Objective To evaluate the security and validity of the acute extreme hypervolemic hemodilution (AEHH) in spine surgery. Methods Thirteen patients(8 males, 5 females; age, 16-65 years; weight, 50-75 kg) who had undergone major spine operations were enrolled in this study. Eleven of them had undergone anterior decompression, who were given the grafting and the internal fixation for their thoracolumber spinal burst fractures; the other 2 patients were given the correction operation for their scoliosis. The baselines of the haematocrit (Hct）were 0.363-0.481 before operation. The patients had no cardiac, pulmonary, hepatic or renal dysfunction or coagulation abnormality. The hemodynamic status and the haematocrit were observed during operation. The parameters of thromboelastography (TEG)，arterial blood gas, and electrolytes were measured and observed at the following time points: before AEHH, after AEHH, 60 minutes after AEHH, 120 minutes after AEHH, and the end of the operation. The total fluid volume was recorded. Results The autologous blood volume was1 050-1 575 ml (average,1 419±198 ml), plasma substitute 2 100-3 150 ml (average,2 838±397 ml), blood loss1 000-3 130 ml (average, 1 747±743 ml), urine 450-1 270 ml (average, 871±374 ml), and the net blood transfusion 1 206-2 661 ml(1 863±598 ml). The homogenous blood of 400 ml was transfused in 1 patient for making upthe blood loss of 3 130 ml. There were no statistically significant differencesin the hemodynamic measurements, arterial blood gas, and electrolyte variables when compared with the baseline values before the hemodilution (Pgt;0.05). The reaction time of TEG was longer 60 minutes after AEHH than before AEHH (Plt;0.05); the other parameters of TEG had no differences when compared with the baseline values (Pgt;0.05). Conclusion The AEHH is safe and efficient in reduction of the perioperative homogenous blood transfusion in spine surgery.
ObjectiveTo investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. MethodsA retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. ResultsAt L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). ConclusionPI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.
Objective To evaluate the effectiveness, safety, cost and optimal dosing regimen of bone morphogenetic protein (BMP) used in the lumbar spine arthrodesis. Methods We formulated the clinical questions according to the PICO principle. We searched the ACP Journal Club (1991 to February 2008), The Cochrane Library (Issue 4, 2007) and PubMed (1990 to February 2008) as well as other relevant databases. The evidence retrieved was critically appraised. Results Current evidence showed that BMP was a satisfactory and safe behavior in lumbar arthrodesis. Its cost was equal to that of autogenous iliac bone graft. The types of BMP currently used in clinical practice are BMP-2 and BMP-7. Finished product of fixed composition ratio was recommended in anterior lumbar inter-body fusion, while in posterolateral fusion, 20mg of BMP-2 or 3.5mg of BMP-7 for each side was recommended, with proper carrier according to the place where it was used. Conclusion BMP may be introduced to China for lumbar spine arthrodesis. Before it is applied extensively, further large-scale, high-quality randomized controlled trials are needed. Meanwhile, more research is necessary to determine the proper dosage and preparation form for the dominant Chinese population.
A new method of anterior decompression for thoracolumbar fractures with paralysi s in six cases was reported. In a follw-up of one to five months, was shown that the neurological functions in all six cases has improved ⅡⅢ rank in Frankl classification. The author believe that the method has the following advantages, such as: less trauma from operation; the level and the limit of decompression could be made without Xray during the operation; usually only 1/5 to 1/4 of the vertebral body was excised so that the stability of the spine was not disturbed, and the obvious favourable results.
Objective To investigate the status of self-perceived burden (SPB) in patients undergoing spine surgery and to explore its influencing factors, in ordering to provide a basis for formulating corresponding nursing interventions. Methods A cross-sectional survey was conducted on patients undergoing spine surgery in Department of Orthopedic Surgery, West China Hospital of Sichuan University between May and August 2024. The patient general information questionnaire, the patient SPB Scale, the Barthel Index, the Medical Coping Modes Questionnaire, and the Social Support Rating Scale were used to investigate the SPB status and its influencing factors in patients undergoing spine surgery. Results A total of 230 patients were included. There were 113 cases in the non-SPB group and 117 cases in the SPB group. There were statistically significant differences in age, marital status, occupation, payment method, the number of family, disease diagnosis, Barthel Index score, caregiver identity, and caregiver gender between the two groups of patients (P<0.05). Among 117 patients with SPB, 83 (36.09%) had mild SPB, 27 (11.74%) had moderate SPB, and 7 (3.04%) had severe SPB. The average SPB scores for mild, moderate, and severe patients were (24.06±2.92), (33.07±2.87), and (44.86±4.56) points, respectively. The results of binary logistic stepwise regression analysis showed that the patient’s marital status, disease diagnosis, and caregiver gender were independent influencing factors for SPB in patients undergoing spine surgery (P<0.05). Conclusion The SPB of patients undergoing spine surgery is at a mild to moderate level, which is affected by factors such as marital status, disease diagnosis, and caregiver gender.
