ABSTRACT
Objective To detect the clinical effect of posterior reduction combined with H-shaped bone grafting and spinous process replantation for reconstruction of spinal structures in treatment of thoracolumbar fracture.Methods Forty-three patients with thoracolumbar burst fracture treated surgically from February 2008 to June 2012 were reviewed retrospectively.There were 30 male and 13 female patients aged 23 to 55 years (mean,38 years).Fracture resulted from high falls in 21 patients,traffic accidents in 16 patients,and a crush by heavy objects in 6 patients.Denis system was used for classification of fracture and Frankel rating for assessing the degree of nerve damage and recovery.After posterior reduction combined with H-shaped bone grafting and spinous process replantation for all patients,visual analogue scale (VAS) was utilized to assess symptom improvement and Cobb' s angle and sagittal spinal canal diameter were measured to help assess the treatment outcome.Results Pain was apparently eased at a 24-month follow-up (range,12-46 months).Cobb' s angle improved from preoperative 43.56° to postoperative 8.23° (t =1.33,P ＜ 0.01).CT findings showed mean spinal canal stenosis rate was 56.3％ before surgery and that mean sagittal canal diameter of the injured spine was larger than that of adjacent segments at follow-up,with the mean ratio of 116.3％ (range,111.3％-120.3％).Rate of spinal canal stenosis was negative for all patients and posterior canal with bone grafts healed.Spinal cord injury improved at least one Frankel grade.Conclusion Posterior reduction combined with H-shaped bone grafting and spinous process replantation is worthy of clinical application,for the procedure can restore the fractured thoracolumbar spine and posterior canal structure,but also effectively avoid the iatrogenic spinal stenosis.
ABSTRACT
Objective To compare the clinical outcomes of modified and traditional posterior lumbar interbody fusion (PLIF) in treatment of lumbar spinal stenosis.Methods A retrospective review was made on 47 patients who sustained monosegmental L4.5 stenosis due to lumbar degenerative revise and characterized by typical intermittent claudication and single or both limb numbness and pain.The patients were randomly allocated to Group A and Group B using the lottery method.Group A (n =24) consisted of 10 males and 14 females at mean age of 52 years (range,47-66 years) and the course of disease averaged 13 months (range,9-23 months).Group B (n =23) contained 8 males and 15 females at mean age of 53 years (range,49-67 years) and the course of disease averaged 11.5 months (range,6-22months).Modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction and interbody fusion was performed in Group A.Traditional PLIF,namely posterior spinal decompression and interbody fusion,was performed in Group B.Waist function rehabilitation after surgery of the patients in the two groups was assessed using the Oswestry disability index (ODI) and postoperative results were analyzed.Results There were no significant differences between Groups A and B regarding the operation time [(1 90 ± 15.66) min vs (170 ± 11.32) min] and intraoperative blood loss [(980 ± 35.58) ml vs (879 ± 21.25) ml] (P ＞ 0.05).Mean period of follow-up was 20 months (range,12-28 months).Postoperative results in Group A were graded as excellent in 19cases,good in three,fair in two and poor in zero,with excellence rate of 88％.While in Group B,the results were excellent in 13 cases,good in four,fair in four and poor in two,with excellence rate of 74％(P ＜ 0.05).ODI score and symptom improvement rate after operation were better in Group A than in Group B (P ＜ 0.05).Conclusion The modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction is relatively an ideal surgical technique for treatment of lumbar spinal stenosis and deserves wide promotion.