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 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.
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.
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
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.
Objective
To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease.
Methods
Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups.
Results
All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group (P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups (χ2=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups (P>0.05).
Conclusion
For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.
ObjectiveTo investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.MethodsA clinical data of 47 patients with old thoracolumbar compression fractures, who met the selection criteria between January 2010 and March 2018, was retrospectively analyzed. Twenty-five patients (group A) underwent the limited middle and posterior column osteotomy via transvertebral space approach, and 22 patients (group B) underwent the pedicle subtraction osteotomy (PSO). There was no significant difference in gender, age, cause of injury, time from injury to operation, fracture segment, and preoperative Cobb angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as postoperative Cobb angle, SVA, VAS score, JOA score, ODI and the differences of all indexes between pre- and post-operation were recorded and compared between the two groups. The neurological function was evaluated by Frankel scale.ResultsThe operations of both groups were successfully completed. The operation time and intraoperative blood loss in group A were significant lower than those in group B (P<0.05). All incisions healed by first intetion. All patients were followed up 23-27 months (mean, 24.2 months) in group A and 24-28 months (mean, 24.8 months) in group B. At last follow-up, the VAS score, JOA score, ODI, Cobb angle, and SVA of the two groups were compared with those before operation, and the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) in the indexes at last follow-up and the difference between pre- and post-operation. The lower extremity neurological symptoms (Frankel grade D) in 3 patients of group A before operation relieved (Frankel grade E) at last follow-up. The other patients were Frankel grade E. At last follow-up, CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.ConclusionFor patients with old thoracolumbar compression fractures, the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness. Compared with PSO, it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.
ObjectiveTo compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment.MethodsThe clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient’s pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications.ResultsThere were significant differences in the number of surgical fusion segments and osteoporosis between groups (P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups (P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups (P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups (P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups (P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups (P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up.ConclusionThe risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients’ quality of life.
Objective To compare the effectiveness and radiological changes of posterior decompression combined with Coflex interspinous dynamic reconstruction or lumbar 360° fusion for degenerative lumbar spinal disorders at L4, 5. MethodsBetween October 2008 and November 2010, a comparative study was carried out on patients with degenerative lumbar spinal disorders at L4, 5. In group A, 29 patients underwent posterior decompression combined with Coflex interspinous dynamic reconstruction; there were 20 males and 9 females with an average age of 45.1 years (range, 21-67 years); and the disease duration was 2 months to 4 years. In group B, 31 patients underwent posterior decompression combined with lumbar 360° fusion treatment; there were 16 males and 15 females with an average age of 56.2 years (range, 32-86 years); and the disease duration was 3 months to 6 years. Except the age, there was no significant difference in gender, disease duration, and etiology etc. between 2 groups (P gt; 0.05). The results were assessed by Japanese Orthopaedic Association (JOA), visual analogue scale (VAS) scores, and Oswestry disabil ity index (ODI). The range of motion (ROM) and intervertebral height of affected and adjacent segments, and the ROM of lumbar were measured before operation and last follow-up. Results Significant differences were found in the operative time and blood loss between 2 groups (P lt; 0.05). Intraoperative dural tear occurred in 1 case of group B, spinal canal venous plexus hemorrhage in 1 case of group B, and postoperative cerebrospinal fluid leakage in 2 cases of group A and B respectively, showing no significant difference (χ2=0.119, P =0.731). The follow-up was 12-21 months in group A and was 12-23 months in group B. At the last follow-up, the JOA, VAS scores, and ODI of groups A and B were significantly improvedwhen compared with the preoperative values (P lt; 0.05). The VAS score of group A was significantly higher than that of group B (P lt; 0.05). There was no significant difference in the intervertebral height of L4, 5 and L5, S1 of groups A and B between pre- and post-operation (P gt; 0.05). In group B, the intervertebral height of L3, 4 was significantly reduced (P lt; 0.05) compared with the preoperative one. There was no significant difference in the ROM of L5, S1 and ROM of lumbar in groups A and B between preand post-operation (P gt; 0.05). At last follow-up, the ROM of L4, 5 was significantly reduced in group A (P lt; 0.05), and the ROM of L3, 4 was significantly increased in group B (P lt; 0.05). Except significant differences in the intervertebral height and ROM of L3, 4 between 2 groups (P lt; 0.05), no significant difference was found in other parameters (P gt; 0.05). Conclusion Posterior decompression combined with Coflex interspinous dynamic reconstruction has the same effectiveness as lumbar 360° fusion in treating degenerative lumbar spinal disorders at L4, 5, but the former has a protective effect on the adjacent segments of fusion and is recommended for initial treatment of young adults and the elderly and frail patients with recurrent.
