ABSTRACT
Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods A retrospective study was conducted within 587 patients (average age 57.1 years,range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital,including 334 males and 253 females.Patients were divided into a symptomatic group and an asymptomatic group.The causes of contralateral neurological symptom were evaluated according to the radiological data.The difference of pre-and post-operative contralateral foramen area (CFA),segmental angle (SA) and the clinical treatment outcomes (VAS,JOA score) were compared between two groups.Results Patients were followed up for 9-21 months,average 15.1 months.Post-operative contralateral radiculopathy occurred in 28 (4.8％) of the patients who underwent unilateral TLIF,including contralateral foraminal stenosis in 16 (57.1％,16/28),screw malposition in 5 (17.9％,5/28),contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7％,3/28),hematoma in 1 (3.6％,1/28),cement compression in 1 (3.6％,1/28),and unknown origin in 2 patients (7.1％,2/28).Nineteen (3.2％,19/587) of the 28 patients received revision surgery because of ineffective conservative treatment.Compared with the asymptomatic group,the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group,while the SA was significantly greater (7.0°±9.8°) in symptomatic group.The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0％±18.1％,P＜0.05).Conclusion The incidence rate of contralateral neurological symptom was 4.8％ in the present study.The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition.The excessive restoration of SA might have an effect on contralateral nerve compression,which should arouse the attention of the surgeon.
ABSTRACT
Complete burst fractures of the L₅ is relatively uncommon. How to accomplish a rigid internal fixation as well as preserve motor function is an enormous challenge. We report such a case treated via a single posterior vertebrectomy with 270-degree decompression and reconstruction using titanium mesh cage. The disc between L₅/S₁ was preserved by placing the titanium mesh cage on the inferior endplate of the L₅. We hope this method can offer a possible solution for other surgeons when they meet a similar fracture pattern.
Subject(s)
Adult , Humans , Male , Decompression, Surgical , Fracture Fixation, Internal , Methods , Internal Fixators , Spinal Fractures , General Surgery , Surgical Mesh , TitaniumABSTRACT
Objective To develop a three-dimensional finite element model of atlantoaxial instability and compare the biomechanical properties of percutaneous anterior transarticular screw (ATS) and posterior transarticular screw (PTS) fixations.Methods A pathologic three-dimensional finite element model of atlantoaxial instability was developed from CT images of the upper cervical spine of volunteers with the aid of softwares,such as Mimics,Freeform,and Ansys.Percutaneous C1-2 ATS and PTS fixation modes were simulated and implanted to the model.Under the preload of 40 N and force moment of 1.5 Nm in anterior flexion,posterior extension,lateral bending,and axial rotation,biomechanical properties of the two fixation modes were compared.Results Under the four loading modalities,both fixation techniques provided maximal inhibition on C1-2 movement.The maximal stress for ATS was larger than that for PTS and maximal displacement for ATS was smaller than that for PTS.Conclusions Both ATS and PTS provide similar outlook and are effective to stabilize the atlantoaxial joint.Biomechanical performance of percutaneous C1-2 ATS is better than that of percutaneous C1-2 PTS.
ABSTRACT
Objective To investigate complications associated with Coflex interspinous process device for degenerative lumbar disc diseases and methods to treat.Methods Clinical data of 121 patients with degenerative lumbar disc diseases,who had undergone surgical decompression and additional fixation of Coflex between November 2007 and June 2011,was analyzed retrospectively.There were 76 males and 45 females,aged from 37 to 75 years (average,54.6 years).Surgery-related complications and sequelae were recorded and analyzed.Results Surgery-related complications occurred in 10 patients,and the incidence was 8.3％ (10/121).There were 3 cases of device-related complications,including wing break in 1 case,prosthetic loosening in 1 case and spinal process fracture in 1 case; all 3 cases were treated conservatively and received good results.There were 7 cases of non-device-related complications,including dura mater dilaceration in 2 cases,superficial wound infection in 1 case,insufficient decompression of spinal canal in 2 cases,recurrence of disc herniation in 1 case,and intraspinal hematoma in 1 case; the former 3 patients recovered after corresponding treatment,and the latter 4 patients also recovered after re-operation.Conclusion The incidences of complications and re-operation associated with application of Coflex are low,and the incidence of device-related complications is also low.The precise intraoperative manipulation is the key to reduce incidence of device-related complications.It's absolutely necessary to strictly master surgical indications and perform sufficient decompression in order to receive good surgical results and avoid non-device-related complications.
