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Purpose: To determine whether unilateral pedicle screw fixation is comparable with unilateral pedicle screw and contralateral percutaneous transfacet screw fixation in single-level lumbar spinal fusion., Methods: Fifty-eight patients were divided into either unilateral (n = 32) or unilateral pedicle screw and contralateral percutaneous transfacet screw fixation (n = 26) instrumentation groups. The operating time, blood loss, length of hospital stay, clinical outcomes, total lumbar scoliotic changes, and fusion and complication rates were compared between the two groups., Results: There were no significant differences between the two groups in blood loss, length of hospital stay, clinical results, total lumbar scoliotic changes, and fusion and complication rates. There were significant differences in duration of operating time between 2 groups., Conclusions: Unilateral pedicle screw fixation may be as effective as unilateral PS with contralateral percutaneous transfacet screw fixation for the treatment of lumbar degenerative disorders.

Objective: To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation., Methods: From December 2007 to August 2008, 50 patients (31 males and 19 females) were treated by surgery of discectomy and discectomy plus Coflex fixation. The average age was 52.5 years (range, 30 - 72 years). There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy. Preoperative and postoperative visual analogue scales (VAS), Japanese Orthopadic Association (JOA) and Oswestry disability index (ODI) were recorded, as well as radiological index. And use a paired t-test and one-way analysis of variance (one-way ANOVA) statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation., Results: Both groups received significant improvement of JOA, ODI and VAS (t = -33.2 - 64.5, P < 0.01), but the group of discectomy was found with deterioration of ODI at last follow-up, 12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3 (t = -19.3, P < 0.05). The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs (HD), distance across the two adjacent spinous processes (DS), distance of intervertebral foramina (DIF) and spinal canal area(SA) (t = -34.4 - 4.5, P < 0.05). In contrast, the group of discectomy was found with significant decrease of HD, DS, DIF and SA (t = 3.4 - 52.8, P < 0.05). Coflex fixed group in HD, DIF, DS significant difference with simple discectomy group, with a statistically significant (F = 14.1 - 25.6, P < 0.05)., Conclusions: Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation. Coflex can significantly increase the HD and DIF when used for lumbar disc herniation, and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation. Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.

Objective: To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases., Methods: From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L(3-4) were 3 cases, L(4-5) 27 cases, L(5)-S(1) 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments., Results: The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ± 4 postoperatively (P < 0.01). The JOA scores were improved remarkably from 9.6 ± 2.2 preoperatively to 23.8 ± 2.0 postoperatively (P < 0.01) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation (P < 0.01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage., Conclusions: The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.

Objective: To assess the clinical outcomes of Coflex interspinous dynamic internal fixation and the imaging changes for degenerative lumbar spinal stenosis., Methods: From October 2007 to February 2009, 30 patients with degenerative lumbar spinal stenosis were treated with Coflex interspinous dynamic internal fixation, including 17 males and 13 females with an average age of 45 years (range, 39 to 65 years). The operation level at L4,5 were 20 cases, L5S1 9 cases and 1 case was in both the two levels. The ODI scores and JOA questionnaires were assessed before and after operation. The radiological measurement included ventral and dorsal intervertebral space height, segmental intervertebral angles formed by lines drawn on the upper and lower endplates of the instrumented and adjacent levels on flexion-extension radiographs; the area of spinal canal, dural sac, the sagittal and transverse diameter of the spinal canal and dural sac on CT scan. All the patients were treated with limited laminectomy and were implanted with Coflex device., Results: All the patients were followed up for 5 to 19 months. There were significant differences in the ODI scores and the JOA questionnaires by paired t-test (P<0.01). All the patients were satisfied with surgical outcomes except 3 patients whose pain were not obviously relieved and need drugs or block therapy; 3 patient complaining of progressive hypoesthesia. There were no complications associated with the Coflex device. The height of dorso-intervertebral disc was increased obviously while the range of motion in adjacent levels was not increased on flexion-extension radiographs; the area of spinal canal and dural sac were significantly increased., Conclusion: It shows a good clinical result to release the degenerative lumbar spinal stenosis symptoms and decrease short-term complications by using Coflex device. It is available for patients with increasing the intervertebral space, area of spinal canal and preventing the adjacent segment degeneration.

Objective: To evaluate the short term effectiveness of lumbar disc herniation by Coflex., Methods: From December 2007 to June 2008, 31 patients (16 males and 15 females) were treated by Coflex. The average age was 51.4 years (range, 33 - 70 years). The average period of follow-up was 10 months. To evaluate the short term effectiveness of lumbar disc herniation by Coflex by JOA, VAS, the conventional radiography and oswestry disability index (ODI)., Results: The average JOA score increased from 9.1 +/- 1.1 preoperatively to 26.4 +/- 1.7 at 6 month postoperatively. ODI decreased from 24.7 +/- 4.8 preoperatively to averaged 4.5 +/- 1.1 at 6 months postoperatively. The VAS score decreased from 7.9 +/- 0.8 to 3.0 +/- 0.9. The clinical symptoms after operation were improved significantly. There were statistically significant differences between the preoperative and postoperative HD (height of dorso- intervertebral discs), DS(distance across the two adjacent spinous processes), DI (distance of intervertebral foramina). The average HD increased from (7.9 +/- 1.1) mm preoperatively to (10.8 +/- 1.3) mm after operation. The average DS increased from (28.3 +/- 2.4) mm preoperatively to (36.4 +/- 1.7) mm postoperatively. The average DI changed from (18.8 +/- 1.0) mm preoperatively to (21.6 +/- 1.7) mm postoperatively. Complications occurred in 3 patients (9.6%). One case complained of persistent low back pain. One case showed opposite lower limb pain in 3 weeks after operation, and was cured after appropriate treatment. One case had the loosening of Coflex in 6 months after surgery, but did not appear related clinical symptoms., Conclusion: Coflex for lumbar disc herniation can increase the HD and DI significantly, and it has positive meaning for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.