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ABSTRACT: PURPOSE: To compare the efficacy and safety of TDR to that of the fusion for the treatment of lumbar degenerative disc disease (LDDD). METHODS: Randomized controlled trials comparing TDR with any other intervention for LDDD were acquired by a comprehensive search in PubMedCentral, MEDLINE, EMBASE, BIOSIS, ClinicalTrials.gov, and the FDA trials register. Methodologic quality was assessed and relevant data were retrieved, and appropriate meta-analysis was performed. Two review authors independently selected studies, extracted data, and assessed risk of bias. Results and upper bounds of confidence intervals were compared with predefined clinically relevant differences. RESULTS: Six relevant randomized controlled trials (RCTs) involving 1,603 patients were identified and reported two year follow-up results. Patients in TDR group compared with lumbar fusion group demonstrated significant improvements in ODI, VAS scores and complication rates at the two year follow-up. Meanwhile, except for operating time in anterior group, intra-operative blood loss, operating time in posterior group, and reoperation rate were without clinical significance between the two groups. In addition, the range of motion (ROM) was maintained within normal ranges after TDR. CONCLUSIONS: The results showed the TDR has significant safety and efficacy comparable to lumbar fusion at two year follow-up. Although superiority compared to fusion could not be proved, by comparing clinical symptoms relieved, motion preserved, and the low reoperation rate during long-term follow-up on TDR, TDR was considered safe and effective. Therefore, the authors suggest adopting TDR on a large scale; with failure of TDR, interbody fusion would be performed.
International Orthopaedics 05/2013; · 2.03 Impact Factor
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ABSTRACT: Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal-recessive disorder. The polyarthritis of PPD has been detailed before. However, the spinal disorder and surgical treatment been rarely mentioned. A 44-year-old patient who has been misdiagnosed as juvenile rheumatoid arthritis (JRA) and given unilateral total hip replacement yet, suffers mainly from severe spinal disorder this time. The platyspondyly, Scheuermann-like lesions of the spine and JRA-like features of the peripheral joints were found on radiographic films, combining negative inflammatory and rheumatoid factors, which most suggested the diagnosis of PPD. As the homozygous nucleotide deletion was found in WISP3 gene, diagnosis of PPD was definite. Neurological examination and further imaging examination indicated severe compression of thoracic and lumbar spinal cord which might lead to his conspicuous spinal disorder. Decompressive laminectomy, posterior fusion and fixation were performed. And an excellent clinical outcome was achieved 1year after the decompression and fusion: leg pain and hypoesthesia resolved and osseous fusion performed. This is the first reported decompression in the adult spine of PPD. Surgical treatment could receive satisfactory result in PPD, however, it is a palliative therapy which has less help to prevent the development of this disease. Early diagnosis and rehabilitation interventions remain the most important. Clinical, radiographic and genetic features in PPD are crucial in the differential diagnosis.
Joint, bone, spine: revue du rhumatisme 04/2013; · 2.25 Impact Factor
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ABSTRACT: To compare the short-term effectiveness of minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) versus open-TLIF in treatment of single-level lumbar degenerative disease.
Between February 2010 and February 2011, 147 patients with single-level lumbar degenerative diseases underwent open-TLIF in 104 cases (open-TLIF group) and MIS-TLIF in 43 cases (MIS-TLIF group), and the clinical data were analyzed retrospectively. There was no significant difference in gender, age, disease type, lesion level, disease duration, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P > 0.05). The operation time, intraoperative radiological exposure time, intra- and post-operative blood loss, postoperative hospitalization time, and postoperative complications were compared between 2 groups. The VAS score and ODI were observed during follow-up. The imaging examination was done to observe the bone graft fusion and the locations of internal fixator and Cage.
