Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.</p><p><b>RESULTS</b>All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C₅ nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(<0.05).</p><p><b>CONCLUSIONS</b>Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.</p>

Clinical observation of dynamic cervical implant (DCI) internal fixation in the surgical treatment of cervical spondylosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the early clinical effects and radiological outcome of dynamic cervical implant (DCI) internal fixation in treating cervical spondylosis, and evaluate its safety and efficiency.</p><p><b>METHODS</b>From June 2009 to December 2011, 19 patients with cervical spondylosis correspond to the indication of DCI internal fixation in the study, including 5 cases of cervical spondylotic myelopathy and 14 cases of cervical spondylotic radiculopathy. There were 8 males and 11 females, aged from 35 to 54 years with a mean of 43.2 years. Pathological segments included C3,4 in 1 case, C4,5 in 6, C5,6 in 6, C6,7 in 4, C3,4 and C5,6, C6,7 in 2. All patients were treated with anterior discectomy and decompression and DCI internal fixation, meanwhile, 2 cases of them with anterior cervical corpectomy and fusion plate fixation. Clinical evaluation included Modified Japanese orthopedics association (mJOA), neck disability index (NDI), visual analogue scale (VAS) score and patient satisfaction index (PSI) at pre-operation and final follow-up. Radiographic evaluation included flexion/extension lateral view at operative level and adjacent segment. The adjacent level degeneration was analyzed according to Miyazaki classification on MRI images.</p><p><b>RESULTS</b>All patients were followed up from 12 to 42 months with an average of 19.8 months. Preoperative mJOA score was 13.6±1.1 and at final follow-up was 16.3±1.2 with improvement rate of 85.0%. Preoperative VAS,NDI was 6.6± 1.4, 17.1±7.4 and at final follow-up was 1.4±0.8, 6.1±3.9, respectively; there was statistical significance in all above-mentioned results between preoperative and final follow-up (P<0.05). Preoperative ROM at operation level was (7.6±1.9)° and final follow-up was (7.8+2.1)°; preoperative ROM at C2-C7 was (38.6±7.2)° and final follow-up was (39.9±6.4)°; there was no statistical significance in all above-mentioned results between preoperative and final follow-up (P>0.05). Preoperative DHI at operation level was (6.3±1.1) mm and final follow-up was (7.1±0.8) mm, there was statistical significance in DHI between preoperative and final follow-up (P<0.05). No heterotopic ossification was found. All patients followed up MRI, degeneration of 3 segments aggravated 1 degree in 38 adjacent segments, without clinical symptom.</p><p><b>CONCLUSION</b>Treatment of cervical spondylosis with dynamic cervical implant can got satisfactory outcome in early follow-up. Activity of operative segment obtain reservation in some degree. The incidence of adjacent segment degeneration is lower and no adjacent segment disease occur. Nevertheless a longer follow-up time should be needed to assess the long term functionality of the DCI and the influence on adjacent levels.</p>

Clinical manifestation and surgical treatment of spinal osteoblastoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.</p><p><b>METHODS</b>From June 2006 to July 2010, 11 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 7 males and 4 females with an average age of 23.5 years (range, 16 - 34 years). The tumors were located at C(5) in 3, C(6) in 4, C(7) in 2, C(6) ~ T(1) in 1 and T(11) in 1. Based on WBB classification, 9 were 1 - 3 or 10 - 12 and 2 were 4 - 9 and 1 - 3. All the operations had been performed with en-bloc resection. The posterior approach was used for 9 patients, and combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 8 patients. To evaluate the change of pain before and after the operation by visual analogue scales (VAS), and to assess functional status of the spine by McCormick scale. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones.</p><p><b>RESULTS</b>All cases were followed up for 12 - 64 months (average, 28.4 months). The average surgical time was 130.5 minutes (range, 90 - 210 minutes), with the average intraoperative blood loss of 560 ml (range, 300 - 1000 ml). During the follow-up period, the VAS grade reduced from 6.3 ± 1.1 to 2.5 ± 1.0 (t = 8.48, P < 0.05). There were 8 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.</p><p><b>CONCLUSIONS</b>Spinal osteoblastoma has its own specific radiographic feature. There are some recurrence in simple curettage of tumor lesion. The thoroughly en-bloc resection of tumor or spondylectomy, bone fusion and strong in ter fixation are the key points for successful surgical treatment.</p>

Posterior debridement for the treatment of iatrogenic purulent lumbar spinal infection / 中国骨伤

