Treatment of lumbar degenerative disease with transforaminal lumbar interbody fusion: minimally invasive procedure versus open surgery / 中华全科医师杂志

Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.

Establishment of a rat caudal disc degeneration model by percutaneous fine-needle aspiration of the fibrous ring / 中国医师杂志

Objective To compare the effect of different size needle gauges to the degenerative response in rat caudal discs.Methods A total of 40 Sprague Dawley (SD) rats,level 5/6,7/8 and 9/10 interverbral discs of rat caudal spine were punctured with 18 or 21 or 25-gauge needles respectively.Radiographs and magnetic resonance imaging (MRI) were obtained at 1,2,4 and 6 weeks postsurgery.At each time point,ten rats from each group were sacrificed for histological analysis.Real-time fluorescent quantitative polymerase chain reaction (qPCR) was used to examine mRNA expression level.Results Significant differences were identified in the disc height index (DHI ％) and MRI grade between 18 G and normal group,MRI grade,histological score between 21 G and normal group at 2,4,and 6 weeks postsurgery.Significant differences were also identified in the histological score and mRNA expression levels between 18 G and normal group,alcian blue stain and hypoxia inducible factor-1α (HIF-1 α) mRNA expression level between 21G and normal group at all time point postsurgery.Significant differences existed in DHI％,type Ⅱ collagen and aggrecan mRNA expression levels between 21 G and normal group,all type mRNA expression levels between 25 G and normal group at 4,6 weeks.There were significant differences in MRI grade and histological score between 25 G and normal group at 6 weeks.Significant differences existed in almost all parameters compared between 18 G and 25 G at all time point.There were significant differences in DHI％,MRI grade,histological score and HIF-1α mRNA expression levels between 18 G and 21 G at 4,6 weeks.There were significant differences in type Ⅱ collagen and aggrecan mRNA expression levels between 18 G and 21 G at all time point.Significant differences exist in DHI％ and HIF-1α mRNA expression level between 21 G and 25 G at 6 weeks.Compared with the 25 G group,the DHI％ and Pfirrmann scores and the pathological score of each time at 2,4 and 6 weeks after operation in 18 G group have significant difference (P ＜ 0.05).Conclusions The middle size needle (21G) is better to induce disc degeneration.The 2-week time point may be the better time frame to further experimental treatments.

A comparison of anterior cervical discectomy and fusion versus fusion combined with cervical disc replacement for treating multi-level cervical spondylotic disease / 国际外科学杂志

Objective To evaluate the clinical efficacy of hybrid surgery,which combines fusion with cervical disc replacement (CDR),compared to anterior cervical discectomy and fusion (ACDF) in patients with multi-level cervical spondylosis.Methods From January 2015 to March 2017,the clinical data of 53 patients with multi-level cervical spondylosis admitted to Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University,were retrospectively analyzed.They were divided into anterior cervical discectomy and fusion group (ACDF) (n =29) and hybrid surgery group (n =24) according to different operative methods.The operation time and intraoperative bleeding were analysised.Visual analogue scale (VAS) score,neck disability index (NDI),Japanese orthopaedic association (JOA) scores,Odom criteria and surgical complications were evaluated when outpatient reviewed for 1,3 and 6 months postoperative.The cervical range of motion (ROM),and adjacent segments degeneration (ASD) were assessed with radiographs.The measurement data of normal distribution were expressed as ((x) ± s),the comparison between groups was conducted by independent sample t test,and the repeated measurement data were analyzed by variance analysis.Counting data were expressed as percentage (％) and intergroup comparisons were performed by x2 test or Fisher exact test,and inter-group comparisons of classified data were performed by Kruskal-Wallis H (K) rank test.Results The operation time [(81.0 ± 15.4) min] and the amount of bleeding [(69.0 ± 38.4) ml] in the hybrid surgery group were less,but there was no statistical difference (t =1.487,1.065,P =0.154,0.301).Compared with postoperative complications,dysphagia occurred in 19 patients (65.5％) in group ACDF,which was significantly higher than 5 in group hybrid surgery (20.8％),but there was no significant difference in overall complications (x2 =9.759,P =0.082).Significant improvements in VAS score,NDI score and JOA score were observed postoperation in ACDF and hybrid surgery group,but there was no significant difference between the two groups (Fintra-group =31.225,70.358,32.412,P =0.000,0.000,0.000;Finter-group =1.258,2.451,0.914,P =0.277,0.135,0.352).There was no significant difference in Odom criteria between the two groups (x2 =260.500,P =0.077).The ROM of C3-C7 in group ACDF decreased significantly,while that in group hybrid surgery was not significantly decreased (t =2.514,1.776,P =0.022,0.093).The ROM of C3-C7 was significantly different at 6 months postoperation (t =2.353,P =0.030).Although no ASD changes were found in the hybrid surgery group during the follow-up period,there was no significant statistical significance in the two groups (x2 =2.632,P =0.105).Conclusion Compared with the previous ACDF operation,there is no significant difference in the clinical results of hybrid surgery operation for multilevel cervical spondylosis,but it can effectively preserve cervical ROM,reduce adjacent segment degeneration and postoperative dysphagia.

