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Vertebral augmentation (VA) is widely used in the clinical treatment of osteoporotic vertebral compression fracture (OVCF), but its clinical efficacy has always been controversial. Since 2009, a total of four high-quality prospective randomized double-blind placebo-controlled studies have been published, but their conclusions on the effectiveness of VA were inconsistent. Latest Cochrane review (2018) and American society for bone and mineral research task report (2019) believed that compared with sham surgery, there is no advantage supporting the use of VA as a routine treatment for patients with OVCF, which triggered a new round of debates. The effectiveness of the VA remains to be determined, which makes it difficult to guide the actual clinical work of surgeons. This paper reviews the key studies in the controversy, sorts out and analyzes the details and latest views in the controversy, summarizes the impact of VA on the mortality rate of OVCF patients, and puts forward the optimal application mode of VA based on the current evidence.
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Objective To analyze the incidence and possible etiological factors of hyponatremia after acute cervical spinal cord injury (CSCI),and evaluate the effect of severity of CSCI,age,sex and injured segment on hyponatremia.Methods From June 2005 to March 2011,a series of patients with CSCI caused by cervical vertebras trauma were treated in our department.Except patients combined with craniocerebral injury or chronic diseases,other patients were divided into three groups:complete CSCI group,incomplete CSCI group and no neurological disorder group.Concentration of natrium in blood in all patients was analyzed respectively.Results All 102 patients (83 males,19 females) were selected with an average of 45.6years old.There were 23 patients with complete CSCI,60 with incomplete CSCI and 19 with no neurological disorder.Hyponatremia was found in 15 patients in complete CSCI group,23 patients in incomplete CSCI group and 1 patient in no neurological disorder group.The incidence of hyponatremia was significantly different between three groups,among which the complete CSCI group had the highest incidence.Multiple linear regression analysis showed hyponatremia was obviously correlated with the injury degree of spinal cord,but not correlated with the age,sex and injury segment of the patients.Conclusion Hyponatremia is a common complication in patients suffered from CSCI.Although the balance of natrium in blood is very complicated and influenced by many factors,autonomic nerve system and neuroendocrine system dysfunction,and hemodynamic changes after CSCI may play a key role in happening of electrolytical abnormality.
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Objective To investigate the effects of current major management strategies on early survival of patients with severe injury of cervical spinal cord. Methods A retrospective analysis was done on 532 patients with severe injury of cervical spinal cord (American Spinal Injury Association Grades A and B). The correlations of the early survival and major treatment measures, post-injury temporary immobilization of neck, operation, tracheotomy, systemic nutritional support, administration of glucocorticoid, were analyzed by Binary Logistic Regression. The problems related to the major treatment measures were also analyzed.Results 438 cases survived within 1 month. There was a positive correlation between the early survival and operation and nutritional support. There was a negative correlation between the early survival and tracheotomy.There was not any significant correlation between the early survival and the other 2 measures. The early sur-vival rate for patients of operation was 93.5%, for those without operation was 32. 7%, for those of goodnutrition was 97.8%, for those without good nutrition was 66. 7%, for those of tracheotomy was 58.1%, and for those without tracheotomy was 87.5%. Conclusions For patients with severe injury of cervical spinal cord, active operation and fine systemic nutritional support may increase early survival rate, undue tra-cheotomy may increase the risk of early death, and glucocorticoid may not have an effect on improvement of early survival rate.
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[Objective]To evaluate the clinical efficacy of posterior pedicle screw instrumentation followed by anterior debridement and bone grafting through the lateral edge of the rectus abdominal muscle and retroperitoneal approach for the treatment of tuberculosis of the lower lumbar spine. [Methods]From June 2002 to January 2007,27 patients suffering from lower lumbar tuberculosis were treated with this technique.[Results]The surgical average time and amount of bleeding was 4.3 h and 438 ml respectively.The length of anterior incision was 5~7 cm.The average time and the amount of bleeding were 21 min and 48 ml respectively during the anterior lesion exposure.The follow-up period were 12~37 months,mean 17.3 months.The average preoperative,immediate postoperative,and final follow-up local lordotic angles of the affected segments were-2.1??4.0?,4.9??1.4?,3.7??3.0?.All patients had healed of disease and there was no recurrence at final follow up.Bony fusion was obtained in all patients.[Conclusion]Anterior exposure through the lateral edge of the rectus abdominal muscle and retroperitoneal approach is simple and less invasive.The spinal stability is achieved through short-segment pedicle screw fixation while reducing the sacrifice of additional motion segments.This technique is safe and effective for the treatment of tuberculosis of the lower lumbar spine.
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Objective: To compare the fixation strength of locking and non-locking anterior cervical plating initially and after fatigue.Methods:AO Cervical Spine Locking Plate(CSLP),Danek Orion plate and AcroMed Acroplate were fixed on lamb cervical spine.The fixation strength and pull-off strength of the screw-plate constructions was performed initially and after fatigue.Results:Locked CSLP and Orion constructions were more rigid than all unlocked unicortical systems initially and after cyclic loading.There was no significant difference in pull-off strength between the CSLP,the Orion,and the unicortical Acroplate.Conclusions:Locking mechanism significantly increased the strength of the tested screw-plate systems initially and after fatigue.
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Objective: To compare the prompt fixation strength and antifatigue strength of the locking and non-locking anterior cervical plating systems. Methods:AO Cervical Spine Locking Plate (CSLP), Danek Orion plate and AcroMed Acroplate were used on the lamb cervical spines. The CSLP and Orion were tested with screws locked and unlocked, and the Acroplate with unicortical and bicortical purchase. The fixation strength and pull-off strength of the screw-plate constructs were performed initially and after fatigue. Results: Locked CSLP and Orion constructs were more rigid than all unlocked unicortical systems initially and after cyclic loading. After fatigue testing, the strength of all unlocked constructs decreased significantly. There was no significant difference in pull-off strength between the CSLP, the Orion and the unicortical Acroplate. Conclusion: The locking mechanism significantly increases the prompt fixation strength and antifatigue strength of the tested screw-plate systems.
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Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.