ABSTRACT
Objective To evaluate the mid-term clinical effects and the imaging changes of Coflex interspinous dynamic internal fixation for low back pain. Methods From February 2007 to June 2009,Coflex interspinous dynamic internal fixation was performed in a consecutive 45 patients. They included 26 males and 19 females, with an average of 51.4 years ranging in age from 45 to 70 years. Thirty-two cases were in L4.5 level, 11 in L5S1 level and 2 in both two levels. The patients were treated with limited laminectomy and implanted with Coflex device. Clinical outcomes were assessed by Oswestry disability index (ODI)scores and Japanese Orthopaedic Association (JOA) questionnaires before and after operation. The imaging examination was obtained to assess height of the intervertebral space, area of the intervertebral foramen,segment movement of the operation level, low lumbar curvature and signal of the lumbar disc on MRI. Results The follow-up time ranged from 10 to 34 months, with an average of 24 months. The ODI scores decreased significantly from 62.82±10.42 preoperatively to 11.80±3.35 postoperatively. The JOA scores were improved remarkably from 9.00±2.63 preoperatively to 24.65±1.86 postoperatively. The proportion with optimal effect was 89% (40 cases). The Cobb angle after operation of L4.5 and L5S1 level was 15.1°±3.9° and 16.3°±3.8° respectively, which was significantly decreased after operation. The range of motion of the L4.5 level increased from 6.5°±1.5° to 8.4°±2.6° while the L5S1 level did not change notedly. The heights of the dorsal intervertebral disc, distance of the spinous processes, intervertebral foramen height and area were significantly higher than those before operation. Conclusion The Coflex interspinous dynamic internal fixation is available to reserve segment movement, to increase intervertebral space height and foramen area. Meanwhile,it is effective to self-repair and prevent degeneration for the disc in adjacent levels.
ABSTRACT
Objective To explore different treatment choices for unilateral cervical facet locking. Methods The study involved 32 patients with cervical unilateral facet locking. Successful reduction by the skull traction was done in eight patients, of whom three were fixated by the head and neck chest plas-ter after a month of traction. Five patients were treated with anterior decompression and internal fusion fixation. The other 23 patients resulted in failure of traction and then were treated with anterior reduction, discectomy and internal fusion fixation in 14 patients, subtotal vertebral decompression and bone graft fix-ation in three, posterior open reduction and anterior bone graft fixation in one, posterior reduction, fixation and internal fusion fixation in three and posterior reduction and decompression plus anterior discectomy decompression and bone graft fixation in two. Due to misdiagnosis, one patient was treated with anterior decompression and fusion eight months after injury. Results A follow-up for average 18 months showed cervical instability in two patients who were treated with only traction, without fusion. The patients treated with anterior cervical fusion obtained bone union after 12 weeks, with satisfactory cervical physiological curvature and vertebral height. There were no internal fixation complications or neurological complications. Conclusions The treatment of lower cervical unilateral facet locking needs a compre-hensive considerations on whether there associates with disc injury, posterior column fractures or spinal cord injuries. As for patients with lower cervical unilateral facet locking combined with traumatic cervical disc herniation, the anterior reduction and decompression is the choice of treatment. While for those with-out disc herniation, traction or posterior open reduction and fixation can be carried out directly.
