Oswestry Dysfunction Index Research Articles

Posterior Vertebral Column Resection Combined With Bone Cement Augmentation of Pedicle Screw Fixation for Treatment of Severe Vertebral Compression Fractures With Kyphotic Deformity: A Retrospective Case Series.

This was a retrospective study. Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity. The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed. All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification. The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P<0.05 compared with before surgery). For patients with severe vertebral compression fractures and kyphotic deformity, PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy. Clinical trials are necessary for confirmation.

Short-term Study of Bushen Jiangu Decoction Combined with PVP in the Treatment of Elderly Patients with Osteoporotic Thoracolumbar Vertebral Compression Fracture

To investigate the clinical effects of Bushen Jiangu Decoction combined with percutaneous vertebroplasty (PVP) in the treatment of elderly patients with osteoporotic thoracolumbar vertebral compression fracture (OVCF). Seventy-four elderly patients with OVCF were enrolled in our hospital and randomized by digital table method, 37 cases each. The control group received PVP treatment, and the observation group was treated with Bushen Jiangu Decoction on the basis of PVP treatment. Cobb angle, bone mineral density, Oswestry dysfunction index questionnaire (ODI) score, and visual analogue scale (VAS) were compared before and after treatment. After treatment, the Cobb angle of the observation group was smaller than that of the control group, and the bone density was higher than that of the control group (P&lt;0.05). The ODI score of the observation group was lower than that of the control group after treatment (P&lt;0.05); 1 month and 3 months after treatment, the VAS score of the 6-month observation group was lower than that of the control group (P&lt;0.05). Bushen Jiangu Decoction combined with Western medicine in the treatment of elderly patients with OVCF can restore Cobb angle, increase bone density, reduce postoperative pain and improve thoracic and lumbar spine function.

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Abstract Objective To compare the clinical efficacy between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of Kümmell’s disease in Chinese patients. Methods The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell’s disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM (from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell’s disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis. Results Through comparison, Cobb angle (95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index (ODI) (95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group (95% CI [−1.27, −0.66], P &lt; 0.001]. However, the PVP group had shorter operation time than PKP group (95% CI [−13.48, −7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale (VAS) score (95% CI [−0.04, 0.27), P = 0.15), cement volume (95% CI [−0.82, 0.32], P = 0.39) and cement leakage (95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures. Conclusions At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell’s disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results (e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation

Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach. Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018. There were 20 males and 12 females, aged 20-47 years [(33.7 ± 6.6)years]. All patients had single-segment lesions. The injured segments were at L3/4 in seven patients, L4/5 in 14 patients, L5/S1 in 11 patients. All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach. The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded. At 24 hours, 3 months and 12 months after operation, the efficacy was evaluated by visual analogue score (VAS), Oswestry dysfunction index (ODI) and modified MacNab criteria. Results All patients were followed up for 12-30 months, with an average of 15.5 months. The incision length was 7-9.5 mm [(8.0±0.9)mm], the average operation time was 60-155 minutes [(80.5±13.2) minutes], the average intraoperative blood loss was 5-25 ml [(10.6±5.7)ml] and the average number of fluoroscopy was 5-25 times [(9.4±3.4) times]. The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation. Postoperative dysesthesia was noted in one patient, who recovered after neurotrophy and physiotherapy after one week. There were no complications such as open surgery conversion, intervertebral space infection, nerve root injury and dural sac laceration. The VAS and ODI at 24 hours, 3 months and 12 months after operation [low back pain VAS: (3.4±1.5)point, (1.8±1.1)points, (1.7±0.9)points; leg pain VAS: (1.8±1.0)points, (1.6±0.8)points, (1.4±0.6)points; ODI: (26.8±9.7)%, (13.9±4.3)%, (12.8±2.8)%] were significantly improved compared with those before operation [ back pain VAS: (7.3±2.1)points, leg pain VAS: (7.9±2.7)points; ODI: (56.2±15.6)%] (P<0.05). According to the modified MacNab criteria, the results were excellent in 25 patients, good in five patients, and fair in two patients, with the excellent and good rate of 94%. Conclusion Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision, less complications, effective pain relief and fast functional recovery. Key words: Lumbar vertebrae; Endoscopy; Surgical procedures, minimally invasive

Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing

To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis. The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from -3.4 to -2.1, with an average of -2.3. Lesion segments: T 11 in 2 cases, T 12 in 6 cases, L 1 in 8 cases, L 2 in 1 case, T 11, 12 in 1 case, T 12, L 1 in 2 cases, and T 12, L 2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up. No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up ( P<0.05). There was no significant difference between at 1 week after operation and at last follow-up ( P>0.05). There was no significant difference in LL before and after operation ( F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points ( P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation. Transintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients' quality of life.

Comparison of intervertebral fusion rates of different bone graft materials in extreme lateral interbody fusion.

To compare imaging indicators and clinical effects of extreme lateral interbody fusion (XLIF) using allogenic bone, autologous bone marrow + allogenic bone, and rhBMP-2 + allogenic bone as bone graft materials in the treatment of degenerative lumbar diseases.This was a retrospective study of 93 patients with lumbar interbody fusion who underwent the extreme lateral approach from May 2016 to December 2017. According to the different bone graft materials, patients were divided into allogenic bone groups (group A, 31 cases), rhBMP-2 + allogenic bone (group B, 32 cases), and autologous bone marrow + allogenic bone (group C, 30 cases). There were no significant differences in gender, age, lesion segment, preoperative intervertebral space height, and preoperative Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) scores among the 3 groups (P > .05). Intervertebral space height, bone graft fusion rate, and ODI and VAS scores were compared immediately after surgery, and at 3, 6, and 12 months after surgery.All groups were followed up for 12 months. The intervertebral space height was significantly higher in the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery, in comparison to before surgery (P < .05). There was no significant difference in the intervertebral space height among the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery (P > .05). The fusion rate of group B and C was higher than that of groups A at 3, 6, and 12 months after surgery (P < .05). In the 3 groups, the VAS and ODI scores at 3, 6, and 12 months after surgery were significantly improved compared with the preoperative scores (P < .05). The VAS and ODI scores in groups B and C were significantly higher than those in group A (P < .05), but there was no significant difference between groups B and C (P > .05).The rhBMP-2 + allograft bone combination had good clinical effects and high fusion rate in XLIF.

Clinical study on Duhuo-Xuduan decoction combined with massage in the treatment of lumbar intervertebral disc herniation with yin deficiency of liver and kidney type

Objective To explore the Duhuo-Xuduan decoction combined with massage in the treatment of lumbar intervertebral disc herniation with yin deficiency of liver and kidney type. Methods According to the random number table method, 67 patients were divided into the control group (n=33) and the study group (n=34). The patients in the control group were treated with traditional massage, while the patients in the study group were treated with Duhuo-Xuduan decoction on the basis of the control group. The groups were treated continuously for 4 weeks. After treatment, the total clinical effective rate of the two groups was counted. The Visual analogue scale (VAS) and Oswestry dysfunction index were measured before and after treatment. At the same time, the level of serum Aggrecan, bone morphogenetic protein 7 (BMP-7), P substance (SP), 5-hydroxytryptamine (5-HT), dopamine (DA) were detected respectively before and after treatment. In addition, the adverse reaction of the two groups were observed. Results The total clinical effective rate of the study group was 97.06% (33/34), significantly higher than 81.82% (27/33) of the control group, and the difference was statistically significant (χ2=4.157, P=0.041). After treatment, the VAS score, Oswestry dysfunction index and serum SP, 5-HT, DA of study group was significantly lower than those of the control group (t=13.175, 12.524, 14.481, 15.729, 14.391, all Ps<0.01), while the level of serum Aggrecan, and BMP-7 of study group was significantly higher than that of the control group (t=18.697, 16.222, all Ps<0.01). There were no serious adverse reactions during treatment in both groups. Conclusions The Duhuo-Xuduan decoction combined with massage can alleviate pain, improve dysfunction of the patients with lumbar intervertebral disc herniation with yin deficiency of liver and kidney type. It is speculated that its mechanism may be related to analgesia and promoting cartilage regeneration of injured lumbar intervertebral disc. Key words: Intervertebral disc displacement; Syndrome of yin deficiency of liver and kidney; Tui Na therapy; Duhuo-Xuduan decoction; Integrated Chinese traditional and western medicine therapy

