Objective To elucidate the new development, structural features and appl ication of the lumbar interspinous process non-fusion techniques. Methods With the review of the development course and important research works in the field of the lumbar inter-spinous process non-fusion techniques, the regularity summary, science induction, and prospect were carried out. Results The lumbar inter-spinous process non-fusion technique was a part of non-fusion insertof spinal division posterior surface. According to the design, it could be divided into two major categories: dynamic and static systems. The dynamic system included Coflex and device for intervertebral assisted motion; the static system included X-STOP, ExtenSure and Wall is. The lumbar inter-spinous process non-fusion technique was a new technique of spinal division, it could reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. A lot of basic and cl inical researches indicated that lumbar inter-spinous process insert had extensive appl ication to curatio retrogression lumbar spinal stenosis, discogenic low back pain, articular process syndrome, lumbar intervertebral disc protrusion and lumbar instabil ity and so on. Conclusion With the matures of lumbar inter-spinous process non-fusion techniques and the increased study of various types of internal fixation devices, it will greatly facil itate the development of treatment of lumbar degenerative disease. But long-term follow-up is needed to investigating the long-term efficacy and perfect operation indication.
Objective To evaluate lumbar laminotomy and replantation in prevention of spinal unstability and peridural adhesion after laminectomy.Methods From February 1995 to March 2001,a total of 169 patients(96 males, 73 females,aged 22-63) with lesions in the lumbar vertebral canals underwent surgery, in which the lesions were removed afterlaminectormy and then the excised laminae were replanted. Results The follow-up for 5-9 years showed that all the patients had no complications after the lesions were removed. According to the evaluation criteria formulated by WANG Yongti，81 patients had an excellent result, 67 had a good result, 19 had a fair result, and2 had a poor result. 87.6% of the patients obtained quite satisfactory results.The X-ray films demonstrated that the replanted laminae obtained bony healing and the spine was stable. The CT scanning demonstratedthat the canals were enlarged with a smooth and glossy interior. Conclusion Lumbar laminotomy and replantation is reasonable in design and convenient in performance, which can be promoted as a basic operation in spinal surgery.
ObjectiveTo measure L1-L5 lumbar isthmus thickness and to construct Chinese adult male lumbar (L1-L5) 3D model by Micro CT 3D reconstruction technique, in order to provide micro-anatomical data for clinical treatment of L1-L5 lumbar spondylolysis. MethodsDry, non-damaged specimens of L1-L5 lumbar isthmus from 60 Chinese adult males were randomly selected from September 2013 to January 2014. Micro CT scanning was carried out, followed by corresponding 3D model construction. The microscopic anatomical parameters such as superior, inferior, inner and outer edge thickness of left and right L1-L5 lumbar isthmus were measured. ResultsL1-L5 lumbar isthmus superior edge thickness was in the order of L1> L2> L3> L5> L4, with the variation ranging from (4.31±0.95) mm to (4.88±0.75) mm. L1-L5 lumbar isthmus inferior edge thickness was in the order of L1< L2< L3< L4< L5, gradually thickened with the variation ranging from (6.03±1.01) mm to (7.27±1.27) mm. L1-L5 lumbar isthmus inner edge thickness amplitude was not obvious, ranging from (6.33±1.21) mm to (6.57±1.27) mm. L1-L5 lumbar isthmus outer edge thickness was in the order of L1< L2< L3< L4< L5, gradually thickened with the variation ranging from (8.44±1.21) mm to (10.27±1.28) mm. ConclusionThere are certain rules within superior, inferior, inner and outer edge thickness of adult L1-L5 lumbar isthmus:the inferior and outer edge thickness of L1-L5 lumbar isthmus gradually becomes thicker, while superior edge gradually becomes thinner. From L1 to L5 lumbar isthmus, the outer edge of the lumbar isthmus is the thickest, followed by inner and inferior edge, and the upper edge is the thinnest.
ObjectiveTo investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. MethodsA retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. ResultsAt L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). ConclusionPI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.
