RESUMEN
Objective:To evaluate the clinical efficacy and changes between Dynesys and Posterior lumbar interbody fusion (PLIF) in the treatment of two-level lumbar degenerative disease.Methods:43 consecutive patients with lumbar degenerative disease were treated using the Dynesys or PLIF between June 2010 and June 2012. In all patients, 23patients were implanted Dynesys and other patients for PLIF. The follow-up period was at least 60 months. Used the Visual analogue scale (VAS) and Oswestry disability index (ODI) to evaluate the clinical outcomes. And during the follow-up period, collected the data for the intervertebral height and the range of motion (ROM), for the operation section and the upper adjacent vertebral. MRI and Grading Scale from the University of California at Los Angeles (UCLA) were used to define the change of intervertebral disc signal.Results:The ODI index and VAS score both improved significantly at the final follow-up evaluation ( P<0.05), as compared to the basal line values. And in terms of imaging, there were no significant difference in the vertebral height of the operation section and the upper adjacent vertebral. The range of motion (ROM) for the operative section in the group of PLIF was significantly lower than that in Dynesys group ( P<0.05). And when it comes to the upper adjacent vertebral space, it was higher at the same time ( P<0.05). According to the UCLA Grading Scale, there were 3 cases in the Dynesys group and 11 in the PLIF group had radiological adjacent degeneration, the difference was significant between two groups ( P<0.05). And when it comes to the second intension, there were 3 patients in PLIF groups (TLIF 1; PLIF 2) but only 1 in Dynesys groups. Conclusion:Dynesys and PLIF are both effective for lumbar degenerative disease and show good medium and long-term clinical and radiographic results. But when it comes the risks in developing ASD and the ROM of adjacent segments, Dynesys stabilization can be the better choice.
RESUMEN
Objective To investigate the early clinical efficacy of bone cement modified with mineralized collagen in the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty(PVP). Methods All 98 cases of sin?gle vertebral osteoporotic compression fracture from June 2017 to August 2018 were studied. Forty?eight cases were treated with bone cement modified with mineralized collagen (modified group) and 50 cases were treated with traditional bone cement (traditional group). The basic clinical information including age, sex and bone mineral density of all patients were analyzed. The injectable time, volume, distribution (bone cement in the vertebra showing a whole mass without interruption or loss is known as type O while bone cement in the vertebra showing two masses with a small amount or none in the middle is known as type H) and leakage of bone cement during operation, visual analogue score(VAS), Oswestry disability index (ODI), height of anterior, middle and posterior columns of injured vertebrae and the incidence of adjacent vertebral fractures were compared between the two groups. Results There were no significant differences in age, sex, bone mineral density T value and bone ce?ment injection volume between the two groups. VSA score, ODI, anterior and middle column heights were significantly improved on the first day and 6 months after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). In?traoperative cement injectable time was shorter in the traditional group than the modified group,and there was significant different between the two groups (t=3.428, P=0.002). The incidence of adjacent vertebral re?fracture was 12% in the traditional group and 2% in the modified group. There was significant different between the two groups (χ2=7.061, P=0.029). The leakage rate of bone cement was 10% in the traditional group and 6% in the modified group, andthere was significant difference between the two groups (χ2=7.963, P=0.019). The distribution of bone cement (O/H) in the traditional group was 20/30 and that in the modified group was 19/29, and there was significant difference between the two groups (χ2=38.992, P<0.001). Conclusion Modified bone cement has the same clinical effect as traditional bone cement in relieving pain and restoring the height of injured vertebra in the treat?ment of osteoporotic vertebral compression fractures with PVP. However, the injectable time of modified bone cement is longer. The leakage rate and the incidence of re?fracture of adjacent vertebrae are significantly reduced.
