Objective To observe the effect of threaded titanium cage and transpedical screw for the treatment of lumbar spondylolisthesis. Methods Eighteen patients with lumbar spondylolisthesis were adopted in this study. Among them, there were 8 males and 10 females, aged from 43 to 62 years old .Roentgenogramshowed that there were 6 cases of Ⅰ° spondylolisthesis, 11 cases of Ⅱ° and 1 case of Ⅲ°. All patients were treated with cages for intervertebral fusion after total laminectomy and pedicle screws for the reduction. Results The cases were followed up from 6 to 12 months with an average of 11 months. The clinical results were excellent in 13 cases and good in 5 cases. All patients achieved successful fusion and bony union . There were no pedicle screw loosening or broken or peripheral nerve dysfunction in this series. Conclusion This method has been proved to be an effective and reliable procedure for treatment of lumbar spondylolithesis. It produces a high fusion rate and clinical success.
OBJECTIVE To investigate the therapeutic effect of percutaneous lumbar discectomy (PLD) combined with sodium hyaluronate (SH) injection in the treatment of lumbar intervertebral disc herniation. METHODS Forty-eight patients suffered from lumbar disc herniation were divided into two groups and treated by PLD combined with SH injection into epidural cavity (treatment group) or single PLD (control group) respectively. All patients were followed up for 24 months. The therapeutic effects in both groups were assessed and compared according to Macnab’s criterion. RESULTS The patients in the treatment group got much more significant improvement than those in the control group, with shorter therapeutic course and more safety. CONCLUSION PLD combined with SH injection into epidural cavity is more effective and safety in the treatment of lumbar disc herniation than of pure PLD.
Objective To analyze the cl inical effects of modified transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disease. Methods From October 2003 to December 2006, 33 patients with lumbar degenerative disease (L3-S1) were treated by modified TLIF. There were 14 males and 19 females with an average age of 52.2 years(33 to 70 years). The median disease course was 1.8 years (4 months to 15 years). A total of 42 levels were fused, including 24 cases of single level and 9 cases of double levels. The results of preoperative diagnosis were lumbar degenerative spondylol isthesis with stenosis (8 cases), isthmic spondylol isthesis (5 cases), degenerative lumbar stenosis (16 cases), huge herniated disc with segmental instabil ity (3 cases) and failed back surgery syndrome (1 case). During the modified TLIF procedure, total inferior facet process and inner half summit of superior facet process of TLIF side were resected to make the posterior wall of foramen opened partly. After the bone graft (3 to 5 mL) was placed into the interbody space, a single rectangle Cage was inserted obl iquely from 30° to 40° toward the midl ine. Combined with pedicle screw instrumentation, TLIF was accompl ished. Middle canal and opposite side nerve root decompression were performed simultaneously when necessary. Results Intraoperative dura mater rupture, postoperative cerebral spinal fluid leakage, deep wound infection and transient nerve root stimulation occurredin 1 case respectively, and were all recovered after treatment. No patients had permanent neurologic deficit or aggravation. All patients were followed up for 20 to 58 months (mean 27.2 months). At the follow-up after 1 year postoperatively, all the operated segments achieved fusion standard and no broken screw or Cage dislocation occurred. All 13 cases of spondylol isthesis were reduced thoroughly and maintained satisfactorily. Nineteen patients remained sl ight chronic back pain. There was significant difference (P lt; 0.05) in JOA score between preoperation (14.9 ± 5.1) and postoperation (25.9 ± 3.0). The rate of cl inical improvement was 80.5% (excellent in 24 cases, good in 7 cases, and fair in 2 cases). Conclusion The modified TLIF carries out the less invasive principles in opening operations, simpl ifies the manipulation and expands the indication of TLIF to some extent, and the cl inical results for the treatment of lumbar degenerative disease is satisfactory.
Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L4, 5 in 36 cases and L5, S1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.
Objective To review the current development of the dynamic stabilization devices and their biomechanics as well as clinical application.Methods The related biomedical research papers at home and abroad were consulted and analyzed Results There were obvious advances in the theoretic foundation and the clinical application in treatment of the degenerative lumbar disorders with the dynamic stabilization devices, especially with the nonfusion dynamic stabilization devices. Conclusion The effectiveness of the dynamic stabilization devices have attracted more and more biomedical researchers, especially the posterior dynamic stabilization device, which has provided a new approach to treatment of the degenerative lumbar disorders.
Objective To review the research progress of stress fracture of the lumbar pedicle. Methods The literature about the stress fracture of the lumbar pedicle was reviewed extensively and summarized. Results There are two types of stress fracture: fatigue and structure insufficient. Stress fracture of lumbar pedicle occurred mainly in the crowd with repetitive and large activities of spine, contralateral spondylolysis, or previous surgery of lumbar vertebra. The main stresses causing stress fracture of the lumbar pedicle are shear stress and twisting stress, followed by sudden hyperflexion or hyperextension of the spine. Stress fracture of lumbar pedicle was easily missed by conventional X-ray examination, usually XCT, MRI, or bone scan was needed to confirm the diagnosis. It is divided into 4 types or 4 periods according to MRI findings: stress reaction, incomplete fracture, complete fracture, and pseudarthrosis. For patients with incomplete, complete, and juvenile stress fractures of the lumbar pedicle without nerve root irritation, the majority of claims preferred conservative treatment and the healing rate of fracture was high; for patients with bilateral pseudarthrosis and with nerve root irritation as well as patients who failed to the conservative treatment, surgical management was advocated and the operation result is good. Conclusion Stress fracture of the lumbar pedicle as one of the causes of low back pain is extremely rare, and is easily missed clinically. Surgery or conservative management should be selected based on type of fracture and specific condition of the patient, the treatment results are satisfactory.
Objective To evaluate the mid-term cl inical outcome of instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae for symptomatic adult isthmic spondylol isthesis. Methods Between October 2004 and March 2008, 44 patients with symptomatic isthmic spondylol isthesis underwent instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae. There were 15 males and 29 females with an average age of38.4 years (range, 28-45 years). The disease duration was 14 months to 7 years (38 months on average). The affected vertebrae was L4-5 in 18 patients and L5, S1 in 26 patients. According to Meyerding’s grade for spondylol isthesis, 28 cases were rated as grade II and 16 as grade III. The visual analogae scale (VAS), Oswestry disabil ity index (ODI), and the short form 36 health survey (SF-36) scores were evaluated before operation and at last follow-up; the radiographical outcome was evaluated by measuring sl i pping percentage, heights of intervertebral space and foramen, and fusion rate. Results All patients were followed up 20-60 months (42 months on average). The VAS, ODI, and SF-36 scores were all significantly improved at last follow-up when compared with those before operation (P lt; 0.05). According to Morelos criteria, the cl inical results were excellent in 32 patients, good in 9, and fair in 3; the excellent and good rate was 93.2%. The preoperative average percentage of sl ip was 47.5%, which was improved to 2.6% 3 days after operation; the total average reduction rate was 97.4%, and it was maintained at last followup. The heights of intervertebral space and foramen were all improved significantly after operation (P lt; 0.05), and there was no significant difference between at 3 days after operation and at last follow-up (P gt; 0.05). X-ray and CT showed bony fusion 1 year after operation in all patients with a fusion rate of 100%. Compl ications included pain at donor site of il iac bone in 4 cases, superficial infection in 2 cases, dural tear in 1 case, and degeneration of adjacent vertebrae in 2 cases; no nerve root injury, pseudoarthrosis, failure of internal fixation, and acquired spinal canal stenosis occurred. Conclusion Instrumented sl ip reduction combined with 360° circumferencial fusion and restoration laminae is a rel iable procedure for adult isthmic spondylol isthesis with satisfactory mid-term results, a high fusion rate and low compl ication rate. The long-term outcomesshould be verified by follow-up in the future.
Objective To explore the feasibil ity and efficacy of percutaneous kyphoplasty (PKP) for the treatment of severe osteoporotic vertebral compression fracture (OVCF), and to assess the cl inical result of the PKP technique. Methods From May 2006 to October 2007, 12 patients with severe OVCF affecting more than 2/3 of the original vertebral body height were treated by using domestic PKP and percutaneous vertebroplasty (PVP) tool systems. There were 3 malesand 9 females, with the age of 56-82 years and a mean disease course of 4.2 months (1-49 months). Eleven thoracic vertebra and 4 lumbar vertebra suffered from severe vertebral compression fractures, which included 3 extremely severe thoracic OVCF. Four thoracic vertebra and 3 lumbar vertebra had not severe OVCF. There were 4 cases of single vertebral compression fracture, 6 cases of double fractures, and 2 cases of triple fractures. Only single side PKP and PVP were performed via extrapedicular approach in thoracic vertebra, and via transpedicular approach in lumbar spine under fluoroscopic control. Eight patients with severe thoracic compression fractures and 4 with severe lumbar fractures were treated by PKP. Four patients with relatively mild thoracic compression fractures and 3 with lumbar fractures were treated by PVP. Results The operation was successfully, 3 patients with extremely severe thoracic compression fractures received no intervention. The maximum expansion pressure of balloon was (1 068 ± 298) kPa, and the volume was (3.1 ± 1.2) mL during operation. The average operative time of PKP was (44.9 ± 10.6) minutes per vertebra, while the average operative time of PVP was (36.5 ± 6.8) minutes per vertebra. The average volume of injected bone cement was (2.5 ± 0.6) mL per thoracic vertebra, and (3.6 ± 1.2) mL per lumbar vertebra. The mean hospitalization time were (3.7 ± 1.6) days. Twelve cases were followed up 5-18 months (mean 8.6 months). The visual analogue scale scoreswere (2.35 ± 0.61) points 2 days after operation and (2.89 ± 1.07) points at last follow-up, there were statistically significant differences when compared with before operation (8.27 ± 1.36) points (P lt; 0.01). Extravertebral leakage of the bone cement into the paravertebral tissue and/or disc occurred in 6 patients (9 vertebra) without significant symptom. Conclusion One side approach PKP is a safe and effective technique for treatment of severe OVCF with markedly rel ief of pain.
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
Objective To evaluate lumbar laminotomy and replantation in prevention of spinal unstability and peridural adhesion after laminectomy.Methods From February 1995 to March 2001,a total of 169 patients(96 males, 73 females,aged 22-63) with lesions in the lumbar vertebral canals underwent surgery, in which the lesions were removed afterlaminectormy and then the excised laminae were replanted. Results The follow-up for 5-9 years showed that all the patients had no complications after the lesions were removed. According to the evaluation criteria formulated by WANG Yongti，81 patients had an excellent result, 67 had a good result, 19 had a fair result, and2 had a poor result. 87.6% of the patients obtained quite satisfactory results.The X-ray films demonstrated that the replanted laminae obtained bony healing and the spine was stable. The CT scanning demonstratedthat the canals were enlarged with a smooth and glossy interior. Conclusion Lumbar laminotomy and replantation is reasonable in design and convenient in performance, which can be promoted as a basic operation in spinal surgery.