Correlation among Inflammatory Cytokine Expression Levels, Degree of Disk Degeneration, and Predominant Clinical Symptoms in Patients with Degenerated Intervertebral Discs

STUDY DESIGN: Observational study. PURPOSE: To assess the correlation among inflammatory cytokine expression levels, degree of intervertebral disk (IVD) degeneration, and predominant clinical symptoms observed in degenerative disk disease (DDD). OVERVIEW OF LITERATURE: Low back pain (LBP) is associated with inflammatory cytokine expression levels, including those of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), and nerve growth factor (NGF). However, the association between cytokine expression levels and the physiological mechanisms of disk degeneration and clinical pain remain controversial. METHODS: Using the enzyme-linked immunosorbent assay, TNF-α, IL-6, and NGF expression levels were analyzed in 58 IVD samples that were harvested from patients with lumbar DDD. Patient samples were grouped according to the degree of IVD degeneration using the Pfirrmann grading system and magnetic resonance imaging, and the correlations between the disease groups and each cytokine expression level were assessed. In addition, on the basis of their predominant preoperative symptoms, the patients were assigned to either an LBP or leg pain group to determine the correlation among these disease manifestations and individual cytokine expression levels. RESULTS: A gradual increase in TNF-α (R=0.391) and IL-6 (R=0.388) expression levels correlated with the degree of IVD degeneration, whereas NGF (R=0.164) expression levels exhibited a minimal decrease with disease progression. Regarding the predominant clinical manifestation, only the LBP group exhibited a significant increase in TNF-α expression levels (p=0.002). CONCLUSIONS: These results suggested that TNF-α and IL-6 play an important role in the pathophysiology of IVD degeneration at any stage, whereas NGF plays an important role during the early disease stages. Moreover, because TNF-α expression levels were significantly high in the LBP group, we propose that they are involved in LBP onset or progression.

Lumbar disc degeneration is associated with local transforming growth factor beta1 and inflammatory cytokines / 中国组织工程研究

BACKGROUND:With the research development of disc degeneration at molecular level, transforming growth factor β1 gene has a role in the proliferation and differentiation of intervertebral disc cels, and it is involved in the repair of intervertebral disc injury. But whether transforming growth factor β1 is also involved in pathophysiological process of disc degeneration has not been determined. OBJECTIVE:To discuss the relationship between transforming growth factor β1, inflammatory cytokines and degree of lumbar disc degeneration. METHODS: Twenty-two patients with lumbar disc degeneration (22 mild, 26 moderate and 24 severe cases) were enroled as observation group, and another 30 patients without lumbar disc degeneration served as control group. Levels of transforming growth factorβ1, interleukin-6, interleukin-8, tumor necrosis factor α were detected and compared among patients with mild, moderate and severe lumbar disc degeneration as wel as between the observation and controlgroups. RESULTS AND CONCLUSION: Levels of transforming growth factor β1, interleukin-6, interleukin-8, tumor necrosis factor α were significantly higher in the observation group than the control group (P moderate cases > mild cases (P < 0.01). There was a positive correlation between these indicators and the severity of lumbar disc degeneration (r=0.198, 0.312, 0.356, 0.275, 0.724,P < 0.01). These findings indicate that the levels of transforming growthfactor β1, interleukin-6, interleukin-8 and tumor necrosis factor α are increased with the severity of lumbar disc degeneration.

