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Background: The new surgical procedure of full-endoscopic interlaminar lumbar discectomy (FILD) has achieved favorable effects in the treatment of lumbar disc herniation (LDH). Along with the wide range of applications of FILD, a series of complications related to the operation has gradually emerged. Objective: To describe the types, incidences, and characteristics of complications following FILD and to explore preventative and treatment measures. Study Design: Retrospective, observational study. Setting: A spine center affiliated with a large general hospital. Method: In total, 479 patients with LDH underwent FILDs that were performed by a single experienced spine surgeon between January 2010 and April 2013.Data concerning the complications were recorded. Results: All 479 cases successfully underwent the procedure. A total of 482 procedures were completed. The mean follow-up time was 44.3 months with a range of 24 to 60 months. The average patient age was 47.8 years with a range of 16 to 76 years. Twenty-nine (6.0%) related complications emerged, including 3 cases (0.6%) of incomplete decompression in which the symptoms gradually decreased following 3 – 6 weeks of conservative treatment, 2 cases (0.4%) of nerve root injury in which the patients recovered well following 1 – 3 months of neurotrophic drug and functional exercise treatment, 15 cases (3.1%) of paresthesia that gradually improved following 1 – 8 weeks of rehabilitation exercises and treatment with mecobalamin and pregabalin, and 9 cases of recurrent herniation (1.9%). The latter condition was controlled in 4 cases with a conservative method, and 5 of these cases underwent reoperations that included 3 traditional open surgeries and 2 FILDs. Furthermore, the complication rate for the first 100 cases was 18%. This rate decreased to 2.9% for cases 101 – 479. The incidence of L4-5 herniation (8.2%) was significantly greater than that of L5-S1 (4.5%). Limitations: This is a retrospective study, and some bias exists due to the single-center study design. Conclusion: FILD is a surgical approach that has a low complication rate. Incomplete decompression, nerve root injury, paresthesia, and recurrent herniation were observed in our study. Some effective measures can prevent and reduce the incidence of the complications including strict indications for surgery, a thorough action plan, and a high level of surgical skill. Key words: Complication, lumbar disc herniation, lumbar discectomy, endoscopic, inter-laminar discectomy, minimally invasive spine surgery

OBJECTIVE: It has been reported that acute‐phase reactions (APR) after infusion of 5 mg zoledronic acid for the first time is common. This study surveyed the incidence and characteristics of APR in Chinese postmenopausal women receiving 5 mg zoledronic acid intravenously for osteoporosis and to evaluate the efficacy of non‐steroidal anti‐inflammatory drugs (NSAID) in preventing or alleviating APR following the first 5 mg zoledronic acid infusion. METHODS: A total of 2601 patients with an average age of 68.14 ± 9.89 years and a mean body mass index of 22.90 ± 3.24 kg/m(2) from 62 centers in China were treated with 5 mg zoledronic acid intravenously for the first time. The incidence of fever and pain were observed in these patients, and the time of fever or pain onset and duration, and the intensity of fever and grade of pain were also recorded. The dosage, duration, and efficacy of NSAID and safety outcomes were also documented. RESULTS: At the end of the study, 18 patients are eliminated due to incomplete records of temperature. The incidence of fever was 28.65% (740/2583) within 7 days following zoledronic acid infusion; 98.34% (727/740) occurred at 1.03 ± 0.66 days after infusion and lasted 1.72 ± 0.93 days. A total of 456 (17.53%) patients had newly onset pain (312 of 1187, 26.28%) or experienced pain aggravation (144 of 1414, 10.18%), which mostly occurred within 3 days after zoledronic acid infusion. A total of 1246 (47.6%) patients had received NSAID for a median time of 2.63 ± 2.45 days. Using NSAID for at least 2 days could decrease body temperature by 0.54 ± 0.86°C, increase the percentage of pain‐free patients by 6.17%, and reduce the percentage of patients with moderate to severe pain by 8.7%. CONCLUSIONS: Compared with Western populations, Chinese patients had a higher rate of fever and pain after their first zoledronic acid infusion. These symptoms were often mild to moderate in intensity and transient in duration. NSAID could effectively reduce the incidence and severity of such APR.

To summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.From January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.The average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.Cervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.

To summarize the mid-term effectiveness of Coflex non-fusion internal fixation treatment of degenerative lumbar disease.From October 2008 to December 2010, a retrospective analysis was carried out on 39 patients (29 males and 10 females) diagnosed as degenerative lumbar disease and treated with Coflex interspinous dynamic device, who had been followed up for 1 year at least, the average age was 45.5 years (range, 23 - 67 years). The results were assessed by Japanese Orthopedic Association (JOA) scores, visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and SF-36 scores; and the range of mobility (ROM), intervertebral disc height of the responsible and adjacent segments were measured on X-film before the operation and at last follow-up. Observed the therapeutic effect of the patients and compared the effect on the patients of different body mass index (BMI) and different age by the One-way analysis of variance and paired t test.The 39 patients were followed up for 30.9 months (range, 12 - 37 months). At the last follow-up, JOA, ODI, VAS and SF-36 scores were improved by 70% ± 12%, 54% ± 12%, 77% ± 10% and 51% ± 9%, and were statistically significant (t = -33.289, 26.448, 26.596 and -20.772, P = 0.00). Patients with BMI ≥ 25 kg/m(2) had lower improvement rates in the scores than those with BMI25 kg/m(2) (F = 10.561, 5.850, 5.651 and 6.519, P0.05). The patients were 50 years older or younger couldn't affected the improvement rates in the scores statistically (P0.05). There were no significant difference in remaining disc height (P0.05), except that the intervertebral disc height of L4-5 increased slightly compared with the preoperative (t = -2.819, P = 0.008). In addition to the ROM of L3-4, L5-S1 and L1-S1 were not significantly different from the preoperative(P0.05), the ROM of L4-5 were decreased (t = 12.598, P = 0.000).The mid-term effectiveness of Coflex non-fusion interspinous fixation in treatment of degenerative lumbar disease is worthy of recognition, and Coflex combined with Isobar has advantages in the treatment of multi-segment degenerative lumbar disease.

Transforaminal endoscopic spine surgery is increasingly used to treat a range of spinal conditions. The success of the surgery requires an accurate insertion of the guide needle and a precise placement of the working cannula and endoscope. However, such a precise placement is challenging for many surgeons to achieve when the pathology is located at the L5-S1 level. On the basis of our years of experience with performing transforaminal endoscopic spine surgery, we have developed a simple technique to help surgeons safely access the L5-S1 level. The technique has been proven intuitive and easy for experienced as well as inexperienced surgeons to learn. The key steps of the technique involve identifying an appropriate entry point on the skin and choosing an accurate trajectory angle for insertion. The purpose of this chapter is to report how to easily identify the entry point and choose a trajectory angle depending on the patient's anatomic characteristics.

To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements.All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Postoperative immediate intervertebral height (2.4 ± 0.2) cm, preoperative intervertebral height (1.9 ± 0.1) cm, comparisons of the two groups was statistically significant (q = 2.48, P0.001). The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant (P0.05). Preoperative Cobb angle was 9.8° ± 1.2°, postoperative immediate Cobb angle was 16.6° ± 1.2°, comparisons of the two groups was statistically significant (q = 14.25, P0.001). The immediate, 3 month, 1 year, 2 year period follow-up group Cobb angle was not statistically significant (P0.05).n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior lower cervical spine fracture and dislocation operation, but further follow-up study is still required to evaluate the long-term effects.

To develop a new bone targeting antitumor therapy system which uses diphosphonate and bone-seeking nuclide to enhance the coordinated effects of chemotherapy and radiotherapy on bones, and to validate the targeting of the new therapy system in vitro and in vivo.Phenamine acid caryolysine was connected to bisphosphonates, and then combined with radioactive nuclide 153Sm to establish a new bone targeting chemotherapeutic and radioactive drug for bone cancers. The targeting of this new therapy system was validated by hydroxyapatite crystal absorbing test and body distribution in vivo methods.The optical spectrum of the phenamine acid caryolysine-bisphosphonates conjugate detected by the nuclear magnetic resonance was consistent with the standard structure of synthesized drugs. The conjugate had good absorbability to hydroxyapatite crystals. The body distribution of the conjugate showed higher radiocounting in bones than in other tissues.The conjugate has a structure that is consistent with the active compound targeting bone tumors.

