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Objective To evaluate biomechanical properties of the nickel-titanium (NiTi) memory alloy stent and its in vitro biomechanical properties for lumbar interbody fusion. Methods The mechanical properties of the NiTi memory alloy stent were tested on mechanical testing machine. Moreover, lumbar interbody fusion was simulated on fresh lumbar specimens, and biomechanical properties of the NiTi memory alloy stent with matching bone graft for used for lumbar interbody fusion were analyzed and compared with the traditional box-shape cage. Results The maximum compressive strength of the NiTi memory alloy stent was ( 12 964 ± 962) N. The maximum deformation within the effective range of memory characteristics was (4. 68±0. 03) mm. The recovery rate of the NiTi memory alloy stent was up to 99. 86% . Compared with the intact lumbar model, the stability of the operative segment after the simulated lumbar interbody fusion using NiTi memory alloy stent alone was increased in the direction of anterior flexion, posterior extension, lateral flexion and rotation, which was equivalent to the box shape cage group (P>0. 05). After the combined use of autogenous bone granule and absorbable bone cement the ROM of the operative segment was further reduced (P0. 05). The pull-out strength of the NiTi memory alloy stent with matching bone graft group was significantly stronger than that of the box-shape cage group (P<0. 05). Conclusions The NiTi memory alloy stent in this study was designed with a matched bone granule-absorbable bone cement graft,which provided a new idea for the further optimization and development of lumbar interbody fusion. With excellent support and deformation properties, this NiTi memory alloy stent is biomechanical equivalent to the traditional box shape cage for lumbar interbody fusion, and can greatly improve the stability of surgical segment and the pull-out strength of implants after the combined use of autogenous bone granule and absorbable bone cement.
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Objective To verify the biomechanical stability of oblique lateral interbody fusion ( OLIF) combinedwith different fixation methods for treating degenerative lumbar scoliosis (DLS) by three-dimensional (3D) finite element analysis. Methods The L1-S1 3D finite element DLS model ( Model 1) was established, and then the OLIF (L2-5) at 3 contiguous levels of fusion and its combination with different internal fixation methods were simulated, namely, stand-alone OLIF model ( Model 2), vertebral screw fixation model ( Model 3), unilateral pedicle screw fixation model (Model 4) and bilateral pedicle screw fixation model (Model 5) were established,respectively. Under upright, flexion, extension, lateral bending and axial rotation states, range of motion (ROM) of fusion segments, as well as cage stress, internal fixation stress, and stress distribution were recorded and analyzed. Results Under six motion states, the overall ROM of fusion segments in Models 2-5 was smaller than that of Model 1. Compared with Model 1, the overall ROM reduction of Model 3 and Model 4 was larger than that of Model 2 and smaller than that of Model 5. Under flexion and extension, the overall ROM reduction of Model 4 and Model 5 was basically equal. Under left and right lateral bending, the overall ROM reduction of Model 3 and Model 5 was basically equal. Under all motion states, the peak stress of Model 3 and Model 4 fusion cage was larger than that of Model 5 and smaller than that of Model 2. The peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 3 increased by 5. 52% , 10. 96% and 7. 99% respectively compared with Model 5 under left lateral bending, and the peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 4 increased by 8. 70% , 7. 00% and 6. 99% respectively under flexion. Under all motion states, the peak stress of screw rod in Model 5 was smaller than that of Model 3 and Model 4, and the peak stresses of screw rod in Models 3-5 were the smallest in upright state. Conclusions The OLIF with unilateral pedicle screw fixation or vertebral screw fixation can provide favorable biomechanical stability of the fusion segment. The results provide some references for clinical application of OLIF technology in the treatment of DLS.
