Objective To observe the effect of titanium mesh cage with self-locked titanium plate on the cervicalinter-body fusion after anterior discectomy of multilevel cervical intervertebral disc protrusion. Methods The therapeuticeffect of 18 patients who received the treatment of titanium mesh cage with self-locked titanium plate from September 2004 to June 2007 were retrospectively analyzed, including 11 males and 7 females (aged 32-75 years, 54 years on average). The course of disease was 6 months to 15 years (5.8 years on average). Sixteen patients suffered sensory dysfunction in l imbs. Concerning the muscle strength of extremities, 3 cases were on the second level, 12 were on the third level, 1 was on the fourth level, and 2 were on the fifth level. Sixteen cases had pyramidal sign, 13 had retention of urine and feces, 8 had sexual dysfunction, and 7 combined with symptoms of nerve root type. Twelve cases were consecutive multilevel and 6 cases were discontinuous multilevel. The mean JOA scores were 8.30 ± 1.21 preoperatively. X-ray films and MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord preoperatively. The height of involved intervertebral space was (6.40 ± 0.87) mm on X-ray films preoperatively. Results All the incisions were healed by first intention. All the patients were followed up for 6-36 months (18 months on average). The recovery of extremities motor function was better than that of sensory function at the early stage after operation. Muscular tension decreased after operation and mobil ity of l imbs was improved. The operated segments were instantly stable and sol id fusion was observed at 3-6 months after operation. JOA scores at 6 months after operation was 12.60 ± 0.78 with an improvement rate of 51.8%, indicating significant difference wasevident when compared with the JOA scores before operation (P lt; 0.05). The height of involved intervertebral space increased significantly to (8.20 ± 0.46) mm postoperatively, indicating the difference was significant (P lt; 0.05). According to Odom’s evaluation scale, 17 patients were graded as excellent and 1 as good. No death and compl ications of spinal cord, nerve, trachea and esophagus were observed. The cage witnessed no translocation. Conclusion Titanium mesh cage with self-locked titanium plate is more stable and effective for the treatment of multilevel cervical intervertebral disc protrusion.
Objective To compare the curative effect of posterior lumbar interbody fusion with autologous il iac crest to that of interbody fusion cage for adult instabil ity of lower lumbar. Methods From February 2003 to October 2006,60 inpatients with lower lumbar instabil ity were treated. Patients were randomized into 2 groups: bone-graft group (n=28) was treated with posterior lumbar interbody fusion with two autologous il iac crests, while cage group (n=32) was treated with posterior lumbar interbody fusion with two quadrate cages. In the bone-graft group, 17 males and 11 females aged (52.78 ± 10.50) years with 3-16 months of disease course, there were 12 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 1 case of L3,4, 17 cases of L4,5 and 10 cases of L5, S1. Relative disc space height was (23.24 ± 6.62) mm, disc space activity was (10.50 ± 5.07)º, sagittal saw sl ippage distance was (4.50 ± 1.15) mm and the JOA score was 18.56 ± 2.68. In the cage group, 19 males and 13 females aged (51.75 ± 10.44) years with 3.5-14.0 months of disease course, there were 16 cases of degenerative instabil ity, 14 isthmus sl it ol isthe and 2 iatrogenic instabil ity, including 16 cases of L4,5 and 16 cases of L5, S1. Relative disc space height was (24.34 ± 7.22) mm, disc space activity was (11.12 ± 5.67)º, sagittal saw sl ippage distance was (4.38 ± 0.75) mm and the JOA score was 19.00 ± 4.12. There was no significant difference between the two groups in termsof age, gender, JOA score, disc space activity and relative disc space height preoperatively (P gt; 0.05). Results All patients received the follow-up at the 1st, 3rd, 6th and 12th month postoperatively. There was no significant difference in operation time and hemorrhage amount between the two groups (P gt; 0.05), but significant difference in the cost of operation (P lt; 0.01). Two cases in the bone-graft group suffered donor site pain and received no treatment. Three cases in the bone-graft group and 2 cases in the cage group had symptom of nerve injury 1-2 days after surgery, which were cured after expectant treatment. There were no pseudoarticulation formation, intervertebral space infection and cage aversion in both groups. Significant difference of relative disc space height was found in each group pre- and post- operatively (P lt; 0.01) and significant differences were evident between the two groups at any of the time points (P lt; 0.01). One month after operation, there was significant difference between the two groups (P lt; 0.05). There was also significant difference at the 3rd, 6th and 12th month after operation (P lt; 0.01). No sign offusion was found in each group at the 1st and 3rd month after operation. In bone-graft group, there were 7 vertebral fusion cases 6 months after operation and 23 vertebral fusion cases 12 months after operation. In cage group, there were 8 vertebral fusion cases 6 months after operation and 29 vertebral fusion cases 12 months after operation. There was no significant difference in the rate of fusion at 6 and 12 months follow-up between the two groups (P gt; 0.05). Significant difference of JOA scores was found in each group pre- and post- operatively (P lt; 0.05). And no significant difference in JOA scores at 1, 3, 6, and 12 months follow-up was evident between the two groups (P gt; 0.05). Conclusion There is no significant difference between the two groups in the fusion time, the fusion rate and the cl inical symptoms alleviation, indicating autologous il iac crest is appl icable to interbody fusion for the treatment of adult instabil ity of lower lumbar and good therapeutic effect can be achieved with no immunoreaction and lower cost.
