目的 探讨颅骨牵引复位配合颈前路减压融合术治疗下颈椎骨折脱位合并关节突绞锁的临床效果.方法 选取解放军总医院第八医学中心2015年1月～2018年1月收治的下颈椎骨折脱位合并关节突绞锁患者96例,根据随机数字表法将所有患者分为对照组和研究组,每组各48例.研究组给予颅骨牵引复位配合颈前路减压融合术治疗,对照组给予前路撑开撬拨复位固定,比较两组患者临床疗效、患者恢复情况、脊髓神经功能、围术期指标,记录两组术后并发症发生情况.结果 研究组总有效率明显高于对照组(P＜0.05).两组术后1年感觉功能、运动功能评分均升高,且研究组高于对照组(P＜0.05).研究组手术时间短于对照组,术中出血量少于对照组(P＜0.05).研究组术后美国脊髓损伤协会(ASIA)分级评分高于对照组(P＜0.05).研究组并发症发生率显著低于对照组(P＜0.05).结论 下颈椎骨折脱位合并关节突绞锁患者经颅骨牵引复位配合颈前路减压融合术治疗效果显著,可有效改善脊髓神经功能,降低并发症的发生.

目的 探讨采用Mobi-C人工颈椎间盘置换术治疗颈椎退行性疾病术后对患者颈椎曲度的影响.方法 回顾性分析自2009-01-2010-12经前路行椎间盘切除减压、Mobi-C人工颈椎间盘置换术治疗的25例颈椎退行性疾病,并进行了5年以上的随访观察.比较术前、术后即刻、末次随访时置换节段脊柱功能单位(FSU)曲度.结果 25例均获得随访,随访时间平均62.5(60～65)个月.术前FSU曲度为(0.28±4.69)°,术后即刻为(2.09±4.15)°,末次随访时为(1.97±4.10)°;手术前后FSU曲度差异有统计学意义(F =3.187,P=0.003),且术后即刻FSU曲度较术前明显改善(P=0.003),但末次随访时FSU曲度与术后即刻比较差异无统计学意义(P =0.044).术前2例FSU后凸＞10°(即FSU曲度＜-10°),术后置换节段仍存在后凸畸形.结论 采用Mobi-C假体行人工椎间盘置换术治疗颈椎退行性疾病可以部分矫正置换节段的后凸畸形,术后置换节段曲度维持良好,但对于术前FSU后凸＞10°的颈椎退行性疾病患者不建议行该手术.

目的:对比微创经椎间孔入路与传统后路手术治疗腰椎结核的临床疗效,评价微创经椎间孔入路治疗腰椎结核的安全性及有效性.方法:回顾性分析本院2012年10月-2013年3月收治的单节段腰椎结核患者73例,所有患者均为单节段病变,以腰痛为主,无神经压迫症状,死骨和脓肿范围不大.其中43例采用传统开放手术,30例采用微创手术,于围术期分别记录两组患者的手术时间、术中出血量及术后引流量,术后1、3、6和12月时采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)进行疗效评估,末次随访时记录并比较两组患者的融合率.结果:所有患者术后腰痛明显减轻,发热患者体温在2周内恢复正常.微创手术组的手术时间、术中出血量及术后引流量分别为240±30 min、520± 50mL和630± 110mL,均明显少于传统手术组的180±35min、350±50 mL和320±80 mL (P＜0.05).在术前、术后1月、3月、6月、12月和末次随访时,微创手术组腰痛VAS评分分别为8.7± 1.2分、4.5± 1.1分、3.5± 1.1分、2.0± 1.4分、1.3± 0.5分和1.2± 0.5分,ODI评分分别为(77±6)％、(31±5)％、(23±8)％、(14±6)％、(8±4)％和(7±3)％;传统手术组VAS评分分别为8.5± 1.1分、2.7± 0.7分、2.1± 0.6分、1.9±0.7分、1.1± 0.4分和1.1± 0.4分,ODI评分分别为(78±5)％、(23±6)％、(14±7)％、(12±5)％、(7±2)％和(7±2)％.其中,术后1个月和3个月,微创组腰痛VAS评分和ODI评分均明显低于开放组(P＜0.05).术后6个月、12个月和末次随访时,两组患者腰痛VAS评分和ODI评分差异无统计学意义(P＞0.05).末次随访时所有病例均获得骨性融合.结论:微创经椎间孔入路手术治疗单节段腰骶椎结核,可获得与传统后路手术相同的临床疗效,且手术时间短,术中出血量及术后引流量较少,具有较高的安全性.

