The guiding value of ultrasound-guided selective nerve root block in the surgical treatment of multilevel lumbar degeneration / 国际外科学杂志

Objective:To evaluate the guiding value of ultrasound-guided selective nerve root block in the surgical treatment of multilevel lumbar degeneration.Methods:Retrospective case-control study was used. Clinical data of 47 patients with multi-level lumbar degeneration who underwent decompression surgery in Honghui Hospital, Xi′an Jiaotong University from January 2019 to December 2021 were retrospectively analyzed. They were divided into nerve root block group ( n=22)and non-nerve root block group( n=25) according to whether ultrasound-guided selective nerve root block was performed before decompression surgery. The operation time, intraoperative blood loss, number of decompression laminae, postoperative drainage volume and length of stay of the two groups were recorded and compared. The visual analogue scale of low back pain, the visual analogue scale (VAS) of leg pain, the Japanese orthopaedic association (JOA) score and Oswestry disability index (ODI) score were all compared before surgery and during follow-up between the two groups. Measurement data with normal distribution were represented as mean±standard deviation( ± s), and the comparison between groups was conducted using the paired t-test. Chi-square test was used for counting data. Results:All 47 patients successfully completed the operation without any serious complications such as neurovascular injury. All patients were followed up for (27.6±7.5)months. In the nerve root block group, the operation time, intraoperative blood loss, number of decompression laminae, postoperative drainage volume and hospital stay were (90.5±12.6) min, (110.5±15.8) mL, 1.2±0.8, (85.6±15.8) mL, (6.2±2.8) d, respectively. In the non-root block group, they were (190.6±25.5) min, (450.5±24.8) mL, 3.8±1.6, (210.5±16.8) mL, (9.5±2.2) d, respectively. The above indexes in the nerve root closure group were less than those in the non-root closure group, and the difference was significant between the two groups ( P< 0.05). The scores of VAS of low back pain and leg pain, JOA and ODI in both groups were significantly improved after surgery and during the follow-up period when compared with those of pre-operation ( P< 0.05). The VAS scores of low back pain on the 3rd day, 6 months after operation and at the last follow-up in the nerve block group were 3.2±1.4, 1.4±0.8, 0.5±0.2, the JOA scores were 15.8±4.3, 21.3±5.6, 25.6±1.4, and the ODI scores were 50.6±10.3, 22.8±7.8, 16.8±4.2, respectively. The VAS scores of low back pain on the 3rd day, 6 months after operation and at the last follow-up in the non-nerve block group were 5.1±1.8, 3.4±1.2, 1.8±0.5, the JOA scores were 14.1±4.8, 20.5±3.2, 24.2±1.8, and the ODI scores were 60.5±9.8, 31.6±8.2 and 21.3±5.5, respectively. The difference between the two groups was statistically significant ( P<0.05). However, there was no statistical difference in the VAS scores of leg pain between the two groups after surgery and during follow-up ( P>0.05). At the last follow-up, the internal fixation position of the two groups was good, no loosening and displacement, and bone graft fusion was good. Conclusion:For patients with multi-level lumbar degeneration, ultrasound-guided selective nerve root block before surgery can identify the responsible segment, and selective decompression and fusion based on this can effectively reduce surgical trauma, while improving patients′ back and leg pain and physical function, which has important surgical guidance value.

Research progress on evaluation and prediction methods of dysphagia after occipitocervical fusion / 中华骨科杂志

Occipitocervical fusion (OCF) is used to treat the instability of the cranio-cervical junction due to various reasons (such as trauma, rheumatoid arthritis, infection, tumor, congenital malformations and degeneration). A satisfactory fusion rate can be obtained and the stability of the occipital neck can be reconstructed by OCF. Dysphagia is one of the most common complications after OCF, which seriously affects the quality of life of patients after surgery. This article mainly focuses on the evaluation and prediction methods of dysphagia after OCF, and summarizes related research in the past 16 years, and provides guidance and direction for how to predict the occurrence of dysphagia during OCF and the evaluation of postoperative dysphagia. The evaluation of dysphagia is mainly conducted using the Bazaz dysphagia score, swallowing quality of life scale (SWAL-QOL) and eating assessment tool-10 (EAT-10) score. However, the clinical prediction of dysphagia is mainly based on the changes of cervical curvature parameters (O-C 2 angle, O-EA angle, Oc-Ax angle, PI angle). At present, there are many methods for clinical evaluation and prediction of dysphagia, but the best evaluation method is still uncertain. We reviews the evaluation and prediction methods of postoperative dysphagia of OCF, showing that the Bazaz dysphagia score, SWAL-QOL score and EAT-10 score scale are suitable for evaluating postoperative dysphagia of OCF. During OCF operation, adjustment of O-C 2 Angle >-5°, O-EA Angle >100°, Oc-Ax Angle >65°, and increase of postoperative PI Angle from preoperative PI Angle (that is, dPI Angle) ≥0° can reduce the probability of dysphagia to a certain extent.

