The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps f...The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation(non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.展开更多
Objective To discuss the selection of therapy for complex Hangman＇s fractures and analyse its results. Methods There were 15 males and 8 females with average age of 36 years （19-54 years）. The fractures were classi...Objective To discuss the selection of therapy for complex Hangman＇s fractures and analyse its results. Methods There were 15 males and 8 females with average age of 36 years （19-54 years）. The fractures were classified according to Levine-Edwards system. All cases were divided into two groups： Group B associated with fractures in other parts of the cervical spine and Group A without. In Group B, there were four cases with Jefferson fracture and instability of atlantoaxis, six with C6 fracture and seven with dislocation.展开更多
Objective:To evaluate the efficacy and significance of posterolateral fusion in preventing failure of short-segment stabilization for the treatment of thoracolumbar burst fractures. Methods:Sixty patients with thoraco...Objective:To evaluate the efficacy and significance of posterolateral fusion in preventing failure of short-segment stabilization for the treatment of thoracolumbar burst fractures. Methods:Sixty patients with thoracolumbar burst fractures were included in the study. The patients were classified into two groups (n =30 in each group). In Group A, patients were treated in our hospital with short-segment instrumentation via posterolateral fusion with iliac bone. In Group B, patients were treated in other hospital with short-segment fixation without fusion. All cases came to our hospital for reexamination. There were 18 males and 12 females in Group A with a mean age of 42.3 years (range, 24 to 52 years) and 16 males and 14 females in Group B with a mean age of 41.5 years (range, 19 to 54 years). Radiographic (Cobb angle, kyphosis of the vertebral body, and sagittal index) and clinical outcomes (Low Back Outcome Score) were analyzed after an average follow-up of 16 months. Results:After operation, Cobb angle was reduced from 19.3°to 3.1°in Group A and from 19. 1°to 3. 3°in Group B (P>0.05).It was 5.9°in Group A and 11. 9°in Group B at the final follow-up (P < 0.01). Its average loss of correction was 2. 8°in Group A and 8. 6°in Group B. Average kyphosis of the vertebral body was reduced from 21.3°to 6.2°in Group A and from 21.7°to 7.4°in Group B (P > 0.05). It was decreased to 7.9°in Group A and 13.5°in Group B at the final follow-up (P < 0. 01). Its average loss of correction was 1.7°in Group A and 6.1°in Group B. Sagittal index was reduced from 21.3°to 3.6°in Group A and from 20. 5°to 3. 8°in Group B (P < 0.05). It was decreased to 5. 1°in Group A and 9. 8°in Group B at the final follow-up (P < 0. 01). Its average loss was 1.5°in Group A and 6.0°in Group B. In Group A, 73.3% of patients had an excellent result based on Low Back Outcome Score system, while that in Group B was only 43.3%. Conclusions:Posterolateral fusion is an effective measure to prevent implant failure, and decrease loss of correction, posttraumatic kyphosis and neurogical deficit during the treatment of thoracolumbar burst fractures. Short-segment fixation of thoracolumbar burst fractures without fusion obviously increases failure rate and it is not an optional procedure.展开更多
文摘The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation(non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.
文摘Objective To discuss the selection of therapy for complex Hangman＇s fractures and analyse its results. Methods There were 15 males and 8 females with average age of 36 years （19-54 years）. The fractures were classified according to Levine-Edwards system. All cases were divided into two groups： Group B associated with fractures in other parts of the cervical spine and Group A without. In Group B, there were four cases with Jefferson fracture and instability of atlantoaxis, six with C6 fracture and seven with dislocation.
文摘Objective:To evaluate the efficacy and significance of posterolateral fusion in preventing failure of short-segment stabilization for the treatment of thoracolumbar burst fractures. Methods:Sixty patients with thoracolumbar burst fractures were included in the study. The patients were classified into two groups (n =30 in each group). In Group A, patients were treated in our hospital with short-segment instrumentation via posterolateral fusion with iliac bone. In Group B, patients were treated in other hospital with short-segment fixation without fusion. All cases came to our hospital for reexamination. There were 18 males and 12 females in Group A with a mean age of 42.3 years (range, 24 to 52 years) and 16 males and 14 females in Group B with a mean age of 41.5 years (range, 19 to 54 years). Radiographic (Cobb angle, kyphosis of the vertebral body, and sagittal index) and clinical outcomes (Low Back Outcome Score) were analyzed after an average follow-up of 16 months. Results:After operation, Cobb angle was reduced from 19.3°to 3.1°in Group A and from 19. 1°to 3. 3°in Group B (P>0.05).It was 5.9°in Group A and 11. 9°in Group B at the final follow-up (P < 0.01). Its average loss of correction was 2. 8°in Group A and 8. 6°in Group B. Average kyphosis of the vertebral body was reduced from 21.3°to 6.2°in Group A and from 21.7°to 7.4°in Group B (P > 0.05). It was decreased to 7.9°in Group A and 13.5°in Group B at the final follow-up (P < 0. 01). Its average loss of correction was 1.7°in Group A and 6.1°in Group B. Sagittal index was reduced from 21.3°to 3.6°in Group A and from 20. 5°to 3. 8°in Group B (P < 0.05). It was decreased to 5. 1°in Group A and 9. 8°in Group B at the final follow-up (P < 0. 01). Its average loss was 1.5°in Group A and 6.0°in Group B. In Group A, 73.3% of patients had an excellent result based on Low Back Outcome Score system, while that in Group B was only 43.3%. Conclusions:Posterolateral fusion is an effective measure to prevent implant failure, and decrease loss of correction, posttraumatic kyphosis and neurogical deficit during the treatment of thoracolumbar burst fractures. Short-segment fixation of thoracolumbar burst fractures without fusion obviously increases failure rate and it is not an optional procedure.
