【Abstract】 Objective To investigate the clinical manifestation of thoracolumbar vertebral osteoid osteoma and to evaluate the surgical procedure and effectiveness of transpedicular tumor resection and spine reconstruction with posterior pedicle screw system and bone graft. Methods Between January 2001 and June 2010, 8 cases of thoracolumbar vertebral osteoid osteoma underwent one-stage transpedicular intralesional excision and bone graft combined with spine reconstruction with pedicle screw system through posterior approach. There were 5 males and 3 females with a median age of 15.5 years (range, 6-27 years). Affected segments included T8 in 1 case, T10 in 1 case, L2 in 2 cases, L3 in 1 case, L4 in 1 case, and L5 in 2 cases. All of the cases had back pain, 1 had radiating pain of lower extremity, and 4 patients presented with scoliosis. The mean diameter of lesions was 1.6 cm (range, 0.9-2.0 cm). Results The mean operation time was 110 minutes (range, 70-170 minutes) and the mean blood loss was 720 mL (range, 300-1 400 mL). The postoperative pathologic examination showed osteoid osteoma in all cases. All patients achieved healing of the incisions by first intention. Immediate relief of pain was observed after operation in all patients without complication. The patients were followed up 12-58 months (mean, 39 months). No local recurrence or spinal deformity was observed during the follow-up. Conclusion CT can show a low attenuation nidus with central mineralization and varying degrees of perinidal sclerosis, so it has great value for final diagnosis of thoracolumbar vertebral osteoid osteoma. One-stage transpedicular intralesional excision supplemented by impaction bone graft and combined posterior pedicle screw stabilization is a safe and effective treatment.
ObjectiveTo investigate the clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients.
MethodsBetween January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T10 to L2, and the kyphotic Cobb angle was (28.79±5.04)° before operation.
ResultsThe operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (t=8.542, P=0.000; t=9.826, P=0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (P < 0.05) and to (23.68±4.35)° at last follow-up (P < 0.05), but no significant difference was found between at immediate and last follow-up (P > 0.05). No loosening or breakage of internal fixation was observed during follow-up.
ConclusionPosterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).
To evaluate the method and effectiveness of anterior focus clearance with autograft bone fusion and internal fixation in treating of adjacent multivertebral tuberculosis in one-stage. Methods Between March 2007 and September 2009, 8 cases of thoracic vertebra tuberculosis were treated. Of 8 cases, 6 were male and 2 were female, aged 32 years on average (range, 20-42 years). The disease duration ranged from 8 to 14 months (mean, 10.2 months). Affected vertebrae included thoracic vertebrae in 35 cases and lumbar vertebrae in 11 cases; 5 vertebrae were involved in 4 cases, 6 vertebrae in 3 cases, and 8 vertebrae in 1 case. According to Frankel classification, there were 2 cases of grade C, 4 cases of grade D, and 2 cases of grade E. All patients had different kyphosis with the Cobb angle of (25.1 ± 6.6)°. All patients received antituberculous therapy 4-6 weeks preoperatively; after complete clearance lesions, autograft bone fusion and internal fixation were performed, and then antituberculous therapy was given for 18 months. Results All incisions healed by first intention. Eight patients were followed up 18-48 months (mean, 29 months). According to JIN Dadi et al. criterion, 7 cases recovered after first operation, 1 case of relapsed tuberculosis with sious was cured after re-focus clearance. The Cobb angle was (19.5 ± 4.2)° at 7 days after operation and was (22.3 ± 3.6)° at last follow-up, showing significant differences when compared with the preoperative value (P lt; 0.05). The nerve function of all cases were classified as Frankel grade E. CT scan showed bone graft fusion at 6-8 months after operation. No loosening or displacement of grafted bone and internal fixation occurred during follow-up. Conclusion The treatment of adjacent multivertebral tuberculosis by anterior focus clearance, intervertebral autograft, and internal fixation in one-stage is effective. Anterior bone fusion and internal fixation in one-stage can correct kyphosis effectively and rebuild spinal stabil ity, so it is a good choice for surgical treatment of adjacent multivertebral tuberculosis.
