Background: Thoracic spinal stenosis (TSS) is a rare but intractable disease that fails to respond to conservative treatment. Thoracic spinal decompression, which is traditionally performed using high-speed drills and kerrison rongeurs, is a time-consuming and technically challenging task. Unfavorable outcomes and high incidence of complications are the major concerns. The development and adaptation of ultrasonic bone scalpel (UBS) has promoted its application in various spinal operations, but its application and standard operating procedure in thoracic decompression have not been fully clarified. Therefore, the purpose of this study is to describe our experience and technique note of using UBS, and come up with a standard surgical procedure for thoracic spinal decompression.Methods: A consecutive of 28 patients with TSS who underwent posterior thoracic spinal decompression surgery with UBS between December 2014 and May 2015 were enrolled in this study. The demographic data, perioperative complications, operation time, estimated blood loss, pre-and postoperative neurological statuses were recorded and analyzed. Neurological status was evaluated with a modified Japanese Orthopaedic Association (JOA) scale and the neurological recovery rate was calculated using the Hirabayashi’s Method.Results: Thoracic spinal decompression surgery was successfully carried out in all cases via a single posterior approach. The average age at surgery was 49.7±8.5 years. The mean operative time of single-segment laminectomy was 3.0±1.4min and the blood loss was 108.3±47.3ml. In circumferential decompression, the average blood loss was 513.8±217.0ml. Two cases of instrument-related nerve root injury occurred during operation and were cured by conservative treatment. Six patients experienced cerebrospinal fluid (CSF) leakage postoperatively, but no related complications were observed. The mean follow-up period was 39.7±8.9 months, the average JOA score increased from 4.7 before surgery to 10.1 postoperatively, and the average recovery rate was 85.8%. Conclusions: The UBS is an optimal instrument for thoracic spinal decompression, and its application enables surgeons to decompress the thoracic spinal cord safely and effectively. This standard operating procedure is expected to help achieve favorable outcomes, and can be used to treat various pathologies leading to TSS.

Study Design: a retrospective study.Summary of Background Data: Long-level spinal instrumented fusion for DLS by intention eliminated spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impaired performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) was a validated measure of the effect of lumbar stiffness on functional activity, however, which might not be fully applicable to elderly Chinese population because of their several special lifestyles.Objective: To evaluate the lumbar stiffness in patients with degenerative lumbar scoliosis (DLS) after long-level fusion by Chinese-LSDI (C-LSDI).Methods: 129 DLS patients underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up were included. The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) considering elderly Chinese lifestyles, and the patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities in elderly Chinese with DLS was assessed for internal consistency and retest repeatability.Results: All patients showed increased lumbar stiffness with significantly improvement in pain and deformity postoperatively, and for items of performing personal hygiene after toileting and getting out of a car, people performed more inconvenient with increasing fixed levels. Compared with LSDI and K-LSDI, the C-LSDI demonstrated high internal consistency (Cronbach’s alpha=0.902) and retest reliability (ICC=0.904) in the elderly Chinese population. Conclusion: This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.

Background: The Italian Spine Youth Quality of Life (ISYQOL) questionnaire is a tool used to evaluate health-related quality of life in adolescents with Idiopathic Scoliosis. The study aimed to undertake the process of cultural adaptation of the ISYQOL questionnaire into Simplified Chinese. Methods: The translation from Italian into Simplified Chinese was performed. It involved 138 adolescents whose Cobb angle ranged between 20-40 degrees, 50 wearing the brace and 88 not wearing the brace. Statistical analysis calculated the reliability, floor and ceiling effects of the ISYQOL. After that, construct validity was measured by analyzing the ISYQOL relationship Scoliosis Research Society-22 patient Questionnaire (SRS-22). Results: There were no floor or ceiling effects in ISYQOL questionnaire. Cronbach’s alpha coefficient evaluated for Internal consistency was 0.75 without the brace and 0.88 with the brace. Intraclass correlation coefficients assessed with the use of the test-retest method was 0.72 without the brace and 0.80 with the brace. A strong relationship exists between the ISYQOL measure and SRS-22 scores (rho=0.63; p< 0.01), reflecting the high validity of the questionnaires. Both ISYQOL and SRS-22 scores showed no statistical difference between groups with and without the brace (p>0.05). Conclusions: Trans-cultural validation in Chinses language showed the reliability and validity of the ISYQOL

Background: Thoracic spinal stenosis (TSS) is a rare but intractable disease that fails to respond to conservative treatment. Thoracic spinal decompression, which is traditionally performed using high-speed drills and kerrison rongeurs, is a time-consuming and technically challenging task. Unfavorable outcomes and high incidence of complications are the major concerns. The development and adaptation of ultrasonic bone scalpel (UBS) has promoted its application in various spinal operations, but its application and standard operating procedure in thoracic decompression have not been fully clarified. Therefore, the purpose of this study is to describe our experience and technique note of using UBS, and come up with a standard surgical procedure for thoracic spinal decompression.Methods: A consecutive of 28 patients with TSS who underwent posterior thoracic spinal decompression surgery with UBS between December 2014 and May 2015 were enrolled in this study. Results: Thoracic spinal decompression surgery was successfully carried out in all cases via a single posterior approach. The mean operative time of single-segment laminectomy was 3.0±1.4min and the blood loss was 108.3±47.3ml. In circumferential decompression, the average blood loss was 513.8±217.0ml. Two cases of instrument-related nerve root injury occurred during operation and were cured by conservative treatment. Six patients have experienced cerebrospinal fluid (CSF) leakage postoperatively, but no related complications were observed. Conclusions: The UBS is an optimal instrument for thoracic spinal decompression, and its application enables surgeons to decompress the thoracic spinal cord safely and effectively. This standard operating procedure is expected to help achieve favorable outcomes, and can be used to treat various pathologies leading to thoracic spinal stenosis.

Study Design. A retrospective analysis.Objectives. The objective of this study was to calculate the range of minimum clinically important difference threshold values using anchor-based and distribution-based methods for back pain, leg pain, the Oswestry Disability Index (ODI), and the Scoliosis Research Society 22R instrument (SRS-22R) in patients with de novo degenerative lumbar scoliosis (DNDLS) who underwent long-segment fusion surgery. Then, we sought to determine a statistically sound meaningful, minimum clinically important difference in patient-reported outcome measures (PROMs) and compare our results with previously reported values for other adult spine deformity (ASD) populations. Summary of the Background Data. Minimum clinically important difference thresholds for back pain, leg pain, and the ODI and SRS-22R have not been widely described in patients with ASD. Materials and Methods. PROMs were obtained preoperatively and two years postoperatively in 128 patients with DNDLS. We applied different minimum clinically important difference calculation methods to the data, and the results were compared.Results. There was a statistically significant improvement in the two-year postoperative PROM scores compared with the preoperative scores. Different preoperative calculation methods yielded an ~10-fold range of values. Minimum clinically important difference values were established as 1.9 for back pain, 1.5 for leg pain, 18.9 for the ODI, 0.8 for SRS-22R pain, 0.5 for SRS-22R activity, 1.6 for SRS-22R appearance, 0.8 for SRS-22R mental, and 0.98 for the SRS-22R subtotal. Compared with the previously reported minimum clinically important differences in ASD, the values for back pain, ODI, and SRS-22R appearance were higher in patients with DNDLS. Conclusions. Sensitivity-based and specificity-based methods provide statistically sound minimum clinically important difference thresholds for the DNDLS population. The minimum clinically important difference thresholds for PROMs in patients with DNDLS were different from the threshold values previously reported for adult patients with spinal deformities.