Internal Spinal Fixation Research Articles

Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study.

The aim of this study was to investigate whether C7 slope can be used as a substitute for T1 slope in idiopathic scoliosis. From January 2014 to October 2019, 101 patients who received posterior spinal internal fixation and fusion in our hospital were retrospectively analyzed. After analyzing the visibility of vertebral endplates, 46 cases of C7/T1 vertebral endplates were visible, including 14 males and 32 females, aged 9 to 18 years (mean 14.6±2.0 y). The upper C7 slope, lower C7 slope, T1 slope, cervical lordosis and C2 to 7 sagittal vertebral axis were measured before and after operation and at the last follow-up. Pearson correlation coefficient was used to evaluate the correlation strength between upper C7 slope and T1 slope, and lower C7 slope and T1 slope. Through simple linear regression analysis, linear regression equations were generated from the upper and lower C7 slopes to predict T1 slope. According to the 2 researchers' judgment, the visibility rate of the upper C7 endplate was 93.1% before operation, 93.1% after operation, and 91.1% at the last follow-up. The lower C7 endplate's visible rate was 72.3% before operation, 70.3% after operation and 68.3% at the last follow-up. The visible rate of T1 upper endplate was 52.5% before operation, 48.5% after operation and 50.5% at last follow-up. Linear regression analysis showed that the upper C7 slope and T1 slope in idiopathic scoliosis patients, regardless of preoperative (r=0.908, P<0.01), postoperative (r=0.0.886, P<0.01), follow-up (r=0.899, P<0.01), or overall (r=0.895, P<0.01), both have a close correlation; the lower C7 slope and the T1 slope are the same before surgery (r=0.882, P<0.01), after surgery (r=0.940, P<0.01), follow-up (r=0.952, P<0.01), or overall (r=0.929, P<0.01) all have statistical significance. When the upper endplate of T1 is not visible on standard radiographs, the upper or lower C7 slope can be used as a reliable alternative measurement parameter for sagittal balance assessment.

Predicting the Failure Risk of Internal Fixation Devices in Chinese Patients Undergoing Spinal Internal Fixation Surgery: Development and Assessment of a New Predictive Nomogram.

The current study is aimed at developing and validating a nomogram of the risk of failure of internal fixation devices in Chinese patients undergoing spinal internal fixation. We collected data from a total of 1139 patients admitted for spinal internal fixation surgery at the First Affiliated Hospital of Guangxi Medical University from May 2012 to February 2019. Of these, 1050 patients were included in the spinal internal fixation group and 89 patients in the spinal internal fixation device failure group. Patients were divided into training and validation tests. The risk assessment of the failure of the spinal internal fixation device used 14 characteristics. In the training test, the feature selection of the failure model of the spinal internal fixation device was optimized using the least absolute shrinkage and selection operator (LASSO) regression model. Based on the characteristics selected in the LASSO regression model, multivariate logistic regression analysis was used for constructing the model. Identification, calibration, and clinical usefulness of predictive models were assessed using C-index, calibration curve, and decision curve analysis. A validation test was used to validate the constructed model. In the training test, the risk prediction nomogram included gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. The model demonstrated moderate predictive power with a C-index of 0.722 (95% confidence interval: 0.644–0.800) and the area under the curve (AUC) of 0.722. Decision curve analysis depicted that the failure risk nomogram was clinically useful when the probability threshold for internal fixation device failure was 3%. The C-index of the validation test was 0.761. This novel nomogram of failure risk for spinal instrumentation includes gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. It can be used for evaluating the risk of instrumentation failure in patients undergoing spinal instrumentation surgery.

Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

Objective: To explore the therapeutic effect of autologous blood reinfusion combined with controlled hypotension in surgical spinal fixation during the outbreak of COVID-19. Methods: 30 patients with spinal internal fixation autologous blood transfusion combined with controlled hypotension were selected as the subjects during the epidemic period from December 2019 to June 2020 in our hospital and during the operation, on the basis of routine blood pressure reduction, the American Haemonetice Corporation autologous blood continuous reinfusion system was used to infuse the blood recovered during the operation to the patient through filtration and other procedures. Results: 30 patients had no complications such as fever and hemolysis; And after the operation, the tube was dialed according to the drainage volume, the cervical thoracic and lumbar brace was customized, and the patient walked on the ground for one week; After no abnormalities, the patient was discharged. Intraoperative comparison of white blood cells (WBC), red blood cells (RBC), red blood cell pressure (HCT), hemoglobin (HGB), and coagulation time (PT) of patients with autologous blood before and after transfusion showed statistically significant differences before and after surgery (P < 0.001). Conclusion: During the new coronavirus pneumonia epidemic, the internal fixation of spinal surgery used a recovery machine to collect intraoperative blood for reinfusion. Intraoperative antihypertensive drugs were used to control blood pressure within a certain safe range. The postoperative clinical observation effect was significant and safe; especially at present the clinical significance during the epidemic was significant.

Sacral and thoracic chordoma with pulmonary metastases: A case report and review of the literature.

Chordoma is a sporadic type of cancer that affects the spine and is particularly challenging to treat due to the paucity of reported cases and scientific literature. In particular, primary chordomas affecting both the sacral and thoracic vertebrae are extremely rare. We herein report a rare case of chordoma in the sacral and thoracic vertebrae with pulmonary metastasis, along with a literature review. The objective of the present study was to explore treatment options and long-term outcomes in patients with metastatic chordoma. Posterior decompression was performed for the thoracic tumor, followed by extended resection of the sacral tumor. The symptoms of the patient were relieved after surgery, and the postoperative Nurick score decreased from grade 3 to grade 2, while the postoperative McCormick score was I. Therefore, complete chordoma excision and internal spinal fixation may effectively reduce tumor recurrence and metastasis.

Atlantoaxial subluxation in the pediatric patient: Case series and literature review

Objective: Atlantoaxial subluxation (AAS) occurs when there is misalignment of the atlantoaxial joint. Several etiologies confer increased risk of AAS in children, including neck trauma, inflammation, infection, or inherent ligamentous laxity of the cervical spine. Methods: A single-center, retrospective case review was performed. Thirty-four patients with an ICD-10 diagnosis of S13.1 were identified. Demographics and clinical data were reviewed for etiology, imaging techniques, treatment, and clinical outcome. Results: Out of thirty-four patients, twenty-two suffered cervical spine trauma, seven presented with Grisel’s Syndrome, four presented with ligamentous laxity, and one had an unrecognizable etiology. Most diagnoses of cervical spine subluxation and/or instability were detected on computerized tomography (CT), while radiography and magnetic resonance imaging (MRI) were largely performed for follow-up monitoring. Six patients underwent cervical spine fusion, five had halo traction, twelve wore a hard and/or soft collar without having surgery or halo traction, and eight were referred to physical therapy without other interventions. Conclusion: Pediatric patients with atlantoaxial subluxation may benefit from limited 3D CT scans of the upper cervical spine for accurate diagnosis. Conservative treatment with hard cervical collar and immobilization after reduction may be attempted, but halo traction and halo vest immobilization may be necessary. If non-operative treatment fails, cervical spine internal reduction and fixation may be necessary to maintain normal C1-C2 alignment.

Percutaneous transpedicular lumber fixation

Background: Posterior Pedicle screw fixation has step by step become popular to thoracolumbar fracture management. Since Roy-Camille et al used application of plates with pedicle screws for thoracolumbar fractures in 1963. Aim of the work: to evaluate the percutaneous transpedicular fixation for management of lumbar fractures. Patients and Methods: This research was done on 20 patients presented by lumbar spine fractures; they were treated with percutaneous transpedicular fixation and stabilization at Al-Azhar University hospitals from June 2019 to February 2020. All patients were without neurological deficits they were fixed either one level above and one level below or two levels above and two levels below the fractured vertebra. Results: Clinical and functional outcomes are preferable or comparable to conventional open procedures. The key disadvantages of this procedure are the steep learning curve and radiation exposure to both doctors, nurses and surly patients, which may be reduced as much as possible by using the new 3D CT screw insertion process. Conclusion: Percutaneous transpedicular spine fixation is a secure technique that follows the same principles as open procedures, allowing the surgeon to conduct biomechanically strong internal spinal fixation with minimal tissue damage, and is a suitable choice for the treatment of unstable thoracolimber fractures with no neurological deficit. This has the benefit of short-time surgery, no loss of blood, almost no muscle damage results in less postoperative pain than conventional open procedures, short hospitalization, early mobilization, a quicker return to work and a low risk of complications

Efficacy and Safety of Early Tracheotomy in Acute Cervical Spinal Cord Injury.

To evaluate the clinical efficacy and safety of early tracheotomy versus delayed tracheotomy for patients with cervical spinal cord injury. A descriptive study. Department of Orthopedic Surgery, The 80th Army Hospital of PLA, Weifang, Shandong, China, from January 2012 to June 2019. Data of 45 patients with cervical spinal cord injury, who underwent tracheotomy and cervical spine internal fixation at the study place, were retrospectively analysed. Twenty-five patients underwent tracheotomy immediately after cervical spine internal fixation (early tracheotomy group) and 20 patients underwent tracheotomy 3-12 days after cervical spine internal fixation (delayed tracheotomy group). Clinical outcomes and tracheotomy complications were compared between the two groups. Compared with the delayed tracheotomy, the early tracheotomy significantly reduced the total duration of mechanical ventilation (p <0.01), duration of mechanical ventilation after tracheotomy (p <0.05), duration of indwelling tracheal tube (p <0.05), and hospital stay (p <0.01). There were no significant differences in pneumonia, mortality, and complications related to tracheotomy between the groups. No incision infection for tracheotomy and cervical spine internal fixation were found in all patients. Compared with delayed tracheotomy, early tracheotomy can significantly reduce the duration of mechanical ventilation, duration of indwelling tracheal tube, and hospital stay. Early tracheotomy did not increase the risk of infection of the cervical spine internal fixation. Therefore, early tracheotomy was beneficial and safe for patients. Key Words: Spinal cord injuries, Tracheotomy, Complications.

Complications of the treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions

Objective . To analyze the results of surgical treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions from the point of view of surgical safety, and to study the structure, frequency and nature of intra- and postoperative complications and intraoperative blood loss. Material and Methods . A retrospective analysis of data of 212 patients for 2015–2018 was performed. Inclusion criteria were: age over 18 years, staged surgical interventions including anterior spinal fusion and posterior internal fixation performed in one surgical session for post-traumatic deformities of the thoracic and lumbar spine. Patient demographic data and surgical intervention protocols were studied taking into account surgical approaches, duration of operations and blood loss. Intraoperative and postoperative complications up to 6 weeks after surgery were taken into account. Intraoperative blood loss was studied both as the absolute volume and as the percentage of circulating blood volume (CBV). Results . Complications after staged surgical correction of post-traumatic deformities were recorded in 14.2 % of patients, including intraoperative complications in 3.3 % of cases, and postoperative complications in 10.9 %. The most common complications were surgical site infections, usually after posterior approach, and pneumonia. The number of neurological complications was 1.4 %. Complications were more frequent after three-stage surgical interventions than after two-stage ones. The lumbar spine deformity correction was associated with higher complication rate than that in the thoracic spine. Intraoperative blood loss in the study group was 562.2 ± 504.7 ml. The most significant blood loss, over 30 % of the СBV, was noted in 13 (6.1 %) patients. Using of minimally invasive transpedicular fixation during the staged surgical intervention provided the least number of infectious wound complications and the smallest amount of intraoperative blood loss. Conclusion . Staged surgical intervention for the correction of post-traumatic deformity of the thoracic and lumbar spine is a safe method of surgical treatment.

Application of clinical nursing path in negative pressure drainage after anterior cervical internal fixation operation

Objective To explore the application of clinical nursing pathway in negative pressure drainage after anterior cervical spine fixation. Methods A total of 80 patients admitted to the hospital from June 2015 to June 2017 who underwent negative pressure drainage after single segmental anterior cervical fixation were selected. According to the random number table, the patients were divided into observation group and control group, with 40 patients in each group.The control group received routine nursing during negative pressure drainage, the observation group received clinical nursing path nursing during negative pressure drainage.The results of drainage, self-care ability and patients' satisfaction with nursing service were compared between the two groups. Results The drainage volume in the observation group was significantly higher than that in the control group 24 hours after surgery, with statistically significant difference (P<0.05). The total drainage time of the observation group was shorter than that of the control group, and the difference was statistically significant (P<0.05). The total scores of self-care ability, drainage knowledge and treatment compliance in the observation group were higher than those in the control group, with statistically significant differences (P<0.05). Satisfaction scores of the observation group on drainage effect, drainage tube maintenance effect, hospital service, basic nursing, ward nursing, nurse service attitude and other aspects were all higher than those of the control group, and the difference was statistically significant (P<0.05). Conclusion Clinical nursing path can effectively improve the compliance and drainage effect of negative pressure drainage after anterior cervical fixation surgery, help shorten the drainage time of patients, improve patients' satisfaction with nursing services, and is worthy of clinical promotion and application. Key words: Clinical nursing path; Anterior cervical spine internal fixation; Negative pressure drainage; Satisfaction

Intelligently Taking Out Universal Screws and Nail Caps After Spine Internal Fixation.

The purpose of this study was to present a surgical technique for taking out universal screw and nail caps which were difficult to removed. We used a variety of industrial hex wrenches, dental drills, and other equipment to take out internal hex nuts with different specifications (32 pieces) and universal screws (15 pieces) in 28 patients. A total of 32 nuts were taken out, 3 of which were polished by the industrial drill. A total of 17 were spun by hand, 2 were spun by locking pliers, 10 were turned by “I” type screwdriver, and 3 were turned by bone blade. A total of 15 screws were taken out, 9 of which were removed with a wrench and the other 6 by means of locking pliers after re‐fixing with a truncated titanium rod. The novel technique is simple and provides a solution following failure of a supporting device.

Effect of osteoporosis on internal fixation after spinal osteotomy: A finite element analysis

Background: Severe kyphotic deformity can affect the quality of life of the elderly and is commonly treated by an osteotomy. Considering that the elderly often suffer from osteoporosis, the safety and efficacy of internal fixation are particularly important. The aim of this study was to analyse the effect of osteoporosis on internal fixation after spinal osteotomy.Methods: One patient with a thoracolumbar kyphotic deformity who underwent spinal osteotomy was included. The CT images of the entire spine were used to construct a finite element model of the spine internal fixation after osteotomy. Material parameters were assigned to osteoporosis and normal bone groups, and the loads were used to simulate different working conditions, including axial compression, flexion, extension and lateral bending.Findings: Compared with normal bone mass, the pressure on osteotomized vertebrae was reduced by 8.32%, 1.92%, 36.79% and 79.80% in mild osteoporosis model during axial compression, flexion, extension and lateral bending, respectively. The pressure on screws and rods was increased in an osteoporosis model under axial compression. During flexion and lateral bending, the pressure on screws was increased but was decreased on rods. The opposite result was found during extension. With the degree of osteoporosis increases, the change of stress is more obvious.Interpretation: Under different bone mass conditions, the distribution patterns of stress in vertebrae, screws and rods were relatively similar. Collectively, the stress levels of vertebral bone were decreased and the stress levels of the screw/rod system were increased in an osteoporosis model compared to a normal bone model. Hence, osteoporosis may increase the risk of fracture and internal fixation failure.

