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BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.
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BACKGROUND: Previous studies on the risk factors of adjacent vertebral fractures after percutaneous vertebroplasty at home and abroad mainly focus on the leakage of bone cement, the amount of bone cement injected, the viscosity of bone cement, the number and location of vertebral fractures, the loss of vertebral height and sex. OBJECTIVE: To predict and analyze the influence of bone cement distribution on adjacent vertebral body fracture after unilateral percutaneous vertebroplasty for single segment osteoporotic vertebral compression fracture. METHODS: Forty patients with single segment osteoporotic vertebral compression fracture, including 16 males and 24 females, aged (71.4 ±5.3) years who received percutaneous vertebroplasty in the Second Affiliated Hospital of Shanxi Medical University from June 2017 to June 2018 were included in this study. These patients were divided into a unilateral group (13 vertebrae in 13 cases) and a bilateral group (27 vertebrae in 27 cases) according to the distribution of bone cement shown on X-ray film. Patients in the unilateral group were sub-divided into groups A (8 vertebrae in 8 cases, contacting the upper and lower endplates at the same time) and B (5 vertebrae in 5 cases, not contacting the upper and lower endplates at the same time) according to whether bone cement contacted the upper and lower endplates at the same time. Patients in the bilateral group were sub-divided into groups C (11 vertebrae in 11 cases, contacting the upper and lower endplates at the same time) and D (16 vertebrae in 16 cases, not contacting with the upper and lower endplates at the same time). Visual analogue scale score, Oswestry disability index, and Cobb angle were compared between unilateral and bilateral groups before and 1 year after surgery. The compression rate between adjacent vertebral bodies and the angle between the upper and lower endplates were compared between groups A, B, C and D. This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Shanxi Medical University. RESULTS AND CONCLUSION: (1) At 1 year after surgery, the Visual Analogue Scale score, Oswestry disability index, and Cobb angle in both unilateral and bilateral groups were significantly decreased compared with before surgery (P 0.05). (2) At 1 year after surgery, the compression rate between adjacent vertebral bodies in groups A-D was significantly increased compared with before surgery (P < 0.05), and the angle between the upper and lower endplates in groups A-D was significantly increased compared with before surgery (P < 0.05). (3) Disordered multiclass logistic regression analysis taking group D as reference showed that the compression degree of adjacent vertebrae in group A was the largest after percutaneous vertebroplasty, which was the risk factor of the compression change of adjacent vertebrae after surgery (P=0.003). Group B and group C were not the risk factors of the compression change of adjacent vertebrae after percutaneous vertebroplasty [P=0.065, 0.660]. (4) These results show that after percutaneous vertebroplasty, if bone cement is distributed unilaterally and closer to the upper and lower endplates of the vertebral body at the same time, then the trend of adjacent vertebral body fracture is greater. Therefore, prediction of bone cement distribution of this type is a risk factor of adjacent vertebral body fracture after percutaneous vertebroplasty.
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Objective: To compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct (PCC). Methods: A clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016. Among them, 50 patients were treated with the zero-profile and self-locking intervertebral cage (group A) and 50 patients with the PCC (group B). There was no significant difference between the two groups in age, gender, bone mineral density, disease duration, operative segment, and preoperative visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height ( P>0.05). The operation time and intraoperative blood loss were recorded. The postoperative VAS and JOA scores were used to evaluate the clinical efficacy. The C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height were measured on lateral X-ray films, and the interbody fusion was evaluated according to Pitzen's criteria. Results: The operation time in group A was significantly shorter than that in group B ( t=2.442, P=0.021), but there was no significant difference in the intraoperative blood loss between the two groups ( t=0.812, P=0.403). All patients were followed up 24-36 months, with an average of 28.5 months. According to Pitzen's criteria for cervical interbody fusion, bone fusion achieved in both groups. The VAS score, JOA score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation ( P0.05). There were significant differences in C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height between the two groups at 24 months after operation ( P0.05). Conclusion: Compared with the PCC, the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy, but the intervertebral height loss and secondary cervical curvature change after operation is more serious.
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As a common type of fracture in cervical, atlas fracture is frequently unstable due to its special anatomical structure. In a previous treatment, external fixation was likely to bring low bony union rate and long-term neck pain, while occipito-cervical fusion and atlantoaxial fusion sacrifice range of motion in cervical spine. Reduction and single section fixation of atlas by anterior lateral mass screws through the transoral approach were reported by some scholars, and the retrospective study demonstrated the high healing rate, reservation of cervical ROM and less bleeding. But it also has high risks of cervical spinal cord and vertebral artery damage, as well as the post-operation infection. Moreover, the indication and fixation strength require further evidences. As a result, this surgical option provides a new way for spinal surgeons to deal with unstable atlas fractures.
