Effect of vertebroplasty with bone cement on osteoporotic compression fractures in elderly patients.

OBJECTIVE: To explore the effect of vertebroplasty with bone cement on elderly patients with osteoporotic compression fractures. METHODS: A retrospective study was conducted on 130 patients with osteoporotic compression fractures treated at the Second Hospital of Hebei Medical University from January 2018 to January 2022. According to different treatment methods, 50 patients who underwent conservative treatment were included in a control group (CG), and 80 patients who underwent vertebroplasty were included in a research group (RG). The anterior vertebral height, kyphotic Cobb angle, and Oswestry Disability Index (ODI) score in both groups were observed before and after treatment. The Visual Analogue Scale (VAS) scores were compared between the two groups before and after treatment. The quality of life and efficacy were evaluated in both groups. RESULTS: After treatment, the anterior vertebral height in the RG exhibited a significant increase compared to that before treatment, and both groups showed a significant decrease in the Cobb angle and ODI (P<0.05). Furthermore, the RG exhibited notably higher anterior vertebral height, and significantly lower Cobb angle and ODI than the CG after treatment (P<0.05). The post-treatment VAS score decreased significantly in both groups (P<0.05), and was lower in the RG than that in CG (P<0.05). After treatment, the quality of life scores improved significantly in both groups (P<0.05), but the RG demonstrated significantly higher scores in the role-emotional, physical functioning, social functioning, and general health (GH) dimensions compared to the CG (P<0.05). The total response rate in the CG was significantly lower than that in the RG (P<0.05). Age, course of disease, underlying disease, distribution of bone cement, and leakage of bone cement were found to be risk factors affecting the prognosis of patients. Logistic regression analysis showed that course of disease, distribution of bone cement, and leakage of bone cement were independent risk factors affecting prognosis. CONCLUSIONS: Vertebroplasty with bone cement is an effective treatment for elderly patients suffering from osteoporotic compression fractures. This intervention can improve anterior vertebral height, kyphotic Cobb angle, and ODI, while alleviating pain and enhancing the quality of life. Given its promising clinical outcomes, this treatment is highly recommended.

Bioimpedance Vector Analysis for Heart Failure: Should We Put It on the Agenda?

Heart failure is a clinical syndrome, resulting in increased intracardiac pressure and/or decreased cardiac output under rest or stress. In acute decompensated heart failure, volume assessment is essential for clinical diagnosis and management. More and more evidence shows the advantages of bioimpedance vector analysis in this issue. Here, we critically present a brief review of bioimpedance vector analysis in the prediction and management of heart failure to give a reference to clinical physicians and guideline makers.

Percutaneous transforaminal endoscopic discectomy in the treatment of senior patients with lumbar degenerative disc disease.

The aim of the current study was to analyze the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar degenerative disc disease for senior patients. The clinical and follow-up data of senior patients were retrospectively reviewed. Patients were divided into a PTED group and an open surgery group. Parameters were analyzed, including surgery time, intraoperative fluoroscopy time, intraoperative blood loss, postoperative complications, visual analog scale (VAS) and Japan Orthopedic Association (JOA) scores. Compared with the open surgery group, the surgery time and intraoperative blood loss were decreased, while the intraoperative fluoroscopy time was increased, in the PTED group (P<0.001). Significant improvements in VAS and JOA scores were identified within both groups from preoperative to 12 months following surgery (P<0.001). VAS and JOA scores were significantly improved in the PTEN group compared with the open surgery group at 1 week after surgery (P<0.001), but there was no significant difference between groups prior to and at 12 months following surgery. The incidence of venous thrombosis of the lower extremities in the PTED group was decreased compared with the open surgery group (P<0.05). In the open surgery group, patients suffered from multiple postoperative complications, including constipation, urinary system infection, wound infection, gastrointestinal hemorrhagic stress ulcer, pneumonia, pulmonary embolism, mortality following myocardial infarction, mortality following cerebral infarction, and hemiplegia following cerebral hemorrhage. By contrast, patients in the PTED group did not experience any of these complications. In conclusion, PTED resulted in reduced trauma and a lower incidence of severe complications compared with open surgery, which suggests that PTED is a safe and effective minimally invasive surgery for senior patients with lumbar degenerative disc disease.

Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 intervertebral disc herniation.

OBJECTIVE: To discuss the significance and the short-term effect of bone puncture technique in transiliac approach to intervertebral endoscopic discectomy for the treatment of L5/S1 intervertebral disc herniation. METHODS: Nineteen patients were diagnosed as L5/S1 disc herniation and treated using transiliac approach to endoscopic discectomy (group I), and 20 patients were diagnosed as L5/S1 disc herniation and underwent conventional approach (group R) [corrected]. Leg pain was evaluated by VAS. MacNab ratings of the last follow-up were recorded to evaluate early clinical efficacy, and postoperative complications were recorded to evaluate surgical safety. The imaging changes of the patients 3 months after surgery were observed. RESULTS: One patient in group I, who felt abnormal in nerve roots, underwent symptomatic treatments, such as rehydration and hormone, and the abnormalities disappeared 3 days after treatment. There were no significant significances in operative time and intraoperative fluoroscopy times between groups I and R (p > 0.05), but there was a higher tendency in group I. The VAS scores of post-operation were significantly lower than that of pre-operation in the two groups (p < 0.05), but there were no significant differences between the two groups (p > 0.05). The MacNab score of the last follow-up showed excellent rate (95%) and good rate (90%) in groups I and R, respectively. CONCLUSIONS: Bone puncture-combined transiliac approach to intervertebral endoscopic surgery could locate iliac puncture point individually, and establish a good iliac channel, which is safe, effective, and minimally invasive.

True anteroposterior view pedicle screw insertion technique.

BACKGROUND: The wide use of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in the treatment of degenerative disc disease of lumbar spine in spinal surgery highlights the gradual decrease in the use of traditional pedicle screw insertion technology. This study aims to analyze the accuracy of the true anteroposterior view pedicle screw insertion technique in MIS-TLIF surgery, compare it with conventional pedicle screw insertion technology, and discuss its clinical application value. METHODS: Fifty-two patients undergoing true anteroposterior view (group A) and 87 patients undergoing conventional pedicle screw insertion (group B) were diagnosed with lumbar disc herniation or lumbar spinal stenosis. Time for screw placement, intraoperative irradiation exposure, accuracy rate of pedicle screw insertion, and incidence of neurovascular injury were compared between the two groups. RESULTS: The time for screw placement and intraoperative irradiation exposure was significantly less in group A. Penetration rates of the paries lateralis of vertebral pedicle, medial wall of vertebral pedicle, and anterior vertebral wall were 1.44%, 0%, and 2.40%, respectively, all of which were significantly lower than that in group B. No additional serious complications caused by the placement of screw were observed during the follow-up period in patients in group A, but two patients with medial penetration underwent revision for unbearable radicular pain. CONCLUSION: The application of true anteroposterior view pedicle screw insertion technique in MIS-TLIF surgery shortens time for screw placement and reduces the intraoperative irradiation exposure along with a higher accuracy rate of screw placement, which makes it a safe, accurate, and efficient technique.

Evaluation of Transforaminal Endoscopic Discectomy in Treatment of Obese Patients with Lumbar Disc Herniation.

