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Survivorship of coflex Interlaminar-Interspinous Implant 椎板间-棘间假体的成活率
Pub Date : 2009-06-01 DOI: 10.1016/S1935-9810(09)70008-8
Thomas J. Errico MD , Jonathan R. Kamerlink MD , Martin Quirno MD , Jacques Samani MD , Robert J. Chomiak MS

Background

The purpose of this study was to determine the indications for implantation of the coflex device (Paradigm Spine, LLC, New York, New York), assess long-term complications, and evaluate the long-term clinical outcomes of patients.

Methods

A total of 127 patients underwent placement of a coflex implant for various indications by one orthopaedic spine surgeon. The mean follow-up was 6.3 years. The original indications for implantation were determined based upon the data provided in the case report forms. Preoperatively and postoperatively, patients were asked to grade their low-back and leg pain using the visual analog scale (VAS) and the pain severity scale: no pain (0), mild pain (1), moderate pain (2), or severe pain (3). Patients were queried about their satisfaction with the surgical procedure. Follow-up radiographs were taken to determine any device-related issues.

Results

The most prevalent diagnoses for implantation were spinal stenosis (19.7%) and spinal stenosis with lumbar disc herniation (35.4%). The mean severity of low-back pain was decreased by 33% (from moderate to mild) at the 2-year follow-up (P < .001) and at the 5-year follow-up (from moderate to mild, P < .001). The mean severity of leg pain was decreased by 66% (from severe to mild) at the 2-year follow-up (P < .001) and at the 5-year follow-up (from severe to mild, P < .001). At the mean follow-up period of 6.3 years, a patient satisfaction query demonstrated that 7% were unsatisfied, 46% were satisfied, and 46% were very satisfied with their clinical outcome. Based on the follow-up radiographs, 92 of patients had no device-related issues and 8% had device-related issues.

Conclusion

The data provided have demonstrated that the coflex implant provides pain relief for patients with low-back pain and leg pain. The most common indications for implantation were spinal stenosis and spinal stenosis with lumbar disc herniation. There were very few device-related complications.

Clinical Significance

Using coflex is a safe and viable option in the selection of instrumentation for spinal stabilization.

本研究的目的是确定coflex装置植入的适应症(Paradigm Spine, LLC, New York, New York),评估长期并发症,并评估患者的长期临床结果。方法对127例不同适应症的患者,由一名脊柱外科医生行椎体内固定。平均随访时间为6.3年。最初的植入适应症是根据病例报告表格中提供的数据确定的。术前和术后,患者被要求使用视觉模拟量表(VAS)和疼痛严重程度量表对腰背痛和腿部疼痛进行分级:无疼痛(0)、轻度疼痛(1)、中度疼痛(2)或重度疼痛(3)。询问患者对手术过程的满意度。随访x线片以确定任何与器械相关的问题。结果植入术中最常见的诊断为椎管狭窄(19.7%)和椎管狭窄合并腰椎间盘突出(35.4%)。在2年随访中,腰痛的平均严重程度降低了33%(从中度到轻度)(P <.001)和5年随访(从中度到轻度,P <措施)。在2年随访中,腿部疼痛的平均严重程度降低了66%(从严重到轻度)(P <.001)和5年随访(从严重到轻度,P <措施)。在平均6.3年的随访期间,患者满意度查询显示,7%的患者不满意,46%的患者满意,46%的患者非常满意他们的临床结果。根据随访x线片,92例患者无器械相关问题,8%有器械相关问题。结论所提供的数据表明,coflex植入物可以缓解腰痛和腿痛患者的疼痛。最常见的适应症是椎管狭窄和椎管狭窄合并腰椎间盘突出。很少有器械相关的并发症。临床意义使用coflex是一种安全可行的脊柱固定工具选择。
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引用次数: 0
Evaluation of Perivascular Adhesion Formation in New Zealand White Rabbits Using Oxiplex and DuraSeal Xact Adhesion Barrier System. 应用oxplex和DuraSeal精确粘连屏障系统评价新西兰大白兔血管周围粘连形成。
Pub Date : 2009-06-01 eCollection Date: 2009-01-01 DOI: 10.1016/SASJ-2009-0006-NT
Fred Mo, James Yue, Jianghui Zhang, Kreg Howk, Allister Williams

Background: Adhesion formation after spine surgery is a result of normal wound healing that may place patients at increased risk for complications during revision surgery. Preventing adhesions could reduce the risk of complications during revision surgery, and possibly reduce the need for revision procedures. This study evaluates the ability of DuraSeal Xact Adhesion Barrier System (DSX) (Covidien, Mansfield, Massachusetts) and Oxiplex/SP gel (OX) (FzioMed, San Luis Obispo, California) to affect the extent and severity of postoperative perivascular adhesion development in an anterior spinal surgical rabbit model.

Methods: We determined the extent and severity of postoperative adhesion development 34 days after surgery in 12 male New Zealand White rabbits randomly assigned to intraoperative treatment with either DSX or OX, or to an untreated control group. Adhesion severity and extent were scored on scale from 0 (none) to 3 (severe).

Results: The extent and severity of adhesions in the DSX group were significantly less than in the untreated control group. The DSX group mean extent score was 1.3 ± 0.5 (vs 2.5, P = .01) and the mean severity score was 1.25 ± 0.5 (vs 2.8, P = .005). The extent and severity of adhesions in the OX group were not significantly different from the control group.

Conclusion: In this study, we found DSX to be the most effective compound in preventing adhesion formation after anterior spine surgery.

Clinical relevance: Extrapolating these results in rabbits to humans, less scarring between the major blood vessels could decrease the rate of complications in revision spine procedures.

背景:脊柱手术后粘连的形成是伤口正常愈合的结果,这可能使患者在翻修手术中出现并发症的风险增加。预防粘连可以减少翻修手术中并发症的风险,并可能减少翻修手术的需要。本研究评估DuraSeal Xact粘连屏障系统(DSX) (Covidien, Mansfield, Massachusetts)和oxplex /SP凝胶(OX) (FzioMed, San Luis Obispo, California)在兔脊柱前路手术模型中影响术后血管周围粘连发展的程度和严重程度的能力。方法:我们测定了术后34天粘连发展的程度和严重程度,12只雄性新西兰大白兔被随机分配到术中使用DSX或OX的组,或未治疗的对照组。粘附严重程度和程度评分从0(无)到3(严重)。结果:DSX组粘连程度和严重程度均明显小于未治疗对照组。DSX组平均程度评分为1.3±0.5 (vs 2.5, P = 0.01),平均严重程度评分为1.25±0.5 (vs 2.8, P = 0.005)。OX组的粘连程度和严重程度与对照组无显著差异。结论:在本研究中,我们发现DSX是预防脊柱前路手术后粘连形成最有效的化合物。临床意义:将这些结果从兔子身上推断到人类身上,减少主要血管之间的疤痕可以降低脊柱翻修手术的并发症发生率。
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引用次数: 5
Co-culture of Adult Mesenchymal Stem Cells and Nucleus Pulposus Cells in Bilaminar Pellets for Intervertebral Disc Regeneration. 成体间充质干细胞与髓核细胞在双层微球中共培养用于椎间盘再生。
Pub Date : 2009-06-01 eCollection Date: 2009-01-01 DOI: 10.1016/SASJ-2009-0005-NT
Aliza A Allon, Richard A Schneider, Jeffrey C Lotz

Background: Our goal is to optimize stem cell-based tissue engineering strategies in the context of the intervertebral disc environment. We explored the benefits of co-culturing nucleus pulposus cells (NPC) and adult mesenchymal stem cells (MSC) using a novel spherical bilaminar pellet culture system where one cell type is enclosed in a sphere of the other cell type. Our 3D system provides a structure that exploits embryonic processes such as tissue induction and condensation. We observed a unique phenomenon: the budding of co-culture pellets and the formation of satellite pellets that separate from the main pellet.

Methods: MSC and NPC co-culture pellets were formed with three different structural organizations. The first had random organization. The other two had bilaminar organization with either MSC inside and NPC outside or NPC inside and MSC outside.

