ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operation and 10. 8 mm (3-20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19. 5 mm(16 - 42)preoperatively and 11. 3 mm (0-32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.Conclusion. If used appropriately, TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.

Assessment of the anterior spinal artery and the artery of Adamkiewicz using multi-detector CT angiography

Background Damage to the spinal cord after the treatment of the descending thoracic and thoracoabdominal aortic aneurysms is an uncommon but devastating complication. The artery of Adamkiewicz （AKA） is the principal arterial supply of the anterior spinal artery （ASA） in the lower thoracic and lumbar level. The purpose of this study was to evaluate the visualization of the anterior spinal artery and the artery of Adamkiewicz, the affecting factors for the detection rate using multi-detector row CT （MDCT）. Methods Ninety-nine consecutive patients （31 women and 68 men; age range, 25-90 years; average age 61.3 years）, with suspicion for thoracic aortic lesions necessitating surgical intervention （31 aortic aneurysm, 45 dissection, 5 intramural hematoma, and 18 normal）, underwent CT angiography from the aortic arch to the aortic bifurcation. Transverse sections, multiplanar reformations and thin maximum intensity projections were used to assess the ASA and AKA. The level of the ASA and AKA origins and CT acquisition parameters were recorded. The contrast-to-noise ratio of the image, an index of the mass of the Tll body （vertebral mass index）, the subcutaneous fat thickness, and the CT value within the aortic arch and at the Tll level were measured. The detection of the ASA and AKA were evaluated relative to the acquisition parameters, scan characteristics, and aortic lesion type. Differences were assessed with the Wilcoxon rank-sum and t tests. Results The ASA was visualized in 51 patients （52%） and the AKA in 18 patients （18%）. The ASA was identified in 36/67 patients （54%） with 1.25 mm thickness and in 15/32 patients （47%） with 2.5-3.0 mm thickness. This difference did not achieve significance （P=0.13）. The detection rate of the ASA and the AKA was influenced by the vertebral mass index and the contrast-to-noise ratio （P〈0.05）. The amount of subcutaneous fat affected the detection rate of the ASA （P 〈0.05） but not the AKA. In CT scans of ASA detection, the mean CT values in the aorta at the arch and at Tll were 360 and 358 HU, respectively, whereas in CT scans without ASA detection, the CT values in the aorta at the arch and at Tll were lower （P 〈0.05）, 297 and 317 HU, respectively. Conclusions The ASA and AKA were less frequently detected in our cohort than previous reports. The visualization of the ASA and AKA was significantly affected by aortic enhancement, the ＂vertebral mass index＂, and the contrast-to-noise ratio. Chin Med J 2009; 122（2）： 145-149

Effects of Epidural Spinal Cord Stimulation and Treadmill Training on Locomotion Function and Ultrastructure of Spinal Cord Anterior Horn after Moderate Spinal Cord Injury in Rats

Objective:To investigate the effects of epidural spinal cord stimulation(ESCS) and treadmill training on the locomotion function and ultrastructure of spinal cord anterior horn after moderate spinal cord injury in rats.Method:Nine adult female Sprague-Dawley rats were randomly distributed into three groups:①spinal cord injury group(SI,n=3).②spinal cord injury plus ESCS group(SE,n=3).③spinal cord injury plus treadmill training group(TT,n=3).All rats received a moderate spinal cord injury surgery.Four weeks after surgery,rats in SE group received an electrode implantation procedure,with the electrode field covering spinal cord segments L2-S1.Four weeks after electrode implantation,rats received subthreshold ESCS for 30 min/d.Rats in TT group received 4cm/s treadmill training for 30min/d.Rats in SI group received no intervention,as a control group.All procedures in these three groups lasted four weeks.The open field Basso,Beattie and Bresnahan(BBB) scale was used before and after intervention to evaluate rats' hindlimb motor function.Result:After four weeks intervention,rats in TT group improved their open field locomotion scores to 20.In contrast,no significant improvement was observed in groups SI and SE.The morphology of synapses and neurons were similar regardless of whether rats had undergone ESCS,treadmill training or not.Conclusion:ESCS alone was not sufficient to improve the walking ability of spinal cord injured rats.ESCS or treadmill training alone might not contribute to the changes of ultrastructure in anterior horn of spinal cord that underlie the recovery of walking ability.Further research is needed to understand the contributions of combination of ESCS and treadmill training to the rehabilitation of spinal cord injured rats.

