Objective: To investigate the effect of modified transforaminal lumbar interbody fusion (TLIF) on coronal degenerative lumbar scoliosis (DLS) in adults with mild Drum Tower Hospital Classification type B and C coronal imbalance. Methods: From January 2011 to December 2015, 31 patients with mild coronal imbalance underwent long-segment fusion for DLS, 27 females and 4 males, with an average age of 63.1±5.5 years (52-76 years), were retrospectively analyzed. According to the coronal balance classification of Drum Tower degenerative scoliosis, there were 20 patients with type B and 11 patients with type C. The average follow-up time was 38.5±9.3 months. Sagittal parameters includingpelvic tilt (PT), PI-LL (pelvic incidence, PI; lumbar lordosis, LL), sagittal vertical axis (SVA) and coronal parameters includingCobb angle, coronal balance distance (CBD), lumbosacral inclination angle (when L ₅ is the lower fusion vertebra, the angle between L₄ upper endplate and horizontal line was measured; when S₁ or S₂ was the lower fusion vertebra, the angle between L ₅ upper endplate and horizontal line is measured), and clinical scores including Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) (excluding sexual life assessment)were recorded before and during the last follow-up. Complications such as internal fixation displacement, fracture and loss of correction were evaluated at the last follow-up. The main method of surgical correction was the modified TLIF operation on the distal compensatory curve and concave side. After the soft tissue is released, the ipsilateral intervertebral fusion cage was implanted to distract the intervertebral space. SPSS 20.0 was used for statistical analysis. All data were expressed as mean ±standard deviation. Paired t-test was used to evaluate the imaging measurement and clinical scores. Independent sample t-test was used to compare the databetween type B and C. P value less than 0.05 has statistical significance. Results: The mean operating time was 4.4±0.9 h (3.1-6.0 h) and the mean intraoperative bleeding was 777±249 ml (500-1 300 ml). For Sagittal balance, PI-LL was 21.7°±5.3° in 31 patients before operation, and the last follow-up was 7.4°±2.4° (t=16.41, P<0.001); PT was 32.6°±7.6° before operation, and the last follow-up was 24.1°±8.5° (t=15.32, P<0.001); SVA was 52.2±16.2 mm before operation, and the last follow-up was 25.5±13.8 mm (t=10.20, P<0.001). For coronal balance, the lumbosacral tilt angle was 8.8°±3.4°, and the last follow-up was 3.9°±2.1°. The average correction rate was 56.0%. The preoperative scoliosis Cobb angle was 41.5°±9.6°, and the last follow-up was 19.7°±6.7° (t=17.90, P <0.001). The average correction rate was 52.7%. The preoperative CBD was 4.3 ±0.7 mm, and last follow-up was 1.6 ± 0.8 mm (t=33.76, P < 0.001). In terms of clinical scores, the VAS score of 31 patients before operation was 6.5±1.0, and the last follow-up was 2.7±1.0 (t=15.97, P <0.001); the ODI score before operation was 34.8%+5.6%, and the last follow-up was 18.0%±5.4% (t=12.42, P <0.001). There were no significant differences in sagittal parameters, coronal parameters and clinical efficacy scores between group B and group C. Conclusion In adult DLS patients with mild coronal B-type and C-type imbalances, the application of modified TLIF interbody fusion and cage insertion in the distal convex side of lumbar scoliosis can achieve the levelization of lumbosacral region and correct coronal imbalance.

Objective To evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2011 to June 2016,Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty.There were 21 patients finally enrolled in this study,which consisted of 11 male and 10 female aging from 55-69,mean(61.48±4.29).The preoperative patients all had severe symptoms of spinal compression.Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender,age,preoperative and postoperative follow-up.The length,width and thickness of OPLL were measured by CT scan and two-dimensional reconstruction of cervical spine during preoperative and follow-up,and the average progress rate was calculated.The relationship between OPLL size before surgery and OPLL progress rate after surgery was analyzed.Results A total of 21 patients were included in this study,with an average age of 61.48±4.29 years-old.The mean follow-up time was 3.36± 1.92 years.The JOA score of cervical spine was 11.81 ± 1.75 before operationand 14.43± 1.69 at the last follow-up time (t=3.8,P＜0.01).The progression rate of OPLL length,width and thickness was 3.54± 2.89 mm/year,0.49± 0.52 mm/year and 0.34± 0.21 mm/year,respectively.Compared with the width and thickness,the average progress speed of the length was statistically significant (t=3.6,P=0.003;t=3.8,P=0.002).The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1,P=0.559).Linear regression showed that OPLL length progression speed (mm) =0.05×preoperative length + 1.23,R2=0.26 and P=0.02.Theprogression rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness.The progression rates of local,segmental,continuous,and mixed OPLL were 3.02±0.26 mm,2.97±0.65 mm,3.65± 1.14 mm,and 3.82± 1.27 mm per year.Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved during a short-term follow up.CT imaging follow-up showed there was progression of OPLL in length,width and thickness,and the progression rate of length was faster than width and thickness.However,there was no significant difference between the progression of rostral and caudal of OPLL.In addition,short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of segmental and limited OPLL.

