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Objective: Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss., Methods: From May 2011 to June 2018, 15 patients with lumbosacral tuberculosis with significant vertebral body loss had undergone single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation. The pre- and postoperative lumbosacral angle, visual analog scale score, erythrocyte sedimentation rate, C-reactive protein, and neurological status were assessed., Results: Surgery was successful for all patients, and no patient experienced tuberculosis recurrence during an average follow-up period of 27.3 months (range, 12-60 months). After surgery, the erythrocyte sedimentation rate and C-reactive protein for all patients had returned to normal within 3 months. At the final follow-up examination, the neurological status had improved in all patients who had had neurological deficits preoperatively. The mean preoperative lumbosacral angle was 12.6° (range, 6.7°-17.9°), and had increased to 27.7° (range, 24.3°-34.6°) after surgery. The average lumbosacral angle was 26.4° (range, 22.1°-32.3°), with an average loss of 1.4° (range, 0.6°-2.3°) at the final follow-up visit., Conclusions: The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To define and analyze the learning curve of percutaneous endoscopic transforaminal decompression (PETD) for lumbar spinal stenosis (LSS)., Methods: From July 2015 to September 2016, 78 patients underwent PETD; one of whom was converted to open surgery, two were lost, and 75 were included in this study. Clinical results were assessed by using the Oswestry Disability Index (ODI) and visual analog scale (VAS). The learning curve was assessed by a logarithmic curve-fitting regression analysis. Of these 75 patients, 35 were defined as the "early" group, and 40 were defined as the "late" group for comparison., Results: The mean follow-up was 25.37 ± 4.71 months. The median operative time gradually decreased from 95 (interquartile range, IQR, 85-110) minutes for the early group to 70 (IQR, 60-80) minutes for the late group (P < .000), and an asymptote was reached after approximately 35 cases. After surgery, the VAS for leg pain (LP) and ODI decreased significantly and remained constant during the follow-up. However, the VAS of low back pain (LBP) increased mildly. The total complication rate was 6.6%. ODI, VAS of LP and of LBP, and complication rate did not significantly differ between two groups. Early ambulation and short hospital stay after surgery were achieved., Conclusion: The learning curve of PETD for LSS was assessed and good clinical results were achieved. The surgeon's experience with this technique correlated with reduced operation time. Proper patient selection, familiarity with pathological anatomy, and manipulation under endoscopic view may shorten the learning curve and decrease complications.

Objective: Recently, full endoscopic transforaminal decompression surgery (FETDS) under local anesthesia has been used to treat symptomatic lumbar spinal stenosis (SLSS) in selective patients. Considering the minimal injury associated with this technique, it has a potential advantage for geriatric patients. In addition, combining thorough preoperative assessments and preparations with this technique to achieve a safer and more effective outcome for geriatric patients with SLSS is necessary., Methods: Between June 2015 and September 2016, after thorough preoperative assessments and preparations, 56 geriatric patients who underwent FETDS with a median 18 months follow-up were enrolled in this study. Clinical results were assessed using the Oswestry Disability Index, visual analog scale (VAS), and the modified Macnab criteria., Results: The median duration of surgery was 75 minutes. The mean VAS score for preoperative leg pain was 6.54 ± 0.66, which improved to 1.79 ± 0.80, 1.50 ± 0.79, 1.43 ± 0.85, and 1.39 ± 0.97 after surgery, at 3 months, at 6 months, and at the last follow-up, respectively. The mean VAS score for preoperative low back pain was 2.00 ± 1.01, which changed to 2.09 ± 0.79, 2.07 ± 0.83, 2.09 ± 0.92, and 2.23 ± 0.76 at the same evaluation times, respectively. The mean preoperative Oswestry Disability Index was 69.30 ± 6.07, which improved to 22.36 ± 8.35, 22.32 ± 8.47, 22.21 ± 6.61, and 24.57 ± 8.23, respectively. The modified Macnab criteria were consistent with excellent or good outcomes in 91.1% of patients. Three patients (5.4%) developed complications., Conclusions: FETDS was effective and safe in the treatment of SLSS in geriatric patients, with minimal physiologic impact, taking advantage of the current protocol of thorough assessments and appropriate preoperative preparation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: This study reports a new technique known as percutaneous endoscopic trans-articular discectomy (PETAD) for huge central/paracentral lumbar disc herniation (LDH)., Methods: Sixteen patients with huge central/paracentral LDH who underwent PETAD in our department from July 2015 to July 2016 were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analog scale (VAS) and Oswestry disability index (ODI) scores and the MacNab criteria. Immediate post-operative MRI and CT were conducted to confirm complete removal of LDH along with follow-up flexion-extension X-ray to observe lumbar stability., Results: The huge central/paracentral LDH was completely removed by PETAD in 16 patients, as confirmed by post-operative MRI and CT. Leg pain was eased after removal of the disc herniations. The satisfactory (excellent/good) results were 93.7%. The mean follow-up duration was 15.6 (range, 3-24) months. The mean pre-operative VAS and ODI scores were 5.72 ± 1.18 (range, 4-9) and 60.1 (range, 51-87), respectively, which decreased to 1.26 ± 0.81 (range, 0-3) and 18.1 (range, 10-31), respectively at the third month post-operatively and to 0.78 ± 0.62 (range, 0-1) and 7.2 (range, 0-15), respectively by the last follow-up visit. No recurrence and segmental instability was observed in any of the 16 patients during the follow-up period., Conclusion: PETAD could be a good alternative for treatment of huge central/paracentral LDH.