There was no significant difference in operation time between 2 groups (t = 0.402, P = 0.688); MIS-TLIF group had a decreased intra- and post-operative blood loss, shortened postoperative hospitalization time, and increased intraoperative radiological exposure time, showing significant differences when compared with open-TLIF group (P < 0.05). Cerebrospinal fluid leakage (2 cases) and superficial infection of incision (2 cases) occurred after operation in open-TLIF group, with a complication incidence of 3.8% (4/104); dorsal root ganglion stimulation symptom (3 cases) occurred in MIS-TLIF group, with a complication incidence of 7.0% (3/43); there was no significant difference in the complication incidence between 2 groups (chi2 = 0.657, P = 0.417). The patients were followed up 18-26 months (mean, 21 months) in MIS-TLIF group, and 18-28 months (mean, 23 months) in open-TLIF group. The VAS scores and ODI of 2 groups at each time point after operation were significantly improved when compared with those before operation (P < 0.05). There was no significant difference in VAS score between 2 groups at discharge and 3 months after operation (P > 0.05); VAS score of MIS-TLIF group was significantly lower than that of open-TLIF group at last follow-up (t = 2.022, P = 0.047). At 3 months and last follow-up, no significant difference was found in the ODI between 2 groups (P > 0.05). The imaging examination showed good positions of Cage and internal fixator, and bone graft fusion in 2 groups.
The shortterm effectiveness of MIS-TLIF and open-TLIF for single-level degenerative lumbar diseases was similar. MIS-TLIF has the advantages of less invasion and quick recovery, but the long-term effectiveness needs more observation.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 03/2013; 27(3):262-7.
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ABSTRACT: To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis.
Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 +/- 1.2 and Oswestry disability index (ODI) was 72.0% +/- 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 +/- 2.8) degrees and (14.1 +/- 1.9) degrees, respectively.
All incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 +/- 0.5) and ODI (17.6% +/- 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P < 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 +/- 2.1) degrees and (13.5 +/- 1.7) degrees, respectively; showing significant differences when compared with preoperative values (P < 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment.
The posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 03/2013; 27(3):274-7.
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ABSTRACT: BACKGROUND CONTEXT: Scoliosis in association with spondylolisthesis is a common phenomenon. According to the traditional opinion, scoliosis should be managed depending on its classification and flexibility. Recently, Crostelli and Mazza proposed a new opinion toward this topic. They advocate that spondylolisthesis-associated scoliosis, especially severe scoliosis, should be considered as idiopathic scoliosis and must be treated with the same principles used in the treatment of idiopathic scoliosis. According to their viewpoints, more scoliotic curves in association with spondylolisthesis need to be treated, either surgically or conservatively. PURPOSE: To describe the spontaneous correction of a severe case of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN: Case report of a patient with scoliosis developing in association with high-grade lumbar spondylolisthesis. METHODS: A 12-year-old girl presented with a 2-year history of spinal curvature. She did not have low back or leg pain. The scoliotic deformity corrected readily in the supine position. Radiographs revealed 88% slippage of L5 on S1 in addition to a long section curve of the spine with the main 50° curve at the thoracic level. The spondylolisthesis was repaired with segmental instrumentation and circumferential fusion of L5 and S1. RESULTS: The scoliosis showed spontaneous resolution gradually after lumbosacral fusion and reached a complete correction 2 years after surgery. CONCLUSIONS: The relationship between scoliosis and spondylolisthesis is complex. If scoliosis is considered to be caused by spondylolisthesis, surgery for the latter condition might be the only required intervention for the patient. Unnecessary operation for scoliosis should be avoided.
The spine journal: official journal of the North American Spine Society 02/2013; · 2.90 Impact Factor
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ABSTRACT: To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS).
Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P > 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter's standard and the correction of Cobb angle was assessed by X-ray films.
All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P > 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (chi2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter's standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= -1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P < 0.05), but there was no significant difference between 1 week and last follow-up (P > 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957).
Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2013; 27(2):129-34.
