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Objective:To access the feasibility and efficacy of percutaneous endoscopic debridement (PED) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis.Methods:49 patients (male 29, female 20), aged 51.2±13.9 years (range 19-81 years), who were diagnosed with lumbar pyogenic spondylodiscitis and received PED with PPSF in Orthopedic Department, Sun Yat-Sen Memorial Hospital and Zhuhai People's Hospital from January 2014 to March 2017, were retrospectively reviewed. The patients were operated in the prone position with the infected locus thoroughly debrided, vertebrae fixed and clinical outcomes were assessed by observing the changes of complaining symptoms, laboratory parameters, clinical functional scores (American Spinal Injury Association impairment scale, AIS; visual analog scale, VAS; Oswestry disability index, ODI) and imaging studies during perioperative and follow-up stages.Results:The mean operative time was 110.1±19.8 min (80-165 min), with intra-operative blood loss 47.8±20.6 ml (range 20-120 ml). All patients reported relief of back pain. Causative pathogens were identified in 36 of 49 biopsy specimens, with staphylococcal bacteria being the most prevalent strain (accounting for 50.0%). During 3-12 months' follow-up, 95.9% (47/49) patients' infection was well-controlled. At 3 month post-operative, C-reactive protein declined from 62.1±37.2 mg/L to 7.5±5.8 mg/L, white blood cell declined from (14.2±3.9)×10 9/L to (6.2±1.1)×10 9/L, ESR declined from 90.3±37.4 mm/1 h to 16.9±7.2 mm/1 h, and the values at 3 months post-operative had significant difference compared with values at pre-operative ( t=10.15, P<0.001; t=13.49, P<0.001; t=13.82, P<0.001). Spontaneous fusion was observed among 56.8% (21/37) of the patients during long-term radiological follow-ups (more than 1.5 years). At the last follow-up, the VAS declined from 7.4±0.6 points pre-operative to 0.5±0.3 post-operative, ODI declined from 78.2%±9.1% pre-operative to 14.0%±8.6% post-operative, and the values at the last follow-up had significant difference compared with values at pre-operative ( t=72.00, P<0.001; t=35.89, P<0.001). There were 38 cases of AIS E, and 11 cases of AIS D at pre-operative, while 43 cases of AIS E and 6 cases of AIS D. However, there were 11 patients developed post-operative complications, among whom 2 with recurrent infection, 2 with secondary neurological impairment. Conclusion:PED combined with PPSF effectively eliminated infected locus, stabilized the affected vertebrae, improved patients' clinical outcomes with small trauma, thereby offering an alternative for the treatment of lumbar pyogenic spondylodiscitis.
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Objective To analyze the perioperative risk factors of postoperative complications after posterior lumbar fusion operation.Methods The clinical data of 654 patients with posterior lumbar fusion during 2010 and 2014 were retrospectively analyzed.Using x2 test and one-way ANOVA,the predicted risk factors were screened for further Logistic regression.Results The total complication rate was 11.6％ among all 654 patients.The major complications included cardiac infarction,deep infection,sepsis,neurological impairment,and secondary operation.And the minor complications included wound dehiscence,urinary tract infection,pulmonary infection,gastrointestinal bleeding,CSF leakage and others.According to x2 test and one-way ANOVA,renal function insufficiency,preoperative neurological injury,ASA higher than Ⅲ level,intraoperative blood loss,long operation length,and usage of autogenous bone were screened as risk factors of complications.Renal function insufficiency,preoperative neurological injury,intraoperative blood loss,and long operation length were screened as risk factors of minor complications.And male,renal function insufficiency,preoperative neurological injury,intervertebral fusion,and posteriolateral fusion were screened as risk factors of major complications.However,according to Logistic regression,the independent risk factor of complications were preoperative neurological injury and long operation length;independent risk factors of minor complications were renal function insufficiency,preoperative neurological injury and long operation length;and independent risk factor of major complications was preoperative neurological injury.Conclusion Preoperative neurological injury,renal function insufficiency and long operation length are proved to be the risk factors of postoperative complication in lumbar fusion surgery.
