Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L1 in 2 cases, L2 in 4 cases, L3 in 3 cases, and L4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation (P<0.05), and further improved at last follow-up (P<0.05). The ASIA scale after operation significantly improved when compared with that before operation (P<0.05), and there was no significant difference (P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation (P<0.05), and without significant loss of correction during the follow-up (P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
Objective To investigate the risk factors of facet joint excessive resection and its influence on effectiveness after the treatment of degenerative lumbar diseases under large-channel endoscope. Methods The clinical data of 212 patients with degenerative lumbar diseases treated with large-channel spinal endoscopic technology between June 2022 and June 2024 were retrospectively analyzed. Among them, 120 were male and 92 were female. The age ranged from 18 to 85 years, with an average of 54 years. According to the facet joint resection rate measured by CT after operation, the patients were divided into preservation group (facet joint preservation rate≥50%) and excessive resection group (facet joint preservation rate<50%). Visual analogue scale (VAS) score for low back and leg pain, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores were used to evaluate the improvement of pain and function before operation, at 1 month after operation, and at last follow-up, and the modified MacNab criteria were used to evaluate the effectiveness at last follow-up. The occurrence of lumbar instability was observed during follow-up. Univariate analysis was performed on variables including gender, age, body mass index, responsible segment, surgical side, whether over-top decompression was performed, whether presence of lateral recess stenosis, whether presence of intervertebral disc calcification, whether presence of lumbosacral transitional vertebrae, whether presence of facet joint hyperplasia, and imaging parameters [facet joint angle (FJA), laminar lateral-oblique angle, maximum width between the medial and lateral margins of the superior articular facet on axial CT (d1), distance between the base of the ipsilateral spinous process and the midline of the facet joint at the responsible segment (d2), as well as the width (d3) and height (d4) of the interlaminar space at the responsible segment on anteroposterior X-ray films] between the preservation group and the excessive resection group. And logistic regression analysis was further used to identify risk factors for facet joint excessive resection. Results All patients underwent operative procedures successfully, and all incisions healed by first intention. No complication such as vascular and nerve injury, infection, and spinal cord hypertension-like syndrome occurred. There were 55 patients enrolled in the excessive resection group, and 157 patients in the preservation group. All patients were followed up 12-36 months, with a mean of 23.5 months. There was no significant difference in low back pain VAS score, leg pain VAS score, ODI, and JOA score between the two groups preoperatively (P>0.05). The low back pain VAS score, ODI of the excessive resection group were significantly higher than those of the preservation group, and JOA score was significantly lower at 1 month after operation (P<0.05), and there was no significant difference in the above indicators between the two groups at other time point (P>0.05). At last follow-up, the effectiveness evaluated according to the modified MacNab assessment criteria was no significant difference between two groups (Z=4.270, P=0.118). During the follow-up, 5 cases occurred lumbar instability in the excessive resection group and 4 cases in the preservation group, there was no significant difference between two groups (χ2=2.831, P=0.092). Univariate analysis showed that there were significant differences between the two groups in terms of age, gender, responsible segment, whether presence of lateral recess stenosis, FJA, d1, d2, laminar lateral-oblique angle, and d3 (P<0.05). Further logistic regression analysis showed that female patients, presence of lateral recess stenosis, FJA (≤45°), d2 (≤11 mm), d3 (≤21 mm) were risk factors for excessive resection of facet joint (P<0.05). ConclusionThe incidence of excessive resection of facet joint in lumbar degenerative diseases treated by large-channel endoscopic depression reached 25.94% (55/212), and excessive resection of facet joint affects the recovery of lumbar pain and function in the short term after operation. Female patients, lateral recess stenosis, and FJA (≤45°), d2 (≤11 mm), d3 (≤21 mm) are risk factors for excessive resection of facet joint, which should be paid attention to in order to reduce the incidence of excessive resection of facet joint.
Objective To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures. MethodsA retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion.ResultsSurgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups (P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group (P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up (P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups (P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group (P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones (P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation (P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively. ConclusionUBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.
HtrA serine peptidase 2 (HTRA2) is a serine protease existing in the mitochondrial gap. Among the four members of the human HtrA serine peptidase family, HTRA2 is the only protease with clear localization in the cell. It plays a dual role in the maintenance of mitochondrial homeostasis and the promotion of cell apoptosis. HTRA2 has been found to be associated with a variety of tumors. Meanwhile, the expression of HTRA2 can enhance the sensitivity of chemotherapy and radiotherapy, and can be used as a diagnostic and prognostic marker for malignant tumors and a target for combined therapy. This article reviews the structure, biological function and role of HTRA2 in malignant tumors, in order to provide clues and basis for early diagnosis and individualized treatment of tumor patients.
Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures. Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively. All patients were treated with percutaneous pedicle screw fixation. The main observation indexes before operation, 3 days after operation and 1 year after operation were compared, including the height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results A total of 38 patients were included. All patients were followed up for more than 1 year. During the follow-up period, there were no complications such as nerve injury, incision infection, internal fixation loosening or fracture. The operation time was (91.7±10.4) min, the amount of intraoperative bleeding was (94.3±19.5) mL, and the length of surgical incision was (9.3±1.8) cm. The height ratio of the anterior margin of fractured vertebra, the inversion angle of posterosuperior fracture fragment, the fragment displacement, the occupancy rate of spinal canal, the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra, the occupancy rate of spinal canal, and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation (P<0.05); the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation (P<0.05), but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation (P<0.05). The VAS score and ODI index 3 days and 1 year after operation were significantly improved compared with those before operation (P<0.05), and the VAS score and ODI index 1 year after operation were improved compared with those 3 days after operation (P<0.05). Conclusion The percutaneous pedicle screw fixation can effectively reduce the retropulsed bone fragment indirectly and restore the Cobb angle of kyphosis of the thoraculumbar burst fractures without neurological deficit, and at the same time reduce the operation time and surgical trauma.