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Ganjun Feng,
Li Li,
Hao Liu, Yueming Song,
Fuguo Huang,
Chongqi Tu,
Bin Shen,
Quan Gong,
Tao Li,
Limin Liu,
Jiancheng Zeng,
Qingquan Kong,
Min Yi,
Melanie Gupte,
Peter X Ma,
Fuxing Pei
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ABSTRACT: OBJECTIVE: We hypothesize that intervertebral disc cells from distinct region respond differently to oxygen environment, and that intervertebral disc cells from patients with disc degeneration can benefit from hypoxia condition. Therefore, we aimed to determine the transcriptional response and extracellular matrix production of nucleus pulposus and annulus fibrosus cells to different oxygen tension. METHOD: Human nucleus pulposus (NP) and annulus fibrosus (AF) from degenerated intervertebral disc were seeded in 3D scaffolds and subjected to varying oxygen tension (2% and 20%) for 3 weeks. Changes in extracellular matrix were evaluated using quantitative real-time reverse transcriptase polymerase chain reaction, histological and immunohistological analyses. RESULTS: Hypoxia significantly enhance nucleus pulposus cells phenotype, which resulted in greater production of sulphated glycosaminoglycan and collagen type II within the constructs and the cells expressed higher levels of genes encoding nucleus pulposus extracellular matrix. A significantly stronger fluorescent signal for HIF-1 α as also found in the nucleus pulposus cells under the hypoxic than normoxic condition. However, there was little effect of hypoxia on the annulus fibrosus cells. CONCLUSIONS: The nucleus pulposus and annulus fibrosus cells respond differently to hypoxia condition on the 3D scaffold, and hypoxia could enhance nucleus pulposus phenotype. When used in concert with appropriate scaffold material, human nucleus pulposus cells from degenerated disc could be regenerated for tissue engineering application.
Osteoarthritis and Cartilage 01/2013; · 3.90 Impact Factor
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ABSTRACT: To study the correlation between the cervical posture in the cervical disc replacement (CDR).
Between January 2008 and August 2010, 51 and the cervical curve restoration in neutral position after surgery. patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C(4, 5) in 5 cases, at C(5, 6) in 42 cases, and at C(6, 7) in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation.
The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P < 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 +/- 9.13) degrees on cervical alignment, (2.10 +/- 5.12) degrees on targeted FSU, and (3.33 +/- 3.75) degrees on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 +/- 7.28), (3.99 +/- 5.37), and (4.29 +/- 5.36) degrees, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t = -4.391, P = 0.698), and between the targeted disc and the cervical alignment (t = -1.917, P = 0.061), but significant difference was found between the targeted FSU and the cervical alignment (t = -2.623, P = 0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P < 0.05).
A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2013; 27(1):62-5.
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ABSTRACT: To evaluate the short-term effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) intervertebral cage for lumbar interbody fusion in the patients with lower lumbar degenerative diseases.
Between January and October 2011, 20 patients with lower lumbar degenerative diseases underwent transforaminal lumbar interbody fusion with n-HA/PA66 intervertebral cage. There were 8 males and 12 females, aged 22-80 years (mean, 51 years). The disease duration was 1 to 24 months (mean, 4 months). L4,5 fusion was performed in 8 cases, L5, S1 fusion in 9 cases, and L4-S1 fusion in 3 cases. Among 20 cases, 3 were diagnosed as having recurrent lumbar disc protrusion, 5 as having lumbar degenerative spondylolisthesis, 9 as having lumbar isthmic spondylolisthesis, and 3 as having lumbar spinal stenosis. The intervertebral height and lordosis were measured on X-ray film to assess the surgical correction and postoperative sustain while osseous fusion was observed on 3-dimensional CT. The Oswestry disability index (ODI) and short-form 36 health survey scale (SF-36) scores were obtained to assess the status of clinical recovery.
All patients had incision healing by first intention. The pain and numb were relieved in varying degrees after operation. No cerebrospinal leakage, nerve root injury, or wound infection was occurred. All patients were followed up 6-9 months (mean, 7 months). No cage displacement or collapse was found. The intervertebral height and lordosis of single fusion segment were significantly improved at 3 days and 3, 6 months after operation when compared with those at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05). The fusion rate was 74% at 3 months after operation and 96% at 6 months after operation, with an average of 4 months (range, 3-9 months) for interbody fusion. The ODI and SF-36 scores were significantly improved at 3 days and 6 months after operation when compared with the scores at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05).