BACKGROUND:Anterior cervical discectomy and intervertebral disc replacement have been extensively used in treatment of cervical degenerative disease. Its short-term therapeutic effects are encouraging, but it lacks of long-term and comprehensive evaluation. OBJECTIVE:To observe the folow-up results of a group of cases of anterior cervical discectomy and Mobi-C intervertebral disc replacement for more than 5 years. METHODS:A total of 25 cases of cervical spondylosis were treated in the 309 Hospital of Chinese PLA from January to September 2009. 19 of them were folowed up. Al patients received anterior cervical discectomy and Mobi-C intervertebral disc replacement. Twenty-three Mobi-C intervertebral disc prostheses were implanted. The range of motion was measured using lateral X-ray films during extension and flexion. Ectopic ossification was assessed by McAfee method. According to the cervical vertebra MRI images, the degeneration of adjacent segments was determined using Pearce classification. NDI score was used to evaluate the function of cervical spine. Pain improvement was evaluated using visual analogue scale score. RESULTS AND CONCLUSION: A total of 19 patients were folowed up for 59-65 months, averagely 62 months. No significant difference in range of motion was detected before surgery and during final folow-up (P > 0.05). Ectopic ossification in two cases and the degeneration of adjacent segments in one case were found during final folow-up. No prosthesis loosening or displacement appeared. Visual analogue scale score and NDI score were significantly lower during final folow-up compared with that before surgery (P < 0.05). These results indicate that under the premise of reasonable choice of indications, the therapeutic effect of Mobi-C intervertebral disc replacement for degenerative cervical spondylosis was satisfactory in five-year folow-up. The range of motion was good, and the incidences of ectopic ossification and the degeneration of adjacent segments were low.

目的 比较横突间入路腰椎椎体间融合术(ILIF)与经椎间孔腰椎体间融合术(TLIF)行病灶清除、椎间融合内固定术治疗腰椎结核和布鲁杆菌病性脊柱炎的疗效.方法 自2010-08-2013-08共采用ILIF治疗腰椎结核和布鲁杆菌病性脊柱炎38例,与之前采用TLIF手术治疗此类患者39例进行比较,分析2种术式在手术时间,术中出血量,疼痛视觉模拟VAS评分,Oswestry功能障碍指数(ODI)和术后并发症的差异.结果 2组手术时间、术中出血量比较差异无统计学意义(P＞0.05),术后VAS、ODI评分比较差异有统计学意义(P＜0.01).结论 ILIF治疗腰椎结核和布鲁杆菌病性脊柱炎的适应证较TLIF有限,仅适合于腰痛为主、无根性和马尾神经压迫症状、病变局限于椎间隙和相邻椎体终板者.其优点是可保留椎管的结构和生物力学完整性,避免病灶与椎管相通,损伤小、术后恢复快.

>脊柱结核和布氏杆菌病性脊柱炎药物治疗是最关键的,但对于伴有严重局部疼痛、脊柱不稳、畸形、脊髓或神经压迫症状的患者[1],仍需要手术治疗。我们采用经椎旁肌间隙后外侧腰椎间孔入路[2-3]治疗上述疾病35例,现报告如下。资料与方法1.一般资料:2010年8月至2012年8月我们采用经椎旁肌间隙后外侧腰椎间孔入路手术治疗腰椎结核和布氏杆菌病性脊柱炎35例,其中31例患者获得随访,包括男性

目的：探讨腰椎间盘突出症合并侧隐窝狭窄的诊断及治疗措施。方法腰椎间盘突出症合并侧隐窝狭窄44例，术前结合临床表现及影像学进行分析，明确诊断后，均行突出椎间盘摘除及侧隐窝扩大减压术治疗，观察治疗效果。结果44例患者通过9个月～4年随访，疗效优39例，良4例，差1例，优良率达97.7％。结论腰椎间盘突出症合并侧隐窝狭窄的诊断主要根据患者的年龄、病史、症状、体征及影像学综合分析而定，手术除椎间盘摘除外，应行侧隐窝扩大减压，以提高治疗效果。

cral TB were subjected to anterior radical debridement and strut grafting and instrumentation, while cases with a large paraspinal abscess, especially lumbar TB, were given the surgical treatment of posterior instrumentation. The differential selection of the patients in each group may itself have influenced the results. In group B (posterior approach), either a titanium cage filled with morcelized rib bone or large autoilliac or costal grafting were used. What were the criteria for choosing either of them? One hundred and eighty-one patients with spinal TB were included in the study. Of these, only 25 patients had a neurological deficit. What was the indication for surgery in the other patients? They could very well have been managed conservatively or with a middle-path regimen [5] . The development of anti-TB drugs has revolutionized the treatment of patients with spinal TB, as most patients do not have extensive destruction of bone, and sequestration can be successfully treated conservatively with chemotherapy, external bracing and prolonged rest [6] . Spinal TB with the lesion situated in the thoracic spine is more prone to develop kyphosis. In their study [1] , the majority of patients in group A had TB in the dorsal spine while those in group B mostly had lesions in the lumbar spine. The poor results in group A cannot be attributed to instrumentation alone. The surgical time and blood loss which are critically important parameters for the choice of approach were not mentioned. Although the mean age was mentioned, the age range in each group was not. In children and young adults, vertebral destruction is more severe because most bone is cartilaginous. In addition, angulation is more significant due to the growth retardation of the anterior column and unrestricted growth of the posterior column. We read the article entitled ‘Outcomes of different surgical procedures in the treatment of spinal tuberculosis in adults’ by Cui et al. [1] with great interest. Despite being an age old disease debate still surrounds the choice of approach. The authors concluded that posterior approach was superior to anterior approach for correcting deformity and maintaining correction. However, this conclusion is drawn from study groups that were not comparable from the beginning. There were statistically significant differences in the preoperative kyphosis angle in the anterior and posterior groups. Hence, the conclusion may not be appropriate. The anterior approach popularized by Hodgson et al. [2] in 1960 is currently considered the gold standard for debridement and decompression in Pott’s spine [3] . Advocates of the traditional anterior approach cite the ability to directly access the disease pathology and perform decompression, the fact that there is less muscle dissection and the ability to place a large graft under compressive load for fusion [2, 4] . In the study of Cui et al. [1] , anterior instrumentation was found to be inferior to posterior instrumentation. One of the reasons given by the authors was that the screws in the vertebral body cannot provide the same strength as the pedicle screws due to osteoporosis of the vertebral body caused by spinal TB. We disagree with the authors, as the screws were put into the normal healthy vertebral body and the affected vertebrae were removed. If there were osteoporosis of the vertebral body, then the hold of the posterior screw would also be poor. The vertebra level operated on and the range of kyphosis angle in each group have not been mentioned. The anterior approach should be avoided in patients with lesions above T5 (as instrumentation above T4 body is difficult), in patients with kyphosis of more than 60° (anterior-only correction causes spinal lengthening), in patients with disease involving the posterior elements and in patients with a bad preoperative chest condition. It would be interesting to know how the authors managed the 28 patients with a kyphosis angle of between 61 and 70°. The size of paraspinal abscess decided the choice of approach. The cases lacking a large paraspinal abscess and without lumbosaPublished online: August 21, 2013

