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Objective:To investigate the effect of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of old thoracolumbar compression fractures combined with kyphosis deformity.Methods:A retrospective case series study was performed to analyze data of 27 patients with old thoracolumbar compression fractures combined with kyphosis deformity admitted in Taizhou Hospital from January 2010 to January 2017. There were 10 males and 17 females, with age range of 45-75 years (mean, 61.7 years). The injured segments and osteotomy segments included T 11 in 5 patients, T 12 in 10, L 1in 8 and L 2 in 4. Time from initial fracture to surgery was 9-120 months (mean, 23.2 months). According to the American Spinal Injury Association (ASIA) classification, neurological impairment symptoms were detected in 9 patients, including grade C in 1 and grade D in 8. All patients underwent one-level middle-column preserved pedicle subtraction osteotomy. Operation time, blood loss, and perioperative complications were recorded. Before operation, at 3 months after operation and at latest follow-up, kyphosis Cobb angle, sagittal vertical axis (SVA) and height of anterior column (AC) as well as posterior column (PC) were measured. Visual analogue scale (VAS) and Oswestry disability index (ODI) score were used to evaluate the clinical efficacy. American Spinal Injury Association (ASIA) score was used to assess neurological function. Results:All patients were followed up for average 18.1 months (range, 12-34 months). Operation time was (155.2±35.4)minutes (range, 130-250 minutes). Blood loss was (338.1±101.4)ml (range, 150-550 ml). No serious neurological or vascular complications occurred during perioperative period. Kyphosis Cobb angle was (6.0±3.1)° at postoperative 3 months compared to preoperative (46.5±8.5)°( P<0.05), and showed no significant loss at latest follow-up [(7.9±3.8)°] ( P>0.05). SVA was improved significantly from preoperative [42.7(25.5, 78.2)]mm to [5.5(1.2, 7.3)]mm at postoperative 3 months ( P<0.05). AC height was increased by average 16.3 mm at postoperative 3 months compared to the preoperative level ( P<0.05), with no significant change in PC height ( P>0.05). There was no significant difference in SVA, AC height and PC height at postoperative 3 months and latest follow-up ( P>0.05). There were significant differences in VAS [(1.7±0.8)points, (2.3±1.4)points] and ODI (17.3±7.5, 19.4±4.3) at postoperative 3 months and at latest follow-up compared to these before operation [(7.7±1.3)points, 61.4±6.2] ( P<0.05), with no significant differences in VAS and ODI at postoperative 3 months and latest follow-up ( P>0.05). No implant failure was noted during follow-up. The osteotomy surface was fused in all patients at postoperative 6 months. At latest follow-up, ASIA grade was improved from grade C to grade D in 1 patient and from grade D to grade E in 8 patients. Conclusion:Middle-column preserved pedicle subtraction closing-opening wedge osteotomy can effectively correct old thoracolumbar fractures with kyphosis, relieve pain and improve nerve function.
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Objective@#To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors.@*Methods@#From October 2009 to March 2018, 17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up.@*Results@#There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred.@*Conclusion@#Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
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Objective To explore the clinical effect of reduction and reconstruction of the removed bony structure after one?stage posterior resection of high cervical tumors. Methods From October 2009 to March 2018,17 patients including 10 males and 7 females of high cervical tumors who underwent one?stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posteri?or arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Ortho?paedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X?ray before the operation and at the last follow?up. Results There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow?up pe?riod was 29.1±28.2 months. No recurrence was found during the follow?up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow?up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow?up in X?ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell?shape tumors is a demanding surgery with high in?cidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.
