BACKGROUND We report a case of Intracardiac,pulmonary,and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone,which was successfu...BACKGROUND We report a case of Intracardiac,pulmonary,and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone,which was successfully managed by conservative treatment.We describe the treatment and outcome of the patient,hoping to shed light on the management of bone cement embolism.CASE SUMMARY A 67-year-old female suffered from progressive low back pain and numbness in lower extremities for 30 years.She was diagnosed with L4 and L5 spondylolisthesis,spinal stenosis,and osteoporosis.The patient underwent spinal canal decompression,an interbody fusion of L4/5 and L5/S1,cement-augmented pedicle screw instrumentation in L4-L5 segments,and regular pedicle screw in S1 segments.Three days postoperatively,a sudden drop in oxygen saturation occurred.Computerized tomography scan confirmed Intracardiac,pulmonary,and intravenous embolism.The patient was treated conservatively by continuous low-flow oxygen inhalation,anti-coagulation,and antibiotic therapy for 1 mo and continued anticoagulation treatment for 6 mo.The patient showed no further symptoms in a 30-mo follow-up.CONCLUSION Intracardiac,pulmonary cement embolism after cement-augmented pedicle screw instrumentation is extremely rare.Careful clinical and radiographic evaluation is required in multiple sites of bone cement embolism.Conservative treatment may be a primary consideration in scattered emboli without life-threatening conditions,but a clinical decision should be made on an individualized basis.展开更多
Objective:To investigate the effect of vertebroplasty combined with pedicle screw fixation in the treatment of senile osteoporotic vertebral compression fractures.Methods:Eighty-one patients with senile osteoporotic v...Objective:To investigate the effect of vertebroplasty combined with pedicle screw fixation in the treatment of senile osteoporotic vertebral compression fractures.Methods:Eighty-one patients with senile osteoporotic vertebral compression fractures were enrolled in our hospital from January 2015 to January 2019.They were randomly divided into a single group(40 cases)and a combined group(41 cases).),a single group was treated with pedicle screw internal fixation,and the combined group was treated with vertebroplasty.The recovery,pain and dysfunction index of the injured vertebrae before and after operation were compared between the two groups.The serum neurological function related indexes before and after operation were compared and the incidence of postoperative adverse events were recorded.Results:There was no significant difference in the recovery of the injured vertebrae between the two groups(P>0.05).The compression ratio,spinal stenosis rate and Cobb angle of the combined group were significantly lower than the single group(P<0.05).On the 3rd postoperative day,there were no significant differences between the two groups in Visual Analogue Scale/Score(VAS)and Oswestry Dability Index(ODI)scores(P>0.05).The VAS and ODI scores of the group were significantly lower than those of the single group(P<0.05).On the 3rd day after surgery,the neuron-specific enolase(NSE)and brain derived neurotrophic factor(brain-derived neurotrophic factor)were used.The levels of BDNF,S100βand Nerve growth factor(NGF)were not significantly different(P>0.05).At 3 months after operation,the level of BDNF in the combined group was significantly higher than that in the single group.The levels of NSE,S100βand NGF were significantly lower than that of the single group.The group(P<0.05);the incidence of adverse events in the combined group was significantly lower than that in the single group(P<0.05).Conclusions:Vertebroplasty combined with pedicle screw fixation for the treatment of senile osteoporotic vertebral compression fracture can effectively improve the recovery of postoperative vertebral body structure,postoperative pain and dysfunction in Jianing patients,improve postoperative neurological function To reduce the incidence of adverse events,with clinical promotion significance.展开更多
目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰...目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床疗效及安全性。方法:在中国知网、中国生物医学文献、万方、维普、PubMed、Cochrane Library、Web of Science以及Embase数据库中,检索有关传统椎弓根螺钉与骨水泥强化螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床对照研究,按相关标准对文献进行筛选和质量评价,采用Rev Man 5.4软件进行Meta分析。结果:①纳入2篇随机对照研究和18篇回顾性队列研究,共20篇文献,包括1566例患者,其中骨水泥强化螺钉组789例,传统螺钉组777例;②Meta分析结果显示,骨水泥强化螺钉组术后日本矫形外科协会评分、椎间隙高度及融合率均高于传统螺钉组(MD=1.60,95%CI:1.14,2.07,P<0.00001;MD=1.26,95%CI:0.62,1.90,P=0.0001;OR=11.24,95%CI:2.86,44.14,P=0.0005),手术时间长于传统螺钉组(SMD=0.82,95%CI:0.42,1.23,P<0.0001),术后目测类比评分、Oswestry功能障碍指数及螺钉松动率均低于传统螺钉组(MD=-0.50,95%CI:-0.78,-0.21,P=0.0007;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.00001),两组间住院时间、术中出血量、术后引流量比较差异无显著性意义(P>0.05)。结论:相较于传统椎弓根螺钉固定,骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病时更能有效改善术后融合率及椎间隙高度、降低术后螺钉松动率,提高远期临床疗效。展开更多
Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this re...Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.展开更多
Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome...Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.展开更多
基金Fundamental Research Funds for the Central Universities,No.20ykpy94.
