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Abstract Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.

Resumo A escoliose idiopática do adolescente (EIA) é considerada a deformidade vertebral de maior gravidade e ocorrência, que acomete crianças e adolescentes ainda na fase de desenvolvimento neuropsicomotor, antes de atingirem a maturidade esquelética. Este estudo teve como objetivo avaliar a abordagem cirúrgica da EIA, considerando resultados associados à redução de curvatura patológica, função pulmonar e repercussões na qualidade de vida dos adolescentes submetidos a tal tratamento. Revisão Sistemática de literatura, com abordagem quanti-qualitativa dos dados coletados, cuja estruturação se deu conforme as orientações de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) realizada nas bases de dados vinculadas à Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A amostra total dos estudos foi de 638 adolescentes com EIA, com uma idade média de 14,93 anos ± 1,24. A correção média da curvatura patológica principal nos estudos foi de 55,06% ± 12,24. Em todos os estudos selecionados com fusão espinhal posterior para correção da EIA verificou-se redução significativa das curvaturas patológicas (> 49%), sendo que a reincidência de curvatura em nenhum dos estudos superou um ganho patológico superior a 5%. Quanto à função pulmonar, os estudos apontaram ganhos significativos de volume expiratório forçado em 1 segundo (VEF1) e capacidade vital forçada (CVF) em pacientes com EIA grave. Além disso, não foram relatados prejuízos de função pulmonar após intervenção cirúrgica para correção da EIA.

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OBJECTIVE@#To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS) and the difference of physiological curvature between different types of scoliosis.@*METHODS@#A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021. The patients were divided into normal group and scoliosis group. The normal group was composed of 179 patients, 79 males and 100 females, aged 10 to 18 years old with an average of (12.84±2.10) years old, with cobb agle less than 10 degrees. The scoliosis group was composed of 126 patients, 33 males and 93 females, aged 10 to 18 years old with an average of (13.92±2.20) years old. The gender, age, Risser sign, thoracic kyphosis(TK) and lumbar lordosis(LL) in 2 groups were compared, and the TK and LL were also compared between different genders, different degrees of scoliosis and different segments of scoliosis.@*RESULTS@#The female ratio(P=0.001) and age (P<0.001) in scoliosis group were higher than them in normal group; the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038). TK was significantly smaller in scoliosis group than in normal group(P<0.001), but there was no significant difference in LL between the 2 groups(P=0.147). There were no significant difference in TK and LL between male and female. The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05), but there was no significant difference in LL between mild and moderate patients(P>0.05). The TK and LL in different segments scoliosis were not found significant difference.@*CONCLUSION@#The physiological curvature of thoracic and lumbar spine is independent of gender. The thoracic physiological curvature becomes smaller in AIS patients, but lumbar curvature remains unchanged. The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients, but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent. The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth, and the specific detailed mechanism needs to be further studied.

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OBJECTIVE@#To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis, summarize the characteristics of the cage subsidence, analyze causes, and propose preventive measures.@*METHODS@#The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females, and the age ranged from 20 to 81 years old, with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease, 12 patients of giant lumbar disc herniation, 5 patients of discogenic low back pain, 33 patients of lumbar spinal stenosis, 26 patients of lumbar degenerative spondylolisthesis, 28 patients of lumbar spondylolisthesis with spondylolisthesis, 11 patients of adjacent vertebral disease after lumbar internal fixation, 7 patients of primary spondylitis in the inflammatory outcome stage, and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis, and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment, 11 patients of two-segment, 8 patients of three-segment, four-segment 1 patient. There were 40 patients treated by stand-alone OLIF, and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation, conducted monofactor analysis on possible risk factors, and observed the influence of fusion cage settlement on clinical results.@*RESULTS@#All operations were successfully completed, the median operation time was 99 min, and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up, except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis, the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence, and 25 patients were abnormal subsidence (23 patients were gradeⅠ, and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm, and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative, and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82), and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03), and the difference was statistically significant (t=9.13, P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%, and there was statistically significant different. The complication rate was 31.3%(45/144), and the reoperation rate was 9.72%(14/144). Among them, 8 patients were reoperated due to fusion cage subsidence or displacement, accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group, Stand-alone OLIF group, 2 or more segments fusion group, and endplate injury group was higher than that in the normal bone mass group, OLIF combined with pedicle screw fixation group, single segment fusion group, and no endplate injury group, and the comparison had statistical differences.@*CONCLUSION@#Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis, Stand-alone OLIF, 2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms, there is a risk of cage migration, and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence, including reoperation.

