Objective To evaluate the efficacy of combined anterior and posterior approaches in treatment of severely unstable lower lumbar burst fractures.Methods A retrospective case series study was made on clinical data of 14 patients with lower lumbar burst fractures collected from August 2009 to August 2014.There were 12 males and 2 females,with a mean age of 39 years.Seven fractures occurred at L3,five at L4,and two at L5.Nine patients were associated with injury to the posterior ligament complex (PLC).According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in two patients,grade C in four,grade D in five and grade E in three.All patients underwent posterior pedicle screw fixation combined with anterior spinal canal decompression and titanium mesh or iliac bone grafting.Lumbar lordosis angle,vertebral height,spinal canal decompression,ASIA grade and complications were evaluated after operation.Results Two patients experienced cerebrospinal fluid leakage postoperatively,which were healed after 2 weeks' local pressure treatment.Three patients experienced recurrent lumbar pain postoperatively,which were relieved after the removal of internal fixation 18 months after operation.All patients were followed up for 12-36 months (mean,18 months).Compared to the detection before operation,final follow-up showed improved lumbar lordosis [(30.2 ± 7.3) ° vs.(41.3 ± 6.5) °],decreased loss of the anterior vertebral height [(62.3 ± 21.5) ％ vs.(11.8 ± 7.8) ％] and reduced canal compromise [(65.7 ± 30.5) ％ vs.(21.9 ± 12.7)％] (all P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade C in one patient,grade D in three and grade E in ten (P ＜ 0.05).Follow-up showed no apparent graft loosening,pseudarthrosis,implant breakage and severe kyphosis.Conclusion Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures can effectively reconstruct the height and stability of the vertebral body,restore the spinal canal volume,and attain satisfactory clinical outcome.

Objective To investigate the effect of minitype titanium plate fixation through transoral approach in the treatment of unstable atlas fractures.Methods A retrospective case series study was made on 21 patients with unstable atlas fractures treated by minitype titanium plate fixation through transoral approach from June 2008 to June 2014.There were 15 males and 6 females,at age of (40.9 ± 10.6)years (range,21 to 57 years).Anterior 1/2 Jefferson fractures were seen in 12 patients and 1/2 ring Jefferson fractures in 9 patients.Preoperative visual analogue score (VAS) was 4-9 points [(7.6 ± 1.3) points].Before operation,degree of mobility of the cervical vertebra was (15.4 ± 3.9) °in bending,(10.8 ± 2.5) °in extending,(18.3 ± 3.1) ° in left-bending,(18.9 ± 2.7) ° in right-bending,(21.8 ± 5.8) °in left-rotation and (22.4 ± 4.6) ° in right-rotation.Operation time,intraoperative blood loss,VAS,cervical mobility and bone healing were detected after operation.Results Operation time was (86.3 ±25.3)m in,and intraoperative blood loss was (120.5 ± 33.3)ml.VAS was improved to 0-2 points [(1.6 ± 0.4) points] at postoperative 3 days (P ＜ 0.05).All patients were followed up for 12 to 48 months[(23.7 ±5.9) months].VAS was improved to 0-2 points[(0.6 ± 0.1) points] at postoperative 3 months (P ＜ 0.05).Degree of mobility of the cervical vertebra was improved significantly at postoperative 3 months,with the bending of(38.6 ± 4.5) °,extending of (39.3 ± 4.0) °,left-bending of (39.2 ± 4.0) °,right-bending of (39.2 ± 2.9) °,left-rotation of (66.8 ± 8.8) ° and right-rotation of (66.3 ± 9.2) ° (P ＜ 0.05).Postoperatively,there were no surgical wound incision infections and vertebral artery or spinal injuries,Bone union was found in all patients,without the occurrence of implant loosening or breakage and the dysfunction of the cervical vertebra.Conclusion Minitype titanium plate fixation through transoral approach is associated with less trauma,high healing rate and preservation of the activity of cervical vertebra in the treatment of unstable atlas fractures.

Objective To evaluate the efficacy of pedicle subtraction osteotomy (PSO) plus long-segment pedicle nail bar system in treating kyphosis in ankylosing spondylitis (AS) combined with thoracolumbar fractures.Methods A retrospective case series study was made on the clinical data of 13 patients with kyphosis in AS combined with thoracolumbar fractures admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to May 2016.There were 11 males and two females,aged 32-64 years [(44.3 ± 10.6) years].Two fractures occurred at T11,five at T12,three at L1,and three at L2.According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in one patient,grade C in four,grade D in five and grade E in three.All patients underwent PSO plus long-segment pedicle nail bar system.The operation duration,intraoperative blood loss,fixation segments,and complications were recorded.Thoracolumbar kyphosis angle (TL) and sagittal vertical axis (SVA) were measured to evalute the correction effect.Visual analogue scale (VAS),Oswestry disability index (ODI),ASIA grade were compared before and after operation to assess the efficacy.Results All patients were followed up for 12-18 months [(15.2 ± 1.2) months].The operation time ranged from 120 to 256 minutes [(175.2 ±40.3)minutes].The intraoperative blood loss ranged from 660 to 3 300 ml [(1 011 ±681)ml].Number of fixed seqments was 12-16 (12.2 ±0.8).Anemia occurred in one patient after operation,and the patient recovered after blood transfusion.Incision infection occurred in one patient after operation,which was improved after antibiotic treatment through osmotic culture.Compared with the detection before operation,postoperative TL was improved significantly [(52.6 ± 6.2) ° vs.(17.1 ± 3.1) °],with an average correction rate of 67.5％;final follow-up showed decreased VAS [(7.5 ± 0.7) points vs.(1.9 ± 0.6) points] and decreased ODI [(75.2 ±5.3) points vs.(22.9 ± 4.4) points] (P ＜ 0.05);SVA was improved significantly [(11.5 ± 2.1) cm vs.(3.5 ± 0.9) cm],with an average correction rate of 69.6％ (P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade D in three patients and grade E in ten patients (P ＜0.05).There was no case of epidural hematoma or infection after operation,and no loosening of internal fixator or pseudarthrosis formation occurred during follow-up.Conclusion For kyphosis in AS combined with thoracolumbar fractures,PSO osteotomy plus long segment pedicle nail bar system treatment can significantly reduce lower back pain and promote functional recovery.