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OBJECTIVE@#To evaluate the effects of electromyography on the clinical manifestations and prognosis after posterior lumbar interbody fusion(PLIF) of degenerative lumbar diseases.@*METHODS@#A retrospective analysis was performed on 68 patients with degenerative lumbar diseases, including 29 males and 39 females, aged 21 to 84 years old, who underwent electromyogram (EMG) from January 2018 to October 2019. The patients were divided into negative and positive groups according to whether theresults of EMG was normal or abnormal, PLIF surgery was performed in both groups. The preoperative duration of illness, postoperative recovery time, operative time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) of low back and lower limb, the Japanese Orthopedic Association(JOA) score before and after operation.@*RESULTS@#All patients were follow-up from 26 to 39 months. The subjective symptoms, clinical signs, daily activities and JOA total scores after operation in two groups were significantly higher than those before preoperation(P<0.05);the clinical signs score and total JOA score in the negative group at 3 months after operation were higher than those in the positive group(P<0.05). The VAS score of leg pain in the negative group after 1 and 3 months was less than that in the positive group(P<0.05). Patients 's illness time, postoperative recovery time, hospitalization time and implantation time in the negative group were shorter than those in the positive group(P<0.05). At other time points, there was no significant difference in low pain VAS, leg pain VAS, JOA scores in the two groups(P>0.05). There was no significant difference in the operation time and intraoperative bleeding volume between the two groups(P>0.05).@*CONCLUSION@#Patients with normal electromyography had shorter disease duration than ones with abnormal electromyography in lumbar degenerative disease;after PLIF, patients with normal electromyography recovered faster than ones with abnormal electromyography, but the results of electromyography had no effect on the final prognosis of PLIF surgery.
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Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Fusion/methods , Lumbar Vertebrae/surgery , Treatment Outcome , PainABSTRACT
OBJECTIVE@#To investigate possible causes and preventive measures for asymptomatic pain in the limbs after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).@*METHODS@#Clinical data from 50 patients with lumbar degenerative disease who underwent MIS-TLIF between January 2019 and September 2020 were retrospectively analyzed. The group included 29 males and 21 females aged from 33 to 72 years old, with an average age of (65.3±7.13) years. Twenty-two patients underwent unilateral decompression, and 28 underwent bilateral decompression. The side(ipsilateral or contralateral) and site(low back, hip, or leg) of the pain were recorded before surgery, 3 days after surgery, and 3 months after surgery. The pain degree was evaluated using the visual analogue scale(VAS) at each time point. The patients were further grouped based on whether contralateral pain occurred postoperatively (8 cases in the contralateral pain group and 42 in the no contralateral pain group), and the causes and preventive measures of pain were analyzed.@*RESULTS@#All surgeries were successful, and the patients were followed up for at least 3 months. Preoperative pain on the symptomatic side improved significantly, with the VAS score decreasing from (7.00±1.79) points preoperatively to (3.38±1.32) points at 3 days postoperatively and (3.98±1.17) points at 3 months postoperatively. Postoperative asymptomatic side pain (contralateral pain) occurred in 8 patients within 3 days after surgery, accounting for 16% (8/50) of the group. The sites of contralateral pain included the lumbar area (1 case), hip(6 cases), and leg (1 case). The contralateral pain was significantly relieved 3 months after surgery.@*CONCLUSION@#More cases of contralateral limb pain occur after unilateral decompression MIS-TLIF, and the reason may include contralateral foramen stenosis, compression of medial branches, and other factors. To reduce this complication, the following procedures are recommended: restoring intervertebral height, inserting a transverse cage, and withdrawing screws minimally.
