Case-control study of therapeutic effects between extreme lateral interbody fusion and conventional posterior operation for the treatment of upper lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes between extreme lateral interbody fusion and conventional posterior operation in the treatment of upper lumbar disc herniation.</p><p><b>METHODS</b>Among 60 patients with upper lumbar disc herniation were treated with extreme lateral interbody fusion(XLIF) or conventional posterior operation from June 2010 to December 2014, 30 patients(19 males and 11 females) were treated with XLIF (XLIF group); and the other 30 patients(17 males and 13 females) were treated with conventional posterior operation (conventional group). In XLIF group, the lesions occurred at T₁₂L₁ segments in 2 patients, at L₁,₂ segments in 6 patients, at L₂,₃ segments in 10 patients, and at L₃,₄ segment in 12 patients. In conventional group, the lesions occurred at T₁₂L₁ segments in 1 patient, at L₁,₂ segments in 6 patients, at L₂,₃ segments in 8 patients, and at L₃,₄ segment in 15 patients. Operative incision lengths, time, blood loss, postoperative draining volume, hospital stays were recorded. Pre-and post-operative visual analogue score(VAS) and Japanese Orthopedic Association(JOA) were compared between two groups. According to the image data, the intervertebral fusion device was observed to be displaced and the rate of interbody fusion was analyzed.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 48 months, with an average of 29 months. The complications included 2 femoral nerve damage in XLIF group (postoperative recovery within 3 months) and superficial incision infection in conventional group(cured by anti-infection). There were no patients with cerebrospinal fluid leakage(CSFL), cauda equina injuries or functional deterioration in the nerve root of lower limbs. In the XLIF group: the operative time was (65.6±20.5) minutes, blood loss was (48.8±15.3) ml, postoperative draining volume was 0 ml. In the conventional group: the operative time was (135.2±33.9) minutes, blood loss was (260.3±125.7) ml, postoperative draining volume was (207.1±50.2) ml. The operative time, blood loss, postoperative draining volume in XLIF group were less than those in the conventional group(<0.05). The JOA and VAS score were significantly improved in both groups during the follow-up period compared with those before operation(<0.05). But the difference of the JOA and VAS score between the two groups 1, 6, and 24 months after surgery had not significant differences(>0.05). There were no significant differences in the fusion rate between the two groups 6 and 12 months after operation(>0.05).</p><p><b>CONCLUSIONS</b>The XLIF fusion for the treatment of upper lumbar disc herniation has several advantages such as minimal invasive, stable vertebral plate, less complications and postoperative fusion rate, which has a better clinical effect.</p>

Risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders / 中华外科杂志

<p><b>OBJECTIVE</b>to evaluate the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders.</p><p><b>METHODS</b>total 104 cases were collected from January 2005 to June 2009. Twelve variables among patients with PPCs and without PPCs were analyzed by logistic regression analysis.</p><p><b>RESULTS</b>the incidence of postoperative pulmonary complications following transoral operation for the atlanta-axis disorders was 22.1% (23/104). There was significantly difference in 9 variables between patients with PPCs and without PPCs, and 5 variables as serum albumin < 35 g/L (OR = 15.185, P = 0.003), tracheotomy (OR = 32.254, P = 0.015), Frankle grade (OR = 8.866, P = 0.001), the duration of intubation > 4 d (OR = 7.934, P = 0.002), the duration of surgery > 6 h (OR = 16.889, P = 0.006) were found to be significantly related to the development to postoperative pulmonary complications by multivariate analysis.</p><p><b>CONCLUSION</b>serum albumin < 35 g/L, tracheotomy, Frankle grade, the duration of intubation > 4 d, the duration of surgery > 6 h are the risk factors for postoperative pulmonary complications following transoral operation for the atlanta-axis disorders.</p>