Visualizing Wallerian degeneration in the corticospinal tract after sensorimotor cortex ischemia in mice

Stroke can cause Wallerian degeneration in regions outside of the brain,particularly in the corticospinal tract.To investigate the fate of major glial cells and axons within affected areas of the corticospinal tract following stroke,we induced photochemical infarction of the sensorimotor cortex leading to Wallerian degeneration along the full extent of the corticospinal tract.We first used a routine,sensitive marker of axonal injury,amyloid precursor protein,to examine Wallerian degeneration of the corticospinal tract.An antibody to amyloid precursor protein mapped exclusively to proximal axonal segments within the ischemic cortex,with no positive signal in distal parts of the corticospinal tract,at all time points.To improve visualization of Wallerian degeneration,we next utilized an orthograde virus that expresses green fluorescent protein to label the corticospinal tract and then quantitatively evaluated green fluorescent protein-expressing axons.Using this approach,we found that axonal degeneration began on day 3 post-stroke and was almost complete by 7 days after stroke.In addition,microglia mobilized and activated early,from day 7 after stroke,but did not maintain a phagocytic state over time.Meanwhile,astrocytes showed relatively delayed mobilization and a moderate response to Wallerian degeneration.Moreover,no anterograde degeneration of spinal anterior horn cells was observed in response to Wallerian degeneration of the corticospinal tract.In conclusion,our data provide evidence for dynamic,pathogenic spatiotemporal changes in major cellular components of the corticospinal tract during Wallerian degeneration.

p75 neurotrophin receptor signal pathway influence on apoptosis in anterior horn neurons of the spinal cord in a rat model of cauda equina compression injury

BACKGROUND： Studies have demonstrated that cauda equina compression results in apoptosis of motor neurons in the spinal cord. The combination of p75 neurotrophin receptor （p75NTR） and precursor of nerve growth factor （pro-NGF） expression initiates the apoptotic pathway and induces neuronal apoptosis. However, few reports have focused on the p75-mediated mechanism of neuronal apoptosis following cauda equine compression injury OBJECTIVE： To determine apoptosis of spinal cord neurons and activation of the pro-NGF-p75NTR-JNK（c-Jun N-terminal kinase） signal pathway in rats following cauda equina compression, and to verify experimental outcomes. DESIGN, TIME AND SETTING： A randomized, controlled, in vivo experiment was performed at the Medical Experimental Center of Xi＇an Jiaotong University between April and November in 2008. MATERIALS： Streptavidin-perosidase kit was purchased from Wuhan Boster, China; in situ end labeling detection kit was provided by Promega, USA; type AEG-220G electron microscope was purchased from Hitachi, Japan. METHODS： A total of 48 healthy, adult, female, Sprague Dawley rats were randomly assigned to three groups： normal （n = 6）, sham-surgery （n = 6）, and compression （n = 36）. The compression group was randomly assigned to six subsets at 1,3, 5, 7, 14, and 28 days, respectively, with 6 rats in each subset. A cylindrical silica gel stick was implanted into the rats to compress 75% of the vertebral canal in the compression group; in the sham-surgery group, only vertebral resection was performed; and no procedures were performed in the normal group. MAIN OUTCOME MEASURES： At 1,3, 5, 7, 14, and 28 days following compression, L2-3 spinal cord segments were processed for immunohistochemistry, in situ cell apoptosis detection, and transmission electron microscopy observation. Nissl staining was used to observe neuronal survival in the L2 spinal cord segment. Immunohistochemistry was applied to detect expressions of pro-NGF, p75NTR, and JNK in the L2 segment. TUNEL fluorometric method was used to observe apoptosis of neurons in the L2 segment. RESULTS： In the normal and sham-surgery groups, little neuronal apoptosis was observed in the L2-3 spinal cord segment. At 3 days after compression injury, pro-NGF, p75NTR and JNK expression was observed in the spinal cord. Expression levels reached a peak at 7 days, and then gradually decreased. In the compression and sham-surgery groups, neurons primarily expressed pro-NGF and p75NTR. The number of JNK-positive neurons in the compression group was dramatically increased compared with the sham-surgery group （P〈 0.05）. A few neurons were apoptotic in the spinal cord 1 day after compression injury. The number of apoptotic neurons gradually increased and reached a peak at 7 days, and subsequently decreased. Apoptosis was still detectable at 28 days. There was a positive correlation between p75NTR expression and neuronal apoptosis （r= 0.75, P〈 0.05）. CONCLUSION： Following cauda equina compression injury, apoptosis of spinal cord neurons was observed. The compression-induced neuronal apoptosis was associated with p75NTR expression in the L2-3 spinal cord segment.

