Objectives:To investigate the vertebral height restoration and its associative factors during highviscosity bone cement vertebroplasty in the treatment of osteopomsis vertebral compression fractures (OVCF).Methods:96 cases using high-viscosity bone cement during vertebroplasty were selected in our hospital from January 2015 to December 2016.There were 44 males and 52 females,aged 56-79 years old,with an average age of 67.36±5.36 years.Thoracic vertebrae were involved in 41 cases and lumbar vertebrae in 55 cases;47 cases had single segment involved and 49 cases had double segments.According to the injection volume of bone cement,those with injection volume ≤4ml were classified as group A1(n=41),injection volume ＞4ml as group A2(n=55);according to the distribution of bone cement,the cases with filling rate ≤ 15％ was classified as group B1(n=37),filling rate ＞15％ as group B2(n=59).The anterior vertebral heights before operation and at 3 days after operation were compared among the four groups and the correlations of anterior vertebral height restoration with bone cement injection volume and diffusion degree were analyzed by linear regression analysis.Results:The anterior vertebral height at 3 days after operation in group A1 was higher than the preoperative one(P＜0.05),and the central vertebral height showed no significant difference compared with the preoperative one(P＞0.05);the postoperative anterior vertebral height and central vertebral height in group A2 were significantly higher than the preoperative ones (P＜0.05),and those levels of group A2 were higher than those of group A1 (P＜0.05).The postoperative anterior vertebral height and central vertebral height in the group B1 showed no significant difference compared with the preoperative ones(P＞0.05),and the postoperative anterior vertebral height and central vertebral height in group B2 were significantly higher than those before operation(both P＜0.05),and those levels of group B2 were higher than those of group B1(P＜0.05).The vertebral height restoration was closely related to the bone cement injection volume(r=0.63) and dispersion degree (r=0.65)(P＜0.01).After 3 months of follow-up,the incidence rate of bone cement leakage in group A2 accounted for 1.82％(1/55),which was slightly lower than that of group A1 of 4.88％(2/41),but there was no statistical significanee(x2=0.47,P＞0.05);the incidence of cement leakage in group B2 was 1.69％(1/59),which was slightly lower than that of group B1 of 5.41％(2/37),which showed no statistically significant difference (x2=0.58,/P＞0.05).Conclusions:The high-viscosity bone cement appropriately increases the bone cement injection volume and dispersion degree which can effectively improve the vertebral height in patients with compression fractures.

Objectives:To analyze the clinical result and the prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease.Methods:2341 patients who suffered from lumbar degenerative disease and underwent lumbar surgery from January 2011 to January 2016 were reviewed,among which 125 cases suffered from foot drop and caused by lumbar spinal stenosis(LSS) or lumbar disc herniation (LDH).Among the 125 patients,108 cases were enrolled with complete follow-up.All patients underwent modified PLIF and nerve roots decompression.The mean follow-up period was 2.4±1.5 years(range,1.4-5.2 years).Patients whose tibialis anterior(TA) muscle strength recovered to grade 4 or grade 5,the ankle could move freely,with a relative normal gait,could be considered as recovery.The following indexes were included in the single factor analysis by Log-rank test:age,gender,type of lumbar degeneration,duration of palsy,preoperative tibialis anterior strength,physical sensation disorder of affected lower limbs,number of affected limbs,preoperative VAS score,cauda equine syndrome,affected levels and history of trauma.Cox regression analysis was used to analyze the prognostic factors of surgical treatment effect.Results:Among 108 cases of patients with foot drop,59 cases were cured,the recovery rate was about 54.6％.Among them,44 cases were LSS,and 15 cases were cured,the rate was 34.1％;64 cases were LDH,44 cases were cured,the rate was 68.7％.The single factor analysis showed that age,type of lumbar degeneration,duration of palsy,preoperative TA muscle strength and number of affected limbs had significant relation with prognosis (P＜0.05).The Cox regression analysis showed the following indexes were the prognostic factors of foot drop:age,type of lumbar degeneration,duration of palsy and preoperative TA muscle strength(P＜0.05).Conclusions:Age,type of degeneration,duration of palsy and preoperative TA muscle strength are significantly related to the prognosis of foot drop caused by lumbar degenerative disease.Patiets with younger age,shorter duration,stronger TA muscle strength recover better;compared with LSS,foot drop caused by LDH recover better.