Diabetes and intervertebral disc degeneration：effects on structure, apoptosis, endplate blood supply and extracellular matrix / 中国组织工程研究

BACKGROUND:Diabetes as a systemic metabolic disease induces the disorders of carbohydrates, fat, and protein metabolism, simultaneously easily causes the lesion of surrounding capilaries, and impacts nutrient metabolism of multiple organs including intervertebral discs. OBJECTIVE:To summarize the research progress of diabetes effects on disc degeneration al over the world. METHODS: The first author used the computer to retrieve the information from PubMed and China National Knowledge Infrastructure. The key words were “intervertebral disc, degeneration, diabetes melitus” in English and Chinese. 8 414 relevant articles were found, which were published from January 1981 to January 2014. Repetitive studies were excluded and 34 articles were in accordance with the inclusion criteria. RESULTS AND CONCLUSION: Pathogenesis of diabetes complications was very complicated. Apoptosis is a hot focus in recent years. Hyperglycemia has been a inducer for apoptosis in intervertebral discs. Diabetes easily leads to systemic smal vessel disease, especialy vascular bud contraction in the terminal plate of vertebral body, and results in regional blood flow decrease or interruption. Thus, the nutrient substance carrying along the end plate was reduced, which resulted in disc dystrophy and degeneration. The reduction in extracelular matrix in the intervertebral discs is a major reason for disc degeneration. The mechanisms underlying diabetes effects on disc degeneration remain unclear and deserve further investigations.

Acellular matrix scaffold for tissue-engineered intervertebral disc which is closest to the normal three-dimensional structure of the nucleus pulposus / 中国组织工程研究

BACKGROUND:At present there is no specific therapy for the treatment of degenerateive disc diseases. The development of tissue engineering technology provides a new therapy idea for it. OBJECTIVE:To review the research progress of acelular matrix scaffold to construct tissue-engineered intervertebral disc. METHODS:A computer-based online search of PubMed, CNKI, Wanfang and Chinese Biomedical Database was performed for relevant articles published between 2005 to 2014 using the keywords of “intervertebral disc degeneration, extracelular matrix, tissue engineering, scaffold, nucleus pulposus, annulus fibrosus” in English and Chinese, respectively. RESULTS AND CONCLUSION:Construction of tissue-engineered intervertebral disc includes three essential elements: cel scaffolds, seed cels and cytokines. Scaffolds are the key. Acelular matrix scaffold is an important scaffold which has been a hot area of research in scaffolds for tissue-engineered intervertebral disc for several years, which can be divided into three types: acelular annulus fibrosus scaffold, acelular nucleus pulposus scaffold and integrated intervertebral disc scaffold. Different scaffolds have a variety of preparation methods. Acelular matrix scaffold has its own significant advantages, such as low antigenicity, good histocompatibility, and a most similarity with the three-dimensional structure of normal nucleus pulposus that can provide a proper microenvironment for cel growth. However, there are stil some disadvantages of acelular matrix scaffold in tissue-engineered intervertebral disc. So, it needs to be further improved.

Degeneration of the intervertebral disc：pathogenesis and repair / 中国组织工程研究

BACKGROUND:So far, the pathogenesis of discogenic low back pain is poorly understood. A great diversity of therapeutic means is developed for discogenic low back pain, but the therapeutic outcomes are mixed. OBJECTIVE:To review the research progress in mechanisms and repair of intervertebral disc degeneration in recent years. METHODS: The first author retrieved the PubMed and CNKI databases for relevant articles published before November 2014 using the keywords of “disc degeneration factor, discogenic low back pain, disc degeneration therapy” in English and Chinese, respectively. Initialy, 78 relevant articles were retrieved, but only 30 articles were included in result analysis folowing elimination of duplicate studies. RESULTS AND CONCLUSION:The relatively respected factors for intervertebral disc degeneration include changes in morphology, inflammatory neurotransmitters and the extracelular matrix as wel as role of growth factors. The treatment for intervertebral disc degeneration stil focuses on the morphological restoration. Some surgical therapies, including percutaneous disc decompression, interbody fusion, artificial disc replacement, dynamic stabilization system, have the exact effects on the symptoms due to intervertebral disc degeneration.

