Axial symptom,also called axial pain or axial neck pain,is a common complication after posterior cervical spine surgery.The symptom can be neck pain,as well as rigid,tension and dullness.The incidence of axial syndrome is estimated between 5.2％ and 61.5％.Often,the symptom does not disappear spontaneously.The quality of patients' life as well as the effectiveness of cervical laminoplasty is affected.It can be divided into early and late axial pain based on the onset time.The mechanism and reason are different,but both are difficult to subside.The incident of axial symptom is relatively high in conventional laminoplasty.However the modified one which preserve posterior ligament-muscular structure can reduce the incidence significantly.C2 spinal process as the attachment of cervical semispinalis,could reduce the incidence of kyphosis after operation.And C7 spinal process is an important structure in posterior ligament-muscular structure.Both should be preserved as much as possible in order to maintain intact attachment of muscles,which facilitates the patient to restore soft tissue tension by rehabilitation.Rigid fixation is another method of modification,it could avoid re-close of the open door,and reduce soft tissue injury.However,attention must be paid not to destroy facet joint to cause new axial symptom.Risk factors of axial symptom include past shoulder and neck pain and stiffness,others remain controversial.There is no correlation between loss of range of motion after surgery as well as change of cervical alignment and axial symptom.It is more likely to be a different result due to muscle atrophy.Although there are no golden standard of laminoplasty,doctors should follow these principles:preserve C2 and C7 spinal process when possible,rigid fixation to avoid reclose,reduce immobilization after operation,and encourage patient to start rehabilitation as early as possible to reduce incident of axial symptom.

Chronic overuse disease of the shoulder is very common in clinical practice.Its pathogenesis is complicated and its treatment is often a combination of medication,rehabilitation and surgery.In recent years,its diagnosis tends to be more definite,leading to more specific treatment.Extracorporeal shock wave therapy has been successfully used in the treatment of such orthopaedic diseases as plantar fasciitis and lateral epicondylitis,and has been tried by some scholars in the treatment of chronic overuse disease of the shoulder.Its therapeutic effect has also been demonstrated to some extent on calcific tendonitis,non-calcific tendonitis and adhesive capsulitis.This review outlines the progress in research of extracorporeal shock wave therapy for the treatment of chronic overuse disease of the shoulder.

The cervical sagittal balance is a description of cervical spine at the standing position. The position of cervical spine is measured by the corresponding sagittal parameters. The commonly used sagittal parameters of cervical spine include cervical lordosis (CL), cervical sagittal vertical axis (cSVA), T 1 Slope (T 1S), etc. Cervical sagittal balance is closely related to the overall balance of the spine, and the imbalance of sagittal parameter is also related to the progression of cervical disease, the choice of surgical methods and the postoperative efficacy. In recent years, more and more researchers have begun to pay attention to the sagittal balance of the cervical spine, especially the variation of sagittal parameters after cervical surgery, which can predict the postoperative neurological recovery and the change of long-term efficacy or complications. However, due to the variety of cervical surgery methods and the variety of cervical sagittal balance parameters, the existing studies can only reflect the relationship between the two from a certain aspect, while lacking overall and comprehensive description. In this paper, the relationship between sagittal plane balance and cervical surgery was reviewed by systematically searching literatures and screening relevant studies. According to our review, the cervical sagittal parameters have different tendency after different cervical surgery. Generally, anterior cervical surgery can maintain or improve the sagittal plane balance of the cervical spine, among which anterior cervical discectomy and fusion (ACDF) surgery has a best effect.After posterior cervical surgery, the cervical sagittal parameters tend to be unbalanced or compensated, and patients with preoperative sagittal imbalance, advanced age, and complex OPLL are more likely to have postoperative imbalance or imbalance aggravation. Therefore, attention should be paid to preoperative evaluation and reasonable surgical design in clinical practice to prevent the occurrence of sagittal imbalance of patients after surgery.

