Objective To invest igate the ef fect iveness and signi f icance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc disease. Methods Between January 2007 and August 2008, 21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer. Among them, there were 13 males and 8 females with an average age of 52 years (range, 28-79 years). And the disease duration ranged from 3 months to 40 years (median, 9 months). The affected segments included T11, 12, T12-L1, L1, 2, and L2, 3 in 1 case respectively, L4, 5 in 4 cases, and L5, S1 in 13 cases. All patients had intractable low back pain or lower extremity radicular symptoms. The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases. Oswestry Disabil ity Index (ODI) and Macnab grading were used to determine the function recovery after operation. And Suk’s standard was used to determine the fusion effects by X-ray. Results All 21 patients were followed up 18 months to 3 years (mean, 23.8 months). Sciatica symptoms disappeared after operation in 19 cases, no significant improvement occurred in 2 cases of thoracic disease. The ODI scores were 79% ± 16% at preoperation, 30% ± 9% at 1 month, 26% ± 10% at 3 months, 21% ± 12% at 6 months, and 20% ± 10% at 18 months after operation, showing significant differences between pre- and postoperation (P lt; 0.05). According to Macnab grading at 6 months postoperatively, the results were excellent in 14 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 90.5%. According to Suk et al. standard, the results were excellent in 1 case, good in 19 cases, and poor in 1 case with an excellent and good rate of 95.2%. The muscle strength of the lower extremities had no improvement in 1 case of T11, 12 disc protrusion; pedicle screws fixation and decompression laminectomy were given after 6 months, but no improvement was achieved during follow-up. Protrusion recurred after 4 months in 1 case of L4, 5 disc protrusion, then was cured by laminectomy discectomy. The remaining patients achieved postoperative rel ief. Conclusion Endoscope combined with interbody fusion is a good combination to solve lumbar instabil ity. B-Twin expandable spinal spacer is a minimally invasive fusion choice of L4, 5 and L5, S1.
Objective To evluate the clinical outcome of autograftsof ilium and interbody fusion cage or bone morphogenetic protein(BMP)／artificial bone material／ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004，114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation． There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114patients, 85 cases were classified as degree Ⅰ, 24 cases as degree Ⅱ and 5 cases as degree Ⅲ. The patients were divided into three groups accordingto the material used for interbody fusion: autografts of ilium (group A, n=42), interbody fusion cages(group B, n=36), and BMP／artificial bone material／ cage (group C, n=36)．The clinical and radiographic results of the patients were compared among three groups． Results All patients were followed from 13 to 30 months with an average of 15 months． There were no statistically significant differences in surgical time, blood loss, and disc space height of preoperation(P＞0.05) among three groups. No severe complication occurred in the three groups(P＞0.05). The excellent and good rates in groups A，B and C were 81.0％, 80.6％, and 83.3％ respectively, showing no statisticallysignificant difference(P＞0.05)．The fusion rate of group C(97.0%) was significantly higher than those of group A(81.0%) and group B(83.3%) (P＜0.05) after 1 year of operation．And the average loss of disc space height in groups B and C was significantly lower than that in group A(P＜0.05). Conclusion Higher fusion rate and lower loss of disc space height can beobtained in treating lumbar spondylolisthesis with BMP／artificial bone materiel.It is an effective method in the treatment of spondylolisthesis.
Objective 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. Methods 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. Results 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 lt; 0.01); there was no significant difference among each time point after operation (P gt; 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 lt; 0.01); there was no significant difference among each time point after operation (P gt; 0.05). Conclusion 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.
ObjectiveTo explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.MethodsA retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups (P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups (P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group (P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones (P<0.05), and no significant difference was found between 2 groups at each time point (P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups (P>0.05) and between 2 groups at each time point after operation (P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation (P<0.05). The VAS score in double-level group was higher than that in single-level group (P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points (P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.ConclusionThe n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.
ObjectiveTo summarize the advances in research on Cage subsidence following lumbar interbody fusion, and provide reference for its prevention.MethodsThe definition, development, clinical significance, and related risk factors of Cage subsidence following lumbar interbody fusion were throughout reviewed by referring to relevant domestic and doreign literature in recent years.ResultsAt present, there is no consensus on the definition of Cage subsidence, and mostly accepted as the disk height reduction greater than 2 mm. Cage subsidence mainly occurs in the early postoperative stage, which weakens the radiological surgical outcome, and may further damage the effectiveness or even lead to surgical failure. Cage subsidence is closely related to the Cage size and its placement location, intraoperative endplate preparation, morphological matching of disk space to Cage, bone mineral density, body mass index, and so on.ConclusionThe appropriate size and shape of the Cage usage, the posterolateral Cage placed, the gentle endplate operation to prevent injury, the active perioperative anti-osteoporosis treatment, and the education of patients to control body weight may help to prevent Cage subsidence and ensure good surgical results.