ABSTRACT
Objective To discuss the clinical characteristics and treatment of upper cervical spine injuries in the elderly. Methods A retrospective study was done on clinical data of 28 elderly patients ( > 60 years old) with upper cervical spine injuries treated from January 2003 to December 2007. There were 20 males and 8 females, at age range of 60-86 years (mean 68.1 years). Injury causes included slip in 16 patients, traffic injury in eight and fall from height in four. Atlas fractures occurred in five patients and axis ones in 15,of which there were eight patients with odontoid fractures, six with C2 vertebral arch fractures and one with C2 body fractures. Upper cervical spine injury was combined with lower cervical spine injuries in five patients. There were combined atlantoaxial injuries including odontoid fractures combined with lateral atlas fracture in one and edontoid fractures combined with anterior atlas arch fracture in one. Atlantoaxial dislocation occurred in one patient and combined spinal injury in four. Of all, eight patients were treated conservatively, eight with open surgical operation and 12 with minimally invasive surgery. Results The average hospital stay was 16.5 days, with no statistical difference be-tween conservative treatment group and open surgical operation group ( P > 0.05 ). While the average hos-pital stay in minimally invasive surgery group was shorter than that in conservative treatment and open sur-gical operation groups ( P < 0.05 ). Of all, two patients in conservative treatment group and one in open surgical operation group died and the other 25 patients were followed up for average 16.8 months (9-56 months). The satisfaction rate was 50% in conservative treatment group, 72% in open surgical operation group and 75% in minimally invasive surgery group. Complications occurred in four patients in conserva-tive treatment group, three in open surgical operation group and two in minimally invasive surgery group. Conclusions With odontoid fracture the most common injury type, upper cervical spine injuries arema-inly caused by low-energy force and characterized by low mobidity of spinal cord injuries and high possi-bility of missed diagnosis in the elderly patients. The surgical treatment especially minimally invasive surgery can bring good results compared with conservative methods.
ABSTRACT
Objective To discuss the functional results of percutaneons compressive screw fixation for float injury to the pubic symphysis. Methods From March 2003 to March 2007, 48 cases of float injury to the pubic symphysis were treated with percutaneons compressive screws, including 27 males and 21 females with an average age of 29.4 years. Of them, 39 eases were complicated with injury to the pelvic posterior ring. Emergency surgery was done for 13 cases, 27 cases were operated on within 3 to 7 days after injury and 8 within 7 to 14 days. Guided pins and screws were used during dosed reduction and percutaneous pelvic fixation was done under the guidance of intraoperative fluoroscopic imaging. Float injury to the pubic symphysis was amended by percutaneous fixation after dosed manipulation. Results The average operation time for the48 patients was 55 (31 to 100) min. The intraoperative bleeding averaged 20 to 30 mL. Satisfactory reduetian and fixation was achieved in 41 cases, but 7 cases had poor reduction. All the fractures healed 3 to 6 months postoperatively without infection, nonunion or injury to vessels, nerves or organs. All the patients could turn the body freely in bed the day after operation. Those without injury to the pelvic posterior ring could walk with crutches 3 days after operation. By the Orlando evaluation system for pelvic fractures, 37 eases were rated as excellent, 7 as good, 3 as fair and I as poor. Conclusions The percutaneous compressive screw fixation may decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures may be avoided by using percutaneons techniques.
ABSTRACT
Objective To study the feasibility and clinical effect of percutaneous C2 pedicle lag screw in treatment of Hangman's fracture and define the indications of the technique. Methods There were 9 patients including 5 males and 4 females at average age of 36 years (26-68 years). According to a Levine and Edwards System, there were 5 patients with type Ⅰ hangman' s fracture, 3 with type Ⅱ hangman' s fracture and 1 with type Ⅱ A hangman' s fracture. According to American spinal injury association (ASIA) system, the spinal cord function was ranked at Type D in 2 patients and Type E in 7. All patients achieved anatomic reduction by skull traction. Under general anesthesia, 9 patients were fixed with percutaneons C2 pedicle lag screw. The whole procedure was done under monitoring of "C"-arm fluoroscopy for safety and accuracy. Results All patients obtained bony fusion within 2-3 months, with no infection, neurological deficits, vertebra artery injury or other complications. CondusionsThe percutaneous C2 pedicle lag screw fixation is minimally invasive and effective for treatment of Hangman's fracture. During the course of treatment, the function of upper cervical spine remains unaffected.
