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Chandirasegaran S, Chan CYW, Chiu CK, Chung WH, Hasan MS, Kwan MK. Analysis of duration of different stages of surgery in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) patients: comparison between severe versus non-severe AIS. Eur Spine J 2024; 33:1683-1690. [PMID: 38294535 DOI: 10.1007/s00586-023-08124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Prolonged surgical duration in severe adolescent idiopathic scoliosis (AIS) patients is associated with increased blood loss and perioperative complications. The aim of this study was to compare the duration of each stage of posterior spinal fusion (PSF) in severe AIS (Cobb angle ≥ 90°) with non-severe AIS patients. This analysis will identify the most time-consuming stage of PSF and help surgeons formulate strategies to shorten operative time. METHODS Retrospective study whereby 90 AIS patients (Lenke type 2, 3, 4, and 6) who underwent PSF from 2019 to 2023 were recruited. Twenty-five severe AIS patients were categorized in Gp1 and 65 non-severe AIS patients in Gp2. Propensity score matching (PSM) with one-to-one with nearest neighbor matching (match tolerance 0.05) was performed. Outcomes measured via operation duration of each stage of surgery, blood loss, number of screws, fusion levels and screw density. RESULTS Twenty-five patients from each group were matched. Total operative time was significantly higher in Gp1 (168.2 ± 30.8 vs. 133.3 ± 24.0 min, p < 0.001). The lengthiest stage was screw insertion which took 58.5 ± 13.4 min in Gp1 and 44.7 ± 13.7 min in Gp2 (p = 0.001). Screw insertion contributed 39.5% of the overall increased surgical duration in Gp1. Intraoperative blood loss (1022.2 ± 412.5 vs. 714.2 ± 206.7 mL, p = 0.002), number of screws (17.1 ± 1.5 vs. 15.5 ± 1.1, p < 0.001) and fusion level (13.1 ± 0.9 vs. 12.5 ± 1.0, p = 0.026) were significantly higher in Gp1. CONCLUSION Screw insertion was the most time-consuming stage of PSF and was significantly longer in severe AIS. Adjunct technologies such as CT-guided navigation and robotic-assisted navigation should be considered to reduce screw insertion time in severe AIS.
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Affiliation(s)
- Saturveithan Chandirasegaran
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Chan CYW, Tan YWE, Chandren JR, Chandirasegaran S, Chung WH, Chiu CK, Kwan MK. Prediction of postoperative curve correction based on the supine radiographs for adult idiopathic scoliosis (AdIS) patients. Spine J 2024:S1529-9430(24)00111-6. [PMID: 38499066 DOI: 10.1016/j.spinee.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT Preoperative supine radiographs are mandatory in the new adult idiopathic scoliosis (AdIS) classification. Supine radiographs are easily reproducible and highly predictive of side bending radiographs. However, few studies evaluated the use of supine radiographs in predicting postoperative curve correction after posterior spinal fusion (PSF) in AdIS. PURPOSE To investigate the use of supine and side bending (SB) radiographs in predicting postoperative curve correction in AdIS patients who underwent PSF. STUDY DESIGN Retrospective study. PATIENT SAMPLE 93 AdIS patients who underwent PSF between 2022 and 2023 were included. OUTCOME MEASURES Demographic data were age, gender, height, weight, body mass index (BMI), Risser grade, Lenke curve types and Cobb angles. Main outcome measures were preoperative and immediate postoperative Cobb angle (proximal thoracic [PT], main thoracic [MT] and thoracolumbar/lumbar [TL/L] curves), Supine Cobb angle and Flexibility rate (PT, MT and TL/L), and Correction rate (PT, MT and TL/L). METHODS Correlation study was performed between Supine Cobb angle vs. postoperative Cobb angle for PT, MT and TL/L curves. A predictive formula was derived from the correlation plots. RESULTS A total of 93 subjects were included in our study with a median age of 24.7 years and comprised of 80 females (86.0%). Preoperative Supine Cobb angle (r=0.835, r=0.881, r=0.767, p<.001) and preoperative SB Cobb angle (r=0.815, r=0.872, r=0.801, p<.001) showed similar strong positive correlation with postoperative PT, MT and TL/L Cobb angle, but preoperative Supine Cobb angle had slightly stronger correlation in PT and MT, whereas preoperative SB Cobb angle had stronger correlation in TL/L curve. Using the derived predictive formulae, there was a significant, strong, positive correlation between the predicted value and actual value of postoperative standing Cobb angle, (r=0.852, p<.001), with 71.0% of the patients had predicted postoperative Cobb angle from the supine radiographs within 5 degrees of the actual value. CONCLUSION Both supine radiographs and side bending radiographs had strong predictability of the postoperative Cobb angle for PT, MT and TL/L curves. In 71.0% of patients, the actual postoperative Cobb angle was within 5 degrees of the predicted postoperative Cobb angle using the predictive formulae.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Yee Wern Evonne Tan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Josephine Rebecca Chandren
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Wang WJ, Lee YJ, Chung WH, Chan CYW, Kwan MK. The widths of the medial and lateral pedicle walls in adolescent idiopathic scoliosis (AIS) with major thoracic curves. Spine J 2024:S1529-9430(24)00083-4. [PMID: 38408520 DOI: 10.1016/j.spinee.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND CONTEXT The widths of medial and lateral pedicle walls in the normal spine of middle-aged and elderly adults have been investigated and these studies found that the medial pedicle wall was thicker than the lateral pedicle wall. However, none had evaluated the widths of medial and lateral pedicle walls on adolescent or young adult scoliotic spines. PURPOSE This study aims to identify the distribution and variation of medial and lateral pedicle wall widths throughout the different vertebral levels of the scoliotic spine and its differences according to age, gender, body mass index (BMI), maturity, curve types and curve severity in adolescent idiopathic scoliotic (AIS) patients with major thoracic curves. STUDY DESIGN Retrospective study. PATIENT SAMPLE A total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study, with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. OUTCOME MEASURES Demographic data were age, gender, height, weight, BMI, Risser grade, Lenke curve types and Cobb angles. The main outcome measures were medial and lateral pedicle wall widths. Associations between pedicle wall widths and demographic data were calculated. METHODS This was a subanalytical retrospective study done on the same patient population as the previously published study on pedicle grading. The data was obtained from the main computed tomography (CT) scan pedicle study dataset. Medial and lateral pedicle wall widths were measured in the axial slices of CT scans from T1 to L5 vertebrae. RESULTS A total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. Right-sided medial pedicle wall widths were narrower from T4-T10 (0.75±0.23 mm) compared to T1-T3 (0.89±0.28 mm) and T11-L5 (0.92±0.30 mm). Left-sided medial pedicle wall widths were narrower from T4 to T7 (0.76±0.24 mm) compared to T1-T3 (0.88±0.26 mm) and T8-L5 (0.90±0.27 mm). Medial cortical wall widths were significantly thicker compared to lateral cortical wall widths for all vertebras from T1 to L5 (right medial 0.85±0.28 mm vs. lateral 0.64±0.26 mm (p<.001), left medial 0.86±0.26 mm vs. lateral 0.64±0.26 mm (p<.001)). The left medial pedicle wall widths were marginally significantly (p<.001) thicker than the right side (right medial 0.85±0.28 mm vs. left 0.86±0.26 mm). The main notable significant differences were located at the periapical region of the thoracic curve between T7 to T10 with the left concave medial pedicle width being thicker than the right convex medial pedicle width. The thinnest medial pedicle walls were located at right concave T7 (0.73±0.24 mm) and T8 (0.73±0.23 mm). We generally found no significant associations between the medial and lateral pedicle wall widths with age, gender, BMI, Risser grade, Cobb angle and curve types. CONCLUSIONS Knowledge on the widths of medial and lateral pedicle walls, their distribution and differences in a scoliotic spine is important for pedicle screw fixation, especially during pedicle probing to find the pedicle channel. The medial pedicle wall widths were significantly thicker than the lateral pedicle wall widths in AIS patients with major thoracic curves. The right concave periapical region had the thinnest medial pedicle walls.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Wee Jieh Wang
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yu Jie Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chin TF, Chung WH, Chan CYW, Kwan MK. Variations in the Number of Vertebrae, Prevalence of Lumbosacral Transitional Vertebra and Prevalence of Cervical Rib Among Surgical Patients With Adolescent Idiopathic Scoliosis: An Analysis of 998 Radiographs. Spine (Phila Pa 1976) 2024; 49:64-70. [PMID: 37146062 DOI: 10.1097/brs.0000000000004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Retrospective Study. OBJECTIVE This study aims to investigate variation in the number of thoracic and lumbar vertebrae, the prevalence of lumbosacral transitional vertebra (LSTV) and the prevalence of cervical ribs among surgical patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Due to variation in the number of thoracic or lumbar vertebrae, inaccurate identification of vertebral levels has been found to be a contributory factor to wrong-level surgery. METHODS This was a retrospective study on AIS patients who underwent posterior spinal fusion. Demographic and anthropometric data (age, gender, height, weight, and body mass index), radiographic data (Lenke curve type, pre-operative Cobb angle, vertebra numbering of cervical, thoracic, and lumbar spine, presence of LSTV based on the Castellvi classification and the presence of cervical ribs) and clinical data were collected. Data were analysed and reported with mean and standard deviation for quantitative parameters and number and percentage for qualitative parameters. Multinomial logistic regression analyses were performed to identify factors associated with the outcomes of interest. RESULTS A total of 998 patients met inclusion criteria, of which 135 (13.5%) were males and 863 (86.5%) were females. The vertebrae number varied between 23 to 25 total vertebrae with 24 vertebrae considered as the typical number of vertebrae. The prevalence of atypical number of vertebrae (23 or 25) was 9.8% (98 patients). We found a total of 7 different variations in number of cervical, thoracic, and lumbar vertebrae (7C11T5L, 7C12T4L, 7C11T6L, 7C12T5L, 7C13T4L, 7C12T6L, and 7C13T5L) with 7C12T5L considered as the typical vertebrae variation. The total prevalence of patients with atypical vertebrae variation was 15.5% (155 patients). Cervical ribs were found in 2 (0.2%) patients while LSTV were found in 250 (25.1%) of patients. The odds of 13 thoracic vertebrae were higher in males (OR 5.17; 95% CI: 1.25, 21.39) and the odds of 6 lumbar vertebrae were higher in LSTV (OR 3.93; 95% CI: 2.58, 6.00). CONCLUSION In this series, we identified a total of 7 different variations in the number of cervical, thoracic, and lumbar vertebrae. The total prevalence of patients with atypical vertebrae variation was 15.5%. LSTV was found in 25.1% of the cohort. It is important to ascertain atypical vertebrae variations rather than the absolute number of vertebrae because variants such as 7C11T6L and 7C13T4L may still have typical numbers of vertebrae in total. However, due to the differences in the number of morphologically thoracic and lumbar vetrebrae, there may still be a risk of inaccurate identification.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur
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Chiu CK, Wang WJ, Lee YJ, Chung WH, Chan CYW, Kwan MK. What is the prevalence and distribution of narrow dysplastic and fully corticalized pedicles in Asian adolescent idiopathic scoliosis patients with major main thoracic curves? A computed tomography scan analysis of 6,494 pedicles. Spine J 2023; 23:1700-1708. [PMID: 37453514 DOI: 10.1016/j.spinee.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND CONTEXT Patients with adolescent idiopathic scoliosis (AIS) have higher prevalence of abnormal or dysplastic pedicles. PURPOSE To investigate the prevalence and distribution of narrow dysplastic and fully corticalized pedicles in Asian AIS patients with major main thoracic curves. DESIGN Retrospective study. PATIENT SAMPLE A total of 6,494 pedicles in 191 patients were measured and evaluated. OUTCOME MEASURES The primary outcomes measures were the pedicle width measurements (total transverse pedicle width, transverse cancellous width, total transverse cortical width) and classification of pedicles. Demographic data (age, gender, height, weight, body mass index), proximal thoracic Cobb angle, main thoracic Cobb angle and lumbar Cobb angle were also obtained. METHODS AIS patients with major (largest Cobb angle) main thoracic curves and had computed tomography (CT) scans prior to corrective spine surgery were reviewed. The pedicles were classified as Grade A: cancellous channel >4 mm; Grade B: cancellous channel 2 to 4 mm; Grade C: cancellous channel <2 mm or corticalized pedicle >4 mm; Grade D: corticalized pedicle ≤4 mm. Grades B, C, and D were dysplastic pedicles while grades C and D were narrow dysplastic pedicles. RESULTS The prevalence of dysplastic pedicles (grades B, C, and D) was 61.7%. There were 22.6% narrow dysplastic pedicles (grades C and D) and 4.1% fully corticalized pedicles (grade D). In the thoracolumbar region, there was a sharp transition from larger and less dysplastic pedicles at T11 and T12 to narrower and more dysplastic pedicles at L1 and L2 (narrow dysplastic pedicles at T11: 3.1%, T12: 3.1%, L1: 39.8% and L2: 23.6%). Higher prevalences of narrow dysplastic pedicles were located at right T3 to T5 (71.2%-83.7%) and left T7-T9 (51.3%-61.2%). Higher prevalences of fully corticalized pedicles were located at right T3 to T5 (20.9%-34.0%) and left T7 to T8 (11.0%-12.0%). These were the concave pedicles of proximal thoracic and main thoracic curves, respectively. CONCLUSION There were 95.9% pedicles with cancellous channels (grades A, B, and C) can allow pedicle screw fixation and only 4.1% fully corticalized pedicles (grade D) that require an alternative method of fixation. For grade C pedicles (18.5%), pedicle screws can still be attempted with caution. Precautions should also be observed at the L1 and L2 levels as there was a transition to narrower pedicles.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Wee Jieh Wang
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu Jie Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Hasan MS, Abdul Razak N, Yip HW, Lee ZY, Chan CYW, Kwan MK, Chiu CK, Yunus SN, Ng CC. Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study. BMC Anesthesiol 2023; 23:177. [PMID: 37226107 DOI: 10.1186/s12871-023-02127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores. METHODS Ninety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group. RESULTS There were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively. CONCLUSION Intraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia.
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Affiliation(s)
- M Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Norashekeen Abdul Razak
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hing Wa Yip
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zheng-Yii Lee
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Mun Keong Kwan
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Chee Kidd Chiu
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Siti Nadzrah Yunus
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Choe Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Lee SY, Ch'ng PY, Wong TS, Ling XW, Chung WH, Chiu CK, Chan CYW, Lean ML, Kwan MK. Patients' Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis. Global Spine J 2023; 13:752-763. [PMID: 33823628 DOI: 10.1177/21925682211007795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To evaluate the perception and satisfaction among adolescent idiopathic scoliosis (AIS) patients on Neck Tilt with Medial Shoulder Imbalance and Lateral Shoulder Imbalance. METHODS Lenke 1 and 2 AIS patients were stratified into 6 groups of preoperative/ postoperative Balanced (B), Lateral Shoulder Imbalance (LSI) (>2 cm), and Neck Tilt with Medial Shoulder Imbalance (NT) (Grade 3). Patients were interviewed using Modified Neck and Shoulder Appearance and SRS-22r questionnaires. T1 tilt, Cervical Axis (CA), Clavicle Angle (Cla-A) and Radiographic Shoulder Height (RSH) were measured. RESULTS A total of 120 Lenke 1 and 2 AIS patients were recruited. NT patients were aware and unhappy with their abnormal neck with medial shoulder appearances (P < .001). Similarly, LSI patients were aware and unhappy with their abnormal lateral shoulder appearances (P < .001). NT group had larger preoperative/ postoperative T1 tilt (9.2 ± 5.0°; 9.5 ± 5.3°) and CA (4.6 ± 3.1°; 7.0 ± 2.0°) (P < .01). LSI group had larger preoperative/ postoperative Cla-A (4.8 ± 2.8°; 4.0 ± 1.3°) and RSH (20.1 ± 9.4 mm; 17.0 ± 6.6 mm) (P < .001). Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains (4.2 ± 0.3; 4.0 ± 0.5; 4.4 ± 0.5) while preoperative LSI scored the lowest comparatively (3.5 ± 0.4; 2.4 ± 0.5; 3.3 ± 0.5) (P < .001). CONCLUSION NT and LSI were major concerns among AIS patients. Both NT and LSI groups were unhappy with their appearances. NT group had larger T1 tilt/ CA whereas LSI group had larger Cla-A/ RSH. Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains.
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Affiliation(s)
- Sin Ying Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Tat Seng Wong
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Xiu Wen Ling
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mei Li Lean
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Chan CYW, Ch’ng PY, Lee SY, Chung WH, Chiu CK, Kwan MK. Preoperative "Cervical Axis" Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients. Global Spine J 2023; 13:443-450. [PMID: 33691529 PMCID: PMC9972263 DOI: 10.1177/2192568221998642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective. PURPOSE To evaluate the relationship between shoulder/ neck imbalance with distal adding-on phenomenon and to identify other risk factors in Lenke 1 and 2 (non-AR curves) adolescent idiopathic scoliosis (AIS) patients. METHODS 100 Lenke 1 and 2 AIS patients with lowest instrumented vertebra (LIV) cephalad to or at L1 were recruited. Medial shoulder/ neck balance was represented by T1-tilt and cervical axis (CA). Lateral shoulder balance was represented by clavicle angle (Cla-A) and radiographic shoulder height (RSH). Distal adding-on phenomenon was diagnosed when there was disc wedging below LIV of >5o at final follow-up. Predictive factors and odds ratio were derived using univariate and multivariate logistic regression analysis. RESULTS Mean age of this cohort was 15.9 ± 4.4 years. Mean follow-up duration was 30.9 ± 9.6 months. Distal adding-on phenomenon occurred in 19 patients (19.0%). Only Risser grade, preoperative CA and final follow-up lumbar Cobb angle were the independent factors. A positive preoperative CA deviation increased the odds of distal adding-on by 5.4 times (95% CI 1.34-21.51, P = 0.018). The mean immediate postoperative T1-tilt, CA, RSH and Cla-A were comparable between the group with distal adding-on and the group without. CONCLUSION Distal adding-on phenomenon occurred in 19.0% of patients. Preoperative "Cervical Axis" was an important factor and it increased the risk of distal adding-on by 5.4 times. Other significant predictive factors were Risser grade and lumbar Cobb angle at final follow-up. Immediate postoperative shoulder or neck imbalance was not a significant factor for postoperative distal adding-on phenomenon.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch’ng
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin Ying Lee
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Mun Keong Kwan, Department of Orthopaedic
Surgery, National Orthopedic Centre of Excellence for Research and Learning
(NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,
Malaysia.
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Chan CYW, Gani SMA, Chung WH, Chiu CK, Hasan MS, Kwan MK. A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients. Global Spine J 2023; 13:81-88. [PMID: 33648369 PMCID: PMC9837521 DOI: 10.1177/2192568221991510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective propensity score matching (PSM) study. OBJECTIVE To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). METHODS 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. RESULTS Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients (P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) (P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable (P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. CONCLUSION Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty
of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Mun Keong Kwan, Department of Orthopedic
Surgery, National Orthopedic Centre of Excellence for Research and Learning
(NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur,
Malaysia.
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10
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Chung WH, Lee YJ, Chiu CK, Hasan MS, Chan CYW, Kwan MK. Severe Lenke 1 and 2 adolescent idiopathic scoliosis had poorer perioperative outcome, higher complication rate, longer fusion and higher operative cost compared to non-severe scoliosis. Eur Spine J 2022; 31:1051-1059. [PMID: 35066683 DOI: 10.1007/s00586-022-07118-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the perioperative outcome and operative cost of posterior spinal fusion (PSF) surgery between severe and non-severe Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) patients. METHODS A total of 509 AIS patients who underwent single-staged PSF between 2013 and 2020 were reviewed. Fifty-four severe scoliosis patients (Cobb angle ≥ 90°) were categorized into Gp1, and 455 non-severe scoliosis (Cobb angle < 90°) patients into Gp2. Propensity score matching (PSM) analysis using one-to-one nearest neighbor matching and match tolerance of 0.001 were performed. Outcome measures were operative time, intraoperative blood loss (IBL), allogeneic transfusion rate, perioperative complication, length of stay, fusion level, number of screws used, postoperative Cobb angle, correction rate (CR), side bending correction index (SBCI) and operative cost. RESULTS From the PSM analysis, 35 patients from each group were matched. The operative time was 155.9 ± 41.4 and 130.0 ± 30.3 min for Gp1 and Gp2, respectively (p = 0.004). The IBL was 1349.2 ± 1019.0 and 781.9 ± 325.1 mLs for Gp1 and Gp2, respectively (p = 0.003). Fusion level (12.5 ± 0.8 vs. 11.2 ± 1.3, p < 0.001) and number of screws used (16.4 ± 1.6 vs. 14.6 ± 1.4, p < 0.001) were higher in Gp1. Four perioperative complications were observed in Gp1 compared to none in Gp2 (p < 0.039). Gp1 had larger postoperative Cobb angle (p < 0.001), lower CR (p = 0.005) and higher SBCI (p < 0.001). The operative cost was higher in Gp1 (p < 0.001). CONCLUSIONS Severe Lenke 1 and 2 AIS patients had poorer perioperative outcome, higher complication rate, longer fusion and higher operative cost than non-severe AIS.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu Jie Lee
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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11
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Chung WH, Mihara Y, Chiu CK, Hasan MS, Chan CYW, Kwan MK. Factors Affecting Operation Duration in Posterior Spinal Fusion (PSF) Using Dual Attending Surgeon Strategy Among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) Patients. Clin Spine Surg 2022; 35:18-23. [PMID: 33979103 DOI: 10.1097/bsd.0000000000001186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. SUMMARY OF BACKGROUND DATA Prolonged operation duration in adolescent idiopathic scoliosis (AIS) surgery was associated with increased perioperative complications. However, the factors affecting operation duration in AIS surgery were unknown. OBJECTIVE The aim of the study was to investigate the factors affecting operation duration in posterior spinal fusion (PSF) surgery using a dual attending surgeon strategy among Lenke 1 and 2 AIS patients. METHODS In all, 260 AIS patients with Lenke 1 and 2 curves who underwent PSF were retrospectively reviewed. Preoperative and intraoperative factors affecting operation duration such as age, sex, height, weight, body mass index, Risser grade, Lenke subtypes, number of fusion level, number of screws, screw density, wound length, upper and lowest instrumented vertebrae level, preoperative Cobb angle, and flexibility of the major curve were assessed using univariate and multivariate linear regression analyses. Independent factors were determined when P-value <0.05. RESULTS The mean operation duration was 122.2±28.6 minutes. Significant independent factors affecting operation duration in PSF among Lenke 1 and 2 AIS patients were Lenke 2 subtypes (β=8.86, P=0.008), number of screws (β=7.01, P<0.001), wound length (β=1.14, P=0.009), and flexibility of the major curve (β=-0.25, P=0.005). The overall model fit was R2=0.525. Operation duration can be predicted using the formula: (8.86×Lenke subtypes)+(7.01×number of screws)+(1.14×wound length)-(0.25×flexibility)-0.54, where Lenke 2=1 and Lenke 1=0. CONCLUSION The factors affecting operation duration in PSF among Lenke 1 and 2 AIS patients were Lenke 2 curves, number of screws, wound length, and curve flexibility. The knowledge of these factors enables the spinal deformity surgeons to plan and estimate the operation duration before AIS surgery.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuki Mihara
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-shi, Shizuoka Prefecture, Japan
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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12
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Chung WH, Mihara Y, Toyat SS, Chiu CK, Hasan MS, Saw A, Chan C, Kwan MK. Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome. Malays Orthop J 2021; 15:99-107. [PMID: 34966502 PMCID: PMC8667250 DOI: 10.5704/moj.2111.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.
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Affiliation(s)
- W H Chung
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Y Mihara
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia.,Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-shi, Japan
| | - S S Toyat
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - C K Chiu
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - M S Hasan
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Cyw Chan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
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Hasan MS, Yunus SN, Ng CC, Chan CYW, Chiu CK, Kwan MK. Tranexamic Acid in Pediatric Scoliosis Surgery: A Prospective Randomized Trial Comparing High-dose and Low-dose Tranexamic Acid in Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery. Spine (Phila Pa 1976) 2021; 46:E1170-E1177. [PMID: 33882541 DOI: 10.1097/brs.0000000000004076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized double-blinded trial. OBJECTIVE The objective of this study is to determine the efficacy of high-dose versus low-dose tranexamic acid (TXA) in adolescent idiopathic scoliosis (AIS) corrective surgery. SUMMARY OF BACKGROUND DATA Corrective surgery for AIS is associated with significant blood loss. Evidence on the optimum TXA dose to reduce bleeding in pediatric population is scarce. METHODS A total of 166 AIS patients aged between 10 and 21 years, of American Society of Anesthesiologists (ASA) physical status I and II, preoperative hemoglobin >10 g/dL, platelet count >150,000 cells/L and Cobb angle of >45° scheduled for elective single-stage posterior spinal fusion (PSF) surgery by two attending surgeons were included between March 2017 and November 2018. Patients were randomized into Group A (High Dose, 30 mg/kg TXA loading dose followed by 10 mg/kg/h infusion) and Group B (Low Dose, 10 mg/kg TXA loading dose followed by 1 mg/kg/h infusion). The primary outcome was total surgical blood loss between both groups. Secondary outcomes were transfusion requirement, perioperative changes in hemoglobin and coagulation profiles, adverse events, and factors that influence total blood loss. RESULTS The mean total surgical blood loss between the two groups was not significant (Group A: 928.8 ± 406.1 mL [range: 348-1857 mL]; Group B: 918.1 ± 406.2 mL [range: 271-2000 mL], P = 0.865). The median duration of surgery was 120 minutes. One patient in each group received allogenic blood transfusion during the perioperative period. There were no significant changes in hemoglobin and coagulation profile at pre-operation, post-operation 0 hour and 48 hours. Sex, number of vertebral levels fused, and duration of surgery were independently associated with total surgical blood loss. No adverse events were observed perioperatively. CONCLUSION Low-dose TXA was as efficacious as high-dose TXA in reducing blood loss and allogenic blood transfusion for AIS patients undergoing PSF surgery.Level of Evidence: 1.
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Affiliation(s)
- Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nadzrah Yunus
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Choe Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chan CYW, Chiu CK, Ch'ng PY, Lee SY, Chung WH, Hasan MS, Kwan MK. Dual attending surgeon strategy learning curve in single-staged posterior spinal fusion (PSF) surgery for 415 idiopathic scoliosis (IS) cases. Spine J 2021; 21:1049-1058. [PMID: 33610804 DOI: 10.1016/j.spinee.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The implementation of a dual attending surgeon strategy had improved perioperative outcomes of idiopathic scoliosis (IS) patients. Nevertheless, the learning curve of a dual attending surgeon practice in single-staged posterior spinal fusion (PSF) surgery has not been established. OBJECTIVE To evaluate the surgical learning curve of a dual attending surgeon strategy in IS patients. STUDY DESIGN Retrospective study. PATIENT SAMPLE 415 IS patients (Cobb angle <90°) who underwent PSF using a dual attending surgeon strategy OUTCOME MEASURES: Primary outcomes included operative time, total blood loss, allogenic blood transfusion requirement, length of hospital stay and perioperative complication rate. METHODS Regression analysis using Locally Weighted Scatterplot Smoothing (LOWESS) method was applied to create the best-fit-curve between case number versus operative time and total blood loss in identifying cut-off points for the learning curve. RESULTS The mean Cobb angle was 60.8±10.8°. Mean operative time was 134.4±32.1 minutes and mean total blood loss was 886.0±450.6 mL. The mean length of hospital stay was 3.0±1.6 days. The learning curves of a dual attending surgeon strategy in this study were established at the 115th case (operative time) and 196th case (total blood loss) respectively (p<.001). In comparison of cases before and after the cut-off points, mean operative time reduced significantly from 147.2±36.5 minutes to 129.5±28.9 minutes and mean total blood loss reduced significantly from 1015.1±506.6 mL to 770.4±357.3 mL (p<.001). No allogenic blood transfusion was required and there were 7 perioperative complications (n=7/415, 1.7%) recorded. CONCLUSION The learning curve of a dual surgeon strategy in single-staged PSF surgery based on operative time and total blood loss were established at 115th case and 196th case respectively (p<.001).
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin Ying Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Chan CYW, Lee SY, Ch'ng PY, Chung WH, Chiu CK, Hasan MS, Kwan MK. Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF): An Analysis of 105 Severe Adolescent Idiopathic Scoliosis Patients (Cobb Angle ≥90°). Spine (Phila Pa 1976) 2021; 46:E663-E670. [PMID: 33306608 DOI: 10.1097/brs.0000000000003866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To assess the learning curve of a dual attending surgeon strategy in severe adolescent idiopathic scoliosis patients. SUMMARY OF BACKGROUND DATA The advantages of a dual attending surgeon strategy in improving the perioperative outcome in scoliosis surgery had been reported. However, the learning curve of this strategy in severe scoliosis had not been widely studied. METHODS A total of 105 patients with adolescent idiopathic scoliosis with Cobb angle of 90° or greater, who underwent posterior spinal fusion using a dual attending surgeon strategy were recruited. Primary outcomes were operative time, total blood loss, allogeneic blood transfusion requirement, length of hospital stay from time of operation and perioperative complications. Cases were sorted chronologically into group 1: cases 1 to 35, group 2: cases 36 to 70, and group 3: case 71 to 105. Mean operative time (≤193.3 min), total blood loss (≤1612.2 mL), combination of both and allogeneic blood transfusion were the selected criteria for receiver operating characteristic analysis of the learning curve. RESULTS The mean Cobb angle was 104.5° ± 12.3°. The operative time, total blood loss, and allogeneic blood transfusion requirement reduced significantly for group 1 (220.6 ± 54.8 min; 2011.3 ± 881.8 mL; 12 cases) versus group 2 (183.6 ± 36.7 min; 1481.6 ± 1035.5 mL; 3 cases) and group 1 versus group 3 (175.6 ± 38.4 min; 1343.7 ± 477.8 mL; 3 cases) (P < 0.05). There were six perioperative complications. Fifty-seven cases were required to achieve the preset criteria (mean operative time and mean total blood loss) (area under the curve 0.740; P < 0.001; sensitivity 0.675; specificity 0.662). CONCLUSION There was significant improvement in operative time and total blood loss when comparing group 1 versus group 2 and group 1 versus group 3. The cut-off point for the learning curve was 57 cases when the preset criteria were fulfilled (≤193.3 min operative time and ≤1612.2 mL of total blood loss).Level of Evidence: 4.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin Ying Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Tan CS, Chung WH, Mohamad SM, Kwan MK, Chan CYW. Mid-long-term outcome and degeneration of the remaining unfused lumbar intervertebral disc in adolescent idiopathic scoliosis patients who had posterior spinal fusion surgery. Eur Spine J 2021; 30:1978-1987. [PMID: 34023966 DOI: 10.1007/s00586-021-06874-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate mid-long-term effects of the lowest instrumented vertebra (LIV) selection on adolescent idiopathic scoliosis (AIS) patients who had posterior spinal fusion (PSF) surgery. METHODS Forty-eight patients were recruited. Inclusion criteria were AIS patients who have had PSF surgery more than 10 years ago. Patients were divided into G1: LIV L3 or higher and G2: LIV L4 or lower. MRI evaluation was classified using Pfirrmann grades. Pfirrmann scores were average of Pfirrmann grades for all unfused discs below LIV. SRS-22r, SF-36, Oswestry Disability Index (ODI) and Modified Cincinnati Sports Activity Scale (MCSAS) were used. RESULTS There were 19 patients in G1 and 29 patients in G2. Demographic parameters showed no significant differences. We found no significant differences in Pfirrmann grades or scores between G1 and G2. There was significant correlation between age and mean Pfirrmann scores (r = 0.546, p < 0.001), Pfirrmann grade for adjacent disc + 1 below LIV (r = 0.475, p = 0.001) and adjacent disc below LIV (r = 0.365, p = 0.011). G2 had significantly lower scores for SRS-22r pain (G1: 4.3 ± 0.5, G2: 4.0 ± 0.6, p = 0.044) and the SF-36 bodily pain (G1: 88.7 ± 12.3, G2: 77.8 ± 18.7, p = 0.018) domains. There were no significant differences in ODI and MCSAS between the two groups. CONCLUSIONS Patients with fusion to L4 or lower had more significant back pain. However, both groups had similar physical function, self-image, satisfaction with treatment, mental health, and functional sports activity. We did not find any significant association between lumbar discs degeneration and the selection of LIV.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia
| | - Chin Siong Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia
| | - Siti Mariam Mohamad
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia.
