ObjectiveTo discuss the effectiveness and safety of intravenous application of tranexamic acid in reducing the blood loss in the perioperative period of lumbar fusion surgery. MethodsA retrospective study of 68 patients with degenerative lumbar spinal stenosis with lumbar instability who were treated with lumbar fusion surgery from March 2013 to March 2014 in West China Hospital was carried out. The patients were divided into tranexamic acid group and control group according to whether tranexamic acid was used. After induction of anesthesia, tranexamic acid was given by intravenous drop to patients in the tranexamic acid group, while the control group did not receive any hemostatic drug. The red blood cell count, hemoglobin, mean corpuscular volume, prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin, intraoperative blood loss, postoperative blood loss, and blood transfusion volume before and after operation were compared. And we also observed whether there was pulmonary embolism or deep vein thrombosis incident. ResultsIt showed no significant difference in intraoperative blood loss between the two groups, but the tranexamic acid group had less blood loss after operation than that of the control group (P<0.05). The tranexamic acid group had a higher red blood cell count, hemoglobin and mean corpuscular volume after operation than that of the control group (P<0.05). There was no significant difference between the two groups in prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin before and after operation (P>0.05). The pulmonary embolism and deep vein thrombosis were not found in the two groups. ConclusionIntravenous application of tranexamic acid is safe and effective in posterior lumbar fusion surgery. It can reduce the postoperative blood loss significantly, without increasing the risk of pulmonary embolism and deep vein thrombosis.
This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery.
ObjectiveTo review the effect of obesity on the effectiveness of posterior lumbar fusion in patients with lumbar degenerative diseases (LDD).MethodsThe related literature at home and abroad was extensively reviewed. And the difficulty of operation, risk of complications, and long-term effectiveness of posterior lumbar fusion for obese patients with LDD were summarized.ResultsAlthough some relevant literature suggest that the posterior lumbar fusion for obese patients is difficult and the risk of postoperative complications is high, the overall research results do not suggest that obesity is a risk factor for the implementation of posterior lumbar fusion. By assessing the physical condition of patients and strictly grasping the surgical indications, obese patients can obtain good surgical efficacy.ConclusionPosterior lumbar fusion is an effective method for the treatment of LDD in obese patients. However, relevant studies need to be completed to further evaluate the safety and efficacy of posterior lumbar fusion for obese patients.
ObjectiveTo summarize the research progress on spontaneous facet fusion (SFF) after lumbar spine surgery, and provide reference for further research on SFF. Methods The definition, development, clinical significance, and related influence factors of SFF were throughout reviewed by referring to relevant domestic and foreign literature in recent years. Results SFF is a phenomenon of joint space disappearance and fusion of upper and lower articular processes, which starts in a ring shape from the outermost edges to the central regions. Currently reported SFF occurred after posterior lumbar pedicle screw fixation. SFF may increase the stability of surgical segments and relieve clinical symptoms of patients. SFF is closely related to the method of lumbar internal fixation, facet osteoarthritis, interbody fusion, age, body mass index, type B fracture (according to AO classification), and the operative segment. Conclusion Most reported SFF occur after posterior lumbar pedicle screw fixation, which can increase lumbar stability, but the mechanism and influencing factors remain to be further clarified.
ObjectiveTo compare the effectiveness of percutaneous coaxial large-channel endoscopic lumbar interbody fusion (PE-LIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of degenerative lumbar spinal stenosis. Methods The clinical data of 134 patients with single-segment degenerative lumbar spinal stenosis who met the selection criteria between January 2019 and January 2021 were retrospectively analyzed, including 52 cases in PE-LIF group and 82 cases in MIS-TLIF group. There was no significant difference in general data such as gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) scores of low back pain and lower extremity pain, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization stay, and complications were recorded and compared between the two groups. The level of serum creatine kinase (CK) was recorded at 1 day before operation and at 1 and 3 days after operation to evaluate intraoperative muscle damage. The Brantigan criteria was used to evaluate the interbody fusion in the two groups. The VAS scores of low back pain and lower extremity pain at 1 day before operation and at 3 days, 3 months, and 1 year after operation, and the ODI scores at 1 day before operation and at 3 months and 1 year after operation were recorded and compared between the two groups. ResultsThere was no significant difference in operation time and hospitalization stay between the two groups (P>0.05). The intraoperative blood loss and postoperative drainage in the PE-LIF group were significantly lower than those in the MIS-TLIF group (P<0.05). There was no significant difference in serum CK between the two groups before operation (P>0.05), and the serum CK in the PE-LIF group at 1 and 3 days after operation were significantly lower than those in the MIS-TLIF group (P<0.05). All patients were followed up regularly for 1 year. The postoperative VAS scores of low back pain and lower extremity pain and ODI score in both groups were significantly lower than those before operation (P<0.05); there was no significant difference between the two groups (P>0.05). At 1 year after operation, 48 patients in PE-LIF group had successful interbody fusion, and 77 patients in MIS-TLIF group had successful interbody fusion. There was no significant difference in the interbody fusion distribution between the two groups at 3 months and 1 year after operation (P>0.05). There were 2 and 3 cases of lower limb numbness, 1 and 3 cases of neuroedema pain, 1 and 1 case of Cage displacement, 1 and 1 case of pedicle screw loosening in the PE-LIF group and MIS-TLIF group, respectively. No infection or dural sac tearing occurred in the two groups. There was no significant difference in the incidence of complications between the two groups (9.6% vs. 9.8%) (χ2=0.001, P=0.979). ConclusionIn the treatment of single-segment degenerative lumbar spinal stenosis, PE-LIF can achieve similar effectiveness as MIS-TLIF, and PE-LIF has less intraoperative blood loss and less muscle damage.
Objective To investigate the accuracy and effectiveness of acetabular cup placement in total hip arthroplasty (THA) after lumbar fusion applying of modified acetabular anteversion and inclination angles test system. Methods A clinical data of 45 patients undergoing THA for osteoarthritis between January 2018 and June 2023 was retrospectively analyzed. All patients had previously received lumbar fusion. The modified acetabular anteversion and inclination angle test system was used in 26 cases (observation group) and not used in 19 cases (control group) during THA. There was no significant difference in baseline data such as gender, age, body mass index, operative side, number of lumbar fusion segments, and preoperative Harris score between the two groups (P>0.05). The position of acetabular prosthesis, hip function (Harris score), and incidence of complications were compared between the two groups.Results In the observation group, all acetabular cups were in the safe zone (anteversion angle, 25°-30°) during operation, and 1 acetabular cup (3.85%) was not in the safe zone after operation. In the control group, 9 acetabular cups (47.37%) were not in the safe zone. The postoperative difference between the two groups was significant (P<0.05). There was no significant difference between intra- and post-operative acetabular inclination angles in the observation group (P>0.05), and the postoperative acetabular inclination angle was significantly smaller in the observation group than in the control group (P<0.05). All incisions healed by first intention and no infection occurred. All patients were followed up 6 months. There was no significant difference in Harris score between the two groups at different time point (P>0.05), and there were significant differences between different time points in the two groups (P<0.05). No joint dislocation occurred in the observation group during follow-up, while dislocation occurred in 2 cases and femoral impingement syndrome occurred in 1 case of the control group. There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion For THA patients with lumbar fusion, the ideal placement angle of the acetabular cup can be obtained by using the modified acetabular anteversion and inclination angles test system during operation.