OBJECTIVETo explore the effect of clinical application of stand-alone MC+PEEK cage in anterior cervical fusion.

METHODSFrom January 2011 to January 2014,50 patients were treated with the MC+PEEK cage filled with autogenous cancellous illic-bone graft after anterior cervical discectomy. There were 22 patients with cervical spondylosis,26 patients with traumatic cervical disc herniation, 2 patients with cervical instability in these patients. There were 32 males and 18 females, aged from 30 to 79 years old with an average of 53.30 years old. There were 32 patients with single segment, 15 patients with double segments and 3 patients with three segments. Cervical AP and lateral and the flexion-extension X-rays were regularly taken in order to assess the cervical physiological curvature, the graft fusion and internal fixation related complications. Nerve function, clinical effect and bone fusion were respectively evaluated according to Japan Orthopedic Association (JOA), Otani grade and Suk method.

RESULTSAll patients were followed up from 6 to 36 months with an average of 20 months. No correlated surgical complications were found and all patients obtained bony fusion with an average time of 4.30 months. JOA score had significantly improvement after surgery (P < 0.05). The JOA score was 10.60 ± 3.00 before surgery and 16.10 ± 2.20, 16.40 ± 2.35 at one week and six months after surgery respectively. According to Otani grade,40 cases got excellent results, 9 good, 1 fair. No significant dysphagia and internal fixation related complications such as displacement of cages were found during the follow-up period.

CONCLUSIONUsing this cage in anterior cervical fusion can obtain satisfactory clinical effect with less operation injury and reduce the complications. It is a better fusion method in anterior cervical fusion.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; adverse effects ; instrumentation ; methods

PURPOSE: The cervical dynamic rotational plating system may induce bone graft subsidence, so it may cause loss of cervical lordosis. However there were few studies for alignments of cervical spines influencing the clinical results after using dynamic rotational plates. The purpose is to evaluate the effect of graft subsidence on cervical alignments due to the dynamic rotational cervical plates and correlating it with the clinical outcomes of patients undergoing anterior cervical fusion. MATERIALS AND METHODS: Thirty-three patients with disease or fracture underwent anterior cervical decompression and fusion using a dynamic rotational plate. The presence and extent of implant complications, graft subsidence, loss of lordosis were identified and Visual Analog Scale score (VAS score), Japanese Orthopaedic Association score (JOA score), clinical outcomes based on Odom's criteria were recorded. RESULTS: Fusion was achieved without implant complications in all cases. The mean graft subsidence at 6 months after the surgery was 1.46 mm. The lordotic changes in local cervical angles were 5.85degrees which was obtained postoperatively. VAS score for radicular pain was improved by 5.19 and the JOA score was improved by 3. Clinical outcomes based on Odom's criteria showed sixteen excellent, ten good and two satisfactory results. There was no significant relationship between clinical outcomes and changes in the cervical angles. CONCLUSION: Dynamic rotational anterior cervical plating provides comparable clinical outcomes to that of the reports of former static cervical platings. The loss of lordosis is related to the amount of graft settling but it is not related to the clinical outcomes.
Adult ; Aged ; Cervical Vertebrae/*radiography/surgery ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion/*adverse effects/instrumentation ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of third generation spinal instrumentation such as TSRH, CD and ISOLA for the treatment of adult scoliosis.

METHODSThirty-five adult scoliosis patients including adult idiopathic and degenerative scoliosis were all surgically treated with third generation instrumentation such as TSRH, CD and ISOLA from July 1999 to January 2003. Preoperative mean cobb angles of major curves of the frontal plane was 58.1 degrees (42 degrees -95 degrees ). The patients received anterior combined with posterior correction or single posterior procedure. Mean follow-up was 20 months (10 - 48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and distance between C(7) and CVSL were measured. We assessed the subjective efficacy by questionnaire.

RESULTSClinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean lost of correction of the coronal plane in the last follow-up was 4.3 degrees , distance between the midline of C(7) and CVSL was corrected from 2.6 cm to 0.24 cm. Questionnaire in the follow-up showed that 89.3% patients were satisfied with operation results. Two cases occurred pneumatothorax and haematothorax. Three cases still complained about low back pain in 1 year after operation, among which 2 were adjacent degeneration and 1 was pseudarthrosis.

CONCLUSIONImageology assessment and patients self-evaluation shows that the third generation instrumentation could gain good correction and trunk balance in the treatment for adult scoliosis. And patients are more satisfied and have less complications.

