ObjectiveTo compare the effectiveness and radiological changes between KMC interspinous dynamic reconstruction and Coflex for degenerative lumbar spinal disorders and evaluate the clinical outcome of the KMC interspinous dynamic internal fixation for degenerative lumbar spinal disorders.
MethodsA randomized controlled double-blind trial was conducted. Thirty-three patients with degenerative lumbar spinal disorders were divided into 2 groups between May 2011 and July 2012, 19 patients received Coflex treatment (group A), and 14 patients received KMC (group B). Single Coflex or KMC fixation was used. There was no significant difference in age, gender, disease duration, affected segment, and disease diagnosis between 2 groups (P>0.05). The Oswestry disability index (ODI) score and visual analogue scale (VAS) score were used to evaluate the effectiveness. The anterior disc height, middle disc height, posterior disc height, and foramen intervertebral height and width of operated segment were measured and compared between at preoperation and last follow-up on the X-ray films. Range of motion (ROM) of operated segment and adjacent segment was measured.
ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative recovery time, and hospitalization time between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 16.2 months) in group A and 12-26 months (mean, 17.9 months) in group B. No shift, loosening, or breaking of internal fixation occurred. The ODI score and VAS score were significantly decreased at last follow-up when compared with preoperative scores (P<0.05); there was no significant difference in the ODI score and VAS score at preoperation and last follow-up, and in improvement rate at last follow-up between 2 groups (P>0.05). The middle disc height and posterior disc height, and foramen intervertebral height and width were significantly increased when compared with preoperative ones (P<0.05), while there was no significant difference in anterior disc height (P>0.05). At last follow-up, ROM of the operated segments was significantly improved when compared with preoperative one in 2 groups (P<0.05), but no significant difference was found at the upper adjacent level (P>0.05). There was no significant difference in ROM of the operated segment and upper adjacent segment between 2 groups at preoperation and last follow-up (P>0.05).
ConclusionThe early effectiveness is satisfactory to treat degeneration lumbar spinal disorders with KMC interspinous dynamic internal fixation.
Objective
To explore the relationship between imbalance in sagittal plane as well as structural factors and lumbar degenerative disease.
Methods
Patients diagnosed between July 2012 and May 2015 were divided into 4 groups according to corresponding diagnostic criteria: lumbar disc herniation group (LDH), lumbar disc protrusion group (LDP), degenerative lumbar spondylisthesis group (DLS) and nonspecific low back pain group (NLBP); 40 patients were included in each group according to their visiting time. All patients underwent X-ray, CT, and MRI. Sagittal parameters and evaluate degeneration level of structural factors were measured, and the difference among the groups were analyzed.
Results
There was statistical significance in differences of pelvic incidence (PI) and lumbar lordosis (LL) among 4 groups (P<0.05). Average PI was followed in descending order: DLS, LDP, NLBP, and LDH; average LL was followed in descending order: DLS, NLBP, LDP, and LDH. There was no statistical differences in sacral slope and pelvic tilting among 4 groups (P>0.05). The difference in the level of lumbar disc degeneration between NLBP group (which had slightest lumbar disc degeneration) and the other groups was significant (P<0.001) while no statistical differences in level and rate of lumbar disc degeneration among the other three groups was found (P>0.05). As to the level of lumbar zygapophyseal joint degeneration, there was statistical differences between NLBP group (which had the lowest level of lumbar zygapophyseal joint degeneration) and the other groups (P<0.001) while no statistical differences in the grade of lumbar zygapophyseal joint degeneration among the other three groups (P>0.05). There was statistical differences in the rate of lumbar zygapophyseal joint degeneration between LDH and DLS group (χ2=11.429,P=0.001).
Conclusions
Vertical lunbar spine is combined with LDH of which the level of lumbar zygapophyseal joint degeneration is minimized, while crooked lunbar spine is combined with DLS of which the level of lumbar zygapophyseal joint degeneration is maximization. NLBP has the lowest level of degeneration of lumbar disc and lumbar zygapophyseal joint degeneration.
Objective
To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury.
Methods
A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated.
Results
All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups.
Conclusion
Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.
Objective To review the feature, biomechanics, and cl inical appl ication of percutaneous 360 degree axial lumbar interbody fusion (AxiaLIF) technique. Methods Recent l iterature on investigation and appl ication of percutaneous360 degree AxiaLIF technique was reviewed. Results Percutaneous 360 degree AxiaLIF technique mainly contained operative approach, axial technique, and posterior fixation. It was obviously different from other lumbar interbody fusion techniques due to its capabil ity of maintaining the integrity of the bilateral facet joints, the anterior/posterior longitudinal l igament, and the annulus fibrosus. Three-dimensional AxiaLIF RodTM provided axial support and firmly fixation, thereby rel ieving stenosis of lumbar intervertebral foramen and restoring the intervertebral disc height and the whole height and physiological curvature of the lumbar spine. The recovery of the intervertebral disc height could restore the folded or crumpled flavum, the posterior longitudinal l igament, and the herniated annulus, resulting in the improvement of stenosis symptoms of nerve root canal or central vertebral canal. Conclusion Percutaneous 360 degree AxiaLIF technique achieves satisfying therapeutic effects, although it has fairly narrow indication and needs long-term follow-up observation.
