OBJECTIVE:To compare the clinical and radiologic outcomes of patients with different 3-dimensional (3D) hemivertebra morphologies undergoing posterior-only hemivertebra resection and fusion. METHODS:The files of patients with congenital scoliosis (CS) due to single hemivertebra undergoing posterior-only hemivertebra resection and fusion from January 2010 to January 2018 were reviewed. After evaluating the 3D computed tomography images, CS patients were divided into a unison hemivertebra group and a discordant hemivertebra group. Clinical outcomes, radiologic outcomes, and incidence of complications were compared. RESULTS:A total of 42 consecutive patients with CS patients due to a single hemivertebra undergoing posterior-only hemivertebra resection and fusion were included in this study. The Cobb angle of the segmental curve was significantly improved postoperatively and at the last follow-up in both groups (all P < 0.05). At both postoperation and the last follow-up, no significant differences were found in the incidence of complications, Cobb angle of the segmental curve, correction rate of the segmental curve, or other radiologic outcomes between the unison hemivertebra group and discordant hemivertebra group (all P > 0.05). Compared with the unison hemivertebra group, increased operation time (P = 0.006) and intraoperative blood loss (P = 0.037) were found in the discordant hemivertebra group. CONCLUSIONS:For CS patients with unison hemivertebra or discordant hemivertebra, satisfactory radiologic results were obtained by posterior-only hemivertebra resection and fusion. In terms of surgery, the radiologic outcomes of discordant hemivertebra patients were similar to those of unison hemivertebra patients, but discordant hemivertebrae could easily result in longer operation time and more intraoperative blood loss.

BACKGROUND Intervertebral disc calcification (IDC) combined with ossification of the posterior longitudinal ligament (OPLL) in cervical discs is rarely reported. This case study presents a rare case of IDC combined with OPLL in the C2-C3 segment. CASE SUMMARY Here, we present a case of a 6-year-old Asian boy with severe neck pain and stiffness. Physical examination showed no neurological or other abnormalities. Digital radiography and computed tomography (CT) revealed a calcified intervertebral disc and OPLL at the C2-C3 vertebrae. The spinal canal compromise at C2-C3 was approximately 50% on magnetic resonance imaging. The final diagnosis was IDC combined with OPLL. We applied a neck brace for the patient to protect the neck. The patient's neck pain and stiffness recovered significantly within approximately 3 wk. At the 3 mo follow-up, the follow-up CT showed resolution of the ossified intervertebral disc herniation, and a small amount of calcification and slight OPLL remained at the involved segment. CONCLUSION IDC combined with OPLL is a relatively rare condition in children. However, the majority of patients could have a favorable outcome, and the ossified mass in the canal would be spontaneously resolved with conservative therapy.

Background Cases of obturator nerve impingement (ONI) caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported. This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve. Case summary A 65-year-old Asian man presented with severe pain and numbness in his left lower limb, which became aggravated during walking and showed intermittent claudication. The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive. Computed tomography (CT) and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint. The results of electrophysiological examination showed peripheral neuropathy. A CT-guided obturator nerve block significantly reduced the severity of pain in this patient. According to the above findings, ONI caused by the osteophyte in the sacroiliac joint was diagnosed. This patient underwent an operation to remove the bone spur and symptomatic treatment. After therapy, the patient's pain and numbness were significantly relieved. The last follow-up was performed 6 mo after the operation, and the patient recovered well without other complications, returned to work, and resumed his normal lifestyle. Conclusion Osteophytes of the sacroiliac joint can cause ONI, which leads to symptoms including severe radiative pain in the lower limb in patients. The diagnosis and differentiation of this disease should attract the attention of clinicians. Surgical excision of osteophytes should be considered when conservative treatment is not effective.

