ABSTRACT
Objective: To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Methods: The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index (ODI), visual analogue scale (VAS) score, and the intervertebral height, foramen intervertebral height (FIH), and range of motion (ROM) of upper operative segment and adjacent segment between the two groups ( P>0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height (ADH), middle disc height (MDH), and posterior disc height (PDH)], FIH, and ROM were measured and compared between the two groups. Results: The operation time and intraoperative blood loss in group A were significantly more than those in group B ( P0.05); the improvement rate of VAS score in group B was significantly higher than that in group A ( t=2.245, P=0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups ( P>0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A ( P0.05). The ROM of adjacent segment in group A increased significantly at last follow-up ( t=2.318, P=0.026). There was significant difference in ROM of adjacent segment between the two groups ( P<0.05). Conclusion: The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.
ABSTRACT
[Objective]To investigate the effect of selectively segmental cervical decompression through anterior approach in the treatment of senile segmental cervical spondylotic myelopathy. [Methods]Twenty-seven cases of senile segmental cervical spondylotic myelopathy experienced selectively segmental cervical decompression through anterior approach from 2004 to 2008 were reviewed retrospectively. Pre-and post-operative JOA scores were compared to evaluate the improvement of neurological function.[Results]Patients were followed up for an average of 19.7 months (ranged,18~27 months). No loosening or displacement was found in all cases. Postoperatively,ratio of JOA improvement was 56.1%,including excellent result in 8 cases (29.5%),good result in 11 cases (40.7%),fair result in 6 cases (22.2%),poor result in 2 cases (7.4%).[Conclusion]Selectively segmental cervical decompression through anterior approach is effective in the treatment of senile segmental cervical spondylotic myelopathy,giving consideration to patient's general physical condition and recovery of neurological function. Correct segments selection of preoperative decompression is the key point of result of postoperative restoration.