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Chiu CK, Tan RL, Gani SMA, Chong JSL, Chung WH, Chan CYW, Kwan MK. Feasibility of Single-Stage Posterior Passive Correction and Fusion Surgery for Congenital Scoliosis in Adolescent Patients Who Have Attained Skeletal Maturity. Asian Spine J 2021; 16:315-325. [PMID: 33957021 PMCID: PMC9260400 DOI: 10.31616/asj.2020.0649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To report the perioperative and radiological outcomes of single-stage posterior passive correction and fusion (SSPPCF) in adolescent patients who present with congenital scoliosis. Overview of Literature The surgical treatment for congenital scoliosis is complex. There is no definitive guide on surgical options for skeletally matured adolescent patients who have congenital scoliosis. Methods Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rommel Lim Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Davao Doctors Hospital, Davao City, Philippines
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessamine Sze Lynn Chong
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwan MK, Loh KW, Chung WH, Chiu CK, Hasan MS, Chan CYW. Perioperative outcome and complications following single-staged Posterior Spinal Fusion (PSF) using pedicle screw instrumentation in Adolescent Idiopathic Scoliosis (AIS): a review of 1057 cases from a single centre. BMC Musculoskelet Disord 2021; 22:413. [PMID: 33947368 PMCID: PMC8097957 DOI: 10.1186/s12891-021-04225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background There has been a growing interest in using all pedicle screw construct in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) surgery in recent years. However, studies focusing on perioperative outcome and complications utilizing only pedicle screw system in AIS population are lacking. This study aims to evaluate perioperative outcomes and to determine the prevalence of major and minor complications following single-staged PSF for AIS. Methods In this retrospective study of prospectively collected data, 1057 AIS patients operated between 2012 and 2019 were included. Main outcome measures were operative time, intraoperative blood loss, allogeneic blood transfusion rate, length of hospital stay after surgery, complication rate, and mean drop of haemoglobin (Hb) level. We documented the number of fusion levels, screw density, and postoperative radiographic parameters. Results There were 917 females and 140 males. Majority were Lenke 1 curve type (46.9%). Mean age was 15.6 ± 3.7 years, with mean BMI of 18.6 ± 3.2 kg/m2. Mean operative time was 146.8 ± 49.4 min. Average intraoperative blood loss was 952.9 ± 530.4 ml with allogeneic blood transfusion rate of 5%. Mean screw density was 1.27 ± 0.21 screws per fusion level. Average hospital stay after surgery was 3.5 ± 0.9 days. Twenty-four complications were documented: twelve superficial infections (1.14%), five transient neurological deficits (0.47%), two deep infections (0.19%), two superior mesenteric artery syndrome, and one case each (0.09%) for massive intraoperative blood loss, intraoperative seizure, and lung atelectasis. Conclusion AIS patients treated with single-staged PSF using pedicle screw construct had a 0.95% rate of major complications and 1.32% rate of minor complications. Rate of neurologic complication was 0.47% while non-neurologic postoperative complications was 1.80% with infection being the leading complication at 1.32%.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Kwong Weng Loh
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Chung WH, Anuar AA, Lee KJ, Hasan MS, Chiu CK, Chan CYW, Kwan MK. Superior mesenteric artery syndrome: A rare complication of scoliosis corrective surgery. J Orthop Surg (Hong Kong) 2021; 28:2309499020945014. [PMID: 32909907 DOI: 10.1177/2309499020945014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare but serious complication following scoliosis surgery. Early diagnosis and management are key factors for successful conservative treatment to avoid the need for emergency laparotomies which causes higher morbidity or even mortality. We report two adolescent idiopathic scoliosis patients with Cobb angle of 49° and 132°, respectively, and low body mass index who presented with SMA syndrome following posterior spinal fusion from T2 to L3 and were treated successfully with conservative management. Abdominal radiographs showed distended gastric shadow. Computed tomography angiography of the abdomen showed decreased aortomesenteric angle and SMA-aorta distance. Both patients were treated successfully with conservative treatment which included three principles: gastric decompression with nasogastric tube, correction of electrolytes imbalance, and nutritional support with low volume, high calorie nutritional supplement. Both patients were started with small but frequent meals. Surgeries were not required in both cases. Early diagnosis and management are the key factors to successful treatment in SMA syndrome. Patients with SMA can be treated successfully with conservative treatment comprising of nasogastric decompression, electrolyte correction, and nutritional support with small but frequent meals.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amir Arif Anuar
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keong Joo Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chan CYW, Chung WH, Mihara Y, Lee SY, Ch'ng PY, Hasan MS, Chiu CK, Kwan MK. Perioperative outcome of severe rigid idiopathic scoliosis: Single-staged posterior spinal fusion utilizing a dual attending surgeon strategy. A report of 41 patients. J Orthop Surg (Hong Kong) 2021; 28:2309499020936005. [PMID: 32762498 DOI: 10.1177/2309499020936005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported. METHODS This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index. RESULTS The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome. CONCLUSIONS Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuki Mihara
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Japan
| | - Sin Ying Lee
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chan CYW, Cheung JPY, Cheung PWH, Gani SMA, Kwan MK. Personal protective equipment usage, recycling and disposal among spine surgeons: An Asia Pacific Spine Society survey. J Orthop Surg (Hong Kong) 2021; 29:2309499020988176. [PMID: 33569998 DOI: 10.1177/2309499020988176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE In this study we investigated on the personal protective equipment (PPE) usage, recycling, and disposal among spine surgeons in the Asia Pacific region. METHODS A cross-sectional survey was carried out among spine surgeons in Asia Pacific. The questionnaires were focused on the usage, recycling and disposal of PPE. RESULTS Two hundred and twenty-two surgeons from 19 countries participated in the survey. When we sub-analysed the differences between countries, the provision of adequate PPE by hospitals ranged from 37.5% to 100%. The usage of PPE was generally high. The most used PPE were surgical face masks (88.7%), followed by surgical caps (88.3%), gowns (85.6%), sterile gloves (83.3%) and face shields (82.0%). The least used PPE were powered air-purifying respirators (PAPR) (23.0%) and shoes/boots (45.0%). The commonly used PPE for surgeries involving COVID-19 positive patients were N95 masks (74.8%), sterile gloves (73.0%), gowns (72.1%), surgical caps (71.6%), face shields (64.4%), goggles (64.0%), shoe covers (58.6%), plastic aprons (45.9%), shoes/boots (45.9%), surgical face masks (36.5%) and PAPRs (21.2%). Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE items compared to general waste. CONCLUSIONS The usage of PPE was generally high among most countries especially for surgeries involving COVID-19 positive patients except for Myanmar and Nepal. Overall, the most used PPE were surgical face masks. For surgeries involving COVID-19 positive patients, the most used PPE were N95 masks. Most PPE were not recycled. Biohazard bins were the preferred method of disposal for all types of PPE.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Cheung JPY, Cheung PWH, Shigematsu H, Takahashi S, Kwan MK, Chan CYW, Chiu CK, Sakai D. Controversies with nonoperative management for adolescent idiopathic scoliosis: Study from the APSS Scoliosis Focus Group. J Orthop Surg (Hong Kong) 2021; 28:2309499020930291. [PMID: 32529908 DOI: 10.1177/2309499020930291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine consensus among Asia-Pacific surgeons regarding nonoperative management for adolescent idiopathic scoliosis (AIS). METHODS An online REDCap questionnaire was circulated to surgeons in the Asia-Pacific region during the period of July 2019 to September 2019 to inquire about various components of nonoperative treatment for AIS. Aspects under study included access to screening, when MRIs were obtained, quality-of-life assessments used, role of scoliosis-specific exercises, bracing criteria, type of brace used, maturity parameters used, brace wear regimen, follow-up criteria, and how braces were weaned. Comparisons were made between middle-high income and low-income countries, and experience with nonoperative treatment. RESULTS A total of 103 responses were collected. About half (52.4%) of the responders had scoliosis screening programs and were particularly situated in middle-high income countries. Up to 34% obtained MRIs for all cases, while most would obtain MRIs for neurological problems. The brace criteria were highly variable and was usually based on menarche status (74.7%), age (59%), and Risser staging (92.8%). Up to 52.4% of surgeons elected to brace patients with large curves before offering surgery. Only 28% of responders utilized CAD-CAM techniques for brace fabrication and most (76.8%) still utilized negative molds. There were no standardized criteria for brace weaning. CONCLUSION There are highly variable practices related to nonoperative treatment for AIS and may be related to availability of resources in certain countries. Relative consensus was achieved for when MRI should be obtained and an acceptable brace compliance should be more than 16 hours a day.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Mihara Y, Chung WH, Mohamad SM, Chiu CK, Chan CYW, Kwan MK. Predictive factors for correction rate in severe idiopathic scoliosis (Cobb angle ≥ 90°): an analysis of 128 patients. Eur Spine J 2021; 30:653-660. [PMID: 33486626 DOI: 10.1007/s00586-020-06701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/01/2020] [Accepted: 12/12/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Knowledge on the factors affecting the correction rate (CR) aids in the surgical planning among severe idiopathic scoliosis (IS) patients. This study aimed to investigate the independent factors affecting CR among patients with severe IS (Cobb angle ≥ 90°) who underwent single-staged posterior spinal fusion (PSF). METHODS We retrospectively reviewed 128 severe IS patients who underwent single-staged PSF. Factors including age, height, weight, body mass index, Risser sign, Lenke subtypes, preoperative major Cobb angle, side bending major Cobb angle, side bending flexibility (SBF), motion segments of the major curve, AR curve, number of levels fused, screw density, operative time and postoperative major Cobb angle were analysed using linear regression analysis. RESULTS The mean age was 15.5 ± 4.5 years with mean Risser sign of 3.1 ± 1.6. The mean preoperative Cobb, SBF, postoperative Cobb and CR were 102.8 ± 12.3°, 37.5 ± 13.7%, 44.4 ± 13.5° and 57.2 ± 10.8%, respectively. From stepwise multiple linear regression analysis, SBF, Risser sign and AR curve were the independent predictive factors for CR, with R2 value of 0.345 (p < 0.001). CR can be predicted using the formula: 47.21 + (0.34 × SBF)-(1.47 × Risser sign) + (3.69 × AR), where AR = 1 and non-AR = 0. CONCLUSION The flexibility of the major curve, Risser sign and AR curve were the most important predictors for CR in a single-staged PSF among patients with severe IS.