A comparison study of two channels during MIS-TLIF in degenerative lumbar spinal stenosis treatment

Objective To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS). Methods All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups. Results The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P 0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction. Conclusion Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spinal Stenosis; Surgical procedures, minimally invasive; Spinal fusion

Efficacy analysis of two surgical treatments for thoracic and lumbar intraspinal tumours

BackgroundSurgery remains the main curative option for the treatment of intraspinal tumour. The purpose of the present study was to analyze the clinical outcomes of laminoplasty with process-lamina complex replantation compared with laminectomy with pedicle screw fixation for intraspinal tumours.MethodsIn our retrospective analysis, 27 patients received tumour resection surgery by laminoplasty with reconstruction plate fixation and 32 patients received laminectomy with pedicle screw fixation. All patients were followed up for at least 1 year. Data, including surgical time, blood loss, volume of drainage, drainage time, hospital stay, complications, and neurological status were compared. In addition, imaging evaluation was also included.ResultsPatients in the laminoplasty group had lower blood loss (laminoplasty group: 281.5 ± 130.2 mL; laminectomy group: 450.0 ± 224.3 mL; p = 0.001), shorter surgical time (laminoplasty group: 141.7 ± 26.2 min, laminectomy group: 175.3 ± 50.4 min; p = 0.003), lower volume of drainage (laminoplasty group: 1578.9 ± 821.7 mL, laminectomy group: 2621.2 ± 1351.0 mL; p = 0.001), shorter drainage time (laminoplasty group: 6.6 ± 2.5 days, laminectomy group: 9.7 ± 1.8 days; p = 0.000), and a shorter hospital stay (laminoplasty group: 16.9 ± 4.9 days, laminectomy group: 21.0 ± 4.4 days; p = 0.002) compared with patients in the laminectomy group. There were significant differences of oswestry dysfunction index (ODI) between the two groups at 12 months postoperatively (p = 0.034). The incidence of secondary spinal stenosis in the laminoplasty group was significantly reduced (p = 0.029).ConclusionsLaminoplasty in intraspinal tumour resection has a lower blood loss and volume of drainage, shorter surgical time and hospital stay as advantages over the standard laminectomy technique. Moreover, laminoplasty can effectively avoid iatrogenic spinal canal stenosis and thus enhancing functional recovery of spinal cord.

Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis

BackgroundThere was a controversy about bone grafting of spinal tuberculosis treatment. The aim of this study was to compare the clinical efficacy of a new bone grafting method—transverse bone grafting (TBG)—with iliac bone grafting (IBG) and titanium mesh grafting (TMG) in the treatment of single-segment thoracic spinal tuberculosis.Material and methodsTBG was undertaken in 30 patients (group A), IBG was carried out in 28 patients (group B), and TMG was performed in 36 patients (group C). The operative time, intraoperative blood loss, postoperative drainage amount, postoperative complications, length of hospital stay, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score for back pain, Oswestry dysfunction index (ODI), intervertebral height, and time to bone graft fusion were compared. Changes in the Cobb angle of kyphosis, intervertebral height, and loss to the final follow-up were measured. Neurological function recovery was evaluated according to the criteria of the American Spinal Injury Association (ASIA).ResultsThe operative times in group A was significantly shorter than those in groups B and C (PAB = 0.036, PAC = 0.005, PBC = 0.901). The hospital stay in group A was significantly shorter than that in groups B and C (PAB = 0.022, PAC = 0.031, PBC = 0.424). The intraoperative blood loss in group A was significantly less than that in groups B and C (PAB = 0.045, PAC = 0.004, PBC = 0.586). The VAS score, ODI, ESR level, CRP level, Cobb angle of kyphosis, and intervertebral height of the affected segment were significantly improved compared with those before surgery (P < 0.05).ConclusionFor the treatment of single-segment thoracic spinal tuberculosis, the new interbody fusion technique using transverse process bone grafting is a safe, reliable, effective, and ideal bone grafting method.

Unilateral approach painless vertebroplasty for osteoporotic vertebral compression fractures of critically ill patients under lateral decubitus position

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures (OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78.5±13.2)years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II (APACHE II) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3±2.9)months]. The operation time was (69.2±25.9)minutes, and the amount of intraoperative bleeding was (7.5±2.6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation (P>0.05). No surgical discontinuation or deterioration occurred. The APACHE II score was (15.2±3.7)points before operation and (8.4±0.7)points at 24 hours after operation (P 0.05). The Cobb angle was (25.6±9.3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8.5±1.2)points before operation, (2.1±0.3)points at one week after operation, and (3.2±1.1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS (P 0.05). The ODI value was 39.9±3.4 before operation, 20.2±5.2 at one week after operation, and 17.2±2.0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI (P<0.05), showing improvement trend during the follow-up (P<0.05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine. Key words: Spinal fractures; Osteoporotic fractures; Vertebral augmentation

Graded surgery for old thoracolumbar osteoporotic fractures

Objective To investigate the effect of graded surgical treatment according to injury classification on old thoracolumbar vertebral compression fractures (OVCFs). Methods A retrospective case series study was conducted to analyze the clinical data of 238 patients with old thoracolumbar OVCFs admitted to the Honghui Hospital affiliated to the College of Medicine, Xi'an Jiaotong University from February 2013 to November 2016. There were 49 males and 189 females, aged 63-78 years, with an average age of 66.8 years. The bone density T value was (-3.8±0.3)SD. The injured segments were located at T7-T9 in 35 patients, T10-L2 in 171, and L3-L4 in 32. A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association (ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation; 60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary; 44 patients with grade III were treated with posterior decompression and reduction and internal fixation; 30 patients with grade IV received posterior osteotomy and orthopedic fusion; 18 patients with grade V were treated based on the major symptoms. The visual analogue score (VAS), Oswestry dysfunction index (ODI), vertebral sagittal index, and the American Spinal Injury Association (ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. Results All patients were followed up for 12-38 months with an average of 18.5 months. The VAS of patients with grade I to V improved from preoperative (8.0±0.7)points, (8.1±0.7)points, (8.3±0.89)points, (8.1±0.7)points, (8.2±0.2)points to (2.1±0.8)points, (2.0±0.8)points, (2.2±0.8)points, (2.3±0.8)points, (2.2±0.8)points at the last follow-up (P<0.05); ODI was improved from preoperative 69.5±3.0, 70.1±2.0, 70.3±2.1, 69.9±1.9, 70.0±2.2 to 39.8±2.2, 39.1±2.4, 40.1±2.1, 39.0±2.3, 39.5±2.3 at the last follow-up (P<0.05); the vertebral sagittal index improved from (89.7±2.1)%, (74.4±8.3)%, (75.0±6.7)%, (72.3±5.2)%, (71.1±2.1)% to (85.2±7.4)%, (84.2±5.5)%, (85.1±4.4)%, (86.2±3.5)%, (83.4±1.7)% (P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients (seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. Conclusions For obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. Different surgical schemes for patients with different conditions can effectively alleviate the pain, restore spinal stability, correct kyphosis deformity, relieve nerve compression and promote functional recovery. Key words: Osteoporotic fractures; Spinal fractures; Thoracic vertebrae; Lumbar vertebrae

Clinical study of Xuefu-Zhuyu decoction combined with interactive acupuncture and ibuprofen sustained-release capsule in the treatment of acute lumbar sprain