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Lumbar spine fusion surgeries have adverse effects on adjacent segments and lead to adjacent segment disease and degeneration which increase the possibility of revision surgery and affect the final outcome.If new degeneration or aggravation of the primary degeneration in the adjacent segment only occurs in the images but without corresponding clinical symptoms,it would be called adjacent segment degeneration;if the corresponding clinical symptoms co-exist with degeneration in images,it would be called adjacent segment disease.Generally,the stress concentration on adjacent intervertebral discs and facet joints caused by spine fusion is the main pathogeny of adjacent segment degeneration and disease.The damage of normal spinal anatomy structure in surgery and the natural spine degeneration process are also important pathogenic factors.The occurrence of adjacent segment degeneration and disease after lumbar surgery is related to age,body weight,postoperative spinal-pelvic sagittal balance and the preoperative degeneration of adjacent segment.Surgical programs including numbers of the fusion segments,surgical approach and whether to adopt non-fusion technology have great effect on the occurrence of adjacent segment degeneration and disease.In the planning of surgeries,necessary measures and methods should be taken to prevent adjacent segment disease and degeneration according to the different patients.Non-fusion technology,minimally invasive spine surgery technique and Topping-off technique can help reduce the occurrence of adjacent segment disease and degenerative.If the patients are combined with high risk factors of adjacent segment degeneration and disease,more attention should be paid and appropriate and individualized therapies should be chosen.
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<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of total en-bloc spondylectomy (TES) in recurrence spinal tumor.</p><p><b>METHODS</b>The study was a retrospective study of recurrence spinal tumor from January 2010 to October 2013. A total of 6 patients with recurrent spinal tumor underwent TES procedures, with 5 cases located in thoracic spine and 1 case located in L1. There were 3 male and 3 female patients, with a mean age of 33.2 years. Pathological diagnosis included giant cell tumor of bone in 3 cases, breast cancer, lung cancer and nasopharyngeal carcinoma with 1 case in each. The operation time, bleeding loss, resected segments, cutting edge, spinal cord function and complications was evaluated.</p><p><b>RESULTS</b>Single segment resected in 1 case, 2 segments resected in 2 cases and 3 segments resected in 3 cases. The average operation time was 8.9 hours (7.5 to 12.0 hours). The average blood loss was 3 116 ml (2 500 to 4 500 ml). The average follow-up period was 23.2 months (12 to 47 months) without recurrence. There was no spinal cord injury during operation. The neurologic function was significantly improved in 2 cases (American Spinal Injury Association (ASIA) grade C to grade D), unchanged in 1 cases (ASIA grade B) and no deteriorated case in 3 cases (ASIA grade E). There was no perioperative deaths case. Complications included 2 cases pleural rupture, 1 case dural tear and 1 case massive haemothorax. No peri-operation death case.</p><p><b>CONCLUSION</b>Some of the recurrent spinal tumors are still suitable for en-bloc resection and TES procedure with the extent of its applicability under strict control.</p>
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Adult , Female , Humans , Male , Lung Neoplasms , Neoplasm Recurrence, Local , Retrospective Studies , Spinal Cord Neoplasms , Spinal Neoplasms , General Surgery , SpineABSTRACT
Objective To investigate the operation key points, instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors. Methods A series of modified instruments have been designed for the TES, including threadwire saw (T-saw) with a diameter of 0.81 mm, director and clamping for the saw, L shape and furcation osteotomes.The corpectomy of original TES which was defined as "one step dissection" from anteriorly to posteriorly, was modified into "two step dissection" which means that corpectomy was performed with saw cutting anteriorposteriorly and the L shape cutting posterior-anteriorly. In the cases with difficulty in pediculotomy using a T-saw, furcation osteotome was used for pediculotomy. Ten patients with thoracic or lumbar tumors were treated with the modified TES. There were 1 case of bone giant cell tumor, 1 case of bone neurilemmoma and 8 cases of metastatic tumors. All patients suffered moderate-severe pain and neurological deficit. Results The average follow-up period was 8.1(3.3-18.1) months. The average operating time was 7.8 h(6.0-10.3 h),and average blood loss was 2100 ml (1200-3500 ml). No disruption of dural mater, the leakage of cerebrospinal fluid, iatrogenic spinal cord injury and major vessel damage occurred. Two patients who underwent pleura disruption happened during the operation were treated with intrathoracic drain remedy. Among 7 cases with thoracic tumors, significant improvement in neurological function were achieved in 5 patients with the improvement of one grade in ASIA classification, while no change was found in 2 cases. In 3 cases with lumbar tumor, lumbar nerve root pain relieved and the muscle strength had recovered to grade 4 at least postoperatively. Conclusion Significant improvement has been achieved in the maneuverability and safety of the modified surgical techniques in TES with a single posterior approach for thoracic and lumbar tumors.