ABSTRACT
BACKGROUND: Lumbosacral vertebral fusion operation is an important treatment for lumbosacral vertebral degenerative disease. Traditional open surgery has great trauma; postoperative recovery time is longer; there are more complications. To reduce the damage to normal tissue and increase the rate of healing, scholars in and outside China improve the lumbar spine fusion surgery, and lumbar fusion becomes a tendency of the development of minimally invasive surgery. In 2004, Cragg introduced lumbosacral vertebral axial fusion (AxiaLIF, axial lumbar intervertebral fusion). The operation is through posterior rectal wall and presacral space approach, axially nailing for fusion of L5/S1. Muscle, ligament and blood vessels of the spine were retained. Mechanical stability was similar to that of traditional fusion. Osseous fusion rate was high at the operation segment. This is in line with the concept of minimally invasive surgery of the spine. OBJECTIVE: To summarize the advantages and disadvantages of traditional and present fusion techniques from traditional lumbar fusion and present lumbar fusion angle, and to explore the application of AxiaLIF in lumbosacral fusion. METHODS: We retrieved PubMed, Web of Science, and Springer database with the English key words of "Axial interbody fusion and (properties or evaluation), biomechanics, spine mechanical test, spine and (kinematics or motion)", and Chinese Journal Full-Text Database with the Chinese key words of "Axial fusion, biomechanics research assessment, biomechanics, anterior sacral space, minimally invasive spine" for studies concerning lumbar fusion, complications, biomechanics, and humanistic medicine that had been published in recent 5 years. Repetitive studies were excluded, and 46 studies were analyzed and discussed. RESULTS AND CONCLUSION: In the past 90 years, scholars in and outside China had studied the methods of lumbar fusion from various levels, analyzed and summarized the advantages and disadvantages of various operative methods, and identified the indications of lumbar spinal fusion. By comparing characteristics of open surgery and minimally invasive surgery, this study suggested that minimally invasive lumbar fusion has become a trend. In-depth understanding of biomechanical stability, complications, and postoperative recovery time after AxiaLIF is still a long way to go in future medical research.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical results of new external spinal skeletal fixation combined with percutaneous injury vertebra bone grafting in the treatment of two-segment thoracolumbar fractures without neural dysfunction.</p><p><b>METHODS</b>The clinical data of 28 patients with two-segment thoracolumbar fractures without neural dysfunction treated from January 2013 to August 2015 were retrospectively analyzed. There were 17 males and 11 females, with a mean age of(37.5±10.3) years (ranging from 19 to 55 years). According to fracture AO classification, all 28 cases were type A, including 2 cases of T₁₀,₁₁, 3 cases of T₁₁,₁₂, 9 cases of T₁₂-L₁, 4 cases of L₁,₂, 5 cases of L₂,₃, 4 cases of L₃,₄, 1 case of L₄,₅. All 28 patients received treatment of new external spinal skeletal fixation and percutaneous injury vertebra bone grafting. Operation time, intraoperative bleeding and related complications were recorded. The informations of vertebral anterior border height percentage and bone fusion were observed by radiography before and after operation, before removed external fixation and final follow-up. Visual analogue scale(VAS) was used to evaluate the clinical effects.</p><p><b>RESULTS</b>All the patients were followed up for 13 to 32 months with an average of (24.5±3.5) months. There was significant difference by the time of 3 days postoperatively, before removed external fixation, final follow-up comparing with the preoperative in vertebral anterior border height percentage and VAS score(<0.05). There was no significant difference in vertebral anterior border height percentage by the time of 3 days postoperatively, before removed external fixation comparing with final follow-up(>0.05). While the VAS score showed a gradually declining trend, screw lossening ocurred in 2 cases and nail tracker infection occurred in 1 case after operation, and no other complications were found.</p><p><b>CONCLUSIONS</b>New external spinal skeletal fixation and percutaneous injury vertebra bone grafting can got satisfactory clinical effect in treating two-segment thoracolumbar fractures without neural dysfunction, which is an effective method of minimally invasive surgery.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical curative effect of the modified Halo pelvic frame and surgery for the treatment of severe scoliosis with rigidity.</p><p><b>METHODS</b>From January 2004 to May 2010,50 patients with severe scoliosis patients with rigidity were treated in our hospital. Twenty-three patients were male and 27 patients were female, with a mean age of 10.8 years old, ranging from 4 to 16 years. Twenty-four patients were congenital scoliosis and 26 patiens were idiopathic scoliosis. The mean body height were (152.1 +/- 11.1) cm and the average Cobb angle of scoliosis and kyphosis were (91.8 +/- 14.5) degrees and (69.5 +/- 14.0) degrees respectively. All the patients were treated with three-stages modified Halo pelvic traction, the second stage anterior release and the third stage posterior correction. The amount of correction was determined by measuring the change of body height, the Cobb angles and correction rate of scoliosis as well as kyphosis before and after the operation.</p><p><b>RESULTS</b>The mean body height were correct to (158.5 +/- 10.5) cm. The average Cobb angle of scoliosis were correct to (30.8 +/- 7.9) degrees. The average Cobb angle of kyphosis were correct to (31.6 +/- 10.1) degrees. After the first stage, the average Cobb angle of scoliosis and kyphosis were changed with the mean of (30.4 +/- 6.6)% correction and (22.3 +/- 5.2)% respectively; after the second stage, the average Cobb angle of scoliosis and kyphosis were changed with the mean (26.7 -/+ 5.1)% correction and (21.2 -/+ 6.0)% respectively; the third stage, above data were (33.7 -/+ 7.2)% and (27.1 +/- 5.3)%. Correction rate of scoliosis and kyphosis were (66.5 +/- 7.2)% and (55.1 +/- 6.4)% respectively by the modified Halo pelvic frame traction and surgery. Body height, the Cobb angles and correction rate of scoliosis and kyphosis on radiographs were different in all stages (P<0.05).</p><p><b>CONCLUSION</b>Operative complications of severe scoliosis with rigidity can be reduced and better deformity correction and trunk balance achieved by the modified Halo pelvic frame traction and surgery.</p>