Nowadays, percutaneous transforaminal endoscopic discectomy (PTED) and microscopic endoscopic disecto?my (MED) are common techniques for lumbar disc herniation and stenosis. Similar to traditional fenestration, MED is per?formed via interlamina approach, and is suitable for most cases of lumbar disc herniation and stenosis. And the mobile MED (MMED) used by author is beneficial to expose and manipulation. The PTED is performed during normal saline irrigation via natural transforaminal or interlamina approach. Compared to MED, PTED is less invasive and has relatively limited operat?ing range, which depends on accurate puncture. MED and PTED have their particular standard and skills, and their indica?tion is crossed and complementary. These two techniques can be selected according to specific conditions of patients.

At present, percutaneous transforaminal endoscopic discectomy (PTED) has been rapidly developed in our country, showing that spine surgery has entered the era of the minimally invasive spine surgery, but we must clearly recognize the learning curve and the difficulties in the operation. According to the specific needs of patients, safe and effective should be premised, and take the most convenient and effective measures, avoid the blind pursuit of new technology and high technical difficulty, avoid increasing the surgical indications and avoid exaggeration effect. We must have a solid foundation of spinal surgery and seriously standardized training. We must establish reasonable access and training system, which can avoid detours, shorten the learning curve, and let the transforaminal endoscopic minimally invasive techniques have a healthy and stable development.

The intervertebral disc disease is a group of clinical diseases with complex etiology, various clinical symptoms and poor conservative treatment effect. The traditional treatment methods include conservative treatment, local injection and open surgery. In recent years, minimally invasive spine surgery has made great progress and development, and its clinical effect has been fully affirmed. Coblation nucleoplasty (CN) has been mainly used in the treatment of contained disc herniation since it has been used in clinical treatment. Its application is not favorable because of narrow indications, uncertain clinical efficacy and other reasons. At present, the application of CN in the intervertebral disc diseases has been reported in many literatures, and its working principle, operation safety, indications and efficacy have been analyzed and extended. Those literatures play an important role in its clinical application. Therefore, in this paper, the application status of CN in the intervertebral disc diseases is reviewed.

Compressive cervical myelopathy (CCM) is a common disease of spinal surgery. Various kinds of reasons such as herniation of cervical disc and ossification of the posterior longitudinal ligament (OPLL) lead to spinal canal stenosis, thereby compressing the spinal cord, and a series of neurological symptoms are caused. Currently, posterior cervical expansive open-door laminoplasty (PCEOLP) is widely used for cervical decompression in patients with CCM involving three or more levels. This operation can expand the spinal canal while preserving the posterior structures of the cervical spine, and non-neurological complications are relatively rare. However, there are characteristic complications to this procedure such as nerve root palsy, axial neck pain, and loss of range of motion (ROM). Various modified techniques of PCEOLP have been developed to reduce postoperative complications. In this review, clinical research progress of PCEOLP in recent years is summarized, mainly focusing on internal fixation of materials and methods, operative approach, cervical decompression level, combined application of different surgical procedures, opening size and application of new technologies.

Tetrodotoxin(TTX) is a potent sodium channel blocker. It can affect the generation of action potentials of cell membranes by blocking sodium channel. Damaged tissues express a Tetrodotoxin resistant(TTX R) Na + current which provides a potential target for therapeutic intervention in a range of pain states. We summarize the influence of tetrodotoxin on sodium channel and the possible mechanism of the analgesic effect.

