Objective To compare the effectiveness of three different bone grafts [autogenous bone, allogeneic bone, and bone morphogenetic protein (BMP) composite bone] combined with screw system for spinal fusion of degenerative lumbardisease. Methods Between January 2005 and January 2010, 102 cases of degenerative lumbar disease were randomly treated with autogenous bone (group A, n=35), allogeneic bone (group B, n=33), and BMP composite bone (group C, n=34). There was no significant difference in sex, age, disease duration, affected segments, Meyerding grade, preoperative intervertebral space height, and the Japanese Orthopaedic Association (JOA) score among 3 groups (P gt; 0.05). The intervertebral space height, bone fusion rate, and JOA score were compared among 3 groups at different time points. Results All patients of 3 groups were followed up 2 to 5 years, with an average of 3.2 years. At 6 to 24 months after operation, the intervertebral space height significantly increased when compared with preoperative value in 3 groups (P lt; 0.05); the intervertebral space height of groups A and C was significantly greater than that of group B at 6, 12, 18, and 24 months after operation (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Bone graft fusion was observed at 6 months in groups A and C and at 12 months in group B; at 24 months, the rate of bone graft fusion was 100% in groups A and C, and 87.88% in group B, showing significant difference (P lt; 0.05). There was significant difference in JOA score between preoperation and postoperative 12th and 24th months (P lt; 0.05); at 12 and 24 months after operation, JOA socre and improving rate of groups A and C were significantly higher than those of group B (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Conclusion The effect of BMP composite bone is equivalent to that of autogenous bone graft in treating spinal fusion of degenerative lumbar disease, and they are better than allogeneic bone graft. BMP composite bone can obtain adequate bone grafts without invasive sampling, and has fast fusion and high successful rate.
Objictive To evaluate the efficacy of decompression with and without fusion in the treatment of degenerative lumbar disease. Methods We searched the Cochrane Library (Issue 1, 2006), MEDLINE (1966 to April, 2006), EMBASE (1984 to April, 2006), the China Biological Medicine Database (to Dec., 2005), VIP (1989 to April, 2006) and hand-searched several related journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) involving the comparison of the outcomes between decompression with and without fusion in the treatment of degenerative lumbar disease. The quality of the included trials was assessed. RevMan 4.2.8 software was used for statistical analysis. Results Seven studies involving 412 patients were included. The results of meta-analysis indicated that no statistically significant differences were observed between the two operative procedures in the cumulative clinical outcome (OR1.83, 95%CI 0.92, 3.41), incidence of postoperative leg pain (OR 1.04, 95%CI 0.48, 2.25), incidence of perioperative complications (OR 1.15, 95%CI 0.51, 2.60), incidence of re-operation (OR 0.68, 95%CI 0.30, 1.56) or pre and postoperative pain scores [Pre-op WMD 0.12, 95%CI (-0.44,0.68); Post-op WMD 0.08, 95%CI (-1.08,1.25)]. The only statistical significance was observed in the incidence of postoperative back pain (OR 0.25, 95%CI 0.14, 0.46). Four studies described the length of operation, the intraoperative blood loss, the duration of external fixation postoperative and the total cost in hospital, which revealed that decompression alone was superior to decompression plus fusion. Three studies described the relationships between the clinical outcome and the changes in segmental range of motion/disc height pre- and post-operatively, as well as the flexion-extension radiographs, which revealed that decompression plus fusion was superior to decompression alone. Conclusions There are no significant differences between the two procedures in clinical outcomes, incidences of postoperative leg pain, re-operation and complications. Decompression with fusion leads to fewer patients suffering from postoperative lumbago than that of decompression alone. There is insufficient evidence to demonstrate that the radiographs may predict the clinical outcomes. More high quality, large-scale randomized controlled trials are required.
ObjectiveTo assess the feasibility and clinical value of lumbar elastic fixation through the clinical research of elastic fixation for lumbar intervertebral fusion. MethodsAccording to the criteria, we selected 12 patients with lumbar degenerative disease diagnosed between September 2011 and March 2013 as our study subjects. Among them, 8 were females, and 4 were males, aged between 40 and 62 years old, averaging 52.9 years. Elastic fixation was adopted in the lumbar fusion. Evaluation indicators included visual analogue scale (VAS) scores, Oswestry disability index (ODI) score and its rate of improvement, intervertebral height changes, the rate of intervertebral fusion, intervertebral bone callus formation, patient satisfaction and clinical success rate. ResultsAll patients were followed up. During various postoperative follow-up points, VAS score and ODI score improved significantly (P<0.05). A large amount of callus formation was shown in lumbar CT. No fracture, loosened or shifted internal fixation occurred. ConclusionElastic fixation for lumbar intervertebral fusion provides another choice for the treatment of lumbar degenerative disease.
ObjectiveTo explore the long-term effectiveness of expandable Cage in treatment of degenerative lumbar disease. MethodsBetween January 2005 and January 2008, 72 patients with degenerative lumbar disease were treated by expandable Cage and followed up for 5 years. Of 72 cases, 41 were male and 31 were female with an average age of 40.5 years (mean, 35-65 years), including 35 cases of lumbar spinal stenosis, 20 cases of degenerative lumbar instability, and 17 cases of serious lumbar intervertebral disc protrusion combined with lumbar instability. The disease duration was 6-28 months (mean, 9 months). The affected lumbar segments were L3, 4 in 6 patients, L4, 5 in 37 patients, and L5, S1 in 29 patients. The Oswestry disability index (ODI) was used to evaluate the effectiveness before and after operation and to calculate the improvement rate. During the follow-up, the anteroposterior, lateral, and dynamic X-ray films were taken to evaluate the operated segment fusion rate. The intervertebral lordosis angle was measured, and adjacent segment degeneration was observed. ResultsThe operation time was 35-90 minutes (mean, 65 minutes); the intraoperative blood loss was 200-450 mL (mean, 280 mL), and all the patients received intraoperative autologous blood transfusion; the postoperative bedridden time was 3-7 days (mean, 4.5 days); the hospitalization days were 10-18 days (mean, 12 days). No complications of nerve root injury, cauda equina injury, or cerebrospinal fluid leakage occurred during operation. All patients achieved primary healing of the incisions. All 72 patients were followed up for 5 years. At 3 months, 1 year, and 5 years after operation, the ODI were 8.2±2.6, 6.9±1.9, and 6.4±1.3 respectively, showing significant differences when compared with preoperative value (41.5±3.5) (P<0.05); the improvement rates were 87.3%±1.2%, 90.1%±0.8%, and 91.6%±1.3% respectively, showing no significant difference (F=0.492, P=0.375); the intervertebral lordosis angles were (5.1±1.2), (5.0±0.5), and (5.4±0.8)°respectively, showing no significant difference (F=0.570, P=0.453). At 5 years after operation, the intervertebral fusion rate was 100%, with no adjacent segment degeneration. ConclusionUsing expandable Cage to treat degenerative lumbar disease can get stabilization without pedicle screw fixation, the good effectiveness is shown after long-term follow-up.
ObjectiveTo compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MethodsBetween October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. ResultsAll procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). ConclusionIntravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.
Objective To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease. Methods Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups. Results All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group (P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups (χ2=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups (P>0.05). Conclusion For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.