【摘要】 目的 觀察鹽酸氨基葡萄糖治療腰椎關節突關節骨性關節炎（lumbar zygapophyseal joint osteoarthritis，LZOA）的臨床療效及安全性。 方法 2009年1月-2010年1月，對90例LZOA患者隨機分成治療組和對照組，各45例。治療組口服鹽酸氨基葡萄糖，6周為1個療程，治療3個療程，前2周均加用洛索洛芬鈉；對照組患者僅給予洛索洛芬鈉口服12周。比較兩組治療后2、6周及3、6、12個月的療效及安全性。 結果 治療后6周、3個月，治療組與對照組癥狀均明顯改善，對照組改善更明顯。治療6個月后，治療組評分持續下降，到12個月時與治療前比較差異有統計學意義（Plt;0.01）；而對照組評分則逐漸增高，到12個月時與其治療前比較差異無統計學意義（Pgt;0.05）。兩組的不良反應率分別為6.67%、15.56%，差異有統計學意義（Plt;0.01）。 結論 鹽酸氨基葡萄糖治療LZOA療效確切，且安全性良好。【Abstract】 Objective To observe the clinical efficacy and safety of glucosamine hydrochloride on lumbar zygapophyseal joint osteoarthritis (LZOA). Methods From January 2009 to January 2010, 90 patients with LZOA were randomly divided into therapeutic group and comparative group, with 45 patients in each group. Patients in therapeutic group were treated with oral administration of glucosamine hydrochloride for 3 courses (6 weeks for one course; adding loxoprofen for the early 2 weeks). Patients in comparative group were treated with oral administration of loxoprofen for 12 weeks. The efficacy and safety between the two groups was compared. Results Symptoms in both group were relieved after 6-week and 3-month treatment. More obvious relief was observed in the comparative group. The scoring of therapeutic group kept decreasing after 6-month treatment. The efficacy showed significant improvement after 12-month treatment compared with which before the treatment was significant（Plt;0.01）. The scoring in comparative group kept increasing, which showed no significant difference after 12-month treatment（Pgt;0.05）. The adverse effect rate was 6.67% and 15.56% respectively in two groups, which was significant different（Plt;0.01）. Conclusions Glucosamine hydrochloride provides good efficacy and safety for patients with LZOA.
The lumbar intervertebral disc exhibits a complex physiological structure with interactions between various segments, and its components are extremely complex. The material properties of different components in the lumbar intervertebral disc, especially the water content (undergoing dynamic change as influenced by age, degeneration, mechanical loading, and proteoglycan content) - critically determine its mechanical properties. When the lumbar intervertebral disc is under continuous pressure, water seeps out, and after the pressure is removed, water re-infiltrates. This dynamic fluid exchange process directly affects the mechanical properties of the lumbar intervertebral disc, while previous isotropic modeling methods have been unable to accurately reflect such solid-liquid phase behaviors. To explore the load-bearing mechanism of the lumbar intervertebral disc and establish a more realistic mechanical model of the lumbar intervertebral disc, this study developed a solid-liquid biphasic, fiber-reinforced finite element model. This model was used to simulate the four movements of the human lumbar spine in daily life, namely flexion, extension, axial rotation, and lateral bending. The fluid pressure, effective solid stress, and liquid pressure-bearing ratio of the annulus fibrosus and nucleus pulposus of different lumbar intervertebral discs were compared and analyzed under the movements. Under all the movements, the fluid pressure distribution was closer to the nucleus pulposus, while the effective solid stress distribution was more concentrated in the outer annulus fibrosus. In terms of fluid pressure, the maximum fluid pressure of the lumbar intervertebral disc during lateral bending was 1.95 MPa, significantly higher than the maximum fluid pressure under other movements. Meanwhile, the maximum effective solid stress of the lumbar intervertebral disc during flexion was 2.43 MPa, markedly higher than the maximum effective solid stress under other movements. Overall, the liquid pressure-bearing ratio under axial rotation was smaller than that under other movements. Based on the solid-liquid biphasic modeling method, this study more accurately revealed the dominant role of the liquid phase in the daily load-bearing process of the lumbar intervertebral disc and the solid-phase mechanical mechanism of the annulus fibrosus load-bearing, and more effectively predicted the solid-liquid phase co-load-bearing mechanism of the lumbar intervertebral disc in daily life.
ObjectiveTo evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.MethodsBetween May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T11 in 4 cases, T12 in 9 cases, L1 in 11 cases, L2 in 10 cases, L3 in 3 cases, and L4 in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.ResultsAll operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation (P<0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week (P<0.05); there was no significant difference between 3 months and last follow-up (P>0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively (P<0.05), and no significant difference was found between the different time points after operation (P>0.05).ConclusionPercutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.
