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In the article, the authors present the cases of two older women who suffer chronic back pain to discuss adjacent intravertebral cement leakage during percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Topics include how PVP can provide pain relief and spinal stability and the types of cement leakages using PVP, including type S leak via the segmental vein.

Objective: To explore clinical outcomes and bone resection of interlaminar fenestration decompression and unilateral biportal endoscopic (UBE) technique in treating lumbar disc herniation(LDH)., Methods: A retrospective study was performed on 105 patients with single-level LDH treated from December 2019 to December 2021. Fifty-four patients in UBE group,including 32 males and 22 females,aged from 18 to 50 years old with an average of(38.7±9.3) years old,were treated with UBE,29 patients with L 4,5 and 25 patients with L 5 S 1 . There were 51 patients in small fenestration group,including 27 males and 24 females,aged from 18 to 50 years old with an average of (39.9±10.0) years old,were treated with small fenestration,25 patients with L 4,5 and 26 patients with L 5 S 1 . Perioperative indexes,such as operation time,postoperative time of getting out of bed and hospital stay were observed and compared between two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between two groups before operation and 1,3,6 and 12 months after operation,respectively;and modified MacNab evaluation criteria was used to evaluate clinical efficacy. Amount of bone resection and retention rate of inferior articular process laminoid complex were compared between two groups., Results: All 105 patients were successfully completed operation. Both of two groups were followed up from 6 to 12 months with an average of (10.69±2.49) months. Operation time,postoperative time of getting out of bed and hospital stay were (58.20±5.54) min,(2.40±0.57) d and (3.80±0.61) d in UBE group,and (62.90±7.14) min,(4.40±0.64) d and (4.40±0.64) d in small fenestrum group,respectively;and had statistically difference between two groups( P <0.05). Postoperative VAS of low back and leg pain and ODI in both groups were significantly lower than those before surgery ( P <0.05). VAS of lumbar pain in UBE group (1.37±0.49) score was lower than that of small fenestration group (2.45±0.64) score,and had statistically difference ( t =9.745, P <0.05). Postoperative ODI in UBE group at 1 and 3 months were (28.54±3.31) % and (22.87±3.23) %,respectively,which were lower than those in small fenestra group (36.31±9.08) % and (29.90±8.36) %,and the difference was statistically significant ( P <0.05). There were no significant difference in VAS and ODI between two groups at other time points ( P >0.05). According to the modified MacNab evaluation criteria at the latest follow-up,49 patients got excellent result,3 good,and 2 fair in UBE group. In small fenestration group,35 patients got excellent,12 good,and 4 fair. In UBE group,amount of bone resection on L 4,5 segment was (0.45±0.08) cm 3 and (0.31±0.08) cm 3 on the segment of L 5 S 1 . In small fenestration group,amount of bone resection on L 4,5 segment was (0.57±0.07) cm 3 and (0.49±0.04) cm 3 on the segment of L5S1,and amount of bone resection of lower articular process laminar complex on the same segment in UBE group was less than that in small fenestration group ( P <0.05). In UBE group,retention rate of laminoid complex on L4,5 segment was (0.73±0.04) and L5S1 segment was (0.83±0.03),while L4,5 segment was(0.68±0.06) and L5S1 segment was (0.74±0.04) in small fenestration group,the lower articular process laminar complex retention rate in UBE group was higher than that in small fenestration group( P <0.05)., Conclusion: Both unilateral double-channel endoscopy and small fenestration of laminae could achieve good clinical results in treating LDH,but UBE has advantages of less trauma,higher efficiency,faster postoperative recovery and less damage to bone structure.

Objective: To investigate the incidence and risk factors of delirium after spinal surgery in elderly patients., Methods: A retrospective analysis was performed on 436 patients with spinal surgery from January 2016 to November 2018. According to delirium occurrancy after the operation, 436 cases were divided into two groups:delirium group and non-delirium group. Body mass index(BMI), history of diabetes, history of coronary heart disease, history of chronic obstructive pulmonary disease (COPD), preoperative white blood cell count, preoperative erythrocyte volume, preoperative hemoglobin level, operation mode, operation time, anesthesia time, American Association of Anesthesiologists(ANA)(ASA) score, cardiac function grading(NYHA), intraoperative blood loss, intraoperative blood transfusion, intraoperative fentanyl, propofol and Dizocine dosage, postoperative white blood cell count, postoperative erythrocyte volume, postoperative hemoglobin level, postoperative electrolytes (sodium, potassium) and univariate logistic regression analysis were used to analyze the risk factors. The independent risk factors were further investigated by multivariate Logistic regression analysis., Results: Among 436 cases, 112 elderly patients had postoperative delirium, the incidence of delirium was about 25.68%. The age, preoperative leukocyte count, erythrocyte specific volume, postoperative hemoglobin level in delirium group and non-delirium group were measured. There were significant differences in the postoperative sodium concentration, anesthesia time, ASA score, cardiac function grading, blood loss during operation, postoperative use of Dizocine, history of diabetes, history of coronary heart disease and history of COPD ( P <0.05). Multivariate logistic regression analysis showed that the age, ASA score, postoperative Dizocine volume, and COPD history were independent risk factors for the occurrence of delirium after spinal surgery in elderly patients., Conclusions: The elderly patients over 72 years old, the ASA score>2, the use of Dizocine analgesic and the patients with COPD are the independent risk factors of postoperative delirium., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To study the clinical outcome of total hip arthroplasty(THA) for traumatic arthritis after acetabular fracture., Methods: From June 2010 to June 2014, 33 hips in 33 patients with traumatic arthritis after acetabular fracture were retrospective analyzed including 21 males and 12 females with a mean age of 44.6 years old. All the patients received THA with bio-prostheses. Harris score was used to evaluate the hip function of patients before and after operation, the X-ray was adopted for radiographic evaluation of the hip prosthesis., Results: All patients were followed up for 7 to 38 months with an average of 21.6 months. The Harris score increased from preoperative 53.6±2.4 to 94.0±3.0 at the final follow-up, the difference was statistically significant( t =55.37, P <0.05). The X-ray evaluation showed the prosthesis was in good position, no loosening of the prosthesis, dislocation and periprosthetic osteolysis., Conclusions: THA is an effective treatment for the traumatic arthritis after acetabular fracture;internal fixation of acetabular fractures could not be removed if it shows difficult but does not affect the prosthesis placement., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To explore the reasons of secondary fracture after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) and discuss the measure of prevention and cure., Methods: From January 2011 to January 2013, the clinical data of 180 patients with primary OVCFs treated by PVP were retrospectively analyzed. There were 75 males and 105 females, aged from 68 to 95 years old with an average of (79.50 ± 5.45) years. The involved vertebrae were identified according to the clinical symptoms and imaging data. PVP were performed in 362 vertebrae and the patients were followed up with an average of 12 months. Subsequent vertebral fractures were found through the pain's reappearance and MRI or bone scan. The patients were divided into secondary fracture group and no-secondary fracture group according to the subsequent fractures or no. Secondary fracture group was divided into two groups according to gender, and the patients with secondary fracture were also categorized into the original surgical vertebral fractures, adjacent vertebral fracture and remote vertebral fractures. The age, gender, the cement volume, the cement leakage, secondary fracture site, the incidence and type of secondary fracture were observed and compared among different groups., Results: Among the 362 vertebrae of PVP, there were 109 vertebrae in male and 253 vertebrae in female. And 27 vertebrae (10 in male and 17 in female) of 22 cases (9 males and 13 females) occurred secondary fracture. The second PVP were performed in 13 cases (16 vertebrae) and the third PVP in 2 cases (4 vertebrae); 7 cases (7 vertebrae) were treated with conservative therapy. There was no statistically significant difference on age, gender, cement volume and leakage between secondary fracture group and no-secondary fracture group (P > 0.05). There was no statistically significant difference on the incidence and type of secondary fracture between male and female (P > 0.05). No significant difference was found on the adjacent and remote vertebral fractures (P > 0.05). Most of secondary fracture occurred in 6 months, and whether the single and double side injection, cement leakage had no obvious relation., Conclusion: There is no significant difference in the subsequent fracture after PVP for the OVCFs different gender and fractured site, and also no significant difference in the adjacent and remote vertebral fractures. The report didn't support the biomechanical viewpoint that vertebral body stiffness increasing after PVP would lead to adjacent vertebral stress increasing and result easily in adjacent vertebral fracture. Secondary fracture occurs always in 6 months after operation, which is the natural course of osteoporosis.

Objective: To evaluate the clinical outcomes of primary anterior radical debridement, bone autograft, and sacral rod fixation for the treatment of tuberculosis of the lumbosacral segment., Methods: From March 2004 to November 2008,11 patients with tuberculosis of the lumbosacral segments received antituberculosis medications for 2 to 3 weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Among the patients, 5 patients were male and 6 patients were female, with an average age of (44.45 +/- 8.50) years (ranged from 29 to 56 years). The average time from stage of onset to operation was 11 months (ranged from 8 to 15 months). All the patients presented with various degrees of lower back pain; one patient experienced preoperative lower extremity radicular pain, while 2 patients experienced saddle area anaesthesia. However, only 6 patients exhibited mild to moderate tuberculous toxic reactions. All the patients were evaluated by plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of tuberculosis was made with reference to clinical and radiological findings. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to (37.2 +/- 9.6) mm/h (25 to 54 mm/h). Lumbosacral angle, visual analogue scale (VAS) scores, ESR, and neurological performance were assessed before and after surgery., Results: All surgical procedures were performed successfully without intra or postoperative complications. There were no instances of spinal tuberculosis recurrence. Patients were followed up for a mean of (19.64 +/- 5.43) months. The mean lumbosacral angle significantly increased from the preoperative mean (12.9 +/- 5.0) degrees to postoperative (21.5 +/- 6.1) degrees and at final follow-up (20.1 +/- 5.2) degrees (P < 0.001). The mean VAS scores and ESR significantly decreased from preoperative (7.3 +/- 1.2) score and (37.2 +/- 9.6) mm/h respectively to final follow-up (0.6 +/- 0.5) score and (10.5 +/- 2.3) mm/h respectively (P < 0.001). Bone fusion occurred in all patients at a mean of (9.0 +/- 1.9) months (ranged 6 to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery., Conclusion: Our findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.

Post-traumatic complex regional pain syndrome type 1 (CRPS1) is uncommon and can cause the disability of patients. Complex dislocation of the metacarpophalangeal joint on the little finger due to interposition of the sesamoid bone is rare and was firstly reported by Pribyl.1 We reported a rare case of CRPS1 after surgery of complex metacarpophalangeal dislocation of the little finger. To our knowledge, this case has not been reported yet.

Objective: To evaluate the operative strategy and therapeutic outcomes of the atlantoaxial instability., Methods: Clinical data of 29 patients with atlantoaxial instability were retrospectively analyzed. There were 27 males and 2 females. The mean age was 33 years old with a range from 18 to 54 years. There were fracture of anterior arch of atlas accompanied with ligamentum transversum rupture in 5 cases, odontiod fracture in 7 cases, Hangman fracture in 6 cases, dysplasia of atlas and axis in 10 cases, ankylosing spondylitis in 1 case. The clinical and imaging manifestation of atlantoaxial instability were found in all patients. The symptoms and physical signs of superior cervical spinal cord disease or cervical spinal injury were found in 18 cases. The patients were treated with simple modified Magerl method (7 cases), cannutated screw fixation(6 cases), resection of C2,3 disc throuth the anterior approach and fusion with Zephir titanium plate (4 cases), percutaneous pedicle screw fixation of C2 (2 cases), release and reduction through anterior oropharynx (LRAO) combined with modified Magerl method (4 cases), LRAO and atlas lateral mass screw and plate fixation through posterior approach (3 cases), cervical occipital fusion through C2 pedicle (3 cases)., Results: All patients were followed up with an average time of 17.2 months ranging from 11 to 38 months. All patients obtained anatomical reduction and bone healing. Using Odom standard to evaluation for 18 cases with spinal injury before operation, the results were excellent in 9 cases,good in 7,fair in 2. No injury of vertebral artery, nerve root, spinal cord, infection of incisional wound, breaking or loosening of internal fixatir were found in the study., Conclusion: Identifying the causes of atlantoaxial instability, rational plan of operation can get satisfactory clinical results.