Objective To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis. Methods The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress. Results Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone. Conclusion The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.
Objective To study the prevention and management of early compl ications associated with anterior cervical spinal surgery. Methods From November 1998 to December 2006, 363 cases were treated with anterior cervicalsurgery, including 268 males and 95 females aged 17-79 years．In these cases, 224 suffered from cervical spondylosis, 39 from cervical disc herniation, 87 from cervical trauma, 9 from cervical tumor and 4 from cervical tuberculosis. Forty-eight cases with anterior cervical surgery were fused by autogenous il iac bones, 132 cases with anterior cervical surgery were fused by autogenous il iac bones and anterior cervical spine locking plates, and 183 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates. Results A total of 282 cases were followed up for 3 months to 5 years with the average of 1 year and 11 months. Twenty-three compl ications associated with surgery were found, with an incidence of 8.16%. Three cases of transient superior laryngeal nerve palsy recovered within 3-7 days after the restriction of l iquid diet and fluid replacement. Two cases of recurrent laryngeal nerve palsy recovered by 3-month pronunciation practice. One case of spinal cord injury was treated with medicine for dehydration and anti-inflammation, and was restored to preoperative muscle power of inferior extremity after 6 months. Two cases of CSF leakage were cured with moderate local compression and meticulous water-tight wound closure. Among the 10 patients with compl ications of internal fixation, one suffering mild dysphagia was reoperated, while the others were treated with cephal-cervico-thorax plaster external fixation and recovered with sol id fusion within 3-18 months. Among the 4 cases with cervical hematoma, 1 died of wrong rescue procedures and 1 was infected. Conclusion Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach and skilled surgical technique are essential for preventing the early postoperative compl ications of anterior cervical spinal surgery．
Objective To study the clinical effects of the artificial vertebral body of the biomimetic nanohydroxyapatite/polyamide 66 (nHA/PA66) compositefor the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the nHA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 1767 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of thevertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%.The Cobb angle on the sagittal plane was 2138° averaged 27.6°. According tothe Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 625 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebralbody was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1grade or 2grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 35 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic nHA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.
ObjectiveTo compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis.MethodsThe data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments (P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A (t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups.ResultsCompared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences (P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] (t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation (P<0.05); the CRP of group B was significantly higher than that of group A (t=–2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups (P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups (Z=–1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference (χ2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation (t=–2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up (t=–1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups (t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A (t=4.824, P=0.000).ConclusionNon-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.
Objective To make a mouse model of traumatic spinal cord injury (SCI) by Allen’s weight dropping (WD),which might be helpful for further research on the mechanism of SCI. Methods A total of 180 healthy female mice, weighing 17 - 23 g (20 g on average), were randomized into 4 groups (n=45 per group): the experimental groups of A, B and C and the control group of D. Experimental groups were distinguished by the amount of weight or the height from which the weight was dropped onto an impounder resting on the dura (2.0 × 2.5 g·cm, 2.5 × 3.0 g·cm, 3.0 × 5.0 g·cm). In group D, neural scute was opened only and spinal cord was exposed without SCI. The recovery of the lower extremity was observed at various time points (0,6 and 12 hours, 1 and 3 days, 1, 2, 4 and 8 weeks) by using the Basso mouse scale (BMS) scoring system, motor evoked potentials (MEP) and histological observation. Results MEP displayed that the incubation period of N1 wave was extended in group B after 6 hours and in group C after 12 hours. As time passed by, the incubation periods of N1 wave in group A, group B and group C began to shorten. The incubation period in group A was close to normal at 4 weeks (2.40 ± 0.12) ms, and there was no significant difference compared with group D (P gt; 0.05). The incubation period in group B was close to normal at 8 weeks (2.96 ± 0.15) ms, and there was no significant difference compared with group D (P gt; 0.05). The incubation period in group C was still relatively high at 8 weeks (3.76 ± 0.13) ms, and there was a significant difference compared with group D (P﹤0.05). Both hind l imbs of all mice were paralytic instantly after SCI, the score of main BMS was 0 point; the score of main BMS was close to 0 at the first 3 days after SCI, the score of main BMS of group A was 8.00 ± 0.13 and group B was 7.50 ± 0.31 at 8 weeks;the score of main BMS of group A was 5.45 ± 0.12 at 1 week and group B was 5.45 ± 0.15 at 2 weeks which were significant difference compared with group D (P﹤0.05).There were significant differences among groups A, B and C after 1 week of SCI (P lt; 0.05), and group C was lower than the others(P﹤0.01). The score of adjuvant BMS of group A was 10.12 ± 0.76 at 2 weeks and group B was 9.85 ± 0.55 at 8 weeks which was no significant difference compared with the group D at the same time (P gt; 0.05). Histological observation showed hemorrhage, cellular edema, inflammatory cell infiltration, nerve cell swell and solution of Nissl body 12 hours after SCI in group C. As time passed by, the number of nerve cells decreased, the gl ial cell prol iferated and Nissl body vanished. There was much gl ial cell prol iferation and cavitation 2 weeks after SCI in group C. The nerve cell decrease and cavitation in group B was sl ighter than that in group C, and group A was the sl ightest. In group D, there was no obvious change of the number of cells during the observation apart from sl ight edema in early period. Conclusion The mouse model precisely reflects the pathological and physiological features and law of change after different degrees of SCI, and can be used as a standard of mouse model of traumatic SCI by Allen’s WD.