Sciatic nerve injury alters the spatial arrangement of neurons and glial cells in the anterior horn of the spinal cord

The spatial arrangement of the cell is important and considered as underlying mechanism for mathematical modeling of cell to cell interaction.The ability of cells to take on the characteristics of other cells in an organism,it is important to understand the dynamical behavior of the cells.This method implements experimental parameters of the cell-cell interaction into the mathematical simulation of cell arrangement.The purpose of this research was to explore the three-dimensional spatial distribution of anterior horn cells in the rat spinal cord to examine differences after sciatic nerve injury.Sixteen Sprague-Dawley male rats were assigned to control and axotomy groups.Twelve weeks after surgery,the anterior horn was removed for first-and second-order stereological studies.Second-order stereological techniques were applied to estimate the pair correlation and cross-correlation functions using a dipole probe superimposed onto the spinal cord sections.The findings revealed 7% and 36% reductions in the mean volume and total number of motoneurons,respectively,and a25% increase in the neuroglial cell number in the axotomized rats compared to the control rats.In contrast,the anterior horn volume remained unchanged.The results also indicated a broader gap in the pair correlation curve for the motoneurons and neuroglial cells in the axotomized rats compared to the control rats.This finding shows a negative correlation for the distribution of motoneurons and neuroglial cells in the axotomized rats.The cross-correlation curve shows a negative correlation between the motoneurons and neuroglial cells in the axotomized rats.These findings suggest that cellular structural and functional changes after sciatic nerve injury lead to the alterations in the spatial arrangement of motoneurons and neuroglial cells,finally affecting the normal function of the central nervous system.The experimental protocol was reviewed and approved by the Animal Ethics Committee of Shahid Beheshti University of Medical Sciences(approval No.IR.SBMU.MSP.REC1395.375) on October 17,2016.

Transfacet approach decompression for thoracic spinal stenosis caused by anterior compression

Objective To study the efficiacy and safety of transfacet approach decompression to treat thoracic spinal stenosis caused by anterior compression. Methods Thirty-three patients with thoracic spinal stenosis caused by anterior

Early electrical field stimulation prevents the loss of spinal cord anterior horn motoneurons and muscle atrophy following spinal cord injury

Our previous study revealed that early application of electrical field stimulation（EFS） with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was neuroprotective in the dorsal corticospinal tract after spinal cord injury（SCI）. The objective of this study was to further evaluate the effect of EFS on protection of anterior horn motoneurons and their target musculature after SCI and its mechanism. Rats were randomized into three equal groups. The EFS group received EFS for 30 minutes immediately after injury at T_（10）. SCI group rats were only subjected to SCI and sham group rats were only subjected to laminectomy. Luxol fast blue staining demonstrated that spinal cord tissue in the injury center was better protected; cross-sectional area and perimeter of injured tissue were significantly smaller in the EFS group than in the SCI group. Immunofluorescence and transmission electron microscopy showed that the number of spinal cord anterior horn motoneurons was greater and the number of abnormal neurons reduced in the EFS group compared with the SCI group. Wet weight and cross-sectional area of vastus lateralis muscles were smaller in the SCI group to in the sham group. However, EFS improved muscle atrophy and behavioral examination showed that EFS significantly increased the angle in the inclined plane test and Tarlov＇s motor grading score. The above results confirm that early EFS can effectively impede spinal cord anterior horn motoneuron loss, promote motor function recovery and reduce muscle atrophy in rats after SCI.

