| Part One The effect of Modic changes in the fusion rate and cage subsidence of intervertebral fusion devices in patients undergoing transfoaminal lumbar interbody fusion with hybrid graftObjective: To analyze the influence of Modic changes(MCs)in patients undergoing transforaminal lumbar interbody fusion with hybrid graft.Methods: Clinical data of 89 patients who underwent single segment transforaminal lumbar interbody fusion between January 2015 and January2019 at our institution were analyzed.Patients were divided into three groups:the MCs-0 group(no endplate changes,used as the control group),the MCs-1group,and the MCs-2 group.The rate of postoperative interbody fusion and the sedimentation rate of interbody fusion apparatus were compared among the three groups.The lumbar function,waist and leg pain were compared between the patients before and at the last follow-up.The height of intervertebral space,lumbar lordosis angle and segmental lordosis angle were compared before,immediately after and at the last follow-up.The c-reactive protein(CRP)and erythrocyte sedimentation ratewere(ESR)compared between preoperative and postoperative 1,3,7,15 and 21 days.Results: There was no significant in the rate of intervertebral fusion between the three groups(P>0.05)but the sedimentation rate of interbody fusion apparatus in MCs-1 group was significantly higher than that in MCs-0group and MCs-2 group(P<0.05).Lumbar function and pain degree of lumbar and leg in 3 groups were significantly improved at the last follow-up(P<0.05),there were no significant in lumbar function and leg pain between the three groups(P>0.05),but the degree of lumbar pain in MCs-1 group was significantly lower than that in MCs-0 group and MCs-2 group(P<0.05).Immediately after surgery and at the last follow-up,disc height and lumbar lordosis Angle of the three groups were increased compared with that before surgery(P<0.05).The levels of CRP and ESR on the 1,3,7 and 15 days after operation were higher than those before operation in 3 groups(P<0.05)and the CRP and ESR levels in MCs-1 and MCs-2 groups were significantly higher than those in MCs-0 group(P<0.05).Conclusions: On this study,Modic changes had no impact on fusion rates and clinical outcomes of transforaminal lumbar interbody fusion with hybrid graft(autologous local bone graft plus allogeneic freeze-dried bone graft).However,MCs-1 groups increased the risk of cage subsidence and showed superior outcomes in terms of visual analog scale scores for low back pain.Patients with MCs are at higher risk of developing inflammatory responses after surgery.Part Two The effect of extended anterior cervical discectomy and fusion in degenerative cervical myelopathyObjective: To evaluate the clinical effect of expanded and modified ACDF in the treatment of degenerative cervical spinal cord disease.Methods: Clinical data of 56 patients of degenerative cervical spinal cord disease treated with traditional ACDF or expanded modified ACDF(EACDF)from February 2016 to February 2020 in the Third Hospital of Hebei Medical University were analyzed.Patients were divided into two groups: ACDF group and EACDF group.Perioperative indexes such as operation time,blood loss and complications were compared between the two groups.The neurological function recovery,neck pain and imaging evaluation indexes were compared in the last follow-up.Results: The operation time of the EACDF group was 131.06±40.14 min,and that of the ACDF group was 152.16±32.09 min.The operation time of the EACDF group was shorter than that of the ACDF group and the difference between the two groups was statistically significant(P<0.05).Intraoperative blood loss was 161.16±95.53 m L in the EACDF group and 175.18±101.57 m L in the ACDF group,there was no significant between the two groups(P>0.05).Postoperative complications in the EACDF group included 1 case of cerebrospinal fluid leakage,2 cases of wound hematoma,2 cases of axial symptoms and 1 case of hoarseness.In the ACDF group,complications included 1 case of spinal cord injury,3 cases of cerebrospinal fluid leakage,1case of wound hematoma,9 cases of axial symptoms and 2 cases of hoarseness.The incidence of axial symptoms in EACDF group(7.7%)was significantly lower than that in ACDF group(30.0%)(P<0.05).The preoperative JOA of the EACDF