Application of anterior debridement and reconstruction with anatomical screw-plate fixation for lumbosacral tuberculosis: A 2-year-plus follow-up.

This study aimed to determine the efficacy and safety of anterior debridement and reconstruction with anatomical screw-plate fixation in patients with lumbosacral junction tuberculosis (TB).A total of 48 patients (30 males and 18 females) diagnosed with lumbosacral junction TB were included in this study. All patients underwent surgery in our institution from January 2008 to July 2014, using anterior debridement and reconstruction with anatomical screw-plate. Outcome data were evaluated before and after surgery and included lumbosacral angle, Frankel classification, bone fusion, and visual analog scale (VAS) scores.All patients were then followed up for an average of 49.4 months (range, 24-96 months). The mean lumbosacral angle improved from 8.36°â€Š±â€Š5.92° pre-operation to 22.38°â€Š±â€Š4.52° post-operation and 21.13°â€Š±â€Š3.73° during the final follow-up (both P < .05). Solid vertebral fusion was achieved in all patients after 7.6 months on average (range, 6-12 months). No severe complications appeared during operation and post-operation. Neurological performance and VAS scores were significantly improved compared with pre-operation (P < .05).Following standard anti-TB chemotherapy, anterior debridement and reconstruction with anatomical screw-plate fixation may be a feasible and effective therapeutical option for lumbosacral junction TB. This procedure can result in satisfactory bone fusion and deformity correction, and effectively restore lumbosacral junction stability.

[GRADED INFUSION OF BONE CEMENT IN PERCUTANEOUS VERTEBROPLASTY FOR Kummell's DISEASE].

OBJECTIVE: To explore the safety and effectiveness of graded infusion of bone cement in the unipedicular percutaneous vertebroplasty (PVP) for Kummell's disease. METHODS: Eighteen patients with Kummell's disease were treated by unipedicular PVP with graded infusion of bone cement between January 2012 and January 2014. Of 18 cases, 6 were male and 12 were female, aged from 65 to 88 years (mean, 75 years), with a disease duration from 3 to 32 months (mean, 11.6 months). The bone mineral density was measured by dual-energy X-ray absorptiometry; the T value ranged from -4.0 to -2.8 (mean, -3.4). Affected segments included T11 in 3 cases, T12 in 10 cases, L1 in 3 cases, and L2 in 2 cases. X-ray films were taken after operation to observe bone cement leakage and anterior height changes of affected vertebrae. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess pain status and functional activity. RESULTS: All cases underwent smoothly unipedicular PVP and were followed up 12-26 months (mean, 14 months). Cement leakage occurred in 4 patients, including 1 case of anterior paravertebral soft tissue leakage, 2 cases of intervertebral disc leakage, and 1 case of canal venous leakage, but there was no other complications. The anterior height of affected vertebrae were significantly improved (P < 0.05) from 29.1% ± 6.7% at preoperation to 68.1% ± 7.3% at 3 days after operation and 67.8% ± 5.9% at last follow-up; the VAS scores were significantly decreased (P < 0.05) from 8.11 ± 1.32 at preoperation to 2.14 ± 0.78 at 3 days and 1.97 ± 0.50 at last follow-up; and ODI were significantly decreased (P < 0.05) from 84.6% ± 8.5% to 24.1% ± 9.7% and 23.8% ± 10.2%; but no significant difference was found between at 3 days and at last follow-up (P > 0.05). CONCLUSION: Graded infusion of bone cement in unipedicular PVP is a safe and effective procedure for Kummell's disease and this technique could decrease the incidence of bone cement leakage.

External spinal skeletal fixation combination with percutaneous injury vertebra bone grafting in the treatment of thoracolumbar fractures.

STUDY DESIGN: A technical report of thoracolumbar fractures managed by percutaneous external pedicular fixation and intracorporeal bone grafting. OBJECTIVE: To develop a new technique by combining simplified percutaneous external pedicular fixator with intracorporeal bone grafting to treat thoracolumbar fractures and assess its technical safety and clinical efficacy. SUMMARY OF BACKGROUND DATA: For surgical treatment of thoracolumbar fractures, the classical techniques are beneficial in decompression, restoration, fixation, and graft fusion, but they are also hugely invasive procedures. The earlier external spinal fixation procedures are good at indirect restoration, decompression, and elastic fixation of spinal fracture. However, they are limited by remains of a large external frame and inability of vertebral reconstruct. Therefore, the minimally invasive techniques combining simplified percutaneous external pedicular fixation and intracorporeal bone grafting might be a useful alternative. METHODS: There were 50 consecutive patients who had thoracolumbar fractures with or without associated incomplete neurologic deficit. They underwent percutaneous external pedicle fixation and intracorporeal bone grafting surgery within 7 days of admission, had their implants removed after 3 months, and were prospectively followed for at least 12 months. American Spine Injury Association grading, spinal canal encroachment, spinal Cobb angle, and vertebral body height were calculated before and after surgery to assess clinical outcome. RESULTS: A minimum of 12-month follow-up was achieved in 50 patients. The average operative time was 90 minutes (range, 50-160 minutes). The mean bone graft volume was 4.8 cm (range, 3.2-10.6 cm). The intraoperative mean blood loss was 100 mL (range, 50-180 mL). Forty-two patients all had at least one American Spine Injury Association grade neurologic improvement on final follow-up observation; there were no surgery-related complications. The mean anterior height of vertebral body was 53.2% (range 25%-78%) before surgery, 93.6% (range 78%-104%) after surgery, and 94% (range 79%-103%) at final follow-up. The preoperative Cobb angle of the primary curve averaged 30.7° (range 8°-67°), and corrected to 4.5° (range 0°-12.0°) immediately after surgery, There were statistically significant (P < 0.01) among them before and after operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any cases. CONCLUSION: The new technique by combination of percutaneous external transpedicular fixation and transpedicular bone grafting is a feasible, safe, useful, efficient, and minimally invasive method to treat thoracolumbar fractures. It is a reasonable alternative method to other minimally invasive techniques of surgical management of the thoracolumbar fractures.

Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases.

With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362-368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique were followed for at least 5 years. We reviewed the clinical and radiographic records of these patients. The postoperative radiographic measures accessed were the anterior intervertebral height (AIH) and the lordosis angle (LDA). Clinical outcomes were determined using the previously validated Japanese Orthopaedic Association (JOA) and the pain visual analog scale (VAS). Patients included had a minimal follow-up period of 5 years and based on the outcomes criteria (JOA, VAS), 86.6% of patients reported excellent or good results. The AIH increased on average 18.7% of the original height (p < 0.01), and the LDA were more physiologic at final follow-up. Of the 67 cases, there was no segmental instability, and the bone fusion rate was 100%. One patient required revision open ACDF due to adjacent segment disc herniation 6 years postoperatively. There were no intraoperative complications, dysphasia or esophageal injury in this study group. It indicated endoscopic technique for ACDF can obtain satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. Compared with a traditional approach, this technique may be associated with less morbidity while improving cosmesis and postoperative recovery. Prospective randomized control trials are needed to directly compare these two procedures.

Percutaneous endoscopic lumbar discectomy and interbody fusion with B-Twin expandable spinal spacer.

BACKGROUND: Posterior lumbar interbody fusion (PLIF) is biomechanically sound as it ablates the degenerated disc, restores the intervertebral height, relieves foraminal stenosis, and positions the bone graft along the weight-bearing axis. But this conventional procedure also results in significant traction on the dural sac and the cauda equina and is thereby a potential source of neurologic damage. Therefore, we performed a minimally invasive technique: percutaneous endoscopic discectomy and interbody fusion (PEDIF) with B-Twin expandable spinal spacer (B-twin ESS) to treat symptomatic lumbar degenerative disc disease and explored the clinical outcome. METHODS: From June 2004 to December 2006, 43 consecutive patients with symptomatic lumbar degenerative disc disease were included in this study. There were 28 males and 15 females, with average age of 47 years (range 26-63). Following a routine micro-endoscopic discectomy or percutaneous nucleotomy, endplate curettage was meticulously carried out. The intervertebral space was packed with autograft cancellous bone cut from lumbar delivered through a 5-mm diameter funnel. The B-twin ESS was introduced into the intervertebral space and then expanded. Both stages were monitored by C-arm fluoroscopy. RESULTS: The mean operative time was 110 ± 36 min (80-150). The mean blood loss was 350 ± 68 ml (210-700). The mean length of hospitalization was 6.6 ± 2.9 days (3-10). All patients were evaluated in follow-up of 12-30 months (mean 18). According to radiological evidence of fusion on dynamic X-ray plain film, 31 cases (72.1%) achieved bone graft fusion after 6 months postoperatively; at the final follow-up, union of the bone graft has been established in all but one patient (97.7%). The subsidence degree of the B-twin ESS was 20-30% in 2 cases and in rest of the cases less than 10%. According to the modified criteria of Chinese Orthopaedic Association, excellent in 31 cases, good in 8 cases, fair in 3 cases, poor in 1 case, and the rate of excellent and good cases was 91%. CONCLUSION: The PEDIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, length of stay and the risk of neurological complications.

[In vivo experimental study of lumbar nucleus replacement with pectin/polyvinyl alcohol composite hydrogel].

OBJECTIVE: To evaluate the anti degenerative effect of pectin/polyvinyl alcohol composite (CoPP) hydrogel as artificial nucleus material in an animal model. METHODS: Thirty-six New Zealand white rabbits were used to build animal models, the L4₋5 intervertebral discs were pierced with a Gauge#16 needle and polyvinyl alcohol (PVA) or CoPP implants were inserted into the holes. For comparative purposes, L3₋4 discs underwent sham treatment or control treatment in which the disc was pierced but no implant was inserted. All the discs were divided into four groups as follows: sham disc group, pierced disc group, PVA disc group and CoPP disc group. The discs were analyzed radiologically and histologically for degenerative changes at 1, 3 or 6 months after surgery. RESULTS: None of the animals died from operative complications, such as paraplegia or infection before being killed. Macroscopically, none of the implants showed any signs of displacement at the time of harvest. The radiological analysis revealed that significantly less disc height loss was found with the PVA and CoPP replacement treatment than with the pierced treatment (P < 0.05). Changes in disc height after the replacement treatment were not significantly different from that after the sham treatment (P > 0.05). Histological degeneration of the replaced discs was delayed in comparison with that of the pierced discs (P < 0.05), but progressed with time, and PVA replacement showed faster disc degeneration than CoPP replacement. CONCLUSIONS: Degeneration of the anulus fibrosus after the CoPP prosthetic nucleus replacement treatment is delayed by preserving disc height and occupying the space of the nucleus pulposus, and it has great potential clinical application value.