Objective To evaluate the short-term effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) intervertebral cage for lumbar interbody fusion in the patients with lower lumbar degenerative diseases. Methods Between January and October 2011, 20 patients with lower lumbar degenerative diseases underwent transforaminal lumbar interbody fusion with n-HA/PA66 intervertebral cage. There were 8 males and 12 females, aged 22-80 years (mean, 51 years). The disease duration was 1 to 24 months (mean, 4 months). L4, 5 fusion was performed in 8 cases, L5, S1 fusion in 9 cases, and L4-S1 fusion in 3 cases. Among 20 cases, 3 were diagnosed as having recurrent lumbar disc protrusion, 5 as having lumbar degenerative spondylolisthesis, 9 as having lumbar isthmic spondylolisthesis, and 3 as having lumbar spinal stenosis. The intervertebral height and lordosis were measured on X-ray film to assess the surgical correction and postoperative sustain while osseous fusion was observed on 3-dimensional CT. The Oswestry disability index (ODI) and short-form 36 health survey scale (SF-36) scores were obtained to assess the status of clinical recovery. Results All patients had incision healing by first intention. The pain and numb were relieved in varying degrees after operation. No cerebrospinal leakage, nerve root injury, or wound infection was occurred. All patients were followed up 6-9 months (mean, 7 months). No cage displacement or collapse was found. The intervertebral height and lordosis of single fusion segment were significantly improved at 3 days and 3, 6 months after operation when compared with those at preoperation (P lt; 0.01); there was no significant difference among each time point after operation (P gt; 0.05). The fusion rate was 74% at 3 months after operation and 96% at 6 months after operation, with an average of 4 months (range, 3-9 months) for interbody fusion. The ODI and SF-36 scores were significantly improved at 3 days and 6 months after operation when compared with the scores at preoperation (P lt; 0.01); there was no significant difference among each time point after operation (P gt; 0.05). Conclusion The interbody fusion with n-HA/PA intervertebral cage is effective and safe to treat the lower lumbar degenerative diseases. The n-HA/PA66 intervertebral cage is an ideal device of interbody fusion with high fusion rate, low subsidence rate, and high transmission X-ray, but the long-term effectiveness need further observation.
Objective To invest igate the ef fect iveness and signi f icance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc disease. Methods Between January 2007 and August 2008, 21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer. Among them, there were 13 males and 8 females with an average age of 52 years (range, 28-79 years). And the disease duration ranged from 3 months to 40 years (median, 9 months). The affected segments included T11, 12, T12-L1, L1, 2, and L2, 3 in 1 case respectively, L4, 5 in 4 cases, and L5, S1 in 13 cases. All patients had intractable low back pain or lower extremity radicular symptoms. The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases. Oswestry Disabil ity Index (ODI) and Macnab grading were used to determine the function recovery after operation. And Suk’s standard was used to determine the fusion effects by X-ray. Results All 21 patients were followed up 18 months to 3 years (mean, 23.8 months). Sciatica symptoms disappeared after operation in 19 cases, no significant improvement occurred in 2 cases of thoracic disease. The ODI scores were 79% ± 16% at preoperation, 30% ± 9% at 1 month, 26% ± 10% at 3 months, 21% ± 12% at 6 months, and 20% ± 10% at 18 months after operation, showing significant differences between pre- and postoperation (P lt; 0.05). According to Macnab grading at 6 months postoperatively, the results were excellent in 14 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 90.5%. According to Suk et al. standard, the results were excellent in 1 case, good in 19 cases, and poor in 1 case with an excellent and good rate of 95.2%. The muscle strength of the lower extremities had no improvement in 1 case of T11, 12 disc protrusion; pedicle screws fixation and decompression laminectomy were given after 6 months, but no improvement was achieved during follow-up. Protrusion recurred after 4 months in 1 case of L4, 5 disc protrusion, then was cured by laminectomy discectomy. The remaining patients achieved postoperative rel ief. Conclusion Endoscope combined with interbody fusion is a good combination to solve lumbar instabil ity. B-Twin expandable spinal spacer is a minimally invasive fusion choice of L4, 5 and L5, S1.
Objective To summarize the basic research and the cl inical appl ication of biodegradable interbody fusion Cage. Methods Recent l iterature concerning biodegradable interbody fusion Cage at home and abroad was extensively reviewed, and current developments of the basic research and the cl inical appl ication of biodegradable interbody fusion Cage were investigated. Results Basic research showes that the stiffness of biodegradable interbody fusion Cage is lower than that of metall ic Cage, so it can enhance interbody fusion. As interbody fusion proceeded, biodegradable interbody fusion Cage degrades constantly, but the speed of degradation can not keep in parallel with that of fusion. In addition, the tissue response to degradation products is controversy. Cl inical appl ication showes that the biodegradable interbody fusion Cage can enhance interbody fusion and maintain disc space height. The short term results are good, however, the long term results need further observation. Conclusion Biodegradable interbody fusion Cage can effectively enhance interbody fusion.
Objective To study the cl inical appl ication of anchoring cervical intervertebral fusion cage (ACIFC) in anterior cervical discectomy with fusion. Methods From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old (average 47.9 years old). The course of disease rangedfrom 3 days to15 years (median 2.3 years). There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instabil ity, 4 with single-segment cervical spondylosis and lower cervical spine instabil ity, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by “40 score” system. And the occurrence of postoperative axial symptom (AS) was assessed with the standard set by Zeng Yan et al. Results All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of compl ication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months (average 20.5 months), and fusion was reached in all the intervertebral discs. Evaluated by “40 score” system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points (P lt; 0.05). During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods (P lt; 0.05). No degeneration of adjacent segment was observed during the follow-up period. Conclusion Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenientand fast, has wide range of indications with satisfying cl inical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.
Objective To evaluate the therapeutic effects of expandable pedicle screw (EPS) combined with interbody fusion cage on lumbar spondylolisthesis. Methods From June 2004 to March 2008, 23 patients with lumbar spondylolisthesiswere treated, including 9 males and 14 females aged 24-72 years old (average 48.7 years old). The course of the disease varied from 6 months to 6 years (average 30.4 months). There were 18 cases of degenerative spondylol isthesis and 5 of isthmic spondylolisthesis, including 1 case at L3,4 level, 14 at L4,5 level, and 8 at L5 and S1 levels. There were 17 cases of grade I, 4 of grade II, and 2 of grade III (including 1 case of recurrent L5 spondylolysis) according to Meyerding classification system. Posterior lumbar interbody fusion was performed using 48 PLIVIOS interbody fusion cages, and spondylolisthesis reduction and internal fixation were conducted using 84 pieces of EPS. The indications for use of EPS were initial operation with bone mass reduction or osteoporosis, reoperation of previous pedicle instrumentation, intraoperative screw relocation, sacral anchoring, and construct reinforcement. Cl inical outcomes, radiographic reduction of spondylol isthesis and bone fusion of lumbar interbody were evaluated based on JOA score, Boxall index, and Cook criteria. Results The incision healed by first intension in all cases except for one revision case that suffered from postoperative cerebrospinal fluid leakage and obtained delayed-healing without infection 23 days after operation using conservative treatment. No operative compl ications such as nerve and organ injuries were found.All cases were followed up for 12-39 months (average 17.8 months). X-ray exams of spine AP, lateral, fully extended position and fully flexed position view showed all 84 EPS were fully expanded within vertebral body. The improvement rate of JOA at the final follow-up visit was markedly effective in 14 cases, and effective in 5 cases, and noneffective in 4 cases, with a total effective rate of 82.61%. Anatomic reduction was achieved in 14 cases, improvement was obtained in 6 cases, no improvement was observed in 3 cases, and the reduction rate was 86.69%. Lumber interbody fusion was achieved in 20 cases, fixation was achieved in 2 cases, failure was observed in 1 cases, and the fusion rate was 86.69%. Conclusion EPS in complex with interbody fusion cage provides effective reduction, internal fixation and interbody fusion for the reconstruction of lumbar spondylolisthesis.
Objective To evluate the clinical outcome of autograftsof ilium and interbody fusion cage or bone morphogenetic protein(BMP)／artificial bone material／ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004，114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation． There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114patients, 85 cases were classified as degree Ⅰ, 24 cases as degree Ⅱ and 5 cases as degree Ⅲ. The patients were divided into three groups accordingto the material used for interbody fusion: autografts of ilium (group A, n=42), interbody fusion cages(group B, n=36), and BMP／artificial bone material／ cage (group C, n=36)．The clinical and radiographic results of the patients were compared among three groups． Results All patients were followed from 13 to 30 months with an average of 15 months． There were no statistically significant differences in surgical time, blood loss, and disc space height of preoperation(P＞0.05) among three groups. No severe complication occurred in the three groups(P＞0.05). The excellent and good rates in groups A，B and C were 81.0％, 80.6％, and 83.3％ respectively, showing no statisticallysignificant difference(P＞0.05)．The fusion rate of group C(97.0%) was significantly higher than those of group A(81.0%) and group B(83.3%) (P＜0.05) after 1 year of operation．And the average loss of disc space height in groups B and C was significantly lower than that in group A(P＜0.05). Conclusion Higher fusion rate and lower loss of disc space height can beobtained in treating lumbar spondylolisthesis with BMP／artificial bone materiel.It is an effective method in the treatment of spondylolisthesis.
Objective To compare the clinical effects of treating prolapse of the cervical intervertebral disc by the Solis cage fusion, the titanium cage fusion or the autogenous iliac crest graft combined with the titanium plate fixation. Methods Sixty-four patients with prolapse of the cervical intervertebral discadmitted to hospital from February 2002 to May 2005 were retrospectively analyzed. In Group A, 20 patients (15 males and 5 females, aged 38.76 years, 30 intervertebral spaces) were treated with the Solis cage fusion, and the preoperative JOAscores were 9-16, averaged 11.4; in Group B, 21 patients (15 males and 6 females,aged 37-78 years, 23 intervertebral spaces) were treated with the titanium cagefusion, and the preoperative JOA scores were 8-13, averaged 10.1; in Group C, 23 patients (18 males and 5 females, aged 32-76 years, 28 intervertebral spaces)were treated with the autogenous iliac crest graft combined with the titanium plate fixation, and the preoperative JOA scores were 9-14, averaged 10.6. The comparative analysis was made among the 3 groups in the following aspects: X-ray exposure time, time working on the iliac bone, operation time, hemorrhage amount，complication incidence after operation, cervical vertebral fusion rate, symptom relief rate, and recovery rate of the JOA score. Results According to the follow-upfor 2-15 months averaged 12 months, the time working on the iliac bone was longer in Group C than in Groups A and B (11.5±2.4 vs 4.1±1.7 minand 4.2±1.9 min, P＜0.05); the operation time was longer in Group C than in Groups A and B (98.3±14.7 min vs 55.5±10.3 min and 56.8±12.6 min, P＜0.05); and the X-ray exposure time was longer in Group C than in Groups A and B (7.8±1.8 min vs 4.3±1.2 min and 4.2±1.3 min, P＜0.05). Also, the hemorrhage amount in Group C was much greater than in Groups A and B (145.8±19.3 ml vs 65.8±10.2 ml and 67.2±12.3 ml,P＜0.05). The postoperative complication rate was lower in Groups A and Bthan in Group C (P＜0.05). There was a significant difference in the complication rate in the cervical region between Group A (5.0%±1.8%) and Group B (14.3%±2.6%,Plt;0.05）. The fusion rate in Groups A and B was 100% 3-4 monthsafteroperation, and there was no difference when compared with that in Group C. The recovery rates of the JOA scores in the three groups were 81.9%±3.2%，78.9%±7.3%, and 76.3%±9.4%, respectively, and there was no significant difference among the three groups. Conclusion The Solis cage fusion has a better therapeutic effect in treating prolapse of the cervical intervertebral disc than the titanium cage fusion and the autogenous iliac crest graft combined with the titanium plate fixation. The Solis cage fusion also makes the operation easier, with a more rapid recovery rate and fewer postoperative complications in the patient.
Objective To compare the clinical outcomes of posterior lumbar interbody fusion（PLIF） using simple cage alone fusion with pedicle screw fixationand autogenous bone grafting and cage fusion with pedicle screw fixation in adult spondylolisthesis. Methods From March 2003 to March 2004，Twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedicle screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defectswere located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers.Thepreoperative mean disc space height was 5.4±2.3 mm, the mean percentage of slip was 36.8％±7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedicle screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 cases, atL5 in 4 cases. Five patients were smokers. The preoperative mean disc space height was 5.7±2.5 mm, the mean percentage of slip was 37.8%±6.2%. Two groupswere compared in the amount of blood loss, duration of hospitalization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate. Results All patientswere followed up for 24-38 months. The mean follow-up was 29(24-36) months in group A and26(24-38) months in group B. There were no statistically significant differences infollow-up period, age,sex, the location of isthmic defects, smoking, the preoperative disc space height and the percentage of slip between two groups (Pgt;0.05).There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups(Pgt;0.05). But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups(Plt;0.05).Thepo stoperative disc space height and the degree of slip of the last follow-up were5.8±2.2 mm and 25.6％±7.2% in group A, 6.2±2.5 mm and 24.1％±7.4 % ingroupB, showing statistically significant difference (Plt;0.05). Conclusion The PLIF using autogenous bone grafting and cage fusion with pedicle screw fixations ismore beneficial to improving the fusion rate and preventing longterm instabilities than simple cage alone fusion with pedicle screw fixation in adult spondylolisthesis.
