Objective To evaluate the clinical efficacy of Hybrid surgery for treatment of multi-level cervical spondylosis.Methods A total of 49 patients (26 males, 23 females) with cervical spondylosis treated with Hybrid surgery between June 2012 and April 2014 were retrospectively reviewed.There were 5 cases with cervical spondylitis radiculopathy (n=5), 10 cases with cervical spondylitis myelopathy (n=10) and 34 cases with mixed cervical spondylitis (n=34).Among the 49 patients, 10 underwent two-segment surgery (n=10) and 39 underwent three-segment surgery (n=39).The mean age of patients was 53.4 years (range from 43 to 62 years).Visual analogue scale (VAS), neck disability index (NDI) and Japanese Orthopedics Association Scores (JOA) were used to evaluate the clinical outcomes.Cervical radiography was used to observe the range of motions (ROM) in C2-C7 segments.Results Mean follow-up time was(42.6±2.2)months (ranging from 24 to 46 months).The mean VAS score for neck pain was significantly decreased from (6.9±1.4) preoperatively to (2.5±0.9) at 3 months postoperatively, and (0.7±0.6)during the last follow-up, respectively(P<0.05).The mean NDI score was significantly reduced from (24.6±8.6) preoperatively to (17.8±6.1) at 3 months postoperatively, and(13.8±4.2) during the last follow-up, respectively(P<0.05).The mean JOA scores increased from (11.9±2.8) preoperatively to(12.6±1.5)at 3 months postoperatively, and (14.8±1.4) during the last follow-up (P<0.05).The ROM of C2-C7 segment reduced from (44.2±8.1)°preoperatively to(34.1±6.8)°at 3 months postoperatively, and(30.4±9.5)°during the last follow-up(P<0.05).Conclusion The clinical outcomes of Hybrid surgery are excellent in the treatment of multilevel cervical spondylosis.The motion of the non-fusion segments is reserved and the decompression is complete.It could be an alternative treatment for multilevel spondylosis.

BACKGROUNDShort-term outcomes of the Wallis system in the treatment of lumbar degenerative disease (LDD) have been shown to be effective, whereas there is a paucity of studies on the mid-long-term effects of the treatment of the Wallis system. This study was to evaluate the mid-long-term effects of the Wallis dynamic stabilization system in the treatment of LDD.

METHODSA total of 26 patients who received the treatment of the Wallis system between February 2008 and January 2009 were included in the study, with 14 patients (Group 1) with L4/5 disc herniation and 12 patients (Group 2) with L5/S1 disc herniation and L4/5 intervertebral disc degeneration (IDD). Visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical outcomes and lumbar X-rays and MRI were obtained to observe imaging changes before and after operation.

RESULTSThe mean follow-up period was (63.50±2.12) months. The mean ODI and VAS scores decreased obviously three months and five years after operation (P < 0.05). In Groups 1 and 2, L4/5 Cobb angle and range of motion (ROM) decreased and L4/5 posterior disc height increased at the last follow-up (P < 0.05). There were no statistically significant changes in L4/5 anterior disc height and L3/4 University of California at Los Angeles grading before and after operation. There was no statistically significant change in Pfirrmann grading system of L4/5 IDD in Group 2 before and after operation. Adjacent segment degeneration at the last follow-up was found in two patients (2/26, 7.69%) and Modic changes in L4/5 endplates were detected in one patient (1/26, 3.85%).

CONCLUSIONSThe mid-long-term effects of the Wallis system in the treatment of LDD were satisfied. The Wallis system, as a dynamic stabilization system, which can preserve some ROM of the fixed segment, sustain the lumbar stabilization, and prevent adjacent segment disease and fixed segment degeneration, is an effective instrument to treat LDD.