<p><b>OBJECTIVE</b>To discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.</p><p><b>METHODS</b>From December 2006 to January 2010, 4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement. There were 2 males and 2 females, ranging in age from 50 to 66 years (respectively in 52, 66, 58, 50 years); in course of disease from 2 weeks to 2.5 months (respectively in 21, 14, 60, 75 days ). All patients had fever, lumbago, local tenderness and limited lumbar activity before operation. White blood cell count (WBC), erythrocyte sedimentation rate (ESR) were abnormal. The clinical effects were evaluated by symptoms and laboratory examination.</p><p><b>RESULTS</b>Symptoms of lumbago and fever vanished in 4 patients, of which wounds were primary healing without complications. The patients were followed up for 3 months, no infection (WBC, C-reactive protein and ESR were normal) and lumbar instability were found.</p><p><b>CONCLUSION</b>Iatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease, clinical symptoms and signs, imaging finding. In the items, magnetic resonance imaging finding have necessarily specificity, once finding abscess-formation, will promptly operate.</p>

Spinal fusion combined with dynamic interspinous fixation with Coflex system for lumbar degenerative disease / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the effect of the implantation of Coflex interspious stabilization device combined with pinal fusion for the treatment of lumbar degenerative disease. METHODS; From March 2008 to March 2010, 18 patients with two levels lumbar degenerative disease were treated with spinal fusion and dynamic interspinous fixation with Coflex system. There were 11 males and 7 females. The average age was 50.2 years (range 41 to 62 years). The VAS and the Oswestry Disability Index (ODI) were used to assess clinical symptoms preoperatively and postoperatively. All patients underwent flexion/extension radiographs examinations before surgery and at last follow-up. Range of motion (ROM) and disc height index (DHI) were recorded.</p><p><b>RESULTS</b>All patients were followed up for 12 months averagely (range 6-30 months). At final follow-up, leg VAS, back VAS and ODI functional score were significant improved than those of preoperation [back VAS: 1.50 +/- 0.90 vs 7.20 +/- 0.90; leg VAS: 1.10 +/- 0.80 vs 5.20 +/- 0.90; ODI functional score: (15.90 +/- 5.80)% vs (52.50 +/- 5.90)%]. The DHI increased from 0.23 +/- 0.05 preoperatively to 0.35 +/- 0.06 postoperatively and to 0.33 +/- 0.04 at final follow-up, the height of intervertebral space were not found significant loss. The ROM at the Coflex stabilized levels on the X-ray views was (8.90 +/- 1.80) degrees preoperatively, (8.30 +/- 1.90) degrees postoperatively, and (8.10 +/- 1.80) degrees at final follow-up. There was no significant difference between final follow-up and preoperative (P = 0.19). The ROM of the lumbar spine (L2-S1) was (20.20 +/- 5.60) degrees preoperatively, (14.40 +/- 5.70) degrees postoperatively, and (15.50 +/- 5.20) degrees at final follow-up. There was significant reduction of the [E-S, ROM at final follow-up (P = 0.01).</p><p><b>CONCLUSION</b>Posterior interspinous stabilization with Coflex system combined with spinal fusion can obtain satisfactory outcomes for patients with two levels lumbar degenerative disease in the short follow-up duration. Nevertheless,no overwhelming evidence suggested that the system is better than traditional fusion at present. The selection of surgical indication is important for the treatment of lumbar degenerative disease.</p>

Position of increased signal intensity in the spinal cord on MR images: does it predict the outcome of cervical spondylotic myelopathy? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Increased signal intensity (ISI) in the spinal cord on T2-weighted MR images has been reported in some previous researches, however no study focused on the position of the ISI in the spinal cord and its potential value. The aim of this study was to investigate the correlation between ISI position and the outcome of surgical treatment for cervical spondylotic myelopathy (CSM) patients.</p><p><b>METHODS</b>A retrospective study was conducted. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopaedic Association (JOA) score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter (group A), in both gray and white matter (group B), and ISI-negative group were compared.</p><p><b>RESULTS</b>Totally 64 patients were enrolled in this retrospective study. Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference (the recovery ratios of the two groups in week 1, week 26, and week 104 were (21.54 +/- 14.65)%, (50.56 +/- 14.76)%, (59.23 +/- 13.08)% and (20.25 +/- 14.32)%, (54.46 +/- 23.16)% and (61.26 +/- 29.4)%, respectively; P > 0.05). The recovery ratios of negative group and group A in week 104 were superior to group B (the recovery ratios of negative group, group A, and group B in week 104 were (61.26 +/- 29.49)%, (65.35 +/- 11.36)%, and (50.33 +/- 10.20)%, respectively; P < 0.05).</p><p><b>CONCLUSIONS</b>Patients with ISI in the gray matter alone on T2-weighted MR images did not have significantly different surgical outcomes compared with those without ISI. Patients with ISI in both gray and white matter had surgical outcomes that were worse than those without ISI.</p>

