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Chen M, Cui J, Liu Y, Cai Z, Yang C, Liu H, Chen Y, Yao Z. Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases. J Orthop Surg Res 2024; 19:95. [PMID: 38287376 PMCID: PMC10826027 DOI: 10.1186/s13018-024-04531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE To compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness. METHODS From January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration. RESULTS All patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF. CONCLUSIONS M-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.
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Affiliation(s)
- Ming Chen
- Guangzhou University of Traditional Chinese Medicine, Guangdong, China
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510000, China
| | - Jianchao Cui
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510000, China.
| | - Youtao Liu
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510000, China
| | - Zhuoyan Cai
- Department of Orthopedic, Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Helong 7 Road, Baiyun District, Guangzhou, 510000, China
| | - Cekai Yang
- Department of Orthopedic, Zhanjiang First Hospital of Traditional Chinese Medicine, Zhanjiang, China
| | - Hao Liu
- Guangzhou University of Traditional Chinese Medicine, Guangdong, China
| | - Yuan Chen
- Jiang Yang Urban Construction Vocational School Abstract, Luzhou, China
| | - Zhensong Yao
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510000, China.
- Department of Orthopedic, Baiyun Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Helong 7 Road, Baiyun District, Guangzhou, 510000, China.
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Wang M, Wang X, Wang H, Shen Y, Qiu Y, Sun X, Zhou D, Jiang Y. Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery. J Orthop Traumatol 2024; 25:2. [PMID: 38217751 PMCID: PMC10787724 DOI: 10.1186/s10195-023-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Recent studies demonstrated that restoring sagittal alignment to the original Roussouly type can remarkably reduce complication rates after adult spinal deformity surgery. However, there is still no data proving the benefit of maintaining ideal Roussouly shape in the lumbar degenerative diseases and its association with the development of adjacent segment disease (ASD). Thus, this study was performed to validate the usefulness of Roussouly classification to predict the occurrence of ASD after lumbar fusion surgery. MATERIALS AND METHODS This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level fusion surgery. Demographic and radiographic data were compared between ASD and non-ASD groups. The patients were classified by both "theoretical" [based on pelvic incidence (PI)] and "current" (based on sacral slope) Roussouly types. The patients were defined as "matched" if their "current" shapes matched the "theoretical" types and otherwise as "mismatched". The logistic regression analysis was performed to identify the factors associated with ASD. Finally, clinical data and spinopelvic parameters of "theoretical" and "current" types were compared. RESULTS With a mean follow-up duration of 70.6 months, evidence of ASD was found in the 68 cases. Postoperatively, ASD group had more "current" shapes classified as type 1 or 2 and fewer as type 3 than the non-ASD group (p < 0.001), but the distribution of "theoretical" types was similar between groups. Moreover, 80.9% (55/68) of patients with ASD were mismatched, while 48.2% (80/166) of patients without ASD were mismatched (p < 0.001). A multivariate analysis identified age [odds ratio (OR) = 1.058)], 2-level fusion (OR = 2.9830), postoperative distal lordosis (DL, OR = 0.949) and mismatched Roussouly type (OR = 4.629) as independent risk factors of ASD. Among the four "theoretical" types, type 2 had the lowest lumbar lordosis, DL, and segmental lordosis. When considering the "current" types, current type 2 was associated with higher rates of 2-level fusion, worse DL, and greater pelvic tilt compared with other current types. CONCLUSIONS DL loss and mismatched Roussouly type were significant risk factors of ASD. To decrease the incidence of ASD, an appropriate value of DL should be achieved to restore sagittal alignment back to the ideal Roussouly type. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Muyi Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xin Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Hao Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yifei Shen
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Dong Zhou
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Department of Orthopedics, Changzhou No.6 People's Hospital, Changzhou, Jiangsu Province, China
| | - Yuqing Jiang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China.
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China.
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Kitaori T, Ota M, Tamura J. Bilateral L5 pedicle fracture with L5-S1 spondylolisthesis after single-level L4-5 posterior lumbar interbody fusion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23279. [PMID: 37581583 PMCID: PMC10555588 DOI: 10.3171/case23279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by an anteriorly shifted lumbar loading axis. OBSERVATIONS The authors report a case complicated by L5 bilateral pedicle fractures and rapidly progressive spondylolisthesis at the L5-S1 segment very early after a single-level PLIF for L4-5 isthmic spondylolisthesis. Meyerding grade III anterolisthesis was observed at L5-S1 segment by 3 months after the initial surgery. Additional surgery was performed, and the fixation was extended to L4-ilium. Fracture healing was observed at 6 months postoperatively. LESSONS This complication may have been caused by abnormal local shear forces on the posterior neural arch of L5 vertebra and L5-S1 intervertebral disc, which were triggered by the fusion surgery for L4 shear-type spondylolisthesis. L4 sagittal vertical axis is considered a reasonable parameter representing lumbosacral sagittal imbalance with an anteriorly shifted loading axis and may be a candidate for the predictive parameters of this rare complication.
