ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
Objective To explore the clinical effect of PSIS-A robot-assisted percutaneous screw in the treatment of thoracolumbar fracture. Methods Patients with thoracolumbar fracture who were hospitalized in Mianyang Orthopedic Hospital between August 2022 and January 2024 and required percutaneous pedicle screw f ixation were selected. Patients were divided into robot group and free hand group by random number table. Operative time, intraoperative bleeding, intraoperative radiation dose and time, implant accuracy rate, small joint invasion rate, Visual Analogue Scale score for pain and other indexes were compared between the two groups. Results A total of 60 patients were included. Among them, there were 28 cases in the robot group and 32 cases in the free hand group. On the third day after surgery, the Visual Analogue Scale score of the robot group was better than that of the free hand group (P=0.003). Except for intraoperative bleeding and radiation frequency (P>0.05), the surgical time, average nail implantation time, and intraoperative radiation dose in the robot group were all lower than those in the free hand group (P<0.05). The accuracy and excellence rate of nail planting in the robot group were higher than those in the free hand group (94.6% vs. 84.9%; χ2=7.806, P=0.005). There was no statistically significant difference in the acceptable accuracy rate (96.4% vs. 91.1%; χ2=3.240, P=0.072) and the incidence of screw facet joint invasion (7.2% vs.14.1%; χ2=3.608, P=0.058) between the two groups. Conclusion The application of PSIS-A type robot assisted percutaneous minimally invasive pedicle screw fixation in the treatment of thoracolumbar fr actures is promising.
OBJECTIVE: To study the changes of neural electrophysiology properties of cauda equina under double level compression and dynamic burdens, and to clarify the mechanisms of intermittent neurogenic claudication. METHODS: Thirty SD rats were divided into 5 groups (6 in each group). The laminectomy of L5 was performed in control group. In the experimental groups, the silicon sheets were inserted into the spinal canal of L4 and L6 to cause double level compression of cauda equina by 30%. Two hours after onset of compression, no dynamic burden was introduced in experimental group 1. Only high frequency stimulation(HFS) was introduced for 6 minutes in experimental group 2. Both HFS and additional increased compression were introduced for 6 minutes in experimental group 3. While only additional increased compression was introduced for 6 minutes in experimental group 4. After 6 minutes of dynamic burdens, all were returned to the status of static compression for another 30 minutes and then electrical examination was made. RESULTS: After 2 hours of compression, motor and sensory nerve conduction velocity (NCV) of all the four experimental groups decreased significantly (P lt; 0.05), but there was no significant difference between them. There was no significant change in the control group. There was no significant change of NCV in experimental group 1 during the last 30 minutes of experiment. NCV in the other three experimental groups decreased after introduction of dynamic burdens, especially in the experimental group 3. CONCLUSION: The above results showed that NCV of cauda equina decreased significantly under dynamic burdens during static compression. Two kinds of dynamic burdens introduced at the same time can cause more profound change than a single one.
Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
Objective To review the research progress of Modic changes and its influence on lumbar interbody fusion. Methods The domestic and foreign literature related to Modic changes and its influence on lumbar interbody fusion was extensively reviewed. The etiology of Modic changes was summarized, and the treatment measures of Modic changes on lumbar interbody fusion were discussed. Results The etiology of Modic changes is not clear, which may be related to mechanical factors, autoimmune factors, low toxic infection factors, and genetic factors. Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion. Preoperative evaluation of endplate sclerosis, reduction of iatrogenic endplate injury, fine operating of intervertebral space, management of osteoporosis, and selection of appropriate cage can prevent or reduce fusion failure or cage subsidence. Conclusion Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion, and active perioperative intervention of Modic changes is helpful to improve the clinical prognosis.
Objective To review the progress in the features, early cl inical outcomes, and cl inical appl ication of axial lumbar interbody fusion (AxiaLIF) for the minimally invasive treatment of lumbosacral degenerative diseases. Methods The l iterature about the features, early cl inical outcomes, and cl inical appl ication of AxiaLIF for the minimally invasive treatment of lumbosacral degenerative diseases in recent years was reviewed. Results Almost 9 000 procedures performed globally in recent years, AxiaLIF has shown its safety and effectiveness because of high fusion rates, short hospital ization days, and less iatrogenic compl ications in comparison with standard fusion procedures. ConclusionPostoperative long-term outcomes, biomechanics stabil ity, and extended appl ication of AxiaLIF still need a further study,though it suggests an original minimally invasive treatment of lumbosacral degenerative diseases.
Objective To assess the clinical application value of tranforaminal unilateral approach for bilateral decompression by comparing the short-term effectiveness of bilateral decompression via unilateral approach of intervertebral foramen with via small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis. Methods Between July 2014 and June 2015, 48 patients with lumbar spinal stenosis underwent decompression and internal fixation by unilateral approach in 24 cases (trial group) and by bilateral small incision approach in 24 cases (control group). There was no significant difference in gender, age, disease duration, disease type, involved segment, combined medical diseases, preoperative level of creatine phosphokinase (CPK), the visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, and the incidence of complications were recorded. The CPK levels were evaluated at 1, 3, and 7 days after operation. VAS score and ODI were used to evaluate the effectiveness, and lumbar X-ray film or CT scanning to determine the intervertebral bony fusion. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05), but significant difference was found in postoperative drainage (t=5.547,P=0.000). At 1 day after operation, the level of CPK in the trial group was significantly lower than that in the control group (t=3.129,P=0.005), but there was no significant difference at 3 and 7 days after operation between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 17 months). All the wounds healed primarily. Heart failure occurred in 1 case of the trial group, and cerebrospinal fluid leakage and pulmonary infection, and nerve root injury occurred in 1 case of the control group respectively. There was no significant difference in the incidence of complications between 2 groups (χ2=0.273,P=0.602). The interbody fusion rate was 95.8% (23/24) in the trial group and was 91.7% (22/24) in the control group, showing no significant difference (χ2=0.356,P=0.551). No cage sink, dislocation or plate and screw loosening and breakage was found in 2 groups. No adjacent segment degeneration occurred during the follow-up, and there was no change of scoliosis and lumbar sagittal curvature. At 3, 6, and 12 months after operation, the VAS score and ODI were significantly improved when compared with the preoperative scores in 2 groups (P<0.05), and the VAS score and ODI of the trial group were significantly better than those of control group (P<0.05). Conclusion The bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion have satisfactory efficacy for the treatment of lumbar spinal stenosis, but the tranforaminal unilateral approach has the advantages of less trauma, avoidance of bilateral muscle stripping and soft paraspinal muscle injury, retention of posterior spinal structure, faster postoperative recovery, shorter hospital stay and good short-term effectiveness.