Adult ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Treatment Outcome

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.
Aged ; *Bone Screws ; Cohort Studies ; Female ; Humans ; Ilium/surgery ; Lumbar Vertebrae/*abnormalities/*surgery ; Male ; Middle Aged ; Sacrum/surgery ; Spinal Fusion/adverse effects/*instrumentation/methods ; Treatment Outcome

OBJECTIVETo observe the short-term clinical results of the adjacent segment degeneration after the implantation of Coflex system at the interspinous space of adjacent segment to lumbar fusion.

METHODSFifty patients with grade III disc (Thompson MRI classification) of adjacent segment to lumbar fusion were included and divided alternately into two groups according to the order of hospitalization from January to November 2009. Coflex system was implanted at the interspinous space of adjacent segment to lumbar fusion in 25 patients as Coflex group, the other 25 patients did not have any surgical treatment were as control group. The followed up time was 2 years. Visual analogue scale (VAS) score of low back pain, changes of disc height and motion range of adjacent segment to lumbar fusion on X-ray imaging were evaluated by independent sample t-test or paired samples t-test.

RESULTSThere were 22 patients in Coflex group and 21 patients in control group were followed up 2 years post-operation. The difference of VAS score between two groups was no significance (P > 0.05). In Coflex group, the change of postoperative disc height was no significance (P > 0.05), but the motion range was significantly reduced to 47% of the preoperative value (t = 7.99, P < 0.05). In control group, the postoperative disc height decreased slightly, without significant difference to the preoperative value (P > 0.05). Between the two groups, no differences of the disc height and motion range were found before operation, but the differences of the disc height changes (t = 6.7, P < 0.05) and motion rang (t = -14.5, P < 0.05) were significant in 2 years post-operation. No complications such as Coflex system loosen, immigration and spinal process fracture were occurred.

CONCLUSIONSCoflex system can obviously limit the motion range and maintain the disc space height of adjacent segment to lumbar fusion, and prevent its degeneration in some degree.

Adult ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Prospective Studies ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Treatment Outcome

OBJECTIVETo evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery.

METHODSThe clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females, aged from 39 to 74 years old with a mean of 53.8 years. Thirty-three were used end plate rings and thirty-eight were not used (end plate rings group and no end plate ring group, respectively). The Japanese Orthopaedic Association (JOA) score, Odom's scale, imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment, intervertebral height of anterior border (Da) and posterior border (Dp), the mean intervertebral height (Dm).

RESULTSAll patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups, there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas, one year after surgery, the Cobb angle of end plate ring group was (9.4 ± 3.8) degrees, and contral group was (7.5 ± 3.9) degrees, which was significantly lower than that of end plate ring group. Meanwhile, the Dm of end plate ring group was (57.3 ± 2.2) mm, and no end ring group was (55.2 ± 2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%, and was 78.9% in no end plate ring group. There was no significant difference in JOA score before and after surgery between two groups. At 1 year after operation, 90.9% (30/33) got excellent or good results in end plate ring group, 89.5% (33/38) got excellent or good results in contral group.

CONCLUSIONThe use of end plate rings could not completely prevent the subsidence of titanium cage, however, which can decrease the occurrence rate of the subsidence and lessen its degree.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Fixation Devices ; adverse effects ; Spinal Fusion ; instrumentation ; methods ; Spondylosis ; pathology ; surgery ; Titanium

OBJECTIVETo investigate device implanted complications and corresponding therapeutic strategies of Coflex interspinous dynamic stabilization system for lumbar spine intraoperatively and postoperatively.

METHODSFrom September 2008 to August 2010, 133 cases of degenerative disease of lumbar spine including 62 males and 71 females, ranging from 35 to 81 years of age (mean 60.8 years), underwent or planed to be underwent decompression with Coflex interspinous dynamic stabilization system were reviewed retrospectively, and 13 cases including 6 males and 7 females, ranging from 41 to 71 years of age (mean 58.6 years), occurred device implanted complications. The Coflex implanted complications were analyzed, and therapeutic strategies according to different character were carried out, scores of visual analogue scale (VAS), Oswestry disability index(ODI) and effect-related data preoperatively, postoperatively, after conservative treatment and in final follow-up were evaluated with paired-samples t test.

