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Background Pedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis. Methods In total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method. Results There were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01). Conclusion In summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.

Purpose: To evaluate the efficacy and safety of different types of anesthesia (LA, LA with IVA, and GA) used during PKP.Patients and methods: A total of 150 patients of single-level OTLF were prospectively included in this study from February 2019 to February 2020. They were randomly divided into three groups of 50 patients each and treated with GA, LA, or LA with IVA. Severity of back pain was measured preoperatively, intraoperatively, and 1 h, 1 day, 1 month, and 1 year postoperatively using VAS scores. The ODI was administered and the AHVB on lateral thoracolumbar radiographs was measured preoperatively and at 1 month and 1 year postoperatively. The MMSE was administered at 1 and 7 days postoperatively to monitor for the development of POCD.Results: 131 patients completed the full postoperative follow-up schedule. The average duration of surgery in the LA group was slightly longer than the other two groups. The intraoperative VAS score of the LA+IVA group was significantly lower than that of the LA group. The MMSE scores at 1 day and 1 week postoperatively were significantly decreased only in the GA group. The incidence of POCD was 45% (18/40) at 1 day and 5% (2/40) and at 1 week postoperatively in the GA group, whereas POCD was not observed in the other two groups. The GA group had the highest incidence of anesthesia-related adverse reactions.Conclusion: IVA with ropivacaine can effectively reduce intraoperative and early postoperative pain, shorten the duration of surgery, reduce surgery-related complications.

Background: To explore the impact of related factors on the surgical site infection (SSI) after combined anterior-posterior surgery for subaxial cervical fracture dislocation (SCFD), and to provide a basis for formulating preventive measures.Methods: A total of 841 patients (531 males and 310 females, aged 24-68 years) with SCFD who received combined anterior-posterior surgery from January 2018 to May 2020 were retrospectively analyzed. According to whether the postoperative SSI occurred, they were divided into two groups. Demographic data, American spinal injury association (ASIA) neurological impairment scale, comorbidity, diet, nursing, and operating room related factors (time interval from skin preparation to operation, whether preoperative urinary catheterization was performed, whether was the consecutive operation, the total number of person in the operating room, operating room temperature, relative humidity, operational duration, and whether there was an intern nurse involved in the operation) of the of patients in the two groups were analyzed by Logistic regression for the factors related to perioperative SSI. Results: SSI occurred in 44 patients with the rate of 5.2% (44/841). The results of univariate analysis showed that there were statistically significant differences between the two groups in the grade of ASIA scale, diabetes, lack of dietary care, time interval from skin preparation to operation, preoperative urinary catheterization, consecutive operations and the total number of person in the operating room (all P> 6h (OR value = 2.342, p=0.022), preoperative urinary catheterization (OR value = 4.476, P > 8 (OR value = 2.921, P = 0.014) were positively correlated with perioperative SSI. Conclusions: The occurrence of SSI in patients with SCFD who undergo anterior-posterior treatment is most likely multifactorial and emphasis should be placed on dietary care, enhanced glucose monitoring, and optimized operating room management.

Background: This study aimed to analyze the risk factors for proximal junctional kyphosis (PJK) for patients with chronic symptomatic osteoporotic thoracolumbar fractures (CSOTLF) and kyphosis who underwent long-segment internal fixation.Methods: We retrospectively reviewed the records of patients with CSOTLF complicated with kyphosis who underwent posterior multilevel internal fixation in our hospital between January 2013 and June 2018. The patients’ age, sex, body mass index (BMI), bone mineral density (BMD), smoking status, cause of injury, comorbidities, injury segments, and American Spinal Injury Association (ASIA) grading non-surgical data; posterior ligament complex (PLC) injury, upper and lower instrumented vertebral position (UIV and LIV, respectively), number of fixed segments surgical data, proximal junctional angle (PJA), sagittal vertebral axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), pelvic incidence-lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) surgical indicators were collected. Patients were divided into postoperative PJK and non-PJK groups. Results: This study included 90 patients; among them, 30 (31.58%) developed PJK postoperatively. All patients were followed up for >24 months (mean 32.5 months). Univariate analysis showed significant differences in age, BMI, BMD, PLC injury, UIV, and LIV fixation position, number of fixation stages, and preoperative PJA, SVA, PI-LL, and SS between the two groups (P < 0.05). Additionally, no significant differences were observed in sex, smoking, cause of injury, complications, injury segment ASIA grade, and preoperative PT between the two groups (P > 0.05). Multifactorial logistic regression analysis showed that age >70 years (OR=32.279, P28 kg/m2 (OR=7.876, P20° (OR=13.301, PConclusions: Elderly patients with CSOTLF and kyphosis aged >70 years with BMI >28 kg/m2, BMD 20°, and PLC injury have increased risk of PJK after posterior long-segment internal fixation. Considering these findings, weight control, osteoporosis treatment, soft tissue protection, and spinal sagittal balance restoration are important to prevent PJK.

Background This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI).Methods In this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR).Results The operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group.Conclusion The present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.