Background: Highly upmigrated herniation can be difficult to remove using percutaneous endoscopic lumbar discectomy (PELD) and the conventional transforaminal approach. Although many surgeons have constantly explored new techniques and approaches, we still lack a more effective, convenient, and economical technique to treat highly upmigrated herniation. We have described a novel approach, the transforaminal isthmus plasty approach, for PELD to treat highly upmigrated disc herniation., Case Description: A 72-year-old man with L3-L4 highly upmigrated disc herniation, who had experienced no relief after a long period of conservative treatment, underwent PELD through the transforaminal isthmus plasty approach. The operation was successful, and he experienced significant symptom relief after the surgery., Conclusions: The transforaminal isthmus plasty approach is an effective and viable alternative approach for PELD to treat highly upmigrated disc herniation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The purpose of the present study was to provide a new classification of the lateral region of the lumbar spinal canal (LLSC) and evaluate the clinical outcomes of surgical treatment of LLSC stenosis guided by the classification., Methods: We developed a new functional classification of the LLSC by dividing the region into 5 zones. Thirty random lumbar imaging studies from patients with single-level LLSC stenosis in our department from January 2015 to June 2015 were evaluated by 3 examiners to validate its reliability. Subsequently, a prospective clinical outcome study of 76 patients with single-level LLSC stenosis from July 2015 to July 2016 with 2-year follow-up available was undertaken. All the patients had undergone either percutaneous endoscopic transforaminal decompression with foraminoplasty or percutaneous endoscopic interlaminar decompression, according to the classification. The clinical outcomes were evaluated using MacNab criteria, and pre- and postoperative leg pain were evaluated using the visual analog scale., Results: We observed a 93.3% agreement among examiners. The mean follow-up duration was 15.6 months (range, 3-24). We found good and excellent outcomes in 93.4% of the patients at the last follow-up examination. The mean preoperative visual analog scale score was 5.72 ± 1.18 (range, 4-9), which had decreased to 1.26 ± 0.81 (range, 0-3) at the third month postoperatively and to 0.78 ± 0.62 (range, 0-1) by the last follow-up visit. Dural tears appeared in 2 patients, and migrated bone had moved into the spinal canal after the surgery in 1 patient., Conclusions: The new classification of LLSC can provide objective criteria for full-endoscopic surgery that could lead to better clinical outcomes., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Study Design: A retrospective study to evaluate the clinical outcomes of a novel surgical method for treating patients with lumbar spondylolysis., Objective: The aim of this study was to investigate the effectiveness of posterior ISOBAR TTL stabilization of the lumbar spine with direct pars repair using Wiltse approach for the treatment of lumbar spondylolysis with or without slight spondylolisthesis and discuss the indications of this surgery., Summary of Background Data: Surgical treatment of lumbar spondylolysis has yielded relatively good results. However, there are still many limitations of the current surgical methods, including, adjacent level degeneration, restricted indications, and soft tissue damage., Methods: Between August 2010 and January 2013, 13 (9 males and 4 females; mean age: 28.2 yrs), patients with lumbar spondylolysis with or without slight spondylolisthesis underwent posterior ISOBAR TTL stabilization of the lumbar spine, with direct pars repair via Wiltse approach. All patients were followed up for at least 24 months at outpatient visits or telephonically. Pre-operative and postoperative radiological assessments included anteroposterior, lateral and flexion extension radiographs, 3-dimensional reconstruction computed tomography (CT), and magnetic resonance imaging (MRI). Data pertaining to intraoperative blood loss, duration of operation, visual analog score (VAS), Oswestry disability index (ODI) scores, and other assessments were collected., Results: The median follow-up duration was 36 months (range, 24-53 months). Surgery was successful in all patients with no complications; bony fusion of pars was confirmed on CT scan at postoperative 2 years. Significant pain relief was achieved in all patients including those with discogenic pain, those >30 years of age, and those with severe disc degeneration (P < 0.01)., Conclusion: We evaluated a new surgical technique for the treatment of patients with spondylolysis with or without slight spondylolisthesis. Besides the good clinical results, the indications for this new surgery are much wider and can potentially overcome the limitations of earlier techniques., Level of Evidence: 4.

