INTRODUCTION:Spinal epidural cavernous hemangiomas (SECHs) are relatively rare intradural epidural lesions of the spinal canal, and those occurring in the lumbar spine are even rarer.CASE PRESENTATION:A 60-year-old man presented for low back pain with right leg pain. His pee and feces were both normal but symptoms were very similar to a typical lumbar disc herniation. The MRI findings suggest an epidural space of unknown nature in the spinal cord at the L2-3 level and a definite diagnosis of SECHs was made by postoperative pathological examination.CLINICAL DISCUSSION:Patients who are suspected of having SECHs should undergo initial classification and differential diagnosis based on MRI imaging features. It is crucial to identify the responsible segment in correlation with the presenting symptoms. During surgery, the primary objective should be the complete removal of the mass, while taking utmost care to protect the nerves. Dynamic stabilization systems, utilizing pedicle rods, can be considered as one of the treatment options for such patients.CONCLUSION:Patients presenting with low back pain and neurological symptoms should undergo MRI, and diagnosed with SECHs should undergo early surgical intervention. For patients with an intradural mass in the spinal canal, complete resection should be performed while prioritizing nerve protection.

To examine the short-term efficacy and imaging results of using the Mobi-C in cervical hybrid surgery on 2-level cervical spondylolisthesis. To observe post-operative changes in the flexion–extension centre of rotation (FE-COR) and anterior bone loss (ABL) of the anterior cervical disc replacement (ACDR) segment. Forty-two patients (20 males and 22 females, aged 42‒67 years) who underwent cervical hybrid surgery were retrospectively analysed. Their ACDR segment used Mobi-C, and the fusion segment used ROI-C, with a follow-up of 25‒42 months (31.1 ± 4.8 months). The modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and visual analogue scale (VAS) were used to assess clinical outcomes. Pre-operative, 6-month post-operative, and final follow-up radiographs were collected to compare total cervical spine curvature (C2–C7), curvature of the operated segments, range of motion (ROM) in the total cervical spine, operated segmental ROM, ACDR segmental ROM, and operated adjacent segmental ROM. The height of the superior articular process (HSAP), the orientation of zygapophyseal joint spaces (OZJS), and the length of the superior articular surface (LSAS) were measured. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The translation distance of the Mobi-C was measured. The degree of disc degeneration in the adjacent segment, bony fusion of the ACDF segment, and ABL of the upper and lower vertebra of the ACDR segment were observed. In our group, all patients have shown improvements in their postoperative mJOA, NDI, and VAS scores. Overall cervical ROM and surgical segmental ROM decreased (P < 0.05). However, there was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with pre-operatively (P > 0.05). For FE-COR-X, only the last follow-up compared with pre-surgery showed statistical significance (46.74 ± 7.71

背景:腰椎融合术后邻椎病的治疗是脊柱外科的研究热点,传统延长融合节段的手术有可能加速邻椎病的再次出现.以椎弓根螺钉为基础的非融合技术在治疗腰椎退行性疾病和预防邻近节段退变中表现出良好的中短期疗效,但采用非融合技术治疗腰椎融合术后邻椎病的临床疗效亟待研究.目的:评估Isobar EVO非融合动态固定治疗腰椎融合术后邻椎病的效果.方法:选择2013年7月至2017年12月于东直门医院因保守治疗无效后再次手术的邻椎病患者,纳入了其中15例接受Isobar EVO原位非融合动态稳定治疗的患者,并回顾了病历、手术报告和X射线成像研究.比较手术前后的临床结果(包括腰痛和下肢痛目测类比评分、腰椎功能障碍指数、SF-36量表生理健康评分)和影像学测量指标(包括手术节段及上位邻近节段活动度、手术节段前凸角和腰椎前凸角、手术节段及上位邻近节段平均间隙高度指数).结果 与结论:15例患者完成了至少3年的随访.①临床结果:末次随访时各项评分较术前有显著改善(P<0.05),但随访各时段之间比较无显著差异(P>0.05).②影像学测量指标:末次随访时,手术节段活动度较术前明显减少[(3.16±0.45)°vs.(6.32±1.81)°,P<0.05],上位邻近节段活动度较术前明显增加[(5.51±1.22)°vs.(4.87±1.47)°,P<0.05],腰椎前凸角较术前明显增加[(30.95±8.96)°vs.(27.12±9.67)°,P<0.05],手术节段前凸角较术前明显增加[(11.32±4.86)°vs.(10.14±6.44)°,P<0.05],手术节段平均间隙高度指数较术前明显增大(33.23±3.83 vs.32.79±4.06,P<0.05),但上位邻近节段平均间隙高度指数较术前差异无统计学意义(P>0.05);以上指标在术后随访各时段之间相比差异均无统计学意义(P>0.05).所有病例在随访周期内未见内置物松动,未再次发生邻椎病.③结论:Isobar EVO非融合动态固定是治疗邻椎病的有效方式,临床效果明显.术后3年以上随访结果显示该术式可在一定程度上预防再手术后邻椎病的发生,长期效果有待于进一步随访的结果和更高级别循证医学证据的支持.

Although the Mobi-C artificial disc and the ROI-C cervical cage have been widely used in the treatment of cervical degenerative disc diseases (CDDD), few reports addressed the features of combined application of both devices. This study is aimed at comparing the clinical and radiological outcomes of treating contiguous two-level CDDD using Mobi-C and ROI-C combined in a hybrid surgery (HS) with anterior cervical discectomy and fusion (ACDF) using ROI-C. We reviewed ninety-one patients who underwent HS (n = 48) or ACDF (n = 43) surgery for symptomatic contiguous two-level CDDD. >2 years’ clinical and radiological outcomes were reviewed and evaluated retrospectively. At the last follow-up, significant improvement in the mean VAS, JOA, and NDI scores was found both in the HS and ACDF groups (p < 0.05), while the differences between groups were not significant (p > 0.05). The global range of motion (ROM) in the HS group was significantly larger than that in the ACDF group (p < 0.05). The local lordosis improved significantly after surgery in all patients (p < 0.05). Bone resorption and heterotopic ossification (HO) were found after surgery. The result showed that, for the selected patients, HS may provide an alternative approach for the treatment of contiguous two-level CDDD. HS also offers the benefit of both greater global ROM and greater ROM at the Mobi-C index level. Some degree of bone resorption may be an integral component in the early stage of bony fusion in the cage index level. Further studies and long-term follow-up are still needed.

[目的]探讨距下关节外融合联合骑缝钉内固定术治疗脑瘫性外翻足的临床疗效.[方法] 2010年8月～2015年8月本科采用骑缝钉技术行关节外距下关节融合术治疗脑瘫性外翻足畸形68例(104足),并根据畸形的程度给予相应的软组织重建手术,包括腓骨肌延长术、跟腱延长术.[结果]所有患儿术后平均随访2年8个月,所有患儿骨性愈合并且畸形没有复发,行走步态改善.3例出现骑缝钉松动、退钉,2例骑缝钉断裂,但没有出现延迟愈合、假关节形成,也没有出现行走时疼痛.[结论]采用骑缝钉技术行关节外距下关节融合术治疗脑瘫性外翻足畸形疗效确切,目前本研究仅为中短期疗效,还需要长期的随访观察.

