目的:观察经皮椎弓根钉内固定治疗胸腰椎骨折的临床疗效及对应激反应的影响。方法:回顾性选取67例胸腰椎骨折患者，根据术式分为对照组30例和观察组37例，对照组予开放椎弓根钉内固定，观察组予微创经皮椎弓根内固定。比较两组手术情况(手术时间、术中出血量、住院时间)、VAS评分、ODI评分，行影像学检查(椎体高度、Cobb角)，测定应激反应指标(肌酸激酶、肾上腺素、皮质醇、C-肽)，记录并发症发生情况。结果:术后两组VAS评分、ODI评分、Cobb角显著降低，椎体高度和血清肾上腺素、皮质醇、肌酸激酶含量显著增加(均 P<0.05)。与对照组相比，观察组VAS评分、ODI评分、血清肾上腺素、肌酸激酶含量均较低(均 P<0.05)；手术时间、术中出血量、住院时间明显较少(均 P<0.05)。观察组并发症发生率为5.4%，低于对照组的23.3%( P<0.05)。 结论:微创经皮椎弓根钉内固定适于治疗胸腰椎骨折。

BACKGROUND:Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain.OBJECTIVE:To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum.STUDY DESIGN:A prospective cohort study.SETTING:Hospital and outpatient surgery center.METHODS:From January 2017 to March 2018, 15 patients with 1 - 2 segment thoracic ossified ligamentum flavum were treated with ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum under local anesthesia. The magnetic resonance imaging and computed tomography of the thoracic spine was reexamined after the operation to evaluate the completeness of ossified ligamentum flavum resection and spinal cord decompression. The patients were followed up on the visual analog scale of back pain and radicular pain, Nurick score and mJOA score of neurological function, and Oswestry Disability Index at 1 week, 3 months, 6 months, one year, and 2 years after operation.RESULTS:All operations of 17 segments thoracic ossified ligamentum flavum in 15 patients were successfully completed without intraoperative conversion to open surgery. There were no intraoperative spinal cord injuries, dura tears, postoperative cerebrospinal fluid leakage, postoperative infections, and postoperative spinal cord injury aggravated symptoms. Postoperative thoracic spine magnetic resonance imaging and computed tomography examinations of all patients showed that the spinal cord was fully decompressed without any residual pressure. Back pain and radicular pain were relieved significantly, and spinal cord function (Nurick, mJOA, and Oswestry Disability Index scores) was obviously restored. The mJOA recovery rate at the 2-year follow-up was 78.3% in average.LIMITATIONS:This is an observational cohort study with relative small sample and short-term follow-up.CONCLUSIONS:Ultrasonic assisted full-endoscopic en block resection of ossified ligamentum flavum is a safe and effective minimally invasive spine surgery for thoracic myelography caused by thoracic ossified ligamentum flavum.

Objective: To study the technical notes and clinical efficacy of full-endoscopic thoracic intervertebral discectomy via transforaminal approach. Methods: We included 16 patients with thoracic disc herniation treated by full-endoscopic thoracic discectomy via transforaminal approach between January 2017 and September 2018 in ours department of orthopedics. The average age is 53.7 years. The compressionare classified by nature: 5 cases of soft thoracic disc herniation, 7 cases of calcified or ossified thoracic disc herniation, and 4 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc. All patients had symptoms of thoracic myelopathy before operation, and 7 of them had radiculopathy. Via transforaminal approach under local anesthesia, enlarged foraminoplasty and full-endoscopic thoracic discectomy were used for treatment. Observe the changes of postoperative imaging, pain symptoms and recovery of spinal cord function at 1 week, 3 months, 6 months and 1 year after operation. Back pain and radicular pain were scored with VAS, neurological function was assessed with Nurick score and mJOA score, and thoracic spine function was assessed with Oswestry disability index (ODI). Results: All operations were successfully completed, and no intraoperative conversion of surgical methods occurred. Postoperative thoracic MRI and CT examinations of all patients showed that the spinal cord was fully decompressed without any residual compression. Back pain and radicular pain were all relieved obviously in all patients, and spinal cord function was obviously restored. Transient intercostal neuralgia occurred in 2 cases after operation, and no other surgical complications occurred. Conclusions: Full-endoscopic or fluoroscopic foraminoplasty and full-endoscopic thoracic discectomyvia transforaminal approach under local anesthesia is a safe and effective treatment for soft and hard thoracic disc herniation located on the ventral side of the spinal cord.

