ABSTRACT
Objectives:To evaluate the clinical efficacy of percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis(LSS)with degenerative scoliosis in geriatric patients.Methods:A retro-spective analysis was conducted on the LSS patients combined with degenerative scoliosis underwent percuta-neous endoscopic decompression between January 2020 and June 2021.18 patients(11 males and 7 females)aged 65-90(78.9±7.1)years old were included in the study.Percutaneous endoscopic unilateral or bilateral decompression was performed according to the clinical symptoms,comorbidities and imaging characteristics of the patients.The operative time,intraoperative blood loss and fluoroscopy times were recorded.Visual ana-logue scale(VAS)was used to evaluate back and leg pain before and immediately after operation,and at 6 months after surgery and final follow-up.Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score were applied to evaluate lumbar function before and after operation,and the Macnab criteria were adopted to assess the efficacy at final follow-up.The sagittal vertical axis(SVA),C7-CSVL,Cobb angle,lum-bar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),PI-LL,and cross-sectional area of spinal canal before and after surgery were measured and analyzed.Results:All the patients underwent the surgery successfully,and 14 cases were treated with bilateral decompression and 4 cases with unilateral decompression.There were no serious complications during the perioperative period.The patients completed more than 12 months of follow-up.The operative time was 69.72±12.66min,intraoperative blood loss was 39.72±10.21mL,and the number of preoperative and intraoperative fluoroscopy was 5.11±1.49 times.The VAS scores of low back and leg pain immediately after operation,at 6 months after operation and final follow-up were significantly lower than those before operation(P＜0.05).The ODI and JOA score at final follow-up were significantly improved compared with those before operation(P＜0.05).The postoperative SVA,C7-CSVL,Cobb angle,PI-LL,and cross-sectional areas of spinal canal were improved compared with the preoperative values,respectively(P＜0.05).There were 7 excellent cases(38.90％),9 good cases(50.00％)and 2 acceptable cases(11.11％)at the final follow-up,and the total excellent and good rate was 88.89％.Conclusions:Percutaneous endoscopic decompression has the clinical efficacies of relieving back and leg pain,improving lumbar function and spino-pelvic alignment,and enlarging intraspinal cross-sectional area in treating old LSS patients with degenerative scoliosis,and it is small in wound,little in bleeding,and short in operative time.
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SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.
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Objective:To explore the effect of mobile C-arm X-ray system in the surgical treatment of thoracolumbar spine fractures.Methods:The clinical data of 120 patients with thoracolumbar spine fractures admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from July 2018 to July 2020 were retrospectively analyzed. According to different surgical methods, they were divided into control group and experimental group, with 60 cases in each group. The control group adopted the traditional posterior median approach lumbar fusion, and the experimental group adopted the percutaneous pedicle screw internal fixation guided by the C-arm system. The operation time, bleeding, operation cost, visual analog score (VAS) and activities of daily living (ADL) and complication rate were compared and analyzed between the two groups. Measurement data with normally distribution were expressed as mean±standard deviation( ± s), and the comparison between groups was performed by two independent samples t test. The comparison between groups of count data was performed by chi-square test. Results:The operation time, the blood loss, the cost, VAS, ADL score, the complication rate of the control group were (119.83 ± 10.96) min, (90.56±30.52) mL, (4.90±0.75) ten thousand yuan, (4.17±0.64) scores, (78.11±12.78) scores and 30%, while the experimental group were (103.50±13.76) min, (73.88±40.35) mL, (4.06 ± 0.97) ten thousand yuan, (2.40±0.49) scores, (86.00±8.86) scores and 5%, respectively, showing a significant difference between the two groups ( P<0.05). Conclusions:Application of mobile C-arm X-ray system in thoracolumbar spine minimally invasive surgery can reduce the probability of complications, improve the quality of life of patients, and accelerate the rehabilitation. It is valuable for popularization.