ABSTRACT
Objective:To observe the diagnostic value of the fat deposition between the base of spinous process and dura mater in the mid-sagittal T1WI image of lumbar spine MRI for occult pars interarticularis defect, and to discuss the its mechanism.Methods:From January 2015 to December 2019, 32 cases with low back and leg pain were confirmed by MR scanning that the fat deposition between the dura mater and the base of spinous process with or without fat deposition in the rest of the spinal canal, including 20 males and 12 females were included. The age was 28.5±6.2 years (range, 18-57 years). Spiral CT scanning and multiplanar reconstruction were used to judge the integrity of the isthmus, levels of defect, and unilateral or bilateral defect. The observation of the above imaging data were independently completed by two orthopaedic doctors.Results:In 32 patients with epidural fat deposition, there were 24 patients with occult isthmus and 8 patients with simple epidural lipomatosis, confirmed by spiral CT multiplanar reconstruction. In 24 cases of isthmus, there were 18 males and 6 females. The age was 27.3±5.3 years (range, 18-45 years). There were 2 cases between the base of L 4 spinous process and dura mater, and 22 cases between the base of L 5 spinous process and dura mater, without fat deposition in the rest of the spinal canal. All 24 cases were bilateral isthmus, and the anterior and lateral X-ray could not be diagnosed. All patients complained of different degrees of mechanical low back pain. 6 cases with disc herniation, and no case with intermittent claudication. In 8 patients with simple epidural lipomatosis, there were 2 males and 6 females. The age ranged from 32 to 55 years, with an average of 38.4±6.7 years. There were 4 cases between the base of L 3 spinous process and dura mater, 3 cases between the base of L 4 spinous process and dura mater, and 1 case between the base of L 5 spinous process and dura mater. All 8 patients had fat deposition between the lamina and dura mater in the upper and/or the same level, and the dura mater was compressed by the fat. 8 patients complained of different degrees of low back pain without tenderness. 2 cases with disc herniation, and one case with intermittent claudication. Conclusion:The fat deposition sign between the base of spinous process and dura mater has certain specificity for occult lumbar spondylolysis. As an effective supplement to the discontinuous bone signal of spondylolysis, it is helpful to the early diagnosis of spondylolysis.
ABSTRACT
Spinal infection was a common disease. It was very important to clarify the type of infection when deciding treatment. After following up of imaging data of spinal infection cases and reviewing the literature reports, some characteristic imaging manifestations were found and summarized, which were very helpful for the differential diagnosis of pyogenic and tuberculous spondylodiscitis. MR features of tuberculous spondylodiscitis were thoracic spine involvement, obvious bone destruction, larger kyphosis angle, vertebral intraosseous abscess, thin and smooth abscess walls, heterogeneous and focal enhancement of vertebral body, 3 vertebrals or more involvement. MR features of pyogenic spondylodiscitis were lumbar spine involvement, a diskitis pattern (disc destruction) with peridiscal bone destruction, homogeneous enhancement of vertebral body, and abnormal signal around the facet joint.
ABSTRACT
The incidence of spinal infectious diseases is on the rise. The diagnosis and treatment of these diseases have always been challenging due to the special location, atypical symptoms, and poor test specificity. In this special issue of spinal infectious diseases, we, together with our colleagues, start from some hot and controversial topics in the current clinical practice, aiming to draw some reference suggestions for the pathogen tracking, imaging characteristics, diagnosis process and treatment methods.
ABSTRACT
Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.
