The comparison of the contrast medium X-ray of radical capsular with the results of operation of the lumbar spinal disc herniation showed that the diagnosis of the spinal disc herniation by the contrast medium X-ray was suitable with the results of the operation of the lumbar - spinal disc herniation in which the lumbar spinal disc herniation in the vertical of L4, L5, L5S1 and double herniation were 70.7%, 13.3% and 8.8%, respectively. The unsuitable rate of diagnosis between them was 5.7%. There were 11 cases that were the false negative due to press of extradural vein and the flaval ligament inflammatory. The X-ray technique should be implement in 3 positions: vertical, side and inclined 3/4 to prevent the missing of lesion
Lumbar Vertebrae ; radiography ; surgery ; therapeutics

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
Arthritis, Rheumatoid/blood/complications/*pathology/radiography ; Female ; Fractures, Compression/etiology/radiography/surgery ; Humans ; Lumbar Vertebrae/*pathology/radiography ; Middle Aged ; Thoracic Vertebrae/*pathology/radiography ; Vertebroplasty

OBJECTIVE: To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent. METHODS: Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. <0.05 was considered statistically significant. RESULTS: There were no significant differences in slippage distance, slippage rate, slippage angle between two groups. In dysplasia group, SVA, L₅I, PT, SPT were (37.0±48.4) mm, (57.0±14.8)°, (42.3±15.4)°, (56.1±21.2) mm, respectively, and (-11.0±22.2) mm, (31.7±19.3) °, ( 15.5±10.2)°, (31.4±19.1) mm in ischemic group; and the differences between the two groups were significant(<0.05). In ischemic group, SS, LSA, STA were (44.1±12.6)°, (103.9±21.7)°, (92.7±9.9)°, respectively, and (25.9±20.2) °, (75.4±16.4) °, (75.4±9.7) ° in dysplasia group; and the differences between the two groups were significant(<0.05). There was no significant difference in TK, LL between two groups(>0.05). CONCLUSIONS Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.
Adolescent ; Child ; Female ; Humans ; Lumbar Vertebrae ; Male ; Pelvis ; Postural Balance ; Radiography ; Retrospective Studies ; Spine ; Spondylolisthesis ; surgery

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult

OBJECTIVETo explore the operative approach and method of internal fixation for the treatment of type-C thoracolumbar fractures.

METHODST wenty-eight patients (male 20, female 8, ranging in age from 20 to 54 years, with an average of 38.5 years) with type-C thoracolumbar fractures were invovled in the study. Distributed segments involved T11 in 2 patients, T12 in 3 patients, L1 in 11 patients, L2 in 8 patient, L3 in 3 patients and L4 in 1 patient. Twenty-six patients were followed up (range from 12 to 20 months). According to the analysis of X-ray and CT image,height of vertebral body, Cobb angle on sagittal and coronal plane and the percentage of occupancy of vertebral canal were measured. The recovery of nerve, happening of back pain and the failure of internal fixation were observed.

RESULTSThe preoperative averaging height-loss decreased from 37.4% to 6.8% and the deformation of coronal plane was completely rectified. The preoperative averaging Cobb angle on sagittal plane recovered from 22.3 degrees to 5.6 degrees and the preoperative occupancy of vertebral canal averaging recovered from 33.7% to 5.9%. The difference was statistically significant (P < 0.05). Moreover, after 1 year follow-up, the changes of the above-mentioned index was no statistically significant (P > 0.05). Except for 8 patients with complete nerve damage losing the possibility of recovery, the others with incomplete nerve damage obtained 1 to 3 degree's improvement. The ratio of back pain occurrence was 19.2%. There was no failure of internal fixation.

CONCLUSIONThe treatment of thoracolumbar type-C fractures with simple posterior long-segment internal fixation or posterior long-segmental fixation added by anterior autograft fusion is a reliable and effective method. The short-term therapeutic effect is satisfactory and the long-term therapeutic effect is to be further observed.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo explore the feasibility of percutaneous vertebroplasty for the treatment of acute burst thoracolumbar fracture.

METHODSFifty-eight patients (male 38 and female 20, ranging in age from 38 to 70 years, with an average of 56.8 years) with acute burst thoracolumbar fracture were treated by percutaneous vertebroplasty. The injuried vertebrae were T11 in 3 cases, T12 18 cases, L1 29 cases, L2 5 cases and L3 3 cases. All suited cases were classified into 3 types according to injuried vertebral shapes,type I (safe type 26 cases), type II (risk type 21 cases), and type III (marginal type 11 cases).

