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Objective:To explore the difference and clinical significance of paraspinal muscle degeneration between single-segment degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis.Methods:From January 2014 to October 2020, a retrospective analysis of 30 patientswere diagnosed with L 4,5 degenerative lumbar spondylolisthesis, aged 61.63±8.42 years old (range 44 to 82 years old), body mass index 24.07±3.17 kg/m 2 and 30 patientswere diagnosed with L 4,5 degenerative lumbar spinal stenosis, aged 59.67±12.89 years old (range 31 to 80 years old), body mass index 25.29±3.48kg/m 2, both of them went on surgery in department of spine surgery, shengjing hospital, China Medical University.30 healthy people were selected from outpatient physical examination in the control group, aged 58.33±7.36 years old (range 52 to 83 years old), body mass index 25.72±2.58 kg/m 2. These three groups were all male. Select all patients with L 3,4, L 4,5 and L 5S 1 disc level axial MRI images, and use the deep learning automatic segmentation measurement system developed by our hospital and Shenyang Institute of Automation Chinese Academy of Sciences to measure multifidus muscle cross sectional area (MMCSA), erector spinae cross sectional area (ESCSA), multifidus muscle fatty infiltration rate (MMFIR) and erector spinae fatty infiltration rate (ESFIR). One-way ANOVA was used to test the imaging parameters of multifidus and erector spinae of the three groups, and LSD- t test was used to compare the imaging parameters in each segment of paraspinal muscles. Results:The gender of three groups were male, there was no significant difference in age ( H=5.303, P>0.05), and there was no significant difference in body mass index ( F=2.267, P>0.05). Multifidus muscle cross-sectional area in L 3,4: degenerative lumbar spondylolisthesis groupincreased 189.11 mm 2 compared with degenerative lumbar spinal stenosis group ( P=0.010). Multifidus muscle cross-sectional area in L 4,5: compared with healthy people group, degenerative lumbar spondylolisthesis group decreased 205.52 mm 2 ( P=0.002), while degenerative lumbar spinal stenosis group decreased 184.14 mm 2 ( P=0.006). Multifidus muscle cross-sectional area in L 5S 1: compared with degenerative lumbar spinal stenosis group, degenerative lumbar spondylolisthesis group decreased 174.93 mm 2 ( P=0.018); compared with healthy people group, degenerative lumbar spondylolisthesis group decreased 406.06 mm 2 ( P<0.001), while degenerative lumbar spinal stenosis group decreased 231.13 mm 2 ( P=0.002). Erector spinae cross sectional area in L 4,5: compared with healthy people group, degenerative lumbar spinal stenosis group decreased 398.70 mm 2 ( P=0.006). Erector spinae cross sectional area in L 5S 1: compared with degenerative lumbar spinal stenosis group, degenerative lumbar spondylolisthesis group decreased 500.02 mm 2 ( P<0.001); compared with healthy people group, degenerative lumbar spinal stenosis group decreased 455.37 mm 2 ( P<0.001). Compared with healthy group, the multifidus muscle fatty infiltration rate of degenerative lumbar spondylolisthesis group in L 3,4 increased 4.96% ( P=0.001). Compared with degenerative lumbar spinal stenosis group, the erector spinae fatty infiltration rate of degenerative lumbar spondylolisthesis group in L 5S 1 decreased 5.41% ( P=0.004). Compared with healthy group, the erector spinae fatty infiltration rate of degenerative lumbarspinal stenosis group in L 5S 1 increased 5.02% ( P=0.008) . Conclusion:Paraspinal muscle cross sectional area of each segment in degenerative lumbar spondylolisthesis group and degenerative lumbar spinal stenosis group decreased in different degrees. In degenerative lumbar spondylolisthesis group, the degree of multifidus muscle fat infiltration was more significant, while indegenerative lumbar spinal stenosis group,the degree of erector spinal fat infiltration was higher.