Clinical outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis with redundant nerve roots / 中国脊柱脊髓杂志

Objectives:To investigate the clinical efficacy and outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis(LSS)with redundant nerve roots(RNRs).Methods:The data of 48 LSS patients with RNRs(23 males and 25 females,aged 45-81 years,on average 65.4±7.5 years)treated with lat-eral lumbar interbody fusion between January 2018 and July 2022 in our hospital were analyzed retrospec-tively.Among the patients,17 cases received single-level surgery and 31 cases received multi-level surgery.On the basis of the postoperative supine MRI scans,the patients were divided into RNRs relieved group(group A)and RNRs unrelieved group(group B).Radiographic assessments included disc heights,segmental angle and cross-sectional area of the spinal canal at the RNRs segment before and after operation were per-formed.The visual analogue scale(VAS),Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score were used to evaluate the clinical outcomes at preoperation and 1 month after surgery.Results:All patients underwent surgery successfully.The preoperative cross-sectional area of the spinal canal was 65.2±21.5mm2 in group A and 35.9±11.5mm2 in group B,with a significant difference(P＜0.05).The posterior disk height and cross-sectional area of the spinal canal was 8.3±1.7mm and 92.6±25.8mm2 respectively in group A,and that of group B was 6.0±2.3mm and 45.4±12.1mm2 respectively,the differences were significant-ly statistical(P＜0.05).Furthermore,in 1 month after operation the VAS leg pain,ODI and JOA scores was 2.4±0.8,(24.1±3.0)%and 22.8±1.9 respectively in group A,and that of group B was 3.3±0.8,(30.2±4.4)%and 17.7±2.5 respectively,the differences were significantly statistical(P＜0.05).The total incidence of complications was 10.4%,including anterolateral thigh pain in 4 cases and hip flexor weakness in 1 case,which were released at 3 months of follow-up.Conclusions:Lateral lumbar interbody fusion can eliminate RNRs by restoring postoperative posterior disc height and enlarging the cross-sectional area of spinal canal,which provides an effective treatment for most LSS patients with RNRs.

Risk factors and predictive model for prolonged length of stay after spinal tuberculosis lesion removal and bone graft fusion with internal fixation / 中国脊柱脊髓杂志