BACKGROUND This study aimed to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in the treatment of obese patients with lumbar disc herniation (LDH). MATERIAL AND METHODS A total of 69 obese patients with LDH (35 males and 34 females; age range, 24 to 43 years; median age, 34 years) were included in this study. These patients had undergone TED from March 2011 to December 2015 in the Third Hospital of Hebei Medical University. Their clinical and follow-up data were prospectively analyzed. The degree of pain and disability were measured on the basis of the Visual Analog Scale (VAS) at 1 day before surgery, immediately after surgery, and 3 months after surgery. Neurologic functions were measured on the basis of the Japanese Orthopaedic Association (JOA) system 1 day before surgery and 3 months after surgery. The MacNab score at last follow-up was recorded to evaluate the early clinical efficacy. Complications during and after the operation were recorded to evaluate the safety of surgery. RESULTS Two patients experienced abnormal sensations in the export nerve root zone postoperatively, which disappeared after 3 days of treatment with dehydration and administration of hormone (dexamethasone). Three cases of recurrence were observed at 6 months, 7 months, and 9 months postoperatively; they were scheduled to receive total laminectomy combined with bone grafting internal fixation. A total of 67 patients were followed up for 3-23 months and mean follow-up was 11.8 months. The VAS scores at postoperative 3 months and 1 year were significantly reduced compared to that before the operation, with significant differences between them (t=43.072, P<0.05; t=43.139, P<0.05). The JOA scores at last follow-up postoperatively was significantly higher than that before surgery (t=-60.312, P<0.05). At the last follow-up, 17 cases (25.3%) had excellent outcomes, 39 (58.2%) good, 7 (10.4%) fair, and 4 (5.9%) poor. Overall, 83.5% of patients had excellent or good rates. CONCLUSIONS The early efficacy of TED is relatively good and safe for the selected obese patients with LDH in this study. Larger-sample studies with longer duration and follow-up are required to detect the safety and effectiveness of TED.

A Clinical Investigation of Contralateral Neurological Symptom after Transforaminal Lumbar Interbody Fusion (TLIF).

BACKGROUND: The aim of this study was to analyze treatment outcomes and morbidity of contralateral neurological symptom in patients after TLIF surgery and to explore its possible causes. MATERIAL AND METHODS: A retrospective study was conducted involving a total of 476 patients who underwent TILF from 2009 to 2012 in our hospital. These cases were divided into a symptomatic group (Group S) and a non-symptomatic group. The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N). In addition, according to whether the patient underwent second surgery, Group S patients were further divided into a transient neurologic symptoms group (Group T) and an operations exploration group (Group O). The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O. RESULTS: Among the 476 patients, 18 had postoperative contralateral neurological symptoms; thus, the morbidity was 3.7815%. The indicators in Group S were lower than in Group N in the differences in contralateral foramen area and disc-height index(DHI) before and after surgery (p<0.05). Five patients (Group O) in Group S had second surgery because of invalid conservative treatment. The surgical exploration rate was 1.0504%. Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05). CONCLUSIONS: Contralateral neurological symptom is a potential complication after TLIF, and its causes are diverse. Surgical explorations should be conducted early for those patients with the complication who present with obvious nerve damage.

Impact of over distraction on occurrence of axial symptom after anterior cervical discectomy and fusion.

OBJECTIVE: A retrospective review was undertaken to evaluate the impact of over distraction on cervical axial symptoms (AS) after anterior cervical discectomy and fusion (ACDF). METHODS: The retrospective review included 421 patients who underwent ACDF for one or two segments. Of these, 78 patients for whom complete follow-up data were available were selected for inclusion in the analysis. X-rays of the cervical vertebra were performed immediately after the surgery, 3 months postsurgery, and at a final follow up (6-24 months). According to the presence/absence of AS, the patients were divided into a symptom group (Group S) and a nonsymptom group (Group N). The ratio of intervertebral height change, change in the overall cervical curvature, change in the local curvature of the surgical segment, cervical total range of motion (ROM), and Japanese Orthopaedic Association (JOA) recovery rate were compared and analyzed. A linear regression analysis of the ratio of intervertebral height change and the symptom and severity of the AS according to the Visual Analogue Scale (VAS) was carried out. RESULTS: The total incidence of AS was 33.97%. C5 nerve root palsy occurred in one case in Group S after the surgery. The neurologic symptoms of both groups were significantly alleviated after the surgery. The ratio of intervertebral height change in Group S was significantly higher than that in Group N at the last follow-up (P < 0.05). However, the changes in the overall cervical curvature, local curvature of the surgical segment, cervical ROM, and JOA recovery rates were not statistically significant (P > 0.05). In Group S, 37% of the patients had symptoms that occurred in the chest area, and the ratio of intervertebral height change was significantly positively correlated with the VAS score of the AS (r = 0.893). CONCLUSIONS: The occurrence of postoperative AS will significantly increase if the ratio of intervertebral height change of the surgical segment after ACDF is over 10%.