Relationship between lumbar disc herniation and Roussouly classification in the sagittal alignment of the spine and pelvis in young people.

Background: The sagittal plane of spine-pelvis morphology of adult patients with lumbar disc herniation (LDH) differs from that of normal people. There is a correlation between abnormal sagittal plane morphology and adult LDH. This study aimed to investigate the relationship between LDH in young people and the Roussouly classification in the sagittal alignment of the spine and pelvis. Methods: A total of 126 patients with LDH hospitalized in our tertiary hospital between January 2020 and January 2021 who met the inclusion and exclusion criteria were retrospectively analyzed in a cross-sectional study. Participants were grouped according to the spinal level of disc herniation (L4/5 group, L5/S1 group, L3/4 group). Pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) of all cases were measured using standing lateral spinal radiographs. Facet joint angles (FJA) were measured using lumbar computed tomography (CT) horizontal radiographs, and the height of the anterior, middle, and posterior margins of the herniated disc was measured using sagittal radiographs. The classification of Pfirrmann disc degeneration was determined via magnetic resonance imaging (MRI) film of the lumbar region. Roussouly classification was performed according to sagittal plane morphology, and data were analyzed among each group. Results: In all, 126 patients aged from 18 to 40 years, with an average age of 31.04±5.886 years were included. There were 63 cases of L4/5 disc herniation, 59 cases of L5/S1 herniation, and 4 cases of L3/4 herniation. There were 35 cases of epiphyseal separation. The Roussouly classification included 21 cases of type 1, 56 cases of type 2, 32 cases of type 3, 4 cases of type 4, and 13 cases of type 3 + anteverted pelvis (type 3-AP). The L4/5 disc herniation group had significantly more types 2 and 3 than the other groups, and the L5/S1 disc herniation group had significantly more types 1 and 2 than the other groups. There were no significant differences in the Pfirrmann grade of intervertebral disc degeneration; epiphyseal separation; the height of anterior, middle, and posterior margins of the herniated disc; the difference between left and right facet angle and bilateral facet angle; and the thoracic kyphosis (TK) value among any of the groups (P>0.05). There were significant differences in PI, PT, SS, lumbar lordosis (LL), and height of the anterior and posterior margins of the intervertebral space among all groups (P<0.05). PI values were grouped at 50°; PT, SS, and LL were significantly different (P<0.05), whereas TK values were not significantly different between the 2 groups (P>0.05). SS values were grouped at 35°, and there were significant differences in PI, TK, and LL between the 2 groups (P<0.05). According to the disc herniation segment, the patients were divided into L4/5 and L5/S1 groups. There were significant differences in PI, PT, anterior edge height, anterior to posterior edge height, left facet angle, right facet angle, and bilateral facet angle (P<0.05). Conclusions: LDH is common in L4/5 and L5/S1 segments. The incidence of Roussouly type 1 and 2 LDH is significantly higher than other types, and type 4 is the lowest. Small PI and small SS are more obvious in the L5/S1 segment. L5/S1 disc herniation is more common in patients with Roussouly type 1 and 2 classifications, whereas L4/5 disc herniation is more frequent in patients with Roussouly type 2 and 3 classifications.

Risk factors for postoperative sympathetic chain dysfunction following oblique lateral lumbar interbody fusion: a multivariate analysis.

PURPOSE: Postoperative sympathetic chain dysfunction (PSCD) was a relatively common complication after anterior lumbar interbody fusion due to the manipulation adjacent to the lumbar sympathetic chain (LSC). This study aimed to investigate the incidence of PSCD and identify its related independent risk factors after oblique lateral lumbar interbody fusion (OLIF) surgery. METHODS: PSCD was defined as either of the following in the affected lower limb compared to the contralateral: (1) increase in skin temperature by 1 ºC or more, (2) reduced skin perspiration, (3) limb swelling or skin discoloration. Consecutive patients who underwent OLIF at L4/5 level from February 2018 and May 2022 at a single institution were retrospectively reviewed and divided into two groups: patients with PSCD and patients without PSCD. Binary logistic regression analyses were performed on patients' demographic, comorbidities, radiological datum and perioperative factors to identify independent risk factors for PSCD. RESULTS: Twelve (5.7%) of 210 patients experienced PSCD following OLIF surgery. Multivariate logistic regression analysis identified the identification of lumbar dextroscoliosis (OR = 7.907, P = 0.012) and the presence of "tear-drop" psoas (OR = 7.216, P = 0.011) as independent risk factors for the PSCD following OLIF. CONCLUSION: This study identified the lumbar dextroscoliosis and the "tear-drop" psoas as independent risk factors for the development of PSCD after OLIF. Spine alignment examination and the morphological identification of psoas major muscle should be highly noticed for the PSCD prevention following OLIF.

Comparison of corrective and clinical effects between SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

BACKGROUND: To compare the corrective and clinical effects between Scoliosis Research Society (SRS)-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis. METHODS: Twenty-four cases of old thoracolumbar osteoporotic fractures with kyphosis treated by grade IV osteotomy in Sichuan Provincial Orthopedic Hospital from January 2018 to December 2019 were reviewed. Eleven cases were treated with grade IV osteotomy combined with the interbody fusion cage (group A), and 13 cases were treated with grade IV osteotomy alone (group B). Operation time, blood loss, and perioperative conditions of the 2 groups were recorded. After operation and the last follow up, the kyphosis angle (Cobb angle) and sagittal vertical axis (SVA) were measured by whole-spine splicing X-ray; clinical effect was analyzed by visual analog score (VAS) and Oswestry disability index (ODI). RESULTS: All operations were successful. Operation time was 239.5±29.0 min in group A and 179.2±22.7 min in group B (P<0.05). Intraoperative blood loss in group A was 1,560.9±378.6 mL and 1,242.3±339.0 mL in group B (P<0.05). Cerebrospinal fluid leakage occurred in 3 cases in group A and 1 case in group B (P<0.05). There were 3 cases of transient neurological symptoms in group A and 1 case in group B (P<0.05). There was no significant difference in Cobb angle and SVA between the 2 groups (P>0.05). There was no significant difference in ODI and VAS between the 2 groups (P>0.05). There were no complications, such as spinal cord injury, internal fixation loosening and fracture, or orthopedic loss. CONCLUSIONS: SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy can achieve good short-term orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. Corrective and clinical effects of the two groups are equivalent, but the operation time of grade IV osteotomy combined with the interbody fusion cage is longer, the amount of intraoperative blood is greater, and the incidence of complications is higher.

Water extract of medicinal ink (WEMI) attenuates lipopolysaccharide-induced NO production of Raw264.7 cells via downregulating JAK2/STAT3-mediated iNOS expression.

ETHNOPHARMACOLOGICAL RELEVANCE: Medicinal ink is used as a traditional topical medicine for treating inflammatory diseases via detoxification, relieving pain, hemostasis, and reducing swelling. However, the effect of medicinal ink on the inhibition of inflammatory responses and the underlying molecular mechanism remain unclear. AIM OF THE STUDY: The present study aimed to investigate the anti-inflammatory function of water extract of medical ink (WEMI) and elucidate its active mechanisms. MATERIALS AND METHODS: Cell viability was assessed using crystal violet staining assay. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA. Nitric oxide (NO) production was measured by Griess assay. The activation of inflammatory signaling molecules stimulated by lipopolysaccharide (LPS) was evaluated by assessing levels of inducible nitric oxide synthase (iNOS), phosphorylated Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) using Western blot assay. RESULTS: Water extract of medical ink (WEMI) did not present cytotoxic effect on murine macrophage Raw264.7 cells. High dosage of WEMI slightly rescued LPS-suppressed cell viability of Raw264.7 cells. WEMI did not induce NO production or IL-6 secretion, though WEMI significantly induced secretion of TNF-α on Raw264.7 cells not stimulated with LPS. On the other hand, LPS effectively stimulated inflammation on Raw264.7 cells; however, WEMI dramatically reduced LPS-induced NO production. WEMI alleviated LPS-stimulated IL-6 secretion but did not affect the content of TNF-α. In addition, WEMI effectively reduced expression of iNOS by abolishing LPS-mediated phosphorylation of JAK2 and STAT3 but not TLR4-mediated NF-κB and MAPK molecules. CONCLUSIONS: Our findings suggest that WEMI targets of the JAK2/STAT3-mediated iNOS expression play a key role in alleviating LPS-induced inflammatory responses in RAW264.7 macrophages. Therefore, medicinal ink may be a potential topical agent for treating fasciitis or synovitis via regulating the immune system.