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Affiliation(s)
- Yuki Mihara
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siti Mariam Mohamad
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Chung WH, Eu WC, Chiu CK, Chan CYW, Kwan MK. Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome. J Orthop Surg (Hong Kong) 2020; 28:2309499019888977. [PMID: 31876259 DOI: 10.1177/2309499019888977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws. METHODS All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up. RESULTS A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved. CONCLUSIONS Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.
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Affiliation(s)
- Weng Hong Chung
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Cheong Eu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Introduction: This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Material and Methods: Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate. Results: Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups. Conclusion: MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.
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Affiliation(s)
- W H Chung
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - W L Ng
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - C K Chiu
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Cyw Chan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Chung WH, Tan RL, Chiu CK, Kwan MK, Chan C. Delayed Post-operative Spinal Epidural Haematoma after Posterior Spinal Surgery: Report of Two Cases. Malays Orthop J 2020; 14:170-173. [PMID: 33403080 PMCID: PMC7752003 DOI: 10.5704/moj.2011.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Delayed post-operative spinal epidural haematoma (DPSEH) is diagnosed when the onset of symptoms is more than three days from the index surgery. DPSEH is a rare but serious complication of spinal surgery. Missed diagnosis will result in irreversible neurological deficit which may lead to permanent disabilities. We report two cases of DPSEH who presented with worsening neurological deficit four days after the index surgery. Magnetic resonance imaging (MRI) showed the presence of an epidural haematoma compressing the spinal cord. Surgical evacuation of haematoma were performed for both patients. Both patients experienced neurological improvement. Surgeons should have high index of suspicion to identify delayed onset of spinal epidural haematoma (SEH) and timely intervention should be taken to avoid irreversible neurological damage.
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Affiliation(s)
- W H Chung
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - R L Tan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - C K Chiu
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Cyw Chan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Hasan MS, Goh KJ, Yip HW, Mohamad SM, Chan TS, Chong KI, Haseeb A, Chiu CK, Wei CCY, Kwan MK. Neuropathic Pain after Adolescent Idiopathic Scoliosis Correction Surgery. Asian Spine J 2020; 15:628-635. [PMID: 33108852 PMCID: PMC8561147 DOI: 10.31616/asj.2020.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective study. Purpose To investigate the prevalence and the associated risk factors of chronic neuropathic pain symptoms using painDETECT questionnaire in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) surgery. Overview of Literature Post-lumbar surgery syndrome is a disease entity that describes neuropathic pain following spinal surgery. However, few studies have investigated the prevalence and risk factors for neuropathic pain in pediatric population undergoing corrective spinal surgery. Methods Forty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors. Results Based on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022). Conclusions Chronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.
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Affiliation(s)
- Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hing Wa Yip
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Mohamad
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Teik Seng Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Ian Chong
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amber Haseeb
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Chan Yin Wei
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chung WH, Chiu CK, Wei Chan CY, Kwan MK. Rapid progression of scoliosis curve in a mature patient with undiagnosed pituitary macroadenoma: A rare case report. Acta Orthop Traumatol Turc 2020; 54:561-564. [PMID: 33155569 DOI: 10.5152/j.aott.2020.19144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Growth hormone secreting pituitary tumor or gigantism has not been previously reported to be associated with rapid progression of scoliosis in the literature. However, there are some reports indicating scoliosis can be worsened by growth hormone therapy in children and adolescents. A 19-year-old boy was referred to our institution for the treatment of a right thoracolumbar scoliosis. The Cobb angle had worsened from 29° to 83° over two years' duration. He attained puberty at the age of 13. He had a previous history of slipped upper femoral epiphysis (SUFE), which was operated in 2015, with no clinical features of gigantism. Preoperative assessment was performed. He was diagnosed with growth hormone secreting pituitary macroadenoma by magnetic resonance imaging with a high serum level of insulin-like growth factor-I (IGF-I). Computed tomography (CT) of the pancreas showed a pancreatic endocrine tumor. The patient was later diagnosed with multiple endocrine neoplasia type 1 (MEN 1). He underwent endoscopic endonasal excision of the pituitary mass and distal pancreatectomy. This case indicates that growth hormone secreting pituitary macroadenoma could result in rapid progression of scoliosis.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
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Wei Chan CY, Chiu CK, Ng YH, Goh SH, Ler XY, Ng SJ, Chian XH, Tan PH, Kwan MK. An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves. J Neurosurg Spine 2020; 34:37-44. [PMID: 32858516 DOI: 10.3171/2020.5.spine20397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS). METHODS The authors grouped patients' curves as Lenke 1-ve (flexible) when their preoperative proximal thoracic side bending (PTSB) Cobb angle was < 15° and as Lenke 1+ve (stiff) when the PTSB Cobb angle was 15°-24.9°. The authors hypothesized that these two subtypes had distinct preoperative and postoperative shoulder and neck balance following PSF using pedicle screw constructs. RESULTS Fifty patients had Lenke 1 (flexible) curves and 61 had Lenke 1 (stiff) curves. The mean preoperative T1 tilt for patients with Lenke 1 (flexible) was -4.9° ± 5.3°, and for those with Lenke 1 (stiff) curves it was -1.0° ± 5.3° (p < 0.001). Mean cervical axis (CA) was -0.1° ± 3.2° for Lenke 1 (flexible) curves and 2.3° ± 3.5° for Lenke 1 (stiff) curves (p < 0.001). Preoperative radiographic shoulder height (RSH) and clavicle angle (Cla-A) were similar between the two curve subtypes. Following surgery, there were significant differences between the subtypes in terms of T1 tilt (p < 0.001), RSH (p = 0.014), and Cla-A (p = 0.031). Interestingly, 41.0% of patients with a Lenke 1 (stiff) curve had +ve T1 tilt compared to 2.0% in Lenke 1 (flexible) group. Moreover, 26.2% of patients with the Lenke 1 (stiff) curve had +ve RSH compared to 12.0% of those with Lenke 1 (flexible) curves. And, 24.6% of patients with Lenke 1 (stiff) had +ve Cla-A compared to 10.0% of those with Lenke 1 (flexible) curves. CONCLUSIONS Lenke 1 (flexible) and Lenke 1 (stiff) curves had distinct preoperative T1 tilt and CA measurements. Following PSF, the authors noted +ve T1 tilt in 41% of patients with Lenke 1 (stiff) curves versus 2.0% in those with Lenke 1 (flexible) curves. The authors also noted a significant difference in postoperative RSH and Cla-A measurements.
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Ong EKS, Wong TS, Chung WH, Chiu CK, Saw A, Hasan MS, Chan CYW, Kwan MK. Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach. J Orthop Surg (Hong Kong) 2020; 27:2309499019879213. [PMID: 31615339 DOI: 10.1177/2309499019879213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.
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Affiliation(s)
- Edwin Kean Siong Ong
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tat Seng Wong
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aik Saw
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Lee SA, Chiu CK, Chan CYW, Yaakup NA, Wong JHD, Kadir KAA, Kwan MK. The clinical utility of fluoroscopic versus CT guided percutaneous transpedicular core needle biopsy for spinal infections and tumours: a randomized trial. Spine J 2020; 20:1114-1124. [PMID: 32272253 DOI: 10.1016/j.spinee.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Biopsy is important to obtain microbiological and histopathological diagnosis in spine infections and tumors. To date, there have been no prospective randomized trials comparing fluoroscopic guided and computed tomography (CT) transpedicular biopsy techniques. The goal of this study was to evaluate the accuracy, safety, and diagnostic outcome of these two diagnostic techniques. PURPOSE To evaluate the accuracy, safety, and diagnostic outcome of fluoroscopic guided and CT transpedicular biopsy techniques. STUDY DESIGN Prospective randomized trial. PATIENT SAMPLE Sixty consecutive patients with clinical symptoms and radiological features suggestive of spinal infection or malignancy were recruited and randomized into fluoroscopic or CT guided spinal biopsy groups. Both groups were similar in terms of patient demographics, distribution of spinal infections and malignancy cases, and the level of biopsies. OUTCOME MEASURES The primary outcome measure was diagnostic accuracy of both methods, determined based on true positive, true negative, false positive, and false negative biopsy findings. Secondary outcome measures included radiation exposure to patients and doctors, complications, and postbiopsy pain score. METHODS A transpedicular approach was performed with an 8G core biopsy needle. Specimens were sent for histopathological and microbiological examinations. Diagnosis was made based on biopsy results, clinical criteria and monitoring of disease progression during a 6-month follow up duration. Clinical criteria included presence of risk factors, level of inflammatory markers and magnetic resonance imaging findings. Radiation exposure to patients and doctors was measured with dosimeters. RESULTS There was no significant difference between the diagnostic accuracy of fluoroscopic and CT guided spinal biopsy (p=0.67) or between the diagnostic accuracy of spinal infection and spinal tumor in both groups (p=0.402 for fluoroscopy group and p=0.223 for CT group). Radiation exposure to patients was approximately 26 times higher in the CT group. Radiation exposure to doctors in the CT group was approximately 2 times higher compared to the fluoroscopic group if a lead shield was not used. Lead shields significantly reduced radiation exposure to doctors anywhere from 2 to 8 times. No complications were observed for either group and the differences in postbiopsy pain scores were not significant. CONCLUSIONS The accuracy, procedure time, complication rate and pain score for both groups were similar. However, radiation exposure to patients and doctors were significantly higher in the CT group without lead protection. With lead protection, radiation to doctors reduced significantly.
