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Objective:To investigate the relationship of osteoporotic vertebral body compression fracture(OVCF)with multifidus muscle and intervertebral disc degeneration in the lower lumbar spine and the lumbar-pelvic parameters in elderly women.Methods:Clinical data of a total of 108 elderly women with osteoporosis were retrospectively analyzed.They were divided into the fracture group(n=56)and the control group(n=52)according to the presence of vertebral body compression fractures.Age, body mass index(BMI)and bone mineral density(BMD)were collected in two groups.The angle of pelvic incidence(PI), angle of pelvic tilt(PT), low lumbar lordosis(LLL)and sacral slope(SS)were measured by the standing lumbar lateral X-ray photography.The degree of degeneration of intervertebral disc L 3-S 1 and multifidus muscle were detected by using the lumbar MRI.These parameters were compared between the two groups. Results:The age, BMI and BMD had no significant difference between the two groups( P>0.05). The degree of intervertebral disc degeneration of L 3-L 4 and L 4-L 5 was statistically significant higher in the fracture group than in the control group( Z=-4.656 and -2.675, P=0.000 and 0.007), while the degree of intervertebral disc degeneration of L 5-S 1 had no statistically significant difference between the two groups( Z=-1.784, P=0.075). There were statistically significant higher multifidus muscle degeneration of L 3-L 4 and L 4-L 5 in the fracture group than in the control group( Z=-3.248 and -4.073, P=0.001 and 0.000), while no significant difference between the two groups in multifidus muscle degeneration of L 5-S 1( Z=-1.096, P=0.282). No statistically significant differences were found in PI, PT, SS and LLL between the two groups( t=1.162, 0.827, -0.082 and -0.677, P=0.248, 0.410, 0.935 and 0.500). Conclusions:The degeneration of intervertebral disc and multifidus muscle of L 3-L 4 and L 4-L 5 is positively correlated with OVCF in elderly women.
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Objective To explore the feasibility and clinical efficacy of modified transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis with lumbar instability in the elderly.Methods Retrospective study was done on 45 elderly patients diagnosed as lumbar spinal stenosis with lumbar instability treated by modified transforaminal lumbar interbody fusion from June 2011 to December 2012.There were 25 males and 20 females aged from 65 to 78 years [mean (70.64.0) years].The operation time,blood loss,and complications were recorded and analyzed.The visual analog scale (VAS) score,and Japanese Orthopaedic Association (JOA) score were used to assess clinical outcomes before and 3 months after treatment and at the last follow-up.According to the criteria of Brantigan-Steffe,intervertebral fusion was evaluated.Results The operation of 45 patients was successful,and there were no severe complication.The average operative time was (126 23) min,(range,100～ 185 min),and the average amount of blood loss was (272±89) ml (range,180-550 ml).There was no injury of nerve root,dural tear,or deep infection.All patients were followed up for 12 months to 30 months with an average of (20.6±5.8) months.The VAS score of low back pain was decreased from (4.8 ± 1.7) before operation to (1.6 ± 0.5) at 3 months after operation and (1.3±0.3) at last follow-up.The VAS score of leg pain was decreased from (6.7±1.6) before operation to (1.2±0.5) at 3 months after operation and (0.6±0.3) at last follow-up.The JOA score was increased from (13.2±4.9) before operation to (23.8±4.0) at 3 months after operation and (24.1 4.2) at last follow-up.There were significant differences in the VAS score and JOA score between pre-and post-operation (F=68.35,98.58,89.73,all P＜0.05),but no significant difference between 3 months after operation and final follow-up (all P ＞ 0.05).We observed no pedicle screw loosening,breaking,orany pullingout of intervertebral fusion cage.All patients showed evidence of fusion in each operated segment according to the criteria of BrantiganSteffe.Conclusions Modified transforaminal lumbar interbody fusion has the advantages including less invasion,sufficient decompression,and less interference to neural structures,and it may provide an ideal surgical method for lumbar spinal stenosis with lumbar instability in the elderly.
