Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients.

OBJECTIVE: This retrospective study was to evaluate the relationship between osteoporosis and dynamic cervical plates in screw-plate or screw-bone interface of elderly cervical spondylotic myelopathy (CSM) patients. METHODS: Retrospective study was conducted on elderly CSM patients, treated by anterior corpectomy and reconstruction with titanium mesh cages (TMC) and dynamic cervical plate between July 2004 and June 2007. All patients underwent bone mineral density (BMD) assessment in preoperation, and according to the osteoporosis degree they have been divided into two groups: moderate osteoporosis degree group and severe osteoporosis degree group. The clinical outcome [Japanese Orthopaedic Association score (JOA) and Visual Analogue Scale (VAS)], bone fusion assessment (CT mielogram), the change of titanium mesh cages and plate of cephalic screw-plate-angle (SPA) and cephalic endplate-plate-angle (EPA) of plain X-ray films were measured. RESULTS: The mean JOA score and recovery rate were not different between the two groups (P > 0.05). There was no loss of sagittal alignment after surgery in any patient, and no significant difference between both groups on lordosis measurements (P > 0.05). Although there was a significant difference of the cage subsidence rate between the two groups (P < 0.001), all patients had favorable bone union and none required additional treatment. The average changes of SPA were greater in A group patients than in B group patients, while the variation of EPA was higher in B group patients than in A group patients (P < 0.001). CONCLUSIONS: Despite the fact that there is a significant difference of the cage subsidence rate between the two groups no clinical outcome, nor sagittal alignment or fusion rate differences among groups was observed in elderly CSM patients.

Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

OBJECTIVE: To compare the therapeutic effect of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (VCFs). METHODS: A total of 244 patients with VCFs were treated by PVP or PKP and 192 had follow-up for at least 1 year. Clinical outcomes were determined by pain Visual Analog Scale (VAS) and Short Form 36 Health Survey (SF-36). Preoperative and postoperative radiographic assessment included measurement of posterior and anterior vertebral body height (AH and PH), as well as the kyphotic angle by the Cobb method. RESULTS: A total of 192 cases had follow-up for at least 1 year and 52 cases lost. The average amount of polymethylmethacrylate (PMMA) cement introduced per vertebra was 3.4 ± 1.5 ml in PVP and 4.5 ± 0.8 ml in PKP (P < 0.05). All patients subjectively reported immediate relief of their typical fracture pain, and the mean VAS decreased significantly from presurgery to postsurgery during the 1-year of follow-up. The RP, BP and GH dimensionality values of SF-36 in PKP were higher than PVP (P < 0.05). The improvement on AH was 11.13 ± 5.68% in PVP and 21.46 ± 9.87% in PKP (P < 0.01); on PH was 2.25 ± 1.36% in PVP and 7.57 ± 2.49% in PKP (P < 0.01). The average improvement in the kyphotic angle after the procedure was 5.21 ± 2.33° in PVP and 11.69 ± 5.18° in PKP (P < 0.01). CONCLUSIONS: PVP and PKP have the ability of reducing pain in osteoporotic VCF patients. The correction of kyphotic deformity and restoration of the anterior vertebral body heights associated with osteoporotic VCFs was better in PKP.

Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis.

This study is to compare the therapeutic effect of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation on treatment in adult degenerative spondylolisthesis. A retrospective analysis of 187 patients to compare the complications and associated predictive factors of the two techniques of one level lumbar fusion. Ninety-one had PLIF with two cages and pedicle fixation (group 1), and ninety-six had TLIF with one cage and pedicle fixation (group 2). The two groups had similar age and sex distribution, and level of pain. Inclusion criteria and outcome measurements were identical in both groups. The two groups were operated on with autograft and cage with pedicle fixation. Before surgery and at the 2-year follow-up, pain (VAS) and functional disability (JOA) were quantified. The results showed there were no intraoperative deaths in our study. In the end 176 cases had 2-year follow-up while 11 cases were lost to follow-up. The follow-up rate was 93.4% (85/91) in the PLIF group and 94.8% (91/96) in the TLIF group. All patients had bone fusion, and there were no cases of cage extrusion. The pain index improved from 7.08 +/- 1.13 to 2.84 +/- 0.89 in PLIF patients and improved from 7.18 +/- 1.09 to 2.84 +/- 0.91 in TLIF patients (P < 0.001). There were 42 cases of excellent, 29 cases of good, 11 cases of general, and 3 cases of poor results in PLIF group. There were 46 cases of excellent, 31 case of good, 12 case of general, and 2 cases of poor results in TLIF group. The JOA score in all patients was 84.1% of good or excellent (83.5% in PLIF and 84.6% in TLIF, P > 0.05). The average preoperative slip was 30.1 +/- 7.2% in PLIF group while in the TLIF it was 31.4 +/- 8.3%. Immediately post operatively it was reduced to 7.3 +/- 2.1% and 7.4 +/- 2.7% and at last F/U it was 8.1 +/- 2.8% and 8.2 +/- 2.6%, respectively. The average of reduction rate was 75.2 +/- 6.4% in PLIF and 75.4 +/- 6.2 in TLIF on the initial post operatively X-ray, and 72.6 +/- 5.2% and 72.4 +/- 5.4% on the follow-up. The percentage rate, reduction rate and lost of reduction rate between the two groups was similar (P > 0.05). The average pre operative disk and foramen height in the PLIF group improved from 6.8 +/- 2.3 and 14.2 +/- 1.7 preoperatively to 11.6 +/- 1.5 and 18.7 +/- 1.8 post operatively, respectively. At last follow up there was minimal lost of correction down to 11.24 +/- 1.2 and 18.1 +/- 1.8, respectively. Similarly in the TLIF group, pre operative disk and foramen height were improved from 6.7 +/- 1.7 and 14.1 +/- 1.8 to 11.4 +/- 1.6 and 18.5 +/- 1.6 immediately post operative. At last follow up minimal lost of correction was noted with average disc height of 11.3 +/- 1.4 and 18.2 +/- 1.7. Both techniques achieve statistical significance in restoration of disc and foraminal (P < 0.01); however, there was no statistical difference between the two techniques. In conclusion, interbody fusion with either a PLIF technique or a TLIF technique provides good outcomes in the treatment of adult degenerative spondylolisthesis. The TLIF procedure is simpler and is as safe and effective as the PLIF technique.