Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Among the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.</p><p><b>METHODS</b>From March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.</p><p><b>RESULTS</b>The mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.</p><p><b>CONCLUSION</b>Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.</p>

One-stage total en bloc spondylectomy and reconstruction via a single posterior approach for thoracic vertebral symptomatic hemangioma associated with spinal cord dysfunction / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the surgical results of one-stage total en bloc spondylectomy (TES) and reconstruction via a single posterior approach for thoracic symptomatic vertebral hemangioma associated with spinal cord dysfunction and evaluate its curative effect.</p><p><b>METHODS</b>A total of 9 patients treated with one-stage TES (7 cases) and total vertebrectomy (2 cases) by posterior approach from March 2006 to January 2010 were retrospectively reviewed. The cases included 2 males and 7 females with a median age of 33.6 years (range 14 to 77 years), and with 1 case of Grade A, 3 cases of Grade B, 3 cases of Grade C, 2 cases of Grade D according to Frankel grade system. All patients suffered from moderate to severe pain and neurological deficit with an average symptom duration of 14.4 months (range 3 - 24 months) MRI revealed severe spinal cord compression. The spinal reconstruction was obtained by titanium mesh filled with autograft and posterior internal fixation with rod-screw system.</p><p><b>RESULTS</b>The operation time was 210 minutes on average (180 - 270 minutes) and the average blood loss was 1800 ml (1000 - 5000 ml). The follow-up period lasted from 18 months to 5 years. All cases with preoperative pain relieved after operation. The visual analogue scale pain scores decreased to 1.1 from 8.3 at 3 months after surgery. No disruption of dural mater, cerebrospinal fluid leakage, iatrogenic spinal cord injury and major vessel damage occurred. Up to now, there was no local recurrence in all cases. Significant neurological function improvement was achieved in all patients with one to three grades in Frankel grade system. Fusion of the autograft was well achieved and no internal fixation failure in all patients.</p><p><b>CONCLUSIONS</b>One-stage TES and spine reconstruction by a single posterior approach is feasible, safe and effective to this disease. It is favourable in decreasing the hemangioma recurrence and improvement of the neurological function.</p>

Animal experiment of memory alloy staples to control the sagittal growth of vertebrates / 中华外科杂志

<p><b>OBJECTIVE</b>To present that Nickel-Titanium (NT) memory alloy staples in fusionless controlling the growth of the vertebrates in the sagittal plane.</p><p><b>METHODS</b>Eighteen infant female goats were selected and equally divided into 3 random groups: long staple group, short staple group and blank control group. Five long staple (the legs' length = 7 mm) and five short staple (the legs' length = 4 mm) were implanted into each goat in long and short staple groups respectively by anterior approach, right on the front of the thoracic vertebrae from T(6) to T(11). The control group was not given any treatment. X-ray examination was performed pre-operatively and post-operatively. Cobb angle of lateral radiograph was measured and the data of Cobb angle were statistically analyzed. At the end of the experiment, whether the staples implanted spinal columns were fused or not were evaluated by gross observation.</p><p><b>RESULTS</b>Finally, all of the goats were included in the final results. Before the operations, T(6-11) sagittal Cobb angle was 7.0° ± 2.3° in short staple group, and 6.2° ± 4.0° in long staple group. And after the operation, the T(6-11) Cobb angle was increased to 12.7° ± 4.7° in short staple group with the increased rate of 81.4%, and 14.0° ± 4.9° in long staple group with the increased rate of 125.8%, respectively. Before and after the surgery, there were no significant differences between long staple group and short staple group in terms of Cobb angle (pre-operation P = 0.655, post-operation P = 0.596). Before the surgery, there were no differences in terms of Cobb angle, between long staple groups and control group (P = 0.929), and short staple groups and control group (P = 0.720). At the end of the experiment, there were significant differences between long staple group and control group in terms of Cobb angle (P = 0.007), and between short staple group and control group (P = 0.021). The staples implanted spinal columns were not fused which was proved by gross observation.</p><p><b>CONCLUSIONS</b>The memory alloy staple implantation by anterior approach, right on the front of the thoracic vertebrae of goats, can control the growth of thoracic vertebrates leading to kyphosis.</p>

Vertebral column decancellation for the management of rigid scoliosis: the effectiveness and safety analysis / 中华外科杂志

<p><b>OBJECTIVE</b>to explore the effectiveness and safety of vertebral column decancellation (VCD) for the management of rigid scoliosis.</p><p><b>METHODS</b>from May 2004 to February 2008, 32 patients with rigid scoliosis underwent VCD were reviewed. There were 12 males and 20 females with an average age of 18 years (range, 10 - 56 years). The operation techniques included multilevel vertebral body decancellation and residual intervertebral disc resection, followed by realignment and posterior correction with pedicle screws. The effectiveness was evaluated by preoperative and postoperative radiography and three-dimensional CT scan reconstruction at final follow-up. The intraoperative and postoperative complications of all patients were recorded.</p><p><b>RESULTS</b>a mean of 2.1 vertebrae were performed with VCD and a mean of 10.6 vertebral levels were instrumented and fused (range, 8 - 13 vertebrae). The mean duration of surgery was 270 minutes (range, 215 - 380 minutes). The average intraoperative blood loss was 1560 ml (range, 900 - 4800 ml). Complications were encountered in 4 patients. There were 2 cases with transient neurological deficits, 1 case with CSF leak, 1 case with epidural hematoma. The average time of follow-up was 31 months (range, 24 - 48 months). The correction rate was 61% on the coronal plane (from 108° to 42°), and the correction rate was 65% on the sagittal plane (from 82.0° to 28.7°). All patients had solid fusion at osteotomy site, and no instrumentational failure and loosening were found over the follow up.</p><p><b>CONCLUSION</b>single stage posterior VCD is an effective option to manage rigid scoliosis.</p>

