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【Objective】 To explore the clinical effect of unilateral double-channel endoscope-assisted bone graft fusion and internal fixation (ULIF) in the treatment of recurrent lumbar disc herniation. 【Methods】 The clinical data of 22 patients with recurrent lumbar disc herniation treated by ULIF in our hospital from August 2020 to October 2020 were analyzed retrospectively. The study indicators included intraoperative blood loss, operation time, bed rest time, and hospital stay. The follow-up data included visual analogue score (VAS) of low back pain, Japanese Orthopaedic Association score (JOA), OSwestry disability index (ODI) score, as well as 36 concise health status survey (SF-36) scores before operation, and 1 week and 6 months after operation. 【Results】 The average operation time was (179.15±42.06) minutes, the average intraoperative blood loss was (132.67±41.92) mL, the average bed rest time was (1.51±0.42) days, and the average hospital stay was (4.82±1.13) days. The VAS score of low back pain at 1 week after operation was lower than that before operation (all P<0.000 1), and further decreased during the follow-up. The ODI score, JOA score and SF-36 score of postoperative follow-up were significantly different from those before operation (P<0.05). The satisfaction rate was 86.4% at 1 week after operation and 95.4% at 6 months after operation. The proportion of significant clinical efficacy at 1 week after operation and postoperative 6 months was 18.2% and 63.6%, respectively. 【Conclusion】 ULIF has the advantages of short-term recovery, less intraoperative blood loss, short bed rest and hospital stay, and good medium-term clinical effect. It is a safe and reliable minimally invasive technique for spinal surgeons in the treatment of recurrent lumbar disc herniation.
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Objective: To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis.
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Objective To analyze the clinical value of anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration.Methods Selected 40 patients with cervical degenerative changes in our hospital from 2012 to 2014,and 20 patients of them underwent anterior decompression and fusion with internal fixation while the other 20 cases took simple decompression.All the patients were well followed up,and the clinical therapeutic effect of the two groups were compared and analyzed.Results After operation,the VAS score and JOA score showed that the scores of the patients underwent anterior decompression and fusion with internal fixation were significandy improved compared with the simple decompression group,and the difference was statistically significant(P ＜ 0.05).Compared with the simple decompression group,the cervical curvature and the curvature of the surgerysection in the anterior decompression and fusion with internal fixation group were significantly improved,especially in the first year after surgery (P ＜ 0.05).The cervical spine joint activity of the two group were improved in the first year after surgery,and the difference was significant (P ＜ 0.05),but there was no significant difference in the degree of cervical joint activity at the last follow-up(P ＞ 0.05).The anterior decompression and fusion with internal fixation is better than simple decompression in the degree of cervical joint activity with statistical significance (P ＜ 0.05).Conclusion The clinical effect of anterior decompression and fusion with internal fixation in treatment of multiple segment degeneration of cervical spine is better than that of simple decompression,it can meet the clinical requirements of biomechanics.
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OBJECTIVE: To investigate the clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients. METHODS: Between January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T10 to L2, and the kyphotic Cobb angle was (28.79±5.04)° before operation. RESULTS: The operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (t=8.542, P=0.000; t=9.826, P=0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (P0.05). No loosening or breakage of internal fixation was observed during follow-up. CONCLUSIONS: Posterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).
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OBJECTIVE: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. METHODS: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P>0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. RESULTS: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P>0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P>0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P0.05). CONCLUSIONS: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.
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Objective To explore the clinical efficacy of polyetheretherketone( PEEK) cages and titanium cages combined with pedicle screw fixation operation in treatment of lumbar degenerative disease,and provide reference for clinic. Methods The data of 50 patients with lumbar degenerative disease in our hospital from March 2011 to March 2013 were retrospectively analyzed. All patients were treated with pos-terior decompression,bone graft and transpedicular screw internal fixation,according to the different cages,they were divided into PEEK group and titanium group. The PEEK group with 25 patients used polyetheretherketone cages,and the titanium group with 25 patients used titanium cages. The JOA scores of patient before surgery,1 month,6 months and 1 year after surgery between two groups were recorded and compared. The ROM of fusion levels and adjacent segment of patients before and after operation between two groups were compared. Results There was no statistical significance of difference in JOA score,Oswestry score and fusion rate between two groups(P>0. 05). There were statistical significance of differences intervertebral disc height change between 2 groups(P<0. 05). The ROM of fusion levels and adjacent segment of patients in PEEK group was better than those in titanium group(P<0. 05). Conclusion The polyetheretherketone cages combined with pedicle screw fixation operation have a good effect in the treatment of patients with lumbar degenerative disease,especially in matter of lumbar spinal motion and intervertebral height lost.
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Objective To study the risk factors of recurrence after debridement bone graft fusion in elderly patients with spi‐nal tuberculosis(TB) .Methods The data of 415 elderly patients with spinal tuberculosis in our hospital from January 2003 to De‐cember 2013 were retrospectively analyzed .Among them ,46 cases (observation group) recurred and 369 cases(control group) had no postoperative recurrence .The preoperative anti‐TB treatment duration ,surgical removal degree of lesions ,postoperative stand‐ardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative braking duration ,complicating systemic disease ,anemia or malnu‐trition ,etc .were statistically analyzed .Results Preoperative anti‐TB treatment duration ,surgical removal degree of lesions ,postop‐erative standardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative braking duration ,complicating systemic disease ,ane‐mia or malnutrition were the major risk factors for postoperative recurrence of senile spinal TB ;preoperative anti‐TB treatment du‐ration ,surgical removal degree of lesions ,postoperative standardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative bra‐king duration ,complicating systemic disease and anemia or malnutrition were closely related with postoperative recurrence of senile spinal TB ,which were their independent risk factors .Conclusion The recurrence of senile spinal tuberculosis and bone graft fusion and is closely related to various factors .
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Objective To study the effect of different approaches of Cage bone graft combined with pedicle screw fixation fusion in trea-ting lumbar spondylolisthesis. Methods From January 2011 to December 2012,120 patients with lumbar spondylolisthesis in our hospital were randomly divided into anterior lumbar interbody fusion (ALIF) group(n=40),postero lateral fusion (PLF) group(n=40) and posteri-or lunbar interbody fusion (PLIF) group(n=40). The related index and body’s function were observed. Results In PLIF group,the opera-tion time was(82. 3 ± 12. 1) h,intraoperative bleeding volume was (60. 3 ± 9. 5) mL,postoperative ambulation time was (5. 5 ± 0. 7) d, NRS score was(1. 5 ± 0. 2),ODI score 3,6,9,12 months after operation were respectively (24. 1 ± 3. 4),(19. 4 ± 3. 1),(13. 5 ± 2. 5), (9. 8 ± 1. 6),which was significantly lower than ALIF group and PLF group;the intervertebral height(9. 3 ± 1. 2)mm were significantly high-er than those of ALIF group and PLF group. Conclusion PLIF has positive clinical value in treating lumbar spondylolisthesis as it can re-duce the operation wound,promote postoperative recovery,and improve the long-term function of body.
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BACKGROUND:There are stil about 10%-30%of patients presenting no obvious improvement of symptoms after lumbar disc herniation surgery, which are col ectively known as the lumbar spine post-surgery failure syndrome, and lumbar instability is one of the important reasons. OBJECTIVE:To evaluate the feasibility and efficacy of surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation on lumbar intervertebral disc protrusion concurring lumbar instability via MAST Quadrant retractor. METHODS:From December 2011 to October 2012, 62 cases of lumbar intervertebral disc protrusion concurring lumbar instability were treated with posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor. There were 38 female and 24 male ranging in age from 37 to 69 years (average 53.7 years). After operation, al patients were fol owed-up to evaluate the effect of the treatment. RESULTS AND CONCLUSION:The operative time was 90-210 minutes, average 145 minutes, and the amount of blood loss was 50-300 mL, average 120 mL. The hospitalization time was 5-9 days, average 6 days. Al incisions healed by first intention. Al patients were fol owed up 7.2 months on average (from 3 to 10 months). The preoperative JOA score was (10.25±2.34) points. The postoperative JOA score decreased to (18.31±3.12) points at the fol ow-up after 1 month and (25.35±2.61) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). The preoperative VAS score was (8.24±1.15) points. The postoperative VAS score decreased to (2.97±1.12) points after 1 month and (1.13±0.39) points at the last fol ow-up, showing significant difference when compared with preoperative score (P<0.01). According to reforming Macnab standard, the results were excel ent in 53 cases and good in 9 cases at the last fol ow-up. The surgery including posterior lumbar spinal canal decompression, intervertebral disc resection, lumbar interbody fusion, and pedicle screw fixation via MAST Quadrant retractor is a safe, effective and minimal y invasive surgical technique in treating lumbar intervertebral disc protrusion concurring lumbar instability.