Adult ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lumbosacral Region ; surgery ; Male ; Middle Aged ; Spinal Fusion

BACKGROUND:It is controversial whether anterior approach alone, or combined anterior and posterior approaches were used for high level and multiple segments of severe ossification of cervical posterior longitudinal ligament.
OBJECTIVE:To explore the difference of anterior approach versus combined anterior and posterior approaches for the treatment of high level and multiple segments of severe ossification of cervical posterior longitudinal ligament.
METHODS:A total of 21 cases of high level and multiple segments of severe ossification of cervical posterior longitudinal ligament were included in this study. There were 9 males, aged 56-72 years, and 12 females, aged 58-70 years. We used anterior decompression and titanium mesh bone graft fusion in 11 cases which lesion located between C2-5 vertebra, and ossification excision, combined anterior (titanium mesh plate and screw) and posterior (lateral mass screw) approaches in 10 cases which between C3-7 vertebra. Japanese Orthopaedic Association score system was used to evaluate the results. The excellent and good rate and improvement rate were calculated.
RESULTS AND CONCLUSION:The excellent and good rate was 90%and improvement rate was 82%in 10 cases using combined anterior and posterior approaches. The excellent and good rate was 73%and improvement rate was 73%in 11 cases using anterior treatment alone. Significant differences in the excellent and good rate and improvement rate were detected between the two groups (P<0.05). These suggested that combined anterior and posterior approaches for high level and multiple segments of severe ossification of cervical posterior longitudinal ligament is a better operative procedure.

The disc degeneration disease has been main research focus in spinal surgery,but the pathogenesis of disc degeneration is still not clear.Appropriate animal models are important for the study of pathogenesis of disc degeneration.Presently,models of disc degenetation are mainly classified into two categaries:vitro models and vivo models.The animal vitro models include disc cell models and disc tissue models.The vivo models include mechanics models and trauma models.This review tries to give a short introduction about the status and progress of animal model about disc degeneration.

0.05)indicating no significant loss of correction.The length of the growth of instrumented spine was 13.3 mm.No sever complications in the series. Conclusion The PRSS which dispenses without bony fusion is a safe and an effective instrumen for management of juvenile scoliosis.It provides and maintains desirable scoliosis correction in one stage procedure,while allowing spinal growth.

Objective To analyze the correlation between impact positions on the head and hyperextension severities of cervical spinal cord,as well as their treatment.Methods A retrospective analysis was done for 41 cases of hyperextension of cervical spinal cord without fracture-dislocation who had received management in our department from January 1999 to January 2004.All the patients had no cervical disorders before injuries.They were injured by impact mostly on the forehead,cheek or lower mandible.Their neurological findings at admission and 6-month follow-ups were assessed according to ASIA (American Spinal Injury Association) rating system.Results Of the 20 patients who were injured by impact on the forehead,four were rated in neural function as grade B,11 as grade C,and five as grade D at admission,while one as grade C,11 as grade D,and eight as grade E at 6-month follow-up.Of the 12 patients who were injured by impact on the cheek,one was rated in neural function as grade B, four as grade C,and seven as grade D at admission,while one as grade C,two as grade D,and nine as grade E at 6-mouth follow-up.Of the nine patients who were injured by impact on the lower mandible,five were rated in neural function as grade B,three as grade C,and one as grade D at admission,while two as grade B,five as grade C,and two as grade E at 6-month follow-up.The 6-month follow-ups after treatment showed that the neural function was rated below grade C in nine patients,seven of whom had been injured by impact on mandible.Two patients of grade B who showed little improvement after treatment had been injured also by impact on mandible.Conclusion Impact on the lower mandible causes mote severe hyperextension than impact on tbe cheek or forehead.Both rea- sonable non-operative and operative treatments can lead to satisfactory outcome for patients with hyperextension of cervical spinal cord but without fracture-dislocation.

Aim To study the inflammatory mechanism of herniatedcervical intervertebral discs from patients with cervical spondyloticmyelopathy, and the roles of the inflammation in the cervical disc degenera-tion and cervical spondylosis. Methods 35 herniated cervical discs wereobtained fron 31 patients with cervical spondylotic myeloyathy during theanterior cervical surgery. 7 normal, nondegenerated cervical discs(controlgroup) were obtained from three fresh cadavers. All discs were divided intotwo samples, one of which was used as histological examination, and theother was used to detect contents of IL-1α. IL-6 and TNF-α biochemi-cally. Results In 35 herniated cervical discs, 18(51% ) were shownabundant inflammatory cell infiltrates in margin of herniated discs; 17(49%) no inflammatory cell infiltrates; normal discs also no any inflam-matory cell infiltrates. Biochemical assay indicated IL-1 α, IL-6 and TNF-αin cervical spondylotic myelopathy was (10.4 ± 1.9), (7.7 ± 2. 1 ) and(7.5 ± 1.7) pg/g respectively and those in noninflammatory infiltrates groupwas (10.2 ± 1.6), (6.7 ± 2.6) and (7.0 ± 1.8) pg/g respectively and thosein the control group was (2.0±0.9), (1.2±1.0) and (1.3±0.8)pg/g.The contents of cytokine IL-1α, IL-6 and TNF-α were obviously higher thanthat of normal discs( P =0. 000 1, t = 11. 359 1, 7. 951 0, 9. 372 8), andthere were no differences in the contents of cytokines between discs withinflammatory cell infiltrates and discs with no inflammatory cell infiltrates(P＞ 0.05, t=0.6120, 2.6204, 1.7394).Conelusion Herniatedcervical disc from the cervical spondylotic myelopathy was inflammatory, andinflammation may play an important role in cervical disc degeneration and inpathogenesis of cervical spondylosis.