ObjectiveTo explore the long-term effectiveness of expandable Cage in treatment of degenerative lumbar disease. MethodsBetween January 2005 and January 2008, 72 patients with degenerative lumbar disease were treated by expandable Cage and followed up for 5 years. Of 72 cases, 41 were male and 31 were female with an average age of 40.5 years (mean, 35-65 years), including 35 cases of lumbar spinal stenosis, 20 cases of degenerative lumbar instability, and 17 cases of serious lumbar intervertebral disc protrusion combined with lumbar instability. The disease duration was 6-28 months (mean, 9 months). The affected lumbar segments were L3, 4 in 6 patients, L4, 5 in 37 patients, and L5, S1 in 29 patients. The Oswestry disability index (ODI) was used to evaluate the effectiveness before and after operation and to calculate the improvement rate. During the follow-up, the anteroposterior, lateral, and dynamic X-ray films were taken to evaluate the operated segment fusion rate. The intervertebral lordosis angle was measured, and adjacent segment degeneration was observed. ResultsThe operation time was 35-90 minutes (mean, 65 minutes); the intraoperative blood loss was 200-450 mL (mean, 280 mL), and all the patients received intraoperative autologous blood transfusion; the postoperative bedridden time was 3-7 days (mean, 4.5 days); the hospitalization days were 10-18 days (mean, 12 days). No complications of nerve root injury, cauda equina injury, or cerebrospinal fluid leakage occurred during operation. All patients achieved primary healing of the incisions. All 72 patients were followed up for 5 years. At 3 months, 1 year, and 5 years after operation, the ODI were 8.2±2.6, 6.9±1.9, and 6.4±1.3 respectively, showing significant differences when compared with preoperative value (41.5±3.5) (P<0.05); the improvement rates were 87.3%±1.2%, 90.1%±0.8%, and 91.6%±1.3% respectively, showing no significant difference (F=0.492, P=0.375); the intervertebral lordosis angles were (5.1±1.2), (5.0±0.5), and (5.4±0.8)°respectively, showing no significant difference (F=0.570, P=0.453). At 5 years after operation, the intervertebral fusion rate was 100%, with no adjacent segment degeneration. ConclusionUsing expandable Cage to treat degenerative lumbar disease can get stabilization without pedicle screw fixation, the good effectiveness is shown after long-term follow-up.
Objective To investigate the effectiveness of trans-intervertebral space osteotomy (TIO) combined with cage implantation in treatment of old thoracolumbar compression fracture with kyphosis. Methods A clinical data of 59 patients with old thoracolumbar compression fracture and kyphosis, who met the selection criteria between January 2010 and August 2020, was retrospectively analyzed. Among them, 20 cases underwent TIO combined with cage implantation (group A), 21 patients underwent TIO (group B), and 18 patients underwent pedicle subtraction osteotomy (PSO; group C). There was no significant difference in gender, age, time from injury to operation, fracture segment, and preoperative Cobb angle, average height of functional spinal unit (FSU), sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry disability index (ODI) between groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications were recorded. Imaging review was performed to observe the fusion of the bone graft. Cobb angle, average height of FSU, and SVA were measured. VAS score, JOA score, and ODI were used to evaluate the degree of low back pain and lumbar function. Frankel grading was used to evaluate neurological function. Results The operations of 3 groups were successfully completed. The operation time and intraoperative blood loss were significantly lower in groups A and B than in group C (P<0.05); there was no significant difference between group A and group B (P>0.05). All incisions healed by first intention. Patients in all groups were followed up 23-27 months, with an average of 24.8 months. There was no significant difference in follow-up time between groups (P>0.05). At last follow-up, VAS score, JOA score, ODI, and SVA of 3 groups significantly improved when compared with those before operation (P<0.05), there was no significant difference in the differences of pre- and post-operation between groups (P>0.05). The neurological function grading of 3 groups was Frankel grade E. The Cobb angle and the average height of FSU in 3 groups at immediate and last follow-up significantly improved when compared with preoperative ones (P<0.05), there was no significant difference between immediately after operation and last follow-up (P>0.05). And there were significant differences in above indexes between groups at each time point (P<0.05). At last follow-up, the osteotomy site fused without internal fixation failure or pseudarthrosis formation were observed in 3 groups. ConclusionFor patients with old thoracolumbar compression fractures with kyphosis, the effectiveness of TIO combined with cage implantation is satisfactory. Compared with TIO and PSO, it can obtain more deformity correction degree and less invasive.