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Objective To compare the infusion outcome of the posterior interbody autogenous micromor-selized bone graft and structure bone graft ,which were used to cure single-segment spinal tuberculosis. Methods The posterior focus debridement and bone graft fusion were conducted on 35 single-segment spinal tuberculosis patients who were cured by micromorselized bone graft and structure bone graft in the hospital from January 2010 to June 2015. Sixteen patients received micromorselized bone graft cases and 19 patients received structure bone graft. According to JOA and VAS,the fusion effects were compared and analyzed in the following aspects,such as opera-tion time,blood loss volume during the operation,kyphosis distorted Cobb angles before and after the operation and fusion time. Results Follow-up visits were paid to all 35 patients and lasted for 12 to 24 months with an aver-age visit time of 18.5 months. Spinal grafted bones showed desirable fusion without invalid screws and grated bones in the spinal canal.(1)No statistical differences were observed between two groups in terms of post-operation JOA and VAS scores.(2)The operation time and blood loss amount during the operation were smaller in the micromor-selized bone graft than those in the structure bone graft ,with significant differences between 2 groups.(3)No sig-nificant differences were observed between the two groups in terms of kyphosis distortion angle ,but regarding to loss of Cobb angles in different intervals after the operation ,it′s greater in the former group than that in the latter one. (4)No significant differences between the two groups in terms of fusion time were observed. Conclusions The two fusion approaches demonstrated no prominent difference in alleviation of the clinical symptoms and the fu-sion time. The micromorselized bone grafting was superior to the structure bone graft in aspects such as operation time and blood loss amount. However ,it′s more likely for the former to lose Cobb angles in the follow-up visits. Both of the two grafting methods were effective in the single-segment spinal tuberculosis operation. All patients ex-cept those with severely unstable spines and osteoporosis and those were too old can adopt the micromorselized bone grafting approach.
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Objective:To analyze risk factors that were associated with loss of correction curvature after short-segment restoration and fixation in cases who had single-segment thoracolumbar fracture.Methods:87 Cases who had experienced single-segment thoracolumbar fracture and had underwent short-segment restoration and fixation in our department from Jan 2008 to Jan 2011,and had complete follow-up imaging were included.Cobb angles were measured on lateral thoracolumbar X-ray preoperatively,postoperatively and before removal of internal fixation.And these included the angle formed by vertebras that located above and below injured vertebrae (α angle),superior endplate of injured vertebrae and its superior vertebrae (β angle),inferior endplate of injured vertebrae and its inferior vertebrae (γ angle),inferior and superior endplate of injured vertebrae (δ angle).T-test was used to analyze these angles and their changes.And correlation analysis was used to analyze relationships between α angle change and other risk factors.Results:When compared with preoperative angles,the mean α angle,β angle,γ angle and δ angle were all significantly increased (p＜0.05) after the operation.The mean α angle and δ angle before the removal of internal fixation were both significantly smaller than those after the operation (p＜0.05),and the mean change ofα angle was-2.85 degrees.After the correlation analysis,we found significant correlations between the change ofα angle and postoperative correction curvature(-0.342,p=0.026),injured region in endplate(0.374,p=0.015),and change of the δ angle(0.231,p=0.041).Conclusion:There was significant loss in the correction curvature before the removal of internal fixation.And the loss was significantly associated with postoperative correction curvature,injured region in endplate,and change of the δ angle.
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Objective To compare the infusion outcome of the posterior interbody autogenous micromor-selized bone graft and structure bone graft ,which were used to cure single-segment spinal tuberculosis. Methods The posterior focus debridement and bone graft fusion were conducted on 35 single-segment spinal tuberculosis patients who were cured by micromorselized bone graft and structure bone graft in the hospital from January 2010 to June 2015. Sixteen patients received micromorselized bone graft cases and 19 patients received structure bone graft. According to JOA and VAS,the fusion effects were compared and analyzed in the following aspects,such as opera-tion time,blood loss volume during the operation,kyphosis distorted Cobb angles before and after the operation and fusion time. Results Follow-up visits were paid to all 35 patients and lasted for 12 to 24 months with an aver-age visit time of 18.5 months. Spinal grafted bones showed desirable fusion without invalid screws and grated bones in the spinal canal.(1)No statistical differences were observed between two groups in terms of post-operation JOA and VAS scores.(2)The operation time and blood loss amount during the operation were smaller in the micromor-selized bone graft than those in the structure bone graft ,with significant differences between 2 groups.(3)No sig-nificant differences were observed between the two groups in terms of kyphosis distortion angle ,but regarding to loss of Cobb angles in different intervals after the operation ,it′s greater in the former group than that in the latter one. (4)No significant differences between the two groups in terms of fusion time were observed. Conclusions The two fusion approaches demonstrated no prominent difference in alleviation of the clinical symptoms and the fu-sion time. The micromorselized bone grafting was superior to the structure bone graft in aspects such as operation time and blood loss amount. However ,it′s more likely for the former to lose Cobb angles in the follow-up visits. Both of the two grafting methods were effective in the single-segment spinal tuberculosis operation. All patients ex-cept those with severely unstable spines and osteoporosis and those were too old can adopt the micromorselized bone grafting approach.