ABSTRACT
Objective:To explore the effect of multidisciplinary collaboration（MDT）mode on perioperative nursing of chronic ulcer of diabetes mellitus patients following lower extremity trauma.Methods:A retrospective case-control study was conducted to analyze the clinical data of 122 diabetes mellitus patients combined with chronic ulcer following lower extremity trauma admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2015 to December 2019. There were 58 males and 64 females at age of 40-76 years［（56.0 ± 4.7）years］. The wounds were located at the heel in 10 patients，at the lateral ankle in 12，at the toe in 22，at the calf in 59 and at the thigh in 19. Sixty patients received MDT care（collaborative care group），and 62 patients received traditional care（traditional care group）. Visual analogue scale（VAS）and level of fasting plasma glucose were measured at days 1 and 3 postoperatively and on the day of discharge. Mental status of the patients was evaluated using self-evaluation of anxiety scale（SAS）and self-rating depression scale（SDS）after nursing. Area and depth of wounds was detected at postoperative 2 weeks and 1 month，and level of fasting glucose was measured again within 1 month after operation. The rate of amputation，incidence of debridement and direct suture rate were documented while hospitalized again at postoperative 1 month.Results:All patients were followed up for 0.5-3 months［（1.2 ± 0.7）months］. VAS was 1.0（1.0，2.0）points，1.0（0.0，1.0）points and 1.0（0.0，1.0）points in collaborative care group at days 1 and 3 postoperatively and on the day of discharge，compared to 2.0（2.0，2.3）points，2.0（2.0，2.0）points and 1.0（1.0，2.0）points in traditional care group（ P < 0.05）. Level of fasting blood glucose was（7.2 ± 0.8）mmol/L，（6.9 ± 0.8）mmol/L and（6.9 ± 0.7）mmol/L in collaborative care group on days 1 and 3 postoperatively and on the day of discharge，compared to（7.8 ± 0.8）mmol/L，（7.8 ± 0.8）mmol/L and（7.7 ± 0.9）mmol/L in traditional care group（ P < 0.05）. Scores of SAS and SDS were（8.4 ± 0.8）points and（11.2 ± 1.0）points in collaborative care group after nursing，compared to（8.7 ± 0.7）points and（12.3 ± 1.0）points in traditional care group（ P < 0.05）. Area and depth of wounds were（29.4 ± 3.9）cm 2 and（1.4 ± 0.4）cm in collaborative care group at postoprative 2 weeks，compared to（33.3 ± 3.6）cm 2 and（1.5 ± 0.5）cm in traditional care group（ P < 0.05）. Area and depth of wounds were（24.5 ± 3.8）cm 2 and（0.9 ± 0.4）cm in collaborative care group at postoprative 1 month，compared to（30.6 ± 4.8）cm 2 and（1.2 ± 0.5）cm in traditional care group（ P < 0.05）. Level of fasting blood glucose in collaborative care group was significantly lower than that in traditional care group at postoprative 1 month（ P < 0.05）. During hospital re-admission 1 month after operation，rate of amputation and incidence of re-debridement were 5%（3/60）and 7%（4/60）in collaborative care group，significantly lower than those in traditional care group［18%（11/62），22%（13/62）］（ P < 0.05），and direct repair suture rate was 88%（53/60）in collaborative care group，significantly higher than that in traditional care group［61%（38/62）］（ P < 0.05）. Conclusion:For chronic ulcer of diabetes mellitus patients following lower extremity trauma，MDT model is superior over traditional nursing for alleviated pain，controlled blood glucose，improved psychological state，promoted wound healing and reduced rate of amputation and incidence of re-debridement.
ABSTRACT
Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.
ABSTRACT
Charcot Spinal Arthropathy (CSA) is a rare and progressive serious degenerative spinal disease. The clinical manifestations of CSA are concealed and atypical, which could lead to missed misdiagnosis, disease prognosis, and a huge burden on patients. However, there is no systematic review of CSA in China. The causes of CSA are mainly divided into spinal cord injury and non-injury neuropathy. The risk factors for CSA caused by spinal cord injury include long-segment fixation, scoliosis, laminectomy, overload spinal exercise and obesity. CSA usually occurs in the lower thoracic or lumbar spine. The symptoms of CSA include spinal deformity, unbalanced sitting posture and local pain. The CSA can be diagnosed after excluding non-specific chronic inflammation in histology and other inflammatory diseases or tumor based on the following items, damage to proprioception, pain and temperature perception, bone destruction, absorption and new bone formation on imaging. Conservative treatment can be considered for patients with CSA who have good stability without infections, stable nerve function, skin fistulas, balanced sitting posture, and autonomic dysfunction. Surgery is recommended for patients with symptoms lasting for more than 6 months with spinal instability, skin fistulas or complicated infections. Before surgery, it is recommended to evaluate the heterotopic ossification or rigidity of both hip joints. During operation, more attention should be paid to the adequate removal of necrotic tissue and inflammatory tissue in the lesion and sufficient bone grafting. Spinal fusion is recommended at the sacrum or pelvis. Postoperative complications include failure of internal fixation, new Charcot joint formation, difficulty in wound healing and infection. The authors emphasize that the overall thoracolumbar spine should be followed up for patients with spinal cord injury and paraplegia for the long-term. The typical symptoms of CSA are helpful for early diagnosis and selection of appropriate interventions.