BJECTIVE: To discuss the clinical effect and the application of AF device fixation system and PROSPACE interbody fusion cage on treating lumbar spondylolisthesis. METHODS: Twenty-one cases of lumbar spondylolisthesis treated by operation from 1999 to 2002 were analyzed retrospectively (13 males and 8 females, 25-66 years old averaging 42 years). We had thorough decompression on the part of nerve compression and had replacement and fixation of the slippage vertebral body with the AF transpedicular screw/rod system so that the normal spine physiological curvature could be recovered, and then performed the posterolateral interbody fusion with implanting the PROSPACE filled with autograft bones. RESULTS: All the patients were followed up for 3 months to 3 years with an average of 15 months. The preoperation symptoms improved in 20 cases (95.2%). CONCLUSION: The combination of AF device fixation system and PROSPACE interbody fusion cage can relieve effectively nerve compression, recover the normal spinal physiological curvature, maintain the height of interbody and promote the nerve fusion. It is reliable and effective in the treatment of spondylolisthesis.
【摘要】 目的 探讨纳米羟基磷灰石/聚酰胺66（nano-hydroxyapatite polyamide66，n-HA/PA66）颈椎融合器在颈椎间盘突出症前路手术重建中的临床疗效。 方法 2008年12月-2010年6月，对14例颈椎间盘突出症患者行前路椎间盘切除、椎管减压，以n-HA/PA66椎间融合器支撑植骨、钢板螺钉内固定治疗。随访时间3～12个月，平均6.3个月；随访时以日本矫形外科学会（Japan Orthopaedic Assoctiation， JOA）评分改善率评价患者神经功能恢复情况，复查X线片评估椎间融合器植骨融合情况，包括椎间高度及椎间融合器下沉情况。 结果 14例患者均成功完成颈椎前路减压手术以及椎间融合器的安放固定。所有患者术前症状均得到不同程度的改善，术后3、6、12个月的JOA改善率分别为87.0%、94.0%、97.0%。影像学检查显示所有患者植骨融合，椎间高度及椎间融合器的位置维持良好，无下沉、移位。 结论 n-HA/PA66颈椎间融合器具有早期支撑稳定功能，可有效维持颈椎椎间高度；术后植骨融合率高且便于X线片观察，是颈椎间盘突出症患者前路手术植骨的理想支撑材料，但长期效果需进一步随访观察。【Abstract】 Objective To evaluate the clinical effect of artificial cervical vertebra fusion apparatus of n-HA/PA66 in anterior reconstruction of cervical intervertebral disc herniation. Methods From December 2008 to June 2010, 14 patients with cervical intervertebral disc herniation underwent anterior cervical discectomy,spinal canal decompression,spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. The patients were followed up for 3 to 12 months with an average of 6.3 months. Neurological function was evaluated by improvement rate of JOA score and situations of the supporting body was observed by X-ray in 3,6,and 12 months after the surgery.The intervertebral height,the 1ocations, and the fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients had undergone the operation successfully.The preoperative symptoms improved to varying degrees.JOA improvement rate were 87.0%, 94.0%, and 97.0% 3,6,and 12 months after the operation,respectively.Imaging studies showed that in all cases graft fusion were achieved,and cervical alignments,intervertebral height,cervical spine stability and the locations of the artificial vertebral body were well maintained.No displacement and subsidence of the artificial vertebral body occurred. Conclusion n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and cervical intervertebral height.It has a high rate of graft fusion and is convenient to observe by X-ray.Therefore,n-HA/PA66 can be taken as an ideal graft for anterior degenerative cervical spine operation,but further follow-up study is still needed to evaluate the long-term effects.