Review of Spinal Pedicle Screws

Background: Pedicle screws are medical implants which are implanted posteriorly into the vertebrae of the spine and longitudinally connected to a rod to form a construct which corrects spinal alignment or promotes stabilization. Pedicle screw fixation is considered to be the gold standard of spinal internal fixation due to its many benefits in a variety of debilitating spinal conditions. Objective: The aim of the work is to evaluate the use of spinal pedicle screws for different lesions in the past, in the present and in the future. Conclusion: Some successful applications of pedicle screws include surgical treatment of scoliosis reduction and stabilization of spondylolisthesis, stabilization of unstable spinal fractures, simple lumbar degenerative disc disease, primary or metastatic tumors of the lumbar spine, and surgical revision of symptomatic pseudoarthrodesis of the lumbar region.

Review of Spinal Pedicle Screws

Background: Pedicle screws are medical implants which are implanted posteriorly into the vertebrae of the spine and longitudinally connected to a rod to form a construct which corrects spinal alignment or promotes stabilization. Pedicle screw fixation is considered to be the gold standard of spinal internal fixation due to its many benefits in a variety of debilitating spinal conditions. Objective: The aim of the work is to evaluate the use of spinal pedicle screws for different lesions in the past, in the present and in the future. Conclusion: Some successful applications of pedicle screws include surgical treatment of scoliosis reduction and stabilization of spondylolisthesis, stabilization of unstable spinal fractures, simple lumbar degenerative disc disease, primary or metastatic tumors of the lumbar spine, and surgical revision of symptomatic pseudoarthrodesis of the lumbar region.

Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients

BackgroundJunction tuberculous spondylitis involves the stress transition zone of the spine and has a high risk of progression to kyphosis or paraplegia. Problems still exist with treatment for spinal junction tuberculosis. This study investigated the surgical approach and clinical outcomes of junction spinal tuberculosis.MethodsFrom June 1998 to July 2014, 77 patients with tuberculous spondylitis were enrolled. All patients received 2–3 weeks of anti-tuberculous treatment preoperatively; treatment was prolonged for 2–3 months when active pulmonary tuberculosis was present. The patients underwent anterior debridement and were followed up for an average of 29.4 months clinically and radiologically.ResultsThe cervicothoracic junction spine (C7-T3) was involved in 15 patients. The thoracolumbar junction spine (T11-L2) was involved in 39 patients. The lumbosacral junction spine (L4-S1) was involved in 23 patients. Two patients with recurrence underwent reoperation; the drugs were adjusted, and all patients achieved bone fusion. The preoperative cervicothoracic and thoracolumbar kyphosis angle and lumbosacral angle were 31.4 ± 10.9°, 32.9 ± 9.2°, and 19.3 ± 3.7°, respectively, and the corresponding postoperative angles were ameliorated significantly to 9.1 ± 3.2°, 8.5 ± 2.9°, and 30.3 ± 2.8°. The preoperative ESR and C-reactive protein level of all patients were 48.1 ± 11.3 mm/h and 65.5 ± 16.2 mg/L which decreased to 12.3 ± 4.3 mm/h and 8.6 ± 3.7 mg/L at the final follow-up, respectively. All patients that had neurological symptoms achieved function status improvement at different degrees.ConclusionFor spinal tuberculosis of spinal junctions, anterior debridement, internal fixation, and fusion can be preferred and achieved. If multiple segment lesions are too long or difficult for operation of anterior internal fixation, combining posterior pedicle screw fixation is appropriate.

