A posterolateral approach to occipitoatlantoaxial ventral lesions: a report of the long-term follow-up of 23 cases.

STUDY DESIGN: A retrospective study of consecutive patient series. OBJECTIVES: To report a technique of odontoidectomy using a transoccipitocervical posterolateral approach for occipitoatlantoaxial ventral lesions in a long-term follow-up study. SUMMARY OF BACKGROUND DATA: Occipitoatlantoaxial malformation and old traumatic dislocation usually cause compression of the high cervical spinal cord from a variety of different directions and angles, leading to high morbidity. The main objective of treatment is to relieve the anteroposterior compression and to restore the stability of the occipitocervical region. Currently, there are 2 approaches to perform the surgical procedure: (1) posterior decompression by suboccipital and occipitocervical fusion and internal fixation; and (2) decompression by a transoral approach to an odontoid resection. However, there are some short points, which need to be changed, such as the incomplete decompression (the former), narrow view, cerebrospinal fluid leakage, and the high infection rates. METHODS: From 1999 to 2006, 23 patients with occipitoatlantoaxial ventral lesions were treated using a transoccipitocervical posterolateral approach for decompression. The procedure included an expansion of the foramen magnum, a resection of the posterior arch of atlas, a lateral occipitocervical epidural exposure to the odontoid and the C2 vertebra, and an excision of the odontoid. Thus, an anteroposterior decompression and occipitocervical spinal fusion was achieved. Neurological function, daily living ability, and the work ability of patients were assessed in a follow-up study. RESULTS: A 28-year-old woman died of respiratory and circulatory failure 10 hours after operation. The remaining patients survived without postoperative infection. The neurological injury in 17 patients did not deteriorate, whereas 5 patients had decreased sensation in the upper limbs, and the elbow flexor muscle strength in 2 patients declined by 1 grade on the operation side. Short-term follow-up (3-6 mo, 22 cases) indicated that 19 patients recovered normal sensation with decreased limb muscle tension. Motor function was improved by >1 grade (5 patients with postoperative nerve injury recovered to preoperative levels or better). Long-term follow-up (>4 y) of 15 patients (10 patients by clinic visit and 5 patients by correspondence) indicated that the occipitoatlantoaxial regions were stable without local discomfort or loss of nerve function. Fourteen patients were able to care for themselves and some patients regained their ability to work. One patient felt no significant improvement after surgery and had no improvement in the quality of life. CONCLUSIONS: Transoccipitocervical posterolateral approach to occipitoatlantoaxial ventral lesions provides a broad and sterile operating field to perform anteroposterior decompression and occipitocervical spinal fusion simultaneously. Neurological improvement is significant, and the long-term follow-up results are satisfactory.

Convex short length rib resection in thoracic adolescent idiopathic scoliosis.

BACKGROUND: Although it brings satisfactory rib hump correction, concomitant thoracoplasty with surgical correction of scoliosis decreases pulmonary function values. To achieve satisfactory rib hump correction and avoid impairment to pulmonary function, we design a new kind of thoracoplasty-convex short length rib resection (CSLRR). This study is to evaluate the effect and outcome of CSLRR in conjunction with pedicle screw instrumentation. METHODS: Seventy patients with thoracic adolescent idiopathic scoliosis treated by pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years. Patients were divided into 3 groups: C-T group (conventional thoracoplasty, n =20), N-T group (no thoracoplasty, n=24), and CSLRR group (n=26). Patients were evaluated for height of rib hump, deformity correction, balance, pulmonary function, and complications. RESULTS: The correction rates of hump height were 74.1% in the C-T group, 47.1% in the N-T group, and 63.2% in the CSLRR group, respectively. The CSLRR group showed significantly better correction of rib hump than the N-T group. In thoracic hypokyphosis correction, the CSLRR group was superior to the N-T group with statistical significance. There were no significant differences in proximal thoracic, main thoracic and lumbar Cobb angle, coronal and sagittal balance, and lumbar lordosis at the final follow-up among 3 groups. Three months after the operation, both absolute values and percent-predicted values of forced vital capacity and forced expiratory volume in 1 second in the N-T group and CSLRR group were better than that in the C-T group. Two years after the operation, absolute values of forced vital capacity and forced expiratory volume in 1 second in the N-T group and CSLRR group were better than that in the C-T group. There were 2 hemothorax in the C-T group and 1 pleural effusion in the CSLRR group. CONCLUSIONS: CSLRR showed significantly better rib hump and thoracic hypokyphosis correction without pulmonary function compromise in the treatment of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation. LEVEL OF EVIDENCE: Therapeutic-level IV retrospective study.

Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis.

BACKGROUND: Very less literature focuses on the treatment of kyphosis in healed stages of spinal tuberculosis (TB), especially in children. The purpose of this study was to evaluate the outcomes of anterior release, decompression, deformity correction, and instrumented fusion, followed by posterior osteotomy, deformity correction, and pedicle screw instrumented fusion, which is used to treat kyphosis in children in healed stages of spinal TB. METHODS: Sixteen children with kyphotic deformity of the spine in healed stages of TB underwent anterior release, decompression, deformity correction, and instrumented fusion, followed by posterior osteotomy, deformity correction, and pedicle screw instrumented fusion between 2003 and 2007 with at least 2 years of follow-up. Radiologic assessment including the angle of kyphosis and scoliosis, and neurologic status using the modified Frankel grade were analyzed before surgery, after surgery, and at the last follow-up. Fusion was evaluated on flexion-extension lateral radiographs. RESULTS: Good cosmetic results were achieved in all patients. Neurologic improvement was shown in all 4 patients with paraplegia. The mean preoperative angle of kyphosis was 55.8 degrees that reduced to 21.7 degrees, postoperatively. The difference in the mean angle of kyphosis was statistically significant (P<0.05). The mean angle of kyphosis at the last follow-up was 23.2 degrees. The mean correction loss was 1.5 degree, and there was no statistically significant difference in the mean angles of kyphosis between the postoperative and last follow-up measurements. The mean preoperative angle of scoliosis was 6.9 degrees that reduced to 0.8 degree postoperatively. The difference in the mean angle of scoliosis was statistically significant (P<0.05). The mean angle of scoliosis at the last follow-up was 0.9 degree. The mean correction loss was 0.2 degree and there was no statistically significant difference in the mean angles of scoliosis between the postoperative and last follow-up measurements. All patients returning for follow-up had bony fusion. There were no cases of failure of fixation. CONCLUSIONS: Combined anterior and posterior osteotomy, deformity correction, and instrumented fusion halted progression of kyphosis and improved neurologic symptoms. LEVEL OF EVIDENCE: Therapeutic-level IV, retrospective study.

Characteristics of crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake.

BACKGROUND: To assess the characteristics, treatment and outcome of patients with crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake. METHODS: Following the Sichuan earthquake, 2728 patients were transferred to the West China Hospital of Sichuan University and 157 of those were admitted to the intensive care unit. The medical records of nine severe crush syndrome patients were retrospectively reviewed. RESULTS: The major associated injuries were in the lower extremities. Renal failure and oliguria developed in all patients. Creatine kinase peaked in all patients. Hyperkalaemia was seen in five patients, and six patients developed acidosis. All patients had amputations; five had two limbs amputated. One patient underwent fasciotomy. Adult respiratory distress syndrome developed in four patients and required mechanical ventilation. All patients underwent haemodialysis. Multiple organ failure and sepsis developed in eight patients, but no patients died. CONCLUSIONS: Crush syndrome caused by extremely long compression has high rates of renal failure, multiple organ failure, sepsis and amputation. Early transportation and immediate intensive care therapy would have improved the outcome and survival rate.

Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults (version 2023) / 中华创伤杂志

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Clinical guideline for diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture (version 2023) / 中华创伤杂志

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Clinical and radiologic comparison of dynamic cervical implant arthroplasty and cervical total disc replacement for single-level cervical degenerative disc disease.

