Minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion combined with posterior percutaneous pedicle screw fixation for lumbar spinal tuberculosis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.

Effect of posterior osteotomy on the sagittal parameters of the spinopelvis in patients with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate the influence of posterior osteotomy on spinopelvic parameters in lumbar degenerative kyphosis (LDK) patients.@*METHODS@#The clinical data of 21 patients with lumbar degenerative kyphosis who underwent osteotomy from January 2012 to December 2015 were retrospectively analyzed. There were 5 males and 16 females, aged from 55 to 76 years with an average of (66.24±5.13) years. All patients had taken preoperative and postoperative full length spinal X-ray, analyzing the spinopelvic parameters as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS).@*RESULTS@#All operations were successful, the average operative time was 190 min (160 to 220 min) and intraoperative blood loss was 1 000 ml (800 to 1900 ml). Parameters of the patients between preoperative and period 1-year follow-up were as follows : preoperative TK increased from (31.67±21.13) ° to (34.67±11.60) °, LL corrected from (4.76±3.17) ° to (37.41±6.28) °, PT reduced from (33.94±5.01) ° to (20.12±5.36) °, and SS improved from (18.47±2.60) ° to (31.71±4.30) °, SVA restored from (13.24±3.60) cm to (2.82±1.33) cm. There were significant differences of spinopelvic parameters between preoperation and postoperation (<0.05).@*CONCLUSION@#Posterior osteotomy can effectively reconstruct the sagittal balance of spinopelvis in patients with lumbar degenerative kyphosis. The recovery of lumbar lordosis and sacral slope is closely related to the reconstruction of sagittal balance.

Digital modeling and analysis of the applicability of backward rotation method in lumbar kyphoplasty with unilateral puncture / 中国骨伤

OBJECTIVE@#The 3D model of lumbar spine was established by using Mimics software. To observe the applicability and needling parameters of lumbar vertebral kyphoplasty with unilateral puncture by backward rotation method using simulated puncture.@*METHODS@#Twenty-four patients (12 males and 12 females) with osteoporotic thoracic fracture in the first time and no signs of lumbar misalignment and bone destruction were scanned by spiral CT on the lumbar spine. The original DICOM file was modeled in 3D with Mimics software, and the vertebral bodies were separated. After being imported into 3-matic software, the posterior wall of the vertebral body was restrained for standardized measurement. A sketch perpendicular to the mid-section of the pedicle and the posterior wall of the vertebral body was drawn. The simulated puncture was performed on the sketch. The angle and distance parameters of the range of motion of the puncture needle were recorded, and the puncture needle was recorded at the top. The crossing points of the anterior, middle and posterior zones of the tangential line of the vertebral body were located at the high extraversion angle, and the results were compared and analyzed.@*RESULTS@#All the data in the left and right sides had no significantly differences(>0.05). Data of different segments in different gender were significantly differences(<0.05). The maximal extraversion angle in lumbar spine increased gradually from (33.41±1.31) degree to (56.53±4.71) degree in males, as same as in females from(28.58±2.55) to (53.86±2.68) degree. There was no crossing point in area A, 3.3% of males and 26.67% of females in area B, rest in area C. The distribution areas on gender showed statistically significance (<0.05).@*CONCLUSIONS@#Backward rotation method can theoretically meet the requirements of puncture point for vertebral compression fracture, especially for males and lower lumbar spine. The determination of the maximum inclination angle is of guiding significance to the backward rotation method.

Efficacy of bilateral sagittal cross percutaneous kyphoplasty for preventing recurrent fracture of the cemented vertebrae / 中国骨伤

OBJECTIVE@#To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP) for preventing recurrent fracture of the cemented vertebrae.@*METHODS@#From January 2017 to June 2017, 85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs) were treated by bilateral sagittal cross PKP(cross group). There were 35 males and 50 females with an average age of (70.1±8.3) years old in cross group. Another 85 patients with single-segment OVCFs were treated by traditional PKP (traditional group). There were 37 males and 48 females with an average age of (73.3±9.5) years old in traditional group. The cement distribution condition, recurrent fracture of the cemented vertebrae, the anterior vertebral body height and sagittal Cobb angle, visual analogue scale(VAS) were observed in two groups.@*RESULTS@#All patients underwent operation successfully. The follow-up time were (11.8±4.5) months in cross group and (12.1±3.7) months in traditional group. In cross group, all patients' bone cement touched the upper and lower endplates of the vertebral body while 67 cases (78.8%) in traditional group did with significant difference between two groups (0.05).@*CONCLUSIONS@#Bilateral sagittal cross PKP was a simple, safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body, thus preventing the recurrent fracture of the cemented vertebrae.

