Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

BACKGROUND: Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. OBJECTIVE: To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). METHODS: From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. RESULTS: Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). CONCLUSION: Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

The correlation between self-Hounsfield units and adjacent vertebral fracture after percutaneous vertebral augmentation: a retrospective cohort study.

Background: Adjacent vertebral fracture (AVF) represents a prevalent and challenging complication after percutaneous vertebral augmentation (PVA) treatment for osteoporosis vertebral compressive fracture (OVCF). Lower bone mineral density (BMD) and intervertebral leakage are reportedly independent risk factors for AVF. Vertebral Hounsfield units (HU) measured from computed tomography (CT) scans can evaluate bone quality. This study sought to explore the risk factors associated with AVF and analyze the relationship between AVF and the Hounsfield units of adjacent vertebrae (self-HU) following PVA. Methods: In this retrospective cohort study, we included consecutive OVCF patients who presented to Xuzhou Central Hospital in Jiangsu Province, China from 1 January 2016, to 31 December 2019 for PVA treatment. Clinical and imaging data were collected, and baseline data were recorded. Patients were divided into the AVF group and the no-AVF group based on the presence of AVF during follow-up. Patients in the AVF group were further subdivided into the leakage group and the no-leakage group according to the presence of intervertebral leakage. Age, body mass index (BMI), fracture location, prior fracture, self-HU, and intervertebral leakage were included in univariate logistic regression analysis. Variables with a P value of less than 0.1 were then included in multivariate logistic regression analysis to determine the risk factors for AVF. Kaplan-Meier curves were plotted to assess the effect of intervertebral leakage on AVF using a log-rank test. Results: A total of 460 patients were included in this study and followed up for an average of 50.9 months (range, 37-83 months). Among them, 82 cases (17.83%) developed AVF and were included in the AVF group. Multivariate logistic regression analysis showed that lower self-HU [odds ratio (OR) =0.972, 95% confidence interval (CI): 0.959-0.985, P<0.001] and intervertebral leakage (OR =2.618, 95% CI: 1.415-4.844, P=0.002) were risk factors for AVF following PVA. In the AVF group, 29 patients (35.37%) with intervertebral leakage were included in the leakage group. Patients in the leakage group had a shorter time to AVF (22.07±13.83 vs. 31.42±18.73, P=0.021) and higher self-HU (78.05±16.41 vs. 64.23±20.49, P=0.002) than those in the no-leakage group. Kaplan-Meier curves showed that the fracture-free time was shorter in the leakage group compared to the no-leakage group (log-rank test, P=0.014). Conclusions: Lower self-HU and intervertebral leakage are risk factors for AVF, and higher self-HU may lead to AVF when intervertebral leakage is present.

Wedge osteotomy combined with internal fixation in the treatment of Mayo IIB olecranon fractures.

OBJECTIVE: This study aimed to present the clinical outcomes and establish a safe range for olecranon wedge osteotomy combined with internal fixation in treating Mayo IIB-type olecranon fractures. METHODS: Ten consecutive patients (10 elbows) underwent treatment involving wedge osteotomy combined with internal fixation. Primary outcome measures included the evaluation of the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), pain severity assessed via a visual analogue scale (VAS), elbow mobility, and the extent of osteotomy at the final follow-up. RESULTS: At the last follow-up, the median OES was 45 (range 38-48), and the median MEPS was 90 (range 75-100). Six out of 10 patients reported no pain based on the VAS. No significant differences were observed between the healthy and affected sides regarding flexion-extension and rotation activities. The mean horizontal lengths of the olecranon articular surface and base osteotomy were 6.2 mm (range 5.5-7.4 mm) and 14.4 mm (range 10.2-16.5 mm), respectively. The mean olecranon shortening was 4.2 mm (range 2.2-5.4 mm), resulting in a shortening rate of 7.3% to 18.9%. Fracture union was achieved in all patients, with a mean time to union of 11.2 weeks (range 8-16 weeks). Early mild (grade 1) degenerative changes were observed in 3 cases. CONCLUSION: Wedge osteotomy combined with internal fixation represents a reliable treatment option for Mayo IIB olecranon fractures, particularly in cases of severe comminuted fractures that are challenging to restore anatomically. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Percutaneous Functional Spinal Unit Cementoplasty versus Posterior Spinal Fixation with Vertebroplasty for Symptomatic Chronic Osteoporotic Vertebral Fractures: A Retrospective Study with a 2-Year Follow up.

PURPOSE: To compare the clinical efficacy of percutaneous functional spinal unit cementoplasty (PFSUP) and posterior spinal fixation combined with vertebroplasty (PSF + VP) for the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVFs). METHOD: Thirty-one patients with SCOVFs were included in this retrospective study and divided into PFSUP (n = 14) and PSF + VP (n = 17) groups. Visual analog scores (VAS) and Oswestry Disability Index (ODI) were recorded before and after surgery and at the last follow-up. Besides, the local kyphosis angle (LKA) and sagittal vertical axis (SVA) were measured. The operation duration, number of X-ray exposures, amount of blood loss, bed rest duration, hospitalization duration, and presence of complications were recorded. RESULT: The VAS, ODI, LKA, and SVA after surgery and at the last follow-up were significantly improved in both groups compared to preoperative measurements. The PFSUP group experienced shorter operation duration (78.2 ± 13.1 vs. 124.7 ± 14.7, p < 0.001), less blood loss (31.1 ± 8.1 vs. 334.7 ± 70.9, p < 0.001), more X-ray exposures (92.1 ± 14.3 vs. 29.4 ± 5.5, p < 0.001), shorter bed rest duration (12.4 ± 3.8 vs. 43.4 ± 10.0, p < 0.001), shorter hospitalization (6.6 ± 2.4 vs. 10.9 ± 2.7, p < 0.001), lower complication rate (28.5% vs. 64.7%, p < 0.05), and higher cement leakage rate (42.9% vs. 5.8%, p < 0.05) than the PSF + VP group. CONCLUSION: During the treatment of SCOVFs, the combination of PFSUP and PSF + VP can restore spinal stability, improve kyphosis, and relieve pain. PFSUP can reduce blood loss and complications, early mobilization, and shorten the hospital stay, but it is associated with a higher cement leakage rate and more radiation exposure.

Clinical outcomes with second injection after insufficient bone cement distribution in unilateral kyphoplasty for osteoporotic vertebral compressive fracture: a cohort retrospective study.

BACKGROUND: Bone cement distribution is an important factor affecting pain relief and long-term prognosis of osteoporotic vertebral compression fracture (OVCF) treated with vertebral augmentation. Unilateral percutaneous kyphoplasty (PKP) is the most common procedure, and insufficient bone cement distribution is more common than bilateral PKP. However, effective remedies are remain lack. In this study, sufficient cement distribution was achieved by adjusting the working channel followed by second cement injection as a remedy in cases with insufficient cement distribution, and the purpose was to evaluate the clinical outcomes by a retrospective cohort study. METHODS: From July 1, 2017 to July 31, 2020, OVCF patients treated with unilateral PKP were included in this retrospective cohort study. According to the bone cement distribution (insufficient cement distribution was confirmed when the cement did not exceed the mid line of the vertebral body in frontal film or/and the cement did not contact the upper/lower vertebral endplates in the lateral film.) and whether second injection was performed during surgery, the patients were divided into three groups. Insufficient group: patients with insufficient cement distribution confirmed by fluoroscopy or postoperative x-ray. Second injection group: patients with insufficient cement distribution was found during the procedure, and second injection was performed to improve the cement distribution. CONTROL GROUP: patients with sufficient cement distribution in one injection. The Primary outcome was cemented vertebrae re-collapse rate. The secondary outcomes included operative time, radiation exposure, cement leakage rate, VAS, ODI, and adjacent vertebral fracture rate. RESULTS: There are 34 cases in insufficient group, 45 cases in second injection group, and 241 cases in control group. There was no significant difference in baseline data and follow-up time among the three groups. PRIMARY OUTCOME: The injured vertebrae re-collapse rate of insufficient group was significantly higher than that of second injection group (42.22% vs 20.59%, P = 0.000) and control group (42.22% vs. 18.26%, P = 0.000). Kaplan-Meier survival analysis showed that there was no significant difference in the survival time between second injection group and control group (P = 0.741, Log-rank test), both of which were significant less than that in insufficient group (P = 0.032 and 0.000, respectively). SECONDARY OUTCOMES: There was no significant difference in VAS score and ODI after operation between second injection group and control group, both of which were superior to those in insufficient group (P = 0.000). At the final follow-up, there was no significant difference in VAS and ODI among the three groups (P > 0.05). The operation time of second injection group was significantly higher than that of insufficient group (53.41 ± 8.85 vs 44.18 ± 7.41, P = 0.000) and control group (53.41 ± 8.85 vs 44.28 ± 7.22, P = 0.000). The radiation exposure of the second injection group was significantly higher than that of insufficient group (40.09 ± 8.39 vs 30.38 ± 6.87, P = 0.000) and control group (40.09 ± 8.39 vs 31.31 ± 6.49, P = 0.000). The cement leakage rate of second injection group (20.59%) was comparable with that of insufficient group (24.44%) and control group (21.26%) (P = 0.877). The length of hospital stay of the second injection group (4.38 ± 1.72) was comparable with that of insufficient group (4.18 ± 1.60) and control group (4.52 ± 1.46) (P = 0.431). CONCLUSIONS: When cement distribution is insufficient during unilateral PKP, second injection may relieve early pain, reduce the incidence of cemented vertebral re-collapse and adjacent vertebral fracture, without increasing the cement leakage rate, although this procedure may increase the operation time and radiation exposure.

Percutaneous endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a meta-analysis.

Introduction: Transforaminal lumbar interbody fusion (TLIF) is commonly used in patients with lumbar degenerative disease (LDD). The most commonly used techniques include minimally invasive TLIF (MIS-TLIF) and percutaneous endoscopic TLIF (PE-TLIF). Aim: To compare the safety and clinical effectiveness of PE-TLIF and MIS-TLIF in treating LDD. Material and methods: We screened for related articles in multiple scientific databases, namely, PubMed, Embase, Cochrane Library, Wanfang, VIP, and CINK, and analyzed the relative outcomes. Results: Based on our inclusion criteria, we selected 8 studies for meta-analysis. There are a total of 229 patients who underwent PE-TLIF and 258 patients who underwent MIS-TLIF. MIS-TLIF and PE-TLIF have similar effectiveness in relieving leg pain and improving the Oswestry Disability Index. However, PE-TLIF is superior in relieving back pain. The pooled data of fusion rates, postoperative analgesic, and complication rates are comparable between the 2 groups. The pooled operation and intra-operative fluoroscopic time are both significantly higher in the PE-TLIF group than the MIS-TLIF group. The pooled intra-operative blood loss, incision length, duration from surgery to ambulation, and hospital stay are significantly lower in the PE-TLIF group than the MIS-TLIF group. Most of the endpoints reveal significant heterogeneity. The endpoints of operation time and intra-operative blood loss reveal significant publication bias. Conclusions: Both PE-TLIF and MIS-TLIF are safe and effective interventions for patients with LDD. When compared, although MIS-TLIF results in reduced operative time, less intra-operative blood loss and enhanced post-operative recovery can be achieved by PE-TLIF.

Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study.

PURPOSE: This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). MATERIALS AND METHODS: We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. RESULTS: There was no significant difference between the two groups in operative time and complication rate. The estimated blood loss and the length of hospital stay in the PETLIF group were significantly better than those in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. CONCLUSIONS: Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.

Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures.

OBJECTIVE: To evaluate the feasibility, clinical efficacy and imaging results of preoperative traction (PT) followed by percutaneous kyphoplasty (PKP) combined with percutaneous cement discoplasty (PCD) for treating severe thoracolumbar osteoporotic vertebral compression fractures (OVCFs). METHODS: A total of 13 patients with severe thoracolumbar OVCFs treated by PT followed by PKP combined with PCD were enrolled. General information, PT time, operation time, postoperative hospital stay, perioperative complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, local kyphosis angle, intervertebral angle (IVA), anterior vertebral height (AVH) and posterior vertebral height (PVH) were recorded. RESULTS: The average VAS score at admission was 7.4±3.5, decreased to 4.3±1.7 after PT and 2.3±0.7 three days after operation, and 1.5±0.9 at last follow-up. The average ODI score was 73.7±21.4 before operation, decreased to 26.6±9.3 three days after operation and 13.7±7.1 at last follow-up. Compared to VAS and ODI scores at admission, these at the third day after operation and last follow-up were significantly different. At admission, the IVA was 3.4°±6.8°, the disc height was 5.7±1.2mm, the AVH was 10.7±3.2mm, and the PVH was 25.7±4.2 mm, which, after PT, changed to 8.1°±7.3°, 8.6±2.6mm, 18.5±2.8mm, and 26.2±7.1mm, respectively, and the differences were significant. The average kyphotic angle was 43.4°±17.8° at admission, and decreased to 26.3°±6.7° after PT, 17.5°±8.4° three days after operation and 19.1°±10.3° at last follow-up, and the differences were significant. CONCLUSION: PT followed by PKP combined with PCD for the treatment of severe thoracolumbar OVCFs was an effective and simple procedure with satisfactory short-term clinical outcomes by relieving pain and improving kyphosis.

Subarachnoid hemorrhage after full endoscopic transforaminal lumbar interbody fusion: a case report.

PURPOSE: Intracranial hemorrhage such as subarachnoid hemorrhage (SAH) is a rare but severe complication of spinal surgery. Current case reports of open lumbar surgery are typically accompanied by intraoperative dural tears and cerebrospinal fluid (CSF) leakage. We report a case of non-aneurysmal SAH without CSF leakage after full endoscopic transforaminal lumbar interbody fusion (FE-TLIF). DESIGN: Case report and literature review. RESULTS: A 62-year-old male patient underwent FE-TLIF for L4/5 lumbar spinal stenosis. There was no intraoperative dural tear or postoperative CSF leakage. The patient reported neck pain immediately after the surgery. Around 12 h after the surgery, the patient complained of mild headaches. One day after the surgery, the patient reported severe headaches, accompanied by nausea and vomiting. CT showed a high-density shadow in part of the sulcus and cistern, suggesting SAH. No apparent neurological symptoms were present. The patient's condition improved after conservative treatment including bed rest, fluid infusions, and blood pressure control. Twelve days after the surgery, CT and MRA of the brain showed no hemorrhage and the patient was discharged. CONCLUSION: This case was among the first that developed SAH without CSF leakage after FE-TLIF. Although the underlying pathologic mechanism is unknown, epidural hypertension may be a possible cause of the hemorrhage. Timely CT or magnetic resonance imaging (MRI) examinations may help to detect this complication and initiate early treatment.

Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum.

OBJECTIVE: This study was performed to evaluate the role of posterior suspension of the laminae-ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF). METHODS: Eight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Neurological functional recovery was evaluated by the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi recovery rate preoperatively, postoperatively, and at the final follow-up. Preoperative and postoperative imaging was performed, and the decompression range and internal fixation positioning were evaluated. RESULTS: The mJOA score significantly improved from 4.63 points preoperatively to 9.0 points at the final follow-up (Hirabayashi recovery rate of 77.75%). Postoperative computed tomography and magnetic resonance imaging revealed sufficient decompression of the surgical segment. At the final follow-up, the internal implants were well-placed, the lamina-ligamentum flavum complex showed no significant displacement, and neurological functional recovery was satisfactory. CONCLUSION: Surgical treatment of TOLF is complicated and high-risk. Characterized by simplicity and sufficient decompression, modified expansive thoracic laminoplasty can reduce the risk of cerebrospinal fluid leakage and nerve injury with satisfactory neurological functional recovery.

Evaluation of Bioabsorbable Multiamino Acid Copolymer/Nanohydroxyapatite/Calcium Sulfate Cage in a Goat Spine Model.

BACKGROUND: Currently, polylactide is the most popular material used to made bioabsorbable cages but too-quick degradation and osteolysis around the cage have been reported in the literature. This study evaluated the fusion effect, biomechanical stability, and histologic characteristics of a novel bioabsorbable multiamino acid copolymer/nanohydroxyapatite/calcium sulfate (MAACP/n-HA/CS) interbody cage in a goat model of anterior cervical discectomy and fusion. METHODS: A total of 24 goats underwent C3/C4 discectomy and fusion with 3 groups of intervertebral implants: MAACP/n-HA/CS cage group (n = 8), titanium cage group (n = 8), and autologous tricortical iliac crest bone group (n = 8). Disc space height and lordosis angle were measured pre- and postoperatively and after 4, 12, and 24 weeks. Range of motion (ROM) was evaluated through biomechanical testing. Histologic analysis was performed to evaluate fusion status and to detect any foreign body reactions associated with the bioabsorbable cages. RESULTS: At 12 and 24 weeks, disc space height in MAACP/n-HA/CS cage group was greater than that of titanium cage group and tricortical iliac crest group (P < 0.05). Lordosis angle in MAACP/n-HA/CS cage group and titanium cage group were lower than that of tricortical iliac crest group (P < 0.05). Biomechanical test showed that ROM did not differ significantly between MAACP/n-HA/CS cage group and titanium cage group, whereas the value of ROM in bone graft group was the largest. Histologic evaluation showed a better interbody fusion in the MAACP/n-HA/CS cage group than in the other 2 groups. MAACP/n-HA/CS cage surface degraded and was absorbed at 24 weeks. All MAACP/n-HA/CS cages showed excellent biocompatibility. CONCLUSIONS: MAACP/n-HA/CS cages can provide good fusion effect, enough biomechanical stability, and integrate closely with the surrounding bone.

[EXPERIMENTAL STUDY ON POLY-AMINO ACID/NANO-HYDROXYAPATITE/CALCIUM SULFATE CAGE FOR LUMBAR INTERBODY FUSION IN GOATS].

OBJECTIVE: To evaluate the effect of poly-amino acid/nano-hydroxyapatite/calcium sulfate (PHC) Cage in lumbar interbody fusion of the goat. METHODS: Eighteen mature female goats (weighing 29-33 kg) were divided into 3 groups randomly: PHC Cage group (group A), titanium Cage group (group B), and ilium group (group C). A left extraperitoneal approach was used to establish the animal model of discectomy and interbody fusion with Cage or ilium. The general situation was observed for 24 weeks after operation. X-ray films were taken to measure disc space height (DSH) before operation and at 4, 12, and 24 weeks after operation. CT three dimensional reconstuction was performed at 24 weeks after operation to evaluate the interbody fusion according to modified Brantigan grading. The specimens of L3,4 were harvested for mechanical test, histological, and scanning electron microscope (SEM) observation at 24 weeks after operation. RESULTS: All goats survived to the end of experiment. DSH at 4 weeks after operation increased when compared with preoperative one in each group, and then decreased; DSH was significantly lower at 12 and 24 weeks after operation than preoperative one in group C (P < 0.05). There was no significant difference in DSH among 3 groups at preoperation and 4 weeks after operation (P > 0.05); at 12 and 24 weeks after operation, DSH of groups A and B was significantly higher than that of group C (P < 0.05), but no significant difference was found between groups A and B (P > 0.05). CT three dimensional reconstuction showed that bony fusion was obtained in all goats of groups A and C, and in 3 goats of group B; according to modified Brantigan grading, the scores of groups A and C were significantlly higher than that of group B (P < 0.05), but no significant difference between groups A and C (P > 0.05). The biomechanical test showed that there was no significant difference in range of motion between group A and group B (P > 0.05), which were significantly lower than that of group C (P < 0.05). Microscopy and SEM observations showed that the interface between the Cage and vertebral body in group A was compact without obvious gap, and most conjunctive region was filled with osseous tissue; the interface was filled with soft tissue, and the connection was slack with obvious gap in some region in group B; the interface connection was compact, most region was filled with osseous tissue in group C. CONCLUSION: The interbody fusion with PHC Cage is effective in goat lumbar interbody fusion model. The interface connection is compact between the Cage and the host bone followed by micro-degradation of PHC Cage, but the long-term degradation need further observation.

[MEDIUM-TERM EFFECTIVENESS OF Waveflex SYSTEM IN TREATMENT OF MULTIPLE LUMBAR DEGENERATIVE DISEASES].

OBJECTIVE: To evaluate the medium-term effectiveness of Waveflex system in the treatment of multiple lumbar degenerative diseases. METHODS: Between May 2010 and July 2012, 26 patients with multiple lumbar degenerative diseases underwent posterior decompression, transforaminal lumbar interbody fusion (TLIF), and internal fixation with Waveflex system. There were 15 males and 11 females, aged 23-65 years (mean, 34.2 years). The disease duration was 9 months to 8 years (median, 3 years and 3 months). The lesion located at L3-S1. The visual analogue scale (VAS), Oswestry disability index (ODI), and the short-form 36 health survey scale (SF-36) were used to evaluate the status of clinical recovery, meanwhile the Stauffer-Coventry evaluation standard was used to access the satisfaction at last follow-up; the disc space height (DSH), intervertebral angle (IVA), and range of motion (ROM) were measured on X-ray film or three-dimensional CT, and the adjacent segment degeneration was classified by Pfirrmann score based on MRI findings. RESULTS: All patients obtained primary incision healing without nerve injury, cerebrospinal fluid leakage, or internal fixation failure. All patients were followed up 31-50 months (mean, 40.6 months). The VAS, ODI, and SF-36 scores were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P<0.05), but no significant difference was found between at 6 months and last follow-up (P>0.05). According to the Stauffer-Coventry evaluation standard, the results were excellent in 21 cases, good in 2 cases, moderate in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5% at last follow-up. X-ray films showed that there was no complication of screws pulling-out or fixed rod rupture and displacement. At 7 days, 6 months, and last follow-up, the DSH of adjacent segment was significantly increased (P<0.05), and the ROM of adjacent segment was significantly decreased (P<0.05) when compared with preoperative ones; there was no significant difference in IVA between at pre- and post-operation (P>0.05). According to Brantigan grade for fusion, 19 cases were rated as grade E, 6 cases as grade D, and 1 case as grade C, and the fusion rate was 96%. There was no significant difference in Pfirrmann score between at pre-operation and last follow-up (Z=0.000, P=1.000). CONCLUSION: The Waveflex system combined with TLIF is effective and safe to treat multiple lumbar degenerative diseases during medium-term follow-up.

Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis.

PURPOSE: The purpose of our study was to compare lumbar fusion and motion-preserving procedures to determine whether lumbar fusion may be associated with a higher prevalence of adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis). METHODS: We performed a systematic review and meta-analysis for articles published up to July 2013. We included randomized controlled trials and cohort studies that reported ASDeg or ASDis after lumbar fusion compared with motion-preserving devices. Two authors independently extracted the articles and the predefined data. RESULTS: A total of 13 studies with 1,270 patients met our inclusion criteria and were included in the final analysis. Our analysis showed that the prevalence of ASDeg and ASDis, and adjacent segment reoperation rate in the fusion group were higher than those in the motion-preserving devices group (P < 0.0001, P = 0.0008, and P < 0.0001, respectively). The prevalence of ASDeg and reoperation rate in the motion-preserving devices group were significantly lower than that in the fusion group for both short- and long-term follow-up (P = 0.0008 and P = 0.001 at <5 years of follow-up; P = 0.003 and P = 0.001 at >5 years of follow-up). CONCLUSIONS: The current evidence suggests that lumbar fusion may result in a higher prevalence of adjacent segment degeneration or disease than motion-preserving procedures.

Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To evaluate the mid- to long-term clinical outcomes after cervical disc arthroplasty (CDA) as compared with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. METHODS: A systematic review and a meta-analysis were performed for articles published up to March 2013. Randomized controlled trials that reported mid- to long-term outcomes (≥48 months) after CDA as compared with ACDF were included. Two authors independently extracted the articles and the predefined data. RESULTS: Five US Food and Drug Administration randomized controlled trials that reported 4-6 years of follow-up data were retrieved. Patients who underwent CDA had a lower mid- to long-term rate of reoperation and had greater mid- to long-term improvements in the Neck Disability Index, neck and arm pain scores, and Short Form 36 Health Survey physical component score than did those who underwent ACDF. Segmental motion was maintained in patients who underwent CDA. The mid- to long-term rates of adjacent segment disease and neurological success were not significantly different between the two groups. CONCLUSIONS: CDA may result in better mid- to long-term functional recovery and a lower rate of subsequent surgical procedures than ACDF would. A review of the literature showed that only an insufficient number of studies had investigated adjacent segment disease; therefore, it is mandatory that adequate future research should focus in this direction.

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches.

PURPOSE: Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. METHODS: In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. RESULTS: Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85). CONCLUSIONS: Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.

Comparison of anterior cervical fusion by titanium mesh cage versus nano-hydroxyapatite/polyamide cage following single-level corpectomy.

PURPOSE: The titanium mesh cage (TMC) is a typical metal cage device which has been widely used in cervical reconstruction for decades. Nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic non-metal cage device growing in popularity in many medical centres in recent years. There has been no comparison of the efficacy between these two anterior reconstructing cages. The purpose of this study was to compare the radiographic and clinical outcomes of these two different devices. METHODS: Sixty-seven eligible patients with single-level ACCF using TMC or n-HA/PA66 cage for cervical degenerative diseases, with four-year minimum follow-up, were included in this prospective non-randomised comparative study. Their radiographic (cage subsidence, fusion status, segmental sagittal alignment [SSA]) and clinical (VAS and JOA scales) data before surgery and at each follow-up was recorded completely. RESULTS: The fusion rate of the n-HA/PA66 group was higher than TMC at one year after surgery (94% vs. 84%) though their finial fusion rates were similar (97% vs. 94%). Finial n-HA/PA66 cage subsidence was 1.5 mm with 6% of severe subsidence over three millimetres, which was significantly lower than the respective 2.9 mm and 22% of TMC (P < 0.0001). Lastly, SSA, VAS and JOA in TMC group were worse than in the n-HA/PA66 group (P = 0.235, 0.034 and 0.007, respectively). CONCLUSIONS: The n-HA/PA66 cage is associated with earlier radiographic fusion, less subsidence and better clinical results than TMC within four years after one-level ACCF. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to TMC in anterior cervical construction.