Objective To study the pathologic characteristics and clinical significance of high intensity zone (HIZ) of lumbar intervertebral disc in the patients with discogenic low back pain. Methods 52 patients with low back pain without disc herniation underwent MRI and following discography of lumbar vertebrae. All patients previously were treated conservatively without relief of their symptoms for more than 6 months. Specimens of lumbar intervertebral discs containing HIZ in the posterior annulus from 11 patients with discogenic low back pain during posterior lumbar interbody fusion (PLIF) were collected to investigate the morphologic patterns and clinical significance. Results In all of 142 discs in 52 patients at discography, 17 discs in 17 patients presented HIZ, all showed painful reproduction and abnormal morphology with annular tears extending either well into or through the outer third of the annulus fibrosus. The histologic study of the consecutive sagittal slices in the HIZ lesions revealed that the normal lamellar structure was replaced by disorganized, vascularized granulation tissue that consisted of small round cells, fibroblasts, and newly formed blood vessels around the tears extending from the nucleus pulposus to the outer region of the annulus fibrosus. Blood vessel proliferation and inflammatory cell infiltration were seen extending along the margins of the tears into the middle and inner annulus, and sometimes the tears were bridged with granulation tissue. Ingrowth of vascularized tissue was sometimes observed to end abruptly at the junction between the inner third of the annulus and the nucleus pulposus. There was also matured scarring collagenous tissue. Conclusion The HIZ in the lumbar disc in the patients with symptomatic low back pain can be considered as a reliable marker of painful outer annular disruption.

Objective　To study the relationship between cartilage end-plate calcification and intervertebral disc degeneration. Methods　An experimental model of cervical disc degeneration in rabbits was established by resection of the cervical supraspinous and interspinous ligaments and detachment of the posterior paravertebral muscles from the cervical vertebrae. Mechanical instability in the cervical spine elicited by this surgical intervention accelerated the process of intervertebral disc degeneration. The extent of intervertebral disc degeneration was graded in morphologically, and the thicknesses of the calcified layer and the uncalcified layer of the cartilage end-plate were measured in each degenerated cervical disc. Results　In less severely degenerative cervical discs, the morphology of the cartilage end-plate showed nearly normal construction, and the tidemark was clear. In severely degenerative discs, the matrix and cells showed fibrosis, the tidemark advanced, and the calcified cartilage thickened. There exists a positive correlation between the thickness of the calcified layer of the cartilage end-plate and the degree of cervical disc degeneration. Conclusion　The calcification of the cartilage end-plate is the key factor that initiates and promotes cervical disc degeneration.

OBJECTIVE: The purpose of this experimental stud y was to explore the mechanism of the vertebral osteophyte formation. METHODS: An experimental model of cervical spondylosis in rabbits was established by resection of the cervical supraspinous and interspino us ligaments and detachment of the posterior paravertebral muscles from cerv ical vertebrae. Because of individual difference, the natural development proced ure of the vertebral osteophyte formation could be seen with a microscope by dyn amic observation. RESULTS: The cartilage end-plate was divided into a growth car tilage layer and an articular cartilage layer. Vertebrae and discs from the 3-m onth control group rabbits showed normal structure. The changes of cartilage pla tes from the 3-month experimental group and the 8-month control group animals showed proliferation in peripheral articular cartilage. The osteophytes from the 8-month experimental group animals could be seen. The osteophyte obviously ari sed from proliferation, calcification and ossification of the peripheral articul ar cartilage. CONCLUSIONS: The vertebral osteophyte arises from proliferation of peripheral articular cartilage which undergoes cartilaginous osteophyte, and then changes into bony osteophyte through an endochondral calcification and ossification.