Anterior vertebral body tethering for idiopathic scoliosis in growing children:A systematic review

BACKGROUND The management of idiopathic scoliosis(IS)in skeletally immature patients should aim at three-dimensional deformity correction,without compromising spinal and chest growth.In 2019,the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering(AVBT),under a Humanitarian Device Exception,for skeletally immature patients with curves having a Cobb angle between 35°and 65°.AIM To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.METHODS From January 2014 to January 2021,Ovid Medline,Embase,Cochrane Library,Scopus,Web of Science,Google Scholar and PubMed were searched to identify relevant studies.The methodological quality of the studies was evaluated and relevant data were extracted.RESULTS Seven clinical trials recruiting 163 patients were included in the present review.Five studies out of seven were classified as high quality,whereas the remaining two studies were classified as moderate quality.A total of 151 of 163 AVBT procedures were performed in the thoracic spine,and the remaining 12 tethering in the lumbar spine.Only 117 of 163(71.8%)patients had a nonprogressive curve at skeletal maturity.Twenty-three of 163(14.11%)patients required unplanned revision surgery within the follow-up period.Conversion to posterior spinal fusion(PSF)was performed in 18 of 163(11%)patients.CONCLUSION AVBT is a promising growth-friendly technique for treatment of IS in growing patients.However,it has moderate success and perioperative complications,revision and conversion to PSF.

Transplantation of neurotrophin-3-transfected bone marrow mesenchymal stem cells for the repair of spinal cord injury

Bone marrow mesenchymal stem cell transplantation has been shown to be therapeutic in the repair of spinal cord injury. However, the low survival rate of transplanted bone marrow mesen- chymal stem cells in vivo remains a problem. Neurotrophin-3 promotes motor neuron survival and it is hypothesized that its transfection can enhance the therapeutic effect. We show that in vitro transfection of neurotrophin-3 gene increases the number of bone marrow mesenchymal stem cells in the region of spinal cord injury. These results indicate that neurotrophin-3 can promote the survival of bone marrow mesenchymal stem cells transplanted into the region of spinal cord injury and potentially enhance the therapeutic effect in the repair of spinal cord injury.

Access related complications during anterior exposure of the lumbar spine

The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation(non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.

Total Spondylectomy of C2 and Circumferential Reconstruction via Combined Anterior and Posterior Approach to Cervical Spine for Axis Tumor Surgery

As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra （C2） surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior （retropharyngeal） cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids （one of them experienced dysphonia） and 1 developed cerebrospinal fluid leakage （CSFL） that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale （VAS） and Japanese orthopedic association （JOA） score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.

Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis

AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

Importance of balance and profile in adult spinal reconstruction

Long before its current understanding, the concept of balance was common among spine surgeons dealing with deformities, but it was a hard one to transfer to clinical practice. Thanks to the pioneering work of Duval-Beaupere and followers, the idea of balancing the sagittal contour of the spine has gained scientific status and is now in the armamentarium of the skilled surgeon as the single most important tool to achieve superior clinical results in adult spinal deformity surgery.

