OBJECTIVE: To review the clinical research progress of spinal epidural lipomatosis (SEL). METHODS: The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. RESULTS: SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. CONCLUSION SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Humans ; Decompression, Surgical/methods* ; Epidural Space/surgery* ; Lipomatosis/surgery* ; Magnetic Resonance Imaging ; Spinal Cord Diseases/surgery*

Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ² test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Intervertebral Disc Displacement/surgery* ; Conservative Treatment ; Quality of Life ; Treatment Outcome ; Spondylosis/surgery* ; Cervical Vertebrae/surgery* ; Spinal Cord Diseases ; Laminoplasty/methods* ; Decompression

Bone Diseases, Metabolic ; Fractures, Compression/surgery* ; Humans ; Osteoporotic Fractures/surgery* ; Spinal Fractures/surgery* ; Treatment Outcome

OBJECTIVE: To explore the clinical efficacy of percutaneous pedicle screw short segment internal fixation with or without the intermediate screw in the treatment of Magerl A3 thoracolumbar fractures with low bone mineral density. METHODS: Patients with Magerl A3 thoracolumbar fracture underwent percutaneous pedicle screw short segment internal fixation from January 2017 to July 2020 were retrospectively analyzed, 93 cases met the diagnosis and inclusion criteria, 9 cases were excluded according to the exclusion criteria, and the remaining 84 cases obtained complete imaging follow-up data. There were 38 males and 46 females, the age ranged from 56 to 73 years old with an average of (64.78±7.12) years old, bone mineral density (BMD) ranged from 0.61 to 0.89 g/cm³ with an average of (0.73±0.14) g/cm³, the follow-up time was 11 to 25 months with an average of (17.58±6.12) months. There were 45 cases in group A with intermediate screw and 39 cases in group B without intermediate screw. The operation time and intraoperative blood loss were recorded, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used for clinical evaluation. The Cobb angle, vertebral wedge angle (VWA) and anterior vertebral body height (AVBH) were measured by X-ray after the operation. The corrected loss of the above parameters was calculated. RESULTS: There were 5 cases of screw loosening in 84 patients (2 cases in group A and 3 cases in group B, P>0.05). There were significant differences in operation time and intraoperative blood loss between two groups(P<0.01). Clinical effects of two groups were good, postoperative VAS and ODI after operation obviously improved, there was no significant difference between two groups during all follow-up periods (3 days, 1 month after operation and the final follow-up) (P>0.05). Three days after the operation, the image evaluations (Cobb angle, VWA and AVBH) were significantly improved (P<0.05), but significant reduction loss was observed in both groups at 1 month after the operation and at the final follow-up (P<0.05). At the final follow-up, the loss of Cobb angle, VWA and AVBH in group A were (5.26±4.18) °, (4.63±3.80) ° and (9.54±8.71)%, respectively;group B was (6.01±4.34) °, (6.55±6.21) ° and (11.67± 9.95)%, respectively;however, there was no significant difference in reduction loss between the two groups(P>0.05). CONCLUSION Although the curative effect of the patients is satisfactory, the stability of the patients can not be improved by increasing the middle injured vertebra screw placement, the two groups of percutaneous short segment internal fixation can not resist the reduction loss of Magerl-A3 thoracolumbar fracture with low bone mineral density. Because the injured vertebra screw increases the operation time and intraoperative blood loss, it is not significant to use the intermediate screw for the elderly Magerl A3 thoracolumbar fractures with low bone mineral density.
Aged ; Blood Loss, Surgical ; Bone Diseases, Metabolic ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; Humans ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fractures/surgery* ; Thoracic Vertebrae/surgery* ; Treatment Outcome

Humans ; Spinal Diseases/surgery* ; Spine/surgery*

OBJECTIVE: To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation. METHODS: From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C RESULTS: All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C CONCLUSION Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.
Cervical Vertebrae/surgery* ; Female ; Humans ; Male ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Fusion ; Spondylosis ; Treatment Outcome

Hand Strength ; Humans ; Lumbar Vertebrae ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Spinal Diseases/surgery* ; Spinal Fusion ; Technology ; Treatment Outcome

OBJECTIVE: To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy. METHODS: The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed. There were 55 males and 34 females, with an average of (52.00±11.36) years old. Among the patients, 34 cases were treated with conventional anterior cervical discectomy with fusion (conventional group), including C RESULTS: Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group ( CONCLUSION Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy. However, microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision, less bleeding and fewer intraoperative complications.
Adult ; Cervical Vertebrae/surgery* ; Diskectomy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases/surgery* ; Spinal Fusion ; Spondylosis/surgery* ; Treatment Outcome

OBJECTIVE: To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM). METHODS: The clinical data of 37 patients with adjacent two segment CSM treated from January 2016 to December 2017 were retrospectively analyzed, including 15 males and 22 females, aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A, =17) and ACCF group (group B, =20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1, 12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy, and the postoperative complications were analyzed. RESULTS: All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml, respectively, while were (115.6±16.8) min, ( 61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups(>0.05);intraoperative blood loss in group B was larger than group A(<0.05). The preoperative and postoperative 1 and 12 months, cervical curvature and Cobb angle of cervical fusion segment in group A were (11.28±1.40)°, (17.56±1.90)°, (16.64±1.80)° and (4.93±4.20) °, (9.44±2.60)°, (9.25±2.80)°, respectively, and in group B were (10.59± 1.20)°, (16.26±2.10)°, (15.76±2.50)° and (4.75±3.90)°, (7.98±2.10)°, (7.79±3.00)°. The cervical curvature and Cobb angle in all cervical fusion segments at 1, 12 months after surgery were obviously improved, and group A recovered more significantly than group B (<0.05). The JOA scores in group A were 9.46±1.70, 11.56±1.40, 14.86±1.20 before operation and 1 and 12 months after operation, and group B were 9.11±1.50, 11.40±1.30, 15.12±1.60, respectively. The postoperative JOA scores of the two groups were significantly improved (<0.05), and there was no statistically significant difference between two groups at the same time (>0.05). At the final follow up, in group A, dysphagia occurred in 2 cases, cage displacement in 1 case, and no titanium plate screw loose was found;and in group B, dysphagia occurred in 4 cases, titanium mesh collapse in 2 cases, titanium plate screw loose in 1 case. CONCLUSION Two types of anterior cervical decompression and fusion for the treatment of two segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly removethe compressive thing at intervertebral level, which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space, which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures, mature technology, and close efficacy.
Adult ; Aged ; Cervical Vertebrae ; surgery ; Diskectomy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases ; surgery ; Spinal Fusion ; Spondylosis ; surgery ; Treatment Outcome

COVID-19/epidemiology* ; Humans ; Singapore/epidemiology* ; Spinal Diseases/surgery* ; Spinal Injuries/surgery* ; Spine/surgery*