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Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture.Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One,Foshan Hospital of Traditional Chinese Medicine.Of them,87 were treated with transpedicular bone grafting (group A),87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C).The 3 groups were compared in terms of cobb angle,loss of correction,bony fusion,internal fixation failure,and Oswestry disability index (ODI).Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P ＞ 0.05).The cobb angles in the 3 groups at one week after operation (4.9° ± 1.0°,4.8° ± 0.6° and 4.8° ± 0.6°) and at the final follow-up (6.1 o ± 1.5°,14.5° ± 3.7° and 15.3° ± 4.1 °) were significantly smaller than those before operation (27.5° ± 4.9°,27.6° ± 4.6° and 27.6° ± 4.2°) (P ＜ 0.05).The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P ＜0.05).At the final follow-up,both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P ＜ 0.05).The fusion rate in group A (100％) was significantly larger than in group B (80.5％) and C (76.2％).There were no significant differences between the 3 groups in the rate of internal fixation failure (0,1.1％ and 2.4％) (x2 =2.108,P=0.348).The ODI for the 3 groups at 6 months after operation (28.5 ± 4.1,28.7 ± 3.9 and 28.8 ± 3.7) and at the final follow-up (10.7 ± 2.6,11.0 ± 2.7 and 11.4 ± 3.1) were all significantly lower than the preoperative values (94.3 ± 0.7,94.4 ± 0.9 and 94.4 ± 0.8) (P ＜ 0.001).In all the patients,the ODI at the final follow-up was significantly lower than that at 6 months after operation(P ＜ 0.001).Conclusions In the treatment of thoracolumbar burst fractures,all the posterior approach plus transpedicular bone grafting,posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion.Although the latter 2 methods of bone grafting are effective,they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction.
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<p><b>OBJECTIVE</b>To compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification.</p><p><b>METHODS</b>One hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years (range, 16-68 years). All the patients had X-ray, CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability.</p><p><b>RESULTS</b>For GATA and SMU classification systems, the inter-observer percentage of agreement averaged (59.9∓4.84)% (κ=0.412∓0.058) and (81.6∓6.06)% (κ=0.753∓0.068), and the intra-observer percentage of agreement was (75.6∓5.27)% (κ=0.624∓0.078) and (89.8∓2.28)% (κ=0.862∓0.037), respectively.</p><p><b>CONCLUSION</b>The SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Observer Variation , Reproducibility of Results , Tuberculosis, Spinal , Classification , DiagnosisABSTRACT
BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient's complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy. METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy. RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.