Objective: To observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation., Methods: Between January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method: the balanced pelvis subgroup (n = 14) and unbalanced pelvis subgroup (n = 11). The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively., Results: All patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P < 0.05), while the TK was significantly smaller than that of control group (P < 0.05). In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P < 0.05). In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P < 0.05). The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P < 0.05); while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P < 0.05)., Conclusion: The LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.

Objective: To determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) for recurrent lumbar disc herniation (RLDH)., Methods: Between June 2009 and December 2011, 56 patients with RLDH underwent PETD after local anesthesia, including 30 males and 26 females, with a mean age of 50 years (range, 24-70 years). The involved segments were L3, 4 in 3 cases, L4, 5 in 34 cases, and L5-S1 in 19 cases. Of 56 patients, 48 suffered from ipsilateral re-herniation, and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years (range, 6 months to 27 years). The visual analogue scale (VAS) score for back pain was 6.18 ± 1.44 and the VAS score for leg pain was 7.66 ± 1.03. Postoperative effectiveness was assessed based on the VAS score and modified MacNab criteria., Results: The mean operation time was 60.4 minutes (range, 30-100 minutes) and the mean duration of hospital stay was 5.1 days (range, 3-6 days). All patients were followed up 28.2 months on average (range, 24-56 months). Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month, 3 months, 12 months, and last follow-up were significantly decreased when compared with preoperative score (P < 0.05). Based on the modified MacNab criteria, the results were excellent in 39 cases, good in 9 cases, fair in 5 cases, and poor in 3 cases at 12 months after operation, and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases (8.9%); one patient (1.8%) suffered from recurrence at 18 months postoperatively, and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery., Conclusion: PETD has several advantages in treating RLDH, such as avoiding from the old scar tissue, decreasing operation-related complications, shortening operation time, reducing trauma, and obtaining rapid postoperative recovery. This technique is feasible and effective for RLDH.

Objective: To investigate the feasibility and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation., Methods: Between July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at Ls level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments., Results: Accurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%., Conclusion: Percutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.