ObjectiveTo explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF).MethodsThe clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation.ResultsThe operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores (P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation (P<0.05); but no significant difference was found between at 6 months and at last follow-up (P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones (P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days (P<0.05).ConclusionThe allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.
ObjectiveTo discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion. MethodsBetween September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C3,4 and C4,5 (1 case), C3,4 and C5,6(5 cases), C4,5 and C5,6 (3 cases), C4,5 and C6,7 (5 cases), and C5,6 and C6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up. ResultsPrimary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively). ConclusionA combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.
Objective To compare the effectiveness between three-dimensional (3D) printed porous titanium alloy cage (3D Cage) and poly-ether-ether-ketone cage (PEEK Cage) in the posterior lumbar interbody fusion (PLIF). Methods A total of 66 patients who were scheduled to undergo PLIF between January 2018 and June 2019 were selected as the research subjects, and were divided into the trial group (implantation of 3D Cage, n=33) and the control group (implantation of PEEK Cage, n=33) according to the random number table method. Among them, 1 case in the trial group did not complete the follow-up exclusion study, and finally 32 cases in the trial group and 33 cases in the control group were included in the statistical analysis. There was no significant difference in gender, age, etiology, disease duration, surgical segment, and preoperative Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, complications, JOA score, intervertebral height loss, and interbody fusion were recorded and compared between the two groups. Results The operations of two groups were completed successfully. There was 1 case of dural rupture complicated with cerebrospinal fluid leakage during operation in the trial group, and no complication occurred in the other patients of the two groups. All incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). All patients were followed up 12-24 months (mean, 16.7 months). The JOA scores at 1 year after operation in both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between groups (P>0.05) in the difference between pre- and post-operation and the improvement rate of JOA score at 1 year after operation. X-ray film reexamination showed that there was no screw loosening, screw rod fracture, Cage collapse, or immune rejection in the two groups during follow-up. At 3 months and 1 year after operation, the rate of intervertebral height loss was significantly lower in the trial group than in the control group (P<0.05). At 3 and 6 months after operation, the interbody fusion rating of trial group was significantly better in the trial group than in the control group (P<0.05); and at 1 year after operation, there was no significant difference between groups (P>0.05). ConclusionThere is no significant difference between 3D Cage and PEEK Cage in PLIF, in terms of operation time, intraoperative blood loss, complications, postoperative neurological recovery, and final intervertebral fusion. But the former can effectively reduce vertebral body subsidence and accelerate intervertebral fusion.
Objective To summarize the basic research and the cl inical appl ication of biodegradable interbody fusion Cage. Methods Recent l iterature concerning biodegradable interbody fusion Cage at home and abroad was extensively reviewed, and current developments of the basic research and the cl inical appl ication of biodegradable interbody fusion Cage were investigated. Results Basic research showes that the stiffness of biodegradable interbody fusion Cage is lower than that of metall ic Cage, so it can enhance interbody fusion. As interbody fusion proceeded, biodegradable interbody fusion Cage degrades constantly, but the speed of degradation can not keep in parallel with that of fusion. In addition, the tissue response to degradation products is controversy. Cl inical appl ication showes that the biodegradable interbody fusion Cage can enhance interbody fusion and maintain disc space height. The short term results are good, however, the long term results need further observation. Conclusion Biodegradable interbody fusion Cage can effectively enhance interbody fusion.
Objective To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). Methods The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. Results The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). ConclusionThe application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Objective To evaluate the effectiveness of Poster Fusion Cage combined with xenogeneic bone graft augmentation for bone defect management in distal radius fractures. MethodsA retrospective analysis was conducted on 20 patients with bone defects complicating distal radius fractures who met the selection criteria and were treated between June 2022 and June 2024. The cohort comprised 2 males and 18 females, aged 54-87 years (mean, 63.3 years). Etiologies included falls in 17 cases, traffic accidents in 2 cases, and crush injury in 1 case. According to AO classification, there were 5 cases of type A, 8 cases of type B, and 7 cases of type C. The interval from injury to operation ranged from 2 to 10 days (mean, 5.8 days). All patients underwent volar plate fixation augmented with Poster Fusion Cage and demineralized xenogeneic bone matrix grafting. The operation time, intraoperative blood loss, fracture healing time, and postoperative complications were recorded. Radiographic parameters, including radial height, volar tilt, and ulnar deviation, were measured on standardized X-ray films obtained immediately postoperatively and at last follow-up, and whether secondary reduction loss occurred was judged. At last follow-up, wrist range of motion (extension, flexion, radial deviation, ulnar deviation, pronation, and supination) and grip strength (expressed as a percentage of the contralateral side) were measured. Wrist function was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and Patient-Rated Wrist Evaluation (PRWE) score. Results The operation time was 70-200 minutes (mean, 116.4 minutes), and the intraoperative blood loss was 10-80 mL (mean, 36.5 mL). All surgical incisions healed by first intention, with no neurovascular complications documented. All patients were followed up 9-12 months (mean, 11.6 months). All fractures healed normally, with a healing time of 8-14 weeks (mean, 9.95 weeks). No significant difference was observed in radial height, volar tilt, or ulnar deviation between immediate postoperatively and last follow-up (P>0.05). All fractures achieved satisfactory reduction, with no secondary loss of reduction or implant failure occurring during follow-up. At last follow-up, the range of motion of the affected wrist joint was 60°-65° (mean, 62.5°) in extension, 67°-75° (mean, 71.1°) in flexion, 18°-23° (mean, 20.4°) in radial deviation, 28°-33° (mean, 30.1°) in ulnar deviation, 69°-80° (mean, 74.7°) in pronation, and 69°-82° (mean, 75.6°) in supination. Grip strength recovered to 75%-85% (mean, 80%) of the contralateral side. Functional scores showed a DASH score of 5-15 (mean, 9.4) and PRWE score of 8.0-12.5 (mean, 10.2). ConclusionThe combination of Poster Fusion Cage and xenogeneic bone graft augmentation provides a safe and effective treatment for bone defects in distal radius fractures.
