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1.
Front Bioeng Biotechnol ; 12: 1337269, 2024.
Article in English | MEDLINE | ID: mdl-38895557

ABSTRACT

Objective: To investigate the technical feasibility of applying a simple suture guide device to close the annulus fibrosus (AF) of the intervertebral discs (IVD). Methods: 30 sheep functional discal units (FDUs) were obtained and subjected to mock discectomy. Mock sutures were performed using 3-0 non-absorbable sutures under a novel AF suture device following a suture procedure. The FDUs were compressed under axial loading at 1.8 mm/min and evaluated for Failure load (N). Results: The failure loads of the hand stitching group (Group H) and suture device stitching group (Group S) were significantly higher than those of the control group (Group C) (p = 0.033; p < 0.001). Conclusion: This study provides reasonable reasons to believe that the simple suture guide device described here is technically feasible for AF defect closure. It thus constitutes an encouraging proof of concept for the proposed device; however, it does not constitute a complete demonstration of the device's feasibility in the clinical setting considering that the annulus closure operation is performed ex vivo on functional spinal units, as opposed to within an environment that mimics the clinical setting. To this end, confirmatory experiments will be conducted such as more multiaxial or dynamic mechanical testing, and notably performing the surgery on sheep models instead of on ex vivo functional spinal units.

2.
J Mater Chem B ; 12(7): 1730-1747, 2024 Feb 14.
Article in English | MEDLINE | ID: mdl-38294330

ABSTRACT

Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.


Subject(s)
Hydrogels , Spinal Diseases , Humans , Quality of Life , Minimally Invasive Surgical Procedures/methods , Neurosurgical Procedures/methods , Spinal Diseases/drug therapy , Spinal Diseases/surgery
3.
BMC Musculoskelet Disord ; 24(1): 939, 2023 Dec 05.
Article in English | MEDLINE | ID: mdl-38053117

ABSTRACT

BACKGROUND: Spinal subdural hematoma (SSH) is a rare cause of compression of the neutral elements of the spinal cord. However, little is known about the presentation of acute SSH after lumbar spine surgery. The reason for this may be that symptomatic SSH occurs rarely and is not given enough attention by spine surgeons. Currently, the decision to perform MRI postoperatively is more dependent on surgeon preference; therefore, no high-quality studies have been published. Our team reports our experience in the diagnosis and management of SSH after lumbar decompression and fusion surgery. METHODS: We retrospectively studied 215 patients who underwent routine MRI following minimal invasive transforaminal lumbar interbody fusion (MI-TLIF) between 2020-01-01 and 2022-06-30. The patients were divided into SSH group (17 cases) and non-SSH group (198 cases) according to the occurrence of SSH. Univariate analysis and multivariate logistic regression analysis were performed to identify relevant risk factors that increase the risk of SSH postoperatively. RESULTS: None of the patients presented with serious neurologic symptoms, such as lower extremity paralysis or cauda equina syndrome that required emergency hematoma debridement. SSH was found in 17 (7.9%) patients and non-SSH in 198 (92.1%). Factors affecting SSH were presence of hypertension, presence of diabetes and postoperative anticoagulant therapy. The significantly independent risk factor of postoperative SSH were diabetes (P = 0.008, OR: 6.988) and postoperative anticoagulant therapy (P = 0.003, OR: 8.808). CONCLUSIONS: SSH after MI-TLIF is not a rare condition, with generally no requirement of emergency evacuation. Comprehensive anti-symptomatic treatment could achieve satisfactory results. Diabetes mellitus and postoperative anticoagulant therapy are independent risk factors for SSH. Spine surgeons should hold applicability of the use of anticoagulants after lumbar surgery.


Subject(s)
Diabetes Mellitus , Hematoma, Subdural, Spinal , Spinal Fusion , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Hematoma, Subdural, Spinal/diagnostic imaging , Hematoma, Subdural, Spinal/etiology , Retrospective Studies , Spinal Fusion/adverse effects , Spinal Fusion/methods , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Risk Factors , Multivariate Analysis , Anticoagulants , Treatment Outcome
4.
Front Bioeng Biotechnol ; 11: 1259731, 2023.
Article in English | MEDLINE | ID: mdl-37811372

ABSTRACT

The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients' quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.

