Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb / 中国骨伤

OBJECTIVE@#To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation.@*RESULTS@#The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L and 27 cases of LS. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation.@*CONCLUSION@#The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.

Application of Gemstone Spectrum Imaging for anterior spinal artery in patients with cervical spinal injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the value of Gemstone Spectrum Imaging (GSI) CT anterior spinal artery angiography in the patients with cervical spinal cord injury, and to evaluate the correlation between the change of the blood flow of the anterior spinal artery and the postoperative recovery of nerve function.</p><p><b>METHODS</b>From January 2014 to June 2016, thirty patients who underwent cervical open door laminoplasty for spinal cord injury were retrospective analyzed and included 21 males and 9 females with an average age of (46.4±9.7) years old ranging from 33 to 59 years. Within 2 weeks after injury, open door laminoplasty was performed through cervical posterior approach. Among them, there were 8 cases of 3 segments of open door decompression, 18 cases of 4 segments, 4 cases of 5 segments. GSI CT were performed at 3 days before operation and 5 days after operation. The anterior spinal artery was reconstructed and evaluated the improvement of blood flow after operation. The cervical JOA score was calculated at 1 day before operation, 5 days after operation and 1, 6 and 12 months after operation, and the JOA score improvement rate of the corresponding follow-up points was calculated.</p><p><b>RESULTS</b>All patients were followed up for 12 to 30 months with an average of (17.4±7.6) months. The iodine content ratio (ASA/VA) of the anterior spinal artery before and after operation was 0.75±0.20 and 0.89±0.02 respectively, the postoperative improvement was significantly higher than that before operation(<0.01). The average ASA/VA improvement rate was(21.05±12.45)% after operation. There was a positive linear correlation between the improvement of blood flow and the improvement of JOA score at 1, 6 and 12 months after operation.</p><p><b>CONCLUSIONS</b>GSI CT anterior spinal artery angiography is safe and feasible, the imaging is satisfactory, it can quantitatively evaluated the blood flow of the anterior spinal artery. There was a positive linear correlation between the improvement of blood flow in anterior spinal artery and the recovery of neurological function. Early postoperative improvement of blood flow in the anterior spinal artery can be used as a reference index for predicting the recovery of neurological function in patients.</p>

Effect of the proximal level on post-laminoplasty loss of lordosis / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the effect whether or not retaining muscle ligament complex of C2 attachment on cervical spine kyphotic deformity after single open-door laminoplasty.</p><p><b>METHODS</b>A total 40 patients with cervical spondylotic myelopathy underwent single open-door laminoplasty from February 2011 to June 2014 were retrospectively analyzed. Of them, single open-door for C₃-C₆ was 40 cases (group A), including 28 males and 12 females, with an average age of (68.4±9.3) years old;and single open-door for C₄-C₆ plus C₃ laminectomy decompression (in order to protect the muscle ligament complex of C₂ attachment) was 40 cases (group B), including 26 males and 14 females, with an average age of (66.8±8.4) years old. Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Cobb angle of sagittal plane from C₂-C₇, cervical range of motion were used to evaluate effects before operation and at the latest follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 24 to 31 months with an average of(26.5±3.4) months. There was no significant differences in VAS, JOA scores and cervical range of motion before surgery between two groups (>0.05) and all above items were significantly improved at the latest follow-up (<0.05), but there was no significant difference between two groups(>0.05). There was no significant difference in cervical Cobb angle before surgery between two groups(>0.05), and postoperative Cobb angle had obviously improved in two groups(<0.05), but the improvement of group B was better than that of group A.</p><p><b>CONCLUSIONS</b>Starting the laminoplasy on C₄ level and retainning the muscle ligament complex of C₂ attachment can obviouly decrease cervical spine syphotic deformity.</p>

Analysis of complications of percutaneous endoscopic lumbar discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD), and discuss how to avoid these complications.</p><p><b>METHODS</b>The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed, including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L₃,₄, 68 of L₄,₅ and 58 of L₅S₁. The incidences of intraoperative and postoperative complications were analyzed.</p><p><b>RESULTS</b>There was spinal dura mater injury in 1 patient, but no cerebrospinal fluid leakage and nerve function deficit was found, the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater; two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients; all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery.</p><p><b>CONCLUSIONS</b>PELD have a steep learning curve, and the technology is a safe and effective method in treating lumbar disc herniation, but the beginners must have enough open surgery experience, and to grasp indications strictly.</p>

Cervical single open door laminoplasty with lateral mass screw fixation for the treatment of cervical spondylotic myelopathy with cervical instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the outcomes of single open door laminoplasty with lateral mass screw fixation in treating cervical spondylotic myelopathy (CSM) with cervical instability.</p><p><b>METHODS</b>From March 2010 to October 2012, 25 patients with spondylotic myelopathy and cervical instability underwent single open door laminoplasty with lateral mass screw fixation. There were 18 males and 7 females, aged from 57 to 68 years with the mean of 57 years. Japanese Orthopaedic Association (JOA) scores were used to evaluate clinical effects before operation and final follow up. Radiographical measures were made in change of Cobb angle by sagittal plane from C₂ to C₇, and cervical range of motion.</p><p><b>RESULTS</b>All the patients were followed up from 18 to 36 months with an average of 25.6 months. Cerebrospinal fluid leakage occurred in 1 case, incision fat necrosis in 1 case, C₅ nerve root palsy in 4 cases. JOA scores was improved from preoperative 5.2±2.1 to 11.3±2.4 final follow up. Cobb angle was changed from preoperative (6.5±3.4)° to (13.2±4.9)° final follow up. Cervical range of motion was changed from preoperative (30.4±9.2)° to (26.5±8.4)° final follow up.</p><p><b>CONCLUSIONS</b>As an effective treatment to CSM with cervical instability, single open door laminoplasty with lateral mass screw fixation has the advantage of extensive application scope, safety and steady, but the incidence rate of complication must be reduced.</p>

Correlation among prevertebral hyperintensity signal, canal sagittal diameter on MRI and neurologic function of patients with cervical vertebral hyperextension injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore the correlation among prevertebral hyperintensity (PVH), sagittal canal diameter on MRI and neurologic function of patients after cervical vertebral hyperextension injury without fracture and dislocation.</p><p><b>METHODS</b>The clinical data of 100 patients with cervical vertebral hyperextension injury without fracture and dislocation were retrospectively analyzed from September 2010 to December 2013. The patients were divided into PVH group and non-PVH group according to the presence of PVH on T2-weighted magnetic resonance imaging. There were 39 patients in PVH group, including 31 males and 8 females, aged from 21 to 83 years old with an average of (58.10 ± 14.78) years; and the other 69 patients in non-PVH group, including 49 males and 12 females, aged from 32 to 77 years old with an average of (55.05 ± 10.36) years. The sagittal disc level canal diameters of subaxial cervical spine were measured on mid-sagittal magnetic resonance imaging. The age, sex, cause of injury, and the segments of spinal stenosis were recorded. American Spinal Injury Association (ASIA) impairment scale and motor score were used to evaluate the neurological status.</p><p><b>RESULTS</b>The ASIA motor score of the group with PVH was 52.56 ± 31.97 while the ASIA motor score was 67.70 ± 22.83 in non-PVH group (P = 0.013). More patients with intramedullary hyperintensity signal on MRI were observed in the PVH group than in non-PVH group (P = 0.006). There was a significant positive correlation between ASIA motor score and sagittal disc level canal diameter of injury segment (P = 0.003). The neurological status was worse in patients with multi-level sagittal canal diameters below 8 mm.</p><p><b>CONCLUSION</b>The PVH and the disc-level canal sagittal diameter of the injury segment are associated with neurological status. The patients with multi-level sagittal canal stenosis are vulnerable to severe cervical spinal cord injury.</p>

Assessment for the stability of fracture thoracic lumber spine(T11~L3) fixed with crossbar equipped pedicle screws / 医用生物力学

Objective To determine the stability of fracture thoracic lumber spine (T11~L3) fixed with crossbar equipped pedicle screws. MethodThe thoracic lumber spine segments (T11~L3) were obtained from calves. A wedge cut was performed on L1 vertebral body to produce a model resembling severe vertebral compressive fracture. Some of the fracture spine segments were fixed with pedicle screws with and without crossbar. Thus, 4 types of spine segments were available: (1) normal segments; (2) unfixed fracture; (3) fracture fixed with crossbar equipped pedicle screws and (4) fracture fixed with pedicle screws without crossbar. The segmental stability was determined by measuring the range of motion (ROM) at directions of flexion/extension, left/right axial rotation and left/right lateral bending using a three dimensional laser scanner. Each ROM was standardized into a stability potential index (SPI) for the comparison among 4 groups. ResultsCompared to unfixed fracture, both fixations significantly increase stability of injuried specimens at each motion direction. The stability of injured segment fix with crossbar equipped pedicle screws is higher than that fixed without crossbar, but the difference does not reach statistically significant. ConclusionsPedicle screw fixation can significantly increase the stability of fracture spine. However, crossbar may not play a further role in raising fixative stability.