[Relationship between variations of severe isthmic spondylolisthesis spino-pelvic parameters and clinical symptoms].

OBJECTIVE: To explore the relationship between variations of severe isthmic spondylolisthesis spino-pelvic parameters and clinical symptoms. METHODS: A retrospective study of spino-pelvic parameters was conducted for 45 patients with L5 severe isthmic spondylolisthesis. Their spino-pelvic parameters were analyzed on preoperative full spinal radiography: grade of spondylolisthesis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), SFHD, SFVD, SC7D and T9 tilting angle. According to the Oswestry score, the patients with low back pain were divided into light and severe groups. T-tests were used to compare their parameters. The analyses of multiple factor correlation, linear regression and stepwise regression were used to examine the associations between all parameters and Oswestry score. RESULTS: Grade of spondylolisthesis, PT, LL, T9 tilting angle, SFHD, SC7D, PT/SS, SFHD/SFVD, LL/TK were significantly greater and SS, SFVD were significantly smaller for patients with severe low back pain versus light low back pain (P < 0.05). PI or TK had no statistically significant difference between two groups. Multiple factor correlation, linear regression and stepwise regression: Grade of spondylolisthesis, PT, SC7D, LL and SFHD had significant positive correlations with Oswestry score. Degree of positive correlation: Grade of spondylolisthesis > SC7D > PT > LL > SFHD. And PI, TK or T9 tilting angle had no significant correlation with Oswestry score. SS and SFVD had significant negative correlations with Oswestry score. Degree of negative correlation: SS > SFVD. PT/SS, SFHD/SFVD and LL/TK had significant positive correlation with Oswestry score. Degree of positive correlation: PT/SS> SFHD/SFVD > LL/TK. CONCLUSION: Clinical symptoms of severe isthmic spondylolisthesis have significant positive correlations with grade of spondylolisthesis, PT, SC7D, LL, SFHD, PT/SS, SFHD/SFVD, LL/TK and significant negative correlations with SS and SFVD. Low back pain symptom has no significant correlation with PI, TK or T9 tilting angle.

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis.

OBJECTIVE: To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis (AS) and the effect of combined anterior and posterior operation. METHODS: Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel's score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. RESULTS: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up. CONCLUSIONS: The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.

[One stage posterior vertebral column resection for the treatment of thorciclumbar tuberculosis with kyphotic deformity].

OBJECTIVE: To evaluate the clinical outcome of one stage posterior vertebral column resection in patients with spinal tuberculosis combined with kyphotic deformity. METHODS: Thirty-six patients with spinal tuberculosis combined with kyphotic deformity underwent posterior one-stage vertebral column resection reducing tension on the spinal cord from 1998 to 2006. The patients were mobilized with a thoracolumbar orthosis for 3 months. All patients had a minimum of a 2-year follow-up, and clinical examinations and radiographs were obtained at 6-month intervals. RESULTS: No perioperative mortality occurred. The average duration of surgery was 208 (145 approximately 385) min. The kyphotic Cobb angle improved from the preoperative average of 57.2 degree(17 degree approximately 86 degree) to a postoperative average of 8.9 degree(-6 degree approximately 27 degree). The average horizontal distance between C(7) and S(1) was 13.6 (8 approximately 19) mm preoperatively and 3.6 (-11 approximately 9) mm postoperatively. Nineteen patients had preoperative neurological deficits. Of them, 89.5% (17/19) showed a postoperative neurologic improvement. Perioperative complications occurred in 3(8.5%) of the 36 patients with pneumonias and superficial infections. Twenty-five patients (69.4%) showed radiographic evidence of solid fusion in the follow-up examinations. In the follow-up, 25% (9/36) patients rated their results as excellent, 66.7% (24/36) as good, 2 as fair, and 1 as poor. CONCLUSION: One stage posterior vertebral column resection for the treatment of spinal tuberculosis with kyphotic deformity is safe and effective. Because this procedure is highly technical, the surgeon must be familiar with the pathoanatomy and the operation must be carefully done.

[Combined anterior and posterior approach for cervical fracture-dislocation with ankylosing spondylitis].

