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Background@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*Methods@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*Results@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P < 0.001), PT (14.7 ± 1.8° vs. 29.1 ± 3.4°, t = -13.277, P < 0.001), and SS (39.8 ± 7.2° vs. 26.1 ± 3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*Conclusions@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.
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BACKGROUND@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*METHODS@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*RESULTS@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*CONCLUSIONS@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.
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Objective To investigate the feasibility to execute percutaneous kyphoplasty(PKP) in the field comprehensive surgical shelter during kinds of natural disasters. Methods Five experimental pigs underwent PKP in a comprehensive surgical shelter during simulated natural disasters, and were observed for operating time, intraoperative blood loss, complications and postoperative survival rate. Results All the 5 pigs had the operations completed successfully with high postoperative performances in extremities motion and survival rate, and the mean operating time was(43±5.7)min and the mean intraoperative blood loss was (42±3.6)ml.Cement penetrated into the intervertebral space of one pig with satisfactory extremities motion,while no complications occurred in the other pigs.Conclusion The comprehensive surgical shelter proves to enable PKP,and thus extends emergency treatment to the frontier during simulated natural disasters.
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Objective To evaluate the accuracy and safety of pedicle screw placement for spinal deformity under intraoperative CT-as-sisted.Methods The clinical data of 28 patients with spinal deformity,who underwent intraoperative CT-assisted placement of pedicle screws in our hospital from March 2014 to March 2017,were analyzed retrospectively.Intraoperative CT-assisted placement of pedicle screws was to observe the position of pedicle screws and adjust the screw position.The safety of pedicle screw fixation was assessed by the postoperative complications.Results All 28 patients of scoliosis were successfully performed surgery.A total of 402 pedicle screws were placed in the spines and the placements of 64 screws of them were adjusted according to intraoperative CT findings.Of 402 screws,377 were placed in the pedicles,13 by grade 1 pedicle breach,8 by grade 2 pedicle breach and 4 by grade 3 pedicle breach according to Gertzbein-Robbins classifi-cation of pedicle screw placement accuracy.No complication was directly related to the screws placement.No patient required reoperation due to the misplacement of the pedicle screws.Conclusion Intraoperative cone-beam CT scan can help the surgeon improve the accuracy and safety of pedicle screw placement for spinal deformity with less complication.
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Objective To investigate the value of intraoperative X-ray guided and CT guided percutaneous biopsy in the diagnosis of thoracic and lumbar space occupying lesions.Methods A total of 97 patients with thoracic and lumbar space occupying lesions who were not diagnosed clinically in our hospital from May 2011 to July 2016 were retrospectively analyzed.All patients underwent percutaneous vertebral biopsy under the guidance of Artis-Zeego robot in the Artis-Zeego complex operating room of our hospital.Thoracic vertebral body biopsy in patients with a total of 46 cases were divided into T group,in which X-ray guided percutaneous biopsy in 25 cases were divided into T-x group,CT guided percutaneous biopsy in 21 cases were divided into T-ct group.Lumbar puncture biopsy in patients with a total of 51 cases were divided into L group,in which X-ray guided percutaneous live review of 24 cases were divided into L-x group,CT guided percutaneous biopsy in 27 cases were divided into L-ct group.According to the packet respectively in X-ray or CT monitoring,the use of bone biopsy needle under local anesthesia,transpedicular approach for spinal lesions of bone amount,by changing the working path or direction bone biopsy needle of different diameter to save drilling samples which were immediately placed in 10％ formalin,specimens were sent for pathological examination and corresponding pathological and cytological examination.The success rate,diagnostic accuracy and complications of percutaneous biopsy were compared between the two groups in X-ray and CT guided percutaneous vertebral biopsy.Results T-x group of 25 patients,5 patients with puncture failure for intraoperative X-ray monitoring difficulties were transferred to puncture under the guidance of CT,the success rate of puncture was 80％ (20/25).Of the patients with success puncture,6 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy in T-x group was 70％ (14/20).The success rate of puncture in T-ct group was 100％,significantly higher than that of T-x group(P ＜ 0.05).In T-ct group,3 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy was 88.5 ％ (23/26),which was significantly higher than that of T-x group (P ＜ 0.05).In the L-x group,1 case with puncture failure for pain during the operation,the success rate of puncture was 95.8％ (23/24),patients of L-ct group were successfully punctured,the success rate was 100％,the difference between the two groups was not significant(P ＞ 0.05).In the L-x group,2 patients failed to confirm the diagnosis,the diagnostic total accuracy rate of L-x group was 87.5％ (21/23);of the L-ct group,1 cases failed to confirm the diagnosis,the diagnosis total accuracy rate of L-ct group was 96.3％ (26/27),the difference between two groups was not significant (P ＞ 0.05).Complications:In the T-x group,1 cases received additional local anesthetic after puncture for pain;1 patients had transient lower extremity paresthesia,and the symptoms were improved 1 weeks later;1 case with intraoperation puncture site paining was not alleviated and had to stop the puncture.All patients with CT guided biopsy had no complications.Conclusion CT and X-ray guided percutaneous biopsy has important significance in diagnosis and treatment of spinal lesions,and CT guided percutaneous biopsy is safer for thoracic lesions with higher diagnostic rate,while for lumbar lesions fluoroscopy,X-ray or CT guided percutaneous biopsy has the same security and diagnostic rate.