How to make animal models of intervertebral disc degeneration that fully simulate the human intervertebral disc degeneration? / 中国组织工程研究

BACKGROUND:The pathogenesis of intervertebral disc degenerative disease has not been determined. To establish the ideal animal model of intervertebral disc degeneration is an important approach to study the pathogenesis or treatment of the disease. OBJECTIVE:To review model selection, modeling method and the advantages and disadvantages of the studies concerning various animal models of intervertebral disc degeneration. METHODS:We retrieved Wanfang database, China National Knowledge Infrastructure database, PubMed database and FMJS database for articles on animal models of intervertebral disc degeneration in vivo and in vitro published in recent five years al over the world. RESULTS AND CONCLUSION:The present literature shows that smal and medium-sized animals are now commonly used animal model. Building methods can be divided into two major categories of in vivo and in vitro models. The in vitro model revealed mechanism of intervertebral disc degeneration by the cel or tissue culture from the cel ular and molecular levels. In vivo model, different kinds of physical or chemical methods are used to intervene intervertebral disc, causing the intervertebral disc degeneration, proving the mechanism of intervertebral disc degeneration by the process of intervention. However, pathogenesis of human intervertebral disc degenerative disease is complex and has not been determined, so the current animal models are not comprehensive simulation of human intervertebral disc degenerative disease.

Histopathology changes and transforming growth factor-bata1 expression in the ligamentum flavum of C 4/5 cervical instability animal models / 中国组织工程研究

BACKGROUND:Destroying posterior stable structure of cervical vertebra may facilitate the ligamentum flavum regeneration. Whether anterior cervical instability can induce the regeneration in posterior and adjacent ligamentum flavum remains unclear. OBJECTIVE:To observe the changes of transforming growth factor-β1 expression and histopathology in the ligamentum flavum of cervical instability animal models. METHODS:Thirty-six New Zealand white rabbits were randomly divided into control group and experimental group, with 18 rabbits in each group. In the experimental group, cervical instability animal models were established made through destroying annulus fibrosus by anterior puncture and absorbing nucleus pulposus in C4/5 . And no intervention was given to the control group. RESULTS AND CONCLUSION:Compared with the control group, fibers in the C 3/4, 4/5, 5/6 ligamentum flavum arranged disorderly and the glass like degeneration was found in the experimental group. The expression of transforming growth factor-β1 in ligamentum flavum was increased, especial y in C 4/5 , in the experimental group. At 4, 8, 12 weeks, transforming growth factor-β1 expression in the C 3/4, 4/5, 5/6 ligamentum flavum segments was similar between the two groups. Experimental findings indicate that, anterior cervical instability can induce the regeneration in posterior ligamentum flavum, especial y in the injured segment.

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

STUDY DESIGN: The prevalence of disc herniation is estimated to be about 100,000 new cases per year in France and disc herniation accounts for 25% to 30% of surgical activity in Departments of Neurosurgery. Classically, sciatica is expected to follow its specific dermatome-L5 or S1-. In clinical practice, we regularly encounter patients showing discrepancy between clinical sciatica and imaging findings. PURPOSE: The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. OVERVIEW OF LITERATURE: To the best of our knowledge, this subject has not yet been discussed in the medical literature. METHODS: The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. RESULTS: We found an apparent clinicoradiological discrepancy between sciatica described by patients on one side and magnetic resonance imaging (MRI) finding on the other side in 27 (11.20%) patients. We did not find any other abnormalities in the preoperative and postoperative period. All of these patients underwent lumbar discectomy via posterior interlaminar approach. Three months after surgery, 25 patients (92.59%) had been totally relieved of sciatica pain. Two patients (7.41%) continued to experience sciatica in spite of the surgery. CONCLUSIONS: The discrepancy between clinical sciatica and disc herniation level on MRI is not rare. Management of this discrepancy requires further investigation in order to avoid missing the diagnosis and treatment failure.

Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

STUDY DESIGN: Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. PURPOSE: The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). OVERVIEW OF LITERATURE: Several studies have shown promising results following this surgery. METHODS: We reviewed the files of 104 patients at the Department of Neurosurgery in Colmar (France) who had been operated on by lumbar spine arthroplasty (Prodisc) between April 2002 and October 2008. RESULTS: Among the 104 patients, 67 were female and 37 were male with an average age of 33.1 years. We followed the cases for a mean of 20 months. The most frequent level of discopathy was L4-L5 with 62 patients (59.6%) followed by L5-S1 level with 52 patients (50%). Eighty-three patients suffered from low back pain, 21 of which were associated with radiculopathy. The status of 82 patients improved after surgery according to the Oswestry Disability Index score, and 92 patients returned to work. CONCLUSIONS: The results indicate that TDA is a good alternative treatment for lumbar spine disk disease, particularly for patients with disabling and chronic low back pain. This technique contributes to improve living conditions with correct patient selection for surgery.

Extracelluar matrix stimulates neurite outgrowth of dorsal root ganglion neurons differently depending on whether extracted from degenerated or normal intervertebral disk / 中国组织工程研究

BACKGROUND:Compared with the normal intervertebral disk, the density of nerve fibers and number of nerve endings and neuropeptides appear to be more in the degenerated intervertebral disk. However, this phenomenon does not occur in the normal y aged disk. OBJECTIVE:To evaluate the axonal growth and induction of a painful neuropeptide and substance P using rat dorsal root ganglion neurons and degenerated human disc cells in vitro. METHODS:The human intervertebral discs were harvested from patients with discogenic low back pain and normal people. And extracelluar matrix extracted from human degenerative intervertebral discs was cultured with rat dorsal root ganglion neurons. The promotion of axonal growth and induction of substance P of dorsal root ganglion neurons in extracted medium were evaluated through morphology observation and enzyme-linked immunosorbent assay, respectively. RESULTS AND CONCLUSION:Compared with the normal group, the content of nerve growth factor in the degenerative group was significantly higher and the average length of neuritis was significantly longer in the experimental group (P<0.05). After intervention with anti-nerve growth factorβ, the average length of neuritis became remarkably shorter. The percentage of substance P-immunoreactive cells was significantly higher in the degenerative group compared with the normal group (P<0.001). Nerve growth factors that highly express in the extracellular matrix from the degenerative intervertebral dick can promote neurite outgrowth of dorsal root ganglion neurons and induce release of neuropeptides related to pain transmission.

Lateral and posterior single cage combined with unilateral pedicle screw fixation for lumbar degenerative disease / 中国组织工程研究

BACKGROUND:Most of lumbar degenerative diseases, such as lumbar instability, lumbar disc herniation and discogenic lumbago, need lumbar spinal fusion for the spine stability, but the choice of internal fixation approaches is controversial. OBJECTIVE:To compare the effectiveness between lateral lumbar interbody fusion with single cage and single cage combined with unilateral pedicle screw fixation for the 4th and 5th single-level lumbar degenerative disease. METHODS:The clinical data of patients with single-level lumbar degenerative diseases (L4 and L5) undergoing lateral lumbar interbody fusion with single cage in 30 cases (experimental group) and single cage combined with unilateral pedicle screw fixation in 45 cases (control group) were analyzed retrospectively, and the curative effects were compared between the two groups. RESULTS AND CONCLUSION:Al patients in the two groups were fol owed up for 13 months on average (ranged from 10 to 37 months). The incisions in the two groups were stage I healing. One case in the experimental group occurred cage displacement, but no obvious syndromes were detected. No significant difference in the effective rate after operation, hospital stay, and volume of drainage was detected (P>0.05). The operative time and bleeding volume in experimental group were better than those in the control group (P0.05). The effectiveness of lateral lumbar interbody fusion with single cage and single cage combined with unilateral pedicle screw fixation for single-level degenerative lumbar diseases was similar. However, the former has the advantages of less invasion and quick recovery.

