Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures.

OBJECTIVE: To evaluate the feasibility, clinical efficacy and imaging results of preoperative traction (PT) followed by percutaneous kyphoplasty (PKP) combined with percutaneous cement discoplasty (PCD) for treating severe thoracolumbar osteoporotic vertebral compression fractures (OVCFs). METHODS: A total of 13 patients with severe thoracolumbar OVCFs treated by PT followed by PKP combined with PCD were enrolled. General information, PT time, operation time, postoperative hospital stay, perioperative complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, local kyphosis angle, intervertebral angle (IVA), anterior vertebral height (AVH) and posterior vertebral height (PVH) were recorded. RESULTS: The average VAS score at admission was 7.4±3.5, decreased to 4.3±1.7 after PT and 2.3±0.7 three days after operation, and 1.5±0.9 at last follow-up. The average ODI score was 73.7±21.4 before operation, decreased to 26.6±9.3 three days after operation and 13.7±7.1 at last follow-up. Compared to VAS and ODI scores at admission, these at the third day after operation and last follow-up were significantly different. At admission, the IVA was 3.4°±6.8°, the disc height was 5.7±1.2mm, the AVH was 10.7±3.2mm, and the PVH was 25.7±4.2 mm, which, after PT, changed to 8.1°±7.3°, 8.6±2.6mm, 18.5±2.8mm, and 26.2±7.1mm, respectively, and the differences were significant. The average kyphotic angle was 43.4°±17.8° at admission, and decreased to 26.3°±6.7° after PT, 17.5°±8.4° three days after operation and 19.1°±10.3° at last follow-up, and the differences were significant. CONCLUSION: PT followed by PKP combined with PCD for the treatment of severe thoracolumbar OVCFs was an effective and simple procedure with satisfactory short-term clinical outcomes by relieving pain and improving kyphosis.

Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum.

OBJECTIVE: This study was performed to evaluate the role of posterior suspension of the laminae-ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF). METHODS: Eight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Neurological functional recovery was evaluated by the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi recovery rate preoperatively, postoperatively, and at the final follow-up. Preoperative and postoperative imaging was performed, and the decompression range and internal fixation positioning were evaluated. RESULTS: The mJOA score significantly improved from 4.63 points preoperatively to 9.0 points at the final follow-up (Hirabayashi recovery rate of 77.75%). Postoperative computed tomography and magnetic resonance imaging revealed sufficient decompression of the surgical segment. At the final follow-up, the internal implants were well-placed, the lamina-ligamentum flavum complex showed no significant displacement, and neurological functional recovery was satisfactory. CONCLUSION: Surgical treatment of TOLF is complicated and high-risk. Characterized by simplicity and sufficient decompression, modified expansive thoracic laminoplasty can reduce the risk of cerebrospinal fluid leakage and nerve injury with satisfactory neurological functional recovery.

[Efficacy evaluation of percutaneous vertebroplasty via an extra-pedicular approach for osteoporotic compression fracture].

OBJECTIVE: To evaluate the effects of relieving pains and restoring vertebral heights of percutaneous balloon kyphoplasty by extra-pedicular approach as a minimally invasive treatment in patients with painful osteoporotic vertebral compressive fractures (OVCF). METHODS: A retrospective analysis was conducted for 96 consecutive patients. There were 64 females and 32 males with a mean age 67 years (range: 55 - 82). Symptomatic levels were identified by correlating their clinical presentations with the findings of magnetic resonance imaging (MRI). The interval between onset of symptoms and surgical intervention ranged from 2 days to 4 months. A total of 118 levels (56 thoracic, 62 lumbar) were treated in this cohort. Immediate and postoperative 3-month follow-up visits were conducted. Visual analog scale (VAS) pain scores, preoperative and postoperative anterior, midline vertebral heights for fractured vertebrae were measured on lateral radiographs to evaluate the procedural outcomes. RESULTS: There was swift pain relief associated with evident augmentation in weight-bearing resistance. Pain decreased from 8.1 to 2.1 points. Through kyphoplasty, the anterior, midline vertebral heights of 118 fractured vertebral bodies increased up to (75.83 ± 19.84)% and (71.23 ± 21.45)% respectively. None of them had worsening of fracture-induced narrowing of spinal canal. No device-related major complications occurred. CONCLUSION: Percutaneous kyphoplasty through an extra-pedicular approach results in immediate clinical improvement of mobility and pain relief. It safely increases vertebral body height and quickly returns geriatric patients to higher activity levels, increased independence and better quality-of-life. And its short-term outcomes are excellent.

[Posterior interbody fusion versus improved transforaminal lumbar interbody fusion in segmental spinal fixation for aged spondylolisthesis with lumbar spinal canal stenosis].

