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Objective:To investigate the clinical outcomes of minimally invasive lateral lumbar interbody fusion (LLIF) and the necessity to perform LLIF plus posterior direct decompression in the treatment of severe degenerative lumbar spinal stenosis (DLSS).Methods:In this prospective randomized, controlled trial, we assigned 71 patients, who were 50 to 80 years old, and diagnosed with severe DLSS (Schizas Classification grade C on magnetic resonance imaging), in a 1∶1 ratio to undergo either one-stage LLIF plus posterior internal fixation (treatment group) or CLIF plus posterior internal fixation with laminectomy (control group). Demographic and perioperative data were collected and compared. The clinical outcome measures included Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) score as well as visual analogue scale (VAS). Patients were followed up for at least 1 year.Results:The treatment group included 36 patients with 46 surgical levels, while the control group included 35 patients with 46 surgical levels. The baseline demographic data of the 2 groups were equivalent in preoperative central canal areas, spinal canal anteroposterior diameter, disc height, ODI, ZCQ score for symptom severity and physical function, as well as VAS scores for back and leg pain. The mean operative time, blood loss, drainage volume and hospital stay of the treatment group are significantly less than the control group (157.2±29.1 min vs. 180.6±26.8 min, 75.6±39.1 ml vs. 108.6±43.3 ml, 136.9±73.9 ml vs. 220.5±121.3 ml, 5.3±1.1 d vs. 6.6±2.3 d). There were 2 cases with dura tear and 1 case with wound infection in control group. Thus, the surgical trauma and complications of the control group were more than the treatment group. At 1-year follow-up, the mean ODI score of treatment group improved from 42.24%±10.70% preoperatively to 18.21%±11.49%, the mean ZCQ symptom severity from 2.89±0.38 to 1.61±0.41, the mean ZCQ physical function from 2.31±0.45 to 1.50±0.37, the mean VAS for back from 5.56±1.19 to 1.97±1.13 and the mean VAS for leg from 4.44±1.81 to 0.94±1.26. At 1-year follow-up, the mean ODI score of the control group improved from 43.65%±14.93% preoperatively to 17.36%±12.15%, the mean ZCQ symptom severity from 2.92±0.52 to 1.65±0.39, the mean ZCQ physical function from 2.37±0.52 to 1.55±0.39, the mean VAS for back from 5.63±1.40 to 2.34±1.47, and the mean VAS for leg from 4.37±2.14 to 0.83±1.20. The ZCQ satisfactory score of both groups were not significant different (1.25±0.45 vs. 1.26±0.43, t=0.07, P=0.944). The mean improvement rate of both groups for ODI, ZCQ symptom severity, ZCQ physical function, VAS back and VAS leg at 1-year follow-up were not significant different (55.43%±27.74% vs. 58.36%±25.06%, 43.07%±17.22% vs. 42.66%±12.95%, 32.25%±23.65% vs. 31.71%±23.24%, 62.65%±21.25% vs. 58.37%±22.44%, 78.94%±26.41% vs. 85.45%±20.53%). One adjacent segment disease was found in each group at 1 year follow-up. Conclusion:CLIF+ posterior internal fixation in the treatment of Schizas Grade C DLSS has satisfactory clinical outcome at 1-year follow-up. Laminectomy increases surgical trauma, but does not significantly improve the clinical outcome at 1-year follow-up.
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Objective:To explore the clinical effect of the application of intraoperative psoas major intramuscular block therapy on the complications related to the approach after multi-segmental crenel lumbar interbody fusion (CLIF).Methods:All of 68 degenerative lumbar scoliosis patients who had received multi-segmental crenel lumbar interbody fusion during January 2020 and June 2020 were retrospectively reviewed. Patients were divided into two groups according to whether the psoas major muscle was treated with block therapy during the operation. The psoas muscle inblock group were filled with gel sponge infiltrated with a mixture of Betamethasone and lidocaine for local block therapy before closing the incision while that in the control group were not filled with gel sponge. There were 33 patients in the control group, 7 males and 26 females with an average of 65.8±7.1 years old (range: 54-81 years old); 35 cases in the block group, 9 males and 26 females with an average of 68.0±6.5 years old (range: 54-85 years old). The complications related to the approach (mainly includes pain, numbness in the front of the thigh, as well as psoas major, quadriceps muscle strength) were recorded respectively 1 day, 1 week, 1 month and 3 months after surgery. The main indicators of outcome including visual analog scale (VAS) of pain, the visual analog scale (VAS) of numbness, muscle strength of psoas major and quadriceps femoris, and the incidence of complications related to the approach were compared between the two groups of patients at different time points after surgery. The clinical outcomes were assessed using the Oswestry disability index (ODI), VAS for low back pain. The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (sagittal vertical axis, SVA).Results:There were no significant differences in age, gender, body mass index (BMI), number of fusion segments, operation time, and intraoperative blood loss between the two groups. The incidence of approach-related complications was 17.1% in the block group and 39.4% in the control group, with statistically significant difference between the two groups ( χ2=4.177, P=0.041). The incidence of postoperative pain, numbness in the front of the thighs, and muscle strength of psoas major in the block group (11.4%, 14.3%) were lower than those in the control group (33.3%, 36.4%) ( χ2=4.740, P=0.029; χ2=4.416, P=0.036). And for numbness in the front of thigh, the block group (14.3) was lower than control group (21.2%), but no significant difference was shown between two groups ( χ2=0.561, P=0.454). However, there was no quadriceps weakness in either group. The VAS scores of painof the block group were lower than those of the control group at 1 day, 1 week, and 1 month after surgery, and the difference was statistically significant ( t=2.220, P=0.031; t=2.235, P=0.031; t=2.086, P=0.044). The difference at 3 months was not statistically significant ( t=0.385, P=0.701). The muscle strength of psoas major of the block group, meanwhile, was higher than those of the control group on the 1day and 1 week after surgery, the difference was statistically significant as well ( t=2.208, P=0.032; t=2.171, P=0.034). The difference at 1 and 3 months was not statistically significant ( t=0.923, P=0.359; t=1.437, P=0.160). No statistically significant differences were found in VAS scores of numbness at 1 day, 1 week, 1 month, and 3 months after surgery. Postoperative low back pain and lumbar spine function were significantly improved in both groups, and there was no statistical significance between the two groups. Coronal Cobb angle and sagittal balance were significantly improved in both groups after surgery, and there was no statistical significance between the two groups. Conclusion:Psoas major intramuscular block therapy can reduce the incidence of early postoperative complications of multi-segmental CLIF. Furthermore, it was found to be effective to alleviate anterior thigh pain within 1 month, and improve psoas major muscle weakness within 1 week.
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Objective To explore the impact of cage position on indirect decompression and cage subsidence in crenel lateral interbody fusion (CLIF).Methods Retrospectively,18 mens and 16 womens with a mean age of 63.98±5.99 years (range:52-75 years) who underwent CLIF for lumbar stenosis by our surgical group during November 2016 and Feburary 2018 were reviewed.Sixty-two segments were included for radiographic evaluation.Endplates thickness was measured using high resolution computed tomography.By image processing,endplate thickness was measured at 10 equally distributed points on the mid-sagittal and mid-coronal planes,and two further planes were measured at an angle of 45° to both the first and second planes.Contour plots representing an isoline of endplate thickness was drawn based on those data.The cages were classified into anterior group and medium-posterior group.Radiographic evaluation included segmental angle,anterior and posterior disk heights,intervertebral foramen heights,and cross-sectional area of the spinal canal.To assess the factors affecting the postoperative segmental angle and cross-sectional area of the spinal canal,univariate and multivariate analysis were performed using the regression analysis model.Cage subsidence was recorded at the last follow-up.Results The mean follow-up time of those patients were 10.88±3.73 months (range:6-18 months).At each spot,the mean thickness was significantly greater for the cranial endplate of disc than the caudal endplate.Contour plots show more areas of thick bony endplates in the anterior and anterolateral part of the endplate than the lateral and posterior part,especially for the cranial endplate.The cage was placed in the anterior area for 19 levels and medium-posterior for 41 levels.The mean increase of anterior disk height was 3.38±3.38 mm in anterior group and 1.83±3.08 mm in medium-posterior group(P=0.04).The mean increase of segmental angle was 2.93°±3.47°in anterior group and 0.73°±3.60° in medium-posterior group(P=0.04).No significant difference was found with mean increase of posterior disk height,mean increase of intervertebral foramen heights,as well as increase ratios of cross-sectional area of the spinal canal between groups.Multivariate analysis showed that the increase of segmental angle was affected by cage position (β=1.24,P=0.03),but the increase ratios of cross-sectional area of the spinal canal was not affected.The subsidence rate of anterior group was 15.79％ (3/19) and medium-posterior group was 24.39％ (10/41),which was not significantly different (x2=0.56,P=0.45).Conclusion There are more areas with thick bony endplates in the anterior and anterolateral parts of the lumbar endplate than the lateral and posterior parts.The cage position at the anterior 1/3 of disk space is better for achieving the restoration of the segmental angle and having lower subsidence rate,without compromising the indirect neural decompression in crenel lateral interbody fusion.