Purpose: Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure which shows satisfying outcomes in the adult population. However, pediatric lumbar disc herniations (PLDH) occur in growing spines and are less related to degeneration, which makes them different from the adult disc herniations. This study evaluates the clinical outcomes of PEID in treating PLDH., Methods: A prospect study was done in the period from June 2010 to December 2012, which included 29 consecutive pediatric patients with a mean age of 16.4 years (range, 13 to 18 years) who underwent PEID for single level lumbar disc herniation. The following measuring tools were used: visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Macnab criteria., Results: There were no severe complications such as dural tear or nerve root damage found in our study. The mean follow-up period was 19.7 months. The VAS score for leg and back pain decreased dramatically at 1 day postoperatively and kept decreasing until the follow-up visit at 3 months postoperatively, when it became stable at a low level. ODI kept improving until the follow-up visit at 6 months postoperatively when it reached a stable low level. Of the patients, 91% reported no longer having leg pain and 9% had occasional leg pain at last follow-up., Conclusions: PEID shows a satisfying outcome with a minimal rate of complications. It has the advantages of minimal traumatization and scar formation and is a safe and effective treatment for PLDH.

Purpose: A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results., Methods: Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients' symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrum-bicoxofemoral distance (SFD)., Results: The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P < 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P < 0.05)., Conclusions: PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.

Objective: To analyze the clinical features and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis., Methods: The clinical data of 11 patients with traumatic lumbar spondylolisthesis who underwent surgeries between January 2008 and June 2012 were retrospectively analyzed. There were 6 male and 5 female patients, aged from 13 to 60 years with a median age of 38 years. The mechanism of injury included heavy pressure injury in 4 cases, falling injury from height in 4 cases, and traffic accident injury in 3 cases. The time of injury to operation was between 3 days and 13 years (median, 20 days). According to Frankel neurological function grading, 2 patients were rated as grade E, 4 as grade D, 3 as grade C, and 2 as grade B before operation; according to Meyerding spondylolisthesis grading, 4 cases were classified as degree I, 4 as degree II, 2 as degree III, and 1 as degree IV preoperatively. The affected segments included L4 in 3 and L5 in 8 patients. The surgical fixation segments were L4, 5 in 2 patients, L5, S1 in 7, and L4-S1 in 2. Eight patients underwent circumferential fusion, while 3 patients underwent posterolateral fusion. The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up. The clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) scores., Results: All patients achieved primary healing of incision after operation. And all patients were followed up 6-40 months with a median time of 12 months. There was no pulling-out or breaking of internal fixation. The fusion rate was 100% on three-dimensional CT scans, and the fusion time was 3-6 months (mean, 4.5 months). The spondylolisthesis was degree 0 in 10 cases and degree I in 1 case according to Meyerding grading, showing significant difference when compared with preoperative spondylolisthesis grading (Z = -2.979, P = 0.003). The Frankel neurological function grading were E in 6, D in 3, and C in 2 at last follow-up, which were significantly improved when compared with preoperative one (Z = -2.271, P = 0.014). At 1 week after operation and last follow-up, VAS and ODI scores were significantly improved when compared with the preoperative scores (P < 0.05); however, no significant difference was found between at 1 week and at last follow-up (P > 0.05)., Conclusion: If lumbar X-ray films suggest multiple fractures of transverses in emergency combined with the mechanism of injury, it strongly indicates the diagnosis of traumatic lumbar spondylolisthesis, moreover earlier decompression and fusion can provide the recovering of the neurological function and satisfactory preliminary effectiveness in these patients.