Objectives:To investigate the clinical outcome of Smiley face rod fixation system for lumbar isthmic spondylolysis.Methods:From January 2016 to June 2017,18 patients with isthmic spondylolysis were treated with smiley face screw-rod fixation system.There were 13 males and 5 females,with an average age of 28.2±3.2(25-32) years old.The average disease duration was 16.3±5.7(7-24) months.L5 isthmic spondylolysis was involved in all cases.All patients had been followed up at 3 months and 1 year after surgery.The preoperative and postoperative visual analogue scale(VAS) and Oswestry disability index(ODI) were compared.The X-ray and CT scan were evaluated to analyze the change of range of motion in the lumber spine and the bony fusion rate.Results:The mean operation time was 90.0±24.1 minutes.The average blood loss was 140±15ml.The average follow-up was 18.5±5.0 (12-24) months.The VAS at 3 months after operation was 3.0±1.2,and the ODI was (17.2±4.5)％ respectively,which showed significant differences compared with the preoperative ones[7.3±2.5 and (67.0±15.1)％](P＜0.05).The VAS and ODI at 1 year after operation were 1.0± 0.6 and (9.1±5.3)％,which showed significant differences compared with 3 months postoperation(P＜0.05).The range of motion between L5 and S1 was 13.1°±2.1° and the incidence of lumbar instability was 83.3％(15/18) preoperatively;it was 9.3°±1.6° and 11.1％(2/18) postoperatively,and there was statistic difference(P＜0.05).All patients achieved bone fusion in the isthmic defect 1 year after operation.Conclusions:The Smiley face rod fixation is a reliable treatment for lumbar spondylolysis with the advantage of minimal invasive,less nerve interference,and to restore normal anatomical structure,maintain the lumbar spine stability.

Objectives: To investigate the role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis.Methods: From February 2014 to November 2014,pus specimens of 49 osteoarticular tuberculosis patients and 32 nontuberculosis patients were detected by Xpert MTB/RIF system,and the sensitivity,specificity,positive predictive value,negative predictive value,agreement rate of Xpert MTB/RIF system were calculated,and clinical diagnosis was used as the reference standard.All the pus specimens were detected by acid-fast stain and fast culturing(BACTECT MGIT 960),to find the difference of sensitivity and specificity among Xpert MTB/RIF,acid-fast stain,and fast culturing.The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis was evaluated through the two factors above.Results: It took 2.3±0.2h to detect each pus specimen by Xpert MTB/RIF.Among the 49 osteoarticular disease patients,46 were positive,3 were negative by Xpert MTB/RIF test.Among the 32 nontuberculosis patients,1 was positive,31 were negative by Xpert MTB/RIF test.The sensitivity,specificity,positive predictive value,negative predictive value,agreement rate was 93.87%,96.87%,97.87%,91.17%,95.06% respectively for Xpert MTB/RIF assay.Among the 46 specimens which were positive by Xpert MTB/RIF test,10 had rifampicin resistance mutation,with the rate of rifampicin resistance mutation as 21.73%.Among the 49 osteoarticular disease patients,8 were positive,41 were negative by acid-fast stain test,the sensitivity was 17.39%,and based on fast culturing test,11 were positive,38 were negative,the sensitivity was 23.91%.All pus specimens of 32 nontuberculosis patients were negative by acid-fast stain test and fast culturing test.As for the sensitivity,Xpert MTB/RIF was superior to acid-fast stain and fast cultureing (P＜0.05).While as for the specificity,there was no statistical difference among Xpert MTB/RIF,acid-fast stain,or fast culturing (P＞0.05).Conclusions: The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis is perfect.It is of time saving,high sensitivity and high specificity,which is superior to the traditional methods.

