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Abstract:The incidence of spinal degenerative disease is increasing in the elderly as China has entered the aging society, but we lack a scientific or standard treatment for this disorder. On one hand, for reasons of behindhand understandings, there are some untimely treatments, and incorrect or unreasonable methods. On the other hand, there are some radical understandings and over-treatments for the disease. It is a big problem we faced in the current clinical practice, which is how to correctly and reasonably diagnose and treat this disease. So we should emphasize and advocate reasonable, sensible and scientific principles of modern strategies which are suitable for our national conditions, that is stepwise and individual principle.

Abstract:Objective To investigate retrospectively the effects of surgical treatment for elderly patients with lumbar disc herniation. Methods A follow-up was conducted in patients who underwent surgery for lumbar disc herniation from July 1994 to November 2011 in our hospital. Ninty-five cases, (59 male and 36 female), aged from 60 to 85 with the average age of 70.3, were followed up for 3 months to 10 years with a mean follow-up of 35.7 months. The standards of Scoring System of Spinal Section of Chinese Orthopaedic Association (SSCOA) and Japan Orthopaedic Association (JOA) were used to investigate the differences in therapeutic effects between various surgery methods(discectomy or arthrodesis), decompression tactics(fenestration, hemilamine- ctomy or laminectomy) and follow up time(within 3 years, 3 to 5 years, or up 5 years). Results According to SSCOA, the total efficiency rate for lumbar disc herniation was 84.2%, whereas the rates in discectomy group and arthrodesis group were 80.5% and 87.0% respectively, without significant difference (P=0.694). Meanwhile according to JOA, the improvement rates in discectomy group and arthrodesis group were (60.89±32.62)% and (65.74±26.32)% respectively, without significant difference (P=0.636). The efficiency rates in fenestration group, hemilaminectomy group and laminectomy group were 80.6%, 91.3% and 85.4% respectively and without significant difference among groups (P=0.958), meanwhile the improvement rates were (59.84±29.84)%, (62.30±27.10)% and (62.94±31.96)% respectively, without significant difference (P=0.835). Of patients receiving follow-up within 3 years, 3 to 5 years , and up 5 years, the efficiency rates were 90.6%, 77.8% and 79.2% respectively, without significant difference (P=0.660), meanwhile, the improvement rates were (62.01±25.97)%, (55.06±35.89)% and (60.83±33.73)% respectively, without significant difference (P=0.811). Conclusion Discectomy group and arthrodesis group may achieve satisfactory results as treatment of lumbar disc herniation in elderly patients. Fenestration, hemilaminectomy and laminectomy may all have good effect. There is no significant difference in curative effects between various follow-up times.

Abstract:Objective To evaluate the clinical effects and indications of dynamic hip screw (DHS) and hemiarthroplasty in the treatment of intertrochanteric femoral fracture in the elderly patients. Methods We retrospectively reviewed the clinical data of 103 elderly patients diagnosed as intertrochanteric femoral fractures between January 2007 and December 2009 in our hospital. The DHS system was used in 71 patients, and hemiarthroplasty was used to treat the other 32 patients. The clinical data including operation time, blood loss volume, post-operative complications, fracture healing and function recovery were recorded and analyzed. Results In the DHS group, the mean operation time was (96.7±8.6)min; the mean blood loss volume was (317.7±26.5)ml. Harris￠s hip function was excellent in 32 cases, good in 26 cases, moderate in 6 cases, and poor in 7 cases, with satisfaction rate of 81.7%. In the hemiarthroplasty group, the mean operation time was (107.0±12.8)min; the mean blood loss volume was (335.3±28.1)ml. Harris￠s hip function was excellent in 10 cases, good in 14 cases, moderate in 2 case, and poor in 1 case, with satisfaction rate of 88.9%. Conclusions Both DHS and hemiarthroplasty are effective in the management for the intertrochanteric femoral fracture in the elderly patients, if combined with anti-osteoporosis treatment and suitable indications. The short and middle-term outcome are both satisfactory.