The interbody fusion with n-HA/PA intervertebral cage is effective and safe to treat the lower lumbar degenerative diseases. The n-HA/PA66 intervertebral cage is an ideal device of interbody fusion with high fusion rate, low subsidence rate, and high transmission X-ray, but the long-term effectiveness need further observation.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2012; 26(12):1425-9.
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ABSTRACT: BACKGROUND CONTEXT: To date, there are no clinical series documenting the treatment of severe and rigid scoliosis in patients with low body weight. To optimize curve correction and minimize the risk of complications, we performed a two-stage vertebral column resection (VCR) with posterior pedicle screw instrumentation to treat patients with severe and rigid scoliosis and low body weight. PURPOSE: The purposes of this study were to report the results of a two-staged VCR for patients with severe and rigid scoliosis and low body weight. STUDY DESIGN: This was a prospective, longitudinal, and descriptive study with a minimum follow-up of 2 years. PATIENT SAMPLE: Sixteen patients (nine women and seven men) with severe and rigid scoliosis and low body weight from the department of orthopedics, West China hospital, Sichuan University. OUTCOME MEASURES: Clinical analysis included rib hump and lumbar hump. Radiographic analysis consisted of Cobb angle measurements of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis. All measurements were taken before surgery, after surgery, and in the final follow-up period. METHODS: For evaluation of surgical effectiveness, comparative analysis of rib hump, lumbar hump, Cobb angle of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis before operation, after operation, and at the most recent follow-up was done. RESULTS: The body weight of patients averaged 33.8 kg (range 27-40 kg). Mean operating time was 580.3 minutes, with a blood loss of 1,581.3 mL. The correction rates of rib hump and lumbar hump were 77% and 85%. Preoperative major curves ranged from 90° to 130° Cobb angle. Coronal plane correction of the major curve averaged 70.7%, with an average loss of correction of 1.8%. The apical vertebral translation of the major curve was corrected by 73.2%. The preoperative coronal imbalance of 0.6 cm (range 0-1.4 cm) was improved to 0.5 cm (range 0-1.4 cm) at the most recent follow-up. The preoperative sagittal imbalance of 0.9 cm (range -3.1 to 4.6 cm) was improved to 0.8 cm (range -1.0 to 3.0 cm) at the most recent follow-up. The preoperative thoracic kyphosis of 50.1° (range 6°-86°) was corrected to 28.9°±7.7° (range 18°-42°) at the most recent follow-up. The preoperative lumbar lordosis of -57.9° (range -85° to -32°) was corrected to -49.0° (range -62° to -40°) at the most recent follow-up. Complications were encountered in two patients. One patient required ventilator support for 12 hours after anterior surgery. Malposition of one pedicle screw was found in one patient. There were no neurologic complications or any deep wound infections. No complication of instrumentation was found at final follow-up. CONCLUSIONS: The use of two-stage VCR for patients with severe and rigid scoliosis and low body weight can achieve a good correction of scoliosis without serious complications.
