Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the tra...Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.展开更多
BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison ...BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10....<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.展开更多
Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral p...Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.展开更多
Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Metho...Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.展开更多
文摘Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.
基金Supported by the Health Science and Technology of Tianjin Municipality,No.RC20204Tianjin Institute of Orthopedics,No.2019TJGYSKY03the National Natural Science Foundation of China,No.818717771177226。
文摘BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Background</span><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. </span><b><span style="font-family:Verdana;font-size:12px;">Objective</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">To evaluate the impact of PPS fixation in patients with PS. </span><b><span style="font-family:Verdana;font-size:12px;">Study Design</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">A retrospective analysis of the medical records. </span><b><span style="font-family:Verdana;font-size:12px;">Subjects, Methods</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span></b><span style="line-height:1.5;font-family:Verdana;"> These cases </span><span style="line-height:1.5;font-family:Verdana;">were </span><span style="line-height:1.5;font-family:Verdana;">divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.051) and CRP inversion (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.020, p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">=</span><span style="font-family:'';font-size:10pt;"> </span><span style="line-height:1.5;font-family:Verdana;">0.354) between </span><span style="line-height:1.5;font-family:Verdana;">the </span><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;">two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. </span><b><span style="font-family:Verdana;font-size:12px;">Conclusion</span></b></span><b style="line-height:1.5;"><span style="font-family:Verdana;">:</span><span style="font-size:10.0pt;font-family:""> </span></b><span style="line-height:1.5;font-family:Verdana;">PPS fixation was effective to achieve shorten</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> the period to ambulation and discharge or transfer. But it was not effective </span><span style="line-height:1.5;font-family:Verdana;">in</span><span style="line-height:1.5;font-family:Verdana;"> infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS show</span><span style="line-height:1.5;font-family:Verdana;">ing</span><span style="line-height:1.5;font-family:Verdana;"> resistance to initial treatment.
文摘Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.
文摘Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.
