[Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion for degenerative lumbar scoliosis].

OBJECTIVE: To explore the surgical techniques and long-term clinical outcomes of degenerative scoliosis (DS) with selective segmental transforaminal lumbar interbody fusion (TLIF) and posterior spinal fusion. METHODS: Ninety-five patients with adult degenerative lumbar scoliosis undergoing posterior long fusion at our department from January 1999 to December 2007 were analyzed retrospectively. The average follow-up period was 7.8 (5-13) years. The clinical outcomes of Oswestry disability index (ODI), visual analog scale (VAS), patient satisfaction and such radiographic parameters as Cobb angle, apical vertebra translation (AVT), Nash-Moe grade, lumbar lordosis (LL) and thoracolumbar kyphosis (TLK) were evaluated. RESULTS: The clinical outcomes of ODI score and VAS significantly improved at the last visit (P < 0.05). The ODI score was 32.2 ± 8.6 before surgery and 11.1 ± 6.8 at the last visit. The VAS was 8.9 ± 2.0 before surgery and 2.0 ± 1.2 at the last visit. Patient satisfaction was 88.2% (84/95) at the last visit. At the final evaluation, Cobb's angle, apical vertebra translation and Nash-Moe grades decreased with a statistically significant difference (P < 0.001) compared with preoperative parameters.Lordotic angle had a significant increase than preoperative angle (P < 0.001). Thoracolumbar kyphosis showed no significant change (P > 0.05). Besides, a significant positive correlation existed between the decrease of ODI score and the increment of lumbar lordotic angle (r = 0.62, P = 0.01) .Long-term complications included broken rod (n = 2), coronal junctional scoliosis (n = 4), L5-S1 spondylolisthesis (n = 2), L5-S1 restenosis (n = 5). And 11 patients underwent reoperation. CONCLUSION: A combination of selective segmental TLIF and posterior spinal fusion is both safe and effective for degenerative scoliosis and excellent long-term clinical outcomes may be achieved. And selective segmental TLIF can facilitate solid fusion, improvement of lumbar lordosis, better correction of lateral spondylolisthesis and asymmetric disc space so as to yield better corrective effects and long-term clinical outcomes.

[Effects of intrathecal injection of methylprednisolone sodium succinate in acute spinal cord injury rabbits].

OBJECTIVE: To investigate the effects and apoptosis of intrathecal injection of Methylprednisolone Sodium Succinate (MPss) for acute spinal cord injury (SCI) in New Zealand rabbits. METHODS: Seventy-two healthy New Zealand rabbits were used for the procedure and were randomly divided into two groups: SCI group and SHAM group, which was both divided into 6 subgroups, such as the vehicle group, the MPss intrathecal injection groups (1.5 mg/kg, 3.0 mg/kg, 6.0 mg/kg group), the MPss intravenous injection group and the combined injection group. TARLOV score was tested daily to evaluate the motor function. The rabbits were sacrificed 7 days after the surgery and the thoracic spinal cord sections and the sacral sections where MPss was injected were harvested for HE and TUNEL staining. Two-Factors Repeated Measures analysis of variance for TARLOV scores tested at various times and One-Way ANOVA analysis of variance for data between groups were used. RESULT: Seven days after surgery in SCI group, there was no statistical difference between the TARLOV scores of intrathecal injection of MPss 3.0 mg/kg group, 6.0 mg/kg group and MPss intravenous injection group (P > 0.05), which were all better than the vehicle group (F = 4.762, P < 0.05). Referring to the lymphocyte infiltration at the injury site in SCI group, there was statistical difference between MPss intrathecal injection 6.0 mg/kg group (1.33 ± 0.21) and the vehicle group (2.67 ± 0.21) (F = 5.793, P < 0.05) and no statistical difference between intrathecal injection of MPss 6.0 mg/kg group and MPss intravenous injection group (P > 0.05). As for the lymphocyte infiltration at the intrathecal injection site in SHAM group, there was statistical difference between MPss intrathecal injection 6.0 mg/kg group (2.50 ± 0.55) and the vehicle group (0.50 ± 0.55) (F = 17.333, P < 0.05). TUNEL staining in SCI group showed statistical difference between MPss intrathecal injection 6.0 mg/kg group (6.3 ± 1.5) and the vehicle group (20.3 ± 2.2) (F = 71.279, P < 0.05). CONCLUSIONS: Intrathecal injection of MPss can improve the functional recovery of lower limb and decrease apoptosis of neuron cells,which can provide same effects as the traditional intravenous injection of MPss in New Zealand rabbits.

[Comparison of allogenic versus ostetic artificial bone in double door laminoplasty].

