To explore the treatment of multi-segmental lumbar disc herniation and spinal canal stenosis by laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and general spine system(GSS) fixation. Methods From January 2004 to January 2006, 21 patients with multi-segmental lumbar disc herniation and spinal canal stenosis were treated by laminectomy, removal of nucleus pulposus and GSS pedicle screw spinal system. There were 14 males and 7 females with an average age of 53 years ranging from 46 to 61 years, and with an average disease course of 18 months ranging from 8 months to 15 years. All of the patients were examined by X-ray with AP position, lateral position and dynamic lateral position, CT and MRI, and all of them proved to be with multi-segmental lumbar disc herniation and different degrees of spinal canal stenosis. A total of 47 nucleuses were picked out, and 47 instable segments were filled in with granule selfbone. Results There were 21 patients who were followed up for 1 to 2 years with an average of 13 months. All patients achieved successful fusion and bony union postoperative from 8 to 12 months, and no artificial joint was formed. As to the cl inical results in 21 cases, according to the Macnab outcome criteria, 14 were excellent, 6 were good and 1 was poor, the excellent and good rate was 95.2%. Conclusion The methods of laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and GSS system fixation are effective in treatment of multi-segmental lumbar disc herniation and spinal canal stenosis．
Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
ObjectiveTo explore the early outcome of 3 different operation methods in the treatment of multi-segmental cervical spondylotic myelopathy (CSM). MethodsA retrospective analysis was made on the clinical data of 74 patients with multi-segmental CSM treated between January 2011 and March 2013. The patients were divided into 3 groups according to operation methods:open-door expansive laminoplasty by plate was used in 21 patients (group A), open-door expansive laminoplasty by anchor fixation in 28 patients (group B), and conventional unilaterally open-door expansive laminoplasty in 25 patients (group C). There was no significant difference in gender, age, disease druation, affected segments, preoperative Japanese Orthopaedic Association (JOA) score, and cervical curvature of C2-7 among 3 groups (P > 0.05). The peration time, intraoperative blood loss, and JOA score, cervical curvature, incidence of axial symptoms were recorded. ResultsThere was no significant difference of operation time and intraoperative blood loss between group A and group B (P > 0.05). All incisions healed by first intention. Cerebrospinal leak occurred in 2 cases (1 case of group B and 1 case of group C) and C5 nerve root palsy in 4 cases (2 cases of group A, 1 case of group B, and 1 case of group C); all the symptoms disappeared after symptomatic treatment. The patients were followed up 12-39 months (mean, 18.3 months). The position of internal fixation was good without loosening and pulling out in groups A and B. Reclosed open-door was observed in 2 cases of group C, which disappeared after the second surgery. The JOA scores were significantly increased at 6 months after operation when compared with preoperative scores in groups A, B, and C (P < 0.05). The cervical curvature of C2-7 at postoperation was significantly improved when compared with preoperative one in groups B and C (P < 0.05) except group A (P > 0.05). There were significant differences in JOA score and the cervical curvature among 3 groups at 6 months after operation (P < 0.05). The incidence of axial symptoms were 4.76% (1/21), 35.71% (10/28), and 72.00% (18/25) in groups A, B, and C respectively, showing significant differences (P < 0.017). ConclusionOpen-door expansive laminoplasty by plate has better early outcome than open-door expansive laminoplasty by anchor fixation and conventional unilaterally open-door expansive laminoplasty in the treatment of multi-segmental CSM.
