Source: Department of Orthopaedic Surgery, Capital Medical University
On April 25, 2020, the largest online academic salon of the Department of Orthopaedic Surgery of Capital Medical University was successfully held in the eyes of all. The online salon was conducted in the form of online video conferencing and multi-platform live broadcast, attracting more than 50,000 people in spine surgery to actively participate in online learning exchanges and discussions.
The salon was chaired by Professor Hai Yong, Director of the Department of Orthopaedic Surgery of Capital Medical University, and Vice Chairmen of the Department of Orthopaedic Surgery of Capital Medical University Ding Lixiang, Hong Yi, Liu Baoge and Professor Lu Shibao as the vice chairmen of the Conference. At the same time, it is also an honor to invite Professors Wang Zheng, Wu Ji, Li Weishi, Li Li, Li Fang, Li Chunde, Li Feng, Shen Jianxiong and Qian Bangping, who are well-known in the field of spine surgery in China, to give wonderful academic speeches and sharing as the speakers and host guests of the salon. In addition, more than 30 spine surgery experts from the lecturer group of the Department of Orthopaedic Surgery of Capital Medical University participated in the discussion of the conference by video. On the hot issue in the field of spine surgery, "Sagittal balance of the spine", they introduced the latest progress from normal to unbalanced and their latest research results, provided the latest research trends to the participants, inspired in-depth academic thinking, caused everyone to have a fierce collision of ideas and interactive discussions, and won the warm response and recognition of the majority of colleagues.
Air Salon expert lineup
Live broadcast (some experts)
"Every spinal surgeon is an artist who pursues beauty, and in the mind of a spine surgeon, beauty is balance." In his opening remarks, Professor Hai Chung said, "Life is a kyphosing process! Therefore, as a spine surgeon, you must pay special attention to the sagittal balance of the spine of various spinal disorders and the negative impact of imbalance on patients. How to better evaluate patients and choose appropriate treatment modalities to help patients maintain or restore spinal balance is a common goal of all spine surgeons. Today, we invited well-known spine surgery experts from all over the country to join the Aerial Academic Salon of the Department of Orthopaedic Surgery of Shouyi Medical College to conduct in-depth discussions on the evaluation and treatment of spinal imbalance, in order to jointly benefit the majority of patients with spinal imbalance. ”
The first session of the Air Academic Salon was presided over by Professor Hai Yong and Professor Ding Lixiang.
Professor Li Feng gave a speech
Professor Li Feng from Tongji Hospital, the first line of the fight against the epidemic and the tongji hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, gave the first speech. Professor Li Feng introduced the strategy and application value of lumbar anterolateral surgery technique (OLIF, ACR) in restoring sagittal position balance in the spine. At present, the concept of spinal sagittal balance has been widely used in spine surgery, and the spine-pelvic parameter is an indicator to evaluate the good balance of the sagittal surface of the spine. In the method of correcting lumbar kyphosis (restoring anterior convexity), the principle of the above technology application is that the posterior column is shortened and the anterior column is extended. Specific applications are shortening the rear column (schwab2-4 grade osteotomy), anterior column extension (ALIF, XLIF/OLIF and ACR technology), and a combination of the two (OWO, COWO). Compared with traditional open surgery, OLIF and ACR anterior techniques have better sagittal correction capabilities, and can also be combined with other surgical techniques to minimize surgical trauma and expand the indications for minimally invasive treatment of scoliosis in adults. However, its corrective ability, surgical technology characteristics and risks are different, and it is necessary to choose the appropriate surgical technique according to the specific situation of the patient in order to achieve smaller trauma and better surgical results.
Professor Shen Jianxiong gave a speech
Professor Shen Jianxiong of Peking Union Medical College Hospital discussed the imbalance of the sagittal position of neuromuscular scoliosis and the difficult problem of treatment, and used typical cases to show everyone the treatment method of neuromuscular scoliosis caused by different primary diseases, emphasizing that restoring sagittal balance is crucial to improving the quality of life of patients. The treatment of neuromuscular scoliosis is complex in terms of etiology and challenges. As a spine surgeon, it is necessary to fully understand and master the sagittal balance, and the goal of treatment should be to correct deformities, improve symptoms, and improve the quality of life of patients, rather than absolutely deliberately pursuing scoliosis and appearance correction.
