Yong Fan

Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: Systematic Review and Meta-Analysis

BACKGROUNDnMany retrospective studies of pedicle screw placement have revealed that intraoperative navigation systems provide higher accuracy rates and safety than do free-hand techniques. The accuracy of various image-guided navigation systems has been studied; however, differences have not been well defined due to the lack of adequate evidence-based comparative studies.nnnOBJECTIVEnA meta-analysis was conducted to focus on the variation in pedicle screw insertion among 3 navigation systems: a 3-dimensional fluoroscopy-based navigation system (3D FluoroNav), a 2-dimensional fluoroscopy-based navigation system (2D FluoroNav), and a conventional computed tomography navigation system (CT Nav).nnnMETHODSnWe screened for comparative studies on different pedicle screw insertion navigation systems published through January 2017 using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases.nnnRESULTSnFrom 125 papers that were identified, 10 articles were finally chosen. The present comparative study included 8 retrospective clinical studies, 1 prospective clinical trial, and 1 randomized controlled cadaveric study. The prevalence rate of pedicle violation in the 3D FluoroNav group was significantly lower than the rates of the 2D FluoroNav group (relative risk [RR] 95%, confidence interval [CI]: 0.16-0.61, P < 0.01) and the CT Nav group (RR 95%, CI: 0.42-0.90, Pxa0= 0.01), and the rate of the CT Nav group was significantly lower than that of the 2D FluoroNav group (RR 95%, CI: 0.29-0.81, P < 0.01).nnnCONCLUSIONnSignificant differences exist among CT Nav, 3D FluoroNav, and 2D FluoroNav. Our review suggests that 3D FluoroNav may be superior to the other 2 methods in reducing pedicle violation and that clinicians should consider 3D FluoroNav as a better choice.

Comparison of Accuracy of Pedicle Screw Insertion Among 4 Guided Technologies in Spine Surgery

Background As an available new tool for spinal surgery, robotic technology holds great potential and has been demonstrated to have better clinical outcomes compared with traditional techniques. However, it has not been compared with other assisted tools for the treatment of lumbar degenerative disease. This article focused on studying such variances. Material/Methods A total of 176 pedicle screws were inserted in 39 patients using a spine robot (group 1), 134 screws were implanted in 28 patients using navigational template (group 2), 234 screws were implanted in 51 patients by O-arm-based navigation (group 3), and 346 screws were implanted in 72 patients by fluoroscopy-guided assistance (group 4). The screw position was evaluated using postoperative scans according to Rampersaud A to D classification, and other secondary data were also collected. Results “Perfect” pedicle screw insertion (Grade A) was 90.34%, 91.79%, 84.19%, and 65.03% of groups 1–4, respectively. “Clinically acceptable” screw implantation (Grade A+B) was 94.32%, 95.52, 90.60%, and 78.03% in groups 1–4, respectively. Deviation sagittal (°) respectively was 3±9, 2±10, 4±7, and 10±8° in groups 1–4, respectively. Deviation transversal (°) screw insertion was 3±8, 3±7, 4±9, and 8±13° in groups 1–4, respectively. Statistical analysis showed group 1 had no significant difference in the accuracy of “Perfect and Clinical acceptable” as well as deviation sagittal or transversal, respectively, compared with groups 2 and 3 but not group 4. Conclusions Robotic-assistance technology no clear advantage in terms of accuracy compared to the navigation template or O-arm systems for screw implantation, but it significantly reduced adverse events, fluoroscopy time per screw, postoperative stay, and blood loss.

Radiological and clinical differences among three assisted technologies in pedicle screw fixation of adult degenerative scoliosis

The purpose of this study was to compare the clinical and radiological differences among three advanced guided technologies in adult degenerative scoliosis. A total of 1012 pedicle screws were inserted in 83 patients using a spine robot (group A), 886 screws were implanted in 75 patients using a drill guide template (group B), and 1276 screws were inserted in 109 patients using CT-based navigation (group C). Screw positions were evaluated using postoperative CT scans according to the Gertzbein and Robbins classification. Other relevant data were also collected. Perfect pedicle screw insertion (Grade A) accuracy in groups A, B, and C was 91.3%, 81.3%, and 84.1%, respectively. Clinically acceptable accuracy of screw implantation (Grades Au2009+u2009B) respectively was 96.0%, 90.6%, and 93.0%. Statistical analysis showed the perfect and clinically acceptable accuracy in group A was significant different compared with groups B and C. Group A exhibited the lowest intra-op radiation dose and group B showed the shortest surgical time compared with the other two groups. Robotic-assisted technology demonstrated significantly higher accuracy than the drill guide template or CT-based navigation systems for difficult screw implantations in adult degenerative scoliosis and reduced the intra-op radiation dose, although it failed to reduce surgery time.

Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients

OBJECTIVEnApplication of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis.nnnMETHODSnFrom January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed.nnnRESULTSnFollow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (Pxa0= 0.000) and lumbar lordosis angle increased (Pxa0= 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%.nnnCONCLUSIONSnApplication of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical outcomes.

Rare Hereditary Abnormal Bone Hyperplasia and Ossification of the Yellow Ligament Complicated by Thoracic Spinal Stenosis

We report a rare case of familial inherited abnormal bone hyperplasia and ossification of the yellow ligament complicated by spinal stenosis. Complete reconstruction of stability and spinal cord decompression were achieved by posterior total laminectomy, fusion, and internal fixation. We cannot clearly describe the inheritance characteristics of the disease. Although the risk of surgical treatment is high, it is still necessary to perform surgery, and the effect of the operation is substantial.

Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block to Promote Early Postoperative Recovery of Lumbar Disc Herniation

OBJECTIVEnTo observe effect of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block to promote early postoperative recovery of lumbar disc herniation.nnnMETHODSnRetrospective analysis was performed of 265 patients with single-level lumbar disc herniation from January 2013 to October 2017. Patients were divided into intervention and control groups based on intraoperative application of gelatin sponge impregnated with a mixture of 3 drugs. All patients underwent unilateral minimally invasive surgical transforaminal lumbar interbody fusion. Clinical data, including bedridden period, postoperative hospital stay, visual analog scale scores for low back pain and leg pain, Japanese Orthopaedic Association score, postoperative satisfaction questionnaire results, and therapeutic effect, were collected.nnnRESULTSnThere were 136 cases in the intervention group and 129 cases in the control group. The intervention group had significantly shorter bedridden period and postoperative hospital stay than control group (P < 0.05). Visual analog scale scores for low back pain and leg pain at postoperative days 1-10 were significantly lower in the intervention group compared with control group (P < 0.05). The Japanese Orthopaedic Association score at postoperative day 6 and satisfaction at 72 hours postoperatively were significantly higher in the intervention group than in control group (P < 0.05). Clinical effect at postoperative day 6 was significantly better in the intervention group than control group (P < 0.05).nnnCONCLUSIONSnApplication of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block can significantly promote early postoperative recovery of lumbar disc herniation and has great short-term clinical efficacy.

Surgery for Multisegment Thoracolumbar Mild Osteoporotic Fractures: Revised Assessment System of Thoracolumbar Osteoporotic Fracture

OBJECTIVEnTo examine the Assessment System of Thoracolumbar Osteoporotic Fracture (ASTLOF), which can effectively guide the treatment of single-segmental thoracolumbar osteoporotic vertebral compression fractures but fails to guide the treatment of multisegmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF).nnnMETHODSnA prospective case series study was designed to enroll elderly patients with MSTMOVCF who had been treated with percutaneous kyphoplasty/percutaneous vertebroplasty (PKP/PVP) from June 2013 to June 2016. Surgery indication was based on revised ASTLOF. Visual analog scale and Oswestry Disability Index (ODI) scores were used to evaluate the postoperative improvement of back pain, and clinical effects were assessed according to the 36-Item Short Form Health Survey. Some imaging measures, such as height of anterior and middle column and Beck value, were measured before the operation and 12 months after the operation. Complications also were collected.nnnRESULTSnA total of 193 patients underwent PKP/PVP surgery. At postoperative 2 days, 3 months, and 1-year follow-up, whereas VAS and ODI scores decreased (Pxa0<xa00.0001, for all) significantly as well as SF-36, the height of anterior and middle column increased (P < 0.0001, for all) compared with preoperation. Beck value at 1-year follow-up was greater than preoperation (Pxa0= 0.001). The improvement rate of ODI was 86.4 ± 8.3%.nnnCONCLUSIONSnPatients with MSTMOVCF who undergo surgery with PKP/PVP can achieve great clinical results. Patients with the sum of revised ASTLOF scores of multiple injured vertebrae ≥5 should be recommended for surgery. The consistency and repeatability of the revised ASTLOF need further study.