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Objective To investigate the efficacy and safety of the minimally invasive percutaneous surgery in the treatment of thoracolumbar fracture combined with posterior ligament injury.Methods The 94 cases of thoracolumbar fracture combined with posterior ligament injury who were admitted into our hospital from Septenber 2012 to January 2016 were selected and equally divided into the observation group and the control group(47 cases in each group) according to different methods.Patients of the observation group were treated with short segment of minimally invasive percutaneous surgery,while patients of the control group were underwent single segment of minimally invasive percutaneous surgery.Recorded the outcomes and prognosis of the two groups.Results There was no significant difference in the operation time and blood loss between the two groups(P ＞ 0.05).The postoperative volume of drainage and the length of stay in the observation group were significantly shorter than those in the control group(P ＜ 0.05).The JOA score of the observation group 1 month after operation was significantly better than that of the control group(P ＜ 0.05).The incidence of complications including pedicle screw breakage,pedicle screw loosening,incision infection,and pulmonary infection in the observation group was 4.3％,which was significantly less than 21.3％ in control group (P ＜ 0.05).The Cobb's angle of the obervation group and control group 1 month after operation were (8.55 ± 1.34) ° and (16.30 ± 2.33) ° respectively,which were significantly lower than (32.19 ± 1.98) ° and (32.08 ± 2.08) ° before operation (P ＜ 0.05).And the Cobb's angle 1 month after operation in the observation group were significantly lower than that of the control group(P ＜ 0.05).Conclusion The short segment of minimally invasive percutaneous surgery for the treatment of thoracolumbar fracture combined with posterior ligament injury can reduce the incidence of postoperative complications,promote the patient's rehabilitation,correct the kyphosis and promote the recovery of neural function,which was safer and more efficient.
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Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.
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Objective To investigate the methods and clinical outcome of the operative treatment of thoracolumbar fractures with pedicle screw single segment fixation and the approach through paravertebral muscles.Methods One hundred and twenty patients were selected as our subjects,who were suffered from thoracolumbar fracture without neurological deficit and underwent surgical treatment in the Central Hospital of Zibo from Jan.2009 to Dec.2010.All cases were randomly divided into mini-invasion group and control group.Patients in mini-invasion group were received the single segment fixation of the spatium intermusculare of longissimus muscle and multifidus,and in control group were received the traditional approach with short segment fixation group.The muscle gap approach along the longest muscle and multifidus muscle gap enters,preserving the integrity of the paraspinal muscles.Results The operation periods of mini-invasion group and control group were (53.8 ± 12.3) min and (88.5 ± 18.5) min (t =1.731,P ＜ 0.05),the intraoperative bleeding volume were (95.7 ±21.5) ml and (280.3 ±83.1) ml(t =2.414,P ＜0.05),the postoperative drainage volume were (20.4±8.2) ml and (132.9 ±50.3) ml(t =2.068,P ＜0.05) and inpatient time were (13.8 ±2.2)d and (20.4 ±5.5)d(t =1.853,P ＜0.05).However,there was no significant difference in terms of fracture healing time,visual analogue scale,Oswestry disability index and radiology(P ＞0.05).All cases had union of fractures and no reduction loss and fixation failure occurred.Condusion The treatment of pedicle screw single segment fixation and the approach through paravertebral muscles on thoracolumbar fracture is proved to be an effective method with minimally invasive,less bleeding volume,simple procedure and fast recovery method.
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[Objective]To study the feasibility and clinical effect of the treatment of thoracolumbar vertebral fracture with limited decompression of neighbouring segments with internal fixation and intervertebral body fusion.[Method]Forty-three patients with thoracolumbar fractures were treated with this technique.The fusion of bone graft,reduction rate of fracture,nerve functional recovery,the loosening of rectification,subsequent low back pain,and the degeneration of adjacent segments were evaluated.[Result]All cases were followed up for 21.4 months and showed the results of strong spine bony fusion,96.1% satisfactory reduction rate without reduction lost,various differences of nerve functional improvement,a rank-sum test P