Objectives:To analyze the risk factors for prolonged length of stay(LOS)after lesion removal and bone graft fusion internal fixation in patients with spinal tuberculosis,and to develop and validate a predictive model.Methods:The clinical data of 152 patients with spinal tuberculosis who underwent lesion removal and bone grafting and fusion internal fixation at Honghui Hospital affiliated to Xi'an Jiaotong Univer-sity from February 2016 to December 2020 were retrospectively analyzed.The patients were divided into the prolonged LOS(PLOS)group and normal LOS(NLOS)group according to whether their postoperative LOS ex-ceeded the postoperative LOS of the 75th percentile of the overall study cohort.Univariate analyses were per-formed for gender,age,hypertension,diabetes,paraplegia,anticoagulation history,tuberculosis resistance,pre-operative anti-tuberculosis time,blood transfusion,surgical site,surgical approach,number of fused vertebrae,operative time,intraoperative blood loss(IBL),postoperative complications,blood transfusion cost,hospital cost,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),albumin(ALB),blood routine,and coagulation function in both groups.Based on Lasso regression,the risk factors significantly associated with postoperative LOS prolongation in spinal tuberculosis were selected and incorporated into a multivariate logistic regression analysis,and thereby a prediction model was established based on the results of multivariate logistic regres-sion analysis.The model was visualized by plotting a nomogram as a means of predicting the probability of risk for prolongation of LOS after spinal tuberculosis surgery.Internal validation of the model was performed using extended Bootstrap,where receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA)were plotted to verify the discrimination,accuracy and clinical applicability.Results:The 152 patients enrolled in the study had a median LOS of 10d,and the 75%LOS was 14d.There were 96 patients in the PLOS group and 56 in the NLOS group.Univariate analysis showed that the differences in age,hypertension,diabetes,anticoagulation history,tuberculosis resistance,preoperative anti-tuberculosis time,surgical site,surgical approach,surgical time,IBL,postoperative complications,CRP,ESR,preoperative ALB,blood routine,and coagulation function were not statistically significant between the two groups(P＞0.05),while the differences in gender,paraplegia,blood transfusion,number of fused vertebrae,blood transfusion cost,and hospitalization cost were statistically significant(P＜0.05).The operative time,IBL,preoperative Hb,and preop-erative ALB were divided according to the Yoden index of ROC as the dividing point,and the cut-off value of operative time was 198(min),the cut-off value of IBL was 1000(mL),the cut-off value of preoperative Hb was 118(g/L),and the cut-off value of preoperative ALB was 38.8(g/L).Through Lasso regression model,the risk factors closely related to the prolongation of LOS after spinal tuberculosis were female,blood transfusion,the number of fused vertebrae≥3,operative time≥198min and IBL≥1000mL,preoperative Hb＜118g/L and preoperative ALB＜38.8g/L.Multivariate logistic regression analysis showed that female,number of fused ver-tebrae≥3,operative time≥198min and IBL≥1000mL were the risk factors for postoperative LOS prolongation in patients with spinal tuberculosis(P＜0.05).A visual nomogram model for logistic regression was constructed,and the predictors included female,number of fused vertebrae,operative time,and IBL.A Bootstrap self-sampling of 1,000 times was performed to complete the internal validation of the model,with a C-index value of 0.882 and an area under the curve(AUC)of ROC of 0.884(95%CI:0.782 to 0.985).The calibration curve showed that the apparent curve of the model fitted well with the curve after deviation correction.The DCA curve showed that the threshold range of 0.2 to 0.9 had the greatest clinical benefit.Conclusions:Female,number of fused vertebrae≥3,operative time≥198min and IBL≥1000mL are the main risk factors for pro-longed LOS after lesion removal and bone graft fusion with internal fixation in patients with spinal tuberculo-sis,and the predictive model based on the above risk factors can help physicians to make clinical decisions and optimize the perioperative management.

Access to the Lumbosacral Spine: A Current View / Acesso à coluna lombossacral: Visão atual

Abstract The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

Cervical anterior arthrodesis: autologous or synthetic graft? / Artrodese cervical via anterior: enxerto autólogo ou sintético? / Artrodesis cervical anterior: ¿injerto autologo o sintético?

ABSTRACT: Objective: To compare patients who underwent anterior cervical arthrodesis with autologous iliac crest graft and those who used synthetic graft. Methods: Analysis of 38 patients aged between 18 and 100 years with anterior cervical spondylosis of 1 or 2 levels in a spine surgery service. Results: degenerative cervical spine changes associated with cervicalgia and cervicobrachialgia. Excluded: previous cervical spine surgeries, fractures, or surgery above two levels. Two groups were formed with 19 patients, one using autologous graft and the other using synthetic tricalcium phosphate - a questionnaire assessed satisfaction (Oswestry and VAS) pre- and postoperatively. Bone consolidation was evaluated by tomography at nine months. Results: Mean ODI (Group 1) was 68.5% ± 4.6% preoperatively and 27.2% ± 3.8% postoperatively, being statistically relevant (p<0.001). VAS performed to evaluate the cervical region, Group 1 pre and post-op was considered statistically relevant (p<0.001). No significant difference was observed when comparing the mean values found in the postoperative period between Group 1 and Group 2 (p=0.463). Only two patients complained of chronic pain, representing 10% of the total. In nine-month tomography, 100% of patients in Group 1 and 100% of Group 2 showed bone consolidation, with no statistically relevant difference (p=0.676) between the groups. Conclusion: Similar functional and osteointegration outcomes were observed in both types of grafts. Synthetic graft minimizes the risks and complications of using allografts. Level of Evidence III; Retrospective comparative study.

RESUMO: Objetivo: Comparar os pacientes que realizaram artrodese cervical anterior associada ao uso de enxerto autólogo de crista ilíaca e os que utilizaram enxerto sintético. Métodos: Análise de 38 pacientes entre 18 e 100 anos com espondilose cervical anterior de nível 1 ou 2 em um serviço de cirurgia da coluna. Inclusão: alterações degenerativas da coluna cervical, associado a cervicalgia e/ou cervicobraquialgia. Excluídos: cirurgias de coluna cervical prévia, fraturas ou cirurgia acima de 2 níveis. Foram formados 2 grupos com 19 pacientes cada, sendo num deles utilizado enxerto autólogo e, no outro, sintético fosfato tricálcico. Foi aplicado o questionário para avaliação de satisfação (Oswestry e EVA) pré e pós-operatória. Consolidação óssea foi avaliada por tomografia no nono mês. Resultados: O ODI médio do Grupo 1 apresentou 68,5% ± 4,6% na avaliação pré-operatória e 27,2%±3,8% no pós, sendo estatisticamente relevante (p<0,001). EVA realizada para avaliar a região cervical, o Grupo 1 no pré e pós foi considerada estatisticamente relevante (p<0,001). Não foi observada diferença relevante quando comparando os valores médios encontrados no pós-operatório entre o Grupo 1 e o Grupo 2 (p=0,463). Apenas 2 pacientes com queixa de dor crônica, representando 10% do total. Tomografia de 9 meses, 100% dos pacientes do Grupo 1 e 100% do Grupo 2 apresentaram consolidação óssea, não tendo diferença estatisticamente relevante (p=0,676) entre os grupos. Conclusão: Foram observados resultados funcionais e de osteointegração similares em ambos enxertos. O enxerto sintético minimiza riscos e complicações do uso de aloenxertos. Nível de Evidência III; Estudo Retrospectivo Comparativo

RESUMEN: Objetivo: Comparar los pacientes sometidos a artrodesis cervical anterior asociada al uso de un injerto autólogo de cresta ilíaca y los que utilizaron un injerto sintético. Métodos: Se analizaron 38 pacientes de entre 18 y 100 años con espondilosis cervical anterior de nivel 1 o 2 en un servicio de cirugía de la columna vertebral. Criterios de inclusión: cambios degenerativos en la columna cervical, asociados a cervicalgia y/o cervicobraquialgia. Excluidos: cirugía previa de la columna cervical, fracturas o cirugía por encima de 2 niveles. Se formaron dos grupos de 19 pacientes cada uno, en uno se utilizó un injerto autólogo y en el otro un injerto sintético de fosfato tricálcico. Se utilizó un cuestionario de satisfacción pre y postoperatorio (Oswestry y EVA). La consolidación ósea se evaluó mediante tomografía computarizada al noveno mes. Resultados: La media del ODI del Grupo 1 fue del 68,5% ± 4,6% en la valoración preoperatoria y del 27,2%±3,8% en la valoración postoperatoria, siendo estadísticamente relevante (p<0,001). La EVA realizada para valorar la región cervical en el Grupo 1 pre y post se consideró estadísticamente significativa (p<0,001). No se observaron diferencias relevantes al comparar los valores medios encontrados en el postoperatorio entre el Grupo 1 y el Grupo 2 (p=0,463). Sólo 2 pacientes se quejaron de dolor crónico, lo que representa el 10% del total. A los 9 meses, el 100% de los pacientes del Grupo 1 y el 100% del Grupo 2 presentaban cicatrización ósea, sin diferencias estadísticamente significativas (p=0,676) entre los grupos. Conclusión: Se observaron resultados funcionales y de osteointegración similares con ambos injertos. El injerto sintético minimiza los riesgos y complicaciones del uso de aloinjertos. Nivel de Evidencia III; Estudio Retrospectivo Comparativo.

