ObjectiveTo investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion (AL).MethodsBetween October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were 8 males and 2 females with an average age of 48.8 years (range, 31-79 years). The disease duration was 1.5-48.0 months (mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T10, 11, 4 cases of T11, 12, and 3 cases of T12, L1. The preoperative visual analogue scale (VAS) score was 8.0±0.8, the Oswestry disability index (ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was (26.3±7.1)°. According to American Spinal Injury Association (ASIA) scoring system, neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E.ResultsAll the operations of 10 patients completed successfully. The operation time was 120-185 minutes (mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL (mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months (mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones (t=17.530, P=0.000; t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were (12.6±4.6)° at 3 days and (13.6±4.6)° at 24 months after operation, which were significantly different from those before operation (P<0.05); there was no significant difference between 3 days and 24 months after operation (P>0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod.ConclusionDebridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion, and a certain correction of local kyphosis.
ObjectiveTo compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms.MethodsThe clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A (28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B (30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score between the two groups (P>0.05). The screw placement time, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo’s criteria.ResultsThe screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B (P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups (P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75% (150/160) and 84.71% (144/170), respectively, and the difference was significant (χ2=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups (χ2=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved (P<0.05); there was no significant difference between the two groups at all time points after operation (P>0.05).ConclusionThe spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms. However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.
ObjectiveTo investigate the effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery.MethodsA clinical data of 510 patients with multi-segmental lumbar degenerative diseases who were treated with surgery between January 2017 and January 2018 was retrospectively analyzed. In study group, the incisions of 230 cases were washed with hydrogen peroxide before suture. In control group, the incisions of 280 cases were washed with normal saline before suture. There was no significant difference in gender, age, lesion type, disease duration, operative segment, and other clinical data between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and postoperative incidence of infection were recorded and compared between the two groups. The Centers for Disease Control and Prevention (CDC) standard was used to evaluate infection, which was divided into superficial infection and deep infection.ResultsAll operations completed successfully. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative drainage volume in the study group was significantly less than that in the control group (t=−2.990, P=0.005). A total of 13 patients developed infection after operation, including 10 cases of superficial infection (2 cases in the study group and 8 cases in the control group) with the infection time of (7.3±1.5) days, and 3 cases of deep infection (all in the control group) with the infection time of (16.6±3.1) days. The incidences of superficial and deep infections in the study group were lower than those in the control group, but there was no significant difference between the two groups (χ2=2.595, P=0.123; P=0.256). All the superficial infections were Staphylococcus aureus infection and recovered after active dressing change. Among the patients with deep infections, 2 cases were infected by Staphylococcus aureus and 1 case was infected by Escherichia coli; and the incisions healed after being washed and sutured thoroughly, and active dressing change.ConclusionThe incidence of postoperative infection and postoperative drainage volume can be reduced by washing the incision with hydrogen peroxide in multi-segmental lumbar surgery.