Novel three-dimensional nerve tissue engineering scaffolds and its biocompatibility with Schwann cells / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To develop a novel scaffolding method for the copolymers poly lactide-co-glycolide acid (PLGA) to construct a three-dimensional (3-D) scaffold and explore its biocompatibility through culturing Schwann cells (SCs) on it.</p><p><b>METHODS</b>The 3-D scaffolds were made by means of melt spinning, extension and weaving. The queueing discipline of the micro-channels were observed under a scanning electronic microscope (SEM).The sizes of the micropores and the factors of porosity were also measured. Sciatic nerves were harvested from 3-day-old Sprague Dawley (SD) rats for culture of SCs. SCs were separated, purified, and then implanted on PLGA scaffolds, gelatin sponge and poly-L-lysine (PLL)-coated tissue culture polystyrene (TCPS) were used as biomaterial and cell-supportive controls, respectively. The effect of PLGA on the adherence, proliferation and apoptosis of SCs were examined in vitro in comparison with gelatin sponge and TCPS.</p><p><b>RESULTS</b>The micro-channels arrayed in parallel manners, and the pore sizes of the channels were uniform. No significant difference was found in the activity of Schwann cells cultured on PLGA and those on TCPS (P larger than 0.05), and the DNA of PLGA scaffolds was not damaged.</p><p><b>CONCLUSION</b>The 3-D scaffolds developed in this study have excellent structure and biocompatibility, which may be taken as a novel scaffold candidate for nerve-tissue engineering.</p>

Efficacy of the third-generation instrumentation for treatment of adult scoliosis / 第二军医大学学报

Objective: To evaluate the efficacy of the third-generation instrumentation including TSRH, CD and ISOLA in the treatment of adult scoliosis. Methods:Thirty-five adult patients with idiopathic or degenerative scoliosis who received treatment with third-generation instrumentation (TSRH,CD and ISOLA) between July 1999 to January 2003 were retrospectively reviewed. The mean preoperative cobb angle of major curves of the frontal plane was 58.1°(42°-95°). The patients received a combined anteroposterior approach or a single posterior procedure. The mean follow-up time was 20 months(10-48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and the distance between C7 and CVLS were measured. The subjective assessment was judged by questionnaire. Results: Postoperative clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean loss of correction of the coronal plane in the last follow-up was 4.3°. The distance between the midline of C7 and CVSL was corrected from 2.6 cm to 0.24 cm. The results of follow-up showed that 89.3% patients were satisfied with the outcome. Pneumatothorax and haematothorax occurred in 2 patients. Three patients still complained of low back pain one year after operation because of adjacent degeneration in 2 patients and pseudoarthrosis in the remaining 1 patient. Conclusion: Imageologic findings and subjective assessment of the patients showed that the third-generation instrumentation can achieve good correction and trunk balance in the treatment of adult scoliosis with fewer complications.

Efficacy of the third-generation instrumentation for treatment of adult scoliosis / 第二军医大学学报

Objective: To evaluate the efficacy of the third-generation instrumentation including TSRH, CD and ISOLA in the treatment of adult scoliosis. Methods:Thirty-five adult patients with idiopathic or degenerative scoliosis who received treatment with third-generation instrumentation (TSRH,CD and ISOLA) between July 1999 to January 2003 were retrospectively reviewed. The mean preoperative cobb angle of major curves of the frontal plane was 58.1°(42°-95°). The patients received a combined anteroposterior approach or a single posterior procedure. The mean follow-up time was 20 months(10-48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and the distance between C7 and CVLS were measured. The subjective assessment was judged by questionnaire. Results: Postoperative clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean loss of correction of the coronal plane in the last follow-up was 4.3°. The distance between the midline of C7 and CVSL was corrected from 2.6 cm to 0.24 cm. The results of follow-up showed that 89.3% patients were satisfied with the outcome. Pneumatothorax and haematothorax occurred in 2 patients. Three patients still complained of low back pain one year after operation because of adjacent degeneration in 2 patients and pseudoarthrosis in the remaining 1 patient. Conclusion: Imageologic findings and subjective assessment of the patients showed that the third-generation instrumentation can achieve good correction and trunk balance in the treatment of adult scoliosis with fewer complications.

