BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.
Decompression, Surgical ; Humans ; Postoperative Complications ; *Spinal Fusion/adverse effects/methods ; Spinal Stenosis/physiopathology/surgery

OBJECTIVETo analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery.

METHODSRetrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed.

RESULTSComplications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain.

CONCLUSIONSThe type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.

Adolescent ; Adult ; Decompression, Surgical ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; adverse effects

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

OBJECTIVETo explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion.

METHODSFrom March 2000 to March 2011, 27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an average age of 55.3 years (ranged from 48 to 72 years). JOA scores and image examination were used to evaluate the clinical effects.

RESULTSAll patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments obtained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up, JOA scores were 9.15 +/- 3.46, 13.96 +/- 2.79 and 13.52 +/- 2.91, respectively, and there was significant difference between preoperation and postoperation (P < 0.05). Intervertebral height and physiological curvature improved obviously than preoperation (P < 0.05).

CONCLUSIONIn order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; adverse effects

Anterior lumbar interbody fusion (ALIF) has become a standard technique for interbody fusion since it was reported by O'Brien in 1983. Now it is used to treat many degenerative disease,such as lumbar discogenic pain, lumbar instability, lumbar spondylolisthesis and so on. In recent years, ALIF has developed greatly in clinical application. Minimal incision operation and laparoscopic anterior lumbar interbody fusion has been already performed, which made the operation less invasive. Many internal fixation instruments are used to improve the stability of ALIF. Interbody fusion devices were developed and the fusion rates enhanced greatly. At the same time, the complications of ALIF also has been realized. This paper overviews the current progress in the clinical application of ALIF.
Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Spinal Fusion ; adverse effects ; methods

Bone tumor metastases is relatively common. Approximately 5%-20% of spinal metastatic tumors will finally invade the spinal cord and exacerbate symptoms. The adoption of combined approach in recent years has significantly increased the survival rate. After excision of the tumors, internal fixation instrumentations are needed to stabilize the vertebrae. These procedures must be performed under the condition that the patients can tolerate the operation. Fused vertebra with instrumentation may cause degenerative diseases at the adjacent segments, which has been a problem of concern recently. Results of biomechanical tests indicated that these degenerative changes are related to the increased motion range of the neighboring segments. An old view is "the more rigid the instrumentation is, the better the results are", which has been disproved by clinical evidences. Improper use of internal spine fixation instrument should be avoided. Artificial intervertebral disc replacement can produce favorable short-time effects, however, its long-term effects and complications still requires further observations.
Humans ; Internal Fixators ; Intervertebral Disc ; surgery ; Spinal Fusion ; adverse effects ; methods ; Spinal Neoplasms ; secondary ; surgery ; Spine ; surgery

Atlantoaxial dislocation (AAD) is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases. The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep. With the increase of the number of operations in the upper cervical region, postoperative complications such as failure of internal fixation, non fusion of bone graft and poor prognosis gradually increase.Incomplete primary operation, non fusion of bone graft, infection and congenital malformation are the potential causes. In addition, considering the objective factors such as previous graft, scar formation and anatomical marks changes, revision surgery is further difficult. However, there is currently no standard or single effective revision surgery method. Simple anterior surgery is an ideal choice in theory, but it has high risk and high empirical requirements for the operator;simple posterior surgery has some defects, such as insufficient reduction and decompression;anterior decompression combined with posterior fixation fusion is a more reasonable surgical procedure, but many problems such as posterior structural integrity and multilevel fusion need to be considered.This article reviews the causes and strategies of AAD revision surgery.
Atlanto-Axial Joint/surgery* ; Humans ; Joint Dislocations/surgery* ; Joint Instability/surgery* ; Reoperation/adverse effects* ; Spinal Fusion/methods* ; 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

OBJECTIVETo investigate the effect of potential spinal growth on the posterior-only spinal instrumentation of adolescent idiopathic scoliosis (AIS).

METHODSFrom June 2003 to October 2007, 40 patients received posterior-only spinal instrumentation. Group of open triradiate cartilage (Group A) included 16 female AIS patients with mean age of 11.8, and group of closed triradiate cartilages (Group B) covered 24 female AIS patients with mean age of 13.7. The mean preoperative Cobb angles of Group A and B were 53.3° and 49.6° respectively, and the mean kyphosis in the sagittal plane was 27.7° and 27.8° respectively.

RESULTSThe post-operative Cobb angles were 22.2° (Group A) vs. 20.7° (Group B) (P = 0.34) with correction rate of 58.3% (Group A) vs. 57.7% (Group B) (P = 0.83). The mean Cobb angles at final follow-up were 24.8° (Group A) vs. 21.1° (Group B) (P = 0.05) with the correction loss of 5.3% (Group A) vs. 1.0% (Group B) (P = 0.01). In the sagittal plane, the average post-operative kyphosis was 22.5° (Group A) vs. 23.9° (Group B) (P = 0.49) with correction of 5.2° (Group A) vs. 3.9°(Group B) (P = 0.63). The mean kyphosis at final follow-up was 20.8°(Group A) vs. 24.7°(Group B) (P = 0.04) with the correction loss of -1.7° (Group A) vs. 0.8°(Group B) (P = 0.01). Group A showed obvious correction loss in the coronal plane and decrease of kyphosis in the sagittal plane. Adding on phenomenon was found in 2 cases with Lenke type I with selected fusion in Group A, but not in Group B.

CONCLUSIONSAlthough similar post-operative correction is found in AIS patients with OTRC or CTRC, the loss of correction and "adding on phenomenon" are more likely to happen in patients with OTRC.

Adolescent ; Child ; Female ; Follow-Up Studies ; Humans ; Postoperative Complications ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; adverse effects ; methods ; Treatment Outcome

BACKGROUND: Bioactive glass-ceramics have the ability to directly bind to bones and have been widely used as bone graft substitutes due to their high osteoconductivity and biocompatibility. CaO-SiO2-P2O5-B2O3 glass-ceramics are known to have good osteoconductivity and are used as bone graft extenders. METHODS: This study aimed to evaluate the effects of the resorbing properties of glass-ceramics in bone fusion after producing and analyzing three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with high osteoconductivity that had enhanced resorption by having an increased B2O3 content. The three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with B2O3 contents of 8.0, 9.0, and 9.5 weight % were designated and grouped as P20B80, P10B90, and P5B95, respectively. Glass-ceramic types were tested for fusion rates and bone formation by employing the lumbar 5-6 intertransverse process fusion model in 51 New Zealand male rabbits. Bioactivity was assessed by soaking in simulated body fluid (SBF). RESULTS: In vitro study results showed sufficient hydroxycarbonate apatite layer formation occurred for P20B80 in1 day, for P10B90 in 3 days, and for P5B95 in 5 days after soaking in SBF. For the rabbit lumbar spine posterolateral fusion model, the autograft group recorded a 100% fusion rate with levels significantly higher than those of P20B80 (29.4%), P10B90 (0%), and P5B95 (14.3%), with high resorbing properties. Resorbing property differences among the three glass-ceramic groups were not significant. Histological results showed new bone formation confirming osteoconductivity in all three types of glass-ceramics. Radiomorphometric results also confirmed the resorbing properties of the three glass-ceramic types. CONCLUSIONS: The high resorbing properties and osteoconductivity of porous glass-ceramics can be advantageous as no glass-ceramics remain in the body. However, their relatively fast rate of resorption in the body negatively affects their role as an osteoconductive scaffold as glass-ceramics are resorbed before bony fusion.
Animals ; Bone Resorption ; Bone Substitutes/adverse effects/*therapeutic use ; Ceramics/adverse effects/*therapeutic use ; Electric Conductivity ; Lumbosacral Region/*surgery ; Male ; Rabbits ; Spinal Fusion/*methods