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Objective To compare the feasibility and efficacy of intervertebral wedge osteotomy and pedicle subtraction osteotomy (PSO),vertebral column resection (VCR),Smith-Petersen osteotomy (SPO) for the treatment of severe kyphosis and scoliosis.Methods The data of 38 cases of severe kyphosis and kyphoscoliosis were retrospectively analyzed from January 2010 to February 2016,including 22 males and 16 females.According to the osteotomy mode,PSO,SPO,VCR and intervertebral disc wedge osteotomy were used to collect the average number of fixed phases,volume of bleeding,length of stay,length of hospital stay,improvement of main cobb angle,improvement of ODI score,and Frankel classification to evaluate the efficacy.Results There were no significant differences in the overall operative time between the four groups.The average number of fixation in 18 patients with SPO was (9.4±3.9) segments,the blood loss was (3 000±410) ml,the average Cobb angle was improved by 55.3％± 9.5％,the average postoperative hospitalization was (14.6±4.9) days,the improvement rate of ODI was 42.1％±7.4％,all the patients were improved to Frankel E;The average number of fixation in 5 patients with PSO was (7.6± 1.5) segments,the blood loss was (4 360± 1 161) ml,the average Cobb angle was improved by 58.9％ ± 15.1％,the average postoperative hospitalization was (18.2±7.0) days,the improvement rate of ODI was 41.3％±9.6％.One Frankel C patient was improved to Frankel D,others remained to be Frankel E as the same as pre-operation;The average number of fixation in 4 patients with VCR was (6.2±2.6) segments,the blood loss was (3 750+ 1 848) ml,the average Cobb angle was improved by 83.9％± 10.9％,the average postoperative hospitalization was (21±7.2) days,the improvement rate of ODI was 39.6％± 18.1％.Three Frankel D patients were improved to Frankel E and one Frankel C patient was improved to Frankel D;The average number of fixation in 11 patients with IWO was (7.1 ± 2.7) segments,the blood loss was (2855±1046) ml,the average Cobb angle was improved by 59.6％±22.05％,the average postoperative hospitalization was (13.5±2.7) days,the improvement rate of ODI was 51.3％±8.3％.One Frankel C patient was improved to Frankel D,eight Frankel D patients were improved to Frankel E,other patients remained to be Frankel E;The mean follow-up time was 25.2 months in 11 patients underwent intervertebral wedge osteotomy.All the patients had successful spinal fusion and no failure of internal fixation.Conclusion Intervertebral wedge osteotomy for the treatment of scoliosis and kyphosis could reduce surgical injury to obtain good biomechanics and surgical result.
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Objective To study the effect of different rod curvature on the postoperative stability and stress of thoracolumbar junction fracture using the finite element simulation.Methods (1) Thoracolumbar finite element model of T11 to L1 from three-dimensional CT data of a 30-year-old healthy male volunteer was established,including the assignment of cortical bone,cancellous bone,disc,ligaments and facet joints.On this basis,the T12fracture model was also established.T11 to L1 bilateral pedicle screw fixation was loaded,and the rod connection was divided into straight rod group and pre-bended rod group (lordotic 15°-25°) according to angle of the rod.A 400 N stress was loaded on the top of the upper endplate of T11 to simulate the upper part body gravity,while applying a 10 N · m torque to generate flexion and extension,lateral flexion and rotation.Stress distribution of different methods of pre-bending for thoracolumbar fractures after reduction was compared.(2) A retrospective cohort analysis was made on 56 cases of thoracolumbar fractures surgically treated from July 2012 to July 2016,including 31 cases in straight rod group and 25 cases in pre-bended rod group.Two groups were compared in angle between adjacent level before operation,after operation and at final follow-up.Results (1) In flexion,extension,lateral bending and rotation,both rod bending methods effectively controlled the thoracolumbar junction displacement.The peak stress of connecting rod (151,315,369,377 MPa respectively) in pre-bended rod group was lower than that in straight rod group (110,239,281,189 MPa respectively) (P ＜ 0.05),and straight rod group appeared relatively obvious stress concentration.(2) Mean follow-up time was 21.4 months (range,4-33 months).Preoperative kyphosis angle was (21.7 ± 7.4)°in straight rod group and (20.3 ± 6.8)° in pre-bended rod group (P ＞ 0.05).Postoperative lordosis angle in straight rod group was (3.3 ± 1.2) °versus (8.3 ± 2.8) ° in pre-bended rod group (P ＜ 0.05).At the final follow-up,the lordosis angle in straight rod group was reduced by (8.7 ± 2.3) ° versus (3.9 ± 1.7)°in pre-bended rod group (P ＜0.05).Implant failure was seen in 3 cases in straight rod group,but there was no implant failure in pre-bended rod group.Conclusion Pre-bended (lordotic 15°-25°) and pre-loaded rods used in internal fixation of thoracolumbar fractures may reduce the stress of rods,decrease the incidence of implant failure and facilitate the recovery of spine stability.
