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Objective:To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative scoliosis.Methods:A retrospective study was performed in 116 patients with lumbar degenerative scoliosis and spinal stenosis, who were admitted to Beijing Jishuitan Hospital from January 2015 to May 2018. The patients were divided into two groups according to the surgical method. Among them, 56 patients underwent the OLIF approach (OLIF group), consisting of 21 men and 35 women, with an average age of 65.2±8.7 years. According to Lenke-Silva classification, there were 41 cases of type II and 15 cases of type III in OLIF group. 60 cases underwent the TLIF approach (TLIF group), consisting of 19 men and 41 women, with an average age of 61.3±11.6 years. There were 43 cases of type II and 17 cases of type III in TLIF group. The preoperative and last follow up visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups. The coronal and sagittal Cobb angle changing and the offset distance for apical midline of the lumbar vertebrae between pre-operation and last follow-up were measured. The respective complications of the two groups were collected.Results:For OLIF group, VAS decreased from 7.7±1.6 at pre-operation to 1.9±1.5 at the last follow up; for TLIF group, VAS decreased from 8.1±1.2 at pre-operation to 2.2±0.9 at the last follow up. Although there were obvious improve for both group compared pre-operation to last follow-up, there was no significant difference between the two groups. For OLIF group, ODI decreased from preoperative 47.5%±9.1% to last follow up 22.4%±6.7%; for TLIF group, ODI decreased from preoperative 52.6%±5.8% to last follow up 25.1%±8.4%. Obvious changes were foundin both group between pre-operation and last follow up, but there was no significant difference between the two groups. For sagittal lumbar cobb angle, OLIF group changed from preoperative 8.6°±5.7° to last follow-up 23.6°±4.3°. TLIF group changed from pre-operation 9.2°±4.2° to last follow-up 21.3°±4.8°. Obvious changes were found in both group between pre-operation and last follow up, while OLIF group had better improvement than TLIF group ( P=0.01). For lumbar coronal Cobb angle, OLIF group changed from preoperative 16.4°±9.6° to last follow-up 2.8°±2.1°, and TLIF group from preoperative 15.2°±7.8° to last follow-up 6.4°±2.7°. Obvious changes were found in both group comparing pre-operation to last follow up, while OLIF group had better improvement. The offset distance for apical midline of the lumbar vertebrae in OLIF group improved from preoperative 26.3±9.4 mm to 4.3±1.9 mm; TLIF group improved from preoperative 23.4±5.5 mm to 7.5±4.2 mm. Obvious changes were found between pre-operation and last follow up for both group, while OLIF group has better improvement compared to TLIF group ( t=-5.26, P=0.03). The fusion rate was 97.7% (127/130) in OLIF group, and 91.1% (164/180) in TLIF group. There was no statistically significant difference between the two groups ( χ2=1.15, P=0.097). The neural complication rate was 16.1% (9/56) in OLIF groupand 8.3% (5/60) in TLIF group. There was no statistical difference between the two groups ( χ2=1.63, P=0.201). The cage subsidence was 12.3% (16/130) in OLIF group and 21.9% (35/180) in TLIF group. There was statistically significant difference between the two groups ( χ2=4.53, P=0.03). Conclusion:OLIF can be considered as an effectivesurgical option for the treatment of lumbar degenerative scoliosis with spinal stenosis, since it can achieve similar clinical effects and better correction of coronal and sagittal imbalances compared to TLIF.
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Objective@#To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis.@*Methods@#A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ2 were used to analyze data.@*Results@#There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P>0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs. (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs. (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs. (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs. (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs. (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs. 4.2±2.4) (t=2.762-16.738, all P<0.05), but need more operation time ((151.3±12.3) minutes vs. (102.2±7.1) minutes) and more X-ray radiation exposure ((26.1±3.3) seconds vs. (5.5±2.1) seconds) (t=6.125, 15.168, both P<0.01). In both groups ODI was significantly lower in final follow-up than that of the pre-operation (t=12.215, 14.036, P<0.01). Intervertebral disc height of the final follow-up in both groups were significantly larger than that of the preoperation (robot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs. (7.5 ± 1.9) mm, traditional open TLIF group: (12.7 ± 2.5) mm vs. (7.9±2.0) mm), and so was the lumbar lordosis angle (robot-assisted minimally invasive TLIF group: (48.7±9.2)°vs. (39.6±7.9)°, traditional open TLIF group: (50.1±10.8)°vs. (41.4±8.8)°), the lordosis angle of the slippage segment (robot-assisted minimally invasive TLIF group: (18.7±5.6)°vs. (10.9±3.8)°, traditional open TLIF group: (17.6±6.1)°vs.(8.7±3.2)°) (t=4.128-16.738, all P<0.01). Slippage rate of the final follow-up in both groups were significantly smaller than those of the pre-operation (robot-assisted minimally invasive TLIF group: (5.3±2.3) % vs. (27.8±7.2) %, traditional open TLIF group: (6.6±2.8) % vs. (29.1±9.5) %) (t=11.410, 18.504, both P<0.01). There was no difference of the upper data between two groups (t=0.106-1.227, P>0.05). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ2=4.247, P=0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ2=0.366, P=0.545).@*Conclusions@#In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less perioperative bleeding, less post-operative pain, and quicker recovery than traditional open TLIF surgery, but it needs more operation time and radiation exposure.