5.
BMC Musculoskelet Disord ; 24(1): 473, 2023 Jun 09.
Article in English | MEDLINE | ID: mdl-37296434

ABSTRACT

PURPOSE: Percutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl's nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy. METHODS: Review the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(Rf). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the Rf, they were divided into excellent, good and poor groups. Differences between groups were investigated. RESULTS: A total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up. CONCLUSIONS: The cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.


Subject(s)
Fractures, Compression , Intervertebral Disc Displacement , Osteoporotic Fractures , Spinal Fractures , Vertebroplasty , Humans , Bone Cements/therapeutic use , Treatment Outcome , Intervertebral Disc Displacement/diagnosis , Pain , Spinal Fractures/diagnostic imaging , Spinal Fractures/surgery , Fractures, Compression/diagnostic imaging , Fractures, Compression/surgery , Osteoporotic Fractures/surgery , Retrospective Studies
6.
Comput Methods Biomech Biomed Engin ; 25(15): 1744-1756, 2022 Nov.
Article in English | MEDLINE | ID: mdl-35230207

ABSTRACT

Percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) are two relatively new minimally invasive surgeries for symptomatic Schmorl's reported in recent decade. However, the clinical evidence for the effectiveness of these two surgeries is insufficient. The purpose of this study was to compare the biomechanical benefits and risks of the two surgeries in order to analyze their biomechanical differences and effectiveness. We reconstructed Five lumbar finite element models via computed tomography data, including control model, PVA-ideal model, PVA-nonideal model, PCD-ideal model, and PCD-nonideal model. The stress and strain of Schmorl's nodes, bone marrow edema zone (BMEZ), affected endplate, and the overall stability of segment were analyzed and compared. The validity of our models was confirmed. As a result, the PVA-ideal model can significantly reduce the stress of Schmorl's node and the strain of BMEZ, while this effect is inappreciable in PVA-nonideal model. The PCD-ideal model significantly reduced the strain of Schmorl's nodes and BMEZ, and significantly improve segmental stability, but also resulted in a significant increase in the stress of Schmorl's nodes, BMEZ and endplates. The PCD-nonideal model not only lacks blocking effect, but also sharply increases the strain of Schmorl's nodes and BMEZ. Thus, We recommend that both PVA and PCD surgeries in ideal distribution facilitated a more stable paranodular biomechanical microenvironment. However, due to the possibility of poor biomechanical outcomes caused by the non-ideal cement distribution, the non-ideal distribution of bone cement needs to be remedied in practice.


Subject(s)
Bone Cements , Intervertebral Disc Displacement , Humans , Finite Element Analysis , Bone Cements/therapeutic use , Spine/diagnostic imaging , Spine/surgery , Tomography, X-Ray Computed , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery
7.
J Orthop Surg Res ; 16(1): 429, 2021 Jul 03.
Article in English | MEDLINE | ID: mdl-34217340

ABSTRACT

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To investigate the radiological and clinical outcomes of patients with or without pedicle-screw rod fixation (PSRF) in OLIF surgery. METHODS: Between June 2017 and December 2019, 66 consecutive patients who underwent OLIF surgery at two centers were divided into stand-alone and combined groups according to whether or not PSRF was used. Imaging and clinical data were collected preoperatively, postoperatively, 3 and 6 months postoperatively, and at the last follow-up. Related coefficient and multiple linear regression analysis was used to detect the influencing factors of cage subsidence (CS). RESULTS: There was a lower baseline BMD in the combined group (p = 0.005). The combined group showed superior VAS score at 3 months postoperatively, although there was no difference in long-term VAS and ODI scores between the two groups. The foraminal height (FH) of the two groups was comparable at preoperatively, postoperatively, and 3 months postoperatively, but the combined group showed better maintenance of FH at 6 months postoperatively (p = 0.049) and last follow-up (p = 0.019). The total CS (tCS) of the combined group was lower than that of the stand-alone group during the whole follow-up period (all p ≤ 0.001). Multiple linear regression suggested that lower BMD was the risk factor for main CS, and PSRF could significantly reduce the BMD threshold for severe CS (-4.77 vs -1.38). CONCLUSIONS: OLIF combined with PSRF can effectively avoid foraminal height loss and prevent severe CS, which may be more suitable for patients with osteoporosis or osteopenia and improve clinical outcomes.


Subject(s)
Lumbar Vertebrae/surgery , Osteoporosis/surgery , Pedicle Screws , Spinal Fusion/instrumentation , Spinal Fusion/methods , Bone Density , Female , Humans , Linear Models , Male , Middle Aged , Osteoporosis/diagnostic imaging , Osteoporosis/physiopathology , Postoperative Period , Radiography , Retrospective Studies , Treatment Outcome
8.
Zhongguo Gu Shang ; 33(5): 420-5, 2020 May 25.
Article in Chinese | MEDLINE | ID: mdl-32452178

ABSTRACT

OBJECTIVE: To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis. METHODS: A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation. RESULTS: VAS and ODI of all 36 cases were obviously improved (P<0.05) at various stages after the surgery and maintained well and showed a continuous downward trend. The VAS at 6 months after the operation was improved significantly compared with that at 1 day after the operation (P<0.05).When comparing the postoperative ODI between 1 day and 3 months after the surgery, 1 day and 6 months after the surgery, 3 months and 6 months after the surgery, the differences were statistically significant (P<0.05). The VAS and ODI of the one-stage operation group at 1 day after radicular block were better than those of delayed operation group. The VAS and ODI of delayed operation group before readmission were significantly higher than those at 1 day after radicular block. There were no significant differences in VAS and ODI at each stage after operation between two groups(P>0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (P<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment. CONCLUSION: The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.


Subject(s)
Decompression, Surgical , Spinal Stenosis , Constriction, Pathologic , Humans , Lumbar Vertebrae , Neuroendoscopy , Retrospective Studies , Spinal Stenosis/surgery , Treatment Outcome
9.
Regen Biomater ; 7(1): 29-34, 2020 Feb.
Article in English | MEDLINE | ID: mdl-32153989

ABSTRACT

To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.

10.
Med Sci Monit ; 26: e918619, 2020 Jan 26.
Article in English | MEDLINE | ID: mdl-31982889

ABSTRACT

BACKGROUND Annular fiber closure techniques have been proven effective in reducing short-term recurrence after discectomy. However, annular fiber closure devices are expensive and still fail at a low rate. We present a novel suture method, needle-guided annular closure suture (NGACS) that does not require a special device and can be performed for annular fiber closure following microendoscopic discectomy. MATERIAL AND METHODS Twenty-five patients who underwent treatment with NGACS were reviewed by analysis of the medical records. The clinical outcomes were assessed and compared preoperatively and immediately, 1, 6, and 12 months postoperatively. The parameters included the Visual Analog Scale (VAS)-back and VAS-leg scores and the Oswestry Disability Index (ODI). Midsagittal T2WI images were obtained to evaluate lumbar disc degeneration using the Pfirrmann grade. Additional adverse events were also recorded and tracked. RESULTS The VAS-back and VAS-leg scores and the ODI were significantly different at each follow-up time point (P<0.001), and improvements in pain and disability were maintained well during the follow-up period. Lumbar disc reherniation or other serious adverse events were not observed in this series. There was no significant difference between the initial and final Pfirrmann grades (Z=-1.414, P=0.157). The preoperative average disc height was 9.94±1.97 mm, and the disc height at 12 months after surgery was 9.14±1.88 mm. The average decrease in disc height was 8.11±3.36%. CONCLUSIONS This study demonstrates the feasibility and superior clinical outcomes of the NGACS technique. This method can be a good substitution when annular fiber closure devices are not available. Moreover, this technique can be easily popularized due to its low cost and few restrictions.


Subject(s)
Diskectomy , Endoscopy , Lumbar Vertebrae/surgery , Needles , Suture Techniques , Adult , Disability Evaluation , Diskectomy/adverse effects , Endoscopy/adverse effects , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Needles/adverse effects , Suture Techniques/adverse effects , Treatment Outcome , Visual Analog Scale
11.
Spine (Phila Pa 1976) ; 44(12): 827-838, 2019 Jun 15.
Article in English | MEDLINE | ID: mdl-30601358

