From January, 1983 through December, 1993, 20 different types of operations were carried out to treat a total of 54 cases from trauma or deformities around the occipitocervical region, in which 4 patients died. The causes of the deaths were analyzed, and the main factors responsible for the mortality were improper selection of the wires for internal fixation, inadequate decompression from operation, incorrect operative technique and errors in the selection of anesthesia.
Objective To study operative methods of treating upper cervical spine instability without injury. Methods Twentythree cases were treated by internal fixation with autologous bone grafts. Atlantoaxial arthrodesis were performed in 10 cases with Apofix interlaminar clamp(5 cases), Atlas cable system(3 cases) and Brookes(2 cases). Occipitocervical fusion were performed in the other 13 cases by using of CD-cervical(3 cases), Cervifix(8 cases) and Ustick fixation(2cases). Results All the 23 cases were followed up for 2.5 years in average (ranged from 6 months to 5 years). Solid arthrodesis was obtained in all 23 cases . Six months after operation, of the 20 cases with preoperation nervous lesion, improvement was achieved in 16 cases. According to JOA standard and Hirabashiformula,the rate of improvement was 27.1%.Conclusion Posterior fusion is recommended for upper cervical unstability.
OBJECTIVE: To observe the early clinical results with degenerative lumbar instability treated with transpedical screw fixation and intertransverse process autogenous bone grafting. METHODS: From September 2000 to February 2002, 19 patients (5 males and 14 females) of degenerative lumbar spine instability were treated with decompression for spinal canal stenosis, transpedical screw fixation and intertransverse process autogenous bone grafting. The locations of degenerative lumbar spine instability were between L4 and L5 in 10 patients, between L3, L4 and L5 in 4 cases, between L3 and L4 in 3 cases, between L5 and S1 in 2 cases. The results were evaluated after operation. The preoperative clinical symptoms disappeared completely as excellent results, relieved obviously as good results, improved as fair results and unrelieved or worsened as poor results. RESULTS: Seventeen patients were followed up for 4-18 months with an average of 8.1 months. The results of the treatment were excellent in 12 patients, good in 4 patients and fair in 1 patient. The excellent and good rate was 94.1%. Intertransverse process arthrodesis was obtained after 6 months of operation in all cases. No loosened and broken instruments occurred. CONCLUSION: The advantages of degenerative lumbar spine instability treated with transpedical screw fixation and intertransverse are reliable fixation, high successful rate of fusion and less influence on spinal canal. The above results show satisfactory clinical outcome.
Objective To investigate the surgical method and prel iminary cl inical result of managing the patient with lumbar burst fracture but not suitable for single-level fixation and fusion surgery with the reservation of the fractured vertebral body and the anterior decompression. Methods From September 2007 to December 2008, 11 patients with lumbar burst fracture underwent the removal of the posterior superior corner of the injured vertebral body, the removal of the inferior intervertebral disc adjacent to the injured vertebral body, bone graft fusion, and internal fixation. There were 8 males and3 females aged 21-48 years old (average 29.4 years old). All the fractures caused by fall ing from high places. Imaging exams confirmed all the fractures were Denis type B burst fracture. The fracture level was at the L1 in 4 cases, the L2 in 4 cases, the L3 in 2 cases, and the L4 in 1 case. Before operation, the nerve function was graded as grade B in 4 cases, grade C in 3 cases, and grade D in 4 cases according to Frankel scales; the visual analogue scale (VAS) was (7.30 ± 0.98) points; lateral X-ray films displayed the kyphosis Cobb angel was (24.94 ± 12.21)°; the adjacent superior and inferior intervertebral disc height was (12.78 ± 1.52) mm and (11.68 ± 1.04) mm, respectively; CT scan showed the vertebral canal sagittal diameter was (9.56 ± 2.27) mm; CT three-dimensional reconstruction revealed that the intact part of the injured vertebra was less than 50% vertebra body height and the fracture l ine crossed the pedicle. The time from injury to operation was 3-11 days (average 4.8 days). The neurological and radiological evaluations were carried out immediately and 3 months after operation, respectively, and compared with the condition before operation. Results All the patients successfully underwent the surgery. The wound all healed by first intention. All the patients were followed up for 6-18 months (average 14 months). All the patients had a certain degree of nerve function recovery. The Frankel scales in all the patients were increased by 1-2 grade immediately and 3 months after operation. The VAS score was (2.80 ± 1.49) points immediately after operation and (1.54 ± 0.48) points 3 months after operation, suggesting there were significant differences among three time points (P lt; 0.05). The vertebral canal sagittal diameter was significantly enlarged to (18.98 ± 4.82) mm immediately after operation and was (19.07 ± 4.37) mm 3 months after operation. The Cobb angle was (7.78 ± 4.52)° immediately after operation and (8.23 ± 3.57)° 3 months after operation. There were significant differences between before and after operation (P lt; 0.05). For the adjacent superior and inferior intervertebral disc height, there was no significant difference when the value immediately or 3 months after operation was compared with that of before operation (P gt; 0.05). X-ray films and CT scan 3 months after operation showed good internal fixation without theoccurrence of loosing and displacement. Conclusion For the treatment of lumbar burst fracture, the method of reserving the injured vertebral body and anterior decompression can decompress the vertebral canal and shorten the duration for bony fusion.