OBJECTIVE:To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture. METHODS:A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded. RESULTS:All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L3, 4 and 19 cases of L4, 5), and 23 patients(including 11 cases of L4, 5 and 12 cases of L5S1) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(P<0.01). At 1 year postoperative follow up, 17 patients got an excellent result, 29 good and 4 fair according to Macnab evaluation system. On the first year after surgery, the sense of damaged nerve roots and muscle strength were significantly restored (P<0.01), but tendon reflexes were not significantly restored (P>0.05). CONCLUSION:Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.

BACKGROUND:An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. OBJECTIVE:The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. STUDY DESIGN:This study used a prospective cohort design. SETTING:The research was conducted in a hospital and outpatient surgery center. METHODS:A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. RESULTS:All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the one-year follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05). LIMITATIONS:This is an observational cohort study with relatively small sample sizes and short-term follow-up. CONCLUSIONS:Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy.

Objective To gather outcome data of percutaneous radiofrequency neurotomy and endoscopic rhizotomy of the lumbar medial branch for facetogenic chronic low back pain, and to compare treatment efficacy of the two approaches. Methods Forty facetogenic chronic low back pain patients were included and randomly assigned to receive percutaneous radiofrequency neurotomy ( RN group, 20 cases ) or endoscopic neurotomy of the lumbar medial branch ( EN group, 20 cases ). Endoscopic neurotomy was performed for the second group. Outcomes were obtained by VAS, ODI and SF-36 preoperatively and at 3 weeks, 6 months, 1 year and 2 years postoperatively. The results of two groups were compared. Results RN group demonstrated excellent results at 3 weeks after operation [ VAS Score decreased from ( 7.15 ± 0.81 ) pre-operatively to ( 2.60 ± 0.75 ) post-operatively; ODI Score decreased from ( 76.75 ± 7.07 ) to ( 28.00 ± 3.84 ); while SF-36 Score increased from ( 79.01 ± 13.81 ) to ( 92.67 ± 11.13 ). The treatment achieved an improve rate of ( 63.04 ± 12.49 ) % and an excellence rate of 100% ]. At 6 months after operation, the clinical data VAS Score, ODI Score and SF-36 Score were ( 3.85 ± 0.88 ), ( 32.50 ± 4.44 ), ( 87.32 ± 17.20 ), indicating less improvement with an improvement rate of ( 45.68 ± 13.18 ) % and an excellence rate of 60%. At 2 years after the operation, patients' conditions became the same as 2 years ago ( P > 0.05 ). EN group demonstrated prolonged excellent clinical outcomes compared with the RN group. At 6 months after operation, VAS Score, ODI Score and SF-36 Score were ( 3.15 ± 0.57 ), ( 27.50 ± 2.96 ), ( 87.89 ± 14.49 ), indicating an improvement rate of ( 55.45 ± 9.01 ) % and an excellence rate of 90%. At 1 year after operation, the efficacy declined. VAS Score, ODI Score and SF-36 QOF Score were ( 3.40 ± 0.68 ), ( 35.70 ± 5.81 ), ( 81.53 ± 12.02 ), indicating an improvement rate of ( 51.49 ± 12.83 ) % and an excellence rate of 80%. At 2 years after operation, the efficacy further declined. VAS Score, ODI Score and SF-36 QOF Score decreased to ( 3.93 ± 0.75 ), ( 44.35 ± 3.99 ), ( 77.86 ± 10.75 ), indicating an improvement rate of ( 44.17 ± 11.33 ) % and an excellence rate of 45%. The data showed significant improvement compared with pre-operative data ( P < 0.05 ). There were no significant differences of VAS Score, ODI Score and SF-36 Score between the 2 groups at 3 weeks after operation ( P > 0.05 ). At 6 months and later after operation, RN group demonstrated better outcomes ( P < 0.05 ). Conclusions For facetogenic chronic low back pain, endoscopic neurotomy and X-ray assisted percutaneous radiofrequency neurotomy of the lumbar medial branch are both effective. Endoscopic lumbar medial branch neurotomy has the advantages of higher surgical precision and better long-term efficacy.

