Intraoperative triggered electromyographic monitoring of pedicle screw efficiently reduces the lumbar pedicle breach and re-operative rate-a retrospective analysis based on postoperative computed tomography scan.

BACKGROUND: To investigate whether intraoperative triggered electromyographic (T-EMG) monitoring could effectively reduce the breach rate of pedicle screws and the revision rate. METHODS: Patients with posterior pedicle screw fixation from L1-S1 were enrolled between June 2015 and May 2021. The patients in whom T-EMG was utilized were placed in the T-EMG group, and the remaining patients were considered in the non-T-EMG group. Three spine surgeons evaluated the images. The two groups were divided into subgroups based on screw position (lateral/superior and medial/inferior) and breach degree (minor and major). Patient demographics, screw positions, and revision procedures were reviewed. RESULTS: A total of 713 patients (3403 screws) who underwent postoperative computed tomography (CT) scans were included. Intraobserver and interobserver reliabilities were perfect. The T-EMG and non-T-EMG groups had 374(1723 screws) and 339 (1680 screws) cases, respectively. T-EMG monitoring efficiently reduced the overall screw breach (T-EMG 7.78% vs. non-T-EMG 11.25%, p = 0.001). in the subgroup analysis, the medial/inferior breach rate was higher in the T-EMG group than in the non-T-EMG group (T-EMG 6.27% vs. non-T-EMG 8.93%, p = 0.002); however, no difference was observed between the lateral and superior breaches (p = 0.064). A significant difference was observed between the minor (T-EMG 6.21% vs. non-T-EMG 8.33%, p = 0.001) and major (T-EMG 0.06% vs. non-T-EMG 0.6%, p = 0.001) medial or inferior screw breach rates. Six screws (all in the non-T-EMG group) underwent revision, with a significant difference between the groups (T-EMG 0.0% vs. non-T-EMG 3.17%, p = 0.044). CONCLUSIONS: T-EMG is a valuable tool in improving the accuracy of screw placement and reducing the screw revision rate. The screw-nerve root distance is vital in causing symptomatic screw breach. TRIAL REGISTRATION: The study is retrospective registered in China National Medical Research Registration and Archival information system in Nov 17th 2022.

Delayed Hemorrhage Followed by Vertebral Artery Injury during Cervical Anterior Controllable Antedisplacement and Fusion Surgery: Case Report and Literature Review.

BACKGROUND: Vertebral artery injury (VAI) during cervical spine surgery is rare. Anterior controllable ante-displacement and fusion (ACAF) surgery is a novel technique for treating degenerative cervical spine disorders, especially ossification of the posterior longitudinal ligament. To date, there have been no reports of VAI during cervical ACAF surgery. Here, we report a rare case of perioperative complication of VAI during ACAF surgery. The available English literature that provides treatment instructions were reviewed. CASE PRESENTATION: A patient diagnosed with mixed ossification of the posterior longitudinal ligament (OPLL) underwent ACAF surgery from C2-C6. Two level transverse foramina were ruptured, and severe bleeding was encountered during ACAF osteotomy. Hemostatic tamponade was performed using bone waxes. The patient had delayed hemorrhage on postoperative day 6. Emergence angiography revealed two vertebral artery pseudoaneurysms in the ruptured transverse foramina. A balloon-expandable covered stent was deployed to treat the pseudoaneurysm. The patient recovered without complications. CONCLUSION: ACAF surgery is a good choice for multiple-level OPLL disease, but special attention should be paid to VAI in the perioperative period. Intraoperative tamponade with bone wax and postoperative digital subtraction angiography (DSA) are effective in preventing disaster-related hemorrhage.

Clinical study on the recovery of wrist joint function after radical distal fracture by combined stasis elimination and powder intervention / 中国生化药物杂志

Objective To study the clinical study of the effect of removing blood stasis and eliminating powder on the recovery of wrist function after distal radius fracture.MethodsA total of 82 patients with distal radius fractures were selected from September 2012 to October 2016.The random number table method was divided into study group and control group.The two groups were given intervention, and the study group (VAS score), the correlation index(swelling time, pain time, fracture healing time), clinical curative effect and the recovery of wrist function were observed and compared with the two groups.ResultsAfter treatment, the VAS scores of the two groups were significantly lower than those before treatment, and the VAS scores of the study group were significantly lower than those of the control group (P<0.05).After the treatment group, the swelling time, pain time (P<0.05).After treatment, the total effective rate was 87.80% higher than that of the control group (68.29%) (P<0.05).After treatment, the two groups were significantly higher than those in the control group (P<0.05), and the wrist function scores of the study group were significantly lower than those of the control group (P<0.05).ConclusionThe combined effect of removing blood stasis and eliminating powder is effective in the treatment of distal radius fractures, which can effectively reduce the pain and reduce the healing time of the fracture and promote the recovery of the wrist function.

Nine issues about clinical application of thoracolumbar injury classification and severity score / 中华创伤骨科杂志

Spinal fractures are a big challenge to orthopedists.Thoracolumbar Injury Classification and Severity Score (TLICS),a newly developed evaluation system for thoracolumbar fractures,has proved to be valid and reliable in the last decade.However,there have still been many problems in the clinical application of TLICS in China.We discussed nine issues about the clinical application of TLICS in this article,hoping to promote better understanding and application of TLICS in Chinese spinal surgeons in their daily practice.

Nine issues about clinical application of thoracolumbar injury classification and severity score / 中华创伤骨科杂志

Spinal fractures are a big challenge to orthopedists.Thoracolumbar Injury Classification and Severity Score (TLICS),a newly developed evaluation system for thoracolumbar fractures,has proved to be valid and reliable in the last decade.However,there have still been many problems in the clinical application of TLICS in China.We discussed nine issues about the clinical application of TLICS in this article,hoping to promote better understanding and application of TLICS in Chinese spinal surgeons in their daily practice.