BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,join...BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,joint,eye,brain,skin,and other sites are easily infected,and there is a marked risk of misdiagnosis.There have been few case reports of infection by S.apiospermum of the lumbar vertebrae;most reports have focused on infection of the lung.CASE SUMMARY An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain,stooping,and limited walking.The symptoms were significantly aggravated 10 d prior to hospitalization,and radiating pain in the back of his left lower leg developed,which was so severe that he could not walk.Movement of the lumbar spine was significantly limited,anterior flexion was about 30°;backward extension,right and left lateral curvature,and rotational mobility were about 10°;tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident,and the muscle strength of both lower limbs was gradeⅣ.Imaging suggested bony destruction of the lumbar 3,4,and 5 vertebrae and sacral 1 vertebra;in addition,the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable.Lumbar vertebral infection was also noted,and the possibility of lumbar tuberculosis was considered.We first performed surgical intervention on the lesioned lumbar vertebrae,cleared the infected lesion,and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device,which restored the stability of the lumbar vertebrae.Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S.apiospermum infection of the lumbar vertebrae;on this basis,the patient was administered voriconazole.At the 6-mo followup,efficacy was significant,no drug-related side effects were observed,and imaging examination showed no evidence of recurrence.CONCLUSION S.apiospermum infection can occur in immunocompetent individuals with no history of near drowning.Voriconazole is effective for the treatment of S.apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.展开更多
Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisth...Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were展开更多
Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumba...Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.展开更多
Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with r...Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with ruptured lumbar disc herniation and treated with natural absorption in our hospital were selected as the research subjects.According to the size of the herniated discs after 2 years,the subjects were divided into the reabsorption lumbar disc herniation group(group 1,2,3,and 4)and the non-reabsorption group(group 0).The pelvic incidence angle(PI),the sacral slope(SS),the pelvic tilting(PT),and the lumbar lordosis(LL)were measured and compared at the time of admission and 2 years after follow-up.Results:There were no significant differences in the PI value and the change of PI value during the entry and re-examination of different groups.There was no significant difference in the PT,SS,and LL values among the patients in each group;At the time of reexamination,the PT had a decreasing trend and the SS and LL had an increasing trend.With the increase of the patient's score,the changes in PT,SS,and LL values showed an increasing trend.Conclusion:The PT,SS and LL values of patients with lumbar intervertebral disc herniation had significant changes before and after treatment.Changes in the sagittal balance index of the lumbar spine were important factors affecting the natural absorption of lumbar disc herniation.展开更多
Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through K...Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through Kambin’s triangle approach.Methods:five complete cadaveric specimens were taken,the soft tissue of the lumbar back was removed,the transverse process,upper and lower articular processes and part of the vertebral lamina were bitten,the Kambin’s triangle area of the lumbar spine was completely exposed,the bottom edge and height of the Kambin’s triangle were measured,and the area of the Kambin’s triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin’s triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Results:the average height of the Kambin’s triangle was 11.20mm±2.10mm,and the average height of the improved four corners was 11.19mm±1.93mm.The height of the improved four corners was slightly shorter than that of the Kambin’s triangle.There was a significant correlation between the two,but the difference was not statistically significant.The average bottom of Kambin’s triangle is 10.78mm±1.95mm,and the average bottom of improved four corners is 12.14mm±1.78mm.The length of the bottom edge of improved four corners is greater than that of Kambin’s triangle.There is a significant correlation between them,and the difference is statistically significant;The average area of Kambin’s triangle is 61.79mm^(2)±20.71mm^(2),and the area of improved four corners is 137.71mm^(2)±38.20mm^(2).The area of improved four corners is significantly larger than that of Kambin’s triangle.There is a significant correlation between the two,and the difference is statistically significant.Conclusion:there is a narrow right angle triangle area surrounded by traveling nerve root,dural sac and superior endplate of lower vertebral body in the lumbar intervertebral foramen.If the traveling nerve root is pulled and fixed to turn the traditional Kambin’s triangle into a quadrilateral,the bottom edge of the Kambin’s triangle area can be significantly longer and the area can be significantly expanded,which can be operated more safely.展开更多
Primary non-Hodgkin lymphoma of the spine is very rare and occurs mostly in adults with strong male predominance.Here,we present the case of a 24-year-old girl harboring a primary diffuse B-cell lymphoma of L2 vertebr...Primary non-Hodgkin lymphoma of the spine is very rare and occurs mostly in adults with strong male predominance.Here,we present the case of a 24-year-old girl harboring a primary diffuse B-cell lymphoma of L2 vertebral body,who was admitted in an emergency with cauda equina syndrome and completely recovered after total spondylectomy and adjuvant chemotherapy.Such findings have never been previously reported.展开更多
Background Spinal pain is a serious health and social-economic problem.Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades,and a variety of e...Background Spinal pain is a serious health and social-economic problem.Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades,and a variety of endoscopic techniques have been invented to treat a wide range of spinal conditions.Purposes The purposes of this 2-part review article are to 1) overview the published techniques of endoscopic spine surgery,2) summarize the applications of these techniques in treating various spinal conditions,and 3) evaluate the clinical evidence of the safety and effectiveness of these endoscopic techniques in treating some of the most common spinal conditions.The first part of the review article provides an overview of currently most commonly used techniques.Methods We searched the PubMed database for publications concerning endoscopic spine surgery and reviewed the relevant articles published in the English language.Results Discectomy and foraminotomy are the most common types of spine surgery that can currently be done endoscopically.Endoscopic techniques have been used to treat a wide range of spinal disorders located in the lumbar,cervical,as well as the thoracic regions of the spine.展开更多
基金Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program,No. 20QNPY071
文摘BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,joint,eye,brain,skin,and other sites are easily infected,and there is a marked risk of misdiagnosis.There have been few case reports of infection by S.apiospermum of the lumbar vertebrae;most reports have focused on infection of the lung.CASE SUMMARY An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain,stooping,and limited walking.The symptoms were significantly aggravated 10 d prior to hospitalization,and radiating pain in the back of his left lower leg developed,which was so severe that he could not walk.Movement of the lumbar spine was significantly limited,anterior flexion was about 30°;backward extension,right and left lateral curvature,and rotational mobility were about 10°;tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident,and the muscle strength of both lower limbs was gradeⅣ.Imaging suggested bony destruction of the lumbar 3,4,and 5 vertebrae and sacral 1 vertebra;in addition,the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable.Lumbar vertebral infection was also noted,and the possibility of lumbar tuberculosis was considered.We first performed surgical intervention on the lesioned lumbar vertebrae,cleared the infected lesion,and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device,which restored the stability of the lumbar vertebrae.Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S.apiospermum infection of the lumbar vertebrae;on this basis,the patient was administered voriconazole.At the 6-mo followup,efficacy was significant,no drug-related side effects were observed,and imaging examination showed no evidence of recurrence.CONCLUSION S.apiospermum infection can occur in immunocompetent individuals with no history of near drowning.Voriconazole is effective for the treatment of S.apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.