The incidence of incision infections after lumbar fusion and the significance of dynamically monitoring serum albumin and C-reactive protein levels.

BACKGROUND: To explore the incidence of incision infections and dynamically monitor albumin (ALB) and C-reactive protein (CRP) levels after lumbar fusion. METHODS: A total of 1,773 patients undergoing lumbar fusion in our hospital from March 2011 to March 2021 were selected and divided into the infection group and the non-infection group according to whether incision infections occurred postoperatively. The incidence of postoperative incision infections, the pathogenic characteristics and drug resistance of the pathogenic bacteria in patients in the infection group were analyzed. The general clinical data, serum ALB and CRP levels at different time points were compared between the two groups of patients, and the correlation between ALB and CRP levels was analyzed. ROC curve was used to evaluate the predictive value of serum ALB and CRP levels on the incidence of postoperative incision infections. RESULTS: Of the 1,773 patients, 41 (2.31%) experienced postoperative incision infections. A total of 57 pathogens were detected, including 36 gram-negative bacteria (63.16%), 18 gram-positive bacteria (31.58%), and 3 fungi (5.26%). Among gram-negative bacteria, Pseudomonas aeruginosa had the highest resistance to ampicillin. Among gram-positive bacteria, Staphylococcus aureus had the highest resistance to penicillin and erythromycin. The age, BMI, the number of diabetes patients, levels of serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and procalcitonin (PCT) IL-8 at 1 d after operation in the infection group were significantly higher than those in the non-infection group (P<0.05). The serum ALB and CRP levels of the two groups differed over time, and the differences were statistically significant in terms of time, inter-group, time and inter-group interaction factors (P<0.05). Correlation analysis showed that ALB was significantly negatively correlated with CRP expression. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) value of combined ALB and CRP detection was 0.856, which was significantly higher than that of single detection with ALB or CRP (P<0.05). CONCLUSIONS: Gram-negative bacterial infection was the main type of incision infection in patients after lumbar fusion. The changes in ALB and CRP levels were related to the incidence of postoperative incision infections.

[Comparison of effectiveness of Vesselplasty and percutaneous kyphoplasty for Kümmell disease].

OBJECTIVE: To investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty (PKP) in treatment of Kümmell disease. METHODS: Between January 2015 and December 2018, 63 patients with Kümmell disease were treated. Among them, 28 cases were treated with Vesselplasty (Vesselplasty group) and 35 cases were treated with PKP (PKP group). There was no significant difference in gender, age, disease duration, bone mineral density (T value), fracture distribution, and preoperative pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), anterior height of injured vertebrae, and kyphosis Cobb angle between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy time, bone cement injection volume, the leakage rate of bone cement, the diffusion area ratio of bone cement, and the complications of the two groups were recorded. VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last follow-up. RESULTS: All patients of the two groups were followed up 12-36 months, with an average of 24.2 months. The operation time, intraoperative fluoroscopy time, bone cement injection volume, and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group ( P<0.05). The leakage rate of bone cement was significantly lower in the Vesselplasty group (7.14%) than in the PKP group (34.29%) ( χ 2=5.153, P=0.023). At 1 day after operation and last follow-up, the VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle of the two groups were superior to those before operation ( P<0.05), and no significant difference between the two groups ( P>0.05). During the follow-up, there was no re-collapse of vertebrae, and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group. There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group (7.14%) and the PKP group (14.29%) ( χ 2=0.243, P=0.622). CONCLUSION: Vesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease. They can effectively relieve the pain symptoms, improve the quality of life, partially restore the height of injured vertebrae, and correct kyphosis. But the Vesselplasty has the advantages of shorter operation time, less intraoperative fluoroscopy time, and less bone cement leakage.

[Application of enhanced recovery after surgery in postoperative rehabilitation of osteoporotic lumbar compression fractures with percutaneous vertebroplasty or percutaneous kyphoplasty].