目的:比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗Kümmell病的临床疗效和安全性.方法:回顾性分析48例Kümmell病患者的病例资料,其中采用PKP治疗28例,采用PVP治疗20例.男5例,女43例;年龄60～75岁,中位数67岁;病变椎体位于T102例、T119例、T1215例、L114例、L24例、L31例、L41例、T12和L11例、T9和T121例.比较2组患者的手术时间、骨水泥注射量及并发症发生情况,以及术前、术后2 d、术后1个月及末次随访时2组患者的腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎前缘高度、伤椎与邻椎前缘高度比值、伤椎后凸Cobb角.结果:①手术时间和骨水泥注射量.PKP组手术时间长于PVP组[(68.35±11.63)min,(45.29±9.76)min,t=-7.454,P=0.000],骨水泥注射量少于PVP组[(2.95±0.56)mL,(3.29±0.66)mL,t=1.856,P=0.070].②腰背部疼痛VAS评分.时间因素与分组因素不存在交互效应(F=0.076,P=0.785);2组患者腰背部疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.132,P=0.895);手术前后不同时间点之间腰背部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=710.533,P=0.000);2组患者腰背部疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(8.00±0.82)分,(3.18±0.61)分,(2.25±1.04)分,(1.82±0.95)分,F=301.206,P=0.000;(7.85±0.93)分,(2.90±0.64)分,(2.30±0.98)分,(2.00±0.97)分,F=189.922,P=0.000].③ODI.时间因素与分组因素不存在交互效应(F=0.785,P=0.380);2组患者ODI比较,组间差异无统计学意义,即不存在分组效应(F=-0.341,P=0.733);手术前后不同时间点之间ODI的差异有统计学意义,即存在时间效应(F=689.909,P=0.000);2组患者ODI随时间均呈降低趋势,且2组的降低趋势完全一致(69.79±10.84,38.39±5.65,25.50±4.14,21.61±3.75,F=296.004,P=0.000;71.55±9.57,40.50±4.38,27.05±3.71,20.25±3.39,F=304.494,P=0.000).④伤椎前缘高度.时间因素与分组因素存在交互效应(F=11.128,P=0.002);2组患者伤椎前缘高度比较,组间差异有统计学意义,即存在分组效应(F=-5.030,P=0.000);手术前后不同时间点之间伤椎前缘高度的差异有统计学意义,即存在时间效应(F=182.068,P=0.000);术前和末次随访时,2组患者伤椎前缘高度比较,差异无统计学意义[(13.33±1.33)mm,(14.05±1.21)mm,t=-1.898,P=0.064;(17.09±1.52)mm,(17.75±1.63)mm,t=-1.441,P=0.156];术后2 d和术后1个月,PKP组伤椎前缘高度均小于PVP组[(19.02±1.51)mm,(20.55±0.72)mm,t=-4.207,P=0.000;(17.56±1.87)mm,(18.75±2.09)mm,t=-2.075,P=0.044].⑤伤椎与邻椎前缘高度比值.时间因素与分组因素存在交互效应(F=13.048,P=0.001);2组患者伤椎与邻椎前缘高度比值比较,组间差异有统计学意义,即存在分组效应(F=-1.605,P=0.011);手术前后不同时间点之间伤椎与邻椎前缘高度比值的差异有统计学意义,即存在时间效应(F=501.461,P=0.000);术前和末次随访时,2组患者伤椎与邻椎前缘高度比值比较,差异无统计学意义[(49.07±2.17)％,(50.78±3.84)％,t=-1.959,P=0.056;(73.50±3.48)％,(74.65±4.19)％,t=-1.036,P=0.306];术后2 d和术后1个月,PKP组伤椎与邻椎前缘高度比值均小于PVP组[(74.81±3.65)％,(78.58±6.73)％,t=-2.497,P=0.016;(73.89±4.24)％,(76.85±3.73)％,t=-2.501,P=0.016].⑥伤椎后凸Cobb角.时间因素与分组因素存在交互效应(F=10.777,P=0.002);2组患者伤椎后凸Cobb角比较,组间差异有统计学意义,即存在分组效应(F=-2.224,P=0.027);手术前后不同时间点之间伤椎后凸Cobb角的差异有统计学意义,即存在时间效应(F=89.178,P=0.000);术前和末次随访时,2组患者伤椎后凸Cobb角比较,差异无统计学意义(20.70°±1.71°,19.89°±1.19°,t=-1.930,P=0.060;13.59°±2.42°,13.39°±2.65°,t=-0.281,P=0.780);术后2 d和术后1个月,PKP组伤椎后凸Cobb角均大于PVP组(16.78°±2.27°,14.69°±3.33°,t=-2.417,P=0.020;14.50°±2.65°,12.89°±2.11°,t=0.140,P=0.024).⑦安全性.PVP组1例出现骨水泥椎旁渗漏,PKP组2例出现骨水泥上椎间隙内渗漏,2组患者均未出现伤椎再骨折和邻椎骨折等并发症;2组并发症发生率比较,差异无统计学意义(P=1.000).结论:采用PVP与PKP治疗Kümmell病,均能缓解腰背部疼痛,恢复椎体高度,纠正后凸畸形,改善脊柱功能,且并发症少.前者在缩短手术时间、恢复椎体高度、纠正后凸畸形方面优于后者,但后者较前者骨水泥注射量少.