ObjectiveTo investigate the diagnosis and effectiveness of limited operative treatment for multi-segmental lumbar disease. MethodsBetween February 2008 and February 2011, 47 patients with multi-segmental lumbar disease were treated, including 27 males and 20 females with an average age of 60.3 years (range, 38-82 years) and a median disease duration of 21 months (range, 6 months to 7 years). Based on preoperative clinical manifestation and imaging examination results, the possibility of preliminary responsible segment was identified as two levels in 31 cases (L4, 5 and L5, S1 in 22 cases, L3, 4 and L4, 5 in 6 cases, L2, 3 and L3, 4 in 3 cases) and three levels in 16 cases (L3, 4, L4, 5, and L5, S1 in 9 cases, L1, 2, L4, 5, and L5, S1 in 4 cases, L2, 3, L4, 5, and L5, S1 in 3 cases). Selective nerve root block (SNRB) was used in all cases to identify the responsible segment. Based on the results, the patients were treated by limited operative treatment. The operation time, intra operative blood loss, postoperative drainage volume, postoperative ambulation time, and complications were recorded. The clinical outcome was evaluated according to the visual analogue scale (VAS) scores for back and leg pain, Japanese orthopaedic association (JOA) scores, and Oswestry disability index (ODI). The position of internal fixators and interbody fusion were observed through lumbar anteroposterior and lateral X-ray films. ResultsThe responsible segment was identified as single level in 33 cases (L4, 5 in 18 cases, L5, S1 in 11 cases, and L3, 4 in 4 cases) and two levels in 10 cases (L4, 5 and L5, S1 in 6 cases, L3, 4 and L4, 5 in 3 cases, L2, 3 and L4, 5 in 1 case) by SNRB. After SNRB, 4 cases did not receive surgical treatment because of a low relief rate of less than 30%. The operations were performed successfully in all 43 patients. The mean operation time was 101.9 minutes; the mean intraoperative blood loss was 164.5 mL; the mean postoperative drainage volume was 238.9 mL; and the mean postoperative ambulation time was 38.2 hours. There was no complication of nerve injury or incision infection. All 43 patients were followed up 12-36 months (mean, 19.3 months). The VAS scores, JOA scores, and ODI after operation were significantly improved when compared with preoperative ones (P<0.05). The postoperative JOA recovery rates were 62.2%±12.6%, 63.4%±12.4%, and 68.6%±14.6% at 3, 6 months, and last follow-up respectively, showing no significant difference (F=2.841, P=0.062). The postoperative X-ray films showed that the internal fixators were in good position without loosening or fracture, and the interbody fusion was good. ConclusionAfter identifying the responsible segment by SNRB in the diagnosis, limited operative treatment is safe and reliable in the treatment of multi-segmental lumbar disease. It can relieve compression effectively, decrease the range of operation, maintain the spinal stabilization, and has a good effectiveness.
ObjectiveTo explore the effect of spinal dural release on the effectiveness of expansive cervical laminoplasty for treating multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament. MethodsA retrospective analysis was made on the clinical data of 32 patients with multi-segmental cervical myelopathy with cervical ossification of posterior longitudinal ligament who underwent expansive cervical laminoplasty and spinal dural release between February 2011 and October 2013 (group A); and 36 patients undergoing simple expansive cervical laminoplasty between January 2010 and January 2011 served as controls (group B). There was no significant difference in gender, age, disease duration, affected segments, combined internal disease, preoperative cervical curvature, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score between 2 groups (P>0.05). Postoperative JOA score and improvement rate, VAS score, posterior displacement of the spinal cord, and the change of cervical curvature were compared between 2 groups. ResultsSpinal dural tear occurred in 3 cases (2 cases in group A and 1 case in group B) during operation. Cerebrospinal fluid leakage occurred in 3 cases (2 cases in group A and 1 case in group B) after operation. The patients were followed up 12-46 months (mean, 18.7 months). At last follow-up, the JOA score and VAS score were significantly improved in 2 groups when compared with preoperative scores (P<0.05). JOA score and improvement rate of group A were significantly higher than those of group B (P<0.05), but VAS score of group A was significantly lower than that of group B (P<0.05). At last follow-up, no significant difference in cervical curvature was found between 2 groups (P>0.05); posterior displacement of the spinal cord of group A was significantly larger than that of group B (P<0.05). No reclosed open-door was observed during follow-up. ConclusionFor patients with multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament, full spinal dural release during expansive cervical laminoplasty can increase the posterior displacement of spinal cord, and significantly improve the effectiveness.