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Objective To investigate the value of intraoperative X-ray guided and CT guided percutaneous biopsy in the diagnosis of thoracic and lumbar space occupying lesions.Methods A total of 97 patients with thoracic and lumbar space occupying lesions who were not diagnosed clinically in our hospital from May 2011 to July 2016 were retrospectively analyzed.All patients underwent percutaneous vertebral biopsy under the guidance of Artis-Zeego robot in the Artis-Zeego complex operating room of our hospital.Thoracic vertebral body biopsy in patients with a total of 46 cases were divided into T group,in which X-ray guided percutaneous biopsy in 25 cases were divided into T-x group,CT guided percutaneous biopsy in 21 cases were divided into T-ct group.Lumbar puncture biopsy in patients with a total of 51 cases were divided into L group,in which X-ray guided percutaneous live review of 24 cases were divided into L-x group,CT guided percutaneous biopsy in 27 cases were divided into L-ct group.According to the packet respectively in X-ray or CT monitoring,the use of bone biopsy needle under local anesthesia,transpedicular approach for spinal lesions of bone amount,by changing the working path or direction bone biopsy needle of different diameter to save drilling samples which were immediately placed in 10％ formalin,specimens were sent for pathological examination and corresponding pathological and cytological examination.The success rate,diagnostic accuracy and complications of percutaneous biopsy were compared between the two groups in X-ray and CT guided percutaneous vertebral biopsy.Results T-x group of 25 patients,5 patients with puncture failure for intraoperative X-ray monitoring difficulties were transferred to puncture under the guidance of CT,the success rate of puncture was 80％ (20/25).Of the patients with success puncture,6 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy in T-x group was 70％ (14/20).The success rate of puncture in T-ct group was 100％,significantly higher than that of T-x group(P ＜ 0.05).In T-ct group,3 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy was 88.5 ％ (23/26),which was significantly higher than that of T-x group (P ＜ 0.05).In the L-x group,1 case with puncture failure for pain during the operation,the success rate of puncture was 95.8％ (23/24),patients of L-ct group were successfully punctured,the success rate was 100％,the difference between the two groups was not significant(P ＞ 0.05).In the L-x group,2 patients failed to confirm the diagnosis,the diagnostic total accuracy rate of L-x group was 87.5％ (21/23);of the L-ct group,1 cases failed to confirm the diagnosis,the diagnosis total accuracy rate of L-ct group was 96.3％ (26/27),the difference between two groups was not significant (P ＞ 0.05).Complications:In the T-x group,1 cases received additional local anesthetic after puncture for pain;1 patients had transient lower extremity paresthesia,and the symptoms were improved 1 weeks later;1 case with intraoperation puncture site paining was not alleviated and had to stop the puncture.All patients with CT guided biopsy had no complications.Conclusion CT and X-ray guided percutaneous biopsy has important significance in diagnosis and treatment of spinal lesions,and CT guided percutaneous biopsy is safer for thoracic lesions with higher diagnostic rate,while for lumbar lesions fluoroscopy,X-ray or CT guided percutaneous biopsy has the same security and diagnostic rate.
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Objective To evaluate the accuracy and safety of screw placement position through second sacral alar -iliac(S2AI)with in-teroperative cone beam CT(CBCT)scan.Methods Collected 22 patients who underwent second sacral alar-iliac screw implant surgery in our hospital from June 2015 to June 2017.All the patients had intraoperative CBCT scan and conventional CT scan after operation.Regard the postoperative CT scan imageing as gold standard to assess the accuracy and safety of S 2AI screws position.The S2AI tract parameters were measured with intraoperative CBCT images and postoperative CT images respectively.Results There was no significant difference between the S2AI tract parameters which were measured with intraoperative CBCT images and postoperative CT images(P>0.05).Conclusion The intraoperative CBCT scan could accurately evaluate the position of S 2AI screws,as well as clarify the damage of the inner and outer plate of the iliac bone in the process of fixation.Compared with postoperative conventional CT scan,the intraoperative CBCT scan can potentially re-duce the reoperation rate.
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Objective To explore the relationship among the prevertebral soft tissue swelling and dysphagia rate after anterior cervical diskectomy and fusion(ACDF),and to investigate the prevertebral soft tissue swelling and dysphagia rate after Zero-p or traditionaI cage and titanium plate for one-level lesion of cervical myelopathy.Methods The clinical data of 54 patients with one-level lesion (C5/6) of cervical myelopathy who undelwent anterior cenrical discectomy and fusion by Zero-p (n =25) or traditional cage and titanium plate (n =29) were analyzed.The postoperative prevertebral soft tissue swelling was measured by lateral radiographs.Patients were divided into the swelling group (n =24) and the non-swelling group(n =30) based on the degree of prevertebral soft tissue swelling and the incidences of dysphagia were analyzed.Patients were divided into the Zero-p group (n =25)and the Cage group (n =29) based on surgical treatment,the postoperative prevertebral soft tissue swelling and dysphagia rate were compared.Results The rate of dysphagia in swelling group was 45.8％,which was higher than 13.3％ in non-swelling group,the difference was significant(P ＜0.05).The postoperative prevertebral soft tissue swelling was 6.22 mm averagely after Zreo-p,which was less than that after traditional cage and titanium plate for anterior cervical discectomy with fusion(9.25 mm),the difference was significant (P ＜ 0.05).The incidence of dysphagia in Zero-p group was 12％,which was lower than 41.4％ in Cage group,and the difference was statistically significant (P ＜ 0.05).Conclusion It is a clinical significance to evaluate the degree of prevertebral soft tissue swelling by cervical lateral X-ray after ACDF,when the degree of prevertebral soft tissue swelling is greater,the incidence of complications such as dysphagia is higher.In addition,The Zero-p for the treatment of single one-level lesion of cervical myelopathy(C5/6) has a lower degree of prevertebral soft tissue swelling and dysphagia rate than the traditional Cage and titanium plate fusion.
