Comparative Study of Three Minimally Invasive Surgical Approaches for the Treatment of L5/S1 Lumbar Intervertebral Disc Herniation.

AIM: To compare the efficacy and safety of minimally endoscopic discectomy (MED), percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of L5/S1 lumbar disc herniation (LDH). MATERIAL AND METHODS: From May 2012 to January 2017, 317 patients with L5/S1 LDH treated with MED, PETD or PEID were reviewed. Pre- and postoperative pain was measured using a visual analog scale (VAS; 0 ?10), and functional status was assessed using the Oswestry Disability Index (ODI; 0 ? 100%). Clinical outcomes, SF-36 scores and CK levels were compared between the 3 groups. RESULTS: There were 177 females and 140 males; the ages ranged from 22 to 74 years; and the course of disease was 15 to 85 days, with an average of 42.8 days. The postoperative bed rest time and average hospital stay in the MED group were higher than in the other two groups, and the differences were statistically significant. There was no significant difference in the results evaluated by the MacNab criteria. There were no significant differences in the levels of CK between the three groups before and after surgery (p > 0.05). CONCLUSION: Three minimally invasive surgeries for the treatment of L5/S1 LDH achieved satisfactory clinical outcomes; however, each procedure has its own advantages, disadvantages and indications. Surgeons need to choose the most appropriate surgery according to the individual condition of the patient to achieve the best therapeutic effect.

Self-Locking Stand-Alone Cage Used from Opposite Approach for the Treatment of Adjacent Segment Disease After an Anterior Cervical Corpectomy and Fusion.

AIM: To investigate the efficacy and safety of the self-locking stand-alone cage used from opposite approach for the treatment of adjacent segment disease (ASD) after an anterior cervical corpectomy and fusion (ACCF). MATERIAL AND METHODS: In this study, we retrospectively analyzed the clinical data of 8 cases of ACCF in the treatment of ASD cervical spondylopathy. All patients received self-locking stand-alone cage treatment. At different time points, the clinical status was evaluated using the Japan Orthopedic Association (JOA) score, JOA recovery rate (RR), and Neck Disability index (NDI) score. X-ray measurements included C2-C7 Cobb angle, fusion segment angle (FSA), cervical vertebral bow depth (VBP), and height of surgical segment (HOS). Statistical imaging parameters of sagittal cervical spine. Bone graft fusion in all self-locking stand-alone cage segments was evaluated. RESULTS: All operations were successfully completed, and no infection, epidural hematoma, or rupture of the dura mater were observed in all patients. Compared with pre-operation, the JOA and NDI scores at 3 months and at the last follow-up were significantly improved (p < 0.05). The JOA recovery rate between the final follow-up and preoperatively was 64.8±5.2%. One patient had dysphagia postoperatively, but was resolved after 3 months. Three months after surgery, the sagittal radiographic outcomes improved significantly and were well maintained during the final follow-up. CONCLUSION: The self-locking stand-alone cage is a reliable and effective method used from the opposite approach for the treatment of ASD after ACCF in terms of JOA and NDI scores. The cervical alignment correction is considered satisfactory.

Anterior cervical discectomy with fusion and posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy: its postoperative stability / 中国组织工程研究

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Effects of Microscopic Anterior Cervical Approach in Cervical Spondylotic Diseases / 天津医药

Objective To assess the curative effect of microscopic anterior cervical approach in cervical spondylotic diseases. Methods A total of 75 patients were selected, who underwent microscopic subtotal anterior cervical decompres-sion and titanium mesh to fusion fixation or microscopic decompression of resection of the cervical intervertebral disc and cage implant fixation in Tianjin People's Hospital since October 2011 to October 2012. The Cervical vertebra gap involved 1 level in 41 cases, 2 levels in 30 cases and 3 levels in 4 cases. Pateints followed up regularly after operation. The nerve func-tion was assessed using Japanese orthopaedic association scoring system (JOA) function was calculated to examine the im-provement rate and to assess the curative effect of microscopic anterior cervical approach. Results All patients were fol-lowed up. The nerve function recovery was excellent in 44 cases, was well in 25 cases, was general in 6 cases, and the ex-cellent and well recovery rate was 92%. There was no significant difference between excellent recovery rate and well recov-ery rate. There were significant differences in values of each cervical levels between before and after surgery in the last fol-low-up of patients (P<0.05). Conclusion Microscopic operative treatment for cervical spondylotic is safe and effective, with less trauma and bleeding. After surgical decompression, the recovery is rapid in patients with early ambulation.

Hip arthroplasty and internal fixation for the repair of femoral neck fracture in the elderly patients:a meta-analysis of reoperation and complications / 中国组织工程研究

BACKGROUND:Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial. OBJECTIVE:To systematical y review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture. METHODS:Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized control ed trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Col aboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality. RESULTS AND CONCLUSION:Six published randomized control ed trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P<0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P<0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23;OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.

Two strengthening pedicle screw techniques and bone cement in lumbar internal fixation / 中国组织工程研究

BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect. OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis. METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group. RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.