目的 分析腰椎板切除内固定术后骶棘肌疝发生的原因,预防措施及治疗的方法.方法 回顾研究分析2006年7月至2014年11月,北京中医药大学东直门医院450腰椎板切除减压内固定术后的患者,收集患者的一般资料、手术方式、术后疗效及随访,观察患者临床疗效.结果 所有患者均成功完成腰椎板切除内固定术,2006年7月至2010年7月行腰椎板切除内固定的手术患者15例发生骶棘肌疝,2010年8月至2014年11月行腰椎板切除内固定术的患者无一例出现骶棘肌疝.15例患者通过佩戴腰围和局部理疗、针灸等对症治疗,腰部疼痛及腰部力量均有不同程度的加强.结论 术中减少剥离范围,尽量保留棘突,重建筋膜、肌肉的附着点.可恢复韧带-筋肉复合体的完整性,可有效防止腰椎板切除内固定术后骶棘肌疝的发生.

The aim of this study was to evaluate the efficacy and safety of an application using spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in difficult pedicle screw fixation. 78 patients with congenital deformity of spinal column and spinal cord (41 cases) or spinal instability after laminectomy or semi-laminectomy (37 cases) were instrumented with pedicle screw system by spinal navigation with the intra-operative 3D-imaging system from September 2004 to September 2014 in our orthopedic department. The position of pedicle screw was assessed by intra-operative 3D-imaging system. The excellent rate of pedicle screw position, mean time of pedicle screw implanted, operating time, blood loss, post-operative complication were recorded. The excellent rate of pedicle screw position was 96% in these cases. The mean time of pedicle screw implanted, operating time and blood loss were 3.90 +/- 0.87 minutes, 147 +/- 65 minutes and 312 +/- 185 ml, respectively. There was no implant-related complication that occurred during operation. With spinal navigation combined with the intra-operative 3D-imaging modality, implantation of difficult pedicle screw in patients with congenital spinal deformity or spinal instability after laminectomy or semi-laminectomy is more simplified, more accurate, safer, and shorter time-consuming.

BACKGROUND:Salvianolic acid B is an effective monomer component of Salvia miltiorrhiza, which has been shown in recent years to have neuroprotective role and to promote nerve recovery, but its mechanism is not clear. OBJECTIVE: To explore the protective mechanism of salvianolic acid B on Schwann cels in rats with spinal cord injury. METHODS: Schwann cels of Sprague-Dawley rats were cultured and divided into normal control group, model group, 10 μmol/L methylprednisolone group and salvianolic acid B group (0.1, 1, 10, 100 μmol/L). Models of Schwann cel injury induced by lipopolysaccharide were established in al the groups except the normal control group. After intervention, growth curve and proliferative activity of Schwann cels were detected, and protein and gene expressions of β-catenin and nuclear factor-κB were observed. RESULTS AND CONCLUSION: At 48, 72, 96 hours after intervention, the cel viability of the model group was significantly lower than that of the normal control group (P < 0.01). Compared with the model group, the cel viability of salvianolic acid B group (10 μmol/L) was significantly increased at 72 and 96 hours (P < 0.05); the expressions of nuclear factor-κB protein and mRNA in the methylprednisolone group and salvianolic acid B group were declined significantly (P < 0.01), but the expressions of β-catenin mRNA and protein in the salvianolic acid B group significantly increased (P < 0.05). These results suggest that salvianolic acid B improves the viability of Schwann cels which are stimulated with lipopolysaccharide, suppresses expression of nuclear factor-κB mRNA&nbsp;and protein, and promotes the expression of β-catenin mRNA and protein. Above may be one of the mechanisms which salvianolic acid B protects Schwann cels.