目的 探讨肋骨畸形(RD)对先天性脊柱侧凸(CS)矫形术后脊柱整体平衡的影响.方法 回顾性分析2009-01—2017-12郑州大学第一附属医院行CS矫形术治疗的86例患儿的临床资料.按是否存在肋骨畸形分为RD组(52例)和NRD组(34例).比较2组患儿的临床资料、术前和术后2周、术后2a时依据全脊椎正侧位X线检查结果,测量、记录、分析影像学参数资料.结果(1)除RD组的术中输血量大于NRD组,差异有统计学意义(P<0.05)外,2组患儿的基线资料和术前影像学参数差异均无统计学意义(P>0.05).(2)术后2周时RD组主弯(MC)的Cobb角大于NRD组,Cobb角减小率(CAD)低于NRD组,差异有统计学意义(P<0.05);2组患者的其他影像学参数差异均无统计学意义(P>0.05).(3)术后2 a时RD组患儿的脊柱矢状位轴(SVA)、CAD小于NRD组,近端交界角(PJA)的变化量(ΔPJA)大于NRD组,差异均有统计学意义(P<0.05);2组患儿的其他影像学参数差异均无统计学意义(P>0.05).(4)术后随访2 a期间,RD组患儿近端交界性后凸(PJK)的发生率高于NRD组,差异有统计学意义(P<0.05).结论 RD对CS术后脊柱整体平衡有负面影响,合并RD患儿的冠状面CAD明显降低,并且矢状面上存在更高的PJK发生率.

目的:分析后路椎弓根螺钉矫形内固定术远端固定椎(lower instrumented vertebra,LIV)为T12或L1对Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱矢状面平衡的影响.方法:回顾性分析2014年1月～2018年12月在我院接受后路矫形椎弓根螺钉内固定融合术的37例Lenke 1型AIS的患者的临床资料,其中男8例,女29例;年龄11～18岁(14.3±1.8岁).将患者分为TV组(LIV固定于T12)和LV组(LIV固定于L1).其中TV组16例,男4例,女12例,年龄11～18岁(14.7±2.1岁);LV组21例,男5例,女16例,年龄11～17岁(14.0±1.7岁),两组患者性别、年龄无统计学差异(P＞0.05).所有患者术后随访2年以上.记录患者术前Risser征、手术时间、失血量、输血量、融合节段,术前和术后2年通过SRS-22量表评分评估两组临床疗效.术前及术后2年时行站立后前位X线片检查,测量患者Cobb角、胸椎后凸角(thoracic kphyosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、脊柱矢状位轴(sagittal vertical axis,SVA).通过独立样本t检验比较两组的统计学差异.使用Pearson相关分析探讨各矢状面影像学参数变化值之间的关系.结果:两组患者术前Risser征、手术时间、失血量、输血量、融合节段、术后2年SRS-22评分差异均无统计学意义(P＞0.05).患者术前Cobb角46.1°±6.6°,TK 24.3°±7.0°,LL 46.0°±8.4°;术后2年 Cobb 角 15.9°±4.7°,TK 18.3°±6.7°,LL 38.8°±8.6°,Cobb 角矫正率(65.6±8.9)％.两组术前及术后2年Cobb角、LL、SS、PT、PI、SVA以及LL变化值、SS变化值、PT变化值、SVA变化值均无统计学差异(P＞0.05).术前TV组TK值为24.1°±6.3°,LV组为24.3°±7.5°;术后2年TV组TK值为19.4°±5.8°,LV组为17.4°±7.4°;术前和术后2年TK两组间比较无统计学差异(P＞0.05).TV组冠状面Cobb 角矫正率为(62.6±8.4)％,LV 组为(67.8±8.9)％;TV 组TK 变化值为4.7°±3.0°,LV 组为6.9°±1.6°,差异具有统计学意义(P＜0.05).TK变化值和LL的变化值存在明显相关性(r=0.602,P＜0.001).结论:远端固定至L1的患者相较于远端固定至T12的患者远期随访TK可能减小更多.后路椎弓根螺钉矫形内固定融合术治疗Lenke 1型AIS患者时,TK和LL共同参与维持矢状面平衡.