The spine journal: official journal of the North American Spine Society 08/2012; · 2.90 Impact Factor
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Ganjun Feng,
Ying Hong,
Li Li,
Hao Liu,
Fuxing Pei, Yueming Song,
Fuguo Huang,
Chongqi Tu,
Tao Li,
Quan Gong,
Limin Liu,
Jiancheng Zeng,
Qingquan Kong,
Melanie Gupte
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ABSTRACT: Study Design. A series study of patients with lower cervical facet dislocation accompanied by traumatic disc herniation treated with anterior decompression and non-structural bone grafting and posterior fixation (ADNGPF).Objective. To describe a surgical technique of ADNGPF and its clinical outcome in a group of patients with lower cervical facet dislocation accompanied by traumatic disc herniation.Summary of Background Data. The optimal treatment for lower cervical facet dislocation with a prolapsed disc is still controversial.Methods. After discectomy and endplate preparation, a layer of morselized cancellous bone grafts from the iliac crest was placed in the interspace, and held in appropriate sagittal position by two layers of gelatin sponge and carefully sutured longus colli mucle. The anterior wound then closed. The posterior elements were exposed and the reduction was performed. Fluoroscopy was used during reduction maneuver to ensure that the graft was still in the appropriate position. A posterior fusion was performed and the posterior wound closed.Results. Between January 2006 and February 2010, 21 patients with cervical facet dislocation accompanied by traumatic disc herniation (13 unilateral dislocations and 8 bilateral dislocations) were recruited for study. All the patients completed at least 1-year follow-up. Average follow-up duration was 29±3.5 months. Average Frankel scales were significantly improved at the end of follow-up, visual analogue scale decreased from 7.8±1.2 before operation to less than 1.6±0.5 (P<0.05) 6 months later. Kyposis was corrected from 17.7°±6.3° to 6.5°±4.1° (P<0.05) and remained at 5.9°±4.2° (P>0.05) 1 year later. The average subsidence of bone graft was 1.28±0.16 mm at 12 months after operation and remained 1.34±0.20 mm at 36 months after operation. All the patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred and no complications were attributed to the use of this technique.Conclusion. Although further study based on injury types as well as long-term follow-up is still needed, ADNGPF provides a promising surgical option for treating cervical facet dislocation with traumatic disc herniation.
Spine 05/2012; · 2.08 Impact Factor
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ABSTRACT: To evaluate the early clinical outcomes of subtotal corpectomy and intervertebral bone grafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracture-dislocation.
Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture or thoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posterior approach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were caused by falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were 10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12 cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancy in vertebral canal. The preoperative Cobb angle was (30.2 +/- 3.9) degrees. According to Frankel classification for neurological function, there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury and operation was 4.5 days (range, 1-12 days).
All incisions healed by first intention, and no infection occurred. Twenty patients were followed up 8-16 months (mean, 12 months). The interbody fusion time was 6-9 months (mean, 7 months). Neurological function recovered 1 to 3 grades: 1 case of grade C, 2 cases of grade D, 17 cases of grade E at last follow-up. The Cobb angle was (6.5 +/- 4.2) degrees at last follow-up, showing significant difference when compared with preoperative value (t = 2.39, P = 0.00). No breaking or loosening of screw and implant sinkage occurred.
A combination of subtotal corpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression, restoration of spinal stability, restoration of vertebral body height, high bone healing rate, and good recovery of neurological function. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 05/2012; 26(5):542-5.
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ABSTRACT: There is few report on dynamic stabilization for posterior cervical reconstruction. To investigate the biomechanical properties of a novel cervical spine posterior fixation using the bio-derived freeze-dried tendon in posterior cervical spine reconstruction.
The palmaris longus flexor tendon and metacarpal extensor tendon were collected from the death donors' stump to prepare bio-derived tendon. Twenty fresh cervical vertebrae (C1-7) were harvested from goats and were randomly divided into 4 groups (n = 5): intact group (group A); injury control group (group B); screw-rods fixation group, fixed with screw-rods on C3, 4 (group C); tendon reconstruction group, cross-fixed with bio-derived freeze-dried tendon on C3, 4 bilatera facet joints (group D). The range of motion (ROM) values in flexion, extension, lateral bending, and axial rotation were measured.
In flexion, the ROM values of group C were significantly lower than those of the other 3 groups (P < 0.05), and the ROM values of group B were significantly higher than those of groups A and D (P < 0.05). In extension, lateral bending, and axial rotation, the ROM values of group C were significantly lower than those of groups A, B, and D (P < 0.05), and no significant difference was found within the other 3 groups (P > 0.05).
The novel cervical spine posterior fixation using the bio-derived frozen-dried tendon can provide enough stability in flexion motion, but it can not limit the lateral bending and axial rotation motion, which can provide dynamic stabilization in animal model.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 04/2012; 26(4):396-400.
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ABSTRACT: To construct a lentiviral expression vector carrying Nogo extra cellular peptide residues 1-40 (NEP1-40) and to obtain NEP1-40 efficient and stable expression in mammalian cells.
