Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion

Objectives:To explore the risk factors and nursing measures of early surgical site infection(SSI)after posterior lumbar interbody fusion(PLIF).Methods:A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study.According to the occurrence of early SSI,the patients were divided into two groups,and the general data were analyzed by univariate analysis.Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures.Results:Among 468 patients with PLIF,18 patients developed early SSI(3.85%).The proportion of female,age,diabetes mellitus and urinary tract infection(UTI),operation segment,operation time,post-operative drainage volume,and drainage time were significantly higher than those in the uninfected group,with statistical significance(P<0.05),whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group,with statistical significance(P<0.05).There was no significant difference between the two groups in the American Society of Anesthesiologists(ASA)grading,body mass index(BMI),complications including cardiovascular and cerebrovascular diseases or hypertension(P>0.05).Logistic regression analysis showed that preoperative diabetes mellitus(OR=2.109,P=0.012)/UTI(OR=1.526,P=0.035),prolonged drainage time(OR=1.639,P=0.029)were risk factors for early SSI.Men(OR=0.736,P=0.027)and albumin level(OR=0.526,P=0.004)were protective factors in reducing early SSI.Conclusions:Women,preoperative diabetes/UTI,hypoproteinemia,and prolonged drainage time are risk factors for early SSI after PLIF.Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.

Biomechanical Comparison of Anterior Lumbar Screw-plate Fixation versus Posterior Lumbar Pedicle Screw Fixation

Anterior lumbar interbody fusion （ALiF） followed by posterior pedicle screw fixation （PSF） in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by an- terior lumbar screw-plate has a lot of advantages, but its biomechanical stability requires confirma- tion. This study evaluated the biomechanical stability of a novel anterior lumbar locked screw-plate （ALLSP） by comparison with posterior lumbar PSF. Twelve fresh human cadaveric lumbar speci- mens （L4-L5） were assigned to four groups： ALIF^PSF group, ALIF＋ALLSP （both fixed） group, ALIF group and an untreated control （both non-fixed） group. The first three groups received implan- tation of a rectangular titanium cage. Tests under axial compression, flexion, extension, lateral bend- ing, or rotation showed that the fixed groups had significantly stronger stability than the non-fixed groups （P=-0.000 for all）. The ALIF＋ALLSP group had significantly greater axial stiffness under ap- plied axial compression and significantly less angular displacement under rotational forces than the ALIF＋PSF group. The angular displacement of the ALIF＋ALLSP group was less under flexion than that of the ALIF＋PSF, and the angular displacement under lateral bending and extension was greater, but these differences were not statistically significant. In summary, the ALLSP conforms to the ante- rior lumbar spine and has good biomechanical stability. It is a reliable choice for enhancing the sta- bility of ALIF.

Can bone mineral density affect intra-operative blood loss of mini-invasive posterior lumbar interbody fusion?

Objective:Many factors affect intraoperative blood loss(BL)in mini-invasive posterior lumbar interbody fusion(PLIF)procedures,but only few has examined.Specifically,the impact of bone mineral density(BMD)levels on intraoperative BL.This study aims to examine the correlation between these two factors.Methods:Retrospective review of 120 patients with low back disorders who were scheduled to undergo mini-invasive PLIF from October 2018 to October 2019 was performed.Patients were divided into two groups based on BMD of the lumbar spine:normal group and abnormal group(osteoporosis and osteopenia).Comparison of age,gender,BMD,BL,BMI,prothrombin time,activated partial thromboplastin time,haemoglobin concentration,intraoperative mean arterial pressure,platelet count,and operative time(OT)between the two groups,and correlation analysis of BMD and BL were conducted.Results:The mean BL of patients in the abnormal group was remarkably higher than that in the normal group:357.22±152.55 ml and 259.37±125.90 ml respectively(p<0.001).The partial correlation coefficient between BL and BMD was0.45(p<0.001).The results of univariate regression analysis demonstrated that only BMD,gender,and OT were related to BL(BMD,r=0.427,p<0.001;gender,r=0.211,p=0.024;OT,r=0.318,p=0.001).While multivariate linear regression analysis demonstrated that patients with lower BMD and longer OT had a higher amount of intraoperative BL(p<0.001).Conclusions:BMD is an important factor influencing intraoperative BL in mini-invasive PLIF.It should be assessed routinely as a part of the preoperative examination to improve preoperative assessment and ensure patient safety.

Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion:A case report

BACKGROUND Delayed arterial symptomatic epidural hematoma(SEH)on the 14th day after posterior lumbar interbody fusion(PLIF)is rare but it may lead to severe complications if not identified and treated in a timely manner.After diagnosis of the current case,early surgical removal of the hematoma and strict hemostasis treatment was accomplished.This case report highlights the importance of swift diagnosis and treatment in SEH patients.CASE SUMMARY A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF.On the 14th post-operative day,the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms.Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH.Emergency surgical removal of the hematoma and hemostasis was performed.About 70 mL of hematoma was found in the left incision.Continuous bleeding was found in the anterior branch of the transverse process of the 4th lumbar artery in the muscle area about 2 cm below the transverse process of the 4th lumbar vertebra.A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding.Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared.There was no recurrence during the 12-mo follow-up.CONCLUSION For delayed arterial SEH on the 14th day after PLIF,preventive measures including pre-,intra-and post-operative prevention should be implemented.

Comparison of Clinical Outcomes of Cortical Bone Trajectory and Traditional Pedicle Screw Fixation in Posterior Lumbar Interbody Fusion

Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.

Biomechanical Effects of Implant Materials on Posterior Lumbar Interbody Fusion: Comparison of Polyetheretherketone and Titanium Spacers Using Finite Element Analysis and Considering Bone Density

Few biomechanical data exist regarding whether the polyetheretherketone (PEEK) spacer or titanium spacer is better for posterior lumbar interbody fusion (PLIF). This study evaluated the biomechanical influence that these types of spacers with different levels of hardness exert on the vertebra by using finite element analysis including bone strength distribution. To evaluate the risk of spacer subsidence for PLIF, we built a finite element model of the lumbar spine using computed tomography data of osteoporosis patients. Then, we simulated PLIF in L3/4 and built models with the hardness of the interbody spacer set as PEEK and titanium. Bones around the spacer were subjected to different load conditions. Then, fracture elements and some stress states of the two modalities were compared. In both models of PLIF simulation, fracture elements and stress were concentrated in the bones around the spacer. Fracture elements and stress values of the model simulating the PEEK spacer were significantly smaller compared to those of the titanium simulation model. For PLIF of osteoporotic vertebrae, this suggested that the PEEK spacer is in a mechanical environment less susceptible to subsidence caused by microfractures of bone tissue and bone remodeling-related fusion aspects. Therefore, PEEK spacers are bio-mechanically more useful.

Use of Nonlinear Finite Element Analysis of Bone Density to Investigate the Biomechanical Effect in the Bone around Intervertebral Cages in Posterior Lumbar Interbody Fusion

Preventing subsidence of intervertebral cages in posterior lumbar interbody fusion (PLIF) requires understanding its mechanism, which is yet to be done. We aimed to describe the mechanism of intervertebral cage subsidence by using finite element analysis through simulation of the osteoporotic vertebral bodies of an elderly woman. The data from computed tomography scans of L2-L5 vertebrae in a 72-year-old woman with osteoporosis were used to create 2 FE models: one not simulating implant placement (LS-INT) and one simulating L3/4 PLIF using polyetheretherketone (PEEK) cages (LS-PEEK). Loads and moments simulating the living body were applied to these models, and the following analyses were performed: 1) Drucker-Prager equivalent stress distribution at the cage contact surfaces;2) the distribution of damage elements in L2-L5 during incremental loading;and 3) the distribution of equivalent plastic strain at the cage contact surfaces. In analysis 1, the Drucker-Prager equivalent stress on the L3 and L4 vertebral endplates was greater for LS-PEEK than for LS-INT under all loading conditions and tended to be particularly concentrated at the contact surfaces. In analysis 2, compared with LS-INT, LS-PEEK showed more damage elements along the bone around the cages in the L3 vertebral body posterior to the cage contact surfaces, followed by the area of the L4 vertebral body posterior to the cage contact surfaces. In analysis 3, in the L3 inferior surface in LS-PEEK the distribution of equivalent plastic strain was visualized as gradually expanding along the cages from the area posterior to the cages to the area anterior to them with increased loading. These analyses suggested that in PLIF for osteoporotic vertebral bodies, the localized stress concentration generated by the use of PEEK cages may cause accumulation of microscopic damage in the fragile osteoporotic vertebral bodies around the cages, which may result in cage subsidence.

Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

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.

Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease： a retrospective study

Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery. Methods The 25 cases that underwent L5-$1 posterior lumbar interbody fusion （PLIF） ＋ L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-$1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading （4 to 6）. The patients were evaluated with visual analogue scale （VAS） and Japanese orthopaedic association （JOA） scores before surgery and in the last follow-up. Modic changes of endplates were recorded. Results The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups （t=-12.1 and 13.5, P 〈0.05）. Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly （Topping-off group： t=-2.30 and -2.24, P 〈0.05; PLIF group： t=--2.76 and -1.83, P 〈0.01）. In the hyperextension and hyperflexion view, Topping-off group＇s range of motion （ROM） and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM （t=--7.82 and -4.90, P 〈0.01） and olisthesis （t=--15.67 and -18.58, P 〈0.01） both significantly increased in extension and flexion. Conclusions Compared with single segment PLIF surgery, Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration, restrict the adjacent segment＇s ROM in extension and prevent excessive olisthesis of adiacent seament in both extension and flexion

Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis

Objective To analyze complications associated with posterior lumbar interbody fusion (PLIF) in which two Bagby and Kuslich (BAK) interbody fusion cages were implanted.Methods A total of 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using two BAK cages filled with morselized autogenous bone. The major clinical and radiographic complications were analyzed after a follow-up with an average time of 2 years and 9 months.Results Complications were divided into intraoperative and postoperative complications. Intraoperative complications mainly included dural tear (4 patients, 3.4%), nerve root injury (3 patients, 2.5%) and suboptimal cage position (9 patients, 7.5%). No death was caused by the operation. Postoperative complications chiefly consisted of cage retropulsion (3 patients, 2.5%), cage subsidence (4 patients, 3.4%), and postlaminectomy arachnoiditis (2 patients, 1.7%). Pseudarthrosis was noted radiographically with evidence of motion between adjacent vertebra on lateral flexion-extension films and luciencies around the cages (2 patient, 1.7%), continuous posterior cage migration (2 patients, 1.7%) or continuous cage subsidence (2 patients, 1.7%). Two patients died, one from a traffic accident and the other from metastatic cancer 1 year postoperatively.Conclusions The results of this study indicate that PLIF with BAK cages is an effective but also technically difficult procedure. The relatively high incidence of complications reminds us of the importance of surgical indications and proper manipulations.

Chylothorax following posterior low lumbar fusion surgery:A case report

BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

One Stage Anterior Reconstruction and Posterior Instrumentation in Surgical Management of Thoracolumbar Spine Fractures

Background: The different methods of anterior reconstruction and posterior instrumentation in surgical management of thoracolumbar spine fractures are PLIF, TLIF, lateral extracaviatary and transpedicular techniques which are increasingly used to perform partial or total corpectomies and anterior reconstructions from a posterior approach. These techniques were being alternative to the standard anterior approach with less morbidity and mortality. Patients and Methods: This study was performed between 2011 and 2014 on 100 patients with acute unstable thoracolumbar spine fractures which were divided into four groups: 30 patients underwent (TLIF), 28 patients underwent (PLIF), 28 patients underwent (PA) and 14 patients underwent (TPA). Neurological outcome, complications, operative times, kyphotic angle, vertebral height loss, spinal canal compromise, pulmonary functions, Denis pain and work scale, VAS score, ODI score, hospital stay, and estimated blood loss (EBL) were evaluated and compared in between the four groups. Results: There was a higher complication rate, increased EBL, and longer operative time with posteroanterior (PA) compared with PLIF, TLIF and (TPA). Patients undergoing PLIF, TLIF and TPA had a greater recovery of neurological function than those in whom PA were performed. Conclusion: TPA appeared to have more favorable results in improving the clinical and radiological outcome and no complications were reported apart from superficial wound infection which healed rapidly. The PLIF, TLIF and TPA appeared to have a comparable morbidity rate to PA. The different methods of anterior reconstruction from posterior approach are more favorable, applicable and convenient than PA approach.

