Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instabil ity. Methods Between January 1998 and October 2010, 48 patients with lumbar degenerative instabil ity were treated by posterior decompression, lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous processand vertebral plate complex and pedicle screw fixation. There were 26 males and 22 females, aged 52-76 years (mean, 62.4 years). The disease duration was 7 months to 25 years (mean, 6.5 years). One segmental instabil ity was located at L3, 4 in 1 case, at L4, 5 in 10 cases, and at L5, S1 in 11 cases; multi-segmental instabil ity was located at L3, 4, L4, 5, and L5, S1 in 5 cases, at L2, 3 and L3, 4 in 2 cases, at L3, 4 and L4, 5 in 10 cases, and at L4, 5 and L5, S1 in 9 cases. Of 48 patients, 32 complicated by lumbar disc herniation, 46 by lumbar spinal stenosis, and 16 by degenerative scol iosis. The cl inical results were evaluated by the Japanese Orthopaedic Association (JOA) score, recovery rate, disc height, and lumbar lordosis angles. Results The incisions obtained healing by first intention after operation. No nerve injury, rod or screw breakage, and infection occurred during and after operation. All 48 patients were followed up 1 to 6 years. The fusion time was 12-18 weeks (mean, 16.2 weeks). Vertebra sl i pping or degenerative scol iosis was corrected, and spinal column series became normal. At preoperation, 6 months after operation, and last follow-up, the disc heights were (5.2 ± 2.3), (11.9 ± 2.0), and (11.6 ± 2.1) mm, respectively; the JOA scores were 3.2 ± 2.1, 12.8 ± 1.6, and 13.6 ± 1.2, respectively; and the lumbar lordosis angles were (—20.5 ± 10.5), (30.5 ± 8.5), and (31.2 ± 5.6)°, respectively. The JOA scores, disc heights, and lumbar lordosis angles were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P lt; 0.05), but no significant difference was found between 6 months after operation and last follow-up (P gt; 0.05). The recovery rate of JOA was excellent in 36 cases, good in 10 cases, and fair in 2 cases at 6 months after operation, with an excellent and good rate of 95.8%. Conclusion Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle crew fixation for lumbar degenerative instabil ity can restore and maintain the intervertebral disc height effectively with high fusion rate. It is a plasty close to anatomic reconstruction.
Objective To elucidate the new development, structural features and appl ication of the lumbar interspinous process non-fusion techniques. Methods With the review of the development course and important research works in the field of the lumbar inter-spinous process non-fusion techniques, the regularity summary, science induction, and prospect were carried out. Results The lumbar inter-spinous process non-fusion technique was a part of non-fusion insertof spinal division posterior surface. According to the design, it could be divided into two major categories: dynamic and static systems. The dynamic system included Coflex and device for intervertebral assisted motion; the static system included X-STOP, ExtenSure and Wall is. The lumbar inter-spinous process non-fusion technique was a new technique of spinal division, it could reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. A lot of basic and cl inical researches indicated that lumbar inter-spinous process insert had extensive appl ication to curatio retrogression lumbar spinal stenosis, discogenic low back pain, articular process syndrome, lumbar intervertebral disc protrusion and lumbar instabil ity and so on. Conclusion With the matures of lumbar inter-spinous process non-fusion techniques and the increased study of various types of internal fixation devices, it will greatly facil itate the development of treatment of lumbar degenerative disease. But long-term follow-up is needed to investigating the long-term efficacy and perfect operation indication.
Objective To introduce a new operative technique of the expansive laminoplasty with reattachment of the spinous process and theextensor musculature for treatment of a tumor in the cervical vertebral channeland evaluate the clinical outcome of the technique. Methods From July 2003 to June 2006, this technique was applied to 26 patients (14 males,12 females; age, 25-57 years; illness course, 3 months-2 years) in our hospital. The four limbs had a muscle force of ⅢⅣ degrees, and with a high musculartension. The tendon reflex was sthenic and 2 patients had patellar clonus and ankle clonus. MRI was used to measure the tumor size (from 1.5 cm ×0.8 cm to 2.8 cm×2.0 cm, at the C3-6 levels) before and after operation.There were 8 cases at the C3,4levels, 9 cases at the C4,5 levels, 9 casesat the C5,6 levles. Results The result of the follow-up (average,8months; range, 6-12 months) showed that all the patients achieved a recovery at different degrees,with no death or complication. Although 10 of the patients felt a pain in the neck, but the pain was relieved after the functional exercise; the cervical active scope was changed a little with no cervical intervertrbal instability. The postoperative MRI and CT showed that the posterior column was maintained, and the “close-door” phenomenon did not happen. The degree of latitule of the cervical vertebra after operation was measured. The antecollis was 28.43°(37.9° onaverage). The hyposokinesis was 3244°(41° on average), the left antecollis was 25.45°(23° on average), and the right antecollis was 35.45°(36.2° on overage).Conclusion The expansive laminoplasty with reattachment of the spinous process and the extensor musculature can provide enough operative space and reserve the normal posterior column of the cervical vertebra. The intervertebral stability can beobtained after conglutination between the spinous process and the vertebral lamina.
In order to modify the plastic operation for lumbar spinostenosis, [symbol: see text]-shaped splitting of spinous process was designed. Fifty-six patients with lumbar spinostenosis were treated. There were 36 males and 16 females, age ranged from 32-67 years old (with an average of 48.9 years old). Among them, 8 patients operation on L2-L5 segments, 16 on L3-L5 segments and 22 patients on L4-L5 segments. After operation, 32 cases were followed up from 8 to 27 months. The results were: 1. The result of operation was excellent in 21 cases, good in 8 fair in 2 and poor in 1. The effective rate was 90.6%. 2. The rate of bony union from laminectomy was 95.1%. 3. The sagittal diameter and transverse diameter of the spinal canal were enlarged in an average of 6.4 mm and 3.2 mm, respectively, with a mean enlargement of 37.6%. The conclusion were that the plastic operation with [symbol: see text]-shaped splitting of spinous process for lumbar spinal canal was easy to handle and it could effectively prevent the lumbar instability and secondary stenosis following operation.
【摘要】 目的 研究棘突顶端上下缘与椎弓根中心点水平面垂直距离的关系，为微创胸腰段脊柱内固定术椎弓根的体表定位提供实验依据。 方法 20具完整脊柱骨标本，测量标本两侧胸11~腰2椎弓根中心点与棘突旁开距离（CO）、棘突上、下缘至椎弓根中心点水平面垂直距离（AC、BC），以棘突顶端的上、下缘为参照点确定椎弓根的最佳体表投影点。选取20例无神经症状的单节段椎体骨折男性患者；年龄23~54岁，平均37.6岁。损伤部位:胸11、胸12、腰1、腰2骨折椎体各5例。以棘突顶端上缘点为确定椎弓根中心的参考点，行经皮椎弓根螺钉固定，分别测定术前、术后相应椎体Cobb角。 结果 男、女性各椎体左右两侧CO、AC、BC比较差异均无统计学意义（Pgt;0.05）。男女组间相同椎体CO和BO及胸11、胸12椎体的AC比较差异均有统计学意义（Plt;0.05），腰1、腰2椎体的AC比较差异无统计学意义（Pgt;0.05）。男性或女性胸11~腰2的CO依次变大、AC和BC逐渐减小，各椎体间比较差异均有统计学意义（Plt;0.01）。临床应用显示，术前、术后相应椎体Cobb角比较，差异均有统计学意义（Plt;0.05）。 结论 棘突顶端上缘为确定椎弓根中心点的最佳参照点，微创脊柱内固定术体表定位椎弓根时应根据性别和具体骨折椎体确定进针点。【Abstract】 Objective To study the anatomic distances from the upper and lower edges of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch, to provide assistance for the percutaneous positioning of the pedicle of vertebral arch in minimally-invasive transpedicular internal fixation for the thoracic and lumbar vertebrae. Methods We studied 20 integral thoraco-lumbar vertebrae samples, and the distance between the vertical plane including the upper and lower points of the spinous process peak and the horizontal plane of the center of pedicle of vertebral arch was measured and marked as CO. We also measured the distances from the upper and lower points of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch and marked them as AC and BC respectively. The upper and lower points of the spinous process peak were designated as reference points to define the optimal body surface projective point of the pedicle of vertebral arch. Twenty male patients with single segmental fractured vertebral body and without nervous symptoms were selected. The age of the patients were ranged from 23 to 54 years old, averaging at 37.6. The fractured vertebral bodies included T11, T12, L1, and L2 with 5 cases for each of them. The percutaneous transpedicular internal fixation was carried out with the upper point of the spinous process peak as the reference point to define the body surface projective point of the pedicle of vertebral arch and the preoperative and postoperative Cobb angle of each fractured vertebral body were measured. Results There was no significant differences in CO, AC and BC on both sides between male and female (Pgt;0.05). Statistical difference existed between male and female in CO and BO of the same vertebra, and AC of T11 and T12 (Plt;0.05), while AC of L1 and L2 had no significant difference (Pgt;0.05). In both males and females, CO of the vertebrae from T11 to L2 increased, while AC and BC decreased, and there was a significant difference among different vertebrae (Plt;0.01). Clinical application showed there was a significant difference between the Cobb angle before operation and that after operation (Plt;0.05). Conclusion The upper point of the spinous process peak is the best reference point to define the center of pedicle of vertebral arch. Deciding on the needle insertion spot should be based on gender and specific vertebral body, when minimally-invasive transpedicular internal fixation is performed to define the body surface projective point of the pedicle of vertebral arch.
ObjectiveTo review the research status in respect of interspinous distraction devices (IDD) in the treatment of degenerative lumbar spinal stenosis (DLSS). MethodsRecent original articles related to IDD in the treatment of DLSS were retrieved extensively, and the effectiveness was analyzed and summarized. ResultsIts short-term effectiveness was superior to that of conservative treatment, no significant difference was found when compared with decompression or fusion alone. Its complication rate was higher than that of decompression or fusion alone, although complication dose not significantly affect treatment results, it still will increase the medical care cost of patients. ConclusionIDD is appropriate for patients who have failed to nonoperative treatment measures and can not tolerate open surgery, but the long-term effectiveness and durability of IDD need further research.
Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L4, 5 in 30 cases and L5, S1 in 22 cases. In 30 patients at L4, 5 level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L5, S1 level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L4, 5 level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L5, S1 level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L4, 5 level and 12-20 months (mean, 17 months) in patients at L5, S1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients (P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients (P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one (P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one (P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
ObjectiveTo investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal.MethodsThe clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score.ResultsThe operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value (t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value (t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%.ConclusionModified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.