Objective To investigate the feasibility,safety and therapeutic effects of minimally invasive percutaneous mono-segment pedicle instrumentation in treating thoracolumbar burst fractures ( AO classification:A 3.1 and A 3.2 ).Methods Twenty-four inpatients with thoracolumbar burst fractures (AO classification:A 3.1 and A 3.2) treated with percutaneous mono-segment pedicle instrumentation from March 2010 to December 2010 were retrospectively studied.The operation time,blood loss,pre-and post-operative visual analogue scale ( VAS),ratio of anterior height between compressed vertebral body and normal vertebral body and vertebral kyphotic Cobb' s angle were evaluated.Results The operation lasted for (90 ± 25) minutes,with intraoperative blood loss of (20 ± 10) ml.The rate of anterior body height rose from pre-operative (56.5 ± 10.1 ) to (92.3 ± 12.2) one week post-operatively and to (90.2 ± 11.l)at the follow-up one year later.The vertebral kyphotic Cobb' s angle was pre-operative ( 16.5 ± 5.2) °,which was reduced to ( 7.3 ± 2.4 )° at oneweek after surgery and ( 7.9 ± 3.5 )° at the follow-up one year later respectively.The VAS scored ( 7.0 ± 1.2) points before surgery,( 1.2 ±0.7) points at one week after surgery and ( 1.1 ± 6..5) points at the follow-up one year later.The ratio of anterior body height at one week after surgery and at the follow-up one year later were both obviously higher than that before surgery (P ＜ 0.05 ),but the ratio one week postoperatively showed no significant difference in comparison with that one year postoperatively (P ＞0.05).The kyphotic Cobb' s angle had significant decrease at one week after surgery and at the follow-up one year later,as compared with that before operation (P ＜0.0 5).Also,the VAS score showed marked improvement at one week after surgery and at the follow-up one year later.Conclusions Minimally invasive percutaneous mono-segmental pedicle instrumentation is effective and safe for thoracolumbar burst fractures (AO classification:A 3.1and A 3.2),but it is not suitable for thoracolumbar burst fracture with severely compressed vertebra.

Objective:To explore the long-term clinical efficacy and complications of modified spinous process splitting laminoplasty using coralline hydroxyapatite (SLAC).Methods:The patients who underwent SLAC surgery in this hospital from 2005.5 to 2011.7 were included retrospectively. The perioperative data were collected and followed up. A total of 165 cases were included. Among them, there were 115 males and 50 females; the average age was 56.5±11.4 years (range: 26-84 years), and the average follow-up period was 136.5±23.2 months (range: 108-182 months). The modified Japanese Orthopedic Association (mJOA) score, the neck disability index (NDI) score were used to evaluate the clinical symptoms of patients, and follow-up imaging to observe the changes in cervical spine curvature and mobility.Results:In terms of functional score: mJOA score increased from 11.4±2.9 before surgery to 15.0±1.8 in the early postoperative period but dropped to 14.0±2.5 at the last follow-up ( F=77.096, P<0.001), and NDI score decreased from 19.2%±14.4% before surgery to 13.0%±15.0% in the early postoperative period, but it rose to 14.0%±14.9% at the last follow-up ( F=6.915, P<0.001). The improvement rate of mJOA was 63.5% (early postoperatively) and 50.8% (last follow-up). Regarding the curvature of the cervical spine, the C 2-C 7 Cobb angle decreased from 14.8°±9.1° before surgery to 11.1°±10.5°, and it was maintained at the last follow-up (11.0°±10.1°) ( F=1.083, P=0.342). The cervical spine range of motion decreased significantly, mainly because the Cobb angle in the flexion position decreased from -19.8°±13.6° before the operation to -3.7°±10.6° at the last follow-up ( P<0.001). Seventy-two patients (44.0%) had complications after operation. Six patients (3.6%) developed neurological symptoms aggravated during follow-up, and their mJOA decreased by more than 3 points. 62 patients (37.6%) developed axial symptoms, of which 7 cases were relieved early (within 6 months post-op), 55 patients had persisted symptom and 17 cases (10.3%) remained painful. C 5 nerve root palsy occurred in 10 cases (6.1%) after the operation, 9 cases resolved within two years and the last patient did not resolve. Conclusion:SLAC surgery can effectively alleviate the patient's neurological symptoms and maintain long-term efficacy and cervical lordosis. The occurrence of persistent axial symptoms and the loss of cervical flexion range are long-term complications after SLAC surgery.