颈椎前路手术后硬膜外血肿的发生率和危险因素

目的:探讨行颈椎前路手术患者术后脊髓硬膜外血肿(spinal epidural hematoma,SEH)的发生率和危险因素。方法:回顾性分析2013年3月至2022年2月因颈椎病于北京大学第三医院择期行颈椎前路手术患者的临床资料,将术后出现SEH的患者作为SEH组,将术后未出现SEH的患者以4∶1的比例随机纳入非SEH组,匹配条件为相同术者、相同性别、相同手术年份和相似年龄(±5岁)。比较两组患者的一般状况、术前合并症、抗凝或抗血小板药物使用情况、术前凝血功能和血小板计数、美国麻醉医师协会体格情况分级、颈椎病分型、术前改良日本骨科学会评分和颈部残障指数评分、手术方式、手术节段、手术节段后纵韧带骨化、手术时间、失血量、术后引流量、术前与术后苏醒期间平均动脉压、住院时间和住院费用等,通过二元Logistic回归筛选出术后发生SEH的独立危险因素,并用受试者工作特征曲线及其曲线下面积(area under curve,AUC)评价指标的准确性。结果:共有85例患者纳入研究,其中SEH组共17例,非SEH组68例。17例SEH患者均接受了血肿清除术,所有患者均成功治疗并出院。椎体次全切除术(OR=7.247;95%CI:1.962~26.766;P=0.003)和术后苏醒期间最高平均动脉压增高(OR=1.056;95%CI:1.002~1.113;P=0.043)是导致SEH的危险因素,其AUC分别为0.713(95%CI:0.578~0.848)和0.665(95%CI:0.51~0.82)。SEH患者的住院时间更长(P<0.001),住院费用更高(P=0.035)。结论:椎体次全切除术和术后苏醒期间最高平均动脉压增高是颈椎前路手术患者出现术后SEH的危险因素,应在围术期对高风险患者进行密切观察。

腰椎融合术选择策略及发展趋势

腰椎融合术已经在腰椎退行性病变、畸形、腰椎骨折或脱位等疾病中广泛应用,是消除或缓解症状、维持疗效的重要方法,也是脊柱外科最重要的技术之一。目前,腰椎融合术式种类繁多,根据不同手术入路分为前侧入路、经侧方入路、后侧入路及椎间孔入路等;微创手术包括关节镜辅助、脊柱内窥镜等手术方式;根据不同植骨融合位置又分为椎体外植骨融合和椎体间植骨融合[1]。临床上腰椎融合手术方式的选择方面尚无完全定论。本文回顾、分析不同腰椎融合术的优缺点,结合脊柱微创融合技术等发展趋势展开评论,旨在为临床腰椎融合术的合理实施提供参考,期待未来深入探索、优化手术方法、提高融合效率,降低并发症的新策略,为腰椎疾病患者带来更好的疗效。

显微镜辅助椎间盘切除融合内固定术对局限型后纵韧带骨化症的疗效研究

目的探析局限型后纵韧带骨化症(OPLL)患者接受显微镜下椎间盘切除融合内固定术(ACDF)治疗的近期与远期疗效情况。方法回顾性选取2020年2月—2022年2月收治的局限型OPLL患者105例,按照ACDF治疗过程中是否辅助使用显微镜分为显微镜组56例和常规组49例,观察围术期指标、视觉模拟评分法(VAS)评分、健康调查评估量表(SF-36)评分、椎管最狭窄处椎管面积与脊髓前后径、颈椎活动度、椎间隙高度、关节功能[日本骨科医师协会评分(JOA)颈椎病评分及颈部障碍指数(NDI)]及并发症风险。结果显微镜组平均手术时间(141.85±18.35)min、平均住院时间(10.18±1.58)d短于常规组的(159.46±21.42)min、(12.03±1.82)d,显微镜组术中平均出血量(80.65±7.28)mL少于常规组的(103.52±10.43)mL,差异有统计学意义(P<0.05);显微镜组术后6个月VAS评分(2.82±0.53)分、SF-36评分(79.56±5.68)分优于常规组的(3.51±0.60)、(72.35±4.77)分,差异有统计学意义(P<0.05);显微镜组与常规组在术后椎管面积、脊髓前后径上比较[(138.24±24.32)mm^(2)与(123.62±18.74)mm^(2),(5.42±0.46)mm与(4.73±0.51)mm],差异有统计学意义(P<0.05);显微镜组与常规组在术后6个月颈椎活动度上比较[(25.21±3.37)°与(28.65±3.56)°],差异有统计学意义(P<0.05);显微镜组并发症发生率为5.36%,低于常规组的18.37%,差异有统计学意义(P<0.05);显微镜组与常规组JOA、NDI评分在时间、组间和交互效应上比较,差异有统计学意义(P<0.05)。结论局限型OPLL患者实施ACDF治疗过程中借助显微镜提供清晰视野,并对骨化灶采用磨钻磨除、打薄处理,能更有效地解除脊髓压迫,改善近期疼痛和关节功能状况,降低脊髓损伤等并发症风险。