ABSTRACT
Objective:To compare the clinical efficacy between puncture assisted by a "TINAVI" orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture(OVCF) of the upper thoracic vertebra.Methods:A retrospective study was conducted of the 19 patients (20 vertebral bodies) with OVCF of the upper thoracic vertebra who had been treated at Department of Spine Surgery, Honghui Hospital from January 2018 to March 2019 by robotic vertebroplasty (robot group) and of another 21 counterpart patients (21 vertebral bodies) who had been treated by conventional vertebroplasty from January 2016 to December 2017 (freehand group). Puncture was conducted by a "TINAVI" orthopaedic robot in the robotic vertebroplasty but freehand in the conventional vertebroplasty. The robot group had 5 males and 14 females, aged from 62 to 88 years; the freehand group had 6 males and 15 females, aged from 64 to 83 years. The 2 groups were compared in terms of operation time, bone cement volume, postoperative complications (cement leakage, infection and embolism), visual analogue scale (VAS), Oswestry disability index (ODI), anterior height (AH) and kyphosis angulation (KA) of the injured vertebra at day 1 and last follow-up after surgery.Results:The 2 groups were comparable because there were no significant differences between them in the preoperative general data ( P>0.05). Vertebroplasty via unilateral puncture approach was completed uneventfully in the 19 patients (20 vertebral bodies) in the robot group and in the 21 patients (21 vertebral bodies) in the freehand group. The 40 patients were followed up for 6 to 12 months (mean, 8.3 month). The operation time [(37.9±8.2) min], bone cement volume [(2.3±0.9) mL] and rate of cement leakage (10.0%, 2/20) in the robot group were all significantly less or lower than those in the freehand group [(46.2±9.4) min, (4.2±1.3) mL and 42.9% (9/21)] ( P<0.05). No infection or embolism was observed in either group. There were no significant differences between the 2 groups in VAS, ODI, AH or KA of the injured vertebra at day 1 or last follow-up after surgery ( P>0.05). Conclusion:In vertebroplaty for OVCF of the upper thoracic vertebra, compared with conventional freehand puncture, puncture assisted by a "TINAVI" orthopaedic robot can lead to satisfactory clinical efficacy because it reduces operation time, volume of bone cement injection, and thus incidence of bone cement leakage.
ABSTRACT
Circular RNA (circRNA) is a kind of RNA with a circular structure. The unique structure of circRNA endows it with various cell biological functions and characteristics. It has become a research hotspot recently. CircRNA can play a role via mechanisms, such as microRNA (miRNA) sponge, RNA binding protein, peptide translation and regulation of gene transcription. CircRNA was found to be associated with disc degeneration, spinal cord injury, scoliosis, and facet arthritis. Some techniques, including bioinformatics and molecular biology techniques, microarray and high-throughput sequencing, can be used to predict and to discover disease-related circRNA, aiming to evaluate whether circRNA can be used as a molecular biomarker for spinal and spinal cord diseases. Based on the current role of circRNA, the corresponding therapeutic strategies have been carried out in experimental animals, which can provide theoretical basis for gene therapy. At present, the researches in circRNA for spinal and spinal cord diseases are still insufficient compared with those in other fields. Currently, the main direction focuses on the miRNA sponge mechanism of circRNA. Due to the variety of diseases in spinal surgery, the research progress of circRNA is also varied. In addition, the development of microarray and high-throughput sequencing technology have greatly promoted the researches in circRNA. The availability of public database is of great significance in the study. The present review summarized the current researches status of circRNA in spinal and spinal cord diseases, aiming to deepen understanding of circRNA in spinal and spinal cord diseases.
