[Analysis of clinical efficacy of C3 expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome].

OBJECTIVE: To explore the clinical efficacy of C3 expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome. METHODS: The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C3 expanded half lamina excision combined with C4-C7 unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C3-C7 unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C5 nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C3 (including intervertebral disc levels of C3, 4). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups. RESULTS: All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (P>0.05). There was no significant difference in intraoperative blood loss and C5 nerve root palsy between the two groups (P>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (P<0.05). Preoperative and postoperative space available for the spinal cord of C3 was (93.61±9.02) mm3 and (153.50±12.76) mm3 respectively, which was obtained obvious improvement in all patients(P<0.05). At the final follow up, JOA scores of improved group and traditional group were 14.36±1.70 and 14.03±1.82 respectively, and NDI scores were 10.36±2.55 and 12.47±3.46 respectively, there was significant difference between two groups (P<0.05). However, there was no significant difference between two groups for the improvement rate (68.36±0.12)%VS (65.01±0.12)%of neurological function(P>0.05). CONCLUSION: C3 expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.

[The value of diffusion tensor imaging and fiber tractography in cervical spondylotic myelopathy].

OBJECTIVE: To study the diagnostic value of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy. METHODS: Twenty healthy volunteers and fifty patients with cervical spondylotic myelopathy underwent DTI in the Affiliated Hospital of Medical College of Ningbo University from January 2014 to April 2015. Healthy volunteers served as controls. Fifty patients were divided into three groups (group A , B, C) according to cervical MRI scan standard. Group A (17 cases) had only the dura mater spinalis compressed; Group B (23 cases) showed the cervical spinal cord compressed, but no high signal in it; Group C (10 cases) had the cervical spinal cord compressed with high signal in the same level. The average apparent diffusion coefficients(ADC) and fractional anisotropy (FA)values in these examinee were analyzed and all subjects were performed fiber tracking. RESULTS: There was no statistically significant differences in ADC and FA values in C2/C3, C3/C4, C4/C5, C5/C6, C6/C7 of control group (P>0.05). The average ADC and FA values in control group were (0.875 +/- 0.096) x10(3) mm2/s and 0.720 +/- 0.051, respectively; compared with group A,there was no statistically significant difference; compared with group B and C, there was significant difference; comparison among group A, B, C, there was significant differences. CONCLUSION: DTI can early and accurately quantify the changes of microstructure in cervical spondylotic myelopathy. Fiber tracking can show the damage range of spinal cord lesions.

[Unilateral pedicle screw fixation and intervertebral fusion for the treatment of far lateral lumbar disc herniation].

OBJECTIVE: To explore the feasibility and clinical efficacy of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion (TLIF) for the treatment of far lateral lumbar disc herniation. METHODS: From January 2007 to January 2011, 18 patients with far lateral lumbar disc herniation underwent a unilateral TLIF procedure in conjunction with posterior unilateral pedicle screw fixation. There were 13 males and 5 females,ranging in age from 42 to 73 years (means 58.5 years). All cases had single segment involved 5 cases in L3, 4, 10 cases in L4,5,3 cases in LSS. The visual analog scale (VAS) of low back pain and leg pain and Oswestry Disability Index scores were observed in postoperative and followed-up period, and compared with preoperative. RESULTS: The operation of 18 patients was successful,there were no severe complication. The average operative time was 105 min (85 to 125 min), the average amount of blood loss was 145 ml (90 to 340 ml). During the followed-up, the visual analog scale and Oswestry disability index scores were significant improved compared with preoperative (P < 0.05). All patients were followed up from 12 to 48 months with an average of 23 months, there was no implant break and displacement in postoperative X-ray. CONCLUSION: The surgical procedure of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion had the advantage including less invasion, quickly recovery, short operative time, and saving fixation cost, it may provide an alternative treatment for patients with far lateral lumbar disc herniation.

[Clinical study of open vertebroplasty in treating thoracolumbar metastatic tumor].

OBJECTIVE: To explore the clinical application and therapeutic effect of open vertebroplasty for thoracolumbar metastatic tumor. METHODS: From September 2003 to December 2009, 21 patients with thoracolumbar metastatic tumor underwent the surgical procedure of posterior spinal cord decompression and open vertebroplasty combined with short-segmental pedicle screw fixation during the same intervention. There were 14 males and 7 females, ranging in age from 48 to 73 years with the mean of 59.5 years and ranging in course of disease from 1 to 4 months with an average of 2.5 months. The primary focus of the tumor of 19 cases were established, lung carcinoma was in 8 cases, breast cancer in 4 cases, prostate carcinoma in 4 cases, hepatocarcinoma in 2 cases and thyroid carcinoma in 1 case. The primary focus of 2 cases could not be established. The spinal function according to Frankel grade, grade B was in 4 cases, C in 6, D in 5, E in 6. The lumbar-back pain, height of anterior and posterior vertebral body, Cobb angle and spinal function were recorded before and after operation. RESULTS: The operation of all patients was successful, there were no severe complications and aggravation of spinal function. The VAS score of lumbar-back pain decreased from 8.78 +/- 0.45 preoperatively to 2.25 +/- 0.36 postoperatively. Among 16 cases combined with pathological fracture, the height of anterior spinal vertebral body increased from (12.7 +/- 2.1) mm preoperatively to (19.5 +/- 3.9) mm postoperatively; the height of posterior spinal vertebral body increased from (14.1 +/- 1.8) mm preoperatively to (20.3 +/- 2.3) mm postoperatively; Cobb angle decreased from (26.0 +/- 8.9) degrees preoperatively to (6.0 +/- 0.9) degrees postoperatively. There was significant difference above items between before and after operation (P < 0.05). The spinal function according to Frankel grade at final follow up, grade C was in 2 cases, D in 4, E in 15. All patients were followed up from 5 to 28 months with an average of 14 months, there was no loosening and breakage of internal fixity, 15 cases died during follow-up period. CONCLUSION: The surgical intervention can effectively preserve spinal instability and alleviate the spinal cord symptoms, improve the life quality of patients. It may provide an alternative treatment for patients in poor general health and shorter life expectancy.