目的：观察半夏白术天麻汤对椎动脉型颈椎病(CSA)的疗效，并探讨其作用机理。方法：将60例椎动脉型颈椎病患者随机分为治疗组(半夏白术天麻汤)和对照组(西比灵)两组，其中治疗组30例，给予半夏白术天麻汤治疗，每天1剂，分早晚服；对照组30例，给予西比灵口服，每次口服5mg，每晚一次。结果：治疗组中医症候疗效及对椎基底动脉供血的改善均优于对照组。结论：半夏白术天麻汤具有改善椎-基底动脉供血不足、是治疗椎动脉型颈椎病的有效方剂。

[Objective]To observe the clinical effect and imaging results of the treatment of adjacent segment cervical spondylosis in the adjacent bi-level BRYAN cervical disc replacement.[Method]A retrospective studying was performed on 19 cases of cervical spondylosis receiving adjacent bi-level BRYAN artificial cervical disc replacement and were followed up from January 2006 to February 2009 in our hospital.Clinical outcome of surgery was evaluated by Japanese Orthopaedic Association score(JOA),neck disability index(NDI) and visual analogue pain scale(VAS)for neck pain before surgery and at 1 week,3,6,12,24,36 months after surgery respectively.The range of motion(ROM) of the surgical segments,the upper and lower adjacent segments,and C2-7 was assessed by cervical dynamic X-ray film before operation and 3,6,12,24,36 months after sugery.Operative adjacent segment degeneration was assessed by X-ray disc degeneration scoring system 12,24 and 36 months after surgery.[Result]The neurological symptoms of each patients were significantly improved.The postoperative JOA score,NDI scores,neck pain VAS scores were improved significantly at each follow-up time point compared with those of preoperation,difference was statistically significant(P0.05),but no statistical significance were noted between each time point after 3-month follow-up(P0.05).ROM of the two operative segment increased significantly compared with the preoperative each time point after 3-month follow-up(P0.05).ROM of the upper and lower adjacent segments slightly reduced and C2-7 slightly increased but both showed no statistical significance compared with the preoperative between each time point after 3-month follow-up(P0.05).To the last follow-up,the surgery had not led to adjacent segment disc degeneration exacerbated and no serious complications occurred.[Conclusion]The clinical result of BRYAN artificial cervical disc replacement in the treatment of adjacent bi-level cervical degenerative disc disease is good,not only reserving the kinematic characteristics of operative segment,adjacent segments,C2-7 segment but preventing of adjacent segment degeneration.No serious complication occurs during mediterm follow-up.

Objective To explore the clinical effect of percutaneous kyphoplasty in treatment of osteoporotic vertebral compressive fracture. Methods From April 2010 to November 2012, 80 patients with osteoporotic vertebral compressive fracture were randomly divided into 2 groups, experimental group (n=40) and control group (n=40). Patients in experimental group were treated with percutaneous kyphoplasty, while patients in control group were treated with percutaneous vertebro-plasty. Results All the patients were followed up for 6 months. The VAS score, Cobb's angle, and ODI score after operation were significantly lower than those before operation in both two groups (P<0.05). The VAS score in experimental group was significantly lower than that in control group 6 months after operation (P<0.05). Furthermore, the Cobb's angle and ODI score in experimental group were significantly lower than those in control group 3 days and 6 months after operation ( P<0.05). In addition, the leakage rate of bone cement in experimental group was significantly lower than that in control group after operation (P<0.05). Conclusion Percutaneous kyphoplasty in treatment of osteoporotic vertebral compressive fracture is effective and reliable. It can be the preferred method in treatment of osteoporotic vertebral compressive fracture.

