ObjectiveThis study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS).MethodsThe data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients’ clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria.ResultsThe mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%.ConclusionBiportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.

ObjectiveThe purpose of this study was to investigate the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) for lumbar spinal stenosis (LSS).MethodsPatients who underwent UBE-TLIF due to single-segment LSS between August 2019 and July 2021 were retrospectively included in the study. Clinical outcomes evaluated include operative time, estimated blood loss (including postoperative drainage), time to ambulation, postoperative hospital stay, complications, visual analog scale (VAS) scores of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and modified Macnab criteria. Interbody bony fusion at the index level was assessed using Bridwell grading criteria.ResultsA total of 73 patients (29 males and 44 females) were enrolled in this study. All surgeries were successfully performed without intraoperative conversion to open surgery. Magnetic resonance imaging (MRI) revealed optimal direct neural decompression after UBE-TLIF. The mean operative time was 150.89 ± 15.58 min. The mean estimated blood loss was 126.03 ± 17.85 ml (postoperative drainage was 34.84 ± 8.31 ml). Time to ambulation was 2.0 ± 0.75 days after the procedure. Postoperatively, the mean hospital stay was 5.96 ± 1.38 days. VAS scores of low back pain and leg pain, JOA, and ODI were significantly improved postoperatively compared with those before the operation, and differences were statistically significant (P < 0.05). Excellent and good outcomes were reported by 87.67% of patients according to the modified Macnab criteria at the final follow-up. A total of nine perioperative complications occurred, with an incidence of 12.33%. X-ray or computerized tomography (CT) 6 months after the procedure showed that 37 cases (50.68%) presented with segmental fusion, 30 cases (41.10%) showed incomplete fusion, and 6 cases (8.22%) showed no signs of fusion. However, bony fusion was achieved in all cases at the final follow-up.ConclusionsUBE-TLIF for LSS has the advantages of less surgical invasiveness and fast postoperative recovery.

Objective: To compare the biomechanical differences between cement- reinforced intramedullary nailing with reinforced screws (a new patented invention), plain PFNA, and cemented nail tract reinforced PFNA for severe osteoporotic Evans II intertrochanteric fractures of the femur. Methods: The CT data of one patient with intertrochanteric femoral fracture with severe osteoporosis (signed and informed) were selected in Mimics 20 software and Geomagic Wrap 2017 software for medium-sized femoral model assembly, assembly standard reference standard of surgical technique. The assembled model was then subjected to osteotomy in the 3-Matic software according to the type Evans II femoral intertrochanteric fracture criteria to obtain the corresponding fracture model, And set the cancellous bone around the spiral blade of the common PFNA screw and around the proximal end of the reinforcing screw in the corresponding fracture model, Save as A (ordinary PFNA), B (nail reinforced PFNA) and C (reinforced screw), Corresponding parameters and conditions according to the CT data and the material standard of internal fixation, according to the force of human mechanics in the femur and the weight of the patient, They were stored separately and analyzed using the Explicit Dynamics module in the ansys2019 software. Observations: The degree of cutting of the screw at the proximal end of the femur, the angle of the femoral neck turning inward, the angle of rotation, the distribution of stress in the femur, and the distance where the femoral fracture part is displaced.Results:The cutting of the screw at the proximal femur, the inward turning angle of the femoral neck(0.32°), the distribution of stress in the bone of the femur and the displacement of the femoral fracture part(0.58 mm) are superior over PFNA and nail reinforcement. Conclusion Reinforced screws have better biomechanical results than common bone PFNA and nail-track reinforced PFNA for severe osteoporotic intertrochanteric Evans II femur fractures.

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