Abstract:

Abstract:[Objective] To compare the clinical efficacy of Wiltse approach pedicle screw fixation (WAPSF) versus percutaneous pedi-cle screw fixation (PPSF) in the treatment of single-level thoracolumbar fracture. [Methods] A retrospective study was conducted on 97 pa-tients who received surgical treatment for single-segment thoracolumbar fracture without nerve injury in our department from January 2013to December 2020. According to the preoperative doctor-patient exchange, 51 patients underwent WAPSF, while other 46 patients werewith PPSF. The data of perioperative period, follow-up and imaging were compared between the two groups. [Results] The operation wassuccessfully completed in both groups. The WAPSF group was significantly better than the PPSF group in operation time [(75.5±8.6) min vs(103.5±9.0) min, P＜0.001], intraoperative fluoroscopy times [(6.4±0.9) vs (15.4±1.6), P＜0.001], the hospitalization cost [(4.3±0.3) 10 k yu-an vs (5.0±0.2) 10 k yuan, P＜0.001], but the former had significantly longer total incision length than the latter [(7.0±0.7) cm vs (6.3±0.5)cm, P＜0.001]. In addition, the WAPSF group had significantly lower blood creatine kinase (CK) than the PPSF group 1 day after surgery[(155.7±9.9) U/L vs (174.3±15.8) U/L, P＜0.001]. The VAS for back pain and ODI scores significantly decreased in both groups with time(P＜0.05), and ODI scores in WAPSF group were significantly higher than that in the PPSF group 3 days after surgery (P＜0.05). In term ofimaging, there was no significant difference in the accuracy of screw placement between the two groups (P＞0.05). The local kyphotic Cobbangle decreased significantly (P＜0.05), while the percentage of anterior vertebra height increased significantly in both groups postoperative-ly compared with those preoperatively (P＜0.05). The WAPSF group proved significantly superior to the PPSF group regarding the local ky-photic Cobb angle at all time points after operation (P＜0.05), and the percentage of anterior vertebral height 3 days after operation (P＜0.05).[Conclusion] Both Wiltse approach pedicle screw and percutaneous pedicle screw are minimally invasive fixation of thoracolumbar frac-tures, and do achieve satisfactory clinical consequence. In contrast, the Wiltse approach is less time-consuming, less doctor and patient ra-diation exposure, less hospitalization costs, and more satisfactory in improving thoracolumbar kyphosis angle and restoring the height of the injured vertebrae.

Abstract:[Objective] To compare the clinical outcome of anterior cervical discectomy and fusion (ACDF) combined with or withoutChinese medicine decoction for cervical spondylotic radiculopathy (CSR). [Methods] A retrospective study was conducted on 43 patientswho had single-segment CSR treated by ACDF in our hospital from January 2022 to December 2022. According to the preoperative doctorpatientcommunication, 22 patients were treated with ACDF combined with traditional Chinese medicine decoction (the combined group),while other 21 patients were treated with ACDF alone (the simple group). The perioperative period, follow-up and imaging data of the twogroups were compared. [Results] All patients in both groups had operation performed successfully, and there were no significant differencesin operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, ambulation time and hospital stay between thetwo groups (P＞0.05). The TCM syndrome score, VAS score, NDI score and JOA score were significantly improved in both groups at the lastfollow-up compared with those preoperatively (P＜0.05). The combined group proved significantly superior to the simple group in terms ofTCM syndrome score [(7.4±2.9) vs (11.6±5.2), P＜0.001], VAS score [(0.9±0.4) vs (1.9±1.1), P＜0.001], JOA score [(15.6±1.1) vs (14.4±0.9),P＜0.001], NDI score [(25.4±4.2) vs (27.9±4.2), P=0.028] at the latest follow-up. As for imaging, there was no significant change in theheight of intervertebral space (P＞0.05), but the cervical lordosis angle was significantly increased (P＜0.05), and the cervical ROM was sig-nificantly decreased in both group at the latest follow-up compared with those preoperatively (P＜0.05). At any corresponding time points,there were no significant differences in the above image indicators between the two groups (P＞0.05). [Conclusion] The ACDF combinedwith Chinese medicine decoction for cervical spondylotic radiculopathy (CSR) does relieve nerve root compression and dredge the blockageof the supervision vein, significantly improve nerve function and promote rapid recovery.