Objectives:To investigate the clinical outcomes of unilateral percutaneous vertebroplasty(PVP) by using curved injection needle in osteoporotic vertebral compression fractures(OVCFs).Methods:From January 2015 to January 2016,47 patients(14 males and 33 females) with OVCFs were enrolled in this study.The patients were 53-89 years old (66.4±6.5 years),36 cases were single segmental vertebral fracture,11 cases were double segment vertebral fracture.T9 fracture occured in 7 cases,T10 fracture in 7 cases,T11 fracture in 9 cases,T12 fracture in 13 cases,L1 fracture in 12 cases,L2 fracture in 9 cases,and L3 fracture in 1 case.The fluoroscopy time and bone cenent dosage were recorded.The VAS score,ODI,relative height restoration of vertebra and Cobb angle were compared between preoperation and postoperation.The bone cement leakage(venous leakage and perivertebral leakage) and other complications were observed.Results:The average fluoroscopy time was 1.6±0.3nin,the average bone cement dosage was 6.7±1.2ml.Bone cement leakage occured in 11 cases with the rate of 23.4％.The patients were followed up for 3-12 months (6.5±1.3 months).The VAS,ODI,the relative height of injured vertebra and the local Cobb angle before operation,at 2 days after operation and final follow-up were:7.6±1.3,(71.4±3.2)％,0.48±0.21,15.5°±4.2°;2.2±1.0,(27.2± 2.6)％,0.82±0.17,7.2°±2.8°;1.7±0.7,(26.5±2.7)％,0.80±0.15,7.5°±3.7°.At 2 days after operation and final follow-up,the VAS score,ODI score,the relative height and Cobb angle of injured vertebra were significantly improved when compared to those before operation (P＜0.05);There was no significant difference between 2 days after operation and final follow-up(P＞0.05).Conclusions:The advantages of unilateral PVP by using curved injection needleless in OVCFs are less fluoroscopy time,even distribution of bone cement,and less leakage.

Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.

Objectives: To survey and analyze the level of acceptance of disability and its risk factors for spinal cord injury(SCI) after 18 months of injury. Methods: 78 patients with SCI in our hospital from March 2006 to December 2008 and 83 cases with SCI from work injury mutual support group were reviewed retre-spectively, their ages at onset were above 18 years(18-62 years, average 36 years) and they suffered from in-jury for more than 18 months(18-35 months, average 27 months). The survey ranged from January to April 2009. Of them, 29 were face-to-face interviewed and 132 were telephone interviewed. The questionnaire con-sisted of World Health Organization Disability Assessment Schedule Ⅱ, Acceptance of Disability Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies Short Depression Scale, Generalized Self-Effi-cacy Scale, and Multidimensional Scale of Perceived Social Support. Results: The acceptance of disability had a fair degree of negative relationship with pain and WHO disability assessment (r=-0.28 and -0.40, P<0.01, respectively), and had a fair degree of positive relationship with self-efficacy and social support ( r=0.45 and 0.36, P<0.01, respectively). It was also found that moderate to good positive relationship between acceptance of disability and self-esteem(r=0.65, P<0.01), moderate to good negative relationship with depression(r=-0.66, P<0.01). The linear regression result indicated that depression, self-esteem and pain intensity were the best predictors for acceptance of disability(P<0.01). Conclusions: Multifactors may influence the acceptance of dis-ability for SCI. However, depression, self-perceived pain intensity and self-esteem are the best predictors for acceptance of disability.

Objective:To study the the correlation between the diameter or angle of thoracic-lumber pedicle and vertebral number.Method:X-ray and CT scan were performed on 46 male spine specimens.The length of pediele screw path,the cress-section angle(e) and the sagittal angle(f) of the pedicle,the width of the inner diameter of the pediele and the distance between the two pedicles were measured.The ordinal number of T1-L5 vertebral segment was numbered by 1-17.SPSS 11.5 software was used for statistical analysis.Result:The data showed a positive linear correlation with the vertebral numbers including length of T1-L4 pedicle screw path (R2=0.716),T8-L5 pedicle width (R2=0.673),T4-L5 pedicle distances (R2=0.771),T1-T2 f-angle (R2=0.767) ,T2-T4 f-angle (R2=0.908),T12-L5 pediele e-angle (R2=0.710).The negative linear correlation with thevertebral numbers included T2-T3 pedicle width(R2=0.792),T1-T4 pedicle distances(R2=0.866),T7-L5 f-an-gle(R2=0.931),T1-T6 pedicle e-angle (R2=0.774).However,the T1-T2 and T4-T7 pediele width,the T4-T6 pediele f-angle,as well as the T6-T12 pedicle e-angle had no significant correlation with the vertebral num-bers.Conclusion:Apart from the T1-T2 and T4-T7 pedicle width,the T4-T6 pedicle f-angle and the T6-T12 pedicle e-angle,the diameter or angle of the thoracic-lumbar pedicle have correlation with the vertebral numbers with meaningful linear regression equation.

