Effect of low-intensity pulsed ultrasound on posterolateral lumbar fusion of rabbit

Objective:To observe the effect of low-intensity pulsed ultrasound in the posterolateral Lumbar fusion of rabbit.Methods:A total of 48 New Zealand white rabbits were randomly divided into the observation group and control group,including the autogenous iliac observation group.artificial bone observation group,artificial bone control group and autogenous iliac control group according to the different bone grafting.The posterolateral lumbar fusion of rabbits in each group was analyzed and compared.Results:After 4 weeks of treatment using the low-intensity pulsed ultrasound,the fusion in the bone grafting area of observation group was good.There was the relatively dense fusion area between the right transverse process and artificial bone.The left transverse process had been completely fused,with the clear bone trabecula through the fusion area.There was no significant fusion sign in the control group.According to the fusion comparison between two groups,the fusion rale of the observation group was 83.3%and it was significantly higher than the one of the control group(37.5%).Results of the comparison were statistically significant(P<0.05).The number of chondrocytes and the increase in the relative gray-scale in the fusion area of the iliac observation group were significantly higher than ones of the iliac control group(P<0.05).The number of chondrocytes and the increase in the relative gray-scale in the fusion area of the artificial bone observation group were significantly higher than ones of the artificial bone control group(P<0.05).The expression of IL-1.IL-6 and IL-17 4 weeks after the treatment of the observation group was significantly lower than the one of the control group,with the statistical significance(P<0.05).It indicated that the treatment of low-intensity pulsed ultrasound could reduce the expression level of inflammatory factors.Conclusions:The low-intensity pulsed ultrasound can significantly increase the bone grafting fusion rate of the rabbit's posterolateral lumbar fusion.The possible mechanism is that it promotes the lumbar posterolateral endochondral ossification and reduces the inflammatory reaction.

Effects of low-intensity pulsed ultrasound stimulation on porous hydroxyapatite blocks for posterolateral fusion of lumbar spine in rabbits

he effects of porous hydroxyapatite blocks（PHABs） and an adjunct low-intensity pulsed ultrasound stimulation（LIPUS） on the fusion rate in a rabbit spinal posterolateral fusion（PLF） model were evaluated.Twenty rabbits underwent PLF with autograft and PHABs were randomly assigned to two groups：treated group with 20 min LIPUS daily and untreated control group for 4 weeks until euthanasia.The fused motion segments were subjected to manual palpation,gross observation,and radiographic investigation before histomorphologic and scanning electron microscopic analyses.Statistical differences between the LIPUS group and the control group are found in the fusion rate,bone density gray scale,trabecular bone formation,osteoblast-like cells,chondrocytes and positive expression of BMP-2 and TGF-β1 in the junction zone（significance level p〈0.05）.The results suggest that LIPUS can increase fusion rates and accelerate bone in-growth into PHAB.Hence,PHAB and LIPUS may be used together to increase fusion rates in a rabbit spinal fusion model with a promising extension to human application.

Comparison of Fusion Rates between Autologous Iliac Bone Graft and Calcium Sulfate with Laminectomy Bone Chips in Multilevel Posterolateral Spine Fusion

Multilevel lumbar fusion usually requires a large quantity of iliac crest bone graft but the supply is usually insufficient, so an alternative bone graft substitute for autograft is needed. This prospective study investigated the efficacy of calcium sulfate by comparing the fusion rates between the experimental material (calcium sulfate pellets with bone chips from laminectomy) and autologous iliac bone graft in long segment (three-or four-level) lumbar and lumbosacral posterolateral fusion. Forty-five patients with degenerative scoliosis or spondylolisthesis received multilevel spine fusion and decompression. The experimental material of calcium sulfate pellets with decompression bone chips was placed on the experimental side and the iliac crest bone graft was placed on the control side. The fusion status was assessed radiographically at three-month intervals, and solid fusion was defined as a clear continuous intertransverse bony bridge at all levels. The average follow-up period was 34.4 months. Twenty-nine (64.4%) patients showed solid fusion on the experimental side and 39 (86.7%) patients on the control side. The overall fusion rate was 86.7%. A statistically significant relation was found between the two sides with the Kappa coefficient of agreement of 0.436. Compared to the control side, the fusion rate of experimental side is significantly reduced (p = 0.014). The fusion ability of autograft is higher than the experimental material in multilevel lumbar posterolateral fusion. However, the overall fusion rate of calcium sulfate pellets is improved, compared with previously reported rates, which suggested that such material may be considered as an acceptable bone graft extender.