OBJECTIVE: To investigate the effect of vascular pedicled rib grafting in treatment of the pyogenic infection of the thoracolumbar intervertebral space. METHODS: From November 1993, 7 cases with pyogenic infection of the thoracolumbar intervertebral space were adopted in this study. Among them, there were 5 males and 2 females, aged from 29 to 58 years old. The position of pyogenic infection located at T10 to 11 in 3 cases, at T11 to 12 in 2 cases and at T12 to L1 in 2 cases. During operation, the pyogenic infection was cleared completely and the rib with vascular pedicle was grafted into the intervertebral space. RESULTS: Followed up for 10 to 60 months, the bone graft unioned in 3 months for 5 patients and unioned in 4 months for 2 patients. There was no recurrence and raised kyphosis. CONCLUSION: The technique of vascular pedicled rib graft is simple, it can shorten the bone union time and reconstruct the stability of spine.
Objective To evaluate the effectiveness and the value of balloon kyphoplasty in treating aged osteoporosis thoracolumbar vertebrae burst fracture. Methods Between January 2003 and January 2008, 36 thoracolumbar vertebrae burst fracture patients were treated. There were 15 males and 21 females with an average age of 65.4 years (range, 59-72 years). Fourteen cases had no obvious history of trauma, 19 had a history of sl ight trauma, and 3 had a history of severe trauma. Forty vertebral bodies were involved, including 1 T7, 3 T9, 8 T10, 10 T12, 9 L1, 7 L2, and 2 L4. All patients displayed local pain and osteoporosis by bone density measurement with no neurological symptom of both lower limbs. Balloon kyphoplasty through unilateral (31 cases) or bilateral (5 cases) vertebral pedicles with polymethylmethacrylate was performed at the injection volume of (3.46 ± 0.86) mL per vertebral body. Before and after operation, the anterior height and posterior height of fractured vertebral body and the sagittal displacement were measured. Results Two cases had intraoperative cerebrospinal fluid leakage; 1 case had no remission of waist-back pain and pain was released after symptomatic treatment. All 36 patients were followed up 2.3 years on average (range, 1.5-4.0 years). No cement leakage was found with good diffusion of cement on X-ray film. The restoration of the height of vertebral bodies was satisfactory without nerve compression symptoms and other compl ications. The Visual Analogue Score at last follow-up (2.34 ± 1.03) was significantly lower than that of preoperation (6.78 ± 1.21), (P lt; 0.05). The compressive percentage of anterior height (19.80% ± 1.03%) of fractured vertebral body after operation was significantly lower than that before operation(25.30% ± 2.50%), (P lt; 0.05). There was no significant difference in posterior compressive percentage and sagittal displacement between pre- and post- operation (P gt; 0.05). Conclusion Based on roentgenographic scores, balloon kyphoplasty is selectively used to treat aged osteoporosis thoracolumbar vertebrae burst fracture, and the radiographic and cl inical results were satisfactory.
ObjectiveTo compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment.
MethodsA retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed.
ResultsIncision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found.
ConclusionBased on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.