Results: By 14 days, all co-culture pellets exhibited budding and spontaneously generated satellite pellets. The satellite pellets were composed of both cell types and, surprisingly, all had the same bilaminar organization with MSC on the inside and NPC on the outside. This organization was independent of the structure of the main pellet that the satellites stemmed from.

Conclusion: The main pellets generated satellite pellets that spontaneously organized into a bilaminar structure. This implies that structural organization occurs naturally in this cell culture system and may be inherently favorable for cell-based tissue engineering strategies. The occurrence of budding and the organization of satellite pellets may have important implications for the use of co-culture pellets in cell-based therapies for disc regeneration.

Clinical relevance: From a therapeutic point of view, the generation of satellite pellets may be a beneficial feature that would serve to spread donor cells throughout the host matrix and restore normal matrix composition in a sustainable way, ultimately renewing tissue function.

背景:我们的目标是优化椎间盘环境下基于干细胞的组织工程策略。我们探索了髓核细胞(NPC)和成体间充质干细胞(MSC)共培养的好处,使用一种新的球形双层颗粒培养系统,其中一种细胞类型被封闭在另一种细胞类型的球体中。我们的3D系统提供了一种利用组织诱导和凝结等胚胎过程的结构。我们观察到一个独特的现象:共培养球团的出芽和从主球团分离的卫星球团的形成。方法:制备三种不同结构组织的MSC和NPC共培养微球。第一种是随机组织。另外两种为双层组织,要么是MSC在内部,NPC在外部,要么是NPC在内部,MSC在外部。结果:14 d时,所有共培养微球均有出芽并自发产生卫星微球。卫星颗粒由两种细胞类型组成,令人惊讶的是,它们都具有相同的双层结构,MSC在内部,NPC在外部。这个组织独立于卫星所产生的主要颗粒的结构。结论:主微球生成的卫星微球自发组织成双层结构。这意味着结构组织在这种细胞培养系统中自然发生,并且可能天生有利于基于细胞的组织工程策略。出芽的发生和卫星微球的组织可能对在基于细胞的椎间盘再生治疗中使用共培养微球具有重要意义。临床意义:从治疗的角度来看,卫星微球的产生可能是一个有益的特征,它将有助于将供体细胞扩散到整个宿主基质中,并以可持续的方式恢复正常的基质成分,最终更新组织功能。
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引用次数: 16
Evaluation of Perivascular Adhesion Formation in New Zealand White Rabbits Using Oxiplex and DuraSeal Xact Adhesion Barrier System 应用oxplex和DuraSeal精确粘连屏障系统评价新西兰大白兔血管周围粘连形成
Pub Date : 2009-06-01 DOI: 10.1016/S1935-9810(09)70009-X
Fred Mo MD , James Yue MD , Jianghui Zhang MD , Kreg Howk MS , Allister Williams MD

Background

Adhesion formation after spine surgery is a result of normal wound healing that may place patients at increased risk for complications during revision surgery. Preventing adhesions could reduce the risk of complications during revision surgery, and possibly reduce the need for revision procedures. This study evaluates the ability of DuraSeal Xact Adhesion Barrier System (DSX) (Covidien, Mansfield, Massachusetts) and Oxiplex/SP gel (OX) (FzioMed, San Luis Obispo, California) to affect the extent and severity of postoperative perivascular adhesion development in an anterior spinal surgical rabbit model.

Methods

We determined the extent and severity of postoperative adhesion development 34 days after surgery in 12 male New Zealand White rabbits randomly assigned to intraoperative treatment with either DSX or OX, or to an untreated control group. Adhesion severity and extent were scored on scale from 0 (none) to 3 (severe).

Results

The extent and severity of adhesions in the DSX group were significantly less than in the untreated control group. The DSX group mean extent score was 1.3 ± 0.5 (vs 2.5, P = .01) and the mean severity score was 1.25 ± 0.5 (vs 2.8, P = .005). The extent and severity of adhesions in the OX group were not significantly different from the control group.

Conclusion

In this study, we found DSX to be the most effective compound in preventing adhesion formation after anterior spine surgery.

Clinical Relevance

Extrapolating these results in rabbits to humans, less scarring between the major blood vessels could decrease the rate of complications in revision spine procedures.

脊柱手术后粘连的形成是伤口正常愈合的结果,这可能使患者在翻修手术中出现并发症的风险增加。预防粘连可以减少翻修手术中并发症的风险,并可能减少翻修手术的需要。本研究评估DuraSeal Xact粘连屏障系统(DSX) (Covidien, Mansfield, Massachusetts)和oxplex /SP凝胶(OX) (FzioMed, San Luis Obispo, California)在兔脊柱前路手术模型中影响术后血管周围粘连发展的程度和严重程度的能力。方法对12只雄性新西兰大白兔进行术后34天粘连程度和严重程度的测定,这些雄性新西兰大白兔被随机分为术中给予DSX或OX治疗组和未给予治疗的对照组。粘附严重程度和程度评分从0(无)到3(严重)。结果DSX组的粘连程度和严重程度均明显小于未治疗对照组。DSX组平均程度评分为1.3±0.5 (vs 2.5, P = 0.01),平均严重程度评分为1.25±0.5 (vs 2.8, P = 0.005)。OX组的粘连程度和严重程度与对照组无显著差异。结论在本研究中,我们发现DSX是预防脊柱前路手术后粘连形成最有效的化合物。临床相关性将这些结果从兔子到人类进行推断,减少主要血管之间的疤痕可以降低脊柱翻修手术的并发症发生率。
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引用次数: 0
A Radicular Syndrome From Developmental Narrowing of the Lumbar Vertebral Canal 发育性腰椎管狭窄引起的神经根综合征
Pub Date : 2009-06-01 DOI: 10.1016/S1935-9810(09)70010-6
Henk Verbiest MD
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引用次数: 0
100 consecutive cases of degenerative lumbar conditions using a non-threaded locking screw system with a 90-degree locking cap. 使用带90度锁定帽的无螺纹锁定螺钉系统连续100例腰椎退行性疾病。
Pub Date : 2009-03-01 eCollection Date: 2009-01-01 DOI: 10.1016/SASJ-2008-0022-RR
Paul C McAfee, Bryan W Cunningham, P Justin Tortolani, Ira L Fedder, John C Sefter, Charles Davis

Background: This prospective study analyzes the perioperative outcomes and long-term fusion success of 100 consecutive lumbar degenerative cases. The cases were managed using a non-threaded locking screw system, in conjunction with polyetheretherketone (PEEK) cages, for posterior lumbar interbody fusion (PLIF) procedures. These 100 cases were compared to another prospective study treating patients with the same inclusion and exclusion criteria using conventional plate-based pedicle screw spinal instrumentation augmented with carbon fiber interbody cages.

Methods: A total of 167 operative levels were treated in 100 patients (51 single-level, 39 two-level and 10 three-level cases). Eleven cases were revisions and 67 patients received interbody fusion cages. Patients had an average of 22.8 ± 4.0 months followup.

Results: There was one instrumentation failure but no significant subsidence at the interbody fusion level. The disc space height was restored as part of the surgical procedure at the interbody cage levels: from 7.5 ± 2.3 mm preoperative to 9.0 ± 2.1 mm postoperative. There were 2 cases of pseudarthrosis (2 / 100 = 2%). The average operative time for 1-level cases was 111 ± 25 minutes; for 2-level cases it was 132.4 ± 21.8 minutes; and for 3-level cases it was 162.6 ± 33 minutes. Blood loss averaged 800 ± 473 cc for 1-level cases, 1055 ± 408 cc for 2 levels, and 1155 ± 714 cc for 3 levels. The length of stay was similar between the 3 groups (4.4 ± 1.2 days for single-level cases, 4.7 ± 1.1 for 2 levels, and 5.0 ± 1.1 for 3 levels; P > .05). There were 3 incidental durotomies, and 4 other patients developed infections postoperatively that required reoperation.

Conclusion: The disc and foraminal heights can be restored and maintained with a unilateral cage and pedicle screw construct. Unilateral transforaminal lumbar interbody fusion using a PEEK cage combined with a non-threaded locking pedicle screw and rod system results in similar fusion rates to those achieved using the bilateral Brantigan interbody fusion cage or a single BAK Vista implant. When compared to the bilateral Brantigan cages, decreased operative time (P < .001), decreased blood loss (P < .001) and reduced incidence of dural tears (P < .001) are advantages of using a non-threaded locking screw system and single PEEK interbody cage for lumbar degenerative conditions without compromising subsequent fusion rates.

背景:本前瞻性研究分析了100例连续腰椎退变病例的围手术期结果和长期融合成功率。这些病例采用无螺纹锁定螺钉系统,并结合聚醚醚酮(PEEK)笼进行后路腰椎椎体间融合(PLIF)手术。将这100例病例与另一项前瞻性研究进行比较,该研究使用传统的基于钢板的椎弓根螺钉脊柱内固定和碳纤维椎体间固定器,采用相同的纳入和排除标准。方法:100例患者共167个手术节段(单节段51例,二节段39例,三节段10例)。11例进行了翻修,67例接受了椎间融合器。患者平均随访22.8±4.0个月。结果:有一例内固定失败,但在椎体间融合水平无明显下沉。椎间盘间隙高度作为手术的一部分在椎间笼水平恢复:从术前的7.5±2.3 mm到术后的9.0±2.1 mm。假关节2例(2 / 100 = 2%)。1级病例平均手术时间为111±25分钟;2级病例为132.4±21.8分钟;三级病例为162.6±33分钟。1级患者平均失血量800±473 cc, 2级患者平均失血量1055±408 cc, 3级患者平均失血量1155±714 cc。3组住院时间相似(单级4.4±1.2 d, 2级4.7±1.1 d, 3级5.0±1.1 d);P > 0.05)。有3例意外硬膜切开术,另外4例术后发生感染,需要再次手术。结论:单侧椎弓根螺钉和椎弓根螺钉可以恢复和保持椎间盘和椎间孔高度。单侧经椎间孔腰椎椎间融合使用PEEK保持器结合无螺纹锁定椎弓根螺钉和棒系统,其融合率与使用双侧Brantigan椎间融合保持器或单个BAK Vista植入物所达到的融合率相似。与双侧Brantigan保持器相比,使用无螺钉锁定螺钉系统和单PEEK椎间保持器治疗腰椎退行性疾病的优点是手术时间缩短(P < 0.001)、出血量减少(P < 0.001)和硬脑膜撕裂发生率降低(P < 0.001),而不会影响随后的融合率。
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引用次数: 0
Prospective, Randomized, Multicenter FDA IDE Study of CHARITÉ Artificial Disc versus Lumbar Fusion: Effect at 5-year Follow-up of Prior Surgery and Prior Discectomy on Clinical Outcomes Following Lumbar Arthroplasty CHARITÉ人工椎间盘与腰椎融合的前瞻性、随机、多中心FDA IDE研究:既往手术和既往椎间盘切除术对腰椎关节置换术后临床结果的5年随访影响
Pub Date : 2009-03-01 DOI: 10.1016/S1935-9810(09)70003-9
Fred H. Geisler MD PhD , Paul C. McAfee MD , Robert J. Banco MD , Scott L. Blumenthal MD , Richard D. Guyer MD , Richard T. Holt MD , Mohamed E. Majd MD

Background

Candidates for spinal arthrodesis or arthroplasty often present with a history of prior surgery such as laminectomy, laminotomy or discectomy. In this study, lumbar arthroplasty patients with prior surgery, and in particular patients with prior discectomy, were evaluated for their clinical outcomes at the 5-year time point.

Methods

Randomized patients from the 5-year CHARITÉ investigational device exemption (IDE) study were divided as follows: 1) fusion prior surgery (excluding prior decompression with fusion) group (FSG); 2) fusion prior discectomy group (FDG); 3) fusion no prior surgery group (FNG); 4) arthroplasty prior surgery group (ASG); 5) arthroplasty prior discectomy group (ADG); and 6) arthroplasty no prior surgery group (ANG). The 5-year clinical outcomes included visual analog scale (VAS), Oswestry Disability Index 2.0 (ODI), patient satisfaction, and work status.

