OBJECTIVE: To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis. METHODS: A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI. RESULTS: Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term. CONCLUSIONS The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.
Adolescent ; Bone Transplantation ; Female ; Humans ; Lumbar Vertebrae ; Male ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Spondylolysis ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVES: To expound the injury-disease relationship between spondylolysis and trauma for the points of forensic identification. METHODS: Total 26 cases of spondylolysis were collected and the characteristics of this disease such as age, accompanied symptoms, treatment and injury manner were discussed. RESULTS: The causal relationship existed between trauma and injury consequence in 2 appraised individuals and both of them aged less than 50 years old. The injury manners of both were high-energy injury with combined injury and these 2 patients were treated by operation. CONCLUSIONS The analysis of injury-disease relationship between spondylolysis and trauma should be paid attention in the middle-young age under 50 years old. More importantly, the injury-disease relationship should be analyzed in the patients who chose operative treatment.
Forensic Pathology ; Humans ; Middle Aged ; Spondylolysis/surgery* ; Wounds and Injuries/surgery*

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Failed Back Surgery Syndrome ; Humans ; Lumbar Vertebrae ; Osteoarthritis ; Radiculopathy ; Spinal Fusion ; Spinal Stenosis* ; Spine ; Spondylolysis

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Failed Back Surgery Syndrome ; Humans ; Lumbar Vertebrae ; Osteoarthritis ; Radiculopathy ; Spinal Fusion ; Spinal Stenosis* ; Spine ; Spondylolysis

OBJECTIVETo discuss the indication and clinical effect of direct repair of adolescent lumbar spondylolysis by screw-laminar hook system.

METHODSFrom August 2003 to December 2008, 28 patients (13 males and 15 females,ranging in age from 15 and 26 years, averaged 21.6 years) with lumbar spondylolysis were treated with isthmic bone grafting and internal fixation with a pedicle screw-laminar hook system. Three patients had spondylolysis at L3, L4; 5 patients had spondylolysis at L4, L5; 8 patients had spondylolysis at L4; and 12 patients had spondylolysis at L5. All the patients had low back pain and lasted over 6 months. According to preoperative and postoperative plain radiograph, CT scan and Macnab criteria, the fusion rate and clinical effect of this technique were evaluated.

RESULTSAll the patients were followed up with a mean period of 14.9 months, ranging from 9 to 24 months. All the patients had bony union according to the X-rays and CT scan. According to the calculation results of Macnab criteria, 22 patients got an excellent result, 5 good and 1 fair.

CONCLUSIONThe direct repair of adolescent lumbar spondylolysis with pedicle screw-laminar hook system can shorten length of operation,decrease blood loss, preserve more posterior structures of spine and avoid iatrogenic instability of spine. The postoperative immediate stability of vertebral segment is acquired and the mobility of adjacent intervertebral discs is reserved. The screw-laminar hook system for the treatment of adolescent spondylolisthesis can get satisfactory clinical results.

Adolescent ; Adult ; Bone Screws ; Bone Transplantation ; Female ; Humans ; Internal Fixators ; Lumbar Vertebrae ; physiopathology ; surgery ; Male ; Spondylolysis ; physiopathology ; surgery

Adolescent ; Female ; Humans ; Sacrum ; pathology ; surgery ; Spondylolysis ; diagnosis ; pathology ; surgery

OBJECTIVETo explore clinical application of minimally invasive transforaminal lumbar interbody fusion (TLIF) for the management of lumbar disorders and discuss its indications, surgical techniques and clinical effectiveness.

METHODSFrom Jan 2005 to Dec 2006, 31 selected patients (22 males and 9 females, aged from 41 to 63 years) with degenerative lumbar diseases were treated with minimally invasive TLIF assisted by METRx X-Tube micro-endoscopy system. The index diagnosis was lumbar disc herniation with Lumbar spinal stenosis in 7, lumbar disc herniation with segmental instability in 16, grade 1 to 2 of lumbar spondylolisthesis in 8. The surgical methods was performed with bilateral or unilateral pedicle screws insertion and a single rectangle cage posterolateral placement. The operating time, blood loss, blood transfusion, drainage, visual analogue scale (VAS), preoperative and postoperative JOA scores were observed as well as radiographic evaluation. The results were compared with standard TLIF group respectively.

RESULTSA total of 116 pedicle screws and 31 cages were implanted of which 4 patients were treated with unilateral pedicle screws fixation. Four pedicle screws were found misplaced in CT scans after surgery. The average operating time was 199 min, blood loss 359 ml, volume of transfusion 32 ml drainage 81 ml, and VAS was 2.37 about 72 hours after surgery, which had statistic difference compared with control group. There was no statistic difference on postoperative improvement rate and JOA scores in two groups.

CONCLUSIONSMinimally invasive TLIF minimizes paraspinal muscle trauma and blood loss, shortens the operating and recovery time. A good long-term outcome can be gained compared with standard procedures.