Anterior cervical discectomy and fusion, to date the most successful spine procedure for the surgical treatment of cervical radiculopathy, has limitations that have led to the development of non-fusion cervical procedures, such as cervical total disc replacement (TDR) and dynamic cervical implant (DCI) arthroplasty. We compared the clinical and radiological results of DCI and cervical TDR for the treatment of single-level cervical degenerative disc disease in Chinese patients. A retrospective review of 179 patients with cervical spondylotic myelopathy who underwent DCI or TDR between April 2010 and October 2012 was conducted, and 152 consecutive patients (67 patients single-level DCI and 85 single-level TDR) who completed at least 2years of follow-up were included. Clinical and radiological assessments were performed preoperatively and at 1week and 3, 6, 12, and 24months postoperatively. The most common operative level was C5/C6 (49.3%). The differences in blood loss, duration of surgery, and duration of hospitalization were not statistically significant. The Japanese Orthopaedic Association scale, Visual Analog Scale, Neck Disability Index, and Short Form-36 scores improved significantly after surgery in both the DCI and TDR groups (P<0.05), but the differences were not statistically significant at the final follow-up. The rate of occurrence of heterotopic ossification was 22.4% and 28.2% in the DCI and TDR groups, respectively. As an effective non-fusion technique, DCI is a more economical procedure. Further prospective, randomized studies with long-term follow-up periods are needed to determine the long-term effects.

Epidemiological characteristics of traumatic spinal cord injury in China in 2018 / 中华创伤杂志

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.

Anterior Retropharyngeal Reduction and Sequential Posterior Fusion for Atlantoaxial Rotatory Fixation With Locked C1-C2 Lateral Facet.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To introduce a new type of atlantoaxial rotatory fixation (AARF) with a locked C1-C2 lateral facet and evaluate its therapeutic strategy. SUMMARY OF BACKGROUND DATA: AARF presenting with torticollis and limited neck motion is commonly seen in teenagers. Fielding and Hawkins' classification is generally applied to AARF. Although conservative treatment is effective for acute AARF, it is often unsuccessful for chronic AARF, which ultimately requires surgery. We introduce a new type of chronic AARF with a locked C1-C2 lateral facet that does not fit into Fielding and Hawkins' classification and describe the appropriate treatment. METHODS: Eight patients who had chronic AARF with a unilaterally locked C1-C2 lateral facet were referred to our clinic. Reduction had failed after traction for 3 to 4 weeks. After open release and reduction using the anterior retropharyngeal approach, we applied posterior C1-C2 transpedicular screw fixation with an autologous iliac bone graft for stage I or II. RESULTS: The anterior retropharyngeal approach provided direct access to the C1-C2 locked lateral facet. The patient in an overall poor condition (stage II) underwent delayed posterior C1-C2 arthrodesis. The others (stage I) underwent immediate posterior C1-C2 arthrodesis. All patients were followed up for an average of 14.8 months (5-37 mo). Three-dimensional computed tomography revealed C1-C-2 arthrodesis bone graft fusion after an average of 3.1 months (2-4 mo). There was no recurrence of symptoms and no dislocations or internal fixation device loosening or breakage. CONCLUSION: AARF with a locked C1-C2 lateral facet is a new type of AARF that cannot be classified using Fielding and Hawkins' classification. The anterior retropharyngeal approach for the release and reduction of AARF, followed by posterior C1-C2 arthrodesis is an effective therapeutic strategy for AARF with a locked C1-C2 lateral facet. LEVEL OF EVIDENCE: 4.

Clinical guideline for surgical treatment of symptomatic chronic osteoporotic vertebral fractures / 中华创伤杂志