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Objective To summarize the experience, technique and curative effect of vertebral column resection via posterior approach for kyphotic deformity in children. Methods The clinical data of 10 children (3 males and 7 females; aged 6-15 years with average of 11 years) who suffered from kyphotic deformity and undergone one-stage posterior vertebral column resection and reconstruction from Jul. 2010 to Aug. 2011 were retrospectively analyzed. The pre-operative Cobb angle of kyphosis was 76°-112° with an mean of 97.8°. Nervous system symptoms were found in 2 children, of them one was of Frankel C class and another one was of Frankel D. All the children underwent one-stage posterior vertebral column resection, pedicle fixation combined with bone graft. Results The operation was successfully in all the patients. The average surgery time was 373min (240-560min), the intraoperative blood loss was 1115ml (550-2200ml), the average post-operative Cobb angle of kyphosis was 29.3°(10°-43°), and the correction rate was 70.0%. The torso and shoulder imbalance in all the 10 children was significantly improved, and dorsolumbar pain was markedly relieved. The Frankel classification of 2 children having preoperative nervous system symptoms were both ameliorated to class E after operation. Conclusions Posterior vertebral column resection with pedicle screw-rod fixation is an effective and safe surgical method for the treatment of kyphotic deformity in children. Satisfactory stability of short segment fixation and bone graft fusion can be accomplished.
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Objective To evaluate biomechanical properties of internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate in reconstructing stability of the upper cervical vertebra, and compare them with conventionally used anterior internal fixation after C2-3 intervertebral fusion and posterior internal fixation by C2 transpedicle screws. MethodsSix fresh human upper cervical vertebra specimens (including C2-4) were divided into five groups: the intact specimen group(control group), the incision of the C2-3 group (Hangman group), the posterior internal fixation by C2 transpedicle screw group (posterior fixation group), the anterior internal fixation after C2-3 intervertebral fusion with Zephir plate group (anterior fixation group), and the internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate group (C2-4 incision +internal fixation group). Range of motion (ROM) of the C2-3 and C3-4 segments was tested respectively under 0.5, 1.5 and 2.5 N•m moment by measurement system for three-dimensional spinal movement, and the statistical analysis was also conducted. Results(1) C2-3 segment: ROM of anterior fixation group and C2-4 incision +internal fixation group was significantly smaller than that of Hangman group and posterior fixation group in all six directions under various loading conditions (P<0.05); there was no significant difference between anterior fixation group and C2-4 incision +internal fixation group. ROM of posterior fixation group was larger than that of intact group in all six directions under various loading conditions (P<0.05); There was no significant difference in flexion and extension direction under all loading conditions between posterior fixation group and Hangman group, but significant difference was found in left/right and right/left axial rotation and under 2.5 N•m moment between posterior fixation group and Hangman group (P<0.05). (2) C3-4 segment: there was no significant difference in ROM in six directions under various loading conditions among all groups except for C2-4 incision +internal fixation group. ROM of C2-4 incision +internal fixation group was significantly smaller than that of other groups in all six direction (P<0.05). Although ROM of anterior fixation group was slightly larger than that of Hangman group and posterior fixation group, the difference was not statistically significant. Conclusions From the view of biomechanics, internal fixation after C3 corpectomy and C2-4 anterior fusion with Zephir plate is a better surgical option for stabilizing the fracture than that of posterior internal fixation by C2 transpedicle screws to treat type II Hangman fracture with C2-3 intervertebral disc injury.
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ObjectiveTo study the range of movement (ROM) in adjacent vertebral segments and the changes in intervertebral disc stress after implanting artificial cervical disc. MethodA 3D finite element model for normal cervical spine was established using CT images scanned from a cadaver cervical spine. Simulation of bone graft and fusion of vertebral bodies as well as implantation of intervertebral disc prosthesis were performed between C5 and C6 . Then the ROM of adjacent functional spinal units (FSU, C4/5、C6/7) and the stress in C4/5 and C6/7 intervertabral disc were analyzed. Results（1）The model including the structures of ligaments, joint capsule and other soft tissue is built with high reality and accuracy；（2）Vertebral fusion increased movement range in adjacent FSU, and the stress in corresponding discs is significantly raised as well. The stress in nucleus pulposus and annulus fibrosus is increased about 70% at upper segment and 40% at lower segment; (3) After implantation of artificial disc, only the extension of cervicle spine is limited（P<0.05）; the stress in adjacent intervertebral disks is increased less than 10%. ConclusionsThe implanted artificial cervical disc can appropriately reduce the stress in adjacent vertebral segments, which is beneficial to improve the movement of the cervical spine.
