Humans ; Lumbar Vertebrae ; surgery ; Spinal Diseases ; surgery ; Spinal Fusion ; instrumentation ; methods

Discogenic low back pain is the common type of chronic low back pain. However,its mechanism has not been completely clarified. Considerable evidence shows that neurotrophins play an important role in discogenic low back pain. The paper summarizes the mechanism of neurotrophins on discogenic low back pain according to the pain transfer pathway of neurotrophins in intervertebral disc, dorsal horn ganglia and spinal trigeminal nucleus. Changing the pain transmission by regulating neurotrophins and its receptor will provide a new way for the treatment of discogenic low back pain.
Humans ; Intervertebral Disc ; metabolism ; pathology ; Low Back Pain ; metabolism ; pathology ; Nerve Growth Factors ; metabolism ; Posterior Horn Cells ; pathology ; Trigeminal Nucleus, Spinal ; pathology

Fracture Fixation, Internal ; methods ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; surgery ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

Contraindications ; Humans ; Vertebroplasty ; adverse effects ; methods

Casts, Surgical ; Humans ; Internal Fixators ; Spine ; surgery ; Tuberculosis, Spinal ; surgery

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction clinical disease. Surgery is the main therapeutic tool for CSM. However, there are obvious differences in clinical functional recovery after operation. For the past few years, the influence factors of prognosis in cervical spondylosis myelopathic has been widely concerned. Age, nerve function, course of desease, imaging findings,surgical method and related factors became the investigative point for prognosis of cervical spondylotic myelopathy. Present viewpoint showed that the older patient, preoperative worse nerve function, longer the course of disease would result in worse outcomes. Imaging examination maybe can indicate the prognosis, but the correlation is unclear. Selection of surgical method and approach should be based on the principles of sufficient decompression, stabilize the alignment of the cervical spine, keeping backward extension of cervical spine, maintain effective decompression, preventing complications. Therefore, the treatment of cervical spondylotic myelopathy should be on the basis of pathogenic condition and imaging examination at early stage and a suitable usrgical procedure should be performed to obtain a better prognosis.
Cervical Vertebrae ; surgery ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Radiography ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; surgery ; Spondylosis ; diagnosis ; diagnostic imaging ; surgery

OBJECTIVETo identify the initial effect of dynamic interspinous implant of Coflex on the treatment of lumbar spinal stenosis.

METHODSA retrospective study of 18 patients who underwent posterior lumbar decompression and fixation with interspinous implant of Coflex between March 2008 and October 2009 was taken to compare the Cobb angel of nature and dynamic position on the segment of Coflex fixation at the time of before and after operation and following time,including 10 males and 8 females with average age of 62.2 years old (54 to 71 years). The symptoms of patients included chronic lower back pain and intermittent claudication and lower extremity numbness. All cases including 17 cases of L4,5 and 1 case of L3,4 were central canal stenosis without obviously segmental instability. Clinical outcomes were evaluated with VAS and ODI.

RESULTSAll patients were followed up from 10 to 18 months with an average of 14.4 months. There did not about internal fixation failure. It was found that postoperative Cobb angel of fixation segment [(12.1 +/- 2.6) degrees] was significantly decreased than preoperative [(14.8 +/- 3.2) degrees] (t = 2.61, P = 0.03). But the Cobb angel [(14.9 +/- 4.1) degrees] increased at final follow-up, even reached the level of before operation (t = 1.39, P = 0.65). The Cobb angle of upper adjacent segment did not obviously change in preoperation, postoperation and final follow-up [(12.1 +/- 2.3) degrees, (12.3 +/- 3.2) degrees, (11.9 +/- 3.0) degrees, respectively]. Dynamic measure showed that Coflex can adequately limit the ROM of extension (t = 4.01, P = 0.001), but the ROM of flexion increased (t = 2.57, P = 0.02). The VAS score in follow-up (2.2 +/- 0.7) was significantly decreased than before operation (4.9 +/- 1.1, t = 2.95, P = 0.02). The ODI score in follow-up [(29.1 +/- 9.0)%] was significantly decreased than before operation [(56.5 +/- 14.2)%, (t = 3.02, P = 0.02)].