ABSTRACT
Objective To study the therapeutic efficacy of the chondroplasty with radiofrequency technique under arthroscope for osteoarthritic knees in the senile patients.Methods Thirty-six patients were divided randomly into control and test groups(in each with 18 patients).The patients suffered from osteoarthritis of knees.The control group confirmed and treated by knee arthroscope,which was subjected to debridement with routine technique.The test group was treated by chondroplasty with radiofrequency technique under arthroscope.Results The patients developed no infection or other complications.Better therapeutic results were obtained after follow up of 6 to 18 months.Conclusions Chondroplasty with radiofrequency technique under arthroscope for the osteoarthritic knees has the advantages of less injury,less bleeding,less complication and quick recovery.
ABSTRACT
<p><b>OBJECTIVES</b>To compare the stability of an enhanced load sharing dynamic pedicle screw fixation device with its equivalent rigid device and to evaluate biomechanical roles of the dynamic fixation.</p><p><b>METHODS</b>A model of L(1) body fracture was produced on seven specimens of fresh adult cadaver spine from T(10) to L(4). Both dynamic and rigid devices were applied in the specimens to strength the injured level. Ranges of three dimensional movements and stiffness under flexion-compression were measured in intact, injured and stabilized specimens.</p><p><b>RESULTS</b>Both dynamic and rigid devices were found to provide significant stability for injured segment in flexion-extension and lateral bending. In axial rotation, the devices could restore the stability to levels similar to those in an intact spine. Results indicated 40% increase in range of motion in flexion-extension and 24.1 Nmm reduction in stiffness of flexion-compression for dynamic device, compared with the rigid device.</p><p><b>CONCLUSION</b>The dynamic device offers a design that may enhance load sharing without sacrificing the stability and will decrease stress-shielding and stress concentration.</p>
Subject(s)
Humans , Male , Biomechanical Phenomena , Bone Screws , Fracture Fixation, Internal , Spinal Injuries , General SurgeryABSTRACT
Objective 7 cases of thoracic spinal cord injury without radiographic abnormality (SCIWORA) were analyzed to elevate the level of diagnosis and treatment.Methods The type of spinal cord injury were classified into complete injury in 2 and incomplete injury in 5 according to Frankel. 5 cases had MRI examination. Conservative therapy was adopted in 5, and operation was programmed in 2.Results 4 cases recovered completely , 2 cases recovered partly , and 1 case had no recovery.Conclusion MRI provides reliable foundation for diagnosis and treatment to thoracic SCIWORA. The result is satisfactory in those incomplete injury.
ABSTRACT
Objective To study the methods of repairing the sole defects and reconstruction of the sensory function. Methods Twenty- nine cases of sole defect were repaired with flaps and full- thickness grafting according to the weight- bearing area and non- weight- bearing area. Sixteen cases had reconstruction of the sensory nerves. Results Twenty- nine cases were followed up for 1－ 9 years. One case failed. One case required thinning the flap. Twenty- eight cases have gained normal weight bearing ambulation. Ulcer occurred in one case, giving an ulcer rate of 3.4％ . The sensation have recovered to S2－ S3 in 16 cases repaired with reconstruction of cutaneous sensory nerves. Thirteen cases repaired with non- innervated flaps and full- thickness grafting showed deep pain sensation, and over the 1－ 2 cm area coverage around the flaps there was light touch sensation. No significant difference was found in the ulcer rate between reinnervated and non- innervated flaps. Conclusion Defects of the weight- bearing area in sole must be repaired with flaps. The medial foot island flap, medial pedal island flap, toe arterial flap and anterolateral thigh flap are the appropriate options. Defects of the non- weight- bearing area could be repaired with full- thickness grafting. The transplantation of non- sensory skin flaps can re- establish the sensory function, so the reconstruction of sensory nerve is of minor importance.
