ObjectiveTo explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. MethodsTwenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. ResultsBoth groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. ConclusionThe new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
OBJECTIVE: To investigate the operative indications and techniques of the universal spine system (USS) in reconstruction of the stability of the lumbar-sacrum joint after resection of sacrum tumor. METHODS: Nine patients were treated with USS after resection of sacrum tumor. Among them, there were 6 males and 3 females, aged from 34-60 years. The operation could be divided into four main procedures: 1. to resect sacrum tumor; 2. to insert the pedicle screw into the normal pedicle (L3 or L4 or L5) above the region of laminectomy; 3. to insert the lower screw into the iliac plate; 4. to put the rods, bone graft and links. RESULTS: There was no recurrence of sacrum tumor by MRI examination during 7-17 month follow-up. The pains of the lumbar-sacrum joint and the spinal nerve root were relieved obviously. The patients could stand and walked normally. There was no loose screw and no fracture of the screw and the rod. There was no appearance of the enlarged screw passage, the lessened pelvis and lowed L5 spine. CONCLUSION: Reconstruction of the lumbar-sacrum joint by the USS after resection of sacrum tumor is a practical operation clinically. It is characterized by the easy manipulation, few complication and stable fixation.
Objective To investigate the effect of removing the implanted plate-rod system for scol iosis (PRSS) on maintaining scol iosis curve correction and preserving spinal mobil ity in patients with scol iosis. Methods From June 1998 to February 2002, 119 cases of scol iosis were treated with the implant of PRSS, which was removed 26-68 months later (average46.8 months). Complete follow-up data were obtained in 21 patients, including 6 males and 15 females aged 11-17 years old (average 13.8 years old). The disease course was 9-16 years (average 12.1 years). There were 2 cases of congenital scol iosis and 19 cases of idiopathic scol iosis, which included 5 cases of IA, 2 of IB, 1 of IIA, 2 of IIB, 2 of IIC, 2 of IIIA, 3 of IIIB, and 2 of IVA according to Lenke classification. There were 13 cases of thoracic scol iosis and 8 of thoracolumbar scol iosis. AP view and the lateral and anterior bending view of X-ray films before and at 3 to 6 months after removing PRSS were comparatively analyzed, the coronal and the sagittal Cobb angle were measured, and the height of vertebral body on the concave side and the convex side were measured, so as to know the effect of PRSS on the growth of the vertebral endplates. Results All the implants were removed successfully with an average operation time of 2.5 hours (range 2-4 hours) and a small amount of intraoperative blood loss. Twenty-one cases were followed up for 6-72 months (average 34.4 months). The coronal Cobb angle before and after the removal of PRSS was (20.25 ± 8.25)° and (23.63 ± 8.41)°, respectively, indicating there was no significant difference (P gt; 0.05); while the sagittal Cobb angle was (39.44 ± 12.38)° and (49.94 ± 10.42)°, respectively, indicating there was a significant difference (P lt; 0.05). The height of the top vertebral body on the concave side before and after the removal of PRSS was (1.78 ± 0.40) cm and (2.08 ± 0.35) cm, respectively, and there was a significant difference (P lt; 0.01); while the height on the convex side was (2.16 ± 0.47) cm and (2.18 ± 0.35) cm, respectively, indicating no significant difference was evident (P gt; 0.05). All the 21 patients had good prognosis and no major operative compl ication occurred. Conclusion PRSS is an effective instrumentation for the management of scol iosis. After the removal of the PRSS, the correction of scol iosis can be maintained, and the spinal mobil ity can be protected and restored.
ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.
Objective To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. Methods Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord.Results Theposterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. Theclinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoracolumbar spinalfractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certaintypes of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field.Conclusion With the rapid development of spine surgery, the repair and reconstruction ofthe injured spine and spinal cord made a great stride in the recent years.
Objective To investigate the operative methods, cl inical outcomes and compl ications of total hi p arthroplasty (THA) in the treatment of patient with hi p joint flexion rigidity due to ankylosing spondyl itis (AS). Methods From May 1992 to July 2004, 56 patients (32 left hips and 39 right hips) with AS received THA through a modified anterolateral approach, including 52 males (67 hips) and 4 females (4 hips) aged 17-48 years with an average of 35.5 years. All the hips were ankylosed in (43.1 ± 7.2)° of flexion and 15 patients had bilaterally ankylosed hips. Preoperatively, Harris hip score was (42.6 ± 5.3) points and all the hips were classified as stage IV according to the standard of American College of Rheumatology (ACR). And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years (average 5.3 years). Postoperatively, 1 patient (1 hip) got subcutaneous soft tissue infection at 8 days, 1 patient (1 hip) got wound disunion at 11 days, 2 patients (2 hips) got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips (5.6%) had loose acetabulum prosthesis, 3 hips (4.2%) had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis (7.0%), and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hips had no further treatment. Fifteen hips (21.1%) had heterotopic ossification, which was rel ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was (82.7 ± 4.1) points, indicating there was a significant difference between before and after operation (P lt; 0.05). Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.
OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.
Objective To compare the effectiveness of spinal robot-assisted pedicle screw placement through different surgical approaches and to guide the clinical selection of appropriate robot-assisted surgical approaches. MethodsThe clinical data of 14 patients with thoracolumbar vertebral diseases who met the selection criteria between January 2023 and August 2023 were retrospectively analyzed, and all of them underwent pedicle screw placement under assistant of the Mazor X spinal surgery robot through different surgical approaches. The patients were divided into posterior median approach (PMA) group (n=6) and intermuscular approach (IMA) group (n=8) according to the surgical approaches, and there was no significant difference in age, gender, body mass index, disease type, and fixed segment between the two groups (P>0.05). The operation time, intraoperative blood loss, screw-related complications, and reoperation rate were recorded and compared between the two groups; the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw were measured based on X-ray films at immediate after operation. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). There was no screw-related complication such as nerve injury in both groups, and no patients underwent secondary surgery. At immediate after operation, the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw in the IMA group were significantly greater than those in the PMA group (P<0.05). ConclusionThere are differences in the position and inclination angle of screws placed with robot-assisted surgery through different surgical approaches, which may be due to the obstruction of the screw path by soft tissues such as skin and muscles. When using spinal robot-assisted surgery, selecting the appropriate surgical approach for different diseases can make the treatment more reasonable and effective.