BACKGROUND: The incidence of stage III Kummell\'s disease without neurological symptoms is increasing in elderly patients with osteoporotic thoracolumbar fractures. However, the surgical method is still controversial in this condition. This report presented a case of Kummell\'s disease in which percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty was performed, providing a reference for the surgical approach.
METHODS: The patient was a 72-year-old female who presented unexplained lower back pain accompanied with limited mobility for the past three months. Based on her medical history, physical examinations, and imaging studies, it was confirmed that she had Kummell\'s disease in stage III without neurological symptoms. We treated her with percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty on the symptomatic vertebrae.
UNASSIGNED: The majority of patients with stage III Kummell\'s disease have severe osteoporosis, which result in failure of the internal fixation and a series of other complications. Maintaining the stability of the internal fixation system is crucial, especially after screwing and subsequent locking. When augmented with bone cement, the grip and pull-out resistance of the percutaneous pedicle screws enhance greatly. Simultaneously, percutaneous vertebroplasty on the symptomatic vertebrae can immediately support the spine unit\'s stability mechanically and maintain the shape of the vertebrae after reduction.
CONCLUSIONS: The percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty on the symptomatic vertebrae is an effective treatment for stage III Kummell\'s disease without neurological symptoms. It can effectively restore the vertebral height, correct the kyphotic deformities, improve spinal canal stenosis, and achieve satisfactory short-term clinical outcomes.

BACKGROUND: Endoscopically assisted screw fixation with lumbar interbody fusion is rarely performed. We succeeded in implanting the cortical bone trajectory (CBT) screws under the guidance of unilateral biportal endoscopy (UBE).
METHODS: We attempted endoscopically assisted screw fixation in a patient with degenerative spondylolisthesis. Through a third portal, ipsilateral CBT screws were implanted without complications.
CONCLUSIONS: We successfully performed unilateral biportal endoscopic lumbar interbody fusion (ULIF) with CBT and reversed CBT screws. Compared with percutaneous pedicle screw (PPS) placement, this procedure is a minimally invasive, endoscopic alternative that allows precise screw placement.

UNASSIGNED: To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study.
UNASSIGNED: Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T 12 in 15 cases, L 1 in 20 cases, L 2 in 19 cases, and L 3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded.
UNASSIGNED: In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05).
UNASSIGNED: UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
UNASSIGNED: 通过前瞻性随机对照研究，探讨超声容积导航（ultrasound volume navigation，UVN）结合X线透视技术引导经皮椎弓根螺钉植入的可行性及准确性。.
UNASSIGNED: 以2022年1月—2023年1月因胸、腰椎骨折拟行经皮椎弓根螺钉内固定治疗的患者为研究对象，其中60例符合选择标准纳入研究。男28例，女32例；年龄29～60岁，平均49.5岁。致伤原因：交通事故伤20例，摔伤21例，跌倒伤17例，重物砸伤2例。受伤至入院时间1～5 d，平均1.57 d。骨折部位：T 1215例，L 120例，L 2 19例，L 3 6例。 研究采用患者自身左右侧对照，随机在骨折椎体上、下节段一侧椎弓根采用UVN结合X线透视技术引导植钉（试验组），另一侧于X线透视下植钉（对照组）；每例患者植入4枚螺钉、2根钉棒。记录每枚螺钉的植钉时间、植钉过程中透视次数，影像学检查实际螺钉与术前规划钉道角度差值、距离偏差值以及螺钉侵犯关节突关节数量。.
UNASSIGNED: 试验组植钉时间、透视次数、钉道角度差值、钉道距离偏差值、关节突关节侵犯率方面均优于对照组，差异均有统计学意义（ P<0.05）。.
UNASSIGNED: UVN结合X线透视技术引导下行经皮椎弓根螺钉植入能减少植钉时间，可实时动态调整，降低操作难度，减少辐射伤害。.

BACKGROUND: To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation (PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis.
METHODS: This is a retrospective case-control study. Patients with degenerative lumbar spondylolisthesis (DLS) treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence, and migration of cages, fusion rate and surgery-related complications were compared between the two groups.
RESULTS: Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at one-week post-surgery (2.3 ± 0.5 vs. 3.5 ± 0.4, P = 0.01), and three months post-operation (2.2 ± 0.3 vs. 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at three months post-surgery(18.1 ± 2.3 mm vs. 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A at 72.0% and 78.6% in group B was not statistically significant (P = 0.75). Fusion was identified in all patients at 24 months post-surgery.
CONCLUSIONS: When compared to PPSF, ASRSF combined with OLIF for DLS can reduce post-operative low back pain in the initial stages, maintain the height of the foramen and improve the performance of lumbar function.

