Objective To compare the curative effect of posterior lumbar interbody fusion with autologous il iac crest to that of interbody fusion cage for adult instabil ity of lower lumbar. Methods From February 2003 to October 2006,60 inpatients with lower lumbar instabil ity were treated. Patients were randomized into 2 groups: bone-graft group (n=28) was treated with posterior lumbar interbody fusion with two autologous il iac crests, while cage group (n=32) was treated with posterior lumbar interbody fusion with two quadrate cages. In the bone-graft group, 17 males and 11 females aged (52.78 ± 10.50) years with 3-16 months of disease course, there were 12 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 1 case of L3,4, 17 cases of L4,5 and 10 cases of L5, S1. Relative disc space height was (23.24 ± 6.62) mm, disc space activity was (10.50 ± 5.07)o, sagittal saw sl ippage distance was (4.50 ± 1.15) mm and the JOA score was 18.56 ± 2.68. In the cage group, 19 males and 13 females aged (51.75 ± 10.44) years with 3.5-14.0 months of disease course, there were 16 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 16 cases of L4,5 and 16 cases of L5, S1. Relative disc space height was (24.34 ± 7.22) mm, disc space activity was (11.12 ± 5.67)o, sagittal saw sl ippage distance was (4.38 ± 0.75) mm and the JOA score was 19.00 ± 4.12. There was no significant difference between the two groups in termsof age, gender, JOA score, disc space activity and relative disc space height preoperatively (P gt; 0.05). Results All patients received the follow-up at the 1st, 3rd, 6th and 12th month postoperatively. There was no significant difference in operation time and hemorrhage amount between the two groups (P gt; 0.05), but significant difference in the cost of operation (P lt; 0.01). Two cases in the bone-graft group suffered donor site pain and received no treatment. Three cases in the bone-graft group and 2 cases in the cage group had symptom of nerve injury 1-2 days after surgery, which were cured after expectant treatment. There were no pseudoarticulation formation, intervertebral space infection and cage aversion in both groups. Significant difference of relative disc space height was found in each group pre- and post- operatively (P lt; 0.01) and significant differences were evident between the two groups at any of the time points (P lt; 0.01). One month after operation, there was significant difference between the two groups (P lt; 0.05). There was also significant difference at the 3rd, 6th and 12th month after operation (P lt; 0.01). No sign offusion was found in each group at the 1st and 3rd month after operation. In bone-graft group, there were 7 vertebral fusion cases 6 months after operation and 23 vertebral fusion cases 12 months after operation. In cage group, there were 8 vertebral fusion cases 6 months after operation and 29 vertebral fusion cases 12 months after operation. There was no significant difference in the rate of fusion at 6 and 12 months follow-up between the two groups (P gt; 0.05). Significant difference of JOA scores was found in each group pre- and post- operatively (P lt; 0.05). And no significant difference in JOA scores at 1, 3, 6, and 12 months follow-up was evident between the two groups (P gt; 0.05). Conclusion There is no significant difference between the two groups in the fusion time, the fusion rate and the cl inical symptoms alleviation, indicating autologous il iac crest is appl icable to interbody fusion for the treatment of adult instabil ity of lower lumbar and good therapeutic effect can be achieved with no immunoreaction and lower cost.