目的 评价腰椎脊神经背内侧支切断术后腰椎肌力及活动度功能的变化.方法 筛选符合小关节源性腰痛诊断标准的患者40例,按照电脑随机数发生器随机分为经皮组(20例)和内镜组(20例).经皮组行X线辅助下经皮穿刺脊神经背内侧支射频消融术,内镜组行内镜辅助下脊神经背内侧支切断术,记录两组术前及术后6个月时的腰椎前屈、后伸、左右侧屈和左右旋共6个方向的最大等长收缩肌力和活动度,进行组内对照及组间对照对比分析.结果 组内对照:两组术后腰椎肌力、前屈活动度与术前相比差异无统计学意义(P>0.05),内镜组术后腰椎后伸活动度为(21.21±0.13)°、左侧屈活动度为(31.95±1.03)°、右侧屈活动度为(34.53±1.12)°、左旋活动度为(45.95±1.19)°、右旋活动度为(45.95±1.19)° 均大于术前[活动度依次为(15.05±1.58)°,(24.02±0.92)°,(22.02±1.95)°,(32.72±0.92)°,(34.02±0.31)°],经皮组术后腰椎后伸活动度为(25.25±1.41)°、左侧屈活动度为(32.01±1.01)°、右侧屈活动度为(35.01±2.21)°、左旋活动度为(38.01±1.64)°、右旋活动度(40.01±0.67)° 均大于术前[活动度依次为(14.99±2.27)°,(26.38±2.10)°,(23.21±1.30)°,(33.03±1.06)°,(35.31±0.14)°],差异有统计学意义(P<0.05);组间对照:术前腰椎前屈、后伸、左右侧屈、左右旋6个方向肌力及活动度两组间差异无统计学意义(P>0.05),内镜组术后腰椎左右旋活动度[分别为(45.95±1.19)° 和(47.37±1.21)°]大于经皮组[分别为(38.01±1.64)°,(40.01±0.67)°]差异有统计学意义(P<0.05),腰椎前屈、后伸、左右侧屈、左右旋6个方向肌力及前屈、后伸、左右侧屈活动度两组间差异无统计学意义(P>0.05).结论 脊神经背内侧支切断并未对腰椎前屈后伸、左右侧旋和左右旋的肌力带来不良影响;脊神经背内侧支切断后,腰椎的腰椎后伸、左右侧屈、左右旋活动度得到了提升;内镜下脊神经背内侧支切断较经皮穿刺射频能获得更为明显的左右旋活动度的提升.

