Lumbar spondylolisthesis is a common condition in spinal surgery, which is often characterized by lower back and leg pain and numbness. There are various treatment methods for this condition, and different treatment plans should be adopted according to different situations. Traditional open surgery methods are relatively traumatic and have longer recovery times, while minimally invasive spine techniques have advantages such as smaller incisions, less bleeding, higher fusion rates, and faster recovery. This review summarizes the relevant literature on the application of minimally invasive techniques in the treatment of lumbar spondylolisthesis in recent years, analyzes and compares the advantages and disadvantages of different approaches and endoscopic techniques, as well as reduction, decompression, and fusion effects. The aim is to provide reference for surgeons in selecting surgical procedures for the treatment of lumbar spondylolisthesis.
ObjectiveTo investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine.MethodsBetween June 2000 and March 2015, the clinical data, diagnosis, and treatment of 12 patients with SP of cervical spine were retrospectively analyzed. There were 8 males and 4 females, with a mean age of 46 years (range, 28-74 years). The mean disease duration was 8.4 months (range, 3-15 months). There were 2 cases in C2 segment, 4 cases in C3, 2 cases in C4, 1 recurrent case in C5, C6, and 3 cases in C7. According to WBB (Weinstein-Boriani-Biagini) surgical staging system, the tumor mainly occupied the vertebral body areas and expanded outside to 4 or 9 radiating zone in 8 cases, expanded both outsides to 4 or 9 radiating zones in 4 cases; 7 cases of them affected A to D layers, other 5 cases affected B to D layers. Preoperative Frankel system showed grade B in 1 case, grade C in 6 cases, and grade D in 5 cases. One vertebra segment was involved in 11 cases, and 2 vertebra segments were involved in 1 case. The unilateral vertebral artery was involved in 4 cases and bilateral vertebral artery in 1 case. One-stage total spondylectomy by anterior and posterior approaches for SP of cervical spine was applied in all patients, which all received adjuvant radiotherapy postoperatively. The operation time, intraoperative blood loss, complications, Frankel system, and visual analogue scale (VAS) score were recorded and analyzed.ResultsThe operation time was 6.8-9.3 hours (mean, 7.2 hours), and the intraoperative blood loss was 1 100-2 600 mL (mean, 1 600 mL). Esophageal leakage occurred in 1 patient with C5, C6 recurrent SP at 1 week after operation and 1 case presented with fat liquefaction of wound, who were cured by symptomatic treatment. Other patients showed no neurological deficit, major vascular injury (especially vertebral artery), phrenic nerve injury, superior laryngeal nerve injury, laryngeal nerve injury, respiratory failure, or other complications. All the 12 patients were followed up 27-98 months (mean, 58 months). The symptoms of spinal cord compression disappeared or improved after operation. At last follow-up, the nerve function was recovered to Frankel grade E in all patients; the VAS score decrease to 1.1±0.7, showing significant difference when compared with preoperative value (6.7±2.7) (t=2.485, P=0.014). Two patients had local recurrence at 29 months and 37 months after operation respectively, which were treated with adjuvant chemotherapy. One of them finally progressed to multiple myeloma and died of multiple organ failure after 43 months, the other one survived with residual tumor. One case presented with internal fixator loosening and breaking at 4 years after operation, who was performed revision surgery. The other patients had no tumor recurrence or malignant change during the follow-up, no complication such as internal fixator loosening or breaking occurred.ConclusionFor patients with SP of cervical spine, surgical intervention is an acceptable treatment option. One-stage total spondylectomy by anterior and posterior approaches can decline the local recurrence and relieve the symptoms of spinal cord compression, so as to improve patients’ life quality. However, patients with progression to multiple myeloma should be treated with individualized therapeutic regimen, and the prognosis may be poor.
