Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Preliminary analysis on X-ray in youth neck type of cervical spondylosis with upper crossed syndrome / 中国骨伤

OBJECTIVE@#To analyze the X-ray characteristics in youth neck type of cervical spondylosis with upper crossed syndrome(UCS).@*METHODS@#The patients who had a neck type of cervical spondylosis with or without UCS were selected from January to October 2017, 20 cases in each group, and 10 normal volunteers were chosen in the study. X-ray examination of lateral and hyperextension-hyperflexion of cervical spine were performed to observe cervical spine angle, angular displacement and adjacent vertebral body slip.@*RESULTS@#The cervical spine angle was (-0.40±9.64)° in the UCS group, significantly less than (14.35±9.01)° in the normal group and (12.34±5.65)° in the non-UCS group(0.05).@*CONCLUSIONS@#In young patients who has a neck type of cervical spondylosis with UCS, the cervical curvature prone to straighten or reverse, the upper cervical flexion and extension are limited, while the lower cervical is in a flexion.

Treatment of displacement-type lumbar intervertebral disc protrusion on L2-L5 with percutaneous endoscopic interlaminar discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the operative characteristic, safety, clinical effect of percutaneous endoscopic interlaminar discectomy (PEID) in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅.</p><p><b>METHODS</b>Form November 2015 to October 2016, 15 patients with displacement-type lumbar intervertebral disc protrusion were treated with percutaneous endoscopic interlaminar discectomy. There were 9 males and 6 females, aged from 19 to 63 years old with an average of 42 years. All the patients with single-segment displacement-type lumbar intervertebral disc protrusion were diagnosed by clinical and iconography data, and complicated with low back pain and single lower limbs radioactivity pain. Lesion occurred in L₄,₅ of 8 cases, L₃,₄ of 4 cases, L₂,₃ of 3 cases. The patients were divided into 4 regions according to Lee standard (displaced nucleus pulposus location on spinal canal), I region was 2 cases, II region was 3 cases, III region was 5 cases, IV region was 5 cases.Preoperative, postoperative 3 months, final follow-up, lumbago-leg pain and lumbar function were assessed by VAS, JOA scores;at final follow-up, MacNab was used to evaluate the clinical effect;postoperative 3 months, rechecked lumbar MRI to observe discectomy condition.</p><p><b>RESULTS</b>All the operations were successfully complete under local anesthesia, and no complications such as injuries of nerve root and dural sac, postoperative hemorrhage, local infection were found. Operative time was 45 to 90 min with an average of 54.8 min;and hospitalization time was 3 to 4 days with an average of 3 days. All 15 cases were followed up for 12 to 13 months with an average of 12.2 months, no recurrence was found. Preoperation, postoperative 3, 12 months, VAS scores were 8.2±1.4, 3.0±0.6, 1.7±0.5, JOA scores were 8.76±3.32, 23.61±2.14, 24.82±3.43, respectively. Postoperative VAS, JOA scores were obviously improved(<0.05). According to MacNab standard to evaluate the clinical effect, 9 cases obtained excellent results, 5 good, 1 fair.</p><p><b>CONCLUSIONS</b>PEID is a micro-trauma surgical method and has advantage of safe and effective in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅, but requires laminoplasty during operation, and under local anesthesia to operation maybe can induce neurostimulation.</p>

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>

The causes and prevention of C₅ nerve root palsy after anterior cervical decompression and fusion / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the causes of muscular paralysis due to C₅ nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way.</p><p><b>METHODS</b>From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C₅ nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case.</p><p><b>RESULTS</b>The follow up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C₅ nerve root palsy to 14.48±2.10 at final follow up, with significant difference(<0.05).</p><p><b>CONCLUSIONS</b>More complicated factors result in C₅ nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication.</p>

Factor analysis of muscular paralysis due to nerve root injury after posterior lumbar interbody fusion (PLIF) / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the reasons of muscular paralysis due to nerve root injury after PLIF.</p><p><b>METHODS</b>From January 2001 to January 2012, 1 250 cases underwent PLIF in our hospital, after operation, 29 cases occurred muscular paralysis due to nerve root injury. There were 10 males and 19 females with an average age of 61 years, 12 cases with one-segment, 14 cases with two-segment, 3 cases with three-segment. The clinical data of 29 patients were retrospectively analyzed including PODx (preoperative diagnosis), surgery procedure, postoperative symptoms and so on.</p><p><b>RESULTS</b>The follow-up time was more than 1 year and the longest was 2.5 years with an average of 1 year and 7 months. Twenty-three patients obtained satisfactory results and muscle strength recovered to 4-5 levels,3 patients was poor and final muscle strength recovered to 0-2 levels. Recovering time after operation was directly proportional to the degree of injury,those muscle strength level was more than 2, usually could have significant improvement within 2 weeks.</p><p><b>CONCLUSION</b>More complicated factors result in the reasons of nerve root injury after PLIF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory effect.</p>