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Objective To observe the fusion rate by using cage filled with osteophyte in anterior cervical disectomy and fusion.Methods From January 2010 to July 2012,81 patients receiving anterior cervical disectomy and spine fusion underwent treatment with cages containing exclusively autologous osteophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space.There were 52 males and 29 females,aged from 55 to 78 years,average 64.1 years in this study.46 patients received one-level fusion,and 35 patients received two-level fusion respectively.Patients were followed up at 3 months,6 months and 1 year after operation.The fusion was evaluated by X-ray film and reconstructive CT.Results The total fusion rate after 3 months of operation was 76.5％ (62/81),the one-level and two-level fusion rate were 78.3％ (36/46) and 74.3％ (26/35),respectively.The total fusion rate after 6 months of operation was 93.8％ (76/81),the one-level and two-level fusion rate were 95.7％ (44/46) and 91.4％ (32/35),respectively.The total fusion rate was 100％ (81/81) after 1 year of operation.No statistically significant difference in fusion rate was found between the two groups.Conclusions The method of using cage filled with osteophyte can acquire ideal fusion rate in one-and two-level anterior cervical disectomy,fusion and plate fixation.
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Objective To discuss the feasibility and the effects of percutaneous vertebroplasty (PVP) in the treatment of the osteoporotic compression fracture in theupper and middle thoracic vertebrae.Methods The study included 101 patients.55 cases were treated with PVP (observation group) and 46 cases were treated with conservative treatment (control group).The clinical efficacy of those two different treatment methods was evaluated by the changes of VAS score,ODI score,vertebral height and Cobb angle before versus after treatment.Results VAS and ODI scores at 48 hours and 6 weeks after treatment was significantly lower in observation group than in the control group (all P＜0.05).Although there was no significant difference in VAS and ODI scores between the two groups after 6 months of treatment (both P＞0.05),the anterior and middle vertebral height was decreased and Cobb angle of spine was increased in control group as compared with observation group (both P＜ 0.05).Conclusions PVP is an effective and safe method in the treatment of osteoporotic vertebral compression fractures in upper and middle thoracic vertebrae.The short-and long-term evaluation indexes are better in PVP than in conservative treatment.But the surgery should be proceeded under highly clear perspective equipment by the surgeons with highly level professional technology.Because the surgery is highly risky,surgery should be proceeded with cautions.
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Objective To evaluate the effect of percutaneous kyphoplasty (PKP) in the treatment of old osteoporotic vertebral compression fractures with intravertebral clefts.Methods 25 patients (25 vertebrae) suffering from old OVCF with vacuum phenomenon were treated with PKP.There were 8 males and 17 females with an average age of 72.7 years (range,64-84 years) and with an average duration of 7.8 months (range,6-24 months).The height of anterior column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at pre-operation and post-operation.Clinical symptoms were evaluated by visual analogue scale (VAS).The amount of bleeding and bone cement and complications were recorded.Results All of 25 operations were performed successfully without severe complications.Cement leakage occurred in 5 cases (20％),including 3 cases at the anterior vertebral edge and 2 cases at the lateral vertebra.The surgery time for each vertebra was 35～60 min (mean 42 min),and bone cement volume for each vertebra was 2.0～5.5 ml (mean 3.1 ml).25 patients were followed up for 12 months (range,6-15 months).The VAS score was decreased from (7.44 ± 1.0) preoperatively to (2.36 ± 0.8) day 3 postoperatively and to (2.12 ± 0.7) the last follow-up; the Cobb' s angle was improved from (28.28±3.76) to (23.28±3.76) and (24.32±3.94) respectively; and the anterior vertebral height was increased from (22.48±4.38) mm to (25.80±4.89) mm and (25.24±4.84) mm respectively.There were significant differences in VAS,Cobb's angle,and anterior vertebral height between prre-and post-operation (F=297.84,12.39 and 3.56,P＜0.001 or 0.05),but there were no significant differences in these indicators between day 3 postoperatively and the last follow-up (all P ＞ 0.05).Conclusions PKP is effective in the treatment of old osteoporotic vertebral compression fractures combined with intravertebral clefts.It can relieve pain rapidly and effectively,correct kyphosis,and prevent vertebra collapse.