STUDY DESIGN:Prospective study.OBJECTIVE:The purpose of this study is to elucidate mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms (CSSS).SUMMARY OF BACKGROUND DATE:The terminology, pathogenesis, diagnosis, and treatment of CSSS remain controversial. Surgical treatment of CSSS has been rarely reported. This is the first prospective study to evaluate the mid-term outcome of surgical treatment of CSSS.METHODS:Thirty-one patients who were diagnosed with CSSS in 2006 were evaluated prospectively. All patients were assigned to undergo anterior cervical fusion with posterior longitudinal ligament (PLL) resection and followed up for ≥5 years. Sympathetic symptoms such as vertigo, headache, and tinnitus, etc. were evaluated using the sympathetic symptom 20-point score. Neurological status was assessed using the Japanese Orthopedic Association (JOA) score. Clinical and radiologic data were prospectively collected before surgery, and at 1 week, 2 months, 6 months, 2 years, and 5 years after surgery. Surgical complications and morbidities of other diseases during the follow-up were also recorded.RESULTS:The mean 20-point score decreased significantly from 7.3±3.5 before surgery to 2.2±2.7 at the final follow-up (P<0.001), giving a mean recovery rate of 66.1%±50.3%. Good to excellent results were attained in 80.6% of these patients. The sympathetic symptoms were relieved in 23 of the 31 patients in the early postoperative period, and 5 patients in 2 months. No relief of sympathetic symptoms was found in 3 patients. The mean JOA score improved significantly from 12.0±1.9 before surgery to 14.8±1.5 by the end of the follow-up (P<0.001). No late neurological deterioration was found in this group.CONCLUSIONS:The mid-term outcomes of anterior cervical fusion with PLL resection for CSSS have been satisfactory. Differential diagnosis before surgery is of great importance. PLL may play a role in presenting sympathetic symptoms.

Dystrophic scoliosis in neurofibromatosis type 1 (NF-1) is difficult to treat. The purpose of this study was to review the clinical and radiological outcome of surgical treatment of dystrophic spinal curves in NF-1, for analyzing its efficacy, safety, and possible complications. This retrospective study consisted of 26 NF-1 patients with spinal deformities treated between 2003 and 2012 in our department. Preoperative X-ray, 3D-CT, and MRI were performed to evaluate the deformities of dystrophic scoliosis accurately. All patients were treated with posterior instrumented fusion alone using screws and hooks. According to the anatomical development situation of each patient's pedicles and the transverse processes, we chose different fixations and different fixed segments. The clinical and radiological outcomes of surgical correction were evaluated postoperatively. The average preoperative kyphosis was 43° (range 15–86°). The postoperative kyphosis had an average of 20° (range 10–39°) yielding 53% correction. At final follow-up, there was an average of 4.6% correction loss. The preoperative scoliosis Cobb angle had an average of 47° (range 35–96°). The postoperative scoliosis Cobb angle had an average of 21° (range 10–37°) yielding 55% correction. At final follow-up, there was an average of 6.6% correction loss. The apical vertebral body rotation was corrected by an average of 48%. At final follow-up, the score of the SRS-30 questionnaire ranged from 97 to 135 with an average of 109. In conclusion, the deformities of dystrophic scoliosis can be accurately determine through preoperative radiolographic evaluation, which plays an important role in guiding the correction of scoliosis program development. The results of this study demonstrate that satisfactory therapeutic effects can be achieved in the dystrophic scoliosis patients by preoperative meticulous surgical plans, intraoperative careful manipulation, and hybrid instrumentation.

Sympathetic symptoms associated with cervical disorders, such as vertigo, headache, dizziness, etc., are common clinical disorders bewildering both clinicians and patients. In our clinical practice we observed that sympathetic symptoms associated with cervical disorders were apparently relieved in some patients after undergoing routine anterior cervical decompression and fusion plus posterior longitudinal ligament (PLL) resection. This study was designed to investigate the sympathetic nerve innervations in the cervical PLL and its potential correlation with cervical sympathetic symptoms such as vertigo.Method: In animal research, cervical PLLs of 9 adult rabbits were harvested and stained with sucrose-phosphate-glyoxylic acid (SPG), which is a specific fluorescence staining method for sympathetic postganglionic fibers. In human research, cervical PLL of 8 patients of cervical spondylosis with sympathetic symptoms were harvested during surgery and stained with SPG. All sections were observed under fluorescence microscope. Sympathetic symptoms were evaluated using the sympathetic symptom 20-point score preoperatively and at 1 week, 2-month, and 6-month postoperatively.Results: In rabbit specimens, a large number of sympathetic postganglionic fibers were distributed in the cervical PLL of every segment. The density of sympathetic fibers distributed in the intervertebral portion of PLL was more than that in the vertebral portion. Compared with deep layer section, the nerve fibers in the superficial PLL layer section were thicker and more densely populated. Existence of sympathetic postganglionic fibers was also confirmed in human specimens. Those nerve fibers were mostly short and isolated in areatus form, with non-interwoven branches. The mean sympathetic symptoms score decreased significantly from 6.6 +/- 2.6 before surgery to 2.0 +/- 1.9 at 6 months postoperatively after anterior cervical decompression and fusion with PLL removed.Conclusion: According to the experimental result and clinical practice, we hypothesized that sympathetic nerve fibers distributed in PLL may represent a pathologic basis of stimulation induced by cervical vertebral degenerative changes and thus are susceptible to being a potential causative factor in cervical spondylosis with sympathetic symptoms. (C) 2014 Published by Elsevier Ltd.