Objective To amplificate,clone and sequence the thymidine kinase (TK) gene of herpes simplex virusⅡ(HSVⅡ); to construct and appraise the fusion gene eukaryon expression vector, pcDNA3/HSVⅡ TK/angiostatin. MethodsThe Hep2 cells were infected by HSVⅡ Sav strain. HSVⅡ genomic DNA was purified from the Hep2 cells suspension and used as template to run PCR for TK gene amplification. The amplified products were cloned into PC DNA3 vector and sequenced. The vector pcDNA/HSVⅡ TK was cut by endonuclease. The gained TK gene was cloned into eukaryon expression vector. pcDNA3/angiostation, which had been constructed. ResultsCoding region of HSVⅡTK gene consisted of 1 128 bp except stop code, it encoded 376 amino acids.After cutting the new vector by endonuclease Hind Ⅲ and BamH Ⅰ,we gained the following gene fragment: 1000 bp (TK) and 700 bp (angiostation).Conclusion The fusion gene eukaryon expression vector， pcDNA3/HSVⅡ TK/angiostatin has been constructed.
Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
Objective To discuss the selection of anterior or posterior or a combination of anterior and posterior surgical treatment of lower cervical dislocation. Methods A retrospectively study was performed on 28 patients with lower cervical dislocation who received operative treatment between January 2005 and October 2008. There were 19 males and 9 femaleswith an average age of 38 years (range, 19-57 years), including 21 cases of fresh dislocation and 7 cases of old dislocation. The time from injury to hospitalization was 3 hours to 58 days. According to Allen classification, all cases had flexion injury, including 19 cases of degree I dislocation, 2 cases of degree II, 5 cases of degree III, and 2 cases of degree IV. At admission according to Frankel classification, 7 cases were rated as grade A, 4 as grade B, 9 as grade C, 3 as grade D, and 5 as grade E. All patients received open reduction, internal fixation, and il iac bone graft spinal fusion. Of them, combined anterior and posterior approach operation were given in 4 cases, single anterior operation in 22 cases, and single posterior operation in 2 cases. Results All operations were completed successfully and the spinal cord injury did not deteriorate after operation. Esophageal fistula occurred in 1 case receiving anterior approach operation and was cured after 1 month. Infection of wound occurred in 1 case and was cured after dressing change. The other incisions healed by first intention. One case (Frankel grade A) died of pulmonary infection 6 weeks after operation. Twenty-seven patients were followed up 21-38 months. Two cases suffered from shoulder pain 12 months after operation. X-ray films showed complete reduction, normal height of vertebral space and normal sequence of cervical spine after operation. All cases obtained bone fusion after 3.5-6.0 months of operation (4.2 months on average). Frankel grades were improved in different degrees after operation. Conclusion The operation plan of lower cervical dislocation should be determined by the neurologic status of the patient, and the classification of the injury as a unilateral or bilateral dislocation. Anterior cervical discectomy, fusion, and fixation were available in the lower cervical dislocation.
Objective To evaluate differences of clinical effects between cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for single symptomatic single-level cervical degenerative disc disease. Methods Randomized controlled trials (RCTs) from the Cochrane Library Central Register of Controlled Trials (Issue 1, 2009), MEDLINE (2000 to May 2009), EMbase (2000 to May 2009), Ovid (2000 to May 2009), CBM (2000 to May 2009) and CNKI (2000 to May 2009) were electronically searched. Additionally, six relevant journals were handsearched to identify RCTs about comparison of TDR and ACDF in the treatment of single-level cervical degenerative disc disease. All RCTs demonstrating these issues were included. RevMan 5.0 software was used for meta-analyses. Results Six RCTs involving 1 340 patients were included. The results of meta-analyses indicated that there were significant differences between the two groups in neurological success (RR=1.06, 95%CI 1.02 to 1.11, P=0.003), secondary surgical procedures (RR=0.30, 95%CI 0.17 to 0.53, Plt;0.0001) and overall success (RR=1.13, 95%CI 1.06 to 1.22, P=0.0006). However, there were no significant differences in Neck Disability Index (NDI) scores (WMD=1.53, 95%CI –0.55 to 3.61, P=0.15), neck pain scores (WMD= –2.87, 95%CI 7.75 to 1.81, P=0.23), arm pain scores (WMD= –0.7, 95%CI –0.86 to –0.54, P=0.48), radiography success (RR=0.96, 95%CI 0.92 to 1.01, P=0.11), and postoperative complications (RR=0.79, 95%CI 0.49 to 1.28, P=0.34) between the two groups. Conclusion The evidence indicates that compared with ACDF, TDR could improve neurological status, reduce secondary surgical procedures and promote overall success for single-level cervical degenerative disc disease, but there are no significant differences in postoperative NDI, neck and arm pain scores, radiography success, and complications.
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.
Objective To evaluate the therapeutic effect ofthe two-level cervical artificial disc replacements combined with the nearby segments fused for the multi-level disc herniations and to investigate their interaction during the treatment. Methods The patient undergoing surgery was diagnosed as having intervertebral disc herniations in the C3-7 intervertebral discs. During the operation, the C4-6 discs were replaced with two Bryan artificial discs while the C3,4 and C6,7 discs were removed, followed by the bone grafting and the Zephir instrumentation. The range of motion (ROM) was assessed before and immediately after operation by the flexion-extension radiography. The patient’s functional exercise began as early as 2 days after operation and lasted for 3 weeks, followed by immobilization for 3 months. Results According to the follow-up for 1 year and 2 months, the patientcould move his neck in all directions without pain. The spinal and neural symptoms were significantly alleviated. ROM was close to the normal level postoperatively.Conclusion Artificial disc replacement combined with bone grafting and fusion is a new way to treat multilevel disc herniations surgically, with good clinical results. Early cervical functional exercise followed byrestriction is an effective way to deal with the contradiction of motion and immobilization.