Percutaneous endoscopic lumbar discectomy (PELD) via the transforaminal approach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventional wisdom is that measurement using lumbar radiography, computed tomography (CT), or magnetic resonance imaging (MRI) is necessary.The objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) technique based on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD for patients with L5-S1 lumbar disc herniation (LDH) combined with HIC.A retrospective analysis.All data were from Honghui Hospital in Xi'an.One hundred patients with L5-S1 LDH combined with HIC were treated with PELD. The LI-Tri technique was used in the first 50 patients (applied group). The other 50 patients were classified as the nonapplied group, in which the conventional technique was performed. Clinical outcome evaluation included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The intervals of follow-up were scheduled at 1 day and 1, 3, 6, 12, and 24 months postoperatively.No significant difference was observed with respect to demographic information (P.05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Together with the remaining 50 patients, the puncture was successful with the LI-Tri technique. The mean operative duration was shorter in the applied group (55 vs 70 min, P.01). Compared to the preoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantly lower at one day postoperatively (P.05, respectively). With the exception of the back pain VAS and ODI at one day postoperatively, no significant differences were observed in the 3 parameters at other time points postoperatively between 2 groups (P.05, respectively).The study is limited by its retrospective, nonrandomized controlled design.For patients with L5-S1 LDH combined with HIC treated by transforaminal PELD, the LI-Tri technique is simple and effective in preoperative evaluations, locating the skin entry point and guiding the puncture trajectory. Compared to the conventional technique, it shows advantages in terms of reducing intraoperative surgical duration and promoting fast postoperative recovery.Endoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.

Background This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI). Material and Method In this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR). Results The operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group. Conclusion The present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.

Study design A retrospective study. Objective To analyze the efficacy and safety of perioperative halo-gravity traction as an adjunct to posterior vertebral column resection (PVCR) in the treatment of patients with severe congenital scoliosis and coexisting asymptomatic intraspinal pathologies (diastematomyelia and/or tethered cord). Summary of background data Few reports to our knowledge review the use of perioperative halo-gravity traction and PVCR in this patient population. Materials and methods A total of 17 patients with a minimum 2-year follow-up who underwent PVCR using perioperative halo-gravity traction were analyzed. Patients were analyzed by age at date of examination (range, 11-23 y; mean, 14.4 y), sex (7 male, 10 female), major coronal curve magnitude (range, 108-149 degrees; average, 125 degrees), major sagittal curve magnitude (range, 72-118 degrees; average, 91 degrees). Complications related to halo traction and PVCR were reviewed. Results Radiographic outcomes demonstrated Cobb angle of major curve had an average correction of 28% after halo traction and it measured 53 degrees (range, 42-84 degrees) at the last follow-up, for a 58% correction. Maximal kyphosis improved to 58 degrees (range, 43-76 degrees) at ultimate follow-up. There were no permanent neurological deficits in this series. Conclusions The study results suggested that surgical treatment for intraspinal abnormality may be unnecessary in asymptomatic patients with severe congenital scoliosis who are undergoing scoliosis corrective surgery. PVCR combined with perioperative traction is a safe and effective alternative for such patients.

Syringomyelia with coexisting intraspinal abnormities is thought to increase the risk of neurologic injury during surgical correction of the scoliosis. However, surgical treatment for intraspinal abnormities carries significant morbidity risks including worsening neurological function and wound complications. The authors’ aim in this study was to evaluate one-stage posterior correction of scoliosis in this patient population without prophylactic surgical treatment for neural axis malformations before scoliosis correction. A total of 29 patients with syringomyelia and coexisting intraspinal abnormities who underwent scoliosis correction were evaluated. The average age was 15.6 years (range 12–23). All patients were examined for neural axis abnormalities using MRI, including syringomyelia with Chiari I malformation in 18 patients, syringomyelia with tethered cord and/or diastematomyelia in 11. None of patients presented with symptoms suggesting significant neurological dysfunction. The surgical efficacies and complications of correction were reviewed. The preoperative Cobb angle of major coronal curve averaged 65° (range 46°–95°), and it measured 28° (range 22°–43°) at the last follow-up, for a 63 % correction. Maximal kyphosis averaged 52° (range 41°–69°) preoperatively, and improved to 29° (range 22°–43°) at ultimate follow-up, for a 46 % correction. The average follow-up was 6 years (4–8 years). None of the patients experienced deterioration in their neurologic status. The study results suggested that prophylactic neurosurgery for intraspinal abnormality may be unnecessary in patients with asymptomatic or minor symptomatic syringomyelia and coexisting intraspinal abnormities. One-stage posterior correction of scoliosis in this patient population does not involve significant complications and seems to be an alternative and safe treatment option.

To investigate the diagnostic value of lumbar discography in discogenic low back pain and the effects of intervertebral fusion surgery.Forty-five cases with 101 discs underwent discography, 360 degree fusion manipulation were performed on 18 discography abnormal cases, 27 cases were treated conservatively. Discography, MRI and provocative pain were observed and all the cases were followed up.Twenty-one cases showed positive provocative pain (21/45, 47%), and 21 discs of 101 were concordant discography (21/101, 21%). All cases were followed up for an average 16 months (15 to 23 months), the satisfactory rate was 83% (15/18) in the surgery group and 41% (11/27) in the conservative group.It is concluded that the discography is moderately sensitive in the diagnosis of discogenic low back pain. Furthermore, the short term follow-up reveals that operative group has better pain relief than conservative group.