Objective To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group (SDSG) classification system for lumbosacral spondylolisthesis. Methods Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Results Pelvic incidence (PI) is the key pathogenic factor of lumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti-Bartolozzi, and Mac-Thiong-Labelle classification systems of lumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. Conclusion It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.
OBJECTIVE: To provide a better treatment method of lumbar stenosis and root pain resulting from simple hypertrophy of ligamentum flavum. METHODS: By studying the records of 143 lumbar pain cases, we found 5 cases caused by simple hypertrophy of ligamentum flavum. All the patients were old man with a long progressed history. There was little difference of clinical features between the disc herniation and hypertrophy of ligamentum flavum. All cases accepted resection of ligamentum flavum. RESULTS: All the symptoms were relieved postoperatively. The patients could walk. CONCLUSION: The degeneration of lumbar ligamentum flavum can cause lumbar stenosis and root pain. Resection of ligamentum flavum can relieve the symptom.
OBJECTIVE To investigate the effect of acid fibroblast growth factor (aFGF) on guided bone regeneration (GBR), to study whether aFGF can promote the repairing ability of GBR in bone defect. METHODS 10 mm long segmental defects were created in the diaphyses of both radii in 16 New Zealand rabbits. The defect was bridged with a silicon tube. Human recombinant aFGF was instilled into the tube on the experimental side, while the contralateral tube was instilled with saline as control group. The radiographic, gross and histologic examination of the samples were analyzed at 2, 4, 6 and 8 weeks after operation. RESULTS On the experimental side, there was new bone formation in the bone medullary cavity, the endosteum and the section surface of the cortex at 2 weeks. At 4 weeks, at the center of the blood clot in the tube there was new bone formation and bone defect was completely healed at 8 weeks. On the control side, new bone formation was less in every period compared with that of the experimental side. At 8 weeks, there was only partial healing of the bone defect. CONCLUSION It can be concluded that aFGF can promote new bone formation and facilitate GBR in bone defect.
Objective To explore an improved surgical approach to the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion to treat lumbar burst fracture and to evaluate its preliminary clinical application. Methods From June to October 2006, 4 patients (2 males, 2 females; age, 17-39 years) with Denis B type lumbar burst fracture underwent the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion. The fracture occurred in 2 patients at L1 and 2 at L2. According to the Frankel scales assessment, before operation, 2patients were at Grade B and the other 2 at Grade C, and the visual analogue scale (VAS) was 7.00±0.82. Radiological evaluation was performed, which revealed the kyphosis Cobb angel of 22.94±11.21°, the adjacent superior and the inferiorintervertebal disc heights of 12.78±1.52 mm and 11.68±1.04 mm, espectively, and the vertebral canal sagittal diameter of 9.56±2.27 mm on the computer tomography (CT) scan. The neurological and the radiological evaluations were also made immediately and 3 months after operation. Results The anterior single segmental decompression and fusion operations were performed successfully in all the patients. The average operating time was 166±29 min and the average amount of blood loss was 395± 54 ml. The Frankel scales assessment showed that at the time immediately after operation, one of the 2 Grade B patients had an improvement to Grade C, but the other patient had no improvement. One of the 2 Grade C patientshad an improvement to Grade D, but the other patient had no improvement. Three months after operation, the 2 Grade B patients had an improvement to Grade C. The 2 grade C patients had an improvement to Grade D or E. The VAS score was significantly decreased to 3.50±1.29 after operation and to 1.25±0.50 3 months later （P＜0.05）. The vertebral canal sagittal diameter was significantly increased to 19.76±3.82 mm (Plt;0.01), but it was maintained to 19.27±3.41 mm3 months later, with no significant difference（Pgt;0.05）. The patients’ kyphosis Cobb angle was significantly improved to 8.71±5.41° (P＜0.05) , but it was maintained to 9.52±5.66° 3 months later, with no significant difference（Pgt;0.05）. The heights of the adjacent discs remained unchanged. No complication was observedduring and after operation, and the radiological and the CT scanning evaluations 3 months later showed no failure of the internal fixation. Conclusion The superior and posterior partial resection of the fractured vertebral body followedby the single segmental fusion can effectively decompress the vertebral canal and maintain the spine stability in treatment of the Denis B type fracture thoughthe longterm effectiveness requires a further follow-up.
ObjectiveTo explore the effectiveness and safety of treatment of thoracic tuberculosis with thoracoscope supported by digital technology. MethodsBetween June 2010 and February 2012, 11 patients with thoracic tuberculosis were treated and the clinical data were retrospectively analyzed. There were 7 males and 4 females with an average age of 23.6 years (range, 16-47 years) and an average disease duration of 16 months (range, 6-18 months). Two vertebral bodies and one intervertebral space were involved at T6-11. At preoperation, the neurologic function degree was classified as Frankel grade E. Three dimensional reconstruction of thorax and spine and surgical procedure design (including focal clearance, bone grafting, and screw fixation) were done at SUPERIMAGE workstation. Surgery procedures were conducted following the preoperative designs. ResultsThe operative procedures were consistent with preoperative designs. All of these operations were successfully performed. The mean time of operation was 146 minutes (range, 120-180 minutes); the mean blood loss was 120 mL (range, 100-150 mL); the mean indwelling time of closed thoracic drainage was 38 hours (range, 24-48 hours); and the mean hospitalization time was 4.6 days (range, 3-5 days). Eleven patients were followed up 12-25 months (mean, 16 months). No complication of nerve damage, incision pain and infection, or pulmonary infection was observed. Rigid fixation and born fusion were obtained at last follow-up; no obvious change of thoracic vertebral alignment was detected and no internal fixation failure occurred. ConclusionIt is a minimally invasive, effective, and safe method to treat thoracic tuberculosis with thoracoscope supported by digital technology.
ObjectiveTo explore early clinical effects of Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium minitype plate fixation, to research the data of the best slotting in the CT-based open-door cervical operation and to provide the reference for accurate operation. MethodsA retrospective analysis of the patients who had received Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation from West China Hospital of Sichuan University from February 2013 to November 2013 were performed. The neurological function assessment results (JOA score), cervical curvature indexhave, Pavlov value, spinal canal cross-sectional area and different position, angle and depth of C7 lamina slotting data of all patients before and after the operation were all analyzed and compared. ResultsA total of 58 patients were included. The postoperative JOA score was significantly higher than that of the preoperative (9.4±2.9 vs. 14.7±2.6, t=11.417, P=0.000). The sagittal diameter of vertebral canal (21.3±2.1 mm vs. 9.7±2.1 mm, t=27.737, P=0.000), Pavlov value (0.92±0.13 vs. 0.44±0.12, t=30.621, P=0.000), and spinal canal cross-sectional area (276±37 mm2 vs. 129±25 mm2, t=32.104, P=0.000) at the end of the last follow-up were significantly greater than those of preoperative. When comparing the last follow-up with preoperative, cervical curvature index showed significant difference (11.2±11.5 vs. 9.3±11.7, t=-1.713, P=0.000). Significant differences were found in the comparison of the ideal position and angle of the open door of the C7 lamina and the angle and position of the operation (all P values >0.05); when comparing the position and angle of the ideal position and angle of the C7 lamina hinge with that of the actual operation, no significant differences were found (all P values >0.05); but when comparing the ideal depth with the actual depth of the operation, a significant difference was found (P<0.05). ConclusionCenterpiece micro plate used in posterior cervical expansive open-door laminoplasty forming operation of laminectomy fixed screw loosening and plate breakage, can effectively maintain the lamina in the open state, and prevent it to be closed. The patients have good recovery of nerve function after operation and the clinical efficacy is good.
Objective To investigate the surgical method and prel iminary cl inical result of managing the patient with lumbar burst fracture but not suitable for single-level fixation and fusion surgery with the reservation of the fractured vertebral body and the anterior decompression. Methods From September 2007 to December 2008, 11 patients with lumbar burst fracture underwent the removal of the posterior superior corner of the injured vertebral body, the removal of the inferior intervertebral disc adjacent to the injured vertebral body, bone graft fusion, and internal fixation. There were 8 males and3 females aged 21-48 years old (average 29.4 years old). All the fractures caused by fall ing from high places. Imaging exams confirmed all the fractures were Denis type B burst fracture. The fracture level was at the L1 in 4 cases, the L2 in 4 cases, the L3 in 2 cases, and the L4 in 1 case. Before operation, the nerve function was graded as grade B in 4 cases, grade C in 3 cases, and grade D in 4 cases according to Frankel scales; the visual analogue scale (VAS) was (7.30 ± 0.98) points; lateral X-ray films displayed the kyphosis Cobb angel was (24.94 ± 12.21)°; the adjacent superior and inferior intervertebral disc height was (12.78 ± 1.52) mm and (11.68 ± 1.04) mm, respectively; CT scan showed the vertebral canal sagittal diameter was (9.56 ± 2.27) mm; CT three-dimensional reconstruction revealed that the intact part of the injured vertebra was less than 50% vertebra body height and the fracture l ine crossed the pedicle. The time from injury to operation was 3-11 days (average 4.8 days). The neurological and radiological evaluations were carried out immediately and 3 months after operation, respectively, and compared with the condition before operation. Results All the patients successfully underwent the surgery. The wound all healed by first intention. All the patients were followed up for 6-18 months (average 14 months). All the patients had a certain degree of nerve function recovery. The Frankel scales in all the patients were increased by 1-2 grade immediately and 3 months after operation. The VAS score was (2.80 ± 1.49) points immediately after operation and (1.54 ± 0.48) points 3 months after operation, suggesting there were significant differences among three time points (P lt; 0.05). The vertebral canal sagittal diameter was significantly enlarged to (18.98 ± 4.82) mm immediately after operation and was (19.07 ± 4.37) mm 3 months after operation. The Cobb angle was (7.78 ± 4.52)° immediately after operation and (8.23 ± 3.57)° 3 months after operation. There were significant differences between before and after operation (P lt; 0.05). For the adjacent superior and inferior intervertebral disc height, there was no significant difference when the value immediately or 3 months after operation was compared with that of before operation (P gt; 0.05). X-ray films and CT scan 3 months after operation showed good internal fixation without theoccurrence of loosing and displacement. Conclusion For the treatment of lumbar burst fracture, the method of reserving the injured vertebral body and anterior decompression can decompress the vertebral canal and shorten the duration for bony fusion.