文摘BACKGROUND We report a case of Intracardiac,pulmonary,and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone,which was successfully managed by conservative treatment.We describe the treatment and outcome of the patient,hoping to shed light on the management of bone cement embolism.CASE SUMMARY A 67-year-old female suffered from progressive low back pain and numbness in lower extremities for 30 years.She was diagnosed with L4 and L5 spondylolisthesis,spinal stenosis,and osteoporosis.The patient underwent spinal canal decompression,an interbody fusion of L4/5 and L5/S1,cement-augmented pedicle screw instrumentation in L4-L5 segments,and regular pedicle screw in S1 segments.Three days postoperatively,a sudden drop in oxygen saturation occurred.Computerized tomography scan confirmed Intracardiac,pulmonary,and intravenous embolism.The patient was treated conservatively by continuous low-flow oxygen inhalation,anti-coagulation,and antibiotic therapy for 1 mo and continued anticoagulation treatment for 6 mo.The patient showed no further symptoms in a 30-mo follow-up.CONCLUSION Intracardiac,pulmonary cement embolism after cement-augmented pedicle screw instrumentation is extremely rare.Careful clinical and radiographic evaluation is required in multiple sites of bone cement embolism.Conservative treatment may be a primary consideration in scattered emboli without life-threatening conditions,but a clinical decision should be made on an individualized basis.
基金Qinhuangdao science and technology research and development program(No.201703A079).
文摘Objective:To investigate the effect of vertebroplasty combined with pedicle screw fixation in the treatment of senile osteoporotic vertebral compression fractures.Methods:Eighty-one patients with senile osteoporotic vertebral compression fractures were enrolled in our hospital from January 2015 to January 2019.They were randomly divided into a single group(40 cases)and a combined group(41 cases).),a single group was treated with pedicle screw internal fixation,and the combined group was treated with vertebroplasty.The recovery,pain and dysfunction index of the injured vertebrae before and after operation were compared between the two groups.The serum neurological function related indexes before and after operation were compared and the incidence of postoperative adverse events were recorded.Results:There was no significant difference in the recovery of the injured vertebrae between the two groups(P>0.05).The compression ratio,spinal stenosis rate and Cobb angle of the combined group were significantly lower than the single group(P<0.05).On the 3rd postoperative day,there were no significant differences between the two groups in Visual Analogue Scale/Score(VAS)and Oswestry Dability Index(ODI)scores(P>0.05).The VAS and ODI scores of the group were significantly lower than those of the single group(P<0.05).On the 3rd day after surgery,the neuron-specific enolase(NSE)and brain derived neurotrophic factor(brain-derived neurotrophic factor)were used.The levels of BDNF,S100βand Nerve growth factor(NGF)were not significantly different(P>0.05).At 3 months after operation,the level of BDNF in the combined group was significantly higher than that in the single group.The levels of NSE,S100βand NGF were significantly lower than that of the single group.The group(P<0.05);the incidence of adverse events in the combined group was significantly lower than that in the single group(P<0.05).Conclusions:Vertebroplasty combined with pedicle screw fixation for the treatment of senile osteoporotic vertebral compression fracture can effectively improve the recovery of postoperative vertebral body structure,postoperative pain and dysfunction in Jianing patients,improve postoperative neurological function To reduce the incidence of adverse events,with clinical promotion significance.
文摘目的:骨水泥强化椎弓根螺钉技术近年来被广泛应用于合并骨质疏松的脊柱内固定手术中,可以显著提高固定强度,但与常规椎弓根螺钉内固定比较是否更具有优势尚缺乏循证医学定论。文章系统评价骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床疗效及安全性。方法:在中国知网、中国生物医学文献、万方、维普、PubMed、Cochrane Library、Web of Science以及Embase数据库中,检索有关传统椎弓根螺钉与骨水泥强化螺钉固定治疗骨质疏松性胸腰椎退行性疾病的临床对照研究,按相关标准对文献进行筛选和质量评价,采用Rev Man 5.4软件进行Meta分析。结果:①纳入2篇随机对照研究和18篇回顾性队列研究,共20篇文献,包括1566例患者,其中骨水泥强化螺钉组789例,传统螺钉组777例;②Meta分析结果显示,骨水泥强化螺钉组术后日本矫形外科协会评分、椎间隙高度及融合率均高于传统螺钉组(MD=1.60,95%CI:1.14,2.07,P<0.00001;MD=1.26,95%CI:0.62,1.90,P=0.0001;OR=11.24,95%CI:2.86,44.14,P=0.0005),手术时间长于传统螺钉组(SMD=0.82,95%CI:0.42,1.23,P<0.0001),术后目测类比评分、Oswestry功能障碍指数及螺钉松动率均低于传统螺钉组(MD=-0.50,95%CI:-0.78,-0.21,P=0.0007;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.00001),两组间住院时间、术中出血量、术后引流量比较差异无显著性意义(P>0.05)。结论:相较于传统椎弓根螺钉固定,骨水泥强化椎弓根螺钉固定治疗骨质疏松性胸腰椎退行性疾病时更能有效改善术后融合率及椎间隙高度、降低术后螺钉松动率,提高远期临床疗效。
文摘Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory （CBT） screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.
文摘Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.