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Male , Female , Humans , Middle Aged , Aged , Adult , Retrospective Studies , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Minimally Invasive Surgical Procedures/methods , Pain, Postoperative , Treatment OutcomeABSTRACT
OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Stenosis/surgery , Blood Loss, Surgical , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment Outcome , Pain, Postoperative , Muscles , Minimally Invasive Surgical Procedures/methodsABSTRACT
Objective To analyze the biomechanical characteristics of lumbar fusion by 3 internal fixation methods using three-dimensional (3D) finite element (FE) method. Methods The FE fixation models of physiological L4-5, unfixed fusion L4-5, translaminar facet screw (TLFS), lumbar pedical screw+translaminar facet screw (LPS+TLFS), bilateral pedical screw (BPS) with complete osteotomy or partial osteotomy of facet joint were established, respectively. The biomechanical characteristics of L4 centrum and implants under six motion states (spinal flexion, extension, lateral bending and axial rotation) in L4-5 fusion model and three fixation models were compared by FE analysis. Results The average maximal displacements of L4 centrum in L4-5 unfixed fusion model, TLFS model, TLFS+LPS model, BPS model were 1.410 8, 0.629 8, 0.336 9, 0.252 8 mm (complete osteotomy of facet joint) and 1.296 7, 0.844 9, 0.340 9, 0.273 8 mm (partial osteotomy of facet joint); the average maximal displacements of cage were 0.479 9, 0.319 5, 0.167 6, 0.126 4 mm (complete osteotomy of facet joint) and 0.378 7, 0.348 4, 0.183 5, 0.137 2 mm (partial osteotomy of facet joint)；the average maximum stresses of screws and rods during 6 motions in TLFS model, TLFS+LPS model, BPS model were 178.34, 79.55, 56.33 MPa (complete osteotomy of facet joint) and 142.29, 103.02, 59.69 MPa (partial osteotomy of facet joint). Conclusions In percutaneous transforaminal lumbar interbody fusion, the fixation effect of BPS model was similar to that of LPS+TLFS model. BPS model could achieve the best spinal stability, and LPS+TLFS model was also a good fixation method. The stability of TLFS model alone was relatively poor, but it was still better than that of cage bone graft without internal fixation. In the absence of internal fixation, preservation of the articular process significantly increased stability of the spine.
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Objective To study the stability of lumbar spine after transforaminal lumbar interbody fusion (TLIF) surgery combined with a novel articular process fixation system (APFS). Methods Based on the validated finite element model of L3-S1 intact segment (Model A), TLIF surgery was simulated to establish bilateral pedicle screw TLIF model (Model B), right unilateral pedicle screw TLIF model (Model C), APFS combined with right pedicle screw fixation TLIF model (Model D). The range of motion (ROM) of the lumbar spine model and stress distributions on pedicle screws, APFS and interbody fusion cages under different working conditions were observed. Results The overall ROMs of Models B, C, and D under different working conditions were comparable, which were all smaller than those of the physiological model. Compared with Models B and C, the maximum compressive stress of the right pedicle screw and the interbody fusion cage in Model D was the smallest or between Models B and C under different working conditions. Model D had the largest peak stress of APFS and right pedicle screw during anterior flexion. Conclusions APFS combined with contralateral pedicle screw fixation can be used as a novel fixation method for TLIF surgery of lumbar spine.
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Objective To evaluate the biomechanical properties of lumbar interbody fusion with NiTi memory alloy stent-autogenous bone granule-absorbable bone cement. Methods The normal L3-5 segment finite element model (M0), L4-5 intervertebral fusion model with box fusion cage (M1), L4-5 intervertebral fusion model with NiTi memory alloy stent (M2) and L4-5 interbody fusion model with bone granule-absorbable bone cement for casting bone graft (M3) were constructed, respectively. The models were applied with mechanical loading to analyze the mechanical stability and the peak stress of L4 interior endplate. Results The range of motion (ROM) of L4-5 segment in M1 and M2 models was significantly lower than that of M0 model under flexion, extension, lateral flexion and axial rotation. In M3 model, the stability of the surgical segment was further improved and the peak stress of L4 interior endplate was much smaller than that of M1 and M2 models. Conclusions NiTi memory alloy stent and traditional box fusion cage have biomechanical equivalence when used alone in lumbar interbody fusion, and application of bone granule-absorbable bone cement for casting bone graft can further improve the stability and reduce the stress of endplate.
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@#OBJECTIVE: The main objective of this study was to evaluate clinical and radiographic outcomes of computer minimally invasive transforaminal lumbar interbody fusion (CNMIS TLIF). METHODS: Blood loss, operating time, complications, and hospital stay were identified through chart review. Numeric rating scale (NRS) scores for pain were taken during recent follow-ups, and these were compared to the pre-operative scores. Three different examiners assessed the pre-operative lumbosacral spine radiographs. At a 2-years follow-up, the patients were evaluated with NRS and the radiographs reassessed by three other examiners. RESULTS: Seventy-four patients with a mean age of 54 years underwent CNMIS TLIF. Average blood loss was 300 mL, operative time was 4.5 hours, and the average length of hospital stay was 8.5 days. A total of four complications were noted in our study. There was an improvement of mean local lordosis and regional lordosis. The paired-sample t-test showed that the anterior, middle, and posterior disc heights at the cage level were significantly increased compared to the pre-operative values. CONCLUSION: CNMIS TLIF is a safe and efficient method to achieve spinal fusion. There was a significant improvement in clinical outcomes in terms of pain relief. Radiologic parameters such as local lordosis, regional lordosis, and anterior, middle, and posterior disc heights showed significant improvements at 2-years follow-up.
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Spinal Fusion , Minimally Invasive Surgical Procedures , ComputersABSTRACT
Spinal fusion is a standard operation for treating moderate and severe intervertebral disc diseases. In recent years, the proportion of three-dimensional printing interbody fusion cage in spinal fusion surgery has gradually increased. In this paper, the research progress of molding technology and materials used in three-dimensional printing interbody fusion cage at present is summarized. Then, according to structure layout, three-dimensional printing interbody fusion cages are classified into five types: solid-porous-solid (SPS) type, solid-porous-frame (SPF) type, frame-porous-frame (FPF) type, whole porous cage (WPC) type and others. The optimization process of three-dimensional printing interbody fusion cage and the advantages and disadvantages of each type are analyzed and summarized in depth. The clinical application of various types of 3D printed interbody fusion cage was introduced and summarized later. Lastly, combined with the latest research progress and achievements, the future research direction of three-dimensional printing interbody fusion cage in molding technology, application materials and coating materials is prospected in order to provide some reference for scholars engaged in interbody fusion cage research and application.
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Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Porosity , Printing, Three-Dimensional , Spinal FusionABSTRACT
The human spine injury and various lumbar spine diseases caused by vibration have attracted extensive attention at home and abroad. To explore the biomechanical characteristics of different approaches for lumbar interbody fusion surgery combined with an interspinous internal fixator, device for intervertebral assisted motion (DIAM), finite element models of anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are created by simulating clinical operation based on a three-dimensional finite element model of normal human whole lumbar spine. The fusion level is at L4-L5, and the DIAM is implanted between spinous process of L4 and L5. Transient dynamic analysis is conducted on the ALIF, TLIF and LLIF models, respectively, to compute and compare their stress responses to an axial cyclic load. The results show that compared with those in ALIF and TILF models, contact forces between endplate and cage are higher in LLIF model, where the von-Mises stress in endplate and DIAM is lower. This implies that the LLIF have a better biomechanical performance under vibration. After bony fusion between vertebrae, the endplate and DIAM stresses for all the three surgical models are decreased. It is expected that this study can provide references for selection of surgical approaches in the fusion surgery and vibration protection for the postsurgical lumbar spine.
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Humans , Biomechanical Phenomena , Finite Element Analysis , Lumbar Vertebrae/surgery , Pedicle Screws , Range of Motion, Articular , Spinal Fusion , VibrationABSTRACT
【Objective】 To investigate the effect of adequate amount of tranexamic acid(TXA)before operation on blood loss and safety in posterior lumbar fusion with multiple segments. 【Methods】 A retrospective analysis was conducted on 105 patients with lumbar spinal stenosis, submitted to our hospital for multilevel PLIF, from March 2017 to December 2019. According to the intervention method, they were divided into control group, group A and group B (n =30, 39 and 36, respectively). TXA was not used in the control group. Dripping of saline solution(100 mL) containing TXA 2g and 1g was given in Group A and Group B, and extra intravenous pumping of TXA [10 mg/(kg·h)] during surgery was conducted in Group B besides the pre-operation dripping of TXA. Total blood loss, dominant blood loss, recessive blood loss, intraoperative blood loss, postoperative drainage volume, transfusion rate and hemoglobin (Hb), hematocrit (Hct), prothrombin time international standardized ratio (PT - INR), platelet count (Plt), D - dimer (D - D), C-reactive protein (CRP), neutrophil percentage (NP), alanine aminotransferase (ALT), and blood urea nitrogen (BUN) before and after operation were compared in the three groups. Postoperative drug-related adverse events were traced. 