Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few re...Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery. Methods The 25 cases that underwent L5-$1 posterior lumbar interbody fusion （PLIF） ＋ L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-$1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading （4 to 6）. The patients were evaluated with visual analogue scale （VAS） and Japanese orthopaedic association （JOA） scores before surgery and in the last follow-up. Modic changes of endplates were recorded. Results The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups （t=-12.1 and 13.5, P 〈0.05）. Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly （Topping-off group： t=-2.30 and -2.24, P 〈0.05; PLIF group： t=--2.76 and -1.83, P 〈0.01）. In the hyperextension and hyperflexion view, Topping-off group＇s range of motion （ROM） and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM （t=--7.82 and -4.90, P 〈0.01） and olisthesis （t=--15.67 and -18.58, P 〈0.01） both significantly increased in extension and flexion. Conclusions Compared with single segment PLIF展开更多
目的 :回顾性分析椎间盘切除+Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效。方法 :2008年7月~2012年7月因腰椎间盘突出症在我院行椎间盘切除+Dynesys动态稳定系统内固定治疗的患者84例,其中61例获得完整随访资料,男38例,女2...目的 :回顾性分析椎间盘切除+Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效。方法 :2008年7月~2012年7月因腰椎间盘突出症在我院行椎间盘切除+Dynesys动态稳定系统内固定治疗的患者84例,其中61例获得完整随访资料,男38例,女23例;年龄31~58岁(46.3±11.5岁),随访时间60~108个月(74±14个月)。术前、术后3个月和末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估,同时行影像学评估,包括手术节段及上位相邻节段椎间隙高度、椎间活动度(rang of motion,ROM)、UCLA椎间隙退变分级(University of California at Los Angeles)以及椎间盘退变Pfirrmann分级。结果:术后3个月、末次随访时VAS评分和ODI均较术前明显改善(P<0.05),所有病例均未见椎间盘突出复发。手术节段椎间隙高度术后3个月(12.3±2.3mm)较术前(11.8±1.8mm)增加,末次随访时(10.1±1.7mm)较术前降低(P<0.05);上位相邻节段各时间点无显著性差异。手术节段椎间ROM在术后3个月及末次随访分别为5.3°±1.8°及3.6°±1.9°,与术前(8.1°±2.8°)比较均显著性降低(P<0.05);上位相邻节段ROM在术后3个月和末次随访分别10.3°±3.8°和11.4°±3.7°,均较术前(8.5°±3.0°)显著性增加(P<0.05)。末次随访时手术节段UCLA分级与术前比较有统计学差异(P<0.05),12例(19.7%)上位相邻节段发生影像学退变,1例发生症状学退变(adjacent segment degeneration,ASD)。手术节段和上位邻近节段术前与末次随访椎间盘Pfirmman分级均有统计学差异(P<0.05)。2例出现螺钉断裂,未发生螺钉松动等其他并发症。结论:腰椎间盘切除后应用Dynesys动态稳定系统内固定治疗腰椎间盘突出症可获得满意的中长期疗效,能维持手术节段稳定,保留手术节段部分椎间活动度。展开更多
Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys ...Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods： Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index （ODI） and visual analog scale （VAS）. Radiographic evaluations included range of motion （ROM） and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration （ASD）. Results： There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODl scores were significantly improved at the final follow-up evaluation, as compared to the baseline values （ 16.1± 5.7 vs. 57.2 ± 14.2, t = 61.4 l, P 〈 0.01 ）. The VA S scores for back and leg pain were significantly improved from 4.82 ±0.89 and 4.04 ± 0.82 preoperatively to 0.93± 0.61 and 0.54 ± 0.51 postoperatively （t = 6.59, P 〈 0.01, and t = 5.91, P 〈 0.01, respectively）. There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8°± 2.4° to 4.5° ± 1.5° （t = 7.18, P 〈 0.05）, while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° （t = 2.87, P = 0.01）. The change in disc height of stabilized segments was not significant （11.9 ±2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, 展开更多
Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is uncle...Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is unclear. This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery. Methods We studied patients with single level degenerative cervical disc disease. The extent of adjacent segment degeneration was estimated from lateral X-rays. Results Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion. All patients were followed up for an average of sixty months. In the Bryan arthroplasty group, nine （17.6%） segments developed adjacent segment degeneration, which was significantly lower than that （60.4%） in the anterior cervical decompression and fusion group. Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee＇s classification and two segments had range of motion less than 2%. In the heterotopic ossification group, four （19.5%） segments developed adjacent segment degeneration, similar to the number in the non-heterotopic ossification group （16.7%）. Adjacent segment degeneration rate was 50% in grade IV group but 11.8% in grade II to III. Conclusions Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion. However, Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion. Patients with grade IV heterotopic ossification lost motion, and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.展开更多
目的:比较颈前路减压零切迹椎间融合器(Zero-P)与传统钛板内固定融合术治疗单/双节段脊髓型颈椎病对术后相邻节段退变的影响。方法:回顾性分析2015年1月~2018年3月采用颈前路减压Zero-P与传统钛板内固定融合术治疗的113例脊髓型颈椎病...目的:比较颈前路减压零切迹椎间融合器(Zero-P)与传统钛板内固定融合术治疗单/双节段脊髓型颈椎病对术后相邻节段退变的影响。方法:回顾性分析2015年1月~2018年3月采用颈前路减压Zero-P与传统钛板内固定融合术治疗的113例脊髓型颈椎病患者的资料,其中Zero-P组(A组)65例,传统钛板组(B组)48例,A组再分为单节段组(n=44)和双节段组(n=21),B组再分为单节段组(n=28)和双节段组(n=20),4组患者年龄、性别构成比、手术节段均无统计学差异(P>0.05)。比较两种术式的手术时间、术中出血量,以及4组的术前、末次随访时的日本骨科协会(Japanese Orthopaedie Association,JOA)评分、疼痛视觉模拟评分(visual analog scale,VAS),末次随访时评估患者术后是否出现吞咽困难,并在颈椎侧位X线片上测量术前、术后即刻、末次随访时相邻节段椎间隙高度,评估术前、末次随访时的相邻椎体骨化情况,在颈椎MRI上应用椎间盘Pfirrmann分级评估术前、末次随访时的相邻节段椎间盘退变情况。结果:单节段A组随访时间为18.0±7.9个月,单节段B组为15.8±8.8个月,双节段A组为14.8±6.4个月,双节段B组为15.8±8.2个月,4组间无统计学差异(P>0.05)。A组手术时间较B组明显缩短(P<0.05),术中出血量两组无明显差异(P>0.05)。4组患者末次随访时的JOA评分、VAS评分较术前均有明显改善(P<0.05),同节段A、B组间比较JOA评分改善率无明显差异(P>0.05),术前、末次随访时同节段A、B组间比较VAS评分无明显差异(P>0.05)。双节段B组末次随访时上、下相邻椎间隙高度较术前、术后均有明显下降(P<0.05),其余3组末次随访时上、下相邻椎间隙高度较术前、术后均无明显差异(P>0.05)。末次随访时,双节段B组上、下相邻椎间隙高度显著低于双节段A组(P<0.05),单节段A、B组末次随访时上、下相邻椎间隙高度无明显差异(P>0.05)。末次随访时,相邻椎体骨化发生率单�展开更多
文摘Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery. Methods The 25 cases that underwent L5-$1 posterior lumbar interbody fusion （PLIF） ＋ L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-$1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading （4 to 6）. The patients were evaluated with visual analogue scale （VAS） and Japanese orthopaedic association （JOA） scores before surgery and in the last follow-up. Modic changes of endplates were recorded. Results The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups （t=-12.1 and 13.5, P 〈0.05）. Neither anterior nor posterior disc height was significantly changed. Segmental lordosis of L4-L5 and total lordosis were all increased significantly （Topping-off group： t=-2.30 and -2.24, P 〈0.05; PLIF group： t=--2.76 and -1.83, P 〈0.01）. In the hyperextension and hyperflexion view, Topping-off group＇s range of motion （ROM） and olisthesis in the L4-L5 segment did not significantly change in flexion, but decreased in extension. In PLIF group, ROM （t=--7.82 and -4.90, P 〈0.01） and olisthesis （t=--15.67 and -18.58, P 〈0.01） both significantly increased in extension and flexion. Conclusions Compared with single segment PLIF
文摘目的 :回顾性分析椎间盘切除+Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效。方法 :2008年7月~2012年7月因腰椎间盘突出症在我院行椎间盘切除+Dynesys动态稳定系统内固定治疗的患者84例,其中61例获得完整随访资料,男38例,女23例;年龄31~58岁(46.3±11.5岁),随访时间60~108个月(74±14个月)。术前、术后3个月和末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估,同时行影像学评估,包括手术节段及上位相邻节段椎间隙高度、椎间活动度(rang of motion,ROM)、UCLA椎间隙退变分级(University of California at Los Angeles)以及椎间盘退变Pfirrmann分级。结果:术后3个月、末次随访时VAS评分和ODI均较术前明显改善(P<0.05),所有病例均未见椎间盘突出复发。手术节段椎间隙高度术后3个月(12.3±2.3mm)较术前(11.8±1.8mm)增加,末次随访时(10.1±1.7mm)较术前降低(P<0.05);上位相邻节段各时间点无显著性差异。手术节段椎间ROM在术后3个月及末次随访分别为5.3°±1.8°及3.6°±1.9°,与术前(8.1°±2.8°)比较均显著性降低(P<0.05);上位相邻节段ROM在术后3个月和末次随访分别10.3°±3.8°和11.4°±3.7°,均较术前(8.5°±3.0°)显著性增加(P<0.05)。末次随访时手术节段UCLA分级与术前比较有统计学差异(P<0.05),12例(19.7%)上位相邻节段发生影像学退变,1例发生症状学退变(adjacent segment degeneration,ASD)。手术节段和上位邻近节段术前与末次随访椎间盘Pfirmman分级均有统计学差异(P<0.05)。2例出现螺钉断裂,未发生螺钉松动等其他并发症。结论:腰椎间盘切除后应用Dynesys动态稳定系统内固定治疗腰椎间盘突出症可获得满意的中长期疗效,能维持手术节段稳定,保留手术节段部分椎间活动度。