Results

In the arthroplasty group, all subgroups had statistically significant VAS improvements from baseline (VAS change from baseline: ASG = -36.6 ± 29.6, P < 0.0001; ADG = -40.2 ± 30.9, P = 0.0002; ANG = -36.5 ± 34.6, P < 0.0001). There was no statistical difference between subgroups (P = 0.5587). In the fusion group, VAS changes from baseline were statistically significant for the FNG and FSG subgroups, but not for the FDG patients (FNG = -46.3 ± 28.8, P < 0.0001; FSG = -24.2 ± 36.4, P = 0.0444; FDG = -26.7 ± 38.7, P = 0.2188). A trend of decreased VAS improvements was observed for FSG versus FNG (P = 0.0703) subgroups. Similar findings and trends were observed in ODI scores (Changes in ODI from baseline: ASG = -20.4 ± 23.8, P < 0.0001; ANG = -26.6±21.1, P < 0.0001; ADG= -17.6 ± 28.6, P = 0.0116; FSG = -14.5 ± 21.2, P = 0.0303; FNG= -32.5 ± 22.6, P < 0.0001; FDG = -10.7 ± 9.4, P = 0.0938). The greatest improvement in work status from preoperative to postoperative was seen in the ADG subgroup (28% increase in part- and full-time employment), while the FDG subgroup showed the greatest reduction in work status (17% decrease).

Conclusions

Arthroplasty patients with prior surgery or prior discectomy had similar clini

背景:腰椎融合术或关节成形术患者通常有椎板切除术、椎板切开术或椎间盘切除术等手术史。在这项研究中,腰椎关节置换术患者既往手术,特别是既往椎间盘切除术患者,在5年时间点评估其临床结果。方法将5年CHARITÉ试验性器械豁免(IDE)研究的患者随机分为:1)术前融合(不包括术前减压融合)组(FSG);2)融合前椎间盘切除术组(FDG);3)融合无手术史组(FNG);4)关节置换术术前组(ASG);5)关节置换术组(ADG);6)关节置换术无手术史组(ANG)。5年临床结果包括视觉模拟量表(VAS)、Oswestry残疾指数2.0 (ODI)、患者满意度和工作状态。结果在关节置换术组,各亚组VAS较基线均有显著改善(VAS较基线变化:ASG = -36.6±29.6,P <0.0001;Adg = -40.2±30.9,p = 0.0002;ANG = -36.5±34.6,P <0.0001)。亚组间差异无统计学意义(P = 0.5587)。在融合组中,FNG和FSG亚组的VAS较基线变化有统计学意义,但FDG患者无统计学意义(FNG = -46.3±28.8,P <0.0001;Fsg = -24.2±36.4,p = 0.0444;Fdg = -26.7±38.7,p = 0.2188)。FSG亚组与FNG亚组相比,VAS改善有降低的趋势(P = 0.0703)。在ODI评分中也观察到类似的结果和趋势(ODI从基线的变化:ASG = -20.4±23.8,P <0.0001;ANG = -26.6±21.1,P <0.0001;Adg = -17.6±28.6,p = 0.0116;Fsg = -14.5±21.2,p = 0.0303;FNG= -32.5±22.6,P <0.0001;Fdg = -10.7±9.4,p = 0.0938)。从术前到术后,ADG亚组的工作状态改善最大(兼职和全职工作增加28%),而FDG亚组的工作状态减少最大(减少17%)。结论既往手术或椎间盘切除术的关节成形术患者临床预后与未手术的关节成形术患者相似,而既往手术或椎间盘切除术的融合术患者临床预后较未手术或椎间盘切除术的融合术患者低。
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引用次数: 0
Osteochondroma arising from the thoracic transverse process. 起源于胸横突的骨软骨瘤。
Pub Date : 2009-03-01 eCollection Date: 2009-01-01 DOI: 10.1016/SASJ-2008-0026-CR
Ding Wenyuan, Li Baojun, Shen Yong, Zhang Wei, Zhang Yingze