Objective To explore and analyze the risk factors of axial symptoms after posterior cervical laminoplasty.Methods Retrospectively follow up the patients taking posterior cervical laminoplasty in Jishuitan Hospital during May 2005 to July 2011,due to multi-segmental cervical stenosis or (and) cervical ossification of posterior longitudinal ligament.All patients' gender,diagnosis,age,preoperative neck and shoulder pain,VAS score,course of disease,presence or absence of root symptoms,medical complications,operation time,operation method,blood loss,postoperative neck support time,presence or absence of C5 nerve root paralysis,preoperative JOA and postoperative best JOA,preoperative C2-C7 Cobb angle in neutral position,flexion position,post-extension and calculate the activity were collected.Record the process of axial symptoms in details and statistically analysis by SPSS.Results All of 146 patients were followed up for 58-134 months with an average of 89.5±18.4 months.There were 57 cases of axial symptoms,the overall incidence was 39.0％;except for 7 cases with symptom relief in 6 months,the other 50 cases (34.25％ of the total number of follow-up) of the axial symptoms continued by the time of follow-up.35 patients (23.97％) were characterized by stiffness and 22 patients (18.49％) showed pain,traction and tightness.36 patients (24.66％) showed axial symptoms on the shoulder and back,10 (6.85％) appeared around the wound and 11 (7.53％) appeared on both the shoulder and the wound.Univariate logistic regression analysis showed that intraoperative blood loss (P=0.019,odds ratio(OR) 1.857,95％ CI 1.107-3.116) and postoperative best JOA score (P=0.008,0R=0.780,95％ CI:0.650-0.936) significantly affected the occurrence of postoperative axial symptoms.Multifactor Logistic regression analysis was carried out by stepwise forward method.It was found that besides the intraoperative blood loss and postoperative best JOA score,the following factors also affected the incidence of axial symptoms after operation (P＜0.05):diagnosis,preoperative age,the extension of C2-C7 Cobb angle before operation,and the operation destruction of C7 spinous process muscle stops.The diagnosis of ossification of the posterior longitudinal ligament,preoperative age,and the extension of C2-C7 Cobb angle before operation were the protective factors for the axial symptoms,and the diagnosis of multiple segments of the cervical spinal stenosis and the operation destruction of C7 spinous process were the risk factors for the axial symptoms after the operation.Conclusion Younger,less preoperative C2-C7 Cobb extension,the operation destroys the C7 spinous process muscle stop point,more intraoperative blood loss,lower postoperative best JOA score and patients with multi-segment cervical stenosis more are more easily to have axial symptoms after posterior cervical double door laminoplasty.

Objective:To introduce a new TIANJI robot assisted targeted puncture technique, and discuss the feasibility and clinical effect of transforaminal percutaneous endoscopic lumbar discectomy (tPELD) using this technique.Methods:The first 14 consecutive cases of single level lumbar disc herniation who underwent robot assisted tPELD procedure were retrospectively analyzed. The mean age was 46.3±16.0 years old (ranged from 16-72). After data transferred from C-arm to robot system and automatic registration, surgeons made plans of the trajectory on robot system based on intraoperative 3-dimensional images of lumbar spine. Move robotic arm to planned position, guide an accurate puncture pathway and establish working cannula. 25 consecutive patients who underwent conventional C-arm assisted tPELD surgery during the same period of time were assessed as the controlled group. The mean age was 45.5±13.7 years old (ranged from 16-68). All patients were followed up for 12 months. Clinical effect was assessed by visual analogue scale (VAS), Oswestry disability index (ODI) and Modified Macnab criteria. Intraoperative parameters and surgery-related complications were recorded.Results:The baseline data of age, surgical level, types of herniation, preoperative VAS scores and ODI had no significant difference between two groups ( P>0.05). In robot group, one case was converted to open microdiscectomy during operation due to technical failure. The other thirteen cases had successful robot assisted tPELD surgeries and were assessed accordingly. The new technique had good clinical outcomes. The immediate post-operative VAS score 2.85±1.79 and the last follow-up VAS score 1.50±1.04 were both significantly decreased than that before surgery 7.62±0.92 ( F=69.747, P<0.01); the last follow-up ODI 18.89%±12.16% was significantly reduced from the pre-operative ODI 71.19%±12.12% ( t=15.430, P<0.01). Between two groups, the immediate post-operative VAS score ( t=0.568, P=0.574), the last follow-up VAS score ( t=0.713, P=0.481), and last follow-up ODI had no significant difference ( t=0.171, P=0.865). The excellent or good rate of modified Macnab criteria at the last follow-up was 92.30% in robot group, comparing to 84.0% in controlled group. The fluoroscopic times during surgery of robot group 8.8±5.5 was significantly lowered the in controlled group 21.3±8.3 ( P<0.01). One case in robot group and two cases in controlled group had recurrence during follow-up period (recurrence rate 7.7% vs. 8.3%). However, there was no significant complications such as nerve root injury, dura injury or increased intracranial pressure in both groups. Conclusion:This study confirmed the feasibility of this new technique. Preliminary results indicated that TIANJI robot could help to build an easy, accurate and safe procedure of tPELD surgery.