Objective To summarize the basic research and the cl inical appl ication of biodegradable interbody fusion Cage. Methods Recent l iterature concerning biodegradable interbody fusion Cage at home and abroad was extensively reviewed, and current developments of the basic research and the cl inical appl ication of biodegradable interbody fusion Cage were investigated. Results Basic research showes that the stiffness of biodegradable interbody fusion Cage is lower than that of metall ic Cage, so it can enhance interbody fusion. As interbody fusion proceeded, biodegradable interbody fusion Cage degrades constantly, but the speed of degradation can not keep in parallel with that of fusion. In addition, the tissue response to degradation products is controversy. Cl inical appl ication showes that the biodegradable interbody fusion Cage can enhance interbody fusion and maintain disc space height. The short term results are good, however, the long term results need further observation. Conclusion Biodegradable interbody fusion Cage can effectively enhance interbody fusion.
Objective To evaluate the safety and effectiveness of anterior cervical discectomy and fusion (ACDF) by using zero-profile anchored cage (ZAC) in treatment of consecutive three-level cervical spondylosis, by comparing with plate-cage construct (PCC). Methods A clinical data of 65 patients with cervical spondylosis admitted between January 2020 and December 2022 and met the selection criteria was retrospectively analyzed. During consecutive three-level ACDF, 35 patients were fixed with ZAC (ZAC group) and 30 patients with PCC (PCC group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, surgical segment, preoperative Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), visual analogue scale (VAS) score, prevertebral soft tissue thickness (PSTT), cervical lordosis, and surgical segmental angle. The operation time, intraoperative blood loss, hospital stay, clinical indicators (JOA score, NDI, VAS score), and radiological indicators (cervical lordosis, surgical segmental angle, implant subsidence, surgical segment fusion, and adjacent segment degeneration), and the postoperative complications [swelling of the neck (PSTT), dysphagia] were recorded and compared between the two groups. Results Patients in both groups were followed up 24-39 months. There was no significant difference in follow-up duration between the two groups (P>0.05). The operation time and intraoperative blood loss were lower in ZAC group than in PCC group, and the length of hospital stay was longer, but there was no significant difference (P>0.05). At each time point after operation, both groups showed significant improvements in JOA score, VAS score, and NDI compared with preoperative scores (P<0.05), but there was no significant difference between the two groups at each time point after operation (P>0.05). Both groups showed an increase in PSTT at 3 days and 3, 6 months after operation compared to preoperative levels (P<0.05), but returned to preoperative levels at last follow-up (P>0.05). The PSTT at 3 days and 3 months after operation were significantly lower in ZAC group than in PCC group (P<0.05), and there was no significant difference between the two groups at 6 months and at last follow-up (P>0.05). The incidences of dysphagia at 3 days and 3 months were significantly lower in ZAC group than in PCC group (P<0.05), while no significant difference was observed at 6 months and last follow-up between the two groups (P>0.05). There was no postoperative complication in both groups including hoarseness, esophageal injury, cough, or hematoma. Both groups showed improvement in cervical lordosis and surgical segmental angle compared to preoperative levels, with a trend of loss during follow-up. The cervical lordosis loss and surgical segmental angle loss were significantly more in the ZAC group than in PCC group (P<0.05). The incidence of implante subsidence was significantly higher in ZAC group than in PCC group (P<0.05). There was no significant difference between the ZAC group and PCC group in the incidences of surgical segment fusion and adjacent segment degeneration (P>0.05). ConclusionIn consecutive three-level ACDF, both ZAC and PCC can achieve satisfactory effectiveness. The former can reduce the incidence of postoperative dysphagia, while the latter can better maintain cervical curvature and reduce the incidence of implant subsidence.
Spinal fusion is a standard operation for treating moderate and severe intervertebral disc diseases. In recent years, the proportion of three-dimensional printing interbody fusion cage in spinal fusion surgery has gradually increased. In this paper, the research progress of molding technology and materials used in three-dimensional printing interbody fusion cage at present is summarized. Then, according to structure layout, three-dimensional printing interbody fusion cages are classified into five types: solid-porous-solid (SPS) type, solid-porous-frame (SPF) type, frame-porous-frame (FPF) type, whole porous cage (WPC) type and others. The optimization process of three-dimensional printing interbody fusion cage and the advantages and disadvantages of each type are analyzed and summarized in depth. The clinical application of various types of 3D printed interbody fusion cage was introduced and summarized later. Lastly, combined with the latest research progress and achievements, the future research direction of three-dimensional printing interbody fusion cage in molding technology, application materials and coating materials is prospected in order to provide some reference for scholars engaged in interbody fusion cage research and application.