Objective To investigate the early effectiveness of Zero-profile interbody fusion system (Zero-P) in the treatment of cervical disc protrusion. Methods Between October 2010 and June 2012, 25 patients with cervical disc protrusion underwent anterior cervical discectomy and fusion (ACDF) using the Zero-P system. There were 15 males and 10 females, aged from 35 to 68 years (mean, 49 years). The disease duration was 3-26 months (mean, 10.5 months). Single segment was involved in all cases (2 cases in C3, 4, 5 cases in C4, 5, 11 cases in C5, 6, and 7 cases in C6, 7). The operation time and blood loss were recorded and analyzed. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used to assess pain and nerve function improvement; the cervical Cobb angle was measured on the X-ray films before and after operation; according to Pitzen’s criteria, intervertebral fusion was evaluated. Results The operation was successful in 25 patients, with no severe complication. The average blood loss was 42.6 mL (range, 20-120 mL). The average operation time was 63.6 minutes (range, 45-90 minutes). Primary healing of incision was obtained in all cases; no injury of spinal cord and nerve root, cerebrospinal leakage, or deep infection occurred. The patients were followed up 6-23 months (mean, 14.5 months). No Cage subsidence and loosening, breaking, or pulling-out were observed. The symptoms and curvature of the cervical spine were obviously improved in all patients after operation. The VAS score, JOA score, NDI, and the cervical Cobb angle at 3 months and last follow-up showed significant differences when compared with preoperative ones (P lt; 0.05), but no significant difference was found between at 3 months and at last follow-up (P gt; 0.05). The interbody fusion was achieved in each operated segment of all patients according to Pitzen’s criteria. Conclusion The early effectiveness of ACDF with Zero-P system is satisfactory in treatment of cervical disc protrusion because it has the advantages of short operation time, less bleeding, good stability and restoration of the cervical alignment.
ObjectiveTo explore early effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of migrated lumbar intervertebral disc herniation. Methods A retrospective analysis was conducted on 87 patients with migrated lumbar intervertebral disc herniation, who were treated with UBE technique between May 2021 and December 2022 and met the selection criteria. There were 55 males and 32 females, with an average age of 48.8 years (range, 29-74 years). The disease duration ranged from 2 to 23 months, with an average of 9.1 months. The surgical segments included 17 cases of L3, 4, 32 cases of L4, 5, and 38 cases of L5, S1. According to Lee’s classification criteria, there were 12 cases of type 1, 17 cases of type 2, 37 cases of type 3, and 21 cases of type 4. The operation time, length of hospital stay, and complications were recorded. The visual analogue scale (VAS) score was used to assess the degree of low back and leg pain before operaion and at 3 days, 3 months, 6 months, and 12 months after operation. The Oswestry disability index (ODI) was used to evaluate the lumbar spine function. At last follow-up, the modified MacNab criteria was used to evaluate the effectiveness. According to the preoperative migrated intervertebral disc classification, the patients were allocated into groups Ⅰ to Ⅳ. The differences in VAS score and ODI were compared. Results All 87 patients successfully completed the operations. There was no nerve root injury, dural sac injury, or dural tear during operation. The operation time was (58.6±14.6) minutes and the length of hospital stay was (4.0±0.8) days. All incisions healed by first intention after operation. No symptomatic epidural hematoma occurred. All patients were followed up for 12 months. There were significant differences in VAS scores and ODI at each time point after operation when compared with those before operation (P<0.05). There were significant differences in VAS score at 3 days after operation when compared with that at 3, 6, and 12 months after operation (P<0.05). For ODI, except that there was no significant difference between 6 and 12 months after operation (P>0.05), there were significant differences between other time points after operation (P<0.05). At last follow-up, the effectiveness was rated as excellent in 66 cases, good in 13 cases, and fair in 8 cases according to the modified MacNab criteria, and the excellent and good rate was 90.8%. There was no intervertebral disc herniation recurred during follow-up period. There was no significant difference in VAS score and ODI among groups Ⅰ -Ⅳ before operation and at each time point after operation (P>0.05). ConclusionThe UBE technique is safe and effective in the treatment of migrated lumbar intervertebral disc herniation, with a low complication rate and satisfactory early effectiveness.