前路病灶清除钛笼植骨内固定治疗胸腰椎结核的效果研究

目的分析前路病灶清除联合钛笼植骨内固定治疗胸腰椎结核(thoraco-lumbar spinal tu⁃berculosis,TLSTB)的效果。方法选取2021年9月—2023年8月吉林省结核病医院收治的90例TLSTB患者为研究对象,按照内植物的不同分为对照组与研究组,各45例。两组患者均采用小切口前路病灶清除术,对照组术中使用髂骨支撑植骨联合钢板内固定,研究组使用钛笼植骨联合钛板内固定。比较两组术中出血量、手术时间、住院时间、植骨融合时间、Cobb角、Oswestry功能障碍指数(Oswestry Dability Index,ODI)评分与并发症发生率。结果与对照组相比,研究组术中出血量更少,手术时间更短,差异有统计学意义(P均<0.05)。两组住院时间、植骨融合时间比较,差异无统计学意义(P均>0.05)。术后6个月研究组Cobb角为(4.78±0.75)°,ODI评分为(17.05±2.56)分,均低于对照组的(5.42±0.90)°、(20.12±2.74)分,差异有统计学意义(t=3.665、5.492,P均<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论TLSTB患者在前路病灶清除中使用钛笼植骨内固定治疗能够缩短手术操作时间,减少术中出血量,抑制Cobb角丢失,促进患者椎体功能恢复。

脊髓型颈椎病颈前入路术后轴性症状治疗进展

脊髓型颈椎病是脊柱外科较为常见的颈椎退行性疾患,多数患者临床症状严重,保守治疗效果不满意。目前主要以手术治疗为主,部分患者由于脊髓神经长期受压等原因,术后仍存在颈肩部酸胀疼痛、麻木、胸腹部紧束感等症状,影响正常工作及生活。中医学采用多种疗法治疗术后脊髓神经功能恢复近年取得满意效果,或联用西药效果显著。文章就脊髓型颈椎病前路术后脊髓神经功能康复的中西医治疗研究进行综述。

颈椎前路Hybrid手术和颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病临床疗效分析

目的:分析颈椎前路Hybrid手术和颈椎后路单开门椎管扩大成形术(EODL)治疗多节段脊髓型颈椎病的疗效,探讨多节段脊髓型颈椎病患者手术方式的选择。方法:对2017年7月—2020年7月在首都医科大学附属北京中医医院手术治疗的70例多节段脊髓型颈椎病患者进行回顾性分析,根据手术方式不同,分为前路组35例和后路组35例,前路组患者行Hybrid手术[颈椎前路椎间盘切除融合术(ACDF)联合人工颈椎间盘置换术(ACDR)],后路组患者行EODL。记录2组患者住院时间、手术时间、术中出血量和术后引流量,通过日本骨科协会(JOA)评分、JOA改善率、颈椎残障功能指数(NDI)、疼痛视觉模拟评分(VAS)和术后满意度评分进行疗效评价,统计2组患者术后并发症发生情况。结果:与后路组比较,前路组患者术中出血量、术后引流量、住院时间和手术时间均明显减少(P<0.01),术前各项评分差异无统计学意义(P>0.05)。末次随访时,与后路组比较,前路组患者JOA评分和JOA改善率明显升高(P<0.01),NDI评分和VAS评分明显降低(P<0.01)。与术前比较,末次随访时2组患者JOA评分明显升高(P<0.01),NDI和VAS评分均明显降低(P<0.01)。按术后满意度评分评价,2组患者术后满意度均较高。2组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论:颈椎前路Hybrid手术和EODL在治疗多节段脊髓型颈椎病方面均取得了较为满意的疗效。Hybrid手术具有出血量少和手术时间短等优点,临床上应根据患者实际情况选择最适宜的术式。