OBJECTIVE: To discuss the clinical properties, operative results of thoracic spinal stenosis and factors correlating with prognosis. METHODS: From September 1992 to January 2001, 16 patients who suffered from thoracic spinal stenosis caused by degeneration, ossified ligamentum flavum, diffuse idiopathic hyperostosis and trauma, were decompressed by operation. The operative method was selected according to the compressed position of spinal cord. All patients were followed up 6 months to 9 years. The pain severity, ambulatory status and paraplegia index were compared between before operation and after operation. The correlation between prognosis and ages, the length of stenosis and the duration of disease was studied. RESULTS: The results of Wilcoxon Signed Ranks Test show significant difference in pain severity, ambulatory status and paraplegia index between before operation and after operation (P lt; 0.01). The results of partial correlation analyzing show that only the duration of disease was correlated with paraplegia index (P lt; 0.05). CONCLUSION: Thoracic spinal stenosis frequently develops in the lower-thoracic segments in middle and old aged men. Decompression by operation early can achieve a good clinical result. Duration of disease affects the prognosis.
Objective To explore the feasibil ity and efficacy of percutaneous kyphoplasty (PKP) for the treatment of severe osteoporotic vertebral compression fracture (OVCF), and to assess the cl inical result of the PKP technique. Methods From May 2006 to October 2007, 12 patients with severe OVCF affecting more than 2/3 of the original vertebral body height were treated by using domestic PKP and percutaneous vertebroplasty (PVP) tool systems. There were 3 malesand 9 females, with the age of 56-82 years and a mean disease course of 4.2 months (1-49 months). Eleven thoracic vertebra and 4 lumbar vertebra suffered from severe vertebral compression fractures, which included 3 extremely severe thoracic OVCF. Four thoracic vertebra and 3 lumbar vertebra had not severe OVCF. There were 4 cases of single vertebral compression fracture, 6 cases of double fractures, and 2 cases of triple fractures. Only single side PKP and PVP were performed via extrapedicular approach in thoracic vertebra, and via transpedicular approach in lumbar spine under fluoroscopic control. Eight patients with severe thoracic compression fractures and 4 with severe lumbar fractures were treated by PKP. Four patients with relatively mild thoracic compression fractures and 3 with lumbar fractures were treated by PVP. Results The operation was successfully, 3 patients with extremely severe thoracic compression fractures received no intervention. The maximum expansion pressure of balloon was (1 068 ± 298) kPa, and the volume was (3.1 ± 1.2) mL during operation. The average operative time of PKP was (44.9 ± 10.6) minutes per vertebra, while the average operative time of PVP was (36.5 ± 6.8) minutes per vertebra. The average volume of injected bone cement was (2.5 ± 0.6) mL per thoracic vertebra, and (3.6 ± 1.2) mL per lumbar vertebra. The mean hospitalization time were (3.7 ± 1.6) days. Twelve cases were followed up 5-18 months (mean 8.6 months). The visual analogue scale scoreswere (2.35 ± 0.61) points 2 days after operation and (2.89 ± 1.07) points at last follow-up, there were statistically significant differences when compared with before operation (8.27 ± 1.36) points (P lt; 0.01). Extravertebral leakage of the bone cement into the paravertebral tissue and/or disc occurred in 6 patients (9 vertebra) without significant symptom. Conclusion One side approach PKP is a safe and effective technique for treatment of severe OVCF with markedly rel ief of pain.
目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
ObjectiveTo investigate the clinical application of three-dimensional (3D) printing technique combined with a new type of thoracic pedicle screw track detector in thoracic pedicle screw placement.MethodsAccording to the characteristics of thoracic pedicle and common clinical screw placement methods, a new type of thoracic pedicle screw track detector was independently developed and designed. The clinical data of 30 patients with thoracic vertebrae related diseases who underwent posterior thoracic pedicle screw fixation between March 2017 and January 2020 were retrospectively analysed. Among them, there were 18 males and 12 females with an average age of 56.3 years (range, 32-76 years). There was 1 case of thoracic disc herniation, 4 cases of thoracic canal stenosis, 2 cases of ossification of posterior longitudinal ligament of thoracic vertebra, 16 cases of thoracic trauma, 2 cases of thoracic infection, and 5 cases of thoracic canal occupation. Three-dimensional CT of the thoracic vertebra was routinely performed preoperatively, and the model of the patient’s thoracic vertebra was reconstructed and printed out. With the assistance of the model, preoperative simulation was performed with the combination of the new type thoracic pedicle screw track detector, and detected no nails after critical cortical damage. During operation, one side was randomly selected to use traditional hand screws placement (control group), and the other side was selected to use 3D printing technique combined with new type thoracic pedicle screw track detector to assist thoracic pedicle screws placement (observation group). The single screw placement time, adjustment times of single screw, and blood loss during screw placement were compared between the two groups. The accuracy of screw placement in the two groups was evaluated according to postoperative CT imaging data.ResultsThe single screw placement time, adjustment times of single screw, and blood loss during screw placement in the observation group were significantly less than those in the control group (P<0.05). Postoperative CT examination showed that the observation group had 87 screws of grade 1, 3 screws of grade 2, and the acceptable screw placement rate was 100% (90/90); the control group had 76 screws of grade 1, 2 screws of grade 2, 11 screws of grade 3, and 1 screw of grade 4, and the acceptable screw placement rate was 86.7% (78/90); showing significant difference in screw placement between the two groups (χ2=12.875, P=0.001). All patients were followed up 6-18 months, with an average of 11.3 months. There was no complication of vascular, nerve, spinal cord, or visceral injury, and screws or rods broken, and no patient was revised.ConclusionThe 3D printing technique combined with the new type of thoracic pedicle screw track detector assisted thoracic pedicle screw placement is convenient, and significantly improves the accuracy and safety of intraoperative screw placement, and overall success rate of the surgery.