Sagittal Alignment Concepts and Spinopelvic Parameters / Conceitos de alinhamento sagital e parâmetros espinopélvicos

Abstract Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Resumo A cirurgia da coluna continua a expandir seus horizontes para cuidar dos pacientes incapacitados com dor e deformidades. Desde a última década, nosso conhecimento sobre o alinhamento espinal, do crânio à pelve, aumentou consideravelmente. Portanto, faz-se necessária a expansão de tal conhecimento para o ortopedista geral, para que possamos proporcionar melhores cuidados para essa população. O alinhamento espinal global é um conceito crítico no entendimento do impacto ocasionado pela condição patológica (doença degenerativa, trauma, deformidade) e mesmo do seu tratamento, como na instrumentação e artrodese da coluna. O tratamento de qualquer doença na coluna deve incluir o entendimento da complexidade do alinhamento espinopélvico. A princípio, todos os parâmetros parecem puramente matemáticos e pouco aplicáveis à realidade do leitor mais desatento. Mas, aos poucos, fica claro que, como tudo em ortopedia, a biomecânica faz parte essencial do conhecimento do sistema musculoesquelético, tornando mais claras as lógicas da fisiologia do movimento. O conhecimento dos conceitos de alinhamento sagital e dos parâmetros espinopélvicos proporcionam uma melhor compreensão dos esqueletos axial e apendicular, além de um melhor entendimento dos processos fisiológicos e adaptativos da coluna frente ao processo degenerativo crescente que ocorre ao longo da vida.

Analgesic effect of buccal acupuncture on patients after lumbar spinal fusion: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of buccal acupuncture on pain after lumbar spinal fusion.@*METHODS@#Sixty patients undergoing lumbar spinal fusion were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case was eliminated). The patients in the control group were treated with routine anesthesia. On the basis of the control group, the patients in the observation group were treated with buccal acupuncture at bilateral back point, waist point, and sacral point for 30 min per treatment. The first acupuncture was given before anesthesia induction, and then once a day postoperation for two days, totally 3 treatments. The dosage of sufentanil, the number of remedial analgesia, and the incidence of nausea and vomiting within 48 h after surgery were compared between the two groups; rest and motion visual analogue scale (VAS) scores at 2 (T1), 8 (T2), 12 (T3), 24 (T4), and 48 (T5) h after surgery were observed; the quality of recovery-15 scale (QoR-15) at 24 and 48 h after surgery were evaluated.@*RESULTS@#The dosage of sufentanil and the number of remedial analgesia within 48 h after surgery in the observation group were lower than those in the control group (P<0.01). There was no significant statistically difference in rest and motion VAS scores between the two groups in T1, T2, T3, T4 and T5 (P>0.05). The QoR-15 scores in the observation group at 24 and 48 h after surgery were higher than those in the control group (P<0.01). The incidence of nausea in the observation group was lower than that in the control group (P<0.05).@*CONCLUSION@#Buccal acupuncture could reduce the amount of postoperative analgesic drugs of patients after lumbar spinal fusion, and promote early postoperative recovery.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Analysis of the causes and clinical results of vertebral fracture during oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.

Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis.@*METHODS@#A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect.@*RESULTS@#The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression.@*CONCLUSION@#Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.

Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.

Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation / 中国骨伤

OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.@*RESULTS@#There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.

Efficacy analysis of autologous facet joint bone block in lumbar interbody fusion of osteoporosis patients / 北京大学学报(医学版)

OBJECTIVE@#To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis.@*METHODS@#From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up.@*RESULTS@#A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (P>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation (P < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups (P < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively (P < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group (P < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group (P < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (P>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation (P < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively (P < 0.05).@*CONCLUSION@#In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.

