ObjectiveTo summarize the research progress of ureteral injury in oblique lumbar interbody fusion (OLIF).MethodsThe literature about incidence, clinical manifestations, diagnosis, and treatment of ureteral injury complications in OLIF was reviewed.ResultsOLIF surgery poses a risk of ureteral injury because its surgical approach is anatomically adjacent to the left ureter. Ureteral injuries in OLIF are often insidious and have no specific clinical manifestations. CT urography is a common diagnostic method. The treatment of ureteral injury depends on a variety of factors such as the time of diagnosis, the location and degree of injury, and the treatment methods range from endoscopic treatment to replacement reconstruction.ConclusionSurgeons should pay attention not to damage the ureter and find the abnormality in time during OLIF. High vigilance of abnormalities is conducive to the early diagnosis of ureteral injury. Furthermore, it is important to be familiar with ureter anatomy and gentle operation to prevent ureteral injury.
Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
【Abstract】 Objective To discuss the main points of techniques and ranges of fusion in posterior operation ofdegenerated lumbar scol iosis compl icated spinal stenosis. Methods From February 2001 to September 2006, 23 cases with degenerated lumbar scol iosis stenosis were treated by posterior operation. There were 9 males and 14 females, with the average age of 65.3 years (ranging from 52 years to 71 years). The course of the diseases was 4 to 8 years. All patients were presented with severe low back pain. All patients were measured for Cobb angle of curves(17° to 53°), and lordosis angle of lumbar (-20° to -10° 10 cases, -40° to -20° 13 cases). Ten cases in which Cobb angle was smaller than 20° were operated by l imited segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation. For the rest 13 cases in which Cobb angle was bigger than 20° were operated by canal decompression, longer instrument for scol iosis correction, intervertebral fusion and posterior-lateral fusion. The fixation and fusion were located at L4-S1 in 6 cases, L1-5 in 5, L2-5 in 4, L1-S1 in 5, L2-S1 in 2 and T10-S1 in 1. Results There was no patient who died from the operation. Average Cobb angle in coronal plane was 0° to 21° with the average of 15.6°. The lumbar lordosis angle was -48.0° to -18.2° with the average of -36.4°. There were 21 cases (91%) with sciatica and intermittent claudication who were clearly released. There were 20 cases (87%) whose low back pain intensely decreased. Three cases with drop-foot returned to normal activities. During the mean 15-month (6 to 54 months) follow-up for 23 cases, there was no change of corrected results and fusion rate was 100%. Conclusion For degenerated lumbar scol iosis patients, the most important purpose of the treatment is to improve cl inical symptoms through sufficient decompression of neural structures. Lumbar stabil ization reconstruction and benign spinal biomechanics l ine conduce to longterm curative effect. Overall estimate of the cl inical appearances and imageology characters is necessary when the decision, that segments are needed to be fixed and fused should be made. The strategy of the individual ized treatment may be the best choice.
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
ObjectiveTo explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation.
MethodsBetween January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up.
ResultsIncision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05).
ConclusionPercutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.
Objective To evaluate the cl inical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with il iac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, il iac autograft, Z-plate internal fixation with il iac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared betweenpreoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 ± 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 ± 2.5)°, the vertebral canal sagittal diameter of L4 was (10.6 ± 3.5) mm. The bone graft volume was (7.5 ± 1.3) cm3 during operation. Results Operations were performed successfully. The mean operative time was (142 ± 25) minutes and the mean amount of blood loss was (436 ± 39) mL. The incisions obtained heal ing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 ± 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 ± 3.7)°, and the vertebral canal sagittal diameter of L4 was (19.8 ± 5.1) mm, showing significant difference when compared with those of preoperation (P lt; 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Cl inical outcomes of anterior surgery for fourth lumbar burst fractures with il iac fenestration are satisfactory. It can facil icate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
ObjectiveTo study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone. Methods The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L1-L5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L5 without a clear travel and with an emanation angel less than 90° were calculated. Results Except for the differences in the vascular emanation angles between L4 and L5, the vascular travel angles between L1, L2 and L4, L5, and the length of vessels in the lateral segments of the vertebral body among L1-L4 were not significant (P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant (P<0.05). There was no significant difference in the distance between vessels of L1, L2 and L2, L3 at Moro Ⅰ-Ⅳ junctions (P>0.05), in L3, L4 and L4, L5 at Ⅱ and Ⅲ junction (P>0.05). There was no significant difference in the vascular distance of L2, L3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L3, L4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction (P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions (P<0.05). Except that there was no significant difference in the distance between L2I and L3S at Ⅰ, Ⅱ junction, L3I and L4S at Ⅱ, Ⅲ junction, and L2I and L3S at Ⅲ, Ⅳ junction (P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments (P<0.05). Comparison between junctions: Except for the L3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference (P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions (P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L1 (41.12%, 44/107) and L5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L1 and L2 were found in the channel of zone Ⅲ (χ2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L5 were less than 90°. Conclusion L1 and L5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L1, 2 (Ⅰ, Ⅱ junction), L3, 4 (Ⅲ, Ⅳ junction), and L4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).
ObjectiveTo review the effect of obesity on the effectiveness of posterior lumbar fusion in patients with lumbar degenerative diseases (LDD).MethodsThe related literature at home and abroad was extensively reviewed. And the difficulty of operation, risk of complications, and long-term effectiveness of posterior lumbar fusion for obese patients with LDD were summarized.ResultsAlthough some relevant literature suggest that the posterior lumbar fusion for obese patients is difficult and the risk of postoperative complications is high, the overall research results do not suggest that obesity is a risk factor for the implementation of posterior lumbar fusion. By assessing the physical condition of patients and strictly grasping the surgical indications, obese patients can obtain good surgical efficacy.ConclusionPosterior lumbar fusion is an effective method for the treatment of LDD in obese patients. However, relevant studies need to be completed to further evaluate the safety and efficacy of posterior lumbar fusion for obese patients.
Objective To review the current development of the dynamic stabilization devices and their biomechanics as well as clinical application.Methods The related biomedical research papers at home and abroad were consulted and analyzed Results There were obvious advances in the theoretic foundation and the clinical application in treatment of the degenerative lumbar disorders with the dynamic stabilization devices, especially with the nonfusion dynamic stabilization devices. Conclusion The effectiveness of the dynamic stabilization devices have attracted more and more biomedical researchers, especially the posterior dynamic stabilization device, which has provided a new approach to treatment of the degenerative lumbar disorders.