OBJECTIVE: To discuss the pathological characteristics of cervical spinal fracture of ankylosing spondylitis (AS), and surgical effect by combined anterior and posterior operation. METHODS: Eighteen AS patients with traumatic cervical fracture-dislocation were treated from January 2000 to January 2006. The symptom duration of AS was 14.5 years in average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D in Frankel's score. All patients underwent surgical procedures by combined anterior and posterior approach. RESULTS: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage. There were some extent neurological improvement in 14 incompletely paraplegic patients, no improvement in 4 complete paraplegia patients. The follow-up period was 21.2 months in average and the bone fusion was 3.6 months. There were 4 complications during perioperative period and 1 in long term follow-up. CONCLUSIONS: The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is the reasonable surgical strategy in the treatment of cervical spinal fracture-dislocation with AS.

[Research on complications of thoracoscopic assisted thoracic spine surgery].

OBJECTIVE: To analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery. METHODS: Retrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed. RESULTS: Complications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain. CONCLUSIONS: The type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.

[Screw-rod technique in treating cervical spinal cord injury without fracture and dislocation].

OBJECTIVE: To evaluate the efficacy of screw-rod technique in treating cervical spinal cord injury without fracture and dislocation. METHODS: The screw-rod technique was used to treat 38 patients with cervical spinal cord injury without fracture and dislocation. The JOA scores before and after the surgery were evaluated. RESULTS: No severe complication occurred. The JOA scores were increased by 4.1, 6.7, 7.8, and 8.1 respectively at 0 th, 4 th, 12 th and 24 th weeks after the operation. Neurological deficits were improved one year after the operation in 1 patient. CONCLUSION: Treating cervical spinal cord injury without fracture and dislocation with screw-rod technique can achive an efficient and safe clinical outcome.

[Surgical treatment of thoracic vertebral angioma with extraosseous extension causing spinal cord compression].

OBJECTIVE: To evaluate the therapeutical effect of surgical treatment for thoracic angioma with extraosseous extension which causes spinal cord compression and neurological dysfunction. METHODS: We retrospectively analyzed 5 cases of thoracic vertebral body angioma with extraosseous extension and spinal cord compression. The operation were performed through anterior approach to resect the involved vertebral body and intracanal angioma in 5 patients. Bone graft and internal fixation were also completed in the meantime. Two patients accepted radiotherapy for 2 periods of treatment postoperatively, and the other 3 patients didn't accept the other supportive therapy. RESULTS: The blood loss during the operation was 1000 mL to 1500 mL. All the patients recovered their neurological function rapidly after the operation. The patients were followed up for 1 to 4 years, and no patient recurred. The bone graft was solidly fused in all patients. No hardware failure occurred. CONCLUSION: The surgical treatment for thoracic vertebral body and extraosseous angioma with spinal cord compression is effective, reliable, and workable. Good long-term result can be obtained.

[Clinical value of ventrofix in the treatment of thoracolumbar spine disorders].

OBJECTIVE: To investigate the clinical value of Ventrofix system in the treatment of thoracolumbar spine disorders. METHODS: Twenty-nine patients of thoracolumbar spine disorders were treated by anterior verterbrae body incision, canal decompression, bone graft by iliac or titanium cage, and fixation with Ventrofix system. RESULTS: All operations were successful. Complications included: low blood volume shock in the operation in one patient, atelectasis in one patient, pleuritis in one patient, and transient chest pain in one patient. All patients were followed up for 3 approximately 15 months. All patients got a good bone fusion, and the spinal cord funciton improved to a certain degree. There was no recurrence in patients with tumor and tuberculosis. CONCLUSION: The anterior focal cleaning and instrumentation is important in treating thoracolumbar spinal disorders. Ventrofix system is an excellent anterior internal implant system for thoracolumbar spinal disorder, with good biomechanical stability and biosuitbility.

[Clinical characteristic and surgical treatments for the fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures].