RESULTSAll the patients were followed up ranging from 1 to 2.5 years (mean 1.6 years). Fifty-three patients could walk in 1 to 3 days after operation. Among 55 patients who obtained complete recovery (CR), 39 patients could do daily works and 16 patients could do houseworks. The CR rate was 95%. Three patients who obtained partial recovery (PR), could live by themselves and felt slight lumbago after movements. The PR rate was 5%.

CONCLUSIONPercutaneous vertebroplasty for the treatment of acute burst thoracolumbar fracture is a feasible and effective method even for particular risks.

Acute Disease ; Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Vertebroplasty ; methods

Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.
Aged ; Arthritis, Rheumatoid/drug therapy ; Fractures, Compression/*radiography ; Glucocorticoids/*adverse effects/therapeutic use ; Humans ; Kyphoplasty ; Lumbar Vertebrae/radiography/surgery ; Male ; Osteoporosis/*chemically induced/radiography/surgery ; Pulmonary Fibrosis/drug therapy ; Thoracic Vertebrae/radiography/surgery ; Vertebroplasty

One hundred and fourteen cases of lumbar herniated nucleus pulposus were studied retrospectively. I reviewed the clinical records and radiographs of patients treated with diskectomy and anterior interbody fusion. I followed the patients from 2 years up to 15 years, for an average of 2.9 years. The results were calculated statistically by Fisher exact test and Chi-square test. Among 114 patients, 69 patients (60.5%) were male and 45 patients (39.5%) were female. The most common age group was in its twenties (28.1%), while the whole study group ranged from 19 to 65 years. The most commonly involved level was L4-5 (73 cases, 60.4%). In clinical results, 83.3% of cases were excellent or good. The rate of solid fusion was 87.8%. The most common type of fusing pattern was type 1. The satisfying clinical result had statistical correlation with the solid union of grafted bone and the fusion state of maintained intervertebral disk height, respectively, by Fisher exact test (p < 0.001). The affecting factors in clinical results were the solid fusion and fusion with the state of maintenance of intervertebral disk height (fusing pattern type I and II). I concluded that anterior diskectomy and interbody fusion is a recommendable method of treatment for lumbar herniated nucleus pulposus.
Adult ; Aged ; Female ; Human ; Intervertebral Disk Displacement/surgery* ; Intervertebral Disk Displacement/radiography ; Lumbar Vertebrae/surgery* ; Lumbar Vertebrae/radiography ; Male ; Middle Age ; Myelography ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion/methods* ; Treatment Outcome

OBJECTIVETo investigate effect of Activ L total lumbar disc replacement on lumbar sagittal alignment.

METHODSThe imaging data of patients with degenerative disc disease received Activ L total lumbar disc replacement at Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University from March 2009 to March 2013 were retrospectively analyzed. The average age was 45.6 years(range, 35-60 years)and the surgery levels were as follows: L3-4 2 cases, L4-5 15 cases, L5/S1 5 cases, L3-4+ L4-5 3 cases, L4-5+ L5/S1 7 cases. All patients were followed up for 15 to 63 months(average, 32 months). Radiographic parameters such as lumbar lordosis angle(LL), segment lordosis angle(SL) and sacral slope angle(SS) were recorded. All the radiographic parameters were compared using one-way ANOVA at different stage. Lumbar lordosis angle of the two-level was compared with the one of one-level by using independent sample t-test before and after the operation. A partial correction test was carried out to determine the corrections between the parameters preoperatively, one month after the operation and at final follow-up.

RESULTSOne month after the operation, the lumbar lordosis angle decreased by an average of 1.8°, but there was no statistically significant(P>0.05). Compared with one month postoperation, the lumbar lordosis angle increased by an average of 6.8°(P<0.05), which also increased a lot compared with preoperation(P<0.05). The value of segment lordosis angle was rising up from preoperation to the final follow-up(P<0.05), so was the value of sacral slope angle, but there was no statistically significant between different stage(P>0.05). The lumbar lordosis angle showed no significant difference between double-level ones and single-level ones at different stage(P<0.05). The lumbar lordosis angle showed positive correlation with the sacral slope(P<0.001), however, the lumbar lordosis angle showed no corrected with the segment angle all the time(P>0.05).

CONCLUSIONSThe total lumbar disc replacement with Activ L prosthesis had contributed to maintain and improve the lumbar alignment in the short and medium term. Double- or single-level total lumbar disc replacement had no significant effect on the value of lumbar lordosis angle. The lumbar lordosis angle showed positive correlation with the sacral slope all the time with no correlation between lumbar lordosis angle and sacral slope.

Diagnostic Imaging ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lordosis ; diagnostic imaging ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; surgery ; Postoperative Period ; Prostheses and Implants ; Radiography ; Retrospective Studies ; Total Disc Replacement