Qingquan Kong

Harvard Medical School, Boston, Massachusetts, United States

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Publications (48)42.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the feasibility and clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) for cauda equina syndrome (CES) caused by disc herniation. 16 patients with CES caused by LDH at the early and middle stages of Shi's classification were selected as the objects of study, who underwent PELD. Clinical outcomes were assessed using the Macnab criteria and the visual analogue scale (VAS). The VAS for leg pain and back pain significantly decreased from preoperative scores of 7.67 ± 1.23 and 7.52 ± 1.42, respectively, to postoperative scores of 1.71 ± 0.53 and 3.18 ± 0.72. Thirteen patients showed favorable results. Complications included one patient of motor weakness, and one patient developed an ipsilateral recurrent herniation who finally acquired satisfactory result after reoperation. Hence, PELD could be used as an alternative surgical method for the treatment of CES in properly selected cases and appropriate patient selection and a reasonable surgical approach will give rise to better outcomes.
    08/2015; DOI:10.1007/s13760-015-0530-0
  • Xi Yang · Qingyu Dou · Qingquan Kong · Yueming Song
    The spine journal: official journal of the North American Spine Society 04/2015; DOI:10.1016/j.spinee.2015.04.039 · 2.80 Impact Factor
  • Lian Xu · Qingquan Kong
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    ABSTRACT: To review the mechanism and research progress of signaling pathways which play key roles in the regulation of osteoblast differentiation and bone formation. Recent articles about signaling pathways of osteoblast differentiation and bone formation were reviewed and comprehensively analyzed. At present, multiple signaling pathways have been found to be involved in the regulation of osteoblast differentiation and bone formation, among which bone morphogenetic protein-Smads, Wnt/β-catenin, Notch, Hedgehog, and fibroblast growth factor signaling pathways may play the most important roles. Not only each pathway has a complex regulatory mechanism itself, but also contacts and impacts with each other, thus they formed a more complicated and sophisticated regulatory network, and regulate together osteoblast differentiation and bone formation. However, the mechanisms in detail of those pathways are still not very clear, because the animal experiment techniques are not yet mature as well as the relevant clinical trials were carried out not too much. The complete molecular mechanism of osteoblast differentiation and bone formation should be further investigated, so as to lay a theory foundation for preventing and treating the common bone diseases in clinical which are involve in osteoblast differentiation and bone formation.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2014; 28(12):1484-9.
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    ABSTRACT: To investigate the feasibility and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. Between July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at Ls level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. Accurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. Percutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.
  • Rong Xing · Qingquan Kong · Zhou Xiang · Jing Yang · Jingcong Luo · Li Deng · Huiqi Xie
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    ABSTRACT: To investigate the specific microRNA (miRNA) in osteogenic and chondrogenic differentiations of C3H10Tl/2 cells. C3H10Tl/2 cells were induced to differentiate into osteoblasts and chondrocytes. Specific miRNA more than 2 fold change and 2 average normalized probe signal between C3H10Tl/2 and C3H10Tl/2-derived osteoblast, and' between C3Hl0Tl/2 and C3H10Tl/2-derived chondrocytes were screened out by miRNA microarray, and verified by real-time fluorescence quantitative PCR (RT-qPCR). Alkaline phosphatase expression of osteogenic induced group was significantly higher than that of control group at 7 days after induced (P < 0.05). RT-qPCR results showed the expressions of Runx2, serine protease (Sp7), collagen type I, and osteopontin (OPN) genes were significantly increased at 7, 14, and 21 days after induced when compared with before induced (P < 0.05). Western blot results showed the expressions of Runx2, Sp7, collagen type I, and OPN proteins of osteogenic induced group were significantly higher than those of control group at 21 days after induced (P < 0.05). The expressions of SOX9, collagen type II, Aggrecan, and Has2 were significantly increased at 5, 10, and 15 days after induced when compared with before induced (P < 0.05). The expressions of SOX9, collagen type 2, Aggrecan, and Has2 proteins of chondrogenic induced group were significantly higher than those of control group at 15 days after induced (P < 0.05). Totally, 10 osteogenic and 3 chondrogenic miRNA more than 2 fold change and 2 average normalized probe signal were screened out by miRNA microarray. RT-qPCR results of these specific miRNAs were similar to microarray results except miR-455-3p. Specific miRNAs are screened out by microarray and it is a good foundation for the future study on miRNA functional verification and target gene prediction.
