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Objective To analyze the clinical results and early complications of corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior approach for severe thoracic and lumbar fractures.Methods Forty-four patients treated by reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior were studied retrospectively.There were 35 males and 9 females,with an average age of 37.3 years(range,19-66 years).The injury segments include 1 case at T11,5 cases at T12,20 cases at L1,11 cases at L2,5 cases at L3 and 2 cases at L4.According to AO classification,there were 24 cases of A3,17 cases of B1 and B2,and 3 cases of C1.According to ASIA,there were 10 cases of grade A,17 cases of grade B,10 cases of grade C and 7 cases of grade D.The neurologic function and effectiveness of correction of preoperative,immediate postoperative and 2years follow-up were compared,and the clinical outcome and early complications were analyzed.Results The follow-up time was 24 to 58 months,mean 38.9 months.At the time of 2 years postoperation,43 cases of incomplete neurologic deficit had improved 1 or 2 ASIA grades except 1 case of grade A.The results of decompression and reduction were satisfactory from the postoperative radiographic examinations.The correction maintained well and the implant loosening was not seen in 43 cases(97.7%)at the last follow-up.The com plications include:excessive blood loss(＞1500 ml)in 9 cases,transient nerve root injury in 4,cerebrospinal fluid leakage in 3,instrumentation failure in 1,mesh cage malposition in 3,iatrogenic leaving of free bone granula into the canal in 2,and superficial infection in 1.Conclusion This technique is effective for decompression and fusion,less invasive than combined anteroposterior procedure,and may be another good alternative for the treatment of severe thoracic and lumbar fractures.The early complications are not rare,but most of them are not serious and are relative to techniques.
ABSTRACT
Objective: To explore and evaluate the biomechanic relationships between different depth of pedicle screw penetration with the sagittal plane reconstruction in thoracolumbar fracture. Methods:Six fresh cadaveric specimens of lumbar spine from L_1 to L_3 were used to make the model of thoracolumbar fracture. The system of universal spine system( USS )pedicle screw was adopted with the 6 mm diameter of screw. Each of two Schanz screws was implanted into the pedicles of L_1 and L_3 A canulated screw was fixed into the former of vertebral body in L_1 and L_3, and the distance of the two canulated screws was taken as the normal height. The axial loads were given while the pedicle screws were implanted at the depth of D1, D2 and D3, and the distance of the two canulated screw was measured as well as the distance was reduced to the normal height by axial load. The index measured included of the depth of pedicle screw penetration, the height of fractured vertebral body and afterload. Results: Along with the increasing of afterload, the height of injured vertebral body was increased accordingly, but the extent was different at three depth of pedicle screw penetration (D1, D2, and D3). While the injured vertebral body was reduced totally (reduced distance 0.00 mm), there was (2 630±13) g of afterload needed in Dl depth, and (2 339±61) g and(2 221± 164) g of afterload in D2 and D3 depth respectively. There was significant difference in distance between D1, D2 and D3 (P 0.05). Conclusion: There is a relationship in the depth of pedicle screw penetration, the capacity of reduction and sagittal plane reconstruction. The depth of pedicle screw had a significant effect on the capacity of reduction for the injured vertebral body, which would be the best option in biomechanics when the pedicle screw was implanted more than 1/2 pedicle or all of it.
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Objective: To explore the effect of umbilical cord blood stem cell transplantation on axon regeneration in spinal cord injury (SCl)in rats. Methods: The umbilical cord blood was collected and prepared into suitable concentration of CD34 positive stem cells. Thirty SD rats were divided into two groups randomly. One group served as control, another one was the treatment group. The models of spinal cord contusion injury were made by Allen's weight dropping method. One week later,the treatment group was transplanted with 10x105 umbilical cord blood stem cells with Hamilton micro-syringe at the sites of rostral and caudal to the lesioned zone respectively, while control group received just the same volume of PBS injection. Five rats in each group were sacrificed at 1 w, 2 w and 6 w after this operation. Histological and immunohistochemieal examinations including GAP-43 and NF200 were used to evaluate axon regeneration. Meanwhile, BBB motion scoring and inclined plane test were performed to assess the motion function changes of hindlimbs. Results: Compared to the control group, the area of cavity in the lesioned spinal cord region decreased significantly and the expressions of GAP-43 and NF200 increased markedly in cell transplantation group. Also the motion function had better restoration in the treatment group. Conclusion: Transplantation of umbilical cord blood stem cell may achieve both morphological and behavioral improvement for the injured spinal cord.
ABSTRACT
Although the development of diagnosis and treatment about degenerative scoliosis has improved significantly,it still remains controversial about how to select appropriate surgical methods.The goal of this review is to raise awareness and stimulate attention on the correlation between clinical manifestation and spinal deformity,which is one of the key factors to affect the surgical outcomes on the opinion of more and more researchers in the past 20 years.When an adult spinal deformity is not the source of symptoms and the clinical symptom is outside of curve,symptomatic relief may be provided through limited decompression.If thoroughly decompression,it will be enough to combine with short segment fixation.However,while an adult deformity is the source of symptoms and the clinical symptoms is within the curve,the options are typically limited decompression on the basis of good stability,otherwise,it will be the only consideration of decompression combined with long segment fixation.