A longitudinal investigation of the endplate cystic lesion effect on oblique lumbar interbody fusion.

OBJECTIVE: To determine longitudinal effects of changes in endplate cystic lesions on oblique lumbar interbody fusion (OLIF), the relationship between bone healing and endplate cystic lesion changes, and clinical significance of cyst formation. PATIENTS AND METHODS: A total of 107 segments in 67 patients who underwent OLIF between January 2013 and July 2016 were examined in this retrospective study. Using computed tomography, radiographic examinations of endplate cystic lesion, positive or negative cyst formation, cage subsidence, and fusion status were performed. Clinical outcomes were measured using visual analogue scale (VAS) pain scores, Oswestry disability index (ODI), and modified Macnab criteria. Outcomes were compared with preoperatively and postoperatively. A logistic regression analysis was performed to evaluate the relationship between measurements for endplate cysts. RESULTS: The fusion rate after OLIF was 94.4% at 2-year follow-up, with 86% of cases reporting satisfactory outcome (based on modified Macnab criteria). A significantly higher (P <  0.01) VAS score for back pain was observed in the cystic lesion group than non-cystic lesion group at 6-month follow-up. Cage subsidence significantly increased the risk of non-union (odds ratio [OR]: 17.24; 95% confidence interval [CI]: 1.67-178.09). Positive cyst sign was a significant risk factor for cage subsidence (OR: 8.52; 95% CI: 2.73-26.62) while cage subsidence was also a significant risk factor for positive cyst formation (OR: 8.37; 95% CI: 2.71-25.89). CONCLUSIONS: Cystic lesion may increase back pain in the early postoperative period. However, the preoperative cystic lesion does not aggravate a positive cyst formation or affect the final clinical result. Positive cyst formation was a significant risk factor for cage subsidence. In addition, cage subsidence was a significant predictor of non-union. Thus, the authors can speculate that positive cyst sign was potentially an indirect predictor of non-union.

A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation.

OBJECTIVE: To assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD). METHODS: 28 consecutive patients who underwent PELD due to large lumbar disc herniation between November 2014 and January 2016 were followed up for 6 months. These patients were divided into two groups according to the treatment they received after PELD. 14 patients (Group A) were treated by PELD and epidural steroids, while the other 14 patients (Group B) were treated by PELD and intravenous steroids. We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain, and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview. Postoperative hospital stay and time return to work were investigated as well. RESULTS: There is a significant decrease in VAS (back, leg), ODI, and time return to work (p < 0.05). For VAS (back), Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p = 0.011, p = 0.017). As for VAS (leg), Group A showed a significant decrease compared with Group B at 1 day, 1 week, 3 weeks, and 3 months follow-up examinations (p = 0.002, p = 0.006, p < 0.001, p < 0.001). For ODI, Group A showed a notable decrease compared with Group B (p < 0.001). The postoperative hospital stay in two groups was not statistically different (p = 0.636). But the time return to work in Group A was significantly shorter than that in Group B (p = 0.023). CONCLUSION: Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders.

PURPOSE: To investigate the usefulness of three-dimensional (3D) printing in complex spinal surgery. METHODS: The study was conducted from October 2014 to March 2015 in Shenzhen Second Peoples' Hospital and 4 cases of complex severe spinal disorders were selected from our department. Among them one patient combined with congenital scoliosis, one with atlas neoplasm, one with atlantoaxial dislocation, and the rest one with atlantoaxial fracture-dislocation. The data of the diseased region was collected from computerized tomography scans for 3D digital reconstruction and rapid prototyping to prepare photosensitive resin models, which were applied in the treatment of these cases. RESULTS: The use of 3D models reduced operating time and intraoperative blood loss as well as the risk of postoperative complications. Furthermore, no pedicle penetrations or screw misplacement occurred according to the postoperative planar radiographic images. CONCLUSION: The tactile models from 3D printing allow direct observation and measurement, helping the orthopedists to have accurate morphometric information to provide personalized surgical planning and better communication with the patient and coworkers. Moreover, the photosensitive resin models can also guide the actual surgery with the drilling of pedicle screws and safe resection of tumor.

The clinical comparative study on high and low viscosity bone cement application in vertebroplasty.

OBJECTIVE: To investigate the clinical effect of high and low viscosity bone cement in vertebroplasty for treatment of osteoporotic vertebral compression fractures. METHODS: 40 cases of patients with osteoporotic thoracolumbar compression fractures admitted into department of orthopeadics in our hospital were reviewed. All patients were divided into high viscosity bone cement group (20 cases) and low viscosity bone cement group (20 cases). Visual Analog Score (VAS), Oswestry Dability Index (ODI), injured vertebral height restoration (Cobb Angle) and bone cement leakage rate, subsequent fracture rate of vertebrae body with or without surgical treatment were measured. RESULTS: Compared with the low viscosity bone cement group, the VAS score, ODI score and Cobb angle of high viscosity bone cement group had a statistical difference (P<0.05). The postoperative complications in high viscosity bone cement group were lower than those in low viscosity bone cement group (P<0.05). CONCLUSION: Compared with low viscosity bone cement, bone cement leakage rate reduced obviously in high viscosity bone cement with good clinical effect and prognosis in vertebroplasty for treatment of osteoporotic thoracolumbar compression fractures.