Extreme lateral interbody fusion versus traditional posterior lumbar fusion for treatment of lumbar infectious diseases / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of extreme lateral interbody fusion (XLIF) in comparison with traditional posterior lumbar fusion in the treatment of lumbar infectious diseases.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients with lumbar infectious disease who had been treated at Department of Spinal Surgery, The Third Hospital of Hebei Medical University from May 2017 to November 2019. There were 18 males and 12 females with an age of (53.3 ± 12.5) years. According to surgical procedures, the patients were divided into group A of 13 cases subjected to XLIF and group B of 17 cases subjected to posterior radical debridement plus lumbar fusion plus internal fixation. The 2 groups were compared in terms of demographic data like age and gender, intraoperative indexes, intervertebral fusion rate, and complications, as well as visual analogue scale (VAS) and Oswestry disability index (ODI) at 3, 6, and 12 months after operation.Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The operation time in group A was significantly shorter than that in group B [(88.5 ± 13.6) min versus (124.1 ± 15.4) min], and the intraoperative blood loss in group A significantly less than that in group B [(66.9 ± 18.4) mL versus (461.8 ± 150.6) mL] ( P<0.05). The VAS and ODI at 3, 6, and 12 months after operation in both groups were significantly lower than those before operation ( P<0.05). The VAS and ODI at 3 months after surgery in group A [2 (2, 2) points and 15.2% ± 5.0%] were significantly lower than those in group B [3 (2, 3) points and 19.5% ± 6.2%] ( P<0.05). There was no significant difference in the fusion rate between groups A and B at 12 months after operation (13 versus 16) ( P>0.05). Postoperatively, left thigh numbness and weakness was reported in 1 case in group A while 2 cases of cerebrospinal fluid fistula and 1 case of poor wound healing were observed in group B, showing no significant difference in the incidence of complications between the 2 groups ( P>0.05). Conclusion:Compared with the traditional posterior lumbar surgery, XLIF demonstrates advantages of less intraoperative blood loss, less tissue damage, shorter operation time, faster postoperative recovery in the treatment of lumbar infectious diseases with no obvious intraspinal abscess or nerve compression.

Reoccurring radicular pain related with shifting overlong articular process following oblique lumbar interbody fusion: a case report / 中华骨科杂志

The oblique lumbar interbody fusion (OLIF) procedure has yielded favorable outcomes for individuals afflicted with degenerative lumbar conditions; however, certain complications warrant attention. We present a case of a 48-year-old female experiencing recurrent radicular pain post-OLIF. This patient, who endured persistent lower back discomfort for a decade, underwent MRI scans which revealed an intervertebral disc herniation at the L 4, 5 level and L 4 spondylolisthesis. The length of the right upper articular process of L 5 was 10.46 mm, and the distance between right upper articular process of L 5 and right nerve root of L 4 was 1.34 mm. Subsequent to OLIF, she reported recurrent radicular pain in her right leg. Post-operative CT scans revealed that the inclination of the right upper articular process of L 5 augmented from 59.46° to 65.22°. The distance from this process to the anterior foramen wall diminished from 0.63 mm to 0.25 mm, while its distance from the superior wall expanded from 0.31 mm to 0.39 mm. Furthermore, the foraminal cross-sectional area decreased from 0.29 mm 2 to 0.18 mm 2, and the lordotic angle of the intervertebral space amplified from 0.52° to 7.33°. Such measurements suggest that following OLIF, there was asymmetric retraction of the intervertebral space, accompanied by an anteroinferior tilt of the upper articular process, leading to persistent nerve root compression and thus necessitating immediate surgical nerve root decompression. This paper also elucidates the influence of the anatomical characteristics of the facet joint or articular process on lumbar functionality. Consequently, it could be postulated that hypertrophic or aberrantly elongated articular processes might induce nerve root compression due to intervertebral space retraction post-OLIF. Hence, spine surgeons should diligently assess and recognize the ramifications of such anomalies on OLIF surgical outcomes.

Clinical efficacy and prevention of adjacent segment degeneration in the treatment of lumbar degenerative diseases through decompression and fusion preserving proximal upper laminae / 中华骨科杂志