Objective:To investigate the influence of interbody cage height during oblique lumbar interbody fusion (OLIF) on lumbar biomechanics with different degrees of degeneration and to provide a reference for cage choice.Methods:The finite element model of normal lower lumbar spine (L 3-S 1) was built and validated, then constructed three different degenerative segments in L 3, 4, and the cages with different height (8, 10,12, 14 mm) were implanted into L 4, 5 disc. All the twelve models were loaded with pure moment of 7.5 N·m to produce flexion, extension, lateral bending and axial rotation motions on lumbar spine, and the effects of cage height on range of motion (ROM), intervertebral pressure in adjacent segments and stress in facet joints were investigated. Results:The ROM of adjacent segments and the maximum stress of intervertebral discs increased with the increase of cage height, but this trend was not obvious in moderate and severe degeneration groups. After implantation of 4 different height cages (8, 10, 12, 14 mm), the ROM of L 3, 4 segment reached the maximum during extension. The ROM of mild degeneration group was 2.68 °, 2.71 °, 2.94 °, 2.98 °, moderate degeneration group was 2.33°, 2.37°, 2.41°, 2.49°, and severe degeneration group was 1.94 °, 1.99 °, 2.14 °, 2.21 °. The stress of L 3, 4 intervertebral disc reached the maximum during right bending. The maximum stress of L 3, 4 intervertebral disc was 23.95 MPa, 24.60 MPa, 24.90 MPa and 25.34 MPa in mild group, 25.57 MPa, 25.60 MPa, 25.82 MPa and 25.89 MPa in moderate group, and 25.95 MPa, 25.99 MPa, 26.48 MPa and 27.13 MPa in severe group. The maximum stress of L 3, 4 facet joint was 15.87 MPa, 15.78 MPa, 16.29 MPa and 16.43 MPa in mild group, 15.97 MPa, 16.31 MPa, 16.53 MPa and 16.79 MPa in moderate group, and 16.17 MPa, 16.49 MPa, 16.95 MPa and 17.35 MPa in severe group. Conclusion:For patients with mild lumbar degeneration requiring OLIF surgery, the intervertebral height of the surgical segment should not be overstretched. But for patients with moderate to severe lumbar degenerative disease who need to undergo OLIF surgery, it is recommended that the cage height be 0-2 mm higher than the original intervertebral space height.

Fusion surgery has been an effective modality for the treatment of spinal disorders for more than 100 years. With the increasing understanding of the disease and the increasing maturity of surgical techniques, lumbar fusion has become more widely performed and its efficacy has been conclusively proven. However, fusion surgery inevitably disrupts the original physiologic motion of the spine and limits segmental motion, resulting in a significant increase in disc and joint protrusion stress in adjacent segments. When a newly identified degenerative change on imaging is present in an adjacent segment or an existing degeneration is more aggravated, this is known as adjacent segment degeneration. When clinical symptoms such as pain and numbness in the lower extremities are present that are consistent with degeneration, this is known as adjacent segment disease. Real world studies (RWS) have become a major focus in medical research in recent years. Since it is closer to clinical practice and more practical for decision-making compared with randomized controlled trail (RCT), it is gaining importance in clinical practice. By searching major national and international databases, this article provides a review of risk factors as well as advances in the treatment of lumbar adjacent segment disease in RWS. According to the retrieved literature, there are many factors that contribute to the development and progression of adjacent segment degeneration and disease, which are mainly divided into patient-related factors and surgery-related factors. In general, patient age, weight, spinal-pelvic sagittal parameters, and internal diseases influence the progression of adjacent segment degeneration. Surgery-related risk factors include the number of segments operated on, the surgical approach, interference with adjacent segments, and whether the spinal-pelvicsagittal imbalance is corrected. To prevent the development of adjacent segment disease, patients can slow the progression of adjacent segment degeneration by reducing their own weight and controlling their internal diseases. The physician can also avoid the influence of surgery-related factors through adequate surgical planning and careful intraoperative management. At the same time, surgeries may be performed in patients who have developed adjacent segmental disease and for whom conservative treatment has failed. The current revision surgical approaches include endoscopic simple decompression and posterior decompression with extended internal fixation.Short-term RWS revealed that the efficacy of endoscopic treatment of adjacent spondylosis might be equivalent to re-fusion internal fixation surgery. Studies with large samples and long-term follow-up are still needed to guide the treatment of adjacent segment disease in the future, in order to improve clinical decision-making.

The technology of three-dimensional(3D)printing emerged in the late 1970s and has since undergone considerable development to find numerous applications in mechanical engineering,industrial design,and biomedicine.In biomedical science,several studies have initially found that 3D printing technology can play an important role in the treatment of diseases in hepatopancreatobiliary surgery.For example,3D printing technology has been applied to create detailed anatomical models of disease organs for preoperative personalized surgical strategies,surgical simulation,intraoperative navigation,medical training,and patient education.Moreover,cancer models have been created using 3D printing technology for the research and selection of chemotherapy drugs.With the aim to clarify the development and application of 3D printing technology in hepatopancreatobiliary surgery,we introduce seven common types of 3D printing technology and review the status of research and application of 3D printing technology in the field of hepatopancreatobiliary surgery.