French door segmented laminectomy decompression for severe cervical ossification of posterior longitudinal ligament complicated with spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of French door segmented laminectomy decompression for severe cervical OPLL complicated with spinal cord injury.</p><p><b>METHODS</b>The clinical data of 38 patients with serious cervical OPLL complicated with spinal cord injury were retrospectively analyzed and these patients were treated with French door segmented laminectomy decompression and internal fixation from June 2012 to June 2014. There were 25 males and 13 females, aged from 42 to 78 years with an average of 58.2 years. Of them, 35 cases suffered from aggravating neurological symptoms with a definite precipitating factor. Spinal cord injury was related to minor injury of the neck, such as hyperextension of the neck in 3 cases. Preoperative Japanese Orthopaedic Score (JOA) was 8.1±1.7 and Neck Disability Index (NDI) was 19.8±4.4. Preoperative CT scans showed the range of OPLL was more than three segments. The spinal canal was occupied 50% to 85% with an average of 70.7%.</p><p><b>RESULTS</b>All the patients were followed up for 10 to 24 months with an average of 15.6 months. The operative time was 90 to 150 min with an average of 120 min and blood loss was 300 to 800 ml with an average of (480±80) ml. At final follow-up, NDI and JOA were 7.5±2.5 and 13.5±2.0, respectively, and they were obviously improved compared with preoperation. Preoperative cervical Cobb angle was (8.10±2.70)° and at final follow-up was (15.60±1.80)°, and there was significant difference between preoperative and postoperative (<0.05). Deep infection occurred in 1 case, epidural hematoma in 1 case, C₅ nerve root palsy in 3 cases, and axial symptom in 8 cases after operation. No serious complications, such as vertebral artery injury, cerebrospinal fluid leakage, deterioration of neurological dysfunction, or internal fixation failure was found.</p><p><b>CONCLUSIONS</b>French door segmented laminectomy decompression is safe and feasible for severe cervical OPLL complicated with spinal cord injury, and it is worth to be popularized in future.</p>

Treatment of flexion-distraction thoracolumbar fractures by postural reduction with instrumental reduction / 中国骨伤

<p><b>OBJECTIVE</b>To study the curative effect of postural reduction with instrumental reduction in treatment of flexion-distraction thoracolumbar fractures.</p><p><b>METHODS</b>A retrospective study was performed on 43 patients with single thoracolumbar flexion-distraction fractures admitted from August 2009 to August 2011, included 28 males and 15 females with an average age of 44 years old (34 to 56 years old). All patients were treated with postural reduction with instrumental reduction. The kyphosis (Cobb angle) recovery of injured vertebral height and complication were analyzed. The visual analogue scale(VAS) and com-plications were followed up and recorded.</p><p><b>RESULTS</b>There was no difference in recovery of injured vertebral posterior height among preoperative, 1 week and 1 year after operation (P > 0.05). There were significantly difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between preoperative and postoperative at 1 week (P < 0.05). There was no difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between 1 week and 1 year after operation (P > 0.05). VAS significantly improved from preoperative (7.2 +/- 1.2) to (0.8 +/- 0.7) at 1 year after operation (t = 18.47, P < 0.001).</p><p><b>CONCLUSION</b>Postural reduction with instrumental reduction is effective for thoracolumbar flexion-distraction fractures and it is beneficial to the recovery of vertebral height and saggital alignment.</p>

Biomechanical study of the atlantoaxial joint after artificial atlanto-odontoid joint arthroplasty / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the stability and three-dimensional movements of the atlantoaxial joint after artificial atlanto-odontoid joint (AAOJ) arthroplasty by comparing with a conventional method.</p><p><b>METHODS</b>After anterior decompression, 24 human cadaveric spinal specimens of C0-C3 were randomly divided into two groups: Group A receiving artificial AAOJ arthroplasty; Group B experiencing anterior transarticular screw (ATAS) fixation. Two groups underwent flexibility test in intact and instrumented states. Rotational angle of the C0-C3 segments was measured to study the immediate stability and function of anterior decompression with AAOJ arthroplasty compared with the intact state and ATAS fixation.</p><p><b>RESULTS</b>Compared with the intact state, anterior decompression with AAOJ arthroplasty resulted in a significant decrease in the range of motion (ROM) and neutral zone (NZ) during flexion, extension and lateral bending (P less than 0.05); however, with regard to axial rotation, there was no significant difference in ROM and NZ (P larger than 0.05). Compared with anterior decompression with ATAS fixation, anterior decompression with AAOJ arthroplasty during flexion, extension and lateral bending, significant difference was found in ROM and NZ (P larger than 0.05); however, as for axial rotation, there was a significant increase in ROM and NZ (P less than 0.05).</p><p><b>CONCLUSION</b>The self-designed AAOJ has an excellent biomechanical performance, which can restore excellent instant stability and preserve the movement of the atlantoaxial joint.</p>

