BACKGROUND: How to effectively treat recurrent osteoporotic vertebral compression fractures in the elderly over 65 years has become an issue of attention in the clinic. OBJECTIVE:To evaluate the clinical efficacy of percutaneous vertebroplasty with polymethylmethacrylate bone cement for treating elderly recurrent osteoporotic vertebral compression fractures. METHODS:Twenty-four patients with elderly osteoporotic vertebral compression fractures were divided into polymethylmethacrylate bone cement group (minimaly invasive group) and conservative treatment group on a voluntary basis (n=12 per group). Visual analog scale score for low back pain, Oswesty dysfunction index, ratio of the anterior/posterior margin height of the injured vertebra, Cobb angle and adverse reactions were compared between the two groups before and after treatment. RESULTS AND CONCLUSION:The 12-month folow-up was completed in al the patients. There was one case of bone cement breakage during treatment in the minimaly invasive group and one case of lower limb deep venous thrombosis in the conservative treatment group at 1 month after treatment. Compared with the conservative treatment group, the visual analog scale score, Oswesty dysfunction index, and Cobb angle were significantly lower, but the ratio of the anterior/posterior margin height of the injured vertebra was significantly higher in the minimaly invasive group at 3 days, 1, 3, 6 and 12 months after treatment (P < 0.05). These findings indicate that percutaneous vertebroplasty with polymethylmethacrylate bone cement for elderly recurrent osteoporotic vertebral fractures can strive for short-term pain relief and long-term recovery of the vertebral height and spinal Cobb angle, thereby significantly improving patient’s quality of life.

Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture.Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One,Foshan Hospital of Traditional Chinese Medicine.Of them,87 were treated with transpedicular bone grafting (group A),87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C).The 3 groups were compared in terms of cobb angle,loss of correction,bony fusion,internal fixation failure,and Oswestry disability index (ODI).Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P ＞ 0.05).The cobb angles in the 3 groups at one week after operation (4.9° ± 1.0°,4.8° ± 0.6° and 4.8° ± 0.6°) and at the final follow-up (6.1 o ± 1.5°,14.5° ± 3.7° and 15.3° ± 4.1 °) were significantly smaller than those before operation (27.5° ± 4.9°,27.6° ± 4.6° and 27.6° ± 4.2°) (P ＜ 0.05).The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P ＜0.05).At the final follow-up,both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P ＜ 0.05).The fusion rate in group A (100％) was significantly larger than in group B (80.5％) and C (76.2％).There were no significant differences between the 3 groups in the rate of internal fixation failure (0,1.1％ and 2.4％) (x2 =2.108,P=0.348).The ODI for the 3 groups at 6 months after operation (28.5 ± 4.1,28.7 ± 3.9 and 28.8 ± 3.7) and at the final follow-up (10.7 ± 2.6,11.0 ± 2.7 and 11.4 ± 3.1) were all significantly lower than the preoperative values (94.3 ± 0.7,94.4 ± 0.9 and 94.4 ± 0.8) (P ＜ 0.001).In all the patients,the ODI at the final follow-up was significantly lower than that at 6 months after operation(P ＜ 0.001).Conclusions In the treatment of thoracolumbar burst fractures,all the posterior approach plus transpedicular bone grafting,posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion.Although the latter 2 methods of bone grafting are effective,they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction.

OBJECTIVETo compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification.

METHODSOne hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years (range, 16-68 years). All the patients had X-ray, CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability.

RESULTSFor GATA and SMU classification systems, the inter-observer percentage of agreement averaged (59.9∓4.84)% (κ=0.412∓0.058) and (81.6∓6.06)% (κ=0.753∓0.068), and the intra-observer percentage of agreement was (75.6∓5.27)% (κ=0.624∓0.078) and (89.8∓2.28)% (κ=0.862∓0.037), respectively.

CONCLUSIONThe SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Reproducibility of Results ; Tuberculosis, Spinal ; classification ; diagnosis ; Young Adult

OBJECTIVE: To explore the microsurgical techniques for insular glioma without damaging its surrounding normal structures. METHODS: We retrospectively analyzed 54 patients with insular gliomas who underwent microsurgical operation by trans-syvian fissure approach between May, 2003 and August, 2008 in Xiangya Hospital. We discussed the techniques in the operation and summarized how to protect the key blood vessels, distinguish and protect the surrounding normal structures. RESULTS: There were 36 complete removals,14 secondary complete removals, and 4 partial removals.Six patients had complications after the craniotomy who had temporal speech disorder (aphasia mostly began to recover about 10 days after the craniotomy),4 patients had opposite side paralysis worsening (3 recovered normally and 1 improved after 6 months),4 had light paralysis, and another 3 had paralysis and speech disorder. CONCLUSION The microsurgery by means of trans-syvian fissure approach can well expose the anatomical relation between tumor and its surrounding structures,so that we can remove the tumor and protect the surrounding normal tissues as much as we can.
Adolescent ; Adult ; Brain Neoplasms ; pathology ; surgery ; Cerebral Cortex ; pathology ; surgery ; Female ; Glioma ; pathology ; surgery ; Humans ; Male ; Microsurgery ; methods ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Young Adult

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.