Objective To explore the surgical procedure and effectiveness of total spondylectomy and spine reconstruction through posterior approach to treat thoracolumbar vertebra tumor. Methods Between June 2004 and July 2008, 14 cases of thoracolumbar vertebra tumor underwent one-stage total spondylectomy through posterior approach and spine reconstruction with posterior pedicle screw system and bone graft. There were 11 males and 3 females with a mean age of 47.2 years (range, 36-60 years). The disease duration was 3-15 months. Affected segments included T3 in 1 case, T4 in 3 cases, T8 in 3 cases, T9 in 2 cases, T10 in 3 cases, T12 in 1 case, and L1 in 1 case. The postoperative pathological results were 3 cases of bony giant cell tumor, 1 case of osteoblastoma, 2 cases of osteosarcoma, and 8 cases of metastatic tumor. According to Tomita et al. grading system, there were 1 case of type II, 5 cases of type III, 3 cases of type IV, and 5 cases of type V. According to Frankel classification of preoperative spinal cord function, 3 cases were rated as grade B, 4 as grade C, 5 as grade D, and 2 as grade E. Results Wound heal ing by first intention was obtained in all cases, and no blood vessel and nerve injury occurred. Fourteen patients were followed up 11-64 months (mean, 32.5 months). The local pain was rel ieved significantly. At 6-8 months after operation, the X-ray films and CT showed that bone graft fusion at Bridwell I grade was achieved. At 10 months, the postoperative spinal cord function was improved from grade B to grade D in 2 cases, from grade C to grade D in 1 case, and the other 9 cases reached grade E. The patients had normal walking function. Two patients died of l iver metastasis and brain metastasis at 11 and 15 months postoperatively, respectively; 1 patient with osteoscarcoma died of lung metastasis at 16 months; and 1 case of osteoscarcoma developed local recurrence at 8 months postoperatively. Internal fixation was rel iable without loosening and breakage and the spine was stable. Conclusion Total spondylectomy and spine reconstruction through posterior approach is an effective method with advantages of relative minimal injury, radical tumor excision, low local recurrence, and adequate spinal cord decompression.
Objective To explore the injury mechanism, clinical features and treatment methods of multiple-level noncontiguous spinal fractures(MNSF). Methods The clinical data of 23 patients with MNSF were analyzed retrospectively. Therewere 15 males and 8 females aging from 13 to 75 years. Five cases missed diagnosis. The locations of the primary injury were cervical region in 3 cases, thoracic region in 7 cases, and thoracolumbar region in 13 cases. The spinal fractures associated with spinal cord injury were 14 cases in the primary injury, and 3 cases in the secondary injury. According to Frankel grade, there were 7 cases ofgrade A, 1 case of grade B, 3 cases of grade C, 6 cases of grade D and 6 cases of grade E. Sixteen cases were treated by surgical stabilization while 7 cases were treated conservatively. Results Twenty patients were followed up from 3 months to 4 years with a mean of 11.5 months except three patients. No neurologic deterioration was observed in patients who were treated conservatively or operatively. No wound infection, no implant failure or bone graft nonunion occurred in patients who were treated operatively. Among 17 patients with neurologic deficit before operation, 12 got 1-3 grade improvement of the Frankel grading, 4 remained unchanged and 1 died. Conclusion The mechanism of MNSF injury is complex, it is easy to miss diagnosis. The patients with spinal injury must be examined carefully and completely. A whole spine radiographic survey should be accomplished if necessary and treatments should be based on the stability of spine fractures and the severity of spinal cord injury.
ObjectiveTo investigate the status of urination in post-spineoperative (cervical thoracic and lumber verteb) patients under the enhanced recovery after surgery (ERAS) mode.MethodsPatients who were admitted to the West China Hospital of Sichuan University from October 2018 to February 2019 were enrolled. The urination status of the patients was collected by using questionnaires. All patients were divided into normal urinating group, induced urinating group and catheterization group according to their urination status after returning to the ward.ResultsA total of 106 patients were included, including 78 (73.6%) who urinated smoothly [the first urinating time (72.18±36.33) min], 20 (18.9%) who urinated after induction [the first urinating time (81.50±41.68) min], and 8 (7.5%) who received catheters after induction failure [the first urinating time (162.50±84.52) min]. The different operation, operation time, position of urination, and postoperative pain degree affecting the placement of urethral catheter differed from each other significantly (P<0.05). Among the three groups, the differences were statistically significant in operation time, operation methods, position of urination (except for the induced urination group vs. catheterization group) and postoperative pain degree (except for the induced urination group vs. catheterization group) in pairs (P<0.05). There was no significant difference in other factors among three groups in pairs (P>0.05).ConclusionsMost post-spineoperative patients can autonomously urinate without catheter under the ERAS mode, which bases on operation methods, operation time, and the first urinating posture after the surgery. Early attention should be paid to patients with dysuresia to promote their early rehabilitation.
Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.
Objective To explore the compliance improvement of rehabilitation exercise for patients after spine surgery. Methods Forty-nine in-patients who underwent spinal surgery between June 1st and July 14th 2016 were selected as the control group and 50 in-patients who underwent spinal surgery between July 15th and August 30th 2016 were selected as the trial group. The control group received conventional nursing for rehabilitation exercise, and the tiral group adopted a series of quality improvement measures for rehabilitation exercise. The compliance of functional exercise, the accuracy of patients’ exercise and the satisfaction with health education of the patients were compared between the two groups. Results The functional exercise compliance in the trial group (complete compliance in 45 cases, partial compliance in 4 cases, non-compliance in 1 case) was higher than that in the control group (complete compliance in 9 cases, partial compliance in 34 cases, non-compliance in 6 cases) with a statistical difference (Z=–6.910, P<0.001). The functional exercise accuracy rate of patients was higher in the trial group [84.00%(168/200)] than that in the control group [53.06% (104/196)] with a statistical difference (χ2=44.060, P<0.001). The patients’ satisfaction with health education in the trial group (4.64±0.49) was higher than that in the control group (4.20±0.89) with a statistical difference (t=3.084, P=0.003). Conclusion The implementation of nursing quality improvement intervention can improve the compliance and accuracy rate of rehabilitation functional exercise of patients undergoing spinal surgery, and improve the satisfaction of patients, which is worth promoting.