Objective To evaluate the effect of Xuefu-Zhuyu decoction combined with interactive acupuncture and ibuprofen sustained-release capsule in the treatment of acute lumbar sprain. Methods A total of 102 patients with acute lumbar sprain were randomly divided into two groups, 51 in each group.The control group received ibuprofen sustained-release capsules orally. The study group was treated with Xuefu-Zhuyu decoction combined with interactive acupuncture on the basis of the control group. Both groups were treated for 2 weeks. The degree of low back pain was assessed by VAS and the improvement of lumbar function was assessed by modified Japanese Orthopaedic Association Scores (M-JOA). The Oswestry dysfunction index (ODI) was used to evaluate the degree of lumbar dysfunction. The serum hs-CRP, IL-6, IL-10 and prostaglandin E2 (PGE2) level was detected by ELISA. The clinical efficacy was evaluated. Results The total effective rate was 80.4% (41/51) in the study group and 62.8% (32/51) in the control group. There was significant difference between the two groups (χ2=3.903, P=0.048). After treatment, the VAS (1.85 ± 0.40 vs. 4.06 ± 0.67, t=20.226), M-JOA (4.41 ± 1.35 vs. 11.18 ± 2.25, t=18.426), and ODI (9.66 ± 3.34 vs. 16.37 ± 3.64, t=9.700) in the study group were significantly lower than those in the control group (P<0.01). The serum level of hs-CRP, IL-6, IL-10 and PGE2 in the study group were significantly lower than those in the control group after treatment (t were 6.694, 8.416, 22.110 and 12.137, respectively, all Ps<0.01). Conclusions The Xuefu-Zhuyu decoction combined with interactive acupuncture and ibuprofen sustained-release capsule can improve the degree of lumbago and lumbar dysfunction in patients with acute lumbar sprain, reduce the level of serum inflammatory cytokines, and improve the clinical efficacy. Key words: Lumbar sprain; Acute disease; Xue Fu Zhu Yu Tang; Interactive acupuncture

Therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Objective To explore the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods A retrospective analysis of 76 patients with OVCF treated with single and double pedicle approach PVP from April 2016 to June 2017 in the First Affiliated Hospital of He′nan University was conducted.According to the operation method, the patients were divided into unilateral group (42 patients, unilateral pedicle approach), and bilateral group (34 cases, bilateral pedicle approach). The operation time, number of intraoperative X-rays, amount of bone cement injection, height of the vertebral body and the complications were compared between the two groups.The visual analogue scale (VAS) and the Oswestry dysfunction index(ODI) score were used to assess the recovery of the patients. Results The unilateral group had less operative time[(33.01±3.78)min], intraoperative X-ray number[(22.06±3.85) times]and bone cement injection[(3.53±0.42) mL] compared with the bilateral group (t=8.54, 5.98, 4.74, all P 0.05). The postoperative VAS and ODI of the two groups were significantly improved compared with those before operation (all P<0.05). Conclusion In the case of reasonable indications, the unilateral approach PVP is better than bilateral, and unilateral approach PVP should be the first choice for OVCF. Key words: Spinal fractures; Vertebroplasty; Osteoporotic; Fractures, compression; Bone cement; Operative time; Comparative effectiveness research

Percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage III Kümmell's disease without neurological deficit

Objective To investigate the clinical efficacy of percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage III Kummell's disease without neurological deficit. Methods A retrospective case series study was conducted to analyze the clinical data of 36 patients with stage III Kummell's disease without nerve injury admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to January 2017. There were 10 males and 26 females, aged 55-75 years, with an average of 67.5 years. The injuried vertebrae were located at T11 in 9 patients, at T12 in 12, at L1 in 10 and at L2 in 5. The course of disease ranged from 6 to 48 months, with an average of 28.5 months. X-ray, CT and MRI were performed before operation. All patients underwent percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty. The operation time, intraoperative bleeding volume, complications, visual analogue scale (VAS), Oswestry dysfunction index (ODI) and sagittal Cobb angle of the injured vertebrae were recorded before operation, 1 week after operation and at the last follow-up. Results All patients were followed up for an average of 32.5 months (range, 12-48 months). Operation time ranged from 0.6 to 1.5 hours[(1.1±0.4)hours]. The intraoperative blood loss was 50-90 ml [(62.5±17.5)ml]. There was no internal fixation failure or fracture of adjacent vertebra. The VAS was improved from preoperative (8.6±0.4)points to (2.5±0.7)points one week after operation and (2.9±0.7)points at the last follow-up (P<0.05). The ODI was improved from preoperative 68.2±3.9 to 22.7±4.3 one week after operation and 25.3±4.8 at the last follow-up (P<0.05). The Cobb angle was improved from preoperative (24.3±9.3)° to (8.6±3.2)° 1 week after operation and (10.5±4.1)° at the last follow-up (P<0.05). Conclusion For stage III Kummell's disease without neurological deficit, percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty can significantly relieve pain, improve spinal function and maintain spinal stability. Key words: Spinal fractures; Internal fixators; Vertebroplasty; Kummell's disease