Proteomics and its application in orthopedic diseases / 中国组织工程研究

BACKGROUND:Proteomics is a new field of research in the post-genomic era. The research subjects of proteomics include the structure and function of entire proteins in tissues or cells. It analyses the vital changes of pathological and physiological process of diseases by examining proteins. OBJECTIVE:To summarize the application of proteomics in orthopedic diseases and its prospect. METHODS:Articles about the application of proteomics in orthopedic diseases and its prospect were retrieved from the Digital Library Al iance of Zhujiang River Delta and PubMed with the key words of“proteomics, orthopedics, review, osteoblasts metabolism, osteoclasts metabolism, intervertebral disc degeneration, osteoporosis, osteoarthritis, serum related orthopedic diseases”in both Chinese and English from January 2001 to September 2013. Reproductive research and atypical reports were excluded. RESULTS AND CONCLUSION:Proteomics has been applied in the osteoblasts metabolism, osteoclasts metabolism, intervertebral disc degeneration, osteoporosis, osteoarthritis and serum related orthopedic diseases that are the most common il nesses in al types of people. These basic and clinical studies undoubtedly bring great benefit for human health, and proteomics technology wil get a bigger breakthrough in basic medicine and clinical medicine, and it shows us a broad prospect.

Early effect of lumbar dynamic fixation for treatment of lumbar disc herniation / 中国组织工程研究

BACKGROUND:Currently, one of common methods is discectomy, nerve root decompression and fusion rigid fixation from the midline approach for disc herniation which is inefficient by conservative treatments. Thus, it is causing degeneration and limiting lumbar physiological activity of adjacent segments. The treatment of non-fusion lumbar disc herniation with the traditional posterior midline incision approach has some disadvantages such as big incision, wide peeling, and back muscle denervation. OBJECTIVE:To observe therapeutic effects of dynamic stabilization system through Wiltse approach on lumbar disc herniation, and to compare the outcomes with traditional posterior approach. METHODA total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lumbar disc herniation at the Renmin Hospital of Wuhan University from January 2011 to January 2013, were enrol ed in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients. RESULTS AND CONCLUSION:Al 46 patients were fol owed up for 7 to 31 months (averagely, 13.8±2.4 months). The length of incision, intraoperative blood loss, and postoperative drainage amount were less in the Wiltse approach group than in the traditional posterior approach group (P0.05). Radiographs revealed that the position of implants was good in al patients, no loosing or breakage. These data verified that the early effect of dynamic stabilization system through Wiltse approach for lumbar disc herniation is similar to that of traditional posterior approach.

Construcciones híbridas del raquis lumbosacro: trabajo preliminar - 20 casos / Construções híbridas da coluna vertebral lombossacral: trabalho preliminar - 20 casos / Hybrid constructions of the lumbosacral spine: preliminary work - 20 cases

OBJETIVO: Presentar la filosofía utilizada y como y por qué decidimos proteger el nivel adyacente a una fusión. MÉTODOS: En el criterio de selección de 620 pacientes operados entre enero de 2007 y agosto de 2011 por patología degenerativa, inestabilidad y estenosis del conducto lumbosacro, se seleccionaron 30 pacientes con estadios de Pfirmann 3 y 4, de los cuales seis se perdieron en la consulta postoperatoria y cuatro rechazaron la terapéutica quirúrgica, quedando 20 pacientes que fueron intervenidos quirúrgicamente. La edad promedio de los pacientes fue de 46 años (rango: 22 a 71 años), siendo 11 hombres (55%) y 9 mujeres (45%). RESULTADOS: El seguimiento de los casos es de 6 meses a 2 años y hasta el momento no se evidenció empeoramiento clínicoo radiológico, ni aflojamiento de la instrumentación en ningún caso. CONCLUSIONES: Entendemos que la protección del nivel adyacente mediante el empleo de barras semirrígidas en PEEK sería una buena alternativa de protección debido a que no es necesario abordar el ligamento o los pedículos del nivel adyacente a la fusión.

