Safe range of shortening the middle thoracic spine, an experimental study in canine

Ji, Le; Ma, Xiaoying; Ji, Wenchen; Huang, Sheng‐Li; Feng, Min; Li, Jingyuan; Li, Heng; Huang, Yajuan; Lan, Binshang

doi:10.1007/s00586-019-06268-8

Cited by 4 publications

(7 citation statements)

References 36 publications

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“…The spinal shortening technique is often used in congenital spinal deformities, benign and malignant invasive tumours, spinal fracture and dislocation, tethered cord syndrome and other diseases [13,[31][32][33]. Among them, pedicle subtraction osteotomy or Smith-Peterson osteotomy was considered safe because of the smaller osteotomy range, smaller spinal shortening, and bone-bone interface contact to improve the fusion rate and stability [34].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, many studies have focused on the safe distance of spinal cord shortening and the mechanism of spinal cord injury caused by spinal column shortening. Many experiments have shown that when spinal shortening exceeds the safe distance limit, the spinal cord will kink, and changes in the spinal cord blood supply, blood barrier and spinal nerve root angle will damage the spinal cord [11][12][13][14], resulting in a series of neurological complications that seriously affect people's quality of life. Recent studies have shown that spinal cord injury will be caused when the spinal column shortens more than 1/2 of the vertebral body height, leading to irreversible injury of somatosensory evoked potential (SSEP) and spinal cord blood flow (SCBF), resulting in neurological dysfunction [13].…”

Section: Introductionmentioning

confidence: 99%

“…Many experiments have shown that when spinal shortening exceeds the safe distance limit, the spinal cord will kink, and changes in the spinal cord blood supply, blood barrier and spinal nerve root angle will damage the spinal cord [11][12][13][14], resulting in a series of neurological complications that seriously affect people's quality of life. Recent studies have shown that spinal cord injury will be caused when the spinal column shortens more than 1/2 of the vertebral body height, leading to irreversible injury of somatosensory evoked potential (SSEP) and spinal cord blood flow (SCBF), resulting in neurological dysfunction [13]. And vertebral resection is performed in patients with a relatively good prognosis, so long-term postoperative stability is particularly important [15].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of spinal column shortening - a finite element study

Han

et al. 2022

BMC Musculoskelet Disord

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Background At present, research on spinal shortening is mainly focused on the safe distance of spinal shortening and the mechanism of spinal cord injury, but there is no research on the biomechanical characteristics of different shortening distances. The purpose of this study was to study the biomechanical characteristics of spine and internal fixation instruments at different shortening distances by the finite element (FE) method. Methods An FE model of lumbar L1-S was established and referred to the previous in vitro experiments to verify the rationality of the model by verifying the Intradiscal pressure (IDP) and the range of motion (ROM) of the motion segment. Five element models of spinal shortening were designed under the safe distance of spinal shortening, and the entire L3 vertebra and both the upper and lower intervertebral discs were resected. Model A was not shortened, while models B-E were shortened by 10%, 20%, 30% and 50% of the vertebral body, respectively. Constraining the ROM of the sacrum in all directions, a 7.5 N ·m moment and 280 N follower load were applied on the L1 vertebra to simulate the motion of the lumbar vertebrae in three planes. The ROM of the operated segments, the Von Mises stress (VMS) of the screw-rod system, the VMS of the upper endplate at the interface between the titanium cage and the L4 vertebral body, and the ROM and the IDP of the adjacent segment (L5/S) were recorded and analysed. Results All surgical models showed good stability at the operated segments (L1-5), with the greatest constraint in posterior extension (99.3-99.7%), followed by left-right bending (97.9-98.7%), and the least constraint in left-right rotation (84.9-86.3%) compared with the intact model. The VMS of the screw-rod system and the ROM and IDP of the distal adjacent segments of models A-E showed an increasing trend, in which the VMS of the screw-rod system of model E was the highest under flexion (172.5 MPa). The VMS of the endplate at the interface between the cage and L4 upper endplate of models A-E decreased gradually, and these trend were the most obvious in flexion, which were 3.03, 2.95, 2.83, 2.78, and 2.61 times that of the intact model, respectively. Conclusion When performing total vertebrae resection and correcting the spinal deformity, if the corrected spine has met our needs, the distance of spinal shortening should be minimized to prevent spinal cord injury, fracture of internal fixations and adjacent segment disease (ASD).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of spinal column shortening - a finite element study

Han

et al. 2022

BMC Musculoskelet Disord

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“…The results showed that the dura sac became shrinking and buckling after one-third to two thirds of vertebral column shortening, more than two-third of vertebral column shortening increased potential of neurologic de cit and decreased the blood ow of spinal cord. Recent study of middle thoracic shortening test in canine model also showed that the safe range was within 1/3 of a vertebral height shortening with two-segment laminectomy [15]. Accordingly, for those of severe kyphosis patients who requires more than 40° correction angle, single level PSO could not achieve satisfactory kyphosis correction.…”

Section: Discussionmentioning

confidence: 98%

A Novel Technique of Transpedicular Opening-wedge Osteotomy for Treatmtent of Rigid Kyphosis in Patients With Ankylosing Spondylitis

Zheng

Hong

Wang

et al. 2021

Preprint

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BackgroundTo investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) for correcting rigid thoracolumbar kyphotic deformity in patients with ankylosing spondylitis (AS).Methods18 AS patients underwent TOWO for correcting rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at last follow-up. SRS-22 questionnaire was assessed before surgery and at last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. ResultsThe mean operating time and estimated blood loss were 236 minutes and 595 ml, respectively. Sagittal parameters improved significantly after surgery. The height of anterior column of osteotomized vertebrae was increased significantly at 1 week after surgery and last follow-up when compared to preoperative, but the height of middle column did not changed significantly. SRS-22 scores were improved significantly at last follow-up than preoperative. Solid fusion was achieved in all patients after 12 months follow-up, no screw loosening, screw pull out or rod breakage was noticed at last follow-up. ConclusionsTOWO could achieve a satisfactory kyphosis correction by opening anterior column instead of vertebral body decancellation and posterior column closing, which simplified the osteotomy procedure and improved the surgical efficacy.

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“…The results showed that the dural sac shrank and buckled after one-third to two-thirds of vertebral column shortening, and more than two-thirds of vertebral column shortening increased the potential for neurologic deficits and decreased the blood flow of the spinal cord. A recent study of the middle thoracic shortening test in a canine model also showed that the safe range was within 1/3 of a vertebral height shortening with two-segment laminectomy [ 17 ]. Accordingly, for severe kyphosis patients who require a correction angle greater than 40°, single-level PSO cannot achieve satisfactory kyphosis correction; however, two-level PSO could provide enough correction angle, but the blood loss and operation time increased significantly [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A novel technique of transpedicular opening-wedge osteotomy for treatment of rigid kyphosis in patients with ankylosing spondylitis

et al. 2022

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Background To investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) was used to correct rigid thoracolumbar kyphotic deformities in patients with ankylosing spondylitis (AS). Methods Eighteen AS patients underwent TOWO to correct rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at the last follow-up. The SRS-22 questionnaire was given before surgery and at the last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. Results The mean operating time and estimated blood loss were 236 min and 595 ml, respectively. The mean preoperative sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT) and thoracolumbar kyphosis (TLK) were 158.97 mm, 51.24 mm, 43.63 mm and 41.74 mm, respectively, and decreased to 66.72 mm, 35.96 mm, 27.21 mm and 8.67 mm at the last follow-up. The mean preoperative lumbar lordosis (LL) and sacral slope (SS) were 8.30 ± 24.43 mm and 19.67 ± 9.40 mm, respectively, which increased to 38.23 mm and 28.13 mm at the last follow-up. The mean height of the anterior column of osteotomized vertebrae increased significantly from 25.17 mm preoperatively to 37.59 mm at the last follow, but the height of the middle column did not change significantly. SRS-22 scores were improved significantly at the last follow-up compared with preoperatively. Solid bone union was achieved in all patients after 12 months of follow-up, and no screw loosening, screw removal or rod breakage was noticed at the last follow-up. Conclusions TOWO could achieve satisfactory kyphosis correction by opening the anterior column instead of vertebral body decancellation and posterior column closing, thus simplifying the osteotomy procedure and improving surgical efficacy.

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Safe range of shortening the middle thoracic spine, an experimental study in canine

Cited by 4 publications

References 36 publications

Biomechanical comparison of spinal column shortening - a finite element study

Biomechanical comparison of spinal column shortening - a finite element study

A Novel Technique of Transpedicular Opening-wedge Osteotomy for Treatmtent of Rigid Kyphosis in Patients With Ankylosing Spondylitis

A novel technique of transpedicular opening-wedge osteotomy for treatment of rigid kyphosis in patients with ankylosing spondylitis

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