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Objective:To investigate the preliminary clinical and radiographic outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with oblique lateral interbody fusion (OLIF) for the degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation.Methods:Data of 11 patients with degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation who had undergone PELD combined with OLIF between March 2017 to July 2018 in our spine surgery center were retrospectively analyzed. There were 5 males and 6 females with an average age of 61.2±6.8 years old. All the patients were diagnosed with degenerative lumbar diseases including lumbar spondylolisthesis (7 cases), lumbar spinal stenosis (3 cases) and segmental instability (1 case). The patients were treated with PELD combined with OLIF. The visual analogue scale (VAS) scores of low back pain and lower limb pain and the Oswestry disability index (ODI) of lumbar function, spinal canal anteroposterior diameter, intervertebral disc height, vertical diameter of intervertebral foramen, segmental angle and the whole lumbar lordotic angle were collected.Results:All patients received PELD with local anesthesia before OLIF with general anesthesia. The mean operation time was 52.3±13.2 min and the mean blood loss was 10.9±4.7 ml for PELD. The mean operation time was 56.8±18.0 min and the mean blood loss was 65.5±24.6 ml for OLIF. All patients were followed up for an average of 11.2 months. At the latest follow-up, the mean VAS score for back pain was 1.3±0.8, the mean VAS score for leg pain 1.1±0.5, the mean ODI 14.6%±5.3%, thus all of those were improved significantly compared to those of pre-operation ( t=10.37, 16.49, 8.73; P< 0.05). The radiographic results showed the mean pre-operative intervertebral disc height, vertical diameter of intervertebral foramen, spinal canal anteroposterior diameter, segmental angle, and lumbar lordosis angle was 7.1±1.2 mm, 15.3±2.2 mm, 6.2±1.3 mm, 10.2°±3.5°, 16.2°±6.2°, and thus all of those were increased significantly to the latest follow-up 11.5±1.8 mm, 19.2±2.6 mm, 10.4±2.5 mm, 19.3°±7.8°, 27.4°±8.3°, respectively ( t=5.83, 4.21, 6.59, 10.32, 7.65; P< 0.05). One of the patients had weakness of flexor hip strength and one had a transient paresthesia immediately post-operation. All symptoms were relieved within 1 month. Another one case had cage subsidence and encountered serious back pain after 1 month, and alleviated after percutaneous pedicle screw fixation. Conclusion:PELD combined with OLIF can overcome the limitations of OLIF with indirect decompression effects, resulting in successful direct neural decompression without posterior decompressive procedures and providing a satisfactory outcome for the patients with degenerative lumbar diseases with ruptured disc herniation.
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Objective:To investigate the short-term clinical outcomes of posterior percutaneous pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating Kümmell's disease with intravertebral instability.Methods:A retrospective case series study was made on 18 patients with Kümmell's disease with intravertebral instability treated at Lishui Hospital of Zhejiang University from January 2012 to February 2016. There were 4 males and 14 females, aged 65-86 years [(76.0±5.5)years]. Segment of injury was T 7 in 1 patient, T 10 in 2, T 11 in 3, T 12 in 4, L 1 in 6, and L 2 in 2. All patients underwent posterior percutaneous pedicle screw fixation combined with PVP. The operation time, intraoperative blood loss, amount of cement injected into the vertebra, and length of postoperative hospital stay were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), Cobb angle, and wedge angle of the operative segment were recorded and compared preoperatively, postoperatively, and at the latest follow-up. Meanwhile, the complications were recorded. Results:All patients were followed up for 12-28 months [(17.7±4.4)months]. The operation time was 110-175 minutes [(137.9±21.9)minutes] and the blood loss was 50-165 ml [(110.7±35.6)ml]. The amount of cement injected into the vertebra was 2.5-6.0 ml [(4.7±0.9)ml]. The length of hospital stay was 7-14 days [(9.4±2.3)days]. The VAS was (7.8±1.2) points preoperatively, (3.3±0.7) points at 1 week postoperatively and (2.4±0.7)points at the latest follow-up. The ODI was (67.3±7.3)% preoperatively, (30.5±7.5)% at 1 week postoperatively and (21.8±8.3)% at the latest follow-up. The Cobb angle was (26.2±9.5)° preoperatively, (12.6±7.2)° at 1 week postoperatively and (16.7±6.2)°at the latest follow-up. The wedge angle was (21.1±6.1)° preoperatively, (8.4±4.6)° at 1 week postoperatively, and (13.2±4.1)° at the latest follow-up. The above clinical and radiological parameters were significantly improved after operation ( P<0.05), and showed no significant differences at the latest follow-up when compared to that at 1 week postoperatively ( P>0.05). Five patients showed slight screw loosening, but there was no obvious dislocation of internal fixation. One case developed distal vertebral compression fracture at 6 months postoperatively and cured after a second PVP. Conclusion:For Kümmell's disease with intravertebral instability, posterior percutaneous pedicle screw fixation combined with PVP can effectively restore and maintain the spinal sequence, rapidly relieve the pain and improve clinical function. However, the long-term efficacy needs further study.
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Objective To evaluate the clinical effect of interspinous H-shaped bone grafting and bilateral facet interbody fusion in treatment of thoracolumbar fracture with severe disc injury and posterior ligamentous complex (PLC) injury after posterior pedicle screw fixation and its role in prevention of delayed kyphosis.Methods The study involved 19 cases of thoracolumbar fractures with severe disc injury and PLC injury,including 11 males and 8 females,at age of 23-59 years (mean 43.8 years.All cases were treated with posterior pedicle screw fixation (including 11 cases treated with unilateral laminectomy decompression) and C-arm X-ray showed favorable fracture reduction.For prevention of postoperative delayed kyphosis,the interspinous H-shaped bone grafting plus bilateral facet interbody fusion by using the iliac autografts was done.Neurologic recovery was assayed by using Frankel scale and lumbar and iliac pain by visual analogue scale (VAS).Cobb angle was detected as well.Results All cases were followed up for 24-64 months.At final follow-up,all cases showed neurological improvement for at least 1 to 2 Frankel grades except for two cases with Frankel Grade A,with mean Cobb angle of (2.0 ± 3.7) ° (range,-4.9°-8.1 °),mean VAS of lower back pain of (1.1 ± 1.2) points (range,0-4 points) and insignificant angle loss or kyphosis.The thin layer CT scan indicated complete integration of the transplanted bone grafts,with no complications like implant loosening or breakage.Conclusion Interspinous H-shaped bone grafting and bilateral facet interbody fusion is a good choice for prevention of delayed kyphosis after posterior pedicle screw fixation of thoracolumbar fracture with severe disc injury and PLC injury.
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Objective To assess the clinical efficacy of minimally invasive internal fixation combined with percutaneous kyphoplasty (PKP) in treatment of thoracolumbar burst fractures in the elderly.Methods Twenty-one cases of neurologically intact thoracolumbar burst fractures treated by PKP between January 2007 and December 2008 were included in this study.There were 8 males and 13 females at age of 65-78 years (means,70.6 years).Mean period from injury to operation was (3.7 ± 1.1) days (range,3-7 days).The injured segments included Ti1 in two cases,T12 in six,L1 in eight and L2 in five.Kphosis Cobb' s angle,correction degree of kyphosis angle,correction loss of kyphosis,perioperative indicators,visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated after operation.Results All the cases were followed up for a period of 26-56 months (mean 34.2 months).Operation averaged 98.7 minutes (range,80-120 minutes) and showed mean blood loss of 32.8 ml (range,30-85 ml).Ambulation started at mean 18.2 hours after operation (range,8-19 hours).VAS averaged (0.9 ± 0.6) points at postoperative one week.Postoperative X-ray films revealed mean 10.4° correction of kyphotic Cobb angle,followed by mean 1.8 °of loss in the follow-up longer than 24 months.According to hyperextension and hyperflexion radiographies,there was no abnormal activity of fixed segments,implant loosening and breakage or adjacent vertebral fractures.Conclusion Minimally invasive internal fixation combined with PKP can relieve pain and restore function in a short time and is thought to be a preferable treatment option for thoracolumbar burst fractures in the elderly.