ObjectiveTo compare the effectiveness of treatment of isthmic spondylolisthesis between two different fusion surgeries combined with pedicle screw fixation system. MethodsA retrospectively analysis was made on the clinical data of 98 patients with lumbar isthmic spondylolisthesis treated between February 2009 and May 2012. Of 98 cases, 53 underwent posterior lumbar interbody fusion (PLIF) combined with internal fixation (group A), and 45 underwent posterolateral fusion (PLF) with internal fixation (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and degree of spondylolisthesis between 2 groups (P>0.05). The operation time, intraoperative blood loss, reduction rate of spondylolisthesis, reduction loss rate, fusion rate, intervertebral space height, Japanese Orthopedic Association (JOA) score, and the recovery rate of JOA score were compared between 2 groups. ResultsThe operation time and intraoperative blood loss of group A were significantly higher than those of group B (P<0.05). Dural tear occured in 4 cases of group A and 1 case of group B during operation; 6 cases had radicular symptoms after operation in group A; incision infection was found in 1 case of 2 groups respectively. The follow-up time was 24-36 months in group A and was 26-40 months in group B. No significant difference was found in the JOA score at preoperation and 2 weeks after operation between 2 groups (P>0.05). The JOA score and the recovery rate of JOA score of group A were significantly better than those of group B at 2 years after operation (P<0.05). X-ray film showed that the reduction rate of group A was significantly higher than that of group B after 2 weeks of operation (P<0.05); the reduction loss rate of group A was significantly lower than that of group B after 2 years after operation (P<0.05). The intervertebral space height of group A was significantly higher than that of group B at 2 weeks and 2 years after operation (P<0.05). The fusion rate of group A was significantly better than that of group B at 2 years after operation (P<0.05). ConclusionPLIF can achieve a greater degree of reduction, better restore disc height, and lumbar curvature than PLF. PLIF is superior to PLF in maintaining intervertebral height after operation. And PLIF has higher fusion rate, restores the stability of the spine in a greater extent, and it also can achieve a better long-term outcome.
ObjectiveTo compare the fixation strength of optimum placed pedicle screw (OS) with re-directionally correctly placed pedicle screw (RS) following a violation of lateral pedicle. MethodsThirty fresh lumbar vertebrae (L1-5) were obtained from 6 pigs weighing 95-105 kg, male or female. Each vertebra was instrumented with a monoaxial pedicle screw into each pedicle using two different techniques. On one side, a perfect screw path was created using direct visualization and fluoroscopy. A pedicle screw of 5 mm in diameter and 35 mm in length was placed with a digital torque driver (OS). On the other side, a lateral pedicle wall violation was created at the pedicle-vertebral body junction with a guide wire, a cannulated tap, and a pedicle probe. This path was then redirected into a correct position, developed, and instrumented with a 5-mm-diameter by 35-mm-long pedicle screw (RS). For each pedicle screw, the maximal torque, seating torque, screw loosening force, and post-loosening axial pullout were measured. Screw loosening and axial pullout were assessed using an MTS machine. ResultsMaximal insertion torque was (111.4±8.2) N·cm and (78.9±6.4) N·cm for OS and RS respectively, showing significant difference (Z=3.038, P=0.002). The seating torque was (86.3±7.7) N·cm and (59.7±5.3) N·cm for OS and RS respectively, showing significant difference (Z=2.802, P=0.005). The screw loosening force was (76.3±6.2) N and (53.0±5.8) N for OS and RS respectively, showing significant difference (Z=2.861, P=0.004). The post-loosening axial pullout force was (343.0±12.6) N and (287.0±10.5) N for OS and RS respectively, showing significant difference (Z=2.964, P=0.003). ConclusionCompared with OS, RS placement after a lateral wall violation shows significantly decreased maximal insertion torque, seating torque, screw loosening force, and post-loosening axial pullout. On this occasion, RS augmentation is a probable option for remediation.