Application analysis of patient reported outcome scale for low back and leg pain / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reliability ,validity and reaction degree of patient reported outcome scale for low back and leg pain.</p><p><b>METHODS</b>Two hundreds inpatients were analyzed between August 2010 and January 2012, including 93 males and 107 females with an average age of 50.3 years old ranging from 22 to 65 years. There were 144 cases of lumbar disc herniation and 56 of lumber spinal stenosis. All patients were tested by the patient reported outcome scale for low back and leg pain, and then analyzed the reliability,validity and reaction degree of the scale.</p><p><b>RESULTS</b>There was no statistical significence difference (P>0.05) and significant correlation (r>0.9) in scores of two times in patients with no change in illness. Measurement result of the scale had significant correlation (r>0.9) with Oswestry disability index (ODI). The total Cronbach's Alpha of the instrument was 0.931, the total split-half reliability was 0.912. The KMO value was 0.919, Bartlett test value was 1882.975 (P<0.001), factor analysis resulted in 3 factors with eigenvalue >1 which contributed to 64.364%. Scores of two times of 43 cases who felt better were 34.80+/-9.00 and 28.77+/-8.73, respectively,with stasitical significance (P<0.01).</p><p><b>CONCLUSION</b>The scale has a good reliability, validity and reaction degree,which can be applied for the therapeutic evaluation of low back and leg pain.</p>

Analysis of curative effect of the intervertebral space lavaging for the treatment of incisions deep infections at early stage after posterior lumber internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reason,diagnose outline,therapeutic tool of the incisions deep infections at early stage after lumber internal fixation.</p><p><b>METHODS</b>From January 2001 to December 2011, 10 patients with incisions deep infections at the early stage after the posterior lumber internal fixation were treated with intervertebral space lavaging. There were 1 male and 9 females with an average age of 63 years, and an average infection started at the 6th day after operation. The main clinical features including backleg pain aggravating, fervescence, fresh seepage from the wound, and blood inflammatory index increased, etc. According to whether the wound could heal at the first treatment stage as a evaluation standard of curative effect.</p><p><b>RESULTS</b>Ten cases were followed up with an average period of 17 months. The wounds of 9 cases healed at the first stage and no recurrence and complications were found. One case underwent debridgement of many times with the therapic period of 7 months,at last,after taking out the vertebral pedicle bolt,the wound healed,and no recurrence after follow-up of 18 months.</p><p><b>CONCLUSION</b>The deep wound infections after the lumber internal fixation should receive intervertebral space lavaging as soon as possible. The method can finally remain internal fixations and obtain satisfactory effects, but avoiding too much tissue cutting and tube setting in the deep intervertebral space are the keys to the successful fixation.</p>

Clinical application of titanium miniplate in cervical expansive open-door laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of titanium miniplate in cervical expansive open-door laminoplasty in treating cervical spondylosis.</p><p><b>METHODS</b>From February 2009 to April 2011, 16 patients underwent expansive open-door laminoplasty by titanium miniplate fixation were classified as group A; 18 patients with conventional unilaterally open-door laminoplasty from March 2007 to January 2009 were served as control (group B). The operative time, blood loss during the operations, JOA score of the 6 months after operation, the incidence of axial symptom, curvature of cervical vertebrae were compared respectively between the two groups.</p><p><b>RESULTS</b>Operative time, blood loss, improvement rate of JOA in group A were respectively (122.0 +/- 26.8) min, (153.0 +/- 46.7) ml, (59.4 +/- 11.6)%; and in group B were (119.0 +/- 28.6) min, (151.0 +/- 50.4) ml, (58.7 +/- 12.7)%. Those showed no significant difference between two groups (P > 0.05). Three cases (18.75%) occurred obviously axial symptom in group A and six cases (33.33%) occurred in group B, there was significant difference in the incidence of axial symptom between two groups (P < 0.01). Preoperative and postoperative curvature of cervical vertebrae in group A was (17.9 +/- 5.2) degrees and (18.2 +/- 4.8) degrees, without significant difference; in group B, postoperative curvature of cervical vertebrae decreased obviously than the preoperative [(16.3 +/- 5.9) degrees vs (18.1 +/- 6.3) degrees] (P < 0.05).</p><p><b>CONCLUSION</b>Both surgical protocols are effective on preventing reclose of opened laminae, moreover the modified laminoplasty is advanced on reducing the occurrence of axial symptoms and loss of cervical curvature.</p>

