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Objective To analyse the cement distribution after vertebroplasty and investigate the feasibility and clinical significance of its typing.Methods A retrospective case-series study examining the bone cement distribution on anteroposterior radiograph after vertebral augmentation was conducted on 1 324 patients (2 119 vertebrae) with osteoporotic vertebral compression fractures (OVCF) from May 2009 to May 2016.Among the patients,due to refracture,147 patients suffered two or more surgeries with a vertebral refracture rate of 11.1％.One or more adjacent vertebrae refracture occurred in 105 patients with the adjacent vertebrae refracture rate of 7.9％.The vertebral body was split into four regions on the basis of the central vertical and bilateral pedicle of vertical line.According to the bone cement distribution in the four regions,there were five distribution types:type Ⅰ:1-4 regions;type Ⅱ:2-3 regions;type Ⅲ:1 and 4 regions;type Ⅳ:3 and 4 or 1 and 2 regions;type Ⅴ:1 or 4 regions.The X-ray of 40 patients was randomly typed by three orthopedics physicians,and the complication rate and refracture rate of adjacent vertebrae in each type were calculated.Credibility and repeatability analysis were performed.Results The average credibility of the typing was 92.5％.The Kappa coefficient was 0.850 on average.The repeatability of two times of typing was on average 95％,and the Kappa coefficient was 0.900 on average.From type Ⅰ to Ⅴ,there were 26 cases (3.5％),16 cases (4.5％),29 cases (7.3％),40 cases (9.9％),and 41 cases (18.1％) of adjacent vertebral refracture.There were 10 cases of the same vertebral refracture and 5 cases of scoliosis deformity in the type Ⅴ,with incidence rates of 4.4％ and 2.2％,respectively.Conclusions Being reliable and repeatable,the typing for cement distribution after vertebral augmentation is simple and practicable.The type Ⅳ and Ⅴ cement distribution carries higher risk of refracture in adjacent or the same vertebral body and long-term scoliosis than others types.
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Objectives:To investigate the clinical outcomes of unilateral percutaneous vertebroplasty(PVP) by using curved injection needle in osteoporotic vertebral compression fractures(OVCFs).Methods:From January 2015 to January 2016,47 patients(14 males and 33 females) with OVCFs were enrolled in this study.The patients were 53-89 years old (66.4±6.5 years),36 cases were single segmental vertebral fracture,11 cases were double segment vertebral fracture.T9 fracture occured in 7 cases,T10 fracture in 7 cases,T11 fracture in 9 cases,T12 fracture in 13 cases,L1 fracture in 12 cases,L2 fracture in 9 cases,and L3 fracture in 1 case.The fluoroscopy time and bone cenent dosage were recorded.The VAS score,ODI,relative height restoration of vertebra and Cobb angle were compared between preoperation and postoperation.The bone cement leakage(venous leakage and perivertebral leakage) and other complications were observed.Results:The average fluoroscopy time was 1.6±0.3nin,the average bone cement dosage was 6.7±1.2ml.Bone cement leakage occured in 11 cases with the rate of 23.4％.The patients were followed up for 3-12 months (6.5±1.3 months).The VAS,ODI,the relative height of injured vertebra and the local Cobb angle before operation,at 2 days after operation and final follow-up were:7.6±1.3,(71.4±3.2)％,0.48±0.21,15.5°±4.2°;2.2±1.0,(27.2± 2.6)％,0.82±0.17,7.2°±2.8°;1.7±0.7,(26.5±2.7)％,0.80±0.15,7.5°±3.7°.At 2 days after operation and final follow-up,the VAS score,ODI score,the relative height and Cobb angle of injured vertebra were significantly improved when compared to those before operation (P＜0.05);There was no significant difference between 2 days after operation and final follow-up(P＞0.05).Conclusions:The advantages of unilateral PVP by using curved injection needleless in OVCFs are less fluoroscopy time,even distribution of bone cement,and less leakage.
