ObjectiveTo explore the surgical indications,decompression and fusion method,and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis.
MethodsBetween April 2000 and November 2011,46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above).Of 46 cases,25 were male and 21 were female,with a mean age of 70.2 years (range,65-81 years) and with a mean disease duration of 6.4 years (range,4 years and 6 months to 13 years).X-ray films showed that the lumbar Cobb angle was (26.7±10.0)°,and the lumbar lordotic angle was (20.3±8.8)°.The lumbar CT and MRI images showed three-segment stenosis in 24 cases,four-segment stenosis in 17 cases,and five-segment stenosis in 5 cases.A total of 165 stenosed segments included 12 L1,2,34 L2,3,43 L3,4,45 L4,5,and 31 L5 and S1.Visual analogue scale (VAS) score,Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness.
ResultsThirteen patients had leakage of cerebrospinal fluid during operation,and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively,who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change,adequate drainage,debridement and suture.No death,paralysis,central nervous system infection,or other complication was observed in these patients.Forty-six cases were followed up 12-72 months (mean,36.2 months).Lumbago and backache and intermittent claudication of lower extremity were obviously improved.During follow-up,no screw incising,loosening and broken screws,or pseudarthrosis was noted under X-ray film and CT scanning.At last follow-up,the lumbar Cobb angle was reduced to (9.8±3.6)°,while the lumbar lordotic angle was increased to (34.1±9.4)°,which were significantly improved when compared with preoperative ones (t=16.935,P=0.000;t=15.233,P=0.000).At last follow-up,VAS,ODI,and JOA scores were 3.2±1.2,35.5%±14.0%,and 26.6±5.7 respectively,showing significant differences when compared with preoperative scores (8.0±2.2,60.8%±13.3%,and 12.9±3.4) (t=19.857,P=0.000;t=16.642,P=0.000;t=15.922,P=0.000).
ConclusionMulti-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms,rebuild spinal balance,and improve the life quality of the patients.It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.
To explore the treatment of multi-segmental lumbar disc herniation and spinal canal stenosis by laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and general spine system(GSS) fixation. Methods From January 2004 to January 2006, 21 patients with multi-segmental lumbar disc herniation and spinal canal stenosis were treated by laminectomy, removal of nucleus pulposus and GSS pedicle screw spinal system. There were 14 males and 7 females with an average age of 53 years ranging from 46 to 61 years, and with an average disease course of 18 months ranging from 8 months to 15 years. All of the patients were examined by X-ray with AP position, lateral position and dynamic lateral position, CT and MRI, and all of them proved to be with multi-segmental lumbar disc herniation and different degrees of spinal canal stenosis. A total of 47 nucleuses were picked out, and 47 instable segments were filled in with granule selfbone. Results There were 21 patients who were followed up for 1 to 2 years with an average of 13 months. All patients achieved successful fusion and bony union postoperative from 8 to 12 months, and no artificial joint was formed. As to the cl inical results in 21 cases, according to the Macnab outcome criteria, 14 were excellent, 6 were good and 1 was poor, the excellent and good rate was 95.2%. Conclusion The methods of laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and GSS system fixation are effective in treatment of multi-segmental lumbar disc herniation and spinal canal stenosis．
Objective To construct a regulatable plasmid containing single chain fusion gene of murine interleukin-12 (mIL-12) which was regulated with mifepristone (RU486) and explore its expression in vitro. Methods The p40 and p35 subunit sequence of mIL-20 were respectively obtained from the plasmid GCp35Ep40PN by polymerase chain reaction (PCR) and they were cloned into pCA14 plasmid after introducing a linker by overlap PCR. The single chain mIL-12 gene was comfirmed by sequencing and subcloned into pRS-17 vector which contains RU486 regulator cassette. The positive clone named pRS-RUmIL-12 was identified by restriction endonuclease digestion and PCR. Lipofectamine 2000 was used to transfect the pRS-RUmIL-12 to HEK293 cells followed by manufacturer’s recommendations. The protein concentration of mIL-12 induced with RU486 in supernatant of the transfected HEK293 cells was measured by ELISA. Results The sequence of single chain mIL-12 what we obtained was the same as the expected result. The results of restriction endonuclease digestion and PCR showed that the RU486-inducible regulatory vector (pRS-RUmIL-12) was successfully constructed. No significant mIL-12 protein concentration in supernatant of HEK293 cells activation was measured without the inducer RU486, whereas higher concentration of the mIL-12 protein was observed in the presence of RU486. The relationship of concentration of the mIL-12 protein and RU486 was positive correlated under definite range. Conclusion A regulatable eukaryotic expression plasmid of mIL-12 single chain fusion gene was constructed, which could be used in the further research of gene regulation and gene therapy.
Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
Objective To amplificate,clone and sequence the thymidine kinase (TK) gene of herpes simplex virusⅡ(HSVⅡ); to construct and appraise the fusion gene eukaryon expression vector, pcDNA3/HSVⅡ TK/angiostatin. MethodsThe Hep2 cells were infected by HSVⅡ Sav strain. HSVⅡ genomic DNA was purified from the Hep2 cells suspension and used as template to run PCR for TK gene amplification. The amplified products were cloned into PC DNA3 vector and sequenced. The vector pcDNA/HSVⅡ TK was cut by endonuclease. The gained TK gene was cloned into eukaryon expression vector. pcDNA3/angiostation, which had been constructed. ResultsCoding region of HSVⅡTK gene consisted of 1 128 bp except stop code, it encoded 376 amino acids.After cutting the new vector by endonuclease Hind Ⅲ and BamH Ⅰ,we gained the following gene fragment: 1000 bp (TK) and 700 bp (angiostation).Conclusion The fusion gene eukaryon expression vector， pcDNA3/HSVⅡ TK/angiostatin has been constructed.
OBJECTIVE: To observe the early clinical results with degenerative lumbar instability treated with transpedical screw fixation and intertransverse process autogenous bone grafting. METHODS: From September 2000 to February 2002, 19 patients (5 males and 14 females) of degenerative lumbar spine instability were treated with decompression for spinal canal stenosis, transpedical screw fixation and intertransverse process autogenous bone grafting. The locations of degenerative lumbar spine instability were between L4 and L5 in 10 patients, between L3, L4 and L5 in 4 cases, between L3 and L4 in 3 cases, between L5 and S1 in 2 cases. The results were evaluated after operation. The preoperative clinical symptoms disappeared completely as excellent results, relieved obviously as good results, improved as fair results and unrelieved or worsened as poor results. RESULTS: Seventeen patients were followed up for 4-18 months with an average of 8.1 months. The results of the treatment were excellent in 12 patients, good in 4 patients and fair in 1 patient. The excellent and good rate was 94.1%. Intertransverse process arthrodesis was obtained after 6 months of operation in all cases. No loosened and broken instruments occurred. CONCLUSION: The advantages of degenerative lumbar spine instability treated with transpedical screw fixation and intertransverse are reliable fixation, high successful rate of fusion and less influence on spinal canal. The above results show satisfactory clinical outcome.
Objective To compare the therapeutic effect of transforaminal lumbar interbody fusion (TLIF) and posterior lateral fusion (PLF) in treatment of thoracolumbar spine fracture and dislocation. Methods From January 2005 to July 2007, 35 patients (22 males, 13 females, aged 17-53 years old) with thoracolumbar spine fracture and dislocation (T11-L3) received posterior open reduction and pedicle nail-stick system internal fixation. Among which, 14 patients underwent TLIF(group TLIF), and the rest 21 patients underwent PLF (group PLF). According to AO classification, group TLIF had 3 cases of A3, 7 cases of B and 4 cases of C, while group PLF had 4 cases of A3, 10 cases of B and 7 cases of C. Based on American Spinal Injury Association (ASIA) Scoring Standard formulated in 2000, the motor score of group TLIF and group PLF was (50.6 ± 3.6) and (50.8 ± 4.2) points, respectively; and the sensory score was (170.5 ± 42.7) and (153.8 ± 23.7) points, respectively. No significant difference was noted between 2 groups in general information (P gt; 0.05). Results The operation time of group TLIF and group PLF was (316 ± 32) minutes and (254 ± 27) minutes, and the blood loss of group TLIF and group PLF was (487 ± 184) mL and (373 ± 72) mL, indicating there were significant differences between 2 groups (P lt; 0.05). Wounds of all patients were healed by first intention and there was no death, aggravation of neurological function impairment and compl ication of internal fixation instrument loosening and breaking. All 35 cases were followed up for 9-23 months with an average of 14.6 months. Postoperatively, the thoracolumbar bone fusion rate of group TLIF and group PLF was 100% and 85.7%, respectively, indicating there was a significant difference (P lt; 0.05). At 3 months after operation, the motor score of group TLIF and group PLF was increased by (10.4 ± 10.0) and (9.4 ± 9.3) points, respectively; and the sensory score was upgraded by (26.5 ± 22.8) and (28.8 ± 28.4) points, respectively, showing there were no significant difference (P gt; 0.05). At immediate moment, 3, 6 and 12 months after operation, the spine height restoration of group TLIF was (5.4 ± 2.1), (5.4 ± 1.9), (5.4 ± 1.4) and (5.3 ± 1.3) mm, respectively; while it was (5.3 ± 2.6), (5.3 ± 2.2), (4.8 ± 3.1) and (4.2 ± 3.6) mm for group PLF. Meanwhile, the Cobbangle recovery of group TLIF was (14.5 ± 3.5), (14.5 ± 3.6), (14.4 ± 3.4) and (14.4 ± 3.6)o, respectively; while it was (14.3 ± 2.7), (14.2 ± 3.1), (12.2 ± 2.8) and (11.7 ± 3.3)o for group PLF. Concerning the spine height restoration and the Cobb angle recovery, no significant difference was observed between 2 groups at immediate moment and 3 months after operation (P gt; 0.05), but significant differences were noted at 6 and 12 months after operation (P lt; 0.05). Conclusion For the treatment othoracolumbar spine fracture and dislocation, TLIF is superior to PLF in bony fusion and restoration of spine column height.