Abstract:[Objective] To compare of clinical consequences of anterior cervical discetomy and fusion (ACDF) versus anterior cervicalcorpectomy and fusion (ACCF) for multi-segment cervical spondylotic myelopathy (MCSM). [Methods] A retrospective study was conductedon 102 patients who had MCSM treated surgically in our hospital. According to the results of doctor-patient communication, 51 patients re-ceived ACDF, while the other 51 received ACCF. The perioperative, follow-up and imaging data of the two groups were compared. [Results]The ACDF group proved significantly superior to the ACCF group in terms of operative time [(125.8±12.6) min vs (136.8±13.7) min, P＜0.001], intraoperative blood loss [(185.6±18.6) mL vs (206.7±21.2) mL, P＜0.001] and hospital stay [(10.6±1.1) days vs (12.7±1.3) days, P＜0.001]. With time went on, the NDI and JOA scores, as well as pyramidal tract sign significantly improved in both groups (P＜0.05). However,the ACDF group proved significantly better than the ACCF group regarding JOA score 6 months after surgery and at the last follow-up[(13.6±1.6) vs (12.1±1.3), P＜0.001; (15.1±1.6) vs (14.4±1.6), P=0.029], and NID score at the latest follow-up [(10.8±1.1) vs (13.6±1.3), P＜0.001]. As for imaging, the cervical lordotic angle, C2~7 sagittal vertical axis (SVA), T1 slope and minimum sagittal diameter of spinal canalsignificantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05). The ACDF group was also significant-ly better than the ACCF group in terms of cervical lordotic angle [(28.8±2.9)° vs (5.1±2.5)°, P＜0.001], SVA [(11.4±1.2) mm vs (15.4±1.6) mm,P＜0.001] and T1 slope [(25.1±2.5)° vs (28.3±2.9)°, P＜0.001]. [Conclusion] The ACDF does effectively reduce surgical trauma and achievebetter clinical outcomes for MCSM over the ACCF.

Abstract:[Objective] To compare the clinical efficacy of Delta endoscopic decompression versus unilateral biportal endoscopy (UBE)counterpart for lumbar spinal stenosis (LSS). [Methods] A retrospective study was conducted on 100 patients who had LSS treated by endo-scopic decompression from January 2022 to June 2023. According to preoperative doctor-patient communication, 46 patients were treatedwith Delta endoscopic decompression, while other 54 patients received UBE decompression. The perioperative, follow-up and imaging datawere compared between the two groups. [Results] The Delta group proved significantly superior to the UBE grpup im terms of operative time[(94.2±15.6) min vs (102.3±13.9) min, P=0.007], the incision length [(2.2±0.2) cm vs (1.3±0.1) cm, P＜0.001] and intraoperative fluoroscopyfrenquency [(3.5±0.4) times vs (6.4±0.6) times, P＜0.001], although there were no significant differences in intraoperative blood loss, the bedrest time, hospital stay, quality of incision healing and incidence of complications between the two groups (P＞0.05). Compared with those pre-operatively the low back pain and leg pain VAS scores, as well as ODI were gradually improved in both groups 3 months after surgery and atthe last follow-up (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05).In addition, there was no significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). As for im-aging evaluation, the vertebral canal area and dural sac cross-sectional area were increased in both groups at the last follow-up comparedwith those preoperatively (P＜0.05), but there was no significant difference between the two groups at any matching time points (P＞0.05).[Conclusion] Both Delta endoscopy and unilateral biportal endoscopy used lumbar canal decompression do achieve satisfactory clinical con-senquence for lumbar spinal stenosis. In comparison, the Delta endoscopy is superior to the UBE in terms of operation time, surgical incisionand fluoroscopy times.