The incidence of osteochondroma is rare and only 2% of such tumors are found in the spine area. When they are found in the vertebral column, less than 1% of all osteochondromas and few tumors occur in the thoracic vertebrae. An osteochondroma arising from the transverse process of the vertebra is even rarer, especially following from the thoracic transverse process. Here we report a giant solitary osteochondroma arising from the thoracic transverse process of T8 vertebra and involving the corresponding transverse process and rib. A 28-year-old man presented with a progressive thoracic node, and neuroradiological evaluation of the spine showed a giant mass lesion involving the transverse process of T8 vertebra and concomitant corresponding facet joint and rib on the left side. At surgery, a firm and cartilaginous tumor originating from the transverse process was radically excised and surgical curettage of the lesion was performed. It is concluded that accurate and prompt diagnosis requires a high index of suspicion followed by surgical treatment to prevent severe morbidity in cases of primary spinal column tumors. The histological examination of this patient revealed the lesion was osteochondroma. The best choice of treatment for spinal osteochondromas is surgical excision or curettage and spinal stabilization, if necessary.

骨软骨瘤的发病率是罕见的,只有2%的此类肿瘤被发现在脊柱区域。当它们发生在脊柱时,不到1%的骨软骨瘤和少数肿瘤发生在胸椎。发生于椎体横突的骨软骨瘤更为罕见,尤其是发生于胸横突的骨软骨瘤。我们在此报告一例巨大的孤立性骨软骨瘤,起源于T8椎体胸横突,并累及相应的横突和肋骨。一名28岁男性患者表现为进行性胸淋巴结,脊柱神经放射学评估显示一巨大肿块病变累及T8椎体横突及左侧相应的小关节和肋骨。在手术中,一个起源于横突的坚固的软骨肿瘤被彻底切除,并对病变进行手术刮除。结论:在原发性脊柱肿瘤病例中,准确和及时的诊断需要高度的怀疑指数,然后进行手术治疗,以防止严重的发病率。该患者的组织学检查显示病变为骨软骨瘤。治疗脊柱骨软骨瘤的最佳选择是手术切除或刮除和脊柱稳定,如果必要的话。
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引用次数: 5
100 Consecutive Cases of Degenerative Lumbar Conditions Using a Non-Threaded Locking Screw System With a 90-Degree Locking Cap 连续100例腰椎退行性疾病使用带90度锁定帽的无螺纹锁定螺钉系统
Pub Date : 2009-03-01 DOI: 10.1016/S1935-9810(09)70001-5
Paul C. McAfee MD , Bryan W. Cunningham MSc , P. Justin Tortolani MD , Ira L. Fedder MD , John C. Sefter DO , Charles Davis MD

Background

This prospective study analyzes the perioperative outcomes and long-term fusion success of 100 consecutive lumbar degenerative cases. The cases were managed using a non-threaded locking screw system, in conjunction with polyetheretherketone (PEEK) cages, for posterior lumbar interbody fusion (PLIF) procedures. These 100 cases were compared to another prospective study treating patients with the same inclusion and exclusion criteria using conventional plate-based pedicle screw spinal instrumentation augmented with carbon fiber interbody cages.

Methods

A total of 167 operative levels were treated in 100 patients (51 single-level, 39 two-level and 10 three-level cases). Eleven cases were revisions and 67 patients received interbody fusion cages. Patients had an average of 22.8 ± 4.0 months follow-up. Results: There was one instrumentation failure but no significant subsidence at the interbody fusion level. The disc space height was restored as part of the surgical procedure at the interbody cage levels: from 7.5 ± 2.3 mm preoperative to 9.0 ± 2.1 mm postoperative. There were 2 cases of pseudarthrosis (2 / 100 = 2%). The average operative time for 1-level cases was 111 ± 25 minutes; for 2-level cases it was 132.4 ± 21.8 minutes; and for 3-level cases it was 162.6 ± 33 minutes. Blood loss averaged 800 ± 473 cc for 1-level cases, 1055 ± 408 cc for 2 levels, and 1155 ± 714 cc for 3 levels. The length of stay was similar between the 3 groups (4.4 ± 1.2 days for single-level cases, 4.7 ± 1.1 for 2 levels, and 5.0 ± 1.1 for 3 levels; P > .05). There were 3 incidental durotomies, and 4 other patients developed infections postoperatively that required reoperation.

