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Objective:To analyze the risk factors for residual pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVF).Methods:Retrospectively analyzed were the patients with OVC who had been treated at Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University by single level PKP from January 2020 to December 2021. They were 40 men and 181 women, with an age of (69.6±8.2) years. By the pain score of visual analogue scale (VAS) on the postoperative day 3, they were assigned into 2 groups: a residual pain group (VAS≥4) and a control group (VAS<4). The general demographics, radiographic and surgical related data of the 2 groups were analyzed by single factor analysis, including their gender, age, bone mineral density, body mass index, glucocorticoid usage, follow-up time, duration of symptoms, fracture location, severity of fracture compression, intravertebral cleft, middle column involvement, thoracolumbar fascia injury, anesthesia method, puncture method, volume of bone cement injected, cement-endplates contact, pattern of cement distribution, cement leakage, vertebral height restoration, preoperative cobb angle and correction of cobb angle. The P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:In the present study, 19 patients were assigned into the residual pain group and 202 patients the control group. The univariate analysis showed that body mass index ( P=0.059), intravertebral cleft ( P=0.049) and thoracolumbar fascia injury ( P< 0.001) increased the risk for residual pain. The multivariate logistic regression analysis showed that thora-columbar fascia injury was an independent risk factor for residual pain ( OR=6.127, 95% CI: 2.240 to 16.755, P<0.001). Conclusion:Thoracolumbar fascia injury is an independent risk factor for residual pain after PKP for OVF.
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Coronavirus disease 2019 (COVID-19) outbreak started in December 2019 that caused difficulties for clinical work. Practical work experience in our spinal outpatient and emergency department during the COVID-19 pandemic is summarized in this article, with combined evidence-based medical evidence to explore a standardized process of diagnosis and treatment for spinal diseases. Outpatient reservation, continuous screening, triage, and isolation, first consultation accountability system, pandemic reporting system, and online revisit were strictly followed. We hope that our experience in prevention and control of COVID-19 can help spine surgeons globally in stopping the spread of COVID-19. Spine surgeons should collaborate with infection control specialists to avoid cross-infection in hospitals and optimize treatment.
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Objective To investigate the safety and effect of zoning laminectomy for the ossification of thoracic ligamentum flavum.Methods From November 2011 to December 2014,34 patients (15 males,19 females;41-76 years old,average 55.0±8.1) with ossification of thoracic ligamentum flavum (OLF) were treated by zoning laminectomy.The course of disease ranged from 1 month to 123 months (average 16.5 months).According to the anatomical characteristics and the pathological ossification process of the thoracic ligamentum flavum,we proposed the concept of "zoning",which divided each segmental thoracic OLF into three zones:"safety zone","middle zone" and "risk zone".From the features of anatomy of LF and process of OLF development,we found there is no or less cerebrospinal fluid between spinal cord and the tip of each ossified nodular masses in severe OLF,any procedures using instruments in this area have the potential to cause irreversible spinal cord injury,we defined this area as "risk zone",the "null" area of each lamina and lateral and dorsal side of nodular masses as "safety zone",and the other area as "middle zone".From "safety zone" to "risk zone" the spinal canal decreased gradually,different zone needs different surgical strategy:This surgical procedure first removed the "null" area of superior and inferior lamina and dorsal side of each segmental OLF.Next,partially or totally resected the "middle zone",exploring the lateral side of nodular masses,and the "risk zone" was exposed and isolated.Finally,dissected the lateral side of nodular masses,and then the "risk zone" was floated and resected with a directly decompressing the spinal cord.Preoperative and postoperative modified Japanese Orthopedic Association (JOA) score and neurologic functional recovery ratio were used to evaluate the surgical outcomes.Results Of the total 83 decompressed OLF segments,5 (6.0％) located in the upper thoracic spine (T1-T4),8 (9.6％) in the midthoracic spine (T5-T8),and 70 (84.4％) in the lower thoracic spine (Tg-L 1).The followed up ranged from 4 to 40 months,with an average of 21.7±9.9 months.The mean JOA score increased significant from 5.3±2.0 preoperatively to 8.8±1.8 at the final follow-up (t=1 1.566,P=0.001).Postoperative average JOA neurologic functional recovery rates were 63.2％±24.7％,including excellent in 15 cases,good in 11 cases and fair in 8 cases.The excellent and good rate was 76.5％.Twelve cases had transient CSF leakage because of dural defect.The dural defect was only treated by tightly suturing the paraspinal muscles,the subcutaneous tissue,and the skin layers.The CSF leakage lasted for 6 to 8 days after operation.Two cases with wound infection were treated with debridement and antibiotics and healed completely.One case with thoracic spinal cord transient incomplete paralysis due to a post-operative epidural hematoma was treated with an emergency operation and got recovered neurological function.Conclusion Zoning laminectomy has the advantages of safe manipulation and thorough decompression,which is an effective choice for the surgical treatment of thoracic OLF.