OBJETIVO: Apresentar a filosofia utilizada e como e por que decidimos proteger o nível adjacente a uma fusão. MÉTODOS: No critério de seleção de 620 pacientes operados entre janeiro de 2007 e agosto de 2011 devido a patologia degenerativa, instabilidade e estenose do canal lombossacral, foram escolhidos 30 pacientes com estágios 3 e 4 de Pfirmann, dos quais seis foram perdidos na consulta pós-operatória e quatro recusaram a cirurgia, restando 20 pacientes que foram submetidos à cirurgia. A idade média dos pacientes era 46 anos (faixa: 22 a 71), sendo 11 homens (55%) e 9 mulheres (45%). RESULTADOS: O acompanhamento dos casos é de 6 meses a 2 anos e, até o momento, não se evidenciou piora clínica ou radiológica, nem afrouxamento da instrumentação em nenhum caso. CONCLUSÕES: Entendemos que a proteção do nível adjacente por meio do emprego de hastes semirrígidas em PEEK seria uma boa alternativa de proteção, devido ao fato de não ser necessário abordar o ligamento ou os pedículos do nível adjacente à fusão.

OBJECTIVE: To present the philosophy used, and demonstrate how and why we decided to protect the level adjacent to a bone union. METHODS: In the selection criteria of 620 patients who had undergone surgery between January 2007 and August 2011 due to degenerative pathology, instability and stenosis of the lumbosacral canal, 30 patients were selected with Pfirmann grades 3 and 4, from which six were lost to follow-up and four refused surgery, leaving 20 patients who underwent surgery. The mean age of the patients was 46 years (range: 22 to 71), with 11 men (55%) and 9 women (45%). RESULTS: The follow-up of the cases was 6 months to 2 years, and so far, no clinical or radiological worsening has been observed, or loosening of the instrumentation in any case. CONCLUSIONS: we understand that protection of the adjacent level through the use of semi-rigid rods in PEEK is a good alternative, as it is not necessary to approach the ligament or pedicles of the level adjacent to the union.

Artroplastia total de disco cervical com prótese de Bryan: resultados clínicos e funcionais / Cervical total disc arthroplasty with Bryan disc: clinical and functional outcomes / Artroplastía cervical total con prótesis de Bryan: resultados clínicos y funcionales

OBJETIVO: Avaliar resultados da artroplastia total disco cervical com a prótese de Bryan para tratamento da cervicobraquialgia (radiculopatia) e da mielopatia compressiva. MÉTODOS: No período de 2002 a 2007, a equipe da CECOL operou 65 pacientes. Somente 28 pacientes foram localizados em 2010 para uma nova coleta de dados. Foi feita avaliação pré e pós-operatória, utilizando-se o questionário CSOQ (Cervical Spine Outcomes Questionnaire). Os critérios de Odom foram utilizados somente na avaliação pós-operatória. Ambos foram traduzidos e adaptados para cultura local. RESULTADOS: Houve melhora funcional e sintomática significativa na maioria dos pacientes. A atenuação da dor cervical (axial) e braquial (radicular) foi semelhante. Os critérios Odom indicaram 82,1% de bons e ótimos resultados, 10% satisfatórios e 7% ruins. Houve apenas uma complicação (3%), que foi revertida com a artrodese anterior. CONCLUSÕES: A artroplastia total de disco cervical demonstrou ser um método seguro e eficaz para tratamento de casos selecionados de hérnia de disco cervical associada a radiculopatia e/ou mielopatia a curto e médio prazo.

OBJECTIVE: To evaluate results of cervical disc arthroplasty with the Bryan prosthesis for treatment of cervicobrachial pain (radiculopathy) and spinal cord compression (myelopathy). METHODS: From 2002 to 2007, the CECOL surgical staff has operated 65 patients. Only 28 patients were found in 2010 to a new data collection. The pre- and post-operative evaluation was conducted using the CSOQ questionnaire (Cervical Spine Outcomes Questionnaire). Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to local culture. RESULTS: There was a significant symptomatic and functional improvement in most patients. The reduction of neck pain (axial) and brachial pain (radicular) was similar. Odom criteria showed 82.1% good and excellent results, 10% satisfactory and 7% poor. There was only one complication (3%) which was reversed with anterior arthrodesis. CONCLUSIONS: The total cervical disc arthroplasty has proved to be a safe and effective method to treat selected cases of cervical disc herniation with radiculopathy and/or myelopathy in the short and medium term.

