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Objective: To explore the microsurgical treatment of spinal canal tumors and to analyze the strategies for clinical treatment of spinal canal tumors. Methods: Were retrospectively analyzed the clinical data of 145 patients with spinal canal tumors who were treated in our hospital from Dec. 2014 to Nov. 2016. Microscopic resection of tumors was performed with half lamina-, full lamina-, or lamina joint-fenestration. Spinal internal fixation was performed in 52 patients. The patients were followed up for 3-26 months. X-ray and magnetic resonance imaging were performed again in all patients, and computed tomographyed was performed in patients undergoing internal fixation. The spinal cord function was assessed by McCormick grade before operation, 1 week after operation and 3 months after operation. Results: Of the 145 patients, 127 underwent total resection, 16 underwent subtotal resection and 2 underwent partial resection. One patient with cervical intramedullary tumors developed kyphosis after operation and underwent reoperation. No screw rod dislocation or spine instability was found in the 52 patients undergoing spinal internal fixation. The McCormick grading was significantly better 1 week and 3 months after operation versus before operation (P<0.05). Conclusion: Microsurgery is an effective method for treatment of spinal canal tumors. Good intraoperative exposure and reliable spinal internal fixation are essential to reduce the complications after spinal canal tumor surgery.
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Extreme lateral interbody fusion (XLIF) can be used to treat various lumbar diseases, such as lumbar facet joints intervertebral disc herniation, spondylolisthesis, stenosis. Compared with other approaches, XLIF establishes the surgical channel behind the peritoneum through lateral abdomen, with the advantages of less blooding in the surgery, smaller invasion, lower complications rate and shorter rehabilitation period. Meanwhile，this technique can not only reduce the risk of vascular injury, but also avoid the damage of back structures，such as muscles and facet joints. Therefore, XLIF has been attracting more and more attention and application. However, there is no conclusive evidence to prove that XLIF is better than other surgical approaches in terms of clinical results and complications rates. This paper reviewed the effects of XLIF for reconstructing spinal stability, as well as its biomechanical properties compared with other classical surgeries.
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STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To investigate the potential clinical use of the spinal instability neoplastic score (SINS) for determining the surgical strategy, especially regarding the need for anterior support. SUMMARY OF LITERATURE REVIEW: The SINS seems to enable an improved qualitative and quantitative assessment of spinal instability in patients with spinal metastasis. MATERIALS AND METHODS: We retrospectively reviewed 69 consecutive patients who underwent surgical treatment for spinal metastasis. We assessed the patients' preoperative status with respect to each component of the SINS. Multiple logistic regression was performed to calculate odds ratios (ORs) representing the associations among SINS, age, Eastern Cooperative Oncology Group performance status, modified Tokuhashi score, as well as the preoperative Nurick grade variables and reconstruction of the anterior spinal column. RESULTS: Among the 6 items in the SINS, those indicating the degree of collapse and alignment had significantly higher scores in those who underwent corpectomy and anterior support (p<0.001). Multiple logistic regression revealed that the total SINS was the only factor significantly associated with predicting whether anterior support should be performed (adjusted OR=1.595). Receiver operating characteristic (ROC) curve analysis suggested that a cut-off value of 10 points on the SINS scale could be used to decide whether anterior support following corpectomy should be performed (AUC=0.706). CONCLUSIONS: The SINS, insofar as it assesses the degree of collapse and alignment, is a potentially useful tool for determining the surgical strategy in patients with spinal metastasis, especially for deciding upon the necessity of additional anterior support procedures.
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Humans , Cohort Studies , Logistic Models , Neoplasm Metastasis , Odds Ratio , Retrospective Studies , ROC Curve , SpineABSTRACT
[Objective]To analyze and evaluate the relevant factors of recurrent lumbar disc herniation for providing strategy of prevention of this syndrome.[Method]Sixteen cases of recurrent lumbar disc herniation were analyzed according to medical history,physical examination and image examination before re-operation and the primary operation,and all the patients received exploration during operation.[Result]The relevant factors of recurrent lumbar disc herniation were as follows:the extent of disc degeneration,the stability of lumbar spine,the time of getting out of bed after primary operation and the weight of the patients.[Conclusion]Besides iatrogenic factors,there are several factors related to recurrent lumbar disc herniation,including the characteristics of disc and lumbar spine,as well as the compliance of patients.To remove these factors is the main preventive strategy of recurrent lumbar disc herniation.
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Between 1984 and 1995, sixty-one patients were treated for facet interlocking of the cervical spine. The most common level of dislocation was C6/7; unilateral facet locking was observed in 27 patients, and bilateral locking in 34. Immediate traction with increasing weight reduced the dislocation in 51 patients, but ten required surgery, and of the 51 patients whose dislocations were successfully reduced with traction, 36 underwent surgery due to spinal instability.In all 46 patients who were operated on, spinal stability was achieved without major complications. On discharge, neurological improvement was observed in 18 patients. These findings suggest that even in neurologically compromised patients, prompt reduction and internal stabilization can facilitate recovery.