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BACKGROUND: Percutaneous vertebroplasty is clinically performed mainly through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach. However, there are still disputes on the clinical effect and complications of the three approaches. OBJECTIVE: To compare the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar vertebral compression fractures among three approaches. METHODS: Seventy-eight patients with thoracolumbar vertebral compression fractures who received treatment in Hainan Provincial Hospital of Traditional Chinese Medicine, China between January 2016 and January 2018 were included in this study. These patients consisted of 30 males and 48 females and were aged 40-71 years. Twenty patients received bone cement perfusion through the unilateral pedicle approach (unilateral pedicle group), 35 patients received bone cement perfusion through the bilateral pedicle approach (bilateral pedicle group), and 23 patients received bone cement perfusion through the unilateral pedicle extrapedicle approach (unilateral pedicle extrapedicle group). Bone cement perfusion volume and cement leakage rate were recorded. All patients were followed up for 1 year. The Visual Analogue Scale score, Oswestry Disability Index, vertebral height reconstruction rate, Cobb angle improvement, patient satisfaction and complications were compared among the three groups. This study was approved by the Hospital Ethics Committee, Hainan Provincial Hospital of Traditional Chinese Medicine, China (approval No. HKL20151203). RESULTS AND CONCLUSION: (1) Bone cement perfusion volume in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P 0.05). At 1 year after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly lower than those before surgery in each group (P < 0.05). (3) Cement leakage rate in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P < 0.05). Cement leakage rate in the unilateral pedicle extrapedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (4) The fracture rate of adjacent vertebral bodies in the bilateral pedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (5) These results suggest that three approaches of vertebroplasty and bone cement injection for treatment of thoracolumbar vertebral compression fractures can achieve better clinical efficacy. Bilateral pedicle approach can significantly reduce the incidence of cement leakage and adjacent vertebral fractures compared with the unilateral pedicle approach and unilateral pedicle extrapedicle approach.
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OBJECTIVE@#To explore the clinical effect of unilateral screw fixation and lumbar interbody fusion under the Quadrant tunnel to treat prolapsed lumbar disc herniation in young patients.@*METHODS@#Between January 2015 and January 2017, 18 young patients with prolapsed lumbar disc herniation were treated with unilateral pedicle screw fixation and lumbar interbody fusion under Quadrant tunnel. Among them, there were 10 males and 8 females, aged from 20 to 28 years old with an average of 22.5 years. The VAS, lumbar JOA scores were compared before sutgery, 1 and 3 months after surgery and at the final follow-up. The improvement of clinical symptoms and bone fusion rate were evaluated according to the improved rate of JOA score and X-rays data at the final follow-up.@*RESULTS@#All 18 patients were followed up from 14 to 34 months with an average of 24.3 months. All incisions got primary healing, and no nerve root injury, screw loose or rupture, threaded fusion cage sink or other complications were found. The postoperative VAS, lumbar JOA scores were improved significantly(<0.05). Neurologic function improved significantly in the final follow-up. The postoperative JOA improvement rate was excellent in 10 cases, good in 6 cases, and fair in 2 cases. Postoperative bone graft fusion rate was 100% at 3 to 6 months.@*CONCLUSIONS@#Unilateral screw fixation and lumbar interbody fusion under the Quadrant tunnel is an effective and safe method in treating prolapsed lumbar disc herniation for young patients, it has advantage of short operation time, small trauma and short hospitalization time. However, the indications should be well considered.
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Adult , Female , Humans , Male , Young Adult , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Lumbar Vertebrae , Pedicle Screws , Spinal Fusion , Treatment OutcomeABSTRACT
Objective A retrospective study to determine the mid-and long-term clinical and radiological outcomes of unilateral instrumented transforaminal lumbar interbody fusion (TLIF) with bilateral decompression via unilateral paramedian incision.Methods From J ul.,2007 to J un.,2010,73 patients with single segmental lumbar stenosis were collected in this study.All of 73 patients had bilateral signs and symptoms of stenosis,and accepted the unilateral TLIF with bilateral decompression via unilateral paramedian incision.The oswestry disability index (ODI),Japanese orthopedic association scale (JOA),visual analog scale (VAS),angle of lumbar lordosis (LL) and angle of segmental lordosis (SL) were calculated and compared at pre-operation,six months after operation and last follow up.In addition,the operating time,blood loss,length of hospital stay,complications and fusion rate were also recorded.Results There were 30 males and 43 females in this study.The mean age,mean operation time,mean blood loss and mean length of hospital stay was (57.7 ± 10.1) years,(92.0 ± 26.7)minutes,(150.5 ± 130.3) mL and (12.3 ± 2.7) days,respectively.The follow up was 5 years at least and the mean follow up was (79.4 ± 11.1) months.The ODI,JOA and VAS at six months after operation and last follow up were significantly better than those at pre-operation.As for the sagittal alignment assessment,the LL and SL at six months after operation and last follow up also increased significantly compared with those at pre-operation.All of 73 patients achieved solid interbody fusion.Conclusions Unilateral instrumented TLIF with bilateral decompression via unilateral paramedian incision is an effective innovation.Compared with the traditional TLIF,it could not only reduced the surgical injury and operation cost but also achieve the same ideal effect.
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<p><b>OBJECTIVE</b>To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases.</p><p><b>METHODS</b>The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications.</p><p><b>RESULTS</b>All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively(<0.05). ODI decreased from preoperative(53.42±8.26)% to postoperative(12.45±7.67)%(<0.05). Postoperative intervertebral space height in different segments were improved than preoperative(<0.05), but in final follow up it was decreased than 3 months after operation(<0.05). There was no significant difference in the postoperative intervertebral space height between the operated side and non operated side. But at final follow up, the intervertebral space height of non operated side was obviously loss. At final follow up, the fusion rate was 95.8%. The incidence of adjacent segment degeneration was 45.8%. The paraspinal muscle fibrosis incidence was 8.3%. No complications such as secondary scoliosis, intervertebral height loss, cage slippage, screw loosening and internal fixation breakage were found.</p><p><b>CONCLUSIONS</b>Unilateral pedicle screw fixation with TLIF is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.</p>
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Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.
