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Objective: To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP) for preventing recurrent fracture of the cemented vertebrae., Methods: From January 2017 to June 2017, 85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs) were treated by bilateral sagittal cross PKP(cross group). There were 35 males and 50 females with an average age of (70.1±8.3) years old in cross group. Another 85 patients with single-segment OVCFs were treated by traditional PKP (traditional group). There were 37 males and 48 females with an average age of (73.3±9.5) years old in traditional group. The cement distribution condition, recurrent fracture of the cemented vertebrae, the anterior vertebral body height and sagittal Cobb angle, visual analogue scale(VAS) were observed in two groups., Results: All patients underwent operation successfully. The follow-up time were (11.8±4.5) months in cross group and (12.1±3.7) months in traditional group. In cross group, all patients' bone cement touched the upper and lower endplates of the vertebral body while 67 cases (78.8%) in traditional group did with significant difference between two groups ( P <0.05). No patient in cross group suffered recurrent fracture of the cemented vertebrae while 10 cases (11.8%) in traditional group did with significant difference between two groups( P <0.05). The anterior vertebral body height, sagittal Cobb angle and VAS in both groups were obvious improved at 2 days after operation ( P <0.05) and there were no significant difference between two groups at 2 days after operation and the final follow-up( P >0.05)., Conclusions: Bilateral sagittal cross PKP was a simple, safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body, thus preventing the recurrent fracture of the cemented vertebrae., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: The 3D model of lumbar spine was established by using Mimics software. To observe the applicability and needling parameters of lumbar vertebral kyphoplasty with unilateral puncture by backward rotation method using simulated puncture., Methods: Twenty-four patients (12 males and 12 females) with osteoporotic thoracic fracture in the first time and no signs of lumbar misalignment and bone destruction were scanned by spiral CT on the lumbar spine. The original DICOM file was modeled in 3D with Mimics software, and the vertebral bodies were separated. After being imported into 3-matic software, the posterior wall of the vertebral body was restrained for standardized measurement. A sketch perpendicular to the mid-section of the pedicle and the posterior wall of the vertebral body was drawn. The simulated puncture was performed on the sketch. The angle and distance parameters of the range of motion of the puncture needle were recorded, and the puncture needle was recorded at the top. The crossing points of the anterior, middle and posterior zones of the tangential line of the vertebral body were located at the high extraversion angle, and the results were compared and analyzed., Results: All the data in the left and right sides had no significantly differences( P >0.05). Data of different segments in different gender were significantly differences( P <0.05). The maximal extraversion angle in lumbar spine increased gradually from (33.41±1.31) degree to (56.53±4.71) degree in males, as same as in females from(28.58±2.55) to (53.86±2.68) degree. There was no crossing point in area A, 3.3% of males and 26.67% of females in area B, rest in area C. The distribution areas on gender showed statistically significance ( P <0.05)., Conclusions: Backward rotation method can theoretically meet the requirements of puncture point for vertebral compression fracture, especially for males and lower lumbar spine. The determination of the maximum inclination angle is of guiding significance to the backward rotation method., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Study Design: This is a retrospective, clinical, and radiologic study of posterior reduction and fusion of the C1 arch in the treatment of unstable Jefferson fractures., Objective: The aim of the study was to describe a new motion-preserving surgical technique in the treatment of unstable Jefferson fracture., Summary of Background Data: The management of unstable Jefferson fractures remains controversial. The majority of C1 fractures can be effectively treated nonoperatively with external immobilization unless there is an injury to the transverse atlantal ligament (TAL). Conservative treatment usually involves immobilization for a long time in Halo vest, whereas surgical intervention generally involves C1-C2 fusion, eliminating the range of motion of the upper cervical spine. We propose a novel method for the treatment of unstable Jefferson fractures without restricting the range of motion., Methods: A retrospective review of 12 patients with unstable C1 fractures between April 2008 and October 2011 was performed. They were treated by inserting bilateral posterior C1 pedicle screws or lateral mass screws interconnected by a transversal rod to achieve internal fixation. There were 8 men and 4 women, with an average age of 35.6 years (range, 20-60 y). Presenting symptoms included neck pain, stiffness, and decreased range of motion but none had neurological injury. Seven patients had bilateral posterior arch fractures associated with unilateral anterior arch fractures (posterior 3/4 Jefferson fracture, Landells type II), and 5 had unilateral anterior and posterior arch fractures (half-ring Jefferson fracture, Landells type II). Seven patients had intact TAL, and 5 patients had fractures and avulsion of the attachment of TAL (Dickman type II)., Results: A total of 24 screws were inserted. Five cases had screws placed in the lateral mass: 3 because of posterior arch breakage, and 2 because the height of the posterior arch at the entry point was <4 mm. The remaining 7 cases had pedicle screw fixation. One patient had venous plexus injury during exposure of lower margin of the posterior arch; however, successful hemostasis was achieved with Gelfoam. Postoperative x-ray and computed tomography scan showed partial breach of the transverse foramen caused by a screw in 1 case, and breach of the inner cortex of the pedicle caused by screw displacement in 1 case; however, no spinal cord injury or vertebral artery injury was found. The remaining screws were in good position. Patients were followed up for 6-40 months (average, 22 mo). All cases had recovery of range of motion of the cervical spine to the preinjury level by 3-6 months after surgery, with resolution of pain. At 6 months follow-up, plain radiographs and computed tomography scans revealed satisfactory cervical alignment, no implant failure, and satisfactory bony fusion of the fractures; no C1-C2 instability was observed on the flexion-extension radiographs., Conclusions: C1 posterior limited construct is a valid technique and a feasible method for treating unstable Jefferson fractures, which allows preservation of the function of the craniocervical junction, without significant morbidity.

Objective: To study the curative effect of postural reduction with instrumental reduction in treatment of flexion-distraction thoracolumbar fractures., Methods: A retrospective study was performed on 43 patients with single thoracolumbar flexion-distraction fractures admitted from August 2009 to August 2011, included 28 males and 15 females with an average age of 44 years old (34 to 56 years old). All patients were treated with postural reduction with instrumental reduction. The kyphosis (Cobb angle) recovery of injured vertebral height and complication were analyzed. The visual analogue scale(VAS) and com-plications were followed up and recorded., Results: There was no difference in recovery of injured vertebral posterior height among preoperative, 1 week and 1 year after operation (P > 0.05). There were significantly difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between preoperative and postoperative at 1 week (P < 0.05). There was no difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between 1 week and 1 year after operation (P > 0.05). VAS significantly improved from preoperative (7.2 +/- 1.2) to (0.8 +/- 0.7) at 1 year after operation (t = 18.47, P < 0.001)., Conclusion: Postural reduction with instrumental reduction is effective for thoracolumbar flexion-distraction fractures and it is beneficial to the recovery of vertebral height and saggital alignment.

Objective: To investigate the clinical effects of one-stage posterior-anterior decompression and internal fixation for the treatment of the severe fractures and dislocations combined with the spinal cord injuries of the lower cervical spine., Methods: From August 2005 to August 2009, 48 patients (male 28 and female 20, aged from 28 to 62 years with a mean of 39.6 years) with severe fractures and dislocations of lower cervical spine were treated by reduction and internal fixation with one-stage combined cervical anterior plating and posterior lateral mass screws and rod or plate systems. Frankel grade A was in 8 cases, grade B in 16 cases, grade C in 20 cases, and grade D in 4 cases before operation. Firstly, the posterior approach was carried out. After inserting the mass screws, decompression and reduction were performed, and the rod or plate systems were embedded. After grafting, the skull traction was removed and initiated the anterior reduction, intervertebral decompression, auto-graft and cervical spine auto-locking plate fixation. The stability and fusion rate of the injured segments were evaluated on the regular postoperative X-ray film. The function of the spinal cord was assessed with Frankle classification., Results: All patients were followed up, ranged from 6 to 28 months with an average of 12 months. Solid fusion obtained in the postoperative 6 months. Frankel grade C was in 28 cases, grade D in 14 cases, grade E in 6 cases after operation. There was no complications related to internal fixation breakage, loosening or displacement. There was no vascular and esophagus complications during the operation., Conclusion: One-stage combined anterior-posterior decompression and internal fixation in treating severe fracture and dislocations of lower cervical spine could restore the cervical curvature, and obtain good reduction and complete decompression, and gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord.

Objective: To investigate the clinical application and efficacy of an internal fixation technique incorporating C(2) laminar screws for upper cervical spine injury., Methods: Using a posterior cervical approach, incorporating C(2) laminar screw fixation and bone grafting were performed on 20 patients with cervical spine injury. There were 12 male and 8 female patients, with a mean age of 45.6 years (range, 32-71 years). All patients were evaluated by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI)., Results: The patients were followed up for 11-35 months (mean, 15 months), and bony union was achieved in all patients. There were no spinal cord or vertebral artery injuries during surgery, and only two instances of vein clump injury, in both of which the bleeding was controlled successfully. Postoperative CT scans showed that all the C(2) laminar screws had been placed properly, and were not encroaching on the spinal canal. No spinal instability, evidence of hardware failure or screw loosening was found during the follow-up period in any patient., Conclusion: Crossing C(2) laminar screw internal fixation technique is simple, and is not limited by the position of the vertebral artery in the body of C(2). The laminar screw method avoids arterial injuries and also can be used as a salvage method after previous misinsertion. As all relevant structures are directly visualized during C(2) laminar screw placement, this kind of technique may be applicable to a large number of patients., (© 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.)

Objective: To explore the surgical treatment and classification of multiple-level noncontiguous thoracolumbar fractures., Methods: From December 2005 to December 2008, 24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A, 2 cases in grade B, 2 cases in grade C, 8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures (MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively., Results: All patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months (means 18.3 months). All cases achieved bone fusion, without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation, 11 got more than one grade improvement of the ASIA grading, 2 remained unchanged., Conclusion: The traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontiguous thoracolumbar fractures should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures.

Objective: To explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2)., Methods: Pedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases, and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures., Results: All subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5, 16 at C6, 42 at C7, and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1, 8 at T2. No injury of spinal cord, nerve roots and vertebral artery was found during operation. Eleven screws (14.9%) were perforated out of the pedicles in cervical spine, in which 7(9.5%) through lateral cortex, 1 (1.4%) through the superior and 3 (4.1%) through the inferior. Three screws (10%) were perforated in upper thoracic spine, in which 2 (6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5. JOA score increased from preoperative (7.5 +/- 2.0) to postoperative (14.5 +/- 2.3) evaluated in 6 months after operation,with statistic difference (t = 6.34, P < 0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries., Conclusion: Implantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine, and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually.

Objective: To explore the clinical effects of posterior monosegmental pedicle screw fixation in selective treatment of thoracolumbar vertebral fractures., Methods: From June 2005 to June 2008, 28 patients (male 17 and female 11, the age was 19- 60-years-old with an average of 36 years) with thoracolumbar fractures were treated with posterior monosegmental pedicle screw fixation in our department. According to the AO classification, 19 patients with type A1 fracture and 9 with type A2. The place of pedicle screw and reduction of injured vertebral body were observed., Results: Postoperative CT scan showed 56 pedicle screws were all placed in the normal part of injured vertebral body. There was no spinal cord injury and infection after surgery. There were restoration of anterior body compression from mean preoperative (42.0 +/- 5.6)% to (12.4 +/- 1.4)% (P<0.05), and restoration of Cobb angle from mean preoperative (25.8 +/- 5.1) degrees to postoperative (1.9 +/- 1.3) degrees (P<0.05). All the patients were followed up for 3-36 months (average in 18.3 months). All fractures achieved bone healing, without significant loss of the vertebrae body height and implant failure., Conclusion: As indication is correctly choosed, posterior monosegmental pedicle screw fixation can be applied to treat thoracolumbar vertebral fractures.