BACKGROUND:Conventional percutaneous endoscopic lumbar discectomy (PELD) with an "inside-outside" technique has 4.3% - 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots.STUDY DESIGN:A prospective cohort study.SETTING:Hospital and outpatient surgical center.OBJECTIVE:To evaluate the outcome and safety of modified PLF-PELD with a specially designed instrument for complex uncontained lumbar HDs.METHOD:From April of 2007 to April of 2009, 148 patients with uncontained lumbar HDs were treated with modified PLF-PELD. Magnetic resonance imaging (MRI) checkup was performed the next morning after the operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, one year, and 5 years after surgery. Low back pain and leg pain were measured by visual analog scale (VAS) score (1 - 100). Functional outcomes were assessed by using the Oswestry Disability Index (ODI) and modified MacNab criteria.RESULTS:Follow-up data were obtained from 134 cases, including 14 cases on L3-4, 78 cases on L4-5, and 42 cases on L5-S1. One hundred-eight cases were prolapse type, while 26 cases were sequestration type. Pre-operative symptoms and deficits included nerve root dermatome hypoesthesia in 98 patients (73%), nerve root myotome muscle weakness in 32 patients (23%), and weakening or disappearance of tendon reflex in 43 patients (32%). No case required conversion to an open procedure during the surgery. Low back pain and leg pain were significantly relieved immediately after surgery in all patients. MRI examination showed adequate removal of HD in all patients. VAS scores and ODI values were significantly lower at all time points after surgery than before surgery. The percentage of pain relief in leg pain was significantly higher than that in low back pain (P < 0.01). But there was no significant correlation between duration of the preoperative symptoms and the percentage of pain relief. MacNab scores at 5 years after surgery were obtained from 134 patients. Seventy-five cases were rated "excellent"; 49 were rated "good," Five patients experienced heavier low back pain, thus being classified as "fair." Five cases with recurrence were rated "poor." Preoperative and postoperative (5 years follow-up) related nerve root function status was compared. Sensation and muscle strength recovered significantly (P < 0.01), while tendon reflex was not changed (P = 0.782). No patients had infections. Five patients were complicated with dysesthesia in distribution of the exiting nerve that was all operated at L5-S1. Complaints were reduced one week after treatment with medium frequency pulse electrotherapy. Five cases required a revision surgery after recurrence.LIMITATIONS:This is an observational clinical case series study without comparison.CONCLUSION:Modified PLF-PELD with a specially designed instrument is a less invasive, effective and safe surgery for complex uncontained lumbar DH.Key words: Lumbar disc herniation, minimally invasive treatment, foraminoplasty, percutaneous endoscopic lumbar discectomy.

outside” technique has 4.3% – 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots.

OBJECTIVE:To evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs). METHOD:From August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1-100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria. RESULT:Two years follow-up data were obtained from 85 cases, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5S1, 1 case on bilateral L5S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4-S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46-78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given "excellent"; 48 were given "good". 6 patients experienced heavier low back pain, thus being classified as "fair". 2 cases with recurrence were given "poor". CONCLUSIONS:PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs.

Percutaneous radiofrequency neurotomy (PRN) is a neurosurgical technique for chronic cervical zygapophyseal joint (Z-joint) pain. However, its failure of some 30% of patients to respond may be compatible with inadequate patient selection, anatomic variation of MB, malposition of electrode, incomplete ablation, and regeneration of MB, etc. In theory, pain will return when the axons regenerate and nociceptive transduction is reinstated. This study aims to evaluate the effect and safety of a newly established percutaneous endoscopic cervical medial branch neurotomy (PECMBN) technique for chronic cervical Z-joint pain. 25 patients of cervical Z-joints pain diagnosed by means of placebo-controlled, diagnostic triple anesthetic medial branch blocks (MBB) were non-randomly divided into conservative group (11 cases) receiving conservative treatment and operation group (14 cases) receiving PECMBN in which target MBs were exposed endoscopically and cut off with micro-punch and ablated with tip-flexible radiofrequency electrode. Visual analogue score (VAS) of neck pain and referred pain were followed up. The MacNab score was recorded at 12 months postoperatively. Results show that the percentage of pain relief (neck/referred) at any time point postoperatively in operation group was higher compared to that in conservative group. MacNab outcomes in operation group were significantly better than that in conservative group. So we concluded that PECMBN for chronic cervical Z-joint pain is an accurate, effective and safe minimally invasive spine surgery. Higher success rate can be achieved compared with reported outcomes of PRN without complications increased.