Adult ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Spinal Fusion ; methods ; Spondylolysis ; surgery ; Treatment Outcome

OBJECTIVETo investigate the effects of Xiaoyusan plaster and Daoyin in the treatment of cervical vertebrae disease, to search new methods in the treatment of cervical vertebrae disease.

METHODSFrom May 2007 to April 2008, 63 patients with disease of cervical vertebrae were treated. By odd or even numbers in random digits table, the patients were randomly divided into two groups included treatment group and control group. Thirty-three patients in the treatment group were treated with Xiaoyusan plaster and Daoyin included 21 males and 12 females with an average age of (30.60+/-7.89) years ranging from 20 to 49. Thirty patients in the control group were treated with Votalin Sustained Release Tablets included 16 males and 14 females with an average age of (32.43+/-8.00) years ranging from 20 to 49. The pain, pressing pain, activity of cervical vertebrae were observed before and after treatment in two groups.

RESULTSCompared the scores before and after treatment in treatment group: pain (t=8.953, P<0.001); pressing pain (t=7.867, P<0.001); activity (t=6.918, P<0.001). Compared the scores before and after treatment in control group: pain (t=8.733, P<0.001); pressing pain (t=7.663, P<0.001); activity (=5.066, P<0.001). The symptoms such as pains, pressing pain, movement restriction improved significantly in two groups.

CONCLUSIONXiaoyusan plaster and Daoyin are one of the effective methods in the treatment of disease of cervical vertebrae, especially can improve symptoms and correct dynamic balance of cervical vertebrae.

Adult ; Arthroplasty, Replacement ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Intervertebral Disc Displacement ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pain ; surgery ; Prosthesis Implantation ; Spinal Fusion ; Spondylitis ; drug therapy ; surgery ; Spondylolysis ; drug therapy ; surgery ; Treatment Outcome

OBJECTIVETo compare the clinical outcome of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) with pedicle screw fixation on the treatment of spondylolisthesis.

METHODSOne hundred and twenty patients with spondylolisthesis who were managed in our department were retrospectively evaluated. They were categorized into TLIF group and PLIF group according to the surgical methods, with 60 cases in each group. The slippage rate, the height of intervertebral space and intervertebral foramen were measured in each patient before and after operation and were compared between the two groups correspondingly. The interbody fusion rate, JOA score and complications after operation were also determined.

RESULTSAll the 120 patients were followed up for an average of 23 months (range, 16 to 35 months). Interbody bony fusion was achieved in every case and cage excursion or subsidence occurred in not any case. JOA score was rated as good or excellent in 83.3% of the TLIF cases and in 81.7% of the PLIF cases. There were no difference between the two groups (P > 0.05). Postoperative slippage rate was significantly less than preoperative ones in both groups (P < 0.01). No difference in lost of reduction at the final follow-up was found between TLIF and PLIF groups (P > 0.05). Significant increases in the height of intervertebral space and intervertebral foramen after operation were approved in both groups (P < 0.01), but no difference in these increases was confirmed between the two groups (P > 0.05). The lost of the height of intervertebral space and intervertebral foramen at the final follow-up were also similar between the two groups (P > 0.05).

CONCLUSIONSTLIF and PLIF are good methods for the treatment of spondylolisthesis, both leading to satisfactory clinical outcomes. However, TLIF is relatively safer owing to its unilateral approach for interbody fusion.

Adult ; Aged ; Bone Transplantation ; methods ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; methods ; Spondylolysis ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the surgical procedure of unilateral transforaminal discectomy, bone grafting, cage (Telamon) insertion and Dylanok pedicle screw fixation using X-tube operation system for the treatment of lumbar disc herniation combined with segmental instability and Spondylolysis with pars defect.

METHODSFrom 2004 to 2006, 42 patients including 17 male and 25 female were treated in our department. The age range from 22 to 77 (mean: 51.6). Etiologies including lumbar disc herniation combined with segmental instability and Spondylolysis with pars defect.

RESULTOf these 42 patients, the mean operation time was 240 min (110 - 320 min), the average blood loss was 140 ml (80 - 420 ml), the average incision length was 3 cm (2.8 - 3.2 cm) and the average hospitalization time was 12.5 days (5 - 25 days). Nakai criteria, Excellent in 23 cases (62.2%), good in 11 cases (29.2%) and fair in 3 cases (8.6%). 5 patients had postoperative complication (complication rate: 16.3%).

CONCLUSIONSThe surgical procedure has shown predominant benefits: small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery which makes it a valuable alternative to conventional surgical procedures.

Adult ; Aged ; Bone Screws ; Bone Transplantation ; Decompression, Surgical ; methods ; Diskectomy, Percutaneous ; methods ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged ; Spinal Fusion ; instrumentation ; methods ; Spondylolysis ; complications ; surgery ; Treatment Outcome