Objective: To investigate the technique of reduction by posterior approach for severe spondylolisthesis, and to discuss the method to prevent nerve stretch injury., Methods: Between July 2007 and April 2011, 17 patients with severe spondylolisthesis underwent reduction, fixation, and fusion by posterior approach. There were 2 males and 15 females with a median age of 15 years (range, 8-67 years) and a median disease duration of 18 months (range, 5 months-16 years and 4 months). The level of spondylolisthesis was at L4 in 1 case and Ls in 16 cases; the spondylolisthesis was at degree III in 12 cases and degree IV in 5 cases according to Meyerding classification. There were 16 cases of developmental spondylolisthesis (high-dysplastic and low-dysplasia spondylolisthesis in 9 and 7 cases, respectively) and 1 case of traumatic spondylolisthesis; 16 cases of developmental spondylolisthesis at L5 level included 6 cases of type 4, 9 case of type 5, and 1 case of type 6 according to Spinal Deformity Study Group (SDSG) classification. All cases underwent posterior spinal decompression, Schanz screw fixation for the slipped vertebrae, the intervertebral and posterolateral fusion and reduction of the slipped vertebrae, and correction of the lumbosacral kyphosis. The reductive degree of slipped vertebrae was modulated according to the strain of exiting spinal root. The slip degree should be reduced within Meyerding degree II. The anteroposterior and lateral radiographs of whole spine were taken in a standardized standing position to observe the correction of displacement severity and lumbosacral angle. The nerve function and pain score of lower extremity were evaluated by neurological Frankel grade and visual analogue scale (VAS). Bony fusion was assessed by followed-up CT three-dimentional reconstruction. Results Exiting nerve root paralysis occurred in 1 case after operation, and released at 4 weeks after operation; no aggravation of nerve damage was observed in the other patients. The incisions primarily healed. All the patients were followed up 12-48 months (mean, 25 months). The slip percentage, the lumbosacral angle, and VAS score of lower extremity were improved from 72% +/- 10%, (18.2 +/- 3.5) degrees, and 7.0 +/-1.5 at preoperation to 12% +/- 6%, (-7.3 +/- 2.9) degrees , and 1.5 + 1.3 at 12 months after operation respectively, all showing significant differences (P < 0.05). Osteosynthesis was seen at the bone grafting area by CT three-dimentional reconstruction at 12 months after operation. No breakage of screw and rod or reduction loss occurred., Conclusion: It can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, the Schanz screw fixation of the slipped vertebrae, the intervertebral and posterolateral fusion for severe spondylolisthesis. The risk of nerve stretch injury can be prevented by choosing the lowest height of intervertebral cage, modulating the reductive degree of slipped vertebrae according to the strain of exiting spinal root, and correcting lumbosacral kyphosis.

Objective: To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis., Methods: Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 +/- 1.2 and Oswestry disability index (ODI) was 72.0% +/- 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 +/- 2.8) degrees and (14.1 +/- 1.9) degrees, respectively., Results: All incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 +/- 0.5) and ODI (17.6% +/- 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P < 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 +/- 2.1) degrees and (13.5 +/- 1.7) degrees, respectively; showing significant differences when compared with preoperative values (P < 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment., Conclusion: The posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.

Objective: To compare the short-term effectiveness of minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) versus open-TLIF in treatment of single-level lumbar degenerative disease., Methods: Between February 2010 and February 2011, 147 patients with single-level lumbar degenerative diseases underwent open-TLIF in 104 cases (open-TLIF group) and MIS-TLIF in 43 cases (MIS-TLIF group), and the clinical data were analyzed retrospectively. There was no significant difference in gender, age, disease type, lesion level, disease duration, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P > 0.05). The operation time, intraoperative radiological exposure time, intra- and post-operative blood loss, postoperative hospitalization time, and postoperative complications were compared between 2 groups. The VAS score and ODI were observed during follow-up. The imaging examination was done to observe the bone graft fusion and the locations of internal fixator and Cage., Results: There was no significant difference in operation time between 2 groups (t = 0.402, P = 0.688); MIS-TLIF group had a decreased intra- and post-operative blood loss, shortened postoperative hospitalization time, and increased intraoperative radiological exposure time, showing significant differences when compared with open-TLIF group (P < 0.05). Cerebrospinal fluid leakage (2 cases) and superficial infection of incision (2 cases) occurred after operation in open-TLIF group, with a complication incidence of 3.8% (4/104); dorsal root ganglion stimulation symptom (3 cases) occurred in MIS-TLIF group, with a complication incidence of 7.0% (3/43); there was no significant difference in the complication incidence between 2 groups (chi2 = 0.657, P = 0.417). The patients were followed up 18-26 months (mean, 21 months) in MIS-TLIF group, and 18-28 months (mean, 23 months) in open-TLIF group. The VAS scores and ODI of 2 groups at each time point after operation were significantly improved when compared with those before operation (P < 0.05). There was no significant difference in VAS score between 2 groups at discharge and 3 months after operation (P > 0.05); VAS score of MIS-TLIF group was significantly lower than that of open-TLIF group at last follow-up (t = 2.022, P = 0.047). At 3 months and last follow-up, no significant difference was found in the ODI between 2 groups (P > 0.05). The imaging examination showed good positions of Cage and internal fixator, and bone graft fusion in 2 groups., Conclusion: The shortterm effectiveness of MIS-TLIF and open-TLIF for single-level degenerative lumbar diseases was similar. MIS-TLIF has the advantages of less invasion and quick recovery, but the long-term effectiveness needs more observation.