The DNA fragment of NEP1-40 coding sequence was amplified by PCR with designed primer from the cDNA library including NEP1-40 gene, and then subcloned into pGC-FU vector with in-fusion technique to generate the lentiviral expression vector, pGC-FU-NEP1-40. The positive clones were screened by PCR and the correct NEP1-40 was confirmed by sequencing. Recombinant lentiviruses were produced in 293T cells after the cotransfection of pGC-FU-NEP1-40, and packaging plasmids of pHelper 1.0 and pHelper 2.0. Green fluorescent protein (GFP) expression of infected 293T cells was observed to evaluate gene delivery efficiency. NEP1-40 protein expression in 293T cells was detected by Western blot.
The lentiviral expression vector carrying NEP1-40 was successfully constructed by GFP observation, and NEP1-40 protein expression was detected in 293T cells by Western blot.
The recombinant lentivirus pGC-FU-NEP1-40 is successfully constructed and it lays a foundation for further molecular function study of NEP 1-40.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2012; 26(2):177-81.
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ABSTRACT: To summarize the current development of the correction of severe and rigid scoliosis.
Recent literature concerning the correction of severe and rigid scoliosis at home and abroad was extensively reviewed, and current developments of the correction of severe and rigid scoliosis were summarized.
The correction of severe and rigid scoliosis shows developments as follows: the application of Halo-gravity traction increase and Halo-femoral traction is applied in posterior correction surgery. Fixation and correction technique with all pedidcle screws was gradually popularized. The applications of posterior vertebral column resection, one-stage anterior and posterior surgery, and posterior-only correction surgery increase.
The developments of all kinds of correction techniques improve the correction effects of severe and rigid scoliosis. Now there is no standardized treatment protocol for severe and rigid scoliosis. Greater development can be expected in the future
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2012; 26(2):238-43.
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ABSTRACT: To study the effectiveness of computer assisted pedicle screw insertion in osteoporotic spinal posterior fixation.
Between December 2009 and March 2011, 51 patients underwent pedicle screw fixation using the computer assisted navigation (navigation group), while 41 patients underwent the conventional technique (traditional group). All patients had osteoporosis under the dual-energy X-rays absorptiometry. There was no significant difference in age, gender, bone mineral density, involved segment, preoperative complications, and other general status between 2 groups (P > 0.05). The amount of blood loss, the operation time, the rate of the pedicle screw re-insertion, and the postoperative complication were observed. The state of the pedicle screw location was assessed by CT postoperatively with the Richter's classification and the fusion state of the bone graft was observed using three-dimensional (3-D) CT scans during follow-up.
A total of 250 screws were inserted in navigation group, and 239 were inserted successfully at first time while the other 11 screws (4.4%) were re-inserted. A total of 213 screws were inserted in traditional group, and 190 were successful at first time while 23 screws (10.8%) were re-inserted. There was significant difference in the rate of screws re-insertion between 2 groups (chi2 = 6.919, P = 0.009). Both the amount of blood loss and the operation time in navigation group were significantly less than those in traditional group (P < 0.05). According to Richter's classification for screw location, the results were excellent in 240 screws, good in 10 screws in navigation group; the results were excellent in 191 screws, good in 21 screws, and poor in 1 screw in traditional group. Significant difference was noticed in the screw position between 2 groups (chi2 = 7.566, P = 0.023). The patients were followed up (7.8 +/- 1.5) months in navigation group and (8.7 +/- 1.5) months in traditional group. No loosening, extraction, and breakage of the pedicle screw occurred in navigation group, and all these patients had successful fusion within 6 months postoperatively. While in traditional group, successful fusion was shown in the other patients by 3-D CT, except the absorption of bone graft was found in only 1 patient at 6 months after operation. And then, after braking by adequate brace and enhancing the anti-osteoporotic therapy, the bone graft fused at 9 months postoperatively.
The computer assisted navigating pedicle screw insertion could effective reduce the deviation or re-insertion of the screws, insuring the maximum stability of each screw, mean while it can reduce the exposure time and blood loss, avoiding complication. The computer assisted navigation would be a useful technique which made the pedicle screw fixation more safe and stable in patients with osteoporosis.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2012; 26(2):196-200.