ObjectiveTo assesse the effectiveness of anterior cervical discectomy and fusion with Cage alone in treating multi-level cervical degenerative disease. MethodsBetween August 2010 and August 2012, 62 eligible patients with multi-level cervical degenerative disease were treated, and the clinical data were reviewed. Of 62 patients, 32 underwent anterior cervical discectomy and fusion with Cage alone (group A), and 30 underwent anterior cervical discectomy and fusion with plate fixation (group B). Both groups showed no significant difference in gender, age, disease duration, lesion types, and affected segments (P>0.05), it had comparability. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score; the fused segment height, subsidence rates of Cages, global cervical lordosis, and fusion rates were also compared. ResultsThe operation time of group B[(109.7±11.2) minutes] was significantly more than group A[(87.8±6.9) minutes] (t=-2.259, P=0.037). Primary healing of incisions was obtained in all patients of 2 groups. All patients were followed up; the follow-up period ranged from 8 to 27 months (mean, 15.8 months) in group A, and from 9 to 28 months (mean, 16.4 months) in group B. There was no complication and internal fixation failure. The JOA score and VAS score were significantly improved at last follow-up when compared with preoperative scores in 2 groups (P<0.05). According to Robinson standard for axial symptom severity, the results were excellent in 20 cases, good in 9, fair in 2, and poor in 1, with an excellent and good rate of 90.63% in group A; the results were excellent in 19 cases, good in 7, fair in 3, and poor in 1, with an excellent and good rate of 86.67% in group B; and no significant difference was found between 2 groups (χ2=0.765, P=0.382). The fused segment height at immediate after operation and at last follow-up and global cervical lordosis at last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference (P>0.05) between groups A and B in the Cage subsidence height[(1.4±0.9) mm vs. (1.2±1.6) mm], Cage subsidence rate[9.52% (8/84) vs. 7.59% (6/79)], and fusion rate[95.24% (80/84) vs. 96.20% (76/79)]. ConclusionAnterior cervical discectomy and fusion with Cage alone can obtain good clinical results and radiologic indexes, avoid plate-related complications and reduce operation time. It is a safe and effective surgical option in the treatment of multi-level cervical degenerative disease.
Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To evaluate the prel iminary cl inical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and fail ing to respond to conservative treatment. Methods From June 2007 to May 2008, 52 patients with CLBP and fail ing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed ith discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 “black intervertebral discs” low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The cl inical outcome was determined by modified Macnab criteria at the final follow-up. Results The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No compl ications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 ± 1.52), (3.62 ± 0.92) and (1.57 ± 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P lt; 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%. Conclusion Prel iminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and fail ing to respond to conservative treatment.
Objective To investigate the clinical efficacy of endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis. Methods The clinical data of patients treated with water medium endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis at Mianyang Orthopedic Hospital between September 2021 and September 2023 were retrospectively collected. The surgical efficacy and nerve injury recovery were evaluated based on the Neck Disabilitv Index (NDI), Japanese Orthopaedic Association (JOA) score, improvement rate of JOA score, Cobb angle and height changes of the affected intervertebral space before surgery and at the last follow-up, as well as the occurrence of surgical complications. Results A total of 29 patients were included, including 18 males and 11 females. The average age was (52.34±8.96) years, and the average duration of illness was (17.31±6.60) months. The average follow-up time was (11.69±3.41) months. At the last follow-up, the patients’ NDI (3.55±3.09 vs. 17.28±5.51), Cobb angle [(15.25±4.83) vs. (−1.34±7.50)°], intervertebral height [(8.04±0.82) vs. (4.67±0.95) mm], and JOA score (15.90±1.11 vs. 11.17±1.65) improved compared to preoperative levels (P<0.05). The JOA score improvement rate assessment showed that 16 cases were excellent, 11 cases were fine, 2 cases were moderate, and the excellent and fine rate was 93.10%. All patients did not experience serious complications after surgery. Conclusion Water medium endoscopy-assisted anterior cervical discectomy and fusion for cervical spondylosis has good clinical efficacy and safety.