文摘Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were
文摘Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.
基金Scientific research project of Sichuan health and Family Planning Commission(No.16pj389)
文摘Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with ruptured lumbar disc herniation and treated with natural absorption in our hospital were selected as the research subjects.According to the size of the herniated discs after 2 years,the subjects were divided into the reabsorption lumbar disc herniation group(group 1,2,3,and 4)and the non-reabsorption group(group 0).The pelvic incidence angle(PI),the sacral slope(SS),the pelvic tilting(PT),and the lumbar lordosis(LL)were measured and compared at the time of admission and 2 years after follow-up.Results:There were no significant differences in the PI value and the change of PI value during the entry and re-examination of different groups.There was no significant difference in the PT,SS,and LL values among the patients in each group;At the time of reexamination,the PT had a decreasing trend and the SS and LL had an increasing trend.With the increase of the patient's score,the changes in PT,SS,and LL values showed an increasing trend.Conclusion:The PT,SS and LL values of patients with lumbar intervertebral disc herniation had significant changes before and after treatment.Changes in the sagittal balance index of the lumbar spine were important factors affecting the natural absorption of lumbar disc herniation.
基金Hainan Provincial Natural Science Foundation(No.819QN365)National Natural Science Foundation of China(No.81902270)。
文摘Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through Kambin’s triangle approach.Methods:five complete cadaveric specimens were taken,the soft tissue of the lumbar back was removed,the transverse process,upper and lower articular processes and part of the vertebral lamina were bitten,the Kambin’s triangle area of the lumbar spine was completely exposed,the bottom edge and height of the Kambin’s triangle were measured,and the area of the Kambin’s triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin’s triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Results:the average height of the Kambin’s triangle was 11.20mm±2.10mm,and the average height of the improved four corners was 11.19mm±1.93mm.The height of the improved four corners was slightly shorter than that of the Kambin’s triangle.There was a significant correlation between the two,but the difference was not statistically significant.The average bottom of Kambin’s triangle is 10.78mm±1.95mm,and the average bottom of improved four corners is 12.14mm±1.78mm.The length of the bottom edge of improved four corners is greater than that of Kambin’s triangle.There is a significant correlation between them,and the difference is statistically significant;The average area of Kambin’s triangle is 61.79mm^(2)±20.71mm^(2),and the area of improved four corners is 137.71mm^(2)±38.20mm^(2).The area of improved four corners is significantly larger than that of Kambin’s triangle.There is a significant correlation between the two,and the difference is statistically significant.Conclusion:there is a narrow right angle triangle area surrounded by traveling nerve root,dural sac and superior endplate of lower vertebral body in the lumbar intervertebral foramen.If the traveling nerve root is pulled and fixed to turn the traditional Kambin’s triangle into a quadrilateral,the bottom edge of the Kambin’s triangle area can be significantly longer and the area can be significantly expanded,which can be operated more safely.
文摘Primary non-Hodgkin lymphoma of the spine is very rare and occurs mostly in adults with strong male predominance.Here,we present the case of a 24-year-old girl harboring a primary diffuse B-cell lymphoma of L2 vertebral body,who was admitted in an emergency with cauda equina syndrome and completely recovered after total spondylectomy and adjuvant chemotherapy.Such findings have never been previously reported.
文摘Background Spinal pain is a serious health and social-economic problem.Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades,and a variety of endoscopic techniques have been invented to treat a wide range of spinal conditions.Purposes The purposes of this 2-part review article are to 1) overview the published techniques of endoscopic spine surgery,2) summarize the applications of these techniques in treating various spinal conditions,and 3) evaluate the clinical evidence of the safety and effectiveness of these endoscopic techniques in treating some of the most common spinal conditions.The first part of the review article provides an overview of currently most commonly used techniques.Methods We searched the PubMed database for publications concerning endoscopic spine surgery and reviewed the relevant articles published in the English language.Results Discectomy and foraminotomy are the most common types of spine surgery that can currently be done endoscopically.Endoscopic techniques have been used to treat a wide range of spinal disorders located in the lumbar,cervical,as well as the thoracic regions of the spine.