Objective To observe the effect of titanium mesh cage with self-locked titanium plate on the cervicalinter-body fusion after anterior discectomy of multilevel cervical intervertebral disc protrusion. Methods The therapeuticeffect of 18 patients who received the treatment of titanium mesh cage with self-locked titanium plate from September 2004 to June 2007 were retrospectively analyzed, including 11 males and 7 females (aged 32-75 years, 54 years on average). The course of disease was 6 months to 15 years (5.8 years on average). Sixteen patients suffered sensory dysfunction in l imbs. Concerning the muscle strength of extremities, 3 cases were on the second level, 12 were on the third level, 1 was on the fourth level, and 2 were on the fifth level. Sixteen cases had pyramidal sign, 13 had retention of urine and feces, 8 had sexual dysfunction, and 7 combined with symptoms of nerve root type. Twelve cases were consecutive multilevel and 6 cases were discontinuous multilevel. The mean JOA scores were 8.30 ± 1.21 preoperatively. X-ray films and MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord preoperatively. The height of involved intervertebral space was (6.40 ± 0.87) mm on X-ray films preoperatively. Results All the incisions were healed by first intention. All the patients were followed up for 6-36 months (18 months on average). The recovery of extremities motor function was better than that of sensory function at the early stage after operation. Muscular tension decreased after operation and mobil ity of l imbs was improved. The operated segments were instantly stable and sol id fusion was observed at 3-6 months after operation. JOA scores at 6 months after operation was 12.60 ± 0.78 with an improvement rate of 51.8%, indicating significant difference wasevident when compared with the JOA scores before operation (P lt; 0.05). The height of involved intervertebral space increased significantly to (8.20 ± 0.46) mm postoperatively, indicating the difference was significant (P lt; 0.05). According to Odom’s evaluation scale, 17 patients were graded as excellent and 1 as good. No death and compl ications of spinal cord, nerve, trachea and esophagus were observed. The cage witnessed no translocation. Conclusion Titanium mesh cage with self-locked titanium plate is more stable and effective for the treatment of multilevel cervical intervertebral disc protrusion.
ObjectiveTo discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion.
MethodsBetween September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C3,4 and C4,5 (1 case), C3,4 and C5,6(5 cases), C4,5 and C5,6 (3 cases), C4,5 and C6,7 (5 cases), and C5,6 and C6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up.
ResultsPrimary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively).
ConclusionA combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.
ObjectiveTo explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF).MethodsThe clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation.ResultsThe operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores (P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation (P<0.05); but no significant difference was found between at 6 months and at last follow-up (P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones (P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days (P<0.05).ConclusionThe allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion (ACCF) combined with anterior cervical corpectomy and fusion (ACDF).MethodsThe clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed. Among them, 13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage (TMC) and Cage as TMC group. There was no significant difference in gender, age, surgical segment, Nurick grade, disease duration, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of fusion segment between the two groups (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, complications, and implant fusion at last follow-up were recorded and compared between the two groups; JOA score was used to evaluate neurological function before operation, immediately after operation, at 6 months after operation, and at last follow-up; VAS score was used to evaluate upper limb and neck pain. Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated. The height of the anterior border (HAB) and the height of the posterior border (HPB) were measured immediately after operation, at 6 months after operation, and at last follow-up, and the subsidence of implant was calculated.ResultsThe operation time of 3D printing group was significantly less than that of TMC group (t=3.336, P=0.002); there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups (P>0.05). All patients were followed up 12-19 months (mean, 16 months). There was no obvious complication in both groups. There were significant differences in JOA score, VAS score, and Cobb angle at each time point between the two groups (P<0.05). There was an interaction between time and group in the JOA score (F=3.705, P=0.025). With time, the increase in JOA score was different between the 3D printing group and the TMC group, and the increase in the 3D printing group was greater. There was no interaction between time and group in the VAS score (F=3.038, P=0.065), and there was no significant difference in the score at each time point between the two groups (F=0.173, P=0.681). The time of the Cobb angle interacted with the group (F=15.581, P=0.000). With time, the Cobb angle of the 3D printing group and the TMC group changed differently. Among them, the 3D printing group increased more and the TMC group decreased more. At last follow-up, there was no significant difference in the improvement rate of JOA score between the two groups (t=0.681, P=0.502), but the Cobb angle difference of the 3D printing group was significantly smaller than that of the TMC group (t=5.754, P=0.000). At last follow-up, the implant fusion rate of the 3D printing group and TMC group were 92.3% (12/13) and 87.5% (14/16), respectively, and the difference was not significant (P=1.000). The incidence of implant settlement in the 3D printing group and TMC group at 6 months after operation was 15.4% (2/13) and 18.8% (3/16), respectively, and at last follow-up were 30.8% (4/13) and 56.3% (9/16), respectively, the differences were not significant (P=1.000; P=0.264). The difference of HAB and the difference of HPB in the 3D printing group at 6 months after operation and last follow-up were significantly lower than those in the TMC group (P<0.05).ConclusionFor patients with multilevel cervical spondylotic myelopathy undergoing ACCF combined with ACDF, compared with TMC and Cage, 3D printing artificial vertebrae body and 3D printing Cage have the advantages of shorter operation time, better reduction of height loss of fusion vertebral body, and maintenance of cervical physiological curvature, the early effectiveness is better.
