Objective To evaluate the special roles of modified procedure of instrumented posterior lumbar interbody fusion (PLIF) for the treatment of the isthmic lumbar spondylolisthesis. Methods Surgical procedure was modified. The definitive reduction of the spondylolisthesis using pedicle screw instrumentation was followed by primary reduction using intervertebral disc space distraction and interbody fusion with insert cages and local morselized bone after decompressive laminectomy. A prospective, single-cohort, observational study of the clinical outcomes and radiological data, was assessed in a series of 46 patients with isthmic spondylolisthesis who underwent surgery from January 1999 to February 2004. The clinical outcomes were evaluated according to Oswestry disability questionnaire, and the radiographic data included slipping degree, slipping angle and posterior height of intervertebral disc. Thin-section helical computed tomography (CT) scanning was used in 5 cases post-operatively to assess the interbody fusion. Results Post-operatively, the slipping degree reduced, the posterior heights of intervertebral space increased and slipping angle decreased. The radiographic data had no obvious loss in mean follow-up time of 36 months (range, 12-73 months). Thin-section helical CT study clearly demonstrated the radiographic presence or absence of bridging bone, and solid bony fusion could be obtained at least one year after operation. The objective clinical outcomes of the Oswestry disability questionnaire were in average 33.6?6.4 before operation and 17.6?5.5 after operation. Conclusion The modified procedure as described offers advantages for isthmic spondylolisthesis, not only in substantial deformity correction, but also in suitable interbody cages choosen and normal sagital plane alignment restoration.

Objective To investigate the morphological characteristics of the intervertebral foramina and their alterations in the process of disc height loss in low lumbar spine in order to provide basic data for the diagnosis and treatment of foraminal stenosis. Methods Eight fresh cadaveric lumbar spines of L3 to S1 were obtained for study, which were cleaned off their surrounding muscles and kept the ligaments, annulus fibrous and nerve roots attached. The morphological characteristics of foramina of L4,5 and L5S1 and their anatomic relationships with the nerve roots were observed with and without nucleus pulposus in situ under different loading conditions (0, 300, 500 N). The foraminal dimensions including heights, maximal widths and minimal widths were measured, and the disc heights were measured on lateral radiograph under above loading conditions as well. Results Without any loading, the foramina were inverted teardrop shaped, the foramina of L4,5 were similar to that of L5S1. The nerve roots were located in the upper part of the foramina, and passed across the foramina obliquely. With 500 N loading, the shapes of the foramina and the relationships with the nerve roots were found to be changed little. After removal of nucleus pulposus and more loading was applied, the foramina became stenotic gradually and the nerve roots were pushed against the superior pedicle. The foraminal heights, maximal widths and the anterior, posterior disc heights became narrower, and were significantly different from those under no loading condition (P

0.05) were obtained. There were no access site bleeding complications in TRCA group as opposed to 7.2% in TFCA group ( P

We reported a clinical caseof gas gangrene in the lower back and buttocks due to local intramuscular injection. A 43-year-old male was treated by local private clinic for low back pain. He underwent local intramuscular injection in his lower back and buttocks. 5 or 6 hours after the treatment,he felt worsen of low back pain (VAS 5 points)with a fever. After one day of treatment, the lower back pain was even worse(VAS 8 points). And he had soy-sauce urine and a high fever. The results of laboratory examination and clinical manifestation suggested multiple organ failure within a short period of time. Imaging (CT) suggested large area of gas and muscle necrosis in the lower back and buttocks. Considering the progress of the disease, emergency surgery on lumbar back and right buttocks was performed after hospitalization. Rapid bacterial smear reported gram-positive coarse bacteria. Anaerobic culture suggested clostridium perfringens. Aerobic culture result did not show any bacterial growth. According to the clinical manifestation, imaging (CT), intraoperative judgment and postoperative anaerobic culture results, the clinical diagnosis was gas gangrene. Gas gangrene is a special infectious disease in clinic, which can be characterized by low morbidity, difficult early diagnosis,rapid disease progression and high mortality. Sinceintramuscular injection leaded to this disease in our case, the importance of standardized aseptic procedures should be emphasized.

