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Bangping Qian - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Subluxation during three column osteotomy in surgical correction of adult spine deformity incidence risk factors and complications
European Spine Journal, 2018Co-Authors: Jun Qiao, Lingyan Xiao, Leilei Xu, Bangping QianAbstract:To investigate incidence, risk factors, and complications of Vertebral Subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and Subluxation vs. non-Subluxation) were compared. 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal Vertebral Subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal Vertebral Subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal Vertebral Subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P < 0.05). VS group had less kyphosis flexibility (11 vs. 23%, P < 0.05). More patients in VS group had preoperative sagittal VS as compared to non-VS group (77.8 vs. 20.9%, P < 0.05). VS group had more neurological complications than non-VS group (25 vs. 5.4%, P < 0.05). VS occurred in one-tenth of patients receiving three-column osteotomies, one-fourth of which would develop neurological deficits. Older age, rigid kyphosis, and the pre-existence of VS were risk factors for developing VS.
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Vertebral Subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications.
European Spine Journal, 2017Co-Authors: Jun Qiao, Lingyan Xiao, Leilei Xu, Bangping QianAbstract:To investigate incidence, risk factors, and complications of Vertebral Subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and Subluxation vs. non-Subluxation) were compared. 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal Vertebral Subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal Vertebral Subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal Vertebral Subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P
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mechanisms predisposing factors and prognosis of intraoperative Vertebral Subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis
Spine, 2017Co-Authors: Bangping Qian, Jun Jiang, Bin WangAbstract:STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the mechanisms, predisposing factors, and prognosis of the intraoperative Vertebral Subluxation (VS) during pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: VS is one of the most daunting challenges that surgeons encounter during PSO closure, especially in patients with AS with ankylosed and mostly osteoporotic spine. Unfortunately, there is a paucity of research designed to conceptualize the mechanisms, predisposing factors, and discuss the complication-avoidance strategies and prognosis. METHODS: A retrospective single-center review was performed for a consecutive series of 153 patients with AS with rigid thoracolumbar kyphosis who underwent one-level PSO from April 2000 to December 2013. The incidence of the VS at the level of PSO during correction was analyzed and the potential causative factors were investigated. RESULTS: VS occurred in six patients with the incidence being 3.9% in this patient cohort. The predisposing factors were (1) early fracture of the anterior cortex of the osteotomized vertebra (OV); (2) excessive decancellation from Vertebral body causing parallel collapse of the Vertebral column with significant loss of the ability to create local lordosis; (3) improper manual osteoclasis due to insufficient decancellation of the OV; and (4) inappropriate application of cantilever technique and concomitant long instrumentation. The early surgical complication involved one patient with cerebrospinal fluid leakage at the osteotomized site, but no devastating neurological deficits. During follow-up, bone healing and adaptive Vertebral remodeling with no rod breakage were observed for all these six patients. CONCLUSION: Intraoperative VS was a rare occurrence associated with inappropriate manual manipulation of osteotomy, gap closure, and rod insertion. Neurological complication was a potential risk, but could be well prevented with extensive laminectomy and emergency actions favoring partial Subluxation reduction. Moreover, adaptive bone remodeling and fusion at the level of VS ensured the maintenance of kyphosis correction and avoidance of instrumentation failure. LEVEL OF EVIDENCE: 4.
Alfredo García Fernández - One of the best experts on this subject based on the ideXlab platform.
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Proximal junctional Vertebral fracture-Subluxation after adult spine deformity surgery. Does Vertebral augmentation avoid this complication? A case report
Scoliosis, 2012Co-Authors: Nicomedes Fernández-baíllo, José Miguel Sánchez Márquez, Francisco Javier Sánchez Pérez-grueso, Alfredo García FernándezAbstract:Background To report to the orthopedic community a case of Vertebral fracture and adjacent Vertebral Subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level. Methods This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized. Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome". Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 Vertebral collapse and T9 Vertebral Subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw. At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowledge, this is an unreported fracture. Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation.
Alfredo Garcia Fernandez - One of the best experts on this subject based on the ideXlab platform.