ABSTRACT
Objective:To compare the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive interbody fusion (MI-TLIF) for degenerative lumbar spondylolisthesis.Methods:Data of 40 patients with I-II degree single level degenerative lumbar spondylolisthesis from January 2018 to December 2018 were retrospectively analyzed. According to the operation procedure, they were divided into two groups: OLIF group and MI-TLIF group, and each group had 20 patients. There were 15 males and 5 females in the OLIF group, aged 50.3±8.8 years; and there were 13 males and 7 females in the MI-TLIF group, aged 51.7±8.7 years. According to the Meyerding's grade system, there were 16 patients of type I in the OLIF group and 15 cases in the MI-TLIF group; and there were 4 patients of type II in the OLIF group and 5 cases in the MI-TLIF group. The operation time, intra-operative hemorrhage, postoperative drainage, recessive blood loss and albumin loss were recorded. The CRP and ESR on the third day after operation, the VAS score and ODI score before and after operation were recorded. The lumbar lordosis (LL), fused segmental lordosis (FSL) and disc height (DH) before and after operation were recorded. The time of getting out of bed and walking and the hospital stay were recorded. Paired t-test was used to analyze the data.Results:Forty patients successfully underwent the operation. The operation time of OLIF group was 96±20 min, with intraoperative blood loss of 61±32 ml and postoperative drainage volume of 18±8 ml. The operation time of MI-TLIF group was 132±26 min, with intraoperative blood loss of 262±102 ml and postoperative drainage volume of 95±42 ml; and there was statistical difference between the two groups ( t=4.901, 8.404, 8.064; P< 0.001). On the third day after operation, the occult blood loss was 139±47 ml in the OLIF group and 486±192 ml in the MI-TLIF group; the albumin loss was 4.2±1.9 g/L in the OLIF group and 10.2±3.9 g/L in the MI-TLIF group; CRP was 34±11 mg/L in the OLIF group and 106±39 mg/L in the MI-TLIF group; ESR was 41±15 mm/1 h in the OLIF group and 71±24 mm/1 h in the MI-TLIF group, and there all were statistical differences between the two groups ( t=7.838, 6.184, 7.983, 4.675; P< 0.001). The VAS scores were 2.2±1.5, 1.8±1.3 and ODI scores were 14%±11%, 59%±17%, respectively. There was no significant difference between the two groups. The LL were 33.41°±9.25°, 32.07°±9.54°, FSL were 11.59°±5.09°, 10.61°±4.56° and DH were 10.35±2.30 mm, 10.85±1.85 mm, respectively. There was no significant difference between the two groups. The follow-up time was 13.5±2.3 months in the OLIF group and 14.1±2.8 months in the MI-TLIF group. Three patients in the MI-TLIF group had radiation pain in the lower extremity on the third day after operation, which relieved after NSAID drugs and mannitol treatment. In the group of OLIF, the skin temperature of the left lower extremity increased in 1 case on the first day after operation, in which sympathetic chain injury was considered, and the patient recovered after 2.5 months; in the group of OLIF, the numbness in the front of the left thigh and the weakness of flexion of the hip was found in 3 cases, in which the edema or injury of the psoas major muscle was considered. Conclusion:Compared with MI-TLIF in the treatment of I, II degree single segment degenerative lumbar spondylolisthesis, OLIF has the advantages of shorter operation time, less intraoperative and postoperative blood loss, lower inflammation index, earlier time to get out of bed and shorter hospital stay. However, the outcomes of the two surgeries were similar.