【Results】 1)The total blood loss, dominant blood loss(mL), intraoperative blood loss(mL), drainage volume(mL) within and after 24h after surgery, and the transfusion rate(%) in group A and B were 892.6±193.5 vs 887.7±320.8, 409.1±109.2 vs, 408.6±98.3, 193.7±69.3 vs 189.6±65.6, 130.5±53.4 vs 128.3±53.5, 63.1±17.6 vs 60.9±13.5 and 7.7 (3/39) vs 8.3 (3/36), respectively, which were significantly lower than that in group C as 1 296.8±329.2, 807.6±231.5, 270.9±65.5, 365.4±127.8, 172.3±66.4 and 36.7(11/30), respectively (P< 0.05). There were no significant differences in the above indexes between group A and group B (P < 0.05). The differences in recessive blood loss was not significant by groups(P<0.05). 2) Compared with pre-operation, the levels of Hb, Hct and Plt in the three groups at 3d after operation decreased: Hb(g/L) 91.5±14.0, 107.6±16.4 and 105.9±17.1; Hct(%) 25.6±3.1, 31.2±3.9 and 30.5±4.4; Plt(×109/L)146.6±31.8, 172.8 ±40.1 and 169.7±39.5(P < 0.05); while D-D, CRP and NP increased: D-D(mmol/L)365.6±67.1, 280.9±50.5 and 286.1±53.1; CRP(mg/L): 65.4±22.0, 53.4±19.6 and 56.8±17.7; NP(%): 87.3±15.6, 73.1±13.7, and 71.9±11.8(P < 0.05), and Pt-INR, ALT and BUN showed no significant changes (P > 0.05). The changes of Hb, Hct, Plt, D-D, CRP and NP in group A and B were significantly lower than those in group C at 3 days after operation [Hb (g/L) : 107.6±16.4, 105.9±17.1, 91.5±14.0; Hct (%) : 31.2±3.9, 30.5±4.4, 25.6±3.1; Plt (×109/L) : 172.8 ±40.1, 169.7±39.5, 146.6±31.8; D-D (mmol/L) : 280.9±50.5, 286.1±53.1, 365.6±67.1; CRP (mg/L) : 53.4±19.6, 56.8±17.7, 65.4±22.0; NP (%) : 73.1±13.7, 71.9±11.8, 87.3±15.6] (P < 0.05), and no significant differences in the above index were noticed between group A and B(P> 0.05).3)No lower limb deep vein thrombosis nor pulmonary embolism were found in group A and group B after operation, and all the incisions were healed in the first stage, and no serious complications such as drug allergy, cardiovascular and cerebrovascular accident, epidural hematoma, epilepsy occurred. 【Conclusion】 The preoperative TXA administration with sufficient single dose showed equivalent hemostatic effect in comparison with intraoperative continuous administration additional to preoperative dripping, which is simple and convenient and does not increase the risk of thrombosis.
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Objective To explore the application and clinical effect of ropivacaine incision infiltration combined with Wiltse approach in the analgesia of lumbar multi-segment decompression and fusion internal fixation. Methods A total of 120 patients with lumbar spinal stenosis and (or) lumbar disc herniation, who received posterior lumbar multisegmental (≥2) transforaminal lumbar interbody fusion (TLIF) in the Second Affiliated Hospital of Nantong University from Jan. 2016 to Jan. 2019, were randomly assigned to four groups: group A (ropivacaine incision infiltration＋Wiltse approach), group B (ropivacaine incision infiltration＋posterior median approach), group C (saline incision infiltration＋Wiltse approach) and group D (saline incision infiltration＋posterior median approach). The operation time, intraoperative blood loss, postoperative drainage volume, postoperative analgesic dosage, the visual analogue scale (VAS) score of low back pain before operation and 6 h, 1 d, 3 d, 7 d, 1 month and 3 months after operation, and the Oswestry disability index (ODI) before operation and 3 d, 7 d, 1 month and 3 months after operation, were compared among the four groups. Results There were no significant differences in gender, age, body weight, operative segments, low back pain VAS score or ODI before operation (all P＞0.05). The intraoperative blood loss, postoperative drainage volume and analgesic dosage were significantly lower in the groups A and C than those in the groups B and D (all P＜0.05). The VAS scores 6 h after operation were significantly lower in the groups A and B than those in the groups C and D, and the VAS scores 3 and 7 d after operation were significantly lower in the groups A and C than the groups B and D (all P＜0.05). The ODI values 3 d and 3 months after operation were significantly lower in the groups A and C than those in the groups B and D (all P＜0.05). Conclusion Preemptive analgesia using ropivacaine incision infiltration combined with Wiltse approach in lumbar multi-segment decompression and fusion internal fixation can effectively relieve postoperative pain, with remarkable analgesic effect and rapid functional recovery, benefiting early recovery of patients after operation.
