Objective To summarize the complications after cervico-occipital fusion and to explore the methods of the prevention and treatment of complications. Methods Three hungred and eighteen patients were fused in cervico-occipital region from January 1985 to January 2003. Of them, 65 cases with postoperative complications were reviewed. The complications in perioperative period comprised vertebral artery injury during the operation, temporary injury of nerve root, leakage of cerebrospinal fluid, spinal cord injury or deterioration, infection and asphyxiation. The complications in mid- to long-term included bone graft nonunion or delayed fusion, vertebral body shifting, internal fixation implants breaking or loosening, slipping of screws and pseudojoint formation. The complications in bone graft donor region were haematoma, pain and infection. Two physicians were assigned to follow-up the patients. Results Three hungred cases were followed up from 18 months to 18 years with an average of 6 years and 8 months. There were 15 cases with complications after surgery in single fusion group, the incidence was 24.4%. 1 case deteriorated of spinal function after surgery, 2 with bone graft displacement, 1 with bone graft absorption, 1 with bone graft nonunion who recovered after reconstruction. 50 complications presented in internal fixation group, the incidence was 19.1%, Foramen magnum was decompressed in 1 case with vertebral displacement and fixed with Cervifix. Odontoid process was resected in 1 case with atlanto-axis dislocation and deterioration of spinal function through oral approach and cervico-occipital region was fused, the symptom was improved obviously after operation. Spinous process fracture was found in 1 case 3 months later post-fixation with Simmons wire, the atlanto-odontoid vertebra was fused again and fixed with Vetex, the bone graft was fused completely. The temporary injury of nerve root due to wrong directions of the screws, were adjusted during the operation. 4 patients who felt pain caused by screw, which were then extruded out. 2 cases with vertebral artery injury were ligated or bleeding ceased after screw fixation. Conclusion The key points to reduce the complications are familiarity with dissection and operative skills. Appropriate internal fixation also can reduce the complications. Pressure dressing was useful to eliminate the haematoma in bone graft donor region.

Objective To summary the results of fixation and fusion with lateral mass screw of atlas and vertebra dentata pedicle screw for the treatment of atlantoaxial instability. Methods From February 2002 to March 2004, 15 cases suffered with atlantoaxial instability were included in this study. There were 9 males and 6 females, with a mean age of 39.5 years old(ranged 15 to 57 years old). There were 5 cases for old odontoid fracture, 4 cases for congenital loose odontoid process, 6 cases for fresh odontoid fracture(Aderson ⅡC). 7 cases were fixed with Vertex, 3 Axis and 5 Cervifix instruments. JOA scores in preoperation were from 5.1 to 10.9, with an average of 7.6. Skull traction was performed in each patient preoperatively. The screws were placed in lateral mass of atlas beside the posterior arch of atlas about 18-20 mm and the point of intersection above 2 mm inferior boarder of posterior arch. Vertical with coronal plane, the tip of the screw made 5? to side of head in sagittal plane. The site of the screws were placed in vertebra dentate was divide equally the inferior articular process of axis, made 15? with sagittal plane and 30? with cross section. The diameter of the screw was 3.5 mm, the length of in lateral mass of atlas was from 28 to 32 mm, and from 22 to 26 mm in vertebra dentate pedicle screw. Results There were no spinal cord and vertebral artery injury after surgery. Follow-up duration was from 10 to 25 months, with average 14 months. The postoperative JOA scores were from 13.2 to 16.8, with average 14.8. The improve rate was 87.5 percent. The plant bones all fused and there were no internal fixation rupture and mobiled. Conclusion Lateral mass screw of atlas and vertebra dentata pedicle screw with three-dimension fixed virtues could be used to treat atlantoaxial instability.