RESUMEN
Objective@#To investigate the early clinical efficacy of bone cement modified with mineralized collagen in the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty(PVP).@*Methods@#All 98 cases of sin-gle vertebral osteoporotic compression fracture from June 2017 to August 2018 were studied. Forty-eight cases were treated with bone cement modified with mineralized collagen (modified group) and 50 cases were treated with traditional bone cement (traditional group). The basic clinical information including age, sex and bone mineral density of all patients were analyzed. The injectable time, volume, distribution (bone cement in the vertebra showing a whole mass without interruption or loss is known as type O while bone cement in the vertebra showing two masses with a small amount or none in the middle is known as type H) and leakage of bone cement during operation, visual analogue score(VAS), Oswestry disability index (ODI), height of anterior, middle and posterior columns of injured vertebrae and the incidence of adjacent vertebral fractures were compared between the two groups.@*Results@#There were no significant differences in age, sex, bone mineral density T value and bone ce-ment injection volume between the two groups. VSA score, ODI, anterior and middle column heights were significantly improved on the first day and 6 months after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). In-traoperative cement injectable time was shorter in the traditional group than the modified group,and there was significant different between the two groups (t=3.428, P=0.002). The incidence of adjacent vertebral re-fracture was 12% in the traditional group and 2% in the modified group. There was significant different between the two groups (χ2=7.061, P=0.029). The leakage rate of bone cement was 10% in the traditional group and 6% in the modified group, andthere was significant difference between the two groups (χ2=7.963, P=0.019). The distribution of bone cement (O/H) in the traditional group was 20/30 and that in the modified group was 19/29, and there was significant difference between the two groups (χ2=38.992, P<0.001).@*Conclusion@#Modified bone cement has the same clinical effect as traditional bone cement in relieving pain and restoring the height of injured vertebra in the treat-ment of osteoporotic vertebral compression fractures with PVP. However, the injectable time of modified bone cement is longer. The leakage rate and the incidence of re-fracture of adjacent vertebrae are significantly reduced.
RESUMEN
Objective To evaluate the feasibility and clinical effects of percutaneous endoscopic technique in treating multi-segmental lumbar spinal stenosis in the elderly.Methods Thirty elderly patients with multi-segmental lumbar spinal stenosis and an indefinite positioning of duty segments were retrospectively analyzed.Based on treatment mode of the stenotic segment of lumbar spine,all patients were divided to two groups.The segments of lateral recess or foraminal stenosis were treated with percutaneous endoscopic decompression via the transforaminal approach,while the segments of central stenosis were treated with percutaneous endoscopic decompression via the interlaminar approach.Results Twenty-seven (90％) patients were treated in double segments and three patients (10％) were treated in three segments.There were significant improvements in Visual Analogue Scale,Japanese Orthopaedic Association and Oswestry disability index scores at 3 day and 1 year after therapy as compared with pre-therapy (both P ＜ 0.05).Conclusions Percutaneous endoscopic technique is safe and effective in the treatment of elderly multi-segmental lumbar spinal stenosis.
RESUMEN
Objective To retrospectively review the clinical experience of percutaneous kyphoplasty (PKP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF) during 10 years,and to propose a new classified treatment for OVCF.Methods 1200 patients with osteoporotic thoracolumbar vertebral compression fracture underwent percutaneous kyphoplasty from Aug.2003 to Aug.2013.There were 62 severe patients (5.2％,81 vertebraes),aged from 69 to 95 years (average 76.5 years),with 66.7％ to 78.9％ (average 71.3％) of vertebral body compression.Patients were followed up for 12 to 120 months (average 78 months).According to the preoperative imaging data,the fractures were classified into four types:simple type,pseudarthrosis type,cavern type,progressive type.Individualized PKP was performed on each patient.Results All the patients tolerated procedure well.The visual analogue scale (VAS) was reduced from (7.2± 2.1)preoperatively to (2.5±1.7) 3 days after PKP(t=13.197,P＜0.01).The Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) scales was improved from (29.5±8.2) to (46.5±9.9) 3 days after surgery(t=22.884,P＜0.01).Most patients were satisfied with the efficacy.The anterior height of vertebral body was increased from (14.21±2.44) mm preoperatively to (19.28 ±4.37) mm 3 days after surgery(t=9.108,P＜0.01).The Cobb angle were decreased from (16.45 ± ±5.37)° to (9.41±4.13)° 3 days after surgery(t=9.355,P＜0.01).The height of vertebrae was lost and the kyphosis angle aggravated with the follow-up time.New vertebral fractures were found in 21 patients (21/62,33.9％) at the last follow-up.Conclusions The preoperative accurate classification of severe osteoporosis vertebral compression fracture and individualized PKP can raise the successful operation rate and reduce the incidences of complications.