findings, and radiographic evidence were used to evaluate the secondary deformity conditions and diagnose the recurrence of spinal tuberculosis. All patients underwent revision surgery. The clinical and radiographic data from before and after previous surgery, before and after revision surgery, and after a minimum follow-up of 9 months were retrospectively reviewed., Results: Among 15 cases of secondary deformity, there were 8 recurrences of spinal tuberculosis. Anterior instrumentation was used in 9 patients, and posterior instrumentation in 6. Regarding previous surgery, the mean number of involved segments was 2 vertebral bodies; a mean of 4 vertebral bodies were fused; the mean preoperative scoliosis of 14.5° was corrected to 6.5° (52.08 % correction); the mean preoperative kyphosis of 56.4° was corrected to 28.9° (44.8 % correction). Before revision surgery, the mean kyphotic angle increased to 58.6° and the mean scoliosis angle increased to 19.6°. New deformity occurred at the primary levels in 11 patients and at the level adjacent to fused segments in 4. After revision surgery, a mean of 8 vertebral bodies were fused; at final follow-up, the mean kyphotic angle was corrected to 26.7° and the mean scoliosis angle was corrected to 2.4°. No neurologic complications were observed during or after revision surgery. No complications with instrumentation and recurrence of spinal tuberculosis were found at final follow-up., Conclusions: Recurrence of spinal tuberculosis, incorrect choice of internal fixation strategy, unsuitable fused segments, and poor achievement of sagittal and coronal balance after surgery may lead to secondary deformity postoperatively. Good clinical outcomes were obtained by revision surgery to extend the fused segments, albeit with decreased spinal range of motion.

Study Design: A retrospective study., Objective: To investigate the preoperative spinopelvic sagittal alignment in Lenke 5 patients with adolescent idiopathic scoliosis (AIS), and analyze how it alters after posterior correction., Summary of Background Data: The structural thoracolumbar or lumbar curve may change the local sagittal alignment thereby altering the sagittal balance in Lenke 5 patients with AIS. However, few studies have evaluated the spinopelvic sagittal alignment before and after the surgery in these patients., Methods: Forty-eight Lenke 5 patients with AIS who underwent posterior correction and fusion were included in this study. Preoperative and postoperative radiographs were reviewed measuring both the coronal and sagittal parameters. Three pelvic sagittal states (anteverted, normal, or retroverted) were evaluated according to the magnitude relationship of individual pelvic tilt with pelvic incidence (PI). Both the coronal and sagittal parameters between different pelvic sagittal states were compared. The alterations of these parameters by surgery would also be analyzed., Results: The mean follow-up was 1.8 years. Preoperatively, the mean PI was 44.3° with a pelvic tilt of 4.1°. There was 48% patients showing the anteverted pelvis, whereas the remaining 52% showing normal. The patients with anteverted pelvis showed a smaller PI and more distal lower end vertebra than normal pelvis ones. Logistic regression analysis revealed PI (odds ratio [OR] = 0.62, P = 0.024) and lower end vertebra (OR = 2.1, P = 0.037) were significantly associated with the risk of developing anteverted pelvis. The pelvic tilt was significantly increased and 61% of patients with preoperative anteverted pelvis had recovered. Logistic regression analysis revealed PI (OR = 0.7, P = 0.034) and lower instrumented vertebra (OR = 6.5, P = 0.002) were significantly associated with the risk of postoperative uncovered of anteverted pelvis., Conclusion: Anteverted pelvis appears in almost half of Lenke 5 patients with AIS, especially in who have smaller PI or distal lower end vertebra. The abnormal pelvic sagittal state will be generally corrected by posterior correction surgery except for patients with a PI less than 39° or a lower instrumented vertebra that extends to L5.