Efficacy comparison of multi-segment and single-segment osteotomy for old osteoporotic vertebral compression fracture combined with kyphosis

Objective To investigate the sagittal correction effect and clinical efficacy of multi-segment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis. Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016. There were 10 males and 14 females, aged 58-72 years, with an average of 65.6 years. Thirteen patients were treated with multi-segment SPO (Group A), six of whom underwent two-segment SPO and seven underwent three-segment SPO. Eleven patients were treated with single-segment PSO (Group B). The operation time, intraoperative bleeding volume, the number of cases using cement-reinforced nail track, postoperative drainage, hospitalization time and postoperative complications were compared between the two groups. Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation, after operation and at the last follow-up. Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up. Results All patients were followed up for 6-24 months, with an average of 15.4 months. The operation time of Group A was (198.1±27.3)minutes, while that of Group B was (237.6±36.1)minutes (P 0.05). Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P 0.05). There was no significant difference in SVA, Cobb angle, TK and LL between the two groups at the last follow-up (P>0.05). There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P>0.05). No complications such as spinal cord injury, embolism caused by cement leakage, extraction or rupture of pedicle screw occurred in either group. Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis, multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy. Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage, yet accompanied with disadvantages of overcorrection, screw loosening, longer operation time and more blood loss. Key words: Osteoporotic fractures; Thoracic vertebrae; Lumbar vertebrae; Kyphosis; Osteotomy

Efficacy observation on long snake moxibustion for lumbar disc herniation with cold-dampness syndrome

Abstrct Objectives To observe and compare the clinical efficacy difference among long snake moxibustion, acupuncture and western medication for treating lumbar disc herniation with cold-dampness syndrome, and to provide a preferred treatment for cold-dampness lumbar disc herniation. Methods A total of 90 patients with cold-dampness lumbar disc herniation were randomized into three groups according to the random number table, including the long snake moxibustion group (31 cases), the acupuncture group (28 cases) and the western medication group (31 cases). Treated with long snake moxibustion, patients in the long snake moxibustion group . The acupuncture group was treated with conventional acupuncture therapy, by adopting acupoints of Shenshū (肾俞 BL23), Dachangshū (大肠俞BL25), Yāoyangguān (腰阳关GV3), Wěizhōng (委中 BL40) and local Ashi points. Patients in the western medication group were given oral diclofenac sodium. Visual analogous scale (VAS), Oswestry Dysfunction Index (ODI) score, yang deficiency scale score and clinical efficacy were observed before and after treatment. Results (1) The VAS scores of the patients after treatment in each group decreased compared with those before the treatment. The long snake moxibustion group decreased from 7.22 ± 1.14 to 1.10 ± 0.75 (P Conclusion The long snake moxibustion therapy has a significant clinical effect for lumbar disc herniation with cold-damp syndrome, which is better than those of acupuncture and western medication groups, the therapy can effectively improve the patients’ physical constitution as a preferred solution for cold-damp lumbar disc herniation by acupuncture therapy.