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ABSTRACT: Cages are used to regain stability of the anterior spinal column following vertebrectomy, which could prevent significant donor-site morbidity from the iliac autograft harvesting and the risk of disease transmission associated with the allograft. The hollow, porous, cylindrical nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage is a new nonmetallic cage device made by combining nanohydroxyapatite with polyamide 66. Few studies have examined its effectiveness and outcomes over a follow-up >2 years.We retrospectively studied 51 consecutive patients with acute traumatic thoracic or lumbar burst fracture who underwent anterior reconstruction with the n-HA/PA66 cage following single-level corpectomy. Radiologic parameters (radiographs and 3-dimensional computed tomography scans) preoperatively and at 1 week and >2 years postoperatively, as well as clinical outcome parameters (SF-36 scores), were analyzed. Mean kyphosis correction in the segment within the cage was 11.8°±7.1°, and mean loss of correction at last follow-up was 1.9°±2.1°. Osseous fusion was achieved in 90.2% of patients, and severe cage subsidence (settling >2 mm) was observed in 19.6% of patients at final follow-up. Significant differences were found in 7 of 8 health dimensions of the SF-36 between neurologically intact patients and neurologically injured patients. Our clinical results indicate that the n-HA/PA66 cage is an effective device for reconstruction after anterior thoracic and lumbar vertebral resection, resulting in a high rate of successful osseous fusion and a low proportion of severe cage subsidence.
Orthopedics 01/2012; 35(1):e66-73. · 2.66 Impact Factor
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ABSTRACT: To study the short-term effects of thoracoscopic anterior spine release combined with posterior correction on the pulmonary function in patients with idiopathic scoliosis (IS).
Between April 2004 and June 2008, 21 cases of IS underwent thoracoscopic anterior spine release combined with posterior correction. There were 9 males and 12 females with a mean age of 15.6 years (range, 12 to 24 years). Of 11 patients, 2 had left protrusion deformity and 19 had right protrusion deformity, including 12 cases of Lenke type I and 9 cases of Lenke type II, with an average coronal Cobb's angle of 79.6 degrees (range, 65-125 degrees). The disease duration ranged from 1 year and 6 months to 9 years (mean, 2.5 years). The results of pulmonary function tests (PFTs) were compared between pre-operation and postoperative 6th month, including lung capacity, ventilation function, and thoracic compliance.
The opening time of the chest was 90 to 150 minutes (mean, 127 minutes) at the thoracoscopic anterior spine release and all incisions healed by first intention with no chest cavity infection. All the patients were followed up from 6 to 36 months (mean, 13.5 months). The average coronal Cobb's angle was 43.7 degrees (range, 36-75 degrees) at 1 week after posterior correction. At 6 months after operation, the vital capacity and total capacity were significantly increased (P < 0.05), but no significant change was observed in the percentage of actual value and expected one when compared with pre-operation (P > 0.05). The functional residual capacity and the percentage of actual value and expected one of residual volume was significantly decreased when compared with those at pre-operation (P < 0.05). The forced expiratory volume in one second (FEVl) and FEVI/FEV were not significantly improved (P > 0.05), but the maximum ventilatory volume was significantly increased when compared with the preoperative value (P < 0.05). In addition, the Raw Total, Raw Insp, and Raw Exp decreased significantly after operation (P < 0.05).
Although the thoracoscopic anterior spine release combined with posterior correction might disturb the function of the thoracic cavity, the PFTs of the patients could be improved at different aspects because of the shape changes of the thoracic cavity, and the pulmonary function still needed further observation.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2012; 26(1):70-3.
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ABSTRACT: This research was to design and prepare interbody fusion cages using composite materials of multi-amino acid copolymer/tri-calcium phosphate (MAACP/TCP) and to test compressive strength of the cages. 16 specimens of C3-4 segments from female adult goats were scanned by X-ray to exclude disease of cervical spine, and then anatomical data were measured, i. e. disc space height of C3-4 segment (DSH), sagittal diameter of C3 lower endplate (SDLE3), sagittal diameter of C4 upper endplate (SDUE4), coronary diameter of C3 lower endplate (CDLE3), and coronary diameter of C4 upper endplate (CDUE4). According to the anatomical data, we designed and prepared the interbody fusion cage using the composite of MAACP/TCP and titanium with the same sizes. The MAACP/TCP Cages were made with the method of injection molding and finish machining, and titanium Cages were made with machining. In the testing of compressive strength of Cages, the specimens were divided into three groups, tricortical iliac crest bone group (isolated from goats), MAACP/TCP Cage group and titanium Cage group. There were 8 specimens in every group with the same sizes, the length of 12 mm, the width of 10 mm, and the height of 6 mm. The compressive strength of all specimens was tested on a universal testing machine. The values of DSH, SDLE3, SDUE4, CDLE3 and CDUE4 were (4.78 +/- 0.17) mm, (15.06 +/- 0.53) mm, (12.46 +/- 0.44) mm, (14.47 +/- 0.51) mm and (12.15 +/- 0.65) mm, respectively. MAACP/TCP Cage was successfully designed and made with a compressive strength of 76.34 MPa, which was much higher than that of tricortical iliac crest bone (18.41 MPa). The maximal loading of universal testing machine was 50 000 N, so the compressive strength of titanium Cages, whose value should be more than 541.35 MPa, could not be tested precisely. It is feasible to make cages with MAACP/TCP composite, and the compressive strength of MAACP/TCP Cages was much higher than that of tricortical iliac crest bone isolated from goats.
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi 12/2011; 28(6):1136-40.
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Lei Wang, Yueming Song,
Fuxing Pei,
Chongqi Tu,
Hong Duan,
Hao Liu,
Limin Liu,
Quan Gong,
Tao Li,
Jiancheng Zeng,
Qingquan Kong
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ABSTRACT: To evaluate the security and effectiveness of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage in reconstruction of spinal stability after resection of spinal tumor.
Between January 2008 and December 2009, 11 patients with spinal tumor underwent surgical resection and strut graft with n-HA/PA66 cage. There were 6 males and 5 females with an average age of 44.5 years (range, 16-61 years). The average disease duration was 6.8 months (range, 2-14 months). The locations of lesions included cervical spine (2 cases), thoracic spine (6 cases), and lumbar spine (3 cases). Among them, there were 5 metastatic carcinomas, 2 giant cell tumors, 1 osteoblastoma osteosarcoma, 1 chondrosarcoma, and 2 non-Hodgkin lymphoma. According to Frankel criteria for nerve function classification, there were 1 case of grade A, 3 cases of grade B, 2 cases of grade C, 2 cases of grade D, and 3 cases of grade E.
Incisions healed by first intention in all patients, no operative or postoperative complication occurred. Four cases of metastatic carcinoma died of primary disease during 5-9 months after operation. Seven cases were followed up 14.4 months on average (range, 10-18 months). All patients gained significant improvement of the neurological function at 3 months after operation. All cases obtained bone fusion and good spinal stability without displacement and subsidence of the n-HA/PA66 cage. The intervertebral height of the adjacent segments was (110.5 +/- 16.1) mm at 3 months after operation and (109.4 +/- 16.2 ) mm at the final follow-up, showing significant differences when compared with the preoperative height [(97.5 +/- 15.4) mm, P < 0.05], but no significant difference between 3 months after operation and the final follow-up. In 2 patients undergoing surgery via anterior approach, bilateral pleural effusion on both sides occurred and were cured after closed thoracic drainage. During the follow-up, 2 cases (1 chondrosarcoma and 1 giant cell tumor) relapsed and underwent reoperations.
n-HA/PA66 cage can provide satisfactory bone fusion and ideal spinal stability without increasing the risk of recurrence and complications during the surgical treatment of spinal tumors. It is an ideal selection for reconstruction of spinal stability.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2011; 25(8):941-5.