Vacuum-assisted closure combined with a closed suction irrigation system for treating postoperative wound infections following posterior spinal internal fixation

BackgroundWound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection.MethodsWe conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records.ResultsWound size decreased significantly after 1 week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8 days. The wound healed completely after an average of 17 days, and the average hospital stay was 33 days. There was no recurrence of infection at the 1-year follow-up.ConclusionsThis study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.

Preliminary efficacy of inter-spinal distraction fusion which is a new technique for lumbar disc herniation.

To investigate the short- and medium-term efficacy of inter-spinal distraction fusion (ISDF) for lumbar disc herniation with a spinal internal fixation device, the BacFuse Spinous Process Fusion Plate. Ninety-five patients who received ISDF between January 2014 and January 2015 were included for the current retrospective study. The symptoms and imaging results before surgery, immediately after surgery, atsixmonths, and at the last follow-up were assessed using the leg visual analogue scale (VAS), Oswestry disability index (ODI), and 12-item short-form survey (SF-12). The intra-operative intervertebral angle (IA), anterior disk height (ADH), posterior disk height (PDH), foramina height (FH), foramina width (FW), and range of motion (ROM) were assessed using X-rays. The foramina and herniated disc area were assessed using computed tomography (CT). The leg VAS, ODI, and SF-12 were significantly improved after surgery. All indices except ADH were also significantly improved after surgery. PDH and FH increased by 15.5% (P < 0.001) and 9.7% (P < 0.001) at the last follow-up. ROM was statistically different from before surgery. CT images indicated that the herniated disc area decreased by 3.1%, while the foramina areas increased by 5.7% at the last follow-up. 92.6% patients demonstrated successful outcome. ISDF significantly alleviated the clinical symptoms, improved spinal structure, and partially retracted the herniated disc. Our findings imply that ISDF is an effective minimally invasive procedure in the treatment of lumbar disc herniation.

Efficacy of posterior lumbar interbody fusion and internal fixation in treatment of lumbar spinal stenosis with redundant nerve roots

Objective To investigate the clinical efficacy of posterior lumbar interbody fusion and internal fixation for the treatment of lumbar spinal stenosis with redundant nerve roots (RNRs). Methods A retrospective case series study was performed on the clinical data of 23 cases of lumbar spinal stenosis with RNRs from January 2009 to December 2014. This study involved 10 males and 13 females, with an average age of 48.4 years(range, 38-58 years). The course of disease averaged 28.1 months(range, 2 months-7 years). There were seven patients with single segment of stenosis, 12 patients with two segments of stenosis, and four patients with three segments of stenosis. RNRs diagnostic criteria: in the sagittal section of the MRIT2 image of lumbar spine, the cauda equina nerve root in the dural sac was circular, tortuous and twining. MRI information was collected and analyzed by three double-blind radiologists, respectively. RNRs were determined based on the unanimous consent of all the three doctors. All patients underwent posterior discectomy, spinal canal decompression, interbody fusion, and internal fixation after admission. The operation time, intraoperative blood loss, and postoperative complications were recorded. The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) score were used to evaluate the back pain and leg pain before operation and 3 months after operation. Fischgrund standard was used for the overall efficacy evaluation. Results All patients were followed up for 12-30 months (mean, 23.3 months). The operation time was (130.0±23.2)minutes, and the intraoperative blood loss was (513.0±165.0)ml. MRI was reviewed 1 week after operation, and the result showed that redundancy of cauda equina disappeared. Preoperatively, the scores of back pain VAS, leg pain VAS, ODI and JOA were (6.3±0.8)points, (6.8±0.9)points, (46.7±2.5)points and (10.3±2.8)points, respectively. At 3 months postoperatively, the scores were (1.4±0.5)points, (1.8±0.7)points, (11.9±2.1)points, and (25.3±1.8)points, respectively (P<0.05). In terms of the efficacy, 17 cases were excellent, four good, and two fair, with an excellent and good rate of 91%. At 12 months after operation, the CT scan showed no screw rupture or cage dislocation, with bony union seen between the vertebrae. Conclusion Posterior lumbar interbody fusion and internal fixation can help relieve the back and leg pain and eliminate redundant nerve roots in patients with lumbar spinal stenosis with RNRs. Key words: Spinal stenosis; Lumbar vertebrae; Internal fixators; Cauda equina

Analysis of delayed infection of proximal junctional zone after posterior spinal internal fixation and its treatment strategy

To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation. The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed. All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor. The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.

