ABSTRACT
【Objective】 Compare the early outcome and safety of endoscopy-unilateral laminectomy for bilateral decompression （Endo-ULBD） and posterior lumbar interbody fusion （PLIF） in the treatment of multi-segment lumbar central spinal stenosis. 【Methods】 We retrospectively analyzed 68 patients with multi-segment central lumbar spinal stenosis treated between October 2019 and October 2020 in the Department of Spine Surgery， Affiliated Hospital of Qingdao University. Of them 33 patients were treated with Endo-ULBD and 35 ones were treated with PLIF. We compared the operation time， times of intraoperative fluoroscopy， estimated intraoperative blood loss， incision length， postoperative time to get out of bed， postoperative hospital duration， complications， visual analogue scale （VAS）， Oswestry dysfunction index （ODI） score before and 1 day， 1 month， and 3 months after operation， Japanese Orthopedic Association Assessment Treatment Score （JOA）， and modified MacNab score 3 months after operation between the two groups of patients. 【Results】 Compared with PLIF group， Endo-ULBD group had significantly shorter operation time， smaller incision length， less intraoperative blood loss， shorter postoperative bed time and postoperative hospital stay， and fewer surgical complications （all P0.05）. However， after treatment Endo-ULBD group outperformed PLIF group in lower back pain VAS， ODI， JOA and the 3-month follow-up excellent and good rates （P<0.05）. 【Conclusion】 For patients with multi-segment central lumbar spinal stenosis， Endo-ULBD treatment can achieve better early clinical outcome than PLIF surgery， with less bleeding， shorter operation time， faster postoperative recovery， and fewer complications.
ABSTRACT
Objective To investigate the effect of bone cement distribution near fracture line after percutaneous vertebroplasty (PVP) on patients with osteoporotic vertebral compression fractures (OVCF). Methods One hundred and twenty OVCF patients who had underwent PVP from September 2015 to August 2017 were selected. The range of fracture line was determined by magnetic resonance lipid suppressor sequence imaging before operation, and the three-dimensional modeling was carried out by computer aided design software. Three dimensional imaging of CT bone cement was performed after PVP. The patients were divided into 2 groups according to the bone cement distribution near fracture line. The bone cement distribution near fracture line area was not good in 52 cases (group A), and the bone cement distribution near fracture line was good in 68 cases (group B). The pain visual analogue score (VAS) and the Oswestry dysfunction index (ODI) were measured before operation, second day after operation and 3 months after operation. Results All the patients completed the operation successfully, and the postoperative pain was significantly relieved. In group A, there were 3 cases of with postoperative bone cement leakage, and 4 cases in group B. There were no obvious clinical symptoms, no serious complications such as nerve injury and infection. There was no significant difference in the amount of bone cement between group A and group B: (4.08 ± 0.74) ml vs. (4.03 ± 1.03) ml, P＞0.05. There were no significant differences in VAS and ODI before operation between 2 groups (P>0.05). The VAS and ODI second day and 3 months after operation were significantly lower than those before operation in 2 groups, VAS: (4.54 ± 0.81) and (1.46 ± 0.51) scores vs. (7.38 ± 0.94) scores, (2.68 ± 0.88) and (1.18 ± 0.58) scores vs. (7.21 ± 1.12) scores; ODI: (70.23 ± 2.70) and (19.42 ± 2.21) scores vs. (90.46 ± 1.79) scores, (48.85 ± 2.23) and (18.85 ± 1.84) scores vs. (90.50 ± 2.02) scores, and there were statistical differences (P＜0.05). The VAS and ODI second day after operation in group B were significantly lower than those in group A, and there were statistical differences (P＜0.01). There were no significant differences in VAS and ODI 3 months after operation between 2 groups (P>0.05). Conclusions PVP can obviously relieve the pain of OVCF patients. The bone cement is well distributed near the fracture line, and the early effect is obvious.
ABSTRACT
Objective To evaluate the value of radiofrequency ablation (RFA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic spinal tumor. Methods The clinical data of 94 hospitalized patients with metastatic spinal tumor from January 2013 to January 2017 were retrospectively analyzed.The patients were divided into PVP group(43 cases)and RFA+PVP(51 cases) according to the different treatment methods. The visual analogue scores (VAS) before operation and 1 month after operation were observed.The serum levels of N-telopeptide of typeⅠcollagen(NTx),carboxy terminal telopeptide typeⅠcollagen(ICTP)and bone alkaline phosphatase(BAP)before operation and 1 month after operation were monitored.The recurrence rate of tumor 6 months after operation was record. Results The VAS before operation in PVP group was (7.67 ± 1.12) scores, in RFA + PVP group was (7.71 ± 1.04) scores, and there was no statistical difference (P>0.05). The VAS of 2 groups after operation was significantly lower than that before operation:PVP group(3.17 ± 0.26)scores,RFA+PVP group (2.66 ± 0.31) scores, and there were statistical differences (P<0.05). The VAS in RFA + PVP group was significantly lower than that in PVP group(P<0.05).The serum levels of NTx,ICTP and BAP before operation in PVP group were(25.39 ± 9.77)nmol/L,(36.71 ± 8.77)μg/L,(73.66 ± 14.60)μg/L;after operation were (19.34 ± 6.32) nmol/L, (21.14 ± 6.66) μg/L, (33.63 ± 7.50) μg/L, and there were statistical differences before and after operation (P<0.05). The serum levels of NTx, ICTP and BAP before operation in RFA+PVP group were(26.63 ± 10.53)nmol/L,(35.37 ± 9.42)μg/L,(75.24 ± 13.01) μg/L; those after operation were (12.10 ± 5.17) nmol/L, (15.14 ± 5.08) μg/L, (27.19 ± 8.22) μg/L, and there were statistical differences before and after operation(P<0.05).The serum levels of NTx,ICTP and BAP after operation in RFA + PVP group were significantly lower than those in PVP group (P < 0.05). The recurrence rate of tumor 6 months after operation in RFA+PVP group was significantly lower than that in PVP group: 3.92% (2/51) vs. 16.28% (7/43), and there was statistical difference (P<0.05). Conclusions Compared with simple PVP, RFA combined with PVP can reduce the pain symptoms, reduce the recurrence rate and improve the quality of life in patients with metastatic spinal tumor.