Clinical studies of pedicle screw-rod fixation of thoracolumbar burst fractures through posterior unilateral approach after vertebrae corpectomy fusion / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation.</p><p><b>METHODS</b>From January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression, fusion, and internal fixation was retrospective analyzed. Among them, 16 patients were treated through posterior approach as posterior group, including 13 males and 3 females aged from 37 to 62 years old; 9 cases caused by falling injury, 3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases, L₁ in 5 cases, L₂ in 7 cases, L₃ in 2 cases; according ASIA grade, 3 cases were grade A, 2 cases were grade B, 2 cases were grade C, 5 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group, including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury, 4 cases by traffic accident injury, 4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases, L₁, in 7 cases, L₂ in 9 cases, L₃ in 2 cases; for ASIA grade: 4 cases were grade A, 2 cases were grade B, 4 cases were grade C, 6 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 4 to 12 days. The operation time, bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade, clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups.</p><p><b>RESULTS</b>All patients were followed up from 12 to 24 months with an average of (15.8 ± 3.3) months. The operation time, bleeding during operation, and postoperative drainage volume had no significant different between two groups (P > 0.05). As compared with preoperative, ASIA grade of two groups at last follow-up had statistically significantly different (P < 0.01), the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative, the difference had statistically significant (P < 0.01), the two groups showed good clinical effect. The clinical results of ASIA grade, JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups ,it bad significant difference had statistical significance compared with preoperative, the two approaches could effectively restore the spinal sequence.</p><p><b>CONCLUSION</b>For patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column, according to the degree of operation performer' skill proficiency and the patient' condition to choose, but for patients must performed the spinal canal decompression anterior and posterior, the three column-reconstruction to required anterior-posterior approach, the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time, reduce the operation wound, it is worth the clinical promotion.</p>

Treatment of lumbar instability with transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability.</p><p><b>METHODS</b>The clinical data of 50 patients with lumbar instability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain, and unilateral primarily or unilateral lower limb radiation pain, X-ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods, they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group, 8 males and 12 females, aged from 26 to 66 years old, 2 cases with isthmic spondylolisthesis of degree I, 8 cases with degenerative spondylolisthesis, 10 cases with lumbar disc herniation; fusion location with L3,4 was in 1 case, L4,5 was in 12 cases, L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group, 14 males and 16 females, aged from 41 to 62 years old, 4 cases with isthmic spondylolisthesis of degree I,14 cases with degenerative spondylolisthesis, 12 cases with lumbar disc herniation; fusion location with L3,4 was in 3 cases, L4,5 was in 15 case, L5S1 was in 12 cases. Operation time, intraoperative blood loss, postoperative drainage, complications were analyzed and intervertebral height, lordosis angle changes, fusion rate and clinical effect were compared between two groups.</p><p><b>RESULTS</b>All incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically, no infection, endorachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was found in unilateral fixation group. All patients were followed up from 8 to 18 months with an average of (10.8?4.3)months. Ac- cording to JOA score improvement rate (RIS) to assess clinical effect, all patients got excellent and good results, there was no statistically significant difference between two groups. Two methods can both effectively increase the pathological intervertebral height. Unilateral fixation group was better than bilateral fixation group in aspect of operation time, intraoperative blood loss and postoperative drainage.</p><p><b>CONCLUSION</b>With strict indication and good skills, transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability has advantages of smaller traumatic, less blood loss, faster recovery for the patient and can reduce the economic cost.</p>

