Spine osteotomy and orthopedics, because of the difficulty of surgery and high paralysis rate, is known as the "crown" surgery of spine surgery, and whether spinal osteotomy can be carried out is an important indicator to measure the level of spine surgery in a hospital. The successful development of this operation marks a new level of spine surgery in the Department of Orthopedics and Traumatology of Nanchang Hongdu Hospital of Traditional Chinese Medicine. It is reported that the operation is the first case in Nanchang Municipal Hospital.
57-year-old Aunt Wu came to the Department of Spine Surgery of Nanchang Hongdu Hospital of Traditional Chinese Medicine for treatment due to the progressive aggravation of lower limb weakness and incomplete paralysis with pain, which seriously affected her life. Over the years, Aunt Wu has sought medical treatment everywhere and has been undergoing various conservative treatments with lumbar disc herniation with sciatica, but the symptoms have not improved, and the muscle strength of her right lower limb is gradually declining.
After coming to Nanchang Hongdu Hospital of Traditional Chinese Medicine, Ruan Huibing, the deputy chief physician in charge of spine surgery, received Aunt Wu. He found that Aunt Wu had been hunched over and asked about her medical history, and Aunt Wu reported that she accidentally fell from a tree when she was 2 years old, resulting in a fracture of the thoracic vertebrae, leaving the sequelae of thoracic kyphosis deformity, which has been more than 50 years. In the past three years, due to the gradual deterioration of his condition, he has been on the way to seek medical treatment every month.
Subsequently, Director Ruan conducted a detailed physical examination of Aunt Wu, and found that she had difficulty lying down, the muscles of her right buttocks and right lower limbs were obviously atrophied, the posterolateral side of her right calf and the soles of her feet were numb and her sensation was reduced, and the iliopsoas muscles, quadricepses, tibialis anterior muscles, and extensor muscles of the right lower limbs were level 2. The MRI report showed that the 2nd and 3rd thoracic vertebrae were incompletely segmented and the thoracic kyphosis was deformed, and the thoracic kyphosis reached 73 degrees.
Combined with the signs and images, Director Nguyen Xuan Bing considered them as: 1. Chronic incomplete quadriplegia (right lower limb), 2. Kyphosis (thoracic vertebrae), 3. Spinal cord injury (chronic), 4. Lumbar disc herniation with sciatica. Because of the patient's symptoms, the doctor recommended that he be treated with orthopedic surgery for thoracic kyphosis. After communication between the doctor and the family, the family agreed to the surgical treatment.
Preoperative CT
MRI
Because the osteotomy site of the patient is close to the heart and lungs, the osteotomy can easily lead to large vascular hemorrhage, and even pneumothorax, which requires the surgeon to have a solid foundation in the anatomy of the spine, exquisite surgical skills and strong psychological quality, in order to ensure the safety of the operation, and then restore the patient's sagittal balance and reshape the curvature of the patient's spine. In order to ensure the safety of the operation, Director Ruan invited the directors of the First Department of Intensive Care Medicine, the Department of Geriatrics, the Second Department of Surgery, and the First Department of Anesthesiology to carry out multidisciplinary discussions and consultations, and formulated Zhou Xiang's surgical plan.
After excluding the contraindications to surgery, preparing sufficient blood sources, and making adequate preparations for surgery, the spine surgery team performed thoracic 2 and 3 kyphotic deformity osteotomy and orthopedic + thoracic 1-2 and 4-6 pedicle nail fixation + spinal canal enlargement and decompression, and the operation process went smoothly.
After careful rehabilitation care by medical staff, Aunt Wu was able to walk on crutches 3 days after surgery without other complications.
"It feels so good to lie flat, and my right lower limb is no longer numb or painful!" Aunt Wu told the doctor after the operation. For a hunchbacked person for more than 50 years, being able to lie flat like a normal person is simply an unattainable dream, and normal walking is even more extravagant. An operation not only removed her pain, but also fulfilled her dream for many years.
Post-orthopedic image (left), pre-orthopedic image (right)
Kyphotic deformity of the thoracic spine
Spinal deformity is a common disease in spine surgery, including scoliosis (high and low shoulder), kyphosis (hunchback) and kyphosis. In appearance, spinal deformity can cause unequal shoulder height, unequal back, unequal leg length, hunched back or chicken breast, pelvic tilt, short body, etc. At the same time, because of the abnormal appearance, it is easy to have an inferiority complex, which will affect the psychological health over time, and in terms of physiology, spinal deformity can cause low back pain, and can affect the spinal cord and nerves. In some cases, it can cause paraplegia or spinal stenosis.
Thoracic kyphotic scoliosis deformity is one of the more serious scoliosis deformities, which seriously affects the patient's appearance, movement, breathing, life expectancy and quality of daily life. The most common manifestation is hunchback, which can cause long-term pain in the chest and back muscles. Secondly, severe kyphotic deformity may damage the spinal cord, causing patients to develop neurological symptoms and even paralysis, requiring surgical treatment to correct the deformity.
Complications of kyphosis
Complications of kyphosis usually occur only in more severe cases, and the main symptom is persistent pain that cannot be controlled by medications. In some cases, a misaligned spine can cause pain, worsen over time, and can be disabling. At the same time, the compression of the spine on the lungs and airways can lead to difficulty breathing and decreased appetite. In severe cases, when the nerves that pass through the spine are compressed or pinched, people with hunchback experience numbness or weakness in the arms and legs, problems with balance, and loss of normal bladder or bowel control. These serious complications require urgent medical care, and surgery is often recommended.