[Objective]To review the therapeutic effect of TSRH in correction of coronal plane,sagittal plane and horizontal plane malformation of the idiopathic scoliosis,and to evaluate the result of screw-rod and screw-crook-rod system.[Method]A total of 79 idiopathic scoliosis patients who were corrected with TSRH were analyzed.There were 48 males and 31 females with an average age of 15.5 years.Only pedicle screws system was used in 56 cases,pedicle crook or vertebral plate crook in thoracic vertebra,pedicle screws system in lumbar vertebrae were used in 23 cases,then the results of two groups were compared.[Result]Cobb's angel in coronal plane was corrected from 18 to 31 after operation,the correction rate was from 56 percent to 87 percent,with an average of 68 percent;while Cobb's angel in sagittal plane was corrected from 21 to 33 after operation,with an average of 25.Rotation was corrected by I degree,heights were increased by 3 cm in average.The mean followed-up duration of 63 cases was two years and a half year.There was significant difference between the two groups in correction rate in coronal plane and sagittal plane,also in loss of correction in coronal plane.[Conclusion]TSRH could make satisfying results in correction of idiopathic scoliosis,and the result would be better if pedicle screws system is used.

[Objective]To summary the methods and results of free hand insertion with the lateral mass screw of atlas and vertebra dentata pedicle screw.[Method]Fifty samples of fresh adult atlas and dentate were used.There were 25 males and 25 females samlpes.Then rongeur forceps was used to bite the bone of entrance.The way of screw was made by Kirschner wire of 1.5mm and 2.5mm in diameter.Guide pin was inserted along the way.The screws were placed in lateral mass of atlas beside the posterior arch of atlas about 18～20mm and the point of intersection above 2mm inferior boarder of posterior arch.Vertical with coronal plane,the tip of the screw was made 5? to side of head in sagittal plane.The site of the screws placed in vertebra dentate was divided equally the inferior articular process of axis,made 15?with sagittal plane and 30?with cross section.There were 26 patients with Atlantoaxial vertebra unsteadiness,15 males and 11 females,with an average age of 39.5 years.Seventeen cases were used with screws and rod system and 9 patients were used screws and plate system.Preoperative JOA scores were from 5.1 to(10.6),with an average of 7.6.[Result]There were no cases with spinal cord and vertebral artery injury after surgery.Follow-up duration was from 10 to 25 months,with an average of 14 months.The postoperative JOA scores were from 12.9 to 16.5,with an average of 14.8.The improve rate was 87.6 percent.The plant bones all fused and there were no internal fixation rupture and mobiled.[Conclusion]The technique of free hand insertion with the lateral mass screw of atlas and vertebra dentata pedicle screw is simple,fixation is reliability and is well worth to spreading.

Objective To investigate the surgery outcomes between patients with different recovery states measured by visual analog scores (VAS),explore the relationships among surgery outcomes,bone cement,and degrees of pain relief,and to find out the best combination of cement volume and cement distribution for Percutaneous kyphoplasty (PKP).Methods There were 220 patients with 220 vertebra,from January 2012 to January 2014,who received PKP in our hospital.Patients were divided into two groups,on the basis of different VAS.The epidemiological data,operative effect,and surgical complications were compared between two groups.Characteristic curve (ROC) was used to analyze the effect of bone cement dosage and distribution on the diagnosis of patients with different recovery state.The correlation was analyzed between the dose and distribution of bone cement and surgery outcomes.Moreover,logistic regression analysis was used to assess the safety of cement implantation.Results A total of 77 recuperators and 143 non-recuperators were included in the study.Two groups of patients in epidemiological data showed no significant difference.The surgery duration,bone cement injection dose,cement distribution,vertebral height restoration rate and improvement of kyphotic angle in the recuperator group were all significantly higher than those in the non-recuperator group.Whether small dose and large dose of bone cement volume and expanded the bone cement distribution area could significantly improve the patient of operation after the recovery rate and bone cement dose with extensive bone cement distribution area and large bone cement dose with limited bone cement distribution area had the same operation after the recovery effect (x2 =2.880,P =0.090).When the cement volume was constant,cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r2 =0.207,P ＜ 0.01;r2 =0.159,P =0.02).Conclusions The value of cement distribution is better than cement volume in relieving patient pain for diagnostic.For PKP,cement distribution above 0.49 with small cement should be suggested.