Objective:To investigate the clinical results of decompression preserving proximal upper laminae combined with lumbar instrumental fusion in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration (ASD).Methods:A retrospective analysis was conducted on 124 patients (the reserved group) with lumbar degeneration who underwent compression preserving proximal upper laminae combined with fusion surgery involving upper half of the lamina, upper half of the spinous process, adjacent facets, and interspinous ligament at Nanjing Drum Tower Hospital between March 2018 and February 2020. These patients were followed up for more than 2 years. Additionally, 130 patients who underwent traditional total laminectomy decompression combined with fusion surgery from January 2016 to February 2018 were selected as the control group (total laminectomy group). In the reserved group, there were 60 males and 64 females, aged 58.3±10.3 years, including 50 cases of giant lumbar disc herniation, 11 cases of lumbar disc herniation with ossification, 10 cases of simple lumbar spinal stenosis, and 53 cases of degenerative lumbar spondylolisthesis. Total laminectomy group comprised 62 males and 68 females, aged 59.6±9.2 years, with 51 cases of giant lumbar disc herniation, 13 cases of lumbar disc herniation with ossification, 11 cases of simple lumbar spinal stenosis, and 55 cases of degenerative lumbar spondylolisthesis. The number of operative segments, operative time, intraoperative blood loss, postoperative hospital stay, complications, extent of laminectomy, dural sac area, and sagittal spinopelvic parameters were compared between the two groups. Fusion status, adjacent segment stability, and the incidence of ASD were assessed at the last follow-up. Oswestry disability index (ODI) and visual analogue scale (VAS) for back and leg were used to evaluate clinical effectiveness.Results:The follow-up time was 30.5±5.4 months in the reserved group and 31.0±5.8 months in total laminectomy group, and the difference was not statistically significant ( t=0.63, P=0.528). In patients undergoing single segment surgery, the operation time (173.6±47.3 min), blood loss (351.7±102.0 ml) and postoperative hospital stay (7.8±3.1 d) in the reserved group were lower than those in total laminectomy group (196.2±34.2 min, 401.9±97.2 ml, 9.9±3.6 d, respectively), and the differences were statistically significant ( t=2.93, P=0.004; t=2.69, P=0.008; t=3.26, P<0.001). The dural sac area in both groups was significantly improved after surgery, but the extent of laminectomy in the reserved group (22.8±4.5 mm) was smaller than that in total laminectomy group (29.5±4.8 mm), and the difference was statistically significant ( t=7.62, P<0.001). The above indicators of the patients with two segment or three segments in the reserved group were better than those in total resection group, with a statistically significant difference ( P<0.05). PI, PT, SS, and LL showed significant improvement in both groups compared to preoperative values ( P<0.05), with no statistically significant differences between the groups ( P>0.05). At the last follow-up, both groups achieved Bridwell I or II fusion level. The proportion of adjacent vertebral instability in the reserved group (11.3%, 14/124) was lower than that in total laminectomy group (22.3%, 29/130), and the difference was statistically significant (χ 2=5.48, P=0.019). The total incidence of ASD in the reserved group (20.9%, 26/124) was lower than that in total laminectomy group (36.2%, 47/130), and the difference was statistically significant (χ 2=7.15, P=0.008). R-ASD (16.9%, 21/124), S-ASD (4.0%, 5/124) and O-ASD (0, 0/124) in the reserved group were lower than those in total laminectomy group [(25.4% (33/130), 9.3% (12/130) and 1.5% (2/130), respectively)], and the difference was statistically significant (χ 2=8.20, P=0.027). ODI and VAS of back and leg were significantly reduced in both groups compared to preoperative values, and the differences were statistically significant ( P<0.05). There were no significant differences in ODI and VAS scores of back and leg in the reserved group compared with total laminectomy group at 3 months, 1 year, and the last follow-up ( P>0.05). Conclusion:Decompression with preservation of the upper half of the lamina can reduce intraoperative blood loss, shorten operation time and postoperative hospital stay, achieve comparable decompression effects to traditional decompression surgery, and effectively reduce the occurrence of adjacent segment instability and ASD.

Analysis of 5 cases of Waveflex semi-rigid internal fixation in treatment of thoracolumbar fracture / 国际外科学杂志

Objective:To investigate various clinical treatment measures for thoracolumbar fractures and provide new diagnosis and treatment methods.Methods:The case data of 5 patients(3 males, 2 females, and the age ranged from 39 to 59 years with an average of 51 years) with thoracolumbar fractures were treated with Waveflex semi-rigid internaI fixation system from May 2020 to December 2021 were retrospectively analyzed, imaging indexes and clinical effects were followed up, and analyzed and summarized in combination with relevant literatures.Results:The operations of all 5 patients were successfully completed, and the follow-up period was 6 months. At the last follow-up, the internal fixation position was good, the height of the injured vertebra was maintained satisfactorily, and the clinical effect was satisfactory.Conclusion:Waveflex semi-rigid internal fixation system combines the advantages of fusion and non-fusion, providing a new idea for the treatment of thoracolumbar fractures, but its long-term effect still needs further follow-up.

