Combined Modality Therapy ; Humans ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery ; therapy

Adult ; Aged ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; physiopathology ; Male ; Middle Aged ; Spinal Canal ; pathology ; physiopathology ; Spinal Stenosis ; complications ; diagnosis ; physiopathology ; surgery

BACKGROUNDThere has been some controversy related to the use of the Wallis system, rather than disc fusion in the treatment of patients with degenerative spine disease. Furthermore, there are no reports concerning the application of this dynamic stabilization system in Chinese patients, who have a slightly different lifestyle with Western patients. The aim of this study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases in Chinese patients.

METHODSThe clinical outcomes of 20 patients with lumbar degenerative disease treated by posterior decompression with the Wallis posterior dynamic lumbar stabilization implant were studied. All of the patients completed the visual analogue scale and the Chinese version of the Oswestry Disability Index. The following radiologic parameters were measured in all patients: global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion was then calculated.

RESULTSNineteen patients (95%) were available for follow-up. The mean follow-up period was (27.25 ± 5.16) months (range 16 - 35 months). The visual analogue scale decreased from 8.55 ± 1.21 to 2.20 ± 1.70 (P < 0.001), and the mean score on the Chinese version of the Oswestry Disability Index was improved from 79.58% ± 15.93% to 22.17% ± 17.24% (P < 0.001). No significant changes were seen in the range of motion at the stabilized segments (P = 0.502) and adjacent segments (above, P = 0.453; below, P = 0.062). The good to excellent result was 94.4% at the latest follow-up. No complications related to the use of the Wallis posterior dynamic lumbar stabilization occurred.

CONCLUSIONSIt was found to be both easy and safe to use the Wallis posterior dynamic lumbar stabilization implant in the treatment of degenerative lumbar disease, and the early therapeutic effectiveness is good. The Wallis system provides an alternative method for the treatment of lumbar degenerative disease.

Aged ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; pathology ; physiopathology ; surgery

OBJECTIVETo explore the clinical application and therapeutic effect of open vertebroplasty for thoracolumbar metastatic tumor.

METHODSFrom September 2003 to December 2009, 21 patients with thoracolumbar metastatic tumor underwent the surgical procedure of posterior spinal cord decompression and open vertebroplasty combined with short-segmental pedicle screw fixation during the same intervention. There were 14 males and 7 females, ranging in age from 48 to 73 years with the mean of 59.5 years and ranging in course of disease from 1 to 4 months with an average of 2.5 months. The primary focus of the tumor of 19 cases were established, lung carcinoma was in 8 cases, breast cancer in 4 cases, prostate carcinoma in 4 cases, hepatocarcinoma in 2 cases and thyroid carcinoma in 1 case. The primary focus of 2 cases could not be established. The spinal function according to Frankel grade, grade B was in 4 cases, C in 6, D in 5, E in 6. The lumbar-back pain, height of anterior and posterior vertebral body, Cobb angle and spinal function were recorded before and after operation.

RESULTSThe operation of all patients was successful, there were no severe complications and aggravation of spinal function. The VAS score of lumbar-back pain decreased from 8.78 +/- 0.45 preoperatively to 2.25 +/- 0.36 postoperatively. Among 16 cases combined with pathological fracture, the height of anterior spinal vertebral body increased from (12.7 +/- 2.1) mm preoperatively to (19.5 +/- 3.9) mm postoperatively; the height of posterior spinal vertebral body increased from (14.1 +/- 1.8) mm preoperatively to (20.3 +/- 2.3) mm postoperatively; Cobb angle decreased from (26.0 +/- 8.9) degrees preoperatively to (6.0 +/- 0.9) degrees postoperatively. There was significant difference above items between before and after operation (P < 0.05). The spinal function according to Frankel grade at final follow up, grade C was in 2 cases, D in 4, E in 15. All patients were followed up from 5 to 28 months with an average of 14 months, there was no loosening and breakage of internal fixity, 15 cases died during follow-up period.

