[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例...[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P<0.01),但相同时间点两组间的差异无统计学意义(P>0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P<0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。展开更多
We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new techn...We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new technique has been adopted in a vast range of applications in spine surgery,such as producing anatomical models,surgical templates,preoperative plans,and spinal implants.Some studies on 3D printing technologies in spine surgery have reported the benefits of this emerging technology with more effective manufacturing,more visualisation for communication,and more precise navigation for screw insertion and osteotomy.In addition,in customised implant design and fabrication processes,3D printing products with anatomical adaptions and complex porous microstructure show some attractive advantages in terms of fit and osteoinductivity.However,there are still some concerns about the safety and feasibility of the application of 3D printing technology in spine surgery.We review the literature on and share our experiences with the application of 3D printing from the beginning of collaborations between doctors and computer-aided design(CAD)designers to the final follow-up of clinical patients.展开更多
A schwannoma is a relatively common benign spinal cord tumour;however,giant schwannomas with extensive cervical vertebral erosion are rare,and the treatment strategy,especially the reconstruction of the upper cervical...A schwannoma is a relatively common benign spinal cord tumour;however,giant schwannomas with extensive cervical vertebral erosion are rare,and the treatment strategy,especially the reconstruction of the upper cervical vertebra,remains a challenge for spine surgeons.Here,we present a rare case of giant invasive high-cervical schwannoma with extensive erosion of the C2—C4 vertebral bodies and tumour-encased left vertebral artery.The surgical strategy and the reconstruction of C2—C4 with 3D printing techniques were discussed and performed.A 32-year-old man presented to our department with complaints of gait disturbance and weakness in both upper and lower extremities.His limb muscle strength was grade 2 or 3/5,and he exhibited severe bladder and bowel dysfunction on admission.X-ray and computed tomography of the cervical spine showed an extremely large erosive lesion at the C2—C4 vertebral bodies and lateral masses.Magnetic resonance imaging of the cervical spine showed a large soft-tissue mass on the left aspect of the C2—C5 vertebra and in the spinal canal at the C3—C4 level.A staged schwannoma resection,instrumented fixation,and reconstruction of C2—C4 with 3D metal printing technique were performed.The patient achieved good postoperative outcomes and returned to normal daily life with no recurrence of schwannoma during follow-up for four and a half years.The 3D-printed implant achieved solid fusion with the remaining cervical spine.We performed staged resection of the giant invasive high-cervical schwannoma and reconstructed the erosive C2—C4 vertebra with the assistance of a 3D printing technique.3D printing technology has facilitated the design and manufacture of customised implants for complex surgical procedures.展开更多
文摘[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P<0.01),但相同时间点两组间的差异无统计学意义(P>0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P<0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。
基金the National Key Research and Development Program of China(No.2017YFB1104104)the Special Foundation for Innovation of Science and Technology of Shanghai Jiao Tong University(Nos.GXQ201810 and GXQ202003)。
文摘We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new technique has been adopted in a vast range of applications in spine surgery,such as producing anatomical models,surgical templates,preoperative plans,and spinal implants.Some studies on 3D printing technologies in spine surgery have reported the benefits of this emerging technology with more effective manufacturing,more visualisation for communication,and more precise navigation for screw insertion and osteotomy.In addition,in customised implant design and fabrication processes,3D printing products with anatomical adaptions and complex porous microstructure show some attractive advantages in terms of fit and osteoinductivity.However,there are still some concerns about the safety and feasibility of the application of 3D printing technology in spine surgery.We review the literature on and share our experiences with the application of 3D printing from the beginning of collaborations between doctors and computer-aided design(CAD)designers to the final follow-up of clinical patients.
基金the National Key Research and Development Program of China(No.2017YFB1104104)the Special Foundation for Innovation of Science and Technology of Shanghai Jiao Tong University(Nos.GXQ201810 and GXQ202003)。
文摘A schwannoma is a relatively common benign spinal cord tumour;however,giant schwannomas with extensive cervical vertebral erosion are rare,and the treatment strategy,especially the reconstruction of the upper cervical vertebra,remains a challenge for spine surgeons.Here,we present a rare case of giant invasive high-cervical schwannoma with extensive erosion of the C2—C4 vertebral bodies and tumour-encased left vertebral artery.The surgical strategy and the reconstruction of C2—C4 with 3D printing techniques were discussed and performed.A 32-year-old man presented to our department with complaints of gait disturbance and weakness in both upper and lower extremities.His limb muscle strength was grade 2 or 3/5,and he exhibited severe bladder and bowel dysfunction on admission.X-ray and computed tomography of the cervical spine showed an extremely large erosive lesion at the C2—C4 vertebral bodies and lateral masses.Magnetic resonance imaging of the cervical spine showed a large soft-tissue mass on the left aspect of the C2—C5 vertebra and in the spinal canal at the C3—C4 level.A staged schwannoma resection,instrumented fixation,and reconstruction of C2—C4 with 3D metal printing technique were performed.The patient achieved good postoperative outcomes and returned to normal daily life with no recurrence of schwannoma during follow-up for four and a half years.The 3D-printed implant achieved solid fusion with the remaining cervical spine.We performed staged resection of the giant invasive high-cervical schwannoma and reconstructed the erosive C2—C4 vertebra with the assistance of a 3D printing technique.3D printing technology has facilitated the design and manufacture of customised implants for complex surgical procedures.
