Treatment of a 3rd Lumbar Vertebra Translational Injury Combined with Incomplete Cauda Equina Syndrome in Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis is a rheumatic disease in which mainly the spinal and sacroiliac joints are affected. Patients with ankylosing spondylitis are at significant risk for spinal fracture when exposed to even minor trauma. Most spinal fractures with ankylosing spondylitis occur in the cervical spine, whereas spinal fractures in thoracic or lumbar spine are rare, especially in the lower lumbar spine. Furthermore, neurologic symptoms in cases of lower lumbar spine fracture are rarer than in cases of cervical and thoracic spinal fracture. We have experienced a case of translation injury of the 3rd lumbar vertebra accompanied by incomplete cauda equine syndrome in ankylosing spondylitis and the authors gained good clinical results with surgical treatment. We have reported here on this case and have included a review of the relevant literature.

Radiographic Analysis of Instrumented Posterolateral Fusion Mass Using Mixture of Local Autologous Bone and b-TCP (PolyBone(R)) in a Lumbar Spinal Fusion Surgery

OBJECTIVE: Although iliac crest autograft is the gold standard for lumbar fusion, the morbidity of donor site leads us to find an alternatives to replace autologous bone graft. Ceramic-based synthetic bone grafts such as hydroxyapatite (HA) and b-tricalcium phosphate (b-TCP) provide scaffolds similar to those of autologous bone, are plentiful and inexpensive, and are not associated with donor morbidity. The present report describes the use of Polybone(R) (Kyungwon Medical, Korea), a beta-tricalcium phosphate, for lumbar posterolateral fusion and assesses clinical and radiological efficacy as a graft material. METHODS: This study retrospectively analyzed data from 32 patients (11 men, 21 women) who underwent posterolateral fusion (PLF) using PolyBone(R) from January to August, 2008. Back and leg pain were assessed using a Numeric Rating Scale (NRS), and clinical outcome was assessed using the Oswestry Disability Index (ODI). Serial radiological X-ray follow up were done at 1, 3, 6 12 month. A computed tomography (CT) scan was done in 12 month. Radiological fusion was assessed using simple anterior-posterior (AP) X-rays and computed tomography (CT). The changes of radiodensity of fusion mass showed on the X-ray image were analyzed into 4 stages to assess PLF status. RESULTS: The mean NRS scores for leg pain and back pain decreased over 12 months postoperatively, from 8.0 to 1.0 and from 6.7 to 1.7, respectively. The mean ODI score also decreased from 60.5 to 17.7. X-rays and CT showed that 25 cases had stage IV fusion bridges at 12 months postoperatively (83.3% success). The radiodensity of fusion mass on X-ray AP image significantly changed at 1 and 6 months. CONCLUSION: The present results indicate that the use of a mixture of local autologous bone and PolyBone(R) results in fusion rates comparable to those using autologous bone and has the advantage of reduced morbidity. In addition, the graft radiodensity ratio significantly changed at postoperative 1 and 6 months, possibly reflecting the inflammatory response and stabilization.

Clinical Comparison of Posterolateral Fusion with Posterior Lumbar Interbody Fusion

OBJECTIVE: The purpose of this study is to compare the outcomes of two methods for stabilization and fusion: Postero-Lateral Fusion (PLF, pedicle screw fixation with bone graft) and Posterior Lumbar Interbody Fusion (PLIF, cage insertion) for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. METHODS: Seventy one patients who underwent PLF (n=36) or PLIF (n=35) between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. RESULTS: The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant (P value= 0.05). The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant (P value=0.017). Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant (P value=0.193). The PLIF group showed statistically significant improvement in Prolo functional scale (P value=0.003). In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration (P value<0.001), change of interbody space (P value<0.001), and range of segmental angle (P value<0.001). CONCLUSION: Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors (fusion type, follow-up duration, change of interbody space, and range of segmental angle). Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.

Clinical outcome of two operation methods in the treatment of degenerative spondylolisthesis / 中国矫形外科杂志

0.05);the better result was obtained including low back pain,Taillard index and relative disc height at the end of follow-up in POLA.[Conclusion]Posterior oblique lumbar arthrodeses is better ideal method in the treatment of degenerative spondylolisthesis.