Ji-dong Zhang

Tianjin Eye Hospital, T’ien-ching-shih, Tianjin Shi, China

Are you Ji-dong Zhang?

Claim your profile

Publications (7)0 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To report three cases of transient paralysis shortly after (within 4 hours) anterior cervical corpectomy and fusion (ACCF), and investigate the possible causes. Clinical and radiological data of three cases (two men and one woman, aged 41-61 years) were analyzed retrospectively. All three patients underwent ACCF for cervical spondylotic myelopathy. The decompressed segments were located in C(5) , C(6) and C(5) + C(6) (-7) discs, respectively. Paralysis occurred from 30 minutes to 4 hours after surgery. In two cases the paralysis was complete; it was incomplete in the third. All patients received immediate dehydration, neurotrophic drugs and high-dose methylprednisolone therapy upon recognition of their paralysis. Meanwhile, cervical MRIs were performed and showed no significant hematomas compressing the cervical spinal cord; spinal cord edema was clearly evident in all cases. In two cases the paralysis resolved within 2 hours of diagnosis and immediate medication. In the third case, because the neurological symptoms were incompletely resolved 24 hours after beginning medication, a second laminoplasty was performed. During decompression, tremendous pressure was released from the cervical spinal cord. The neurological symptoms had resolved completely by 1 week after decompression. The precise cause for transient paralysis after these anterior cervical surgeries is not yet clear. Spinal cord ischemia-reperfusion injury is generally regarded as the most likely cause. Therefore, a combination of cervical spinal cord edema and limited anterior decompression space may have been the main contributing factors to the paralysis reported here. Early diagnosis and early intervention to relieve the paralysis can restore spinal cord function and result in a satisfactory prognosis.
    Orthopaedic Surgery 02/2013; 5(1):23-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To explore the clinical efficacies and outcomes of regional method axis pedicle screw insertion technique. During the period of April 2004 to June 2010, a total of 23 cases with traumatic instability of upper cervical vertebrae were recruited. There were 19 males and 4 females with a mean age of 45.8 years. They underwent surgical operations after an excellent traction reduction of cervical vertebrae. The entry points were drawn on axial facet joint and all of them distributed in the region of upper inner 1/4 of lower articular process. So the regional method was employed to determine the entry point. All subjects underwent the reconstruction of posterior stability. Axial pedicle screws were inserted by the insertion technique of axial pedicle screw via the "regional method". The entry region was in the upper inner 1/4 area of lower articular process. The entry angle, medial inclination and superior inclination were determined by the direction of inner wall and upper wall of isthmus. Postoperative cervical radiography and CT examination were performed to confirm the screw position. Forty-six axial pedicle screws were implanted. No significant complications occurred. All screws stayed in excellent positions without the invasion of vertebral artery and spinal canal. The "regional method" insertion technique of axial pedicle screw require no memory of complex entry points and entry angle parameters. And there is no need of identifying the anatomical landmarks. Thus this approach is accurate, safe and suitable for most patients.
    Zhonghua yi xue za zhi 03/2012; 92(9):624-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To discuss the effect of SB Charité lumbar artificial disc position on intervertebral range of motion (ROM) and clinical management. Between 2004 and 2007, 30 discogenic low back pain patients confirmed by discography underwent 1/2-level total disc replacement (TDR) implantation with 32 prostheses. There were 12 males and 18 females with a mean age of 44 years old (range: 28-55). All indexed levels were inserted between L4-S1 involving L4-5 (n = 9), L5S1 (n = 19) and L4-S1 (n = 2). The clinical outcome was measured by Oswestry disability index (ODI) and visual analogue scale (VAS). Radiographic outcome measures included flexion/extension ROM, restoration of operative level intervertebral disc height, maintenance of disc height at the final follow-up. A technique previously described by McAfee was used to evaluate TDR position in three groups. Paired t test was used to compare the preoperative and postoperative ROM and clinical ODI, VAS scores. Twenty-eight patients were followed-up for 24-60 months with an average of 38 months. All the prostheses were solidly immobilized with the vertebral endplate. No disc prosthesis rupture, dislocation, subsidence or heterotopic ossification was observed. Preoperative ODI, VAS back pain and VAS leg pain scores were 70.34 ± 9.21, 7.46 ± 2.65, 4.81 ± 2.75;and postoperative corresponding scores 7.65 ± 8.61, 0.68 ± 0.69, 0.35 ± 0.32 respectively. The positions of disc prostheses were graded as Group I, excellent, n = 17; Group II, suboptimal, n = 6; Group III, poor, n = 5. Preoperative mean intervertebral flexion/extension ROM (degree) of Group I to Group III were 9.75 ± 2.80, 10.30 ± 1.20 and 10.08 ± 2.43 respectively. The postoperative mean intervertebral flexion/extension ROM (degree): 6.68 ± 3.83, 4.22 ± 3.51 and 3.48 ± 3.56 respectively. Postoperatively all clinical outcome scores were lower than preoperative ones. Disc height was significantly restored. Mean intervertebral ROM decreased versus preoperative. Although there was a tendency of mean intervertebral ROM increasing with a better disc position, no statistical difference was observed. The mid-term clinical outcome of TDR is generally satisfactory. The TDR position influences intervertebral ROM to some extent. Efficient clinical management can reduce prosthetic malposition.