目的 探讨骨质疏松性单节段椎体骨折经皮椎体后凸成形术(percutoneous kyphoplasty,PKP)后,责任椎体引起背部疼痛复发的原因,为预防和临床治疗提供参考.方法 笔者所在单位同一组医生自2006年1月至2009年12月共收治因骨质疏松引起单节段椎体压缩骨折而行PKP的患者共52例,其中28例术后随访＞ 12个月,其中男11例,女17例;年龄68 ～ 86岁,平均(74.13±4.18)岁.随访时间12 ～ 34个月,平均(18.50±7.26)个月.按照是否复发背部疼痛分为A、B组:术后未复发背部疼痛为A组(n=20),术后复发背部疼痛为B组(n=8).所有患者均记录年龄、性别、症状出现的时间,采用相同手术方法(PKP),记录骨水泥注入量(filling PMMP volume,FPV).手术前、后及复查时均采用视觉模拟评分(visual analogue scale,VAS)评估疼痛程度;通过骨密度(bone mineral density,BMD)比较手术前后及随访时BMD的T评分;通过X线、MRI检查比较手术前后及随访时骨折椎体的压缩率(compression rate,CR)、压缩的恢复率或丢失率,比较手术前后及随访时骨折椎体的后凸角度(kyphotic angle,KA)和后凸角度恢复率或丢失率;比较术后及随访时骨水泥(甲基丙烯酸甲酯)与椎体上下终板间距离(postoperation PMMP to endplate distance,PPED)的改变.对所有数据进行统计学分析.结果 背部疼痛复发患者原手术椎体均有不同程度的再骨折或塌陷.A、B组FPV有差异,但无统计学意义.A、B组CR术后均明显增加,两组差异无统计学意义;末次随访时B组CR恢复率为(17.4±9.3)％,A组为(24.1±11.1)％,两组间差异有统计学意义(P＜0.05);KA呈现同样的改变.A、B两组手术前VAS评分分别为(8.8±0.6)分、(8.6±0.5)分;术后分别为(2.1±0.6)分、(2.2±0.8)分,与术前比较差异有统计学意义(P＜0.05);B组末次随访时VAS评分为(7.5±1.2)分,与B组术后及A组末次随访(3.1±0.7)分比较,差异有统计学意义(P＜0.05).A组骨水泥上缘至上终板距离术后与末次随访比较,差异无统计学意义(P＞0.05);术后A组骨水泥下缘至下终板距离平均为(2.5±0.6)mm,末次随访时为(2.4±0.7)mm,与术后比较差异无统计学意义(P＞0.05);术后B组骨水泥上缘至上终板距离平均为(3.5±0.4) mm,末次随访时为(2.7±0.9)mm,与术后比较差异有统计学意义(P＜0.05),术后B组骨水泥下缘至下终板距离平均为(4.5±0.6)mm;末次随访时(3.3±0.4)mm,与术后比较差异有统计学意义(P＜0.05).结论 手术椎体再骨折或塌陷是引起单椎体压缩骨折PKP术后背痛复发的重要原因,适量的FPV可能有利于减少手术椎体再骨折或塌陷.适时监测CR、KA、T评分、PPED的变化可以为预防复发背部疼痛提供参考.

OBJECTIVES: We designed a novel surgical strategy named one-stage selective discectomy combined with expansive hemilaminectomy, which might theoretically reduce the postoperative complications of cervical spon-dylotic myelopathy (CSM). The objective of this study is to evaluate its efficacy and safety.METHODS: Sixty-two patients with CSM were enrolled in this study. The procedure includes selective discectomy with fusion at 1 or 2 segments of maximal cord compression and expansive hemilaminectomy on the symptomatic or severe side of the body. Neurologic function was evaluated using the Japanese Orthopedics Association Score before and after surgery. Midsagittal dural sac diameter, dural sac transverse area at segments of discetomy on magnetic resonance imaging, and lordosis of the cervical spine on lateral plain film were measured. All patients were followed up for more than 1 year.RESULTS: A total of 88 discs and 272 hemilaminas were resected from 62 patients. The Japanese Orthopedics Association Score improved from 8.7 +/- 1.76 preoperatively to 13.4 +/- 1.61 at 1 year follow-up (P < 0.001). The mean midsagittal dural sac diameter, dural sac area, and lordotic angle also increased from 0.45 +/- 0.10 cm, 0.83 +/- 0.14 cm(2), and 7.9 +/- 2.60 +/- to 0.81 +/- 0.08 cm, 0.96 +/- 0.14 cm(2), and 11.7 +/- 3.06 degrees, respectively (P < 0.05). No case of postoperative axial pain, C5 palsy, nonunion, or kyphosis was reported.CONCLUSIONS: One-stage selective discectomy combined with expansive hemilaminectomy is an effective surgical approach for the treatment of CSM in patients whose neurologic function, midsagittal dura sac diameter, and dura transverse area can be improved and has few postoperative complications.

