Zhonghai Li

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4-L5 in 51 patients, L5-S1 in 19 patients, and L3-L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1 years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH.

Clinical Features and Surgical Management of Spinal Osteoblastoma: A Retrospective Study in 18 Cases

Objectives To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma. Methods From June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years（range, 16-38 years). The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS) to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones. Results All cases were followed up for 24-80 months (average, 38.4 months). The average surgical time was 120.8 minutes (range, 80-220 minutes), with the average intraoperative blood loss of 520 ml (range, 300-1200 ml). During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05). 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up. Conclusions Spinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment.

A Comparison of Multilevel Anterior Cervical Discectomy and Corpectomy in Patients with 4-level Cervical Spondylotic Myelopathy: A Minimum 2-year Follow-up Study.

Study Design: Retrospective clinical series. Objectives: To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of segmental anterior cervical corpectomy and fusion (sACCF) plus preservation of middle vertebrae with those of multilevel anterior cervical discectomy and fusion (mACDF) in 70 patients with 4-level cervical spondylotic myelopathy (CSM). Methods: Between July 2006 and May 2011, 70 consecutive patients [49 males and 21 females; mean age 56.8 y (range, 38–72 years)] with 4-level CSM were enrolled in this study and divided into sACCF (n=39) group and mACDF (n=31) group. The study compared perioperative parameters, complication rates, clinical parameters, and radiologic parameters. Results: No significant differences between the groups were found in demographic, baseline disease characteristics, operation time, hospital stay, and follow-up time. Significant improvements of clinical outcome were seen from preoperative to postoperative in both groups. Satisfaction was rated as excellent or good by 79.5% of the sACCF group and 80.6% of the mACDF group, which was not a significant difference. Mean postoperative cervical lordosis was significantly greater in the mACDF group than in the sACCF group. Blood loss was significantly greater in the sACCF group than in the mACDF group and instrumentation-related and/or graft-related complication rate significantly lower for the mACDF group. Both sACCF and mACDF groups achieved solid fusion rates (87.1% and 90.3%, respectively). Conclusions: Both mACDF and sACCF provide satisfactory clinical outcomes and fusion rates for 4-level CSM. However, mACDF is associated with better radiologic parameter, less blood loss, and lower instrumentation-related and/or graft-related complication rate.

Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobbs angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.

Comparison of Three Reconstructive Techniques in the Surgical Management of Patients With Four-level Cervical Spondylotic Myelopathy

Study Design. Retrospective clinical series. Objective. To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of three reconstructive techniques after the anterior decompression of four-level cervical spondylotic myelopathy (CSM). Summary of Background Data. At present, the decision to treat multilevel CSM, especially four-level CSM, remains controversial. No one compares multilevel anterior cervical discectomy and fusion (mACDF), segmental anterior cervical corpectomy and fusion (sACCF) to multilevel anterior cervical discectomy and fusion with cage alone (mACDF-CA) in four-level constructs. Methods. Between July 2006 and February 2014, 97 consecutive patients with four-level CSM were enrolled in this study and divided into sACCF (n = 39) group, mACDF (n = 31) group, and mACDF-CA (n = 27) group. The study compared perioperative parameters, complication rates, clinical and radiologic parameters of three reconstructive techniques after the anterior decompression of four-level CSM. Results. The mACDF-CA group had the least bleeding and cost of index surgery compared with the sACCF group having the most bleeding and cost. Although significant pain relief and functional activity improvement have been achieved in the three groups at the final follow-up, there was no significant difference in the Japanese Orthopedic Association, SF-36 and NDI scores among the three groups (P >0.05). The mACDF group maintained the best cervical lordosis at the final follow-up, compared with the sACCF group maintained the worst cervical lordosis. Solid fusion was achieved in 87.1% of subjects in sACCF group, 90.3% in mACDF, and in 88.9% in mACDF-CA. The mACDF-CA group had a higher rate of subsidence and lower rate of dysphagia than other two groups. Conclusion. mACDF-CA can be considered an effective and safe alternative procedure in the treatment of the four-level CSM. Level of Evidence: 4

Risk factors and the surgery affection of respiratory complication and its mortality after acute traumatic cervical spinal cord injury.

Abstract The aim of this study is to estimate the risk factors of both respiratory complication (RC) and mortality after acute traumatic cervical spinal cord injury (TCSCI). Between July 2005 and July 2015, in 181 patients (142 males and 39 females; mean age 41.0 years) with acute TCSCI, we compared the difference and odds ratio in RC group (n = 73) with that of non-RC group (n = 108), and also death group (n = 15) and survival group (n = 166). We collected injury-related information after half a year of injury, which is as follows: the causes of injury, time of surgery, ICU (intensive care unit) days, ventilator days, ASIA (American Spinal Injury Association) classification, neurological injury, CIPS (Clinical Pulmonary Infection Score), and BMI (body mass index). Besides these, we gathered the general information such as age, gender, smoking history, and use of steroids. The study compared perioperative parameters; surgery-related and instrumentation- and graft-related complication rates; clinical parameters; patient satisfaction; and radiologic parameters. Variations like gender (odds ratio [OR] = 1.269, 95% confidence interval [CI] [0.609–2.646]), smoking history (OR = 2.902, 95% CI [1.564–5.385]), AIS grade (grade A) (OR = 6.439, 95% CI [3.334–12.434]), neurological level (C1-C4) (OR = 2.714, 95% CI [1.458–5.066]), and steroid use (OR = 2.983, 95% CI [1.276–6.969]) have a facilitated effect on RC. When we estimated surgery-related affection, only the time of surgery and anterior approach compared with posterior has significant difference in RC (P < .05). Between death and survival group, the aspect of age, non-surgical, CPIS, AIS grade, and BMI have statistically significant difference. Survival analysis reveals significant difference in aforementioned groups. In patients suffering from acute TCSCI, those who are old, have long smoking history, complete spinal cord injury, C1-C4, high CPIS, and fat have high incidence of RC and mortality.

A new zero-profile, stand-alone Fidji cervical cage for the treatment of the single and multilevel cervical degenerative disc disease

To investigate the clinical and radiological results of the new zero-profile, stand-alone Fidji cervical cage to treat single- and multiple-level cervical DDD, and evaluate the safety and efficiency. Between October 2011 and July 2014, 72 consecutive patients (41 males and 31 females; mean age 50.9years [range, 33-68years]) with cervical DDD who underwent surgery and were followed for more than 2years were enrolled in this study (mean 31.1months, range 24-47months). The study compared clinical outcomes, radiologic parameters and complication rates. The SF-36, VAS, NDI, and JOA scores of all patients were improved significantly after surgery at any time point. (all p<0.05). The C2-C7 Cobb angle and the disc height index (DHI) of all patients were improved significantly after surgery at any time point (all p<0.05). From 3months after surgery to final follow-up the DHI showed a significant reduction comparing 1week after surgery (all p<0.05). The fusion rates were 91.7% (66/72) and the radiologic mean fusion time was 9.9months. Radiological evidence of adjacent segment degeneration (ASD) was observed in 4/41 patients (9.8%). Postoperative complications included epidural hematoma, hoarseness, dysphagia, axial neck pain, and subsidence. The zero-profile, stand-alone Fidji cervical cage for ACDF can be considered an effective, reliable and safe alternative procedure in the treatment of cervical DDD.