BACKGROUND: Thoracolumbar fractures have the characteristics of acute onset, rapid change, and severe trauma. The best way to treat thoracolumbar fractures is through fracture reduction surgery. The surgical methods include percutaneous pedicle screw, posterior percutaneous pedicle screw internal fixation, and open pedicle screw internal fixation.
METHODS: We searched the PubMed, Embase, and Medline English database from April 1991 to April 2021, and the keywords included \"percutaneous tablet screen\", \"posterior percutaneous tablet screen fixation\", \"open tablet screen fixation\", \"fracture of thoracic vertebrae\", \"thoracic fractures\", \"thoracic\", and \"vascular fracture\". RevMan5.3 provided by Cochrane was used for meta-analysis.
RESULTS: A total of 9 articles were included in this study. Percutaneous pedicle screw fixation and posterior percutaneous pedicle screw fixation were adopted as the surgical methods, and patients were enrolled into experimental and control groups. Open pedicle screw internal fixation was set as the control group. The mean difference (MD) of operation time, blood loss, pain score, postoperative complications, screw debris rate, and hospital stay were -0.73, -192.16, -0.70, 1.49, 0.32, and -1.26, respectively; 95% confidence intervals (CIs) were (-0.94, -0.51), (-213.23, -171.09), (-0.82, -0.57), (0.47, 4.79), (0.10, 0.99), and (-1.82, -0.71), respectively; Z values were 6.71, 17.87, 10.95, 0.67, 1.97, and 4.46, respectively; and P values were <0.00001, <0.00001, <0.00001, 0.50, 0.05, and <0.00001, respectively.
CONCLUSIONS: A total of 9 articles were included in this meta-analysis. Compared with open surgery, the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation had less blood loss, shorter operation time, shorter hospital stay, less pain, as well as lower screw dislocation and postoperative infection rates, indicating that the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation is more effective than open surgery.

OBJECTIVE: There are few reports about minimally invasive decompression and fixation for patients with thoracolumbar fracture and neurological symptoms. The previously reported method requires complete laminectomy, and removal of the medial part of the pedicle to expose the spinal canal for reduction. Thus, some approach-related damage to the bony structure and soft tissue still occurs. This study was performed to describe a modified minimally invasive tube technique for decompression and reduction of thoracolumbar fracture with neurological symptoms. This modified technique preserves most of the posterior structures of the spine as well as the muscle.
METHODS: Percutaneous pedicle screws were placed on the vertebrae superior and inferior to the fracture and at the fracture segment on the side with less severe symptoms. After retraction, the tube for decompression was placed on the facet joint where the decompression was needed. Under microscopic vision, part of the lamina and ligamentum flavum were removed to expose the spinal canal, and an L-shaped probe was used to reduce the bone fragment.
RESULTS: The modified method was successfully used in eight patients. Complete decompression was achieved and the bone fragment was safely reduced through the tube under microscopy in all cases. Fluoroscopy confirmed that the positioning of the percutaneous pedicle screw was good and the bone fragment was reduced. The neurological status was improved in all patients at last follow up.
CONCLUSIONS: The modified method of minimally invasive decompression and fusion is effective in treating thoracolumbar fractures with neurological symptoms and preserves most of the ligaments and bone structure.

BACKGROUND: Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved.
METHODS: This retrospective study explored the effects of electromagnetic navigation on improving Endo-TLIF with percutaneous pedicle screw fixation. Clinical information from 42 patients who had received Endo-TLIF with percutaneous pedicle screw fixation from May 2019 to November 2020 was analyzed retrospectively. The procedures were assisted under electromagnetic navigation. The rate of adjustment for guide wires, frequency of X-ray exposure, operative time, accuracy of pedicle screw location, and clinical outcomes were recorded.
RESULTS: The mean follow-up for 42 patients was 11.9 ± 3.1 months. The mean age of the patients was 56.1 ± 9.26 years, with a female/male ratio of 25:17. According to postoperative CT scans and 3D reconstructions, the excellent and good rate of pedicle screws was 96.4%. The rate of adjustment for guide wires under the assistance of electromagnetic navigation was 1.78%, and the frequency of X-ray exposure was 8.27 ± 1.83. The operative time was 167.25 ± 28.16 min, including the duration of guide wire insertion (14.63 ± 5.45 min) and duration of decompression and cage placement (75.43 ± 13.97 min). The duration of hospitalization after operation was 2.59 ± 1.16 days. The preoperative VAS score was 7.51 ± 1.91, and the preoperative ODI was 82.42 ± 8.7%. At the last follow-up, the VAS score was 2.09 ± 0.59, and the ODI was 11.09 ± 3.2%. There were statistically significant improvements in the VAS score and ODI in all patients at the follow-up (p < 0.05).
CONCLUSIONS: Electromagnetic navigation can provide accurate positioning and guidance in real time, which improves the surgical efficiency of percutaneous pedicle screw placement and endoscopic decompression in Endo-TLIF with reduced radiation exposures.