Purpose The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed. Method 27 men and 28 women with a mean age of 46.4 ± 8.7 years were prospectively followed up for 2 years. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), visual analog scale (VAS) and Odom’s criteria. Radiographic information including segment and overall alignment, functional spinal unit (FSU) and overall ROM, and disc heights were prospectively collected during the follow-up. The correlations between the postoperative FSU ROM at last follow-up and influencing factors were analyzed. Results Mean NDI, JOA and VAS scores showed statistical improvements at last follow-up. Anterior migration of the prosthesis was detected in six cases. Heterotopic ossification was observed in ten patients. Mean FSU angle, endplate angle of the treated level and mean overall cervical alignment were all improved significantly at last follow-up ( P < 0.001). However, mean FSU ROM of the treated segment significantly decreased postoperatively ( P = 0.008), while mean overall ROM showed no significant differences. A significant correlation was found between preoperative FSU ROM and postoperative FSU ROM by the Pearson correlation coefficient ( r = 0.325, P = 0.034). Multiple linear regression analysis confirmed that preoperative FSU ROM contributed independently to a model with a coefficient of determination of 0.37 ( P = 0.034). Conclusions In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM.

The purpose of this study was to compare modified plate-only laminoplasty and laminectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postoperative complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant enlargement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent laminectomy and fusion; however, a greater decompression did not seem to produce a better clinical outcome. No significant difference was observed in Japanese Orthopaedic Association and Nurick scores between the 2 groups. Patients who underwent plate-only laminoplasty showed a better improvement in Neck Dysfunction Index and visual analog scale scores. In addition, limited decompression, rigid reconstruction of the spinal canal, and preservation of cervical mobility combined with preservation of the posterior structure resulted in a lower rate of postoperative C5 palsy and axial pain in the modified laminoplasty group. For this reason, modified laminoplasty may be a more viable option for patients with cervical stenotic myelopathy.

Introduction and hypothesis The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency. Methods A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment. Results After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility ( p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % ( p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % ( p > 0.05). Conclusions LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.

Objective To compare the incidence of C5 nerve palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From January 2005 to June 2010,68 patients with MCSM were treated with laminoplasty (27 patients,group A) or laminectomy with internal fixation (41 patients,group B).There were 21 males and 6 females in group A,aged 33-80 years (average,60.4 years),31 males and 10 females in group B,aged 22-77 years (average,58.7 years).All the patients were followed up for 12-48 months (average,22 months).In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index (CCI) before and after operation.The incidence of C5 nerve palsy was recorded and compared.Then we further compared preoperative and postoperative the cervical lordosis angle and CCI of 9 patients with C5 nerve palsy (group B1) and 32 patients without C5 nerve palsy (group B2) in group B.Results The incidence of C5 nerve palsy in group A was 3.7％(1/27),while 22.0％(9/41) in group B (x2=4.32,P＜0.05).For all ten patients with C5 nerve palsy,the muscle strengths of paralyzed muscles were recovered to grade 4 or better after being treated with conservative treatment for an average of 14 months.The change rate of preoperative and postoperative CCI in group B1 was 38.07％±18.03％,while 22.81％±12.71％ in group B2.There was a statistical difference between group B1 and group B2 (t=2.88,P＜0.05).Conclusion Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve palsy.The C5 nerve palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may be one of its important pathomechanisms.