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proximal junctional Vertebral fracture Subluxation after adult spine deformity surgery does Vertebral augmentation avoid this complication a case report
Scoliosis, 2012Co-Authors: N Fernandezbaillo, Jose Miguel Sanchez Marquez, Francisco Javier Sanchez Perezgrueso, Alfredo Garcia FernandezAbstract:Background To report to the orthopedic community a case of Vertebral fracture and adjacent Vertebral Subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level.
Marsha Hensley - One of the best experts on this subject based on the ideXlab platform.
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proximal junctional Vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs analysis of morphological features
Spine, 2010Co-Authors: Kei Watanabe, Lawrence G Lenke, Keith H Bridwell, Yongjung J Kim, Linda A Koester, Marsha HensleyAbstract:Study Design. A retrospective comparative study. Objective. To investigate the morphologic features of proximal Vertebral fractures in adults following spinal deformity surgery using segmental pedicle screw instrumentation. Summary of Background Data. Fractures above pedicle screw constructs are a clinical problem that warrants further investigation for prevention and treatment. Methods. Ten adult patients (6 lumbar scoliosis, 4 degenerative sagittal imbalance) who underwent segmental spinal instrumented fusion were analyzed. Patients were divided into 2 groups according to the features of Vertebral fracture: upper instrumented Vertebral collapse + adjacent Vertebral Subluxation (SUB group: n = 5), and adjacent Vertebral fracture (Fracture group: n = 5). Results. Both groups demonstrated a high frequency of osteopenia and all patients in the SUB group had comorbidities before surgery. The SUB group demonstrated a shorter interval between initial surgery and the fracture (Subluxation: 3 ± 1.9 months; fracture: 33 ± 25.3 months, P < 0.05), and hypokyphosis (T5―T12) in the thoracic region before surgery (SUB: 13° ± 6.4°; fracture: 33° ± 15.6°). Both groups demonstrated severe global sagittal imbalance (SUB: 151 ± 62.8 mm; fracture: 94 ± 102.2 mm), and hypolordosis (T12―S1) in the lumbar spine (SUB: ―19° ± 24.4°; fracture: ―33° ± 22.7°) before surgery. Global sagittal imbalance in the SUB group was corrected to 8 ± 17.4 mm immediately postoperative (P < 0.05), but increased to 64 ± 19.9 mm after the junctional fractures (P < 0.05). The SUB group demonstrated a significantly higher wedging rate (SUB: 65% ± 12.4%; fracture: 36% ± 16.0%, P < 0.05) and greater local kyphosis (SUB: 42° ± 11.1°; fracture: 17° ± 4.1°, P < 0.05) after the fracture. Two of 5 patients in the SUB group demonstrated severe neurologic deficit from E to B after the fractures by a modified Frankel classification. Conclusion. Old age, osteopenia, preoperative comorbidities, and severe global sagittal imbalance were found to be frequent in patients with proximal junctional fracture. In addition, marked correction of sagittal malalignment might be considered as a risk factor of upper instrumented vertebra collapse followed by adjacent Vertebral Subluxation, which occurred in the first 6 months after corrective surgery with the potential for causing severe neurologic deficit because of the severe local kyphotic deformity.
Jun Qiao - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Subluxation during three column osteotomy in surgical correction of adult spine deformity incidence risk factors and complications
European Spine Journal, 2018Co-Authors: Jun Qiao, Lingyan Xiao, Leilei Xu, Bangping QianAbstract:To investigate incidence, risk factors, and complications of Vertebral Subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and Subluxation vs. non-Subluxation) were compared. 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal Vertebral Subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal Vertebral Subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal Vertebral Subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P < 0.05). VS group had less kyphosis flexibility (11 vs. 23%, P < 0.05). More patients in VS group had preoperative sagittal VS as compared to non-VS group (77.8 vs. 20.9%, P < 0.05). VS group had more neurological complications than non-VS group (25 vs. 5.4%, P < 0.05). VS occurred in one-tenth of patients receiving three-column osteotomies, one-fourth of which would develop neurological deficits. Older age, rigid kyphosis, and the pre-existence of VS were risk factors for developing VS.
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Vertebral Subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications.
European Spine Journal, 2017Co-Authors: Jun Qiao, Lingyan Xiao, Leilei Xu, Bangping QianAbstract:To investigate incidence, risk factors, and complications of Vertebral Subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and Subluxation vs. non-Subluxation) were compared. 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal Vertebral Subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal Vertebral Subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal Vertebral Subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P