ABSTRACT
Objective:To investigate the safety, key techniques and clinical efficacy of OLIF (oblique lumbar interbody fusion) corridor combined with lumbar intervertebral debridement, fusion with two interbody and internal fixation for the treatment of single-level lumbar pyogenic spondylodiscitis.Methods:From February 2016 to March 2017, data of 12 patients with single-level lumbar intervertebral pyogenic infection diagnosed in our hospital who had undergone oblique lumbar interbody fusion with two interbody and posterior pedicle screw fixation via Wiltse approach were retrospectively analyzed. Among them, there were 10 males and 2 females, aged from 49 to 79 years, with an average age of 65.4±9.5 years. The white blood cells (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded and analyzed before operation and at the last follow-up. Lumbar pain was assessed by visual analogue acale (VAS), Oswestry disability index (ODI), and clinical efficacy was assessed by the MOS 36-item short-form health survey (SF-36) and Kirkaldy-Willis criteria. The hospitalization time, operation time, intraoperative blood loss, pathological reports, etiological results and complications were recorded. Disc height (DH), segmental angle (SA) and Lumbar Lordosis (LL) were measured before operation and at the last follow-up. The fusion time was recorded. Paired t-test and ANOVA was used for data analysis. Results:All patients underwent surgery successfully, including 6 cases using two titanium meshes and 6 cases using two autologous tricortical iliac bones. Pathogenic culture was positive in 10 cases, with a positive rate of 83.3%, including 4 cases of streptococcus, 4 cases of Staphylococcus aureus, 1 case of Escherichia coli, and 1 case of Klebsiella pneumoniae. All patients were followed up for 16.1±5.1 months. At the last follow-up, WBC ([6.25±2.02] ×10 9/L) was lower than that before operation ([4.89±1.28] ×10 9/L), CRP (preoperation 58.73±52.56 mg/L vs postoperation 8.48±8.79 mg/L) and ESR (preoperation 51.88±19.04 mm/1 h vs postoperation 9.25±5.50 mm/1 h) were significantly lower ( P< 0.01). The VAS score was preoperation 6.67±1.63 and postoperation 1.50±0.55, ODI score was preoperation 72.57%±3.41% and postoperation 18.00%±2.31%, and both were significantly lower postoperatively ( P < 0.01). SF-36 score (preoperation 56.33±4.93 vs postoperation 73.73±5.86) was significantly higher ( P< 0.01) respectively. The postoperative height of intervertebral space ([11.68±2.64] mm) was significantly higher than that before operation ([5.18±1.58] mm). The disc height at the last follow-up was (11.22±2.25) mm, and the loss rate was 1.89% compared with that of the immediate postoperatively; The postoperative lumbar lordosis angle (32.89°±14.52°) was significantly increased compared with that of the preoperative (24.16°±13.49°), and maintained well at the last follow-up (32.27°± 14.21°); The postoperative segmental angle (10.8°±8.51°) was significantly increased compared with that of the preoperative (5.81°±7.44°), and maintained well at the last follow-up (9.94°±7.87°). The fusion time ranged from 6 to 16 months, with an average of 9.2±3.5 months. The clinical efficacy was excellent in 10 cases (83.3%) and good in 2 cases (16.7%). The excellent and good rate was 100%. One case of pulmonary infection and pulmonary embolism occurred 2 days after operation, and recovered after use of antibiotics and anticoagulation treatment in ICU; one case of intramuscular venous thrombosis was found 1 day after operation, and recovered after anticoagulation treatment; no loosening of internal fixation was found, and no complications related to OLIF corridor occurred. Conclusion:The treatment of single-level lumbar intervertebral pyogenic infection with OLIF corridor combined with lumbar intervertebral debridement, fusion with two interbody and internal fixation has the advantages of less blood loss, shorter operation time, more direct clearance of intervertebral space and left paravertebral focus, no disturbance of intraspinal canal and posterior structure, higher positive rate of etiology detection, shorter bedrest time and better restore of disc height and lumbar lordosis after operation. What’s more, the fusion rate is high and the clinical efficacy is satisfactory.
