Objective To analyze the incidence of remaining symptoms after discectomy with different operation,and investigate its causes and clinical significance.Methods Two hundred and twentyfour patients were followed up.The incidence of remaining symptoms and clinicai situation after discectomy were observed with different operation:discectomy (110 patients,single group),discectomy with bone grafting internal fixation (70 patients,fusion group),and discectomy with dynamic fixation (44 patients,non-fusion group).The SPSS 19.0 software was used to analyze the data.Results One hundred and sixpatients (47.32％,106/224) occurred remaining symptoms in 224 patients.In single group was 69 patients (62.73％,69/110),in fusion group was 26 patients (37.14％,26/70),and in non-fusion group was 11 patients (25.00％,11/44).The incidence of remaining symptoms among three groups was significant difference(x2 =22.177,P =0.000).The incidence of remaining symptoms in single group was significantly higher than that in non-fusion group and fusion group (x2 =17.921,P =0.000;x2 =11.235,P =0.001).The incidence of remaining symptoms in non-fusion group and fusion group had no significant difference (x2 =1.817,P =0.178).Conclusions There is significantly different in the incidence of lumbar disc herniation with different surgery methods.Discectomy with bone grafting internal fixation and with dynamic fixation can effectively reduce the incidence of remaining symptoms.

BACKGROUND: Limb salvage operations with preservation of the epiphysis (LSPPE) had been used clinically in order to overcome discrepancy of affected limb and poorer limb function, but more post-operation complications existed, including infection, grafting bone resorption, fracture and internal fixation cinch.OBJECTIVE: To study the clinical related matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma.DESIGN: Clinical observation regularly.SETTING: General Hospital of Jinan Military Area Command of Chinese PLA.MATERIALS: Eleven patients corresponded selected standard and accepted treatment from January 1999 to January distal metastasis was found with lung X-ray check and CT scanning, the patient would be excluded this study. There were 5 males, 6 females, and the mean age of (8±2) years old (4-11 years). The disease history was 1-6 months.FO) were adopted. After 2 weeks of chemotherapy, the operations of inactivated bone replantation with preservation of the epiphysis were performed. The operation was performed under epidural or general anesthesia. The patient lied on operating table. The knee anteriomedialis incision was adopted. Firstly, femur periosteum was opened beyond proximal end 2-3 cm from tumor, subperiosteum stripping was done to the proximal femur, descend femur with wire saw, separated and disconnected aboral periosteum, blunt dissecting femur aboral blood vessel and nerves to the popliteal fossa,deligating blood vessel around the tumor. Attachment of gastroenemius was cut off. Epiphyseal plate was identified carefully. According to pre-operation MR, the distal femur descend level was determined and the femur was descend with electro-saw. It was determined with cytology that no tumor cell existed in descend level, and reconstruction of bone de-fect with inactivated tumor-bone shell with 95% alcohol and bone cement containing ADR (20 g bone cement: 10 mg ADR), the diaphysis was fixed by intramedullary nail and screws were inserted in the residual epiphysis for the osteosynthesis of the distal osteotomy. One drainage tube was placed into and closed incision The affected limb was protected with plaster cast. Post-operative treatment: Regular usage of antibiotics was adopted to prevent infection. The drainage tube was pulled out when drainage amount ＜ 50 Ml/24 hours. The progressive passive exercise was initiated during the protection of affected limb with plaster cast for 8 weeks. Twelve to 14 days after operation, stitches were taken out. The postoperative chemotherapy then initiated, drug and dosage were identified on the response to the preoperative chemotherapy. Eight weeks after operation, patients were permitted to walk with the protection of double crutches and ery analysis: To observe ncision healing and existing of nerve and blood vessel injure, or not. During follow-up, patient recoveries were determined with affected knee function, limb length, distal metastasis, post-operative complications and dynamic imaging inspection of bone healing.imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.MAIN OUTCOME MEASURES: ① The response to chemotherapy was evaluated with tumor cell necrosis rate. ② Post-operative recovery was determined with parameters such as knee function, limb length, distal metastasis, etc. ③ Dynamic imaging inspection of bone healing.RESULTS:All patients in this study were done follow-up.①The histological response of 11 patients to preoperative chemotherapy were classified as 7 in gradeⅣ,4 ingrade Ⅲ.②Post-operation recovery:No nerve and blood vessel injury existed and all incision healed well,there was not incision infection and healing.Eleven patients were followed-up from 10 to 72 months.Three patients could flexed affected knee joint ≥110,90-110 in 3 cases,60-90 in 4 cases,＜60 in one patient .The length of both lower extremity equaled in 4 cases,the length of affected limb was shorter than 2.0 cm in 5 cases,2.0-3.0 cm in 2 cases. One patient with recurrence,two with metastasis,three died.Screw cinch in one patient and one patient with inactivated bone fracture. ③Dynamic imaging inspection: No recurrence was found around epiphysis. Essential bone healing existed between the inactivated bone and epiphysis,callus formation between the inactivated bone and diaphysis at 2 months after operation; more callus formed and 4 months; 6 months after operation,bone complete healing was found between the inactivated bone and diaphysis.④Post-operation recovery:During follow-up, a screw cinch was found in one patient, and dislodged the screw because of bone healing well. One patient underwent open reduction, bone grafting and internal fixation with encircle device because of inactivated bone fracture.four months of the operation, grafting bone healed well. At post-operative 24 months, the length of both lower extremities equaled and the affected knee flexed to 110°.CONCLUSION: Inactivated bone replantation with preserving epiphysis for osteosarcoma in children was propitious to recover limb function and keep limb length.