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    ABSTRACT: Study Design: A retrospect study. Objective: To investigate the effect of Centerpiece mini-plate fixation on the complete fracture and bony fusion of the hinge side in unilateral open-door cervical expansive laminoplasty. Summary of Background Data: Cervical laminoplasty is an effective and safe surgery for cervical canal stenosis. The Centerpiece mini-plate is an instrument used to secure the laminae and maintain cervical canal expansion. Stability of the new laminae is largely dependent on healing of the hinge side bone fracture and the degree of bony fusion. To date, few studies have reported on the effects of mini-plate fixation on these two important factors. Methods: Between September 2009 and March 2011, 58 patients received unilateral open-door cervical expansive laminoplasty at the authors' hospital. The group included 47 males and 11 females, with a mean age of 61 (35-81) years. Two hundred twenty five laminae were fixed using the Centerpiece mini-plate (group A), while 62 laminae were fixed using suture suspension (group B). The rates of fracture and bony fusion of the hinge were observed via CT scan and compared between the two groups. The complete fractures were subdivided into four groups based on the degree of displacement of the fractured ends: type I (no displacement), type II (mild to moderate displacement), type III (complete displacement or separation), or type IV (the hinge had collapsed into the cervical canal). Results: The number of incomplete fractures and type I-IV fractures in group A were 95, 93, 25, 8, and 4 respectively; and 29, 25, 4, 2, 2 in group B. There were no significant differences between the two groups in terms of complete fracture rates (P=0.309) and complete fracture type distribution (P=0.694). Group A had a significantly higher rate of bony fusion of the hinge three months after surgery (82% vs. 70%, P=0.042), however, this rate was not statistically significant six months after surgery (P=0.141). For type I complete hinge fracture, group A had higher bony fusion rates, both three months (86% vs. 57%, P=0.004) and six months (92% vs. 85%, P=0.048) postoperatively. The rates of bony fusion were also significantly different among all complete fracture types three months (P<0.001) and six months (P<0.001) postoperatively. Conclusion: Centerpiece mini-plate fixation in unilateral open-door cervical expansive laminoplasty might not increase the complete fracture rate compared with suture suspension, and might promote bony fusion of type I complete hinge fractures.
    Journal of Spinal Disorders & Techniques 07/2014; Publish Ahead of Print. DOI:10.1097/BSD.0000000000000131 · 1.89 Impact Factor
  • Xi Yang · Limin Liu · Yueming Song · Qingquan Kong · Jiancheng Zeng · Chongqi Tu
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    ABSTRACT: Cages have been widely used for the anterior reconstruction and fusion of cervical spine. Nonmetal cages have become popular due to prominent stress shielding and high rate of subsidence of metallic cages. This study aims to assess fusion with n-HA/PA66 cage following one level anterior cervical discectomy. Forty seven consecutive patients with radiculopathy or myelopathy underwent single level ACDF using n-HA/PA66 cage. We measured the segmental lordosis and intervertebral disc height on preoperative radiographs and then calculated the loss of segmental lordosis correction and cage subsidence over followup. Fusion status was evaluated on CT scans. Odom criteria, Japanese Orthopedic Association (JOA) and Visual Analog Pain Scales (VAS) scores were used to assess the clinical results. Statistically quantitative data were analyzed while Categorical data by χ(2) test. Mean correction of segmental lordosis from surgery was 6.9 ± 3.0° with a mean loss of correction of 1.7 ± 1.9°. Mean cage subsidence was 1.2 ± 0.6 mm and the rate of cage subsidence (>2 mm) was 2%. The rate of fusion success was 100%. No significant difference was found on clinical or radiographic outcomes between the patients (n=27) who were fused by n-HA/PA66 cage with pure local bone and the ones (n=20) with hybrid bone (local bone associating with bone from iliac crest). The n-HA/PA66 cage is a satisfactory reconstructing implant after anterior cervical discectomy, which can effectively promote bone graft fusion and prevent cage subsidence.