OBJECTIVE: To study effects of postoperative regular training of core muscle strength guided by the concept of enhanced recovery after surgery (ERAS) on the rehabilitation of elderly patients with osteoporotic lumbar vertebral compression fracture after vertebroplasty (PVP) and kyphoplasty(PKP). METHODS: Ninety-four elderly patients with osteoporotic lumbar compression fractures who underwent PKP or PVP from January 2016 to January 2018 and met inclusion criteria were divided into observation group and control group. All the patients were treated with routine anti osteoporosis therapy after operation. There were 47 patients in the observationgroup, including 18 males and 29 females, with an average age of (62.62±3.21) years old;in the control group, there were 47 cases, including 17 males and 30 females, with an average age of (62.38±2.84) years old. The patients in the control group were trained by traditional way, and the patients in observation group were instructed to conduct regular training of core muscle strength according to ERAS concept. The patients were followed up for 1, 3 and 6 months after operation. Patients' conditions were quantitatively evaluated according to Barthel scale, JOA low back pain score and Oswestry Disability Index, and the differences in treatment effects between two groups were statistically analyzed and compared. RESULTS: All the patients were followed up, and the Barthel scale, JOA low back pain score and Oswestry Disability Index score of the observation group were all better than those of the control group on the 1st and the 3rd months after surgery(P< 0.05). The Oswestry Disability Index score of the observation group on the 6th month after surgery were superior to those of the control group (P<0.05). However, there was no significantly difference in JOA low back pain score and Barthel scale between two groups at 6 months after surgery (P>0.05). The comparison of Barthel scale, JOA low back pain score and Oswestry Disability Index before and after the operation of 1, 3 and 6 months between the two groups were significantly improved (P<0.05). CONCLUSION: Early regular core strength training has a positive effect on early functional recovery and improvement of life ability after PKP or PVP for elderly patients with osteoporotic lumbar compression fractures, which is in line with the concept of accelerated rehabilitation surgery.

[Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage â ¢ Kümmell disease].

OBJECTIVE: To compare the effectiveness of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease. METHODS: A clinical data of 44 patients with stage Ⅲ Kümmell disease met the selection criteria between January 2014 and December 2017 was retrospectively analyzed. Eighteen cases were treated with short-segment bone cement-augmented fixation combined with vertebroplasty (short-segment group) and 26 cases were treated with long-segment bone cement-augmented fixation combined with vertebroplasty (long-segment group). There was no significant difference in gender, age, disease duration, fracture segment, bone mineral density (T value), Frankle grading, and preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior edge height of injured vertebrae, kyphosis Cobb angle, and thoracolumbar kyphosis (TLK) between the two groups ( P>0.05). The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK were compared between the two groups. RESULTS: The operation time and the intraoperative blood loss in the short- segment group were significant lower than those in the long-segment group ( P<0.05). There was no significant difference in bone cement injection volume and bone cement leakage rate between the two groups ( P>0.05). All patients were followed up 12-36 months, with an average of 24.4 months. The VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK significantly improved at 1 week after operation and last follow-up in the two groups ( P<0.05), there was no significant difference between the two groups ( P>0.05). At last follow-up, the neurological function of the two groups recovered, and there was no significant difference in Frankle grading between the two groups ( P>0.05). There were 3 cases (16.67%) of non-surgical vertebral fractures in the short-segment group and 6 cases (23.08%) in the long-segment group, showing no significant difference between the two groups ( P>0.05). Bone rejection occurred in 1 case in the short-segment group, and neither internal fixation failure nor collapse of the injured vertebrae occurred during follow-up. CONCLUSION: Both short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty can achieve good effectiveness in treatment of stage Ⅲ Kümmell disease, and can maintain the height of the injured vertebra and prevent the collapse of the injured vertebra. Compared with long-segment fixation, short-segment fixation has the advantages of shorter operation time and less intraoperative bleeding.

[Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly].

OBJECTIVE: From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures. METHODS: A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF). RESULTS: There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (P>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (P<0.05), which was no significant difference at 1 day after operation and final follow-up (P>0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (P>0.05). The pain in both groups continued to improve at follow up after operation (P<0.05), the local Cobb angle increased (P<0.05) and AVHR decreased slightly (P<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth. CONCLUSION: CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.

