Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying...Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the retative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study. Methods From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2Wl sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray. Results In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side （P 〈0.001）. The vertebral body height on the convex side was greater than the height on the concave side （P=0.016） There was a significant difference between the scoliosis group and the control group （P=0.003）, and between T-value and the rate of osteoporosis between the two groups （both P 〈0.001）. Results were verified using multiple linear regression analysis. Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.展开更多
Background Spine surgery using computer-assisted navigation （CAN） has been proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing versus the conve...Background Spine surgery using computer-assisted navigation （CAN） has been proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing versus the conventional intraoperative image intensifier （CⅢ）. However, as we know, few previous studies have described the learning curve of CAN in spine surgery.Methods We performed two consecutive case cohort studies on pedicel screw accuracy and operative time of two spine surgeons with different experience backgrounds, A and B, in one institution during the same period. Lumbar pedicel screw cortical perforation rate and operative time of the same kind of operation using CAN were analyzed and compared using CⅢ for the two surgeons at initial, 6 months and 12 months of CAN usage.Results CAN spine surgery had an overall lower cortical perforation rate and less mean operative time compared with CⅢ for both surgeon A and B cohorts when total cases of four years were included. It missed being statistically significant,with 3.3% versus 4.7% （P=0.191） and 125.7 versus 132.3 minutes （P=0.428） for surgeon A and 3.6% versus 6.4%（P=0.058）, and 183.2 versus 213.2 minutes （P=0.070） for surgeon B. in an attempt to demonstrate the learning curve,the cases after 6 months of the CAN system in each surgeon＇s cohort were compared. The perforation rate decreased by 2.4% （P=0.039） and 4.3% （P=0.003） and the operative time was reduced by 31.8 minutes （P=0.002） and 14.4 minutes （P=0.026） for the CAN groups of surgeons A and B, respectively. When only the cases performed after 12 months using the CAN system were considered, the perforation rate decreased by 3.9% （P=0.006） and 5.6% （P 〈0.001） and the operative time was reduced by 20.9 minutes （P 〈0.001） and 40.3 minutes （P 〈0.001） for the CAN groups of surgeon A and B, respectively.Conclusions In the long run, CAN spine surgery decreased the lumbar screw cortical perforation rate and operative time. The learning curve showed a sharp drop after 6 months of using CAN that plateaued after 12 months; which was demonstrated by both perforation rate and operative time data. Careful analysis of the data showed CAN is especially useful for less experienced surgeon to reduce perforation rate and intraoperative time, although further comparative studies are anticipated.展开更多
文摘Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the retative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study. Methods From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2Wl sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray. Results In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side （P 〈0.001）. The vertebral body height on the convex side was greater than the height on the concave side （P=0.016） There was a significant difference between the scoliosis group and the control group （P=0.003）, and between T-value and the rate of osteoporosis between the two groups （both P 〈0.001）. Results were verified using multiple linear regression analysis. Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.
文摘Background Spine surgery using computer-assisted navigation （CAN） has been proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing versus the conventional intraoperative image intensifier （CⅢ）. However, as we know, few previous studies have described the learning curve of CAN in spine surgery.Methods We performed two consecutive case cohort studies on pedicel screw accuracy and operative time of two spine surgeons with different experience backgrounds, A and B, in one institution during the same period. Lumbar pedicel screw cortical perforation rate and operative time of the same kind of operation using CAN were analyzed and compared using CⅢ for the two surgeons at initial, 6 months and 12 months of CAN usage.Results CAN spine surgery had an overall lower cortical perforation rate and less mean operative time compared with CⅢ for both surgeon A and B cohorts when total cases of four years were included. It missed being statistically significant,with 3.3% versus 4.7% （P=0.191） and 125.7 versus 132.3 minutes （P=0.428） for surgeon A and 3.6% versus 6.4%（P=0.058）, and 183.2 versus 213.2 minutes （P=0.070） for surgeon B. in an attempt to demonstrate the learning curve,the cases after 6 months of the CAN system in each surgeon＇s cohort were compared. The perforation rate decreased by 2.4% （P=0.039） and 4.3% （P=0.003） and the operative time was reduced by 31.8 minutes （P=0.002） and 14.4 minutes （P=0.026） for the CAN groups of surgeons A and B, respectively. When only the cases performed after 12 months using the CAN system were considered, the perforation rate decreased by 3.9% （P=0.006） and 5.6% （P 〈0.001） and the operative time was reduced by 20.9 minutes （P 〈0.001） and 40.3 minutes （P 〈0.001） for the CAN groups of surgeon A and B, respectively.Conclusions In the long run, CAN spine surgery decreased the lumbar screw cortical perforation rate and operative time. The learning curve showed a sharp drop after 6 months of using CAN that plateaued after 12 months; which was demonstrated by both perforation rate and operative time data. Careful analysis of the data showed CAN is especially useful for less experienced surgeon to reduce perforation rate and intraoperative time, although further comparative studies are anticipated.