Efficacy analysis of Smith-Petersen osteotomy assisted by releasing disk space from posterior approach for thoracolumbar kyphosis

Objective: To evaluate the efficacy and safety of Smith-Petersen osteotomy (SPO) assisted by releasing disk space from posterior approach for thoracolumbar kyphosis. Methods: A review was conducted on 8 patients (3 males and 5 females) with thoracolumbar kyphosis were treated with SPO assisted by releasing disk space from posterior approach at Department of Orthopaedics, Peking University Third Hospital from June 2016 to September 2017. The age was 56.5 years (range:18-71 years). There were 3 cases of Scheuermanns kyphosis, 2 cases of degenerative kyphosis, 1 case of proximal junctional kyphosis (PJK) after lumbar surgery, and 2 cases of kyphosis after thoracolumbar laminectomy. The paired t test was used for statistical analysis in thoracolumbar kyphosis angle, osteotomy segment kyphosis angle, sagittal vertical value (SVA), visual analogue score (VAS), Oswestry dysfunction index (ODI) before and after surgery. Statistical difference was confirmed with P<0.05. Results: Osteotomy level included 2 cases in T(11-12), 3 cases in T(12)-L(1), 3 cases in L(1-2.) The average operation time was 339 min (range: 247-416 min), bleeding volume was 1 275 ml (range: 500-2 500 ml). The mean follow-up time was 16.5 months (range: 12-24 months). The average thoracolumbar kyphosis angle was 59.9° (range: 40°-73°) pre-operation, 9.5°(range:-5.1°-20°) post-operation and 13.5°(range:-1.3°-28°) at the latest follow-up. It made an average correction with 46.4°and corrective rate with 78.0%. The osteotomy segment kyphosis angle was 37.9° (range: 26°-46°) pre-operation, -1.3° (range:-11°-13°) post-operation making an 39.2° open-up angle, and 2.0° (range:-13.5°-13°) at the latest follow-up. Lumbar lordosis was 47.5° (range: 2°-76°) pre-operation, 41.2°(range:15°-62°) post-operation and 36.9°(range:15°-58°) at the latest follow-up. SVA was 54 mm(range:-34 mm-149 mm) pre-operation and 39 mm(range:-3 mm-119 mm) at the latest follow-up. VAS score of low back pain was 6.3(range:0-9) pre-operation and 3.0(range:0-6) at the latest follow-up. ODI score was 21.9(range: 0-42) pre-operation and 11.0(range: 0-26) at latest follow-up. Comparing to pre-operation value, there were statistical difference in the thoracolumbar kyphosis angle(t= 8.547, P=0.000), osteotomy segment kyphosis angle(t=9.739, P=0.000), VAS(t=3.077, P=0.018), ODI(t=5.800, P=0.001) at the latest follow-up. There was no neuropathic complication in all patients. Cerebrospinal fluid leakage occurred in 2 cases with spinal surgery history, and recovered after symptomatic treatment. Conclusions: SPO assisted by releasing disk space from posterior approach could safely achieve effective correction of rigid thoracolumbar kyphosis deformity within 40°.

Clinical efficacy of anterior artificial vertebral body reconstruction and internal fixation after failed posterior thoracolumbar fracture surgery