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Affiliation(s)
- She Ann Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Nur Adura Yaakup
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Abd Kadir
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
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Shetty AP, Rajavelu R, Viswanathan VK, Watanabe K, Chhabra HS, Kanna RM, Cheung JPY, Hai Y, Kwan MK, Wong CC, Liu G, Basu S, Nene A, Naresh-Babu J, Garg B. Validation Study of Rajasekaran's Kyphosis Classification System: Do We Clearly Understand Single- and Two-Column Deficiencies? Asian Spine J 2020; 14:475-488. [PMID: 32493003 PMCID: PMC7435303 DOI: 10.31616/asj.2020.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Multicenter validation study. Purpose To evaluate the inter-rater reliability of Rajasekaran’s kyphosis classification through a multicenter validation study. Overview of Literature The classification of kyphosis, developed by Rajasekaran, incorporates factors related to curve characteristics, including column deficiency, disc mobility, curve magnitude, and osteotomy requirements. Although the classification offers significant benefits in determining prognosis and management decisions, it has not been subjected to multicenter validation. Methods A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations. Results The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte’s (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6). Conclusions Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.
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Affiliation(s)
| | - Rajesh Rajavelu
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
| | | | - Kota Watanabe
- Division of Spine and Spinal Cord, Keio University, Tokyo, Japan
| | | | | | - Jason Pui Yin Cheung
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, Beijing, China
| | - Mun Keong Kwan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chung Chek Wong
- Deaprtment of Orthopedics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Gabriel Liu
- Spine Division, Department of Orthopedics, National University Hospital, Singapore
| | - Saumajit Basu
- Department of Spine Surgery, Kothari Medical Center, Kolkata, India.,Department of Spine Surgery, Park Clinic, Kolkata, India
| | - Abhay Nene
- Department of Spine, Wockhardt Hospital, Mumbai, India.,Department of Orthopaedics, Hinduja Healthcare Surgical, Mumbai, India.,Department of Orthopaedic Surgery, Lilavati Hospital & Research Centre, Mumbai, India.,Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India.,Department of Orthopedics, Wadia Children's Hospital, Mumbai, India
| | - J Naresh-Babu
- Department of Spine Surgery, Mallika Spine Center, Guntur, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Wong TS, Abdul Rashid ML, Hasan MS, Chiu CK, Chan CYW, Kwan MK. C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: Is it possible? J Orthop Surg (Hong Kong) 2020; 27:2309499019840763. [PMID: 30955474 DOI: 10.1177/2309499019840763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The presence of anatomical anomalies such as absence of C1 posterior arch and presence of C2 high-riding vertebral artery may not allow a conventional C1-C2 fusion, and this patient will require occipitocervical fusion. A 62-year-old lady presented with cervical myelopathy. CT scan demonstrated an os odontoideum with C1-C2 dislocation. The posterior arch of atlas on right C1 vertebra was absent, and there was high-riding vertebral artery on left C2. MRI revealed severe cord compression with cord oedema. The chronic atlantoaxial dislocation was reduced successfully with skeletal traction. Hybrid C1-C2 fusion augmented with autogenous local bone graft with corticocancellous iliac crest bone graft was performed to avoid an unnecessary occipitocervical fusion. She was stable throughout surgery and discharged 6 days later. CT scan 6 months post-operation showed a solid posterior fusion mass. Hybrid C1-C2 fusion can be performed to avoid occipitocervical fusion despite presence of abnormal anatomy at C1 and C2 vertebrae.
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Affiliation(s)
- Tat Seng Wong
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Lutfi Abdul Rashid
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- 2 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chan CYW, Naing KS, Chiu CK, Mohamad SM, Kwan MK. Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: A preoperative analysis of 311 lower limb axis films. J Orthop Surg (Hong Kong) 2020; 27:2309499019857250. [PMID: 31232161 DOI: 10.1177/2309499019857250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To analyze the incidence, pattern, and contributing factors of pelvic obliquity among Adolescent Idiopathic Scoliosis (AIS) patients who will undergo surgery. METHODS In total, 311 patients underwent erect whole spine anteroposterior, lateral and lower limb axis films. Radiographic measurements included Transilium Pelvic Height Difference (TPHD; mm), Hip Abduction-Adduction angle (H/Abd-Add; °), Lower limb Length Discrepancy (LLD; mm), and Pelvic Hypoplasia (PH angle; °). The incidence and severity of pelvic obliquity were stratified to Lenke curve subtypes in 311 patients. The causes of pelvic obliquity were analyzed in 57 patients with TPHD ≥10 mm. RESULTS The mean Cobb angle was 64.0 ± 17.2°. Sixty-nine patients had a TPHD of 0 mm (22.2%). The TPHD was <5 mm in 134 (43.0%) patients, 5-9 mm in 104 (33.4%) patients, 10-14 mm in 52 (16.7%) patients, 15-19 mm in 19 (6.1%) patients, and ≥20 mm in only 2 (0.6%) patients. There was a significant difference between the Lenke curve types in terms of TPHD (p = 0.002). L6 curve types had the highest TPHD of 9.0 ± 6.3 mm followed by L5 curves, which had a TPHD of 7.1 ± 4.8 mm. In all, 44.2% of L1 curves and 50.0% of L2 curves had positive TPHD compared to 66.7% of L5 curves and 74.1% of L6 curves which had negative TPHD. 33.3% and 24.6% of pelvic obliquity were attributed to PH and LLD, respectively, whereas 10.5% of cases were attributed to H/Abd-Add positioning. CONCLUSIONS 76.4% of AIS cases had pelvic obliquity <10 mm; 44.2% of L1 curves and 50.0% of L2 curves had a lower right hemipelvis compared to 66.7% of L5 curves and 74.1% of L6 curves, which had a higher right hemipelvis. Among patients with pelvic obliquity ≥10 mm, 33.3% were attributed to PH, whereas 24.6% were attributed to LLD.
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Affiliation(s)
- Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kyaw Soe Naing
- 2 Institute of Medicine (1), Yangon Orthopaedic Hospital (Spine Unit), Yangon General Hospital (Trauma unit), Yangon, Myanmar
| | - Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Mohamad
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chan CYW, Chandren JR, Ong JY, Loo SF, Hasan MS, Kwan MK. Letters about Published Papers. J Orthop Surg (Hong Kong) 2020; 27:2309499019861233. [PMID: 31362584 DOI: 10.1177/2309499019861233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Josephine Rebecca Chandren
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun Yin Ong
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Shweh Fern Loo
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- 2 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chan CYW, Chandren JR, Ong JY, Loo SF, Hasan MS, Kwan MK. After-hours elective spine deformity corrective surgery for patients with Adolescent Idiopathic Scoliosis: Is it safe? J Orthop Surg (Hong Kong) 2020; 27:2309499019839023. [PMID: 30947617 DOI: 10.1177/2309499019839023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the outcome of after-hours electively planned Posterior Spinal Fusion surgeries for Adolescent Idiopathic Scoliosis (AIS) patients with daytime surgeries. METHODS This was a retrospective propensity score-matched study using prospectively collected data. Surgeries performed between 08:00 and 16:59 h were labeled as daytime surgeries (group 1) and surgeries performed between 17:00 and 06:00 h were labeled as after-hours surgeries (group 2). The perioperative outcome parameters were average operation time in and out, operation duration, intraoperative blood loss, blood transfusion, intraoperative hemodynamic parameters, preoperative hemoglobin, postoperative hemoglobin, and total patient-controlled anesthesia (PCA) morphine usage. Radiological variables assessed were Lenke subtypes, preoperative Cobb angle, number of fusion levels, number of screws used, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, complications rate, and length of hospitalization. RESULTS Average operation time in for daytime group was 11:32 ± 2:33 h versus 18:20 ± 1:05 h in after-hours group. Comparing daytime surgeries with after-hours surgeries, there were no significant differences ( p > 0.05) in the operation duration, intraoperative blood loss, intraoperative pH, bicarbonate, lactate, postoperative hemoglobin, hemoglobin drift, blood transfusion, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, length of hospitalization, and complications rate. Total PCA morphine usage was significantly lesser in the after-hours group (18.2 ± 15.3 mg) compared with the daytime group (24.6 ± 16.6 mg; p = 0.042). CONCLUSIONS After-hours elective spine deformity corrective surgeries for healthy ambulatory patients with AIS were as safe as when they were done during daytime.
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Affiliation(s)
- Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Josephine Rebecca Chandren
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun Yin Ong
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Shweh Fern Loo
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- 2 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Chong KI, Chan TS, Mohamad SM, Hasan MS, Chan CYW, Kwan MK. The anatomical locations of postoperative pain and their recovery trajectories following Posterior Spinal Fusion (PSF) surgery in Adolescent Idiopathic Scoliosis (AIS) patients. Med J Malaysia 2020; 75:12-17. [PMID: 32008013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS). METHODS We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded. RESULTS A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day- 12. CONCLUSIONS Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.