CONCLUSIONThe surgical intervention can effectively preserve spinal instability and alleviate the spinal cord symptoms, improve the life quality of patients. It may provide an alternative treatment for patients in poor general health and shorter life expectancy.

Aged ; Female ; Humans ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; physiopathology ; therapy ; Spinal Neoplasms ; pathology ; surgery ; Thoracic Vertebrae ; pathology ; Treatment Outcome ; Vertebroplasty ; methods

Adult ; Cauda Equina ; injuries ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; complications ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Recovery of Function

Adolescent ; Diskectomy ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; therapy ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Male ; Postoperative Period ; Time Factors ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the surgical methods and clinical results of modified transforaminal lumbar interbody fusion and internal fixation for the treatment of upper lumbar disc herniation.

METHODSClinical data of 32 cases of upper lumbar disc herniation in our department from June 2005 to June 2009 were retrospectively analyzed. There were 21 males and 11 females, the age from 24 to 59 years with an average of 38.5 years. All the cases were treated by the use of nucleus pulposus removed, modified transforaminal lumbar interbody fusion (TLIF) and internal fixation with pedicle screw system. All patients were followed up with an average of 9 months (from 3 to 18 months), according to Japanese Orthopedic Association (JOA) scores and visual analogue scores (VAS) to evaluate clinical effects.

RESULTSAll the cases were followed up from 3 to 18 months with an average of 9 months and the fusion rate was 100%. The JOA sores before and after operation were 10.5 +/- 2.1, 26.2 +/- 2.4 respectively, and the improvement rate was 84.9%. The VAS before and after operation was 7.2 +/- 1.3 and 1.4 +/- 1.1 respectively, and the rate of catabatic pain was 80.6%. Lumbar rigidity and unwell had 4 cases, obviously leg pain had 2 cases after operation, but the systems vanished gradually at 1-8 weeks after non-operative treatment.

CONCLUSIONModified transforaminal lumbar interbody fusion has the advantages of simple, safe operation and thoroughly decompression, and it is a therapeutic method for upper lumbar disc herniation.

Adult ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Intervertebral Disc Displacement ; physiopathology ; surgery ; therapy ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Treatment Outcome

Humans ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Postoperative Complications ; etiology ; Soft Tissue Injuries ; etiology ; Spondylolisthesis ; complications ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed

Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Recovery of Function

PURPOSE: The purpose of this study was to evaluate and compare the biomechanical behavior of the lumbar spine after posterior decompression with the spinous process osteotomy (SPiO) technique or the conventional laminectomy (CL) technique using a finite element (FE) model. MATERIALS AND METHODS: Three validated lumbar FE models (L2-5) which represented intact spine and two decompression models using SPiO and CL techniques at the L3-4 segment were developed. In each model, the ranges of motion, the maximal von Mises stress of the annulus fibrosus, and the intradiscal pressures at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) under 7.5 Nm moments were analyzed. Facet contact forces were also compared among three models under the extension and torsion moments. RESULTS: Compared to the intact model, the CL and SPiO models had increased range of motion and annulus stress at both the index segment (L3-4) and the adjacent segments under flexion and torsion. However, the SPiO model demonstrated a reduced range of motion and annulus stress than the CL model. Both CL and SPiO models had an increase of facet contact force at the L3-4 segment under the torsion moment compared to that of the intact model. Under the extension moment, however, three models demonstrated a similar facet contact force even at the L3-4 model. CONCLUSION: Both decompression methods lead to postoperative segmental instability compared to the intact model. However, SPiO technique leads to better segmental stability compared to the CL technique.
Biomechanical Phenomena ; Decompression, Surgical/*methods ; *Finite Element Analysis ; Humans ; Intervertebral Disc/physiopathology/surgery ; Laminectomy/*methods ; Lumbar Vertebrae/pathology/physiopathology/*surgery ; Male ; Middle Aged ; Models, Anatomic ; Osteotomy/*methods ; Range of Motion, Articular ; Stress, Mechanical ; Zygapophyseal Joint/pathology/physiopathology/surgery