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BACKGROUND:Screw fixation of the fractured vertebral body can share the stress of implant, increase fixing strength, and help to maintain the stability of late fracture. However, whether it can assist reduction using fracture vertebral screw, but no relevant clinical reports were found at present. OBJECTIVE:To explore the effectiveness of self-designed screw-assisted reduction of fractured vertebrae. METHODS:161 cases of thoracolumbar fracture who had been hospitalized between June 2001 and June 2009 were enrol ed in this study, including 101 males and 60 females, at the age of 22-67 years, averagely 36 years. By Denis classification, 64 cases affected burst fractures and 97 flexion-compression fractures. Fracture levels involved T11 (9 cases), T12 (63 cases), L1 (74 cases) and L2 (15 cases). The self-designed method of reduction assisted with screw insertion was used. The efficacy of this reduction method was evaluated by operation time, intraoperative bleeding, fracture union time, height ratio of anterior borders of injured and normal vertebrae, sagittal Cobb’s angle, and reduction of fragments. RESULTS AND CONCLUSION:The operation time ranged from 60 to 150 minutes, averaging 80 minutes. The intraoperative bleeding ranged from 67 to 750 mL, averaging 98 mL. The fol ow-up time ranged from 16 to 42 months in 161 patients. Fracture union time ranged from 10 to 18 weeks, averaging 12.6 weeks. The ratio of anterior heights and sagittal Cobb’s angle of fractured vertebrae were significantly improved from (54.39±9.60)%and (22.55±7.90)° respectively preoperati on to (82.80±6.63)%and (8.91°±5.85)° 12 months postoperation (P<0.05). The size of spinal canal was increased by (46.5±2.6)%postoperatively. CT scan revealed satisfactory fragment reduction and no deep infection appeared. These findings suggest that our self-designed screw-assisted reduction of the fractured vertebrae can improve the reduction quality in the treatment of thoracolumbar fractures.
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Percutaneous endoscopic lumbar discectomy belongs to minimally invasive spine operation Its superiority includes smalleroperation wound,less bleeding,shorter hospital day,and earlier return to function,conpared with the traditional operation.At the same time,percutaneous endoscopic lumbar discectomy has complications,as the open operation.This paper reviews its common complications,diagnosis,prevention and control.
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Objective To explore the clinical and radiographic outcomes of minimally invasive transforarninal lumbar interbody fusion (MIS-TLIF) with unilateral pedicle screw fixation in treatment of one-level lumbar degenerative disease.Methods A total of 65 patients suffered from one-level lumbar degenerative disease between October 2009 and December 2011.They were divided into 2 groups according to different fixation ways.31 patients were given MIS-TLIF with unilateral pedicle screw fixation.The other 34 patients were given MIS-TLIF with bilateral pedicle screw fixation.Microscopic tubular retractor system (METRxMD) and Sextant system were used in all the procedures of treatment.The whole lumbar lordosis (WL),the segmnental lordosis (SL),fusion level disc space angle,lumbar scoliosis angle,and segmental scoliosis angle were measured pre and post operation according to standarded X-rays.The disc height index (DI) and the lumber curvature index (LI) were also evaluated.The Oswestry disability index (ODI) score and visual analog scale (VAS) pain score data were obtained from all the patients pre-operation and during each following-up procedure.Results All the patients were well followed up 18 months to 36 months(average 26.6 months).All the 65 patients were proved to achieve bone fusion in 12 months post-operation.The ODI and VAS scores post-operation improved significantly in each group,but showed no significant difference between the 2 groups.Likewise,there were no significant differences between the 2 groups in datas of WL,SL,fusion level disc space angle,lumbar scoliosis angle,segmental scoliosis angle,DI,and LI.But there was a positive linear correlation between the LI and WL in the 2 groups.Conclusion MIS-TLIF with unilateral pedicle screw fixation is as good as MIS-TLIF with bilateral pedicle screw fixation in patients of one-level lumbar degenerative disease.