The efficacy of third-generation instrumentation for the treatment of adult scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of third generation spinal instrumentation such as TSRH, CD and ISOLA for the treatment of adult scoliosis.</p><p><b>METHODS</b>Thirty-five adult scoliosis patients including adult idiopathic and degenerative scoliosis were all surgically treated with third generation instrumentation such as TSRH, CD and ISOLA from July 1999 to January 2003. Preoperative mean cobb angles of major curves of the frontal plane was 58.1 degrees (42 degrees -95 degrees ). The patients received anterior combined with posterior correction or single posterior procedure. Mean follow-up was 20 months (10 - 48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and distance between C(7) and CVSL were measured. We assessed the subjective efficacy by questionnaire.</p><p><b>RESULTS</b>Clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean lost of correction of the coronal plane in the last follow-up was 4.3 degrees , distance between the midline of C(7) and CVSL was corrected from 2.6 cm to 0.24 cm. Questionnaire in the follow-up showed that 89.3% patients were satisfied with operation results. Two cases occurred pneumatothorax and haematothorax. Three cases still complained about low back pain in 1 year after operation, among which 2 were adjacent degeneration and 1 was pseudarthrosis.</p><p><b>CONCLUSION</b>Imageology assessment and patients self-evaluation shows that the third generation instrumentation could gain good correction and trunk balance in the treatment for adult scoliosis. And patients are more satisfied and have less complications.</p>

Protective effect of liposome-mediated glial cell line-derived neurotrophic factor gene transfer in vivo on motoneurons following spinal cord injury in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of liposome-mediated glial cell line-derived neurotrophic factor (GDNF) gene transfer in vivo on spinal cord motoneurons after spinal cord injury (SCI) in adult rats.</p><p><b>METHODS</b>Sixty male Sprague-Dawley rats were divided equally into two groups: GDNF group and control group. The SCI model was established according to the method of Nystrom, and then the DC-Chol liposomes and recombinant plasmid pEGFP-GDNF cDNA complexes were injected into the injured spinal cord. The expression of GDNF cDNA 1 week after injection was detected by RT-PCR and fluorescence microscope. We observed the remaining motoneurons in the anterior horn and the changes of cholinesterase (CHE) and acid phosphatase (ACP) activity using Nissl and enzyme histochemistry staining. The locomotion function of hind limbs of rats was evaluated using inclined plane test and BBB locomotor scale.</p><p><b>RESULTS</b>RT-PCR and fluorescence observation confirmed the presence of expression of GDNF cDNA 1 week and 4 weeks after injection. At 1, 2, 4 weeks after SCI, the number of motoneurons in the anterior horn in GDNF group (20.4+/-3.2, 21.7+/-3.6, 22.5+/-3.4) was more than that in control group (16.8+/-2.8, 17.3+/-2.7, 18.2+/-3.2, P<0.05). At 1, 2 weeks after SCI, the mean gray of the CHE-stained spinal motoneurons in GDNF group (74.2+/-25.8, 98.7+/-31.6) was less than that in control group (98.5+/-32.2, 134.6+/-45.2, P<0.01), and the mean gray of ACP in GDNF group (84.5+/-32.6, 79.5+/-28.4) was more than that in control group (61.2+/-24.9, 52.6+/-19.9, P<0.01). The locomotion functional scales in GDNF group were higher than that in control group within 1 to 4 weeks after SCI (P<0.05).</p><p><b>CONCLUSIONS</b>GDNF gene transfer in vivo can protect motoneurons from death and degeneration induced by incomplete spinal cord injury as well as enhance locomotion functional restoration of hind limbs. These results suggest that liposome-mediated delivery of GDNF cDNA might be a practical method for treating traumatic spinal cord injury.</p>

Study of complications of spinal internal fixation surgery / 第二军医大学学报

Objective: To study the factors and preventive method of post-operative complications of spinal implant operation. Methods: The post-operative complication of 451 cases who had undergone spinal implant operation were analysed retrospectively. The relative factors of complications were analyzed. Results: Infection, thrombosis of deep vein and failed fusion were the most common complications. Among the factors, the age, operation time and blood lose during operation were closely related with the complication. Using antibiotic was effective to reduce the infection. Conclusion: It is effective to reduce the post-operative complication of spinal implant operation by proper pre-operative evaluation. Using antibiotic to control other diseases is also effective.

