ObjectiveTo make a comparison between microsurgical lumbar discectomy(MSLD) and microendoscopic discectomy(MED) in terms of methods,feathers,and effectiveness for lumbar disc herniation (LDH).MethodsA prospective clinical review was conducted.From January 2006 to December 2009,900patients with single segment lumber disc herniation were randomly divided into the MSLD group and the MED group.There were 450 patients in each group.Comparison would be made in terms of the length of skin incision,the operative time,amount of bleeding,incidence of complication,duration of hospitalization,the time of recovery to ordinary work or life,pre- and post-operative assessment based on the criteria of visual analogue scales (VAS),and the Oswestry disability index(ODI).ResultsThe mean lengths of skin incision were (3.8±1.1) cm and (2.4±0.7) cm for MSLD and MED respectively; the operative time were (51.0±14.2) min and (62.0±16.3) min; and the blood loss were (60±35) ml and (106±43) ml,which showed a significant difference(P＜0.05).There was no significant differences in terms of the hospitalization time and the time of recovery to ordinary work or life between the two groups (P＞0.05).The results of VAS and ODI of two groups also showed no significant difference at final follow-up (P＞0.05).As for the complications,the incidence of dural tear,acute hematomas of sacrospinalis,nerve roots and cauda equina injury and recurrence in MSLD group were much lower than that of MED group (P＜0.01).There was no incidence of wrong segment,greater artery injury,or postoperative infection in each group.ConclusionThe clinical effects of both minimal invasive methods are satisfactory.However,MSLD has advantages of simpler maneuvering,shorter learning curve,and less complication than MED.

ObjectiveTo Compare the clinical results between microscope and loupes which used in microsurgical discectomy.MethodsA prospective randomized controlled trial of 93 patients who had undergone microsurgical discectomy from January 2007 to December 2010 was performed.Clinical results were assessed by comparing the following parameters between patients who had undergone the surgery by microscope and loupes:length of stay,hospitalization cost,operative time,estimated blood loss,Japanese Orthopaedic Association (JOA) score and JOA recovery rate,Odom's standard.ResultsForty-nine patients underwent surgery by microscope,and forty-four patients underwent surgery by loupes.Eighty patients received outpatient or telephone follow-up.The follow-up period was 6.17 to 52.90 months with an average of (29.64±13.05) months,and the follow-up rate was 86.02％.According preoperative data,the two groups didn't differ with respect to age,gender,level of radiculopathy,or preoperative JOA score and JOA recovery rate.No statistically significant differences were identified in postoperative JOA score and JOA recovery rate,length of stay,hospitalization cost,length of follow-up,or relapse rate.Statistically significant differences were identified in operative time,estimated blood loss,and follow-up JOA score and JOA recovery rate.Conclusion Microscope can provide relatively more clear and comfortable vision for the surgery.It can short the operative time,decrease blood loss,reduce the potential risk of nerve injury,and retain more normal tissue,which can ensure better clinical results.

ObjectiveTo explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis.MethodsFrom March 2008 to August 2010,73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed.The patients were divided into different groups by clinical features,imaging manifestations,and concurrent diseases.The minimal invasive surgical methods were chosen according to the classification.Operation time,intra-operative bleeding,and complications were recorded.The lumbar function was evaluated by Oswestry disability index (ODI),and the clinical results were assessed by JOA pre- and postoperatively.ResultsMinimal invasive surgery was completed in all cases,which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression.Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression.Intraoperative blood loss and operation time were related to surgical methods.One case was complicated with dural tear.Cage was inserted into upper vertebral body during interbody fusion in 1case with osteoporosis,removed the cage and implanted bone fusion.Incisions of 3 cases were poor healing after surgery.The average follow up time was 13 months(range,10-35).JOA score and ODI before surgery were 9.2±5.1 and 62.3％±18.5％ respectively; while 6 months after surgery,JOA score and ODI were 23.5±7.2 and 18.4％±6.4％ respectively.JOA score and ODI showed statistically significant improvements after operation(P＜0.01).Twenty-two cases got solid fusion at the final follow-up.ConclusionTreatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes,but the proper minimal invasive strategy should be chosen according to specific patients,surgeons and hospitals.