Abstract:Objective To evaluate the clinical outcomes and efficiency of the unipedicular percutaneous kyphoplasty(PKP) in vertebral fragility fractures. Methods A prospective observational study was performed. Twenty patients with a total of 34 vertebral compression fractures underwent kyphoplasty utilizing a unilateral pedicular/unipedicular approach. The vertebral bodies were measured at the anterior margins. And visual analog scale(VAS), Cobb￠s angle were compared preoperatively, at day 2 and the end of follow-up postoperatively. Complications were recorded. Height restoration, pain relief and Cobb￠s angle change were assessed pre- and post-operatively. Results Twenty patients underwent unipedicular PKP for a total of 34 levels. The mean duration of follow-up was 15.5 months (ranging 10 to 20 months). The mean pre-operative anterior vertebral height was (17.68±3.33)mm and postoperative one was (30.94±3.22)mm, which was significantly different (P＜0.05). The mean VAS was (7.15±1.17), (2.20±0.53) and (2.10±0.45) preoperatively, at day 2, and at the end of follow-up respectively, with significant difference between the 3 time points (P＜0.05). The VAS change had no statistica1 significance between day 2 and the end of follow-up time point (P＞0.05). The Cobb￠s angle decreased from (21.53°±5.22°) to (7.35°±2.16°), with statistical significance (P＜0.05). Cement extravagation was observed in one asymptomatic case (2.9%). Adjacent vertebral fractures were observed on 2 levels (5.9%) in 2 cases, who underwent kyphoplasty again. Conclusions Unipedicular PKP is both a safe and efficacious alternative to the traditional bipedicular kyphoplasty for the treatment of painful vertebral fragility fractures. And it is comparable with bipedicular kyphoplasty in height restoration, pain relief and Cobb￠s angle change. And also, it is faster, less expensive and involves less radiation exposure for the patient. It improves the life quality of the involved elderly cases.

Abstract:Objective To compare the clinical effect of autogenous bone and polymethylmethacrylate (PMMA) augmentation of screw fixation in degenerative scoliosis with osteoporosis. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative scoliosis combined with osteoporosis who accepted pedicle screw fixation from December 2000 to December 2006. Fourteen of them underwent fixation with pedicle screw by augmentation with PMMA and the other 17 patients with autogenous bone. Peri-operative data were recorded. Preoperative, postoperative and final follow up corrective effects were compared. Results No significant difference was found in clinical data except for administration time of oral pain relief medicines and surgery cost between the two surgical strategies. Cement leakage was observed in 2 patients in PMMA augmentation group, but there was no evidence of nerve damage. Conclusion There is no difference in surgical effect between two surgery strategies on degenerative scoliosis combined with osteoporosis. Less oral pain medicines are taken in the polymethylmethacrylate-augmented pedicle screw fixation and fusion, but with much more cost and danger of cement leakage.

Abstract:Objective To analyze retrospectively clinical curative effect of partly reduction and intervertebral fusion on stable degenerative lumbar spondylolisthesis. Methods A retrospective follow-up analysis included 17 patients with L4-L5 stable lumbar degenerative spondylolisthesis receiving partly reduction and intervertebral fusion treatment from May 2008 to August 2011. Visual analog score(VAS) of back pain and leg pain before and after operation were compared. The lumbar 4 was found slipped in all patients and lumbar hyperextension and hyperflexion X-ray files showed no evidence of lumbar instability. All patients were followed up in 6-12months after operation. Results There was no nail or rod broken, and intervertebral fusion rate was 94%. VAS of low back pain and leg pain were significantly decreased post-operatively(P＜0.01). Conclusion Short-term clinical outcome of partly reduction and intervertebral fusion for treatment of stable degenerative lumbar spondylolisthesis is satisfactory.

Abstract:Objective The aim of this study was to evaluate the short-term clinical outcomes of lumbar spinal canal decompression and Wallis interspinous dynamic stabilization for single-segmental lumbar spinal stenosis in the aged. Methods We retrospectively analyzed the data of 25 aged patients who suffered from the degenerative spinal stenosis of L4-5 and received spinal canal decompression and Wallis interspinous dynamic stabilization operation in Chinese PLA Air Force General Hospital during January 2008 to December 2010. There were 11 males and 14 females, with an average age of 65 years. The follow up period of every patient was not less than 6 months. We recorded the Oswestry dysfunction index(ODI) and visual analog score(VAS) preoperatively, at 3 days, 1 months and 6 months postoperatively and measured the height of intervertebral spaces and intervertebral foraminas of the operative segment(L4-5) and the adjacent segment(L3-4 and L5-S1) in the radiograph images. All the intraoperative and postoperative complications of every patient were also recorded. Results The Wallis systems were all successfully implanted after spinal canal decompression in total 25 cases. No operation-relatived complications happened. Every patient got symptomatic relief to some extent after the operation, with significant difference in ODI and VAS between preoperation and 3 days, 1 months and 6 months postoperatively. (P＜0.01). And there was no statistical difference in the height of intervertebral spaces and intervertebral foraminas of the adjacent segment(L3-4 and L5-S1) between 3 days and 1 months and 6 months postoperatively(P＞0.05). Conclusions Spinal canal decompression and Wallis interspinous dynamic stabilization for degenerative spinal stenosis in the aged can get satisfactory short-term clinical outcomes. The Wallis system is effective to keep the height of intervertebral space and intervertebral foramina of the operative segment, and no degeneration of the adjacent segments is observed in short-term follow up.