Conclusion

The disc and foraminal heights can be restored and maintained with a unilateral cage and pedicle screw construct. Unilateral transforaminal lumbar interbody fusion using a PEEK cage combined with a non-threaded locking pedicle screw and rod system results in similar fusion rates to those achieved using the bilateral Brantigan interbody fusion cage or a single BAK Vista implant. When compared to the bilateral Brantigan cages, decreased operative time (P < .001), decreased blood loss (P < .001) and reduced incidence of dural tears (P < .001) are advantages of using a non-threaded locking screw system and single PEEK interbody cage for lumbar degenerative conditions without compromising subsequent fusion rates.

本前瞻性研究分析了100例连续腰椎退变病例的围手术期结果和长期融合成功率。这些病例采用无螺纹锁定螺钉系统,并结合聚醚醚酮(PEEK)笼进行后路腰椎椎体间融合(PLIF)手术。将这100例病例与另一项前瞻性研究进行比较,该研究使用传统的基于钢板的椎弓根螺钉脊柱内固定和碳纤维椎体间固定器,采用相同的纳入和排除标准。方法100例患者共167个手术节段(单节段51例,二节段39例,三节段10例)。11例进行了翻修,67例接受了椎间融合器。患者平均随访22.8±4.0个月。结果:有一例内固定失败,但在椎体间融合水平无明显下沉。椎间盘间隙高度作为手术的一部分在椎间笼水平恢复:从术前的7.5±2.3 mm到术后的9.0±2.1 mm。假关节2例(2 / 100 = 2%)。1级病例平均手术时间为111±25分钟;2级病例为132.4±21.8分钟;三级病例为162.6±33分钟。1级患者平均失血量800±473 cc, 2级患者平均失血量1055±408 cc, 3级患者平均失血量1155±714 cc。3组住院时间相似(单级4.4±1.2 d, 2级4.7±1.1 d, 3级5.0±1.1 d);P比;. 05)。有3例意外硬膜切开术,另外4例术后发生感染,需要再次手术。结论单侧椎弓根螺钉和椎弓根固定器可以恢复和维持椎间孔高度。单侧经椎间孔腰椎椎间融合使用PEEK保持器结合无螺纹锁定椎弓根螺钉和棒系统,其融合率与使用双侧Brantigan椎间融合保持器或单个BAK Vista植入物所达到的融合率相似。与双侧Brantigan保持器相比,手术时间缩短(P <.001),出血量减少(P <.001),硬脑膜撕裂发生率降低(P <.001)是使用无螺纹锁定螺钉系统和单PEEK椎间固定器治疗腰椎退行性疾病而不影响后续融合率的优点。
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引用次数: 0
Lumbar Disc Herniation: A Controlled, Prospective Study with Ten Years of Observation 腰椎间盘突出症:一项10年观察的对照前瞻性研究
Pub Date : 2009-03-01 DOI: 10.1016/S1935-9810(09)70005-2
Henrik Weber MD

Two hundred eighty patients with herniated lumbar discs, verified by radiculography, were divided into three groups. One group, which mainly will be dealt with in this paper, consisted of 126 patients with uncertain indication for surgical treatment, who had their therapy decided by randomization which permitted comparison between the results of surgical and conservative treatment. Another group comprising 67 patients had symptoms and signs that beyond doubt, required surgical therapy. The third group of 87 patients was treated conservatively because there was no indication for operative intervention. Follow-up examinations in the first group were performed after one, four, and ten years.

The controlled trial showed a statistically significant better result in the surgically treated group at the one-year follow-up examination. After four years the operated patients still showed better results, but the difference was no longer statistically significant. Only minor changes took place during the last six years of observation.

280例腰椎间盘突出患者经神经根造影证实,分为三组。其中一组是126例手术适应症不确定的患者,采用随机分组的方法,将手术治疗和保守治疗的结果进行比较。另一组包括67名患者,其症状和体征无疑需要手术治疗。第三组87例患者因无手术干预指征而保守治疗。第一组在1年、4年和10年后进行随访检查。对照试验显示,手术治疗组在一年随访检查中有统计学意义的更好的结果。四年后,手术患者仍然表现出更好的结果,但差异不再具有统计学意义。在过去六年的观察中,只发生了微小的变化。
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引用次数: 51
期刊
SAS journal
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