Objective To investigate the safety and effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of single-segment thoracic ossification of ligamentum flavum (TOLF). Methods Between August 2020 and December 2021, 11 patients with single-segment TOLF were treated with UBE technique. There were 6 males and 5 females, with an average of 58.2 years (range, 49-72 years). The responsible segment was T6, 7 in 1 case, T7, 8 in 1 case, T8, 9 in 2 cases, T9, 10 in 2 cases, T10, 11 in 2 cases, and T11, 12 in 3 cases. Imaging examination showed that the ossification were located on the left side in 4 cases, on the right side in 3 cases, and on bilateral sides in 4 cases. The main clinical symptoms were chest and back pain or lower limb pain, all accompanied by lower limb numbness and fatigue. The disease duration ranged from 2 to 28 months (median, 17 months). The operation time, postoperative hospital stay, and complications were recorded. Visual analogue scale (VAS) score was used to evaluate the chest and back pain and low limb pain, and Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score were used to evaluate functional recovery before operation and at 3 days, 1 month, 3 months after operation, and last follow-up. The anteroposterior diameter of the coronal spinal canal was measured by CT before and after operation to evaluate the effect of surgical decompression. Results All operations were successfully completed. The operation time was 50-105 minutes, with an average of 80.0 minutes. No postoperative complication such as dural sac tear, cerebrospinal fluid leakage, spinal nerve injury, or infection occurred. The postoperative hospital stay was 2-5 days, with an average of 3.1 days. All incisions healed by first intention. All patients were followed up 6-22 months, with an average of 14.8 months. CT measurement at 3 days after operation showed that the anteroposterior diameter of the spinal canal was (8.63±1.61) mm, which was significantly larger than that before operation [(3.67±1.37) mm] (t=−12.181, P<0.001). The VAS score of chest and back pain and lower limb pain and ODI at each time point after operation were significantly lower than those before operation (P<0.05). The above indexes were further improved after operation, except that there was no significant difference between at 3 months after operation and at last follow-up (P>0.05), the differences between other time points were significant (P<0.05). There was no recurrence during the follow-up period. Conclusion UBE technique is a safe and effective method to treat single-segment TOLF, but its long-term effectiveness needs to be further studied.
OBJECTIVE: To discuss the value of anterior operation in fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae. METHODS: From 1997, 21 patients with fracture-dislocation of connect of cervical vertebra and thoracic vertebrae were operated on. The interval between injury and operation was within 24 hours in 4 cases, 2-7 days in 9 cases, 8-14 days in 3 cases and within 4 weeks in 5 cases. The locations were C6,7 in 7 cases, C7 in 9 cases and T1 in 5 cases. The nerves function of spinal of all the cases have different degrees of injury. Classification of Frankel were the following: 3 cases of grade A, 6 cases of grade B, 9 cases of grade C, and 3 cases of grade D. The operative procedure included the following: anterior operation of cervical vertebrae; incision of most fracture vertebral body to decompress; transplantation of ilium bone grafting fusion; and internal fixation of anterior cervical vertebrae with locking-steel. RESULTS: In 21 patients, 1 died of accompanying by pulmonary infection; 20 were followed up 8 months to 3 years with an average of 21 months. All transplanted ilium had fused. The nerve function of spinal cord had recovered in different degrees(2 cases of grade A, 1 case of grade C, 9 cases of grade D and 8 cases of grade E); the turn of vertebral column was normal. No internal fixation failed. CONCLUSION: Anterior operation is a better way to treat fracture-dislocation of connect of cervical vertebrae and thoracic vertebrae with easy operation, less complications, satisfactory reduction of fracture and good stability.
ObjectiveTo observe the clinical efficacy of lesion clearing, decompression and fusing, and fixation with single nail from the anterior way for thoracic vertebra tuberculosis. MethodsFrom January 2008 to September 2011, 42 patients with thoracic vertebra tuberculosis were treated in our hospital. There were 28 males and 14 females with the age between 27 and 63 years old, averaging 45. The course of the disease ranged from 4 to 12 months, averaging 8 months. According to the affected parts and segments, there was 1 case of upper thoracic vertebrae involvement, 20 of inner thoracic spine, 21 of lower thoracic vertebrae, 9 of multiple segments, and 2 of multi-level noncontiguous tuberculosis. All patients accepted preoperative normal anti-tuberculosis drugs for 2 to 4 weeks. After confirming that the anti-tuberculosis treatment was effective, we cleared the lesion, fused by decompression at iliac crest bone graft sites and fixed by single nail from the anterior way. Postoperative regular follow-up was carried out. X ray film was used to detect the fusion, paralysis Frankel classification was adopted to evaluate the function recovery of patients, and visual analog pain score (VAS) was used to assess the relief of patients' symptoms. ResultsAll incisions of the patients were healed by the first intention. There was no recurrence in the tuberculosis focus area. Follow-up was done in forty cases for 12 to 34 months, averaging 23 months. X-ray review showed that the bone graft area turned into osseous fusion in all patients with the fusion time ranging from 10 to 16 months, averaging 13 months. No nail bar system loose or fracture occurred. Paralyzed patients Frankel classification showed that there were 2 A-level, 3 B-level, 9 C-level, 25 D-level, and 3 E-level cases before operation. During the last follow-up, there were no A-level, 1 B-level, 5 C-level, 10 D-level, and 26 E-level cases. Local pain VAS score results showed that preoperative point was 7.82±1.03, and the final follow-up point was 0.52±0.31, with a significant difference (P<0.05). ConclusionLesion clearing, fusion and single nail application from the anterior way is one of the reliable and efficient ways in thoracic vertebra tuberculosis surgery and the results are satisfying.