Posterior Lumbar Interbody Fusion versus Posterolateral Fusion in Surgical Treatment of Lumbar Spondylolithesis

Background: The optimal surgical technique for lumbar spondylolithesis remains debated. Although posterior lumbar interbody fusion (PLIF) theoretically offers more advantages than posterolateral lumbar fusion (PLF), the evidence remains inconclusive. Aim: The aim of this study is to compare the clinical and functional outcomes of PLIF versus PLF in patients with lumbar spondylolithesis. Patients and Methods: We enrolled 38 patients with lumbar spondylolithesis (degenerative and isthmic) who underwent PLIF (N = 19) or PLF (N = 19). We collected operative data and performed follow-up for 12 months after the surgery. The collected data were analyzed using the SPSS software to detected significant differences between both groups. Results: The PLF and PLIF groups exhibited similar pre-operative characteristics between both groups in terms of age (p = 0.57), sex (p = 0.73), clinical presentation (p = 1), required levels of fixation (p = 1), pre-operative VAS score (p = 0.43) or muscle weakness (p = 1). However, the PLIF group had significantly more blood loss and longer operative time than the PLF group. Moreover, both groups had similar levels of postoperative pain (up to six months after surgery), and post-operative complications. The rates of arthrodesis were higher in PLIF group than PLF group within six months while no significant difference within 12 months of follow-up. Conclusion: In our comparative study, we achieved comparison between pedicle screw fixation with posterolateral fusion alone (PLF) in compare with pedicle screw fixation with posterior lumbar interbody fusion (PLIF). Results indicate better results of fusion rate in PLIF as regards arthrodesis with slightly more rate of complication than PLF. So we recommend PLIF in cases of lumbar spondylolithesis than PLF.

PLF与PLIF手术治疗腰椎滑脱症的疗效比较

目的:对比研究后外侧融合(PLF)与经后路椎体间融合(PLIF)治疗Ⅰ度和Ⅱ度腰椎滑脱症的疗效。方法:67例腰椎滑脱症患者分为PLF组32例,PLIF组35例。两组年龄、病程、术前临床表现及影像学资料相近似。PLF组JOA评分16.3±7.8分,PLIF组14.5±6.5分。两组均进行了后路椎板减压,短节段经椎弓根钉系统复位与固定。结果:PLF组手术时间平均187min,出血量平均680ml;PLIF组手术时间248min,出血量平均945ml。PLIF组慢性下腰痛改善明显高于PLF组(P=0.042),而临床疗效JOA评分两组间无显著性差异。骨融合率PLF组74.8%,PLIF组94.3%(P=0.011),经随访PLF组矫正率丢失30.9%,而PLIF组为9.8%(P<0.05)。PLF组各种并发症19例,PLIF组11例。结论:PLF与PLIF手术均是治疗腰椎滑脱症的有效术式,PLIF手术时间较长,创伤大,但骨融合率高,内固定失败率低,滑脱矫正率丢失少,晚期慢性下腰痛发生率低。

PLF与PLIF治疗峡部裂性腰椎滑脱的疗效比较

目的对比研究后外侧融合(posterolateral fusion,PLF)与后路椎间融合(posterior lumbar interbody fusion,PLIF)治疗Ⅰ～Ⅱ度峡部裂性腰椎滑脱的疗效。方法76例采取植骨融合附加椎弓根内固定的手术方法,33例采用后外侧融合,其余采用椎间融合,比较两种植骨方式术后植骨融合率和临床症状改善情况。结果临床优良率分别为81．82％和88．37％,两者无显著性差异(P>0．05);骨融合率分别为75．76％和90．7％,两者有显著性差异(P<0．05)。结论后外侧融合与椎间融合治疗Ⅰ～Ⅱ度峡部裂性腰椎滑脱的疗效相似,无明显差别。