Abstract:Objective To investigate the surgical indications by retrospectively analyzing the surgical methods and outcomes in 71 cases with thoracic spinal tuberculosis (TB). Methods Between January 2001 and December 2010, 112 adult patients with thoracic spinal TB were treated with different surgical procedures. We followed up 81 patients (average age 38 years, range 17-68 years), without multiple-level noncontiguous spinal TB, for 17-72 months (mean 37 months), in which 23 patients had neurological deficits. The patients were divided into 5 groups receiving different procedures according to location and extent of the lesion: group A (18 cases) receiving anterior radical debridement and strut grafting with instrumentation by extrapleural approach; group B (21 cases) getting anterior radical debridement and strut grafting with instrumentation by transthoracic approach; group C (10 cases) having posterolateral decompression and strut grafting with posterior instrumentation; group D (27 cases) receiving posterior instrumentation and interlaminar bone grafting with anterior radical debridement and strut grafting in one-stage or two-stage; group E (10 cases) having anterior radical debridement and strut grafting by splitting the manubrium of sternum or the breast bone in the treatment of upper thoracic spinal TB. Results (1) The average operation time and blood loss were 3.5h and 350ml in group A, 3.0h and 350 ml in group B, 3.0h and 300ml in group C, 4.5h and 640ml in group D, and 4.0h and 600ml in group E respectively. (2) The degree of kyphosis was corrected by (47.5±11.8)% in group A, (46.9±10.2)% in group B, (59.9±17.4)% in group C, (61.7±18.6)% in group D, and (44.1±8.7)% in group E respectively. (3) The correction loss at last visit was (64.8±19.3)% in group A, (53.6±15.6)% in group B, (56.9±11.8)% in group C, (54.9±15.4)% in group D, and (44.1±8.7)% in group E respectively. All the 23 cases with neurological deficit were improved at least one grade according to Frankel scoring system. Conclusion These results suggest that all the surgical procedures can obtain good results in correction and maintenance of the deformity, clearance of the foci, decompression of the spinal cord and pain relief in the treatment of thoracic spinal TB, providing that the patients are chosen correctly according to location and extent of the lesions, and patients’ general health status. Posterolateral decompression and strut grafting with posterior instrumentation is recommended for the elderly considering their poor general health condition. Posterior instrumentation may be superior to anterior instrumentation in correction and maintenance of the deformity.

Abstract:Objective To evaluate the clinical efficacy of percutaneous bipedicular kyphoplasty with double or single balloon in treatment of elderly patients with osteoporotic vertebral compression fractures(OVCFs). Methods From April 2008 to Feb 2010, 26 patients with OVCFs involving 35 vertebrae were treated by percutaneous kyphoplasty(PKP), and randomized to single or double balloons group. The average age of the single balloon group ( 15 patients with 21 involved vertebrae) was 72 years and that of the double group (11 patients with 14 vertebrae) was 70.8 years. Each procedure included insertion of inflatable balloon(single or double), fracture reduction and cement filling under monitoring. Preoperative and postoperative pain levels, radiographs and complications were recorded and analyzed. Results The mean operation time were 37.5 (33～85)min and 33.9 (30～75)min for single and double balloon groups respectively. The mean follow-up duration was 14.8 (12～18)months. The mean VAS pain score of single balloon group decreased significantly from 7.6±2.2 preoperatively to 2.5±1.8 postoperatively (P＜0.05) and 3.1±2.0 at final follow-up, the mean VAS pain score of double balloon group decreased significantly from 7.9±2.3 preoperatively to 2.4±2.0 postoperatively (P＜0.05) and 2.9±2.1 at final follow-up, while no significant difference in changes of VAS pain was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were observed after the operation and maintained at final follow-up for both groups (P＜0.05). The mean correction of local kyphosis was (7.0°±4.5°) for single balloon group and (7.7°±3.9°) for double balloon group, and no significant difference was found between two groups. Conclusions PKP is effective and relatively safe for OVCFs with either single or double balloons.

Abstract:Objective To investigate the risk factors associated with non-surgical vertebral fractures after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Methods From February 2009 to March 2010, 76 patients with OVCFs were included in this study. There were 11 males and 65 females with the average age of (66.7±7.3) years. The average follow-up time was 13.6 months, ranging from 6 to 22 months. All patients underwent X-Ray and MRI to confirm the onset of vertebral fracture. Forty-four patients underwent PVP and 32 patients PKP. The bone mineral density (BMD) of lumbar spine was measured by dual-energy X-ray absorptiometry, and age, sex, body mass index (BMI), cement volume, cement leakage (%), and kyphosis correction of all patients were recorded. The risk factors associated with the non-surgical vertebral fractures were analyzed. Results Student's t test showed statistically significant differences (P＜0.05) between two groups with respect to cement volume and kyphosis correction. There were no significant differences between cement leakage and new vertebral compression fractures between two groups. Multiple logistic regression analysis showed BMD less than -2.5SD was the only risk factor associated with non-surgical segment fracture. Patients with the kyphosis correction more than 5.0° had a short period to the new vertebral fractures than those whose kyphosis correction were less than 5.0°. Conclusion BMD less than -2.5SD is the risk factor of nonsurgical vertebral fractures after PVP for OVCFs. In those osteoporosis patients with low T values, excess kyphosis correction may follow by a soon onset of non-surgical vertebral fractures.