An experimental study of correction of idiopathic-type scoliosis by staple / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of the correction idiopathic-type scoliosis by implanting the staple in growing animal models.</p><p><b>METHODS</b>Fourteen female goats were performed unilateral pedicle screws asymmetric tethering in left side in combination with right rib resection (age: 5 to 8 weeks, weight: 6 to 8 kg). The observing time was about 8 weeks. Goats that had been created scoliosis model successfully were classified in 2 groups randomly.</p><p><b>CONTROL GROUP</b>just removing the posterior tether, no treatment was offered. Correct group: the removing of posterior tether and the stapling of anterior spinal epiphysis were performed simultaneously. Dorsoventral and lateral plain radiographs were taken preoperatively and postoperatively. Serial X-ray postoperatively were performed every 4 weeks to measure the Cobb angle of the spine and to observe the condition of the insert. The observing time is about 8 weeks.</p><p><b>RESULTS</b>Radiography showed that 12 goats had created scoliosis model successfully. CONTROL GROUP (n = 6): Series X-ray show that the change of the Cobb angle was not obviously. The initial curves after the procedures measured an average of 40.8 degrees (28 degrees-56 degrees), the average Cobb angle was 42.5 degrees (30 degrees-58 degrees) after 8 weeks, no statistics difference are found (P > 0.05). Treatment group (n = 6): no complication such as pedicel screw break, instrument loosen, dislocation, injury of blood vessel, nerve injury and organ injury of thoracic cavity etc, were found during the observing period. The initial curves after the procedures measured an average of 44.5 degrees (36 degrees-57 degrees), to some degree, the Cobb angle decreased and the average was 42.5 degrees (30 degrees-58 degrees) after 8 weeks. There are statistics difference between the initial and final curves (P < 0.05).</p><p><b>CONCLUSION</b>As a means of mechanical modulation, stapling can be manipulate conveniently and safely, and can modulate the spinal growth of the animal model successfully, predicted that it may be a new selection for idiopathic-type scoliosis in growing children.</p>

Clinical outcomes of single level Bryan cervical disc arthroplasty: a prospective controlled study / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes of single level Bryan cervical disc replacement with traditional anterior cervical discectomy and fusion (ACDF).</p><p><b>METHODS</b>From Dec 2003 to May 2005, 59 patients with primary, single-level cervical radiculopathy and/or myelopathy were prospectively randomized into 2 groups: Bryan group with artificial disc replacement and ACDF group with traditional anterior cervical discectomy and fusion. Operation time, blood loss and hospitalization duration were compared between the 2 groups. Follow-up was taken at six weeks, 3, 6, 12 and 24 months after operation, and each case in both groups was evaluated with serial radiographic studies, neck disability indices (NDI), visual analog scale scores (VAS) for arm and neck pain.</p><p><b>RESULTS</b>No difference was found in the operation time, intraoperative blood loss and hospital stay between the 2 groups. But at the follow-up of 6 weeks and 3 months after operation, significant difference in NDI and VAS of neck pain existed. All replaced segments remained normal range of motion in sagittal rotation, while no motion occurred in any of the fusion segments. In ACDF group movement of the whole cervical spine decreased but gradually recovered to preoperative level in 6 months after operation. In Bryan group, pre- and postoperative motion of the whole cervical spine remained unchanged at any of the follow-up time.</p><p><b>CONCLUSIONS</b>Bryan disc replacement can achieve similar clinical improvement compared with traditional ACDF. Arthroplasty has the advantages of motion maintenance for the cervical spine and short recovery time after operation.</p>

Experimental study on controlling unilateral spine growth by shape memory alloy staple / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the effects that shape memory alloy (SMA) staples implanted to the lateral aspect of the thoracic vertebrae on spinal growth in goats.</p><p><b>METHODS</b>Sixteen goats (age 2 - 3 months) were divided into 3 groups: six in single staple group; six in double staples group and four in control group. Single staples group underwent right-side thoracotomy for exposing the thoracic spine through the eighth rib. Five SMA staples were placed laterally into vertebral bodies of T(6 - 11) spanning discs. Double staples group underwent the same operation. Laterally directed 10 SMA staples were placed into vertebrae of T(6 - 11) spanning discs and two staple spanning each disc. The last four goats in control groups just only underwent right-side thoracotomy. In the next 4 months after operation, radiographs were taken to observe the spinal growth every month.</p><p><b>RESULTS</b>The radiographic analysis demonstrated scoliosis of 12.83 degrees +/- 12.17 degrees in single staple group and 12.00 degrees +/- 3.22 degrees in double staple group after 2 months of the operation. Cobb angle of 6.00 degrees +/- 4.94 degrees and 25.17 degrees +/- 3.71 degrees were observed in the two groups respectively after 4 months of operation, as compared with 0 degrees in the control groups. Only 2 goats developed kyphosis.</p><p><b>CONCLUSIONS</b>Compression between vertebral bodies by SMA staples can depress spinal growth in the same side and greater compression result in larger curves.</p>