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Affiliation(s)
- C K Chiu
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - K I Chong
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - T S Chan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - S M Mohamad
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
| | - M S Hasan
- University of Malaya, Faculty of Medicine, Department of Anaesthesiology, Kuala Lumpur, Malaysia
| | - C Y W Chan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia.
| | - M K Kwan
- University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia
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Hasan MS, Tan JK, Chan CYW, Kwan MK, Karim FSA, Goh KJ. Comparison between effect of desflurane/remifentanil and propofol/remifentanil anesthesia on somatosensory evoked potential monitoring during scoliosis surgery-A randomized controlled trial. J Orthop Surg (Hong Kong) 2019; 26:2309499018789529. [PMID: 30058437 DOI: 10.1177/2309499018789529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drugs used in anesthesia can affect somatosensory evoked potential (SSEP) monitoring, which is used routinely for intraoperative monitoring of spinal cord integrity during spinal surgery. OBJECTIVE The objective of this study was to determine whether combined total intravenous anesthesia (TIVA) technique with propofol/remifentanil is associated with less SSEP suppression when compared to combined volatile agent desflurane/remifentanil anesthesia during corrective scoliosis surgery at a comparable depth of anesthesia. DESIGN It is a randomized controlled trial. SETTING The study was conducted at the Single tertiary University Hospital during October 2014 to June 2015. PATIENTS Patients who required SSEP and had no neurological deficits, and were of American Society of Anesthesiologist I and II physical status, were included. Patients who had sensory or motor deficits preoperatively and significant cardiovascular and respiratory disease were excluded. A total of 72 patients were screened, and 67 patients were randomized and allocated to two groups: 34 in desflurane/remifentanil group and 33 in TIVA group. Four patients from desflurane/remifentanil group and three from TIVA group were withdrawn due to decrease in SSEP amplitude to <0.3 µV after induction of anesthesia. Thirty patients from each group were analyzed. INTERVENTIONS Sixty-seven patients were randomized to receive TIVA or desflurane/remifentanil anesthesia. MAIN OUTCOME MEASURES The measurements taken were the amplitude and latency of SSEP monitoring at five different time points during surgery: before and after the induction of anesthesia, at skin incision, at pedicle screw insertion, and at rod insertion. RESULTS Both anesthesia techniques, TIVA and desflurane/remifentanil, resulted in decreased amplitude and increased latencies of both cervical and cortical peaks. The desflurane/remifentanil group had a significantly greater reduction in the amplitude ( p = 0.004) and an increase in latency ( p = 0.002) of P40 compared with the TIVA group. However, there were no differences in both amplitude ( p = 0.214) and latency ( p = 0.16) in cervical SSEP between the two groups. CONCLUSIONS Compared with TIVA technique, desflurane/remifentanil anesthesia caused more suppression in cortical SSEP, but not in cervical SSEP, at a comparable depth of anesthesia.
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Affiliation(s)
- M Shahnaz Hasan
- 1 Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Jin-Keat Tan
- 1 Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 2 Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 2 Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Khean-Jin Goh
- 3 Division of Neurology, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CK, Lisitha KA, Elias DM, Yong VW, Chan CYW, Kwan MK. Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft? J Orthop Surg (Hong Kong) 2019; 26:2309499018806700. [PMID: 30352524 DOI: 10.1177/2309499018806700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty. METHODS Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated. RESULTS A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04). CONCLUSIONS Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.
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Affiliation(s)
- Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Dahlia Munchar Elias
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Voon Wei Yong
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Choo QQ, Chiu CK, Lisitha KA, Chan CYW, Kwan MK. Quantitative analysis of local bone graft harvested from the posterior elements during posterior spinal fusion in Adolescent Idiopathic Scoliosis patients. J Orthop 2018; 16:74-79. [PMID: 30662243 DOI: 10.1016/j.jor.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022] Open
Abstract
Objective This study analyses the quantity of local bone graft obtained from different anatomical parts of the posterior elements during corrective surgery for Adolescent Idiopathic Scoliosis patients. Summary of background data Locally harvested autogenous bone graft eliminates possible donor site morbidity and has all the important basic bone graft properties such as osteoinductivity, osteogenicity and osteoconductivity. Its usage was reported to be adequate to achieve fusion but none had quantifies the amount of local bone graft harvested. Methods Total of 40 AIS patients were recruited in the study. All posterior spinal fusion surgeries were performed by the same dual surgeons and same anesthetist with a single observer collecting and measuring bone grafts harvested. The bone grafts harvested from each respective posterior element (spinous processes, laminas, facets and transverses processes) and measured accordingly. Results There were 36 females and 4 males. Amongst cases recruited, there were 32% Lenke 1, 28% Lenke 2, 8%Lenke 3, 22%Lenke 5 and 10% Lenke 6. Total thoracic levels involved were 333, whereas lumbar levels were 81. The mean total weight of bone graft obtained per case was 36.5 ± 13.7 g. The total weight of lumbar bone graft to the number of lumbar fusion levels (4.5 ± 1.2 g/fusion level) was significantly higher than the total weight of thoracic bone graft to the number of thoracic fusion levels (3.2 ± 1.2 g/fusion level). The amount of bone graft was obtained was highest from lumbar spinous process (42%), followed by thoracic spinous process (32%), lumbar lamina (29%), lumbar facet (28%), thoracic lamina (25%), thoracic facet (22%), and thoracic transverse process (21%). Conclusions Lumbar vertebra provided more bone graft than thoracic vertebra. Spinous processes contributed the highest amount of local bone graft in the thoracic and lumbar spine.
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Affiliation(s)
- Qi Qi Choo
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwan MK, Chiu CK, Tan PH, Chian XH, Ler XY, Ng YH, Ng SJ, Goh SH, Chan CYW. Radiological and clinical outcome of selective thoracic fusion for patients with Lenke 1C and 2C adolescent idiopathic scoliosis with a minimum follow-up of 2 years. Spine J 2018; 18:2239-2246. [PMID: 29733900 DOI: 10.1016/j.spinee.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In Lenke 1C and 2C curves, the choice between selective thoracic fusion (STF) versus non-selective thoracic fusion as the optimal surgical treatment is controversial. OBJECTIVE This study aimed to assess the radiological and clinical outcome of patients with Lenke 1C and 2C curves treated with STF. STUDY DESIGN This is a retrospective study. PATIENT SAMPLE A total of 44 patients comprised the study sample. METHODS Forty-four patients with Lenke 1C and 2C curves with adolescent idiopathic scoliosis who underwent STF were reviewed. Radiological parameters and Scoliosis Research Society (SRS)-22r scores were assessed preoperatively, postoperatively, and on final follow-up. The incidence of coronal decompensation, lumbar decompensation, and adding-on phenomenon were reported. RESULTS Mean follow-up duration was 45.1±12.3 months and mean age was 17.0±5.1 years. The preoperative middle thoracic and thoracolumbar/lumbar (MT:TL/L) Cobb angle ratio was 1.4±0.3 and the MT:TL/L apical vertebra translation (AVT) ratio was 1.6±0.8. Final follow-up coronal balance was -13.0±11.5 mm, main thoracic AVT was 6.9±11.8 mm, and lumbar AVT was -20.4±13.8 mm (p<.05). Lumbar Cobb angle improved from 47.5°±7.8° to 24.9°±8.2° after operation and 23.3°±9.8° at final follow-up. The spontaneous lumbar curve correction rate was 50.9%. There were 9 patients (20.5%) who had coronal decompensation, 4 patients (9.1%) who had lumbar decompensation, and 11 patients (25.0%) who had adding-on phenomenon. We did not perform any revision surgery. The SRS-22r scores improved significantly in the overall scores, self-image, and mental health domain. CONCLUSIONS Selective thoracic fusion led to improvement in the radiological and clinical outcome for patients with Lenke 1C and 2C. Although no patients required revision surgery, the rate of coronal decompensation, lumbar decompensation, and adding-on phenomenon are significant.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Pheng Hian Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Xue Han Chian
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Xin Yi Ler
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yun Hui Ng
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sherwin Johan Ng
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Saw Huan Goh
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Chan CYW, Gani SMA, Lim MY, Chiu CK, Kwan MK. APSS-ASJ Best Clinical Research Award: Is There a Difference between Patients' and Parents' Perception of Physical Appearance in Adolescent Idiopathic Scoliosis? Asian Spine J 2018; 13:216-224. [PMID: 30472823 PMCID: PMC6454293 DOI: 10.31616/asj.2018.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/16/2018] [Indexed: 01/22/2023] Open
Abstract
Study Design Prospective study. Purpose To compare patients’ and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. Overview of Literature Few studies have looked into the differences between patients’ and parents’ perceptions of their appearance. Methods AIS patient–parent pairs (n=170) were recruited. The patients’ and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. Results Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. Conclusions There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients’ perception of the six PAs had weak correlation with SRS-22r scores.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Min Yuen Lim
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Cheung JPY, Cheung PWH, Chiu CK, Chan CYW, Kwan MK. Variations in Practice among Asia-Pacific Surgeons and Recommendations for Managing Cervical Myelopathy: The First Asia-Pacific Spine Society Collaborative Study. Asian Spine J 2018; 13:45-55. [PMID: 30326696 PMCID: PMC6365774 DOI: 10.31616/asj.2018.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Surgeon survey. PURPOSE To study the various surgical practices of different surgeons in the Asia-Pacific region. OVERVIEW OF LITERATURE Given the diversity among Asia-Pacific surgeons, there is no clear consensus on the preferred management strategies for cervical myelopathy. In particular, the role of prophylactic decompression for silent cervical spinal stenosis is under constant debate and should be addressed. METHODS Surgeons from the Asia-Pacific Spine Society participated in an online questionnaire comprising 50 questions. Data on clinical diagnosis, investigations and outcome measures, approach to asymptomatic and silent cervical spinal stenosis, guidelines for surgical approach, and postoperative immobilization were recorded. All parameters were analyzed by the Mantel-Haenszel test. RESULTS A total of 79 surgeons from 16 countries participated. Most surgeons used gait disturbance (60.5%) and dyskinetic hand movement (46.1%) for diagnosis. Up to 5.2% of surgeons would operate on asymptomatic spinal stenosis, and 18.2% would operate on silent spinal stenosis. Among those who would not operate, most (57.1%) advised patients on avoidance behavior and up to 9.5% prescribed neck collars. For ossification of the posterior longitudinal ligament (OPLL), anterior removal was most commonly performed for one-level disease (p<0.001), whereas laminoplasty was most commonly performed for two- to four-level disease (p=0.036). More surgeons considered laminectomy and fusion for multilevel OPLL. Most surgeons generally preferred to use a rigid neck collar for 6 weeks postoperatively (p<0.001). CONCLUSIONS The pooled recommendations include prophylactic or early decompression surgery for patients with silent cervical spinal stenosis, particularly OPLL. Anterior decompression is primarily suggested for one- or two-level disease, whereas laminoplasty is preferred for multilevel disease.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Choo CH, Kwan MK, Chris Chan YW. Surgical reduction technique (transpedicle) for unstable thoracolumbar burst fractures with retropulsion resulting in severe spinal canal stenosis: a preliminary case report. AME Case Rep 2018; 2:38. [PMID: 30264034 DOI: 10.21037/acr.2018.07.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 11/06/2022]
Abstract
Thoracolumbar burst fractures are common entity in polytraumatized patients. The retropulsed burst vertebral fracture may result in spinal canal invasion with or without neurological deficit. In this situation, early surgical stabilization with decompression is vital to restore neurological function. We employed a posterior approach with a unique transpedicular reduction technique at the level of fracture for decompression and stabilisation.