Abstract:Objective To evaluate the efficacy of lumbar posterolateral fusion(PLF) versus posterior lumbar interbody fusion(PLIF) in the treatment of the degenerative lumbar disease. Methods We searched Medline(1966 to March, 2012), Embase(1984 to March, 2012), Cochrane Central Register of Controlled Trial(1th Quarter 2012), Current Controlled Trials, The China Biological Medicine Database (1984 to March, 2012), and several related journals. The qua1ity of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 5.0 software was used for data analysis. Results Four studies involving 329 patients were included. The results of meta-analysis indicated that in the fusion rate(OR 0.41, 95%CI 0.19-0.85, P=0.02) and back pain visual analogue scale(VAS) (WMD 0.43,95%CI 0.10-0.76, P=0.01), PLIF group was significantly better than PLF group. Blood lost during operation and during the 1st postoperative day was significantly less in PLIF group than in PLF group (WMD 320.03, 95%CI 241.26-398.79, P＜0.00001). There were no statistically significant differences in the Oswestry disability index(WMD 2.86, 95%CI -0.56-6.26, P=0.1), leg pain VAS(WMD 0.34, 95%CI -0.11-0.79, P = 0.13) and lumbar lordotic angle (WMD -2.43, 95%CI -5.42 -0.55), P = 0.11). Conclusions To compare with PLF, PLIF has the advantages of less blood loss, higher fusion rate, and better back pain relief. More high quality large-scale randomized controlled trials are required.

Abstract:The non-fusion dynamic stabilization techniques maintain the motion of the lumbar vertebrae without fusion spinal segments, so it may have more advantages than fusion surgery. In this review, we discussed the main types, advance, indications and contraindications, advantages and disadvantages of the lumbar non-fusion surgical treatment for the eligible elderly patients. We believed that major non-fusion techniques had more advantages and less disadvantages in delaying the process of disc degeneration of the targeted segment, preserving the motion of segment, preventing degeneration of adjacent segments, alleviating clinical symptoms, and improving quality of life. There would be great prospect of the lumbar non-fusion surgery in the treatment of degenerative lumbar diseases.

Abstract:As the society develops, people￠s life expectancy has increased dramatically and the whole population is aging. As a result, spinal diseases and their surgeries have become part of life for more and more aged people. Due to their naturally declining metabolic capability and body￠s reserve capacity, the aged people are subject to perioperative and postoperative complications, and other accidents, which often leads to reversal operative effects and damage people￠s life quality. Therefore, scholars are increasingly interested in exploring the causes, precautionary measures and treatment measures for such complications. This paper reviewed the related researches.

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Abstract:Objective To assess the long-term outcomes of patients with coronary atherosclerotic heart disease undergoing coronary artery bypass grafts (CABG) and percutaneous coronary intervention (PCI). Methods Patients with coronary heart disease undergoing CABG or PCI and suffering angina again, were enrolled, with 40 in CABG group and PCI group respectively. Age, gender, myocardial infarction, hypertension, hyperlipidemia, heart failure, stroke and medicinal history were matched between two groups. The long-term efficiency was compared between the two groups by coronary angiography. Results Compared with CABG group, the long-term stenosis and blocking rate declined by 34.3% in PCI group. Compared with bypass artery of the left internal mammary artery of patients in CABG group, the long-term stenosis and blocking rate of the left anterior descending branches declined by 14.8% in PCI group. Compared with bypass vein of the left circumflex branches and the right coronary of patients in CABG group, the long-term stenosis and blocking rate of the left circumflex branches and the right coronary declined by 49.8% in PCI group. Conclusion The long-term revascularization rate is higher in PCI group than in CABG group. The drug stent in PCI is superior to bypass artery in CABG.

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Abstract:The aging of society and the higher incidence of cardiovascular diseases with advancing age are leading to greater numbers of elderly patients，aged over 70 years old, undergoing cardiac surgery. Although there are more risk factors in elderly patients，currently, coronary artery surgery, valvular surgery and aortic surgery can be performed with a short- and long-term outcome comparable to those of younger patients. The main difference between elderly and younger patients with regard to the outcome after cardiac surgery is the incidence of stroke. Minimally invasive and hybrid procedures are trends in cardiovascular surgery in elderly patients.