ObjectiveTo investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial.MethodsTwenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation.ResultsThe time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021].ConclusionCompared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.
OBJECTIVE: To discuss the value of anterior operation in fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae. METHODS: From 1997, 21 patients with fracture-dislocation of connect of cervical vertebra and thoracic vertebrae were operated on. The interval between injury and operation was within 24 hours in 4 cases, 2-7 days in 9 cases, 8-14 days in 3 cases and within 4 weeks in 5 cases. The locations were C6,7 in 7 cases, C7 in 9 cases and T1 in 5 cases. The nerves function of spinal of all the cases have different degrees of injury. Classification of Frankel were the following: 3 cases of grade A, 6 cases of grade B, 9 cases of grade C, and 3 cases of grade D. The operative procedure included the following: anterior operation of cervical vertebrae; incision of most fracture vertebral body to decompress; transplantation of ilium bone grafting fusion; and internal fixation of anterior cervical vertebrae with locking-steel. RESULTS: In 21 patients, 1 died of accompanying by pulmonary infection; 20 were followed up 8 months to 3 years with an average of 21 months. All transplanted ilium had fused. The nerve function of spinal cord had recovered in different degrees(2 cases of grade A, 1 case of grade C, 9 cases of grade D and 8 cases of grade E); the turn of vertebral column was normal. No internal fixation failed. CONCLUSION: Anterior operation is a better way to treat fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae with easy operation, less complications, satisfactory reduction of fracture and good stability.
ObjectiveTo observe the clinical efficacy of lesion clearing, decompression and fusing, and fixation with single nail from the anterior way for thoracic vertebra tuberculosis.
MethodsFrom January 2008 to September 2011, 42 patients with thoracic vertebra tuberculosis were treated in our hospital. There were 28 males and 14 females with the age between 27 and 63 years old, averaging 45. The course of the disease ranged from 4 to 12 months, averaging 8 months. According to the affected parts and segments, there was 1 case of upper thoracic vertebrae involvement, 20 of inner thoracic spine, 21 of lower thoracic vertebrae, 9 of multiple segments, and 2 of multi-level noncontiguous tuberculosis. All patients accepted preoperative normal anti-tuberculosis drugs for 2 to 4 weeks. After confirming that the anti-tuberculosis treatment was effective, we cleared the lesion, fused by decompression at iliac crest bone graft sites and fixed by single nail from the anterior way. Postoperative regular follow-up was carried out. X ray film was used to detect the fusion, paralysis Frankel classification was adopted to evaluate the function recovery of patients, and visual analog pain score (VAS) was used to assess the relief of patients' symptoms.
ResultsAll incisions of the patients were healed by the first intention. There was no recurrence in the tuberculosis focus area. Follow-up was done in forty cases for 12 to 34 months, averaging 23 months. X-ray review showed that the bone graft area turned into osseous fusion in all patients with the fusion time ranging from 10 to 16 months, averaging 13 months. No nail bar system loose or fracture occurred. Paralyzed patients Frankel classification showed that there were 2 A-level, 3 B-level, 9 C-level, 25 D-level, and 3 E-level cases before operation. During the last follow-up, there were no A-level, 1 B-level, 5 C-level, 10 D-level, and 26 E-level cases. Local pain VAS score results showed that preoperative point was 7.82±1.03, and the final follow-up point was 0.52±0.31, with a significant difference (P<0.05).
ConclusionLesion clearing, fusion and single nail application from the anterior way is one of the reliable and efficient ways in thoracic vertebra tuberculosis surgery and the results are satisfying.
Objective To investegate the effectiveness of transarticular approach in treating thoracic spinal stenosis due to ossification of l igamentum flavum (OLF) and ossification of posterior longitudinal l igament (OPLL) at the samelevel. Methods A retrospective analysis was performed in 35 patients with single-level thoracic spinal stenosis of calcifiedl igament who accepted transarticular approaching operation between January 2006 and March 2008. There were 12 males and 23 females with an age range of 40-67 years (mean, 58.6 years), including 16 cases of thoracic OLF, 11 cases of thoracic OPLL, and 8 cases of thoracic OPLL and OLF. The disease duration was 8-48 months (mean, 16 months). The affected segments included T2, 3 in 4 cases, T3, 4 in 3 cases , T4, 5 in 1 case , T6, 7 in 3 cases , T7, 8 in 1 case , T8, 9 in 2 cases , T9, 10 in 5 cases , T10, 11 in 9 cases, and T11, 12 in 7 cases. CT and MRI were taken to definite the ossification position and the condition of thoracic spinal stenosis. The Japanese Orthopaedic Association (JOA) score was 6.1 ± 1.3 before operation. According to Otani scoring system, the results were excellent in 3 cases, good in 16 cases, fair in 11 cases, and poor in 5 cases. Results All operations were successful, and no nerve injury occurred. Allincisions healed at stage I. Cerebrospinal fluid leakage occurred in 5 cases, and recovered after symptomatic treatment. One case had epidural hematoma 6 hours after operation, and the muscle strength recovered after symptomatic treatment. All cases were followed up 1.5-2.6 years (mean, 2.1 years) and the symptoms were improved in different degrees; no neurological symptoms deteriorated and spinal instabil ity occurred. The JOA score had a significant recovery at 3 months (9.2 ± 1.8) and at last follow-up (9.6 ± 2.3) when compared with preoperative value (P lt; 0.05). At last follow-up, the rate of the cl inical improvement was 71.43% ± 18.20%. According to Otani scoring system at last follow-up, the results were excellent in 12 cases, good in 15 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 77.14%, showing significant difference when compared with preoperative value (u=2.711, P=0.007). Conclusion The transarticular approach in treating thoracic spinal stenosis of calcified l igament can obtain goodcl inical results. Moreover, extra attention should be paid to during operation so as to avoid catastrophic spinal cord injury.
ObjectiveTo explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.MethodsThe clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.ResultsAll patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).ConclusionPosterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.
ObjectiveTo compare the safety and accuracy of pedicle screw placement assisted by robot system with freehand pedicle screw placement in upper thoracic surgery.MethodsBetween December 2017 and December 2019, 39 cases with upper thoracic pedicle screw internal fixation were included in the study, including 19 cases in robot group (group A, robot assisted pedicle screw placement) and 20 cases in freehand group (group B, freehand pedicle screw placement). There were 104 screws implanted in group A and 108 screws in group B. There was no significant difference in age, gender composition, body mass index, disease type, number of screws implanted, and segmental distribution between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative drainage were recorded and compared between the two groups. CT scan was performed in all patients at 2 days after operation to evaluate the screw accuracy based on the Gertzbein-Robbins grading standard.ResultsThe operation time of group A was significantly longer than that in group B (t=2.759, P=0.009). There was no significant difference in intraoperative blood loss and postoperative drainage between the two groups (t=?0.796, P=0.431; t=?0.814, P=0.421). At 2 days after operation, according to Gertzbein-Robbins grading standard, the accuracy of pedicle screw implantation in group A were grade A in 94 screws, grade B in 9 screws, and grade C in 1 screw; and in group B were grade A in 72 screws, grade B in 26 screws, grade C in 9 screws, and grade D in 1 screw; the difference between the two groups was significant (Z=4.257, P=0.000). The accuracy rate of group A was 99.04%, and that of group B was 90.74%, showing significant difference (χ2=7.415, P=0.006).ConclusionCompared with traditional freehand pedicle screw placement, robot-assisted pedicle screw placement significantly improves the accuracy and safety of screw placement without increasing the bleeding and postoperative drainage.
Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.