Clinical efficacy analysis of DELTA endoscopic lumbar interbody fusion for the treatment of lumbar spondylolisthesis / 中国医师杂志

Objective:To explore the clinical efficacy of DELTA endoscopic lumbar interbody fusion for the treatment of mild to moderate, single segment lumbar spondylolisthesis.Methods:A retrospective analysis was conducted on the clinical data of 48 surgical cases of grade Ⅰ to Ⅱ lumbar spondylolisthesis admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from February 2020 to March 2022. Among them, 24 cases treated with DELTA endoscopic lumbar interbody fusion surgery were classified as the DELTA group, and 24 cases treated with traditional minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery were classified as the MIS-TLIF group. Two groups of patients were compared in terms of perioperative indicators (surgical time, postoperative drainage volume, incision length, hospital stay), clinical efficacy [Visual Analogue Scale (VAS) score for low back and leg pain, lumbar Japanese Orthopaedic Association Scores (JOA), improved MacNab standard excellence rate], and lumbar fusion rate (Bridwell intervertebral fusion grade).Results:The DELTA group had longer surgical time than the MIS-TLIF group, and the postoperative drainage volume, incision length, and hospital stay were all lower than the MIS-TLIF group, with statistically significant differences (all P<0.05). The VAS score of lower back and leg pain and lumbar JOA score of the two groups of patients at 1 week, 3 months, and the last follow-up were significantly improved compared to those before surgery (all P<0.01), and the DELTA group had better VAS score of lower back and leg pain and lumbar JOA score at all time points after surgery than the MIS-TLIF group, with statistically significant differences (all P<0.05). The improved MacNab standard was used to evaluate the efficacy of the two groups of patients at the last follow-up after surgery, and there was no statistically significant difference in the excellent and good rates ( P>0.05); There was no statistically significant difference ( P>0.05) in the fusion rate between the two groups. Conclusions:DELTA endoscopic lumbar interbody fusion has a significant therapeutic effect on lumbar spondylolisthesis, with the advantages of small surgical incision and fast recovery; After crossing the DELTA endoscopic learning curve and optimizing surgical procedures, this technology can become an alternative to MIS-TLIF technology.

Risk factors for adjacent vertebral compression fracture after fusion surgery of lumbar canal stenosis in the elderly / 中华创伤杂志

Objective:To evaluate the risk factors for adjacent vertebral compression fracture (AVCF) after fusion surgery of lumbar canal stenosis in the elderly.Methods:A retrospective cohort study was designed for 297 patients with lumbar canal stenosis who underwent fusion surgery in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from January 2017 to December 2020. There were 42 males and 255 females, aged 68-85 years [(76.3±7.2)years]. The patients were divided into AVCF group ( n=67) and non-AVCF group ( n=230) according to with or without the occurrence of AVCF. The indicators recorded were the gender, age, body mass index, education level, number of combined basic diseases, course of the disease, preoperative bone mineral density, intraoperative bleeding volume, number of level fused during operation, postoperative blood transfusion volume, postoperative observation in the ICU, types of postoperative external fixation and time of external fixation. Univariate analysis was conducted to analyze the correlation between above risk factors and AVCF after fusion surgery of lumbar canal stenosis in the elderly. Multivariate Logistic regression analysis was used to determine the independent risk factors for the occurrence of AVCF in these patients. Results:In the univariate analysis, age, education level, preoperative bone mineral density, intraoperative bleeding volume, postoperative blood transfusion volume and postoperative observation in the ICU were correlated with AVCF after fusion surgery of lumbar canal stenosis in the elderly ( P<0.05 or 0.01), while there was no correlation of AVCF with gender, body mass index, number of combined basic diseases, course of the disease, number of level fused during operation, types of postoperative external fixation and time of external fixation (all P>0.05). Multivariate Logistic regression analysis showed that gender ( OR=4.02, 95% CI 1.35, 12.00, P<0.05), preoperative bone mineral density≤-2.5 SD ( OR=2.01, 95% CI 1.47, 2.75, P<0.01), intraoperative bleeding volume≥475 ml ( OR=1.01, 95% CI 1.00, 1.01, P<0.01) and postoperative blood transfusion volume≥434 ml ( OR=0.99, 95% CI 0.98, 1.00, P<0.01) were significantly associated with AVCF after fusion surgery of lumbar canal stenosis in the elderly. Conclusion:The female, bone mineral density≤-2.5 SD, intraoperative bleeding volume≥476 ml and postoperative blood transfusion volume≥434 ml are independent risk factors for AVCF after fusion surgery of lumbar canal stenosis in the elderly.