Objective To evaluate the cl inical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with il iac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, il iac autograft, Z-plate internal fixation with il iac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared betweenpreoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 ± 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 ± 2.5)°, the vertebral canal sagittal diameter of L4 was (10.6 ± 3.5) mm. The bone graft volume was (7.5 ± 1.3) cm3 during operation. Results Operations were performed successfully. The mean operative time was (142 ± 25) minutes and the mean amount of blood loss was (436 ± 39) mL. The incisions obtained heal ing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 ± 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 ± 3.7)°, and the vertebral canal sagittal diameter of L4 was (19.8 ± 5.1) mm, showing significant difference when compared with those of preoperation (P lt; 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Cl inical outcomes of anterior surgery for fourth lumbar burst fractures with il iac fenestration are satisfactory. It can facil icate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
Objective To observe the effect of threaded titanium cage and transpedical screw for the treatment of lumbar spondylolisthesis. Methods Eighteen patients with lumbar spondylolisthesis were adopted in this study. Among them, there were 8 males and 10 females, aged from 43 to 62 years old .Roentgenogramshowed that there were 6 cases of Ⅰ° spondylolisthesis, 11 cases of Ⅱ° and 1 case of Ⅲ°. All patients were treated with cages for intervertebral fusion after total laminectomy and pedicle screws for the reduction. Results The cases were followed up from 6 to 12 months with an average of 11 months. The clinical results were excellent in 13 cases and good in 5 cases. All patients achieved successful fusion and bony union . There were no pedicle screw loosening or broken or peripheral nerve dysfunction in this series. Conclusion This method has been proved to be an effective and reliable procedure for treatment of lumbar spondylolithesis. It produces a high fusion rate and clinical success.
ObjectiveTo isolate nucleus pulposus cells (NPCs) from the caudal and lumbar intervertebral disc of rat, and to identify the morphology and to compare the characteristics. MethodsThe whole spine was separated from 8-week-old Sprague Dawley rats under the sterile conditions. NPCs of different segments (lumbar group: L1,2-L6, S1; caudal group: C1,2-C17,18) were cultured by adherent cultivation approach. Cellular morphologic change was noted by HE staining and continuous observation under inverted phase contrast microscope. Besides, the aggrecan and collagen type Ⅱexpression were examined by toluidine blue and immunocytochemistry staining respectively. The total protein contents, senescence level, and the cell viability of passage 1-5 (P1-5) were detected. The growth curves of the P1 cells in lumbar and caudal groups were determined by cell counting kit 8. ResultsThe NPCs were isolated and identified successfully. The adherence time of the primary cells (the cell fusion reached 90%) in lumbar group was significantly longer than that in caudal group in primary generation (P<0.05). HE staining showed that cytoplasm was pink with the blue nucleus. Lumbar disc NPCs were spindle. The larger caudal disc NPCs were polygonal or irregular. Toluidine blue staining showed that the proteoglycan was stained as blue. In the cytoplasm of cells, collagen type Ⅱwas stained as brown surround the blue-black nucleus. The cell viability had no significant difference between lumbar and caudal groups and between different passages in the same group (P>0.05). The caudal disc NPCs reached their logarithmic growth phase after 3 days of culture, while the cells in lumbar segments did after 4-5 days of culture. The cell proliferation in caudal segments was more than that in lumbar segments at 3-9 days (P<0.05). The difference in the total protein contents was not significant between cells at P1-5 in 2 groups (P>0.05), and the caudal disc NPCs had higher protein contents than lumbar disc NPCs (P<0.05). There was no significant difference in cell senescence rate between cells at P1, P2, and P3 in 2 groups (P>0.05), but significant difference was shown in senescence rate between 2 groups in cells at P4 and P5 (P<0.05). ConclusionCaudal disc NPCs have a better status, which is more suitable for experiment as a seed cell than the lumbar disc NPCs in the same generation.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.