Diagnosis and treatment for complicated atlantoaxial dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and treatment methods for complicated atlantoaxial dislocation.</p><p><b>METHODS</b>A retrospective evaluation was done to summarize and analyze the clinical characteristics and complicated factors of 54 patients with complicated atlantoaxial dislocation who could not to be treated effectively by using conventional therapy in our hospital from February 2005 to October 2008. According to different complicated factors, different treatment methods mainly including transoral atlantoaxial reduction plate-III (TARP-III) operation, decompression procedure with deep grinding guided by computer aided design-rapid prototyping (CAD-RP), screw placement technique with CAD-RP guide plate and extensile approach surgery were performed.</p><p><b>RESULTS</b>The average follow-up period was 24 months. Among 54 cases, 48 cases achieved immediate anatomic reduction completely and 6 cases almost achieved anatomical reduction. All the compressed spinal cords were decompressed sufficiently. The decompression rate was 86.0% and the improvement rate of nerve function was 77.8%. Two cases suffered postoperative intracranial infection.</p><p><b>CONCLUSION</b>Some cases of complicated atlantoaxial dislocation can be effectively treated by using TARP-III operation, decompression procedure with deep grinding guided by CAD-RP, individualized screw placement technique with CAD-RP guide plate and extensile approach surgery.</p>

Treatment of traumatic intervertebrae disk herniation in cervical thoracic junction through transforminal approach / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the treatment for traumatic intervertebrae disk herniation in cervical thoracic junction.</p><p><b>METHODS</b>From 2003 to 2008, there were 10 patients with trautimatic intervertebral disk herniation in cervical thoracic junction, which included 6 males and 4 females, aged from 23 to 66 years (means 41.5 years). All of them were performed through the transforminal approach combined with internal fixation. After operation all patient underwent hyperbaric oxygen treatment. The function of spine was evaluated by JOA score system.</p><p><b>RESULTS</b>All patients were followed up for 8 to 16 months(means 13 months). All patients got recovery of spine function to some extent except one case with complete spine damaged. The JOA scores was improved from (8 +/- 3) before operation to (15 +/- 2) after operation.</p><p><b>CONCLUSION</b>Early and effective treatment by transforminal operation could be helpful for the recovery of spine function.</p>

Clinical study of transforaminal instrumented lumbar interbody fusion / 中国骨伤

<p><b>OBJECTIVE</b>To study the effect and complications of transforaminal lumbar interbody fusion technique.</p><p><b>METHODS</b>The medical records and radiographs of 40 patients undergone transforaminal lumbar interbody fusion between 2005 and 2007 were retrospectively reviewed. There were 49 segments with fusion. Preoperative and 1 year postoperative functional evaluation were graded with ODI and VAS scoring system. The height and angle of the intervertebral space and the fusion status were measured as well.</p><p><b>RESULTS</b>All patients were followed-up for 12 to 24 months with the average of 18 mouths. There were no severity postoperative complications. The operation time averaged 160 min and average blood loss 510 ml. The effect results were excellent in 28 cases, good in 7 and fair in 5. The fusion rate was 100%. One year after operation, the pain relief in the VAS and the reduction of the ODI were significant (P < 0.01), the height and angle of the intervertebral space increased obviously (P < 0.05). Fifteen patients complained low back pain to some extent untill the last follow-up.</p><p><b>CONCLUSION</b>Transforaminal lumbar interbody fusion can achieve satisfactory clinical and radiographic results especially for the failed back surgery syndrome.</p>

A biomechanical study of anterior screw fixation for type II odontoid fracture with anteroinferior-posterosuperior fracture line / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the biomechanical effect of anterior screw fixation on the type II fractured odontoid process.</p><p><b>METHODS</b>Twenty fresh human C1-C2 vertebrae specimens were harvested and randomly divided into three groups. The angle of type II fracture line was 0 degree in group I (n=6), 17 degrees in group II (n=8) and 25 degrees in group III (n=6). The fractures were treated by anterior screw fixation. Insertion torque,maximal axial pullout force and stiffness of the bone-screw were tested.</p><p><b>RESULTS</b>There was no significant difference of screw insertion torque and the pull-out strength between each group. The displacement of the odontoid fragment had an association to the angle of the fracture line,the displacement of the small angle was significantly higher than that of the large one (P < 0.5). No significant difference of structure stiffness of the bone-screw was found between each group.</p><p><b>CONCLUSION</b>Anterior screw fixation is feasible for type II odontoid fracture with certain fracture line extends from anteroinferior to posterosuperior.</p>