PLIF联合PLF与单纯PLIF治疗腰椎退行性疾病的临床比较研究

目的:比较后路椎体间融合(PLIF)联合后外侧融合(PLF)与单纯PLIF治疗腰椎退行性疾病的疗效。方法:78例接受脊柱融合治疗的腰椎退行性疾病患者,随机分为PLIF联合PLF组(n=40)和单纯PLIF组(n=38),随访24周,在不同的时间点观察所有病例的OD I指数、腰椎前凸角、节段前凸角、椎间隙高度、腰椎滑脱率及融合率,并记录术中出血量、术后48 h内引流量、术后切口疼痛程度及并发症发生情况,根据随访结果对两组进行比较。结果:78例均获得随访,PLIF联合PLF组与单纯PLIF组之间临床症状改善、腰椎前凸角、节段前凸角及椎间隙高度、滑脱率改善、两组间融合率和出血量无明显统计学差异(P>0.05),PLIF联合PLF组术后48 h内引流量较单纯PLIF组多(P<0.05),术后3 d切口疼痛程度大于单纯PLIF组(P<0.05)。结论:联用或不联用PLF对椎弓根内固定下PLIF治疗腰椎退行性疾病的短期临床疗效、融合率无明显影响,联用PLF可增加手术创伤。

单纯PLIF与PLIF联合PLF治疗腰椎退行性疾病的临床效果对比研究

目的对比研究单纯后路椎体间融合术与后路椎体间融合联合后外侧融合术治疗腰椎退行性疾病的疗效。方法选择我院2011年2月～2013年1月收治的腰椎退行性疾病患者100例,其中行单纯后路椎体间融合术47例患者,行后路椎体间融合联合后外侧融合术53例患者。回顾两组患者的病历资料,并比较两组术后的临床效果及影像学表现。并记录术中出血量、术后切口疼痛程度、术后48 h内引流量及并发症发生情况。结果 100例患者均获得随访。两组术中手术时间、出血量、并发症发生率、住院天数等进行比较,差异无统计学意义(P>0.05);术后3 d切口疼痛VAS评分、48 h内伤口引流量,两组比较差异有统计学意义(P<0.05)。两组腰椎前凸角、融合节段前凸角、临床疗效、融合率差异无统计学意义(P>0.05)。结论联用或不联用PLF对椎弓根内固定下PLIF治疗腰椎退行性疾病的短期临床疗效、融合率无明显影响,且椎间融合联合后外侧融合增加住院时间。

后路椎弓根钉固定联合PLF、TLIF治疗腰椎滑脱型椎管狭窄症的疗效对比分析

目的 探讨分析后路椎弓根钉固定联合PLF、TLIF治疗腰椎滑脱型椎管狭窄症的疗效对比分析.方法 选择2010年4月至2011年12月在涟水县人民医院骨科与鼓楼医院骨科就诊的Ⅰ°与Ⅱ°腰椎滑脱型椎管狭窄症患者54例,均采用椎弓根螺钉复位内固定,根据不同适应证选择PLF和TLIF治疗,各27例,采用Nakai评分及影像学检查对临床疗效进行评价.结果 术后随访时间6 ～24个月,两组临床疗效分析显示,TLIF组优良率及骨性融合率高于PLF组,但差异无统计学意义（P＞0.05）.结论 在合理选择适应证的情况下,应用椎弓根螺钉复位内固定行PLF、TLIF治疗Ⅰ°与Ⅱ°腰椎滑脱型椎管狭窄症均可获得较好的临床疗效.