ABSTRACT
Oblique lateral interbody fusion (OLIF) is a popular minimally invasive lumbar fusion technique in the world, which has become an important technique for lumbar interbody fusion. In 2014, OLIF was firstly introduced into the mainland of China, however, due to some defects of OLIF technique, such as steep learning curve, high rates of early complications, and difficult surgical exposure approach, the initial development of OLIF in China was not smooth. In order to make OLIF simpler and safer, the domestic scholars designed special exposure retractors for OLIF, and put forward a new technique for OLIF, called anteroin-ferior psoas exposure technique under direct vision. Driven by the OLIF technique trainings, live operation demonstrations, and literature publications, et al., the OLIF technique begun to settle down and flourish in China. Up to now, the number of surgical cases of Medtronic OLIF25 has reached more than 6 000, and the domestic scholars have published more than 30 OLIF papers in the international journals. However, our domestic spine surgeons still need to pay attention to the standardized application of OLIF, appropriate OLIF devices according to the Chinese anatomical characteristics, and the multicenter randomized controlled study of large samples, et al.
ABSTRACT
According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.
ABSTRACT
Osteoporotic fractures are the most common bone disease in the elderly. The spine is the most common site for osteoporotic fractures, while osteoporotic fractures in the thoracolumbar segment of the spine account for more than 90% of all spinal fractures. In order to standardize the diagnosis and treatment of osteoporotic thoracolumbar fracture, the authors analyze the diagnosis, treatment, surgical methods and related hot issues of osteoporotic thoracolumbar fractures with a review of the current literatures in order to provide references for the standardized clinical diagnosis and treatment.
ABSTRACT
Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.
ABSTRACT
Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.
ABSTRACT
Objective To investigate the application of combination of thoracolumbar injury classification severity score and load sharing classification (TLICS + LSC) in deciding the surgery for thoracolumbar fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with thoracolumbar fractures admitted to Sir RunRun Shaw Hospital affiliated to Medical College of Zhejiang University from January 2013 to November 2015.There were 28 males and 14 females,aged 19-58 years [(39.5 ± 11.5)years].The injured segments included T11 in 2 patients,T12 in 12,L1 in 4,L2 in 24.According to American Spinal Injury Association (ASIA) classification,there were two patients with grade A,five patients with grade B,six patients with grade C,and two patients with grade D.The rest of the patients had good neurological function.Surgical methods were selected according to the TLICS + LSC system.Seventeen patients were treated with posterior internal fixation (TLICS ＞ 4 points,LSC ＜ 7 points) (Group A),19 patients were treated with anterior reconstruction and internal fixation (TLICS ≤4 points,LSC ≥ 7 points) (Group B),and six patients were treated with anterior reconstruction and posterior internal fixation (TLICS ＞ 4 points,LSC ≥ 7 points) (Group C).ASIA grading criteria were used to assess the neurological function recovery of the patients.Vertebral height and sagittal Cobb angle changes were measured on full-length,lateral X-ray or CT sagittal reconstruction images.Artificial vertebral body and screw loosening were observed on lateral X-ray or CT sagittal reconstruction images.Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate pain relief and functional recovery.Results All patients were followed up for 18-24 months [(22.2 ± 2.0) months].base on ASIA grading criteria:one grade A (Group C) was restored to grade C,three grade B (Group B) were restored to grade D,two grade B (Group C) were restored to grade C,six grade C (four in Group A,two in Group B) and two grade D (Group A) were restored to grade E (P ＜ O.05).The correction of sagittal Cobb angle was restored from (26.1 ± 5.6) ° before surgery to (3.7 ± 1.5) ° immediately after surgery and was (4.8 ± 1.0) ° at last follow-up (P ＜ 0.05).There was no loosening of artificial vertebral body or screw in any patient.The VAS score dropped from (6.3 ± 0.9) points before surgery to (2.0 ± O.7) points at the last follow-up,and ODI score was also significantly decreased from (72.6 ± 9.2) points before surgery to (25.2 ± 5.2) points at the last follow-up (P ＜ 0.05).Conclusion The combination of TLICS and LSC can clearly guide the surgical decision-making of patients with thoracolumbar fracture.The operation plan can be made according to the results of the combined scoring.After the operation,the local kyphosis angle of the patients recovers significantly,the pain is relieved and the function is improved significantly.