    Indian Journal of Orthopaedics 03/2014; 48(2):152-7. DOI:10.4103/0019-5413.128753 · 0.62 Impact Factor
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    ABSTRACT: To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction. There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores. All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05). The n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2014; 52(1):20-4.
  • Xi Yang · Yueming Song · Qingquan Kong
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    ABSTRACT: La dysplasie pseudorhumatoïde progressive (DPP) est une maladie autosomique récessive rare. L’atteinte polyarticulaire périphérique de la DPP a déjà été bien décrite auparavant. Cependant, l’atteinte rachidienne ainsi que son traitement chirurgical ont rarement été mentionnés. Un patient âgé de 44 ans, diagnostiqué de façon erronée comme atteint d’une polyarthrite rhumatoïde à début juvénile (PRJ) et déjà opéré avec la mise en place d’une prothèse totale de la hanche, souffrait essentiellement de problèmes rachidiens au moment de sa consultation. Les radiographies avaient mis en évidence une platyspondylie, des lésions Scheuermann-like du rachis et une atteinte périphérique ressemblant aux lésions de PRJ. L’absence de syndrome inflammatoire et l’absence des facteurs rhumatoïdes avaient suggéré le diagnostic de DPP. Une mutation de type délétion nucléotidique homozygote a été retrouvée au niveau du gène WISP3, confirmant le diagnostic de DPP. Une laminectomie décompressive associée à une fixation postérieure ont été réalisées. Un très bon résultat clinique a été constaté un an après la décompression et la fusion : la douleur du membre inférieur et l’hypoesthésie ont disparu et la fusion osseuse était complète. Il s’agit du premier cas documenté de décompression rachidienne chez un adulte atteint de DPP.
    Revue du Rhumatisme 12/2013; 80(6):615–617. DOI:10.1016/j.rhum.2013.06.006
  • Rong Xing · Jin Yang · Qingquan Kong · Chongqi Tu · Yong Zhou · Hong Duan
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    ABSTRACT: cell tumour of bone in the appendicular skeleton of patients first diagnosed and treated at the Orthopaedic Department of the West China Hospital in Sichuan University between 1988 and 2007. Fifty-eight percent of the tumours involved the knee region. The most common primary treatment was curettage (162 patients) combined with adjuvant local therapy. The effects of bone cement (PMMA), high-speed burring, electro- cauterization, liquid nitrogen, and phenol on the recurrence rate were also analyzed. The differences in local recurrence rates were analyzed between giant-cell tumours confined to bone (Campanacci grades 1 and 2) and giant-cell tumours with extraosseous extension (Campanacci grade 3) treated with intralesional curettage. The recurrence rate of patients who received the first treatment at our institution was 11.2%. Recurrence was observed in 31 cases and multiple recurrences were observed in 5 cases. Treatment included intralesional curettage (17.3%), marginal excision (14.3%), wide excision (1.9%), or radical resection (0%). Metastases, which mainly involved the lung, occurred in 6 cases (2.2%). There was a significantly lower recurrence rate (p = 0.004) following intralesional curettage combined with highspeed burring (n = 102) as compared with intralesional curettage without high-speed burring (n = 60). Although the efficacy of liquid nitrogen and electrocauterization did not reach significance, they seem to have a similar effect to high-speed burring. Therefore, we recommend high-speed burring as a necessary adjuvant therapy. The combination of all adjuvants (burring, liquid nitrogen, and electro-cauterization) is recommended as a standard treatment. Cement filling of the cavity after curettage was not widely used in this series, but its merits have been reported in several studies ; we therefore recommend that cement filling should be added to the adjuvants to be used after burring, liquid nitrogen and/or electrocauterization.