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Objective To discuss the clinical curative effect of percutaneous vertebroplasty(PVP)combined with percutaneous pedicle screw fixation for thoracolumbar fracture.Methods Retrospectively analyzed the clinical data of 43 patients with thoracolumbar fracture who underwent PVP combined with percutaneous pedicle screw fixation in our hospital from November 2015 to June 2017.Those patients included 28 males and 15 females,and the age of patients ranged from 50 to 66 years old,with an average age of(58.26 ±3.67)years old.The func-tional outcome were evaluated by VAS scores and ODI scores before and after the operation.The sagittal Cobb angle was used to evaluate the reduction of fracture.Results All these patients all successfully completed the operation,and there was no complications after operation.The operation time ranged from 60 to 126 min,with an average time of(96.07 ±15.69)min;the blood loss ranged from 60 to 180 min,with an average time of(113.26 ±24.7)min.All the patients were followed up for 4 to 23 months,with an average time of(12.07 ±4.01)months. The VAS score,ODI score and sagittal Cobb angle were significantly decreased in the last follow -up period compared with those before surgery,and the difference was statistically significant(P<0.05).Conclusion PVP combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture has smaller incision,less blood loss,shorter operation time and better improvement of local pain,func-tional movement and kyphosis.
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Objective To evaluate the accuracy and safety of screw placement position through second sacral alar -iliac(S2AI)with in-teroperative cone beam CT(CBCT)scan.Methods Collected 22 patients who underwent second sacral alar-iliac screw implant surgery in our hospital from June 2015 to June 2017.All the patients had intraoperative CBCT scan and conventional CT scan after operation.Regard the postoperative CT scan imageing as gold standard to assess the accuracy and safety of S 2AI screws position.The S2AI tract parameters were measured with intraoperative CBCT images and postoperative CT images respectively.Results There was no significant difference between the S2AI tract parameters which were measured with intraoperative CBCT images and postoperative CT images(P>0.05).Conclusion The intraoperative CBCT scan could accurately evaluate the position of S 2AI screws,as well as clarify the damage of the inner and outer plate of the iliac bone in the process of fixation.Compared with postoperative conventional CT scan,the intraoperative CBCT scan can potentially re-duce the reoperation rate.