group and ACDF group were 7.19±1.06 and7.23±1.10,there was no significant between the two groups(P>0.05).At the last follow-up,the JOA were 12.88±1.07 and 13.07±1.44,significantly higher than that before surgery(P<0.05).But there was no significant between the two groups(P>0.05).The preoperative improvement rates of spinal cord function in the EACDF group and ACDF group were 58.43% and 60.29%,there was no significant difference between the two groups(P>0.05).The preoperative NDI of the EACDF group and ACDF group were 39.27±3.12 and39.13±2.43,there was no significant difference between the two groups(P>0.05).The NDI at the last follow-up was 12.42±2.93 and 11.43±2.42 significantly lower than the preoperative NDI(P<0.05).But there was no difference between the two groups(P>0.05).The preoperative NRS of the EACDF group and ACDF group were 5.73±1.15 and 6.30±1.02,there was no significant difference between the two groups(P>0.05).The NRS of the last follow-up were 1.57±0.58 and 2.10±0.96 which were significantly lower than those before surgery(P<0.05).The pain degree of EACDF group was lower than that of ACDF group(P<0.05).The Cob angles of the EACDF group and ACDF group were 8.49±2.41° and 9.38±2.96° respectively before surgery,there was no significant difference between the two groups(P>0.05).The Cob angles increased to 18.20±2.69° and 16.62±3.92° at the last follow-up(P<0.05).But there was no significant difference between the two groups(P>0.05).The FSH loss score of 2.52±0.54 mm in EACDF group was significantly higher than that of 2.03±0.51 mm in ACDF group(P<0.05).Before surgery,the maximum rate of spinal canal invasion in the EACDF group and ACDF group were 59.34%±8.36% and 54.70%±10.73%,there was no significant difference between the two groups(P>0.05).And the maximum rate of spinal canal invasion in the last follow-up was reduced to6.42%±3.41% and 7.00%± 3.96%(P<0.05).But there was no significant difference between the two groups(P>0.05).The fusion rate of the EACDF group was 96.2% and that of the ACDF group was 76.7%,the fusion rate of the EACDF group was significantly higher than that in ACDF group(P<0.05).Conclusions: EACDF can ensure sufficient decompression range,promote early intervertebral fusion to maintain stability,and preserve motor units as much as possible without increasing the intervertebral settlement rate.At the same time,the pain degree of patients was significantly improved,the incidence of axial symptoms was reduced,and the clinical efficacy was improved.Part Three Animal experimental study of intervertebral implant fusion with endplate preparationsObjective: To investigate the fusion effect of PEEK interbody fusion device combined with the central non-bearing area of endplate,provide experimental basis for the treatment of endplate in patients.Methods: Total eight sheep were randomly divided into treatment group(n=4)and control group(n=4).All sheep were treated with anterior cervical discectomy and internal fixation with interbody bone grafting and fusion.The central non-bearing area of the endplate was treated in the experimental group,while the central non-bearing area of the endplate was not treated in the control group.To compare the efficacy of two groups of experimental sheep interbody fusion.Results: Three months after the operation,X-ray and CT showed that the fusion of the treatment group was significantly better than that of the control group(P<0.05).The BVF of the treatment group was 33.52%±2.32%,and that of the control group was 25.05% ±1.98%,the BVF of the treatment group was significantly higher than that in the control group(P<0.05).Tissue sections showed that the bone area in the interbody fusion device accounted for35.02%±1.87% in the treatment group and 31.68%±2.19% in the control group,the bone area in the interbody fusion device of the treatment group was significantly higher than that in the control group(P<0.05).Conclusions: The treatment of the endplate in the non-bearing area of the central endplate can increase the blood supply and nutrient supply of intervertebral bone grafting without loss of endplate support,increase the contact area of bone trabecula,promote bone in growing,and improve the bone fusion rate of intervertebral bone grafting. |
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