Objective To explore the reliability and validity of poly ether ether ketone (PEEK) rods and pedicle screw system for lumbar degenerative diseases.Methods Sixty-three patients,including 23 men and 40 women with the mean age of 56.2±5.1 years (range,35-75 years),treated by PEEK rods pedicle screw system from September 2012 to March 2013 were retrospectively recruited.Fusion procedure were performed in 10 patients,with 2 cases at L3,4,5 cases at L4,5,3 cases at L5S1; nonfusion procedure were performed in 17 patients,with 4 cases at L3,4,10 cases at L4,5,3 cases at L5S1; hybrid procedure were performed in 36 patients,with 22 case fusion at L4,5 and nonfusion at L3,4,with 2 cases fusion at L3,4 and nonfusion at L4,5,with 12 cases fusion at L5S1 and nonfusion at L4,5.Clinical effects were evaluated via Japanese Orthopedics Association (JOA) score and Oswestry disfunction index (ODI) at 3 months,6 months and 24 months postoperatively.Disc heights were measured by disc height index on lateral lumbar radiograph.Range of motion (ROM) was measured by extension-flexion lumbar X-ray.Three-dimensional CT reconstruction was achieved to observe the integrity of PEEK rods at the final follow-up.Results The mean follow-up were 23.4±3.3 months.The mean operation time were 110±17 min in the fusion group,98±22 min in the non-fusion group and 121±25 min in the hybrid group.The mean blood loss were 270±85 ml in the fusion group,255±72 ml in the non-fusion group and 316±80 ml in the hybrid group.The JOA score improved from 10.5±2.6 preoperatively to 24.0±3.1 at the final follow-up in the fusion group,from 10.3±2.2 to 24.3±3.4 in the non-fusion group and from 11.1±2.3 to 23.9±3.3 in the hybrid group (P＜0.05).The ODI decreased from 51.8％±10.3％ preoperatively to 14.1％±3.7％ at the final follow-up in the fusion group,from 52.2％±11.1％ to 13.2％±3.2％ in the non-fusion group and from 53.4％±9.2％ to 13.8％±2.5％ in the hybrid group.There was no significantly statistical difference in the disc height index at 3 months,6 months and 24 months postoperatively compared with that at preoperative.The ROM decreased from 8.8°±1.8° preoperatively to 2.2°±0.3° at the final follow-up (P＜0.05).One case demonstrated cage migration at one month follow-up,bony fusion in situ at 3 months follow-up,and the patient had no related symptoms during the follow-up.No screw loosening or breakage and rods breakage was observed during the follow-up.Conclusion PEEK rods and pedicle screw system for lumbar degenerative diseases by fusion,non-fusion and hybrid procedure can achieve considerable clinical outcome with low complication rate.

Lumbar spondylolysis refers to the bone injury between the upper and lower articular processes and the transition zone of the transverse process of the unilateral or bilateral pedicle of the lumbar spine, being a common cause of low back pain in patients that seriously affects their quality of life. The mechanism of the occurrence and development of lumbar spondylolysis is complex, and long-term stress wear and sudden damage with an external force are the main causes. At the same time, risk factors related to spinal anatomy are important causes of lumbar spondylolysis. A full understanding of the pathogenesis of lumbar spondylolysis, early identification of high-risk groups, and active preventive measures can reduce its incidence. For this purpose, the authors reviewed the research progress in risk factors related to the spinal anatomy of lumbar spondylolysis from three aspects including genetical susceptibility, local anatomy and overall spine-pelvic sequence, so as to provide references for the prevention and treatment of spondylolysis.

Objective:To introduce a novel risk factor for lumbar spondylolysis, the pedicle isthmus angle (PIA), and to explore its underlying mechanism and clinical relevance.Methods:A retrospective analysis of CT imaging data from young male patients with lumbar spondylolysis, admitted to the 960th Hospital of the Joint Logistic Support Force of the PLA between January 2018 and August 2023, was conducted. The study included 119 cases of unilateral spondylolysis and 339 cases of bilateral spondylolysis, with a mean age of 22.8±3.4 years (range 18-30 years). A control group of 458 patients with normal lumbar CT scans, presenting with low back pain, was also analyzed. Their mean age was 22.9±3.5 years (range 18-30 years). The PIA of the left and right sides of the L 3, L 4, and L 5 vertebrae in both the spondylolysis and control groups were measured using CT imaging. Differences in PIA measurements between the left and right sides, as well as between groups, were compared. Binary logistic regression analysis identified risk factors for lumbar spondylolysis. The receiver operating characteristic (ROC) curve and Youden index were used to determine the critical risk threshold for lumbar spondylolysis. Results:No significant differences were found between the spondylolysis and control groups in terms of gender, age, height, weight, or body mass index (BMI) ( P>0.05). Similarly, there was no significant difference in the left and right PIA measurements for the L 3, L 4, and L 5 vertebrae in either group ( P>0.05). The PIA of the L 3 and L 4 vertebrae was not significantly different between the groups (107.2°±3.5° vs. 107.1°±3.5°, t=0.270, P=0.787; 110.6°±3.5° vs. 110.5°±4.0°, t=0.441, P=0.659). However, the PIA of the L 5 vertebra was significantly larger in the spondylolysis group (117.7°±4.7°) compared to the control group (114.0°±4.9°) ( t=11.654, P<0.001). Logistic regression analysis identified an increased PIA at L 5 ( β=0.159, OR=1.172, P<0.001) as a risk factor for lumbar spondylolysis. According to the ROC curve and Youden index, the risk of lumbar spondylolysis increased substantially when the L 5 PIA exceeded 115.8°. The area under the curve (AUC) was 0.709, with a sensitivity of 0.670 and a specificity of 0.644. Conclusion:PIA is an objective and effective imaging parameter for predicting lumbar spondylolysis. It aids in understanding the pathophysiology of spondylolysis, identifying high-risk individuals, and informing prevention and treatment strategies for lumbar spondylolysis.