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Affiliation(s)
- Ch'ng Hwei Choo
- Orthopaedic Surgery Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Orthopaedic Surgery Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yin Wei Chris Chan
- Orthopaedic Surgery Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Chiu CK, Bashir ES, Chan CYW, Kwan MK. Cervical Supine Side-Bending versus Cervical Supine Traction Radiographs: Which Is Better in Predicting Proximal Thoracic Flexibility for Lenke 1 and 2 Adolescent Idiopathic Scoliosis? Asian Spine J 2018; 12:669-677. [PMID: 30060375 PMCID: PMC6068410 DOI: 10.31616/asj.2018.12.4.669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/17/2017] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective cohort study. Purpose This study compared cervical supine side-bending (CSSB) and cervical supine traction (CST) radiographs to assess the flexibility and predict the correctability of the proximal thoracic (PT) curve for patients with adolescent idiopathic scoliosis (AIS) classified as Lenke 1 and 2. Overview of Literature Knowledge of the flexibility of the PT curve is crucial in the management of patients with AIS. There are no reports comparing CSSB and CST radiographs to assess this parameter. Methods Thirty patients with Lenke 1 and 2 AIS scheduled for posterior spinal fusion surgery were recruited. A standing whole spine radiography and physician-supervised CSSB and CST radiographies were performed. Patient demographic and radiological parameters were recorded, including age, gender, weight, height, body mass index, PT angle, main thoracic angle, CSSB PT angle, CST PT angle, and postoperative PT angle. From the data collected, the curve flexibility and curve correction index were calculated and compared. Results CSSB had a significantly (p <0.05) smaller PT angle (16.6°±10.4°) in comparison to CST (23.7°±10.7°). CSSB had significantly (p <0.05) greater flexibility (44.2%±19.7%) in comparison to CST (19.5%±18.1%). The CSSB correction index (1.2±0.9) was significantly closer to 1 in comparison to the CST correction index (4.4±5.3). There was no difference (p =0.72) between the CSSB PT angle (16.6°±10.4°) and the postoperative PT angle (16.1°±7.5°). However, the CST PT angle (23.7°±10.7°) was significantly (p <0.05) larger than the postoperative PT angle (16.1°±7.5°). Conclusions CSSB radiographs were better for demonstrating PT flexibility and more accurately predicted correctability in comparison to the CST radiographs.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwan MK, Chiu CK, Chan CYW, Zamani R, Hansen-Algenstaedt N. The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6): Is it safe? J Orthop Surg (Hong Kong) 2018; 25:2309499017722438. [PMID: 28748740 DOI: 10.1177/2309499017722438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6). METHODS Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm. RESULTS There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%). CONCLUSION Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.
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Affiliation(s)
- Mun Keong Kwan
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Reza Zamani
- 2 Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany
| | - Nils Hansen-Algenstaedt
- 2 Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany.,3 Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chiu CK, Chan CYW, Kwan MK. The accuracy and safety of fluoroscopic-guided percutaneous pedicle screws in the thoracic and lumbosacral spine in the Asian population: A CT scan analysis of 1002 screws. J Orthop Surg (Hong Kong) 2018; 25:2309499017713938. [PMID: 28705124 DOI: 10.1177/2309499017713938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study investigates the safety and accuracy of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracolumbosacral spine among Asian patients. METHODS Computerized tomography scans of 128 patients who had surgery using fluoroscopic-guided percutaneous pedicle screws were selected. Medial, lateral, superior, and inferior screw perforations were classified into grade 0 (no violation), grade 1 (<2 mm perforation), grade 2 (2-4 mm perforation), and grade 3(>4 mm perforation). Anterior perforations were classified into grade 0 (no violation), grade 1 (<4 mm perforation), grade 2 (4-6 mm perforation), and grade 3(>6 mm perforation). Grade 2 and grade 3 perforation were considered as "critical" perforation. RESULTS In total, 1002 percutaneous pedicle screws from 128 patients were analyzed. The mean age was 52.7 ± 16.6. There were 70 male patients and 58 female patients. The total perforation rate was 11.3% (113) with 8.4% (84) grade 1, 2.6% (26) grade 2, and 0.3% (3) grade 3 perforations. The overall "critical" perforation rate was 2.9% (29 screws) and no complications were noted. The highest perforation rates were at T4 (21.6%), T2 (19.4%), and T6 (19.2%). CONCLUSION The total perforation rate of 11.3% with the total "critical" perforation rate of 2.9% (2.6% grade 2 and 0.3% grade 3 perforations). The highest perforation rates were found over the upper to mid-thoracic region. Fluoroscopic-guided percutaneous pedicle screws insertion among Asians has the safety and accuracy comparable to the current reported percutaneous pedicle screws and open pedicle screws techniques.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Hasan MS, Choe NC, Chan CYW, Chiu CK, Kwan MK. Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial. J Orthop Surg (Hong Kong) 2018; 25:2309499017718951. [PMID: 28675975 DOI: 10.1177/2309499017718951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery. METHODS Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h). RESULTS There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 ± 1.15 and group B 2.76 ± 1.00) showed no significant difference ( p = 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 ± 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 ± 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 ± 0.67 g/dl) and within the next 24 h (1.16 ± 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion ( p = 0.33). CONCLUSIONS The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.
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Affiliation(s)
- M Shahnaz Hasan
- 1 Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ng Ching Choe
- 1 Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 2 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- 2 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 2 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwan MK, Chiu CK, Chan TS, Abd Gani SM, Tan SH, Chan CYW. Flexibility assessment of the unfused thoracic segments above the "potential upper instrumented vertebrae" using the supine side bending radiographs in Lenke 5 and 6 curves for adolescent idiopathic scoliosis patients. Spine J 2018; 18:53-62. [PMID: 28751241 DOI: 10.1016/j.spinee.2017.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Selection of upper instrumented vertebra for Lenke 5 and 6 curves remains debatable, and several authors have described different selection strategies. OBJECTIVE This study analyzed the flexibility of the unfused thoracic segments above the "potential upper instrumented vertebrae (UIV)" (T1-T12) and its compensatory ability in Lenke 5 and 6 curves using supine side bending (SSB) radiographs. STUDY DESIGN A retrospective study was used. PATIENT SAMPLE This study comprised 100 patients. OUTCOME MEASURES The ability of the unfused thoracic segments above the potential UIV, that is, T1-T12, to compensate in Lenke 5 and 6 curves was determined. We also analyzed postoperative radiological outcome of this cohort of patients with a minimum follow-up of 12 months. METHODS Right and left SSB were obtained. Right side bending (RSB) and left side bending (LSB) angles were measured from T1 to T12. Compensatory ability of thoracic segments was defined as the ability to return to neutral (center sacral vertical line [CSVL]) with the assumption of maximal correction of lumbar curve with a horizontal UIV. The Lenke 5 curves were classified as follows: (1) Lenke 5-ve (mobile): main thoracic Cobb angle <15° and (2) Lenke 5+ve (stiff): main thoracic Cobb angle 15.0°-24.9°. This study was self-funded with no conflict of interest. RESULTS There were 43 Lenke 5-ve, 31 Lenke 5+ve, and 26 Lenke 6 curves analyzed. For Lenke 5-ve, >70% of thoracic segments were able to compensate when UIV were at T1-T8 and T12 and >50% at T9-T11. For Lenke 5+ve, >70% at T1-T6 and T12, 61.3% at T7, 38.7% at T8, 3.2% at T9, 6.5% at T10, and 22.6% at T11 were able to compensate. For Lenke 6 curve, >70% at T1-T6, 69.2% at T7, 19.2% at T8, 7.7% at T9, 0% at T10, 3.8% at T11, and 34.6% at T12 were able to compensate. There was a significant difference between Lenke 5-ve versus Lenke 5+ve and Lenke 5-ve versus Lenke 6 from T8 to T11. There were no significance differences between Lenke 5+ve and Lenke 6 curves from T1 to T11. CONCLUSIONS The compensatory ability of the unfused thoracic segment of Lenke 5+ve curves was different from the Lenke 5-ve curves, and it demonstrated characteristics similar to the Lenke 6 curves.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Teik Seng Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shun Herng Tan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Zubair M, Ravindran T, Chan CYW, Saw LB, Kwan MK. Acute Brown-Séquard Syndrome following Brachial Plexus Avulsion Injury. A Report of Two Cases. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Brown-Séquard syndrome is an unusual sequelae of pre-ganglionic brachial plexus injury. There have been sporadic case reports indicating that the cause of this condition is due to tethering of the cord, vascular ischaemia or direct avulsion injury of the nerve roots. This is a report of two patients with complete pre-ganglionic brachial plexus avulsion injuries who developed acute partial Brown-Séquard syndrome due to haematoma. Cases Two patients developed acute partial Brown-Séquard syndrome associated with complete pre-ganglionic brachial plexus avulsion injuries. In the first case the neurology recovered fully after the evacuation of the large subdural hematoma. Whereas, in the second case the neurology only recovered after 4 weeks closed observation in view of the compression was due to small epidural haematoma. Conclusion Acute Brown-Séquard syndrome occurring in association brachial plexus injury should be investigated with urgent magnetic resonance imaging to exclude any reversible haematoma compression.
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