ObjectiveTo systematically review the effectiveness and safety of dynamic neutralization system (Dynesys) versus posterior lumbar interbody fusion (PLIF) for lumbar degenerative disease. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, CBM, VIP and WanFang Data were searched to collect studies about Dynesys versus PLIF for lumbar degenerative disease from inception to May 31st 2016. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 22 studies involving 1 482 patients were included. The results of meta-analysis showed that, compared with PLIF, Dynesys could reduce operative time (MD=-29.62, 95%CI -36.67 to -22.57), operative blood loss (MD=-112.10, 95%CI -130.60 to -93.61), length of hospital stay (MD=-2.62, 95%CI -4.96 to -0.28), postoperative adjacent segment ROM (MD=-1.29, 95%CI -1.72 to -0.86) and maintain postoperative operated segment ROM (MD=3.53, 95%CI 1.99 to 5.08). There were no significant differences between two groups in postoperative ODI (MD=-1.51, 95%CI -3.58 to 0.55), postoperative back VAS (MD=-0.15, 95%CI -0.38 to 0.08), postoperative leg VAS (MD=-0.09, 95%CI -0.22 to 0.04) and postoperative complications (OR=0.69, 95%CI 0.45 to 1.06). ConclusionThe current evidence shows that compared with PLIF, Dynesys for lumbar degenerative disease has shorter operative time, less operative blood loss, shorter hospitalization days, and Dynesys can also maintain operated segment ROM and delay the degeneration of adjacent segment. Due to the limited quality of the included studies, more studies are needed to verify the above conclusion.
ObjectiveTo explore the effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation for thoracolumbar tuberculosis. MethodsBetween January 2009 and January 2013, 97 patients with thoracolumbar tuberculosis were treated with posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in 53 cases (group A), and with traditional posterior operation in 44 cases (group B). There was no significant difference in age, sex, disease duration, affected segments, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), sagittal Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P>0.05). The surgery and follow-up results were compared between 2 groups. ResultsThe patients were followed up 24-60 months. All patients achieved intervertebral bone fusion after operation. The bone graft fusion time of groups A and B was (6.79±1.68) months and (6.89±2.00) months respectively, showing no significant difference (t=-0.251, P=0.802). There was no significant difference in operation time, intraoperation blood loss, and postoperative hospitalization time between 2 groups (P>0.05); the postoperative drainage volume of group A was significantly less than that of group B (P<0.05). The CRP and ESR at 1 year and the VAS score at last follow-up were significantly decreased when compared with preoperative values in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). The Cobb angle at 1 week and at last follow-up and ODI at 3 months and at last followup were significantly improved in 2 groups (P<0.05), but there was no significant difference between the time points after operation (P>0.05). At 3 months after operation, the ODI of group A was significantly lower than that of group B (t=-2.185, P=0.027), but no significant difference was found in Cobb angle, Cobb angle loss, and ODI at other time points between 2 groups (P>0.05). At last follow-up, the Frankel classification of nerve function was improved 1-2 grades in 2 groups, showing no significant difference between 2 groups (Z=-0.180, P=0.857). No complication of internal fixation breakage or loosening was observed. ConclusionThe effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in the treatment of thoracolumbar tuberculosis is satisfactory, with the advantages of less trauma, strong spinal stability, and fast function recovery.
ObjectiveTo assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. MethodsWe collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. ResultsIn these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. ConclusionWith regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.
ObjectiveTo explore the effectiveness of posterior lumbar interbody fusion in the treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. MethodsBetween February 2008 and December 2013, 17 patients with double-segmental bilateral isthmic lumbar spondylolisthesis were treated with posterior lumbar interbody fusion. There were 12 males and 5 females, with an age ranged 48-69 years (mean, 55.4 years). The disease duration ranged from 11 months to 17 years (median, 22 months). According to the Meyerding classification, 30 vertebrea were rated as degree I, 3 as degree Ⅱ, and 1 as degree Ⅲ. L4, 5 was involved in 14 cases and L3, 4 in 3 cases. The preoperative visual analogue scale (VAS) score was 8.6±3.2. ResultsCerebrospinal fluid leakage occurred in 2 cases because of intraoperative dural tear; primary healing of incision was obtained, with no operation related complication in the other patients. The patients were followed up 1-6 years (mean, 3.4 years). At last follow-up, VAS score was decreased significantly to 1.1±0.4, showing significant difference when compared with preoperative score (t=7.652, P=0.008). X-ray films showed that slippage vertebral body obtained different degree of reduction, with a complete reduction rate of 85% (29/34) at 1 week after operation. All patients achieved bony union at 6-12 months (mean, 7.4 months). According to the Lenke classification, 13 cases were rated as grade A and 4 cases as grade B. No internal fixation loosening and fracture were observed during the follow-up. Intervertebral disc height was maintained, no loss of spondylolisthesis reduction was found. ConclusionIt can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, and screw fixation for posterior fusion in treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. The key points to successful operation include accurate insertion of screw, effective decompression, distraction before reduction, rational use of pulling screws, and interbody fusion.