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BACKGROUND:It is difficult to expose bilateral facet joints in L5 spondylolysis patients compared with non-spondylolysis patients. Thus, vertebral facet joint spacing and height in L5 spondylolysis patients can be used as indirect diagnostic signs that play key roles in the diagnosis of spondylolysis. OBJECTIVE:To analyze the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra and the relationship between the lumbar spondylolysis and the relative spacing of articular process. METHODS:(1) Analysis of anatomical structure characteristics and diagnostic methods of lumbar spondylolysis:The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra in diagnosing feasibility of lumbar spondylolysis was analyzed. (2) A total of 23 patients with L5 spondylolysis from Department of Orthopedics, Puyang Oilfield General Hospital and 30 normal controls were col ected from April 2013 to February 2015. The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra was measured between the two groups. RESULTS AND CONCLUSION:(1) The ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra reflected that the occurrence of L5 spondylolysis was probably associated with the width of L5 vertebral facet joint spacing. (2) Clinical trial results showed that the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra in L5 spondylolysis patients was higher than normal controls. (3) Results indicate that the ratio of vertebral facet joint spacing and height in L5 spondylolytic vertebra reflects the occurrence of L5 spondylolysis.
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BACKGROUND:Discectomy and pedicle fixation fusion are golden standard to repair lumbar degenerative disease, but the treatment would induce other complications such as degeneration of adjacent segments or severer pre-existing spinal degeneration. For the problem of lumbar fusion and fixation, lumbar elastic fixation has recently been a hot focus. ＜br> OBJECTIVE:To evaluate the short-term effectiveness of dynamic lumbar pedicle fixation in repair of lumbar spinal stenosis and lumbar disc herniation. ＜br> METHODS:From December 2010 to December 2012, 62 cases of lumbar spinal stenosis and lumbar disc herniation treated with lumbar dynamic system were included. The involved segments included:5 cases at L 3/4 , 20 cases at L 4/5 , 20 cases at L 5 S 1 , 6 cases at double segment L 3/4 and L 4/5, 8 cases at double segment L 4/5 , L 5 S 1 , 3 cases at L 3/4 and L 5 S 1 . There were 34 males and 28 females with an average age of 50.8 years (range 32 to 72 years). According to different fixation systems, they were assigned to three groups:general dynamic lumbar fixation system in 17 cases, K-Rod posterior dynamic stabilization system in 28 cases, and Dynesys system in 17 cases. The fol ow-up time was from 24 to 48 months. Evaluation indexes included visual analogue scale, Oswestry disability index, imaging analysis and excellent and good rate of curative effects. ＜br> RESULTS AND CONCLUSION:Compared with before treatment, visual analogue scale score and Oswestry disability index were significantly improved at 6 months after treatment and final fol ow-up (P＜0.01). No apparent changes were detected in the length of inserted segments and adjacent segments before treatment and during final fol ow-up. There were no significant differences in the excellent and good rate in each group after treatment (P>0.05). These data indicated that the lumbar dynamic system was an effective option for lumbar disc herniation and spinal stenosis. Although there are some differences in the structure of three kinds of flexible fixation, no obvious difference in early therapeutic effects was detected. Long-term effects deserve further investigations.
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BACKGROUND:Due to the puncture and difficult reduction, severe vertebral compressive fracture is considered to be the relative contraindication of vertebroplasty and kyphoplasty. OBJECTIVE:To investigate the vertebra reduction after the treatment of severe vertebral compressive fractures with percutaneous kyphoplasty. METHODS:Thirty patients (42 vertebral bodies) with severe compressive fractures were included. The compressive rate of the affected vertebral bodies was 75%-83%. The direction of percutaneous puncture was guided under digital subtraction angiography, and then postural reduction and local kyphoplasty were performed. After satisfactory reduction, bone cement was injected. RESULTS AND CONCLUSION:Al the 30 patients tolerated procedure wel . The mean height of the anterior, mid and posterior vertebral body was improved from (0.48±0.17) cm, (0.83±0.23) cm and (2.44±0.33) cm preoperatively to (0.71±0.22) cm, (1.21±0.25) cm and (2.44±0.33) cm respectively after operation. The postoperative height of the anterior, mid and posterior vertebral body was significantly higher than that before operation. The visual analogue scale score after treatment was significantly lower than that before operation. The results indicate that percutaneous kyphoplasty can ease pain, restore vertebral body height and improve quality of life of the patients with severe vertebral compressive fractures.