ABSTRACT

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: This study aimed to compare the clinical effects and imaging features of polymethyl methacrylate (PMMA) bone cement with and without mineralized collagen (MC) in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). SUMMARY OF BACKGROUND DATA: PKP with PMMA is widely performed for OVCF. However, numerous complications have also been reported about the PMMA bone cement. Moreover, PMMA bone cement with and without MC have not been compared with respect to their postoperative efficacy and long-term follow-up. METHODS: From July 2016 to July 2017, 105 OVCF patients were randomly divided into two groups based on their PKP treatment: MC-PMMA group and PMMA group. Clinical operation, cement leakage, Oswestry Disability Index, visual analog scale, height of the fractured vertebrae, Cobb angle, refracture of the adjacent vertebra, recompression, and computed tomography values of the injured vertebra were compared between the two groups postoperatively and after 1-year follow-up. RESULTS: Clinical operation showed no differences between the two groups. Visual analog scale scores, Oswestry Disability Index scores, and Cobb angles showed statistically significant differences between the two groups after 1-year follow-up. The height of the vertebral body showed significant difference at 3 days postoperatively and preoperatively in each group and significant difference after 1 year between the two groups. The rate of refracture and leakage of the MC-PMMA group was lower than that of the PMMA group. The computed tomography value of the MC-PMMA group was obviously higher than that of the PMMA group after 1-year follow-up. CONCLUSION: MC-modified PMMA did not change the beneficial properties of PMMA. This new bone cement has better biocompatibility, can form a stable structure in the vertebral body, and improve the prognosis of patients by reducing pain and reoperation. LEVEL OF EVIDENCE: 3.


Subject(s)
Bone Cements/therapeutic use , Collagen/therapeutic use , Fractures, Compression/surgery , Osteoporotic Fractures/surgery , Polymethyl Methacrylate/therapeutic use , Spinal Fractures/surgery , Aged , Female , Follow-Up Studies , Fractures, Compression/diagnostic imaging , Humans , Kyphoplasty/methods , Male , Middle Aged , Osteoporotic Fractures/diagnostic imaging , Polymethyl Methacrylate/chemistry , Retrospective Studies , Spinal Fractures/diagnostic imaging , Treatment Outcome
12.
Zhongguo Gu Shang ; 30(2): 142-146, 2017 Feb 25.
Article in Chinese | MEDLINE | ID: mdl-29350005

ABSTRACT

OBJECTIVE: To evolve the formula of relationship between opening angle of laminoplasty and the increased value of cross-sectional area, and to predict the opening angle according to the opening size of lanminoplasty. METHODS: From January 2013 to December 2015, 26 patients underwent single open-door laminoplasty in C3-C7. Among them, 10 patients with ossification of posterior longitudinal ligament, there were 6 males and 4 females, aged from 39 to 58 years old with an average of 49.2 years; and 16 patients with cervical spondylotic myelopathy, there were 10 males and 6 females, aged from 40 to 58 years old with an average of 50.2 years. Through the changes of spinal canal shape between preoperation and postoperation to set up the regular geometric model, and to deduce the formula of the relationship between the opening angle of laminoplasty and the increased value of cross-sectional area, and predict the formula of opening angle. According to the preoperative and postoperative CT scan, the needed parameters were measured, and were substituted in the above formula to get the change of cross-sectional area before and after operation, predicting the opening angle of laminoplasty. The differences between the change of cross-sectional area before and after operation, predictive the opening angle of laminoplasty and practical measured data were analyzed by statistical methods, thus to verify the feasibility of formula in practical application. RESULTS: All imaging data of 26 patients were obtained. There were significant differences in changes of cross-sectional areas in every patients (laminoplasty in C3 to C7) before and after operation in the same segment(P<0.01). The increasing extent in cross-sectional areas was gradually diminished following the opening angle increasing. There was no significant difference between the opening angle attained by formula and the data measured by software in the same segment(P>0.05). CONCLUSIONS: Increment of cross-sectional areas following C3-C7 laminoplasty can be accurately attained and the opening angle can also be predicted by a certain formula, which can help surgeons to attain the accurate opening angle and reduce the postoperative complications.


Subject(s)
Algorithms , Cervical Vertebrae/surgery , Laminoplasty/methods , Spinal Diseases/surgery , Adult , Female , Humans , Laminectomy , Male , Middle Aged , Spinal Canal/pathology , Treatment Outcome
13.
Clin Neurol Neurosurg ; 139: 272-7, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26546886

ABSTRACT

OBJECTIVE: To investigate the correlation between the kyphosis angle of injured vertebral body and the risk of upper adjacent vertebral fracture after percutaneous kyphoplasty (PKP) using an osteoporotic vertebral compressed fracture model. MATERIALS AND METHODS: 24 functional spinal units (FSUs, T9 to L4) were selected from 6 elderly formalin preserved vertebral specimens to build the vertebral compressed fracture model. According to the kyphosis angle between the upper plate of upper vertebral body and the horizontal plane, group A (0°) and group B (20°) were defined, with each group comprised with 12 FSUs. The stiffness and fracture load were measured in both groups. RESULTS: After PKP, the stiffness was (571.513 ± 83.373)N/mm and the fracture load was (1751.659 ± 112.291)N in group A, with both significantly higher than those of group B (stiffness, (307.706 ± 46.723)N/mm; fracture load, (1128.011 ± 125.417)N). CONCLUSIONS: To reduce the risk of upper adjacent vertebral fracture, it is better to restore the height of injured vertebral body and decrease the angle of kyphosis to increase the capability of upper adjacent vertebral body against fracture.


Subject(s)
Fractures, Compression/surgery , Kyphoplasty , Lumbar Vertebrae/surgery , Osteoporotic Fractures/surgery , Postoperative Complications/epidemiology , Spinal Fractures/surgery , Thoracic Vertebrae/surgery , Aged , Biomechanical Phenomena , Female , Humans , In Vitro Techniques , Kyphosis , Models, Anatomic , Spinal Fractures/epidemiology , Stress, Mechanical , Weight-Bearing
14.
Zhongguo Gu Shang ; 28(11): 988-93, 2015 Nov.
Article in Chinese | MEDLINE | ID: mdl-26757523

ABSTRACT

OBJECTIVE: To evaluate the clinical effects of dynamic neutralization system (K-Rod) in treating multisegmental lumbar degenerative disease. METHODS: From October 2011 to October 2013, 20 patients with multisegmental lumbar degenerative disease were treated with dynamic neutralization system (K-Rod). There were 8 males and 12 females with an average age of 45.4 years old (ranged from 31 to 65) and an average course of 3.8 years (ranged from 9 months to 6.25 years). All patients had the history of low back and legs pain. Among them, 10 cases were far lateral lumbar disc herniation, 7 cases were lumbar spinal stenosis, 3 cases were lumbar spondylolisthesis (degree I in 2 cases and degree II in 1 case). Every patient had only one responsible segment which causing the symptom would have to be rigidly fixed during operations, and the adjacent intervertebral disc of the responsible segments at least 1 segment has already obvious degenerated. All patients underwent the operation to relieve compressed nerves and reconstruct spinal stability with K-Rod system (the responsible segments were fixed with interbody fusion, and the adjacent segments were fixed with dynamic stabilization). Visual analogue scale (VAS), Japanese Orthopaedic Association Scores (JOA) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects. Imaging data were used to analyze the range of motion (ROM), intervertebral disc height and intervertebral disc signal (according to modified Pfirrmann grading system) in degenerative adjacent segment. RESULTS: All patients were followed up for more than 1 year, and preoperative symptoms obviously relieved. There were significant differences in VAS, JOA, ODI between preoperative and postoperative (postoperative at 1 week and 1 year) (P<0.05). Radiological examination showed that all responsible segments had already fused, and no looseness, displacement and breakage of internal fixations were found. Postoperative at 1 year, the ROM of adjacent segments were decreased (P<0.05). There was no significant difference in intervertebral disc height between preoperative and postoperative at 1 year (P>0.05). According to modified Pfirrmann grading system to classification for the 25 disks of adjacent segment, 8 disks (32%) got improvement, 15 disks (60%) got no change and 2 disks (8%) got aggravation at 1 year after operation. CONCLUSION: Dynamic neutralization system (K-Rod) combined with interbody fusion could obtain short-term clinical effects in the treatment of multisegmental lumbar degenerative disease.


Subject(s)
Lumbar Vertebrae/surgery , Spinal Diseases/surgery , Spinal Fusion/methods , Adult , Aged , Female , Humans , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Range of Motion, Articular , Spinal Stenosis/surgery , Spondylolisthesis/surgery
15.
Zhongguo Gu Shang ; 28(11): 1000-5, 2015 Nov.
Article in Chinese | MEDLINE | ID: mdl-26757525

ABSTRACT

OBJECTIVE: To explore the clinical effects of Dynesys system for the treatment of multiple segment lumbar degenerative disease. METHODS: A total of 28 patients with lumbar degenerative disc disease treated with Dynesys system from December 2008 to May 2011 were retrospectively reviewed. There were 16 males and 12 females, aged from 27 to 75 years old with an average of 49.1 years. Thirteen patients with multiple segmental lumbar intervertebral disc protrusion, including L3-L5 in 7 cases, L2-L4 in 1 case and L4-S1 in 5 cases. Fifteen patients with multiple segmental lumbar spinal stenosis, including L3-L5 in 10 cases, L4-L5 in 4 cases and L2-S1 in 1 case. The symptoms of lumbago and (or) intermittent claudication in all patients were treated with conservative treatments for more than 6 months and these methods did not work. Visual analogue scale (VAS) was used to analyze the lumbar and leg pain, imaging data were used to measure the intervertebral space height and intervertebral motion of fixed segment and upper adjacent segment, Oswestry Disability Index (ODI) was used to evaluate the clinical effect. RESULTS: All operations were successful and the patients were followed up from 38 to 65 months with an average 50.6 months. At final follow-up, ODI and VAS of the low back pain and leg pain were (25.10±6.52)%, (1.25±0.70) points and (1.29±0.89) points, respectively and were decreased compared with preoperative (P<0.05). Postoperative intervertebral space heights were increased and intervertebral motions were decreased in fixed segment compared with preoperative (P<0.05). There were no significant differences in intervertebral space heights and intervertebral motions of upper adjacent segment between preoperative and postoperative (P>0.05). CONCLUSION: Dynesys system may obtain long-term clinical curative effect in treating multiple lumbar degenerative disease. It can partially preserve the intervertebral motions of the fixed segments, have little effect on adjacent segments. The long-term clinical effect of Dynesys still need longer time follow-up observation.


Subject(s)
Intervertebral Disc Degeneration/surgery , Lumbar Vertebrae , Adult , Aged , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/pathology , Joint Instability , Magnetic Resonance Imaging , Male , Middle Aged , Visual Analog Scale
16.
Zhongguo Gu Shang ; 27(5): 363-6, 2014 May.
Article in Chinese | MEDLINE | ID: mdl-25167662

ABSTRACT

OBJECTIVE: To evaluate the clinical effects of transpedicular eggshell technique in treating thoracolumbar deformity. METHODS: From December 2008 to December 2011,36 patients with thoracolumbar deformity were treated with transpedicular eggshell technique. There were 20 males and 16 females with an average age of 45 years old (ranged from 20 to 58). Among them, 5 cases were congenital hemivertebrae deformity, 12 cases were secondary to tuberculotic deformity, 14 cases were post-traumatic deformity with pain, 5 cases were ankylosing spondylitis. Low back pain, living ability, scoliotic Cobb angle were analyzed according to VAS scoring, Oswestry Disability Index (ODI), radiological examination. RESULTS: Average operative time was 245 min and average bleeding was 1 900 ml in 36 patients. All patients were followed up more than 1 year and obtained bone fusion at 1 year after operation. Preoperative,postoperative at 1 week and 1 year, VAS scoring was 7.2 +/- 1.4, 2.5 +/- 1.0, 1.8 +/- 0.5, respectively; ODI was (72.50 +/- 10.80)%, (42.50 +/- 11.10)%, (22.50 +/- 7.90)%, respectively; kyphosis Cobb angle was (76.31 +/- 2.52) degrees, (23.66 +/- 1.16) degrees, (23.67 +/- 1.16) degrees, respectively; lumbar scoliosis Cobb angle was (71.86 +/- 4.02) degrees, (30.81 +/- 2.33) degrees, (30.82 +/- 2.32) degrees, respectively. Postoperative at 1 week and 1 year,above data had obviously improved than that of preoperative (P < 0.05); and there was no significant difference in Cobb angle between postoperative at 1 week and postoperative at 1 year (P > 0.05). CONCLUSION: Treatment of thoracolumbar deformity with transpedicular eggshell technique could obtain effective correcting and clinical results.


Subject(s)
Orthopedic Procedures/methods , Thoracic Vertebrae/abnormalities , Thoracic Vertebrae/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
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