ABSTRACT
Objective To explore a new method in the treatment of odontoid pr ocess fracture with a self-designed screw and anterior percutaneous odontoid fix ation. Methods Computerized tomography (CT) was used to measure the coronal and sagittal external diameter of the base of odontoid process, the length of the od ontoid process, the total height of the axis and the angle between the axial lin e of the odontoid process and the vertical line of the anterosuperior border of the C3 vertebral body in 40 normal adults aged from 20 to 45 years. Ten odontoid process fractures were fixed with cannulated anterior odontoid screws and monit ored under fluoroscope. According to Anderson's classfication, there were 4 of t ype Ⅱand 6 of type Ⅲ. 4 had no any displacement of the dens, 3 had displacemen t less than 5 mm, and 3 had displacement of 5 mm or more. The fractures were fre sh in 8, and the other 2 were old. Each fracture was fixed by one screw, and ant erior bone-graft was performed in old fracture after screw fixation. Results The coronal external diameter of the base of odontoid process was (8.8?1.2) mm, wh ile the sagittal external diameter was (10.9?1.0) mm, the length of the odontoi d process was (14.2?1.2) mm, the total height of the axis was (38.2?1.8) mm an d the angle between the axial line of the odontoid process and the vertical line of the anterosuperior border of the C3 vertebral body was 23.1??1.4?. Satis factory results were achieved in all patients, and all screws were in good posit ion. No neurological deterioration occurred. After a mean follow-up of 19 months (range, 10 to 25 months), 8 cases showed radiographic union, while 2 nonunion. Neither clinical symptoms nor screw loosening or breakage occurred. Conclusion The direct anterior percutaneous screw fixation is practical for fractures of t he dens with appropriate instrumentation, as long as the surgeon is familiar wit h the topographic anatomy and makes sure the insertion point, the depth and the angle on percutaneous insertion of the screws, the satisfactory outcome will be obtained. There is no stiffening of the C1,2 and the motion limitation. The ant erior percutaneous procedure is surgically less traumatic than the conventional cervical approaches. One screw is optimal for this procedure.
ABSTRACT
Objective To compare the influence of the dynamic device(DD) of pedicle screw fixation and its equivalent rigid device (RD) on bone mineral density and bone structure of the vertebrae. Methods 24 goats were randomly divided into 4 groups: control group, single posterolateral fusion group, dynamic device with posterolateral fusion group and rigid device with posterolateral fusion group. After 24 weeks postoperative observation, the animals were sacrificed and the fixed lumbar spines were harvested. The bone mineral density (BMD) of these harvested specimens was measured by quantitative computed tomography (QCT). Then the L3 segment was embedded in methyl methacrylate and sectioned after alcoholic dehydration. Undecalcified slides (50 ?m in thickness) were stained with toluidine blue. Quantitative histologic analysis was performed in a semiautomatic way. The static parameters consisted of trabecular bone volume (TBV), the mean trabecular plate thickness (MTPT) and mean trabecular spacing (Tb.Sp). The main dynamic histomorphometric parameter, bone mineralization rate (MAR), was calculated by measuring the mean distance between two flurochrome labelings. Results The BMD in the rigid device group decreased significantly compared with control group (P
ABSTRACT
For orthopaedic care of patients to continue to improve, new approaches, especially minimally invasive spinal technique, must be continually developed.To verify this technique actually provides improved outcomes, these approachs must be subjected to rigorous scientific study. However, because outcomes of clinical interventions only can be studied in human subjects, this practice must not only meet scientific criteria. it also must meet strict ethical criteria. The author analysised the state of minimally invasive spinal technique in china and foreign countries, and illustrated ethical problems and countermeasure on playing of minimally invasive technique into spinal practice.
ABSTRACT
The author analysised the state of playing of human cadaver specimens in orthopedic biomechanical study in china and illustrated ethical problems an countermeasure on this issue.