Effect of pre-programmed guidance of functional exercise on exercise compliance and accuracy of patients after lumbar surgery

Objective To explore effect of pre-programmed guidance of functional exercise on exercise compliance and accuracy of patients after lumbar surgery. Methods From January to March 2016, 60 patients who had undergone the surgery of lumbar spine internal fixation were selected as the research object. All patients were divided into intervention group and control group randomly, 30 patients in each group. Patients in the control group underwent routine postoperative functional exercises. Patients in the intervention group received preoperative functional exercise instruction before 2 days. According to the self-designed questionnaire, we evaluated the compliance and accuracy of functional exercises of the two groups by asking, checking and demonstrating. Results At first day after operation, the proficiency on ankle pump exercises and straight-leg-raising movement showed no significant difference between two groups (P>0.05) ; However, on supine siding leg movement to right-left, compared with the control group, the intervention group were significantly better (Z=-5.100, P 0.05) , but on straight-leg-raising movement (Z=-2.316, P=0.021) , supine siding leg movement to right-left (Z=-4.238, P<0.001) , lateral siding leg movement to front-back (Z=-3.027, P=0.002) and lateral straight-leg-raising movement (Z=-3.027, P=0.002) , the intervention group was significantly better than the control group. Moreover, as far as adherence of exercise, patients in the intervention group were obvious better (Z=-2.156, P=0.031) . Conclusions The pre-programmed guidance of functional exercise can improve the patient's awareness and confidence of functional exercise on rehabilitation, reduce the patients' psychological anxiety, so as to improve the compliance and the correct rate of functional exercise, promote their recovery. It also can save time for propaganda, improve work efficiency. Key words: Lumbar spinal diseases; Functional exercise; Adherence; Accuracy; Orthopedic surgery

Experience of operative treatment in 27 patients with intraspinal neurilemmoma.

To investigate the clinical outcomes of posterior laminectomy on intraspinal neurilemmoma. Twenty-seven patients with intraspinal neurilemmoma admitted to the Second People's Hospital of Changzhou Affiliated to Nanjing Medical University from January 2010 to October 2015 were selected, and they received posterior laminectomy, and there were 5 patients whose nerve root and tumor were removed together because they could not be separated; 17 patients receiving total laminectomy or semi-laminectomy combined with facetectomy on the affected side were treated with spinal dynamic pedicle screw fixation or replantation of lamina or bone graft fusion and internal fixation. The patients were followed up regularly to observe the clinical outcomes after operation. The spinal stability and bone graft fusion were observed via X-ray film in review. Whether there was tumor recurrence was observed via MRI in review according to the individual condition. The operation time was 2.5–8 h (4.2 h on average). The intraoperative blood loss was 420–1,500 ml (760 ml on average). Tumors in 26 patients were totally resected, and tumor in 1 patient was partially resected due to tumor tissue invasion against the anterior sacral vascular plexus. All patients were pathologically confirmed as neurilemmoma after operation. Ten patients suffered from cerebrospinal fluid leakage in different degrees after operation. During the follow-up for 6–75 months after operation, clinical symptoms and neurological functions of all patients were significantly improved; there was 1 case of tumor residual and no recurrence. During the follow-up, the internal fixation in all patients receiving internal fixation of spine was stable with no vertebral instability. Posterior laminectomy can achieve satisfactory clinical outcomes in the treatment of intraspinal neurilemmoma. Internal fixation is needed to reestablish spinal stability during operation for those patients with great damage to spinal stability.