Objective To review and summarize the surgical techniques and their outcomes for the treatment of lumbar spondylolysis in young patients by direct surgical repair. Methods Both home and abroad literature on the surgical techniques and their outcomes respectively for the treatment of lumbar spondylolysis in young patients by direct surgical repair was reviewed extensively and summarized. Results Direct surgical repair of lumbar spondylolysis can offer a simple reduction and fixation for the injured vertebra, which is also in accord with normal anatomy and physiology. In this way, normal anatomy of vertebra can be sustained. As reported surgical techniques of direct repair, such as single lag screw, hook screw, cerclage wire, pedicle screw cable, pedicle screw rod, and pedicle screw hook system, they all can provide acceptable results for lumbar spondylolysis in young patients. Furthermore, to comply strictly with the inclusion criteria of surgical management and select the appropriate internal fixation can also contribute to a good effectiveness. Within the various methods of internal fixation, pedicle screw hook system has been widely recognized. Conclusion Pedicle screw hook system fixation is simple and safe clinically. With the gradual improvement of this method and the development of minimally invasive technologies, it will have broad application prospects.
Objective To review the present clinical research situation of adjacent segment degeneration (ASD) after lumbar spinal fusion. Methods The recent literature concerning ASD in the concept, the incidence, the risk factors, and prevention was reviewed. Results The concept of ASD includes radiographic ASD and clinical ASD. The incidences of radiographic ASD and clinical ASD were 8%-100% and 5.2%-18.5%, respectively. The risk factors for ASD include both patient and surgical factors. Patient factors include age, gender, preoperative condition, and so on. Surgical factors include the length of the fusion, mode of fusion, internal fixator, sagittal balance, excessive distraction of disc space, and so on. It can prevent ASD to reduce the length of the fusion, to keep sagittal balance, and to use the non-fusion technology. Conclusion Many researches have proved that the incidence of ASD is increased after lumbar spinal fusion, and it can be reduced by the non-fusion technology. Non-fusion technology has obtained good short-term results. But the long-term results should be further observed because there are some complications.
Objective To compare the short-term effectiveness between dynamic neutralization system (Dynesys) and posterior lumbar interbody fusion (PLIF) in the treatment of lumbar degenerative disease. Methods The clinical data were retrospectively analyzed, from 14 patients undergoing Dynesys and 18 patients undergoing PLIF to treat lumbar degenerative disease between February 2009 and March 2011. No significant difference in gender, age, duration of disease, and lesion segments was found between 2 groups (P gt; 0.05). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and radiographic results were compared between 2 groups at preoperation and last follow-up. Results Thirty-one cases were followed up 12-21 months (mean, 17 months). No internal fixation loosening, broken screws, and broken rods was found during follow-up. The mean interbody fusion time was 15 months (range, 13-19 months) in PLIF group. The VAS score and ODI were significantly improved in 2 groups at last follow-up when compared with the preoperative ones (P lt; 0.05); but there was no signficant difference between 2 groups (P gt; 0.05). Imaging assessment: the range of motion (ROM) of operated segment in PLIF group was (0.1 ± 0.4)° at last follow-up, showing significant difference when compared with preoperative ROM (7.8 ± 0.6)° (t=28.500, P=0.004); the ROM in Dynesys group (5.0 ± 1.5)° decreased, but showing no significant difference when compared with preoperative ROM (7.5 ± 0.8)° (t=0.480, P=0.113); and significant difference was found between 2 groups (t=5.260, P=0.008) at last follow-up. The ROM of adjacent segment in Dynesys group at last follow-up (7.2 ± 0.7)° decreased when compared with preoperative ROM (7.3 ± 1.8)°, but showing no significant difference (t=0.510, P=0.108); however, ROM of adjacent segment in PLIF group (8.7 ± 0.4)° increased significantly when compared with preoperative ROM (7.0 ± 1.6)°, showing signifcant difference (t=3.440, P=0.042); and there was significant difference between 2 groups (t= — 2.100, P=0.047) at last follow-up. Conclusion Dynesys and PLIF have equivalent short-term effectivness in the treatment of lumbar degenerative disease. However, the Dynesys could retain ROM of operated segment without increased ROM of the adjacent segment, which will promote the disc recovery of operated segment and prevent degeneration of adjacent segment.