Professor Li Fang gave a speech
Professor Li Fang from the Seventh Medical Center of plastered General Hospital of the People's Liberation Army delivered a speech entitled "Evaluation and Treatment Strategies of Proximal Junctional Kyphosis PJK". Professor Li began by introducing the definitions, diagnostic criteria and incidence of PJK and PJF. Subsequently, the risk factors for the occurrence of PJK/PJF are described, which mainly include surgical factors, imaging factors and patient factors. Then it highlights the PJK prevention strategies, pathological and clinical typing, compares the advantages and disadvantages of the currently commonly used Yagi typing and Hart-ISSG classification, and details the PJK hazards and how to predict the occurrence and prevention of PJK/PJF through GAP scores. Finally, Professor Li introduced the treatment methods of PJK/PJF and gave an in-depth explanation of the diagnosis and treatment of PJK/PJF through clinical cases. It is emphasized that before surgery, special attention should be paid to the relevant risk factors of PJK to prevent problems before they occur. Most patients with PJK should be observational and often do not require special treatment. Only those with obvious symptoms require surgery, with prolonged internal fixation as the main surgical treatment.
Professor Li Chunde gave a speech
In his speech entitled "Treatment Strategies for Sagittal Imbalance in the Spine", Professor Li Chunde of Peking University First Hospital first reviewed the compensatory mechanism of bone morphology changes, physiological spinal curves and sagittal position balance, then introduced the judgment of the overall balance of the sagittal position of the spine, and discussed the uncertainty of SVA for the determination of the overall sagittal balance of the sagittal surface. Professor Li recommends the use of thoracic pelvic angle (TPA) and overall tilt angle (GT) to judge the overall sagittal balance of the spine. For the judgment of local balance of sagittal position, Professor Li introduced the coordination judgment of different parts of the pelvis, lumbar spine and thoracic vertebrae, emphasized that the factors affecting the assessment of sagittal balance include PI value, PI-LL matching, age, asana, etc., and proposed muscle factors that have attracted much attention in recent years, and the sagittal imbalance caused by muscle factors can be assessed through MRI imaging. Finally, Professor Li compared the structural imbalance and functional imbalance of sagittal position through spinal parameters and other aspects, and stressed that the understanding and application of gait assessment in China need to be improved and popularized.
Professor Li Li gave a speech
Professor Li Li of the Fourth Medical Center of the PLA General Hospital introduced in detail the progress of human cognition of the sagittal sequence of the spine over the years in the lecture "Compensation Mechanism and Surgical Decision of The Sagittal Sequence of the Spine", and shared the valuable experience of the sagittal morphology of the spine and the assessment of spinal degeneration and deformity. Professor Li pointed out that Roussouly spine typing analyzed different degeneration characteristics of different vertebral contact stresses, which in turn led to different types of spinal diseases. In addition, the intrinsic relationship and transformation between each curvature are analyzed, and the corresponding surgical strategy is proposed. Professor Li stressed that when choosing a treatment method, it is necessary to "adapt to local conditions". The sagittal curvature of the spine is in a mutually adaptive mode, and typing is of great significance for surgical reconstruction of the balance of the sagittal force line of the lumbar spine, and fully understanding the sagittal balance, that is, understanding the relationship between PI, LI and TK, is the key to in-depth exploration of the types of sagittal imbalance and related compensatory mechanisms manifested by degenerative diseases.
The second session of the air salon was presided over by Professor Wu Ji and Professor Hong Yi of the Air Force General Hospital.
Professor Liu Baoge gave a speech
Professor Liu Baoge from Tiantan Hospital Affiliated to Capital Medical Daxu gave a systematic and in-depth explanation of the overview and classification of kyphosis malformations, common measurement indicators, surgical indications, purposes and techniques, etc. under the title of "Kynecove deformity at the junction of cervical spine and cervicothoracic vertebrae: Evaluation and Orthopedic Strategies", and shared his rich experience in diagnosis and treatment. Cervical stiff kyphosis deformity has been hotly discussed in recent years because of its difficulty and risk of treatment. Professor Liu pointed out that changes in cervical curl in patients with kyphosis often cause compensation of the thoracolumbar spine, which causes spinal imbalance. Clinician evaluation of malformations should not focus solely on function and symptoms, but also on the assessment of changes in the appearance of congenital or syndochonal cervical deformities and the analysis of the corresponding surgical plan. The choice of surgical modality is particularly important, if there is a severe stiff deformity of the cervical spine, multi-segment fixation + local osteotomy should generally be used to solve the imbalance problem. During the operation, it is also necessary to pay attention to the condition of the vertebral artery at all times to avoid the occurrence of vertebral artery injury.
Professor Wang Zheng gave a speech
Professor Wang Zheng of the PLA General Hospital gave a speech entitled "Sagittal deformity in the treatment of degenerative scoliosis malformations - what should we pay attention to", detailing his team's experience in the diagnosis and treatment of degenerative scoliosis deformities. Starting from the definition, mechanism and evolution of imaging parameter measurement of sagittal imbalance, Professor Wang emphasized that the evaluation of imaging parameters and postoperative function evaluation are the focus and focus of spinal orthopedic doctors. Professor Wang better explained the importance of attaching equal importance to bone line balance and myogenic balance in the diagnosis and treatment process through the sharing of diagnosis and treatment experience of five typical cases, and only by achieving a comprehensive assessment combining dynamic assessment and static assessment can we better find the initiating factors of degenerative scoliosis deformity leading to sagittal imbalance, and then successfully complete the reconstruction of sagittal balance.
