ObjectiveTo investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD).MethodsA clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT.ResultsAll incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant (Z=−0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups (t=−9.033, P=0.000; t=−15.835, P=0.000); while no significant difference was found between the two groups (t=−0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups (Z=−0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups (Z=−0.681, P=0.496).ConclusionFor RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.
ObjectiveTo compare the effectiveness of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease.MethodsA clinical data of 44 patients with stage Ⅲ Kümmell disease met the selection criteria between January 2014 and December 2017 was retrospectively analyzed. Eighteen cases were treated with short-segment bone cement-augmented fixation combined with vertebroplasty (short-segment group) and 26 cases were treated with long-segment bone cement-augmented fixation combined with vertebroplasty (long-segment group). There was no significant difference in gender, age, disease duration, fracture segment, bone mineral density (T value), Frankle grading, and preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior edge height of injured vertebrae, kyphosis Cobb angle, and thoracolumbar kyphosis (TLK) between the two groups (P>0.05). The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK were compared between the two groups.ResultsThe operation time and the intraoperative blood loss in the short- segment group were significant lower than those in the long-segment group (P<0.05). There was no significant difference in bone cement injection volume and bone cement leakage rate between the two groups (P>0.05). All patients were followed up 12-36 months, with an average of 24.4 months. The VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK significantly improved at 1 week after operation and last follow-up in the two groups (P<0.05), there was no significant difference between the two groups (P>0.05). At last follow-up, the neurological function of the two groups recovered, and there was no significant difference in Frankle grading between the two groups (P>0.05). There were 3 cases (16.67%) of non-surgical vertebral fractures in the short-segment group and 6 cases (23.08%) in the long-segment group, showing no significant difference between the two groups (P>0.05). Bone rejection occurred in 1 case in the short-segment group, and neither internal fixation failure nor collapse of the injured vertebrae occurred during follow-up.ConclusionBoth short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty can achieve good effectiveness in treatment of stage Ⅲ Kümmell disease, and can maintain the height of the injured vertebra and prevent the collapse of the injured vertebra. Compared with long-segment fixation, short-segment fixation has the advantages of shorter operation time and less intraoperative bleeding.
ObjectiveTo investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty (PKP) in treatment of Kümmell disease.MethodsBetween January 2015 and December 2018, 63 patients with Kümmell disease were treated. Among them, 28 cases were treated with Vesselplasty (Vesselplasty group) and 35 cases were treated with PKP (PKP group). There was no significant difference in gender, age, disease duration, bone mineral density (T value), fracture distribution, and preoperative pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), anterior height of injured vertebrae, and kyphosis Cobb angle between the two groups (P>0.05). The operation time, intraoperative fluoroscopy time, bone cement injection volume, the leakage rate of bone cement, the diffusion area ratio of bone cement, and the complications of the two groups were recorded. VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last follow-up.ResultsAll patients of the two groups were followed up 12-36 months, with an average of 24.2 months. The operation time, intraoperative fluoroscopy time, bone cement injection volume, and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group (P<0.05). The leakage rate of bone cement was significantly lower in the Vesselplasty group (7.14%) than in the PKP group (34.29%) (χ2=5.153, P=0.023). At 1 day after operation and last follow-up, the VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle of the two groups were superior to those before operation (P<0.05), and no significant difference between the two groups (P>0.05). During the follow-up, there was no re-collapse of vertebrae, and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group. There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group (7.14%) and the PKP group (14.29%) (χ2=0.243, P=0.622).ConclusionVesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease. They can effectively relieve the pain symptoms, improve the quality of life, partially restore the height of injured vertebrae, and correct kyphosis. But the Vesselplasty has the advantages of shorter operation time, less intraoperative fluoroscopy time, and less bone cement leakage.