UNASSIGNED: To explore the efficacy of percutaneous pedicle screw internal fixation and minimally invasive lateral small incisions lesion debridement and bone graft fusion via dilated channels in the treatment of lumbar tuberculosis.
UNASSIGNED: The clinical data of 22 cases of lumbar tuberculosis treated with percutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incision lesion debridement and bone graft fusion between January 2016 and June 2018 were retrospectively analyzed. There were 12 males and 10 females, with an average age of 47.5 years (range, 22-75 years). The affected segments were L 2, 3 in 5 cases, L 3, 4 in 8 cases, and L 4, 5 in 9 cases, with an average disease duration of 8.6 months (range, 4-14 months). Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA), with 3 cases of grade C, 9 cases of grade D, and 10 cases of grade E. The operation time, intraoperative blood loss, and postoperative complications were recorded. At preoperation, 3 months after operation, and last follow-up, the C reactive protein (CRP) and erythrocyte sedimen- tation rate (ESR) were tested to evaluate tuberculosis control; the pain visual analogue scale (VAS) score was used to evaluate the recovery of pain, and the Oswestry disability index (ODI) was used to evaluate the function recovery of the patient\'s lower back; the kyphosis Cobb angle was measured, and the loss of Cobb angle (the difference between the Cobb angle at last follow-up and 3 months after operation) was calculated. At last follow-up, the ASIA classification was used to evaluate the recovery of neurological function, and the effectiveness was evaluated according to the modified MacNab standard.
UNASSIGNED: The operation time was 110-148 minutes (mean, 132.8 minutes) and the intraoperative blood loss was 70-110 mL (mean, 89.9 mL). Two patients experienced fat liquefaction of the incision and delayed healing; the incisions of the remaining patients healed by first intention. All patients were followed up 18-24 months, with an average of 21.3 months. All bone grafts achieved osseous fusion, the pedicle screws were fixed in reliable positions, without loosening, displacement, or broken rods. There was no recurrence of tuberculosis. The ESR, CRP, VAS scores, ODI scores, and kyphosis Cobb angle of the affected segment at 3 months after operation and last follow-up were significantly improved ( P<0.05); there were no significant differences between at last follow-up and 3 months after operation ( P>0.05), and the loss of Cobb angle was (0.6±0.5)°. The patient\'s neurological function recovered significantly. At last follow-up, the ASIA grades were classified into 1 case with grade C, 1 case with grade D, and 20 cases with grade E, which were significantly improved when compared with preoperative grading ( Z=-3.066, P=0.002). According to the modified MacNab standard, 16 cases were excellent, 3 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 86.4%.
UNASSIGNED: Percutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incisions lesion debridement and bone graft fusion has the advantages of less bleeding, less trauma, and faster recovery, which is safe and effective in the treatment of lumbar tuberculosis.
UNASSIGNED: 探讨经皮椎弓根钉内固定联合扩张通道微创侧方小切口病灶清除椎间植骨融合术治疗腰椎结核的临床疗效。.
UNASSIGNED: 回顾分析 2016 年 1 月—2018 年 6 月 22 例采用经皮椎弓根钉内固定联合扩张通道微创侧方小切口病灶清除椎间植骨融合术治疗的 22 例腰椎结核患者临床资料。其中男 12 例，女 10 例；年龄 22～75 岁，平均 47.5 岁。病变节段：L 2、3 5 例，L 3、4 8 例，L 4、5 9 例。病程 4～14 个月，平均 8.6 个月。术前神经功能按美国脊髓损伤协会（ASIA）分级，C 级 3 例，D 级 9 例，E 级 10 例。记录手术时间、术中出血量及术后并发症发生情况。术前、术后 3 个月、末次随访时，检测 C 反应蛋白（C reactive protein，CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）以评价结核控制情况；采用疼痛视觉模拟评分（VAS）评价疼痛恢复情况，Oswestry 功能障碍指数（ODI）评价患者腰背部功能恢复情况；测量病变椎体后凸 Cobb 角，并计算 Cobb 角丢失值（末次随访与术后 3 个月 Cobb 角的差值）。末次随访时采用 ASIA 分级评价神经功能恢复情况，按照改良 MacNab 标准评定疗效。.
UNASSIGNED: 手术时间 110～148 min，平均 132.8 min；术中出血量 70～110 mL，平均 89.9 mL。术后 2 例患者出现切口脂肪液化，延迟愈合；其余患者切口均Ⅰ期愈合。所有患者均获随访，随访时间 18～24 个月，平均 21.3 个月。所有植骨均达骨性融合，椎弓根钉固定位置可靠，无松动、移位及钉棒断裂发生，无结核复发。术后 3 个月及末次随访时患者 ESR、CRP、VAS 评分、ODI 评分及病变节段后凸 Cobb 角均较术前显著改善（ P<0.05），末次随访与术后 3 个月比较差异均无统计学意义（ P>0.05），其中 Cobb 角丢失值为（0.6±0.5）°。患者神经功能恢复明显，末次随访时 ASIA 分级为 C 级 1 例、D 级 1 例、E 级 20 例，较术前明显改善（ Z=−3.066， P=0.002）。按照改良 MacNab 标准评定，获优 16 例、良 3 例、可 2 例，差 1 例，优良率 86.4%。.
UNASSIGNED: 经皮椎弓根钉内固定联合扩张通道微创侧方小切口病灶清除椎间植骨融合术具有出血少、创伤小、恢复快等优点，治疗腰椎结核安全、有效。.