Professor Li Weishi gave a speech
Professor Li Weishi of the Third Hospital of Peking University gave a speech entitled "The Effect of Lumbar Spondyloplastic Surgery on Cervical Curvature of severe dysplasia", detailing the results of his team's research on the planning and implementation of surgery in the population of severe dysplasia slip (HDDS) and the postoperative cervical curvature change. Starting from the classification of lumbar spondylolisthesis, Professor Li introduced the changes in the parameters of the full-length sagittal position sequence of the spine of HDDS patients, and combined with previous related studies, introduced the changes in cervical kyphosis in HDDS patients. The results show that HDDS reduction orthopedic surgery can improve kyphosis and restore the sagittal curvature of the pelvic pelvis of the normal spine; while the reduction of lumbar spondylosis, more attention should be paid to the correction of lumbosacral kyphotic deformity, and efforts should be made to achieve a Dub-LSA > 90°, in order to obtain a better sagittal sequence and a more satisfactory orthopedic effect.
Professor Qian Bangping gave a speech
Professor Qian Bangping of Gulou Hospital Affiliated to Nanjing University School of Medicine delivered a speech entitled "Sagittal Considerations in Surgical Strategies for Ankylosing Spondylitis complicated with Hip, Thoracolumbar and Cervical Thoracic Segment Composite Deformities". Ankylosing spondylitis is accompanied by hip, cervicothoracic spine, thoracic spine, thoracolumbar complex deformity caused by disability, high incidence of obstruction, surgical treatment strategies are more complex. Professor Qian introduced the current 5 surgical treatment strategies, described the relevant indications of 5 treatment strategies through relevant cases, and shared the experience and skills of C7PSO and complication prevention. Professor Qian Bangping pointed out that in the process of formulating surgical strategies, the hip deformity, thoracolumbar deformity, and cervical deformity that have the greatest impact on the function and appearance of patients should be distinguished first, and then the following sagittal factors should be considered when choosing cervical osteotomy or thoracolumbar osteotomy: (1) According to the specific values of C7SVA and C2SVA and the main purpose of the operation is to correct C2SVA, or C7SVA; (2) CT sagittal reconstruction to determine whether there is a cervical thoracic flexion deformity Only by following these basic principles can the greatest degree of deformity correction, functional reconstruction and improvement of quality of life be achieved.
Professor Lu Shibao gave a speech
At the end of the salon academic exchange, Professor Lu Shibao from Xuanwu Hospital of Capital Medical University delivered a speech entitled "Treatment Strategy of Spinal Sagittal Imbalance", which led everyone to deeply understand the special manifestations of spinal sagittal imbalance in elderly patients, and gave in-depth explanation and guidance on the overview and classification of spinal sagittal imbalance, surgical treatment strategies and typical cases based on classification. Spinal sagittal imbalance differs from previous spinal sagittal imbalances diagnosed by imaging alone in that the diagnosis incorporates an assessment of quality of life. Previous literature has pointed out that spinal sagittal imbalance has a greater impact on the quality of life of the elderly, and in recent years, with the intensification of population aging, under the condition that the sagittal imbalance of the elderly has a significant impact on the quality of life, how to best improve sagittal imbalance and restore the surgical treatment strategy of life treatment is particularly important. Professor Lu Shibao pointed out that the formulation of surgical strategies should be based on the causes and compensatory mechanisms of sagittal imbalance. According to different etiological classifications and compensation mechanisms, it is important to choose the appropriate surgical strategy based on previous diagnosis and treatment experience.
Online "group photo" of the participants
At the end of the meeting, Professor Hai Yong made a concluding speech on behalf of the Department of Orthopedic Surgery of Capital Medical University, the organizer. Professor Hai thanked everyone for their attention and support for this conference.
Although the covid-19 pandemic has blocked everyone from face-to-face academic exchanges together, today's online academic exchanges can also provide you with the latest academic developments, comprehensive academic progress, in-depth academic discussions and extensive peer attention, which is a novel academic activity with rich content and thorough communication!
As the earliest orthopedic surgery academic group based on medical universities in China, the Department of Orthopedic Surgery of Capital Medical University has been committed to extensive and in-depth academic research and exchanges for more than 10 years since its establishment, and since the beginning of this year, it has successively hosted and will launch a series of aerial academic salons for orthopedic surgery, which will provide an academic exchange platform across time and space for the majority of orthopedic colleagues.
We sincerely thank and look forward to the continued attention and support of our colleagues, and let us see each other again in the next air academic salon!
Disclaimer: The content and pictures of this article are provided by the contributors, which are for learning and exchange only and do not represent the online views of orthopedics.