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OBJECTIVE@#To observe the clinical efficacy of lesion removal, bone grafting, fusion, and external fixation in the treatment of late-stage wrist tuberculosis.@*METHODS@#From October 2015 to May 2019, 25 patients with late-stage wrist tuberculosis were treated using lesion removal, bone grafting, fusion, and external fixation. Among these patients, there were 14 males and 11 females, aged from 40 to 74 years old, with an average age of (60.72±8.45) years old. The duration of the disease ranged from 5 to 24 months, with an average of (11.52±7.61) months. There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis, with 5 cases accompanied by sinus formation. Postoperative regular anti-tuberculosis treatment was continued. Visual analogue score (VAS), inflammatory indicators, Gartland-Werley wrist function score, and upper limb function score were observed before and after treatment.@*RESULTS@#All 25 patients were followed up for ranging from 12 to 36 months with an average of (19.7±6.3) months. At the latest follow-up, all wounds were healed satisfactorily, and there was no recurrence of tuberculosis or infection. VAS at one week before operation and three months after operation were (5.16±1.14) score and (1.68±0.80) score respectively. One week before operation and three months after operation, erythrocyte sedimentation rate (ESR) was (44.20±20.56) mm·h-1 and (14.44±1.14) mm·h-1, and C-reactive protein (CRP) was (12.37±7.95) mg·L-1 and (4.3±3.37) mg·L-1. The differences in all three data sets were statistically significant (P<0.01). According to Gartland-Werley wrist function scoring, the scores at one week before operation and one year after operation were (21.32±3.44) and (14.96±1.37) respectively, showed a statistically significant difference (P<0.01). According to the upper limb function score (disabilities of the arm, shoulder, and hand, DASH), the score was (70.52±7.95) at one week before operation and(28.84±2.30) at one year after operation. The difference was statistically significant (P<0.01). At the latest follow-up, no patient had a recurrence of tuberculosis.@*CONCLUSION@#The short-term clinical efficacy of treating wrist tuberculosis with lesion removal, bone grafting, fusion, and external fixation is satisfactory.

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Introducción: La cirugía mínimamente invasiva de columna se ha vuelto cada vez más popular en los últimos años. Se han desarrollado técnicas nuevas y menos invasivas que se han convertido en procedimientos de elección para determinadas enfermedades. El tamaño del corredor aorto-psoas es un factor determinante al elegir la técnica oblicua de fusión intersomática. Objetivos: Describir las modificaciones en el tamaño del corredor aorto-psoas en decúbito lateral derecho y decúbito supino mediante resonancia magnética y su asociación con el índice de masa corporal. materiales y métodos: Se realizó una resonancia magnética de los espacios discales de L1-L2 a L4-L5 a 13 voluntarios en decúbito supino y decúbito lateral derecho. Se midió el corredor y se comparó el tamaño en cada nivel. Resultados: El tamaño del corredor aorto-psoas y de la distancia arteria-disco tuvo un aumento estadísticamente significativo al posicionar al paciente en decúbito lateral derecho. Conclusiones: La resonancia magnética es de suma importancia en la planificación prequirúrgica, pues deja en evidencia la movilidad de las estructuras abdominales. Se producen cambios significativos en el corredor aorto-psoas y la distancia arteria-disco al ubicar al paciente en decúbito lateral derecho. Sin embargo, estos cambios no tienen una relación significativa con el índice de masa corporal. Nivel de Evidencia: IV

Introduction: Minimally invasive spine surgery (MISS) has gained popularity in recent years. New and less invasive techniques have emerged as the preferred procedures for certain pathologies. The size of the aorta-psoas corridor is decisive when choosing the oblique interbody fusion technique. Objectives: To describe the changes in the size of the aorta-psoas corridor in the right lateral decubitus and supine decubitus positions by magnetic resonance imaging and their association with body mass index. materials and methods: 13 volunteers underwent MRI of the disc spaces from L1-L2 to L4-L5 in the supine and right lateral decubitus positions. The corridor was measured, and the sizes at each level were compared. Results: A statistically significant increase in the size of the aorta-psoas corridor and the artery-disc distance was obtained when positioning the patient in the right lateral decubitus position. However, these have no significant relationship with BMI. Conclusions: The use of MRI in pre-surgical planning is extremely important. This study reveals the mobility of the abdominal structures. We can conclude that, as stated in the objective of the study, significant changes occur in the aorta-psoas corridor and the artery-disc distance when the patient is positioned in the right lateral decubitus position. Level of Evidence: IV

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Introducción: El abordaje lateral de la columna lumbar en la artrodesis intersomática está descrito para tratar varias enfermedades. Si bien es un procedimiento seguro, a medida que la técnica ha ganado popularidad, se han publicado diversas complicaciones asociadas. El objetivo de este artículo es presentar una revisión narrativa de la bibliografía para proveer al lector de un resumen organizado de las complicaciones comunicadas más frecuentes relacionadas con esta técnica. Materiales y métodos: Se llevó a cabo una revisión narrativa de la bibliografía obtenida en las bases de datos PubMed, Web of Science, Scopus y LILACS para identificar artículos que detallen complicaciones relacionadas con el abordaje lateral de la columna lumbar. Resultados: Luego del análisis de los resultados de la búsqueda bibliográfica, se seleccionaron 18 artículos para esta revisión. Conclusiones: Las complicaciones más frecuentes directamente relacionadas con este abordaje son la cruralgia y el déficit motor para la flexión de la cadera o la extensión de la pierna que, en su gran mayoría, son transitorias y reversibles. Hay escasos reportes de lesiones vasculares severas o fatales. Nivel de Evidencia: III

Introduction: The lateral approach for lumbar interbody fusion has been described for the treatment of diverse pathologies. Although it is a safe procedure, its popularity has led to an increase in reports of complications associated with it. The objective of this work is to conduct a narrative review of the literature on the most frequently reported complications associated with this surgical approach. Materials and methods: We performed a narrative review of the literature based on the publications obtained from the following databases: PubMed.gov, Web of Science, Scopus and Lilacs to identify published articles that detail complications related to the lateral approach to the lumbar spine. Results: After analyzing the results of the bibliographic search, 18 articles were selected to carry out this review. Conclusions: The most frequent complications directly related to this approach are thigh pain and motor deficit for hip flexion and/or leg extension, which are mostly temporary and reversible. Severe or fatal vascular injuries have rarely been reported. Level of Evidence: III

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Abstract The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

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Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications

Resumo Objetivo Analisar comparativamente as abordagens cirúrgicas por via posterior isolada e dupla abordagem para tratamento da escoliose severa. Métodos Analisou-se retrospectivamente prontuários de 32 pacientes com escoliose de valor angular > 70° submetidos a tratamento cirúrgico em hospital terciário entre 2009 e 2019. Dividiu-se estes pacientes em dois grupos: Grupo VP com 17 pacientes submetidos a artrodese por via posterior isolada (VP) e Grupo VAP com 15 pacientes abordados por via anterior e posterior (VAP). O Grupo VP apresentou 16 pacientes do sexo feminino e 1 do masculino, com idade média de 16,86 anos. No grupo VAP, 10 pacientes do sexo feminino e 5 do masculino, com idade média de 17,71 anos. Os ângulos de Cobb foram mensurados por único cirurgião de coluna, manualmente, em radiografias panorâmicas, em ortostase no pré- e pós-operatório. Foram avaliados também peso, altura pré- e pós-operatória e duração do procedimento. Resultados No Grupo VP, o ângulo de Cobb pré-operatório e pós-operatório, verificados na curva principal, foram respectivamente 96,06° ± 8,45° e 52,27 ± 15,18°, apresentando taxa média de correção de 0,54 ± 0,16. No grupo VAP, esses valores foram de 83,12° ± 11,60° para o ângulo de Cobb pré-operatório, 48,53 ± 10,76, pós-operatório, com a taxa de correção da curva principal de 0,58 ± 0,11. Conclusão As duas formas de abordagem cirúrgica para tratamento de escoliose severa se equiparam quanto à taxa de correção da deformidade. Portanto, o acesso posterior isolado apresenta vantagem em relação a dupla via, baseado no menor tempo cirúrgico, menor tempo de internação e menos risco de complicações

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Abstract Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Resumo A cirurgia da coluna continua a expandir seus horizontes para cuidar dos pacientes incapacitados com dor e deformidades. Desde a última década, nosso conhecimento sobre o alinhamento espinal, do crânio à pelve, aumentou consideravelmente. Portanto, faz-se necessária a expansão de tal conhecimento para o ortopedista geral, para que possamos proporcionar melhores cuidados para essa população. O alinhamento espinal global é um conceito crítico no entendimento do impacto ocasionado pela condição patológica (doença degenerativa, trauma, deformidade) e mesmo do seu tratamento, como na instrumentação e artrodese da coluna. O tratamento de qualquer doença na coluna deve incluir o entendimento da complexidade do alinhamento espinopélvico. A princípio, todos os parâmetros parecem puramente matemáticos e pouco aplicáveis à realidade do leitor mais desatento. Mas, aos poucos, fica claro que, como tudo em ortopedia, a biomecânica faz parte essencial do conhecimento do sistema musculoesquelético, tornando mais claras as lógicas da fisiologia do movimento. O conhecimento dos conceitos de alinhamento sagital e dos parâmetros espinopélvicos proporcionam uma melhor compreensão dos esqueletos axial e apendicular, além de um melhor entendimento dos processos fisiológicos e adaptativos da coluna frente ao processo degenerativo crescente que ocorre ao longo da vida.

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OBJECTIVE@#To observe the effect of buccal acupuncture on pain after lumbar spinal fusion.@*METHODS@#Sixty patients undergoing lumbar spinal fusion were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case was eliminated). The patients in the control group were treated with routine anesthesia. On the basis of the control group, the patients in the observation group were treated with buccal acupuncture at bilateral back point, waist point, and sacral point for 30 min per treatment. The first acupuncture was given before anesthesia induction, and then once a day postoperation for two days, totally 3 treatments. The dosage of sufentanil, the number of remedial analgesia, and the incidence of nausea and vomiting within 48 h after surgery were compared between the two groups; rest and motion visual analogue scale (VAS) scores at 2 (T1), 8 (T2), 12 (T3), 24 (T4), and 48 (T5) h after surgery were observed; the quality of recovery-15 scale (QoR-15) at 24 and 48 h after surgery were evaluated.@*RESULTS@#The dosage of sufentanil and the number of remedial analgesia within 48 h after surgery in the observation group were lower than those in the control group (P<0.01). There was no significant statistically difference in rest and motion VAS scores between the two groups in T1, T2, T3, T4 and T5 (P>0.05). The QoR-15 scores in the observation group at 24 and 48 h after surgery were higher than those in the control group (P<0.01). The incidence of nausea in the observation group was lower than that in the control group (P<0.05).@*CONCLUSION@#Buccal acupuncture could reduce the amount of postoperative analgesic drugs of patients after lumbar spinal fusion, and promote early postoperative recovery.

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OBJECTIVE@#To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas, through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy.@*METHODS@#This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019. There were nine patients in the group of 3D artificial vertebral body (3D group), and 15 patients in the group of titanium mesh cage (Mesh group). The patients' characteristics and treatment data were extracted from the medical records, including age, gender, CT hounsfield unit of cervical vertebra and surgical information, such as the surgical segments, time and blood loss of surgery, frequency and degree of prosthesis subsidence after surgery. Radiographic observations of prosthesis subsidence during the follow-up, including X-rays, CT, and magnetic resonance imaging were also collected. SPSS 22.0 was used to analysis the data.@*RESULTS@#There was no significant difference between the two groups in gender, age, CT hounsfield unit, surgical segments, time of surgery, blood loss of posterior surgery and total blood loss. Blood loss of anterior surgery was 700 (300, 825) mL in 3D group and 1 500 (750, 2 800) mL in Mesh group (P < 0.05). The prosthesis subsidence during the follow-up, 3 months after surgery, there was significant difference between the two groups in mild prosthesis subsidence (P < 0.05). The vertebral height of the 3D group decreased less than 1 mm in eight cases (no prosthesis subsidence) and more than 1 mm in one case (mild prosthesis subsidence). The vertebral height of the Mesh group decreased less than 1 mm in five cases (no prosthesis subsidence), and more than 1 mm in eight cases (mild prosthesis subsidence). Two patients did not have X-rays in 3 months after surgery. There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 12 months (P < 0.01). The vertebral height of eight cases in the 3D group decreased less than 1 mm (no prosthesis subsidence) and one case more than 3 mm (severe prosthesis subsidence). Four of the 15 cases in the Mesh group decreased less than 1 mm (no prosthesis subsidence), two cases more than 1 mm (mild prosthesis subsidence), and nine cases more than 3 mm (severe prosthesis subsidence). There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 24 months (P < 0.01). The vertebral height of seven cases in the 3D group decreased less than 1 mm (no prosthesis subsidence), one case more than 3 mm (severe prosthesis subsidence), and one case died with tumor. One case in the Mesh group decreased less than 1 mm (no prosthesis subsidence), one case more than 1 mm (mild prosthesis subsidence), 11 case more than 3 mm (severe prosthesis subsidence), one case died with tumor and one lost the follow-up. Moreover, at the end of 12 months and 24 months, there was significant difference between the two groups in severe prosthesis subsidence rate (P < 0.01).@*CONCLUSION@#3D-printed artificial vertebral body for anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma can provide reliable spinal stability, and reduce the incidence of prosthesis subsidence after 2-year follow-up.

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OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

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OBJECTIVE@#To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis.@*METHODS@#Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches, 32 patients in each group. There were 16 males and 16 females in transforaminal approach group, aged from 52 to 84 years old with an average of (66.03±9.60) years, L2 slippage in 4 cases, L3 slippage in 5, and L4 slippage in 23. There were 17 males and 15 females in interlaminar approach group, aged from 46 to 81 years old with an average of (61.38±9.88) years, L3 slippage in 3 cases, L4 slippage in 15, and L5 slippage in 14. Operative time, intraoperative fluoroscopy times, and postoperative bedtime were compared between two groups. Anteroposterior displacement values, interbody opening angles, and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain, and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed, and clinical effects were evaluated according to the modified MACNAB criteria.@*RESULTS@#All operations were successfully completed, and patients in both groups were followed up for more than 1 year, and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P>0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P<0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P<0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values, interbody opening angles, and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P>0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1, 12 months after the operation compared with the preoperative(P>0.05), but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P<0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P<0.05). There was no significant difference in VAS of low back pain, lower extremity pain and JOA scores between two groups during the same period after surgery(P>0.05). According to modified Macnab criteria, excellent, good, fair and poor outcomes were 21, 7, 3 and 1 in transforaminal approach group respectively, and which in intervertebral approach group were 20, 7, 5 and 0, there was no significant difference in clinical effect between the groups(P>0.05).@*CONCLUSION@#Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime, both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage.

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OBJECTIVE@#To investigate the effectiveness of percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of patients with spinal metastases.@*METHODS@#In the study, 12 patients of spinal metastases treated with percutaneous pedicle screw fixation combined expandable tubular retractor in our hospital were retrospectively reviewed between June 2017 and October 2019. Among the 12 patients, 9 were males and 3 were females; the median age was 62.5 years [(65.1±2.9) years]. The decompression segment of 7 patients was located at the lower thoracic spine (including 1 patient with incomplete paraplegia) and the decompression segment of 5 patients was located at the lumbar spine; Tomita score was 6.0±0.6. Perioperative data of the patients were reviewed. Visual analog scale (VAS score), Karnofsky score, and Eastern Cooperative Oncology Group (ECOG) score were compared before and after surgery. The patient's survival, adjuvant treatment, and internal fixation failure were observed in the follow-up period.@*RESULTS@#All the 12 patients had a successful operation with percuta-neous pedicle screw fixation combined expandable tubular retractor. The average operative time, blood loss, and blood transfused of the patients were (247.0±14.6) min, (804.2±222.3) mL and (500.0±100.0) mL, respectively. The average amount of drainage was (240.8±79.3) mL. Drainage tubes were pulled out early postoperative [(3.2±0.3) d], allowing early mobilization. The patients discharged (7.8±0.8) d postoperative. All the patients were followed up for 6-30 months, and the average overall survival time was (13.6±2.4) months. During the follow-up period, 2 patients experienced screw displacement, the internal fixation was stable after conservative treatment and no revision surgery was performed. The VAS of the patients was 7.1±0.2 before surgery, which decreased to 2.3±0.1 and 2.8±0.4 at 3 and 6 months after surgery (P < 0.05). The Karnofsky score of the patients was 59.2±1.9 before surgery, which increased to 75.0±1.9 and 74.2±3.1 at 3 and 6 months after surgery (P < 0.05). The ECOG of the patients was 2.3±0.2 before surgery, which decreased to 1.7±0.1 and 1.7±0.2 at 3 and 6 months after surgery (P < 0.05).@*CONCLUSION@#For selected patients with spinal metastases, minimally invasive surgical treatment of spinal metastases (percutaneous pedicle screw internal fixation combined with expandable tubular retractor) can effectively relieve the clinical symptoms and improve the quality of life, with satisfactory clinical outcome.