    Acta orthopaedica Belgica 12/2013; 79(6):731-7. · 0.57 Impact Factor
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    ABSTRACT: Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure which shows satisfying outcomes in the adult population. However, pediatric lumbar disc herniations (PLDH) occur in growing spines and are less related to degeneration, which makes them different from the adult disc herniations. This study evaluates the clinical outcomes of PEID in treating PLDH. A prospect study was done in the period from June 2010 to December 2012, which included 29 consecutive pediatric patients with a mean age of 16.4 years (range, 13 to 18 years) who underwent PEID for single level lumbar disc herniation. The following measuring tools were used: visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Macnab criteria. There were no severe complications such as dural tear or nerve root damage found in our study. The mean follow-up period was 19.7 months. The VAS score for leg and back pain decreased dramatically at 1 day postoperatively and kept decreasing until the follow-up visit at 3 months postoperatively, when it became stable at a low level. ODI kept improving until the follow-up visit at 6 months postoperatively when it reached a stable low level. Of the patients, 91 % reported no longer having leg pain and 9 % had occasional leg pain at last follow-up. PEID shows a satisfying outcome with a minimal rate of complications. It has the advantages of minimal traumatization and scar formation and is a safe and effective treatment for PLDH.
    Child s Nervous System 11/2013; 30(5). DOI:10.1007/s00381-013-2320-4 · 1.16 Impact Factor
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    Zhongjie Zhou · Yueming Song · Qianyun Cai · Qingquan Kong
    The spine journal: official journal of the North American Spine Society 11/2013; 14(6). DOI:10.1016/j.spinee.2013.11.015 · 2.80 Impact Factor
  • Lei Wang · Yueming Song · Haifeng Yuan · Limin Liu · Quan Gong · Qingquan Kong · Xi Yang
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    ABSTRACT: To investigate the influence of Nogo extracellular peptide residues 1-40 (NEP1-40) gene modification on the survival and differentiation of the neural stem cells (NSCs) after transplantation. NSCs were isolated from the cortex tissue of rat embryo at the age of 18 days and identified by Nestin immunofluorescence. The lentiviruses were transduced to NSCs to construct NEP1-40 gene modified NSCs. The spinal cords of 30 Sprague Dawley rats were hemisected at T9 level. The rats were randomly assigned to 3 groups: group B (spinal cord injury, SCI), group C (NSCs), and group D (NEP1-40 gene modified NSCs). Cell culture medium, NSCs, and NEP1-40 gene modified NSCs were transplanted into the lesion site in groups B, C, and D, respectively at 7 days after injury. An additional 10 rats served as sham-operation group (group A), which only received laminectomy. At 8 weeks of transplantation, the survival and differentiation of transplanted cells were detected with counting neurofilament 200 (NF-200), glial fibrillary acidic portein (GFAP), and myelin basic protein (MBP) positive cells via immunohistochemical method; the quantity of horseradish peroxidase (HRP) positive nerve fiber was detected via HRP neural tracer technology. At 8 weeks after transplantation, HRP nerve trace showed the number of HRP-positive nerve fibers of group A (85.17 +/- 6.97) was significantly more than that of group D (59.25 +/- 7.75), group C (33.58 +/- 5.47), and group B (12.17 +/- 2.79) (P < 0.01); the number of groups C and D were significantly higher than that of group B, and the number of group D was significantly higher than that of group C (P < 0.01). Immunofluorescent staining for Nestin showed no obvious fluorescence signal in group A, a few scattered fluorescent signal in group B, and strong fluorescence signal in groups C and D. The number of NF-200-positive cells and MBP integral absorbance value from high to low can be arranged as an order of group A, group D, group C, and group B (P < 0.05); the order of GFAP-positive cells from high to low was group B, group D, group C, and group A (P < 0.05); no significant difference was found in the percentage of NF-200, MBP, and GFAP-positive cells between group C and group D (P > 0.05). NEP1-40 gene modification can significantly improve the survival and differentiation of NSCs after transplantation, but has no induction on cell differentiation. It can provide a new idea and reliable experimental base for the study of NSCs transplantation for SCI.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 11/2013; 27(11):1368-74.
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    ABSTRACT: To investigate the effect of the penetration of mini-plate mass screws into facet joint on axial symptoms in cervical laminoplasty. A retrospective analysis was made on the clinical data of 52 patients who underwent unilateral open-door cervical expansive laminoplasty fixed with Centerpiece mini-plate between September 2009 and December 2011. There were 42 males and 10 females, with a mean age of 61.2 years (range, 34-83 years). Seventeen patients exhibited simple degeneration cervical canal stenosis, 25 patients had multilevel cervical disc protrusion, and 10 patients had ossification of posterior longitudinal ligaments. Disease duration ranged 1-120 months (median, 11 months). The Japanese Orthopedic Association (JOA) score was used to assess neurological function, and JOA recovery rates were calculated. The visual analogue score (VAS) and the neck disability index (NDI) were used to evaluate the axial pain and neck daily activities. The axial symptoms and other complications were recorded. The cervical canal diameter, cervical curvature, cervical canal cross area, and open angle were measured according to the X-ray films, CT scans, and MRI scans. The postoperative CT three dimensional (3-D) reconstruction images were used to identify whether the screws penetrated into the facet joints. All the patients were divided into 3 groups according to involved facet joints: no joint penetrating group (no penetrated facet joint), oligo-joint penetrating group (one or two penetrated facet joints), and multi-joint penetrating group (three or more penetrated facet joints). Five patients suffered from C5 nerve palsy, and 2 patients had cerebrospinal fluid leakage. The follow-up time ranged 3-35 months (mean, 15.7 months). At the final follow-up, the JOA scores, NDI, cervical canal diameter, and cervical canal cross area were significantly improved when compared with preoperative ones (P < 0.05). At 1 week after operation, CT 3-D reconstruction showed that 16 patients had no penetrated facet joint, 23 patients had one or two penetrated facet joints, and 13 patients had three or more penetrated facet joints. There was no significant difference in age, gender, disease duration, operation time, intraoperative blood loss, and follow-up time among 3 groups (P > 0.05). And at the final follow-up, there was no significant difference in JOA score, VAS score, cervical curvature, cervical canal diameter, cervical canal cross area, the JOA recovery rates, and lamiae open angle among 3 groups (P > 0.05). The NDI of the multi-joint penetrated group was significantly higher than that of other 2 groups (P < 0.05). Axial pain occurred in 1 case of no penetrating group, in 4 cases of oligo-joint penetrating group, and in 5 cases of multi-joint penetrating group, showing no significant difference among 3 groups (Chi(2)=4.881, P=0.087). The penetrations of lateral mass screws into articular surface of facet joint may contribute to the axial symptoms after cervical laminoplasty. The risk of axial symptom raises accompany with increased penetrated facet joints.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 11/2013; 27(11):1324-30.
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    ABSTRACT: To assess the correction effect of hemivertebra resection for unbalanced multiple hemivertebrae by measuring corresponding parameters in both coronal and sagittal planes on series posteroanterior and lateral radiographs and report the related complications. Twelve children with unbalanced multiple hemivertebrae were operated on by hemivertebra resection through a combined anterior and posterior approach or a posterior-only procedure. Mean age at time of surgery was 9.8 years (range 2-14 years). They were retrospectively studied with a mean follow-up of 48.7 months (range 30-60 months). The mean Cobb angle of the main curve was 65.3° (range 45°-92°) before surgery and 13.8° (range 4°-30°) at the last follow-up. The correction rate was 80.0 % (range 65.5-92.4 %). The compensatory cranial curve was corrected from 25.8° (range 5°-53°) to 11.7° (range 0°-34°) with a correction rate of 65.9 % (range 33.3-100 %), and the compensatory caudal curve was corrected from 32.4° (range 17°-57°) to 7.1° (range 0°-20°) with a correction rate of 81.4 % (range 53.1-100 %). The angle of segmental kyphosis was 41.3° (range 12°-76°) before surgery and 17.0° (range -12° to 45°) at the final follow-up. The coronal imbalance was -1.0 cm (range -3.5 to 3 cm) before surgery and 0.0 cm (range -1.0 to 1.5 cm) at the most recent follow-up. The sagittal imbalance was 0.9 cm (range -3.2 to 3 cm) before surgery and 0.6 cm (range -3.0 to 3.5 cm) at the most recent follow-up. Complications including pedicle fractures, and pseudarthrosis were found in two patients (20 %). In the patients with unbalanced multiple hemivertebrae, hemivertebra resection allows for excellent correction in both the coronal and sagittal planes, and great care should be taken to reduce the rate of complications.