Objective To analyze the clinical results of percutaneous vertebr oplasty (PVP) for osteolytic spinal tumor. Methods Forty patients with osteolyt ic vertebral metastases or myeloma were selected from Feb. 2000 to Jun. 2003 to undergo percutaneous vertebroplasty. All patients complained of back pain. Among them, 6 cases had radiculopathy, and 1 had paraplegia. Based on CT or MR scanni ng, the posterior vertebral wall was involved in 21 cases. 42 PVP was performed on 59 segment levels under fluoroscopic or CT guidance, including 1 at cervical spine, 29 at thoracic spine, 27 at lumbar spine and 2 at sacrum, and biopsy was performed in 28 cases simultaneously. CT scanning was conducted after interventi on to assess the lesion filling and cement leakage, and all patients were asked to remain lying on bed for 4 hours prior to axial loading. In combination with P VP, radiotherapy, chemotherapy, medicament were administered before or after the intervention. Results The procedure was technically successful in all patients with an average injection amount of 6.5 ml cement per vertebral body. Partial or complete pain relief was achieved in 39 cases, associated with improved mobilit y in 38 cases, the symptoms of patients with radiculopathy and paraplegia were u nchanged. Two cases with severe multiple vertebral destruction underwent PVP at one segment, neither of them experienced improved mobility. In one case, the sev erity of pain was unchanged, while the other experienced partial pain relief for 48 hours. Leakages were detected with CT at 21 levels of 17 cases. 2 of 7 epidu ral leakage produced transitory radicular pain, which were relieved in 6 h and 8 h respectively. 2 with intervertebral foraminal venous leakage, 8 with paravert ebral leakage, and 6 with intra-disc leakage had no clinical symptoms. 37 cases were followed up from 2 to 32 months (average, 8.5 months). Exclusive of poor re sults in 2 patients, pain relief was sustained in 29 cases, and 6 patients exper ienced relapse of pain following partial pain relief, which was related to the d eterioration of tumors. Conclusion PVP of osteolytic spinal tumors is a minimal invasive procedure that provides immediate and stable pain relief with improved mobility. It can be combined with radiotherapy or chemotherapy.

Objective To analyze the results and indications of anterior, posterior or combined surgery for thoracolumbar burst fractures. Methods A retrospective review of surgically managed thoracolumbar burst fractures from 1998 to 2003 was performed. There were 76 males and 13 females, and the age of the patients were from 17 to 51 years with an average of 36.8 years. The fractures were located at T11 in 10, T12 in 21, L1 in 29, L2 in 18 and L3 in 11. According to Magerl classification, type A fractures were 68, and type C were 21. Of the 89 patients, 41 received posterior surgeries, 40 anterior surgeries, and 8 combined anterior and posterior surgeries. Operative notes, preoperative and postoperative neurological status, radiographs, CT scans, and follow-up records were reviewed. Results All of the 89 cases had successful surgery. Seventy-eight patients were followed-up for 6 to 48 months (average 12 months). Neurological status improved at least 1 ASIA grade in all of the 65 patients who had preoperative incomplete paraplegia. In the posterior surgeries, pedicle screws broken in 2 cases, deep infection in 1 case which was cured after debridement. The correction of anterior vertebral body height and Cobb's angle averaged 9.4 mm and 14.8? postoperatively, and the correction loss averaged 0.5 mm and 7.5? respectively at 6 months after surgery. And the correction loss was most evident at the above disc spaces, then the below disc spaces. In the anterior surgeries, leakage of cerebrospinal fluid in 2 cases which cured with dressing change, the other cured after debridement, implant removal and posterior fixation. The spinal canal was enlarged, and the spine recovered normal curvature. No evident correction loss, pseudoarthrosis or implant failure was noted at follow-up. Conclusion The choice of anterior, posterior or combined surgery for thoracolumbar burst fractures depends on neurological status and column stability. The vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.

Objective To evaluate the clinical value of vertebral body venography in performance of percutaneous vertebroplasty(PVP). Methods 92 patients with 124 vertebraes underwent PVP. Before injecting the bone cement, venography was performed with injection of nonionic contrast material into vertebral body. 124 vertebraes were classified into four groups according to the results of vebgrophy. Group A: no draining veins displayed; group B: draining veins appeared late; group C: draining veins appeared ahead of time; group D: draining veins appeared ahead of time, then intervention such as adjusting the puncture needle's position or gelatin sponge embolization of vein was performed to delay the appearance of veins. Results 94 of 124 vertebraes displayed draining veins. According to the results of vebgrophy, there're 30 vertebraes in group A, 25 in group B, 30 in group C, 39 in group D. Thirty-seven vertebraes demonstrated cement extravasation, cement entering vein was observed in sixteen vertebraes and two patients among them had pulmonary embolism. Venograms showed all correlative venous extravasation. Bone cement extravasation rate of each groups was 20.0%, 24.0%, 56.7% and 20.5% respectively. Moreover, extravasation rate of group C was higher than any other group. Pain reduction was observed in 88 of 92 patients after 30 days of the operation, the rate of pain relief was 95.7%. Conclusion Vertebral body venography could describe the velocity of venous blood flow within vertebral body and predict the direction of bone cement leaking to veins effectively, which could provid valuable information in takeing some measures to prevent bone cement leaking into veins. Vertebral body venography has very impotant clinical value in improving the safety and preventing complication of PVP.