Objective To investigate the effect of anterior artificial vertebral body reconstruction and internal fixation after the failed posterior thoracolumbar fracture surgery. Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients whose posterior thoracolumbar fracture surgery failed admitted to Sir Run Run Shaw Hospital School of Medicine affiliated to Zhejiang University from January 2014 to June 2017. There were eight males and six females, aged 29-69 years [(43.6±11.9)years]. The involved segments included T11 in one patient, T12 in two patients, L1 in five patients, L2 in four patients and L3 in two patients. According to AO classification, there were four patients with type A2 , six with type A3, two with type B1 and two with type B2. The thoracolumbar injury severity scores (TLICS) ranged from 4 to 8 points [(5.3±1.1)points]. There were six patients with nonunion, three with nonunion following screw loosening, three with nonunion following breakage, and two with neurological dysfunction. Revision plan: for patients with internal fixation loosening or rupture or long nail placement, the posterior internal fixation would be removed first, and then the stage I anterior revision would be performed after changing the position; for patients with complete internal fixation, only anterior revision would be performed. The operation time, intraoperative blood loss, intraoperative and postoperative complications, pain visual analogue score (VAS), Oswestry dysfunction index (ODI) score and kyphosis angle changes before and after operation were recorded. Results All patients were followed up for 12-54 months [(25.9±13.0)months]. The anterior operation time ranged from 100 to 180 minutes [(137.9±23.6)minutes]. The intraoperative blood loss ranged from 280 to 750 ml [(452.9±145.4)ml]. There were no intraoperative or postoperative complications such as spinal nerve injury, cerebrospinal fluid leakage, vascular injury, abdominal organ injury, incision infection and hemorrhage. VAS decreased from preoperative (6.1±0.9)points to (1.9±0.7)points 3 months after operation and to (1.4±0.5)points at the last follow-up; ODI increased from preoperative (30.4±7.1)points to (7.9±6.4)points 3 months after operation and to (8.1±4.3)points at the last follow-up; kyphosis degree decreased from preoperative (-20.1±6.5)° to (5.6±6.4)° 3 months after operation and to (5.4±6.8)° at the last follow-up. The VAS, ODI score and kyphosis degree were significantly improved at the last follow-up compared with those before operation (P<0.01). Conclusions For patients with failed thoracolumbar fracture posterior surgery, anterior artificial vertebral body reconstruction and internal fixation can significantly relieve back pain, improve function and kyphosis deformity, with satisfactory clinical effect, which can be an ideal treatment option for the revision of thoracolumbar fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Revision

Therapeutic effect of massage and electro-acupuncture combined with Yaobi-Zhuyu-Zhitong decoction on lumbar intervertebral disc herniation with qi stagnation and blood stasis type

Objective To explore the efficacy of electroacupuncture and massage combined with Yaobi-Zhuyu-Zhitong decoction in the treatment of lumbar disc herniation (LDH). Methods A total of 100 LDH patients with qi stagnation and blood stasis type who met the inclusion criteria were randomly divided into two groups, 50 in each group. The control group was treated with Yaobi-Zhuyu-Zhitong decoction, and the observation group was treated with electroacupuncture and massage on the basis of the control group. Both groups were treated for 4 weeks. The VAS scale was used to evaluate the degree of pain. The Japanese Orthopedic Association Scores (JOA) was used to evaluate the efficacy of low back pain. The Oswestry dysfunction index was used to evaluate the recovery of lumbar function, and the improvement of daily activities of patients after treatment was evaluated. Results After treatment, the VAS score of the observation group was significantly lower than that of the control group, and the JOA score was significantly higher than that of the control group (t value were 9.870, 8.214, P<0.01). The excellent and good rates of Oswestry dysfunction index before and after treatment in the observation group were 34.0% (17/50) and 86.0% (43/50), respectively, and the control group was 24.0% (12/50) and 44.0% (22/50), respectively. The excellent rate of Oswestry dysfunction index in the two groups was significantly higher than that in the same group before treatment (χ2 values were 28.167, 4.456, P<0.01), and the observation group was significantly higher than the control group (χ2=19.385, P<0.001). The scores of daily activities such as walking, weight-bearing, sitting for a long time, bending over, washing, standing, sleeping and turning over in the observation group were significantly higher than those in the control group (t values were 3.689, 1.661, 3.621, 3.621, 3.300, 1.661, 1.461 respectively, all Ps<0.05). The total effective rate was 94.0% (47/50) and the control group was 76.0% (38/50). The difference between the two groups was statistically significant (χ2=6.353, P=0.012). Conclusions Electroacupuncture and massage combined with Yaobi-Zhuyu-Zhitong decoction can improve the lumbar function, reduce the degree of lumbar pain, improve the quality of life of the LDH patients with qi stagnation and blood stasis type. Key words: Intervertebral disc displacement; Qi stagnation and blood stasis; Electroacupuncture; Tui Na therapy; Yaobi-Zhuyu-Zhitong decoction; Activities of daily living; Quality of life