Surgical treatment
Mild spinal deformities can be corrected by brace fixation, functional exercises, etc., while kyphosis or scoliosis is more frequent and too large, and it progresses rapidly in a short period of time, or patients with neurological impairment often need surgical treatment. One of the core technologies of spinal orthopedic surgery is osteotomy, that is, a certain amount of bone and soft tissue is removed in a certain part of the spine to produce controllable instability of the spine, and then fixed and fused through the nail rod system and bone grafting materials to achieve the purpose of correcting the deformity.
According to the scope of osteotomy and the correctable kyphotic angle, the spinal osteotomy was divided into 6 levels, and the difficulty increased in turn——
1级：下关节突截除（SPO）；
2级:全关节突截除(Bridge);
Grade 3: partial vertebral and pedicle asection (PSO);
Grade 4: partial vertebral body, pedicle and single discectomy (BDBO);
Grade 5: complete resection (VCR) of the vertebral body and adjacent upper and lower discs;
Grade 6: Multiple vertebral and discectomy (VCRs).
Spine osteotomy has always been one of the most challenging topics in the field of spine surgery due to its complex operation and high technical requirements. At the same time, the complex and special anatomical features of the spine and its surroundings expose spinal deformities to a high risk of neurovascular injury, which can have catastrophic consequences if not careful.
Recommend an expert
Ruan Huibing: Head of Spine Surgery and Deputy Chief Physician
He is a member of the Spine Society of North America (NASS), a member of the International (LSRS), a youth member of the Spine and Spinal Cord Group of the Chinese Association of Traditional Chinese Medicine, a youth member of the Minimally Invasive Surgery Group of the Orthopaedic Branch of the Chinese Medical Association, a youth member of the Spine and Spinal Cord Group of the World Federation of Chinese Medicine Societies, a standing member of the Spinal Cord Injury Professional Committee of the Jiangxi Rehabilitation Medical Association, and a standing member of the Orthopedic Trauma Special Committee of the Jiangxi Integrative Medicine Trauma Emergency Branch.
Studying at the University of California, San Francisco (3rd in the world), he is good at various diseases of spine surgery, such as lumbar disc herniation, lumbar spondylolisthesis, spinal stenosis, spinal tuberculosis, spinal tumors, etc., especially in juvenile scoliosis orthopedic surgery and correction of congenital complex deformities, ankylosing spondylitis caused by flat back deformity and hunchback orthopedics, etc., and has been to the North American Spine Society (NASS) annual meeting, the world's top CNS Congress Spine Branch, Asian Orthopedic Summit Forum, etc. He has participated in 3 patents and published 7 SCI papers.
Zheng Chao: Attending physician of spine surgery
Master's degree candidate, engaged in orthopedics for more than 10 years, has accumulated rich clinical experience, good at the diagnosis and treatment of neck, shoulder, waist and leg pain, spinal fractures, proficient in the completion of minimally invasive spinal fracture (PVP, PKP) surgery and open reduction and internal fixation of spinal fractures, good at the diagnosis and treatment of common limb fractures and hip fractures, closed reduction intramedullary nail technology. Participated in 2 projects and published 2 papers.
Xu Jiaxiang: Attending physician of spine surgery
Master's degree candidate, engaged in orthopedics for many years, has rich clinical experience, good at the diagnosis and treatment of neck, shoulder, waist and leg pain, spinal fractures, proficient in the completion of minimally invasive spinal fracture (PVP, PKP) surgery and open reduction and internal fixation of spinal fractures, good at the diagnosis and treatment of femoral head necrosis, hip dysplasia, femoral neck fracture, knee pain, and shoulder and elbow joint pain and deformity diseases, hip, Knee artificial joint primary replacement, proficient in the completion of international advanced DAA minimally invasive hip arthroplasty, diagnosis and treatment of common limb fractures and hip fractures, open reduction plate fixation technology, closed reduction intramedullary nail technology, buttock pressure sore wound repair surgery. Participated in 1 project of the Provincial Health Commission and published 2 papers. On August 19, 2021, on Chinese Doctor's Day, he was named "Top Ten Moving Doctors in Jiangxi Province".
Ronglin Zhong: Spine Surgery Resident
Master's degree candidate, mainly engaged in clinical and scientific research work of spinal trauma and degenerative diseases, specializing in the diagnosis and treatment of common diseases such as lumbar spinal stenosis, lumbar intervertebral disc herniation, vertebral fractures, and cervical spondylosis.
Panpan Ke: Resident in Spine Surgery
Master's degree candidate, engaged in the clinical work of traditional Chinese medicine orthopedics for many years, good at the diagnosis and treatment of vertebral compression fractures, cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis and other spinal diseases, with solid orthopedic theoretical knowledge and rich clinical experience. He has published 1 paper and participated in 1 project.
Source: Nanchang Hongdu Hospital of Traditional Chinese Medicine
Correspondents: Qiu Peijun Zeng Huilan
Editor: Huang Menglin
Reviewer: Xie Tao
Issued: Daley Red
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