PLF与TLIF手术治疗腰椎不稳症的疗效比较

目的对比研究用腰椎后外侧融合术(PLF)与经椎间孔椎体间融合术(TLIF)治疗腰椎不稳症的临床疗效。方法45例均行减压短节段椎弓根钉系统固定,TLIF组26例,PLF组19例。比较术中出血量、手术时间、手术前后的椎间高度、融合率、JOA改善率等指标,综合判断近期疗效。结果经随访9～18个月,平均12.2个月。两组手术时间、出血量比较,P<0.05;两组椎间高度重建、骨融合率、并发症发生率比较P<0.05,两组JOA疗效改善率比较P>0.05。结论PLF手术与TLIF手术均是治疗腰椎不稳症的有效术式,TLIF手术时间较长,出血量较大,但骨融合率高、并发症极少。

360°环形融合术(PLIF+PLF)在成人腰椎滑脱中的临床研究

目的探讨360°环形融合术(PLIF+PLF)治疗成人腰椎滑脱的临床疗效。方法选择2004～2012年于我院接受手术治疗的96例腰椎滑脱患者,随机分为360°环形融合术(PLIF+PLF)组和后外侧融合术(PLF)组,每组48例,回顾性分析并比较两组患者在腰椎融合率、腰椎前凸角、JOA评分改善率的差异。结果 360°环形融合术组患者的腰椎融合率、腰椎前凸角、JOA评分改善率优于后外侧融合术组,两组相比差异显著(P<0.05)。结论 360°环形融合术治疗成人腰椎滑脱能更好地保持腰椎生理前凸,获得更高的腰椎融合率,提高JOA评分,值得进一步探讨和推广。

患椎棘突骨板在胸腰椎脊柱骨折PLF手术中应用的效果观察

目的比较胸腰椎脊柱骨折经后路切开复位椎弓根钉棒系统内固定植骨(PLF)手术不同骨源植骨的临床疗效。方法将65例胸腰椎脊柱骨折患者随机分为3组,均行PLF手术。A组20例取髂骨瓣植骨,B组21例行同种异体骨植骨,C组24例行患椎棘突骨板植骨。结果手术时间:A组(128±25)min,B组(95±7)min,C组(92±5)min;术中出血量:A组(563±135)mL,B组(351±60)mL,C组(336±57)mL;A组手术时间与出血量与B组和C组比较均有显著性差异。A组、C组患者术后切口均I期愈合;B组出现排异反应4例,2例行异体骨取出清创术后愈合2,例经长期换药愈合。3组均无死亡、神经功能损害加重及内固定器械松动断裂等情况发生。A组发生术后取骨区疼痛7例占35%,B组发生伤口痛、渗液4例占19%,C组无不良并发症发生。术后A组及C组胸腰椎骨性融合率均为95%,B组融合率为84%。术后3个月、6个月、12个月神经功能损伤评分3组比较均无显著性差异。结论胸腰椎脊柱骨折取患椎棘突骨板植骨能保证术后融合率,恢复脊柱的远期稳定,其较取髂骨与同种异体骨操作简便、安全经济、创伤小、并发症少,是一种值得临床推广的植骨思路。

PLF与PLIF治疗峡部裂腰椎滑脱效果的Meta分析

目的系统性评价后外侧融合(internal fixation and posterolateral fusion,PLF)与后路椎间融合(posterior lumbar interbody fusion,PLIF)治疗短节段峡部裂型腰椎滑脱的临床效果。方法计算机检索Medline、PubMed、Cochrane Library、Ovid、SpringerLink、中国生物医学文献数据库、万方、维普等数据库,并手工检索相关杂志搜集关于PLF和PLIF的随机对照试验。按纳入和排除标准对检索到的文献进行筛选,采用RevMan 5.1软件对结局指标进行Meta分析。结果纳入5篇随机对照试验(randomized controlled trials,RCT)文献,共409例患者,PLF组206例,PLIF组203例。Meta分析结果显示,与PLIF组相比,PLF组的平均手术时间较少(MD=-29.71,95%CI:-42.85^-16.57,P<0.000 01),融合率较低(OR=0.41,95%CI:0.22~0.76,P=0.005),但两组术式在平均失血量(MD=172.35,95%CI:-78.03~422.729,P=0.18)、并发症(OR=1.62,95%CI:0.59~4.51,P=0.35)、再次手术率(OR=3.03,95%CI:0.46~20.00,P=0.25)及临床结果优良率(OR=0.59,95%CI:0.30~1.15,P=0.12)方面差异无统计学意义。结论与PLIF治疗短节段峡部裂型腰椎滑脱相比,PLF的手术时间较短,融合率较低,其余方面未见差异。但本Meta分析的某些比较存在明显异质性,同时也存在多种偏倚的可能,所以此结果仍需要长期随访的高质量的随机对照试验进一步证实此结论。

Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis

Introduction: Surgical interventions for degenerative spondylolisthesis are varied with comparable claims of success. Fusion based technique is one of the most commonly used surgical interventions in treating this condition. The aim of this meta-analysis is to compare the effectiveness of the Lumbar Interbody Fusion techniques (specifically Posterolateral Interbody approach—PLIF) versus Posterolateral Instrumented Fusion (PLF). The clinical outcomes investigated were: back pain, leg pain, function, Oswestery Disability Index (ODI), Disability Rating Index (DRI), fusion and revision rates if reported. Methods: Combinations of keywords and MeSH terms, where appropriate, were used to search for studies in Medline via Ovid, Embase, Cochrane Library, and Google scholar. The initial search was conducted on 10 August 2016 and updated on 13 June 2017. Eligibility criteria for the studies to be selected for this meta-analysis were: Randomised Controlled Trials (RCTs), cohort and consecutive cases studies that compared at PLIF versus PLF surgical interventions at the lumbar region. Heterogeneity indicators and Forest plot were computed using RevMan 5. Results: Out of the initial hits of 3021, 5 articles were selected as relevant and assessed for risk of bias and then data was extracted and tabulated. These 5 studies reported data from (900 patients’ records, follow up ranges from 6 months to 5 years) undergone one of 2 interventions (PLIF or PLF). The overall effect for ODI and leg pain showed no advantage of any intervention over the other while there was a greater odd ratio of fusion if the operation applied PLIF techniques (Overall Z = 2.86, p = 0.004). Conclusions: There is a need for more high quality clinical trials to compare these two interventions. However, available data indicate that there are comparable results in the main clinical outcomes between PLIF and PLF. PLIF has superior fusion rate which does not seem to affect post-operative pain ratings.

Surgical Management of Spondylolisthesis by Pedicular Screw Rod System and Postero-Lateral Fusion

Introduction: Incidence of spondylolisthesis in general population is 5% - 7%. No matter what the etiology is, patients usually have significant functional disability. Few studies have investigated the long term effect of posterolateral fusion on functional outcome. Objectives: To study the efficacy of posterolateral fusion in spondylolisthesis especially in terms of functional outcome. Methodology: From July 2010 to June 2012, a total of 86 patients, operated with postero-lateral fusion were followed up and evaluated based on VAS for low back pain, ODI and neurological deficits. Results: Follow up was 83% of original study population (86). Average follow up was 13 months. The mean difference between pre-operative and post-operative VAS at final follow up was 3.5 cms (SD = 2.94);ODI was 28% at 4 months and 36% at 8 months. Claudication pain relieved in all;functional outcome was good in 67%, fair in 27.5% and failed in 5.5%;75% had fusion at an average of 5.5 months. Conclusion: Posteriolateral fusion is still a safe, promising and appealing technique.

Unilateral pedicle screw fixation combined with lumbar interbody fusion for the treatment of lumbar degenerative diseases

Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.