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Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive opendoor laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament.Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old,ranging from 39 to 71 years.Among these patients,21 patients underwent C2 domelike expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty,the patients in both groups underwent the C3-C7 expansive open-door laminoplasty.The preoperative and postoperative Neck Disability Index (NDI),Japanese Orthopedic Association (JOA) score,the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed.Results All patients were followed up,the follow-up time was from 15 to 63 months (mean 42.3±17.7 months).There was no significant difference in the general condition,NDI,JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups.There were significant differences in the NDI,JOA,VAS and SAC between preoperative and postoperative follow-up in 2 groups.The VAS score in C2 dome-like expansive laminoplasty group 1.52± 1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23,P＜0.05),while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 1 L86± 1.014(t=-6.89,P＜0.05).No failure of internal fixation or recurrent compression was found during follow-up.Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level,both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty can achieve good results.The SAC in C2 expansive open-door laminoplastygroup was superior to that in C2 dome-like expansive laminoplasty group,while the postoperative pain was more obvious.There was no significant difference in postoperative neurological recovery between the two groups.Using C2 dome-like expansive laminoplasty could reduce postoperative axial pain than the C2 expansive open-door laminoplasty surgery.For patients withossified tissue in the spinal canal,which occupies more than 50％ of the sagittal diameter of the spinal canal,or with developmental spinal stenosis,C2 expansive open-door laminoplasty may berecommend to get more adequate decompression.
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Objective To present the modified surgical technique of lateral lumbar interbody fusion and investigate its approach related complications.Methods Fifty-eight patients treated with novel surgical technique of lateral lumbar interbody fusion(LLIF)from June 2016 to January 2017 were studied retrospectively.There were 24 males and 34 females,aged from 45 to 82 years old(averaged at 66.1±12.1).The diagnosis was as following:degenerative spinal scoliosis in 24 cases,degenerative lum-bar spinal stenosis in 16,lumbar spinal spondylolisthesis in 14,spinal infection and spinal trauma in 2 respectively.The modified surgical technique included operation under direct visualization,the"safety"transpsoas approach and the adjustable microretrac-tor.The patient was placed in a lateral decubitus position,and a transverse or oblique skin incision was planned using fluoroscopy to target the center of the desired disc spaces.The 3 abdominal layers were split longitudinally along the muscle fiber.The psoas major was split longitudinally along the muscle fiber according to the"safety"working window.The adjustable microretractor was used as working corridor to carry out interbody fusion. Oswestry disability index (ODI) was used to assess the clinical outcome. The surgical time,estimated blood loss and approach related complications(pain/numbness at anterior thigh,weakness of psoas muscle and quadriceps)were recorded.Results All patients were followed up from 6-12months,the mean follow-up time(9.1± 2.3)months.A total of 132 levels were performed with novel surgical technique of LLIF,one level in 19 cases,2 levels in 10,3 lev-els in 23 and 4 levels in 6 cases.The mean surgical time was(57.2±13.3)min for 1 level,(94.5±31.3)min for 2 levels,(129.8± 42.1)min for 3 levels and(208.3±22.7)min for 4 levels.The estimated blood loss during surgery was less than 10ml every level. Preoperative ODI was 61.8%±20.1%,it was 22.5%±18.3%(t=7.572,P=0.000)at the last time follow-up.The incidence rate of ap-proach related complications was 12.1%(7/58),with anterior thigh pain in 6 cases(10.3%),numbness 5 cases(8.6%)and psoas major weakness 3 cases(5.2%).No quadriceps weakness,vascular injury,sympathetic nerve injury,visceral injury and ureteral in-jury was found in these series.The incidence rate of complications increased significantly in patients underwent three or more lev-els interbody fusion(χ2=4.453,P=0.035).Conclusion The modified surgical technique reduces the approach related complica-tions of traditional lateral lumbar interbody fusion through the operation under the direct visualization, the"safety"transpsoas approach and the adjustable microretractor.
