BACKGROUND: Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release antituberculosis drugs, increase local drug concentration, and repair local bone defects and promote bone fusion. OBJECTIVE: To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions. METHODS: Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected, including 10 males and 18 females, at the age of 36-69 years. Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions. Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach. Operation time, intraoperative blood loss, and hospital stay were recorded. At 3 months postoperatively and at the last follow-up, erythrocyte precipitation, C-reactive protein level and Cobb angle, visual analogue scale score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups. The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group (P < 0.05). (2) The erythrocyte sedimentation rate and C-reactive protein levels at 3 months after surgery and at the last follow-up in both groups were lower than those before surgery (P < 0.05), while those in the experimental group were lower than those in the control group (P < 0.05). (3) Visual analogue scale scores and Oswestry disability index scores of both groups were lower 3 months after surgery and at the last follow-up than those before surgery (P < 0.05), and lumbar Japanese Orthopaedic Association score was higher than that before surgery (P < 0.05). The visual analogue scale score of the experimental group 3 months after operation was lower than that of the control group (P < 0.05). (4) Postoperative Cobb angle was lost in both groups, and there was no significant difference between the two groups (P > 0.05). (5) The results show that compared with the traditional posterior approach and combined anterior and posterior approaches in the treatment of lumbar tuberculosis, posterior lateral foramen endoscopic implantation of artificial bone with streptomycin sulfate combined with posterior percutaneous pedicle screw fixation can also achieve satisfactory clinical effect, and has the advantages of small trauma and rapid recovery.

BACKGROUND:At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is stil common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is stil controversial. OBJECTIVE:To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS: According to the Cochrane Colaboration search strategy, we searched MEDLINE, PubMed, EMBASE, CBMdisc, CNKI, VIP and WanFang Data. Randomized controled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was criticaly assessed. RevMan5.1 software was used for meta-analysis. RESULTS AND CONCLUSION: Six randomized controled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI (-43.79, -36.79)], intraoperative blood loss [WMD=-74.13, 95%CI (-86.13,-62.13)], length of hospital stay [WMD=-1.04, 95%CI (-1.30,-0.79)], final folow-up Visual Analogue Scale score [WMD=0.33, 95% CI (0.24, 0.42)], final folow-up Oswestry dysfunction index [WMD=-1.07, 95%CI(-1.57, -0.56)]; unilateral side was better than bilateral side (P < 0.000 1). There was no significant difference in complication rate [RR=0.54, 95% CI(0.25, 1.17)] and fusion rate [RR=0.53, 95%CI (0.22, 1.28)] (P=0.12 andP=0.16). These results suggested that unilateral and bilateral pedicle screw fixation and single lumbar fusion in the treatment of lumbar degenerative disease has achieved satisfactory results. Unilateral pedicle screw fixation can reduce operation time, intraoperative blood loss and length of stay. Visual Analogue Scale score and Oswestry dysfunction index improved significantly in a short period after treatment.

Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups.The observation group was treated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated by open reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI score were compared.Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group.There were no complications such as incision infection after operation in the two groups.The two groups were statistically significant postoperative pain and leg pain VAS score and ODI score compared with preoperative difference.The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference.Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.