Thoracic pedicle screws have superior anchoring strength compared with other available fixation techniques. However, these are not universally accepted in many developing countries because of the concerns regarding safety and complications. In addition, there is evidence that pedicle morphology is unique in Chinese patients. The goal of this study was to analyze the complications seen at our institution, while using thoracic pedicle screws for the treatment of thoracic deformity, and to determine the safety of our techniques for the treatment of thoracic deformity in a Chinese population. From 1998 to 2005, there were 208 thoracic deformity patients treated at our institution, 70 of whom were male and 138 were female. Their age ranged from 11 to 55 years (mean of 14.9 years). All of them underwent corrective deformity surgery using posterior pedicle screw systems and follow-up was available for at least 3 years. Etiologic diagnoses included adolescent idiopathic scoliosis in 119 patients, congenital kyphoscoliosis in 38, adult scoliosis in 37 and undetermined in 14. Screw positions were evaluated using intraoperative and postoperative radiographs and a CT scan was performed when a concern for screw malposition was present. All radiographic evaluations were carried out in a double-blinded fashion. A total of 1,123 thoracic pedicle screws were inserted (5.4 thoracic screws/patient). The deformity correction rate was 81, 65 and 62% for idiopathic, congenital and adult scoliosis patients, respectively. The overall complication rate was 16.5% at the final follow-up. Complication rates directly and indirectly related to pedicle screws were 7.2 and 9.3%, respectively. There were no significant screw-related neurologic or visceral complications that adversely affected long-term results. The complications seen with thoracic pedicle screws in a Chinese population were similar to other populations and could be utilized safely for the treatment of thoracic deformity in this population.
Endoscopically assisted anterior retropharyngeal release combined with posterior fixation is a safe and effective alternative for the treatment of irreducible atlantoaxial dislocation.
OBJECTIVES: Our objective was to assess the accuracy of radiation-free magnetic method of scoliosis curve measurement (Ortelius 800) and its usefulness in clinical practice, as well as to judge whether it can replace x-rays, which represent currently the golden standard for scoliosis measurement. BACKGROUND: Patients with adolescent idiopathic scoliosis have to undergo multiple full-length spinal x-rays. Repeated exposure to ionizing radiation leads to higher incidence of breast cancer, thyroid cancer, and leukemia. One of the radiation-free methods that are candidates for replacing the x-rays is the magnetic measurement of the spine with Ortelius 800. METHODS: Twenty-eight patients with adolescent idiopathic scoliosis were measured with Ortelius. Data from Ortelius were compared with standard spinal x-rays taken the same week. RESULTS: The average Cobb's angle measured by x-ray was 35.11 degrees. The average absolute difference between Ortelius and x-rays was 6.69 degrees. The difference was statistically signifi cant (p = 0.0443). An acceptable difference was measured in subgroup of curves that do not exceed 40 degrees (difference 5, p = 0.8915). CONCLUSION: Ortelius is most accurate in curves in range of 15-30 degrees of Cobb's angle. In larger curves it is increasingly inaccurate. Most important for clinical practice is the Cobb's angle range over 40 degrees, where the conservative therapy is to be replaced with surgery. Ortelius is not accurate enough in this range and therefore cannot fully substitute full spinal x-rays. It can be used to reduce the number of x-rays in the follow-up of smaller curve angles (Tab. 4, Fig. 8, Ref. 10).
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