[Objective]To discuss the effective method of idiopathic scoliosis and evaluate the result of screw-rod and screw-hook-rod system.[Method]From January 2000 to January 2004,85 cases with idiopathic scoliosis were treated by CD-Horizon instrument.Fifty-one cases were corrected with pedicle screws system only(group A),34 cases were applicated with pedicle hooks or vertebral plate hooks in thoracic vertebra,while with pedicle screws system in lumbar vertebrae(group B).The Cobb's angle of coronal plane and sagittal plane and horizontal plane malformation were compared in preoperative score,postoperative score and the score at 2 years follow-up.[Result]The mean followed-up duration of 85 cases was three years and a half.The coronal plane and sagittal plane correction rate of group A was higher than that of group B at postoperative and 2-year follow-up(P0.05).[Conclusion]Using CD-Horizon instrument is a very effective choice for patients with idiopathic scoliosis.Pedicle screw-rod system offers a significantly better curve correction compared with screw-hook-rod system.

[Objective]To discuss the methods of insertion the pedicle screws of thoracic vertebrae and sum the results of correction of idiopathic scoliosis.[Method]Bone of entrance was removed with rongeur forceps.According to the depth and rotation preoperative,to drill using 1.5 mm and 2.5 mm Kirschner wire.If the resistance was increasing and Kirschner wire was bending,it needs to adjust the direction.Stop to drill whenachieve the depth,after checking the hole using special probe then strike awl in the hole.Checking the hole using specillum again then insert the screws.[Result]97% were successful inserted by one time.There were no patients with spinal cord injury and leakage of cerebrospinal fluid and no infection of incisionsl wound.The correction rate in coronal plane was 73% after surgery.The Cobb's angle in sagittal plane was from 6? to 30?,with average of 23?.Rotation deformity was corrected Ⅰ to Ⅱ degree.There were 103 patients.Follow-up duration was with average 4.9 years.Trunk balance was good and no flat back was happen.Bone graft fused well.The correction lost 3.7% in coronal plane at final follow up.One case was with late infection and 2 patients were with screws broken.The internal fixations were removed out.[Conclusion]Using Kirschner wire to made screw hole is a good way to insert thoracic vertebrace pedicle screw.Screw-rod system had favourable three diamensions correct control force.Fully pedicle screw to correct idiopathic scoliosis has good results.

0.05).There were no pseudoarthrosis and internal fixation failure.The incidence of proximal junction kyphosis was higher in group B(P

[Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis,operated by back decompression,fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed.Ninety-eight were males and 78 were females,with an average age of 58.5 years.Patient history was from 2 to 31 years.Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more.Forty patients were complicated with one degree degenerated olisthe,42 were complicated with lumbar scoliosis and Cobb's angle more than 20?,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together,fused by bone graft and fused articular process.To the patients with more than two segments affection,processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Patients with scoliolosis were decompressed and inserted pedicle screws.Revolve rod combined with compression and brace technique was used to correct scoliolosis,fuse the disk and articular process to the patient with severe intervertebral disk hernia and others were fused post-lateraly.[Results]Operation time was from 80 to 250 minutes.Blood loss was from 450ml to 1600ml and no patient died.The follow-up duration averaged 5.6 years.Fused disks had good to excellent rate of 87.4%,and multi-segments had good to excellent rate of 86.1%,and combined with scoliolosis good to excellent rate of 89.8%.The Cobb's angle was average 6.7? and correct rate was 73.8%.The fused rate of post-lateral was 92%(60/65),while the interbody vertebral fused rate was 97.9%(139/142).[Conclusion]The operation of complicated lumbar spinal stenosis is difficult to operate and has high risk.Back decompression,fused by bone graft and internal fixation by pedicle screws is a good method.