DOI: 10.1097/BRS.0000000000000618 TO THE EDITOR: Re : He B, Yan L, Guo H, et al. The Difference in Superior Adjacent Segment Pathology After Lumbar Posterolateral Fusion by Using 2 Different Pedicle Screw Insertion Techniques in 9-Year Minimum Follow-up. Spine (Phila Pa 1976) 2014;39:1093–8. We read with interest the recent article “The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum followup” by He et al . 1 The authors are to be congratulated on designing this simple randomized control trial study to provide strong evidence that a more lateral starting point results in less radiographical and clinical adjacent segment disease (ASD). However, we think that the study still has some limitations. Sagittal alignment has been shown in some studies 2–4 to infl uence adjacent level degeneration after lumbar or cervical fusion, which is one of the most important proposed surgical risk factors for ASD. However, there is no information about the sagittal parameters of each group in this article. Whether the sagittal malalignment is the causative factor for ASD or just the screw insertion technique can only be determined by also measuring the preoperative parameters for sagittal alignment and comparing the changes over time between each group. However, this comparison was not conducted by the authors of this study. The patient-selection and surgical intervention in this study might also have an enlarged and amplifi ed effects of screw insertion techniques on ASD, which could also help explain why their ASD rate (61.5%) was signifi cantly higher than others. 2–5 First, this prospective study includes 210 patients with low grade isthmic spondylolisthesis, these patients inherently, have a greater loss of disc height, and consequently, some loss of lordosis, which have more chance to be sagittal malalignment. Second, surgical decompression intervention they used is “removal of the spinous process and bilateral laminectomy, and partial bilateral foraminotomy,” which means the posterior ligament complex of the superior adjacent segment is completely removed. According to the tension band mechanism, loss of posterior ligament complex is another risk factor for adjacent segment degeneration. Third, the restoration of sagittal balance after spinal reconstruction has been identifi ed as an increasingly important risk factor for subsequent degeneration at adjacent levels. 6 Nevertheless, the authors did not mention any surgical technique for spondylolisthesis reduction procedures, nor use interbody fusion (just posterior lateral fusion instead), in these circumstances, we can only speculate there will not be any signifi cant improvement of sagittal imbalance, if it does exist.

目的:探讨腰椎棘突截骨椎板开门腰椎间盘摘除椎管成型扩大“∞”粗丝线固定法治疗腰椎间盘突出症、腰椎管狭窄症的临床效果.方法:将400例患者随机分为2组,各200例,治疗组采用腰椎棘突截骨椎板开门腰椎间盘摘除椎管成型扩大“∞”粗丝线固定法治疗,对照组采用腰椎间盘摘除椎间植骨椎弓根系统固定术治疗,对比2组患者手术时间、术中出血量及术后恢复时间.结果:治疗组治疗效果、手术时间、术中出血量及术后恢复时间均优于对照组,组间比较差异有统计学意义(P＜0.05).结论:腰椎棘突截骨椎板开门腰椎间盘摘除椎管成型扩大“∞”粗丝线固定法是治疗腰椎间盘突出症、腰椎管狭窄症的理想方法.

OBJECTIVE:To investigate surgical methods and outcomes in the treatment of spinal tuberculosis (TB) in adults.SUBJECTS AND METHODS:One hundred and eighty-one patients (average age 39 years) without multiple-level noncontiguous spinal TB were followed up for 22-72 months. The patients were divided into four groups according to surgical procedure on the basis of the position and extension of the foci: group A (74 cases): anterior radical debridement and strut grafting with instrumentation; group B (83 cases): posterior instrumentation and bone grafting with anterior radical debridement and strut grafting in a single- or two-stage procedure; group C (10 cases): extrapleural anterolateral decompression and strut grafting with posterior instrumentation in thoracic or thoracolumbar spine, and group D (27 cases): single-stage transforaminal decompression and posterior instrumentation and fusion.RESULTS:There was a significant decrease (p < 0.05) in mean preoperative (81%) Oswestry's Disability Index. Except for 24 patients with lumbosacral TB who were only instrumented posteriorly, kyphosis degrees were corrected by a mean of 11.5° in the anterior instrumentation group and 12.6° in the posterior instrumentation group (p < 0.01). The correction loss was 6.8° in the anterior instrumentation group and 6.1° in the posterior instrumentation group at the last follow-up (p < 0.01).CONCLUSION:The four surgical procedures obtained good results for correction and maintenance of the correction, clearance of the foci, decompression of the spinal cord and pain relief in the treatment of spinal TB in adults, providing that the operative indication is accurately identified. However, the posterior approach was superior to anterior instrumentation for correcting deformity and maintaining the correction.