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<p><b>OBJECTIVE</b>To study the relationship between cervical pedicle and compressed spinal cord.</p><p><b>METHODS</b>One hundred and five patients (53 male,52 female,age from 29 to 80 years) with cervical spondylotic myelopathy who needed surgery were included from December 2011 to January 2013 in Shengjing Hospital. Plain MRI scan was used for cross section of C4 - C7 vertebral bodies parallel to the axis of bilateral pedicle, and the images were sent to the workstation. PACS system was applied to measure the anatomical parameters related to the security of cervical pedicle screw, including the shortest distance from medial left/right cervical pedicle to the cervical spinal cord (LH/RH), and the smallest angle between the longitudinal axis of left/right cervical pedicle and the screw which was assumed to just touch the cervical spinal cord (LSA/RSA). All these data in each segment were classified according to compression or not:with compression and without compression. Twelve cases were selected and measured by MRI and 3D cervical CT for spinal canal width D, namely the straight-line distance between the medial margins of cervical pedicle. And the results of two methods were compared to see whether there were statistical differences.</p><p><b>RESULTS</b>At C4, LH was (7.2±1.3) mm, RH was (6.7±1.4) mm, and the average was (6.9±1.4) mm; at C5, LH was (7.7±1.4) mm, RH was (6.7±1.4) mm, and the average was (7.2±1.5) mm; at C6, LH was (8.2±1.5) mm, RH was (6.9±1.3) mm, and the average was (7.5±1.5) mm; at C7, LH was (8.2±1.4) mm, RH was (7.3±2.1) mm, and the average was (7.7±1.8) mm. At C4, LSA was 34.4°±4.2°, RSA was 34.4°±5.2° and the average angle was 34.4°±4.7°; at C5, LSA was 35.9°±5.2°, RSA was 34.6°±5.4° and the average angle was 35.3°±5.3°; at C6, LSA was 37.4°±4.8°, RSA was 34.8°±4.8° and the average angle was 36.1°±5.0°; at C7, LSA was 39.2°±5.8°, RSA was 37.1°±5.2° and the average angle was 38.1°±5.6°; There were no statistically significant differences between segments with and without compression in H, SA and D (all P>0.05).</p><p><b>CONCLUSIONS</b>There is security space between the medial vertebral pedicle and compressed spinal cord. There is individual variation in security space. It is very necessary to identify security space before surgery by MRI, emphasize individual procedure and avoid spinal cord injury.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Screws , Cervical Vertebrae , Magnetic Resonance Imaging , Neck , Pedicle Screws , Spinal Cord Compression , General Surgery , Spinal Cord Diseases , Spinal Cord Injuries , SpineABSTRACT
ObjectiveTo identify the anatomical feasibility of cross screw fixation in the atlas via posterior arch,provide a reference for clinical applications.MethodsA total of 10 dry atlas specimens were used to measure anatomic data and three dimension(3D) CT data.The data included height of the posterior tubercle,width of the posterior arch,distance from the ideal point to the interior of the vertebral artery sulcus,from nail point to central line,and the ideal direction of the screws.Statistical analysis was done to compare the two methods.Then 100 3D CT data were measured.The parameters included height of the posterior tubercle (mid-sagittal plane),width of the posterior arch (the inner side where arch transformed to the vertebral artery sulcus),distance from the ideal point to the interior of the vertebral artery sulcus (where screws completely located in the medullary cavity),distance between the nail point to central line,and angle of the ideal screws (between screws and horizontal line).The anatomy of the atlas was analyzed for whether height of the posterior tubercle is more than 7 mm,width of the posterior arch is more than 3.5 mm,and whether or not cross screws can be planted.ResultsThere was no statistical