Percutaneous laser disc decompression for the stability of cervical vertebra / 中国组织工程研究

BACKGROUND: As a novel procedure in minimally invasive spine surgery (MISS), percutaneous laser disc decompression(PLDD) has been applied widely in the recent development in clinical practices.OBJECTIVE: This study was designed to evaluate the influences of PLDD on the stability in cervical spinal constructs.DESIGN: A before-after comparison trail based on patients.SETTING: The experiment was performed at the spine surgery department of a hospital affiliated to a university.PARTICIPANTS: Twenty-eight patients who were diagnosed as lateral cervical disc herniation at the Spine Surgery Department of Shenzhen People' s Hospital, Second Hospital Affiliated to Jinan University were involved from October 2001 to April 2003. Of all of the patients, 17 were male and 11 were female. They have 29 cervical disc protrusions altogether.INTERVENTIONS: Monitored by X-ray, a 400 μm fixed optical fiber was introduced into the injured intervertebral disc via a 9-gauge flexible trocar through an anterior cervical approach. An Nd-YAG laser system,with a 1 060 nm wavelength and an output power of 15W, was employed to ablate or decompress the inner disc tissue. The disc tissue was exposedto 500- 950 J laser powers.MAIN OUTCOME MMEASURES: Before and 6 months after the PLDD, the deviation of adjacent vertebra displacements was observed and changings of the wedge angles of the intervertebral discs were calculated respectively.RESULTS: The deviation of adjacent vertebra displacements showed no significant difference between before and after operation, when the patients were examined with a more flexed-position or a more extended-position(t=0.811 7-0.827 2, P＞ 0.05), and no significant changes in the wedge angles of the intervertebral discs could be observed either(t=0.768 7-0.827 1,P ＞ 0.05).CONCLUSION: Applying percutaneous laser disc decompression to lateral cervical disc herniation has many advantages, such as simplicity of operation, minimal invasion and having no impact on the stability in cervical spinal constructs.

The clinical application of percutaneous laser disc decompression in the treatment of cervical disc herniation / 中华骨科杂志

Objective To review the clinical results of percutaneous laser disc decompression(PLDD)in the treatment of cervical disc herniation.Methods PLDD was adopted in the treatment of cer-vi cal disc herniation in32patients.There were19males and13females with an average age of 54years,ranging from33to67years.The lesions were located at the levels of C 3,4 in4cases,C 4,5 in11cases,C 5,6 in13cases and C 6,7 in7cases.The laser fiber was introduced into the herniated disc space with the needle puncturing percu taneously in anterior surface of neck under fluoroscopic guidance.The ND:YAG laser was of 1060nm wave-length,and the diameter of the fiber was400?m.The laser output power was15w with1s emission and5s interval.The compression of spinal cord and surrounding tissue was eliminated by reducing the intra-disc pressure through the vaporization of the disc nucleus.The total laser output power was decid ed depending on the age of the patients,degenerative degree of the disc and the reactive process of heat.The total powers of the group were360J to1100J.Results The mean follow-up was8months,ranging from3to15months.The clinical evaluations were classified as excellent in16cases(50%),good8cases(25%),fair4cases(12.5%)and poor 4cases(12.5%).The general effective ratio was87.5%,the ex cellent and good ratio was75%.The remission ratio of the symptoms was80.7%for the neck and shoulder pain,84.2%for ra-diating pain of the nerve roots of upper extremities,60%for symptoms of the lower ex tremities and78.5%for cervi cal dizziness.No complications occured.Conclusion PLDD could relieve the symptoms and signs of patients cervical disc herniaton.PLDD is easy to manipulate,safe,mini-invasive,and the patients recov-ered sooner with less complications.

The use of cervical lateral mass plate for the treatment of fracture and dislocation of the cervical spine / 中华骨科杂志

Objective To discuss the application of cervical lateral mass plate for the treatment of fractures and dislocations of the cervical spine. Methods From January 1998 to January 2001, internal fixation with cervical lateral mass plate and bony fusion were performed in 21 patients during posterior decompression for the treatment of fractures and dislocations of the lower cervical spine . A posterior median approach was used to expose the lateral edge of the articular process. All patients received spinal decompression and reduction according to the types of fracture and dislocation. A cervical lateral mass plate was applied in each lateral mass, a suitable bicortical screw was inserted using Magerl technique (the inserting point of the screw was 2 mm medial and superior to the center of lateral mass, the direction was 20?-25? laterally and 30?-40? cranially). Results The follow-up of all 21 cases ranged from 9 months to 3 years and 9 months (with the mean of 27 months). There were 20 cases with complete reduction of antero-posterior and rotational dislocation, and 1 case with incomplete reduction according to post-operative X-ray film. Patients could sit up with the protection by wearing soft collar 4 days (2-7 days) after the surgery. The mean off-bed time of those without spinal cord injuries or with spinal cord injuries less than Frankel C grade were 9 days (3-14 days) after operation. All cases obtained solid bony fusion 6 months postoperatively. Eighteen cases with spinal cord injury improved one ASIA grade, 2 cases without root injury obtained complete recovery eventually. No severe complications such as injuries of vertebral artery, nerve root and spinal cord or aggravation of spinal cord injury occurred. Conclusion Cervical lateral mass plate fixation has the advantages of wide indications, strong stability, short segment fixation and easily reduction. The results suggested that this technique is an efficient, reliable segmental posterior fixation.