The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine.</p><p><b>METHODS</b>From Jan. 2000 to July 2008, 5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman's fractures (type II ), 2 of C2.3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the "window" between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman's fractures underwent the C2,3 intervertebral disc discectomy, bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy, decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting.</p><p><b>RESULTS</b>C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months (means 13.5 months). There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion.</p><p><b>CONCLUSION</b>The "window" surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure, and can get minimally invasive surgery results and few and far between wound complication, that is safe if corresponding experience is achieved.</p>

Transpedicular balloon kyphoplasty for the selective treatment of osteoporotic thoracolumbar burst fractures in vitro / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the feasibility of using transpedicular balloon kyphoplasty for aged osteoporotic thoracolumbar burst fractures with an in vitro model.</p><p><b>METHODS</b>Simulated osteoporotic thoracolumbar burst fractures were created in 11 vertebral bodies. The burst fractures without obvious canal occupation were confirmed by spiral CT before the procedure. This operation involved the percutaneous insertion of two inflatable bone tamps into a fractured vertebral body transpedicularly under fluoroscopic guidance. Inflation of the bone tamp elevated the endplates, restored the vertebral body height, while created a cavity to be filled with bone cement. Preoperative and postoperative heights were measured, preoperative and postoperative sagittal diameter of vertebral canals were measured, and the repaired vertebral bodies were compressed to determine strength and stiffness values. The cement distribution and extravasation was evaluated by spiral CT after the procedure.</p><p><b>RESULTS</b>The transpedicular balloon kyphoplasty resulted in the significant restoration of the vertebral body height. The mean vertebral body heights was (20.73 +/- 1.37) mm before operation and (24.82 +/- 1.61) mm after operation (P < 0.01). Preoperative and postoperative sagittal diameter of vertebral canals were similar (P > 0.05). The cement distribution was regular, and the extravasation into spinal cannula was found in one case. The preoperative strength was significantly larger than the postoperative strength, whereas the postoperative stiffness was significantly less than the preoperative stiffness (P < 0.05).</p><p><b>CONCLUSIONS</b>Transpedicular balloon kyphoplasty is an effective way to treat aged osteoporotic thoracolumbar burst fractures without obvious canal occupations and neurologic deficit in vitro. The procedure can increase strength and restore height of aged osteoporotic thoracolumbar burst fractures. Cement distribution and vertebral canal stenosis can be avoided.</p>

Selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fracture.</p><p><b>METHODS</b>Twenty-two consecutive procedures were performed in 17 aged patients with osteoporotic spinal compression fractures from April 2002 to June 2004. The signal changes in different sequences were confirmed by magnetic resonance imaging before the procedures. This operation involved the percutaneous insertion of two inflatable bone tamps into a fractured vertebral body transpedicularly under fluoroscopic guidance. Every patient was treated individually, according to the results of radiography and CT scan before operation. Preoperative and postoperative complications, visual analogue scale, and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed.</p><p><b>RESULTS</b>All patients tolerated the procedure well with immediate relief of their back pain in 24 hours. There was no leakage of cement into the epidura. The mean loss percent of the anterior and middle vertebral heights were (35.32 +/- 13.15)% and (27.53 +/- 12.61)% before operation, and (14.21 +/- 12.43)% and (16.2 +/- 7.5)% after operation. The height restoration of vertebra was confirmed by X-ray after the procedure (P < 0.01). The mean kyphosis was improved from (25.3 +/- 4.2) degrees to (8.6 +/- 5.1) degrees. No complications occurred. No patient had nerve injury. The patients were allowed to walk next day after the procedure.</p><p><b>CONCLUSION</b>The selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures has satisfactory short-term clinical efficacy. It is also an effective way to prevent complications.</p>

The contrast study between single and double balloon bilateral dilatation of kyphoplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To contrast single and double balloon-inflated kyphoplasty for vertebral compression fractures (VCFs) and evaluate its clinical efficacy.</p><p><b>METHODS</b>From May 2000 to May 2004, 90 consecutive procedures were performed in 58 patients who suffered from painful vertebral compression fractures, transferring tumour and angioma. Ninety vertebrae were inflated while 62 as A group were double balloon and 28 as B group were single balloon, fracture reduction and bone cement augmentation. Preoperative and postoperative symptom levels, variables, complications were recorded and the vertebral height and Cobb angle were measured and analyzed.</p><p><b>RESULTS</b>All patients' pain was alleviated or disappeared without syndrome, and the vertebral height and Cobb angle of both groups were improved. The average recovery rate was 72.6% (22.9% approximately 100%), Cobb angle from 17.9 degrees (3.1 degrees approximately 31.6 degrees ) were corrected to 9.6 degrees (0.6 degrees approximately 28.2 degrees ), the average angle was 8.7 degrees (0.3 degrees approximately 27.2 degrees ), and the contrast between preoperative and postoperative showed obvious differences (P <0.001). The average recovery rate of A group was 77.6% (55.3% approximately 100%), B group was 64.3% (22.9% approximately 100%). The average postoperative Cobb angle of A group was 9.9 degrees (0.3 degrees approximately 27.2 degrees ), B group was 8.6 degrees (0.6 degrees approximately 19.8 degrees ) (P >0.05).</p><p><b>CONCLUSIONS</b>As a promising minimally invasive surgery, balloon kyphoplasty can provide early relief of pain and improve the function as well as spinal alignment in treatment of painful compression fracture owing to recovering the vertebral height and Cobb angle of the vertebral body. Single balloon-inflated kyphoplasty can improve VCFs as double balloon.</p>