    Zhonghua yi xue za zhi 10/2010; 90(39):2750-4.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To study a mini-invasive extraperitoneal approach to lumbar spine and discuss its exposure technique, complications and management. Anterior lumbar surgery was performed in 52 patients via the mini-invasive anterior extraperitoneal approach. Diagnoses included lumbar degenerative instability (n=23), discogenic lumbar pain (n=25), lumbosacral congenital deformity (n=2) and revision after posterior laminectomy & discectomy (n=2). The patients underwent anterior lumbar interbody fusion (n=32) and total disk replacement (n=20). The operated disks included L(4-5) and L5-S1. There were single level (n=47) and double level (n=5). Operation time, blood loss, perioperative complications, postoperative bed-leaving time, incision length, pain of abdomen incision and postoperative hospitalization duration were recorded in details. All cases were exposed clearly and no one needed to prolong incision or change operation for an insufficient exposure. Average operation time was 85 min, average blood loss 155 ml, average postoperative bed-leaving time 3 days and average incision length 6.5 cm. All cases felt very little pain of abdominal incision and postoperative hospitalization duration was 7-10 days. Perioperative complications included vena cava tear (n=1), peritoneum tear (n=2), postoperative abdominal distention (n=3) and postoperative fever (n=5). No retrograde ejaculation was found in all male cases. The technique of mini-invasive extraperitoneal approach to anterior lumbar has such multiple advantages as fewer complications, less trauma, excellent exposure to anterior vertebrae and disk and without destruction of posterior spinal component
    Zhonghua yi xue za zhi 06/2009; 89(23):1607-10.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the clinical results of simultaneously combined anterior and posterior surgery for severe thoracolumbar fracture dislocations, and to clarify the surgical indications for these high-energy injuries. Thirty-four patients with severe thoracolumbar fracture dislocations were managed with simultaneously combined anterior and posterior surgery. The injured segments included the following: T11 (2 patients), T12 (5), L1 (1), L2 (8), L3 (5), L4 (2) and L4 and L5 (1). When classified according to the Magerl Classification, the breakdown was as follows: 12 A3 injuries, 2 B1, 2 B2, 12 C1 injuries, 4 C2, and 2 C3. Clinical data, including operative procedures, neurological changes, postoperative CT scans and sequential radiographs, was collected and analyzed. Thirty-two patients were followed up for an average of 13 months (range, 6-60). Operative time ranged from 180 to 320 min with a mean of 230 min. Intraoperative blood loss ranged from 900 to 2400 ml with a mean of 1200 ml. According to the classification of the American Spinal Injury Association (ASIA), neurological status improved at least 1 grade in all of the 24 patients who had an incomplete paralysis preoperatively. Satisfactory decompressions, reductions and reconstructions were obtained and well maintained in all patients at all intervals of follow-up. For severe thoracolumbar fracture dislocations that cannot be effectively treated with either an anterior or posterior approach alone, simultaneously combined anterior and posterior surgery is a reliable method that can achieve a sufficient decompression, reduction and reconstruction.
    Orthopaedic Surgery 02/2009; 1(1):28-33.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the diagnostic effectiveness of discography in discogenic low back pain (LBP). Ninety-six cases of chronic LBP with or without referred thigh pain were enrolled in this study. All these cases received CT scan following discography once conservative treatment for at least 6 months had failed. There were 42 men and 54 women, aged from 24 to 67 years (average 46.4). Discography was performed on 218 discs. The positive discs were classified morphologically according to the Dallas Discogram Description (DDD). (i) The 56 cases (58.3%) which were positive on discography were divided into two subgroups of age less or more than 50 years. Positive rates for the two subgroups were 33.3% and 66.7%, respectively; (ii) one hundred and twenty-two discs, of which 62 (50.8%) were positive on discography, showed morphologic abnormality, whereas all the discography positive discs showed morphologic abnormality. No complication related to discography was found in any case. (i) Compared with the younger patients, older LBP patients have a lower positive rate of discography despite the presence of more serious degenerative disc changes; (ii) outer layer disruption of the annulus fibrous correlates with positive discography; (iii) MRI intensity changes are not specific in diagnosing discogenic pain. Additional discography is needed to identify the painful disc; and (iv) the contrast volume injected into discs can be affected by a variety of factors which restrict its diagnostic value.
    Orthopaedic Surgery 02/2009; 1(1):47-51.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the spinal segment instant and fatigue stability of anterior lumbar interbody fusion with stand-alone cage. The vertebrae L4 and S1 of 6 human lumbar specimens (L3 - S1) were embedded with dental base acrylic resin powder and fixed on mechanical machine, and the L4/L5 and L5/S1 disk spaces were left active. The 6 specimens underwent mechanical test as control group first, and then used as experimental group with a cage implanted in L5/S1. Instant instability was tested in three directions: flexion, extension, and lateral bend. The relative movement of L4/L5 and L5/S1 was recorded. Fatigue instability was tested after 50 000 times of flexion-extension movement, and the relative displacement between the cage and S1 was recorded. In the three directions of flexion, extension, and lateral bend, the relative movements of L5/S1 in the experimental group were 0. 83 +/- 0.26 degrees, 1.60 +/- 0.19 degrees, and 0.72 +/- 0.20 degrees respectively, all significantly decreased than those of the control group (3.60 +/- 0.30 degrees, 4.82 +/- 0.34 degrees, and 3.80 +/- 0.28 degrees respectively, all P < 0.01). The relative movement of L4/L5 of the experimental group were 5.82 +/- 0.36 degrees, 5.38 +/- 0.30 degrees, and 4.96 +/- 0.29 degrees in the three directions respectively, all significantly higher than those of the control group (4.16 +/- 0.33 degrees, 4.02 +/- 0.30 degrees, and 3.48 +/- 0.34 degrees respectively, all P <0.01). After 50 000 times of flexion-extension fatigue movement, the relative displacement between the cage and S1 was zero. Anterior lumbar interbody fusion with a stand-alone cage has excellent instant and fatigue stability, which can provide enough stability for clinical bone fusion without other internal fixation.
    Zhonghua yi xue za zhi 02/2008; 88(7):457-60.