difference between anatomic and 3D-CT measures.Thickness of the C1 laminar was (4.7±0.9) mm in the left side,(4.6±0.8) mm in the right side,and 93.5％ of specimens were thicker than 3.5 mm.Distance of the ideal screw was(15.9±3.0) mm in the left side,(15.9±3.0) mm in the right side.Height of the C1 posterior tuber was (7.8±1.2) mm,with 91％ of the data higher than 7.0 mm.Angle between the axial of C1 laminar and frontal plane was 26.8°±6.8° (8°-44°) in the left side,26.8°±6.3°(13°-44°) in the right side,and about 11％ of them can not cross plant.ConclusionIt is feasible and safe to place cross screws in the posterior arch of the C1 in anatomy.
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Objective To discuss the complication risk factors for early death after cervical injuries and explore the indication for treatment. Methods A retrospective study was carried out on early death and complications in 419 patients with cervical injuries admitted into our hospital. We observed the relationship of all kinds of complications with cervical cord injury severity and the incidence rate of complications in all patients. Results The respiratory complication was the main cause of early death, accounting for 79.11%. There found complications including hypoalbuminemia ( 85.29% ), hypotension(50%) and hyponatremia ( 35.29% ) in the death patients. Conclusions The existence of complications, especially hypoalbuminemia, can aggravate the original dysfunction and is the risk factor for early death. The early treatment of the dangerous complications could prevent multiple organ failure and early death and provide sound condition for functional recovery.
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Objective To study the safety and efficacy of transpedicular osteotomy en bloc lamina resection to treat thoracic spinal stenosis.Methods A retrospective study of 23 consecutive patients underwent transpedicular osteotomy en bloc lamina resection from June 2004 to December 2008,including 12 males and 11 females,with a mean age of 46 years(range,38-62 years)was conducted.The courses of diseases were 1.5 to 20 months with an average of 6.5 months.There were 18 cases caused by thoracic ossification of ligamentum flavum(OLF),4 cases caused by ossification of posterior longitudinal ligament(OPLL)and 1 case caused chondroma.Preoperative CT and MRI examinations showed that all patients got spinal cord compression.Preoperative ASIA Grade was A for 1 case,B for 3 cases,C for 7 cases and D for 13 cases.Postoperative neurological status was evaluated by ASIA grade system.Results The postoperative follow-up duration ranged from 16 to 58 months(mean 30 months).The operation time varied from 90 to 210 min,with the average of 163 min.Blood loss varied from 600 to 3200 ml,with the average of 2150 ml.Pedicle screws were used in 10 cases with T9-T12 stenosis,and dura excisions were repaired by lumbodorsal fascia in 5 cases.Cerebrospinal fluid leakage occurred in 2 cases.Postoperative ASIA grade showed that there was A for 1 case,B for 2 cases,C for 2 cases,D for 5 cases and E for 13 cases.Conclusion Transpedicular osteotomy is a good approach,which avoid sclerotic cortex and ossified ligamentum flavum,to resect en bloc lamina with with shorter operative time and less blood loss.
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Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures (Aderson ⅡC), three with rapture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pedicle screws and 26 pedicle screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vertebral artery and spinal cord was observed. All patients were followed up for 4-25 months (mean 13 months). The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% (mean 81%). The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-aflantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.