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Objective To determine the outcome of unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation.Methods A retrospective case series study was made on 17 patients with unstable atlas fractures combined with rupture of transverse ligament treated by posterior atlantoaxial transpedicular screw fixation and fusion from January 2008 to December 2015.There were 13 males and 4 females,with age range of 34-69 years (mean,47.8 years).All atlas fractures were Jefferson fractures (Levine-Edwards type Ⅲ).Classification of transverse ligament rupture was type Ⅰ in 12 patients and type Ⅱ in 5 patients.No patients had neurologic deficit [American spinal injury association (ASIA) classification grade E].Operation time,blood loss,implant failure,bone fusion and visual analogue scale (VAS) were recorded after operation.Results Operation time was 85-120 min (mean,102 min).Blood loss was 90-150 ml (mean,115 ml).All patients were followed up for 10-20 months (mean,17.8 months).At the final follow-up,all patients achieved bone union,with no implant loosening or breakage happened.VAS was improved from preoperative (5.5 ± 1.8) points to (2.4 ± 1.5) points at tbe final follow-up (P ＜ 0.05).ASIA Grade E remained in all patients.Conclusion Posterior atlantoaxial transpedicular screw fixation of unstable atlas fractures combined with rupture of transverse ligament is a safe and effective surgical procedure that is able to restore the atlanto-axial vertebral stability and relieve pain.
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<p><b>OBJECTIVE</b>To investigate the effects of three-dimensional parallel collagen scaffold on the cell shape, arrangement and extracellular matrix formation of tendon stem cells.</p><p><b>METHODS</b>Parallel collagen scaffold was fabricated by unidirectional freezing technique, while random collagen scaffold was fabricated by freeze-drying technique. The effects of two scaffolds on cell shape and extracellular matrix formation were investigated in vitro by seeding tendon stem/progenitor cells and in vivo by ectopic implantation.</p><p><b>RESULTS</b>Parallel and random collagen scaffolds were produced successfully. Parallel collagen scaffold was more akin to tendon than random collagen scaffold. Tendon stem/progenitor cells were spindle-shaped and unified orientated in parallel collagen scaffold, while cells on random collagen scaffold had disorder orientation. Two weeks after ectopic implantation, cells had nearly the same orientation with the collagen substance. In parallel collagen scaffold, cells had parallel arrangement, and more spindly cells were observed. By contrast, cells in random collagen scaffold were disorder.</p><p><b>CONCLUSION</b>Parallel collagen scaffold can induce cells to be in spindly and parallel arrangement, and promote parallel extracellular matrix formation; while random collagen scaffold can induce cells in random arrangement. The results indicate that parallel collagen scaffold is an ideal structure to promote tendon repairing.</p>
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Humains , Collagène , Chimie , Matrice extracellulaire , Physiologie , Lyophilisation , Congélation , Cellules souches , Biologie cellulaire , Tendons , Biologie cellulaire , Ingénierie tissulaire , Structures d'échafaudage tissulaires , ChimieRésumé
Platelet-enriched plasma (PRP) contains high concentration of platelets and abundant growth factors, which is made by centrifuging of blood and separating of blood elements. PRP promotes tendon repair by releasing various cytokines to enhance cell proliferation, tenogenic differentiation, formation and secretion of matrix; meantime, it can reduce pain by inhibiting the expression of pain-associated molecules. A number of clinical studies demonstrated that PRP was effective in treatment of tendinopathy, including patellar tendinopathy, lateral epicondylitis and plantar fasciopathy. However, some studies did not support this conclusion, because of disparity of PRP types, therapeutic courses and injections protocols in clinical application. Based on its safety, PRP can be a choice of treatment for tendinopathy, in case other non-surgical therapies are of no effect.
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Humains , Plaquettes , Biologie cellulaire , Cytokines , Métabolisme , Protéines et peptides de signalisation intercellulaire , Métabolisme , Plasma riche en plaquettes , Tendinopathie , ThérapeutiqueRésumé
Objective To investigate the damage sequence of posterior ligamentous complex (PLC) and its clinical significance in thoracolumbar fracture.Methods Data of 132 patients with spinal fracture evaluated with X-rays,CT and short-tau inversion-recovery (STIR) sequences in MRI were collected prospectively.Fracture morphology was classified using the AO classification.PLC components including interspinous ligament (ISL),supraspinous ligament (SSL),ligamentum flavum (LF) and facet capsules (FC) were assessed and classified as intact,edema,or tear.ISL edema was further subdivided depending on the extension (＞ 50％ or ≤50％).Correlation between MRI signal and AO progressive scale of morphological damage was analyzed.Results AO type A1/A2 fracture associated with only FC distraction.AO type A3 fracture showed additional ISL tear,usually less than 50％,with neither LF nor SSL tear.AO type B1 fracture showed FC distraction,ISL edema or disruption,and low rate of SSL/LF tear,but B2 fracture increased the rate of SSL/LF tear.AO type C fracture showed facet fracture or dislocation and ISL,SSL as well as LF tear.High correlation was found between AO progressive scale and MRI signal (P ＜ 0.01).Conclusions MRI study can well display the PLC damage and damage sequence.MRI correlates with AO progressive scale of morphological damage,which shows a progressive orderly rupture sequence among different PLC components as traumatic forces increase.
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Objective To investigate the radiographic features and surgical approach of severe fixed cervical kyphosis.Methods Seventeen cases of severe fixed cervical kyphosis from January 2007 to January 2012 were studied retrospectively.There were 8 males and 9 females,with an average age of 49.7 years.The etiologies were 3 cases of infection,3 cases of degeneration,3 cases of neurofibromatosis,3 cases of prior laminectomy,2 cases of idiopathic,2 cases of trauma and 1 case of neuromuscular disease.The average length of kyphosis was 4.3 ± 1.2 segments.All patients complained of severe neck pain (visual analogue scale,VAS,7.6±1.5) or progressive cervical kyphosis.There were 4 cases with myelopathy,2 with radiculopathy,3 with difficulty of forward gaze and 1 with difficulty of swallowing.All patients were underwent dynamic flexion-extension radiographs and traction views.CT scans were carried out to identify the sites of fixed kyphosis.Continuous traction was performed after general anesthesia,and the surgical approach was decided according to spinal cord compression,length of kyphosis and the cause of fixed kyphosis.Surgical outcomes were assessed in terms of correction of Cobb angle and Odom criteria.Results All patients were followed-up for 2 to 5 years.According to the CT scans,the sites of fixed kyphosis were identified:anterior bony ankylosis in 7 cases,posterior in 6 cases and both anterior and posterior in 4 cases.The surgical approach were as following:anterior only in 4 cases,posterior only in 2 cases,anterior-posterior in 5 cases,posterior-anterior in 3 cases,anterior-posterior-anterior in 1 case and posterior-anterior-posterior in 2 cases.The Cobb angle was corrected from 49.3°± 14.6° preoperation to 2.1 °±6.8° at the latest follow-up,with an average correction of 47.2°.According to Odom criteria,there were 7 excellent outcome,8 good,2 fair and none poor outcome.Revision surgery was performed in 1 case due to proximal junctional kyphosis.At the latest follow-up,bony fusion was found in all patients.Conclusion CT scan is helpful in identifying the cause of fixed kyphosis.The surgical approach of fixed cervical kyphosis is decided by spinal cord compression,length of kyphosis and cause of fixed kyphosis.Anterior approach is suitable for anterior ankylosis,posterior approach for posterior ankylosis,combined approach for both anterior and posterior ankylosis.