Development of quantitative real-time polymerase chain reaction for the detection of Vibrio vulnificus based on hemolysin (vvhA) coding system / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To establish a TaqMan real-time fluorescent quantitative PCR to detect Vibrio vulnificus based on the hemolysin gene (vvhA) coding cytolysin.</p><p><b>METHODS</b>Primers and probes in the conserved region of the vvhA gene sequence were designed for the TaqMan real-time PCR to detect 100 bp amplicon from V. vulnificus DNA. Recombinant plasmid pMD19-vvhA100 was constructed and used as a positive control during the detection. Minimal amplification cycles (Ct value) and fluorescence intensity enhancement (DeltaRn value) were used as observing indexes to optimize the reaction conditions of TaqMan real-time PCR. The TaqMan assay for the detection of Vbirio vulnificus was evaluated in pure culture, mice tissue which artificially contaminated Vibrio vulnificus and clinical samples.</p><p><b>RESULTS</b>The established TaqMan real-time PCR showed positive results only for Vibrio vulnificus DNA and pMD19-vvhA100. The standard curve was plotted and the minimum level of the vvhA target from the recombinant plasmid DNA was 10(3) copies with a Ct value of 37.94+/-0.19, as the equivalent of 0.01 ng purified genomic DNA of Vibrio vulnificus. The results detected by TaqMan PCR were positive for the 16 clinical samples and all the specimens of peripheral blood and subcutaneous tissue of mice which were infected with Vibrio vulnificus.</p><p><b>CONCLUSION</b>TaqMan real-time PCR is a rapid, effective, and quantitative tool to detect Vibro vulnificus, and can be used in clinical laboratory diagnosis of septicemia and wound infection caused by Vibrio vulnificus.</p>

Establishment of TaqMan real-time quantitative PCR assay based on vvhA gene for quick detection of Vibrio vulnificus / 中华急诊医学杂志

Objective To establish a TaqMan real-time fluorescent quantitative PCR to detect Vibrio vulnificus based on hemolysin gene(vvhA)that coding cytolysin.Method By using software Primer Express, the PCR primers and TaqMan probe,which located in the conserved region of vvhA gene sequence,were designed for establishment of a TaqMan real-time fluorescent quantitative PCR to detect 100 bp amplicon from V.vulnificus DNA.A recombinant plasmid pMD19-vvhA100 as a positive control during detection was constructed using gene cloning technique.Minimal amplification cycles(Ct value)and fluorescence intensity enhancement (△Rn value)were used as observing index to optimize the reaction conditions of the TaqMan real-time fluorescent quantitative PCR.The DNAs with different concentrations from V.vulnificus and other eight bacteria and pMD19- vvhA100 were applied as templates to determine the specificity,sensitivity and reappearance of the TaqMan real- time fluorescent quantitative PCR.ICR mice were intraperitoneally,subcutaneously and orally infected with V. vulnificus,respectively.The detection effect of the TaqMan real-time fluorescent quantitative PCR was measured using the specimens of peripheral blood,subcutaneous tissue and intestinal content collected from the infected mice.Results The established TaqMan real-time fluorescent quantitative PCR showed positive results only for V. vulnificus DNA and pMD19-vvhA100.The detection effectiveness of the TaqMan real-time fluorescent quantitative PCR was as high as 0.01 ng of V.vulnificus DNA or 103 copies of pMD19-vvhA100.The SD values of the detection results repeated for three times using pMD19-vvhA100 with different concentrations were lease than 0.79. The detection results of TaqMan real-time fluorescent quantitative PCR were positive for all the specimens of peripheral blood and subcutaneous tissue.Conclusions The TaqMan real-time fluorescent quantitative PCR established in this study for V.vulnificus vvhA gene detection has advantages such as quickness,stability, sensitivity and specificity,indicating this method can be used for clinical laboratory diagnosis of septicemia and wound infection caused by V.vulnificus.

Anatomic evaluation the entry point of C2 pedicle screw / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark.</p><p><b>METHODS</b>Fifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established.</p><p><b>RESULTS</b>The medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process.</p><p><b>CONCLUSIONS</b>There is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.</p>

The anatomical study of transoral atlantoaxial reduction plate internal fixation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study relevant anatomical features of the structures involved in transoral atlanto-axial reduction plate (TARP) internal fixation through transoral approach for treating irreducible atlanto-axial dislocation and providing anatomical basis for the clinical application of TARP.</p><p><b>METHODS</b>Ten fresh craniocervical specimens were microsurgically dissected layer by layer through transoral approach. The stratification of the posterior pharyngeal wall, the course of the vertebral artery, anatomical relationships of the adjacent structures of the atlas and axis, and the closely relevant anatomical parameters for TARP internal fixation were measured.</p><p><b>RESULTS</b>The posterior pharyngeal wall consisted of two layers and two interspaces: the mucosa, prevertebral fascia, retropharyngeal space, and prevertebral space. The range from the anterior edge of the foramen magnum to C(3) could be exposed by this approach. The thickness of the posterior pharyngeal wall was (3.6+/-0.3) mm (ranging 2.9-4.3 mm) at the anterior tubercle of C1, (6.1+/-0.4) mm (ranging 5.2-7.1 mm) at the lateral mass of C(1) and (5.5+/-0.4) mm (ranging 4.3-6.5 mm) at the central part of C(2), respectively. The distance from the incisor tooth to the anterior tubercle of C(1), C(1) screw entry point, and C(2)screw entry point was (82.5+/-7.8) mm (ranging 71.4-96.2 mm), (90.1+/-3.8) mm (ranging 82.2-96.3 mm), and (89.0+/-4.1) mm (ranging 81.3-95.3 mm), respectively. The distance between the vertebral artery at the atlas and the midline was (25.2+/- 2.3) mm (ranging 20.4-29.7 mm) and that between the vertebral artery at the axis and the midline was (18.4+/- 2.6) mm (ranging 13.1-23.0 mm). The allowed width of the atlas and axis for exposure was (39.4+/-2.2) mm (ranging 36.2-42.7 mm) and (39.0+/-2.1) mm (ranging 35.8-42.3 mm), respectively. The distance (a) between the two atlas screw insertion points (center of anterior aspect of C(1) lateral mass) was (31.4+/-3.3) mm (ranging 25.4-36.6 mm). The vertical distance (b) between the line connecting the two C(1) screw entry points and that connecting the two C(2) screw entry points (at the central part of the vertebrae, namely 3-4 mm lateral to the midline of C(2) vertebrae) was (21.3+/-2.7) mm (ranging 19.4-24.3 mm), with an a/b ratio of 1.3-1.5. The screws of TARP had a lateral tilt of 12.2 degrees+/-0.4 degrees(ranging 10.2 degrees-14.6 degrees) at C(1) and a medial tilt of 7.3 degrees+/-0.3 degrees (ranging 5.1 degrees-9.4 degrees) at C(2) relative to the coronal plane.</p><p><b>CONCLUSIONS</b>An atlanto-axial surgery through transoral approach is safe and feasible. This approach is suitable for an anterior TARP internal fixation, and the design of the internal fixation system should be based on the above anatomical data.</p>

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP), introduce the operation procedure, and evaluate its preliminary clinical effects.</p><p><b>METHODS</b>A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis.</p><p><b>RESULTS</b>Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory.</p><p><b>CONCLUSIONS</b>The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications.</p>