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BACKGROUND:For patients with osteoporosis, bone mineral density and other factors can lower the success rate of posterior lumbar interbody fusion. But there is no comprehensive report on the effects of different bone graft materials and osteoporosis on the posterior lumbar interbody fusion. OBJECTIVE:To explore the influence of different bone graft materials and osteoporosis on the success rate of posterior lumbar interbody fusion. METHODS:Clinical data of 227 patients undergoing posterior lumbar interbody fusion were retrospectively analyzed, and these patients were assigned into autogenous iliac bone group (n=121), fusion cage combined with autogenous cancelous bone group (combined group,n=65) and alograft group (n=41) according to different bone graft materials. There were 20, 22, 6 patients with osteoporosis in the three groups, respectively. Al the patients were folowed up for 24 months, and postoperative bone fusion, fusion time, intervertebral height and internal fixation failure and other adverse events were recorded and compared among three groups. RESULTS AND CONCLUSION:The failure rate of internal fixation, fusion time and loss of intervertebral height were higher, but the fusion rate was lower in the alograft group than the other two groups (P < 0.05). In addition, there was no difference between the autogenous iliac bone group and combined group. For the osteoporosis patients, the failure rate of internal fixation and fusion time were higher, while the loss of intervertebral height and fusion ratewere lower in the alograft group than the other two groups (P < 0.05); compared with the autogenous iliac bone group, the combined group had longer fusion time and higher fusion rate (P < 0.05). These findings indicate that autogenous iliac bone graft combined with or without fusion cage can achieve higher fusion rate and less internal fixation failure in the posterior lumbar interbody fusion; however, for osteoporosis patient, the autogenous iliac bone graft can obtain better fusion effects.
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Objective To study the clinical outcome of percutaneous vertebroplasty (PVP) for the s disease who had been suffering severe back pain even after conservative therapy for months were treated with PVP. Their preoperative CT images indicated nonunion of factures and "vacuum signs". Dynamic X-ray films demonstrated formation of pseudoarthrosis in the involved vertebral bodies in some eases. Their back pain was evaluated with visual analogue scale (VAS). Their preoperative and postoperative VAS scores and radiological indexes were compared. Results The mean VAS scores were 7.0±1.2 preoperatively, but 3.1±1.5 at the follow-up (P < 0.05) . The height of anterior margin of involved vertebral body was (2.1±0.3) cm pre-operatively, but (2.3±0.2) cm at the follow-up (P < 0.05). The ratio of anterior margin height to posterior margin height of the involved vertebral body was 0. 67±0. 10, but 0.84±0.08 at the follow-up (P<0.05), The focal kyphosis angle was 27.3°± 6.4° preoperatively but 20.7°±5.0° at the follow-up (P < 0.05). No pulmonary embolisms or neurological injuries happened. Conclusion PVP is an effective method for anterior margin of the involved vertebral body partially, and decrease the focal kyphosis.
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[Objective]To examine whether collagen scaffold(CS) would strengthen calcium phosphate cement(CPC) in vitro,and to investigate whether CPC enhanced with CS would accelerate the osteogenesis for repairing bone defect in rabbits.[Method] A standard 3-piont flexural test was used to fracture the set specimens and to measure the flexural strength,work-of-fracture(WOF) and elastic modulus of CPC and cpclcs.Both cements were implanted into cylinder cavities drilled in 20 rabbit femoral condyles.After 22 and 54 weeks of implantation,histological observations were performed.[Result]The CS had significant effects on composite of mechanical properties.The CPC/CS had a flexural strength 64.2% higher,WOF 3 933.3% higher,and elastic modulus 45.7% lower than the CPC without CS.At 22 weeks,histological study showed collagen fibers of the CPC/CS composite were entirely resorbed and new bone was formed instead.With unreinforced CPC,there were a little bone formation and biodegradation of cement on the margin but not in the interior of CPC.At 54 weeks,plentiful growing bone and bone marrow-like tissue fully filled in pores created by biodegradation of CPC/CS.Although bone formation and biodegradation of cement were more obvious on the margin of CPC cylinder at 54 weeks than 22 weeks,new bone did not present in the interior of CPC yet.[Conclusion]Collagen scaffold not only reinforces CPC,but also accelerates bone formation in the interior of CPC/CS composite.Therefore,CPC/CS could be novel biomaterial as an endosteal implant.