Abstract:[Objective] To investigate the efficacy of ultrasound-CT fusion imaging for percutaneous transforaminal endoscopic discec-tomy (PTED). [Methods] A total of 54 patients who were undergoing PTED for disc herniation were enrolled into this study in our hospitalfrom January 2021 to January 2023, and randomly divided into two groups, with 27 patients in each group. The fluoroscopy group had PTEDperformed under C-arm X-ray machine guide, while the image fusion group had PTED conducted with guide of ultrasound-CT fusion image.Perioperative, follow-up and imaging data were compared between the two groups. [Results] The image fusion group proved significantly su-perior to the fluoroscopy in terms of the operation time [(89.2±10.7) min vs (109.3±11.8) min, P＜0.001], puncture time [(9.2±1.1) min vs(13.8±2.5) min, P＜0.001], intraoperative fluoroscopy times [(3.8±0.8) times vs (6.2±0.9) times, P＜0.001], and success rate of first puncture[cases (%), 22 (81.5) vs 15 (55.6), P=0.040]. All patients in both groups were followed up for 12 months, and the low back pain and leg painVAS scores, as well as ODI and JOA scores in both groups were significantly improved over time (P＜0.05). The image fusion group was signif-icantly better than the fluoroscopy group regarding low back pain VAS score [(3.6±0.9) vs (4.5±1.1), P＜0.001; (0.9±0.2) vs (1.3±0.3), P＜0.001], leg pain VAS score [(3.2±0.8) vs (3.7±0.9), P＜0.001; (1.1±0.2) vs (1.6±0.5), P＜0.001], ODI score [(45.5±5.6) vs (51.8± 6.7), P＜0.001;(20.4±2.6) vs (25.4±3.4), P＜0.001], JOA score [(16.2±2.3) vs (14.1±2.5), P＜0.001; (23.5±3.2) vs (19.7±3.5), P＜0.001] 1 month after surgeryand at the latest follow-up. As for imaging, the ratio of vertebral canal occupied area was significantly decreased at the last follow-up com-pared with that preoperatively (P＜0.05), while the vertebral space height and lumbar lordosis angle remained unchanged significantly in bothgroups (P＞0.05). At corresponding time points, there were no statistically significant differences in the above imaging indicators (P＞0.05).[Conclusion] Ultrasonic CT fusion imaging PTED does significantly improve the pain symptom and lumbar function, and enhance the safetyof surgery.

Abstract:[Objective] To compare the clinical consequence of unilateral biportal endoscopic (UBE) debridement and instrumented fu-sion versus open debridement and instrumented fusion for lumbar brucellosis spondylitis (LBS). [Methods] A retrospective research wasdone on 34 patients who received surgical treatment for single-segment LBS and were followed up after surgery. Of them, 16 patients in thelater stage were treated with UBE-assisted posterior debridement and drainage combined with interbody bone allografting and antibrucello-sis drugs, as well as percutaneous pedicle screw fixation (the UBE group), while 18 patients in the early stage underwent the open counter-parts (the open group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in bothgroups had corresponding surgical procedures conducted smoothly. Although the UBE group consumed significantly longer operative time[(191.3±18.6) min vs (143.3±34.4) min, P＜0.001] and more intraoperative fluoroscopy times [(5.6±1.0) vs (2.4±0.8), P＜0.001] than the opengroup, the former proved significantly superior to the latter in terms of incision length [(5.4±0.3) cm vs (14.8±0.9) cm, P＜0.001], intraopera-tive blood loss [(185.7±18.1) mL vs (261.9±17.9) mL, P＜0.001], bed rest time [(2.1±0.4) days vs (5.4±0.6) days, P＜0.001] and hospital stay[(8.8±3.0) days vs (13.7±7.2) days, P=0.017]. All patients were followed up for more than 12 months, and the VAS, ODI and JOA scores inboth groups were significantly improved over time (P＜0.05). The UBE group was significantly better than the open group regarding to VASscore [(1.8±0.7) vs (4.1±0.6), P＜0.001], ODI score [(32.2±7.0) vs (40.5±4.6), P＜0.001], JOA score [(20.2±1.7) vs (17.2±1.0), P＜0.001] 1month postoperatively. As for auxiliary examination, the ESR and CRP were significantly decreased (P＜0.05), and vertebral space height andlumbar lordotic angle were significantly improved in both groups after surgery (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). At the last follow-up, there was no significant difference in Bridwell fusionscale between the two groups (P＞0.05). [Conclusion] UBE assisted debridement and instrumented fusion for disc type LBS has the advantag-es of less pain in the early postoperative period, less intraoperative blood loss, and shortening postoperative hospital stay over the open coun-terparts.

