Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results.</p><p><b>METHODS</b>From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery (MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases) or open surgery (improved transforaminal lumbar interbody fusion, 38 cases).</p><p><b>RESULTS</b>The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P < 0.05 for all). MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P < 0.01). Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P < 0.01). The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up.</p><p><b>CONCLUSIONS</b>MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.</p>

Value of preoperative magnetic resonance imaging measurements in thoracic percutaneous vertebroplasty using unilateral / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Increasing the successful puncture rate of the percutaneous vertebroplasty (PVP) in thoracic vertebral compression fracture by unilateral puncture is a problem that spinal surgeons are trying to solve. The aim of this study was to assess the value of preoperative MRI imaging measurements for PVP using a unilateral puncture.</p><p><b>METHODS</b>We performed a retrospective, comparative study of two groups of osteoporotic thoracic vertebral compression fracture patients who had received a PVP using a unilateral puncture. Group A (22 patients with 27 valid vertebrae) received PVP with a unilateral puncture between October 2005 and February 2007. Group B (18 patients with 24 valid vertebrae) received a routine MRI imaging measurements before a PVP between March 2007 and June 2008. We determined the target area to puncture based on the preoperative MRI cross-sectional images of vertebra. The PVP used a simultaneous puncture through a unilateral posterolateral approach, so the vertical distance from the point of skin puncture to the posterior median line, as well as the puncture angle, were measured using the MRI. The results were used to guide the PVP operation. We compared these two groups based on the average time for a single vertebra operation, the achievement ratio of puncture, and the incidence of bone cement leakage during surgery. The mean follow-up period was 14.2 months (range 12 - 23 months). The pre- and post-operative visual analogue score (VAS) (3 and 12 months post-surgery), the variation of Oswestry disability index (ODI) and the incidence of long-term complications were also compared.</p><p><b>RESULTS</b>The average time of a single vertebra operation in groups A and B were (34.7 ± 5.4) and (23.3 ± 4.2) minutes, respectively. In groups A and B, the success rates of puncture were 74.1% and 91.7%, respectively. Postoperative reduction of the average VAS scores in groups A and B at 3 and 12 months post-surgery were 5.8 ± 2.1, 6.1 ± 1.8, 6.1 ± 2.0, 6.2 ± 1.6, respectively. However, the ODI increase was 41.6% ± 5.7%, 40.6% ± 6.0%, 46.3% ± 5.2%, 46.1% ± 6.7%. Paired t test evaluation of the values above showed a significant difference in the time of single-vertebra operation and the success rates between groups A and B (P < 0.05), but no significant difference was seen in the reduction of VAS scores and ODI (P > 0.05). There was no statistically significant difference in the complication rate between the two groups.</p><p><b>CONCLUSIONS</b>A preoperative MRI measurement effectively reduced the time of PVP with a unilateral puncture, which improved the success rate of the puncture without an additional risk of operation related complication.</p>

The anatomic study and clinical significance of the modified transforaminal lumbar interbody fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance.</p><p><b>METHODS</b>Completed the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages.</p><p><b>RESULTS</b>The early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words: Take a posterior-middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. (1) Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. (2) Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. (3) Avoid excessive traction to the thecal sac and traversing nerve roots and decrease the injury rate due to the reservation of the midline structures and the oblique manipulation, and less injury rate of the exiting nerve root, because of not necessary to expose it routinely.</p><p><b>CONCLUSIONS</b>The modified TLIF is safe and feasible, could effectively reduce the nerve roots injuries. Maybe it's a better choice for most of the Chinese patients at present.</p>

Appraise operative outcome for acute central cervical spinal cord injuries without fracture and dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical outcome for acute central cervical spinal cord injuries without fracture and dislocation.</p><p><b>METHODS</b>A retrospective study was performed on 52 patients with acute central cervical cord injuries without fracture and dislocation from 2000 to 2005. All of patients underwent cervical anterior or posterior decompression, fusion and inter fixation. Spinal function was evaluated by ASIA (American Spinal Injury Association) guidelines. Pre- and post-operation ASIA scores were analyzed using liner correlation and regression. The neurological function was recorded during followed-up. The average follow-up was 29 months (range, 12 to 42).</p><p><b>RESULTS</b>After operation, the ASIA scores increased significantly (P<0.01). Finally, ASIA motor, pin pricking and light touching scores of the 41 patients were 91 +/- 7, 107 +/- 6 and 107 +/- 6 respectively.</p><p><b>CONCLUSION</b>Decompression and inter fixation for injured segment can make a stable and broad space for spinal cord, promoting early neurological recovery and long-term improvement.</p>