Clinical application of centerpiece titanium plate fixation in open door laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical application of Centerpiece titanium plate fixation in open door laminoplasty.</p><p><b>METHODS</b>From January 2009 to December 2010,25 patients with cervical spinal stenosis were treated by open door laminoplasty with Centerpiece titanium plate fixation. There were 16 males and 9 females,with a mean age of (57.2 +/- 6.7) years (ranged, 44 to75 years). There were multilevel cervical myelopathy in 8 cases, posterior longitudinal ligament ossification in 12 cases and congenital cervical spinal stenosis in 5 cases. According to Japanese Orthopedic Association (JOA) score to evaluate nerve function and calculate improvement rate. X-ray and CT were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side. The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 6 months after operation respectively, and the expansion rate of spinal canal was calculated [(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter) x 100%].</p><p><b>RESULTS</b>The operative time and intraoperative blood loss were respectively (165.5 +/- 35.6) min and (325.0 +/- 75.1) ml. All patients were followed up from 6 to 18 months with an average of (7.3 +/- 3.8) months. The JOA score increased from 9.3 +/- 1.1 before operation to 14.7 +/- 2.1 at 6 months after operation (t = 4.12, P < 0.05), and the improvement rate was (64.5 +/- 10.2)%. Radiographic data showed spinal canal enlarged perfectly, bone fusion at hinge side and no cervical spinal stenosis was found. The sagittal diameter of C5 spinal canal improved from (9.0 +/- 1.5) mm before operation to (14.3 +/- 2.0) mm at 6 months after operation (t = 7.61, P < 0.05), and the expansion rate was (67.6 +/- 11.8)%.</p><p><b>CONCLUSION</b>Clinical application of Centerpiece titanium plate fixation in open door laminoplasty is safe and effective. While vertebral plate is elevated to obtain instantly stability, at the same time, the integrity of spinal canal is also recovered.</p>

Clinical analysis of one-stage posterior-anterior operative approach in treating lower cervical spine fracture and dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of one-stage posterior-anterior decompression and internal fixation for the treatment of the severe fractures and dislocations combined with the spinal cord injuries of the lower cervical spine.</p><p><b>METHODS</b>From August 2005 to August 2009, 48 patients (male 28 and female 20, aged from 28 to 62 years with a mean of 39.6 years) with severe fractures and dislocations of lower cervical spine were treated by reduction and internal fixation with one-stage combined cervical anterior plating and posterior lateral mass screws and rod or plate systems. Frankel grade A was in 8 cases, grade B in 16 cases, grade C in 20 cases, and grade D in 4 cases before operation. Firstly, the posterior approach was carried out. After inserting the mass screws, decompression and reduction were performed, and the rod or plate systems were embedded. After grafting, the skull traction was removed and initiated the anterior reduction, intervertebral decompression, auto-graft and cervical spine auto-locking plate fixation. The stability and fusion rate of the injured segments were evaluated on the regular postoperative X-ray film. The function of the spinal cord was assessed with Frankle classification.</p><p><b>RESULTS</b>All patients were followed up, ranged from 6 to 28 months with an average of 12 months. Solid fusion obtained in the postoperative 6 months. Frankel grade C was in 28 cases, grade D in 14 cases, grade E in 6 cases after operation. There was no complications related to internal fixation breakage, loosening or displacement. There was no vascular and esophagus complications during the operation.</p><p><b>CONCLUSION</b>One-stage combined anterior-posterior decompression and internal fixation in treating severe fracture and dislocations of lower cervical spine could restore the cervical curvature, and obtain good reduction and complete decompression, and gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord.</p>

Feasibility study on posterior laminar screw fixation techniques in the axis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To get morphologic parameters of Chinese adults through observation and measurement on axial laminas, to evaluate the feasibility of placing axial laminar screws and to introduce the technique.</p><p><b>METHODS</b>Relative parameters of 28 sets of fresh Chinese adults'axial specimens, including distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas, superior, middle, inferior thickness and height of the axial laminas, length and angle of the axial laminar screw trajectories, distance from the entry points of axial laminar screws to the transverse foramen and central points of the inferior articular process, were measured with a digital caliper and a goniometer. Data were statistically analyzed.</p><p><b>RESULTS</b>Averagely, distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas was 5 mm and 9 mm, superior, middle, inferior thickness and the height of the axial laminas were 3.2 mm, 6.7 mm, 5.5 mm and 12.8 mm respectively, and the length of the superior and inferior axial laminar screw trajectories was 26.2 mm and 25.5 mm, respectively.</p><p><b>CONCLUSIONS</b>It is feasible and reliable to apply posterior laminar screw fixation techniques to the axes of Chinese adults. Also the C2 laminar screw fixation technique can be taken as a supplementary to conventional posterior screw fixations of C2.</p>