OBJECTIVE: To study the application of allogenic bone and Ostetic artificial bone in double door laminoplasty. METHODS: From June 2004 to June 2010, a total of 111 patients underwent double door laminoplasty. And allogenic (group A, n = 63) and Ostetic artificial (group B, n = 48) bones were used. They had spinal stenosis at least several levels or OPLL (Ossification of posterior longitudinal ligament). Their follow-up period was 12 months. Anteroposterior compression ratio was used to evaluate the neurological status. Range-of-movement (ROM) of cervical spine and bone fusion was determined by radiography and computed tomography (CT) during the follow-ups. RESULTS: Anteroposterior compression ratio: group A improved from 0.18 preoperation to 0.43 postoperation while group B increased from 0.20 preoperation to 0.44 postoperation; ROM: group A decreased postoperatively to (22.6 ± 3.3)° from (39.5 ± 6.1)° while group B decreased postoperatively to (22.9 ± 3.7)° from (39.3 ± 6.7)°. When Groups A and B were compared, bone fusion between allograft and spinous processes was completed in 73.1% vs 64.2%, partial fusion in 22.4% vs 18.7% and failed in 6.3% vs 17.1%. CONCLUSION: Uses allogenic and Ostetic artificial bones in double door laminoplasty may achieve an excellent decompression of spinal cord. But the application of allogenic bone yields a higher bone fusion rate after surgery.

[Experimental correlation study of lumbar spinal stenosis and knee joint degeneration].

OBJECTIVE: To explore the correlation of lumbar stenosis and knee osteoarthritis by establishing a rabbit lumbar spinal stenosis model and observing the hind limb movement function and pathological change of articular cartilage of knee joint. METHODS: A total of 36 healthy adult rabbits were randomly divided into model group and control group. In the model group, spinal canal was filled with bone pieces to make lumbar spinal stenosis; in the control group, sham operation was performed and materials were inserted into spinal canal. Movement function was evaluated by Tarlov method and pathological features were observed by Mankin's scores under light microscope at 4, 8 and 12 weeks. RESULTS: Early degenerative changes of knee cartilage were observed in the model group at 4 and 8 weeks post-operation. There were synovial hyperemia and hyperplasia, increased synovial fluid effusion and lightly-stained cartilage. The Mankin score was 3.3 - 4.5 and Tarlov score 3 - 4. Intermediate stage changes of osteoarthritis were found in the model group at 12 weeks post-operation, showing synovial hyperplasia, decreased synovial fluid, fissure in cartilage surface, tangled cartilage cells and unevenly stained matrix. The Mankins score was 7 - 9 and Tarlov score 2 - 3. Most of articular cartilage was normal in the control group with Mankin score of 0 - 1 and Tarlov score of 4. CONCLUSION: Lumbar stenosis may be correlated with knee joint degeneration.

[Surgical treatment of multilevel lumbar degenerative spondylolisthesis].

OBJECTIVE: To discuss the surgical treatment of multilevel lumbar degenerative spondylolisthesis. METHODS: From March 2005 to September 2008, 25 cases of multilevel lumbar degenerative spondylolisthesis were treated with total laminectomy, reduction of spondylolisthesis and 360 degrees circumferential fusion through interbody (PLIF), transverse process (PLF) and pedicle screw fixation. All cases were followed up for 0.5 - 4 years. The Lenke grading system was used to assess the spinal fusion and Henderson grading system was used to assess the clinical outcomes. RESULTS: Complete reduction of spondylolisthesis was achieved in all cases. The bone fusion was grade A in 23 cases, grade B in 2 cases. The clinical outcome was excellent in 16 cases, good in 6 cases and poor in 3 cases. CONCLUSIONS: The pathogenesis of lumbar degenerative multilevel spondylolisthesis is different from that of single-level spondylolisthesis. Complete decompression, reduction of spondylolisthesis sufficient fusion and reliable pedicle screw fixation can provide successful interbody fusion and satisfactory clinical results.It's crucial to reduce multilevel spondylolisthesis by proper techniques based on different types of listhesis.

[Transforaminal lumbar interbody fusion in treatment of upper lumbar disc herniation: analysis of 18 cases].

OBJECTIVE: To study the effectiveness and advantages of transforaminal lumbar interbody fusion (TLIF) in the treatment of upper lumbar disc herniation. METHODS: Eighteen cases with upper lumbar disc herniation, 12 males and 6 females, aged 21 - 67, underwent TLIF. Follow-up was conducted for 19.8 months (12 - 54 months). The surgical process, outcomes, and complications were reviewed retrospectively. In TLIF operation, pedicle screw fixation was performed first, unilateral or bilateral facet joints were then excised. Disc removal and titanium mesh or fusion cage insertion were completed via transforaminal approach. RESULTS: Unilateral TLIF was performed in 14 cases and bilateral TLIF was accomplished in 4 cases. The mean operation time was 82.4 minutes and the intraoperative blood loss was 323 ml. No injury of spinal cord or nerve roots happened during the operation. The follow-up showed that the operation results were excellent in 11 cases, good in 4 cases, and fair in 3 cases. No worsening or relapse of preoperative symptoms was observed. Disc spaces and lumbar lordosis were restored satisfactorily. No internal fixation failure was found. CONCLUSION: Able to excise disc completely, restore physiological lumbar curve effectively and prevent postoperative instability, TLIF is one of effective surgical treatments for upper lumbar disc herniation for selected patients.