Objective To evaluate the incidence,related risk factors and treatment strategy of the early deep infections following instrumented lumbar posterior spinal fusion.Methods A total of 1 492 consecutive patients who underwent instrumented lum-bar posterior spinal fusion procedure at our hospital from 2003 to 2011 were retrospectively reviewed.The incidence of early deep infection was calculated.Each patient was assigned an infection risk factor score (RFS)depending on the number of RFS indentified in that patient preoperatively.The mean RFS was compared between the patients who developed early deep infection and those without infection.The outcome of continuous irrigation-suction combined with intravenous antibiotic therapy plus wound debridement and retention of implants was assessed to identify the most appropriate conditions for removing the implant during initial wound debridement.Results Early deep infection occurred in 11 out of the 1 492 patients (0.74%).The mean RFS was 2.64±0.24 for the patients who developed infections and 0.78±0.55 for the patients without infection (P =0.032). The infection was eradicated completely in 6 of the 9 patients who were managed by continuous irrigation-suction combined with intravenous antibiotic therapy plus wound debridement and retention of implants.The other 3 patients who had persistent wound discharge received second debridement and removal of implants,which resulted in infection free in 2 patients and death due to septic shock 1 month after wound healing in 1 patient. The infection was successfully treated in the 2 patients who had prior long-term use of corticosteroids and RFS ≥ 3 by complete debridement in combination with continuous irriga-tion-suction drainage,intravenous antibiotic therapy and re-moval of implant during initial wound debridement.Conclusions The incidence of early deep infection following instrumented lumbar posterior spinal fusion is relatively low.Continuous irrigation-suction drainage combined with intravenous antibiotic ther-apy plus wound debridement and retention of implants is a relatively effective method for management of the early deep infections following instrumented lumbar posterior spinal fusion.For the patients who have prior long-term use of cortocosteroids and RFS≥ 3,removal of implant during initial wound debridement may be better for infection control.

目的 评价Wallis治疗腰椎间盘突出症的疗效.方法 回顾我科2011年1月～2012年6月收治的46例腰椎间盘突出症患者,均行椎板开窗减压置入Wallis治疗.通过随访术前、术后腰腿痛视觉模拟量表(visual analogue scale,VAS)；椎间隙高度的变化；中华医学会骨科分会脊柱外科学组手术疗效标准进行分析.结果 患者术后均未发生手术相关并发症,所有患者术后症状和体征均有不同程度改善,术前、术后2周及末次随访(12个月)疼痛VAS评分别为8.2±1.4、2.6±1.8和1.8±0.8,差异有统计学意义(P＜0.01)；术前、术后2周及末次随访(12个月)X线侧位片Wallis植入节段的椎间高度分别为(8.2±2.4)mm、(10.2±2.3)mm和(10.1±1.8)mm,术后2周及末次随访(12个月)植入节段椎间高度较术前有所增加,差异有统计学意义(P＜0.05)；末次随访时植入节段椎间高度较术后2周无明显丢失(P＞0.05)；末次随访患者功能恢复优良率为92.4％,对手术整体的满意度为93.8％.结论 Wallis治疗腰椎间盘突出症简便安全,随访疗效满意.

