结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

A new method for the treatment of scoliosis is described in which a metal system of rods and hooks is implanted, and distraction and compression forces applied, to correct the curve and stabilize the treated segments in the corrected position by skeletal fixation. The technique and principles of this method of treatment and a summary of the preliminary results are given.

JBJS classics: Treatment of scoliosis: Correction and internal fixation by spine instrumentation

Introduction
Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine.

/pdf/compensatory-mechanisms-contributing-to-keep-the-sagittal-3o058i5gn9.pdf

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Objectives 1. List the types of spondylolisthesis described by Wiltse, and fully describe the types seen in children and adolescents 2. Describe commonly used radiographic parameters used to quantitate the severity of spondylolisthesis 3. Discuss the etiology of spondylolisthesis 4. Discuss the risk of progression of a child or adolescent with spondylolisthesis, and factors which contribute a higher risk of progression 5. Discuss factors related to symptoms in patients with spondylolisthesis 6. Describe physical findings associated with mild and severe spondylolisthesis 7. Discuss indications for surgery for spondylolisthesis, including specific procedures useful for both mild and severe slippage

Spondylolisthesis 의 手術治驗例

Literature studies showed a very wide range of pedicle screw loosening rates after thoracolumbar stabilization, ranging from less than 1 to 15 % in non-osteoporotic patients treated with rigid systems and even higher in osteoporotic subjects or patients treated with dynamic systems. Firstly, this paper aims to investigate how much this complication is affecting the success rate of pedicle screw fixation, in both non-osteoporotic and osteoporotic patients, and to discuss the biomechanical reasons which may be related to the variability of the rates found in the literature. The secondary aim was to summarize and discuss the published definitions and conventions about screw loosening from a clinical and radiological point of view. Narrative literature review. Screw loosening appears to be a minor problem for fixation and fusion of healthy, non-osteoporotic bone. Pedicle screw fixation in osteoporotic bone is believed to be at risk of loosening, but clinical data are actually scarce. Both expandable and augmented screws may be a viable option to reduce the risk of loosening, but clinical evidence is missing. Posterior motion-preserving implants seems to have a significant risk of screw loosening. Standardization appears to be lacking regarding the radiological assessment. Marked differences in the loosening rates found based either on planar radiography or on CT scanning were observed. Reported loosening rates primarily depended on the protocol used for the clinical examination during follow-up and on the conventions used for the radiological assessment. Aiming to a better comparability of published data, we recommend the authors of clinical studies to describe which criteria were used to assess a loosened screw, as well as the protocol of the clinical follow-up examination. Low-dose CT should be used for the assessment of screw loosening whenever possible.

Pedicle screw loosening: a clinically relevant complication?

Introduction
Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine.

/pdf/classification-of-sagittal-imbalance-based-on-spinal-57merlih5o.pdf

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

Purpose
To review the literature on the use of extreme lateral interbody fusion (XLIF) in adult spinal deformity, to discuss on its limits and advantages and to propose a guide to surgical strategy.

/pdf/far-lateral-approaches-xlif-in-adult-scoliosis-3xwjaroewh.pdf

Far lateral approaches (XLIF) in adult scoliosis

Purpose
To present in a single source the relevant information needed to assess spinopelvic balance and alignment, and to estimate the amount of correction needed in a patient during surgical treatment.

/pdf/criteria-to-restore-the-sagittal-balance-in-deformity-and-3dnm0ypmsv.pdf

Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis

Lumbar fusion has been found to be a clinically effective procedure in adult patients. The lateral transpsoas approach allows for direct visualization of the intervertebral space, significant support of the vertebral anterior column, while avoiding the complications associated with the posterior procedures. The aim of this study is to determine the fusion rate of inter body fusion using computed tomography in patients treated by extreme lateral intersomatic fusion (XLIF) technique. All patients intervened by XLIF procedure between 2009 and 2013 by a single operating team at a single institution were recruited for this study. A clinical evaluation and a CT scan of the involved spinal segments were then performed with at least 1-year follow-up following the standard clinical practice in the center. A total of 77 patients met inclusion criteria, of which 53 were available for review with a mean follow-up of 34.5 (12–62) months. A total of 68 (87.1 %) of the 78 operated levels were considered as completely fused, 8 (10.2 %) were considered as stable, probably fused, and 2 (2.6 %) of the operated levels were diagnosed as pseudarthrosis. When stratified by type of graft material complete fusion was obtained in 75 % of patients in which autograft was used to fill the cages, compared to 89 % of patients in which calcium triphosphate was used, and 83 % of patients in which Attrax™ was used. Reports of XLIF fusion rate in the literature vary from 85 to 93 % at 1-year follow-up. Fusion rate in our series corroborates data from previous publications. The results of this series confirm that anterior inter body fusion by means of XLIF approach is a technique that achieves high fusion rate and satisfactory clinical outcomes.

Fusion rate following extreme lateral lumbar interbody fusion.

In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.

https://link.springer.com/content/pdf/10.1007/s00586-018-5826-3.pdf

Claudio Lamartina

Papers

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

Far lateral approaches (XLIF) in adult scoliosis

Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis

Fusion rate following extreme lateral lumbar interbody fusion.

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline