Efficacy of posterior pedicle screw reduction and internal fixation of atlantoaxial fractures: comparison between O-arm navigation assisted and free-hand techniques / 中华创伤杂志

Objective:To investigate the effect of O-arm navigation assisted posterior pedicle screw reduction and internal fixation of atlantoaxial fractures.Methods:A retrospective case-control study was conducted to analyze 37 patients with atlantoaxial fractures admitted to Third Hospital of Hebei Medical University from January 2016 to June 2018, including 22 males and 15 females, aged from 29 to 68 years [(50.9±9.8)years]. The posterior pedicle screw reduction and internal fixation was performed under O-arm navigation system (navigation group, n=24), and using free-hand technique (free-hand group, n=13). The operation time and blood loss were compared between the two groups. The Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were used to evaluate the clinical efficacy before operation, 7 days operation and at the last follow-up. The complications were detected. A total of 86 screws were placed in navigation group (Neo grade 0: 83 screws, grade 1: 2 screws, grade 2: 1 screw ), and 44 screws were inserted in free-hand group (Neo grade 0: 36 screws, grade 1: 5 screws, grade 2: 2 screws, grade 3: 1 screw)( P<0.05). Classification of screw positions proposed by Neo et al was used to evaluate the position relationship between the screw and the bone cortex and the incidence of screw penetration. Results:All patients were followed up 24-38 months [(27.7±4.0)months]. The operation time in navigation group was (189.8±35.4)minutes, significantly shorter than (221.5±48.6)minutes in free-hand group ( P<0.05). The bleeding volume in navigation group was 300.0 (250.0, 537.5)ml , significantly less than 500.0 (425.0, 625.0)ml in free-hand group ( P<0.05). Both groups showed significantly enhanced JOA and decreased NDI after operation and at last follow-up, compared with those before operation ( P<0.05). However, there was no significant difference in JOA and NDI between the two groups ( P>0.05). No severe complications such as neurovascular injury occurred during operation. The incidence of cortical penetration was 3% (3/86) in navigation group and 18% (8/44) in free-hand group ( P<0.05). Conclusions:In the process of posterior atlantoaxial pedicle screw placement, the application of O-arm navigation can significantly reduce the operation time and amount of bleeding, and enhance the accuracy of pedicle screw implantation.

The complications of oblique lateral interbody fusion procedure / 中华骨科杂志

Oblique lateral interbody fusion (OLIF) was minimally invasiveprocedure for lumbar interbody fusion (LIF) through the space between anterior margin of retroperitoneal psoas major muscle and the vessels (ATP). Although OLIF had many advantages over other approaches, there were also various kinds of surgical complications, the incidence of which was 3.69%-81.82%. Most of the complications were relieved by conservative or symptomatic treatment. Only a small number of complications were difficult to recover, if so, revision surgery was needed and might remain persistent symptoms. OLIF complications included intraoperative and postoperative complications. Major vascular injury was a dangerous complication during operation, which requires immediate compression or suture to prevent bleeding. The incidence of nerve injury could be reduced by avoiding violent traction and tissue separation and reducing the operation time. When injury of thorax and peritoneum occurs, suture should be done as soon as possible. Transient hip flexion weakness and transient thigh/groin sensory disturbance was the most common post-operative complication, most of which would disappear after several months. Intestinal obstruction is caused by the pulling of peritoneum during operation, most of which was incomplete and would be relieved after some time. Postoperative infection was mostly superficial and would be cured by dressing change and antibiotic application. Subsidence of cage and collapse of intervertebral space were the most common complications related to instrumentations which might not lead to related clinical symptoms; however the severe cases need to be repaired. The incidence of pseudarthrosis is relatively low and a few patients with clinical symptoms need revision surgery. The sample size of most studies was small and follow-up period was short. In the future, large samples and multi-center studies are needed to improve our understanding of OLIF complications in the future.

Efficacy comparison of two posterior osteotomy methods for old thoracolumbar compressive fracture accompanied with kyphotic deformity / 中华创伤杂志

Objective To compare the clinical efficacy of pedicle subtraction osteotomy(PSO)and posterior unilateral vertebral column resection(PUVCR)for old thoracolumbar compressive fracture accompanied with kyphotic deformity.Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with old thoracolumbar fracture accompanied with kyphotic deformity admitted to the Third Hospital of Hebei Medical University from January 2010 to January 2016.There were 29 males and 22 females,aged 46-69 years,with an average age of 54.9 years.In terms of the injured segments,there were 11 patients with T11,10 with T12,17 with L1,and 13 with L2.A total of 22 patients were treated with traditional PSO(PSO group),and 29 patients PUVCR(PUVCR group).The operation time,intraoperative blood loss,hospital stay,Cobb angle improvement 2 weeks after operation and postoperative 1 year,visual analogue scale(VAS) 1 year after operation and Japanese Orthopedic Association(JOA)scores were compared between the two groups.Intraoperative and postoperative complications were recorded.Results All patients were followed up for 3-18 months,with an average of 13.5 months.There were no significant differences between PSO group and PUVCR group in hospital stay[(13.8±1.1)days vs.(14.1±1.2)days],thoracolumbar Cobb angle 2 weeks after operation[(8.3±1.5)°vs.(9.1±2.0).]and JOA scores[(26.2±1.2)points vs(25.5±1.5)points](P＞0.05).Significant differences were found between PUVCR group and PSO group in operation time[(184.9±22.9)minutes vs.(219.9±17.1)minutes],intraoperative blood loss[(911.5±70.2)ml vs.(1136.1±92.0)ml],Cobb angle 1 year after operation[(10.0±1.6)°vs.(12.7±1.9)°],and VAS 1 year after operation[(2.3±0.5)points vs.(2.9±0_ 7)points](P＜0.05).No serious complications occurred during operation and follow-up.Conclusions For old thoracolumbar compressive fracture accompanied with kyphotic deformity,PSO and PUVCR can both effectively improve kyphosis and relieve dysfunction.But PUVCR has the advantages of shorter operation time,less intraoperative blood loss,better-improved kyphosis,and lower incidence of spinal nerve injury.

Safety ofscrew placement for severe spinal deformity with the use of O-arm three-dimensional computer-assisted navigation system / 中国组织工程研究

BACKGROUND:O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a chalenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE:To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS:Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION:(1) Totaly 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, 2 mm, 4 mm, including 0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P< 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.

Correlation between magnetic resonance T2 image signal intensity ratio and cell apoptosis in a rabbit spinal cord cervical myelopathy model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cervical spondylotic myelopathy (CSM) is a common cause of disability in elderly patients. Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy. Although changes in magnetic resonance imaging (MRI) T2 signal intensity ratio (SIR) are considered to be an indicator of CSM, little information is published supporting the correlation between changes in MRI signal and pathological changes. This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.</p><p><b>METHODS</b>Forty-eight rabbits were randomly assigned to four groups: one control group and three experimental chronic compression groups, with each group containing 12 animals. Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra. The control group underwent sham surgery. Experimental groups were observed for 3, 6, or 9 months after surgery. MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials (CSEPs) were periodically monitored. At each time point, rabbits from one group were sacrificed to determine the level of apoptosis by histology (n = 6) and Western blotting (n = 6).</p><p><b>RESULTS</b>Tarlov motor scores in the compression groups were lower at all time points than the control group scores, with the lowest score at 9 months (P < 0.001). Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group. All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls, and higher SIR was also found at 9 months compared with 3 or 6 months. Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups, but not in the control group. There were significant differences in apoptosis degree over time (P < 0.001), with the 9-month group displaying the most severe spinal cord apoptosis. Spearman's rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting (r = 0.824. P < 0.001).</p><p><b>CONCLUSIONS</b>Clear apoptosis of spinal cord tissue was observed during chronic focal spinal compression. Changes in MRI T2 SIR may be related to the severity of the apoptosis in cervical spinal cord.</p>

Correlation between the 4th lumbar degenerative spondylolisthesis and radiographic parameters / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between radiographic parameters and the 4th lumbar(L4) degenerative spondylolisthesis.</p><p><b>METHODS</b>From April 2010 to April 2012, 60 patients with the L 4 degenerative spondylolisthesis (DLS) were enrolled in DLS group, 56 healthy volunteers were recruited in control group. A series of radiographic parameters were measured in the two groups, including disc height (DH), disc degeneration index(DDI), L4 vertebral inclination angle(L4-VA), pelvic incidence (PI), L4 vertebral size (L4-VS), lumbar lordosis angle (LLA), facet joint angulation (FJA) of cephalad and caudad portions, delta FJA of cephlad and caudad portions, asymmetry variation of FJA, bone mineral density(BMD). Student's test was used to compare difference of parameters between two groups. Multivariate logistic regression analysis was used to reveal risk factors of the development of DLS.</p><p><b>RESULTS</b>Fifty-three cases of L4 spondylolisthesis in DLS group were classified into grade I, 7 cases of L4 spondylolisthesis were classified into grade II. The average Boxall index was 0.17 ± 0.05. There were significant difference of DH, DDI, L4-VS, L4-VA, LLA, PI, FJA, BMD between DLS group and control group (t = 2.28-9.33, P = 0.021-0.043) . There were significant differences of delta FJA of cephlad and caudad portions in L3-4, L4-5 between DLS group and control group (t = 3.398 and 28.122, P = 0.000 and 0.039). There was no significant difference of asymmetry variation of FJA in L3-4, L4-5 between DLS group and control group (t = 0.209-0.465, P = 0.295-0.858). Multivariate logistic regression analysis showed that LDS was more frequent among patients with smaller L4-VS(OR = 1.01, 95%CI = 1.000-1.024, P = 0.048), larger L4-VA (OR = 1.88, 95%CI = 14.000-14.600, P = 0.037), larger LLA (OR = 1.90, 95%CI = 1.600-15.800, P = 0.040), larger PI (OR = 2.58, 95%CI = 18.000-19.600, P = 0.029) and the more sagittal FJA (OR = 2.46, 95%CI = 1.400-16.400, P = 0.035) than those in control group.</p><p><b>CONCLUSIONS</b>DLS is signifantly correlated with L4-VS, L4-VA, LLA, PI, FJA . They may be risk factors of the development of DLS.</p>

Clinical outcome of posterior approach 360° vertebral canal decompression for ossifying thoracic disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical results and the value of the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of ossifying thoracic disc herniation.</p><p><b>METHODS</b>Thirty nine cases of ossifying thoracic disc herniation who accepted the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation were included in this study. There were 21 male and 18 female patients. The age ranged from 33 to 69 years, with an average of 53 years. The course of disease ranged from 1 month to 18 months, with an average of 6.5 months. The lesion locations were T7-8 for 1 case, T8-9 for 4 cases, T9-10 for 9 cases, T10-11 for 7 cases, T11-12 for 10 cases, T12-L1 for 6 cases, and both T11-12 and T12-L1 for 2 cases. The clinical results were evaluated by Otani scored system.</p><p><b>RESULTS</b>The operative time was from 2.5 to 5.0 hours, with average of 3.3 hours. The blood loss was from 400 to 2 000 ml, with average of 850 ml. All patients were successfully operated without neurological symptoms aggravation and accidents. The followed-up period was 24 to 60 months, mean 40.5 months. According to Otani scored system, there were excellent results in 16 cases and good results in 18 cases. The clinical satisfaction rate was 87.2%. All obtained bony fusion without instrument failure.</p><p><b>CONCLUSION</b>Posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation is a safe and effective surgical procedure for the treatment of ossifying thoracic disc herniation.</p>

Imaging study of paravertebral muscle degeneration in degenerative lumbar instability / 中华外科杂志

<p><b>OBJECTIVES</b>To compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.</p><p><b>METHODS</b>Sixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.</p><p><b>RESULTS</b>The difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).</p><p><b>CONCLUSIONS</b>Compared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.</p>

Pedicle subtraction osteotomy with trephine for old thoracolumbar compression fracture with kyphotic deformity / 中华骨科杂志

Objective To explore value of trephine in pedicle subtraction osteotomy (PSO) for old thoracolumbar compression fracture with kyphotic deformity.Methods Thirty seven patients who underwent surgical treatment for old thoracolumbar kyphotic deformity in our hospital from February 2005 to February 2010 were retrospectively reviewed.Among them,21 patients underwent conventional PSO and 16 patients underwent PSO with trephine.In conventional PSO group,there were 14 males and 7 females,the average age was 55.6±3.7 years and the mean Cobb angle was 45.3°±4.6°.In PSO with trephine group,there were 11 males and 5 females,the average age was 53.3±4.2 years and the mean Cobb angle was 47.6°±5.9°.Results All patients were successfully followed up.The duration of follow-up ranged from 12 to 22 months in conventional PSO group,while 13 to 20 months in PSO with trephine group.The operation time,blood loss,amount of blood transfusion were 224±45 min,1043±234 ml,876±300 ml respectively in conventional PSO group,while 180±31 min,785±163 ml,500±230 ml in PSO with trephine group.Immediately after operation,correction rate of Cobb angle was 91.4％ in conventional PSO group and 90.9％ in PSO with trephine group.At final follow-up,the correction of Cobb angle lost 5.8％ in conventional PSO group and 6.2％ in PSO with trephine group.The improvement rate of JOA score was 81.1％ in conventional PSO group and 83.7％ in PSO with trephine group.The VAS score decreased 7.7±1.1 in conventional PSO group and 7.8±0.8 in PSO with trephine group.One patient in conventional PSO group experienced saddle numbness immediately after operation,which alleviated at final follow up.All patients achieved bony fusion at final follow up.No infection,screw loosening or breakage occurred in both groups.Conclusion The use of trephine in PSO for old thoracolumbar compression fracture with kyphotic deformity can reduce operation time,blood loss and improve efficiency of osteotomy.

Modified eggshell technique through posterior approach for the hard thoracic disc herniation / 中华骨科杂志

Objective To evaluate the clinical outcomes of modified eggshell technique through posterior approach for the treatment of hard thoracic disc herniation. Methods From January 2006 to June 2009, 22 patients admitted for hard thoracic disc herniation were reviewed, including 13 males and 9 females, with an average age of 49.5 years (range, 33-69). The courses of disease were 11 months on the average (range, 3-18 ). The lesions located in T8-9 for 4 cases, T9-10 for 9, T10-11 for 7, T11-12 for 2. Each of the patients underwent X-ray, CT scanning and MRI examination before surgery. There were 16 cases of central type, and 6 cases of paracentral type. All patients were treated surgically by modified eggshell technique via posterior approach. Results The mean operative time was 210 min (range, 180-300 min), with a mean blood loss of 860 ml (range, 600-1200 ml). All surgeries were performed successfully without neurological symptoms aggravation. Surgical complications included dural laceration in 2 cases, both dural lacerations were repaired intraoperatively, epidural hematoma in 1 case with lower extremity neurological symptoms, full neurologic recovery was observed after surgical removal of the hematoma. All patients were followed up for average 27.5 months (range, 12-54). The mean JOA score increased from 3.36±1.79 before operation to 7.45±2.99 after the operation at 12 months follow up, and the mean improvement rate of neurological status was 58.3%±30.7%. There was significant difference in JOA score before and after surgery(t=10. 12,P＜0.01 ).The results of 14 cases were ranked as good, 6 as fair, 2 as unchanged, and none as worsened. All cases obtained bony fusion without instrument failure. Conclusion Modified eggshell technique enable ventral and dorsal spinal decompression from the posterior approach in cases of hard thoracic disc herniation, with reduction of the rate of postoperative paralysis.

Efficacy and safety of the resection of cervical posterior longitudinal ligament in Bryan cervical disc arthroplasty / 中华骨科杂志

Objective To investigate the efficacy and safety of the resection of cervical posterior longitudinal ligament (PLL) in Bryan cervical disc arthroplasty. Methods Thirty-one patients underwent Bryan cervical disc implantation only in one level from August 2006 to January 2009 were investigated in this study. Cervical PLL was preserved in 14 patients, but not in other 17 patients. The clinical (JOA score,VAS score for neck and arm pain) and radiographic parameters (the FSU angle, ROM and diameter of the spinal cord) were compared between the two groups. Results No differences were found in terms of age, affected segment, gender, follow-up period, operation time and blood loss between the two groups. Patients underwent removal of cervical PLL were significantly superior to those underwent reservation of cervical PLL in term of clinical outcomes. There were no differences between the two groups with regard to the increase of FSU angle and ROM. However, the diameter of the spinal cord had a significant increase in patients underwent removal of cervical PLL. No severe complication was found in the two groups. Conclusion Removal of the cervical PLL is beneficial for the clinical outcomes and does not have an impact on the angle and ROM of the affected segment. The procedure is safe and feasible.

Primary results of the 3-in-1 technique of Disc-FX system for the discogenic low back pain / 中华骨科杂志

ObjectiveTo investigate the clinical efficacy of the 3-in-1 technique of Disc-FX system,namely:discectomy,radiofrequency ablation and annuloplasty for discogenic low back pain in the early stage.MethodsFrom February 2010 to February 2011,40 patients with the discogenic low back pain underwent discectomy,radiofrequency ablation and annuloplasty using Disc-FX system were retrospectively analyzed,including 22 males and 18 females with an average age of 38.7 years(range,32-58 years).The visual analogue scale (VAS) scoring was applied to evaluate the back and low limb pain at preoperative,postoperative 1week,3 months,6 months,and last follow-up.The Macnab score was also evaluated at last follow-up.Results All the patients were followed up for average 13.8 months (range,6-18 months).The operative time averaged 26 min(range,20-40 min).No surgical complication was found during the follow-up.The VAS of preoperative low back pain was 6.60±1.47,VAS score of low back pain at postoperative 1 week,3 months,6 months,and final follow-up were 1.05±0.68,1.15±0.70,1.00±0.62,0.95±0.63,respectively.The postoperative VAS of low back pain decreased significantly compared with that preoperative.The VAS of preoperative limb pain was 3.05±1.23,VAS score of limb pain at postoperative 1 week,3 months,6 months,and final follow-up after operation were 1.10±0.74,1.15±0.70,1.10±0.72,0.95±0.54,respectively.The postoperative VAS of limb pain decreased significantly compared with that preoperative.The evaluation of Macnab score were excellent in 20 patients,good in 17,fair in 2,and poor in 1,suggesting an effective rate of 92.5％ (37/40).Conclusion Disc-FX system,which combined three surgical technique in one procedure,provides a new choice for orthopedics to treat discogenic low back pain.It can give satisfactory clinical outcomes during a short-term followup,but the long term clinical outcomes remains unknown.

Interbody fusion cage implantation and bilateral inferior articular process resection for the treatment of degenerative lumbar soinal stenosis / 中国组织工程研究

BACKGROUND: Degenerative lumbar spinal stenosis could be treated by laminectomy internal fixation placement,unilateral or bilateral decompression,posterior laminectomy and so on.However,whether laminectomy internal fixation placement can be used remains unclear.OBJECTIVE: To evaluate the efficacy of interbody fusion cage implantation of pedicle screw fixation,in combination with posterior lumbar laminectomy,bilateral resection and decompression of the inferior articular process,autologous facet joint bone transplantation in the treatment of degenerative lumbar spinal stenosis.METHODS: A total of 41 patients of degenerative lumbar spinal stenosis,who failed after 3 months of conservative therapy,including 23 males and 18 females,at a mean of 60.3 years,Received posterior lumbar laminectomy,bilateral inferior articular process resection and decompression,autologous facet joint bone and cage interbody fusion implant pedicle fixation.They were followed up for 24 months,preoperative and postoperative Japanese Orthopedic Association(JOA)score evaluations were performed to assess the therapeutic efficacy of the patients,radiological examination was done to investigate the graft fusion and vertebral stability of surgical segments in patients.RESULTS AND CONCLUSION: During the follow-up,JOA score significantly increased compared with the preoperative score(P＜0.01)and clinical excellence rate was 90%; 40 cases obtained bony fusion,with a fusion rate of 98%,1 patient exhibited signs of lumbar instability.There was no loosening,fracture and other complications after internal fixation,but 2 cases appeared dural tear,1 case pedicle position deviation,1 case pseudoarticulation formation.The results suggest that the posterior lumbar laminectomy,bilateral inferior articular process resection and decompression,autogenous facet joint bone and cage interbody fusion implanted pedicle screw fixation show good clinical effects for the treatment of degenerative lumbar spinal stenosis.

Selection of surgical approach in management of cervical cord injury following ossification of the posterior longitudinal ligament / 中华创伤杂志

Objective To investigate the appropriate surgical approach in the management of cervical cord injury following ossification of the posterior longitudinal ligament. Methods The clinical data of 25 patients with cervical cord injury following ossification of the posterior longitudinal ligament who received surgical treatment were retrospectively analyzed. According to Frankel grades, two patients were at grade A, three at grade B, 14 at grade C and six at grade D. The surgical procedures consisted of anterior decompression (12 patients), posterior decompression (8 patients) and combined posteroanterior decompression (5 patients). Results No iatrogenic injury of great vessels, trachea, esophagus or spinal cord occurred. All the patients were followed up for 15-86 months (mean 38.3 months). All segments with anterior fixation attained solid fusion, without implants loosening or breakage. No reelosed open-door was found in patients who received posterior laminoplasty. The spinal function got improved in 21 patients, and a relief of pain or numb of the upper limb was attained in four patients whose spinal cord injury was not cured. Conclusions The surgical outcome of cervical cord injury following ossification of the posterior longitudinal ligament is satisfactory. It is important to select a suitable surgical approach according to the imaging manifestations associated with the general conditions of the patients.

The prevention and cure of postoperative neck axial symptoms after open-door laminoplasty for cervical spondylotic myelopathy / 中华物理医学与康复杂志

Objective To evaluate the effectiveness of rehabilitative treatment after extended open-doorlaminoplasty of the cervical spine for cervical spondylotic myelopathy.Methods Sixty patients(mean age 61.7 ±12 years)who had undergone extended open-door laminoplasty of the cervical spine for cervical spondylotic myelopa-thy were studied for an average of 40.7 months.They are divided into a rehabilitation group and a control group with 30 patients in each.The patients in the rehabilitation group received systematic rehabilitation therapy pre-and post-operation.In both groups,the neurological recovery rate,the cross-sectional areas of the cervical posterior muscles,and the incidence of axial symptoms and post-operative complications were recorded and compared. Results The wounds of patients in the rehabilitation treatment group healed with no complicating infections,but the wounds of three patients in the control group became infected.There was no statistically significant difference in neurological recovery between the two groups.In the rehabilitation treatment group,the rate of atrophy and the cross-sectional areas of the cervical posterior muscles were significantly lower than in the control group.At the same time,the rate of neck axial symptoms was 23% in the rehabilitation group but 60%in the control group.a difference which was statistically significant. Conclusions Although rehabilitation treatment pre-and post-operation may not speed up neurological recovery,it may prevent postoperative atrophy of the cervical extensors and lower the incidence of neck axial symptoms.

Three-dimensional finite element analysis on artificial cervical disc replacement for activities of lower cervical spine / 中国组织工程研究

This study was aimed to establish the three-dimensional model of C_(3-7) segment of lower cervical spine after artificial disc implantation, to analyze the movement of lower cervical spine after artificial disc replacement. According to CT films of 1 patient at 6 months after artificial disc implantation, three-dimensional finite element model that included Bryan~(TM) artificial cervical disc prosthesis of the lower cervical spine was established using finite element method, then introduced into Ansys 9.0, the vertebral cortical bone, cancellous bone and intervertebral disc were meshed and analyzed by using under several states such as flexion/extension, lateral bending and rotation, thus understanding their motion characteristics. By comparison with previous research findings, test results nearly accorded with or exhibited identical trend with previous study. The results suggest that, cervical disc replacement can basically guarantee the stability of lower cervical spine movement.

The clinical significance of rehabilitative treatment for severe cervical spondylotic myelopathy after surgery / 中华物理医学与康复杂志

Objective To evaluate the effectiveness of rehabilitative treatment for severe cervical spondylotic myeiopathy after combined posterior-anterior surgery. Methods Fifty-four patients (mean age, 59.5) who had undergone combined posterlor-anterior surgery of the cervical spine due to severe cervical spondylotic myelopathy were studied with an average follow-up of 38.7 months. All the patients were allocated into either a rehabilitation treatment group (28 patients) or a control group (26 patients). Neurological function in the two groups was assessed using the Japanese Orthopedic Association (JOA) grading system. In addition, the status of axial symptoms, wound healing and post-operative complications were also evaluated. Results The bone grafts completely fused in both groups. All of the wounds in the rehabilitation treatment group healed without any infection. Three wounds were infected in the control group, but were cured by prompt treatment. Two patients in the rehabilitation group and 9 in the control group suffered laryngeal edema. There was no significant difference between the two groups before the operation with regard to their JOA scores, which significantly increased postoperation in both groups. In the rehabilitation treatment group, the postoperation JOA scores were significantly higher than in the control group. At the same time, there were significantly fewer patients with neck axial symptoms in the rehabilitation treatment group than that in the control group (25.0% versus 69.2% , P < 0.01 ). Conclusions Systematic rehabilitation treatment pro-and post-operation of patients with severe cervical spondylotie myelopathy can accelerate neurological recovery and help prevent postoperative complications and neck axial symptoms.

Clinical effect of different operative methods for cervical spondylotic myelopathy / 中国矫形外科杂志

[Objective]To explore the therapeutic effect of three surgical procedures(anterior approach,posterior approach and posterior-anterior approach) for cervical spondylotic myelopathy(CSM). [Methods]A total of 111 patients with cervical spondylotic myelopathy treated with three surgical procedures from June 2002 to December 2007 were retrospectively analyzed.Group A(anterior approach) comprised 54 patients with a mean age of 57.1 years(ranged,44~75 years).Group B(posterior approach,Laminoplasty) comprised 33 patients with a mean age of 61 years(ranged,41~73 years).Group C(posterior-anterior approach) comprised 24 patients with a mean age of 62 years(ranged,48-78 years).All patients were followed-up,neural function and cervical sagittal alignment were recorded.According to JOA score,preoperative and postoperative follow-up scores were compared,improvement rates were calculated,respectively.[Results]Patients were followed up for 3 months to 5 years with an average of 2 years.JOA scores of the three groups at 3,6,12 months and at the last follow-up after operation were compared with those of preoperation(P0.05).Cervical sagittal alignment(D numerical value) had no statistical difference at the postoperative and the final follow-up between group A and group C(P=0.434,P=0.492,P=0.569).There was significant difference between group B and group A/C(P

Comparative study of posterior or anterior lumbar interbody fusion operation for superior position intervertebral disc herniation / 中国矫形外科杂志

[Objective]To evaluate the curative effects of the posterior or anterior lumbar interbody fusion for the treatment of superior position intervertebral disc herniation. [Method] Forty-seven patients with superior position intervertebral disc herniation were followed up.There were 29 males and 18 females with mean age of 53.3 years(from 35 to 67 years).Twewty-five patients were treated with posterior lumbar interbody fusion(PLIF)using facet joint autograft and cage additional of pedicle screw internal fixation(posterior way group),and 22 patients were treated with anterior disckectomy,bone graft and plates internal fixation(anterior way group).The mean follow-up time was 53.5?5 months(from 24 to 78 months).The clinical results were compared between two groups.Clinical functional assessment standard was used to evaluate the clinical curative effect.The changes of the therapeutic effects,the radiographic findings and complications were evaluated.[Result]In regard to the operation time and bleeding,the posterior way group was superior to anterior way group.There was no difference between the two groups in clinical recovery rates and nerve root injury rates.Complications included dural tear(n=3),and pedicle screw deviating(n=1) in the posterior way group;and dural tear(n=2),unilateral transient lower extremity paresthesia(n=3),and hard controlled singultation(n=1) in the anterior way group.The rates of bone fusion were 96.00% and 95.45% in the posterior and anterior way groups. [Conclusion] Operation for the superior position intervertebral disc herniation is effective.The posterior lumbar interbody fusion using facet joint autograft and cage additional of pedicle screw internal fixation to shorten the operation time and decrease bleeding is recommend for the treatment of superior position intervertebral disc herniation.