Single-segment pedicle screw fixation for the treatment of thoracolumbar fractures through the gap of paravertebral muscles / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effect of thoracolumbar fractures between single-segment pedicle screw fixation approach for the gap of paravertebral muscles and double-segment pedicle screw fixation approach for the stripping of paravertebral muscles.</p><p><b>METHODS</b>From September 2008 to January 2010, 65 patients with incomplete compressed thoracolumbar fractures or burst thoracolumbar fractures with unilateral endplate injury were randomly divided into two groups. Thirty patients were treated with single-segment pedicle screw fixation through the gap of paravertebral muscles (treatment group). Thirty-five patients were treated with double-segment pedicle screw fixation through the stripping of the paravertebral muscles (control group). All the internal fixations were taken out during 10-12 months after operation. Operative time, perioperative blood loss volume and postoperative drainage volume were compared between two groups. At final follow-up, the change of neurological ASIA grade were recorded; and postoperative 5 days and final follow-up, compared Denis classification of lumbar and back pain between two groups; and analyzed the sagittal index and compressibility of anterior border of vertebral body by X -ray lateral projection.</p><p><b>RESULTS</b>All patients were follow-up from 14 to 22 months with an average of 18.3 months. No postoperative infection, secondary spinal cord injury was found. One case of control group occurred internal fixation breakage at the 11th month after operation and other internal fixation no loosening. There was no significant difference in operative time, the recovery of neurological function between the two groups (P > 0.05). Perioperative blood loss volume and postoperative drainage volume of treatment group was less than that of control group (P < 0.01). And in Denis classification of lumbar and back pain, the treatment group recovered more quickly, and the residual pain of lumbar and back was less than that of control group (P < 0.01). Postoperative posterior salient and compression of anterior border of vertebral body improved in two groups (P < 0.01), there was no significant difference in degree of improvement between two groups (P > 0.05); but both loss existed at final follow-up (P < 0.01), there was no significant difference in loss of posterior salient between two groups (P > 0.05). In the treatment group, the loss of rectify of anterior border of vertebral body existed, but it was less than that of the control group.</p><p><b>CONCLUSION</b>In the premise of strict controlling surgery indications, the treatment of thoracolumbar fractures with single-segment pedicle screw fixation through the gap of paraspinal muscles, can effectively recover the height of vertebral body and rectify posterior salient, and reduce the fixed segment. Compared with the traditional operative method of double-segment pedicle screw fixation through the stripping of paraspinal muscle, it can obviously reduce the operation wound and the bleeding, lessen the pain of lumbar and back. And the recent clinical effect is satisfied.</p>

Application of single interbody fusion cage with pedicle screws by transforaminal approach in treating lumbar instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the value of transforaminal approach single interbody fusion cage combining with fixation with pedicle screws in treating lumbar instability.</p><p><b>METHODS</b>From 2006 to 2009, 36 patients (39 interspaces) with lumbar instability were retrospectively analyzed, included 14 males and 22 females; aged from 45 to 68 years with an average of 54 years; course of disease was from 6 months to 12 years with an average of 4 years. Of them, instability in lumbar disc herniation had 8 cases, lumbar spinal stenosis 5 cases, postoperative instability in lumbar disc herniation 3 cases, lumbar spondylolysis 20 cases; unstable segment in L3,4 had 2 cases, L4,5 18 cases, L5S1 13 cases, and double segment 3 cases (both L4,5 and L5S1). All patients underwent decompression, reduction, interbody fusion with single cage from transforaminal approach with pedicle screws and posterolateral fusion. The clinical effects were evaluated according to imaging results and JOA scoring system.</p><p><b>RESULTS</b>All the patients were followed up from 8 to 32 months with an average of 18 months. The results of 38 intervertebral fusion, suspicious fusion of a vertebral space, fusion rate was 97.4% (38/39). Segmental lordosis angle after operation was increased (4.09 +/- 0.13) degrees than before operation (P < 0.01), and final follow-up was reduced (3.83 +/- 0.17) degrees than after operation (P > 0.05). JOA scoring before operation and final follow-up were respectively 8.14 +/- 1.09 and 13.54 +/- 1.19, there was statistically significant between the two periods (P < 0.01); the JOA score improvement rate (RIS): 28 cases got excellent result, 6 good and 2 fair, the rate of excellent and good was 94.4%.</p><p><b>CONCLUSION</b>The path through the transforaminal approach single-fusion cage, implantation of pedicle screw fixation fusion surgery can simplify operations, reduce complications, and can obtain satisfactory clinical efficacy, which is an effective method for the treatment of lumbar instability.</p>