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Objective To observe the MRI imaging manifestations of the ligaments and soft tissues around the atlanto-axial joint in children with atlanto-axial rotation instability.Methods Assigned into observation group were 50 children with atlantoaxial rotatory displacement who had been treated in our hospital from January 2013 to March 2014.Another 50 healthy children were chosen as a control group who underwent health check-ups during the same period in our hospital.Both groups received MRI examinations of the ligaments and soft tissues around the atlantoaxial joint using the same equipment and methods.MRI manifestations and characteristics of the ligaments and soft tissues around the atlantoaxial joint were analyzed and compared between the 2 groups.Results In the observation group,odontoid gap asymmetry appeared on both sides,with left shift in 32 cases and right shift in 18 cases.The MRI imaging PDWI sequence showed a significant better diagnostic sensitivity than the other sequences (T1WI,T2WI and SPAIR) (P ＜ 0.05).The MRI examinations on all the children with different sequences found 50 cases of degree Ⅰ lesion in the observation group and 4 cases of degree Ⅰ lesion in the control group,and 12 cases of degree Ⅱ lesion in the observation group and none degree Ⅱ lesion in the control group,showing a significant difference between the 2 groups regarding the diagnostic sensitivity of lesions of degrees Ⅰ and Ⅱ (P ＜ 0.05).Conclusions MRI can clearly show the rotation displacement of atlanto-axial joint associated with transverse ligament,alar ligament and lesions of the surrounding soft tissues.MRI has a dcfinite diagnostic value for atlanto-axial rotation displacements in children,especially those caused by transverse ligament tear after trauma.
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Objective To analyse the outcome of different regimens for the treatment to patients with aeute promyelocytic leukemia(APL)accompanied by disseminated intravagcular coagulation(DIC).Methods The outcome of different chemotherapy regimens was compared. Results The median time achieving complete remission by all-trans retinoic acid(ATRA)combined with arsenic trioxide(As2O3)or alternative of ATRA and As2O3 were 34 days and 35.5 days,respectively.The median time of CR for the patients treated with ATRA only was 62 days.There is a statistical difference where three-year disease-free survival rates of the patients given by ATRA and As2O3 or alternative of them were 78 percent and 80 percent,respectively.Compared with the patients administered with ATRA only.there is significant difference(P＜0.05).The time of improving DIC was about 16 days to 18 days.There was no significant difference among this three chemotherapy regimens.Among 15 patients with autologous henmtopeietic stem cell transplantation,the disease-free survival time of 13 cases.who have no PML-RARα gene deteced by PCR was 13.5 years except 2 cases with relapse.Conclusion The time achieving complete remission of APL was reduced dramaticaly by administering all-trans retinoic acid(ATRA)combined with arsenic trioxide(As2O3)or alternative treatment of them and principles of blood transfusion and anti-fibmolysis to improve DIC,this regimen showed a relatively higher three-year disease-free survival (DFS) rate.These cases who received hematopeietic stem cell transplantation after six mortths of remission,DFS time wag further prolonged.