文摘Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods： Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index （ODI） and visual analog scale （VAS）. Radiographic evaluations included range of motion （ROM） and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration （ASD）. Results： There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODl scores were significantly improved at the final follow-up evaluation, as compared to the baseline values （ 16.1± 5.7 vs. 57.2 ± 14.2, t = 61.4 l, P 〈 0.01 ）. The VA S scores for back and leg pain were significantly improved from 4.82 ±0.89 and 4.04 ± 0.82 preoperatively to 0.93± 0.61 and 0.54 ± 0.51 postoperatively （t = 6.59, P 〈 0.01, and t = 5.91, P 〈 0.01, respectively）. There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8°± 2.4° to 4.5° ± 1.5° （t = 7.18, P 〈 0.05）, while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° （t = 2.87, P = 0.01）. The change in disc height of stabilized segments was not significant （11.9 ±2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43,
文摘Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is unclear. This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery. Methods We studied patients with single level degenerative cervical disc disease. The extent of adjacent segment degeneration was estimated from lateral X-rays. Results Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion. All patients were followed up for an average of sixty months. In the Bryan arthroplasty group, nine （17.6%） segments developed adjacent segment degeneration, which was significantly lower than that （60.4%） in the anterior cervical decompression and fusion group. Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee＇s classification and two segments had range of motion less than 2%. In the heterotopic ossification group, four （19.5%） segments developed adjacent segment degeneration, similar to the number in the non-heterotopic ossification group （16.7%）. Adjacent segment degeneration rate was 50% in grade IV group but 11.8% in grade II to III. Conclusions Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion. However, Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion. Patients with grade IV heterotopic ossification lost motion, and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.
文摘目的:比较颈前路减压零切迹椎间融合器(Zero-P)与传统钛板内固定融合术治疗单/双节段脊髓型颈椎病对术后相邻节段退变的影响。方法:回顾性分析2015年1月~2018年3月采用颈前路减压Zero-P与传统钛板内固定融合术治疗的113例脊髓型颈椎病患者的资料,其中Zero-P组(A组)65例,传统钛板组(B组)48例,A组再分为单节段组(n=44)和双节段组(n=21),B组再分为单节段组(n=28)和双节段组(n=20),4组患者年龄、性别构成比、手术节段均无统计学差异(P>0.05)。比较两种术式的手术时间、术中出血量,以及4组的术前、末次随访时的日本骨科协会(Japanese Orthopaedie Association,JOA)评分、疼痛视觉模拟评分(visual analog scale,VAS),末次随访时评估患者术后是否出现吞咽困难,并在颈椎侧位X线片上测量术前、术后即刻、末次随访时相邻节段椎间隙高度,评估术前、末次随访时的相邻椎体骨化情况,在颈椎MRI上应用椎间盘Pfirrmann分级评估术前、末次随访时的相邻节段椎间盘退变情况。结果:单节段A组随访时间为18.0±7.9个月,单节段B组为15.8±8.8个月,双节段A组为14.8±6.4个月,双节段B组为15.8±8.2个月,4组间无统计学差异(P>0.05)。A组手术时间较B组明显缩短(P<0.05),术中出血量两组无明显差异(P>0.05)。4组患者末次随访时的JOA评分、VAS评分较术前均有明显改善(P<0.05),同节段A、B组间比较JOA评分改善率无明显差异(P>0.05),术前、末次随访时同节段A、B组间比较VAS评分无明显差异(P>0.05)。双节段B组末次随访时上、下相邻椎间隙高度较术前、术后均有明显下降(P<0.05),其余3组末次随访时上、下相邻椎间隙高度较术前、术后均无明显差异(P>0.05)。末次随访时,双节段B组上、下相邻椎间隙高度显著低于双节段A组(P<0.05),单节段A、B组末次随访时上、下相邻椎间隙高度无明显差异(P>0.05)。末次随访时,相邻椎体骨化发生率单�
