The early treatment principles of spinal cord injury (SCI) included early drug using, early surgery and early rehabilitation.The literatures on how to use drug early and how to control the time for SCI before surgery were reviewed.

Objective To analyze the long term results of thoracolumbar burst fractures treated with short segment pedicle instrumentation. Methods Sixty eight cases of thoracolumbar burst fractures fixed with short segment pedicle instrumentation were followed up for at least 5 years (5-13 years, average 8 years). All of them were checked with radiography pre and post operation and before implant removal. At final follow up assessment, all were examined with radiography, 18 cases were checked with CT scan as well. Results 1) Neurological status improved at least 1 Frankel grade in 90.3% of the patients who had preoperative incomplete paraplegia, while no improvement was obtained in those who had preoperative complete paraplegia. Low back pain was evaluated according to Denis Pain Scale, the results showed P1 41 cases (60.3%), P2 24 cases (35.3%), P3 3 cases (4.4%). 2) The shortest distances between the upper and lower pedicle screws tips shortened for 0-6.5 mm (average 2.5 mm) before removal in contrast to that at post operative immediately. Of the 68 cases, nuts loosened in 1 case, pedicle screws loosened in 1 case, bent in 2 cases and broken in 5 cases. Of the 8 cases whose implants were not removed timely, screw broke in 2 cases, and seepage occurred through incision in 2 cases. 3) At final follow up, the correction of anterior vertebral body height averaged 30.5%, and Cobb angle 5.8?, despite a mean correction loss of Cobb angle 12.1?. Correction loss was most evident at the above disc spaces, then the below disc spaces. Correction loss of vertebral body height averaged 1.9% in the anterior, and 6.0% in the middle part. 4) The collapse of vertebral body was most serious in the middle part. The deformity of "codfish vertebrae" occurred in the superior part of vertebrae body in 21 cases, among them the upper adjacent vertebral body sank into the injured body in 5 cases, 3 of whom engendered kyphoses greater than 25?. Evident intra corporeal gaps were found in 16 of 18 patients who were checked with CT, and the gaps communicated with the above disc space. The fractured body could have a deformity of the "cup" after reduction. 5) Degeneration and narrowing of the disc spaces next to fractured vertebrae were very common, and the above space disappeared in 27 cases, while the lower space disappeared in 14 cases. The upper disc space adjacent to fixation levels degenerated in 1 of 8 cases whose implants were not removed timely. Five patients had Cobb angle greater than 20?, three of them had low back pain, and one had mild symptom of nerve compromise. Low back pain was not correlated with degeneration of discs. Conclusion Short segment pedicle instrumentation provides satisfying stability for thoracolumbar burst fractures. It helps physiologic postural contour restoration and facilitates neural recovery, but is associated with relatively high rates of implant failure and correction loss which is most evident at adjacent discs spaces. Deficiency of bone grafting and delayed implant removal are the most probable causes for correction loss.

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful osteoporotic vertebral compressive fractures. Methods From May 2000 to June 2002, 56 consecutive procedures were performed in 30 patients of painful osteoporotic vertebral compressive fractures with intact posterior vertebral body wall. Each procedure includes bilateral insertion of inflatable balloon, fracture reduction and fulfilled with bone cement. Preoperative and postoperative symptom levels, complications and radiographic findings were recorded and analyzed. Results All 30 patients tolerated the procedure well with immediate relief of their back pain in 48 hours. The mean loss of the anterior and mid vertebral body heights were (13.6?2.3) mm, (9.2?1.4) mm preoperatively and (4.7?1.5) mm, (3.4?1.1) mm postoperatively. The mean kyphosis was improved from 23.4??5.2? to 9.2??4.7?. Cement leakage and cerebrospinal fluid leakage occurred at one level respectively and resulted in no clinical symptoms, no other complication was found. Conclusion As a promising minimally invasive surgery, balloon kyphoplasty can provide early improvement of pain and function as well as spinal alignment in treatment of painful osteoporotic compressive fractures.

Objective To investigate the clinical results of bilateral transpedicular kyphoplasty for the osteoporotic vertebral compression fractures with single balloon. Methods From March 2002 to February 2004, percutaneous bilateral transpedicular kyphoplasty with single balloon was performed in 15 patients, who presented with painful vertebral compression fractures. In the group, there were 6 vertebrae of 6 males and 11 vertebrae of 9 females, and the average age of the patients was 70.5 years with a range of 62 to 82 years. 17 osteoporotic vertebral compression fractures, which involved 8 T12, 7 L1, 1 T8 and 1 T11, were treated. Osteoporosis was identified in all cases by the measurement of lumbar bone mineral density (BMD) and the evaluation of radiographs. The average BMD was 0.603 g/cm2. CT scan showed the posterior vertebral wall intact in all patients, and MRI displayed low signal on T1WI and high signal on T2WI of the vertebral fractures. Results All patients experienced dramatic pain relief after the procedures. The mean pain score (VAS) decreased significantly from 8.3 preoperatively to 2.1 after operation. The mean vertebral body height restoration was 54.2%?34.1% on the anterior border, 60.5%?35.4% in the middle portion, and 40.7%?32.3% on the posterior border respectively. And the sagittal alignment was improved significantly, as the average correction of the Cobb's angle reached 9.5?. No cement leakage was found on X-ray, except one with less cement at the anterior vertebral edge, but no clinical symptom occurred. All the patients were available at the final follow-up, the mean period was 10.5 months (range, 2-48 months). Conclusion Bilateral transpedicular kyphoplasty with single balloon not only can provide effective pain relief and vertebral height restoration, but also can improve the sagittal alignment significantly. Its clinical outcome was satisfactory.