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Objective To investigate the consistency of M RI detecting posterior ligamentous complex (PLC) injury associated with thoracolumbar factures.Methods MRI data of 170 cases of thoracolumbar fractures were reviewed retrospectively.Each case underwent MRI around one week postinjury.MRI data were analyzed and compared by three physicians respectively to discuss the consistency in MRI detection of PLC injury and the severity of PLC injury.Results Kappa coefficient was 0.846 between observer 1 and 2,0.768 between observer 1 and 3,and 0.793 between observer 2 and 3.Interobserver reliability was high and overall Kappa coefficient was 0.803.Severity of PLC injury was interrelated with spinal cord nerve injury (P ＜ 0.05).Conclusions Accurate detection of PLC injury in thoracolumbar fractures is beneficial to clear the mechanical stability of the spine.MRI detection of PLC injury is of high consistency and hence deserves wide use.
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Objective To investigate the correlation between sagittal spinal and pelvic parameters in different types of degenerative lumbar scoliosis (DLS).Methods Standing anteroposterior and lateral radiographs of the whole spine including hip joints were carried out in 70 volunteers without spinal deformity and 110 patients with DLS.The following parameters were measured:thoracic kyphosis (TK),thoracolumbar kyphosis (TL),lumbar lordosis (LL),sagittal vertical axis (SVA),pelvic incidence (PI),pelvic tilt (PT) and sacral slope (SS).According to the sagittal spinal alignment,the patients with DLS were classified into 3 types:type Ⅰ (45 cases),type Ⅱ (48 cases) and type Ⅲ (17 cases).The sagittal spinal and pelvic parameters were compared between control group and different types of DLS group,and the relationship between the sagittal spinal parameters and pelvic parameters in different groups were also investigated.Results PI in type Ⅲ patients was lower than those in other groups; PT in type Ⅱ and Ⅲ patients was higher than those in controls and type Ⅰ patients,and there was a significant difference between type Ⅱ and Ⅲ patients; SS in type Ⅱ and Ⅲ patients was lower than those in controls and type Ⅰ patients,and there was no significant difference between type Ⅱ and Ⅲ patients.Sagittal spinal imbalance was found in 17.8％ of type Ⅱ patients and 29.4％ of type Ⅲ patients.There were significant correlations in sagittal spinal parameters,pelvic parameters and spinopelvic parameters in controls and type Ⅰ patients.However,in type Ⅱ and Ⅲ patients,the correlations in sagittal spinal parameters and spinopelvic parameters decreased,even disappeared,though significant correlations were still found in pelvic parameters.In any group,SVA showed a significant correlation with LL and PT,especially with PT.Conclusion The sagittal spinal alignment has a ladder-like change in patients with DLS,and the correlations in pelvic parameters and spinopelvic parameters also change in type Ⅱ and Ⅲ patients,for whom the sagittal spinal imbalance is more likely to occur.
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Objective To compare the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS).Methods Forty DLS patients with Cobb angles of 20 to 60 degrees were divided randomly into PLF and TLIF groups.Operative time,intraoperative blood loss,imaging results,and clinical outcomes were compared.Results Complete information was available in 37 patients,including 18 patients in the PLF group and 19 in the TLIF group.There were significant differences between two groups with regard to the operative time (P=0.002) and the intraoperative blood loss (P=0.048).The incidence of early complications in the 2 groups was 11.1％ and 26.3％.There was no significant difference in the recovery rates of the Cobb angle and the spinal coronal balance between two groups.However,the recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different between two groups (36.7％ vs.62.5％ and 44.8％ vs.64.1％,respectively).In various domains of SRS-22,the scores for pain and satisfaction with treatment in TLIF was better that those in PLF groups.There was no significant difference in ODI score between two groups.Conclusion TLIF helps to improve lumbar lordosis and sagittal balance,which leads to better clinical outcomes.For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively,PLF is still an option.
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Objective To analyze the perioperative complications of posterior transpedicular osteotomy (wedge osteotomy and total vertebral osteotomy) for patients with spinal deformity.Methods From January 2007 to December 2011,73 patients with spinal deformity underwent posterior transpedicular spinal osteotomy (wedge osteotomy and total vertebral osteotomy).Among them,30 patients,including 8 males and 22females,aged from 8 to 68 years (average,40.7 years),presented with at least one perioperative complication.There were 10 cases of scoliosis,9 cases of kyphoscoliosis and 11 cases of kyphosis.Twenty two patients underwent total vertebral osteotomy,and 8 patients underwent wedge osteotomy.A retrospective analysis on perioperative complications of 30 patients was performed.Results Except 1 patient dying of hemorrhagic shock after operation,29 patients were followed up for 6 to 61 months (average,17.2 months).The total perioperative complication rate was 41.1％.Neurological complications occurred in 16 patients (21.9％),bleeding complications in 2 patients (2.7％),dural injury in 6 patients (8.2％),postoperative cerebrospinal fluid leakage in 4 patients (5.5％),wound infection in 4 patients (5.5％) and pleural effusion in 4 patients (5.5％).Conclusion Posterior transpedicular osteotomy is an effective surgical technique for spinal deformity.However,perioperative complications are common,including nerve injury,bleeding,dural injury,wound infection and so on.Among them,nerve injury and bleeding are most common.