Treatment of thoracolumbar burst fracture with lateral anterior decompression, internal fixation with Ventrofix and bone graft with titanic mesh / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of lateral anterior decompression, internal fixation with Ventrofix and bone graft with titanic mesh in the treatment of severe thoracolumbar burst fracture.</p><p><b>METHODS</b>From January 2008 to January 2010, 21 patients with severe thoracolumbar burst fracture were treated with lateral anterior decompression, internal fixation with Ventrofix, bone graft with titanic mesh. There were 15 males and 6 females, ranging in age from 21 to 46 years with an average of 32.2 years. Segment of fracture: 3 cases were in T11, 6 cases in T12, 7 cases in L1, 5 cases in L2. The mean kyphosis angle was 20.1 degrees and loading of fracture was 7.8 scores. Twenty-one cases accompany with incomplete paralysis. Nerves functions were observed according to Frankel grade; correction and maintain of kyphosis angle were observed by X-rays and CT.</p><p><b>RESULTS</b>All the patients were followed up from 12 to 34 months with an average of 18.5 years. Postoperative complication including injury of pleura in 1 case, dynamic ileus in 2 cases, ilioinguinal nerve injury in 1 case, faulty union of wound in 1 case. All the above complications got recovery after symptomatic treatment. The mean kyphosis angle in fusional segment were 4.2 degrees and the rate of correction was 79%. Nerves functions of all patients got improvement and no internal fixation fail, kyphosis angle obviously lost, titanium mesh shifting, loosening and breakage of screw were found at final follow-up.</p><p><b>CONCLUSION</b>Lateral anterior decompression, bone graft with titanic mesh, internal fixation with Ventrofix is an idea technique for severe thoracolumber burst fracture, but the method can not be used for patient with severity osteoporosis.</p>

Treatment of senile osteoporotic vertebral compression fractures with percutaneous kyphoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of percutaneous kyphoplasty in treating vertebral compression fractures.</p><p><b>METHODS</b>From October 2008 to May 2010,41 patients with osteoporotic vertebral compression fractures were treated with percutaneous kyphoplasty. There were 10 males and 31 females, ranging in age from 61 to 83 years, with an average of 67.5 years. Fracture site was from T9 to L4 including 65 vertebral bodies. Clinical symptom was lumbar and back pain to affect orthobiosis. The pain, height of vertebral body, Cobb angle, function of daily activities were analyzed by VAS sore, imaging data, Oswestry score before and after operation.</p><p><b>RESULTS</b>All operations were successful and no severe complications were found. Bone cement leakage occurred in 7 vertebrae, but no clinical sympton. All lumbago obtained obviously anesis after operation. All patients were followed up from 7 to 26 months with an average of 14 months. Preoperative, postoperative and at final follow-up, VAS score was 8.38 +/- 0.60, 2.45 +/- 0.38, 2.53 +/- 0.36, respectively; Oswestry score was 40.00 +/- 1.16, 17.00 +/- 2.11, 15.00 +/- 1.41, respectively; height of vertebral body was (14.64 +/- 1.30), (25.11 +/- 1.12), (23.16 +/- 1.14) mm, respectively; Cobb angle was (30.17 +/- 1.45) degrees, (12.10 +/- 1.37) degrees, (14.31 +/- 0.51) degrees, respectively. There was significant difference between postoperative and preoperative, and between at final follow-up and preoperative (P<0.05). There was no significant difference between final follow-up and postoperative (P>0.05).</p><p><b>CONCLUSION</b>Percutaneous kyphoplasty is effective for treatment of senile osteoporotic vertebral compression fractures, which can expeditiously relieve pain and effectively recover height of vertebral body and kyphosis Cobb angle, has advantages of minimal trauma and good security.</p>