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Objective To introduce a new minimally invasive lumbar positioning system and its positioning method as well as conduct a prospective control study on the differences in positioning time,positioning frequency and radiation exposure dose between the new positioning method and the traditional positioning method.Methods 121 patients with lumbar disc herniation combined with lumbar instability and patients with thoracolumbar vertebral fracture admitted in our hospital from May 2010 to February 2013 were randomized into two groups.68 patients in Group A had undergone the traditional positioning method before and during operation.Among the 68 patients,41 were with single-segment lesion and 27 were with two-segment lesion.53 patients in Group B had undergone the new minimally invasive lumbar positioning system before and during operation.Among the 53 patients,34 were with single-segment lesion and 19 were with two-segment lesion.There were no significant differences in gender,age,course of disease and other general information between the two groups.The positioning time,positioning frequency and radiation dose of the two groups before and during operation were compared and statistically analyzed.Results The positioning time of Group A and Group B were 8.26±3.44 min and 3.51±1.82 min respectively; the positioning frequencies were 3.57 and 1.22; the accuracy were 60.8％ and 96.2％.For the patients with single-segment lesion,the positioning time before implanting two percutaneous pedicle screws during operation were 15.12±4.69 min and 5.51±1.32 min respectively and the positioning frequency were 6.47 and 2.45.For the patients with two-segment lesion,the positioning time before implanting three percutaneous pedicle screws during operation were 24.91±7.43 min and 8.84±2.32 min respectively and the positioning frequency were 11.72 and 3.69.Moreover,the radiation dose detected at neck,chest and wrist of the surgical staff in Group A were 3.09±0.24 Gy,4.23±0.71 Gy and 5.17±0.62 Gy and that detected in Group B were 1.38±0.47 Gy,2.69±0.33 Gy and 3.21±1.05 Gy.There were significant differences in positioning time,positioning frequency and radiation dose between Group A and Group B.Conclusion The minimally invasive spine positioning system and positioning method can simplify the operative procedures and largely reduce radiation exposure,which is characterized by high positioning accuracy,short positioning time,low fluoroscopy frequency and X-ray radiation dose.
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ObjectiveTo explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis.MethodsFrom March 2008 to August 2010,73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed.The patients were divided into different groups by clinical features,imaging manifestations,and concurrent diseases.The minimal invasive surgical methods were chosen according to the classification.Operation time,intra-operative bleeding,and complications were recorded.The lumbar function was evaluated by Oswestry disability index (ODI),and the clinical results were assessed by JOA pre- and postoperatively.ResultsMinimal invasive surgery was completed in all cases,which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression.Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression.Intraoperative blood loss and operation time were related to surgical methods.One case was complicated with dural tear.Cage was inserted into upper vertebral body during interbody fusion in 1case with osteoporosis,removed the cage and implanted bone fusion.Incisions of 3 cases were poor healing after surgery.The average follow up time was 13 months(range,10-35).JOA score and ODI before surgery were 9.2±5.1 and 62.3％±18.5％ respectively; while 6 months after surgery,JOA score and ODI were 23.5±7.2 and 18.4％±6.4％ respectively.JOA score and ODI showed statistically significant improvements after operation(P＜0.01).Twenty-two cases got solid fusion at the final follow-up.ConclusionTreatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes,but the proper minimal invasive strategy should be chosen according to specific patients,surgeons and hospitals.
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Interspinous dynamic stabilization is popular in the non-fusion spine surgery.It is characterized in the motion preservation of segmental lumbar,avoiding the stress change after fusion surgery and adjacent disc degeneration.Interspinous dynamic stabilization systems have got fast development and are widely used in the treatment of lumbar spine disease.As an innovation of traditional fusion surgery,the clinical evaluation is the focus of spine surgeon.In this paper,the recent studies of the clinical evaluation of interspinous dynamic stabilization are reviewed.
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[Objective]To discuss the influence of posterior cervical titanium internal fixation system on magnetic resonance image(MRI).[Method]Six cases that had operated in Changhai hospital with posterior cervical titanium internal fixation system performed MRI scan.The MRI system were 1.0-T or 1.5-T scanner.Patients all performed sagital T1,T2 and axial T1-weighted image scan under turbo spin echo(TSE)sequence,then the artifacts and its influence on the MRI image were analyzed.[Result]Mean artifact size ranged from 2 to 3 times of actual screw size.The artifact was similar to the primary shape of internal fixation system with low intensity signal on center and high intensity signal on the margin.The details in the spinal canal can be distinguished.The rod had small artifact,but the laminar hook had large artifact which obscured the posterior structure of spinal canal,and the artifact of pedicle screw had influence on lateral spinal canal,nerve root and vertebral artery.[Conclusion]Patients with posterior cervical titanium internal fixation system should choose Turbo spin echo(TSE)sequence for MRI scan,if the spin echo is performed,the TE should be minimized.
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We conducted Chinese-English bilingual education on clinical study of medical students and also discussed related problems.Chinese-English bilingual education has very good results in improving professional English study of medical students.
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The authors analyzed current situation of teachers and students' law consciousness and proposed that we should well know the rights and obligations of the doctor and patient and improve the quality of case history.
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To analyze the prevention and treatment of cerebrospinal fluid leakage in spinal surgery.Methods:A retrospective analysis was taken to the 21 cases suffered from cerebrospinal fluid leakage after spinal surgery from January 1995 to May 2000.Results:Through careful treatment peri-operation,20 cases cured between 6 days and 36 days by conservative measurements,incision was applied in one case for repairing dura mater,no cerebrospinal meningitis occured;6 cases after lumbar spinal sugery had cerebrospinal fluid cysts formation after 3 months to 2 years.Conclusions:Almost all cerebrospinal fluid leakage can be cured by repairing dura mater or blocking up leakage in operation and regular conservative treatment after operation.A few cases failing to conservative treatment need reopen incision for repairing dura mater.The symptomatic and conmmunicating cerebrospinal fluid cysts can be treated by surgery.
