Posterior short-segment fixation with undermining decompress for upper lumbar burst fractures / 中国骨伤

<p><b>OBJECTIVE</b>To observe clinical effects of posterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures.</p><p><b>METHODS</b>From October 2010 to March 2013,23 patients with upper lumbar burst fractures (Denis B type) were treated by posterior short-segment fixation with undermining decompress by posterior ligament complex. There were 18 males and 5 females aged from 26 to 64 years old with an average of 45.7 years old. Twelve patients were caused by falling down, 5 cases were caused by traffic accident, 4 cases were the bruise injury caused by heavy object and 2 cases were caused by other injury. Fourteen patients were L1 fracture and 9 patients were L2 fracture. Thirteen patients were combined with nerve injuries (degree D according to ASIA classification). Internal fixation were removed from 12 to 20 months with an average of 14.3 months. JOA scores and imaging changes were recorded and compared at different time points.</p><p><b>RESULTS</b>All patients were followed up from 18 to 24 months with an average of 20.4 months. Thirteen patients with nerve injuries were completely recovered at 3 to 6 months after operation. JOA score at 1 year after operation was 20.63 ± 0.92, and 20.38 ± 1.06 at 3 months after removal of internal fixation,which were improved obviously than 9.90 ± 2.73 at 3 months after operation. (P > 0.05) Anterior height of injured vertebrae, vertebral body angle and local Cobb angle was (95.0 ± 0.53)%, (2.78 ± 1.36) and (2.43 ± 1.52) °respectively, and improved obviously than that of before operation (P < 0.05). There was no statistical significance in JOA scores at 3 months after removal of internal fixation and 1 year after operation (P > 0.05).</p><p><b>CONCLUSION</b>posterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures has advantages of minimally invasive, could effective recover vertebrae height, maintain stability of spine, decrease low back pain. It is a safe and effective operative method.</p>

Surgical Outcome in Thoracolumbar Fractures Managed by Short-segment Pedicle Instrumentation

<p><b>INTRODUCTION</b>This study aims to evaluate the efficiency of short-segment instrumentation in treating thoracolumbar fractures in our institute.</p><p><b>MATERIALS AND METHODS</b>Twenty-two patients underwent posterior short-segment instrumentation for thoracolumbar fractures in our institute from 2007 to 2010 were included in this retrospective study. Radiological evaluations were carried out by measuring regional kyphosis angle (RA), anterior vertebral body compression percentage (AVC), and sagittal index (SI) during preoperative, postoperative and final follow-up, with the aim to investigate the rate of correction loss and implantation failure in relation to the Arbeitsgemeinschaft für Osteosythese(AO) classification of fracture system and the Load Sharing score system. CT scans were also used to determine the preoperative to postoperative canal compromise ratio. During the final follow-up, clinical outcomes were analysed based on scores from the Denis' Pain's and Work scales and neurological function was scored according to the Frankel classification.</p><p><b>RESULTS</b>At the final follow-up (average duration of 15 months), 21 patients (95%) who partially or fully recovered from thoracolumbar fractures were able to resume daily activities with no complaints of pain, or only slight pain. No deterioration in neurological function were recorded. Upon evaluation at each point of time, (preoperative, postoperative and final follow-up), the average RA improved from 21º to 3.5º to 5.6º, average AVC improved from 40.8% to 90.2% to 88.2%, and average SI changed from 19.1º to 3.1º to 4.1º, respectively. Average canal compromise ratio decreased from 45% to 6.7% after surgery. No correlation was found between loss of correction and AO classification of fracture system, and loss of correction and Load Sharing system scores. Also, no correlation was found between clinical outcomes and the correction loss limited to 10º.</p><p><b>CONCLUSION</b>Posterior short-segment fixation in thoracolumbar fractures showed a satisfactory outcome in 95% of the patients based on a 15-month follow-up in our institute, even among patients with comminuted fractures injuries.</p>

Diagnosis and management for the non-traumatic epidural sequestered cervical disc extrusion / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion.</p><p><b>METHODS</b>From January 2002 to July 2011, the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65), the course of disease ranged from 1 month to 4 years (mean, 15 months). All patients manifested numbness and weakness of four limbs, unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function.</p><p><b>RESULTS</b>Ten patients were followed up, and the duration ranged from 15 to 32 months, with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20 +/- 1.55 preoperative to 13.60 +/- 1.90 postoperative (t = -11.8, P < 0.001), and excellent in 3 cases, good in 6 cases and moderate in 1 case.</p><p><b>CONCLUSION</b>Anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion.</p>