The incidence of tuberculosis (Tbc) infection is high in some parts of the world and tuberculous cold abscess of the chest wall (CACW) often fails to respond to medical treatment. Medical records of 178 patients who underwent surgical treatment of chest wall abscesses from July 1970 to Sept. 2000 were reviewed and 89 patients who were pathologically confirmed as Tbc cold abscess cases were included in this study. Their ages ranged from 9 to 71 years (mean 33.3 years) and the male to female ratio was 1.2:1 (49 male, 40 female). The symptoms were palpable chest wall mass, pain and pus discharge, and three patients had multiple lesions. Twenty-five patients (28%) underwent excision of chest wall abscesses and 64 patients (72%) underwent chest wall and rib resection. Tbc medication was given preoperatively in 39 patients for an average of 6.3 months and all patients were given Tbc medication postoperatively for an average of 12 months. Postoperative complications were bleeding, pus discharge, empyema, pleural effusion, wound dehiscence, subcutaneous emphysema and activation of pulmonary Tbc. The disease recurred in 7 patients (7.8%) and these 7 patients all underwent a second operation. We recommend preoperative Tbc medication and complete resection of chest wall abscesses including any suspicious ribs. Postoperative Tbc medication for a minimum of 12 months is essential to decrease the risk of a relapse.
Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.
Most common causes of revision spine surgery due to sagittal imbalance were failure to enhance lumbar lordosis and adjacent disc degeneration after lumbar fusion surgery. These patients were effectively treated with a combined anterior and posterior arthrodesis. Following these surgical treatment, sagittal balance was generally improved with fair-to-good clinical outcomes, high patient satisfaction, and low perioperative complication rates.
ObjectThe authors investigate the correlation between thoracic and lumbar curves in patients with degenerative flat back syndrome, and demonstrate the predictability of spontaneous correction of the thoracic curve and sacral angle after surgical restoration of lower lumbar lordosis.MethodsThe cases of 28 patients treated with combined anterior and posterior spinal arthrodesis were retrospectively reviewed. Inclusion criteria included loss of lower lumbar lordosis resulting in sagittal imbalance. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C-7 plumb line length were measured on pre- and postoperative lateral views of the whole spine. Postoperative changes in thoracic kyphosis, sacral slope, and length of the C-7 plumb line were measured and evaluated according to extent of lumbar lordosis restoration.ResultsThe mean (± standard deviation) preoperative sagittal imbalance was 64.6 ± 63.2 mm, which improved to 15.8 ± 20.7 mm after surgery (p < 0.0001). The preoperative mean lumbar lordosis was 15.6 ± 14.1°, which increased to 40.3 ± 14.5° at follow-up (p < 0.0001). The preoperative mean thoracic kyphosis was 1.6 ± 10.5° and increased to 17.2 ± 12.5° at follow-up (p < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.628, p = 0.0003), and between lordosis and sacral slope (r = 0.647, p = 0.0002). Postoperative correlations also existed between kyphosis and lordosis (r = 0.718, p < 0.0001 and r = 0.690, p < 0.0001, respectively).ConclusionsLower lumbar lordosis plays an important role in sagittal alignment and balance. Surgical restoration of lumbar lordosis results in predictable spontaneous correction of the thoracic curve and sacral slope in patients with degenerative flat back syndrome.
Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.
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