Objective To analyze the results of one-stage combined anteroposterior surgery in lateral position for serious thoracolumbar fracture dislocation. Methods A retrospective review was performed for surgically treated thoracolumbar fractures from October 1998 to September 2005. Of all the 192 patients, the 34 serious cases were treated with one-stage combined anteroposterior surgery. There were 25 males and 9 females, 34.2 years old on the average (ranging from 18 to 56 years). Segments involved: T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 8 cases, L3 in 5 cases, L4 in 2 cases and L4,5 in 1 case. According to the Classification of Magerl, there were 12 cases of type A3, 2 cases of B1, 2 cases of B2, 12 cases of C1, 4 cases of C2 and 2 cases of C3. During the operation the patients were in lateral position. Laminectomy and pedical screw insertion were performed posteriorly first; anterior corpectomy, reduction and strut graft were accomplished through an additional anterior approach. The final fixation was finished by clapping the strut graft with pedical screw system. Operative notes, preoperative and postoperative neurological status, ASIA scales, radiographs, CT scans, and follow-up records were reviewed. Results All these surgeries were performed successfully without any neurological deterioration. 32 of 34 patients were followed-up for 6 to 60 months (13 months on average). Neurological status improved at least 1 ASIA grade in 24 patients with preoperative incomplete paraplegia. 6 patients complained intercostals nerve injury symptom which alleviated with conservative treatment. During follow-up, lumbar physical lordosis was reconstructed and no evident correction loss, pseudoarthrosis or implant failure was noted. Conclusion One-stage combined anteroposterior surgery can be accomplished in a lateral position. It was proved to be an effective treatment for serious thoracolumbar fracture dislocation.

0.05).2)a.There was no severe side effects related to cement in 20dogs,and no pulmonary embolic necrosis was found in autopsy.Cement leakage was frequent which occupied the spinal canal no mo re than 1/4of the median sagittal dia meter without major neurological complication.The epidural leaks we re related to the vertebral morpholo gy.b.The average peak temperatures were 70.5℃at the core,53.5℃at the in terface,40.8℃at the anterior corte x,and 40.5℃in the spinal canal.The temperature above 50℃lasted for 2.9minutes at the core,and 1.3minutes at the interface.In pathological examination,necrosis of osteocytes was found focally at t he periphery of the cement,and resid ual bone in this area showed signs of acti ve remodeling.3)The procedure was technically successful in all pa-tients,with an average injection am ount of 6.3ml cement per vertebral body.No clinically significant com-plications were noted.The 3slight e pidural leaks,1slight neural foram ina leak,and 5paravertebral leaks detected with CT had no clinical importance.Partial or complete pain relief was achieved in all patients as-sociated with improved mobility,an d 1patient experienced transitory worsening of pain followed by significant pain relief.Patients with vertebra l haemangioma or compression fractu res were discharged in 1-4days(average,1.6days)after the procedure.Of the 26patien ts,22were followed up from 6to 24mon ths(average,13.5months),partial or complete pain relief were sustained in 21cases,the other one experienced relapse of pain following partial pain relief,which was related to the deterioration of the metastases.Con-clusion Minimal invasive PVP is a valuable alternative in the treatment of painfu l vertebral haemangioma,osteoporotic vertebral fractures,and osteolytic metastases or myelom a,providing acute pain relief and ea rly mobilization in appropriate patien ts.[