0.05). Conclusion The study of the characteristic of track of percutaneous transpedicular puncture is good for the safe procdure under image guidance. The standard track is safe for transpedicular or parapedicular puncture. The percutaneous transpedicular puncturing sites can be located according to the spinous process.

Objective To investigate therapeutical methods on lumbar disc herniation with posterior edge separation of the vertebral body. Methods Different methods were applied to 31 patients, including 24 males and 7 females whose ages ranged from 18 to 61 years. Except that 2 patients with mild lumbar pain were treated with conservative therapy, the other 29 patients were treated with operation. The operations were made according to the relationship between compressive hernia and vertebral canal. For instance, for cases that the herniated mixtures were lateral, decompression with fenestration or amplified fenestration was applied to the trouble side; for cases that mixtures were central or paracentral, the same treatment was applied to both sides; and posterior lumbar interbody fusion(PLIF) or transforaminal lumbar interbody fusion (TLIF) was applied to those that the mixtures occupied most part of the front canal. Results The follow-up studies were made for all the patients for 1 to 4 years with an average period of 2.6 years. For the two patients treated with conservative therapy, one was fully recovered and the other, who took no effect from former therapy, was finally recruited after decompression with fenestration on the trouble side. Among the patients who were treated with operation, those with lateral herniated mixtures received significant effect, while only 60% of those with central or paracentral mixtures recovered (the unrecovered or even worsened patients after operation finally recruited by PLIF), and for those with mixtures occupying most part of the front canal, satisfactory effect were achieved. Conclusion Operation treatment should be applied to patients as early as possible when conservative therapy has no obvious effect. Different operation methods should be taken according to the relationship between compressive hernia and vertebral canal: 1) Decompression with fenestration or amplified fenestration on the trouble side be applied to those with lateral herniated mixtures; 2) Decompression with fenestration on both sides be applied to those with paracentral mixtures but no lateral crypt narrowness, and PLIF or TLIF to those with central mixtures or lateral crypt narrowness; 3) PLIF or TLIF be applied to those with mixtures occupying most part of the front canal.

Objective To discuss the individual method and its feasibility and security of balloon kyphoplasty for the treatment of osteoporotic vertebral fractures with vertebral body wall incompetence. Methods Thirty-nine vertebral bodies were performed for kyphoplasty in 35 osteoporotic patients with vertebral compression fractures with incompetence of vertebral body wall. During operation, the cement was injected twice to avoid anterior leaking in the patients with anterior wall incompetence, while in the patients with posterior or lateral wall incompetence, the cement was injected with continuously X-ray monitoring by C-arm to prevent lateral or posterior leaking. The symptoms improvement, vertebral height restoration and complications were observed. Results All patients tolerated the procedure well with immediate relief of back pain after kyphoplasty. No symptomatic complications were found in all patients. The vertebral height had a recovery rate of 68.46%, and the mean Cobb angle was improved 8.6?. There was significant difference in Cobb angles between preoperation and postoperation (P

Objective To evaluate the effects of nutritional status on wound healing after hip fracture in the elderly. Methods From July 2002 to December 2004, 127 patients with hip fracture who were older than 65 years were treated surgically in our department. Their preoperative nutritional status was reviewed. There were 69 males and 58 females, with an average age of 72.7 years (from 65 to 99 years). 60 cases had femoral neck fractures, and 67 cases had intertrochanteric fractures. The parameters indicative of nutritional status (serum albumin, serum transferrin and total lymphocyte count levels) at the time of admission were assessed, along with Rainey McDonald nutritional index and age. Suture removal was performed on postoperative day 14. Results Delayed wound healing complicated 31 of the 127 cases. The preoperative serum transferrin levels were significantly lower in patients who subsequently had delayed wound healing. Only preoperative serum transferrin levels( P

Objective To study the method of percutaneous vertebroplasty (PVP) and investigate its clinical efficacy. Methods Tweenty five cases (13 patients with painful osteoporotic vertebral fractures, 8 cases with metastatic neoplasms and 4 cases with hemangionmas) were treated by the injection of polymethyl methacrykate (PMMA) under DSA fluoroscopic guidance. the time of follow up ranged from 1 15 months. Results The procedure was successful in all patients. Among 25 patients, 18 experinced with complete relief of pain, 6 with conspicuous relief, 1 with no significant change. Two patients showed transient symptom of radiculopathy and no clinical complication in others. Conclusions PVP is a safe and feasible treatment for patients with hemangiomas and vertebral fractures caused by malignancies and osteoporosis.

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients (96 vertebrae) with painful multi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years (range 56-91 years). Each pro-cedure included insertion and insertion of balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kypho-sis correction and complications were recorded and analysed. Results All 42 patients tolerated the opera-tion well and were followed up for average 31.4 months (range 12-71 months). The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were (1.8±0.5) cm, (1.6±0.6) cm preoperatively and (2.3±0.6) cm, (2.2±0.7) cm postoperatively. No significant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscahs measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms (intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case), and 1 case of pulmonary embelization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.