Abstract:Due to the unique anatomical structure of the upper cervical spine, atlantoaxial dislocation can lead to severe neurologicaldeficits, with patients presenting symptoms such as limb pain and numbness. In severe cases, it can even be life-threatening. Single posteri-or decompression and fixation often fail to achieve complete reduction of the atlantoaxial joint. However, the transoral atlantoaxial reductionplate (TARP) internal fixation system allows for atlantoaxial decompression, reduction, internal fixation, and fusion through a single ap-proach in one procedure. TARP internal fixation surgery is an effective supplementary method for treating atlantoaxial disorders. This studyaims to employ bibliometric methods and visualization techniques to conduct a comprehensive and in-depth analysis of the literature relat-ed to TARP surgery. This will not only contribute to a more profound understanding of the research trajectory, current state, and future di-rections in this field but also reveal potential weaknesses and possible research directions in the existing studies, thereby providing new in-sights and guidance for subsequent research.

Abstract:The flexion-distraction injury (FDI) is a three-column spinal injury commonly occurring in the thoracolumbar region, charac-terized by damage to the spinous process or the posterior ligamentous complex (PLC). It is often accompanied by vertebral compression frac-tures or burst fractures, while Chance fractures represent only one subtype of FDI. In clinical setting, the attention is often given to the moreapparent vertebral fractures and neural compression, while understanding to thoracolumbar flexion-distraction injuries (TLFDI) remains in-adequate, which usually leads to misdiagnosis and missed diagnosis, and hampers appropriate selection of treatment plans. Inproper treat-ment strategies can result in spinal instability and worsening of neurological function. This article aims to review the current progress in theinjury mechanism, clinical classification, diagnostic methods, treatment options, and the debate on whether to remove internal fixation forTLFDI, to enhance clinicians' understanding of these injuries and provide a reference for clinical decision-making in TLFDI management.

Abstract:Spondylolysis is a prevalent cause of low back pain among adolescents. Conservative treatment is the most commonly pre-scribed approach. However, surgical intervention becomes necessary if the conservative treatment fails to alleviate the symptoms or whenthere is a vertebral slippage. Generally, surgical remedies have a high success rate in remedying spondylolysis. Nevertheless, the recoveryprocess may be hindered by multiple factors, such as endogenous items, including the position of the isthmus segment, stages of the isth-mus, the condition of the opposite isthmus, metabolic disorders, vitamin D deficiencies, and exogenous factors, involving smoking habits,the choice of internal fixation, the type of bone graft used in the surgical site, environmental factors and medication usage. The purpose ofthis paper is to provide an all-inclusive scrutiny of the factors leading to inadequate postoperative healing in adolescent spondylolysis.