ObjectiveTo compare the clinical results of small surgical incision of bilateral spinous process and traditional open surgical incision in posterior single level lumbar interbody fusion,and assess the application value of the small surgical incision of bilateral spinous process in posterior single level lumbar interbody fusion.MethodsFrom December 2006 to June 2008,70 patients with lower lumbar vertebral diseases underwent single segment posterior lumbar interbody fusion.Patients were randomly divided into small surgical incision of bilateral spinous process group(Hereinafter referred to as small incision group) of 36 cases and 34 cases of conventional open group.Small incision group included 20 males and 16 females with an average age of 52.0 years.Traditional open group included 16 males and 18 females with an average age of 53.2 years.Two groups of operative time,blood loss,postoperative drainage,X-ray projection operation frequency,hospital stay,complication rate,creatine phosphokinase (CPK) level,multifidus cross-sectional area,postoperative low back pain visual analogue scale(VAS),Oswestry disability index(ODI),interbody fusion rate were compared,respectively.ResultsAll of 70 cases were followed up for 12-24 months (average,16).There were no statistically differences in the operation time,the number of X-ray projection,complication rate,and fusion rate between the two groups (P＞0.05),but there were significant differences in blood loss,postoperative drainage,the first day and the third day of postoperative the level of CPK,postoperative multifidus muscle cross-sectional area,postoperative low back pain VAS,hospital stay,and postoperative ODI between the two groups(P＜0.05).ConclusionSmall surgical incision of bilateral spinous process and traditional open surgical posterior lumbar interbody fusion were satisfied with the efficacy,but small surgical incision of bilateral spinous process with less trauma,shorter hospital stay,and rapid postoperative recovery.

ObjectiveTo observe the morphological features of the basivertebral foramen (BF) in thoracolumbar (T12,L1,L2 and L3).MethodsA total of 36 health adults were underwent multi-slice CT thin slice scans and three-dimensional reconstruction.In the horizontal and sagittal CT reconstruction images,BF weight (BFW),BF depth (BFD),BF high (BFH),BF relative to the body weight (BFWr),BF relative to the body depth (BFDr),and BF relative to the body high (BFHr),were measured.The distance between the BF and each side in the horizontal and sagittal CT images were also measured.The correlation between the measured parameters of BF and the gender,age,body mass index(BMI) were analyzed statistically.Results 81％ BF was triangular or trapezoid.There was a bone interval within 6％ BF.In the same level in 36 cases,the maximum of BFW,BFD and BFH were approximately 1/3 vertebral body in the same plane.The average BFW,BFD and BFH were approximately 25％ vertebral body in the same plane.In all four levels,the distance from the BF to the cranial endplate was shorter than to the caudal endplate (P＜O.05).The mean BFW,BFH,BFWr,BFHr in different levels were no significant difference(P＞0.05).The mean BFD and BFDr in L3,however,were greater than other levels.There were no significant correlations among gender and BFW,BFWr,BFD,BFDr,BFH,BFHr.There was a correlation between the age and L1BFHr and L2BFHr,and a correlation between BMI and L1BFH,L2BFW,L3BFH and L3BFHr.ConclusionThere was a BF in all specimens.The most common appearance of BF was triangular or trapezoid.BF was closer to the cranial endplate in all four levels in the sagittal CT images.Variations of BF were significantly different in individuals.

Objective To ev aluate clinical results of selective anterior corpectomy combined with segmental discectomv and fusion for multilevel cervical myelopathv andits related factors.Methods Twenty-five patients of multilevel cervical myelopathv with 3 or 4 consecutive segments were treated with selective anterior corpectomy combinedwith segmental discectomy and fusion.The clinical results were evaluated by the parameters including improvement of Japanese Orthopaedic Association (JOA)score postoperatively,fusion rate,and the degree of spinal canal decompression and range of motion of the cervical spine.Results JOA score were improved from 9.5±1.3 pre-operatively to 13.8±0.8(P＜0.01)6 months post operation and 1 3.6±0.9(P＜0.05)atthe final follow-up.Bony fusion was verified by X-ray and 3D-CT scan 1 2 months post operation and final follow-up.Moreover,the degree of decompression of the spinal canal was also remarkable.The range of motion of the cervical spine after operation decreased significantly(P＜0.05).Conclusion Selective anterior corpectomy combined with segmental discectomy and fusion was an alternative choice for the surgical treatment of multilevel cervical myelopathy.

Objective To study the anatomy of the innervation of hallucis longus muscle,and discuss the clinical value of the innervation.Methods Nineteen limbs of 10 cadavers were studied.There were 4 female cadavers and 6 male cadavers.Nine were left legs and 10 were right legs.The specimens were anatomied to confirm the tibialis anterior,extensor digitorum longus and hallucis longus muscle.The innervation of hallucis longus muscle was been observed along the deep peroneal nerve.Measuring the muscular branches length (nerve length,NL),the distance from the tip of the fibular head to the muscular brance (nerve-fibula head length,NFL),and fibular length (fibula length,FL).The hematoxylin and eosin stain was used to observe the numbers of nerve fascicle for each branch of EHL.Results Twenty-three muscle branches of hallucis longus muscle were found in 19 limbs,15 limbs had a single branch,4 limbs had the double branches.All branches were originated in the deep peroneal nerve.Fourteen branches were into hallucis longus muscle from the fibular side,3 from anterior side,6 from the tibial side.The fibula length was 37.0±1.9 cm (range,34.5-40.6 cm); the nerve-fibula head length was 89.0±5.2 mm (range,75.4-97.2 mm);nerve length was 48.5±5.0 mm (range,33.6-57.4 mm); the nerve-fibula head length/fibula length was 0.245±0.020 (range,0.211-0.280).Among 15 specimens with single branch,3 branches had a unique nerve fascicle and 12 had two fascicles.Among 4 specimens with doulbe branches,only 1 branch had two fascicles,7 branches had a unique fascicle.Conclusion Special anatomical features of muscular branches might be the reason of isolated extensor hallucis longus dysfunction.

Objective To evaluate the distribution of Schmorl's nodes (SN) in patients with low back pain or radiculopathy,and to analyze the correlation between SN and degeneration of lumbar intervertebral discs.Methods In 2012,1024 patients with low back pain or sciatica were examined by magnetic resonance (MR) scan and plain film.There were 448 males and 576 females,with an average age of (54.3 ± 12.7) years (range,22-90).The features distribution of SN in lumbar endplate on age,sex,segment and the type and grade of intervertebral disc degeneration were analyzed retrospectively.Results Among 5120 lumbar intervertebral segments of the 1024 patients,295 (28.8％) cases and 532 (5.2％) endplates were involved with SN,302 located in the cranial and 230 in the caudal endplate.According to percent prevalence per lumbar segment,L1,2 was the most common level (29.1％),followed by L3,4 (23.7％) and L2,3 (21.1％).The incidence of SN was positively correlated with elder age,but not with sex,body weight,height,or body mass index.SN occurred more often in bulging,extrusion,Modic changes,spondylolisthesis and osteophyte comparing with normal disc or protrusion or high intensity zone.The distributions of the grade of intervertebral disc degeneration were significantly different between groups with and without adjacent SN.Intervertebral discs with adjacent SN were more degenerated than those without adjacent SN.The number,size and volume of SN were associated with the degrade of intervertebral discs degeneration.SN was divided into two types,i.e.,acute edematous SN and non-acuteSN,according to the signal type on T1-and T2-weighted MR images,and the degeneration of the corresponding intervertebral discs was more severe in the latter than the former group.Conclusion SN occurred more often in the upper lumbar spine and cranial endplate in patients with low back pain or radiculopathy.SN were correlated with elder age and the degeneration of lumbar intervertebral discs.The number,size,volume and signal type on MR images of SN impacted on its correlation with lumbar intervertebral disc degeneration.

Objective: To optimize the decolorization technology of activated carbon for the plant pigment in Bletilla striata polysaccharide.Methods: Using L 9 (3 4) orthogonal test with activated carbon as the decolorizer, the amount of activated carbon, decolorization temperature, decolorization liquid pH and decolorization time were investigated.The decolorization rate and polysaccharide retention rate were investigated.The decolorization rate and polysaccharide retention rate were taken as the indices.Results: The optimum decolorization technology was as follows: the amount of activated carbon was 1.0%, the decolorization temperature was 40 ℃, the pH value was 5 and the decolorization time was 30 min.Under those conditions, the decolorization rate of Bletilla striata polysaccharide was 91.3% and the retention rate of polysaccharide was 80.6%.Conclusion: The selected decolorization technology of activated carbon can make Bletilla striata polysaccharide get the best decolorizing effect.