ObjectiveTo summarize the advances in research on Cage subsidence following lumbar interbody fusion, and provide reference for its prevention.MethodsThe definition, development, clinical significance, and related risk factors of Cage subsidence following lumbar interbody fusion were throughout reviewed by referring to relevant domestic and doreign literature in recent years.ResultsAt present, there is no consensus on the definition of Cage subsidence, and mostly accepted as the disk height reduction greater than 2 mm. Cage subsidence mainly occurs in the early postoperative stage, which weakens the radiological surgical outcome, and may further damage the effectiveness or even lead to surgical failure. Cage subsidence is closely related to the Cage size and its placement location, intraoperative endplate preparation, morphological matching of disk space to Cage, bone mineral density, body mass index, and so on.ConclusionThe appropriate size and shape of the Cage usage, the posterolateral Cage placed, the gentle endplate operation to prevent injury, the active perioperative anti-osteoporosis treatment, and the education of patients to control body weight may help to prevent Cage subsidence and ensure good surgical results.
ObjectiveTo discuss the early effectiveness of polyaminoacid/nano-hydroxyapatite/calcium sulfate (PAA/HA/CS) Cage (PHC Cage) in lumbar fusion surgery.
MethodsThirty cases undergoing lumbar fusion of single segment between March and September 2014 were enrolled in this study. The patients were randomly divided into the trial group (n=20) and the control group (n=10). The PHC Cage was implanted in the trial group, while the polyetheretherketone (PEEK) Cage was implanted in the control group. The patients of 2 groups mainly presented lumbocrural pain and lower limb radiation pain or numbness. There was no significant difference in gender, age, type, affected segment, disease duration, preoperative intervertebral height, the lordosis angle of fusion segments, and the Oswestry Disability Index (ODI) between 2 groups (P > 0.05). Lateral lumbar X-ray films and three dimensional CT were taken preoperatively and at 1 week and 3, 6, and 12 months postoperatively. The intervertebral height and the lordosis angle of fusion segments at 1 week and 3, 6, and 12 months after operation and ODI at 3, 6, and 12 months after operation were measured; and the bone graft fusion rate was evaluated according to Brantigan criteria.
ResultsThere was no significant difference in operation time, intraoperative blood loss, and the amount of autologous blood transfusion between 2 groups (P > 0.05). Healing by first intention was obtained in 30 cases. All patients were followed up 12 months. The intervertebral height of fusion segments, the lordosis angle of fusion segments, and ODI at each time point after operation were significantly improved when compared with preoperative ones (P < 0.05). The ODI showed significant difference between 3 months and 6, 12 months (P < 0.05), but there was no significant difference between the other time points after operation (P > 0.05). There was no significant difference in the intervertebral height and the lordosis angle of fusion segments between groups at different time points (P > 0.05). There was no significant difference in the above indexes between the trial group and the control group at each time point (P > 0.05). At last follow-up, 5 cases were rated as Brantigan grade E, 13 cases as grade D, and 2 cases as grade C in the trial group; 4 cases were rated grade E, 5 cases as grade D, and 1 case as grade C in the control group. The bone fusion rate was 90% in 2 groups.
ConclusionThe PHC Cage can effectively restore and maintain the disc height of fusion segment, normal sequence and biomechanical stability of the lumbar spine. The PHC Cage is similar to the PEEK Cage and has good clinical outcome in short-term follow-up.
ObjectiveTo explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.MethodsA retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups (P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups (P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group (P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones (P<0.05), and no significant difference was found between 2 groups at each time point (P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups (P>0.05) and between 2 groups at each time point after operation (P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation (P<0.05). The VAS score in double-level group was higher than that in single-level group (P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points (P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.ConclusionThe n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.
ObjectiveTo explore the long-term effectiveness of expandable Cage in treatment of degenerative lumbar disease.
