We have made a biomechanical evaluation of titanium mesh with anterior plate fixation in anterior cervical decompression. Six fresh cervical spine specimens (C3-7) of young cadavers were used in the biomechanical test. Subtotal vertebrectomy was performed on C5, C5-6 and C4-6. We accomplished two constructions: (1) bone graft; (2) titanium mesh with anterior plate fixation. Then their biomechanic stabilities were tested in all groups and compared with those of intact specimens. We found that titanium mesh with anterior plate fixation improved the stability of the unstable spine, showing a significant difference when compared with that of the intact group (P < 0.05). The anterior cervical interbody fusion by bone graft and the titanium mesh implantation is stabler than the intact cervical sample, and the stability decreases with the increase in number of cervical segment.
Biomechanical Phenomena ; Cadaver ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; instrumentation ; methods ; Humans ; Internal Fixators ; Spinal Fusion ; instrumentation ; methods ; Stress, Mechanical ; Titanium

Complete burst fractures of the L₅ is relatively uncommon. How to accomplish a rigid internal fixation as well as preserve motor function is an enormous challenge. We report such a case treated via a single posterior vertebrectomy with 270-degree decompression and reconstruction using titanium mesh cage. The disc between L₅/S₁ was preserved by placing the titanium mesh cage on the inferior endplate of the L₅. We hope this method can offer a possible solution for other surgeons when they meet a similar fracture pattern.
Adult ; Decompression, Surgical ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Internal Fixators ; Male ; Spinal Fractures ; surgery ; Surgical Mesh ; Titanium

OBJECTIVETo evaluate clinical results of microscope-assisted minimally invasive decompression for degenerative lower lumbar spinal stenosis.

METHODSFrom May 2007 to November 2008, 26 patients with degenerative lower lumbar spinal stenosis were treated with microscope-assisted minimally invasive decompression. Including 9 males and 17 females, the mean age were 53.7 years (range in 47-75 years). The course of disease was from 2 to 8 years with an average of 3.6 years. Single segment symptom had 20 cases and double segments had 6 cases. The clinical effects were evaluated and improvement rate was calculated according to JOA scoring before and after operation.

RESULTSThe operative time in single segment was 60-90 minutes with an average of 75 minutes and in double segments was 80-180 minutes with an average of 95 minutes. The operative bleeding in single segment was 50-120 ml with an average of 85 ml and in double segments was 60-150 ml with an average of 100 ml. All the patients were followed up with an average of 8.6 months (range in 6-24 months). The clinical effects were evaluated according to JOA scoring,excellent in 18 cases,good in 7,poor in 1,the rate of excellent and good was 96% and improvement rate was 86%. The mean JOA scoring was respectively 3.92 +/- 0.83 and 12.67 +/- 1.92 before and after operation. There was significantly statistic difference between before and after operation (P < 0.01).

CONCLUSIONMicroscope-assisted minimally invasive decompression for degenerative lower lumbar spinal stenosis can obtain satisfactory therapeutic effect,which had advantages of short operative time, less trauma, subtle operation, fast restoration, but it is inapplicable for the patients with obviously ossification or calcification of vertebral body, severe vertebral canal adherence.

Aged ; Decompression, Surgical ; instrumentation ; methods ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Spinal Stenosis ; surgery ; Treatment Outcome

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
Adult ; Aged ; Decompression, Surgical ; instrumentation ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastric Outlet Obstruction ; etiology ; surgery ; Gastroparesis ; etiology ; surgery ; Gastroscopy ; instrumentation ; methods ; Humans ; Intubation, Gastrointestinal ; instrumentation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; etiology ; surgery

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; instrumentation ; methods ; Diskectomy ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Prospective Studies ; Spinal Fusion ; instrumentation ; methods

OBJECTIVETo evaluate the short-term outcomes of patients receiving orthopedic surgery with posterior pedicle screw fixation for degenerative lumbar scoliosis.

METHODSBetween March, 2006 and August, 2009, 36 patients with degenerative lumbar scoliosis (19 males and 17 females) underwent procedures of decompression, bone implantation and pedicle screw fixation. Fifteen patients were also treated by PLIF and 21 cases received posterior-lateral fusion. The JOA scores, Oswestry disability index (ODI), and Cobb angle were recorded before and after the operation, and the surgical complications were also observed.

RESULTSThe JOA scores increased significantly by 83.3% after the operation (P<0.05). The procedures resulted in significantly lowered ODI from (67.1∓11.4)% before the operation to (32.1∓10.8)% after the operation (P<0.01). A significant improvement of the coronal Cobb's angle was achieved after the operation (26.7° preoperatively vs 12.3° postoperatively, P<0.01), and the lordosis angle was improved from 10.7° to 36.6° after the operation (P<0.01). All the patients were followed up for 12 to 50 months (mean 38 months), and no implant loosening, displacement or fragmentation, or pseudarthrosis was found at the final follow-up.

CONCLUSIONPosterior pedicle screw fixation shows good short-term therapeutic effect in treatment of degenerative lumbar scoliosis. Individualized surgical plans and adequate preoperative evaluation are keys to successful operations.