Objective: To analyze the surgical strategy, safety and clinical outcome of full-endoscopic discectomy through interlaminar approach in the case of L5/S1 intervertebral disc excision.Methods: From April 2011 to December 2011,72 cases of intracanalicular non-contained disc herniations at L5/S1 level were treated with full-endoscopic discectomy through interlaminar approach. L5/S1 disc herniation was divided into three types according to position of herniated disc related to S1 nerve root: axilla type, ventral type and shoulder type. Axilla approach was selected for axilla type while shoulder approach was selected for ventral type and shoulder type. After operation, MRI was reexamined to evaluate the resection completeness of prolapsed disc material. Visual analog scales (VAS) of low back pain and sciatica, and Oswestry disability index (ODI) were recorded in certain preoperative and postoperative time points. MacNab scores were evaluated at the 12-month follow-up.Results: All operations were completed without conversion to other surgical techniques. Average operation time was 45 min (20-80 min). Only one reoccurrence was revised with microendoscopic discectomy. No nerve injury and infection were complicated. Postoperative ODI and VAS of low back pain and sciatica were significantly decreased in each time point (P < 0.05). MacNab scores of 12-month follow-up include 44 excellent, 26 good, 1 fair and 1 poor.Conclusion: With proper selection between axilla approach and shoulder approach according to the sites of prolapsed or sequestered disc materials, full-endoscopic L5/S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes. (C) 2015 Elsevier B.V. All rights reserved.

Current solutions for treating uncontained lumbar disk herniation include laser assisted endoscopic foraminoplasty and Transforaminal Endoscopic Spine System, both of which have some issues in clinical practice. This study aims to report the design of a new instrument for percutaneous posterolateral foraminoplasty. 148 patients with uncontained lumbar disk herniation were treated with percutaneous foraminoplasty followed by transforaminal endoscopic discectomy. Follow up were obtained for 134 cases. The VAS scores of pre-operative and post-operative low back pain and sciatica were compared. Oswestry Disability Index (ODI) and MacNab scores were also obtained. Follow-up was up to 5 years postoperatively. There were 75 of excellent, 49 of good and 5 of fair according to MacNab score system, with total successful rate up to 92.5%. 5 cases with L5S1 disc herniation complained about irritation to the dorsal root ganglion. In conclusion, the new transforaminal endoscopic discectomy instrument is safe and effective for percutaneous foraminoplasty.

Transforaminal percutaneous endoscopic lumbar discectomy(TF-PELD) is a minimally invasive procedure,which has developed very fast recently.The appearance of Yeung Endoscopy Spine System(YESS)marked the maturation of TF-PELD.The YESS consists of a video system and a rigid endoscope including optical fiber lighting,wide-angle lens,some irrigation channels and a working channel.Inclusive lumbar disc herniation can be treated,but it is inadaptable for herniated lumber disc prolapsed in the canal.The cross-sectional area of the intervertebral foramen will be expanded by using Transforaminal Endoscopic Spine System(TESSYS),so as to put the working tube into the canal.The puncture point is moved outside and the working tube will be put into the canal in the far-lateral technique invented by Ruetten et al.The deficiency of YESS is offset by the 2 techniques stated above,and the operation indications of TF-PELD are extended.In recent 20 years,the side injuries have been constantly reduced and as good clinical results as in traditional decompression procedures have been achieved.TF-PELD will hold a bright prospect.