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<p><b>OBJECTIVE</b>To provide evidence-based recommendations for clinical application and provoke thoughts for future researchers by conducting a comprehensive summary and evaluation of the current evidence profile for the role of Chinese medicine (CM) in treating myocardial infarction (MI).</p><p><b>METHODS</b>Online databases including PubMed, EMBase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Medicine (CBM), VIP Journal Integration Platform, and Wanfang database were systematically searched for literatures on CM in treating MI. After screening, studies were categorized into 5 types, i.e. systematic review (SR), randomized controlled trial (RCT), observational study, case report and basic research. General information was abstracted, and the quality levels of these studies and their conclusions were summarized and assessed.</p><p><b>RESULTS</b>A total of 452 studies including 10 SRs, 123 RCTs, 47 observational studies, 28 case reports, and 244 basic researches were selected. Clinical studies centered primarily on herbal decoction and mostly were not rigorously performed. High-quality studies were predominantly on Chinese patent medicines (CPMs) such as Danshen Injection (), Shenmai Injection (), Shengmai Injection () and Qishen Yiqi Dripping Pills (). The most frequently observed pattern of drug combination was decoction plus injection. Results of SRs and clinical studies showed that CM may reduce mortality, decrease risk of complication, reduce myocardial injury, improve cardiac function and inhibit ventricular remodeling. Findings from basic researches also supported the positive role of CM in reducing infarct size and myocardial injury, promoting angiogenesis, preventing ventricular remodeling and improving cardiac function. According to the current evidence body, CM has proven effects in the prevention and treatment of MI. It is also found that the effects of CPMs vary with indications. For instance, Shenmai Injection has been found to be especially effective for reducing the incidence of acute clinical events, while CPMs with qi-nourishing and bloodcirculating properties have been proven to be effective in inhibiting ventricular remodeling. High quality evidence supports the use of CM injection for acute MI and CPM for secondary prevention. Reports on adverse events and other safety outcomes associated with CM for MI are scarce.</p><p><b>CONCLUSIONS</b>Sufficient evidence supported the use of CM as an adjuvant to Western medicine for preventing and treating MI. The choice of drug use varies with disease stage and treatment objective. However, the quality of the evidence body remains to be enhanced.</p>
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Objective To evaluate the safety and effectiveness of percutaneous alcohol embolization(PAE) combined with percutaneous vertebroplasty(PVP) for aggressive vertebral haemangiomas (AVHs) with epidural extension.Methods The data of 26 consecutive patients underwent PAE combined with PVP for the treatment of AVHs with epidural extension from October 2013 to November 2015 were analyzed retrospectively.The average follow-up time was (12.21 ± 1.34) months.The pain symptom before and after surgery were evaluated with a visual analogue scale (VAS).Results Pre-procedure mean VAS score was (7.23 ± 1.3) and the postoperative VAS score was (3.11 ± 1.9) at last follow-up.Ten patients (38.5％) remained asymptomatic.Eighty-eight percent of the patients with neurosensory disorders had complete regression of these symptoms.Two of the three patients with motor deficit did not show any improvement.No major complication was recorded.Conclusion PAE combined with PVP is a minimally invasive safe and effective therapeutic approach for AVH with epidural extension.This technique appears mainly effective for pain and neurosensory symptoms,but seems less effective for motor deficit relief.
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Objective To analyze the clinical features and operative treatment of traumatic cervical spinal fractures in order to improve the prevention and surgical treatment.Methods A review of 324 cases of traumatic cervical spinal fractures admitted to general hospital of Shenyang military area command from January 2006 to December 2015 was performed to analyze their statistical epidemiology.Data included age,gender,etiologies of trauma,anatomical distribution,ASIA classification of neurological deficit and associated injuries.Results The ages of 324 patients ranged from 18 to 85 years,with a mean value of 43.8 years,70.4％ of all the patients (228/324) received operations,the 30 to 39 year-old patients formed the largest group,accounting for about 27.2％ (88/324).Combined cervical and other segments fracture accounting for about 8.0％ (26/324),among which combined cervical and thoracic spine fracture,combined cervical and lumbar spine fracture,combined cervical,thoracic and lumbar spine fracture accounted for 5.9％ (19/324),1.5％ (5/324),0.6％ (2/324) respectively.The frequency of neurological deficit (65.1％),frequency of complications (4.7 ％) was the largest in the ≥ 60 year-old patients group.The frequency of combined injuries(34.2％) was the largest in the 40 to 49 year-old patients group.High fall,road traffic accident and low fall were the most common etiologies,accounting for 34.6 ％ (112/324),32.1％ (104/324) and 18.8 ％ (61/324) respectively.The sex ratio (7.7 ％),frequency of neurological deficit (92.3％) and frequency of combined injuries (34.6％) were the largest in the patients caused by struck by object group.Among 228 patients who received operations,47 patients presented with ASIA A,12 patients with ASIA B,29 patients with ASIA C,63 patients with ASIA D and 77 patients with ASIA E before operation.After operations,46 patients presented with ASIA A,7 patients with ASIA B,23 patients with ASIA C,53 patients with ASIA D and 99 patients with ASIA E.There were 38 patients(16.7％) had got 1 to 2 grade recovery.Conclusion The epidemiological survey of traumatic cervical spinal fractures reveals that the 30 to 39 year-old patients and high fall was the most common age and etiology for injuries of cervical spinal fracture.The ≥60 year-old patients group and struck by object group presented with the highest frequency of neurological deficit,operation can improve the recovery of neurological deficit,the prevention and treatment should be designed according to the injury features of different individuals.
