Thoracolumbar fractures are common injuries. Accurate diagnosis and classification are of great significance for guiding treatment. Although there are many classification systems, they have not been universally accepted and used to guide clinical practice. Denis classification, load sharing classification, Magerl/AO classification, and Thoracolumbar Injury Classification and Severity Score have a great clinical influence, but they also have some shortcomings. Recently, some new classifications of thoracolumbar fractures have been proposed, and some of them have been updated and revised, which makes it easy to cause confusion, and puts forward new requirements on how to grasp and apply these classification systems. This article reviews the main and commonly used classification systems of thoracolumbar fractures, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks ahead to the future research direction.
Objective To review current status of surgical treatment for angular kyphosis in spinal tuberculosis and provide reference for clinical treatment. Methods The literature on the surgical treatment for angular kyphosis of spinal tuberculosis in recent years was extensively reviewed and summarized from the aspects of surgical indications, surgical contraindications, surgical approach, selection of osteotomy, and perioperative management. Results Angular kyphosis of spine is a common complication in patients with spinal tuberculosis. If kyphosis progresses gradually, it is easy to cause neurological damage, deterioration, and delayed paralysis, which requires surgical intervention. At present, surgical approaches for angular kyphosis of the spine include anterior approach, posterior approach, and combined anterior and posterior approaches. Anterior approach can be performed for patients with severe spinal cord compression and small kyphotic Cobb angle. Posterior approach can be used for patients with large kyphotic Cobb angle but not serious neurological impairment. A combined anterior and posterior approaches is an option for spinal canal decompression and orthosis. Osteotomy for kyphotic deformity include Smith-Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO), vertebral column resection(VCR), vertebral column decancellation (VCD), posterior vertebral column resection (PVCR), deformed complex vertebral osteotomy (DCVO), and Y-shaped osteotomy. SPO and PSO are osteotomy methods with relatively low surgical difficulty and low surgical risks, and can provide 15°-30° angular kyphosis correction effect. VCR or PVCR is a representative method of osteotomy and correction. The kyphosis correction can reach 50° and is suitable for patients with severe angular kyphosis. VCD, DCVO, and Y-shaped osteotomy are emerging surgical techniques in recent years. Compared with VCR, the surgical risks are lower and the treatment effects also improve to varying degrees. Postoperative recovery is also a very important part of the perioperative period and should be taken seriously. Conclusion There is no consensus on the choice of surgical treatment for angular kyphosis in spinal tuberculosis. Osteotomy surgery are invasive, which is a problem that colleagues have always been concerned about. It is best to choose a surgical method with less trauma while ensuring the effectiveness.
Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L4, 5 in 36 cases and L5, S1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.
Objective To summarize the advances in MRI-based bone quality scoring systems and their clinical applications. Methods A comprehensive literature review was conducted on recent studies related to the MRI-based bone quality scoring system, focusing on measurement methods, influencing factors, and clinical significance. Results Osteoporosis has a high incidence in China, significantly impacting patients’ quality of life and the postoperative outcomes of related orthopedic surgeries. Early identification of osteoporosis holds important clinical significance. In recent years, both domestic and international research has enriched the MRI-based bone quality scoring systems, which includes vertebral bone quality scoring, endplate bone quality scoring, and pedicle bone quality scoring. Compared to the “gold standard” of bone density measurement, dual-energy X-ray absorptiometry, the bone quality scoring systems demonstrate good efficacy in identifying abnormal bone mass and predicting postoperative complications, while being less influenced by degenerative changes in the lumbar spine, indicating its important clinical application value. ConclusionThe MRI-based bone quality scoring systems have good value in clinical applications. However, current studies are mostly retrospective cohort and case-control studies, which carry a risk of bias. The clinical application value needs further clarification through meta-analysis and large-scale prospective studies.
Objective To investigate the clinical effect of polylactic acid membrane in prevention of epidural scar and adhesion. Methods From July 1998 to April 2000, 62 patients with lumbar disc herniation were randomly assigned into two groups. All were treated surgically with discectomy by fenestration or laminectomy.One group were placed with a thin of polylactic acid membrane covering the interlaminar space(n=32). The thickness of the film was 0.1mm. The other group was blank control(n=30). After 2 weeks of operation, we observed the local and systemic reactions. After 6 months clinical symptoms were revaluated and the degrees of epidural scar and adhesion were determined by CT scans. Results After 2 weeks, we found no adverse systemic reactions in all patients. Wound healing was excellent. No abnormalities of hepatic and renal functions as well as blood for routine were found. Temperature after operation was normal. After 6 months, the curative effects were as follows in experimental group and in control group: excellent in 27 patients and in 24 patients, good in 4 patients and in 4 patients, fair in 1 patient and in 1 patient, and poor in 0 patient and in 1 patient, respectively. There are no significant difference between two groups. The CT scans showed no adhesion between the epidural scar and the dural sac in all patients of experimental group. There existed various extents of adhesion in control group. Conclusion The results demonstrate that the polylactic acidmembrane can effectively prevent the epidural scar adhesion with a good biocompatibility and no toxity. Its clinical application was promising.
With the development of three-dimensional (3D) printing technology, more and more researches have focused on its application in the region of intervertebral fusion materials; the prospects are worth looking forward to. This article reviews the researches about 3D printing technology in spinal implants, and summarizes the materials and printing technology applied in the field of spinal interbody fusion, and the shortcomings in the current research and application. With the rapid development of 3D printing technology and new materials, more and more 3D printing spinal interbodies will be developed and used clinically.
Traditional bone repair materials, such as titanium, polyetheretherketone, and calcium phosphate, exhibit limitations, including poor biocompatibility and incongruent mechanical properties. In contrast, ceramic-polymer composite materials combine the robust mechanical strength of ceramics with the flexibility of polymers, resulting in enhanced biocompatibility and mechanical performance. In recent years, researchers worldwide have conducted extensive studies to develop innovative composite materials and manufacturing processes, with the aim of enhancing the bone repair capabilities of implants. This article provides a comprehensive overview of the advancements in ceramic-polymer composite materials, as well as in 3D printing and surface modification techniques for composite materials, with the objective of offering valuable insights to improve and facilitate the clinical application of ceramic-polymer composite materials in the future.
ObjectiveTo investigate the relationship between O-EA angle and lower cervical curvature in patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion, and to analyze the effect of O-EA angle on lower cervical curvature.MethodsThe clinical data of 61 patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion who were admitted between April 2010 and July 2018 and met the selection criteria were retrospectively analyzed. There were 32 males and 29 females, with an age of 14-76 years (mean, 50.7 years). The fixed segment included 19 cases of C0-C2, 27 cases of C0-C3, 14 cases of C0-C4, and 1 case of C0-C5. The O-EA angle, C2-7 Cobb angle, and T1 tilt angle were measured before operation and at last follow-up. According to the O-EA angle measured at last follow-up, the patients were divided into <95° group (group A), 95°-105° group (group B), and >105° group (group C), and compared the differences of gender, age, fixed segment (short segment was at C3 and above, long segment was beyond C3), and C2-7 Cobb angle. Correlation analysis between the O-EA angle and C2-7 Cobb angle before operation and at last follow-up, as well as the changes of O-EA angle and C2-7 Cobb angle between before operation and at last follow-up were analyzed.ResultsAll 61 patients were followed up 12-24 months, with an average of 22.4 months. There was no significant difference in O-EA angle, C2-7 Cobb angle, and T1 tilt angle before operation and at last follow-up (P>0.05). According to the last follow-up O-EA angle grouping, there were 14 cases in group A, 29 cases in group B, and 18 cases in group C. There was no significant difference in age, gender composition, and fixed segment composition among the three groups (P>0.05); the differences in C2-7 Cobb angles among the three groups were significant (P<0.05), groups A, B, and C showed a gradually increasing trend. The O-EA angle was positively correlated with C2-7 Cobb angle before operation and at last follow-up (r=0.572, P=0.000; r=0.618, P=0.000); O-EA angle change at last follow-up was also positively correlated with C2-7 Cobb change (r=0.446, P=0.000).ConclusionThe O-EA angle of patients with anterior atlantoaxial dislocation is positively correlated with C2-7 Cobb angle. Too large O-EA angle should be avoided during occipitocervical fixation, otherwise it may accelerate the degeneration of the lower cervical spine.
Objective To evaluate the safety and efficacy of the operation performed under the video-assisted thoracoscope to release the anterior part of the spine of the patient with severe adolescent idiopathic scoliosis (AIS). Methods From April 2004 to July 2006, 24 patients with AIS (Illness course, 1.5-9 years; Lenke Ⅰ in 17 patients, Lenke Ⅱ in 7; right scoliosis in 22, left scoliosis in 2), among whom there were 9 males and 15 females, with an average age of 14.7 years (range, 11-21 years) at the time of the operation. Before operation, the thoracic vertebral Cobb anger at the coronal plane was averaged 78.3°(range, 65-125°). All the patients had normal muscle strength and muscle tension in their lower limbs, but 5 of the patients had a decrease of the superficial sensation in their lower limbs. All the patients had a moderately or severely decreased lung reserve function. Under general anesthesia, the patient was placed in the lateral position to set up a work channel for thoracoscopy. The releasing of the thoracic intervertebral space and the confluence of the bone grafts were performed. During Stage Ⅰ or Stage Ⅱ, the orthopedic procedures for the posterior part of the scoliosis spine, the internal fixation, and the confluence ofthe bone grafts were completed. ResultsAll the patients survived the periodof perioperation. During operation, there was a hemorrhage of 50-200 ml, averaged 100 ml, with a postoperative thoracic closely-drained fluid of 100-150 ml. The incision was healed by the first intention. Each patient underwent the releaseof 4-6 intervertebral spaces, with an average of 5.5 spaces released. The average coronal Cobb angle was 45.6°(range, 25-75°). The physiological curvatureat the sagittal plane was normal, with an improved shape of the spine. The follow-up for 3-18 months averaged 9.3 months revealed that the bilateral pulmonary markings were clear, with confluence of the orthopedic segment of the spine. The patients could live and work normally, and had a significantly-improved psychological condition and an active social participation because of their improved appearance. Conclusion The releasing of the anterior part of the spine under the video-assisted thoracoscope can effectively release the adolescent idiopathic scoliosis and improve the flexibility of the spine, with a smaller degree of the surgical wound and a faster and clearer exposure of the spinal column during operation.
ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.