ObjectiveTo design a new operation approach:extreme lateral transforaminal lumbar interbody fusion (E-TLIF) via digital technology and to discuss its feasibility in treatment of degenerative lumbar diseases.MethodsCT scan image data of lumbar vertebra were obtained from volunteer (a healthy male of 26 years old,67 kg in weight and 172 cm in height).Mimics was used to read and reconstruct the data into 3D images.We observe the anatomical bone structures of intervertebral foramen and nerve roots through CT scan and 3D reconstruction in Mimics to analysis the feature of this area.Then E-TLIF operation,pedicle screw insertion and cage placement were simulated by computer via digital technology in Mimics.The feasibility of this new approach was proved through operating on lumbar of formalin doused body with E-TLIF approach.ResultsAn incision of 9 cm lateral form the central line and 45° from the sagittal plane is operated to fully expose the foraminal area.Remove superior facet while save inferior facet is feasible with this approach in E-TLIF.There is enough room for fully revealing and excision of intervertebral disc,and cage placement through enlarged foraminal area.Digital technology is a more economic,efficient way to design a new operation approach.The results are in accord with the formalin doused body test.ConclusionMimics is an effectively,reliable and economic method to design an operation approach.And the result suggested that E-TLIF is a safe,less minimal invasive and more efficient operation approach in treatment of degenerative lumbar diseases.

ObjectiveTo compare the therapeutic effects of percutaneous cervical discectomy (PCD group),percutaneous cervical disc nucleoplasty(PCN) and the association of them (PCDN) for the treatment of cervical intervertebral disk displacement and instability of cervical vertebral column.Methods From February 2003 to April 2011,171 consecutive patients with cervical disc herniation have presented at the authors' hospital and were retrospectively studied.The average age of patients was 47.8 years(ranged,21-74).Ninety-seven cases were treated with PCD,50 cases with PCN,and the other 24 cases with PCDN.Clinical result and the stability of cervical vertebral column after operation were evaluated and compared among the 3 groups.ResultsAll cases had been followed up for a median of 4.1 years.There was significant difference in the pre- and post-operation the Japanese Orthopaedic Association(JOA) scoring system on within 3groups (PCD:t=21.85,P＜0.05; PCN:t=14.50,P＜0.05; PCDN:t=8.56,P＜0.05).All cases had been successfully operated.There was no significant difference between groups among the 3 groups in terms of the clinical outcomes(The recovery rate of JOA standard evaluation,F=2.19,P=0.12).According to Odom criteria,the excellent and good rate are as follows:81.35％ in PCD,82.44％ in PCN,83.19％ in PCDN,respectively.There was no significant difference between groups among the 3 groups in terms of the clinical success rate (P＞0.05).There was no instability of cervical vertebral column cases in 3 groups after operation(P＞0.05),and no significant difference was found in terms of cervical vertebral column stability in pre- and post-operation in each group.ConclusionAll the three operations including PCN,PCD and PCDN are safe,minimally invasive spine surgery for the treatment of cervical intervertebral disk displacement; they achieve good clinical outcomes and there are no difference on the stability of cervical vertebral column between preoperation and postoperation.

ObjectiveTo retrospectively analyze the treatment of odontoid fractures using percutaneous and open anterior screw fixation,and compare the clinical and radiographic results of the two techniques.MethodsFrom March 2003 to May 2010,115 patients with odontoid fracture were treated with anterior screw fixation,and all patients were followed up.The mean age of the patients was 43.5 years (range,16-71).Forty-seven patients who underwent percutaneous anterior screw fixation were set as the percutaneous fixation group,including 42 cases of type Ⅱ odontoid fracture and 5 of rostral type Ⅲ fracture.Sixtyeight patients who received open anterior screw fixation were set as the open fixation group,composing of 61cases of type Ⅱ odontoid fracture and 7 of rostral type Ⅲ fracture.We compared the operative time,intraoperative blood loss,X-ray exposure time,fracture union and complications between the two groups.Results The average follow-up duration was 37.6 months with a range of 12-70 months.The gender,age,classification of odontoid fractures,time after the injuries and concomitant spinal injuries showed a similar pattern in both groups.The operating time and intra-operative blood loss in percutaneous fixation group were (40.3±9.5)min and (5.6±4.1) ml respectively,and in open fixation group were (62.9±15.3) min and (47.1±28.6) ml respectively,both of them were significantly superior in percutaneous fixation group than in open fixation group (P＜0.05).There was no statistical difference in radiation exposure time,fracture union and incidence of complication between the two groups.ConclusionComparing with open screw fixation,percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type Ⅱ and rostral type Ⅲ odontoid fractures with potential advantages.

ObjectiveTo evaluate the clinical effect of the percutaneous fixation for atlas-axis combined fractures in the elderly patients,especially with brain injury.MethodsFrom March 2006 to February 2011,a total of 7 cases with C1,2 combined fractures entered the study,including 5 males and 1 female with an average age of 72.4 years (range,64-84 years).Fracture combinations included two Jefferson/type Ⅱ odontoid,two anterior ring/type Ⅱ odontoid,two anterior and posterior ring/type Ⅱ odontoid,and one anterior and posterior ring+lateral mass/type Ⅲ odontoid.There were 5 patients with head injuries in varying degrees of coma.All patients underwent percutaneous placement of odontoid screw and anterior C1,2 transarticular screws (triple anterior screw fixation),and were immobilized in a hard collar for 3 months postoperatively.Results The average duration of the operation was 56 min(range,36-78 min).Satisfactory results were achieved in all patients,and all screws were in good position.There were no intraoperative surgery-related complications.The mean follow-up period was 10.7 months.During the follow-up,no pullout,loosening,distortion,or breakage of internal screws was observed.Radiographic union occurred in all odontoid fractures and C1,2 stable was found in all case.ConclusionFor elderly patients especially those with brain injury,the triple anterior screw fixation is reliable and effective in dealing with combined atlas-axis fractures.This percutaneous surgery has the advantages of less invasive,less blood loss,less pain and early recovery.