ABSTRACT
Objective To evaluate the influence of age on the surgical risk and prognosis for elderly patients who suffered from lumbar spinal stenosis.Methods A total of 129 patients above 70 years old with lumbar stenosis from January 2015 to August 2018 were divided into 4 groups by age:younger than 69 years,70-74 years,75-79 years and 80 years and above.50 patients below 69 years old were chosen at random as control group.Different parameters such as operation methods,predicted complication rate (POSSUM score),actual complication rate,number of operation levels,operation time,surgical blood loss,occult blood loss,total hospital stay,postoperative hospital stay,hospital cost and the ODI score in 3 months followup were recorded.The surgical risk and prognosis of elderly patients were analyzed by comparing the differences of above parameters between different age groups.Results There was no significant correlation between different age groups and surgical methods (F=15.637,P=0.208).The operation time and surgical blood loss both showed no significant difference between 4 groups.The predicted incidence of complications (POSSUM score) in group older than 80 years old (38.5％+12.34％) and 75-79 years old (41.1％+ 11.82％) were higher than the group younger than 69 years old (28.4％+ 15.44％).There was no significant difference between the two groups over 75 years old,and there was no significant difference between the 70-74 years old group and the other three groups.The actual incidence of complications was 43.75％ in group over 80 years old,42.86％ in group 75-79 years old and 42.03％ in group 70-74 years old.The actual complication rate of the group younger than 69 years was lower than other three groups,and the three other groups showed no significant difference between each other.The totally hospital stay and numbers of operation levels in groups 75-79 and 80 years and above were higher than groups 70-74 and 69 years and below.There was no significant difference in those parameters between groups 75-79 and 80 years and above,and between groups 70-74 years and 69 years and below.The ODI scores between 4 groups also showed no significant difference.Conclusion The risk of surgery for lumbar disc stenosis patients older than 75 years has increased,but the patient's surgical outcome has not decreased.Old age should not be a key factor in determining whether a patient is suitable for surgery.
ABSTRACT
Objective To investigate the effect of anterior artificial vertebral body reconstruction and internal fixation after the failed posterior thoracolumbar fracture surgery.Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients whose posterior thoracolumbar fracture surgery failed admitted to Sir Run Run Shaw Hospital School of Medicine affiliated to Zhejiang University from January 2014 to June 2017,There were eight males and six females,aged 29-69 years[(43.6±11 .9)years].The involved segments included T11 in one patient,T12 in two patients,L1 in five patients,L2 in four patients and L3 in two patients.According to AO classification,there were four patients with type A2,six with type A3,two with type B1 and two with type B2.The thoracolumbar injury severity scores(TLICS)ranged from 4 to 8 points[(5.3±1.1)points].There were six patients with nonunion,three with nonunion following screw loosening,three with nonunion following breakage,and two with neurological dysfunction.Revision plan:for patients with internal fixation loosening or rupture or long nail placement,the posterior internal fixation would be removed first,and then the stage I anterior revision would be performed after changing the position;for patients with complete internal fixation,only anterior revision would be performed.The operation time,intraoperative blood loss,intraoperative and postoperative complications,pain visual analogue score(VAS),Oswestry dysfunction index(ODI)score and kyphosis angle changes before and after operation were recorded.Results All patients were followed up for 12-54 months[(25.9±13.0)months].The anterior operation time ranged from 100 to 180 minutes[(137.9±23.6)minutes].The intraoperative blood loss ranged from 280 to 750 ml[(452.9±145.4)ml].There were no intraoperative or postoperative complications such as spinal nerve injury,cerebrospinal fluid leakage,vascular injury,abdominal organ injury,incision infection and hemorrhage.VAS decreased from preoperative(6.1±0.9)points to(1.9±0.7)points 3 months after operation and to(1.4±0.5)points at the last follow-up;ODI increased from preoperative(30.4±7.1)points to(7.9±6.4)points 3 months after operation and to(8.1±4.3)points at the last follow-up;kyphosis degree decreased from preoperative(-20.1±6.5)° to(5.6±6.4)° 3 months after operation and to(5.4±6.8)0 at the last follow-up.The VAS,ODI score and kyphosis degree were significantly improved at the last follow-up compared with those before operation(P＜ 0.01).Conclusions For patients with failed thoracolumbar fracture posterior surgery,anterior artificial vertebral body reconstruction and internal fixation can significantly relieve back pain,improve function and kyphosis deformity,with satisfactory clinical effect,which can be an ideal treatment option for the revision of thoracolumbar fracture.