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients / 中华骨科杂志

Objectives To assess the clinical outcomes,the technical characteristics of percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients.Methods From May 2014 to June 2015,76 elderly patients with lumber lateral recess stenosis were accepted percutaneus endoscopic interlaminar decompression,including 48 males and 28 females aged from 60-91 years old (average,71.7:8.8 years).There were 40 patients with stenosis in L45,29 patients with stenosis in L5S1 and 7 patients with stenosis in L4.5 and L5S1.Back and leg pain were assessed by visual analogue scale (VAS).The influence of pain was evaluated by Oswestry disability index (ODI).The change of spinal canal was assessed by lateral recess angle.The MacNab criteria was evaluated at last follow-up.Results All of the 76 operations had been completed successfully with an average operation time of 64.3±23.9 min (range,56-98 min).An average follow-up time was 31.5 months (range,24-36months).There was no operative segment errors and nerve root tear during operation.Dural sac tear in 1 case,2 cases of nerve root injury and 1 case of postoperative kakesthesia,transient seizures after anesthesia occurred in 1 case and 1 case had postoperative delirium.There were significances in lumbocrural pain scores,leg pain scores and ODI scores between preoperation and postoperative 1,3,6,12 month and last follow-up (P＜0.05).In the MacNab last follow-up,the fineness rate was 92.1％,including 52 cases of excellence,18 cases of good,and 6 cases of fair.The latera recess angle between preoperation and postoperation was significantly different.During follow-up period,there were 3 cases developed into lumbar instability.No recurrence,discitis and leakage of cerebrospinal fluid were found,delayed incision healing was found in 1 case.Conclusions Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients is a safe,effective and minimally invasive method of operation with the characteristics of precise decompression of bone stenosis,sufficient resection of ligamentum flavum to decompress soft stenosis,small effect on spinal stability and low complications.

Treatment of Denis type B thoracolumbar burst fractures by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach / 中华创伤杂志

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.

Evaluation of bioabsorbable multiamino acid copolymer/α-tri-calcium phosphate interbody fusion cages in a goat model.

STUDY DESIGN: A study of cervical interbody fusion using polyamino acid-based bioabsorbable fusion cages in a goat model. OBJECTIVE: To compare interbody fusion of a bioabsorbable multiamino acid copolymer/α-tri-calcium phosphate (MAACP/α-TCP) fusion cage with an autologous tricortical iliac-crest bone graft and a titanium cage. SUMMARY OF BACKGROUND DATA: Polyamino acid is widely used as a carrier for drug delivery. To our knowledge, no study investigates interbody fusion cage made of polyamino acid. METHODS: A total of 15 sheep underwent C3/C4 discectomy and fusion. The following stabilization techniques were used: group A, autologous tricortical iliac crest bone graft (n = 5); group B, MAACP/α-TCP cage filled with autologous cancellous bone graft (n = 5); group C, titanium cage filled with autologous cancellous bone graft (n = 5). Radiographic scans to determine disc space height were performed before and after surgery and after 4, 8, and 12 weeks, respectively. After 12 weeks, the C3/C4 motion segment was isolated and sectioned to create a 5-mm thick parasagittal section from which lateral radiographs were obtained. All the radiographs were encoded and reviewed in a blinded fashion to evaluate interbody fusion within the cage devices according to a three-point radiographic score. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine range of motion (ROM). Histomorphological and histomorphometrical analyses were performed to evaluate fusion and foreign-body reactions associated with the bioabsorbable cages. RESULTS: Radiographic results showed that the disc space height (DSH) in MAACP/α-TCP cage group was better than that of bone graft group and the best radiographic score was found in MAACP/α-TCP cage group. Biomechanical test showed that no significant difference was found in ROM between MAACP/α-TCP cage group and titanium cage group whereas the value of ROM in bone graft group was the largest. Histologic evaluation showed a higher intervertebral bone volume/total volume ratio and a better interbody fusion in the MAACP/α-TCP cage group than in the other two groups. Two MAACP/α-TCP cages showed microcracks and the other three cages had maintained their original geometry. All MAACP/α-TCP cages showed excellent biocompatibility. CONCLUSION: After 12 weeks, there was no significant difference between the MAACP/α-TCP cage and the titanium cage in distractive properties and biomechanical properties. Compared with titanium cages, MAACP/α-TCP cages showed an advanced interbody fusion. Although MAACP/α-TCP cages developed cracks after only 12 weeks, they showed significantly better distractive properties, biomechanical properties, and an advanced interbody fusion than the tricortical iliac crest bone graft. Improvement should be made to insure the strength of MAACP/α-TCP cage last at least 6 month after implantion.

Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdomi-nal muscle and retroperitoneal approach / 中华骨科杂志

Objective To investigate the clinical efficacy and indication of surgical treatment of L5S1 tuberculosis us?ing a medial edge of rectus abdominal muscle and retroperitoneal approach. Methods From Jan. 2010 to Nov. 2014, totally 18 cases of L5S1 tuberculosis were surgically cured by debridement, fusion and internal fixation via a medial edge of rectus ab?dominal muscle and retroperitoneal approach. There were 10 males and 8 females, with an average age of 35.6±10.1 years (21 to 55). The mean course of disease was 5.3±2.2 months. The primary destruction lesions were located at L5S1, and one patient of whom L4 was also involved, three cases S2 involved, and one S3 involved. Abscess pre sacrum was noticed in all cases. Six patients were combined with abscess in vertebral canal. Neural deficiency was detected in 3 patients, all grading as Frankel D. Dubousset's lumbosacral angle was 104°-126°, mean 114.6°±6.0°. Formal anti?tuberculosis medicine treatment was given for at least 2-3 weeks. All patients were treated using a medial edge of rectus abdominal muscle and retroperitoneal approach. Af?ter debridement, a tri?cortical iliac bone was used for structural inter?vertebrae fusion. The iliac bone was fixed to the sacrum by one cortical screw. Operation time, volume of blood loss, and surgery complications, including wound infection, looseness and shift of internal fixation, sinus occurrence, vascular injury, retrograde ejaculation in male patients were evaluated. The X?ray and 3D CT of lumbosacral spine, together with ESR and CRP were used to evaluate the control of tuberculosis during fol?low?up. The Dubousset's lumbosacral angle, visual analogue score, and the Frankel grade were compared between preoperative and postoperative. The bone graft fusion were also observed. Results The operation time was 147±16 min in average. The mean blood lose was 275 ± 77 ml. No vascular or neurological injury was noticed. There was also no retrograde ejaculation happened in this group. All patients were followed up from 18 to 28 months. Dubousset's lumbosacral angle was 122.4°±3.8° post?operatively and 121.4°±3.7° at the final follow?up. There was a significant difference between the lumbosacral angles pre and post operation, whereas no statistical difference between the post operation and the final follow?up. Bone fusion was noticed in all cases. All pa? tients have intact neurological function at the final follow?up. No screw breakage or graft bone migration occurred. VAS was 5.6± 1.09 pre?operation and 0.83±0.71 at the 3rd month's follow?up, and there was a significant difference between them. Conclusion Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdominal muscle and retroperitoneal approach is an effective method in terms of minimal trauma, low rate of modality, good ability in restore and maintenance of lumbosacral junction alignment and high fusion rate.

Reconstruction of segmental stability of goat cervical spine with poly (D, L) Lactide cage / 中华骨科杂志

Objective To design a type of poly (D, L) Lactide (PDLLA) cage, compare the characteristics of inter body fusion using PDLLA cage with those of titanium cage and autologous tricortical iliac crest graft in a goat cervical spine model in vi?vo. Methods Twenty?four goats underwent C3-4 discectomy and fusion were assigned to 3 groups, PDLLA cage group (n=8), titani?um alloy cage group (n=8) and autologous iliac bone group (n=8). Radiography was performed pre?and post?operatively and 1, 2, 4, 8, and 12 weeks after operation. At the same time points, disc space height (DSH), intervertebral angle (IVA), and lordosis angle (LA) were measured. After 12 weeks, the goats were killed and fusion sites were harvested. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine the stiffness and range of motion. All cervical fusion speci?mens underwent histomorphological observation. Results The IVA of PDLLA cage 4 weeks after operation and DSH 8 and 12 weeks after operation was statistically greater than that of autologous iliac bone graft (P0.05). Radiographic and histomorphological observa?tion showed better fusion results in cage groups than in autologous bone group. Conclusion This type of PDLLA cage has excel?lent biocompatibility and can provide an appropriate biological environment for bone ingrowth and osteogenesis at bone?implant in?terface. Furthermore, PDLLA cage can maintain DSH and increase the stability of fusion segments to create a good biomechanical environment for the last bone fusion.

