ABSTRACT
Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.
ABSTRACT
Objective: To investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion (AL). Methods: Between October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were 8 males and 2 females with an average age of 48.8 years (range, 31-79 years). The disease duration was 1.5-48.0 months (mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T10, 11, 4 cases of T11, 12, and 3 cases of T12, L1. The preoperative visual analogue scale (VAS) score was 8.0±0.8, the Oswestry disability index (ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was (26.3±7.1)°. According to American Spinal Injury Association (ASIA) scoring system, neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E. Results: All the operations of 10 patients completed successfully. The operation time was 120-185 minutes (mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL (mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months (mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones (t=17.530, P=0.000; t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were (12.6±4.6)° at 3 days and (13.6±4.6)° at 24 months after operation, which were significantly different from those before operation (P0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod. Conclusion: Debridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion, and a certain correction of local kyphosis.