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To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs) with intravertebral clefts.The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed. The patients were divided into group A and group B according to different operative methods. In group A, 45 patients were treated with unilateral approach PVP, including 17 males and 28 females, aged (75.35±11.82) years old, with a bone density T-value of (-4.28±0.65) g/cm³; in group B, 49 patients treated with manual reduction combined with unilateral approach PVP, including 19 males and 30 females, aged (76.79±9.64) years old, with a bone density T-value of (-4.33±0.72) g/cm³. The operation time, bone cement injection volume and postoperative complications of two groups were recorded. The VAS and ODI scores of two groups were analyzed respectively at 1, 12, 18 months after operation. Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12, 18 months after operation. The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated.There was no significant difference in operation time between two groups. The amount of bone cement injection was(8.42±1.24) ml in group A and(9.19±1.09) ml in group B, and the difference between two groups was statistically significant(In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts, the manual reduction combined with PVP is more effective than single PVP, which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.

To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy.From June 2012 to June 2015, 73 patients with cervical spondylotic myelopathy were treated, including 42 males and 31 females, aged from 29 to 73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group (34 cases) and the operation combined with traditional Chinese medicine group(39 cases) according to the idea of themselves. The anterior discectomy or subtotal corpectomy with internal fixation or posterior simple open-door decompression with lateral mass screw fixation were performed in the patients. Among them, 39 cases were treated with traditional Chinese medicine after surgery. The Japanese orthopedic association (JOA) score of spinal cord function, the improvement rate of neural function, the neck dysfunction index (NDI) score and the governor vessel stasis syndrome score were compared between two groups preoperative and postoperative 1 week, 1 month and the final follow-up respectively. The internal fixation and the condition of spinal cord decompression were observed by CT, MRI and X-rays before and after operation.All the operations were successful, no injuries such as dura mater, spinal cord and nerve root were found. All the wounds were healed without infection except one patient had a superficial infection. It was solved after intermittent debridement and anti-infective therapy. Hematoma occurred in 1 case, complicated with spinal cord compression, caused incomplete paralysis, and promptly performed the re-operation to remove the hematoma without any obvious sequelae. All the patients were followed up from 12 to 24 months, (14.6±0.8) months for simple operation group and (13.5±0.7) months for operation combined with traditional Chinese medicine group, and there was no significant difference(Spinal card decompression for the treatment of cervical spondylotic myelopathy can extend the spinal canal, relieve the compression of nerve, achieve the deoppilation of governor vessel, the regulation of qi and blood, the restore of Yangqi, combined with traditional Chinese medicine of activating blood removing stasis, warming yang and activating meridians, reinforcing liver benefiting kidney, which may obtain better clinical effect.

To explore the clinical efficacy of unilateral open-door laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament(OPLL).The clinical data of 45 patients with OPLL underwent surgical treatment between September 2011 and September 2015 were retrospectively analyzed. There were 26 males and 19 females with a mean age of 53.6 years old(ranged from 28 to 71 years). Among them, 24 cases received the surgery of unilateral open-door cervical laminoplasty combined with foraminotomy(combined group), and 21 cases received a single unilateral open-door cervical laminoplasty(single group). Operation time, intraoperative blood loss, complications including C₅ nerve root palsy and axial symptoms were compared between two groups. Pre-and post-operative Japanese Orthopedic Association(JOA) score, improvement rate of neurological function, Neck Disability Index(NDI) score, and cervical Cobb angle were recorded and analyzed between the two groups.All the patients were followed up for 12-24 months, with an average of (14.3±2.8) months for combined groups and (13.7±3.1) months for single group, and no significant difference was found between the two groups(Unilateral open-door cervical laminoplasty combined with foraminotomy is an effective method to treat cervical OPLL, which could provide sufficient decompression of spinal cord and nerve root, prevent the C₅ nerve root palsy.

To analyze the clinical outcome of kyphoplasty on costal pain which develops following thoracic osteoporotic compression fractures and evaluate the factors related to costal pain.From May 2014 to May 2016, a total of 188 patients with thoracic osteoporotic compression fractures undergoing kyphoplasty were reviewed retrospectively. The patients were divided into two groups: the costal pain group included patients who had costal pain after a vertebral fracture and the no costal pain group included patients without costalgia. Visual analogue scale(VAS)and Oswestry Disability Index(ODI)of all patients were measured preoperatively and 3 days, 1 month, 6 months postoperatively respectively. Gender, age, the fracture level, bone mineral density, vertebral body fracture type, and fracture severity were compared between two groups, and the causes of costal pain were analyzed.Among 188 patients, 38 patients (20.2%) complained of costal pain with back pain. The mean follow-up time was 8.3 months (ranged from 6 to 15 months). The VAS and ODI score of two groups decreased after operation, and there was significant difference between pre-operation and post-operation(The fracture type and fracture severity had significant relation to costal pain of thoracic osteoporotic compression fractures. The kyphoplasty effect on costal pain may not be effective, especially during early post-operation period.

To investigate the meaning of pedicle exposure technique for screw fixation on atlas with the vertebral groove height less than 4 mm by using reconstructive computed tomography.From April 2015 to June 2015, 84 pedicles of 51 patients with groove heights less than 4 mm were studied by digital reconstruction respectively. Parameters of atlas pedicle screw fixation were measured.Among the 51 cases, the vertebral groove height was (3.28±0.51) mm. Lateral mass heights, lateral mass widths and the transition area heights between lateral mass and posterior arch were fit for 3.5 mm screw implanting. Ideal pedicle screw trajectory lengths from 0° to 15° (0°, 5°, 10°, 15°) were (27.36±1.81), (27.01±1.68), (27.07±1.75), (27.48±1.72) mm, exposed trajectory lengths from 0° to 15°(0°, 5°, 10°, 15°) were(23.44±1.79), (23.87±1.84), (24.58±1.89), (25.56±2.01) mm, trajectory length of lateral mass was (20.78±2.05) mm. The mean CT values on 5 sections through pedicle trajectory and lateral mass trajectory were (701.89±141.48) HU and (599.11±137.33) HU, respectively. There were no significant differences between ideal pedicle trajectory lengths from 0° to 15°(Screws can be implanted in atlas with vertebral groove height less than 4 mm by using pedicle exposure technique. Few trajectory lengths will be sacrificed with favorable pull out strength due to adequate bone mass purchased.

To investigate the clinical effects and operative options for the treatment of Forestier disease.From June 2005 to May 2012, 8 patients with progressive dysphagia due to Forestier disease were treated through anterior approach, their clinical data were retrospective analyzed. There were 6 males and 2 females, aged from 65 to 83 years old with an average of 73 years. Among the patients, osteophytes removal was performed in 3 cases, osteophytes removal with discectomy and fusion was performed in 2 cases, osteophytes removal with corpectomy and fusion was performed in 3 cases. According to Bazaz dysphagia score to assess the improvement of the patients' symptoms before and after operation.All patients were followed up from 12 to 40 months with the mean of 18.5 months. Seven cases were asymptomatic and 1 case had mild symptom in the last follow-up. Radiographs showed the space enlargement between vertebral body and trachea.It is effective to treat patients with progressive dysphagia due to Forestier disease through surgical method. And the operative options depend on the stability of cervical spine and the neurological symptoms of the patients.

To explore effectiveness and safety of segmental anterior cervical decompression in treating multi-level cervical myelopathy.Twenty-four patients with four levels of cervical myelopathy were treated with segmental anterior cervical decompression (reservation of middle vertebrae, bone graft and plate-screws fixation). Among patients, there were 15 males and 9 females aged from 47 to 75 (averaged 57.9) years old. Preoperative, postoperative at 1 week and the latest following-up AP and lateral X-rays were used to observe bone union, displacement of implant, adjacent segment degeneration, changes of Cobb angle of fusion segment. JOA scoring were applied for evaluate recovery of nerve function.All operations were completed successfully, 2 cases ocurred hoarseness, and improved after treated symptomatically. Nineteen patients were followed up from 3.1 to 5.3 years with an average of 3.9 years. Bone union time ranged from 3 to 7 (averaged 4.5) months. No screw loosening and displacement occurred. Nine patients occurred titanium mesh subsidence in different degrees, and 4 of them subside3 mm; four patients ocurred adjacent segment degeneration. Postoperative Cobb angle of fusion segment at 1 week (10.40±2.94)° was improved from preoperative (5.76±4.16)°, but decreased at the latest follow-up (8.57±2.82)°, and had significant meaning compared with preoperative (P0.01). JOA score at the latest follow-up (14.6±1.1) was higher than that of before operation (8.2±1.9), and had siginificant differences (P0.01).Segmental anterior cervical decompression for the treatment of multilevel cervical myelopathy has a high clinical operability, and plays an important role in recovering cervical curvature and nerve function based on completely decompression.

To explore clinical effects of multi-segmental cervical spondylosis myelopathy through anterior approach by surgical treatment.From September 2006 to September 2012, the data of 85 patients with multi segmental cervical spondylosis myelopathy were retrospectively analyzed. Among them, 48 cases were male, 37 cases were female, ranging the age from 34 to 86 years old (mean, 54.5 years old). Surgical procedure included anterior discectomy and fusion (19 cases), anterior secondary discectomy and fusion (45 cases) and anterior discectomy combined with anterior cervical corpectomy with fusion (21 cases). Bone fusion were evaluated by X-ray at the 3rd day after operation and following up. JOA score and improvement rate were compared.All patients were followed up from 6 to 30 months with an average of 18 months. Decompression were done throughly during operation and good intervertebral space height and cervical curvature were obtained. X-ray showed nonunion in 3 cases, and improvement rate was 96%. JOA score after operation was higher than before operation, and had significant differences (P0.05). Fifty-six cases got excellent results, 16 moderate, 9 effective and 4 invalid according to JOA scores.Surgical procedures for cervical spondylosis myelopathy should be chosen reasonably in accordance with sympotoms, signs, imaging data, so as to obtain good results in decompression, recoving intervertebral height and cervical curature, improving fusion rate.

To research the correlation between surgical treatment for atlantoaxial dislocation and dredging Governor vessel.From June 2004 to June 2010,113 patients were reviewed, including 65 males and 48 females, with the mean age of 42.6 years (ranged, 8 to 64 years). All the patients were classified and treated by TOI clinical classification which included traction and decompression and reduction, and inter fixation fusion by surgery. The SAC (space available for the cord), Governor vessel Yuzu score, JOA score, NDI score (cervical spine dysfunction index) before treatment were compared with those of after treatment.The SAC in each group before treatment were (13.34 +/- 3.21), (10.43 +/- 2.42), (7.89 +/- 3.14), (10.50 +/- 0.71) mm respectively, the last follow-up of (16.02 +/- 1.42), (15.34 +/- 1.87), (14.49 +/- 1.58), (12.50 +/- 0.71) mm; Governor vessel Yuzu score before treatment were (8.37 +/- 1.87), (6.87 +/- 1.35), (5.17 +/- 1.13), (7.50 +/- 0.71) respectively, the last follow-up of (10.59 +/- 0.94), (10.25 +/- 1.01), (8.41 +/- 1.31), (9.0 +/- 0); JOA, NDI score significantly improved compared with that of before treatment.Atlantoaxial dislocation confirmed and treated by TOI clinical classification can effectively relieve the nerve function and Governor vessel Yuzu syndrome, and show that surgical treatment is closely related with dredging the Governor vessel.

To investigate the clinical effect and indication of bone graft and impaction on posterior interbody fusion for lumbar instability.From January 2001 to July 2008, 95 patients with lumbar instability were treated by bone graft and impaction on posterior interbody fusion. Including 41 males and 54 females, the age from 45 to 76 years old with an average of 59 years. There were 68 cases with single level, 22 cases with two-level, 5 cases with three-level in patients, which were 127 intervertebral space altogether. The neural canal and affected side nerve root were decompressed thoroughly during operation. Resected the disc from the affected side and erased the cartilage to plate extensively combined with pedicle screw fixation, and impaction on interbody fusion with the excisional vertebral plate bone was achieved. To assess the improvement of the patients' symptom, sign, and JOA scores pre and post operatively. Meanwhile, the changes of intervertebral height from the lumbar radiographs were measured and the degrees of interbody bone fusion were evaluated according to SUK method.All the 95 patients were followed up from 12 to 90 months with the mean of 44.8 months. All the clinical symptom were improved significantly or disappeared completely. All the 127 intervertebral space achieved good bone fusion. There was no displacement of bone graft and severe complication happened. According to the radiograph, all the intervertebral heights were increased obviously. The mean JOA score improved from 11.3 +/- 3.3 preoperative to 25.1 +/- 2.8 at 8 weeks postoperative; achieved 24.8 +/- 3.2 with followed up at the last time (P0.001).Bone graft and impaction on posterior interbody fusion was one of the most effective methods for the lumbar instability. It has extensive range of application, and it's suitable for senile lumbar degeneration instability especially.