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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.
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Vertebral augmentation has been widely used for treating the osteoporotic vertebral compression fractures. However, the occurrence of new fractures in adjacent vertebrae is also common. In order to understand the mechanism of adjacent vertebral fractures to prevent its happening, many scholars have carried out a lot of experiments and clinical studies by different research methods for years. As a result, many theories about the mechanism of adjacent vertebral fracture have been formed. Including the patients' general conditions (age, gender, bone mineral density, body mass index, et al), material characteristics of bone cement, distribution of bone cement (volume of bone cement and under-endplate distribution, acentric or bilateral distribution, compact and solid cement filling pattern, bone cement leakage), factors of spinal sagittal imbalance, factors of anti-osteoporosis treatment and the behavioral therapy, the location of initial injured vertebral level, the degeneration of adjacent disc, all of above were considered as potential risk factors. However, various researches lead to diverse conclusions because of different methods were used and different research factors were included, some conclusions were even opposite. Therefore, it is still controversial that whether some of the risk factors were effective. In this research, the current researches and the reliability and limitations of various research methods were reviewed to put forward a relatively objective interpretation, in order to provide evidences for understanding the risks of adjacent vertebral fracture after vertebral augmentation, and to provide reference for treatment.
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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.
Résumé
Vertebral augmentation has been widely used for treating the osteoporotic vertebral compression fractures. However, the occurrence of new fractures in adjacent vertebrae is also common. In order to understand the mechanism of adjacent vertebral fractures to prevent its happening, many scholars have carried out a lot of experiments and clinical studies by different re?search methods for years. As a result, many theories about the mechanism of adjacent vertebral fracture have been formed. Includ?ing the patients'general conditions (age, gender, bone mineral density, body mass index, et al), material characteristics of bone ce?ment, distribution of bone cement (volume of bone cement and under?endplate distribution, acentric or bilateral distribution, com?pact and solid cement filling pattern, bone cement leakage), factors of spinal sagittal imbalance, factors of anti?osteoporosis treat?ment and the behavioral therapy, the location of initial injured vertebral level, the degeneration of adjacent disc, all of above were considered as potential risk factors. However, various researches lead to diverse conclusions because of different methods were used and different research factors were included, some conclusions were even opposite. Therefore, it is still controversial that whether some of the risk factors were effective. In this research, the current researches and the reliability and limitations of various research methods were reviewed to put forward a relatively objective interpretation, in order to provide evidences for understand?ing the risks of adjacent vertebral fracture after vertebral augmentation, and to provide reference for treatment.
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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.
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Objective Finite element method was used to clarify the biomechanics effect of cement intervertebral leakage during vertebral augmentation.Present a novel classification of bone cement intervertebral leakage.Analyze the effect of stress changing of bone cement intervertebral leakage on adjacent endplate by finite element method.Methods Based on Churojana's classification method,we redefined diverse kinds of intervertebral leakage:as the Type Ⅰ (intervertebral-extradiscal leakage),Type Ⅱ (intradiscal leakage) and Type Ⅲ (combined leakage).Type Ⅱ was also been divided into Ⅱa (anterior),Ⅱb (central),Ⅱc(posterior),Ⅱd (lateral) and Ⅱe (cross-region) due to the location of the leaked bone cement.All the Type Ⅱ cases were divided into 1 or 2 two subtypes according to whether the cement had reached the adjacent vertebral endplate.We established 3D reconstruction of volunteer thoracolumbar spine using Mimics 17.0 software,and using Geomagic 2015 to generate L1 vertebral compression fracture model.In the Ansys 17.0 software,we simulated the L1 bone cement leakage into the T12/L1 intervertebral space model.After validating the validity of the model,calculate the solution of the intact model,non-leakage model and various leakage models,the stress distribution of the caudal endplate of T12 was analyzed in neutral,flexion,extension,lateral bending and torsion.Results The maximum stress of inferior endplate of T12 vertebra of intact model is 11.476 MPa,19.517 MPa,16.879 MPa,42.346 MPa,43.033 MPa,6.568 MPa,6.568 MPa in neutral,flexion,extension,left bending,right bending,left rotation,right rotation respectively.For the non-leakage model,the maximal stress of adjacent vertebral endplate was 12.967 MPa (112.99％),23.134 MPa (118.53％) and 20.403 MPa (120.88％) in neutral,flexion and extension compared to the intact model.No significant increasing can be found in other conditions.Compared to the non-leakage model,the stress of adjacent vertebral endplate is similar when type Ⅰ leakage occurs.In type Ⅱ leakage,the Ⅱa1 was 28.506 MPa (123.40％) in the flexion;the Ⅱa2 was 84.791 MPa (366.52％) in the flexion;the Ⅱb2 was 14.138 MPa (122.82％) in the neutral and 27.313 MPa (118.06％) in the flexion;the Ⅱc1 was 19.695 MPa (128.50％) in the extension;the Ⅱc2 was 67.740 MPa (441.97％) in the extension,and the Ⅱd2(right) was 123.940 MPa (285.83％) in the right bending.In the left/right rotation motions,the stress values are small,ranging from 5.095-15.585 MPa.Conclusion After vertebral augmentation,the stress of adjacent vertebral endplate increased slightly.Type Ⅰ leakage did not further increase the stress of adjacent vertebral endplates.Type Ⅱ leakage increases the stress of adjacent endplates in the direction of leaked cement.Subtype 2 of Type Ⅱ offer more stress than subtype 1.When the peripheral type of leakage (Ⅱa,Ⅱc and Ⅱd) occurred,if the spine flexes in the direction of leakage,then the stress increase of adjacent endplates will increase further.
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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.
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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.
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Objective To estimate the clinical value of percutaneous vertebroplasty (PVP)performed on the elderly patients aged 80 years and over with osteoporotic vertebral fractures.Methods Since January 2000, 19 patients aged 80 years and over were treated with PVP, and 17 patients from 60 to 79 years old underwent percutancous kyphoplasty (PKP). Visual analogue scale (VAS) was tested preoperatively and 1 to 7 days, 3 months, 6 months, 1 year and 2 years after operation. The time of radiation, volume of bone cement injection and hospital charges were compared betwecn two procedures. Results Over the 2-year follow-up, there were no significant differences in analgesia effects between thc two groups (P＞0.05). The radiation time of PVP and PKP was (107±37)s and (151±76)s respectively (t=2.24, P＜0.05). The hospital charges of PVP and PKP were ￥(16 124±5850) and ￥(34 265±6655) respectively (t=9.26,P＜0.01). Conclusions PVP is better than PKP for treating osteoporotic compression fractures in the elderly patients over 80 years, because of the former's simplicity and efficiency.