There are few articles in the literature comparing outcomes between anterior and posterior instrumentation in the management of thoracic and lumbar spinal tuberculosis (TB).

目的 回顾性分析成人胸椎结核的手术方法及疗效,探讨胸椎结核术式选择的适应证.方法 2001年1月至2010年12月采用不同手术方法治疗成年胸椎结核患者1 12例,81例非跳跃性结核患者获得平均37( 17～72)个月的随访.其中有23例合并脊髓功能障碍.根据病灶部位和病变程度采用5种手术方式:A组(18例),胸廓内胸膜外病灶清除、植骨融合内固定术；B组(21例),经胸病灶清除、植骨融合内固定术；C组(10例),胸膜外经肋横突入路病灶清除、植骨融合内固定术；D组(27例),后路固定一期或二期前路经胸或胸膜外病灶清除、植骨融合内固定术；E组(5例),上胸段结核胸骨柄或胸骨劈开入路病灶清除、植骨融合内固定术.结果 (1)手术时间和出血量:手术平均时间A,B,C,D,E组分别为3.5,3.0,3.0,4.5,4.0h;术中平均出血量A,B,C,D,E组分别为350,450,300,640,600ml.(2)脊柱后凸畸形矫正率:A组(47.5±11.8)％,B组(46.9±10.2)％,C组(59.9±17.4)％,D组(61.7±18.6)％,E组(44.1±8.7)％.(3)末次随访时矫正角度丢失率:A组(64.2±19.1)％,B组( 63.8±18.1)％,C组(56.9±11.8)％,D组(53.6±15.6)％,E组(63.5±17.1)％.23例伴有脊髓压迫症状的患者中神经功能Frankel分级至少提高了一级.结论 胸椎结核的术式选择应根据病变的部位、范围以及患者的一般状态而定.老龄患者由于体质差,最好采用胸膜外经肋横突入路病灶清除、植骨融合内固定术.后路固定在矫正脊柱后凸畸形及维持矫形方面要优于前路固定.

OBJECTIVE:To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB). METHODS:Between January 2004 and December 2009, 241 adult patients with thoracolumbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages. The mean age was 39 years (range: 16 - 67). The mean follow-up period for 189 patients was 37 months (range: 22 - 72). Among them, 157 cases underwent > 3 weeks of chemotherapeutic regimen of isoniazid, rifampin, pyrazinamide and ethambutol and the remaining 32 were operated for neurological impairment after 6-18 h with the same chemotherapeutic regimen. Except for 8 patients with skip lesions undergoing hybrid anteroposterior instrumentation, anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B). RESULTS:In both groups, local symptoms of all patients were relieved significantly 1-3 weeks postoperatively. And 10/14 cases (71%) in Group A and 14/19 cases (74%) in Group B with neurological deficits had excellent or good clinical outcomes (P > 0.05). The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8-12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5° in Group A and 12.6° in Group B (P < 0.01). The correction loss was 6.8° in Group A and 6.1° in Group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8% respectively at the final follow-up (P > 0.05). Severe complications did not occur. CONCLUSION:Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity, clearance of foci, decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected. Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.