Objective To investigate the effect of total disc replacement (TDR) in the treatment of cervical spondylotic myelopathy (CSM) with sympathetic symptoms.Methods Twenty-seven patients (15 males and 12 females) with CSM at single level accompanied by sympathetic symptoms,who underwent TDR surgery(Prestige or Discover prosthesis) with the posterior longitudinal ligament (PLL) resected at the area of decompression between October 2008 and May 2011,were retrospectively analyzed.All patients were followed up for at least 6 months (average,15.1 months).Clinical and radiologic evaluations were obtained preoperatively,1 week postoperatively,and at the final follow-up.The sympathetic symptoms were scored by our original 20-point system.The clinical outcomes were assessed by Japanese Orthopedic Association (JOA) scoring system and the Short Form-36 Health Survey (SF-36).Results The sympathetic symptoms were improved in all patients and the score was significantly improved after surgery.The sympathetic symptoms scores were (8.5±2.5) points preoperatively,(1.6±1.4) points 1 week postoperatively,and (2.3±1.1) points at the final follow-up.The patient's subjective satisfaction was excellent in 15 patients,good in 8,fair in 4,with an excellent and good rate of 85.2％.The corresponding JOA scores were (10.8±2.4) poiuts, (11.1±2.5) points,and (14.9±1.4) points,respectively.The SF-36 scores showed statistical improvements from preoperative (102.7±8.7) points to postoperative (129.8±5.5) points.Based on X-ray examination,the range of motion of the treated segment were reserved.During the follow-up period,there was no prosthesis subsidence or excursion.Conclusion The CSM patients with sympathetic symptoms could be managed successfully with TDR.And thoroughly resection of the PLL may be the key factor for good prognosis.

The treatment of atrophic fracture nonunion continues to represent a therapeutic challenge. Large segmental osteopenia is often seen in patients who received uniplanar or hybrid external fixators as the definitive method of fixation for high-energy fractures, and this adds more difficulties to the treatment of fracture nonunion. This retrospective study was designed to assess the outcome of locking compression plating with autologous bone grafting in patients with long-bone atrophic nonunion following external fixation. From January 2004 to December 2009, a series of consecutive patients with atrophic nonunion of the long bone following external fixation were treated with this method in our institution. The clinical outcomes and complications of these patients were retrospectively analyzed. Twenty-seven patients with 28 fracture nonunions were involved in this study. Mean follow-up was 14.2±3.4 months. Bony union was achieved in all 27 patients within a mean 18.6±4.8 weeks after revision surgery. Two patients developed superficial wound infections. No deep infections were found, and no implant failure was seen. Three patients reported minor pain in the donor site of the bone graft, and no other donor site complications were found. Revision osteosynthesis of long-bone atrophic nonunion following external fixation by locking compression plating with autologous iliac crest bone grafting represents a safe and efficacious modality for the treatment of these challenging conditions.

Objective: To design a comprehensive interventional surgery record form in order to standardize and simplify interventional work process and to increase the operative safety. Methods: A comprehensive interventional surgery record form was designed by the authors, which was suitable for making necessary record of different kinds of interventional procedures, for counting operation time, X-ray exposure time and for recording the dose, velocity and injection pressure of the contrast agent used in interventional procedure. The record form made a close combination of the nursing notes with the technological information and focused on compiling the clinical key points. The record form included independent parts for taking the preoperative, in-operative and postoperative facts and evaluations. The corresponding items after employing this record form were compared with that before using this form. The usefulness of the form was evaluated. Results: The use of comprehensive interventional surgery record form overcame the limitations of previously used interventional record chart. The previous record chart paid attention only to the vital signs and operative process, while the newly designed form emphasized the scientific management, which would make the therapeutic procedure to be more standard and the control of X-ray dose and contrast media dosage to be more strict, providing powerful data for scientific administration. After using the comprehensive interventional surgery record form both the nurses' and technicians' comprehensive abilities were improved markedly. Conclusion: The specific and comprehensive interventional record form designed by the authors fully meets the requirements of various interventional procedures, reflecting the particular needs for medical record. The use of this record form can standardize the administration of clinical interventional work.

Purpose: To evaluate the therapeutic results of oxygen-ozone combined collagenase injection for the treatment of lumbar disc herniation compared to the surgery. And to explore the role of this minimally invasive treatment as an alternative to disc surgery.Materials and methods: Two groups of patients (n = 108) were treated with different ways respectively. Minimally invasive group of patients was treated with the injection of oxygen-ozone combined with collagenase into the lumbar disc or the epidural space; the other group was treated with traditional surgery. After the treatment, the patients were followed-up and the therapeutic effect was assessed at 2 weeks, 3 and 12 months by the modified Macnab criteria.Results: The success rate was 86.11% and 88.89% in minimally invasive group at 3 and 12 months respectively. while 92.59% and 95.37% in surgical group. There was no statistically significant difference between two groups at 3 and 12 months (P = 0.123, P = 0.08). However, the surgical group produced a statistically significant greater improvement for back pain and disability in the first few weeks (P = 0.0001). The success rate was 51.86% and 85.18% at 2 weeks in minimally invasive group and surgical group respectively. No serious complication occurred in this group.Conclusions: The combination of the oxygen-ozone with collagenase shows significant reductions in pain and improvements in function at 3 and 12 months, it can be considered as an option for the treatment of non-contained lumbar disc herniation instead of surgery. (C) 2008 Elsevier Ireland Ltd. All rights reserved.