Objective To prospectively study the surgical strategy, safety and early clinical outcomes of percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach. Methods From April 2012 to April 2013, 37 patients with lumbar lateral recess stenosis with or without calcified disc herniations or osteophytes on the posterior aspect of the vertebral body were treated with percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach. The lumbar MRI images were reexamined at 2 days and 3 months after the operation to evaluate decompression of the lateral recess and resection completeness of the prolapsed disc material. The Visual Analogue Scale ( VAS ) scores of low back pain and sciatica and Oswestry Disability Index ( ODI ) scores were recorded preoperatively and at 3, 6 and 12 months after the operation, and the statistically signiifcant differences were compared. The MacNab scores were evaluated at 12 months after the operation. Results All the operations were successfully completed without conversions to other surgical techniques. The average operation time was 50min ( range: 25-80 min ). Only 1 case of reoccurrence was revised with percutaneous transforaminal endoscopic discectomy. One case of facet syndrome was relieved by medial branch block. No nerve injuries, infections or other complications were noticed. The VAS score of low back pain was decreased from ( 24.4±14.0 ) points preoperatively to ( 7.5±6.9 ), ( 5.8±6.0 ) and ( 5.6±8.1 ) points at 3, 6 and 12 months after the operation respectively. The VAS scores of sciatica was decreased from ( 76.1±9.9 ) points preoperatively to ( 3.6±6.4 ), ( 1.7±3.8 ) and ( 1.7±3.8 ) points at 3, 6 and 12 months after the operation respectively. The ODI score was decreased from ( 74.7±10.0 ) points preoperatively to ( 27.7±5.3 ), ( 10.1±5.3 ) and ( 14.4±4.8 ) points at 3, 6 and 12 months after the operation respectively. The postoperative ODI and VAS scores were signiifcantly decreased at each time point when compared with the preoperative scores. According to the MacNab scores at 12 months after the operation, there were 20 excellent cases, 15 good cases, 1 fair case and 1 poor case. Conclusions Percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach is a safe and rational minimally invasive spine surgery technique for lumbar lateral recess stenosis, with excellent short-term outcomes.

Objective To explore the expressions and signiifcance ofμ-Calpain after spinal cord ischemia-reperfusion injury. Methods An adult Sprague-Dawley ( SD ) rat model of spinal cord ischemia-reperfusion injury was established. Quantitative real-time lfuroscent polymerase chin reaction ( PCR ) and Western-blot technique were used to detect the expressions of mRNA and protein ofμ-Calpain at 2 h, 6 h, 12 h, 24 h, 48 h and 72 h after the model was established. The degradation ofα-II specrin of the speciifc substrate of ofμ-Calpain was detected by Western-blot technique, and the results were compared with that of the control group. Results The expressions ofμ-Calpain mRNA of the injured spinal cord began to increase at 2 h after the model was established, but there were no statistically significant differences. The expressions were obviously increased at 12 h, and there were statistically significant differences ( P<0.05 ). The peak was reached at 48 h after the model was established ( P<0.001 ). The expressions ofμ-Calpain mRNA remained at a higher level at 72 h when compared with that of the control group, and there were statistically signiifcant differences ( P<0.05 ). The expressions ofμ-Calpain protein of the injured spinal cord began to increase at 2 h after the model was established, and the peak was reached at 48 h ( P<0.001 ). The expressions ofμ-Calpain protein remained at a higher level at 72 h after the model was established when compared with that of the control group, and there were statistically signiifcant differences ( P<0.05 ). Theα-II spectrin began to degenerate at 2 h after the model was established, but there were no statistically signiifcant differences. There were still someα-II spectrin remains at 72 h. Conclusions The expressions ofμ-Calpain mRNA and protein are increased after the spinal cord ischemia-reperfusion injury model is established, and meanwhile theα-II specrin of its speciifc substrate begins to degenerate. Theμ-Calpain is involved in the pathological course of spinal cord ischemia-reperfusion injury.

