ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.
ObjectiveTo summarize and analyze the characteristics of L1-L4 vertebrae and hip bone mineral density (BMD) in patients with degenerative lumbar scoliosis under dual energy X-ray absorptiometry (DEXA). MethodsWe collected all the preoperative total spine frontal and lateral X-ray images and DEXA examination results of patients with degenerative lumbar scoliosis who were hospitalized in the Department of Orthopedic Surgery in West China Hospital between August 2013 and August 2014. SPSS 21.0 was used to analyze patients’ age, height and body weight; BMD of each vertebra of L1-L4 vertebrae and L1-L4 vertebrae as a whole, and the T score; BMD of left femoral neck, Ward triangle, greater trochanter, and femoral shaft, and the general BMD of femoral neck, and the T score. ResultsThirty-eight patients with an average age of (67.4±8.2) years were enrolled in this study. DEXA examination results showed that 23.7% (9/38) and 28.9% (11/38) of the patients were osteoporotic in the spine and the hip, respectively; the examination results of total lumbar vertebrae and total femoral neck bones were concordant in 60.5% (23/38) of the patients. For lumbar vertebrae, the BMD from high to low was listed as: L4 vertebra, L3 vertebra, total L1-L4 vertebrae, L2 vertebra, and L1 vertebra. The BMD of L4 vertebra was significantly higher than that of L1 vertebra, and the BMD of lumbar vertebrae from L1 to L4 in turn presented a step-like increasing trend. For hip bones, the BMD from high to low was listed as: femoral shaft, total femoral neck area, femoral neck, greater trochanter, and Ward triangle. The BMD of the femoral shaft was significantly higher than that of Ward triangle. In the whole DEXA examination, the BMD of total L1-L4 lumbar vertebrae and its T score were higher than the BMD of left femoral neck area and its T score, respectively. ConclusionsDegenerative changes of the lumbar spine may lead to misinterpretation of BMD measurements and cause underdiagnosis of osteoporosis with DEXA. Routine reporting of spine BMD at L1 can add valuable information for reassessment and monitoring. The BMD of hip is less affected by osteoarthritis, osteophytes than the lumbar spine, and thus, it will be more meaningful in diagnosing and monitoring of the disease.
Objective To analyze the spinal injury in Wenchuan earthquake and to investigate its cl inical features. Methods Data of 146 patients in Wenchuan earthquake with spinal injuries (79 males, 67 females; aged 11-88 years old, average 51 years old) were collected and analyzed epidemiologically. Two patients under 16 years of age, 15 patients withthe fractures of spinous process, transverse process or vertebra lamina, 1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification, and 9 patients with upper cervical injuries were excluded. The remaining 119 patients were divided into two groups according to their age: group A in which 78 patients were under 60 years of age, including 40 males and 38 females aged 18-58 years old (average 41 years old), and group B in which 41 patients were 60 years of age or above, including 24 males and 17 females aged 60-88 years old (average 71 years old). Analyses for the two groups were compared. Results The leading causes of spinal injuries were fall from high places (27.40%) and crush by heavy objects (67.81%). According to Denis classification, the major types of spinal injuries were burst fracture (54.62%) and compression fracture (33.61%). Serious nerve injury, defined as grade A, B and C in ASIA neurological function assessment, occurred in 31.51% of patients. The most common injured site was in thoracic or lumbar vertebrae (78.77%), and 52.74% of patients had combined injuries, among which the fractures of l imb (30.14%) and rib (19.86%) were the most common. Multilevel spinal fractures happened to 22.60% of patients. Comparative analysis revealed the rate of injury caused by fall from high places in group A (34.62%) was much higher than that in group B (12.20%). The commonest type of fracture in group A was burst fracture (58.97%), and it was compression fracture in group B (48.78%). The rate of serious nerve injury in group B (24.39%) was much lower than that in group A (44.87%). The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%, respectively, which was much higher than that in group A (combined injury 43.59%; multilevel vertebral body injury 21.79%). There were significant differences between two groups in all the indicators derived from cl inical data (P lt; 0.05). Conclusion In Wenchuan earthquake, the leading causes of spinal injuries are fall from high places and crush by heavy objects, the major types of fracture are compression fracture and burst fracture, and the occurrence rates of spinal injury, combined injury and multilevel vertebral body injury are high.
Objective To evaluate pulmonary function changes in patients with severe scol iosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. Methods FromJanuary 2006 to July 2007, 16 patients with severe scol iosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 ± 10.9)° and the preoperative thoracic kyphotic angle was (30.0 ± 4.2)°. The preoperative height of “razor back” deformity was (5.9 ± 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 ± 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 ± 0.62) L. The percentage of actual values to expected ones in FVC was 70% ± 16%, and that in FEV1.0 was 67% ± 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation. Results All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 ± 18.6)° and the correction rate was 49.0% ± 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 ± 2.4)° and the correction rate was 13.3% ± 2.2%. The height of “razor back” deformity at 24-month follow-up was (2.2 ± 0.8) cm. Compared with preoperative level, all these data showed significant differences (P lt; 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 decl ined, but no significant difference was found (P gt; 0.05). At 12 and 24 months, the actual values of FVC andFEV1.0 were close to the preoperative level (P gt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC decl ined 19% 3 months postoperatively (P lt; 0.05) and 12% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FEV1.0 decl ined 16% 3 months postoperatively (P lt; 0.05), and 10% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P gt; 0.05). Conclusion In severe scol iosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.
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.