Objective To investigate the effect of tetramethylpyrazine (TMP) with a certain concentration added to vitrification solution on peripheral nerve allografts regeneration. Methods Forty-eight healthy clean SD male rats were selected as donors, and 96 healthy clean Wistar male rats as recipients, all rats being 3 months old and weighing 200-250 g. The sciatic nerves segments of 15 mm were removed from the donors, then randomly divided into 4 groups according to vitrificationsolution containing TMP. No TMP was used in group A as the control group; 100 mg/L, 200 mg/L and 400 mg/L TMP were used in group B, group C and group D, respectively. Then them were cryo-preserved at — 196 ℃ for 3 weeks. Nerve defect of 10 mm in length was made in the sciatic nerves of recipients. After rewarming, the allografts were transplanted to the corresponding rats. The gross appearance, the morphological and electrophysiological changes, the image analysis of axons and motor end-plate were detected at 4, 8, 12 and 16 weeks. Results All rates survived to the end of the experiment. The adhesion and edema of allografts in group A and group B were obvious 4 weeks after operation; then adhesion and edema was obvious in group A and were improved in the other groups 8 weeks after operation. Adhesion was observed in groups A and B; no adhesion was observed in groups C and D at 12 weeks. The number of regeneration nerve, the latent, the ampl itude, the nerve conduction velocity, the medullary sheath/μm2, the medullary sheath density/μm2 and the image analysis of axons and motor end-plate in groups A and B were significantly lower than those in groups C and D (P lt; 0.01); and there were no significant differences between groups C and D (P gt; 0.05). The observation of transmission electron microscope showed that medullated nerve fibers and myel in sheath of groups C and D were thicker than groups A and B, layers of groups C and D were clear. Conclusion The vitrification solution with 200 mg/L tetramethylpyrazine has protective effect on regeneration of peripheral nerve allografts．
To analyze the effectiveness of posterior pedicle screw system combined with interbodyfusion in treating lumbar spondylol isthesis. Methods Between January 2005 and January 2009, 26 patients with lumbar spondylol isthesis underwent posterior pedicle screw system combined with interbody fusion, including 11 males and 15 females with an average age of 56.8 years (range, 36-73 years). The disease duration was 7 months to 11 years. The affected lumbars were L3 in 3 cases, L4 in 12 cases, and L5 in 11 cases. According to the Meyerding evaluating system, 21 cases were classified as degree III, 5 cases as degree III-IV, and 1 case as degree IV. The cl inical results were investigated by measuring radiographic measurements, including Taillard index, Boxall index, sl i pping angle, lumbar lordosis angle,and intervertebral height index preoperatively, immediately, 2 weeks and 3 months postoperatively, respectively. SUK’s criteria was used to judge bone graft fusion. Results Primary heal ing of the incisions was achieved in all cases. Allpatients were followed up 25.8 months on average (range, 10-51 months). There were significant differences in Taillardindex, Boxall index, sl i pping angle, lumbar lordosis angle, and intervertebral height index between preoperatively andimmediately, 2 weeks, 3 months after operation (P lt; 0.05). Bone graft fusion was achieved at 3-8 months after operation(mean, 3.5 months); and the fusion rate was 100%. According to Japanese Orthopedic Association (JOA) scoring, theresults were excellent in 17 cases, good in 7 cases, fair in 1 case, and poor in 1 case; and the excellent and good rate was 92.3%. Compl ications occurred in 2 cases, including nail or rod breakage and nerve injury, and they were cured aftertreatment. Conclusion Posterior pedicle screw system combined with interbody fusion treating lumbar vertebralspondylol isthesis can afford sol id internal fixation and achieve a satisfactory reduction, so it maybe an ideal procedure and a worthy recommended method for treating lumbar spondylol isthesis.
ObjectiveTo explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.MethodsA retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups (P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups (P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group (P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones (P<0.05), and no significant difference was found between 2 groups at each time point (P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups (P>0.05) and between 2 groups at each time point after operation (P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation (P<0.05). The VAS score in double-level group was higher than that in single-level group (P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points (P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.ConclusionThe n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.
ObjectiveTo compare the effectiveness of decompression and short fusion or long fusion for degenerative scoliosis (DS) with a Cobb angle of 20-40° combined with spinal stenosis.MethodsThe clinical data of 50 patients with DS who were treated with decompression combined with short fusion or long fusion between January 2015 and May 2017 were retrospectively analysed. Patients were divided into long fusion group (fixed segments>3, 23 cases) and short fusion group (fixed segments≤3, 27 cases). There was no significant difference in gender, age, disease duration, and preoperative visual analogue scale (VAS) score of leg pain, Oswestry disability index (ODI), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic incidence (PI), pelvic title (PT), and sacral slope (SS) between the two groups (P>0.05); however, the VAS score of low back pain, Cobb angle, and sagittal vertical axis (SVA) in long fusion group were significantly higher than those in short fusion group (P<0.05), and the lumbar lordosis (LL) was significantly lower than that in short fusion group (t=2.427, P=0.019). The operation time, intraoperative blood loss, fluoroscopy times, hospital stay, and complications were recorded and compared. The VAS scores of low back pain and leg pain and ODI score were used to evaluate the clinical outcomes before operation and at last follow-up. X-ray films of the whole spine in standard standing position were taken before operation, at 6 months after operation, and at last follow-up, and the spino-pelvic parameters were measured.ResultsThe operation time, intraoperative blood loss, and fluoroscopy times in the short fusion group were significantly less than those in the long fusion group (P<0.05); there was no significant difference in hospital stay between the two groups (t=0.933, P=0.355). The patients were followed up 12-46 months with an average of 22.3 months. At last follow-up, the VAS scores of low back pain and leg pain and ODI score significantly improved when compared with those before operation (P<0.05). Except for the improvement of VAS score of low back pain (t=8.332, P=0.000), the differences of the improvements of the other scores between the two groups were not significant (P>0.05). The Cobb angle, SVA, TLK, and PT significantly decreased, while SS and LL significantly increased in the long fusion group (P<0.05), while the Cobb angle and PT significantly decreased and SS significantly increased in the short fusion group at last follow-up (P<0.05). There was no significant difference in spino-pelvic parameters between the two groups at 6 months after operation and at last follow-up (P>0.05). The improvements of Cobb angle, SVA, LL, PT, and SS in the long fusion group were significantly higher than those in the short fusion group at last follow-up (P<0.05). There was no perioperative death in both groups. The incidence of complications in the long fusion group was 34.8% (8/23), which was significantly higher than that in the short fusion group [11.1% (3/27)] (χ2=4.056, P=0.034).ConclusionThe DS patients with the Cobb angle of 20-40°can achieve satisfactory clinical outcomes and improve the spino-pelvic parameters by choosing appropriate fixation levels. Short fusion has less surgical trauma and fewer complications, whereas long fusion has more advantages in enhancing spino-pelvic parameters and relieving low back pain.
ObjectiveTo compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.MethodsBetween June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.ResultsExcept that the operation time of group B was significantly longer than that of group A (t=–2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=–2.716, P=0.007).ConclusionPosterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.