[目的]前瞻性研究经椎板间完全内镜下L2～5椎间盘摘除术的手术策略、安全性及临床疗效.[方法] 2011年4月～2011年12月,采用经椎板间完全内镜下L2～5椎间盘摘除术治疗61例L2～5椎管内非包含型椎间盘突出症,其中4例L2、3,12例L3、4,45例L4、5.将椎管内L2～5椎间盘非包含型突出按照突出物与走行神经根的关系分成腋型(22例)、腹型(27例)及肩型(12例).对肩型及腹型突出采用肩路,将内镜及工作套管置入走行神经根肩部进行手术;对于腋型突出,如果走行神经根在硬膜囊的发出点位于椎间盘平面或椎间盘平面以上,单纯采用腋路,将内镜及工作套管直接置入走行神经根腋部进行脱出物及椎间盘内松动髓核的摘除;如果走行神经根在硬膜囊上的发出点位于椎间盘平面以下,先采用腋路,摘除腋部脱出或游离椎间盘组织,然后将工作区域移至走行神经根肩部,摘除椎间盘内松动髓核组织.术后第2d及术后3个月复查腰椎MRI评估突出物切除的彻底性.记录术前,术后3、6、12个月的腰痛视觉模拟评分(visual analogue scales,VAS)、腿痛VAS评分及Oswestry残疾指数(Oswestry disability index,ODI),并比较术前及术后各时间点的统计学差异.评估术后12个月时MacNab腰椎功能评分.[结果]手术均顺利完成,手术时间平均55 min (30～90 min).有1例术后椎间盘突出复发,采用显微内窥镜下椎间盘摘除术翻修,有1例术后走行神经根损伤加重并功能障碍;无感染及其他手术并发症.术后各时间点腰痛VAS、腿痛VAS及ODI评分均较术前明显降低;术后12个月时MacNab评分,33例优,25例良,1例可,2例差.[结论]根据椎间盘突出部位选择腋路或肩路经椎板间完全内镜下腰椎间盘摘除术是治疗L2～5椎管内非包含型椎间盘突出症安全、合理、疗效优异的微创脊柱外科手术技术.

Objective: To study the effectiveness of surgical dorsal endoscopic tizotomy for the treatment of facetogenic chronic low back pain.Methods: From April 2011 to November 2011,58 patients who were diagnosed with lumbar facetogenic chronic low back pain (CLBP) and thereafter experienced >80% reliefs of pain with two comparative lumbar medial branch blocks were recruited in the study. Of those 58 patients, 45 cases (the operation group) received dorsal endoscopic rhizotomy, and the remaining 13 cases (the conservative group) received conservative treatment. Patients' preoperative and postoperative VAS score, percentage of pain relief and the MacNab score were analyzed and compared. Anatomic variations and any possible complications were recorded.Results: In the operation group, VAS scores of pain (low back/referred) at any time point postoperatively were significantly lower than that before MBB (P< 0.05), which, however, showed no significant difference as compared to the scores after MBB (P> 0.05). In the conservative group, VAS scores of pain (low back/referred) at any time point postoperatively with conservative treatment decreased significantly compared with that before MBB (P< 0.05) and were significantly higher than that after MBB (P< 0.05). Percentage of pain relief in the operation group at any time point postoperatively were significantly higher than that in the conservative group (P< 0.01). The MacNab scores of 1 year follow-up in the operation group were higher than that in the conservative group. In addition, four separate newly identified anatomical variations of medial branch anatomy were observed and reported.Conclusion: Dorsal endoscopic rhizotomy is safe and effective for the facetogenic CLBP, and can achieve better clinical outcome than the conservative treatment. (C) 2014 Elsevier B.V. All rights reserved.