Anatomic identification of the location of the pedicle of atlas with the lateral mass of C2 to C4 as the landmark / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relevant position of the pedicle of C1 to the lateral mass of C(2-4), set up an identification technique for the entry point decision of C1 pedicle screw by using the lateral mass of C(2-4) as anatomic landmarks.</p><p><b>METHODS</b>Twenty cadaver specimens were used to measure the distance from the sagittal midline of spine to the medial border, the midpoint and the lateral border of C1 pedicle or the lateral mass of C2, C3 or C4. The anatomic relation between the measurements data of C1 pedicle and that of the lateral masses of the cervical vertebrae were analyzed, and the technique of C1 pedicle screw fixation was established.</p><p><b>RESULTS</b>The average medial border of the lateral mass of C2, C3 and C4 was 0.37 mm, 0.27 mm and 0.24 mm lateral to that of C1 pedicle, the average midpoint of the lateral mass of C2, C3 and C4 was 1.18 mm, 1.41 mm and 1.74 mm lateral to that of C1 pedicle, and the average lateral border of the lateral mass of C2, C3 and C4 was 1.96 mm, 2.54 mm and 3.24 mm lateral to that of C1 pedicle, respectively.</p><p><b>CONCLUSION</b>There is a steady anatomic location relation between C1 pedicle and the lateral mass of C2, C3 or C4. As well as the lateral mass of C2, the lateral mass of C3 or that of C4 could be convenient anatomic landmarks to determine the location of C1 pedicle and the position of C1 pedicle screw entry point.</p>

Design and preliminary clinical application of transoralpharyngeal atlantoaxial reduction plate / 中华外科杂志

<p><b>OBJECTIVE</b>To design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.</p><p><b>METHODS</b>A brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.</p><p><b>RESULTS</b>The reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.</p><p><b>CONCLUSION</b>TARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.</p>

Surgical anatomy of transoral atlantoaxial reduction plate internal fixation / 中华外科杂志

<p><b>OBJECTIVE</b>To provide anatomical data for transoral atlantoaxial reduction plate internal fixation.</p><p><b>METHOD</b>Microsurgical dissecting was performed on 10 fresh craniocervical specimens layer by layer according to transoral approach. Stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationships of atlas and axis and correlative anatomical parameters of internal fixation to atlantoaxial joint were observed.</p><p><b>RESULT</b>(1) Posterior pharyngeal wall consisted of 2 layers and 2 interspace: mucosa, anterior fascia of vertebrae, posterior interspace of pharynx and anterior interspace of vertebrae. (2) The range from anterior rim of foramen magnum to C3 could be exposed by this approach. (3) The distance between the vertebral artery at atlas and midline was (25.2 +/- 2.3) mm and that between the vertebral artery at axis and midline was (18.4 +/- 2.6) mm. (4) The width of atlas and that of axis could be exposed respectively to (39.4 +/- 2.2) mm and (39.0 +/- 2.1) mm. The distance (a) between 2 atlas screw inserting points (center of anterior aspect of C-1 lateral mass) was (31.4 +/- 3.3) mm. The vertical distance (b) between the connecting line of 2 atlas screw inserting points and that of 2 axis screw inserting points (at the central part of the vertebrae which was 3 - 4 mm lateral to the midline of C-2 vertebrae) was (18.7 +/- 2.7) mm. The odds of a/b was 1.5 approximately 1.7.</p><p><b>CONCLUSIONS</b>Anterior atlantoaxial plate internal fixation through transoral approach is suitable and feasible. The design of the plate should be based on the above data.</p>

The reason and prevention of upper cervical reoperations / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease.</p><p><b>METHODS</b>Thirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations.</p><p><b>RESULTS</b>The reasons for reoperations included 9 cases with unstable or re-dislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital-cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone-plant slipped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom.</p><p><b>CONCLUSIONS</b>The common reasons for upper cervical reoperations were due to instability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.</p>

Percutaneous vertebroplasty in treatment of compression fracture of thoracic and lumbar vertebrae / 中华创伤杂志

Objective To discuss the value and experience of the percutaneous vertebroplasty (PVP)in the treatment of vertebral body compression fracture(VCF)in aged osteoperosis.Methods PVP was performed in 44 cases with VCF including 28 with single vertebral compressed fracture,12 with double compressed fracture and four with triple compressed fracture,with 67 vertebrae,for clinical and radiologieal evaluation.Results The mean follow-up was 15 months(4-23 months).There could be seen immediate relief of pain in 40 cases,out-of-bed activities at operation day in 19 and out-of-bed activ- ities at second day after operation in 25.Postoperative X-ray showed uniformly distributed bone cement in the vertebral,without leakage.Conclusion PVP is a recommendable method for VCF,for it has ad- vantages of pain relief,vertebrae stabilization,minimal invasion and minor complications.