Modified percutaneous Kyphoplasty technique in the treatment of osteoporotic thoracolumbar burst fractures: could it reduce the odds of cement leakage?

BACKGROUND: Osteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty and kyphoplasty is limited in these patients. This study aims to investigate the efficacy and safety of the modified percutaneous kyphoplasty (MPKP) in the treatment of OTLBF. METHODS: Clinical data of the OTLBF patients treated with MPKP and the osteoporotic thoracolumbar compression fracture (OTLCF) patients undergone PKP from January 2014 to June 2016 were collected. The key procedure of the MPKP was to fill the bone cavity with gel-foam by the first balloon inflation and to press the gel-foam by a second balloon inflation. Pain intensity, Oswestry disability index (ODI), and bone cement leakage of the patients in the two groups were analyzed. RESULTS: In the burst fracture group, the overall spinal canal occupancy was relatively low, and the maximum occupancy was 1/3 of the sagittal diameter of the spinal canal. The surgical duration was longer in the burst fracture group (39.0 ± 5.0 min with 95% CI: 37.7, 40.3) than in the compression fracture group (31.7 ± 4.3 min with 95% CI: 31.1, 32.3), and the difference between the two groups was statistically significant (Z = -8.668 and P = 0.000). Both the Oswestry disability index (ODI) and the visual analog scales (VAS) were apparently improved, but there was no significant difference between the two groups. Cement leakage occurred in 13 out of the 53 cases (24.5%) in the burst fracture group and 35 out of the 193 cases (18.1%) in the compression fracture group, and there was no significant difference between the two groups (Z = - 1.038 and P = 0.299). Neither group had consequential symptoms, such as spinal cord lesion, pain, and numbness of the peripheral nerve. CONCLUSION: Similar to the efficacy of PKP in the treatment of OTLCF, MPKP efficiently reduced the cement leakage rate and improved the safety of the surgery, although it prolonged the surgical duration and introduced more surgical steps.

[Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation].

OBJECTIVE: To investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD). METHODS: A clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT. RESULTS: All incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant ( Z=-0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups ( t=-9.033, P=0.000; t=-15.835, P=0.000); while no significant difference was found between the two groups ( t=-0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups ( Z=-0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups ( Z=-0.681, P=0.496). CONCLUSION: For RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.

Efficacy of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty for Kummell disease.

In the present study, the efficacy of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty (PKP) for Kummell disease was compared. Between March 2015 and June 2017, 63 patients with Kummell disease were recruited and underwent PKP with two different puncture techniques: A total of 38 patients were treated by unilateral transverse process-pedicle PKP and 25 patients were treated by bilateral PKP. The operative time, intra-operative fluoroscopy time, volume of bone cement injection and bone cement leakage were recorded. Prior to surgery and 1 day post-surgery, the visual analogue scale (VAS) pain score and Oswestry disability index (ODI) were determined, and the vertebral body height and Cobb angle were measured. The results indicated that the incidence of bone cement leakage in the unilateral group was similar with the bilateral group (15.79% vs. 16.00%), with no statistically significant difference between the two groups. None of the patients in the two groups had any obvious damage of the spinal cord. The operative time, intra-operative fluoroscopy time and volume of bone cement injection in the unilateral group were lower than those in the bilateral group. A chest X-ray examination at 1 day post-surgery revealed no pulmonary embolism in the two groups. The VAS score, ODI, vertebral body height and Cobb angle were significantly improved in the unilateral and bilateral groups at 1 day post-surgery and at the last follow-up (12 months post-surgery) as compared with these parameters prior to surgery. In conclusion, the unilateral transverse process-pedicle and bilateral puncture techniques in PKP exhibited good efficacy as a treatment for Kummell disease. The operative time, intra-operative fluoroscopy time and volume of bone cement injection were lower in the unilateral group.

[Clinical comparative study of short-segment and long-segment fixation for single-segment thoracic and lumbar spine III stage Kümmell disease].