RESULTSThirteen cases of Coflex implanted complications and treatment applied included: 3 cases occurred fracture of spinous processes intraoperatively were treated by pedicle screws instead; 2 cases occurred fracture of spinous processes postoperatively or during follow-up, including 1 case underwent revision with pedicle screws, another 1 case treated with conservative treatment; 4 cases with degenerative coronal spondylolysis in surgical segments, 1 case with sagittal instability preoperatively, and 1 case with device dislodgment in follow-up all suffered aggravated pain and received conservative treatment; 1 case suffered implanted malposition intraoperatively was underwent internal fixation with pedicle screws instead; at length, 1 case with aggravated pain postoperatively and without definite reason received revision with internal fixation of pedicle screws demolishing the Coflex. The follow-up time of 13 cases ranged from 20 to 38 months (mean 27.6 months); and 7 cases implanted Coflex with aggravated pain of lumbar and lower limb, but the position of device can still maintained, were received conservative treatment, and whose score of VAS and ODI in the final follow-up were 1.9 ± 0.7 and 23.2 ± 3.4, and comparing to 6.1 ± 1.1 and 58.1 ± 3.0 preoperatively, evident improvement was got finally (t = 8.2 and 18.2, P < 0.01). Scores of VAS and ODI of 2 cases with Coflex implanted complications underwent revision with pedicle screws were also improved correspondingly.

CONCLUSIONSCoflex interspinous dynamic stabilization system implanted should be avoided to cases who suffered with osteoporosis, too narrow interspinous space and intervertebral coronal spondylolysis or sagittal instability; and choice of device, depth of implantation and intensity of clumping should be appropriate. For patients with symptom but device still in right position, conservative treatment can be carried out; but for patients subjected to malposition of device, failure of implantation intraoperatively or intolerance to device, revisions and salvages should be underwent with internal fixation of pedicle screws.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; adverse effects ; Intervertebral Disc Degeneration ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Treatment Outcome

OBJECTIVE: To analyze the etiology and prevention of complications related to the pedicle screw technique in the treatment of thoracic scoliosis. METHODS: There were 183 thoracic deformity patients 110 idiopathic scoliosis, 32 adult scoliosis, 28 congenital kyphoscoliosis, 8 Marfan syndrome with scoliosis, and 6 others. All patients' Cobb angles were evaluated preoperatively, intraoperatively, and postoperatively by roentgenograms. The deformity correction rate was calculated. All radiographic evaluations were carried out in a double-blind fashion. The complication rate was analyzed perioperatively and postoperatively. RESULTS: The deformity correction rate was 72%, better than others treated with hook-rod system. The perioperation complication rate was 8.4% (pedicle fracture 1.5%, infection 3.8%, pneumothorax and plural effusion 1.6%, transitory neurological damage 0.5%, and over-bleeding shock 1%). The complication rate at follow-up was 3.6% (infection 0.5%, fatigue fracture 1%, loss of deformity correction 1.6%, and transitory neurological damage 0.5%). Compared with those treated with hook-rod system, the perioperation complication rate, loss of deformity correction, permanent damage, and complications related to the internal fixation were all low. CONCLUSION The complication rate of pedicle screw fixation system was low in the treatment of thoracic deformity. When surgeons are thoroughly familiar with the technique and related pathoanatomy, and with the spinal cord function wardship by SEP, complications related to the pedicle screw technique in the treatment of thoracic scoliosis will be well controlled.
Adolescent ; Adult ; Bone Screws ; adverse effects ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Internal Fixators ; adverse effects ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Postoperative Complications ; epidemiology ; prevention & control ; Scoliosis ; surgery ; Spinal Fusion ; instrumentation ; Thoracic Vertebrae ; surgery ; Young Adult

In this study, we compared the paramedian interfascial approach (PIA) and the traditional midline approach (MA) for lumbar fusion to determine which approach resulted in the least amount of postoperative back muscle atrophy. We performed unilateral transforaminal posterior lumbar interbody fusion via MA on the symptomatic side and pedicle screw fixation via PIA on the other side in the same patient. We evaluated the damage to the paraspinal muscle after MA and PIA by measuring the preoperative and postoperative paraspinal muscle volume in 26 patients. The preoperative and postoperative cross-sectional area, thickness, and width of the multifidus muscle were measured by computed tomography. The degree of postoperative paraspinal muscle atrophy was significantly greater on the MA side than on the contralateral PIA side (-20.7% and -4.8%, respectively, p<0.01). In conclusion, the PIA for lumbar fusion yielded successful outcomes for the preservation of paraspinal muscle in these 26 patients. We suggest that the success of PIA is due to less manipulation and retraction of the paraspinal muscle and further studies on this technique may help confirm whether less muscle injury has positive effects on the long-term clinical outcome.
Adult ; Aged ; *Bone Screws ; Female ; Humans ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Muscle, Skeletal/pathology ; Muscular Atrophy/etiology/pathology ; Postoperative Complications/etiology/pathology ; Reproducibility of Results ; Retrospective Studies ; Spinal Fusion/adverse effects/instrumentation/*methods ; Tomography, X-Ray Computed