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Objective:To compare the clinical outcomes and correction effects of kyphosis between Zero-profile device (Zero-p) and plate/cage structures (PCC) in treating cervical spondylotic myelopathy (CSM) patients with cervical kyphosis.Methods:From August 2016 to July 2018, a total of 54 cases of cervical spondylotic myelopathy patients with cervical kyphosis were analyzed retrospectively, including 26 cases treated with Zero-p and 28 cases treated with PCC system. There was no significant difference between the two groups in gender, age, body mass index (BMI) and operative segment. The operation duration and the blood loss were recorded. The clinical outcomes of the patients were measured by visual analogue score (VAS) for neck pain and Japanese Orthopedic Association (JOA) score for neurological function. Moreover, JOA recovery rate was obtained to assess the surgical results. The cervical lordosis (C 2-C 7 Cobb angle), the Cobb angle of the operation segment, the C 2-C 7 vertical axis (C 2 SVA) and the cervical range of motion (ROM) were measured on the lateral and dynamic radiographs of the cervical spine, respectively. Results:In the Zero-p group, the operation duration was 83.0±14.9 (range 60-120) min, intraoperative blood loss was 70.5±27.3 (range 30-150) ml. In PCC group, the operation duration was 100.0±23.9 (range 65-145) min, intraoperative blood loss was 104.2±38.8 (range 30-250) ml. There were significant difference in above parameters between two groups ( t=3.40, 2.06; P=0.00, 0.04). The follow-up duration in Zero-p group was 30.4±5.8 (range 24-36) months and 31.2±4.9 (range 24-36) months in PCC group without significant difference ( t=1.061, P=0.291). The VAS/JOA score of the Zero-p group was improved from (5.9±1.0)/(9.2±1.7) preoperatively to (2.1±0.8)/(14.9±1.0) at 1 month postoperatively, and to (3.4±1.0)/(15.1±0.9) at the last follow-up. The difference between them was statistically significant ( F=130.96, 221.40, P=0.00). The VAS/JOA score of the PCC group was improved from (5.9±1.1)/(8.7±1.6) preoperatively to (2.3±0.9)/(14.9±1.0) at 1 month after surgery, and to (2.6±0.9)/(15.6±1.1) at the last follow-up. The difference between them was statistically significant ( F=303.35, 126.64, P=0.00). However, the VAS score of neck pain in the Zero-p group at the last follow-up was significantly deteriorated, which was significantly higher than that in PCC group ( P<0.05). The cervical lordosis/operative segment Cobb angle in the Zero-p group was improved from preoperative (-6.7°±2.7°)/(-6.5°±3.2°) preoperatively to (14.2°±4.9°)/(12.9°±4.9°) at 1 month postoperatively, and to (5.9°±4.7°)/(5.0°±4.0°) at the last follow-up with statistical significance ( F=196.98, 179.97, P=0.00). The cervical lordosis/operative segment Cobb angle in the PCC group was improved from (-5.7°±3.5°)/(-6.1°±4.0°) preoperatively to (13.9°±6.9°)/(13.0°±6.4°) 1 month after surgery, and to (11.0°±5.5°)/(10.4°±5.6°) at the last follow-up with statistical significance ( F=127.27, 119.98, P=0.00). However, the cervical lordosis and operative segment Cobb angle at the last follow-up in the Zero-p group were significantly lost compared with those at 1 month after surgery, which were significantly smaller than those in the PCC group ( P<0.05). The incidence of dysphagia after operation was 7.7% (2/26) in the Zero-p group and 28.6% (8/28) in the PCC group (χ 2=5.11, P=0.02). Conclusion:For CSM patients with cervical kyphosis, PCC could achieve much better mid-term kyphotic correction and clinical outcomes. However, Zero-p should be avoided as much as possible.
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20?) or vertebral semiluxation and vertebral pathological fracture group (n=14),which was treated with full laminectomy and limited correction with pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract; mild coronal plane deformity (Cobb’s angle
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In recent years, lumbar non-fusion as a novel technique of spinal surgery, can reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. It is possible for the lumbar non-fusion to substitute lumbar fusion, but its application requires a reasonable and perfect verification. The implants’ safety and biocompatibility with the host need further clinical researches for the satisfactory outcomes.
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Interspinous process device is a kind of non-fusion implant for posterior spinal surgery.It is classified by static system and dynamic system according to its characteristics.With rapid development of internal fixator manufacture,materials for interspinous process device become increasing,such as bone allograft,titanium,poly(ether-ether-ketone) and lactoprene composite.A large number of experimental and clinical researches reveal the advantages of this technology in degenerative spinal stenosis,intervertebral original lower back pain,facet syndrome,protrusion of intervertebral disk,and lumbar instability.However,there are still many problems such as the influence on the lumbar posterior column,the mechanism to lumbar disc and the effect on the stability of spine etc.In addition,the clinical indications need to validate by long-term follow up.
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Objective: To study the biocompatibility of CFR/PEEK composite in bone tissue after implanted in lumbar intervertebral space and to evaluate its role in the interbody fusion compared to the allograft bone. Methods: Thirteen beagles were chosen among which 7 were implanted with the disk-like CFR/PEEK composite in the lumbar intervertebral space and the other 6 were implanted with allograft bone. X-ray, QCT and histological examination were employed at 6, 12 and 24 months postoperatively. Results: The X-ray results of fusion segment were in conformity with the QCT's as well as that of histological results. All animals obtained a complete fusion at 24 months. Histological examination revealed that the anterior soft tissue to the implant exhibited a nonspecific foreign body reaction with connective tissue embed the biomaterials. Carbon fragment were seen in the surrounding tissue and some of the debric were phagocytosed by foreign body giant cell. Histological examination of bone and material revealed that new bone grew along the hole of CFR/PEEK implant. Conclusion: CFR/PEEK has an excellent biocompatibility to bone tissue.
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Objective: To study the factors and preventive method of post-operative complications of spinal implant operation. Methods: The post-operative complication of 451 cases who had undergone spinal implant operation were analysed retrospectively. The relative factors of complications were analyzed. Results: Infection, thrombosis of deep vein and failed fusion were the most common complications. Among the factors, the age, operation time and blood lose during operation were closely related with the complication. Using antibiotic was effective to reduce the infection. Conclusion: It is effective to reduce the post-operative complication of spinal implant operation by proper pre-operative evaluation. Using antibiotic to control other diseases is also effective.
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0.05). X ray film revealed that there was no loosening and displacement of internal fixation device in the test group 3 days after operation. In control group, there were 2 cases of slight graft bone displacement. Both groups exhibited a stiff bone fusion at operative level 3 months later. The intervertebral disc height of fusion level increased by (1.2?0.7) mm in the test group while decreased by (1.5?0.8) mm in the control group. CT scan revealed that there was tight contact between the internal fixation device and bone 3 days after operation. Both groups had obtained bone fusion in CT image 3 months later. Conclusion:Threaded cervical interbody fusion device made from carbon fiber reinforced PEEK has an excellent biocompatibility and can restore the intervertebral disc hight effectively with satisfactory fusion rate.
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Objective:To study the relationship between dynamic Hoffmann's sign(DHS) and the early diagnosis of cervical spondylotic myelopathy. Methods:Patients with neck, shoulder and back pain (218 cases) were employed in this investigation. Among them, 96 cases had positive reaction to DHS test and they received 3 7 years follow up as study group. The other 122 cases negative to DHS test were taken as control group. The clinical data included the patient's symptoms and signs, sagittal diameter of cervical spinal canal, Pavlov rate, angular displacement and horizontal displacement between cervical vertebral, etc . Results:There were 72 cases in study group developed cervical spondylotic myelopathy and needed operation during follow up. Meanwhile, 11 cases in control group received surgical treatment. The incidence of stenosis of cervical spinal canal, herniation of cervical intervertebral disc and instability of cervical spine in DHS group were significantly higher than that of the control group. Conclusion:DHS is closely related to the onset of cervical spondylotic myelopathy. The patients should be followed up closely if they present positive reaction to DHS, and should be operated on early when their neurological symptom is progressing.
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Idiopathic scoliosis is a common disorder in spinal surgery, and operative intervention with three-dimensional interfixation is an effective treatment for it. Postoperative evaluation of spinal balance is an important index to evaluate the efficacy of the operative intervention. The radiologic parameters for evaluating postoperative spinal balance in coronal, sagittal and axial view were reviewed in this article.
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Objective To study the treatment strategy and clinical results of surgical management for unstable Hangmans fracture. Methods From May 1994 to December 2001, 52 cases of Hangmans fracture were admitted and recorded in Changhai hospital and Changzheng hospital. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangmans fracture, there were stable fracture (type Ⅰ) in 24 cases, all of whom were treated conservatively, and unstable fracture in 28 cases, who were subdivided into type Ⅱ in 9 cases, type ⅡA in 12 cases and type Ⅲ in 7 cases. The clinical results of 28 cases of unstable Hangmans fracture were analyzed in the study retrospectively. Of 28 unstable fractures, there were 22 males and 6 females, aging from 17 to 62 years with an average of 39 years, and all patients were treated surgically. The interval from injury to the index operation was from one to sixteen days(mean, 4 days). The mechanisms of injury were traffic accident in 13 cases, bruise in 6 cases, falling down in 5 cases, hyperextension in 2 cases and other cause in 2 cases. 12 cases were complicated with neurological symptoms. The patients were given traction from 2 kg to 4 kg increasing gradually; and bedside X-ray examination was taken to confirm the reduction of fracture two to seven days later. 20 cases received anterior fusion and internal fixation with anterior plate; other 8 cases received posterior fusion and internal fixation. The treatment results of anterior and posterior approach group were evaluated. Results One week after operation, X-ray films showed complete reduction of C2,3 dislocation and satisfied internal fixation in all patients. 20 cases of anterior fixation and 4 cases of posterior pedicle screws fixation obtained normal fuction of cervical spine, however, 4 cases using posterior approach, bone grafting and wire fixation had cervical rotational loss of 50% to 70%. Temporary larynx edema occurred in 7 cases, and cured with spray inhalation and dehydration therapy within 72 hours. All of the cases achieved bony fusion; and the neurological function were restored satisfactorily once the fracture and dislocation were reduced. Conclusion Anterior fusion and plate fixation for unstable Hangmans fracture provide an immediate instability, early ambulation and retain the maximal motion range of cervical spine.