BACKGROUND: Posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures, which needs surgery treatment. However, the choice of approach method is an argument. OBJECTIVE: To explore the therapeutic effect of transpedicular decompression and pedicle fixation for the treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity.METHODS: A total of 23 cases with obsolete thoracolumbar fractures combined with kyphosis admitted at the Department of Spinal Surgery, First Affiliated Hospital, University of South China were selected, including 14 males and 9 females, aged 18-60 years, mean aged 36 years; The JOA scores of patients were (11.02±1.24) points prior to operation, with (37.43±3.76)° Cobbangel. All patients were treated by transpedicular decompression and pedicle fixation. The functional recovery of lumbar vertebra,bone healing, as well as the complications was compared before and after operation.RESULTS AND CONCLUSION: All patients were followed-up for 6-28 months with an average of 12.5 months. The lumbar vertebra function and kyphosis deformity was notably improved postoperatively. After treatment, the JOA score and Cobb angle was (14.04±2.12) points and (11.02±3.58)°, which was obviously different than that of preoperative (P<0.05). The surfaces of cut bone were healed at 6 months after operation, without complications of pseudoarticulation formation or correction loss. The results suggested that transpedicular decompression and pedicle fixation can achieve a satisfactory result in deformity correction and neurological decompression, which can precipitate the functional recovery.

ObjectiveTo evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.MethodsFrom January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years(range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody fusion with cage under laparoscopic.ResultsThe operation time was 100 min in average (range,60-140),the blood loss was 120 ml in average(range,50-300).There was no case with severe complications of retrograde ejaculation and injury of great vessels or nerves.Delayed intestinal obstruction was discovered in two intraperitoneal route patients.The average follow-up time was 18.7 months(range,6-35).According to the back pain grading criteria of Chinese Medical Association Orthopedics Society of Spine Group,the results were excellent in 23 patients,good in 11,and fair in 3.The interbody fusion was obtained in 3 months later in 23 cases and 6 months later in 12 cases.Cage subsidence occurred in 2 cases in 6months after operation,in which the height loss of intervertebral space was 1.3 mm and 1.9 mm,but no obvious symptoms of discomfort.No fixation displacement or loosening occurred.ConclusionThe anterior discectomy and interbody fusion by internal fixation with laparoscopic technique is feasible with low complications rate,less trauma and shorter bedtime.Postoperative ileus by abdominal approach is relatively common.The surgeons experience and the anatomy of artery and vein of anterior lumbosacral spine should be considered before the choice of surgical approach.