Objective To evaluate the effects of Wallis treatment of lumbar disc herniation. Methods From Jan 2011 to Jun 2012, a retrospective analysis was done and 46 patients who received stabilization of the segment using the Wallis device were reviewed. Preoperative and postoperative visual analogue scales(VAS) were recorded and Efficacy standard of Chinese Medical Association of Orthopaedic Spine Surgery Group were adopted to evaluate the clinical efficiency, imageology diversity was assessed by X-ray. Results Improvement has been shown by all cases received fenestration and the implantation of Wallis. No complications were recorded.The average VAS preoperatively and postoperatively for back and leg pain was respectively 8.2±1.4,2.6±1.8 and 1.8±0.8(P<0.01). Difference was statistically significant. Preoperatively, two weeks postoperatively and last follow-up X-ray photography Wallis implant segment intervertebral height were respectively(8.2±2.4)mm,(10.2±2.3)mm,(10. 1±1.8)mm,which indicates that, after two weeks the intervertebral height increased compared with the preoperative height(P<0. 05) and remains stable(P>0.05). Last follow-up in patients with good functional recovery was 92.4%.Overall satisfaction with the surgery was 93.8%. Conclusion Wallis treatment of lumbar disc herniation is simple and safe,the results are satisfactory.

Objectives: To investigate the clinical efficacy and imaging results of the adjacent segment instability in patients with cervical spondylosis treated by Bryan cervical disc replacement.Methods: A retrospective review was performed on 9 cases suffering from adjacent segment instability before surgery.All 9 cases underwent Bryan artificial cervical disc arthoplasty and were followed up from July 2005 to January 2009 in our hospital.There were 4 males and 5 females with an average age of 33.5 years(range,26-43 years).Japanese Orthopaedic Association(JOA) score was 10.16±3.17(7-13),and visual analogue pain scale(VAS) was 4.3±2.7(1-7) before surgery.All patients underwent cervical flexion and extension plain film and cervical MRI before surgery.Imaging instability was confirmed in the adjacent segment,which was asymptomatic.C4/5 replacement,1 cases instability in C5/6;C5/6 replacement 4 cases,3 cases instability in C4/5,1 cases instability in C6/7;C6/7 replacement,2 cases instability in C5/6.The double segment replacement 2 cases,each 1 cases instability in C4/5,C5/6 and C5/6,C6/7,which both are adjacent to the head-end segment.Clinical outcome of surgery was evaluated by JOA,neck pain VAS and Odom before surgery and at 1 week,3,6,12,24,36 months after surgery respectively;the range of motion(ROM) of the surgical segment,adjacent unstable segment,C2-C7 and cervical malalignment were assessed by cervical dynamic X-ray before operation and 3,6,12,24,36 months after surgery.Results: The JOA score,neck pain VAS were improved significantly at each follow-up 3 months later after surgery compared with those of preoperation,difference was statistically significant(P0.05).Odom score was excellent in 6 cases,good in 1 case,fair in 2 case,good rate of 77.8% 1 week and 3months after surgery,excellent in 6 cases,good in 2 case,fair in 1 case,good rate of 88.9% 6 months after surgery,excellent in 7 cases,good in 1 case,fair in 1 case,good rate of 88.9% 12,24 and 36 months after surgery.The angular displacement and cervical curve of adjacent unstable segment at 3,6,12 months after operation showed no statistically significant difference compared with the preoperative ones(P0.05),while decreased significantly at 24 and 36 months(P0.05).ROM of implanted segment and cervical curve at 24 and 36 months after operation increased significantly(P0.05) compared with preoperative ones.The postoperative ROM of C2-C7 remained unchanged at each follow-up compared with the preoperative ones.During the follow-up,no surgical related complications were noted.Conclusions: The short and medium term clinical result of Bryan artificial cervical disc replacement for cervical spondylosis is reliable,which can relieve adjacent segment instability.

