Purpose: In this study, computed tomography (CT) radiographic measurements and common clinical scores were used to evaluate the effectiveness of percutaneous posterior full-endoscopic resection of an ossified thoracic ligamentum flavum. Methods: A prospective study was conducted on 16 patients treated with posterior endoscopy from September 2017 to November 2019. Before the operation, 3 days after the operation and 1 year after the operation, the area of ossification in the ligamentum flavum was assessed by sagittal CT scans and transected to evaluate the decompression effect of posterior endoscopic surgery. The clinical efficacy of the surgery was evaluated at the above time points by using the visual analog scale for pain, modified Japanese Orthopedic Association scale, ODI and Macnab efficacy evaluation. Results: The area of sagittal ossification in the ligamentum flavum in 16 patients was 116.62±32.72 mm2 before the operation, 15.99±12.54 mm2 3 days after the operation, and 16.78±11.49 mm2 1 year later. The sagittal canal invasive proportions were 48.10±10.04% before the operation, 6.46±4.86% 3 days after the operation, and 6.83±4.48% 1 year later. The area of transected ossification in the ligamentum flavum was 141.59±27.25 mm2 before the operation, 11.72±8.64 mm2 3 days after the operation, and 10.82±7.57 1 year later. The transected spinal canal invasive proportions were 57.58±11.37%, 4.76±3.45% and 4.40±3.01%. The mJOA score were 3.50±1.10, 6.19±0.91 and 9.19±1.38, with a n average recovery rate of 73.96±16.58%. According to the Macnab evaluation, the recovery status of the 16 patients 1 year after the operation was excellent in 9 patients, good in 5 patients, and fair in 2 patients; the excellent and good rate was 87.50%. The differences were statistically significant (P<0.05). Intraoperative dural tears occurred in 2 of 16 patients, but no complications, such as cerebrospinal fluid leakage, were observed. Conclusion:The measurements of ossification ligamentum flavum area and spinal canal invasive proportion can appropriately evaluate the degree of spinal canal stenosis in thoracic myelopathy caused by ossification of the ligamentum flavum. This method can be used together with other common clinical scores to better evaluate the efficacy of surgery.
Introduction: Intravenous sedation and analgesia are widely used in minor surgeries. Remifentanil and remimazolam are advantageous in this setting because of their rapid onset of action, and short duration of action leading to a rapid recovery. However, the two drugs combined need to be titrated to avoid airway-related adverse events. Case presentation: This article reports a case of severe respiratory depression and severe laryngeal spasm induced by remifentanil and remimazolam when they were used for analgesia and sedation in a patient undergoing oral biopsy. Conclusion: We aim to improve awareness about the safety of these drugs among anesthesiologists and increase their ability to manage the risk associated with their use.
Background: Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems.Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.Methods:From July 2018 to November 2020, 70 cases of TBFs were included. 35 cases were treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation (observation group), 35 cases were treated with short-segment transpedicular screw fixation (control group).Before operation, after application of the transpedicular reducer(not needed in the control group),3 days after operation, 3 months after operation, 6 months after operation, and 12 months after operation, the two groups were recorded and compared respectively: the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients.And we compared the pain VAS score and quality of life GQOL-74 score at the last follow-up.At last,we evaluated the distribution of bone grafts and bone healing 12 months after the operation.Results:All 70 cases were followed up for at least 12 months.The observation group's anterior and middle heights of the injured vertebral, AVBHr and MVBHr were higher than those of the control group at 3 days,3 months,6 months and 12 months after operation, the cobb angle was smaller than that in control group, the pain VAS score and the quality of life GQOL-74 score at the last follow-up were better than those of the control group, and these difference were statistically significant (P <0.05). The observation group showed no obvious defects on CT at 12 months after operation, and the bone healing was good. Conclusion: The new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for TBFs has a good clinical efficacy.
Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.
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