Effect of nucleus pulposus autograft to the cavum epidurale on the structure and function of nerve roots in rats / 第二军医大学学报

Objective: To find out the pathomechanism of low back and leg pain related to intervertebral disc. Methods: The nucleus pulposus of coccygeal vertebral was transplanted to the cavum epidurale of rats to establish the non-compressive model with transplanted nucleus pulposus. The evoke potentials and morphology of nerve roots were observed. Results: Even without mechanical compression, rats transplanted with nucleus pulposus resulted in significant harm to evoked potential and morphology of cauda equina. Conclusion: The biomechanical and/or immunologic inflammatory effect of nucleus pulposus can result in nerve roots injury and is an important factor in the pathogenesis of low back and leg pain.

Experimental study of interbody fusion using CFR/PEEK / 第二军医大学学报

Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.

Study of complications of spinal internal fixation surgery / 第二军医大学学报

Objective: To study the factors and preventive method of post-operative complications of spinal implant operation. Methods: The post-operative complication of 451 cases who had undergone spinal implant operation were analysed retrospectively. The relative factors of complications were analyzed. Results: Infection, thrombosis of deep vein and failed fusion were the most common complications. Among the factors, the age, operation time and blood lose during operation were closely related with the complication. Using antibiotic was effective to reduce the infection. Conclusion: It is effective to reduce the post-operative complication of spinal implant operation by proper pre-operative evaluation. Using antibiotic to control other diseases is also effective.

Effect of nucleus pulposus autograft to the cavum epidurale on the structure and function of nerve roots in rats / 第二军医大学学报

Objective: To find out the pathomechanism of low back and leg pain related to intervertebral disc. Methods: The nucleus pulposus of coccygeal vertebral was transplanted to the cavum epidurale of rats to establish the non-compressive model with transplanted nucleus pulposus. The evoke potentials and morphology of nerve roots were observed. Results: Even without mechanical compression, rats transplanted with nucleus pulposus resulted in significant harm to evoked potential and morphology of cauda equina. Conclusion: The biomechanical and/or immunologic inflammatory effect of nucleus pulposus can result in nerve roots injury and is an important factor in the pathogenesis of low back and leg pain.

Experimental study of interbody fusion using CFR/PEEK / 第二军医大学学报

Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.

Management of cerebrospinal fluid leakage complicated in anterior cervical surgery / 中华骨科杂志

Objective To investigate the management and outcome of cerebrospinal fluid leakage(CSFL)complicating anterior cervical surgery.Methods1052patients were performed anterior cervical surgery between October1997and October2002.Of 1052cases,926cases were of cervical spondylotic myelopathy(CSM),and126of ossification of posterior longitudinal ligament (OPLL).11patients suffered from cerebrospinal fluid leakage during operation.There were8males and3females aging from46to72years(average,58years).In the group of CSM,there were2cases of CSFL(0.22%)occurred in resection of osteophyte of the posterior vertebral edge,who were serious CSM of C 4,5 and C 5,6 with severe anterior compression by osseous mass to spinal cord showed on MRI.In the group of OPLL,there were9cases of CSFL(7.14%)occurred in resection of the ossified posterior longitudinal ligament accompanied with severe spinal canal stenosis and anterior compression to spinal cord on radiological imagings,4of them were con-tinuous OPLL from C 2 to C 6 combined with herniation of cervical disc,3segmental,and2mixed.Results The defect area of spinal dura were(0.6～2.0)cm?(1.0～1.5)cm.The cerebrospinal fluid was blocked with fascia and absorbable gelatin sponge during the operation.If CSFL was persistent more than3days after oper-ation,expectant treatment was performed.After the operation,no CSFL occurred in8of 11patients,and the other3cases with postoperative CSFL were cured5,14and17days by dressing change,blocking the wound with gelatin sponge,and suturing of the wound respectively.All patients were followed up for 10to62months(mean,26months).No cerebrospinal fluid cyst and infection occurred.There were no significant negative effects of CSFL on the recovery of neuromuscular function.Conclusion CSFL following cervical anterior surgery can be cured by blocking up leakage of spinal dura during operation,however,conventional conservative treatment including of dressing change,antibiotics administration,horizontal position with low pillow are necessary after operation.