Purpose: This study aimed to compare efficacy, safety, and cost between staged vertebral column resection (VCR) and anterior release with internal distraction in treating severe and rigid idiopathic scoliosis., Methods: We examined the records of 43 patients with severe and rigid idiopathic scoliosis treated in our hospital. Group A included 26 patients who underwent anterior VCR followed by posterior vertebral column resection and instrumentation from July 2007 to October 2009. Group B included 17 patients who underwent anterior release with temporary posterior internal distraction, followed by posterior fusion and instrumentation from November 2009 to June 2011. The average preoperative main curve for group A was 101.3° (range 90°-130°) and for group B was 104.8° (range 90°-136°). Minimum follow-up was 2 years. Radiographic and clinical outcomes were compared between the groups., Results: A t test demonstrated that the differences between the groups in preoperative and postoperative coronal and sagittal imbalance, thoracic kyphosis correction, and lumbar lordosis were not statistically significant. Patients in group B showed better postoperative (P = 0.031) and final (P = 0.030) main thoracic curve correction (76.8 and 75.6 %, respectively) than patients in group A (68.3 and 67.7 %, respectively). Patients in group B had better thoracolumbar or lumbar curve correction (85.8 %) than those in group A (76.8 %; P = 0.048). The differences in blood loss and operation time were not statistically significant (P = 0.094 and P = 0.060, respectively). Hospital stay was longer (P = 0.001) and patient cost was higher (P < 0.001) for patients in group B. One patient in group A required ventilator support for 12 h after anterior surgery. One transient dyspnea occurred in group B. No neurologic deficits occurred in either group., Conclusion: Anterior release with posterior internal distraction produces better corrective effects than anterior and posterior VCR, though hospital stay and costs are greater.

Objective: To explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology., Methods: Between June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-ll. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs., Results: The operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred., Conclusion: It is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.

Objective: To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS)., Methods: Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P > 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter's standard and the correction of Cobb angle was assessed by X-ray films., Results: All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P > 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (chi2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter's standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= -1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P < 0.05), but there was no significant difference between 1 week and last follow-up (P > 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957)., Conclusion: Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.

Cages are used to regain stability of the anterior spinal column following vertebrectomy, which could prevent significant donor-site morbidity from the iliac autograft harvesting and the risk of disease transmission associated with the allograft. The hollow, porous, cylindrical nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage is a new nonmetallic cage device made by combining nanohydroxyapatite with polyamide 66. Few studies have examined its effectiveness and outcomes over a follow-up >2 years.We retrospectively studied 51 consecutive patients with acute traumatic thoracic or lumbar burst fracture who underwent anterior reconstruction with the n-HA/PA66 cage following single-level corpectomy. Radiologic parameters (radiographs and 3-dimensional computed tomography scans) preoperatively and at 1 week and >2 years postoperatively, as well as clinical outcome parameters (SF-36 scores), were analyzed. Mean kyphosis correction in the segment within the cage was 11.8°±7.1°, and mean loss of correction at last follow-up was 1.9°±2.1°. Osseous fusion was achieved in 90.2% of patients, and severe cage subsidence (settling >2 mm) was observed in 19.6% of patients at final follow-up. Significant differences were found in 7 of 8 health dimensions of the SF-36 between neurologically intact patients and neurologically injured patients. Our clinical results indicate that the n-HA/PA66 cage is an effective device for reconstruction after anterior thoracic and lumbar vertebral resection, resulting in a high rate of successful osseous fusion and a low proportion of severe cage subsidence., (Copyright 2012, SLACK Incorporated.)

Study Design: A series study of neurologically deficient patients with Denis B type thoracolumbar burst fractures treated with anterior single segmental decompression and fixation (ASSDF)., Objective: To describe a surgical technique of ASSDF and its clinical outcome in a group of neurologically deficient patients with Denis B type thoracolumbar burst fractures., Summary of Background Data: The optimal treatment for thoracolumbar burst fractures is still controversial., Methods: The canals of selected patients were fully decompressed with partial dissection on fractured vertebral body. Single segmental fusion was achieved with grafting and fixation. Clinical evaluation (including Frankel scales and visual analogue scale) and radiologic assessments (including the measurements of the kyphosis Cobb angle, adjacent superior, inferior intervertebral disc height, and vertebral canal sagittal diameter on radiograph film and computer tomography scans) were performed before the operation and at 3-day, 6-month, 1-, 2-, and 3-year intervals after the operation., Results: Between June 2006 and May 2008, 37 patients with Denis B type thoracolumbar burst fractures were recruited for study. Thirty-four patients with successful ASSDF accomplished a 1-year follow-up. Average follow-up duration was 26 ± 9.2 months. The average operation time and blood loss were 173 ± 26 minutes and 445.6 ± 164.4 mL, respectively. Average Frankel scales were significantly improved at the end of follow-up. visual analogue scale decreased from 7.2 ± 0.8 before operation to less than 1.7 ± 0.7 (P < 0.05) 6 months later. The vertebral canal sagittal diameter was enlarged from an average of 5.9 ± 1.2 mm to 16.2 ± 1.0 mm (P < 0.01). The canal stenosis index also improved, from 36.0% to 99.1%. Kyphosis was corrected from 21.5° ± 6.1° to 7.3° ± 3.2° (P < 0.05) and remained at 8.2° ± 3.6° (P > 0.05) 1 year later. Adjacent disc heights remained constant. No serious complications or fixation failures were observed during follow-up., Conclusion: ASSDF provides a novel and effective surgical option for treating Denis B type fracture with neurologic deficiency.