OBJECTIVE: To analyze the clinical characteristics of fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures and to discuss the surgical procedure for the fracture. METHODS: The clinical materials of 15 patients who suffered from the disease mentioned above were retrospectively analyzed. RESULTS: The common physical examination findings were local bump in the dorsal or lumbar spine area and palpation of rupture ends of paraspinal muscles and ligaments. The common MRI manifestations were ruptures of anterior longitudinal ligament, intervertebral disc, paraspinal muscles, and spinous process ligaments. The common operative findings were similar to MRI findings. The fractured vertebrae in 5 patients who underwent posterior reduction and fixation with two-segments pedicle screw did not restore their shape, but 10 patients who underwent posterior three-segments pedicle screw reduction and fixation restored the shape of fractured vertebrae. CONCLUSION: The fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures is a severe spine injury. Clinical physical examination and MRI appearance and intraoperative observation are important for the selection of operation procedure. The open reduction and internal fixation with pedicle screw-rod system, and intervertebral resection and fusion via posterior approach is a good procedure for the special thoracolumbar fracture.

[Study on the effect of enzymatic activity and acute toxicity of three PAEs on Eisenia foetida].

The acute toxic effects of DMP, DEP and DBP to earthworms (Eisenia foetida) were examined in this study. The two pollutants are tested by filter paper contact method and natural soil method, results indicated that they were both poisonous to earthworms. Earthworms were exposed to DMP and DEP for 48 h by filter paper contact method, LC50 (DMP) is 129.603 microg x cm(-2) and LC50 (DEP) is 145.336 microg x cm(-2). Earthworms were exposed to DMP and DEP for 14 d by natural soil method, LC50 (DMP) is 1 560. 120 mg x kg(-1) and LC50 (DEP) is 1516. 186 mg x kg(-1). While non-calculatable for the LC50 of DBP due to its low water solubility, penetrating into the skin and cells of earthworm is not easy. The natural soil test method was used to study the effects of DMP, DEP and DBP on enzyme activities of earthworms, activities of superoxide dismutase (SOD), catalase (CAT) and acetylcholinesterase (AChE) were measured. SOD activity was induced by DMP and DEP, CAT is the most sensitive and the activity was induced by DEP and DBP at the low concentration and inhibited at the high concentration. AChE activity was inhibited by DEP and DBP at the low concentration and induced at the high concentration, finally exhibited a tendency to recover to the control level at 28 d.

Thoracoscopy-assisted mini-open surgery for anterior column reconstruction in thoracic spinal tuberculosis.

OBJECTIVE: To evaluate the clinical effects of thoracoscopy-assisted mini-open surgery for anterior column reconstruction in thoracic spinal tuberculosis. METHODS: Fifty-eight patients, 35 men and 23 women, aged 39.2 (range, 19-60) years with thoracic spinal tuberculosis with an average kyphotic angle of 29.2° (range, 18°-42°) underwent thoracoscopy-assisted mini-open surgeries, including thorough debridement and anterior spinal reconstruction. According to the Frankel Grading system, preoperative neurological function was judged as Grade B in 3 cases, Grade C in 7, Grade D in 28, and Grade E in 20. All patients were followed up for an average of 4.6 years. Outcomes were evaluated retrospectively. RESULTS: Surgery was accomplished successfully in all cases. The average operation time was 230 min (range, 180-320 min), the average intraoperative blood loss 570 ml (range, 350-1200 ml), and the mean drainage duration 3.6 days (3-5 days). Complications occurred in 19 patients (32.8%). Neurological improvement of one to three grades had occurred in 29 patients by final follow-up. The average correction rate of the kyphotic angle was 36.4%, and no obvious correction loss was detected during follow-up. No recurrent tuberculosis was found in the group. CONCLUSIONS: Thoracoscopy-assisted mini-open surgery provides a simple, safe, effective, and practical technology with minimal invasiveness for the treatment of thoracic spinal tuberculosis.

[Primary anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis].

OBJECTIVE: To discuss the effect of primary anterior debridement, interbody autografting, and anterior internal fixation on the surgical management of thoracolumbar spinal tuberculosis. METHODS: Ninety-one cases of thoracolumbar spinal tuberculosis were treated with primary anterior debridement, interbody autografting, and anterior internal fixation. RESULTS: All cases were treated without any recurrence after follow-up for an average of 13 months. Spinal fusion occurred in 3.7 months on average with 20 degree of kyphosis correction achieved after surgery and 95.5% of the patients obtained good results. CONCLUSION: Primary anterior debridement, interbody autografting, and anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis are safe and effective and play an important role in reconstruction of spinal stability.