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Objective To investigate the feasibility to execute percutaneous kyphoplasty(PKP) in the field comprehensive surgical shelter during kinds of natural disasters. Methods Five experimental pigs underwent PKP in a comprehensive surgical shelter during simulated natural disasters, and were observed for operating time, intraoperative blood loss, complications and postoperative survival rate. Results All the 5 pigs had the operations completed successfully with high postoperative performances in extremities motion and survival rate, and the mean operating time was(43±5.7)min and the mean intraoperative blood loss was (42±3.6)ml.Cement penetrated into the intervertebral space of one pig with satisfactory extremities motion,while no complications occurred in the other pigs.Conclusion The comprehensive surgical shelter proves to enable PKP,and thus extends emergency treatment to the frontier during simulated natural disasters.
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<p><b>OBJECTIVE</b>Combining K-line (the connecting line of the midpoint of C₂ and C₇ spinal canal on the cervical lateral X-ray film) to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament (OPLL) and surgical prognosis.</p><p><b>METHODS</b>A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open-door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K-line (+) group and K-line (-) group according to the position realationship of OPLL and K-line. The lesion of ossification of the posterior longitudinal ligament was not over than the K-line known as K-line (+). Conversely, the lesion of ossification of the posterior longitudinal ligament crossing the K-line was called K-line (-). Preoperative and postoperative 3 months JOA scores were observed, and postoperative 3 months JOA improvement rate were computed to assess patient's neurological function recovery. Preoperation and postoperative 3 months, OPLL occupation ratio (OOR), cervical lordotic angles (CLA) and cervical lordotic value (CLV) were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV>0 group and CLV<=0 group was evaluated in different K-line subgroups.</p><p><b>RESULTS</b>For the patients in K (+) group and K (-) group, preoperative CLA were (14.7±9.6)° and (-6.4±9.5)°(<0.05) respectively, postoperative at 3 months CLA were (14.0±8.0)° and (-1.4±10.4)°(<0.05) respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5 (>0.05) respectively, postoperative at 3 months JOA scores were 14.2±1.8 and 12.6±2.2 (<0.05) respectively, and postoperative at 3 months JOA score improvement rate were (54.7±17.6)% and (25.5±15.7)%(<0.05) respectively. In the K-line (+) group, there were 29 patients in CLV>0 group at 3 months after operation, with improvement rate of (52.3±17.2)%, and 4 patients in CLV<=0 group, with improvement rate of (72.2±7.8)%. The improvement rate of the patients in CLV<=0 group was significantly better than that of the patients in CLV>0 group (<0.05).</p><p><b>CONCLUSIONS</b>No matter whether the ossification of cervical posterior longitudinal ligament was classified as K-line (+) or K-line (-), the cervical posterior single open-door laminoplasty can improve the neurological symptoms of patients, especially the patients in the K-line(+) group with better prognosis. The patinets in K-line(+) group, when postoperative at 3 months CLV>0, their improvement rate was lower than that of the patients with postoperative at 3 months CLV<=0.</p>
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Objective To evaluate the safety and effectiveness of percutaneous alcohol embolization(PAE) combined with percutaneous vertebroplasty(PVP) for aggressive vertebral haemangiomas (AVHs) with epidural extension.Methods The data of 26 consecutive patients underwent PAE combined with PVP for the treatment of AVHs with epidural extension from October 2013 to November 2015 were analyzed retrospectively.The average follow-up time was (12.21 ± 1.34) months.The pain symptom before and after surgery were evaluated with a visual analogue scale (VAS).Results Pre-procedure mean VAS score was (7.23 ± 1.3) and the postoperative VAS score was (3.11 ± 1.9) at last follow-up.Ten patients (38.5％) remained asymptomatic.Eighty-eight percent of the patients with neurosensory disorders had complete regression of these symptoms.Two of the three patients with motor deficit did not show any improvement.No major complication was recorded.Conclusion PAE combined with PVP is a minimally invasive safe and effective therapeutic approach for AVH with epidural extension.This technique appears mainly effective for pain and neurosensory symptoms,but seems less effective for motor deficit relief.