CONCLUSIONThe Coflex implanting combined with decompression can get good result clinically, but imaging showed that Coflex can not maintain the relatively kyphosis gained after operation except for extension limitation.

Aged ; Female ; Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Prostheses and Implants ; Retrospective Studies ; Spinal Stenosis ; surgery

OBJECTIVETo compare the clinical efficiency of patellar fixed pin and Kirschner's nail with tension band in treating patellar fracture.

METHODSFrom November 2010 to January 2012, the clinical data of 42 patients with patella fracture were treated with patella fixed needle and Kirschner's nail with tension band. The patellar fixed needle group included 21 cases (14 males and 7 females,aged 26 to 65 with an average of 43.6 years old); The Kirschner's nail with tension band group included 21 cases (12 males and 9 females,aged 32 to 58 with an average of 41.5 years old). The operation time, intra-operative blood loss and healing time were compared between two groups. Böstman score was applied to compare the therapeutic effects.

RESULTSAll patients were followed up with an average of 11.5 months ranged from 6 to 14 months. The fractures healed well without complications such as nonunion and infection. According to Böstman score, there was no significant difference between two groups in clinical efficiency (Z = -0.83, P = 0.407). There was significant difference in operation time (t = 6.67, P = 0.00), while no difference in intra-operative blood loss, bone healing time (t = 1.90, P = 0.064; t = 0.612, P = 0.544).

CONCLUSIONBoth methods can obtain good results. However, patellar fixed pin combined with tension band is one of the ideal methods for the treatment of patellar fracture, it has an advantage of simple with shorter operation time, rigid fixation, less complications and well recovery.

Adult ; Aged ; Bone Nails ; Bone Wires ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Knee Injuries ; surgery ; Male ; Middle Aged ; Patella ; injuries ; surgery ; Splints

BACKGROUNDThe value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated.

METHODSEach of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type I, II, III and IV. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed.

RESULTSAccording to the configurations of the SEPs, there were 27 patients (36%) of Type I, 30 patients (39%) of Type II, 8 patients (11%) of Type III, and 11 patients (14%) of Type IV. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P<0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P<0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups.

CONCLUSIONSSEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.

Aged ; Evoked Potentials, Somatosensory ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; Prognosis ; Spinal Osteophytosis ; diagnosis ; physiopathology ; surgery

OBJECTIVETo discuss the clinical results of hook plate internal fixation for the treatment of distal traumatic injuries of clavicle,and to analysis the mechanism of the complications.

METHODSFrom 2001.9 to 2008.2, 36 patients with fresh distal clavicle fractures of Neer type II and 14 patients with dislocation of Acromioclavicular joint of Tossy type III were treated with hook plate internal fixations. Among the patients, 36 patients were male and 14 patients were female, ranging in age from 19 to 77 years, with an average of 43 years. After the operation, the range of motion of shoulder joint was measured and the complications were studied. The Karlsson and Constant-Murley criteria were used to evaluate the therapeutic effects.

RESULTSAll the patients were followed up with a mean duration of 12 months (7 to 18 months). All the patients could move shoulder joint actively 1 week after operation, and recover to the normal ROM at the 6th week after operation. According to Karlsson criteria, 44 patients got an excellent result, 6 good. According to Constant-Murley criteria, the average score of wound shoulder was (73.8 +/- 8.3) before operation, and (59.6 +/- 6.7) after operation, and the postoperative score was higher than preoperative score. No incision infections were found and 5 patients with complications were cured. No re-dislocation of acromioclavicular joint occurred.

CONCLUSIONIt is advocated that hook plate for the treatment of distal clavicular fractures of Neer type II and acromioclavicular dislocation of Tossy type III could provide sufficient stability to allow early functional rehabilitation, and to decrease the rate of complications.

Adult ; Aged ; Bone Plates ; Clavicle ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult