Treatment of senile lumbar spinal stenosis by unilateral approach and bilateral decompression with large channel endoscopy / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis.@*METHODS@#The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females, aged 65 to 84 years old with an average of (70.6± 8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs, of which 28 cases were accompanied by intermittent claudication. Narrow segments were L@*RESULTS@#All the patients were followed up for 12-24 (17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation, and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases, all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days, 3 months, 1 year after operation, VAS scores of low back pain were 4.62 ±1.41, 2.73 ±1.35, 1.21 ±1.17, 1.11 ±0.34, respectively;VAS scores of leg pain were 6.83 ± 1.71, 3.10±1.50, 1.08±0.19, 0.89±0.24, respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (@*CONCLUSION@#It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression, less trauma, fast recovery, high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis.

Transforaminal percutaneous endoscopic lumbar discectomy combined with anchorage technique of pedicle for the treatment of high prolapse free lumbar disc herniation / 中国骨伤

OBJECTIVE@#To investigate the clinical effects of percutaneous spinal endoscopy (percutaneous endoscopy) in the treatment of high prolapse free lumbar disc herniation.@*METHODS@#From May 2016 to June 2018, 24 patients with highly prolapse free lumbar disc herniation were enrolled in this study, including 11 males and 13 females, ranging in age from 48 to 72 years old, with an average of (59.5±7.2) years old. There were 1 case of L, 5 cases of L, 18 cases of L. The course of disease ranged from 8 to 26 months, with an average of (16.2±6.3) months. All the patients were subjected to local infiltration anesthesia. The clinical outcomes were evaluated by visual analog scale (VAS) for leg pain, low backpain and Oswestry Disability Index (ODI) at preoperative, first day after operation and 6 month after surgery. All data were statisticed by SPSS 22.0.@*RESULTS@#All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (17.5±5.3) months. The average operation time was(69.8±14.2) minutes. One patient had cerebrospinal fluid leakage, which improved after supine rest. VAS scores of lower back pain were 6.36±1.27, 3.94±1.03, 1.62±0.87, 0.44±0.27, 0.37±0.29. VAS scores of leg pain were 8.28±1.74, 3.16±1.24, 2.83±1.13, 0.83±0.31, 0.46±0.31, and the differences were statistically significant (<0.05). The ODI were (48.79±9.83)%, (36.51±11.24)%, (21.05±6.35)%, (9.83±4.62)% and (7.24±4.72)% 1 day before and 1 weeks, 3 months, 6 months and 1 year after the operation, respectively. One year after the operation, the modified Macnab evaluation system was used to evaluate the clinical efficacy of the patients, 19 patients got an excellent result, 3 good, 2 fair and 0 poor.@*CONCLUSION@#Percutaneous endoscopic pedicle anchoring technique for the treatment of high prolapse free lumbar disc herniation can effectively improve the clinical symptoms of patients, and has the advantages of less trauma, less bleeding, rapid recovery, complete removal of the nucleus pulposus, and less pain of patients, etc., its clinical efficacy is accurate, operability is strong, it is worth promoting in the clinical use.

The relationship between angle of puncture and distribution of bone cement of unilateral percutaneous kyphoplasty for the treatment of thoracolumbar compression fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the relationship of bone cement distribution and the puncture angle in the treatment of thoracolumbar compression fractures with unilateral percutaneous kyphoplasty (PKP).</p><p><b>METHODS</b>The clinical data of 37 patients with thoracolumbar osteoporotic compression fractures underwent PKP between January 2013 to March 2014 were retrospectively analyzed, all punctures were performed unilaterally. There were 6 males, aged from 65 to 78 years old with an average of (71.83 ± 6.15) years; and 31 females, aged from 57 to 89 years old with an average of (71.06 ± 7.89) years. Imaging data were analyzed and puncture angle and puncture point were measured before operation. According to the measured data, the puncture were performeds during the operation. Distribution area of bone cement were calculated by X-rays data after operation. The effect of bone cement distribution on suitable puncture angle was analyzed; VAS score was used to evaluate the clinical effects.</p><p><b>RESULTS</b>The puncture angle of thoracic vertebrae in T8-T12 was from 28° to 33° with an average 30.4°; and the puncture angle of lumbar vertebrae in L1-L5 was from 28° to 35° with an average of 31.3°. Postoperative X-rays showed the area ratios of bilateral bone cement was 0.97 ± 0.15. Bilateral diffuse area were basic equal. Postoperative VAS score decreased significantly (1.89 ± 1.29 vs 7.03 ± 1.42).</p><p><b>CONCLUSION</b>Through measure imaging data before operation with PKP,the puncture point and entry point can be confirmed. According the measured data to puncture during operation, unilateral puncture can reach the distribution effect of the bilateral puncture in the treatment of thoracolumbar compression fractures.</p>

Transpedicular bone graft for the treatment of thoracolumbar vertebral fractures through Wiltse approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore methods and therapeutic effects of transpedicular bone graft in treating thoracolumbar fractures through Wiltse approach.</p><p><b>METHODS</b>From March 2009 to February 2012,56 patients with thoracolumbar fractures were treated by transpedicular bone graft through Wiltse approach. Among them, there were 36 males and 20 females, ranging in age from 14 to 55 years old (mean, 41 years old). The time from injury to operation from 2 to 15 d (mean,3 d). Twenty-five cases were caused by falling down, 7 cases were caused by slipping, 20 cases were caused by car accident and 4 cases were caused by crush trauma. MRI was performed before operation to exclude pathological fracture. The distance between multifidus muscle and longissimus to midcourt line was measured. Self-made trocar was applied in operation. According to AO classification,there were 33 cases with type A1 compression fracture,5 cases with type A2 cleavage fracture and 18 cases with type A3 burst fracture. Sixteen cases of the 56 cases combined with spinal cord injury. Based on Frankel neurologic grading system, preoperative neurological function was grade B in 5 cases, grade C in 2 cases, gade D in 9 cases. Preoperative Denis gading were P5. Frankel and lumbago Denis clssification were used to evaluate neurological function and lumbago. The imaging data before, after operation and the latest follow-up were used to evaluate correction vision.</p><p><b>RESULTS</b>All patients were followed up over 24 months. At the time of the latest follow-up, Frankel B were 3 cases, Frankel C were 2 cases, Frankel D were 4 cases and Frankel E were 7 cases. According to lumbago Denis clssification, P1 (painlessness) were 32 cases, P2 ( slight pain without treatment) were 18 cases, P3 ( moderate pain and taking medicine occasionally) were 6 cases. The anterior vertebral height improved from preoperative (13.38 +/- 4.72)mm to postoperative (22.18 +/- 1.44)mm. The Cobb's angle decreased from preoperative (28.39 +/- 2.64) degrees to (10.07 +/- 3.05) degrees. There were no nails broken, rod broken, internal fixation lossen and vertebral body recompression.</p><p><b>CONCLUSION</b>Transpedicular bone graft for thoracolumbar fractures through Wiltse approach can reduce intraoperative blood loss and postoperative complications, and aviod "eggshell" vertebral body. Mastering revealed way, drafting detailed preoperative plan and eariler exercise is the key to the success of treatment.</p>