Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. This study aimed to evaluate and compare the efficacy of vertebroplasty with high-viscosity cement and conventional kyphoplasty in managing severe OVCFs. 37 patients of severe OVCFs experiencing vertebroplasty or kyphoplasty were reviewed and divided into two groups, according to the procedural technique, 18 in high-viscosity cement percutaneous vertebroplasty (hPVP) group and 19 in conventional percutaneous kyphoplasty (cPKP) group. The operative time, and injected bone cement volume were recorded. Anterior vertebral height (AVH), Cobb angle and cement leakage were also evaluated in the radiograph. The rate of cement leakage was lower in hPVP group, compared with cPKP group (16.7% vs 47.4%, P = 0.046). The patients in cPKP group achieved more improvement in AVH and Cobb angle than those in hPVP group postoperatively (37.2 ± 7.9% vs 43.0 ± 8.9% for AVH, P = 0.044; 15.5 ± 4.7 vs 12.7 ± 3.3, for Cobb angle, P = 0.042). At one year postoperatively, there was difference observed in AVH between two groups (34.1 ± 7.4 vs 40.5 ± 8.7 for hPVP and cPKP groups, P = 0.021), but no difference was found in Cobb angle (16.6 ± 5.0 vs 13.8 ± 3.8, P = 0.068). Similar cement volume was injected in two groups (2.9 ± 0.5 ml vs 2.8 ± 0.6 ml, P = 0.511). However, the operative time was 37.8 ± 6.8 min in the hPVP group, which was shorter than that in the cPKP group (43.8 ± 8.2 min, P = 0.021). In conclusion, conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement.

Background Surgical procedure usually causes serious postoperative pain and poor postoperative pain management negatively affects quality of life, function and recovery time. We aimed to investigate the role of wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia (PCA) in postoperative pain control for patients undergoing transforaminal lumbar interbody fusion. Methods One hundred twelve patients undergoing lumbar fusion were retrospectively reviewed and divided into two groups (ropivacaine and control groups) according to whether received wound infiltration with ropivacaine or not. Visual Analogue Scale (VAS) score, analgesics consumption, number of patients requiring rescue analgesic, hospital duration and incidence of complications were recorded. Surgical trauma was assessed using operation time, intraoperative blood loss and incision length. Results The amount of sufentanil consumption in ropivacaine group at 4 h postoperatively was lower than that of control group (24.5 ± 6.0 μg vs 32.1 ± 7.0 μg, P < 0.001) and similar results were observed at 8, 12, 24, 48 and 72 h postoperatively(P < 0.001). Fewer patients required rescue analgesia within 4 to 8 h postoperatively in ropivacaine group (10/60 vs 19/52, P = 0.017). Length of postoperative hospital durations were shorter in patients receiving ropivacaine infiltration compared to control cohorts (6.9 ± 0.9 days vs 7.4 ± 0.9 days, P = 0.015). The incidence of PONV in ropivacaine group was lower than that in control group (40.4% vs 18.3%, P = 0.01). However, VAS scores were similar in two groups at each follow-up points postoperatively, and no difference was observed(P > 0.05). Conclusion Wound infiltration with ropivacaine effectively reduces postoperative opioid consumption and PONV and may be a useful adjuvant to PCA to improve recovery for patients undergoing lumbar spine surgery.

Rationale: Intradural disc herniation has been documented rarely and the pathogenesis remains unclear. The region most frequently affected by intradural lumbar disc herniations is L4–5 level, and the average age of intradural disc herniations is between 50 and 60 years. Although magnetic resonance imaging is a valuable tool in the diagnosis of this disease, it is still difficult to make a definite diagnosis preoperatively. Patient concerns: In this report, we described a 58-year-old male patient who presented with intermittent pain of low back and radiating pain of the both lower extremities for 2 years as well as decreased muscle strength of the both legs and dysfunction of urinary and defecation for 1 month. Diagnosis: Lumbar disc herniation was diagnosed during the first clinical examination in the local hospital. Magnetic resonance imaging revealed a mass disc filling almost the entire spinal canal at the L4/5 level and a stalk connecting the mass to the intervertebral disc was detected in the sagittal T2-weighted image. The massive lesion caused cauda equina compression, resulting in dysfunction of urinary and defecation. Interventions: Considering the mass's volume, bilateral hemilaminectomy, and transforaminal lumbar interbody infusion were performed. During the surgery, we found a perforation in the ventral dura and major part of herniated disc was located in the intradural space through it. The disc was carefully dissected from the surrounding nerve roots and the ventral dura and then totally removed. The defect on the ventral dura was sutured to prevent cerebrospinal fluid leakage. Outcomes: The patient presented complete recovery of the radiculopathy and cauda equina syndrome and significant improvement of muscle strength of both legs at 12 months follow-up. Lessons: The diagnosis of intradural disc herniations is very difficult and mainly based on intraoperative and histopathological results. Surgical intervention is only effective method to manage this disease and to relieve symptoms and prevent severe neurological deficits.