Objective: To evaluate the safety and efficacy of the operation performed under the video-assisted thoracoscope to release the anterior part of the spine of the patient with severe adolescent idiopathic scoliosis (AIS)., Methods: From April 2004 to July 2006, 24 patients with AIS (Illness course, 1.5-9 years; Lenke I in 17 patients, Lenke II in 7; right scoliosis in 22, left scoliosis in 2), among whom there were 9 males and 15 females, with an average age of 14.7 years (range, 11-21 years) at the time of the operation. Before operation, the thoracic vertebral Cobb anger at the coronal plane was averaged 78.3 degrees (range, 65-125 degrees). All the patients had normal muscle strength and muscle tension in their lower limbs, but 5 of the patients had a decrease of the superficial sensation in their lower limbs. All the patients had a moderately or severely decreased lung reserve function. Under general anesthesia, the patient was placed in the lateral position to set up a work channel for thoracoscopy. The releasing of the thoracic intervertebral space and the confluence of the bone grafts were performed. During Stage I or Stage II , the orthopedic procedures for the posterior part of the scoliosis spine, the internal fixation, and the confluence of the bone grafts were completed., Results: All the patients survived the period of perioperation. During operation, there was a hemorrhage of 50-200 ml, averaged 100 ml, with a postoperative thoracic closely-drained fluid of 100-150 ml. The incision was healed by the first intention. Each patient underwent the release of 4-6 intervertebral spaces, with an average of 5.5 spaces released. The average coronal Cobb angle was 45.6 degrees (range, 25- 75 degrees). The physiological curvature at the sagittal plane was normal, with an improved shape of the spine. The follow-up for 3-18 months averaged 9.3 months revealed that the bilateral pulmonary markings were clear, with confluence of the orthopedic segment of the spine. The patients could live and work normally, and had a significantly-improved psychological condition and an active social participation because of their improved appearance., Conclusion: The releasing of the anterior part of the spine under the video-assisted thoracoscope can effectively release the adolescent idiopathic scoliosis and improve the flexibility of the spine, with a smaller degree of the surgical wound and a faster and clearer exposure of the spinal column during operation.

Background: Several studies have explored cervical kyphosis (CK) in adolescent idiopathic scoliosis (AIS) patients. However, few studies have evaluated the cervical alignment in these patients according to their coronal curve type. The aim of this study was to analyze the radiological features of cervical sagittal alignment in Lenke 1 AIS patients before and after surgery.Methods: This is a retrospective study enrolled 50 patients. Preoperative and postoperative standing full-length radiographs (at last follow-up after operation) were used to measure the coronal and sagittal parameters. Main sagittal parameters included C2-C7 angle, thoracic inlet angle (TIA), T1 slope, proximal thoracic kyphosis (PTK, T1-5 kyphosis) and thoracic kyphosis (TK, T5-12 kyphosis).Results: The TIA of patients with CK was significantly smaller than that of patients with CL (63.0° vs. 76.3°, p < 0.05) and the cutoff value was 71°. The TIA of patients with CK after surgery was significantly smaller than that of patients with CL postoperatively (62.5° vs. 74.6°, p < 0.05) and the cutoff value was 62°. In patients with postoperative CL, there was a significant increase in their PTK and a reduction in their TK, regardless of preoperative CL or CK. In patients whose CL deteriorated to CK after surgery, both their PTK and TK significantly decreased after surgery.Conclusions: Patients with TIA less than 71° were more likely to have CK. And patients with TIA less than 62° would lead to the postoperative uncorrected or new onset of CK. The increased PTK after operation could have a beneficial effect on the improvement of CL. [ABSTRACT FROM AUTHOR]