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<p><b>OBJECTIVE</b>To elucidate whether ZFP580 is involved in the cardioprotective effects of intermittent hypobaric hypoxia (IHH) against myocardial ischemia/reperfusion (I/R) injury.</p><p><b>METHODS</b>Thirty two male Wistar rats were randomly divided into 2 groups (n = 16): normoxia control group and IHH preconditioning group. Rats in IHH group were exposed in a hypobaric chamber (equivalent to an altitude of 5 000 m) for a 6 h period each day for 42 d. Plasma was collected and lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) were measured after 2 h of myocardial I/R injury. ZFP580 protein expression in myocardial tissue was assayed by Western blot. Other 8 rats in each group were used to evaluate I/R-induced cardiac infarction by TTC staining. Lentivirus-mediated gene transfection was performed in H9c2 cells 72 h prior to simulated ischemia/reperfusion (SI/R) exposure. The degree of cell apoptosis was determined by annexin V/7-AAD staining and flow cytometry analysis.</p><p><b>RESULTS</b>Compared with normoxia control group, adaptation to IHH attenuated infarct size and plasma leakage of LDH and CK-MB. In addition, ZFP580 expression in the myocardium was up-regulated by IHH. The results of gene transfection showed that ZFP580 overexpression significantly inhibited cells apoptosis induced by SI/R.</p><p><b>CONCLUSION</b>Our findings demonstrate that the cardioprotective effect of IHH against I/R injury is mediated via ZFP580, a novel transcription factor, with anti-apoptotic roles in myocardial cells.</p>
Subject(s)
Animals , Male , Rats , Apoptosis , Cell Line , Creatine Kinase, MB Form , Metabolism , Hypoxia , L-Lactate Dehydrogenase , Metabolism , Myocardial Reperfusion Injury , Myocardium , Metabolism , Myocytes, Cardiac , Cell Biology , Rats, Wistar , Transcription Factors , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To explore the role of toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4) in myocardial ischemia/reperfusion injury (MI/RI) by observing the dynamic expression changes at mRNA and protein levels early after myocardial ischemia/reperfusion (I/ R).</p><p><b>METHODS</b>The Wistar rats were randomly divided into Sham and I/R group (n = 42), and killed according to different reperfusion time (1, 2, 4, 6, 12, 24 h and 7 d). Structural and morphous changes of myocytes were observed under optical microscope. The mRNA and protein levels of TLR2 and TLR4 were detected using real-time PCR (RT-PCR). Monocyte chemokine protein-1 (MCP-1) and interleukine-6 (IL-6) mRNA levels were measured by reverse transcriptase-polymerase chain reaction (rt-PCR).</p><p><b>RESULTS</b>(1) With the extension of reperfusion time, the myocardial infarct size increased smoothly, and reached the plateau at 4 h, then stayed in the platform. After reperfusion for 7 d, the ventricular had been remodeled. (2) At the beginning of reperfusion, myocardial structure showed no significant change in Sham group, but had different degrees of injury in I/R group. In rats of the group reperfused for 7 d the left ventricular remodeling could be visible. (3) Compared to sham group,TIR2, TLR4, MCP-1, IL-6 mRNA level were increased in myocardium in I/R group. TLR2 and TLR4 both peaked at 4 h of reperfusion, IL6 peaked at 6 h, followed by a gradually decrease. TLR4 and IL-6 mRNA levels rose again at 7 d. MCP-1 level in I/R group remained fairly with sham group at the beginning of reperfusion, and markedly elevated at 7 d.</p><p><b>CONCLUSION</b>Expression of TLRs mRNA in myocardium during early after myocardial ischemia/reperfusion increased rapidly and activated TLRs might play an important role in MI/RI through promoting the generation of inflammatory factors. At the late reperfusion, TLRs levels raise again and the expression of inflammatory factors increase once again, Those may probably affect the remodeling of ventricular, and injure myocardial structure and function.</p>
Subject(s)
Animals , Male , Rats , Chemokine CCL2 , Metabolism , Disease Models, Animal , Interleukin-6 , Metabolism , Myocardial Reperfusion Injury , Metabolism , Rats, Wistar , Toll-Like Receptor 2 , Metabolism , Toll-Like Receptor 4 , MetabolismABSTRACT
Based on the structure and function of acupoint and in association of the definition and principle of sensor, the acupoint is the sensitive element, being sensitive to the physical stimulation with acupuncture and moxibustion and sensitively responded to the disorders; the acupoint is the sensing element, transforming the changes of the acupoint information via the complicated internet conduction, integration and regulation, so as to generate the effects on organic body; the acupoint is the conversion element, transforming every irritation into the bioelectric signal or optical signal so that the organic body could recognize it. Therefore, the acupoint is regarded as the sensor of information in the organic body.