OBJECTIVE: To assess the clinical and radiographic outcomes of posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis so as to address the suitability of a dynamic stabilization. METHODS: A total of 28 consecutive patients underwent posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis. Among them, 13 patients underwent posterior interface fusion (PLIF) and pedicle screw fixation. And improved transforaminal lumbar interbody fusion (ITLIF) and placement of the same system were performed in 15 patients. Their clinical, economic, functional, and radiographic data were recorded both pre- and postoperatively. RESULTS: The average changes of economic and functional scores on the Prolo scale were 1.36 and 1.48 respectively. In patients with posterior interbody fusion; the average preoperative vertebral slippage was 46.9% (range: 25 - 75%) versus 14.6% (range: 15 - 25%) postoperatively. In patients with ITLIF, the average changes in economic and functional scores were 1.75 and 1.63 respectively. And the average preoperative vertebral slippage was 45.2% (range: 28 - 78%) compared with 26.3% (range: 14 - 28%) postoperatively. When two fusion techniques were compared, an overall superior reliability and resistance of systems was associated with the ITLIF procedure. But their clinical outcomes did not differ greatly (P > 0.05). CONCLUSIONS: The application of a segmental pedicle screw fixation is both feasible and efficacious.

[Surgical treatment of postoperative deep wound infection after posterior lumbar interlumbar fusion of the lumbar stenosis].

OBJECTIVE: To study surgical treatment for the deep wound infections after the operation of posterior lumbar interlumbar fusion (PLIF) in lumbar spinal stenosis. METHODS: From December 2005 to December 2010,10 patients with the deep wound infection of the PLIF were analyzed retrospectively, including 4 males and 6 females, with a mean age of 52.8 years (ranged from 34 to 70 years). All the patients were treated with debridement and the drainage. The sensitive antibiotics were used. The VAS score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and JOA lumbar score were used to compare the clinical results pre-and post-operation. RESULTS: All the patients were followed up, and the mean duration was 24 months (ranged from 19 to 28 months). One patient developed to an intervertebral space infection and the cage was removed. One patient suffered a radical central nerve system infection and died after the debridement. Other 8 patients got a good clinical result. The VAS score decreased from preoperative 8.0 +/- 0.4 to postoperative 2.8 +/- 0.3; JOA score improved from preoperative 10.30 +/- 3.02 to postoperative 24.10 +/- 2.85; ESR decreased from preoperative (85.0 +/- 17.0) mm/h to postoperative (14.0 +/- 6.0) mm/h; both CRP and WBC decreased from preoperative (73.5 +/- 14.3) mg/L, (11.1 +/- 1.8) x 10(9)/L to postoperative (5.1 +/- 1.1) mg/L, (7.4 +/- 0.5) x 10(9)/L respectively. CONCLUSION: Treatment of patients with deep wound infections after PLIF with debridement, drainage, and sensitive antibiotics could get a good long-term clinical result, which is important to treat the patients with high-risk factors. Early diagnosis and operation is the key to deal with the patients with deep wound infections after PLIF.

[Comparison between bipedicular approach and uni-extrapedicular approach in application of vertebroplasty].

OBJECTIVE: To analyze the advantages and disadvantages of bipedicular approach and uni-extrapedicular approach of vertebroplasty in treating osteoporotic vertebral compression fractures (OVCFs). METHODS: From January 2008 to December 2010,53 patients with OVCFs were retrospectively analyzed. There were 24 males, 30 females with an average age of 66.9 years (ranged,59 to 88 years). Among them, 26 cases were treated with bipedicular approach, 28 cases were treated with uni-extrapedicular approach. The data of bone cement injection, radiology exposure times, operation time, bone cement leakage and vessels nerve complications were observed. Cobb angle, vertebral compression ration were observed by imaging data, and evaluate recovery of deformity. RESULTS: The data of bone cement injection, radiology exposure times, operation time, VAS score were (6.6 +/- 0.8) ml and (6.8 +/- 1.5) ml, (21.7 +/- 4.0) times and (17.9 +/- 3.6) times, (40.5 +/- 5.5) min and (31.6 +/- 9.1) min, (2.8 +/- 0.6) scores and (3.1 +/- 0.5) scores respectively. Cobb angle,vertebral compression ration were (7.6 +/- 2.0) degrees and (6.9 +/- 2.6) degrees, (18.1 +/- 5.8)% and (16.5 +/- 6.1)%. There were no vascular nerve complications occurred. For bone cement leakage, 3 cases (11%) in bipedicular approach and 3 cases (11%)in uni-extrapedicular approach. There was no significant differences between two groups in VAS score, recovery of vetebral body, Cobb angle, bone cement injection and bone cement leakage, but had significant differences in radiology exposure times and operation time (P<0.05). CONCLUSION: Both of two approaches can treat OVCFs well, especially extropedicle approach which could reduce operation time and radiation shoot frequency.

[Treatment of upper cervical spine instability with posterior fusion plus atlantoaxial pedicle screw].

OBJECTIVE: To evaluate the clinical efficacies, indications and application values of posterior fusion plus pedicle screw fixation in the treatment of upper cervical spine instability. METHODS: From May 2006 to December 2010, a total of 24 patients with atlantoaxial instability were treated with C1-2 pedicle screws and rod fixation under general anesthesia. There were 18 males and 6 females with a mean age of 49.8 years old (range: 17 - 69). RESULTS: The postoperative radiographs verified a good position of all screws with satisfactory atlantoaxial reduction. A mean follow-up period of 23 months (range: 3 - 45) showed no injury of spinal cord and vertebral artery or inter fixation failure. Atlantoaxial alignment and stability were restored without instrumentation-related complications. CONCLUSION: Posterior atlantoaxial pedicle screw and rod fixation provide immediate three-dimensional rigid fixation of atlantoaxial joint. It is a more effective technique than with previously reported techniques.