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Objective: To observe the bone graft fusion of goat cervical model implanted with anterior cervical-adjustable fusion fixator(AC-AFF), laying a foundation for future studies. Methods: Eighteen experiment goats were implanted with AC-AFF, titanium mesh and autogenous iliac bone combined cervical plate after corpectomy. Six months later, the fused cervical spine vertebrae were collected, prepared, and observed grossly, under microscope, by X-ray photographs and CT scan; the fusion of the graft was evaluated. Meanwhile, the fusion of AC-AFF with the adjacent vertebral surface was observed. Results: All the experiment animals survived after operation; all the implants were stable, without displace or loosening. The interface where the titanium or AC-AFF contacts the vertebral body surface was bulged and ossified. All iliac bone graft fused well and a great deal of bony callus was found covering the vertebral body surface. Lucency area was not seen surrounding the bone graft, titanium and AC-AFF on the X-ray films, and there was new bone formation in the interface of internal fixation and bone. The central region of titanium and AC-AFF became vague and new bone formation was found in the intracavitary area of implants by CT scan. And part of the new bone transited the parietal reticulation and connected with normal ossea at titanium and AC-AFF. A large number of phoroblasts and chondrocytes were found microscopically in the bone fusion sites in all cases; however, the region without bony callus still existed in the titanium mesh lateral wall. Conclusion: There are no differences in bone fusion between AC-AFF with titanium mesh and autogenous iliac bone combined cervical plate. New phoroblasts and chondrocytes can be generated in the bone graft interface. AC-AFF has been proven as an important method for cervical stability reconstruction after decompression operation.
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[Objective]To evaluate the short-term and long-term effectiveness of the surgical technique of one-stage one-step surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and autograft bone graft fusion in the treatment thoraco-lumbar spinal tuberculosis with kyphotic deformity.[Method]The outcome of sixty eight cases suffered from thoraco-lumbar spinal tuberculasis with kyphotic deformity between July 1998 and March 2004 managed by the surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and antograft bone graft fusion through posteroiateral costotransversectomy or kidney incision was analyzed.All cases wer given a longitudinal study follow-up for a mean of 3.3(2.2~6.3)years postoperatively.[Result]All patients showed successful autograft bone graft fusion.Among 45 cases accompanied with neurotic symptom of Potts paraplegia,25 were completely recovered,15 were partly recovered,total the ratio of recovery was 88.89% at the end of postoperative follow-up.The average immediate postoperative correction of kyphosis angle was 28.9?,the average loss of correction was only 2.7? at final follow-up.[Conclusion]The surgical technique of one-stage one-step Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debrideraent and autograft bone graft fusion is found helpful in strengthening the stability of the spine in thoraco-lumbar spinal tuberculosis with kyphotic deformity,providing successful interbody fusion and recovery of Potts paraplegia,correcting the kyphosis,and preventing progress of kyphosis.
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[Objective]To assess the effect of a new invented spondylolisthesis reduction system:elevating-pull reduction system for surgical treatment of lumbar spinal spondylolisthesis associated with isthmic spondylolysis.[Method]Sixty-two patients with lumbar spinal spondylolisthesis were treated with elevating-pull reduction system combined with SRS(spondylolisthesis reduction system),after surgery the patients were evaluated for symptom improvement,intervertebral bone graft fusion,and internal fixation.[Result]The patients were followed up from 1 to 6 years(average 2 years and 5 months) in 62 patients.According to the criterion,excellent results were in 43 patients,good in 16,moderate in 3.No patient showed worse.No internal fixation loosening and breakage were found.[Conclusion]The new invented spondylolisthesis elevating-pull reduction system combined with SRS are more effective and reliable,especially for those osteoporosis patients and serious cases,the reduction and fixation are more effectively.In this procedure the pedicle entrance mouth can be seen straightly and the pedicle screw is inserted more easily.It can prevent the nerve injury,save the operation time,reduce the blood lossing,and excellent outcome can be obtained.
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@#ObjectiveTo evaluate the clinical effectiveness of posterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement in the treatment of dorsal and lumber spinal tuberculosis. MethodsFrom March 1996 to July 2000,posterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement procedures were used in 62 patients suffering from dorsal and lumber spinal tuberculosis in our department,48 of them were involved in a longitudinal study follow-up for a mean of 3.6(1.5-5.5)years postoperatively. ResultsAll patients showed successful posterolateral bone graft fusion. Among 38 cases of Pott's paraplegia, 30 were completely recovered,5 were partly recovered,the rate of recovery was 92.1%. The average immediate postoperative correction of kyphosis angle was 29.1°,the average loss of correction was only 3.2°at final follow-up.ConclusionsPosterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement procedure were found helpful in strengthening the stability of the spine in dorsal and lumber spinal tuberculosis, providing successful interbody fusion and recovery of Pott's paraplegia, correcting the kyphosis, and preventing progression of kyphosis.