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Humans , Acupuncture Points , Electrophysiological Phenomena , MeridiansABSTRACT
Objective To evaluate biomechanical properties of internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate in reconstructing stability of the upper cervical vertebra, and compare them with conventionally used anterior internal fixation after C2-3 intervertebral fusion and posterior internal fixation by C2 transpedicle screws. MethodsSix fresh human upper cervical vertebra specimens (including C2-4) were divided into five groups: the intact specimen group(control group), the incision of the C2-3 group (Hangman group), the posterior internal fixation by C2 transpedicle screw group (posterior fixation group), the anterior internal fixation after C2-3 intervertebral fusion with Zephir plate group (anterior fixation group), and the internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate group (C2-4 incision +internal fixation group). Range of motion (ROM) of the C2-3 and C3-4 segments was tested respectively under 0.5, 1.5 and 2.5 N•m moment by measurement system for three-dimensional spinal movement, and the statistical analysis was also conducted. Results(1) C2-3 segment: ROM of anterior fixation group and C2-4 incision +internal fixation group was significantly smaller than that of Hangman group and posterior fixation group in all six directions under various loading conditions (P<0.05); there was no significant difference between anterior fixation group and C2-4 incision +internal fixation group. ROM of posterior fixation group was larger than that of intact group in all six directions under various loading conditions (P<0.05); There was no significant difference in flexion and extension direction under all loading conditions between posterior fixation group and Hangman group, but significant difference was found in left/right and right/left axial rotation and under 2.5 N•m moment between posterior fixation group and Hangman group (P<0.05). (2) C3-4 segment: there was no significant difference in ROM in six directions under various loading conditions among all groups except for C2-4 incision +internal fixation group. ROM of C2-4 incision +internal fixation group was significantly smaller than that of other groups in all six direction (P<0.05). Although ROM of anterior fixation group was slightly larger than that of Hangman group and posterior fixation group, the difference was not statistically significant. Conclusions From the view of biomechanics, internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate is a better surgical option for stabilizing the fracture than that of posterior internal fixation by C2 transpedicle screws to treat type II Hangman fracture with C2-3 intervertebral disc injury.
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<p><b>OBJECTIVE</b>To choose a proper method of lumbar transpedicular screw fixation at different lumbar levels among the three methods (Roy-Camille's method, Magerl's method and Du's method) in the Chinese population.</p><p><b>METHODS</b>Three-dimensional (3-D) images were reconstructed with image data of 42 adult lumbar segments that were scanned by Electron Beam CT. The three methods of lumbar pedicle screw fixation were simulated on the 3-D reconstructed images and the parameters of implanting pedicle screws were measured.</p><p><b>RESULTS</b>There was statistically significant difference at the distance from the entrance point to the pedicle axis between the three methods (P<0.001). The distances measured by Du's method were shortest from L1 to L4, and the distances measured by Magerl's method were shortest at L5 (P<0.05). There was no significant difference from L1 to L2 (P >0.05) but significant difference from L3 to L5 at inserting safe ranges of TSA (transverse section angle) was found between the three methods (P<0.05). From L3 to L4, the inserting safe ranges of TSA measured by Du's and Magerl's methods were significantly larger than that measured by Roy-Camille's method (P<0.05), but there was no significant difference between them (P>0.05). At L5, the inserting safe ranges of TSA measured by Magerl's method were largest among the three methods (P<0.05).</p><p><b>CONCLUSIONS</b>Among the three methods, Du's method is the best choice from L1 to L4 because its distance from the entrance point to the pedicle axis is shortest and the safe range of TSA is largest; Magerl's method can be used from L3 to L5 and is the best choice at L5; Roy-Camille's method is applicable at L1 and L2.</p>