Objective To explore the surgical procedure and effectiveness of total spondylectomy and spine reconstruction through posterior approach to treat thoracolumbar vertebra tumor. Methods Between June 2004 and July 2008, 14 cases of thoracolumbar vertebra tumor underwent one-stage total spondylectomy through posterior approach and spine reconstruction with posterior pedicle screw system and bone graft. There were 11 males and 3 females with a mean age of 47.2 years (range, 36-60 years). The disease duration was 3-15 months. Affected segments included T3 in 1 case, T4 in 3 cases, T8 in 3 cases, T9 in 2 cases, T10 in 3 cases, T12 in 1 case, and L1 in 1 case. The postoperative pathological results were 3 cases of bony giant cell tumor, 1 case of osteoblastoma, 2 cases of osteosarcoma, and 8 cases of metastatic tumor. According to Tomita et al. grading system, there were 1 case of type II, 5 cases of type III, 3 cases of type IV, and 5 cases of type V. According to Frankel classification of preoperative spinal cord function, 3 cases were rated as grade B, 4 as grade C, 5 as grade D, and 2 as grade E. Results Wound heal ing by first intention was obtained in all cases, and no blood vessel and nerve injury occurred. Fourteen patients were followed up 11-64 months (mean, 32.5 months). The local pain was rel ieved significantly. At 6-8 months after operation, the X-ray films and CT showed that bone graft fusion at Bridwell I grade was achieved. At 10 months, the postoperative spinal cord function was improved from grade B to grade D in 2 cases, from grade C to grade D in 1 case, and the other 9 cases reached grade E. The patients had normal walking function. Two patients died of l iver metastasis and brain metastasis at 11 and 15 months postoperatively, respectively; 1 patient with osteoscarcoma died of lung metastasis at 16 months; and 1 case of osteoscarcoma developed local recurrence at 8 months postoperatively. Internal fixation was rel iable without loosening and breakage and the spine was stable. Conclusion Total spondylectomy and spine reconstruction through posterior approach is an effective method with advantages of relative minimal injury, radical tumor excision, low local recurrence, and adequate spinal cord decompression.
Objective To observe the effects of Crumbs (Crb) proteins on different types of zebrafish photoreceptors. Methods The retinal cell population dynamics of adult wild-type zebrafish and Tg (RH2-2:Crb2b-sf-EX/RH2-2:GFP)pt108b transgenic zebrafish (called pt108b zebrafish for short) were evaluated by monitoring the densities of three categories of retinal photoreceptors (rod cells, UV cone cells and RGB cone cells) in different retinal regions, which were visualized by Feulgen nuclear staining histology technique. Results The wild-type zebrafish retinal photoreceptor cell densities are generally higher in the central region than the peripheral regions. Compared with wild-type zebrafish, pt108b zebrafish had much less RGB cone cells at the top of outer nuclear layer, and no RGB cone cells at the central and intermediate regions of retina. While pt108b zebrafish had normal density of UV cone cells at the top of rods and the bottom of outer limiting membrane, they had much higher density of rods. Conclusions Crb proteins may affect the zebrafish retinal cell densities of different photoreceptor types.
【Abstract】 Objective To investigate the clinical significances of the thoracic pedicle classification determined by inner cortical width of pedicle in posterior vertebral column resection (PVCR) with free hand technique for the treatment of rigid and severe spinal deformities. Methods Between October 2004 and July 2010, 56 patients with rigid and severe spinal deformities underwent PVCR. A total of 1 098 screws were inserted into thoracic pedicles at T2-12. The inner cortical width of the thoracic pedicle was measured and divided into 4 groups: group 1 (0-1.0 mm), group 2 (1.1-2.0 mm), group 3 (2.1-3.0 mm), and group 4 (gt; 3.1 mm). The success rate of screw-insertion into the thoracic pedicles was analyzed statistically. A new 3 groups was divided according to the statistical results and the success rate of screw-insertion into the thoracic pedicles was analyzed statistically again. And statistical analysis was performed between different types of thoracic pedicles classification for pedicle morphological method by Lenke. Results There were significant differences in the success rate of screw-insertion between the other groups (P lt; 0.008) except between group 3 and group 4 (χ2=2.540，P=0.111). The success rates of screw-insertion were 35.05% in group 1, 65.34% in group 2, and 88.32% in group 3, showing significant differences among 3 groups (P lt; 0.017). According to Lenke classification, the success rates of screw-insertion were 82.31% in type A, 83.40% in type B, 80.00% in type C, and 30.28% in type D, showing no significant differences (P gt; 0.008) among types A, B, and C except between type D and other 3 types (P lt; 0.008). In the present study, regarding the distribution of different types of thoracic pedicles, types I, II a, and II b thoracic pedicles accounted for 17.67%, 16.03%, and 66.30% of the total thoracic pedicles, respectively. The type I, II a, and II b thoracicpedicles at the concave side accounted for 24.59%, 21.13%, and 54.28%, and at the convex side accounted for 10.75%, 10.93%, and 78.32%, respectively. Conclusion A quantification classification standard of thoracic pedicles is presented according to the inner cortical width of the pedicle on CT imaging: type I thoracic pedicle, an absent channel with an inner cortical width of 0-1.0 mm; type II thoracic pedicle, a channel, including type IIa thoracic pedicle with an inner cortical width of 1.1-2.0 mm, and type IIb thoracic pedicle with an inner cortical width more than 2.1 mm. The thoracic pedicle classification method has high prediction accuracy of screw-insertion when PVCR is performed.
The risk of vertebral cortical shell fracture increases with aging. However, it remains unclear how aging contributes to cortex fracture at present. The aim of this study is to make understanding of the mechanism of how the spinal aging influences the cortical shell strain. Two finite element (FE) models of spinal segments (mildly and fully aged) were created, and then were compared to the FE models of the healthy spinal segment. The FE models of the aged spinal segments were generated by modifying both the geometry of the intervertebral disc (IVD) and the material properties of the spinal components. To find out under which case the cortical shell strain was influenced more, we created two types of FE model comparison methods: one with changes only in the spinal material properties and the other with changes only in the IVD geometry. The results showed that the cortical shell strains increased with aging and that compared to the changes of IVD geometry, the changes of spinal material property have a higher influence on the cortical shell strains. This study may suggest that for the prevention and treatment of vertebral cortex fracture, the augmentation of the vertebral body is a more effective treatment.
Objective To investigate the clinical therapeutic effects on malignant spinal tumors treated by percutaneous vertebroplasty(PVP) under the guidance of the digital subtraction angiography(DSA). Methods A retrospective analysis was performed in 196 patients (99 males and 97 females, aged 23-85 years, averaged 60.4 years) with malignant spinal tumors, who underwent the PVP treatment combined with standard chemotherapy and other comprehensive treatment from January 2002 to January 2005. The malignant spinal tumors had their origins as follows: lung cancer (66 cases), breast cancer (55 cases), liver cancer (19 cases), colon cancer (15 cases), stomach cancer (9 cases), prostate cancer (12 cases), multiple myeloma (16 cases), and malignant lymphoma of the spine (4 cases).The metastatic tumors involved the cervical vertebra (32 cases), thoracic vertebra (93 cases), lumbar vertebra (71 cases), and spinal column, including 1 vertebral segment (135 cases), 2 segments (50 cases), and more than 3 segments (11 cases). During the follow-up survey, changes in the visual analogue pain scale(VAS) and changes in the X-ray measurements of the average anterior height, midline height, and posterior height of the diseased vertebra were observed. Results The follow-up for 6 months to 3 years revealed that the percutaneous vertebroplasty on279 vertebral segments had a success with an operational success rate of 100%. Bone cement was injected into the lesions 1-9 ml per segment of the spine. The postoperative X-ray and CT evaluations revealed that spinal stabilization was obtained in all the patients. After operation, 193（98.5%）patients had an obvious decrease or disappearance of the pain in the lower back, and only 3 (1.5%) patients had no obvious improvement in the pain. There was a significant statist-ical difference in the VAS scores between before operation and after operation (Plt;0.05). There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation（15.71±2.80 mm vs 16.61±3.01 mm）, in the midline height（13.65±2.93 mm vs 14.52±2.72 mm）, and in the posterior height（23.67±2.81 mm vs 23.70±3.13 mm,Plt;0.05). The patients with lung or liver cancer had a mean survival time of 9 monthsafter PVP; the patients with breast cancer, stomach cancer, prostate cancer, lymphoma, or other metastatic tumors had a mean survival time of 18 months. The patients with multiple myeloma had a mean survival time of 27 months. The differences were statistically different (Plt;0.01). Conclusion PVP under the guidance of the DSA is an easier operation witha small wound and few complications. It can effectively alleviate the patient’s pain due to metastatic spinal tumor, stabilize the spine, improve the patient’s quality of life, and reduce the incidence of paraplegia.
For rat spinal magnetic resonance imaging (MRI) experiments, due to the lower main magnetic field strength, shallower detected depth and poor spatial compatibility of the traditional radio frequency (RF) coil, the image signal-to-noise ratio (SNR) of rat spinal was rather lower. In this paper, a RF coil for rat spinal MRI at 9.4 T was developed to improve the image quality and at the same time to avoid the space limitation while scanning in special conditions (cardiac catheterization, etc.). In this article, open birdcage structure was built and magnetic field distribution was calculated. The phantom and rat spine MRI imaging were experimented at 9.4 T to verify the advantage of the coil in rat spine MRI application.
ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.