Jack vertebral dilator kyphoplasty for treatment of osteoporotic vertebral compression fractures.

Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly population and often involve the thoracolumbar vertebrae. Clinical symptoms of OVCFs include severe pain, loss of vertebral height, progressive kyphosis and increased mortality. Jack vertebral dilator kyphoplasty is a recently developed OVCFs treatment modality, with few systematic studies present in the literature. This retrospective study was designed to investigate the safety and efficacy of Jack vertebral dilator kyphoplasty for treating thoracolumbar OVCFs. Sixteen elderly patients (55-85 years) with solitary thoracolumbar OVCFs were treated with this procedure and followed-up (10-27 months). The amount of injected bone cement and operative time, preoperative and postoperative visual analogue scores, anterior and middle vertebral body heights, local kyphosis angle, and complications was analysed. The results showed that the method provided long-term pain relief and restoration of the vertebral body height and spinal alignment. No serious complications occurred, but two patients experienced recompression of the vertebral body, and one patient experienced cement leakage into a disc. In conclusion, Jack vertebral dilator kyphoplasty is a safe and effective minimally invasive procedure for treatment of OVCFs.

Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge.

Most osteoporotic vertebral fractures (OVFs) can be treated successfully with conservative methods. In about 10% of patients, nonunion develops and warrants surgical management with minimally invasive procedures such as vertebroplasty and kyphoplasty. Nevertheless, for patients with nonunion fractures that involve the posterior vertebral body wall, vertebroplasty and kyphoplasty are relatively contraindicated due to the risk of extravertebral polymethylmethacrylate cement leakage through vertebral fracture cracks. To this end, we developed a method for pedicle screw fixation combined with transpedicular bone grafting for such a condition. Briefly, after posterior pedicle screw fixation and reduction in the affected vertebra, the demineralized bone matrix was inserted into the vertebral body via a 'bone grafting funnel' created through the pedicle of the affected vertebra. The current retrospective study analysed the safety and efficacy of this approach. A total of 12 patients who fulfilled the criteria were treated with this procedure. Visual analogue scale scores for back pain and anterior vertebral heights were recorded. At 3-month follow-up, pain was significantly relieved compared with presurgery and the anterior vertebral heights were successfully restored and maintained. In conclusion, short-segment pedicle instrumentation combined with transpedicular bone grafting is a useful alternative in the treatment of nonunion of OVFs with loss of posterior edge integrity.

[Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture].

Objective: To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods: Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results: The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion: Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.

Lumbar intervertebral disc puncture under C-arm fluoroscopy: a new rat model of lumbar intervertebral disc degeneration.

To establish a minimally invasive rat model of lumbar intervertebral disc degeneration (IDD) to better understand the pathophysiology of the human condition. The annulus fibrosus of lumbar level 4-5 (L4-5) and L5-6 discs were punctured by 27-gauge needles using the posterior approach under C-arm fluoroscopic guidance. Magnetic resonance imaging (MRI), histological examination by hematoxylin and eosin (H&E) staining, and reverse transcription polymerase chain reaction (RT-PCR) were performed at baseline and 2, 4, and 8 weeks after disc puncture surgery to determine the degree of degeneration. All sixty discs (thirty rats) were punctured successfully. Only two of thirty rats subjected to the procedure exhibited immediate neurological symptoms. The MRI results indicated a gradual increase in Pfirrmann grade from 4 to 8 weeks post-surgery (P<0.05), and H&E staining demonstrated a parallel increase in histological grade (P<0.05). Expression levels of aggrecan, type II collagen (Col2), and Sox9 mRNAs, which encode disc components, decreased gradually post-surgery. In contrast, mRNA expression of type I collagen (Col1), an indicator of fibrosis, increased (P<0.05). The procedure of annular puncture using a 27-gauge needle under C-arm fluoroscopic guidance had a high success rate. Histological, MRI, and RT-PCR results revealed that the rat model of disc degeneration is a progressive pathological process that is similar to human IDD.

Transpedicular intracorporeal grafting for patients with thoracolumbar burst fractures.

OBJECTIVE: To evaluate the efficacy of reinforcing short-segment fixation with transpedicular intracorporeal grafting in restoring vertebral body height and preventing loss of correction in patients with thoracolumbar burst fractures. METHODS: This retrospective study was carried out from the Affiliated Hospital of Jiangsu University, Jiangsu, China. Forty-six patients with thoracolumbar burst fractures without neurological deficit were operatively treated between July 2008 and June 2011. Patients in group A (n=21) were treated by short-segment fixation with transpedicular intracorporeal grafting, whereas patients in group B (n=25) were treated by short-segment fixation without bone grafting. The preoperative, postoperative, and follow-up radiographs (anterior, middle, posterior vertebral height, and local kyphosis angle) were evaluated. RESULTS: All 46 patients in both groups obtained satisfactory reduction of fractured vertebrae. There were no significant differences between the 2 groups according to the improvement of body height and local kyphosis angle. However, correction losses were observed in both groups. Less losses of anterior body height (p=0.0007), middle body height (p<0.0001), and local kyphosis angle (p=0.0447) were detected in group A than group B. The rate of failure in group A (4.8%) was significantly lower than that in group B (28.0%) (p=0.0383). CONCLUSION: Reinforcement of short-segment fixation with transpedicular intracorporeal grafting can effectively restore vertebral body height and prevent loss of correction for patients with thoracolumbar burst fractures.

[Minimally invasive approach for cervical spondylotic radiculopathy].