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OBJECTIVE@#To investigate the feasibility of predicting proximal junctional kyphosis (PJK) in adults after spinal deformity surgery based on back-forward Bending CT localization images and related predictive indicators.@*METHODS@#A retrospective analysis was performed for 31 adult patients with spinal deformity who underwent posterior osteotomy and long-segment fusion fixation between March 2017 and March 2020. There were 5 males and 26 females with an average age of 62.5 years (range, 30-77 years). The upper instrumented vertebrae (UIV) located at T 5 in 1 case, T 6 in 1 case, T 9 in 13 cases, T 10 in 12 cases, and T 11 in 4 cases. The lowest instrumented vertebrae (LIV) located at L 1 in 3 cases, L 2 in 3 cases, L 3 in 10 cases, L 4 in 7 cases, L 5 in 5 cases, and S 1 in 3 cases. Based on the full-length lateral X-ray film of the spine in the standing position before and after operation and back-forward Bending CT localization images before operation, the sagittal sequence of the spine was obtained, and the relevant indexes were measured, including thoracic kyphosis (TK), lumbar lordosis (LL), local kyphosis Cobb angle (LKCA) [the difference between the different positions before operation (recovery value) was calculated], kyphosis flexibility, hyperextension sagittal vertical axis (hSVA), T 2-L 5 hyperextension C 7-vertebral sagittal offset (hC 7-VSO), and pre- and post-operative proximal junctional angle (PJA). At last follow-up, the patients were divided into PJK and non-PJK groups based on PJA to determine whether they had PJK. The gender, age, body mass index (BMI), number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, osteotomy grading, and related imaging indicators were compared between the two groups. The hC 7-VSO of the vertebral body with significant differences between groups was taken, and the receiver operating characteristic curve (ROC) was used to evaluate its accuracy in predicting the occurrence of PJK.@*RESULTS@#All 31 patients were followed up 13-52 months, with an average of 30.0 months. The patient's PJA was 1.4°-29.0° at last follow-up, with an average of 10.4°; PJK occurred in 8 cases (25.8%). There was no significant difference in gender, age, BMI, number of fusion segments, number of cases with coronal plane deformity, bone mineral density (T value), UIV position, LIV position, operation time, intraoperative blood loss, and osteotomy grading between the two groups ( P>0.05). Imaging measurements showed that the LL recovery value and T 8-L 3 vertebral hC 7-VSO in the PJK group were significantly higher than those in the non-PJK group ( P>0.05). There was no significant difference in hyperextension TK, hyperextension LL, hyperextension LKCA, TK recovery value, LL recovery value, kyphosis flexibility, hSVA, and T 2-T 7, L 4, L 5 vertebral hC 7-VSO ( P>0.05). T 8-L 3 vertebral hC 7-VSO was analyzed for ROC curve, and combined with the area under curve and the comprehensive evaluation of sensitivity and specificity, the best predictive index was hC 7-L 2, the cut-off value was 2.54 cm, the sensitivity was 100%, and the specificity was 60.9%.@*CONCLUSION@#Preoperative back-forward Bending CT localization image can be used to predict the occurrence of PJK after posterior osteotomy and long-segment fusion fixation in adult spinal deformity. If the patient's T 8-L 2 vertebral hC 7-VSO is too large, it indicates a higher risk of postoperative PJK. The best predictive index is hC 7-L 2, and the cut-off value is 2.54 cm.

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OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.

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OBJECTIVE@#To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis.@*METHODS@#A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect.@*RESULTS@#The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression.@*CONCLUSION@#Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.

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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.

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OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.@*RESULTS@#There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

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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.