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PURPOSE: The purpose of this study was to investigate the effects of unilateral pedicle screw fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models. MATERIALS AND METHODS: Four L3-4 fusion models were simulated according to the extent of decompression and the method of pedicle screws fixation in L3-4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3-4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motion at the L2-3 and L3-4 segments were analyzed under flexion, extension, lateral bending, and torsional moments. RESULTS: Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment, but larger motions were noted at the fusion segment (L3-4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superior adjacent L2-3 segments and fusion segment. CONCLUSION: The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely, in the case of hemi-laminectomy, unilateral fixation could be an alternative option, which also has potential benefit to reduce the stress of the adjacent segment.
Subject(s)
Humans , Male , Middle Aged , Biomechanical Phenomena , Computer Simulation , Lumbar Vertebrae/surgery , Models, Anatomic , Pedicle Screws , Range of Motion, Articular , Software , Spinal Fusion , Stress, MechanicalABSTRACT
STUDY DESIGN: This is a prospective clinical study. OBJECTIVES: We wanted to compare the clinical results of conventional vertebroplasty(VP) and the newly devised unilateral partial vertebroplasty(UPVP). SUMMARY OF LITERATURE REVIEW: There has not been any study on how to reduce the amount of cement used while maintaining the height of the vertebral body and minimizing the adjacent compression fractures. MATERIALS AND METHODS: From 2004 to 2008, Group 1 underwent VP and group 2 underwent UPVP. We compared the difference of the VAS score, the period of hospitalization, the infused amount of cement, the progression of the vertebral body collapse and fresh fracture of the adjacent vertebral body on the follow-up simple radiographs. RESULTS: In group 1, the mean VAS score changed from 6.69 to 2.80, the mean period of hospitalization was 2.30 days and the mean amount of cement infused was 6.50cc. The degree of vertebral body collapse was 0.83, 0.76, 0.69 and 0.63 on follow-up, and 3 cases had fresh fracture. In group 2, the mean VAS score changed from 6.41 to 2.61, the mean period of hospitalization was 2.23 days and the mean amount of cement infused was 3.74cc. The degree of collapse was 0.71, 0.69, 0.68 and 0.63 on follow up and 1 case had fresh fracture. The two groups showed no statistical significance for the change of the VAS score and the period of hospitalization, and the amount of cement was significantly less in group 2. The degree of collapse was not significantly different on the 4 times of follow-up. The frequency of fresh fracture was significantly less in group 2. CONCLUSIONS: UPVP could achieve similar results for pain relief, the period of hospitalization and vertebral body collapse as compared to that of VP, but fresh fracture of the adjacent vertebral body was less. So, UPVP could be a better method than VP.
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Follow-Up Studies , Hospitalization , Prospective Studies , VertebroplastyABSTRACT
0.05). Incision size,operating time,blood loss,hospital stay,medical device expenses,postoperative VAS and ODI,clinical outcomes,fusion rates,and complication rates were studied and tested with independent sample t test and x2 test.[Results]The mean follow-up was 19.1 months (range,12~25 months) in group A and 24.6 months (range,9~36 months) in group B.There were statistically significant differences in the incision size,operating time,blood loss,hospital stay and medical device expenses (P0.05).[Conclusion]Unilateral transforaminal lumbar interbody fusion with unilateral pedicle screw fixation has the advantages of small incision,little bleeding,no destruction of the contralateral structure,short operating time or hospital stay,low medical device expenses and good recovery.But the operation indications must be strictly defined.
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0.05).Operation time in group A was shorter than that in group B,with significant difference(P0.05).No postoperative complication was found in two groups.[Conclusion]Unilateral TLIE technique has achieved satisfying postoperative effect compared with bilateral TLIF,with a good prospect in clinical application.
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STUDY DESIGN: We have studied prospectively the clinical and radiological results after unilateral pedicle screw fixation in degenerative lumbar spinal stenosis. OBJECTIVE: To evaluate the clinical significance of unilateral pedicle screw fixation. SUMMARY OF LITERATURE REVIEW: The use of pedicle screw fixation has significantly increased fusion rate in degenerative lumbar spinal surgery. However, the rigid spinal fixation may result in deterioration of the juxta-fusion segments and lead to the stress-shielding of vertebral bodies within the stabilized segments. MATERIALS AND METHODS: From July 1997 to October 1998, we had performed bilateral posterolateral fusion and unilateral pedicle screw fixation for degenerative spinal stenosis in nign cases. The main indications for unilateral pedicle screw fixation included patients undergoing decompressive laminectomies, which preserved the facet joints. One of the patients was initially scheduled for bilateral pedicle screw fixation. However, during the application of the instrumentation, loosening of a pedicle screw was occurred. Only unilateral pedicle screw fixation on the contralateral side was kept. The clinical results were assessed the back pain, radiating pain and claudicaion. We assessed the radiologic results such as fusion status and maintenance of disc height. RESULTS: The back pains were improved in 6 cases , and the radiating pain and claudication were improved in eight cases after the operation. According to Lenke's grade, fusion status were showed grade A in nign segments and grade B in four segments at the last follow-up radiograph. The loss of disc height averaged 7.8(1-25)% in thirteen segments. CONCLUSION: Unilateral pedicle screw fixation is one of the useful methods for patients undergoing decompressive laminec-tomies, which preserve the facet joints in degenerative lumbar spinal stenosis.