Objective: To evaluate the short-term effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) intervertebral cage for lumbar interbody fusion in the patients with lower lumbar degenerative diseases., Methods: Between January and October 2011, 20 patients with lower lumbar degenerative diseases underwent transforaminal lumbar interbody fusion with n-HA/PA66 intervertebral cage. There were 8 males and 12 females, aged 22-80 years (mean, 51 years). The disease duration was 1 to 24 months (mean, 4 months). L4,5 fusion was performed in 8 cases, L5, S1 fusion in 9 cases, and L4-S1 fusion in 3 cases. Among 20 cases, 3 were diagnosed as having recurrent lumbar disc protrusion, 5 as having lumbar degenerative spondylolisthesis, 9 as having lumbar isthmic spondylolisthesis, and 3 as having lumbar spinal stenosis. The intervertebral height and lordosis were measured on X-ray film to assess the surgical correction and postoperative sustain while osseous fusion was observed on 3-dimensional CT. The Oswestry disability index (ODI) and short-form 36 health survey scale (SF-36) scores were obtained to assess the status of clinical recovery., Results: All patients had incision healing by first intention. The pain and numb were relieved in varying degrees after operation. No cerebrospinal leakage, nerve root injury, or wound infection was occurred. All patients were followed up 6-9 months (mean, 7 months). No cage displacement or collapse was found. The intervertebral height and lordosis of single fusion segment were significantly improved at 3 days and 3, 6 months after operation when compared with those at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05). The fusion rate was 74% at 3 months after operation and 96% at 6 months after operation, with an average of 4 months (range, 3-9 months) for interbody fusion. The ODI and SF-36 scores were significantly improved at 3 days and 6 months after operation when compared with the scores at preoperation (P < 0.01); there was no significant difference among each time point after operation (P > 0.05)., Conclusion: The interbody fusion with n-HA/PA intervertebral cage is effective and safe to treat the lower lumbar degenerative diseases. The n-HA/PA66 intervertebral cage is an ideal device of interbody fusion with high fusion rate, low subsidence rate, and high transmission X-ray, but the long-term effectiveness need further observation.

Objective: To evaluate the early clinical outcomes of subtotal corpectomy and intervertebral bone grafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracture-dislocation., Methods: Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture or thoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posterior approach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were caused by falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were 10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12 cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancy in vertebral canal. The preoperative Cobb angle was (30.2 +/- 3.9) degrees. According to Frankel classification for neurological function, there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury and operation was 4.5 days (range, 1-12 days)., Results: All incisions healed by first intention, and no infection occurred. Twenty patients were followed up 8-16 months (mean, 12 months). The interbody fusion time was 6-9 months (mean, 7 months). Neurological function recovered 1 to 3 grades: 1 case of grade C, 2 cases of grade D, 17 cases of grade E at last follow-up. The Cobb angle was (6.5 +/- 4.2) degrees at last follow-up, showing significant difference when compared with preoperative value (t = 2.39, P = 0.00). No breaking or loosening of screw and implant sinkage occurred., Conclusion: A combination of subtotal corpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression, restoration of spinal stability, restoration of vertebral body height, high bone healing rate, and good recovery of neurological function. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.