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OBJECTIVE: To investigate the expression of Toll-like receptor 4 (TLR4)/myeloid differentiation factor (MyD88)/nuclear factor-κB (NF-κB) pathway genes and related inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-12, IL-6 in patients with secondary spinal cord injury (SSCI) and the correlations with prognosis. METHODS: The clinical data of 105 SSCI patients and 40 healthy subjects were reviewed. According to Frankel's classification of spinal cord injury, the patients were divided into complete injury group and incomplete injury group, and according to the improvement of Japanese Orthopedic Association (JOA) scores, the patients were divided into good prognosis group and poor prognosis group. The expression of TLR4, MyD88, NF-κB in peripheral blood mononuclear cells (PBMC) and serum TNF-α, IL-12, IL-6 levels were compared between SSCI patients and healthy controls, between patients with complete and incomplete injury, between patients with poor and good prognosis. Logistic regression analysis was used to analyze the risk factors leading to poor prognosis of SSCI, and Pearson's correlation analysis was used to analyze the correlation between JOA score and the above indicators. RESULTS The expressions of TLR4, MyD88, NF-κB in PBMC and serum TNF-α, IL-12, IL-6 levels in SSCI patients were significantly higher than those in healthy subjects (all P<0.01), those in complete injury group were higher than those in incomplete injury group, and those in poor prognosis group were higher than those in good prognosis group (all P<0.01). The proportions of patients with Frankel grade A, spinal cord edema or hemorrhage, spinal cord injury length longer than 4 cm in poor prognosis group was significantly higher than those in good prognosis group (all P<0.01). Logistic regression analysis showed that Frankel grade, spinal cord edema or hemorrhage, length of spinal cord injury, relative expressions of TLR4, MyD88, NF-κB in PBMC, serum levels of TNF-α, IL-12 and IL-6 were risk factors for poor prognosis in SSCI patients (P<0.05 or P<0.01). Pearson's correlation analysis showed that JOA improvement rate was negatively correlated with the relative expressions of TLR4, MyD88, NF-κB mRNA in PBMC and serum TNF-α, IL-12, IL-6 levels (P<0.05 or P<0.01). CONCLUSIONS The activation of TLR4/MyD88/NF-κB pathway and the up-regulation of the expression of related inflammatory factors TNF-α, IL-12 and IL-6 are involved in the progression of SSCI, which are closely related to the neuroinflammatory injury, and can be used as reference indexes for evaluating prognosis in SSCI patients.
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[Objective]To investigate the effects of the expansive Z-open-door laminoplasty for the ossification of posterior longitudinal ligaments(OPLL).[Methods]Thirty-six cases of OPLL were operated by the expansive Z-open-door laminoplasty.According to JOA score(17 Points) the proximate effects of all patients were analyzed.[Results]All cases were followed-up for average 18.6 months.JOA improved from 8.3 preoperatively to 13.8 postoperatively.Improved rate averaged 58.6%.Image show:3 of 31cases of anterior protruding type were changed to straight type,5 cases of straight type still kept initial type.None of all cases changed into posterior protruding type after operation.The flexion and extention range of the neck were less 1/3 and the axis-ward pain happened commonly.[Conclusion]Improved expensive Z-open door laminoplasty for DPLL can decompression clearly.It has advantages of adeguate canal expansion,preventing re-dosing the door,and being safe and reliable.
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[Objective]To evaluate the clinical effect for the treatment of severe thoracolumbar vertebral burst fracture by the method of anterior vertebral decompression and fusion combining anterior or posterior fixation,and investigate its indications in different conditions.[Method]At the standard of Denis,twenty-eight cases were treated by anterior vertebral decompression and fusion combining anterior or posterior fixation.In a total of 28 cases,25cases were single vertebral fractures,2 cases were two adjacent vertebral fractures and 1 case was two vertebral fractures comparted by one unfractured centrum,the level of vertebral destruction was ruled by LSC scale of McCormack.[Result]26 cases were reviewed,all patients' pain were relieved obviously after the operation,(VAS scale improved),the height and shape of the fractured centrums recovered obviously(Cobb's angle improved 14.5? in average).After an average of 21.5 months follow-up,the pain all disappeared,the intervertebral grafted bone reached bony union,no Cobb's angle increased and no apparent implication occurred in all cases.[Conclusion]Application of anterior vertebral decompression and fusion combining anterior or posterior fixation can increase the stability of the anterior column of the spine,decompress completely,the intervertebral bone graft with kinds of interbody fixation enables the patients to move as early as possible,it is an effective method in treatment of severe thoracolumbar vertebral burst fracture.