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Clinical characteristics and pathogenesis of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosisObjectives:In the clinical,we found that in addition to the local spinal cord injury caused by thoracolumbar rigid kyphosis,it also causes spinal stenosis in adjacent segments of the kyphosis area.However,only several cases have been reported so far about thoracolumbar kyphosis and adjacent segmental spinal stenosis.This study aimed to summarize the clinical characteristics and explore pathogenesis of adjacent segmental spinal stenosis caused by thoracolumbar rigid kyphosis,improving our understanding of such spinal cord injury and providing guidance for clinical work.Methods:Thirty-one patients with thoracolumbar rigid kyphosis and adjacent segmental spinal stenosis were enrolled.The basic baseline data,clinical characteristics,imaging data and surgical outcomes were summarized,with the purpose of investigating the pathogenesis of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis.Results:Of the 31 patients with thoracolumbar kyphosis and adjacent segmental spinal stenosis,17 were male and 14 were female.The average age of patients was 58.4±9.3 years,and the average duration of kyphosis was 30.8?13.2 months.The average Cobb angle was 68.3±19.7,and the couse of spinal cord symptoms was 14.2±12.4 months.The clinical features were most common with low back pain(83.9%).Spinal stenosis segments were most common with T11/12(24.3%)and T10/11(18.9%),mainly were single-segment lesions(83.9%).The average value of pelvic incidence was 35.6±11.8°,the average value sacral slope was 20.3±14.8°,the average value of lumbar lordosis was 59.2±14.7°,the average value of sagittal vertical axis was 51.1±35.7mm and the average value of PI-LL was 23.5±11.2°.In all patients,the average preoperative JOA score was 5.35±1.11,the average postoperative JOA score was 7.45±1.12,and the average JOA score was 8.97±0.95 at the last follow-up.The average recovery rate was 65.1±13.1%at the last follow-up.The average intraoperative blood loss was 893.5±350.4ml,and the average postoperative hospital stay was 16.3±3.5 days.Postoperative complications were more common with dural tear and cerebrospinal fluid leakage.Conclusions:(1)For adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,stenosis is dominated by the lower thoracic segments and single segmental damage.(2)Thoracolumbar rigid kyphosis can accelerate the degeneration of adjacent segments.Even if the patient's sagittal plane is balanced,degeneration of adjacent segment may occur.(3)For patients with adjacent segmental spinal stenosis secondary to thoracolumbar kyphosis,as the age and course of the disease increase,the risk of developing nerve damage increases,so early treatment should be selected.For early treatment,patients are often able to achieve effective neurological recovery.(4)Pathogenesis of adjacent segmental spinal stenosis secondary to thoracolumbar kyphosis:I.the kyphosis can cause the gravity line of the spine to move forward.In order to maintain the sagittal balance of the spine,the thoracic and lumbar lordosis increases;?.long-term flexion compensation can lead to compensatory overextension of the vertebral body,leading to the shortening of posterior column and accelerating degenerative changes;III.the kyphosis can increase the local instability,resulting in an increased tendency of the vertebral body to separate,and eventually increase degeneration of adjacent segments;IV.rigid kyphosis causes compensatory activity and increased mechanical load of adj acent segments.Part II Surgical outcomes and prognostic factors of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosisObjectives:At present,there are few reports on adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,and the prognostic factors of postoperative neurological recovery are still unkonwn.On the basis of patients baseline data,imaging data,and surgical-related data,this study analyzed prognostic factors for neurological recovery,with the aim of providing guidance for clinical treatment.Methods:Thirty-one patients with thoracolumbar kyphosis and adjacent segmental spinal stenosis were enrolled,and were divided into two groups:good group(RR?50%)and poor group(RR<50%),based on neurological recovery rate(RR).And statistical methods were used to conduct prognostic analysis for 27 prognostic indicators including age,gender and course of kyphosis,etc.Results:Seven prognostic factors were filtrated by preliminary screening.And then Spearman correlation analysis were conducted.The results showed that there was a significant relationship between preoperative JOA score(P=0.002),postoperative JOA score(P=0.001),intramedullary signal level(P=0.026)and postoperative neurological recovery rate.Multiple linear regression analysis showed a higher preoperative JOA score(B=-0.202,?=-0420,P=0.011)and lower signal on MRI(B=0.363,?=0.352,P=0.031)are prognostic factors of postoperative neurological recoveryConclusions:For patients with adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,postoperative neurological recovery rate is related with preoperative JOA scores and intramedullary signal on MRI.Therefore,the higher preoperative JOA score and low intramedullary signal on MRI can predict the postoperative neurological recovery rate of patients with adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosisPart ? Comparison of postoperative outcomes and complications of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis and thoracic ossification of ligamentum flavumObjectives:So far,there are no reports of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,so the postoperative outcomes and complications are still unclear.OLF is one of the most common causes of thoracic spinal stenosis.And laminectomy is currently the most common surgical procedure for the treatment of thoracic ossification of ligamentum flavum.At present,studies had described the postoperative neurological function and complications of TOLF.This study used systematic review and meta-analysis to evaluate the outcomes and complications of posterior laminectomy for the treatment of TOLF,and compare the relationship between adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,with the purpose of providing guidance for the clinical.Methods:Twenty patients with adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis who underwent posterior laminectomy were evaluated for postoperative outcomes and complications.Electronic searches were performed using PubMed,Cochrane and Embase databases.Intake studies in which patients underwent laminectomy for thoracic myelopathy due to OLF,and collect neurological outcomes(preoperative JOA score,postoperative JOA score and neurological recovery rate)and complications(cerebrospinal fluid leakage,dural tear,neurological deficits,surgical site infection,hematoma,etc.).All analyses were performed using software of Stata 15 and R version 3.5.2.To compare the postoperative outcomes and complications of posterior laminectomy in the treatment of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis and TOLF.Results:20 patients with posterior laminectomy for the treatment of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis,neurological outcomes showed average preoperative JOA scores were 5.10±1.07,the average last follow-up JOA scores were 8.85±0.99,the average recovery rates were 64.7±13.9%;postoperative complications results showed that 3 patients(15%)with dural tears,3 patients(15%)with CSF leaks,and 1 patient(5)%)with infections.A total number of 416 patients were included in the study of TOLF.The pooled preoperative and postoperative JOA scores were 5.59(95%CI,4.43-6.75)and 8.86(95%CI,8.40-9.23),respectively,with a pooled recovery rate of 61.76%(95%CI,54.80%-68.71%).Pooled proportion estimates for CSF leaks,early neurological deficits,infections,wound dehiscence,hematoma,dural tears were 7%(95%CI,2.9%-11.1%),2.3%(95%CI,0.1%-6.5%),2.1%(95%CI,0.3%-5.2%),1.1%(95%CI,0%-4.3%),3.5%(95%CI,0.7%-7.7%)and 16.9%(95%CI,12.7%-21.1%)Conclusions:Posterior laminectomy for the treatment of adjacent segmental spinal stenosis secondary to thoracolumbar rigid kyphosis and TOLF,the postoperative outcomes and complications are about the same.Although the neurological function of patients improved postoperatively,the overall neurological status remains poor.The most common complications after surgery are dural tears and CSF leaks. |
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