Objictive To evaluate the efficacy of decompression with and without fusion in the treatment of degenerative lumbar disease. Methods We searched the Cochrane Library (Issue 1, 2006), MEDLINE (1966 to April, 2006), EMBASE (1984 to April, 2006), the China Biological Medicine Database (to Dec., 2005), VIP (1989 to April, 2006) and hand-searched several related journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) involving the comparison of the outcomes between decompression with and without fusion in the treatment of degenerative lumbar disease. The quality of the included trials was assessed. RevMan 4.2.8 software was used for statistical analysis. Results Seven studies involving 412 patients were included. The results of meta-analysis indicated that no statistically significant differences were observed between the two operative procedures in the cumulative clinical outcome (OR1.83, 95%CI 0.92, 3.41), incidence of postoperative leg pain (OR 1.04, 95%CI 0.48, 2.25), incidence of perioperative complications (OR 1.15, 95%CI 0.51, 2.60), incidence of re-operation (OR 0.68, 95%CI 0.30, 1.56) or pre and postoperative pain scores [Pre-op WMD 0.12, 95%CI (-0.44,0.68); Post-op WMD 0.08, 95%CI (-1.08,1.25)]. The only statistical significance was observed in the incidence of postoperative back pain (OR 0.25, 95%CI 0.14, 0.46). Four studies described the length of operation, the intraoperative blood loss, the duration of external fixation postoperative and the total cost in hospital, which revealed that decompression alone was superior to decompression plus fusion. Three studies described the relationships between the clinical outcome and the changes in segmental range of motion/disc height pre- and post-operatively, as well as the flexion-extension radiographs, which revealed that decompression plus fusion was superior to decompression alone. Conclusions There are no significant differences between the two procedures in clinical outcomes, incidences of postoperative leg pain, re-operation and complications. Decompression with fusion leads to fewer patients suffering from postoperative lumbago than that of decompression alone. There is insufficient evidence to demonstrate that the radiographs may predict the clinical outcomes. More high quality, large-scale randomized controlled trials are required.
Objective?To evaluate differences of clinical effects between cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for single symptomatic single-level cervical degenerative disc disease. Methods?Randomized controlled trials (RCTs) from the Cochrane Library Central Register of Controlled Trials (Issue 1, 2009), MEDLINE (2000 to May 2009), EMbase (2000 to May 2009), Ovid (2000 to May 2009), CBM (2000 to May 2009) and CNKI (2000 to May 2009) were electronically searched. Additionally, six relevant journals were handsearched to identify RCTs about comparison of TDR and ACDF in the treatment of single-level cervical degenerative disc disease. All RCTs demonstrating these issues were included. RevMan 5.0 software was used for meta-analyses. Results?Six RCTs involving 1 340 patients were included. The results of meta-analyses indicated that there were significant differences between the two groups in neurological success (RR=1.06, 95%CI 1.02 to 1.11, P=0.003), secondary surgical procedures (RR=0.30, 95%CI 0.17 to 0.53, Plt;0.0001) and overall success (RR=1.13, 95%CI 1.06 to 1.22, P=0.0006). However, there were no significant differences in Neck Disability Index (NDI) scores (WMD=1.53, 95%CI –0.55 to 3.61, P=0.15), neck pain scores (WMD= –2.87, 95%CI 7.75 to 1.81, P=0.23), arm pain scores (WMD= –0.7, 95%CI –0.86 to –0.54, P=0.48), radiography success (RR=0.96, 95%CI 0.92 to 1.01, P=0.11), and postoperative complications (RR=0.79, 95%CI 0.49 to 1.28, P=0.34) between the two groups. Conclusion?The evidence indicates that compared with ACDF, TDR could improve neurological status, reduce secondary surgical procedures and promote overall success for single-level cervical degenerative disc disease, but there are no significant differences in postoperative NDI, neck and arm pain scores, radiography success, and complications.
Objective To study operative methods of treating upper cervical spine instability without injury. Methods Twentythree cases were treated by internal fixation with autologous bone grafts. Atlantoaxial arthrodesis were performed in 10 cases with Apofix interlaminar clamp(5 cases), Atlas cable system(3 cases) and Brookes(2 cases). Occipitocervical fusion were performed in the other 13 cases by using of CD-cervical(3 cases), Cervifix(8 cases) and Ustick fixation(2cases). Results All the 23 cases were followed up for 2.5 years in average (ranged from 6 months to 5 years). Solid arthrodesis was obtained in all 23 cases . Six months after operation, of the 20 cases with preoperation nervous lesion, improvement was achieved in 16 cases. According to JOA standard and Hirabashiformula,the rate of improvement was 27.1%.Conclusion Posterior fusion is recommended for upper cervical unstability.