Regeneration and repair after ChABC,GDNF and Nogo-A Ab combination treatment in experimental spinal cord injury model / 西安交通大学学报(医学版)

Objective To investigate regeneration and repair effect after ChABC,GDNF and Nogo-A Ab combination treatment for experimental spinal cord injury model.Methods Rat (T7-8 )complete spinal cord injury crosscutting animal model was established.The SD rats were randomly divided into 6 groups:normal group, sham operation group,simple transection group,A (ChABC)group,G (GDNF)group,N (Nogo-A antibody) group,and AGN (ChABC+GDNF+Nogo-A antibody)group.At 24 w after spinal cord injury,BDA tracer,NF-200,GAP-43,and GFAP immunohistochemistry were evaluated.Results BDA tracer of A group,G group and N group showed dye light,the proximal end of damaged zone showed the blue tracer particles,while damaged zone showed few blue regenerated nerve fibers.AGN group showed visible blue nerve fibers through the damaged zone and the distal segment in the damaged zone;the central zone of injury vacuolar degeneration showed the blue dyed fibers.NF-200 immunohistochemical staining showed NF-positive staining in A group,AGN was stronger than that in control group and simple transection group (P 0.05 ).SEP wave was detected in control group and AGN group,while the latency time was longer in AGN group than in control group.Conclusion ChABC,GDNF,and anti-Nogo-A antibody used alone or in combination can improve spinal cord injury and nerve cell function,and the joint application could improve regeneration after spinal cord injury than any monotherapy.

The surgical treatment of the chronic atlantoaxial rotatory dislocation with C1, 2 lateral facet locked through combined anterior and posterior approach / 中华骨科杂志

Objective To describe the clinical manifestation of the chronic atlantoaxial rotatory dislocation (AARD) with C1,2 lateral facets locked,and explore the effect of the operation combined with anterior retropharyngeal approach and posterior approach.Methods Data of 8 patients with chronic AARD with C1,2 lateral facet locked who had undergone open reduction with the anterior retropharyngeal approach and C 1,2 transpedicular screw fixation with autologous iliac bone graft from Oct.2010 to Jun.2013 were retrospectively analyzed.There were 4 males and 4 females with an average age of 31 years old (range,11-57 years old).The intervals from onset to diagnosis were from 29 to 180 days and the mean time was 70.6 days.5 cases were chronic AARD with right C1,2 lateral facets locked and 3 with left C1,2 lateral facets locked.Reduction was failed to obtain by traction for two to four weeks.Subsequently,after open reduction with the anterior retropharyngeal approach,the patients were performed C 1,2 transpedicular screw fixation with autologous iliac bone graft for one stage or two.Results 1 patient underwent open reduction with the anterior retropharyngeal approach in stage one and C1,2 transpedicular screw fixation in stage two because of an overall severe condition,and the other patients did anterior and posterior operation in one stage.The average operation time was 205 min (range,160-260 min).The mean blood loss was 210 ml (range,100-300 ml).There were no operation complications except one young girl reflected pain in autologous iliac donated area,and pain relieved when taking non-steroidal anti-inflammatory by oral for one week.All patients had been followed up for a mean period of 14.8 months (range,5-37 months).Three-dimensional computed tomography revealed C1,2 arthrodesis bone graft fusion from two to four months and the average was 3.1 months.Neither recurrence of symptoms nor dislocation was observed at the latest follow-up.Conclusion Open reduction through the anterior retropharyngeal approach with C1,2 transpedicular screw fixation is an effective treatment strategy for chronical AARD with C1,2 lateral facets locked,which reduces surgical complications with less operation difficulty.

Three-dimensional Finite Element Analysis of Biomechanical Effect of Rigid Fixation and Elastic Fixation on Lumbar Interbody Fusion / 生物医学工程学杂志

This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery.

Effectiveness of nano-hydroxyapatite/polyamide 66 cage in anterior spinal reconstruction: a mid-term study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction.</p><p><b>METHODS</b>There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores.</p><p><b>RESULTS</b>All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05).</p><p><b>CONCLUSIONS</b>The n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.</p>