Early Functional Outcome of Posterior Spinal Decompression for Lumbar Spinal Stenosis at a Tertiary Health Institution, South East Nigeria

Background: Surgical treatment of lumbar spinal stenosis by posterior spinal decompression may be indicated if non-surgical management for the symptoms of low back and lower limbs radicular pains is unsuccessful and/or in patients with persisting or worsening neurological deficits. It has been reported to be an effective treatment modality in well selected patients. This procedure is however not without possible complications which can adversely affect the outcome of treatment in the affected patients. This prospective study was therefore undertaken to evaluate the early functional outcome of posterior spinal decompression for lumbar spinal stenosis at our health institution. Method: All patients with symptomatic lumbar spinal stenosis admitted for posterior spinal decompression and who met the inclusion criteria were recruited with their written informed consent. The patients’ pain severity and functional disability were assessed preoperatively with visual analogue scale (VAS) and Oswestry Disability Index (ODI). The VAS and ODI were also used to reassess the patients postoperatively, at 2 weeks, 6 weeks and 12 weeks respectively. All intraoperative and/or postoperative complications were documented and the results were analyzed. Results: The patients’ mean preoperative lower back pain and leg pain VAS score was 8.26 ± 1.46 while the mean preoperative ODI was 62.4% ±13.56. The commonest combination of spinal decompressive procedure done in the patients was laminectomy + foraminotomy in 10 (25% patients). The most common decompressed spinal level was L4/L5 (89.7%);while almost equal number of patients had either one spinal level or two-spinal level decompression (43.6% and 46.1% respectively). Postoperative pain assessment showed a mean VAS of 3.79 ± 1.15, 2.55 ± 1.27 and 2.00 ± 1.41 at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). Functional outcome assessment with ODI was 34% ± 11.79%, 24% ± 10.75% and 18.12% ± 10.61% at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). The commonest surgical complication seen was dura tear which occurred in nine patients (23.1%). Conclusion: There was significant reduction in low back and radicular pains with consequent functional improvement in majority of the patients who had posterior spinal decompression for lumbar spinal stenosis at our health institution. There were few complications of which dura tear was the commonest.

KINEMATIC ANALYSIS OF THE POSTERIOR ELEMENT OF LUMBAR SPINE IN ROTATORY CHIROPRACTIC

Rotatory chiropractic is one of the key manipulations in the treatment of low-er backache. The present paper reports the kinematic changes in the posterior element oflumbar spine during rotatory manipulation, using motion segments of lumbar spine fromfresh cadavers as specimens and an electromechanical system for the measurements. Theanalysis of the angle-displacement curve and the load-angle curve reveals that rotatorychiropractic is a kind of complicated 3-D. 6-degree-of-freedom motion. Correctmanipulation may adjust the volume of the nerve root canal and relax the articulation be-tween the upper and lower joint processes so as to relieve the adhesion of the enclosuresin the nerve root canal and relieve the adhesion of the facet joints, and bring aboutimprovement of local circulation and amelioration of symptoms.

Clinical Study on CT-guided Modified Akupotomye in the Treatment of Lumbar Nerve Posterior Branch Compression

Objective: To observe the clinical effect of modified akupotomye closed lysis under CT guidance on compression of posterior lumbar nerve branch.Methods: Patients were diagnosed by HRCT 3-D reconstruction combined with clinical symptoms and signs.After HRCT three-dimensional reconstruction combined with clinical symptoms and signs, the patients were confirmed as posterior lumbar nerve compression.After CT accurate surface positioning, CT-guided modified akupotomye was used for closed lysis of the posterior lumbar nerve branch.Oswestry Dysfunction Index Questionnaire(ODI) was used for quantitative scoring, 7 days before and after treatment and 6 months after treatment.Results: In 62 cases, 20 cases were cured, with 25 cases markedly effective, 11 cases effective, and 36 cases ineffective.The total effective rate was 90.3%.ODI score: Self-paired t test 7 days before after treatment, P < 0.01;Before treatment and 6 months after treatment, self-paired t test(P < 0.01);Self-paired t-test was performed 7 days after treatment and 6 months after treatment(P > 0.05).Conclusion: With CT precise positioning, the modified akupotomye can be used to do closed lysis, to relieve the adhesion and compression, so that the low back pain can be relieved, with good clinical.The akupotomye closed lysis, combined with modern imaging technology has not only achieved good clinical effect, but also can improve the accuracy, safety and scientificity of akupotomye treatment.

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach

Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified