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Objective: To summarize and analyze the complications of interspinous implants for degenerative lumbar disease., Methods: From September 2007 to September 2011, 177 cases with degenerative lumbar diseases were treated with interspinous implants. There were 99 male patients and 78 female patients, the average age was 44.5 years (26 - 71 years). According to the application interspinous dynamic stabilization system type were divided into the Wallis group (136 cases) and Coflex group (41 cases). The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score. The radiological results including segmental lodosis and segement movement degree were assessed by lumbar X ray and dynamic X ray. Summarize and analyze the complications both during operation and post operation. Quantitative datas were compared by paried-samples t test and complication rate was compared by χ(2) test., Results: There were 168 cases had completed follow-up and the average time was 34.7 months (3 - 50 months). In the final follow-up, lumbar pain VAS, lower limber pain VAS, lumbar JOA score and Prolo functional score were better than pre-operation (t = 10.7, 7.9, 13.4 and 8.8, P < 0.01). Segment lodosis angles was 14° ± 4° which was less than pre-operation 19° ± 4° (t = 9.4, P < 0.01).Segment movement degree was larger in Coflex group (12.6° ± 3.1°) than in Wallis group (9.7° ± 2.7°) (t = 8.6, P < 0.05). Complication rate was 10.7% (18/168), which of Wallis group was 6.2% (8/130) and Coflex group was 26.3% (10/38) (χ(2) = 12.5, P < 0.01). In Wallis group, there were 3 cases with dura tear and cerebrospinal fluid leakage, 1 case with nerve root injury and foot drop, 2 cases with spacer breakage when implantation and change the implants and 2 cases with recurrence of lumbar disc herniation. In Coflex group, there was 1 case with dura tear and cerebrospinal fluid leakage, 2 cases with mild displacement post operation, 1 case with debridement for aseptic wound exudates, 1 case with implant removal for breakage 1 week post operation, 4 cases with recurrence of lumbar disc herniation and 1 case with lumbar disc herniation 6 months post operation of lumbar stenosis., Conclusions: The application of interspinous implants for degenerative lumbar diseases is effective and relative safe, but would suffer from the risk of complications.

Objective: To evaluate the clinical characteristics and reoperation of symptomatic adjacent segment degeneration postoperation of lumbar fusion., Methods: In the study, 28 cases of symptomatic adjacent segment degeneration postoperation of lumbar fusion from May 2007 to April 2012 were retrospectively reviewed,with an average age of (64.3±8.7) years. The mean period between reoperation and primary fusion surgery was (47.5±30.8) months. Symptomatic adjacent segment degeneration located in cephalic segments in 12 cases, in caudal segments in 14 cases and in both segments in 2 cases. Of all the 28 patients, 12 suffered from lumbar stenosis, other 13 from lumbar disc herniation and still other 3 from both lumbar stenosis and disc herniation, of whom 11 were together with segment instability. Localization diagnoses of 19 cases were clear and other 9 received diagnostic nerve root block. The cases were divided into two groups by the type of reoperation,of which 8 cases were in adjacent degenerative segment nonfusion group and the other 20 cases in adjacent degenerative segment fusion group. The clinical results were assessed by lumbar pain visual analog score (VAS) and lower limber pain VAS,lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score before operation and in the final follow-up., Results: In adjacent degenerative segment nonfusion group, the average operation time was (86.3±17.1) min and average blood volume was (125.0 ±37.8) mL of reoperation and 1 case with dural injury; and in adjacent degenerative segment fusion group, the average operation time was (201.6 ±71.0) min and average blood volume was (313.6±218.9) mL of revision surgery and 4 cases with dural injury. The average follow-up period was 25.5 months. In the final follow-up,lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 2.4±1.2, 2.8±1.4,23.5±4.2 and 8.2±1.5,which were better than preoperation 5.5±2.9, 6.8±2.5, 13.7±5.2 and 4.3±2.1, P<0.001; lumbar pain VAS, lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 3.3±1.9, 3.1±1.2, 22.2±4.4 and 7.7±1.6, which were better than preoperation 5.4±2.7, 7.0±2.4, 13.0±5.6 and 3.9±1.9, P<0.001.In the final follow up, lumbar pain VAS of adjacent degenerative segment nonfusion group was better than that adjacent degenerative segment fusion group(P=0.028)., Conclusion: Symptomatic adjacent segment degeneration postoperation of lumbar fusion is difficult for diagnosis and treatment. Appropriate reoperation could get the good results.

Objective: To study the identification characters of Houttuynia cordata and its confused herb Gymnotheca chinensis and establish an identification method., Methods: LMVP (leaf morphological-venation pattern for identification Chinese herbs), and QAERM (quantitatively analyze and evaluate reliability for the method of identification Chinese herbs) were applied for the study., Results: Both venations were brochidodromous-acrodromous and arising from the mid-petiole or the upper section of petiole. The main characteristic of the leaf of Houttuynia cordata: surface with small gray-white stoma protuberances; Ligulate process of stipule-petiole sheath were clear; Primary veins 7 or 5; The innermost pair of primary vein closed up the top of the sinus at blade base or above sinus, and the section of closed vein was straight; Emitted a smell of fish when fresh leaf was kneaded into pieces. The main feature of the leaf of Gymnotheca chinensis: no small gray-white stoma protuberances; Ligulate process of stipule-petiole sheath were not clear; Primary veins 5; The innermost pair of primary vein closed into the sinus at blade base, and the section of closed vein was slightly curve; No smell of fish. With the mentioned key differences, the both plants could be successfully identified from each other. The accuracy of identification results (AC) was 100%, the repeatability of identification results: agreement rate for observation (ARO) was 100% and Kappa value was 1.00., Conclusion: The established method is simple, rapid, economic and reliable.

Objective: To study the microscopic and UV-Vis spectrum characteristic of Sapium sebiferum., Methods: The microscopic identification and UV-Vis spectrum identification were adopted., Results: There were cluster crystals in cortical cells of roots and stems and parenchyma cells of the leaves. A few stone cells were found in cortex of the stem. The vascular bundles arranged in the form of a circle in the main vein of the leaves. It could be observed that many crystals and crystal fibers in the powder. Six kinds of solvent of crude drug had absorption peaks between 200 - 800 nm., Conclusion: These results can provide the scientific evidence for the establishment of standard for quality control and further study.

Objective: To investigate the efficacy and safety of venous thrombus embolism (VTE) prophylaxis according to risk stratifications after spinal surgery., Methods: From June 2008 to June 2009, we separated 298 spinal patients who had different VTE risk factors into low-, medium- and high-risk groups for 22 cases, 48 cases and 228 cases respectively. Physical prevention measures such as thigh-length thromboembolic deterrent stockings (TEDS) and pneumatic sequential compression device (PSCD) were used in low- and medium-risk groups. In high-risk groups, low molecular weight heparin(LMWH) was applied in addition to physical prevention measures. Lower limb vascular doppler ultrasonography was used to monitor thrombosis pre- and postoperatively. Simultaneously the occurrences of epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin and nerve damage caused by extradural hemorrhage were monitored., Results: Among the 298 cases of patients with spinal surgery, DVT occurred in 23 cases, the incidence of DVT was 7.7%. There were 0, 2 and 21 patients with positive findings of deep vein thrombosis on duplex ultrasonograph respectively in low-, medium- and high-risk groups. There was no case of PE. All DVT was thrombosis in calf which was distal to the knee. There was no clinical symptom of VTE. The DVT needed no therapy. The vein with thrombosis was recanalized 3 months after operation. No case caught epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin or nerve damage caused by extradural hemorrhage., Conclusion: Individual VTE prophylaxis was taken according to risk stratifications. No VTE of clinical value or no complications from prophylaxis happened. So our prophylaxis is effective and safe. But more prospective, case-control studies are needed to assess the efficacy and safety of VTE prophylaxis.

Objective: To assess the indications,efficacy and safety of application of interspinous implants for degenerative lumbar diseases by mid-term follow-up and analysis of the failure cases., Methods: In our study, 52 cases of degenerative lumbar diseases treated with interspinous implants From September 2007 to September 2008 were divided into Wallis group (25 cases) and Coflex group (27 cases). The clinical results were assessed by lumbar pain visual analog score (VAS) and lower limber pain VAS, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score; the radiological results including implant positon, segmental lodosis and segment movement degree were assessed by lumbar X ray post-operation compared with pre-operation. For cases of discogenic low back pain, lumbar disc changes were assessed by lumbar MRI 12 months post operation., Results: Fifty-two cases had complete follow-up and the average time was 30.4 months. In the final follow up, lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of Wallis group were (2.5 ± 1.7),(2.7 ± 1.4),(23.4 ± 3.1)and(8.9 ± 1.4), which were better than pre-operation (5.3 ± 3.0),(7.4 ± 2.6),(13.5 ± 4.6)and(4.5 ± 2.6 ),lumbar pain VAS P=0.027, all others P<0.001 ;lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of Coflex group were (2.6 ± 2.9),(3.8 ± 1.9),(21.2 ± 3.5)and(8.5 ± 1.8),which were better than pre-operation (5.5 ± 3.2),(7.1 ± 2.8), (13.1 ± 4.8)and(4.2 ± 2.5), lumbar pain VAS P=0.036, all others P<0.001;in the final follow up,lower limber pain VAS of Wallis group was (2.7 ± 1.4), which was better than (3.8 ± 1.9) of Coflex group(P=0.039);in the final follow up, Segment lodosis angles of Wallis group was 14.3° ± 3.9°, which was larger than 13.2° ± 3.5° of Coflex group (P=0.028); Segment movement degree of Wallis group was 9.6° ± 2.8°, which was smaller than 12.8°±3.0°of Coflex group (P=0.019).In Coflex group,four cases of lumbar disc herniation relapsed and three cases received second operation. One case with lumbar stenosis suffered from lumbar disc herniation of the same segments and received second revision operation., Conclusion: Treatments with interspinous implants for the degenerative lumbar diseases are effective, but we should pay attention to the indication and apply them for lumbar disc herniation with caution.