ABSTRACT
Objective To compare the long-term effect between minimally invasive (MIS) and open approaches in one-level posterior lumbar interbody fusion (O-PLIF) after more than 10 years follow up. Methods All 131 patients (lumbar spine le-sions) in our hospital were randomized into MIS-PLIF group and O-PLIF group from March 2006 to March 2008. In MIS-PLIF group, there are 66 patients, 34 males and 32 females, with the average of 52.3 ± 6.7 years old (range from 40 to 63). In O-PLIF group, there are 65 patients, 29 males and 36 females, with the average of 51.1 ± 6.9 years old (range from 46 to 63). Regarding March 2018 as last follow-up, differences in intervertebral disc height and segmental lordosis restoration of the operation segment , lumbar lordosis restoration, multifidus cross section area (CSA), multifidus atrophy rate, fusion rate, visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index(ODI), Japanese Orthopaedic Association cores (JOA) and postoperative long-term compli-cations were evaluated between the two groups. The related risk factors of postoperative long-term complications were evaluated in further analysis. Results Complete follow-up data were available on 37 patients in MIS-PLIF group and 35 patients in O-PLIF group, with the follow-up rate of 56.1％and 53.8％respectively,and with the mean follow-up time of 134.5 ±8.4 and 137.1±5.8 months respectively. At three time nodes of one year after operation, five years after operation and last follow-up after operation, there were significant differences in lumbar lordosis restoration (one year after operation and last follow-up after operation)( 5.0°± 2.3° vs. 3.9°±1.4°;4.7°±2.4° vs. 3.7°±1.5°), multifidus CSA (965.4±164.9 mm2 vs. 884.9±168.2 mm2;891.1±155.9 mm2 vs. 783.2± 163.0 mm2; 764.8 ± 148.3 mm2 vs. 643.5 ± 150.0 mm2), multifidus atrophy rate (8.5％± 2.5％ vs. 16.6％± 5.8％; 15.6％± 3.5％ vs. 26.2％±7.4％;27.6％±6.5％vs. 39.3％±9.3％), postoperative VAS for back pain (2.2±1.0 vs. 2.9±1.2;1.7±0.9 vs. 2.2±1.0;1.4±1.0 vs. 2.2±1.2), JOA score (22.3±3.8 vs. 19.9±4.2;23.1±4.3 vs. 19.3±3.9;22.4±4.2 vs. 19.6±4.0) and ODI (11.6％±4.8％vs. 22.0％± 7.7％;9.4％±3.9％vs. 12.3％±4.9％;8.6％±4.0％vs. 11.0％±4.6％) between the two groups (P<0.05). However, there were no sig-nificant differences in segmental lordosis, intervertebral height restoration, lumbar lordosis restoration (one year after operation), fusion rate or postoperative VAS for leg pain between MIS-PLIF and O-PLIF(P>0.05). Intractable back pain and adjacent segment disease were the major postoperative long-term complications for MIS-PLIF group (3 cases and 2 cases) and O-PLIF group (10 cas-es and 7 cases), and the difference was statistically significant in the intractable back pain incidence rate ( 8.5％vs. 28.6％,χ2=5.090, P=0.024), but not in the adjacent segment disease(5.4％vs. 20％,χ2=0.002, P=0.061). What's more, patients with intracta-ble back pain suffered more obviously multifidus atrophy than patients without intractable back pain at three time nodes of one year after operation (19.4±4.4％vs. 10.9±5.1％, P<0.05), five years after operation (30.2±5.4％vs. 18.7±6.7％, P<0.05) and last fol-low-up after operation (44.5±5.7％vs. 30.8±8.9％, P<0.05) . Conclusion In the long-term follow up, compared with O-PLIF, MIS-PLIF had advantages in better maintenance of lumbar lordosis, protection of the multifidus muscle, reduced lower back pain, JOA score, ODI score and intractable back pain incidence rate. Multifidus atrophy may be a related risk factor of intractable back pain.