The Research And Clinical Significance Of Adult Kyphosis

Part One Imaging analysis of whole-body sagittal position in two different standing postures of healthy adultsObjective: For patients with spinal deformity,a series of imaging examinations are performed before the operation.X-ray inspection is an important part.When performing X-ray examinations,patients are often required to stand in a specific posture,and this posture is not the most commonly used as standing or walking posture in daily life.In everyday life,people often stand in a posture that can make them feel comfor table and relaxed to save energy.Recalling relevant research,whether the difference between these two standing positions has an impact on the design of the surgical plan and the postoperative recovery and complic ations of the patient is currently inconclusive.In order to better guide the clinical work,help us to better formulate surgical procedures in clinical work,and reduce the incidence of postoperative complications,We analyzed the imaging differences of sagittal position of healthy young people when standing in standard upright posture and natural and comfortable upright posture.Methods: Radiographic parameters of 50 young and healthy adults were evaluated including the global cervical angle(GCA),global thoracic angle(GTA),global lumbar angle(GLA),which were used to depict the spine profile;the distance from the cranial sagittal vertical axis(CSVA)to the posterior corner of S1(CSVA-S),the center of the hip(CSV A-H),the center of the knee(CSVA-K)and the ankle(CSVA-A),respectively in both upright positions and natural and comfortable upright position,which were employed to describe the whole-body balance.?Results: Significant differences could be observed in all the GCA(17.39±6.90 vs.10.90±3.77,P<.001),GTA(25.63±7.27 vs.45.42±8.15 P<.001),GLA(42.64±8.05 vs.20.21±7.47 P<.001),CSVA-S(0.33±2.76 cm vs. 8.54±3.78 cm,P<0.001),CSVA-H(1.53±3.11 cm vs.5.71±3.26 cm,P<0.001),CSVA-K(3.58±2.47 cm vs.5.22±2.69 cm,P=0.002)and CSVAA(1.79±1.92 cm vs.4.79±2.51 cm,P<0.001)in the two different standin g postures,respectively.Compared with standard upright position,natura l and comfortable upright position results in a more kyphotic spine prof ile.Conclusions: Significant differences in sagittal radiographic paramet ers were found between the standard upright position and natural and c omfortable upright position,with the latter revealing a more kyphotic sp inal profile more common in everyday life,which may explain the exist ing spinal pathologies as well as predict postoperative complications.Th e natural and comfortable upright position should be a factor to conside r when performing a surgical plan.Part Two Correlation between spinopelvic sagittal parameters and quality of life in elderly patients with spinal deformity and clinical significanceObjective: As the aging problem continues,the spinal deformity in the elderly people has become an important issue that cannot be ignored.Spinal deformity in the elderly people,whether it is degenerative deformity or prolonged from idiopathic deformity,will take not only the appearance but also much inconvenience in life to the patients,especially the quality of life of patients.More and more patients with spinal deformity choose surgical treatment with the maturity of spinal deformity correction surgery,and hope that surgical treatment can not only reconstruct the shape,relieve symptoms,but also help improve the quality of life after surgery.The spinal deformity,including the sagittal,coronal and axial imbalance,and within the spinopelvic sagittal imbalance plays an important role in the progression and treatment of spinal deformity.Adjust the patient's spinopelvic sagittal balance reasonable is a guarantee of better quality of life for patients,which is also an important issue for surgeons.The aim of this study was to investigate the relationship between the changes of spinopelvic sagittal parameters and the quality of life of patients with spinal deformity in patients over 60 years old.Methods: A retrospective analysis of 30 patients more than 60 years with spinal deformity treated by operation in our hospital from September 2014 to February 2017,including 6 male patients and 24 female patients,aged 62-71 and the mean age is 64.2 years old.Spinal-pelvic sagittal balance parameters were measured before and 6 months after surgery,including sagittal vertical axis(SVA),T1 pelvic angle(TPA),pelvic incidence(PI),lumbar lordosis(LL),pelvic tilt(PT)and sacral slope(SS).Evaluate Scoliosis Research Society-22(SRS-22)scores,Visual Analogue Scale(VAS)of back and lower extremity pail and Oswestry Disability Index(ODI)of the patients preoperatively and 6 months postoperativelyResults: The pain,psychological status,self-image,functional status and satisfaction of treatment in the SRS-22 scale preoperatively were 11.6±2.6 points,14.6±1.3 points,14.2±2.8 points,13.6±3.2 points and 1.2±1.8 points,respectively.The preoperatively ODI,back pain and lower extremity pain of VAS were(42.3±16.6)%,6.1±2.2 points,and 4.1±1.8 points,respectively.The pain,psychological status,self-image,functional status,and satisfaction with treatment in the SRS-22 postoperatively were 18.5±.2.2 points,17.8 ± 2.6 points,18.9 ± 1.9 points,19.6 ± 1.8 points and 6.8 ± 1.6 points.The postoperatively ODI,back pain and lower extremity pain of VAS were(7.8 ± 2.7)%,2.2 ± 2.0 points,and 0.8 ± 1.3 points,respectively.SVA,TPA,PI,LL,PT,SS,and PI-LL of patients preoperatively were 6.3 ± 4.9 cm,28.4 ± 14.1 °,43.7 ± 8.4 °,-22.1 ± 15.8 °,27.0 ± 6.5 °,and 16.7 ± 7.5°,21.6 ± 12.4 °,respectively.SVA,TPA,PI,LL,PT,SS,and PI-LL of patients postoperatively were 1.3±2.2cm,11.3±5.1°,43.7±8.4°,35.3±11.6°,13.7±6.2°,30.1±8.2°,8.4 ± 12.2°,respectively.Pain,self-image,functional status,satisfaction with treatment in the SRS-22 scores,ODI and VAS scores of lumbar and lower extremity pain were significantly correlated with SVA and TPA before and after surgery(P<0.05).And significant correlation was found between LL,PT and PI-LL and ODI?VAS scores of lumbar and lower extremity pain(P<0.05).No significant correlation was found between PI?SS and SRS-22 scores(P>0.05).Conclusion: In elderly patients more than 60 years with spinal deformity,changes in TPA and SVA are closely related to pain,self-image,functional status,and satisfaction with treatment;changes in LL,PT,and PI-LL are closely related to the pain of the patient.Part Three Evaluation of the effect of posterior unilateral vertebral column resection as the revision for severe thoracolumbar kyphosisObjective: With the development and advancement of medicine,more and more patients with spinal deformity are willing to undergo surgery.According to our clinical experience,one of the goals of surgery should be to achieve a solid fusion in the surgical area except satisfied deformity correction efficacy.Before the patients are given surgical treatment,the patients should be carefully examined to help the patients preparing for the operation.It is hoped that the patients can obtain functional improvement as well as cosmetic promotion.However,revision surgery may be necessary when deformities progress,for e.g.symptom persistence or deterioration,development of new or different symptoms,especially severe thoracolumbar angular kyphosis.The revision of severe thoracolumbar angular kyphotic deformities presents a greater challenge for spine surgeons as compared to the first operation.Moreover,the best surgical option remains controversial,based on the few available studies.In order to achieve the purpose of reducing the operation time,blood loss and perioperative complications of revision surgery,the safety and efficacy of posterior unilateral vertebral column resection(PUVCR)was assessed as a revision surgery in treating the patients with severe thorocolumbar angular kyphosis.And it is hoped that this method could be used as one of the optional methods as a revision surgery for patients with severe thoracolumbar angular kyphosis.Methods: A retrospective analysis of 28 patients who underwent revision surgery in our hospital between September 2013 and August 2017 for severe thoracolumbar angular kyphosis,including 12 males and 16 females,aged 52-68 years,mean age 62.5 years.The follow-up time was one year.Patients were divided into two groups according to the surgery they underwent.The patients who underwent PUVCR surgery involved into PUVCR group and the patients who underwent PVCR surgery involved into PVCR group.Perioperative complications and clinical outcomes,including blood loss,operation time,Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI),and preoperative and postoperative kyphotic angles,were analyzed.Differences between the 2 groups were analyzed by Student's t-test.Results: This study included 28 patients who were divided into the PUVCR group and the posterior vertebral column resection(PVCR)group.Age(P=0.620)?gender distribution(P=0.438)were similar in the two groups.Shorter mean operation time was observed in the PUVCR group as compared to the PVCR group(P<0.001).In addition,less blood loss was recorded in the PUVCR group as compared to the PVCR group(P=0.001).There were no significant differences between the two groups in change of VAS scores post-operation vs pre-operation(P=0.966),and at postoperative three months(P=0.875),6 months(P=0.836)and 12 months(P=0.638)vs post-operation,respectively.There were no significant differences between the two groups in ODI changes post-operation vs pre-operation(P=0.358),and at postoperative three months(P=0.689),6 months(P=0.667)and 12 months(P=0.831)vs post-operation,respectively.PUVCR and PVCR were comparable in deformity correction (P=0.434)and final angle correction(P=0.795).Complication rates in the PUVCR and PVCR groups were 8.3% and 31.3%,respectively.Conclusion: PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis,with the advantages of shorter operation time,less blood loss and fewer complications.