Abstract:With the development of medical 3D printing technology, it has shown great advantages in precision and personalized medi-cine, effectively promoting the development of medicine. Especially in the field of spine surgery, 3D printing technology has shown broad ap-plication prospects in the design and manufacture of personalized implants, surgical auxiliary guides, surgical planning, extracorporeal or-thotics, teaching and training, doctor-patient communication and biomaterials. This paper intends to review the application status of 3Dprinting technology in the field of spinal surgery in recent years, so as to provide reference for the accuracy and individualization of spinalsurgery.

Abstract:Deep vein thrombosis refers to local swelling and pain caused by disorders of venous return, which can cause serious compli-cations such as pulmonary embolism. The incidence of deep vein thrombosis in patients undergoing spinal surgery varies greatly, which is re-lated to factors such as disease type, monitoring method, and monitoring time. Anticoagulation remains the treatment of choice, and the opti-mal anticoagulant and duration of treatment depends on clinical evaluation. This article reviews the incidence, early diagnosis and treatmentof common diseases in spine surgery, such as lumbar degenerative surgery, spinal fracture, cervical spondylosis and so on in the periopera-tive period, so as to provide a reference for clinical practice.

Abstract:Scoliosis is a common three-dimensional spinal deformity in children. Early and accurate diagnosis and intervention can ef-fectively prevent the progression of scoliosis. In recent years, artificial intelligence has made remarkable progress in image recognition tasks,processing medical images through steps such as data collection, feature extraction and model construction, and has been initially applied tothe intelligent diagnosis of scoliosis, and is expected to overcome the shortcomings of manual measurement relying on doctor experience,time-consuming and laborious, and poor repeatability. This paper reviews the research progress of artificial intelligence in the diagnosis ofscoliosis in children, and provides research ideas and references for the development of automatic and intelligent scoliosis diagnosis andtreatment tools in the future.

Abstract:[Objective] To investigate the clinical efficacy of the modified enlarging laminoplasty for multi-level lumbar spinal stenosis( LSS) in elderly. [Methods] A retrospective study was conducted on 35 elderly patients who received the modified enlarging laminoplastyfor multi-level LSS in our hospital from February 2020 to December 2022. The clinical and imaging data were evaluated. [Results] All pa-tients were successfully operated on without serious complications, and were followed up for a mean of (23.9±9.2) months.With time preop-eratively, 3 months postoperatively and the last follow-up, the low back pain VAS score [(4.8±1.3), (1.5±0.7), (1.4±0.5), P＜0.001], leg painVAS score [(6.9±1.1), (2.5±0.7), (2.3±0.6), P＜0.001] and ODI scores [(90.0±20.0), (10.0±10.0), (10.0±10.0), P＜0.001] were significantly de-clined, whereas the continuous walking distance on flat land [(183.7±114.4) m, (817.1±108.4) m, (1 212.9±175.5) m, P＜0.001] significantlyincreased. As for imaging, spinal canal area [(1.3±0.1) cm2, (1.8±0.1) cm2, (1.8±0.1) cm2, P＜0.001) and sagittal diameter of lateral recess[(3.0±0.5) mm, (5.4±0.6) mm, (5.5±0.6) mm, P＜0.001] were significantly increased over time. [Conclusion] This modified enlarging lamino-plasty is a safe and feasible method for the treatment of multi-level LSS in elderly and achieves satisfactory clinical consequence.

Abstract:[Objective] To investigate the difference of magnetic resonance imaging parameters (MRIPs) in low back pain with or with-out lumbar instability. [Methods] A retrospective analysis was performed on 361 patients who were diagnosed of low back pain in our hospi-tal from January 1, 2021 to August 31, 2023. Based on whether lumbar translation ＞3 mm on the dynamic lateral X-rays at hyperextensionand hyperflexion, 181 cases were fall into the unstable group, while the remaining 180 case were into the stable group. The MRI parametersof lumbar spine, including the thickness of the facet joint effusion, facet joint angle (FJA), and disc height index (DHI), were compared be-tween the two groups. [Results] The unstable group proved significantly greater than the stable group in terms of joint effusion thickness[(1.2±0.8) mm vs (0.9±0.7) mm, P 0.023], and FJA on both sides [left, (61.2±9.8)° vs (57.2±8.4)°, P 0.039; right, (62.9±10.1)° vs (59.1±6.5)°, P 0.003], while the former had significantly less DHI than the latter [(0.3±0.1) % vs (0.3±0.1) %, P 0.005]. In addition, the unstablegroup was marked significantly severer degeneration grade than the stable group (P＜0.05). [Conclusion] MRIPs measurement in low backpain might accurately evaluate lumbar instability and provide a basis for surgical planning.

Abstract:[Objective] To investigate the effect of cognitive behavioral intervention on kinesophobia after posterior lumbar interbody fu-sion (PLIF) for lumbar degenerative diseases. [Methods] From January 2021 to January 2023, a total of 100 patients who underwent PLIF forlumbar degenerative diseases and suffered from postoperative kinesophobia were enrolled into this study. The patients were randomly divid-ed into two groups by coin toss method. Among them, 50 patients were given cognitive behavioral intervention on the basis of routine care,while the other 50 cases were only given postoperative routine care. The clinical data of the two groups were compared. [Results] The inter-vention group proved significantly superior to the routine group in terms of bed rest time [(2.1±0.6) days vs (3.8±0.8) days, P＜0.001], hospitalstay [(7.2±1.1) days vs (8.5±1.3) days, P＜0.001], and the total incidence of complications (8% vs 24%, P=0.029). In addition, the interven-tion group returned to full weight-bearing activities significantly earlier than the routine group [(45.3±4.9) days vs (53.8±6.6) days, P＜0.001]. As time went on, Tampa scale for kinesiophobia (TSK) significantly decreased (P＜0.05), while JOA score significantly increased inboth groups (P＜0.05). At 1 week and 1 month after surgery, the intervention group was significantly better than the routine group in terms ofTSK score [(32.1±5.3) vs (44.8±6.6), P＜0.001; (23.4±3.7) vs (30.4±4.7), P＜0.001] and JOA score [(20.6±3.5) vs (18.8±3.2), P＜0.001; (22.4±3.0) vs (20.5±3.4), P＜0.001]. [Conclusion] Cognitive behavioral intervention does promote early recovery of kinesophobia after PLIF forlumbar degenerative diseases, reduce the incidence of complications and promote functional rehabilitation.

Abstract:[Objective] To analyze the significance of drainage culture before removal of drainage tube in spinal surgery. [Methods]From September 2019 to September 2024, 933 patients who underwent open spinal surgery in our hospital were included in this study. Be-fore the drainage tube was removed, the drainage fluid of the incision drainage tube was harvested for bacteria culture. The results of bacteri-al culture were recorded and compared according to clinical indicators. [Results] Of the 933 patients, 89 were positive with 97 pathogenicstrains isolated, including 49 gram-positive strains, 47 gram-negative strains and 1 fungal strain. As results of stratified comparison, the pos-itive rate according to the surgical site was ranked from high to low as, posterior cervical ＞ thoracic ＞ lumbar ＞ anterior cervical, with a statis-tical significance (P＜0.05). The positive rate of culture in patients with operation time ≥4 h was significantly higher than that in patients withoperation time ＜4 h (11.7% vs 6.8%, P=0.013), and the positive rate of culture in patients with increased inflammatory indexes was signifi-cantly higher than that in patients without increased inflammatory indexes (23.1% vs 7.3%, P＜0.001). The positive rate of culture in patientswith incision exudate was significantly higher than that in those without incision exudate (15.2% vs 7.5%, P＜0.001). However, there was nosignificant difference in culture positive rate between diabetic and non-diabetic patients (7.3% vs 10.2%, P=0.220). [Conclusion] The re-sults of incision drainage culture in spinal surgery have a certain predictive role on postoperative wound deep infection, but the samplingtechnique should be improved to reduce false positive results.