Objective To evaluate the clinical results and the value of usefulness with the operation methods of posterolateral transpedicular approach in treating thoracic disc herniation. Methods Selecting the patient who treated in our hospital from November 1999 to November 2003. In all the 45 patients who suffered from thoracic disc herniation, we had got 43 patients followed up, the following-up times were from 1.2 to 3.5 years. 38 patients were treated with posterolateral unilateral transpedicular approach operation method. There were 26 males and other 19 females. The patients were from 30.5 years old to 67.5 years old, and the mean age was 46.5 years old. The interval between onset of symptoms and operation ranged from 5 to 12 months, and 9 months for average. In this group, 45% patients were involved in T9-10 and T10-11 disc herniation, 4 cases(11%) in T8-9, 4 cases(11%) in T11-12, and 4 cases(11%) in T12L1. All patients underwent X-ray and MR examination. 22 patients underwent myelography, 25 patients underwent CT or CTM examination. Using Otanni scored system to evaluate the clinical results. Selecting the SPSS 11.5 to do the statistics works. Results A perfect result was found in 16 patients, a good result was found in a further 18 patients, and a fair result was found in 2 patients the outcome was unchanged with no effect in 2 cases. No clinical or radiographic features of instability, nervous symptoms and wound infection were found. The clinical satisfaction rate was 89.74%, the results showed that it was a good result of posterolateral entrance operation. Conclusion The posterolateral transpedicular entrance operation shows a good result in treating patients who suffered from thoracic disc herniation.

[Objective]To study the clinical manifestation,early diagnosis and surgical outcomes of traumatic thoracic disc herniation.[Method]Eleven patients of traumatic thoracic disc herniation were selected from June 2000 to June 2005.There were 8 males and 3 females with an average age of 23.96 years old(ranged,15-38 years old).The average time from traumatism to diagnosis were 4.1 months(range,2 days to 8 months).After early clinical diagnosis,discectomy through posterolateral transpedicular approach were carried out for all 11 patients.[Result]All 11 patients were followed up for an average time of 2.6 years(range,1.1～3.8 years).According to Otani's classification criterion,the results were excellent in 7cases,good in 3 cases,fair in I cases,no poor case and failure case.The excellent and good results were obtained in 90.91% of the patients.[Conclusion]The incidence of traumatic thoracic disc herniation is rather low,and this disease has no representative symptom and sign.Early diagnosis and operative treatment is a very effective guarantee to curative effect for traumatic thoracic disc herniation.

[Objective]To evaluate the effectiveness of posterior lumbar interbody fusion(PLIF) in the treatment of upper lumbar disc herniation.[Method]Twenty six patients of upper lumbar disc herniation underwent posterior lumbar interbody fusion,lumbago VAS and the pain in waist and lower extremities grades were tested before operation,all patients had an average follow-up period of 20.8 months,then lumbago VAS and the pain in waist and lower extremities grades were tested at last follow-up,lumbago VAS and the pain in waist and lower extremities grades were compared through paired t-test.[Result]All 26 patients had a followed-up.Postoperative VAS had significant lower than preoperative,statistical analysis has remarkable significance(P

[Objective] To investigate the height change of intervertebral space after anterior cervical fusion and its relation to neck axial symptoms.[Method]Totally 122 patients receiving anterior cervical fusion were followed up for 2 to 5 years,average 3.9 years.The height change of intervertebral space of the fused segment on X-rays were evaluated before,3 months and 2 years after operation.All patients were classified into 3 groups by means of the postoperative height change of intervertebral space.The axial symptoms after operation were observed and analyzed during follow-up.[Result]The incidence of neck axial symptoms was 54.55%,25.84% and 45.45%,respectively.There were significant differences in statistical analysis in group A group B,group B to group C(x2=7.18,P0.0125).[Conclusion]There is significant relation between height change of intervertebral space and neck axial symptoms after anterior cervical fusion.

[Objective]To analyze and compare the results of the posterolateral entrance and posterior laminectomy in treating thoracic disc herniation.[Method]From Nov.1998 to Feb.2006,fifty-one cases were treated with posterolateral entrance combined with the facet disectomy(Group A),and 26 patients were treated with the vertebral disectomy instead of the thoracic disc tissue disectomy.Complications occurring in the follow-up time were investigated and the improving rates were calculated.Otanni Systems was used to evaluate the clinical results.The SPSS 13.0 was used for statistic work.[Result]The operation time was 130～185 min(mean 162 min) for Group A,145～205 min(mean 168 min) for Group B.No difference existed(P=0.062).The blood lost was 400～600 ml(mean 485 ml),while in group B,it was 500～800 ml(mean 646 ml),tbere was significant difference(P=0.013).The clinical satisfaction rate of group A was 86.3%,26 patients returned to perfect results,with 18 in good,6 in fair and 1 in poor results.In group B,the clnical satisfaction rate was 69.2%.There was significant difference between 2 groups(P=0.025).Seven out of the 51 patients had complications in group A.Two patients of neurological dysfunction showed no improvement.One patient was found having spinal cord reactive edema.Internal fixation system was removed in 2 patients because of loosening and paresthesia.Anterior spinal artery syndrome was found in 1 patient.Leakage of CSF was observed in 1 patient.While in the Group B,six patients neurological dysfunction showed no improvement.One patient was found having spinal cord reactive edema.Internal fixation system was removed in 1 patient.Anterior spinal artery syndrome was found in 1 patient.Leakage of CSF was observed in 2 patients.There were obvious difference(P=0.034).[Conclusion]Posterolateral entrance is effective in treating thoracic disc herniation.Comparing with the posterior laminectomy,this operation method is safer,more effective and has less complications.

[Objective]To introduce the composion and mechanism of Iliac Bars Lever Reduction and Fixation System(IBRFS),and to evaluate the clinical efficacy of IBRFS.[Method]IBRFS was made of stainless steel composing of pedicle screw,anglar lift,reduction rod,iliac bar and screw nut A,B,C.Eighteen volunteers offered their contribution for this study.There were 6 males and 12 females with mean age of 53 years(range from 43-66 years).The classification was DS 9,IS 8,trauma 1.The slip segments were L4 6,L5 12.The reductive operation was conducted by IBRFS.Clinical efficiency was evaluated by slip ratio,slip angle,sacral slope and the height of intervertebral space.[Result]Eighteen patients were followed up from 8 to 28 months(average 14.9 months).Preoperative JOA scores ranged from-1 to 22(mean 10.7).Postoperative JOA scores ranged from 13 to 29(mean26.9).The overall recovery rate ranged from 42.9% to 98%(mean 88.3%).There was no neurologic complication.Slip ratio was improved from 20.80% to 5.01%,slip angle from 6.67?to 12? and sacral slope from 32.2? to 43.3?.The height ratio of intervertebral space was increased from 0.78 to 0.97.[Conclusion]The reduction efficiency of IBRFS is reliable.The restoration of height of intervertebral space is improved.IBRFS is an effective internal fixation.

Degeneration of the lumbar facet joints is considered to be one of the main causes of low back pain,which severely impact the life quality of people.This article sums up the research advancement of the lumbar facet joints degeneration of domestic and foreign scholars in recent years,and summarizes the characteristics of the X-ray,CT and MRI and clinical significance of the degeneration of articular process,of which the characteristic of MRI was rarely reported domesticly.The purpose is to provide ideas and references for domestic scholars aiming to further clinical research of related fields in the future.

[Objective]To verify the clinical outcome of cervical arthroplasty in the treatment of spondylotlc myelopathy exclusively.[Method]From January 2004 to August 2003,twelve spondylotic myelopathy patients who underwent cervical arthroplasty were included in this study.Preoperative and final follow-up Nuriek grade,Oswestry neck disability index(ONDI)score,neck and arm pain VAS score of patients were recorded and compared.Surgical outcome was also measured using odom' s criteria.[Result]100% of patients had good or excellent outcomes using Odom' s criteria,while the final follow-up Nurick grade,ONDI score,neck and arm pain VAS score were improved significantly compared with the preoperative valule.[Conclusion]Cervical arthroplasty is effective in the treatment of spinal cord compression secondary to spondylotic disease with interveterbral movement being preserved.

Objective To analyse the relationship between lumbar discectomy outcomes and herniated type and annular integrity. Methods Two hundred and sixty patients who underwent conventional posterior discectomy for lumbar herniated disc were reviewed and followed-up for 6-14 years, with an average of 8.5 years. The criteria of enrolled patients include: all of the cases with low lumbar disc herniation at a single level, laterally protruded disc(one side sciatica) without spinal canal stenosis. Four categories of intraoperative findings were found basing on the defect size of annular and extruded fragments, and postoperative outcomes was compared statistically. Results The patients with larger disc fragments and minimal annular defects had the better outcomes and lowest incidence of recurrence after surgery. On the contrary, small fragments with massive annular defects did worse by comparison. Conclusion The outcomes of lumbar discectomy have close relationship with herniation type and annular integrity. Patients with mild clinical symptoms, small and broad-based disc herniations should be exempted from open discectomy. If open discectomy unavoidable, annular integrity and bony stability should be preserved as much as possible.

Objective To evaluate the distribution of Modic changes of cervical endplate in patients with cervical spondylotic myelopathy and its related factors.Methods All of 426 patients with cervical spondylotic myelopathy were examined by MRI scan and X-ray.According to the criteria of Modic changes,the distribution feature of Modic changes in cervical endplate on age,course of disease,segment and grade of intervertebral disc degeneration were retrospectively analyzed.Results Among 2556 intervertebral discs in 426 cases of patients,54 (12.7 ％) patients and 69 (2.3 ％) intervertebral discs were involved with Modic changes.22 (0.8％) discs in 15 (3.5％) cases were type Ⅰ; 34(1.2％) discs in 31 (7.3％) cases were type Ⅱ ; 13 (0.3％) discs in 8 (1.9％) cases were type Ⅲ.There were 0 (0) lesion in C2-3 disc,5 (0.2％) in C3-4,16 (0.6％) in C4-5,26 (1.0％) in C 19 (0.7％)in C6-7 and 3 (0.1％) in C7T1.Modic changes were distributed mainly over the age of 40 and correlated with disc degeneration,disc level,condition of cervical curve,course of disease and ages,moreover,disc degeneration played the most important role in the occurrence of Modic changes.Conclusion Modic changes of cervical endplate mainly occur in C5-6,and type Ⅱ is the most and type Ⅲ is the least.Modic changes are distributed mainly over the age of 40 and correlated with disc degeneration,disc level condition of cervical curve,course of disease and ages,moreover,disc degeneration plays an important role in the occurrence of Modic changes.