[Show abstract][Hide abstract]ABSTRACT: To evaluate the clinical therapeutic outcomes for severe burst fracture of lumbar vertebrae via a posterior approach for one-stage spinal "three-column" reconstruction.
An retrospective analysis of data was performed for 21 patients with severe burst fracture of lumbar vertebrae undergoing a posterior approach for one-stage spinal "three-column" reconstruction from 2005 to 2010. It was compared with previous 15 cases undergoing a staged anteroposterior approach. The operative duration, volume of blood loss, pre- and post-operative imaging measurements of kyphosis and vertebral height and nerve function recovery were evaluated.
The values of operative duration and volume of blood loss in the one-stage posterior approach group were significantly less than those of the two-stage anteroposterior approach group [(263 ± 72) min vs (439 ± 75) min, t = -5.303, P < 0.01; (1143 ± 296) ml vs (1471 ± 399) ml, t = -2.169, P = 0.042)]. Statistical significance existed in postoperative kyphosis between two groups [(0.5 ± 2.0)° vs (3.9 ± 2.6)°, t = -3.336, P = 0.003]. Vertebral height had no statistical significance pre- and post-operatively between two groups while restoration of vertebral height did [(0.47 ± 0.19) mm vs (0.26 ± 0.15) mm, t = 2.669, P = 0.015].
Posterior approach for one-stage vertebral resection, mesh implantation, pedicle screws and rod internal fixation for reconstructing spinal "three-column" structures offers excellent feasibility and safety. And it may avoid complications associated with an anteroposterior approach for two-stage procedures. The median length of hospital stay is also reduced.
[Show abstract][Hide abstract]ABSTRACT: To assess the effect of modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process upon maintaining the cervical lordotic alignment and axial syndrome and to determine whether preserving the posterior extensor musculature inserted into C2 and C7 spinous process can reduce the complications.
Twenty-eight patients undergoing modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process and 21 patients undergoing conventional C3-C7 cervical expansive open-door laminoplasty were investigated in pre-operative, post-operative and 3-month follow-up. The investigators assessed the effects of two different cervical laminoplasty types in the recovery rate of JOA score, the changes of Cobb angle and Ishihara's index, axial syndrome, operating duration and intra-operative blood loss, analyzed the results in SPSS and tried to find the difference in two operative types.
There were the same results in the recovery rate of JOA score and intra-operative blood loss in modified expansive open-door cervical laminoplasty group and the conventional C3-C7 cervical expansive open-door laminoplasty group. The smaller changes of Cobb angle and Ishihara's index in the follow-up of modified laminoplasty group were found. The modified laminoplasty group had fewer patients suffering the axial syndrome in follow-up. The operating duration was shorter in the modified laminoplasty group.
Preventing muscle injuries in cervical laminoplasty can reduce the incidence of complications. The modified expansive open-door cervical laminoplasty preserving the posterior extensor musculature inserted into C2 and C7 spinous process can protect cervical posterior extensor musculature. This is helpful to maintain the cervical lordotic alignment and reduce the incidence of post-operative axial syndrome.
[Show abstract][Hide abstract]ABSTRACT: To investigate the methods for, and clinical outcome of, the operative treatment of thoracolumbar fractures through an approach via the paravertebral muscle (PVM).
From June 2005 to August 2006, 62 patients, comprising 48 men and 14 women with an average age of 45.2 years (range, 21-58) with thoracolumbar fractures without neurological involvement underwent surgical treatment. Twenty-one fractures were located at T12, 24 at L1 and 17 at L2. The study comprised 15 compression and 47 burst fractures with an intact posterior column. Thirty-four cases were selected randomly to undergo surgery through the above approach, while the other 28 cases underwent the traditional procedure. After making a posterior midline incision, which not only facilitates insertion of pedicle screws and fusion of the graft bone at facet joints, but spares the attachment of PVM, the interval between the longissimus and multifidus muscles was undermined. Drainage was not routinely needed and the patients became ambulant with a brace earlier post-operatively.
The new approach had statistically significant advantages (P < 0.005) over the traditional one in regard to blood loss, drainage, duration of recumbency and visual analogue scale (VAS), although the time required was almost the same for the two procedures. Till August 2007, 56 patients were successfully followed up for 12 to 26 months (mean, 18.6) and bone fusion was identified in all cases. Neither reduction loss nor loosening or breakage of the fixation occurred.
The technique of operating through an approach between the PVM is recommended for thoracolumbar fractures because it is much less invasive, can reduce blood loss and accelerates rehabilitation.
[Show abstract][Hide abstract]ABSTRACT: To explore the long-term outcome of lumbar disc herniation (LDH) after the treatment with modified mini-invasive Love operation.
From January 1995 to December 2000, 373 patients suffered from LDH underwent the modified mini-invasive Love operation. There were 250 male and 123 female patients aged from 11 to 77-years-old (with a mean of 45.0-years-old). Most patients complained of sciatica accompanying back pain. The lesion level included L3,4 in 11 patients, L4,5 in 159 patients, L5-S1 in 195 patients and L4,5 combined with L5-S1 in 8 patients.
The average operative duration was 65 min. The average blood lose was 22 ml. The average incision length was 3.2 cm. Till September 2005, 317 patients were available at the final follow-up during the period from 5 years and a half to 10 years and 5 months. The average duration of follow-up was 7 years and 8 months. A total of 135 patients underwent the CT discogram. According to the modified Roland-Morris Dysfunction Questionnaire, 198 patients were rated as excellent, 68 as good, and 51 as fair. The excellent rate was 84.0%. The scores for young patients were higher than senile patients. Herniation recurrence occurred in 10 patients (3.2%), in which 7 patients underwent the operation of internal fixation and 1 patient preferred the conservative treatment. One patient got the spondylolisthesis.
The long-term outcome of the modified mini-invasive Love operation is effective. It is a good choice for the LDH patients.
Article · Jul 2008 · Zhonghua wai ke za zhi [Chinese journal of surgery]