OBJECTIVE: By comparing the clinical efficacy of short-segment and long-segment fixation for single-segment thoracic and lumbar spine III stage Kümmell disease to explore a more suitable fixed segment for the disease. METHODS: The clinical data of 46 patients with single-segment thoracic and lumbar spine III stage Kümmell disease treated from July 2013 to December 2016 were retrospectively analyzed. Forty-six patients were divided into short-segment fixation group(one vertebra above and below the diseased vertebra) and long-segment fixation group(two vertebrae on the upper and lower of the diseased vertebra) according to different methods of cement stick fixation. There were 25 patients in the short-segment fixation group, including 9 males and 16 females, with an average age of (75.3±4.5) years old, lumbar spine bone mineral density T-value of (-3.1±0.3) g/cm³, follow-up time of (13.0±2.3) months; there were 21 patients in long-segment fixation group, 6 males and 15 females, with an average age of (74.5±3.9) years old, lumbar spine bone mineral density T-value of (-3.2±0.3) g/cm³, follow-up time of (14.7±3.6) months.The gender, age, follow-up time, operation time, intraoperative blood loss, cement leakage, and the rate of adjacent vertebrae fractures were compared between two groups, as well as pain VAS score, ODI, and kyphosis angle before and after surgery. RESULTS: There were no significant differences in age, gender, bone density, pain VAS score, ODI, and kyphosis between two groups before surgery. The operation time and intraoperative blood loss of short-segment fixation group were less than that of long-segment fixation group. The pain VAS score, ODI and kyphosis of the two groups were significantly improved at 7 days after the operation and at the latest follow-up, there was no significant difference between two groups. There were no significant differences in bone cement leakage(9/25 vs 11/21) and adjacent vertebrae fractures(4/25 vs 3/21). CONCLUSIONS: Both long-segment fixation and short-segment fixation can effectively relieve pain, correct kyphosis, improve functional index, and achieve better clinical results, but short-segment fixation has less operation time and less intraoperative blood. So single-segment thoracic and lumbar spine III stage Kümmell disease does not need to extend the fixed segment, short-segment fixation is more in line with clinical needs and worthy of further study.

[Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease].

Objective: To compare the effectiveness between unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease. Methods: The clinical data of 45 patients with Kümmell disease that met the criteria between January 2014 and February 2016 were analyzed retrospectively. Among them, 26 cases were treated by unilateral PKP (unilateral group), 19 cases were treated by bilateral PKP (bilateral group). There was no significant difference in gender, age, disease duration, injured vertebral segment, bone mineral density (T value), and the preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height, and kyphosis Cobb angle between 2 groups ( P>0.05). The operation time, intraoperative fluoroscopy times, amount of injected bone cement, and hospitalization time were recorded, and the situation of bone cement leakage was observed. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle were evaluated before operation, at 1 day after operation, and at last follow-up. Results: Bone cement leakage during the operation were found in 4 cases (15.38%) of unilateral group and 3 cases (15.79%) of bilateral group without obvious neurological symptoms; there was no significant difference in the incidence of bone cement leakage between 2 groups ( χ2=0.000, P=1.000). The operation time, intraoperative fluoroscopy times, and amount of injected bone cement in the unilateral group were significantly lower than those in the bilateral group ( P<0.05); but there was no significant difference in the hospitalization time between 2 groups ( P>0.05). The X-ray film examination showed that there was no pulmonary embolism in all patients at 1 day after operation. All the patients were followed up 12-24 months, with an average of 16.4 months. There was no complication such as vertebral re-fracture or cement block displacement in the injured vertebra. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle at 1 day after operation and at last follow-up were significantly improved when compared with preoperative values in 2 groups ( P<0.05); the VAS score and ODI in 2 groups were further reduced at last follow-up when compared with the value at 1 day after operation ( P<0.05), but the anterior vertebral height and kyphosis Cobb angle in 2 groups at last follow-up did not change significantly ( P>0.05). There was no significant difference in above indexes at 1 day after operation and at last follow-up between 2 groups ( P>0.05). Conclusion: Both unilateral and bilateral PKP can achieve good effectiveness in treatment of Kümmell disease. But the unilateral puncture technique possesses advantages such as shorter operation time, less radiation dose, and less amount of injected bone cement.