[Application of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery].

OBJECTIVE: To explore the safety, effectiveness and consistency of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery. METHODS: From March 2016 to October 2018, 21 patients with cervical spondylotic radiculopathy were enrolled. Endoscopic foraminotomy and nucleus pulposus enucleation were performed in the patients. There were 13 males and 8 females, aged from 35 to 56 years old with an average of (47.3±5.1) years. The surgical segment of 6 cases were C4,5, 10 cases were C5,6 and 5 cases were C6,7. The "Zoning Method" was proposed and used to complete the foraminotomy under endoscope, and then to perform nucleus pulposus removal and nerve root decompression. The operation length, intraoperative bleeding volume and complications were recorded, and NDI, VAS were evaluated before operation, 1 day after the operation and 1 week after the operation. RESULTS: All the operations were successful. The operation length was(46.10±26.39) min, intraoperative bleeding volume was (50.10±18.25) ml, and there were no complications such as nerve injury, dural tear or vertebral artery injury. All 21 patients were followed up for 3 to 9 months, with a median of 6 months. Postoperative VAS and NDI were obvious improved (P<0.05);there was significant difference in VAS between postoperative 1 d and 1 week(P<0.05);and there was no significant difference in NDI between postoperative 1 d and 1 week (P>0.05). CONCLUSION: Endoscopic foraminotomy with "Zoning Method" is safe clinically significant, and consistent.

[Double-door laminoplasty combined with C2 dome decompression for the treatment of cervical spinal stenosis].

OBJECTIVE: To investigate the clinical effect of double-door laminoplasty combined with C2 dome decompression in treatment of cervical spinal stenosis. METHODS: The clinical data of 28 patients with cervical spinal stenosis who underwent double-door laminoplasty combined with C2 dome decompression from June 2016 to June 2018 were retrospectively analyzed, including 17 males and 11 females, aged 39 to 74 years with an average of (61.0±6.7) years. The clinical effects were evaluated by JOA score, axial symptoms, cervical spine activity, cervical spinal cord compression degree and so on. RESULTS: All patients were followed up for 6 to12 months with an average of 10.2 months. The JOA score in the final follow-up was significantly improved (P<0.05). The range of cervical activity before and after surgery was respectively (41.8±15.3) °, (36.3±18.2) °, and there was no significant difference (P>0.05). After operation, sagittal diameter at the narrowest level of C2-C3 spinal canal was (16.20±1.82) mm, which was significantly higher than (8.38±1.16) mm before operation (P<0.05). There were 4 cases with axial symptoms in 24 patients with the incidence rate of 14.29% (4/24). CONCLUSION: Double-door laminoplasty combined with C2 dome decompression can directly expand the volume of C2-C3 spinal canal, relieve the compression of spinal cord and nerve root, reduce the damage to the posterior cervical ligament complex as much as possible, maintain the stability of cervical spine sequence, reduce the occurrence of axial symptoms, and the operation is relatively simple, without the need of metal internal fixation.

[Correlation analysis on plasma D-dimer level with deep venous thrombosis after spinal surgery].

OBJECTIVE: To analyze the relation of plasma D-dimer levels and incidence of deep venous thrombosis after spinal surgery. METHODS: The clinical data of 63 patients underwent spinal surgery from October 2009 to October 2010 were retrospective analyzed. There were 40 males and 23 females with an average age of 48 years old(21 to 76) in operation. Operation levels of 15 cases were in cervical vertebrae, 4 cases were in thoracic vertebrae,and 44 cases were in lumbar vertebrae. Thirty patients with spinal fracture were caused by trauma and 33 patients without trauma, 11 patients combined with nerve injury. The patients were divided into two groups according to plasma D-dimer levels, more than or equal to 500 microg/L was D-dimer positive group and less than 500 microg/L was D-dimer negative group. Venous blood of all patients early morning with empty stomach were testd on admission, and at 2 h, 1 d, 2 d, 3 d, 4 d, 6 d, 8 d, 10 d, 15 d after operation,respectively. RESULTS: There was no statistically significant differences in sex, operative segments, implants, operative posture, age, bleed volume, body weight, peroperative D-dimer levels between two groups. After operation, plasma D-dimer of 19 patients were more than or equal to 500 microg/L, with persistent or progressive increasing. Two cases occurred deep venous thrombosis in D-dimer positive group, they respectively were found at 3 days and 8 days after operation. Both of them underwent posterior decompression and internal fixation. However,no deep venous thrombosis was found in D-dimer negative group. CONCLUSION: Postoperative D-dimer assay can effective predict deep venous thrombosis occurrence. D-dimer level more than or equal to 500 microg/L will be considered as a risk factor for deep venous thrombosis after spinal surgery.