Objective: To assess the efficacy and safety of combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases., Methods: From September 2007 to September 2008, 16 cases with degenerative lumbar diseases were treated with combined application of interspinous process fixation system and rigid fixation system. The clinical results were assessed by VAS of pain of lumbar and lower limbs, lumbar JOA score and Prolo functional score. The radiological results including implant position (interspinous process, pedicle screws and plates), spinous process fracture, segmental range of motion (the non-fusion fixation segment, and the intermediate segments between fused and non-fused segments) which were assessed by lumbar static and dynamic X rays., Results: All 16 cases obtained an average follow-up of 17.6 months. At final follow up, lumbar VAS, lower limbers VAS, lumbar JOA score and Prolo functional score were significant improved than those of pre-operation (lumbar VAS: 1.9 +/- 1.4 vs. 4.5 +/- 3.1; lower limbs VAS: 1.7 +/- 1.2 vs. 6.3 +/- 2.9; lumbar JOA score: 22.8 +/- 3.3 vs. 12.5 +/- 4.7; Prolo functional score: 8.3 +/- 1.2 vs. 4.0 +/- 2.3). Range of motion of the non-fusion fixation segment was (9.8 +/- 4.2) degrees and that of the intermediate segments between fused and non-fused segments was (13.2 +/- 3.5) degrees ., Conclusions: Combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases provides a new idea to avoid the multi-segment fusion fixation and pertinent potential problems. Short-term clinical results are successful.

Objective: To retrospectively analyze the causes and treatment of distant pain after thoracolumbar compressive fracture., Methods: The investigators retrospectively analyzed 14 cases of thoracolumbar compressive fracture with distant pain, observed the pain region and its relationship with thoracolumbar compressive fracture and administered the treatment of pain., Results: There were 14 cases of thoracolumbar compressive fracture with lumbar sacral pain whose painful region were located in paravertebral muscles (n = 6), near iliac crest (n = 5) and in hypochondrium (n = 3). Five and 7 cases of pain disappeared after vertebroplasty and local injection respectively and 2 cases were relieved with analgesics. Eighteen patients with thoracolumbar vertebrae fractures (T11-L2) were fixed with short segment pedical screw fixation, the instrumentation removed at 1 year post-operation and their Cobb's angle and trauma vertebra height measured from 0.5 - 2 years after instrumentation removal., Conclusion: The cause of distant pain after thoracolumbar compressive fracture maybe be related with radiating pain resulting from irritated nerves in the vertebral fracture region or distant soft tissue pain. A timely pain treatment can relieve the patients' symptoms.

Objective: To assess the indications, efficacy and safety of applying interspinous implants for degenerative lumbar diseases., Methods: From September 2007 to September 2008, 68 cases with degenerative lumbar diseases were treated with interspinous implants. The clinical outcome was assessed by VAS of pain in back and lower extremities, lumbar JOA score and Prolo functional score; the radiological results including implant position, segmental lodosis and segment movement degree were assessed by lumbar X ray including dynamic post-operative versus pre-operative X ray., Results: Sixty-four cases had a complete follow-up and the average time was 11.4 months. At the final follow up, lumbar VAS 1.7 +/- 1.5, lower extremity VAS 1.3 +/- 1.0, lumbar JOA score 23.5 +/- 3.1 and Prolo functional score 8.6 +/- 1.4. They were better than those at pre-operation (1.7 +/- 1.5, 1.3 +/- 1.0, 23.5 +/- 3.1, 8.6 +/- 1.4). Segment lodosis angle (15.4 +/- 4.2) degrees was less than (19.6 +/- 4.7) degrees at pre-operation; segment movement degree was (10.3 +/- 4.5) degrees . Two cases with lumbar disc herniation relapsed and received a second operation., Conclusion: The application of interspinous implants for degenerative lumbar diseases is still in its infancy and the selection of indication is very important. Its efficacy and safety have been confirmed by a short follow-up.

Objective: To evaluate the strength of pedicle screw fixation with bone cement in human cadaveric lumbar vertebral bodies by using biomechanical test., Methods: Twenty-four fresh frozen cadaveric lumbar vertebral bodies were randomly divided into 3 groups, which each group had 8 bodies. The bodies in the first group were drilled only. The bodies in the second group were drilled with tap. The bodies in the third group were drilled and the holes were enlarged by borer. Each vertebral body was drilled in both right and left sides, which one side served as control with the pedicle screws fixation only and another side served as testing side with the pedicle screw fixation with bone cement. The pullout strength was tested on both sides by using borer., Result: There was significant difference of manifestation of pull-strength between the control side and the testing side in all groups (P < 0.001). For the manifestation of pull-strength of testing side in different groups, which had pedicle screw fixation with bone cement, there was no significant difference between the second group and third group, however, the difference between the first group and the second group and between the first group and third group were significant., Conclusion: The pedicle screws with bone cements could significantly enhance the strength of fixation in cadaveric lumbar compared with pedicle screws only.