To compare clinical efficacy, radiographic outcome, and radiation exposure between mini-open pedicle screw (MPS) fixation with the Wiltse approach and percutaneous pedicle screw (PPS) fixation in treatment of young and middle-aged patients with thoracolumbar burst fractures.
Of 60 patients with thoracolumbar vertebrae fractures treated in our hospital from January 2017 to January 2018, 30 were randomly assigned to the MPS group and 30 were randomly assigned to the PPS group. Clinical efficacy, radiographic outcome, and radiation exposure were compared between the 2 groups.
The average age of patients was 42.2 ± 6.7 years in the MPS group and 43.0 ± 6.9 years in the PPS group (P = 0.668). There was no significant difference between the 2 groups in blood loss, hospital stay, postoperative visual analog scale score for back pain, and Oswestry Disability Index score. The vertebral body height and vertebral body angle of the MPS group were significantly better than those of the PPS group at the last follow-up. There was no significant difference in the accuracy rate of pedicle screw placement between the MPS group and the PPS group; the facet joint violation was significantly higher in the PPS group. The average radiation exposure dosage was lower in the MPS group.
Both MPS fixation with the Wiltse approach and PPS fixation are safe and effective in the treatment of single-segment thoracolumbar vertebral fractures. Nevertheless, considering the surgical duration, radiation exposure, facet joint violation, vertebral body height, and vertebral body angle at the last follow-up, MPS fixation with the Wiltse approach is a better choice than PPS.

Percutaneous pedicle screws have been used in the treatment of thoracolumbar fractures for decades, and conventional fluoroscopy is commonly used to confirm the positions of the Jamshidi needles during the procedure. In this article, a modified method is reported for the placement of Jamshidi needles. The attending surgeons did not receive any radiation during the procedure and the fluoroscopy time for the patients was little. In our method, all six Jamshidi needles were placed on the pedicles and hammered 2 mm into each entry site. When the verification images were acquired, the medical personnel went behind a lead-lined wall. The positions of the needles were first reviewed and adjusted as needed based on the anterior-posterior (AP) image. Then, the C-arm was rotated and lateral images were obtained to further verify the needle placement. The rest of the screw placement procedure remained the same. The proposed technique was applied in 45 patients with thoracolumbar fractures. It took an average (range) of 5 (4-7) single-shot images to ensure all the needles were positioned at the ideal entry site and 12 (10-17) minutes to complete this step. No neurological symptoms were reported by the patients. Using the proposed technique, the radiation exposure for the surgeons is zero, and the patients are well-protected from excessive radiation exposure. This modified method of embedding all the Jamshidi needles at the entry sites before fluoroscopy is an improved technique compared with the conventional method.