Enhanced bone regenerative properties of calcium phosphate ceramic granules in rabbit posterolateral spinal fusion through a reduction of grain size

Osteoinductivity is a crucial factor to determine the success and efficiency of posterolateral spinal fusion(PLF)by employing calcium phosphate(Ca-P)bioceramics.In this study,three kinds of Ca-P ceramics with microscale to nanoscale gain size(BCP-control,BCP-micro and BCP-nano)were prepared and their physicochemical properties were characterized.BCP-nano had the spherical shape and nanoscale gain size,BCP-micro had the spherical shape and microscale gain size,and BCP-control(BAM®)had the irregular shape and microscale gain size.The obtained BCP-nano with specific nanotopography could well regulate in vitro protein adsorption and osteogenic differentiation of MC3T3 cells.In vivo rabbit PLF procedures further confirmed that nanotopography of BCP-nano might be responsible for the stronger bone regenerative ability comparing with BCP-micro and BCP-control.Collectedly,due to nanocrystal similarity with natural bone apatite,BCP-nano has excellent efficacy in guiding bone regeneration of PLF,and holds great potentials to become an alternative to standard bone grafts for future clinical applications.

椎间植骨融合与横突间植骨融合治疗腰椎滑脱症的比较

目的:比较横突间植骨融合内固定与椎间植骨融合内固定治疗腰椎滑脱症的效果.方法:对111例腰椎滑脱症患者分别采用横突间植骨融合内固定(81例)与椎间植骨融合内固定(30例),回顾两组患者的临床资料,比较两种植骨方式术后植骨融合率及临床症状改善情况.结果:随访7～68个月,平均19.9个月.横突间植骨组融合率85.2%,椎间植骨组融合率96.7%,两组无显著性差异(P＞0.05).对于真性滑脱及Ⅰ度以上退变性滑脱,椎间植骨融合率100%,横突间植骨融合率75%,两组有显著性差异(P＜0.05).椎间植骨组优良率93.3%,横突间植骨组优良率88.9%,两组无显著性差异(P＞0.05).结论:椎间植骨与横突间植骨治疗腰椎滑脱症的疗效相近.对于Ⅰ度退变性滑脱,横突间植骨仍是有效的植骨融合方法,但对于真性滑脱或Ⅰ度以上退变性滑脱,应行椎间植骨融合.

后路环周融合治疗老年人重度腰椎管狭窄症

[目的]探讨后路环周腰椎融合在老年人重度腰椎管狭窄症的应用和效果。[方法]2001年11月～2004年5月，采用后路腰椎间融合（PLIF）联合后外侧融合（PLF）的环周融合术治疗老年人腰椎管狭窄症83例。随访18～42个月，观察术后并发症，采用JOA评分评估治疗效果，X线片和CT判定植骨融合情况。[结果]术后所有患者12～14d即可下地行走，3例出现症状性下肢深静脉血栓，10例腰腿痛一过性加重。末次随访腰腿痛明显缓解，JOA评分由术前平均（13．6±3．8）分改善至（22．3±4．6）分。椎间植骨均获骨性融合。[结论]后路环周融合术是治疗老年人重度腰椎管狭窄的安全、有效、合理的选择之一。

应用纳米晶胶原基骨材料行腰椎后外侧融合初步效果分析

目的: 探讨在腰椎后外侧植骨融合中应用纳米晶胶原基骨材料(nHAC/PLA) 的可行性和效果。方法: 随访分析64例腰椎多节段椎板切除减压、后外侧植骨融合辅助椎弓根螺钉内固定治疗各类腰椎退行性疾病的临床疗效, 植骨材料采用nHAC/PLA颗粒和自体骨颗粒混合, 采用VAS疼痛10分法和中华医学会骨科分会脊柱外科组手术疗效标准评估; 腰椎正、侧及屈、伸动力位X线片判定融合情况。结果: 所有病例切口愈合良好; 1年和1年半复诊术后功能恢复优良率分别为90. 3%和94. 4%, 融合率分别为83. 9%和88. 9%, 假关节发生率为0, 椎弓根螺钉无松动和移位。结论: 纳米晶胶原基骨材料在腰椎后外侧植骨融合中应用是安全的, 具有良好的生物相容性, 可作为自体骨移植的补充, 两者混合使用效果接近自体骨, 弥补了减压过程中自体骨的不足, 避免再取髂骨。