ObjectiveTo investigate the accuracy of the two-dimension computer-aided surgery navigation system in the lumbar pedicle screw fixation on recombinant CT section after operation. MethodsBetween February 2011 and April 2013, 218 patients undergoing lumbar spinal pedicle screw fixation were divided into 2 groups:two-dimension computer-aided surgery navigation system was used in 95 cases (the navigation group) and X-ray fluoroscopy assistant technology in 123 cases (the fluoroscopy assistant group). There was no significant difference in age, gender, and type of disease between 2 groups (P>0.05). The mean operating time, blood loss volume, and fluoroscopy times, and the one-time success rate of pedicle screw implant were observed. The sagittal screw angle (SSA), the relationship between the pedicle cortex and screw, the accuracy rate of pedicle screw, and the sagittal angle on both sides (SBA) were observed. ResultsA total of 504 screws were inserted in navigation group, 432 (85.7%) were inserted successfully at first time and 472 (85.7%) were inserted successfully at end time. A total of 656 screws were inserted in fluoroscopy assistant group, 474 (72.3%) were successfully inserted at first time, and 563 (85.8%) were inserted successfully at end time. There were significant differences in the one-time success rate and final success rate of pedicle screw implant between 2 groups (χ2=30.19, P=0.00; χ2=18.16, P=0.00). There was no significant difference in the mean operating time and the blood loss volume of pedicle screw implant between 2 groups (t=0.88, P=0.38; t=1.47, P=0.14); but the fluoroscopy times of pedicle screw implant in navigation group 0.7±0.3 were significantly less than that in fluoroscopy assistant group 1.5±1.0 (t=-8.09, P=0.00). The SSA and SBA in navigation group[(3.7±0.9)° and (1.7±0.8)°] were significantly less than those in fluoroscopy assistant group[(6.0±1.7)° and (3.5±1.6)°] (t=-26.92, P=0.00; t=-22.49, P=0.00). ConclusionThe sagittal screw angle and accuracy of pedicle screw implant can be significantly improved using the two-dimension computer-aided surgery navigation system in lumbar posterior fixation.
Objective To analyze the cl inical effects of modified transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disease. Methods From October 2003 to December 2006, 33 patients with lumbar degenerative disease (L3-S1) were treated by modified TLIF. There were 14 males and 19 females with an average age of 52.2 years(33 to 70 years). The median disease course was 1.8 years (4 months to 15 years). A total of 42 levels were fused, including 24 cases of single level and 9 cases of double levels. The results of preoperative diagnosis were lumbar degenerative spondylol isthesis with stenosis (8 cases), isthmic spondylol isthesis (5 cases), degenerative lumbar stenosis (16 cases), huge herniated disc with segmental instabil ity (3 cases) and failed back surgery syndrome (1 case). During the modified TLIF procedure, total inferior facet process and inner half summit of superior facet process of TLIF side were resected to make the posterior wall of foramen opened partly. After the bone graft (3 to 5 mL) was placed into the interbody space, a single rectangle Cage was inserted obl iquely from 30° to 40° toward the midl ine. Combined with pedicle screw instrumentation, TLIF was accompl ished. Middle canal and opposite side nerve root decompression were performed simultaneously when necessary. Results Intraoperative dura mater rupture, postoperative cerebral spinal fluid leakage, deep wound infection and transient nerve root stimulation occurredin 1 case respectively, and were all recovered after treatment. No patients had permanent neurologic deficit or aggravation. All patients were followed up for 20 to 58 months (mean 27.2 months). At the follow-up after 1 year postoperatively, all the operated segments achieved fusion standard and no broken screw or Cage dislocation occurred. All 13 cases of spondylol isthesis were reduced thoroughly and maintained satisfactorily. Nineteen patients remained sl ight chronic back pain. There was significant difference (P lt; 0.05) in JOA score between preoperation (14.9 ± 5.1) and postoperation (25.9 ± 3.0). The rate of cl inical improvement was 80.5% (excellent in 24 cases, good in 7 cases, and fair in 2 cases). Conclusion The modified TLIF carries out the less invasive principles in opening operations, simpl ifies the manipulation and expands the indication of TLIF to some extent, and the cl inical results for the treatment of lumbar degenerative disease is satisfactory.