OBJECTIVE: To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). METHODS: The recent literature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. RESULTS: There were two techniques of minimally invasive approach for CSR at present: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneous puncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopic discectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local ligamentum flavum thickening and spondylotic foraminal stenosis. CONCLUSION: The minimally invasive procedure has the advantages of simple handling, minimally invasive and low incidence of complications. But the scope of indications is relatively narrow at present.

[Effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hip screw fixation].

OBJECTIVE: To study the technique and effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hip screw (DHS) fixation. METHODS: Between April 2004 and August 2007, 33 patients with intertrochanteric fracture were treated with DHS fixation and adjunctive cancellous screw. There were 13 males and 20 females, aging 43-82 years with an average age of 67 years. Fractures were caused by traffic accident in 7 patients, by falling from height in 11 patients, by sprain in 15 patients. All fractures were closed. The patients were operated 3-12 days after injury. According to Evans classification, there were 12 cases of type II, 15 cases of type III, and 6 cases of type IV. Twenty-two cases had osteoporosis. Weight bear time and complication were recorded. Fracture healing and neck-shaft angle were observed on radiogram. Hip functions were evaluated using Radford criterion. RESULTS: Thirty-three patients had no intraoperative complications with incision healing by first intension. All patients were followed up from 14 months to 38 months, with an average of 21 months. Fracture healing was achieved within 14 weeks to 21 weeks, with an average of 17 weeks after operations. The neck-shaft angles were (134.2 +/- 13.7) degrees 3 days after operation, (128.6 +/- 8.9) degrees 8 weeks after operation, and (128.5 +/- 9.3) degrees after fracture healing, showing no significant difference when compared with that of the third day after operation (P > 0.05). According to the Radford criterion at last follow-up, the excellent and good rate of hip function was 93.9% (excellent in 21 cases, good in 10 cases, and poor in 2 cases). Complications such as loosening, breakage, or grievous migration of hardware were not observed. CONCLUSION: The adjunctive cancellous screw in treatment of intertrochanteric fractures with DHS fixation can provide counteraction of tension and rotation, promote fixation stability, enhance fracture healing and decrease complication.

[Effects of insulin-like growth factor 1 on inhibition of osteoblastic proliferation and function by ethanol].

OBJECTIVE: To investigate the effects of insulin-like growth factor 1(IGF-1) and ethanol (EtOH) on the changes in the osteoblast proliferation and the osteoblast function under the normal serum concentration and serum starvation. METHODS: The osteoblasts harvested from the SD rat calvaria were incubated in the following six conditions according to the supplements in DMEM: the F15 group: 15% newborn calf serum (NCS); the Fis/EtOH group:100 mmol/L of EtOH added to 15% NCS; the F2 group: 2% NCS; the FZ/EtOH group: 100 mmol/L of EtOH added to 2% NCS;the F2/IGF-1 group:25 ng/ml of IGF-1 added to 2% NCS;the F2/IGF-1/EtOH group: 100 mmol/L EtOH added to 25 ng/ml IGF-1 and 2% NCS. The osteoblasts were analyzed by the MTT assay, alkaline phosphatase (ALP) activity, and RT-PCR at 24, 48, 72 and 96 hours after the culture. RESULTS: The absorbance (A), the ALP activity, and the expression of BGP mRNA (the proliferation and function indicators of the osteoblasts) were significantly decreased in the F15/EtOH group at all the time points when compared with those in the F15 the group (P < 0.05); the above 3 indicators were significantly decreased in the F2 group when compared with those in the F15 group (P < 0.05); they were significantly decreased in the F2/EtOH group when compared with those in the F2 group (P < 0.05); however, the indicators in the F2/IGF-1 group were significantly increased when compared with those in the F2 group (P < 0.05); the A value in the F2/IGF-1/EtOH group was not significantly decreased when compared with that in the F2/IGF-1 group, with an exception of the A value at 24 hours (P > 0.05); however, ALP and BGP mRNA were significantly decreased (P < 0.05). All the indicators were significantly increased when compared with those in the F2/ EtOH group (P < 0.05). CONCLUSION: Ethanol can inhibit the osteoblast proliferation and the osteoblast function, and can increase the inhibition when the osteoblasts were cultured under the serum starvation. This may be one of the mechanisms for alcoholic bone disease. IGF-1 can prevent the inhibition of the osteoblasts under the serum starvation and counteract the ethanol-induced proliferation inhibition; therefore, IGF-1 is an alternative therapeutic intervention for alcoholic bone disease.

[Comparison of restoring and maintaining the cervical curvature and height by using three different anterior cervical plate systems].

OBJECTIVE: To investigate and compare the effects of restoring and maintaining the cervical curvature and height of the fused segment by using three different anterior cervical plate systems. METHODS: From January 2002 to June 2004, 122 patients underwent anterior cervical decompression, autogenous iliac bone graft and plate fixation. Of the 122 patients (85 males, 37 females, aged 14-70), 37 underwent surgery involving the fixation with the Orion plate system, 39 with the Zephir plate system, and 46 with the Codman plate system. The cervical curvature and height of the fused segment were measured on the lateral X-ray films so as to compare the changes of the conditions preoperatively, 1 week after surgery, and during the follow-up, and also to compare the difference among the three groups. RESULTS: The follow-up of the patients for 6-35 months (average 17.3 months) showed that all the patients developed the bone fusion 6 months after operation. There was a significant improvement in the cervical curvature and height of the fused segment before operation versus 1 week after operation (P < 0.05); however, there were no significant changes 1 week after operation versus during the follow-up in each group(P > 0.05); there was no significant difference among the three groups (P > 0.05). CONCLUSION: The three plate systems can effectively reconstruct and maintain the cervical curvature and height of the fused segment, with a satisfactory effect in a short term.