Aged ; Aged, 80 and over ; Bone Screws ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Orthopedic Procedures ; instrumentation ; methods ; Scoliosis ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome.

METHODSThis study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association (JOA) score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments.

RESULTSThere was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group.

CONCLUSIONSThe median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine.The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.

Decompression, Surgical ; Endoscopy ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Fusion ; instrumentation ; methods ; Spinal Stenosis ; surgery ; Treatment Outcome

BACKGROUND: Surgical techniques used in the treatment of patients with high grade lumbar spondylolisthesis (> 50% slippage) are usually associated with a great deal of controversies. We aim to evaluate the surgical outcomes of high grade spondylolisthesis treated with an intraoperative temporary distraction rod. METHODS: We retrospectively studied 21 patients (14 females and 7 males), aged 50.4 +/- 9.2 years, who had high grade lumbar spondylolisthesis that was treated with intraoperative temporary distraction rods, neural decompression, pedicular screw fixation, and posterolateral fusion involving one more intact upper vertebra. The mean follow-up period was 39.2 months. Radiologic and clinical outcomes were measured by slip angle, slip percentage, correction rate, Oswestry Disability Index (ODI), visual analogue scale (VAS), patient's satisfaction rate in the pre- and postoperative period. Data were analyzed by SPSS ver. 11.5. RESULTS: Analysis of the preoperative visits and final follow-up visits indicated that surgery could improve ODI, lumbar VAS, and leg VAS from 60.5% to 8.2%, from 6.7 to 2.2, and from 6.9 to 1.3, respectively. Slip angle and slip percentage were also changed from -8degrees to -15degrees and from 59.2% to 21.4%, respectively. Mean correction rate at the final follow-up visit was 64.1%. Loss of correction was insignificant and a neurologic complication occurred in one patient due to misplacement of one screw. Excellent and good levels of satisfaction were observed in 90.5% of the patients. CONCLUSIONS: In the surgical treatment of refractory high grade spondylolisthesis, the use of a temporary distraction rod to reduce the slipped vertebra in combination with neural decompression, posterolateral fusion, and longer instrumentation is associated with satisfactory clinical and radiologic outcomes.
Adult ; Bone Nails ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion/instrumentation/*methods ; Spondylolisthesis/*surgery ; Treatment Outcome

A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings.
Aged ; Common Bile Duct/*injuries ; Constriction, Pathologic/surgery ; Decompression, Surgical/instrumentation/methods ; Humans ; Male ; Self Expandable Metallic Stents/adverse effects ; *Stents ; Torsion Abnormality/*surgery

Enhanced recovery after surgery (ERAS) is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition and psychology. It aims to minimize surgical stress and maintain physiological function in perioperative care, thereby expediting recovery. ERAS theory has been clinically applied for nearly 20 years and it is firstly used in colorectal surgery, then widely used in other surgical fields. However, ERAS is not used commonly in esophagectomy because of its surgical complexity and high morbidity of postoperative complications, which limits the application of ERAS in the field of esophagectomy. In recent years, with the increasing maturation of minimally invasive esophagectomy, attention to tissue and organ protection concept, improvement of making gastric tube, breakthrough of anastomosis technique, and the presentation and application of new concepts, ERAS has made great progress in the field of esophagectomy. This article summarizes some ERAS measures in the treatment of esophageal cancer based on evidence-based medicine, and performs an effective ERAS mode for clinical application of esophagectomy. During preoperative preparation and evaluation, we propose preoperative education and nutrition evaluation without regular intestinal preparation, and advocate preemptive analgesia without preanesthetic medication. During intra-operative management, anesthesia scheme should be optimized, fluid transfusion should be controlled properly, suitable operation mode should be chosen, and intraoperative hypothermia should be avoided. During postoperative management, sufficient analgesia should be administered with non-opioid analgesics, drainage tube placement must be decreased and removed earlier, urinary catheter and gastrointestinal decompression tube should be removed earlier, and oral intake and ambulation should be resumed as early as possible. "Received surgery yesterday, oral intake today, discharged home 5-7 days", ERAS program based on "non tube no fasting" has been applied in some medical centers and becomes more and more maturation. In the future, we will rely on the increasing improvement and systemic training of ERAS mode in order to promote such application in more medical centers. With the multi-center clinical trials, based on constant enrichments and improvements, a general expert consensus will be made finally.
Analgesia ; methods ; Anesthesia, General ; methods ; Decompression, Surgical ; instrumentation ; methods ; Drainage ; instrumentation ; methods ; Esophageal Neoplasms ; rehabilitation ; surgery ; Esophagectomy ; methods ; psychology ; rehabilitation ; Evidence-Based Medicine ; Feeding Methods ; Humans ; Length of Stay ; Minimally Invasive Surgical Procedures ; methods ; rehabilitation ; Nutritional Status ; Patient Education as Topic ; methods ; Perioperative Care ; methods ; Urinary Catheterization ; methods ; Walking