OBJECTIVE:To evaluate the surgical indications and clinical effectiveness of different operative procedures in the treatment of lower lumbar tuberculosis.METHODS:From June 2001 to Oct 2008, 72 patients with lower lumbar tuberculosis were treated by different operative procedures. Including 38 males and 34 females, with an average age of 38.5 years old ranging from 16 to 70 years. The average duration of symptom was 6.8 months (ranging from 4 months to 2 years). A single vertebrae was involved in 10 patients,two contiguous vertebrae in 50 cases and three vertebrae in 12 cases. The average preoperative lordotic angle was 13.1 degree (ranging from -5.0 degrees to 34.0 degrees). Three different operative procedures included: (1) posterior debridement and posterolateral fusion and posterior instrumentation in 28 patients; (2) anterior radical debridement and anterior fusion and anterior instrumentation in 32 patients; (3) image-guided percutaneous drainage (PCD) of tuberculous abscesses in 12 patients. The selection of the procedure was made according to the degree of the lesions. The resolution of inflammatory process, bony fusion, correction of sagittal angles and JOA scores were used for evaluating the result of the surgery and the complications were analyzed.RESULTS:All patients were followed up from 1.5 to 8.0 years (means 3.6 years). PCD was an effective treatment in 11 out of the 12 patients, one required surgical debridement and fusion. Among them, 57 (95%, 57/60) patients were treated by open operation showed successful bony fusion. The complications maily included common iliac vein injury in 3 patients, dural tear in 2 patients, they were all cured by intro-or postoperative treatment. The average immediate post-operative lordotic angle was 27.3 degree (35.0 degrees to 16.0 degrees), the average lordotic angle was 25.6 degree (33.0 degrees to 15.0 degrees) at final follow-up. Preoperatively and at final follow-up, JOA scores were respectively (15.2 +/- 3.4), (25.6 +/- 2.4) (P<0.01).CONCLUSION:Different operative procedures should be selected to treat lower lumbar tuberculosis according to the degree of lesions. Aggressive surgical treatment was found helpful in the resolution of inflammatory process and correcting the loss of lordosis, preventing progression of kyphosis.

Objective:To investigate the surgical procedures and their outcomes for spinal tuberculosis(TB) in adults.Method:Between January 2004 and December 2009,241 adult patients with thoracolumbar and lumbosacral TB undergoing different surgical procedures were reviewed retrospectively.A total of 181 patients with multiple-level continuous spinal TB were followed up for 22-72 months(mean,37 months).Of 25 patients with neurological deficit,there were 14 Frankel D and 11 Frankel C.The involved vertebrae included 4 continuous vertebrae in 11(thoracic),3 continuous vertebrae in 45,2 continuous vertebrae in 98,and 1 vertebra in 27 cases.It showed obvious defect in 132 patients and paraspinal abscess in 153 cases by CT and MRI examination.The kyphosis Cobb angle ranged from-23° to 30° in 104 cases,31° to 60° in 49 cases and 61° to 70° in 28 cases.Erythrocyte sedimentation rates(ESR) raised in 169 cases.All patients were divided into 4 groups according to site and extent of the lesion.Group A included 74 cases who underwent anterior radical debridement and instrumentation.Group B included 70 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage.Group C included 10 cases who underwent front side radical debridment,strut graft and posterior instrumentation in thoracic or thoracolumbar spine.Group D included 27 cases who underwent single-stage posterior debridement and instrumentation.Emergency surgery was performed in 25 patients with neurological impairment following short term chemotherapy prior 6-18h before surgery.The chemotherapy medicine was administered to the remaining 156 cases over 3 weeks before surgery and continued till 12 months after operation.Result:The average operation time and blood loss were 3.5h and 450ml in group A,4.5h and 640ml in group B,3.0h and 350ml in group C and group D.Severe complications were not noted in each group.ESR returned to normal 8-12 weeks after operation.Kyphosis was corrected by(47.5±11.8)% in group A,(61.5±18.6)% in group B,(58.7±15.9)% in group C and(59.9±17.4)% in group D,with loss of correction at final follow-up of(64.8±19.3)% in group A,(53.6±15.6)% in group B,(56.9±11.8)% in group C and(54.9±15.4)% in group D.And at final follow-up,18 cases had Frankel level improved 1 level,and 7 cases had it improved 2 levels.Sinus was found in the each of Group A,B and C at half a month,one month and one and a half months respectively,which was healed by proper intervention 1-2 months later.Instrument loosening was found in 1 patient of group A one year later,however no intervention was performed due to evidenced fusion.No recurrence was observed at final follow-up in all groups.Conclusion:Different surgical approaches are indicated for debridement,decompression and kyphosis correction,which are reliable for spinal tuberculosis.Posterior approach is superior than anterior approach due to its deformity correction and maintaining of correction.