Objective:To investigate the surgical outcome of one-stage combined anterior and posterior ap-proach for severe thoracolumbar and lumbar spine fracture.Method:A total of 62 cases suffered from severe thoracolumbar and lumbar spine fracture undergoing surgery from Jan 2003 to Jan 2008 were reviewed retro-spectively.Of these,there were T11 involved in 2 cases,T12 in 13 cases,L1 in 28 cases,L2 in 10 cases,L3 in 6 cases and L4 in 3 cases.There were 58 fresh fractures and 4 old fractures.Based on Dennis classifica-tion,12 were compression fracture,33 were burst fracture and 17 fracture dislocation.All cases had spine load score≥7 and TLICS score≥5.Of 19 cases with neurological deficit according to Frankel grade,there were 7 A,5 B and 7 C.Combined anterior and posterior approach was performed in all cases,anterior bony graft plus posterior pedicle instrumentation were performed either,of these,52 cases had additional anterior decompres-sion.Result:All operations were performed successfully,with the mean surgical time of 170min (range, 150-210min) ,the average blood loss was 819ml(range,400-2900ml).No iatrogenic neuroinjury,skin infection, dural matter tearing and graft displacement were noted.The preoperative Cobb's angle was 8°-40°(mean, 23.9°), while the postoperative counterpart returning to normal with 5 cases having 2°-10° kyphosis.The preoperative compression rate was 20%-95%(mean,54.5%),while the postoperative counterpart returning to normal in 47 cases,with 15 cases having 2%-30%.The preoperative canal stenosis rate was 5%-90%(mean,51.1%) while the postoperative counterpart was 0-30%(mean,4.7%),which showed significant difference with regarding to these 3 parameters (P<0.05).All cases were followed up for an average of 31 months (range,12-72 months). Bony fusion was evidenced in cases undergoing anterior bony graft.At 10-12 months, the Cobb's angle was 0°-15°(mean,0.62°) ,the vertebral compression rate was 0-30%(mean,4.6%),no significant difference were noted between them and their postoperative counterparts(P>0.05).At final foUow-up,15 of 19 cases with neu-rological deficit had neurofunction improved,while 4 remained unchanged.According to our hospital criteria,of 43 cases with no neurological deficit,there were 30 excellent,9 good,3 fair and 1 bad with the total excel-lent to good rate of 90.6%.Cage subsidence and pedicle screw breaking was noted in 1 case,who developed severe kyphosis presenting with irreducible back pain.Conclusion:One-stage combined anterior and posterior approach for severe thoracolumbar and lumbar spine fracture can ensure three column stability as well as complete decompression,which has good early outcome.

Objective:To evaluate the feasibility and clinical efficacy of the treatment of lumbar spine steno-sis by modified unilateral approach for bilateral decompression under microendoscope.Method:217 cases with degenerative lumbar spine stenosis from September 2003 to December 2008 were treated by modified unilater-al approach for bilateral decompression of central spinal canal and nerve root canal under microendoscope.A-mong them laminectomy of one segment was done in 163 cases,two segments were done in 54 cases.After surgery,the routine radiograph were carried out and the Nakai criterion was used for assessment.Result:The mean operative time was 48±13min (range,25 to 95min),the average blood loss was 37±9ml (range,25 to 180ml),the average skin incision length was 2.2±0.2cm(1.8 to 2.4cm).2 cases had dural matter tearing,which healed after filling with gelatin foam and 2 weeks bed rest,after that no cerebrospinal fluid leakage was noted after surgery.Mislocation was noted in 1 case.No nerve inury and postoperative infection oceurred.Postoperative CT scan demonstrated complete decompression of the central spinal canal and nerve root canal.All patients were followed-up for an average of 14 months (range,3 months to 24 months).The Nakai criterion at final follow-up showed clinical excellent in 134 cases,good in 63 cases,fair in 16 cases and worse in 4 cases, with the excellent and good rate of 90.8%.No lumbar spine instability was noted.Conclusion:Treatment of de-generative lumbar spine stenosis by modified unilateral approach for bilateral decompression under mieroendo-scope has the merit of minimal invasive,less complications and reliable therapeutical effect.