To compare and evaluate the whole effect of anterior decompression approach to treat cervical spondylotic myelopathy by using cervical retractor systems and the traditional surgical approach. Methods From April 2001 to August 2004, group A included 30 males and 23 females aging from 31 to 69 years, and the involved time was from 7 months to 15 years. Involved segments included 22 one-segments, 24 two-segments and 7 three-segments. In all 53 cases, anterior windowing decompression and fusion with autograft and titanium plate internal fixation by using traditionalcircular saw were performed. Group B included 48 males and 20 females aging from 33 to 74 years, and the involved time was from 5 months to 18 years. Involved segments included 23 one-segments, 34 two-segments and 11 three-segments. In all 68 cases, anterior undermined far-reaching decompression and fusion with autograft and titanium plate internal fixation by using removing disc merely in the single-level or separately in the multilevels employing self-retractor and Caspar cervical retractor systems via interspinal approach were performed. X-rays and MRI showed cervical disc degeneration, herniation and spinal cord compression. The surgery time, loss of blood, vertebral body fusion time, difference in height of involved segments preor postoperatively and compl ications were counted up and compared between the two groups. Improvement rate of spinal function pre- or postoperatively were valued by using JOA score. Results A total of 92 cases including 42 of group A and 50 of group B were followed up for 3 to 5 years, mean 3.5 years. In group A, surgery time, loss of blood, time of vertebral body fusion, difference in height of involved segments pre- or postoperatively, and improvement ratio of spinal function were(76.80 ± 28.41) min,(564.00 ± 181.96) mL,(12.10 ± 3.58) weeks, (1.30 ± 0.67) mm and 0.49% ± 0.14%, respectively. In group B, they were(57.90 ± 15.01) min,(317.50 ± 136.92) mL,(9.75 ± 1.36) weeks, (3.00 ± 0.56) mm and 0.71% ± 0.17% , respectively. The differences between the two groups were significant in all measured values(P lt; 0.05). Compl ications occurred in 7 cases ofgroup A including 1 spinal cord injury, 1 plate displacement, 1 bonegraft displacement and 4 disfunctions of il iac region. No compl ication happened in group B. Conclusion Anterior decompression approach using cervical retractor systems is significantly superior to the traditional approach as to the whole effect to treat cervical spondylotic myelopathy, and furtherperfects the traditional anterior decompression approach. The modified approach is scientific, safe and easily spread.
Objective To investigate the effectiveness of the unilateral biportal endoscopy (UBE) technique in the treatment of high-grade migrated lumbar disc herniation (LDH). Methods Between January 2020 and February 2021, 23 cases of high-grade migrated LDH were treated with discectomy via UBE. There were 14 males and 9 females, with a mean age of 48.7 years (range, 32-76 years). All patients had low back and leg pain. The disease duration ranged from 2 months to 7 years (median, 13 months). Lesion segments were L3, 4 in 2 cases, L4, 5 in 15 cases, and L5, S1 in 6 cases. The operation time, intraoperative blood loss, the time when the patients started to move off the floor, and postoperative complications were recorded. The effectiveness was evaluated using the visual analogue scale (VAS) score, the modified Oswestry disability index (ODI), and the modified MacNab criteria. Results All operations were completed successfully, and no complication such as dural tear, epidural hematoma, nerve injury, or vascular injury occurred. The operation time ranged from 53 to 96 minutes, with an average of 71.0 minutes. The intraoperative blood loss ranged from 32 to 56 mL, with an average of 39.3 mL. All patients were removed the drainage tube and wore a lumbar brace to move off the floor around 1 to 2 days after operation. All patients were followed up 3-12 months after operation, with an average of 5.7 months. The VAS scores of low back pain and leg pain and the modified ODI at all postoperative time points were lower than those before operation, and the differences were significant (P<0.05). The differences were significant (P<0.05) when comparing the above indexes between the time points after operation. At last follow-up, the effectiveness was evaluated according to the modified MacNab criteria, and 17 cases were excellent, 4 cases were good, and 2 cases were fair, with an excellent and good rate of 91.3%. There was no recurrence of LDH during follow-up. ConclusionDiscectomy via UBE is an effective method for the treatment of high-grade migrated LDH because of its flexibility, clear view, and wide range of intraoperative exploration, which can effectively reduce the risk of residual nucleus pulposus after operation.
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.
ObjectiveTo explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis. MethodsSeventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association (JOA) score and imaging data were observed. ResultsThirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation. ConclusionACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.