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ObjectiveTo investigate the efficacy of percutaneous pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of thoracolumbar fractures.MethodsA total of 20 patients with thoracolumbar fractures (type A,load sharing ≥7,without neurological deficit) underwent percutaneous pedicle screw fixation of Sextant systems combined with transpedicular interbody bone grafting were retrospectively studied.The perioperative parameters,radiographic and clinical outcomes were compared with another 20 patients underwent traditional short-segment pedicle screw fixation combined with transpedicular interbody bone grafting.All patients were followed up for at least 2 years after surgery.ResultsThere were no significant differences between the two groups in sex,age,injury to operation interval,and load sharing scores.However,there were significant differences between the two groups in operating time and blood loss(P＜0.05).The vertebral body height and kyphosis angle were corrected significantly after surgery (P＜O.05),however,the recovery of the vertebral body height and kypbosis angle were reduced significantly one year after surgery in both groups (P＜0.05).At the final follow-up,there were no significant progressive losses of the recovery of the vertebral body height and kyphosis angle,as compared with that of one year after surgery in two groups.There were no significant differences in radiographic parameters and the clinical outcomes between the two groups,even though less radiographic correction and better clinical outcomes were found in percutaneous techniques.ConclusionShort-segment pedicle screw fixation with transpedicular grafting remains a reliable surgical method for the treatment of severe thoracolumbar fractures without neurological deficit.Percutaneous pedicle screw fixation proved to be an effective method with the advantages of minimal invasiveness and less blood loss.
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Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent different surgical procedures.There were 40 males and 16 females,aged from 43 to 76 years(average 58.1 years).The courses of disease were 3 months to 5 years,average 13.4 months.CT and MRI examinations were used to observe ossification involving levels,distributions,ossification nest shapes,spinal canal stenosis and spinal cord compression and so on.All patients were treated with en bloc or dissolved laminectomy combining with posterolateral fusion.Japanese Orthopaedic Association(JOA)score was used to evaluate postoperative outcomes.Results The patients were followed up for 18 to 70 months,with an average of 25 months.The mean JOA score increased from 6.25±2.47 preoperatively to 7.53±3.20 at the final follow-up.According to CT scans,the ossifications were divided into lateral type in 6 cases,diffuse type in 17 and thickened nodular type in 33 cases.Patients of lateral type was treated with en bloc laminectomy,and the excellent and good rate was 83.3%.In the patients of diffuse type,11 were treated with en bloc laminectomy and 6 with dissolved laminectomy,and the excellent and good rate was and 81.8% and 83.3% respectively.For patients of thickened nodular type,4 were treated with en bloc laminectomy and 29 with dissolved laminectomy,the excellent and good rate was 50% and 82.8% respectively,and 2 cases presented spinal cord injury aggravation.Conclusion En bloc laminectomy combining with lateral fusion is ideal surgical procedure for lateral type and diffuse type,dissolved laminectomy combining with laeral fusion is suitable for thickened nodular type.
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Objective To evaluate the clinical efficacy of anterior C2-3 discectomy and fusion in treatment of type Ⅱ traumatic spondylolisthesis of the axis. Methods A total of 27 patients with type Ⅱ traumatic spondylolisthesis of the axis were treated with anterior C2-3 discectomy, fusion and plate fixa-tion. There were 19 males and 8 females, at average age of 38 years (22-67 years). The spinal cord function was at Fraukel D in four patients. Results Operation lasted for 75-95 minutes (mean 86 mi-nutes), with blood loss of 100-160 ml (mean 135 ml). Hospital stay was 9-12 days ( mean 10.8 days). Follow-up for 9-24 months (mean 14 months) showed that all patients achieved bony fusion within three months postoperatively, with no anterior displacement or kyphosis. The range of cervical movement was normal, with no chronic neck pain ocurred. Conclusions Anterior approach can minimize surgical trauma, shorten recovery time and hospital stay. Anterior C2-3 discectomy and fusion is a feasible and safe surgical technique and can get satisfactory therapeutic effect in treating type Ⅱ traumatic spondylolisthesis of the axis.