To evaluate the patients with bone injury in Wenchuan earthquake.From May 12th to June 15th 2008 the data of 1410 patients with bone injury in Wenchuan earthquake were analyzed to evaluate clinical intervention and remedy-managing experience.The 1410 patients average age was from 4 to 103 years old. And 744 cases (52.7%) suffered from blunt injuries, 379 cases (26.9%) from buried injuries, 287 cases (20.4%) from falling injuries; And 1317 cases were with fracture, 93 with limbs soft tissue injuries; 261 patients combined with other parts of injuries including 45 cases with paralysis; 66 cases were with crush syndrome, 25 with gas gangrene, 76 with acute kidney failure, 26 with multiple organ failure. And 912 operations were performed including 402 fracture fixation, 224 debridement, 152 debridement and suture, 85 amputation, 29 implant skin, 8 fixation of joint dislocation, 5 surgical flaps transplantation, 4 nerve and tendon suture, 2 arthroscopes, 1 joint replacement. Among the 66 crush syndrome patients, 49 accepted continuous renal replacement therapy, in which 9 cases were bleeding from named arteries and 20 blood vessels were getting embolism. Among the 1410 cases, 1 died from multiple organ failure.Among the patients with bone injury in Wenchuan earthquake, the elderly patients are more than the youth; The injuries are always combined with other complications; Opened injuries are polluted severely; It is difficult to deal with the crush syndrome; Paraplegia cases are less, but the amputees are more.

To evaluate the predictive value of the Tokuhashi revised scoring system for the life expectancy of patients with spinal metastases.A retrospective review of 447 patients with spinal metastases was performed, which comprised 291 men and 156 women with a mean age of 56. 1 years. All of the patients were scored with the Tokuhashi revised scoring system based on the available clinical, pathological and radiographic data. The relation between the survival time and the Tokuhashi revised score was analyzed.The patients had a median survival time of 7. 9 months and a mean Tokuhashi revised score of 8. 23 points. The median survival time of 155 patients with high grade primary tumor of lung, liver, gastrointestinal tract, esophagus, bladder and pancreas was 4. 7 months. The median survival time of 146 patients with low grade primary tumor of thyroid, breast and prostate was 12 months. The median survival time of 146 patients with medium grade primary tumor of kidney, lymphoma, ovary and uterus, and unknown primary tumor was 7. 1 months. The median survival time of 211 patients with the Tokuhashi revised score of 0 to 8 points was 4 months. The median survival time of 147 patients with the Tokuhashi revised score of 9 to 11 points was 10 months. The median survival time of 89 patients with the Tokuhashi revised score of 12 to 15 points was 29 months. The differences between the groups were significant (P0. 01 or 0. 0001). The Tokuhashi revised score was positively correlated with survival time (r=0. 833, P0. 001).The Tokuhashi revised score could support decision making with reliable estimation of life expectancy of patients with spinal metastases. Surgery could be a better choice to extend life span for those patients with solitary spinal metastasis of slow-growth primary tumor and those with the Tokuhashi revised score of 12 to 15 points.

To establish an orthotopic transplantation model of human osteosarcoma in nude mice.The cell suspensions of serial passage of MG-63 cell line with high tumor formation rate were implanted into the distal femur of nude mice. The tumor tissue were treated with routine pathologic HE stain and observed under microscope, and made to the x-ray inspection.In two weeks, the neoplasm was found to grow at local tissue of nude mice, and also found in x-ray film when it was after implant operated for 4 weeks. The typical characteristics of osteosarcoma of tumor tissue were found under microscope. The tumor formation rate of tumor tissue transplantation was 100% and the tumor formation rate of MG-63 cell suspension was 70%.The orthotopic transplantation model of osteosarcoma in nude mice is well established and provides a more similar human internal milieu for researches of osteosarcoma.