    European Spine Journal 10/2013; 23(3). DOI:10.1007/s00586-013-3065-1 · 2.47 Impact Factor
  • Xi Yang · Qingquan Kong · Yueming Song · Limin Liu · Jiancheng Zeng · Rong Xing
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    ABSTRACT: A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results. Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients' symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrum-bicoxofemoral distance (SFD). The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P < 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P < 0.05). PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.
    European Spine Journal 10/2013; 23(3). DOI:10.1007/s00586-013-3067-z · 2.47 Impact Factor
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    ABSTRACT: To determine the surgical indications for posterior expansive open-door laminoplasty (EOLP) extended to the C1 level. Seventeen patients undergoing C3-7 or C2-7 open-door laminoplasty were included as the case group between September 2005 and January 2010, whose spinal cord injury symptoms were not alleviated or aggravated again because of the cervical stenosis at C-4 level, and the causes of the surgery itself were eliminated, all of these patients underwent reoperation with decompress upward to C1 level. Fifteen patients with cervical stenosis who underwent C2-7 laminoplasty and C1 laminectomy were selected as the control group. There was no significant difference in gender, age, and disease duration between 2 groups (P > 0.05). The pre- and post-operative cervical curvature and spinal cord compression were evaluated according to the patients' imaging data; the pre- and post-operative neurological recovery situation was evaluated by Japanese Orthopaedic Association (JOA) 17 score and spinal cord function Frankel grade; the neurological recovery rate (according to Hirabayashi et al. method) was used to assess the postoperative neurological recovery situation. In the case group, 8 patients underwent primary C37 laminoplasty. In 3 of these patients, there was a cervical stenosis at C1, 2 level, and discontinuous cerebrospinal fluid around the spinal cord was observed; 5 of them with a compression mass which diameter was exceed 7.0 mm in the C2-4 segments. The remaining 9 patients in the case group underwent primary C2-7 laminoplasty, and the diameter of the compression mass was exceed 7.0 mm in the C2-4 segments. In all 17 patients of the case group, reoperation was performed with the decompression range extended to the C1 level, and the follow-up time was 35-61 months with an average of 45.6 months. Cervical curvature: there were 11 cases of cervical lordosis, 4 cases of straight spine, and 2 cases of cervical kyphosis before operation; but after operation, 2 cases of cervical lordosis became straight spine and 1 straight case became kyphosis. The postoperative neurological improvement was excellent in 8 cases, good in 7, and fair in 2. In the control group, all the patients had a compression mass which anteroposterior diameter was exceed 7.0 mm in the C2-4 segments before operation. The follow-up time was 30-58 months with an average of 38.7 months. Cervical curvature: there were 13 cases of cervical lordosis and 2 cases of straight spine before operation; but after operation, 1 case of cervical lordosis became straight spine. The postoperative neurological improvement was excellent in 8 cases, good in 6, and fair in 1. No significant difference was found in the JOA score at pre- and post-operation between 2 groups (P > 0.05); however, there were significant differences (P < 0.05) in the JOA score between at last follow-up and at preoperation. The initially surgical indications which can be used as a reference for EOLP extended to C1 are as follows: (1) Upper cervical (C1, 2) spinal stenosis: C1 posterior arch above the lower edge part of cerebrospinal fluid around the spinal cord signal is not continuous, and the anteroposterior diameter of the spinal canal actual is less than 8.0 mm as judgment standard. (2) There is a huge compression at the lower edge of C2-4 vertebrae, and the most prominent part of the diameter is exceed 7.0 mm, which can not be removed through the anterior cervical surgery, or the operation is high-risk.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2013; 27(10):1214-20.
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    ABSTRACT: The titanium mesh cage (TMC) is a typical metal cage device which has been widely used in cervical reconstruction for decades. Nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic non-metal cage device growing in popularity in many medical centres in recent years. There has been no comparison of the efficacy between these two anterior reconstructing cages. The purpose of this study was to compare the radiographic and clinical outcomes of these two different devices. Sixty-seven eligible patients with single-level ACCF using TMC or n-HA/PA66 cage for cervical degenerative diseases, with four-year minimum follow-up, were included in this prospective non-randomised comparative study. Their radiographic (cage subsidence, fusion status, segmental sagittal alignment [SSA]) and clinical (VAS and JOA scales) data before surgery and at each follow-up was recorded completely. The fusion rate of the n-HA/PA66 group was higher than TMC at one year after surgery (94 % vs. 84 %) though their finial fusion rates were similar (97 % vs. 94 %). Finial n-HA/PA66 cage subsidence was 1.5 mm with 6 % of severe subsidence over three millimetres, which was significantly lower than the respective 2.9 mm and 22 % of TMC (P < 0.0001). Lastly, SSA, VAS and JOA in TMC group were worse than in the n-HA/PA66 group (P = 0.235, 0.034 and 0.007, respectively). The n-HA/PA66 cage is associated with earlier radiographic fusion, less subsidence and better clinical results than TMC within four years after one-level ACCF. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to TMC in anterior cervical construction.
    International Orthopaedics 09/2013; 37(12). DOI:10.1007/s00264-013-2101-4 · 2.02 Impact Factor
  • Quan Gong · Qingquan Kong
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    ABSTRACT: To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group (SDSG) classification system for lumbosacral spondylolisthesis. Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Pelvic incidence (PI) is the key pathogenic factor oflumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti-Bartolozzi, and Mac-Thiong-Labelle classification systems oflumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 09/2013; 27(9):1134-7.
  • Xi Yang · Yueming Song · Qingquan Kong · Hao Liu · Limin Liu · Quan Gong · Tao Li
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    ABSTRACT: To analyze the clinical features and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis. The clinical data of 11 patients with traumatic lumbar spondylolisthesis who underwent surgeries between January 2008 and June 2012 were retrospectively analyzed. There were 6 male and 5 female patients, aged from 13 to 60 years with a median age of 38 years. The mechanism of injury included heavy pressure injury in 4 cases, falling injury from height in 4 cases, and traffic accident injury in 3 cases. The time of injury to operation was between 3 days and 13 years (median, 20 days). According to Frankel neurological function grading, 2 patients were rated as grade E, 4 as grade D, 3 as grade C, and 2 as grade B before operation; according to Meyerding spondylolisthesis grading, 4 cases were classified as degree I, 4 as degree II, 2 as degree III, and 1 as degree IV preoperatively. The affected segments included L4 in 3 and L5 in 8 patients. The surgical fixation segments were L4, 5 in 2 patients, L5, S1 in 7, and L4-S1 in 2. Eight patients underwent circumferential fusion, while 3 patients underwent posterolateral fusion. The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up. The clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) scores. All patients achieved primary healing of incision after operation. And all patients were followed up 6-40 months with a median time of 12 months. There was no pulling-out or breaking of internal fixation. The fusion rate was 100% on three-dimensional CT scans, and the fusion time was 3-6 months (mean, 4.5 months). The spondylolisthesis was degree 0 in 10 cases and degree I in 1 case according to Meyerding grading, showing significant difference when compared with preoperative spondylolisthesis grading (Z = -2.979, P = 0.003). The Frankel neurological function grading were E in 6, D in 3, and C in 2 at last follow-up, which were significantly improved when compared with preoperative one (Z = -2.271, P = 0.014). At 1 week after operation and last follow-up, VAS and ODI scores were significantly improved when compared with the preoperative scores (P < 0.05); however, no significant difference was found between at 1 week and at last follow-up (P > 0.05). If lumbar X-ray films suggest multiple fractures of transverses in emergency combined with the mechanism of injury, it strongly indicates the diagnosis of traumatic lumbar spondylolisthesis, moreover earlier decompression and fusion can provide the recovering of the neurological function and satisfactory preliminary effectiveness in these patients.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2013; 27(8):965-8.

Publication Stats

61 Citations
42.03 Total Impact Points

Institutions

  • 2015
    • Harvard Medical School
      • Department of Orthopaedic Surgery
      Boston, Massachusetts, United States
  • 2010–2014
    • Sichuan University
      • Department of Orthopedic Surgery
      Hua-yang, Sichuan, China
    • Peking University
      Peping, Beijing, China