ObjectiveTo investigate the effectiveness of stand-alone MC+polyether-ether-ketone (PEEK) Cage (single blade type) in anterior cervical double-level fusion for more than 2 years follow-up.Methods A clinical data of 30 patients who were treated with anterior cervical fusion surgery with stand-alone MC+PEEK Cage (single blade type) between January 2013 and December 2016 and followed up for more than 2 years, was retrospectively analyzed. There were 16 males and 14 females, aged from 34 to 72 years with an average of 52.2 years. There were 16 cases of cervical spondylotic myelopathy, 8 cases of cervical spondylotic myelopathy, and 6 cases of traumatic cervical disc herniation. The continuous double segments were C4, 5, C5, 6 in 12 cases and C5, 6, C6, 7 in 18 cases; and the disease duration ranged from3 days to 24 months (mean, 12 months). Postoperative neck hematoma and wound healing were observed; dysphagia was assessed by Bazaz system; and bone fusion was assessed by Suk method. Before operation, at 1 week after operation, and at last follow-up, the Japanese Orthopaedic Association (JOA) score was used to evaluate the neurological recovery; the cervical X-ray film was performed to record the cervical curvature (C2-C7 Cobb angle), the height of the intervertebral space of the fusion segment, and to judge the occurrence of the fusion Cage subsidence.ResultsNo complication such as neck hematoma, incision infection, or esophageal fistula was found, primary healing of incisions was obtained in all cases. All patients were followed up 24-72 months (mean, 46 months). Neurological symptoms such as limb numbness and pain gradually disappeared after operation; during the follow-up period, the cervical curvature could be effectively maintained; dysphagia and internal fixation related complications such as displacement of Cages were not found. All patients obtained bony fusion from 3 to 8 months with an average time of 4.3 months. Compared with preoperative ones, the JOA score, intervertebral space height, and Cobb angle of cervical spine were significantly improved at 1 week after operation and at last follow-up (P<0.05), but there was no significant difference between 1 week after operation and last follow-up (P>0.05).ConclusionThe application of stand-alone MC+PEEK Cage (single card type) in anterior cervical fusion can provide early cervical stability, effectively maintain the physiological curvature of cervical spine and the height of fusion intervertebral space.
Objective To compare the clinical outcomes of posterior lumbar interbody fusion（PLIF） using simple cage alone fusion with pedicle screw fixationand autogenous bone grafting and cage fusion with pedicle screw fixation in adult spondylolisthesis. Methods From March 2003 to March 2004，Twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedicle screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defectswere located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers.Thepreoperative mean disc space height was 5.4±2.3 mm, the mean percentage of slip was 36.8％±7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedicle screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 cases, atL5 in 4 cases. Five patients were smokers. The preoperative mean disc space height was 5.7±2.5 mm, the mean percentage of slip was 37.8%±6.2%. Two groupswere compared in the amount of blood loss, duration of hospitalization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate. Results All patientswere followed up for 24-38 months. The mean follow-up was 29(24-36) months in group A and26(24-38) months in group B. There were no statistically significant differences infollow-up period, age,sex, the location of isthmic defects, smoking, the preoperative disc space height and the percentage of slip between two groups (Pgt;0.05).There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups(Pgt;0.05). But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups(Plt;0.05).Thepo stoperative disc space height and the degree of slip of the last follow-up were5.8±2.2 mm and 25.6％±7.2% in group A, 6.2±2.5 mm and 24.1％±7.4 % ingroupB, showing statistically significant difference (Plt;0.05). Conclusion The PLIF using autogenous bone grafting and cage fusion with pedicle screw fixations ismore beneficial to improving the fusion rate and preventing longterm instabilities than simple cage alone fusion with pedicle screw fixation in adult spondylolisthesis.