Objective To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor. Methods Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. Results The operation time of group A was significantly longer than that of group B (P lt; 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P lt; 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (χ2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (χ2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= — 0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P gt; 0.05). Conclusion MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.
Objective To analyze the effectiveness of combined treatment of lumbar spondylolisthesis with MED, Quadrant, and Sextant-R systems. Methods Between August 2006 and June 2011, 35 patients with lumbar spondylolisthesis were treated, including 11 cases of isthmic spondylolisthesis and 24 cases of degenerative spondylolisthesis. There were 25 males and 10 females, with a mean age of 55 years (range, 33-71 years). The mean disease duration was 37 months (range, 8-75 months). Spondylolisthesis occurred at L4, 5 level in 21 patients and at L5, S1 level in 14 patients. According to Meyerding classification, 35 cases were rated as dergee I. The minimally invasive surgeries were performed by paraspinal muscle approach; Quadrant system was used for decompression and fusion at severe side, MED system for windowing of lamina at mild side, and Sextant-R system for fixation and reduction. Visual analogue scale (VAS) score was used to evaluate pain, Oswestry disability index (ODI) to evaluate clinical outcomes, spondylolishesis ratio and intervertebral height to evaluate spondylolisthesis reduction. Results Lumbar continuous thin layer CT at postoperation showed that no pedicle screw invaded spinal canal and intervertebral fusion device was at good position. Incisions healed by first intention. All patients were followed up 18-38 months (mean, 26 months). All patients got bone fusion and had no internal fixation failure by radiologic examination at 1 year after operation. Low back pain was relieved, lumbar function improved obviously, and satisfactory reduction of spondylolisthesis was obtained. At 2 weeks and 1 year after operation, the VAS score, ODI score, spondylolisthesis ratio, and intervertebral height were significantly improved when compared with preoperative ones (P lt; 0.05). VAS score and ODI score showed significant differences (P lt; 0.05) between at 2 weeks and 1 year after operation. Spondylolisthesis ratio and intervertebral height showed no significant difference (P gt; 0.05) between at 2 weeks and at 1 year after operation. Conclusion Minimally invasive surgical management for lumbar spondylolisthesis via MED, Quadrant, and Sextant-R systems is a safe and effective surgical technique. However, its indications should be well considered.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.
Objective To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Methods Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
Objective To investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (TLIF) assisted with microscope for lumbar degenerative disease. Methods Retrospective analysis was made on the clinical data of 82 patients with lumbar degenerative disease (minimally invasive group) undergoing minimally invasive TLIF assisted with microscope between January 2010 and June 2011, which was compared with those of 76 patients (traditional group) undergoing traditional open TLIF. There was no significant difference in age, gender, disease duration, disease type, lesion level, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P gt; 0.05). The perioperative related parameters, radiography index, and effectiveness were documented and compared. Results There was no significant difference in operation time and intraoperative radiological exposure time between 2 groups (P gt; 0.05), but intraoperative blood loss and postoperative drainage volume in the minimally invasive group were significantly less than those in the traditional group (P lt; 0.05). Dural tear occurred in 2 patients of the traditional group. Superficial infection of incision occurred in 1 case in each group, respectively; and primary healing of incision was obtained in the other patients. All patients were followed up 12-28 months (mean, 18 months). No failure of internal fixation occurred. Radiological analysis showed that the bone graft fusion rate was 96.1% (73/76) in the traditional group and 95.1% (78/82) in the minimally invasive group at last follow-up, showing no significant difference (χ2= 0.012 2, P= 0.912 0). The postoperative ODI and VAS score were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); the ODI of the minimally invasive group were significantly better than those of the traditional group at 3 months (t= — 11.941 1, P=0.000 0), and the VAS score of the minimally invasive group was significantly lower than that of the traditional group at 1 day and 3 months (P lt; 0.05); but no significant difference was found in ODI and VAS score between 2 groups at 1 year and last follow-up (P gt; 0.05). Conclusion Minimally invasive TLIF is an effective method to treat lumbar degenerative disease. This procedure is safe and reliable because it has less injury, less blood loss, and milder pain than the traditional open TLIF, and the short-term effectiveness is comparable in 2 procedures.