MethodsBetween January 2005 and January 2008, 72 patients with degenerative lumbar disease were treated by expandable Cage and followed up for 5 years. Of 72 cases, 41 were male and 31 were female with an average age of 40.5 years (mean, 35-65 years), including 35 cases of lumbar spinal stenosis, 20 cases of degenerative lumbar instability, and 17 cases of serious lumbar intervertebral disc protrusion combined with lumbar instability. The disease duration was 6-28 months (mean, 9 months). The affected lumbar segments were L3, 4 in 6 patients, L4, 5 in 37 patients, and L5, S1 in 29 patients. The Oswestry disability index (ODI) was used to evaluate the effectiveness before and after operation and to calculate the improvement rate. During the follow-up, the anteroposterior, lateral, and dynamic X-ray films were taken to evaluate the operated segment fusion rate. The intervertebral lordosis angle was measured, and adjacent segment degeneration was observed.
ResultsThe operation time was 35-90 minutes (mean, 65 minutes); the intraoperative blood loss was 200-450 mL (mean, 280 mL), and all the patients received intraoperative autologous blood transfusion; the postoperative bedridden time was 3-7 days (mean, 4.5 days); the hospitalization days were 10-18 days (mean, 12 days). No complications of nerve root injury, cauda equina injury, or cerebrospinal fluid leakage occurred during operation. All patients achieved primary healing of the incisions. All 72 patients were followed up for 5 years. At 3 months, 1 year, and 5 years after operation, the ODI were 8.2±2.6, 6.9±1.9, and 6.4±1.3 respectively, showing significant differences when compared with preoperative value (41.5±3.5) (P<0.05); the improvement rates were 87.3%±1.2%, 90.1%±0.8%, and 91.6%±1.3% respectively, showing no significant difference (F=0.492, P=0.375); the intervertebral lordosis angles were (5.1±1.2), (5.0±0.5), and (5.4±0.8)°respectively, showing no significant difference (F=0.570, P=0.453). At 5 years after operation, the intervertebral fusion rate was 100%, with no adjacent segment degeneration.
ConclusionUsing expandable Cage to treat degenerative lumbar disease can get stabilization without pedicle screw fixation, the good effectiveness is shown after long-term follow-up.
Objective To explore the effectiveness of posterior single-level osteotomy with 360° release and correction for the treatment of osteoporotic vertebral compression fractures (OVCF) complicated with moderate to severe kyphosis. Methods A retrospective analysis was conducted on 11 patients with OVCF complicated with moderate to severe kyphosis between January 2022 and March 2023. There were 4 males and 7 females with an average age of 57 years ranging from 47 to 69 years. The disease duration ranged from 3 to 15 months, with an average of 7 months. Fracture segments included T11 in 3 cases, T12 in 5, L1 in 2, and L2 in 1. The T value of lumbar spine bone density was ?5.0 to ?2.0, with an average of ?3.5. The preoperative neurological function was grade E according to Frankel grading. The Pfirrmann classification of the intervertebral disc above the injured vertebra was grade Ⅲ in 8 cases and grade Ⅳ in 3 cases. All patients underwent posterior single-level osteotomy with 360° release and correction. The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Thoracolumbar local kyphosis Cobb angle, the mean height of the functional spinal unit (FSU), the sagittal vertical axis (SVA), and the sagittal index (SI) were measured. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the improvement of pain and function before operation, at 1 month after operation, and at last follow-up. Results The operation successfully completed in all patients, and there was no obvious complication. The operation time ranged from 100 to 190 minutes, with an average of 153 minutes, and the intraoperative blood loss ranged from 200 to 800 mL, with an average of 468 mL. The length of hospital stay was 8-14 days (mean, 12 days). All patients were followed up 6-24 months, with an average of 12.4 months. At last follow-up, all the 11 patients had bony fusion in the osteotomy area, and there was no displacement or subsidence of the Cage, no complication such as internal fixation failure or pseudarthrosis formation was found. The Cobb angle of local thoracolumbar kyphosis, the mean height of FSU, SVA, and SI significantly improved immediately after operation and at last follow-up when compared with preoperative ones, and the VAS score and ODI also significantly improved at 1 month after operation and at last follow-up (P<0.05); there was no significant difference in above indexes between the two time points after operation (P>0.05). Conclusion Posterior single-level osteotomy with 360° release and correction is an effective surgical method for treating OVCF complicated with moderate to severe kyphosis, with definite early effectiveness.
