Objective： To identify the biomechanical feasibility of the thoracic extrapedicular approach to the placement of screws. Methods. Five fresh adult cadaveric thoracic spine from T： to T8 were harvested. The screw wa...Objective： To identify the biomechanical feasibility of the thoracic extrapedicular approach to the placement of screws. Methods. Five fresh adult cadaveric thoracic spine from T： to T8 were harvested. The screw was inserted either by pedicular approach or extrapedicular approach. The result was observed and the pullout strength by pedicular screw approach and extrapedicular screw approach via sagittal axis of the vertebrale was measured and compared statistically. Results： In thoracic pedicular approach, the pullout strength of pedicle screw was 1001.23 N ± 220 N （288.2-1561.7 N） and that of thoracic extrapedicular screw approach was 827.01 N±260 N when screw was inserted into the vertebrae through transverse process, and 954.25 N±254 N when screw was inserted into the vertebrae through the lateral cortex of the pedicle. Compared with pedicular group, the pullout strength in extrapedicular group was decreased by 4.7% inserted through transverse process （P〉0.05） and by 17.3% inserted through the lateral cortex （P 〈 0.05）. The mean pullout strength by extrapedicular approach was decreased by 11.04% as compared with pedicular approach （P〈0.05）. Conclusions： It is feasible biomechanically to use extrapedicular screw technique to insert pedicular screws in the thoracic spine when it is hard to insert by pedicular approach.展开更多
To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. Methods ： A retrospec...To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. Methods ： A retrospective analysis was conducted in 38 consecutive patients （28 females, 10 males）, whose ages ranged from 56 to 82 years （mean age 72 years）. The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments （36 thoracic, 26 lumbar） were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. Results. The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76% ±26.84%, 88.82 % ± 21.75 % and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. Conclusions： Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient＇s activity. The short-term results are approved excellent, and the long-term results need further judgment.展开更多
文摘Objective： To identify the biomechanical feasibility of the thoracic extrapedicular approach to the placement of screws. Methods. Five fresh adult cadaveric thoracic spine from T： to T8 were harvested. The screw was inserted either by pedicular approach or extrapedicular approach. The result was observed and the pullout strength by pedicular screw approach and extrapedicular screw approach via sagittal axis of the vertebrale was measured and compared statistically. Results： In thoracic pedicular approach, the pullout strength of pedicle screw was 1001.23 N ± 220 N （288.2-1561.7 N） and that of thoracic extrapedicular screw approach was 827.01 N±260 N when screw was inserted into the vertebrae through transverse process, and 954.25 N±254 N when screw was inserted into the vertebrae through the lateral cortex of the pedicle. Compared with pedicular group, the pullout strength in extrapedicular group was decreased by 4.7% inserted through transverse process （P〉0.05） and by 17.3% inserted through the lateral cortex （P 〈 0.05）. The mean pullout strength by extrapedicular approach was decreased by 11.04% as compared with pedicular approach （P〈0.05）. Conclusions： It is feasible biomechanically to use extrapedicular screw technique to insert pedicular screws in the thoracic spine when it is hard to insert by pedicular approach.
文摘To evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine. Methods ： A retrospective analysis was conducted in 38 consecutive patients （28 females, 10 males）, whose ages ranged from 56 to 82 years （mean age 72 years）. The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments （36 thoracic, 26 lumbar） were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure. Results. The method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76% ±26.84%, 88.82 % ± 21.75 % and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred. Conclusions： Balloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient＇s activity. The short-term results are approved excellent, and the long-term results need further judgment.