Decompression for Traumatic Thoracic/Thoracolumbar Incomplete Spinal Cord Injury: Application of AO Spine Injury Classification System to Identify the Timing of Operation

OBJECTIVEnApplication of AO spine injury classification system (AOSICS) to identify the timing of operation for different types of traumatic thoracic/thoracolumbar incomplete spinal cord injury (SCI).nnnMETHODSnA single-center prospective cohort study was conducted to enroll patients with thoracic/thoracolumbar incomplete SCI from April 2013 to November 2016; they were divided into an early group (<24 hours after SCI) and a late group (24-72 hours after SCI). Each group was divided into A, B, C subgroups according to AOSICS. The primary outcomes were ordinal changes in ASIA Impairment Scale at 12-month follow-up. The secondary outcomes included the Medical outcomes study 36-term short form health survey physical component summary (PCS), complications, mortality, and hospital length of stay (LOS).nnnRESULTSnSeven hundred twenty-one patients with thoracic/thoracolumbar incomplete SCI were included; 335 patients underwent early surgery, and 386 patients underwent delayed surgery. Statistical results included the following comparisons of the early versus late groups: AIS improvement of 1 grade or more (combined groups: Pxa0= 0.009, odds ratio [OR]xa0= 1.487; A: Pxa0= 0.777, ORxa0= 1.072; B: Pxa0=xa00.029, ORxa0= 1.701; C: Pxa0= 0.007, ORxa0= 1.762), AIS improvement 2 grades or more (combined groups: Pxa0= 0.002, ORxa0= 2.471; A: Pxa0= 0.189, ORxa0= 3.939; B: Pxa0= 0.011, ORxa0= 2.550; C: Pxa0= 0.035, ORxa0= 3.964) and PCS (combined groups: Pxa0= 0.327; A: Pxa0= 0.776; B: Pxa0= 0.019; C: Pxa0= 0.562). LOS (combined groups: P < 0.0001; A, B and C: P < 0.0001). Complications (combined groups: P = 0.267; A: P = 0.830; B: P = 0.111; C: P = 0.757).nnnCONCLUSIONSnPatients with type-A injuries with incomplete SCI do not have to undergo aggressive early operations. Patients with type-B and type-C injuries should undergo an operation early to achieve better clinical results.

Great Hospitals of Asia: Neurosurgery and Spine Surgery at Xi'an Jiaotong University-Affiliated Honghui Hospital

Established in 1987, the Spine Surgery Hospital at Honghui Hospital is one of the oldest spinal surgical departments in China. The first chairman, Yuan Fuyong, devoted himself to the development of the department. The current president, Hao Dingjun, assumed the position in November 2008. The current department consists of 5 wards and 235 beds, encompassing the entire spectrum of spinal surgical diseases, with 27 specialized faculty members and care teams. The remarkable growth of the hospital during the last 30 years made it possible to perform 8000 operations in 2017. A total of 300 articles were published in scientific journals, of which more than 100 were published in international journals between 1987 and 2017. At present, the developmental model of neurosurgery and spine surgery at Honghui Hospital is based on the concept of holistic integrative medicine. It was jointly developed by several departments including those of spine surgery, neurosurgery, traditional Chinese medicine rehabilitation, and basic research. This article traces the history, research and teaching accomplishments, academic exchanges, and future directions.

The analysis of MSTMOVCF (Multi-segment thoracolumbar mild osteoporotic fractures surgery or conservative treatment) based on ASTLOF (the assessment system of thoracolumbar osteoporotic fracture)

To investigate the issue that conservative or surgical treatment for multi-segmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF) by applying the assessment system of thoracolumbar osteoporotic fracture (ASTLOF). A single-center prospective cohort study was designed to enroll elderly patients with MSTMOVCF from June 2013 to June 2016, which were divided into conservative and surgery group. The primary outcomes were Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score, with secondary outcomes including SF-36 and imaging measures such as height of anterior and middle column, Beck value, complications. A total of 470 patients with MSTMOVCF were enrolled. 193 patients underwent surgery of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and 277 patients underwent conservative treatment. The VAS score of operation group was significantly lower than that of conservative group (Pu2009<u20090.0001, for all). The ODI score of the operation group was significantly lower than that of conservative group (Pu2009<u20090.0001, for all). The SF-36 score, height of anterior and middle column, Beck value in the operation group were higher than those in conservative group (Pu2009<u20090.0001, for all) at 1-year follow-up. MSTMOVCF underwent surgery can achieve great short-term clinical results. The patient with the sum of revised ASTLOF scores of multiple injured vertebraeu2009≥u20095 was recommended for surgery.