Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods...Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This展开更多
Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects,...Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.展开更多
Background： The cause of the adjacent segment degeneration （ASD） after fusion remains unknown. It is reported that adjacent facet joint stresses increase alter anterior cervical discectomy and fusion. This increase...Background： The cause of the adjacent segment degeneration （ASD） after fusion remains unknown. It is reported that adjacent facet joint stresses increase alter anterior cervical discectomy and fusion. This increase of stress rate may lead to tissue injury. Thus far, the load rate of the adjacent segment facet joint after fusion remains unclear. Methods： Six C2-C7 cadaveric spine specimens were loaded under tour motion modes： Flexion, extension, rotation, and lateral bending, with a pure moment using a 6° robot arm combined with an optical motion analysis system. The Tecscan pressure test system was used for testing facet joint pressure. Results： The contact mode of the facet joints and distributions of the force center during different motions were recorded. The adjacent segment facet joint forces increased faster after fusion, compared with intact conditions. While the magnitude of pressures increased, there was no difference in distribution modes before and after fusion. No pressures were detected during flexion. The average growth velocity during extension was the fastest and was significantly faster than lateral bending. Conclusions： One of the reasons for cartilage injury was the increasing stress rate of loading. This implies that ASD after fusion may be related to habitual movement before and after fusion. More and faster extension is disadvantageous for the facet joints and should be reduced as much as possible.展开更多
AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of ...AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman’s coefficient of rank correlation was used for statistical analysis,with significance set at P 【 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.展开更多
BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural intervent...BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural interventions.For some refractory cases that fail conservative therapies,dorsal ramus medial brunch radiofrequency ablation is warranted.However,as nerve fibers can regenerate,their efficacy is impermanent,and the recurrence rate is relatively high.Considering synovial impingement is a paramount pathogenesis of LFJS,in this case,we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope.As the culprit hyperplastic joint capsule was excised,it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS.She complained of low back pain and right buttock pain for half a year.The patient was placed in the prone position.After disinfection and draping,a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process.Subsequently,a guidewire,dilating tubes,and a working cannula was inserted successively.The spinal endoscope was positioned in the working cannula.Under the endoscope,the microvascular tissue,muscle tissue attached on the L5 inferior articular process and S1 superior articular process,as well as the capsule and minor portion of the inferior articular process were removed.After the joint space was clear and no bleeding points existed,the endoscope and working cannula were shifted,and the incision was sutured.After treatment,the symptoms were completely relieved.The patient was pain-free during the follow-up period of 6 mo.CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS,especially for cases caused by synovial impingement.展开更多
AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain...AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.展开更多
Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical...Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.展开更多
Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big ...Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain(LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-toapply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intraarticular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.展开更多
The management of symptomatic lumbar synovial cysts is still a challenge and a matter of debate with no existing strong consensus. There are different treatment techniques and strategies, the most debated matter is to...The management of symptomatic lumbar synovial cysts is still a challenge and a matter of debate with no existing strong consensus. There are different treatment techniques and strategies, the most debated matter is to fuse or not to fuse, efficiency of less invasive techniques. One of our purposes was to provide an updated review of a literature about treatment of juxta facet synovial cysts and as standard surgical strategies are inconsistent, we present a small series of patients treated using different approaches, most of them were treated with MISS techniques, endoscopy, providing good results.展开更多
Objective： To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions （DRGs） in order to clarify the causes of diffuse neck pain, headache,...Objective： To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions （DRGs） in order to clarify the causes of diffuse neck pain, headache, and shoulder pain. Methods： Forty-two male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups： Group A （ n = 18） , Group B （ n = 18） , and Group C （ n = 6 ）. Under anesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 μl 5 % bisbenzimide （Bb） were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep reanesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, C1 -C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined. Results ： Neurons labeled with Bb were present in C1- C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb （＋） neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb （ ＋ ） neurons after sympathectomy was significantly less than that without sympathectomy. Conclusions： The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.展开更多
Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations （FVs） because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures cle...Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations （FVs） because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures clearly,and may help to lower the rate of FVs during pedicle screw insertion.This study used computed tomography （CT） to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.Methods A prospective study,including 142 patients having lumbar and lumbosacral fusion,was conducted between January 2013 and April 2014.All patients had bilateral posterior pedicle screw-rod instrumentation （top-loading screws） implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures.All patients underwent CT examinations within 6 months postoperation.The CT scans were independently reviewed by three reviewers blinded to the technique used.Results The cohort comprised 68 percutaneous and 74 open cases （136 and 148 superior-level pedicle screw placements,respectively）.Overall,superior-level FVs occurred in 20 patients （20/142,14.1％）,involving 27 top screws （27/284,9.5％）.The percutaneous technique （7.4％ of patients,3.7％ of top screws） had a significantly lower violation rate than the open procedure （20.3％ of patients,14.9％ of top screws）.The open group also had significantly more serious violations than did the percutaneous group.Both groups had a higher violation rate when the cranial fixation involved the L5.A 1-level open procedure had a higher violation rate than did the 2-and 3-level surgeries.Conclusions With computer-assisted navigation,the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur,they tend to be less serious.Performing a single-level open lumbar fusion,or the fusion of the L5-S1 segment,requires caution to avoid cranial adjacent FVs.展开更多
文摘Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This
文摘Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.
基金This study was supported by grants from the National Science Foundation of China，the Beijing Municipal Science and Technology Plan Projects，the National Science and Technology Support Plan
文摘Background： The cause of the adjacent segment degeneration （ASD） after fusion remains unknown. It is reported that adjacent facet joint stresses increase alter anterior cervical discectomy and fusion. This increase of stress rate may lead to tissue injury. Thus far, the load rate of the adjacent segment facet joint after fusion remains unclear. Methods： Six C2-C7 cadaveric spine specimens were loaded under tour motion modes： Flexion, extension, rotation, and lateral bending, with a pure moment using a 6° robot arm combined with an optical motion analysis system. The Tecscan pressure test system was used for testing facet joint pressure. Results： The contact mode of the facet joints and distributions of the force center during different motions were recorded. The adjacent segment facet joint forces increased faster after fusion, compared with intact conditions. While the magnitude of pressures increased, there was no difference in distribution modes before and after fusion. No pressures were detected during flexion. The average growth velocity during extension was the fastest and was significantly faster than lateral bending. Conclusions： One of the reasons for cartilage injury was the increasing stress rate of loading. This implies that ASD after fusion may be related to habitual movement before and after fusion. More and faster extension is disadvantageous for the facet joints and should be reduced as much as possible.
文摘AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman’s coefficient of rank correlation was used for statistical analysis,with significance set at P 【 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.
文摘BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural interventions.For some refractory cases that fail conservative therapies,dorsal ramus medial brunch radiofrequency ablation is warranted.However,as nerve fibers can regenerate,their efficacy is impermanent,and the recurrence rate is relatively high.Considering synovial impingement is a paramount pathogenesis of LFJS,in this case,we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope.As the culprit hyperplastic joint capsule was excised,it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS.She complained of low back pain and right buttock pain for half a year.The patient was placed in the prone position.After disinfection and draping,a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process.Subsequently,a guidewire,dilating tubes,and a working cannula was inserted successively.The spinal endoscope was positioned in the working cannula.Under the endoscope,the microvascular tissue,muscle tissue attached on the L5 inferior articular process and S1 superior articular process,as well as the capsule and minor portion of the inferior articular process were removed.After the joint space was clear and no bleeding points existed,the endoscope and working cannula were shifted,and the incision was sutured.After treatment,the symptoms were completely relieved.The patient was pain-free during the follow-up period of 6 mo.CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS,especially for cases caused by synovial impingement.
文摘AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.
文摘Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
文摘Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain(LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-toapply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intraarticular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.
文摘The management of symptomatic lumbar synovial cysts is still a challenge and a matter of debate with no existing strong consensus. There are different treatment techniques and strategies, the most debated matter is to fuse or not to fuse, efficiency of less invasive techniques. One of our purposes was to provide an updated review of a literature about treatment of juxta facet synovial cysts and as standard surgical strategies are inconsistent, we present a small series of patients treated using different approaches, most of them were treated with MISS techniques, endoscopy, providing good results.
文摘Objective： To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions （DRGs） in order to clarify the causes of diffuse neck pain, headache, and shoulder pain. Methods： Forty-two male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups： Group A （ n = 18） , Group B （ n = 18） , and Group C （ n = 6 ）. Under anesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 μl 5 % bisbenzimide （Bb） were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep reanesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, C1 -C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined. Results ： Neurons labeled with Bb were present in C1- C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb （＋） neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb （ ＋ ） neurons after sympathectomy was significantly less than that without sympathectomy. Conclusions： The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.
文摘Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations （FVs） because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures clearly,and may help to lower the rate of FVs during pedicle screw insertion.This study used computed tomography （CT） to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.Methods A prospective study,including 142 patients having lumbar and lumbosacral fusion,was conducted between January 2013 and April 2014.All patients had bilateral posterior pedicle screw-rod instrumentation （top-loading screws） implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures.All patients underwent CT examinations within 6 months postoperation.The CT scans were independently reviewed by three reviewers blinded to the technique used.Results The cohort comprised 68 percutaneous and 74 open cases （136 and 148 superior-level pedicle screw placements,respectively）.Overall,superior-level FVs occurred in 20 patients （20/142,14.1％）,involving 27 top screws （27/284,9.5％）.The percutaneous technique （7.4％ of patients,3.7％ of top screws） had a significantly lower violation rate than the open procedure （20.3％ of patients,14.9％ of top screws）.The open group also had significantly more serious violations than did the percutaneous group.Both groups had a higher violation rate when the cranial fixation involved the L5.A 1-level open procedure had a higher violation rate than did the 2-and 3-level surgeries.Conclusions With computer-assisted navigation,the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur,they tend to be less serious.Performing a single-level open lumbar fusion,or the fusion of the L5-S1 segment,requires caution to avoid cranial adjacent FVs.