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Objective: To find out the pathomechanism of low back and leg pain related to intervertebral disc. Methods: The nucleus pulposus of coccygeal vertebral was transplanted to the cavum epidurale of rats to establish the non-compressive model with transplanted nucleus pulposus. The evoke potentials and morphology of nerve roots were observed. Results: Even without mechanical compression, rats transplanted with nucleus pulposus resulted in significant harm to evoked potential and morphology of cauda equina. Conclusion: The biomechanical and/or immunologic inflammatory effect of nucleus pulposus can result in nerve roots injury and is an important factor in the pathogenesis of low back and leg pain.
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Objective:To discuss the influence of posterior thoracic and lumbar titanium internal fixation system on magnetic resonance image(MRI).Methods: Twelve patients who received thoracic-lumbar posterior titanium internal fixation system were subjected to MRI scanning.The artifact characteristics of titanium internal fixator and its influence on the spinal canal structure were analyzed.Results: The artifact size was 2-3 times that of the internal fixator.The details in the spinal canal and spinal cord were clearly displayed on the sagittal T_1 and T_2 weighted images and axial T_1 weighted image.The link rod had small artifact and had influence on the images of adjacent lamina and facet,but had little influence on the observations after operation.The pedicle screw in the right position had considerable artifact,which influenced the images of lateral spinal canal,foramina,nerve root,and posterolateral herniated disc.Conclusion: Turbo spin echo sequence should be chosen for MRI scanning in patients implanted with posterior thoracic and lumbar titanium internal fixation system,with the echo time minimized.When reading the MRI images,the influence of titanium fixation system on the postoperative MRI should be considered in order to obtain the correct information of the patients.
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Objective:To study the role of phospholipase A 2 in the pathomechanism of low back and leg pain. Methods:Phospholipase A 2 was injected into rats′ cavum epidurale, then the pathologic changes of cauda equina was viewed under light microscopy and electronic microscopy. The substance P(SP) in the dorsal root ganglia(DRG) and spinal cord was determined by immunohistochemistry. Results:After phospholipase A 2 injection, the nerve fibers of cauda equina displayed significant degeneration and demyelination. In L 4 to L 6 segment, the number and area of SP positive neurons in the DRG increased significantly. The relative density of positive nerve endings in the dorsal horn of spinal cord was also increased significantly. There were significant difference compared to the normal solution control group by statistic analysis. Conclusion:Phospholipase A 2 is a nocuous substance to cauda equina. It may play an important role in the pathomechanisms of low back and leg pain related to lumbar disc herniation.
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Objective To review and analyze the sexual function of patients with spinal fractures complicated by incomplete paraparesis. Methods A total of 73 patients with incomplete paraparesis resulted from spinal fractures were retrospectively analyzed. Frankel Grade was used to determine the neurologic function and international index of ecrectile function (IIEF) to evaluate patients' sexual function. The patients with sexual dysfunction also were examined for reflex erection and psychogenic erection function. Results There were 21 patients with sexual dysfunction. Through ?2 test, significant difference was found between Frankel grade B and grade C as well as between grade D and grade E (P
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Objective:To evaluate the validity and reliability of adapted simplified Chinese Version of the Scoliosis Research Society-22(SRS-22)questionnaire.Methods:The English version of the SRS-22 was translated into simplified Chinese and was subjected to cross-culture adaptation;the final version of the simplified Chinese SRS-22 questionnaire was a consensus reached by an expert committee.Then the simplified Chinese version SRS-22 questionnaire and 36-Item Short Form Health Survey(MOS SF-36)questionnaire were used to survey 87 patients with adolescent idiopathic scoliosis who had been surgically treated;63 patients(72.4%)responded to the SRS-22 questionnaire.The average age of these patients(6 male,57 female)was(17.7?3.1)years(range,14.3-23.8 years).Fifty-six of the 63 patients returned the MOS SF-36 questionnaire.The 2 indicators of reliability were Cronbach's ? of internal consistency and intraclass correlation coefficient(ICC).Concurrent validity of the SRS-22 questionnaire was measured by comparing with domains of the SF-36 questionnaire,which was reflected by Pearson correlation coefficient(r).Results:The Cronbach ? values for 4 domains(function/activity,pain,self-image/appearance,and mental health)were all higher than 0.7;and the Cronbach ? value for satisfaction of management domain was acceptable.The intraclass correlation coefficients for function/activity,pain,self-image/appearance,mental health,and satisfaction domain were 0.74,0.78,0.86,0.81 and 0.84,respectively,demonstrating a satisfactory reproducibility.For the concurrent validity,3 domains had excellent correlation,10 had good correlation,and 21 had moderate correlation.Conclusion:The adapted simplified Chinese Version of the SRS-22 questionnaire has satisfactory reliability and concurrent validity,and might be suitable for post-operation clinical evaluation of Chinese adolescent patients with scoliosis.