Objective To evaluate the results of the clinical outcomes of patients with lumbar intervertebral disc herniation with PDN artificial nucleus pulposus intervertebral disc replacement.Methods Nineteen patients undergone lumbar intervertebral disc herniation with PDN artificial nucleus pulpous intervertebral disc replacement from March 2002 to July 2004 were followed up.Total cases were implanted with a single PDN.The contents included symptom,physical check,MPQ investigation,ODI assess,VAS scores,lumbar X-ray and MRI examination etc.Results All patients were followed up 52 to 67 months(average 55.3 months).After surgery,19 patients experienced clinical symptom relief.The displacement of PDN was observed in 2 cases and 1 PDN was escaped to the posterior aspect of lumbar canal.The heights of intervertebral space were lost in 7 cases and endplate subsiding happened in 2 cases.The disc degeneration in adjacent segment occurred in 1 case.Conclusion Artificial nucleus pulposus intervertebral disc replacement acquires satisfactory in short term clinical result,but there are some operated syndromes in long-term clinical result.The operating indications of artificial nucleus pulposus intervertebral disc replacement and lumbar spinal fusion should be choosen strictly.

OBJECTIVE:To study the clinical application of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR).METHODS:Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, Cs, 6 in 7 cases, C6, 7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by "40 score" system (COA) preoperatively, immediately postoperatively, and at follow-up. The quality of life was evaluated by neck disability index (NDI) and visual analogue scale (VAS) score.RESULTS:All incisions healed by first intention. No perioperative complication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operated segment between preoperation and follow-up duration (t = 0.808, P = 0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 +/- 1.14) was significantly higher than preoperative one (32.10 +/- 2.96), (t = 9.278, P = 0.000), and the improvement rate at last follow-up was 77.2% +/- 5.4%. VAS score at last follow-up (3.20 +/- 1.23) had significant difference when compared with preoperative one (5.10 +/- 1.29), (t = 10.585, P = 0.000). NDI score at last follow-up (29.40 +/- 4.55) had significant difference when compared with preoperative one (39.20 +/- 3.80), (t = 16.039, P = 0.000).CONCLUSION:A satisfactory short-term curative effect can be obtained by using Mobi-C prosthesis in treatment of anterior cervical discectomy and ADR.

OBJECTIVE:To explore the surgical measurements and principles in the treatment of thoracic and thoracolumbar spinal tuberculosis. METHODS:A total of 232 cases of previously treated thoracic or thoracolumbar spinal tuberculosis in recent 7 years were retrospective analyzed. Preoperative assessments were as follows: Cobb angles of kyphosis: < 30° (n = 65), 30 - 60° (n = 147) and > 60° (n = 20); Frankel B (n = 13), C (n = 12), D (n = 41) and E (n = 166). Forty-eight cases were performed with one-stage transpedicular screw system and anterolateral debridement by single incision, 184 cases with one-stage anterior approach (debridement, fusion and plate-screw fixation) routinely. The tissues and liquor paris debrided from focus were sent for pathology, Bacillus tuberculosis detection and culture, and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. The follow-up parameters included relapse rate, fusion of bone graft, the status of neurological restoring and kyphosis correction. RESULTS:All 232 cases recovered from perioperation and 230 cases achieved primary wound healing. Two cases undergoing single incision one-stage posterior instrumentation and anterolateral debridement were complicated with wound healing and sinus formation. There was delayed healed by changing dressings. The complications included intercostals neuralgia (n = 135) and pneumothorax or hydrothorax requiring no special measure (n = 13). The follow-up period ranged from 1.0 to 4.5 years old (mean: 2.6). There was no recurrence within the follow-up period and bone union was found in all cases. All 66 cases with neurological deficits recovered partially or totally. Kyphosis correction was achieved by 27.5° on average postoperatively and showed a mild loss of 4.2° on average during the follow-up period. All cases were confirmed pathologically as Bacillus tuberculosis infection. Bacillus tuberculosis was detected and cultured successfully in 107 cases (46.1%). Forty strains (37.4%) were drug resistant among which 8 strains (7.5%) was multi-drug resistant. CONCLUSION:For the patients with thoracic and thoracolumbar spinal tuberculosis, directional chemotherapy, one-stage anterior approach with thorough debridement, auto-rib or Ti-mesh fusion and plate-screw fixation may be the first-line therapy.