OBJECTIVE:To evaluate the intermediate and long-term follow-up effect of posterior dynamic lumbar stabilization in lumbar degenerative disease.METHODS:The clinical outcomes of 96 patients (male 51, female 45, age from 21 to 68 years, mean 41.5 years) whose follow-up time were more than 2 years with lumbar degenerative disease treated by posterior decompression with Wallis posterior dynamic lumbar stabilization implant or combined with posterior lumbar fusion from August 2007 to January 2010 were retrospectively studied, and assessed with visual analogue scale (VAS) and spinal operative standard of Chinese Medical Association. The early and long-term follow-up effect and complications associated with Wallis posterior dynamic lumbar stabilization were recorded. The height of intervertebral space at the treated level in lateral plain film were measured at preoperatively, 3 month postoperatively and last follow-up, respectively. The finds of MRI obtained at over 6 month postoperative were recorded.RESULTS:The operative procedure of Wallis posterior dynamic lumbar stabilization implant was easy and less invasive. The VAS scores were 78 ± 24, 28 ± 16 and 14 ± 12 preoperatively, 3 month postoperatively and last follow-up, respectively. The good or excellent result was 91.7% at the last follow-up. No complication related with Wallis posterior dynamic lumbar stabilization was found. The rate of patient's satisfaction with the Wallis implant operation was 95.8%. The disc height at the treated level in lateral plain film were (8.2 ± 3.7), (10.4 ± 2.6) and (10.1 ± 1.9) mm at preoperatively, 3 month postoperatively and last follow-up, respectively. There is no further degenerative change found in MRI obtained at over 6 month postoperative. MRI 1 year after Wallis procedure showed rehydration of the formerly black disc at the treated level.CONCLUSIONS:It is easy and safe to use Wallis posterior dynamic lumbar stabilization in treatment of degenerative lumbar disease, and the effect of the intermediate and long-term follow-up more than 2 years is good. The Wallis system provides an alternative for treatment of lumbar degenerative disease.

目的探讨高龄退变性腰椎管狭窄症患者的临床特点和疗效。方法对272例高龄退变性腰椎管狭窄症行手术治疗,椎板间开窗减压55例(A组),全椎板或半椎板切除减压69例(B组),全椎板切除减压结合椎弓根螺钉内固定结合横突间自体植骨148例(C组)。结果 244例获得随访6～45个月,平均25.8个月,A、B、C组优良率分别为78.8%、75.9%、81.3%。结论高龄退变性腰椎管狭窄症具有特殊的临床特点,手术风险高,应合理选择手术方法,可减少并发症。

目的探讨三维影像脊柱导航引导下后路内固定及融合治疗退行性腰椎滑脱的临床疗效。方法对38例退行性腰椎滑脱进行影像导航引导下后路经椎弓根螺钉内固定、减压及后外侧植骨融合术。结果临床症状明显改善,融合率达92.1%,术后JOA评分明显高于术前(P<0.05),VAS评分明显低于术前(P<0.05)。结论术中三维影像导航引导下治疗退行性腰椎滑脱,准确定位椎弓根螺钉置入点,减少并发症,提高后外侧植骨融合率,可获得满意的疗效。

[Objective] To evaluate the early effect of posterior dynamic lumbar stabilization in lumbar degenerative disease.[Methods]The clinical outcomes of 31 patients with lumbar degenerative disease treated by posterior decompression with Wallis posterior dynamic lumbar stabilization implant or combined with posterior lumbar fusion were retrospectively studied,and assessed with visual analogue scale(VAS)and spinal operative standard of Chinese Medical Association.The early effect and complications associated with Wallis posterior dynamic lumbar stabilization were recorded.[Results]The operative procedure of Wallis posterior dynamic lumbar stabilization implant was easy and less invasive.The VAS scores were 7.9±2.0,2.6±1.2 and 1.7±0.8 at one day preoperatively,two week postoperatively and final follow-up,respectively.The good to excellent result was 94.4% at the lastest follow-up.No compliction related with Wallis posterior dynamic lumbar stabilization was found.[Conclusion]It is easy and safe to use Wallis posterior dynamic lumbar stabilization in treatment of degenerative lumbar disease,and the early effect is good.The Wallis system provides an alternative for treatment of lumbar degenerative disease.