Surgical treatment and classification of multiple-level noncontignous thoracolumbar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the surgical treatment and classification of multiple-level noncontiguous thoracolumbar fractures.</p><p><b>METHODS</b>From December 2005 to December 2008, 24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A, 2 cases in grade B, 2 cases in grade C, 8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures (MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively.</p><p><b>RESULTS</b>All patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months (means 18.3 months). All cases achieved bone fusion, without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation, 11 got more than one grade improvement of the ASIA grading, 2 remained unchanged.</p><p><b>CONCLUSION</b>The traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontiguous thoracolumbar fractures should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures.</p>

Selective treatment of thoracolumbar fracture with posterior monosegmental pedicle screw fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of posterior monosegmental pedicle screw fixation in selective treatment of thoracolumbar vertebral fractures.</p><p><b>METHODS</b>From June 2005 to June 2008, 28 patients (male 17 and female 11, the age was 19- 60-years-old with an average of 36 years) with thoracolumbar fractures were treated with posterior monosegmental pedicle screw fixation in our department. According to the AO classification, 19 patients with type A1 fracture and 9 with type A2. The place of pedicle screw and reduction of injured vertebral body were observed.</p><p><b>RESULTS</b>Postoperative CT scan showed 56 pedicle screws were all placed in the normal part of injured vertebral body. There was no spinal cord injury and infection after surgery. There were restoration of anterior body compression from mean preoperative (42.0 +/- 5.6)% to (12.4 +/- 1.4)% (P<0.05), and restoration of Cobb angle from mean preoperative (25.8 +/- 5.1) degrees to postoperative (1.9 +/- 1.3) degrees (P<0.05). All the patients were followed up for 3-36 months (average in 18.3 months). All fractures achieved bone healing, without significant loss of the vertebrae body height and implant failure.</p><p><b>CONCLUSION</b>As indication is correctly choosed, posterior monosegmental pedicle screw fixation can be applied to treat thoracolumbar vertebral fractures.</p>

Application of the pedicle screws for cervicothoracic fracture-dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2).</p><p><b>METHODS</b>Pedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases, and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures.</p><p><b>RESULTS</b>All subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5, 16 at C6, 42 at C7, and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1, 8 at T2. No injury of spinal cord, nerve roots and vertebral artery was found during operation. Eleven screws (14.9%) were perforated out of the pedicles in cervical spine, in which 7(9.5%) through lateral cortex, 1 (1.4%) through the superior and 3 (4.1%) through the inferior. Three screws (10%) were perforated in upper thoracic spine, in which 2 (6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5. JOA score increased from preoperative (7.5 +/- 2.0) to postoperative (14.5 +/- 2.3) evaluated in 6 months after operation,with statistic difference (t = 6.34, P < 0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries.</p><p><b>CONCLUSION</b>Implantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine, and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually.</p>

Analysis of complications in scoliosis surgery / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the complications occurred in scoliosis surgery and evaluate its prevention strategy.</p><p><b>METHODS</b>From June 2002 to May 2007, 86 cases of idiopathic scoliosis were treated. There were 21 male and 65 female with an average age of 17.8 years(range, from 8 to 22 years). According to Lenke classification, 33 cases were type 1, 10 type 2, 18 type 3, 5 type 4, 10 type 5 and 10 type 6. Five cases were Risser 0 to I, 20 cases II to III, 61 cases 1V to V. Cobb angles were from 45 degrees to 85 degrees (mean 60.35 degrees). The pedicle screw technique was used to correct all the scoliasis, and the results and complications were studied.</p><p><b>RESULTS</b>The average operation time was 3.2 hours and average blood loss volume was 1000 ml (800-2400 ml), 924 pedicle screws were inserted and the average postoperative Cobb angle was 18.46 degrees. All the patients were followed up for 5 to 40 months(mean 20.5 months). The complications were as following: 1 case of spinal cord injury; 25 screws misplaced; 2 cases of nerve root injury; 1 case of pleura injury; 1 case of superior mesenteric artery syndrome; 3 cases of wound infection; 2 cases of trunk decompensation; 1 case of junction kyphosis; 3 cases of implant loosening; 2 cases of pseudarthrosis; 1 case of crankshaft phenomenon; 2 cases of flatback syndrome.</p><p><b>CONCLUSION</b>Many kinds of complications may occur in scoliosis surgery. Exactitude procedures of diagnosis and surgery for the scoliosis are the key to decrease and prevent the complications related to the operation.</p>