ObjectiveTo observe the 2-8 years' follow-up results of percutaneous laser disc decompression(PLDD) on cervical spondylotic radiculopathy,and to identify factors affecting the outcome of PLDD.MethodsEighty-seven patients with cervical spondylotic radiculopathy were treated consecutively by PLDD in our hospital from December 2002 to June 2009,who were followed up for 2-8 years.There were 32males and 26 females,with the mean age of 51.8 years (range,26-74).The results were evaluated according to the Japanese Orthopedic Association's score of cervical spondylotic radiculopathy(JOA 20 score) and numeric rating scales (NRS) after surgery.Two years after the operation,the excellent and good rate of JOA score of patients with different genders,ages and duration of each subgroup will be compared.ResultsThe excellent and good rate were 37.9％,51.7％,65.5％,81.0％,82.8％,80.9％,72.4％ and 72.7％ at 1,3,6months and 1,2,4,6,8 years after operation respectively.Significant difference was found between the time points of 6 months to eight years after operation and that of one month after operation.The NRS score of the pain symptoms at the final follow-up was significantly reduced(P＜0.05).The excellent and good rate of patients whose course of disease (93.3％) was less than 18 months was significantly higher than that of those whose course of disease was over than 18 months(71.4％) two years after operation (P＜0.05).Conclusion The intermediate-term curative effect of PLDD for the treatment of cervical spondylotic radiculopathy is reliable and stable,and the postoperative curative effect may be influenced by patients' duration of disease.

ObjectiveTo evaluate the clinical effects of transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion(PLIF) using microendoscopic discectomy under X-Tube system in treatment of lumbar degenerative disc diseases.MethodsFrom December 2007 to April 2008,32 patients with low back disorders were treated by microendoscopic discectomy TLIF or PLIF under X-Tube system,including 19 cases in TLIF and 13 in PLIF.Etiologies including lumbar disc herniation combined with segmental instability in 21 cases,and spondylolisthesis in 11 cases.All patients were under regular postoperative follow-up and radiological examination.The clinical functional outcomes were evaluated according to Oswestry disability questionnaire.ResultsThe mean operation time was 120 min(range,90-180),and the average blood loss was 190 ml (range,100-400).There were no complications,such as infection and internal fixation failure.Bony fusion was achieved in all patients.The follow-up was from 14 months to 41 months with 21 months in the average.The average 0swestry scores decreased from preoperative 40.1％±4.1％ to 9.5％±3.7％ three months after the operation.The outcomes of this operation were rated as excellent.ConclusionMicroendoscopic discectomy TLIF or PLIF under X-Tube system in treatment of lumbar degenerative disc diseases has the characteristics of less blood loss,tissue trauma and quick recovery.

ObjectiveTo evaluate the surgical techniques and 2-year follow-up results of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF).MethodsFrom September 2006 to October 2008,54 patients with single-level lumbar degeneration disease were treated by Mast Quadrantassisted modified TLIF.Under the guidance of C-arm,the Mast Quadrant's retractor was placed and the lower articular process of the upper vertebrae and 1/2-2/3 of the lamina,flavum ligament and hyperplastic cohesive part of the lower articular process were removed,the nerve roots and the central canal were decompressed.After cleaning up intervertebral disc space,bone grafting and pedicle screw fixation were achieved.Visual analogue scale(VAS) and Oswestry disability index(ODI) results,as well as the fusion rate at the last follow-up were analyzed.ResultsAll patients were treated by Mast Quadrant-assisted modified TLIF,in which 51 patients were followed up for 2 years.An average operating time was(178.7±63.2) min,and an average blood loss was (224.2±136.5) ml; an average postoperative drainage loss was (117.2±91.4) ml,and an average postoperative stay was(5.8±3.6) d.There were statistic significances between pre- and post-operative ODI and VAS scores,respectively.At last follow-up,51 patients were achieved radiographic fusion without internal fixation failure and other complications.ConclusionMast Quadrant-assisted modified TLIF had a good vision,was relatively safe and easy to be acceptable by surgeons,and which had a good clinical results for the patients with single-level lumbar degenerative disease.