Objective To investigate the therapeutic effect of artificial dura mater on the prevention and treatment of cerebrospinal fluid (CSF) leakage associated with thoracolumbar fracture and dislocation. Methods A total of 58 patients with thoracolumbar fracture and dislocation combined with dura mater injury and CSF leakage were treated in Affiliated Hospital of Southwest Medical University from January 2011 to December 2016, including 30 males and 28 females, aged from 15 to 86 years, with an average of (51.8±16.3) years. All patients were treated with posterior pedicle screw system for decompression, reduction fixation and fusion, dura mater and spinal cord injury were investigated, and external nerve roots or caudate nerves were exposed. At the same time; the dura mater was sutured and repaired and partially covered with gelatinous sponge (group A, 24 cases), or after dura mater was sutured and repaired, the artificial dura mater was partially covered (group B, 34 cases). The curative effect and complications of the two different treatment methods were evaluated. Results All operations were successfully completed. The operative time was 110–340 minutes, with an average of (195.0±10.4) minutes; the intraoperative blood loss was 200–2 800 mL, with an average of (845.0±26.5) mL. In group A, 13 patients (54.1%) acquired wound healing, and the average CSF leakage duration was (13.4±1.6) days postoperatively, among whom 3 cases were complicated with pseudomeningocele; 11 cases (45.9%) failed and necessitated additional management. Among the 11 cases, 6 case had no decreasing tendency of CSF leakage after 10-day drainage, and after subarachnoid drainage was performed, CSF leakage disappeared about 15 days after operation; 3 (12.5%) with wound infection underwent operative incision debridement, after the repair of the dura sac, the subarachnoid CSF was drainage at the lumbar part combined with the systemic situation with antibiotics and other symptomatic treatment, and the patients were cured about 16 days after the operation; 2 (8.3%) with spinal meningitis underwent subarachnoid CSF drainage and administration of antibiotics, and the CSF leakage ceased about 14 days after operation. In group B, 27 patients (79.4%) acquired wound healing, and the average CSF leakage duration was (9.1±1.7) days postoperatively; among whom, 4 cases were complicated with pseudomeningocele; 7 cases (20.6%) failed and necessitated additional management. Among the 7 cases, 5 cases had no decreasing tendency of CSF leakage after 10-day drainage, and CSF leakage disappeared around 12 days after treatment; 1 case (2.9%) with wound infection and 1 case (2.9%) with spinal meningitis, both were cured after the treatment as in group A. Conclusion Dural suture repair combined with artificial dura mater mulch repair can more effectively repair the dura tears associated with thoracolumbar vertebral fracture dislocation and reduce the incidence of CSF leakage.
Objective To investigate the efficacy of the pedicle screw fixation and allograft bone in posterior spinal fusion for the treatment of thoracolumbar vertebral fractures. Methods From September 2006 to March 2008, 105 cases of thoracolumbar vertebral fractures were treated with allograft bone in posterior spinal fusion after the pedicle screw fixation,including 75 males and 30 males aged 15-65 years (mean 37 years). The mixture which consisted of spinous process and vertebral plate sclerotin and homogeneity variant bone was used as bone graft to implant into articular process and processus transversus space or vertebral plate space. The time from injury to surgery varied from 8 hours to 21 days, with an average of 3 days. There were 52 cases of fall ing injuries from height, 35 cases of traffic accident injuries, 11 cases of bruise injuries and 7 cases of tumbl ing injuries. Before operation, the primary cl inical symptoms of patients included local pain combined with l imitation of activity, 30 cases compl icated by various degrees of spinal cord and nerve root functional disturbance. According to Mcaffee classification, there were 7 cases of flexion depressed fractures, 86 cases of blow-out fractures, 9 cases of Chance fractures and 3 cases of dislocation-fracture. According to Frankel grade, there were 11 cases of grade A, 2 cases of grade B, 7 cases of grade C, 10 cases of grade D and 75 cases of grade E. The X-ray examination of all patients denoted that the bodies of injuryed vertebra were compressed and wedge-shaped, and the CT scan showed that 98 cases had spinal stenosis. After 2 weeeks and 3, 6, 12 months, the X-ray films were taken to evaluate bone graft fusion. The Cobb angle was measured. The recovery of nerve function was analyzed. Results The operation time was 55-180 minutes (mean 90 minutes) and the blood loss was 100-900 mL (mean 200 mL). All patients achieved heal ing by first intention with no compl ication. After operation, 93 cases were followed up for 6-15 months with an average of 11 months. Except for 11 patients who were at grade A before operation, one to two grade recover was observed in other patients. The average Cobb angle of injury segment was improved from preoperative 32.1° to postoperative 5.2°. The height of anterior border of injuried vertebral body was recovered from the preoperative average compressed remaining height 61.5% to postoperative 96.8%. The vestigial degree of canal is spinal is anteroposterior diameter was recovered from preoperative 65.7% to postoperative 89.9%. Imageology examination showed that all the patient achieved bone union within 6 months. The fusion rate of bone graft in spinal fusion was 100%. No loosening and breaking of nails occurred. Conclusion Pedicle fixators can restore and fix the thoracolumbar fractures, and the combination of autograft and allograft bone transplantation is a safe, rel iable and effective method.
Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.