OBJETIVO: Evaluar los resultados de la artroplastia discal cervical con la prótesis de Bryan para el tratamiento del radiculopatía y compresión de la médula espinal (mielopatía). MÉTODOS: El equipo de CECOL ha operado 65 pacientes en el período de 2002 a 2007. Sólo 28 pacientes fueron localizados en 2010 para una nueva recolección de datos. La evaluación pre y postoperatoria se realizó mediante un cuestionario CSOQ (Cervical Spine Outcomes Questionnaire). Los criterios de Odom sólo fueron utilizados en la evaluación postoperatoria. Ambos fueron traducidos y adaptados a la cultura local. RESULTADOS: Hubo una mejora significativa sintomática y funcional en la mayoría de los pacientes. La atenuación del dolor de cuello (axial) y braquial (radicular) fue similar. Los criterios Odom demostraron 82,1% de resultados buenos y excelentes, 10% satisfactorios y el 7% malos. Hubo sólo una complicación (3%), que se revirtió con artrodesis anterior. CONCLUSIONES: La artroplastia discal cervical ha demostrado ser un método seguro y eficaz para el tratamiento de casos seleccionados de hernia de disco cervical asociada a la radiculopatía y/o a compresión de la médula espinal en el corto y mediano plazo.

Estabilización dinámica con ligamentoplastia interespinosa en discopatía degenerativa de columna vertebral lumbar / Dynamic stabilization with interspinous ligamentoplasty in degenerative discopaty of lumbar spine

El tratamiento de la Discopatía Degenerativa lumbar, mediante dispositivo suave de estabilización dinámica, con el uso de ligamento para reforzamiento interespinoso, altera favorablemente el movimiento y la transmisión de carga de un segmento vertebral, proporcionando estabilidad y previniendo la enfermedad del segmento adyacente. Por lo tanto se realiza un estudio prospectivo, longitudinal con 25 pacientes con edades comprendidas entre 15 y 58 años, con diagnóstico de Discopatia degenerativa lumbar; con estudios de imágenes previos con radiografias en proyección AP, lateral y laterales dinámicas además de Resonancia Magnética, con los cuales se confirmo el diagnóstico, al igual que control radiológico postoperatorio, a los que se les practico semihemilaminectomia mas discectomíamas foraminectomía mas ligamentoplastia interespinosa del segmento afectado y adyacentes. Se obtuvo como resultado mejoría clínica inmediata en la mayoría de los pacientes y con pronto reintegro a sus actividades habituales luego de la cirugía.

The treatment of lumbar degenerative discopaty, by means of a soft dynamic stabilization device, with the use of ligament for interspinous reinforcement, alter favorably the movement and load transmission of a vertebral segment, providing stability and preventing the disease of the adjacent segment. Therefore a prospectivelongitudinal study is carried out on 25 patients with ages ranging from 15 to 58 years, with a lumbar degenerative disease diagnosis; previous radiographicstudies in AP, lateral and dynamic-laterals projectionsand also Magnetic Resonance Imaging confirm the diagnosis, along with postoperative radiological controls. The patients received semi-hemilaminectomy plus discectomy plus foraminectomy plus interspinous ligamentoplasty of affected and adjacent segments. As result, inmediate clinical improvement in most patients was obtained and a soon return to their usual activities after the surgery.

A Case of Intraspinal Gas-containing Cyst associated with Severe Lumbar Spondylosis

Intraspinal gas collection is rare and also can be a cause of lumbar radiculopathy. Occasionally, the gas formation makes a severe pain which results from nerve root compression. We report a patient who had a radiculopathy caused by the gascontaining cyst in L3-L4 associated with severe spondylosis.