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BACKGROUND: The sciatic scoliosis is considered as a compensatory attempt of the body to relieve nerve irritation. If dealt with inappropriate and delayed, it may be developed in structural scoliosis. There was controversial about the treatment of such cases. OBJECTIVE: To compare the safety and effectiveness of single-level open versus minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation. METHODS: Data of 47 patients with sciatic scoliosis caused by lumbar disc herniation who were treated in Peking University People’s Hospital from January 2010 to January 2014 were retrospectively analyzed. The main symptom was severe back and lower limb pain, complicated with trunk tilt. Twenty-five patients underwent single-level open transforaminal lumbar interbody fusion therapy (open group). Twenty-two patients underwent minimally invasive transforaminal lumbar interbody fusion therapy (minimal invasion group). The single-level surgery was conducted in both groups. The patients were followed up for at least 2 years. The clinical effects and photographic parameters were compared between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in age, gender, spinal levels operated and all the coronal and sagittal parameters preoperatively between the two groups (P > 0.05). (2) There was no significant difference in operation time between the two groups (P >0.05). The amount of bleeding, postoperative time to the ground, and average length of hospital stay were better in the minimal invasion group than in the open group (P 0.05). (4) Balance of coronal plane and sagittal plane: The deformity at 2 years after operation was significantly improved compared with that before operation (P 0.05). (5) Solid fusion was achieved in both groups. (6) It is concluded that minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level sciatic scoliosis caused by lumbar disc herniation obtained similar effect as open fusion. Moreover, it has the advantages of less bleeding, faster recovery and shorter hospital stay.
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BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P interbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or pooriy placed plate injury to adjacent segmental intervertebral discs. OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage. METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People’s Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage implantation, n=30). All patients in the two groups had informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score were used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage. RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed in stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature were better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical discectomy and fusion using Zero-P is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but it is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation.
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BACKGROUND: Posterior decompression and pedicle screw fixation combined with interbody fusion is a method for the treatment of cervical vertebral degenerative lesions. There are few reports on the measurement of strain electricity in simulating C5/6 intervertebral disc fusion after pedicle screw removal. OBJECTIVE: To analyze stress and strain immediately after C5/6 discectomy, pedicle screw fixation combined with interbody fusion. METHODS: Eighteen fresh pig cervical specimens were randomly divided into three groups: Bone cage fusion group, PEEK fusion group, and titanium mesh fusion group (n=6). Each group simulated C5/6 discectomy and pedicle screw fixation, and then different fusion cages were used for interbody fusion. Before and after fusion, the resistance strain gauges were attached under the vertebral body at the position of pedicle screw fixation, at the edge of vertebral body at the fusion position of fusion cage, at the edge of adjacent vertebral body. The strain values of each sample were measured under the compression state by static resistance strain gauge. The stress values at each measurement point before and after fusion in posterior fixation with pedicle screws for cervical vertebrae in each group were calculated by material mechanics formula. RESULTS AND CONCLUSION: (1) Under the same load, the strain and stress of each measurement point in the titanium mesh fusion group were smaller than those in the bone cage fusion group and the PEEK fusion group, and the difference was significant (P < 0.05). (2) Under the same load, the strain and stress of each test point in the bone cage fusion group were larger than those in the PEEK fusion group, and the difference was significant (P < 0.05). (3) These results confirm that simulated C5 discectomy in vitro, posterior pedicle screw fixation and implantation of different fusion cages have different changes of stress and strain. The selection of appropriate interbody fusion cage can reduce the effect of stress concentration on adjacent segments.