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Objective To study the diagnosis and treatment for distractive extension injuries of the cervical vertebrae.Method From 2000 to 2005.the clinical and image data of fifty-six patients in the Second Affiliated Hospital of Zhejiang University College of Medicine with distractive extension injuries of the cervical vertebrae were studied and treated with anterior discectomy or subtotal vertebrectomy in the second affiliated Hospital of zhejiang university collegeof medicine,bone grafting and internal fixation with plate.Results The follow-up period was six to seventeen months in fourty-eight patients.The neurological recovery was found after operation in five of nine case with complete spinal cord injuries and thirteen patient had complete recovery.Neck pain completely disappeared in 6 patients with oboslete injury and neurological recovery was improved in 4 patients.Condusions MRI examination is the essential approach to diagnoze distractive extension injuries of the cervical vertebran,and early operation,including anterior discectomy,bone graftillg and internal fixiation with plate,is a best choice of surgical interrention to achieve cervical stabilization and neurological improvement.
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Objective To study the effect of the expansive open-door laminoplasty on the three-dimensional motion and stiffness of the cervical spine. Methods 55 cases after open-door laminoplasty of cervical spine due to myelopathy were follow-up for an average of 35.9 months. Cervical axial symptoms, neural functionality (JOA scoring system) and pre- and post-surgery dynamic cervical spine lateral X-ray films were evaluated. The Three-dimensional Motion and Stiffness of the Cervical Spine of Human Body Measuring Equipment was used in 12 post-operative open door laminoplasty cases and 10 pre-operative cases to measure the active and passive range of motion(ROM), load-displacement relationship, stiffness of cervical spine and torque caused by the isometric contraction of the extensors and flexors of the cervical spine. Results The average rate of improvement was 66. 2%. The excellent and good rate was 78.2%. The number of cases with distinct or severe cervical axial symptoms increased after the surgery ( P ＜ 0. O1 ) . The patients who have severe axial symptoms tend to have less curved cervical spine (P ＜ 0. 01 ) . There was no significant statistic difference between the severity of post-surgery cervical axial symptoms and JOA improvement level (P ＞ 0. 05). The active and passive ROM of extension, rotation and lateral bending of cervical spine were decreased after the surgery ( P ＜ 0. 05), and the main affection was on the middle and lower part of the cervical spine. The load-displacement figure of cervical spine can fit into an exponential equation T= b0eb1θ. In each direction, the lateral bending had the strongest stiffness, then the extension and flexion. The stiffness of rotation was the weakest. The stiffness of cervical spine of the post-surgery group was stronger than that of the contrast group. Conclusion The open-door laminoplasty of cervical spine damages the static mechanic balance on the sagittal plane and decreases the ROM and the flexibility of cervical spine. The curvature of the cervical spine is related to the severity of the axial symptoms and seems not to be related to the JOA score improvement.
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AIM: To investigate the synergistic induction of apoptosis in rhabdomyosarcoma cells by the combination of TRAIL or TRAIL gene with cisplatin. METHODS: Rhabdomyosarcoma cells were treated with TRAIL, (Ad/GT)-TRAIL, cisplatin, respectively or the combination for 3 days. The cytotoxicity was observed by MTT assay. The apoptotic rates and the expression rates of Fas protein were measured by flow cytometry (FCM). The expression of cFLIP mRNA was determined by RT-PCR. RESULTS: Rhabdomyosarcoma cells were treated with Ad/ GT-TRAIL and TRAIL (100.0 ?g/L), the cytotoxicity index were 52.5% and 43.5%, the percentage of apoptotic cells were 12.95% and 10.26%, respectively. Combined with cisplatin, the cytotoxicity index and the percentage of apoptotic cells were increased significantly (P