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BACKGROUND: Recent clinical studies have found that during the implantation of biomaterials, the internal environment of the body will change to a certain extent, and different levels of immunity and stress responses will occur. There are also obvious differences in the immune and stress responses of different biological materials. OBJECTIVE: To investigate the effect of 3D printed interbody fusion cage on patients with cervical spondylosis of spinal cord type and its effect on serum cortisol and norepinephrine levels. METHODS: Sixty-three patients with cervical spondylotic myelopathy who were admitted to the Affiliated Hospital of Chengde Medical University from July 2015 to July 2018 were selected, including 40 males and 23 females, aged 30-78 years old. The patients were randomly divided into a research group (n=31) and a control group (n=32) according to a random number table. All patients received anterior cervical decompression and bone graft fusion and internal fixation. Patients in the research group were implanted with 3D printed intervertebral fusion cage during operation. The patients in the control group were implanted with polyetheretherketone interbody fusion cage and allogeneic bone. The operation and complications of the two groups were compared. Serum cortisol and norepinephrine levels were detected before and 1 and 3 days after operation. Cervical curvature and intervertebral height were measured before surgery, 1 week, and 6 months after surgery. Axial symptoms were counted at 6 months after surgery. The trial was approved by the Ethics Committee of the Affiliated Hospital of Chengde Medical University. RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss and hospitalization time were not significantly different between the two groups (P > 0.05). (2) Among 31 cases, there were 1 case of screw loosening and 1 case of implant movement in the research group. Among 32 cases, there were 3 cases of screw loosening, 3 cases of immune rejection, 2 cases of implant movement, and 1 case of implant collapse in the control group. The incidence of complications was lower in the research group than that in the control group (P < 0.05). (3) At 1 and 3 days after operation, the levels of cortisol and norepinephrine were higher in both groups than those before surgery (P < 0.05), but above levels were lower in the research group than in the control group (P < 0.001). (4) The cervical curvature and intervertebral height at 1 week and 6 months after operation in both groups were higher than those before surgery (P < 0.05), and above indexes were higher in the research group than in the control group (P < 0.05). (5) The axial symptom in the research group was lighter than that in the control group at 6 months after operation (P < 0.05). (6) The results show that the application of 3D printed interbody fusion cage to cervical spondylotic myelopathy can reduce complications, promote the recovery of cervical curvature and intervertebral height, and improve the stability of cervical spine, and the body’s stress response and axial symptoms are mild.
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BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.
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BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate. OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation. METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery. RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.
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BACKGROUND: Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease. OBJECTIVE: To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation, unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion. METHODS: Eighteen fresh calf L3-5 specimens were selected. Different forms of fixation were conducted under transforaminal lumbar interbody fusion. The specimens were divided into group A (complete specimens) and group B (bilateral pedicle screws), group C (unilateral pedicle screws), and group D (unilateral pedicle screw combined with contralateral translaminar facet screw). The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension, forward bending, left bending, right bending, left rotation and right rotation and the stiffness of fusion segment L4-5 were tested. RESULTS AND CONCLUSION: (1) For the range of motion of fusion segment L4-5, the stability was highest in the group B in six directions, followed by group D, which showed similar results in rotation in the group B (P > 0.05). The stability of right curvature and left rotation in group C was insufficient, and there was no significant difference in range of motion between group A and group C (P > 0.05). The range of motion in group A was largest and the stability was worst in the six motion directions. (2) For the stiffness value of fusion segment L4-5, the stiffness value of group B was largest in six directions, which was significantly different from other groups (P 0.05). There was no significant difference between group C and group A in the range of motion of six directions (P > 0.05). (4) The results showed that the motion ramge of unilateral pedicle screw fixation in the right and left rotation directions was large in the early stage, which was close to that of the complete specimen group. There is a shortage of stability, so we need to use it carefully and grasp the indications strictly. Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation improves the disadvantages of asymmetric fixation of unilateral pedicle screw, increases the stability of rotation and lateral bending, and avoids the influence of bilateral pedicle screw fixation on adjacent segments, thus becoming an effective clinical surgical treatment.