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Luan H, Wang Y, Liu K, Sheng W, Deng Q. Efficacy of transforaminal lumbar interbody fusion in the treatment of double-level lumbar spondylolisthesis with sagittal imbalance. BMC Musculoskelet Disord 2022; 23:1038. [PMID: 36451156 PMCID: PMC9714229 DOI: 10.1186/s12891-022-06018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the clinical efficacy of transforaminal lumbar interbody fusion (TLIF) in the treatment of continuous double-level lumbar spondylolisthesis with sagittal imbalance. METHODS The clinical data of 36 patients with double-level spondylolisthesis treated with TLIF were included and divided into L3/L4 double spondylolisthesis group and L4/L5 double spondylolisthesis group according to the site of spondylolisthesis. The sagittal parameters of the patients were measured by standing anteroposterior and lateral X-rays of the whole spine, and the visual analogue scale (VAS) for lumbar and lower limb pain, Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) were recorded. The imaging parameters and clinical parameters of the patients before surgery, after surgery, and at the last follow-up were compared and statistically analyzed. RESULTS A total of 36 patients were included in the study and all had sagittal imbalance. Among them, there were 21 cases of L3 and L4 spondylolisthesis, 6 males and 15 females, with an average age of 64.7 ± 9.4 years; there were 15 cases of L4 and L5 spondylolisthesis, 4 males and 11 females, with an average age of 66.5 ± 8.0 years. 36 patients completed the operation, the operation time was 190.28 ± 6.12 min, and intraoperative blood loss was 345 ± 11 ml. Compared with preoperative, there were significant differences in SVA, TPA, T1-SPi, LL, PT, SS, PI-LL, SD, SA, and SP between patients after surgery and at the last follow-up (P < 0.05). Compared with preoperative, VAS score, JOA score, and ODI index of waist and lower limbs were significantly improved after the operation and at the last follow-up, and there was a significant difference (P < 0.05). CONCLUSION TLIF can effectively relieve the symptoms of patients with continuous double-level lumbar spondylolisthesis, restore lumbar lordosis and sagittal spinal sequence, and improve the quality of life of patients.
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Affiliation(s)
- Haopeng Luan
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Yao Wang
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Kai Liu
- grid.412631.3Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Weibin Sheng
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Qiang Deng
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
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Kato S, Terada N, Niwa O, Yamada M. Factors Affecting Incomplete L5/S Posterior Lumbar Interbody Fusion, Including Spinopelvic Sagittal Parameters. Asian Spine J 2021; 16:526-533. [PMID: 34470098 PMCID: PMC9441434 DOI: 10.31616/asj.2021.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective observational study. Purpose In this study we identify risk factors, including patient demographics, sagittal parameters, and clinical examinations, affecting incomplete L5/S posterior lumbar interbody fusion (PLIF). Overview of Literature The lumbosacral spine is considered to have an interbody fusion rate lower than that of the lumbar spine, but few studies have investigated the cause, including investigating the pelvis. We believe that pelvic morphology can affect L5/S interbody fusion of the lumbosacral spine. Methods We observed 141 patients (61 men, 80 women; average age, 65.8 years) who had undergone PLIF and checked for the presence of L5/S interbody fusion. We investigated factors such as age, gender, the presence of diffuse idiopathic skeletal hyperostosis (DISH), fusion level, and grade 2 osteotomy, as well as pre-, post-, and post-preoperative L5/S disk height and angle, lumbar lordosis, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and pelvic incidence (PI), comparing those with and without L5/S interbody fusion. In addition, we analyzed the patients classified into short-level (n=111) and multi-level fusion groups (n=30). Results Overall, the L5/S interbody fusion rate was 70% (short-level, 78%; multi-level, 40%). Age and pre- and post-preoperative L5/S disk angle were significantly different in each fusion level group. DISH presence, grade 2 osteotomy, and postoperative VAS and JOA scores were significantly different in the short-level fusion group, whereas PI was significantly different in the multi-level fusion group. Conclusions Incomplete union after L5/S PLIF correlates with advanced age, many fusion levels, and a large value of preoperative and a small value of post-preoperative L5/S disk angles.
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Affiliation(s)
- Shinichi Kato
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Nobuki Terada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Osamu Niwa
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Mitsuko Yamada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, School of Medicine, Fujita Health University, Nagoya, Japan
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Optimal Reconstruction of Sagittal Alignment According to Global Alignment And Proportion Score Can Reduce Adjacent Segment Degeneration After Lumbar Fusion. Spine (Phila Pa 1976) 2021; 46:E257-E266. [PMID: 33475277 DOI: 10.1097/brs.0000000000003761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases. SUMMARY OF BACKGROUND DATA The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates. METHODS This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD. RESULTS Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P < 0.01) and 0.865 (95% CI: 0.771∼0.958, P < 0.01), respectively. CONCLUSION Our study revealed a significant association between postoperative GAP score and occurrence of ASD after lumbar fusion surgery. Setting surgical goals according to the GAP score may help reduce the occurrence of ASD, especially for S-ASD.Level of Evidence: 4.
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Liu T, Qiu S, Xu Z, Gu J, Luo Z, Wu D. [Effect of percutaneous kyphoplasty on lumbar-pelvic correlation in osteoporotic vertebral compressive fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1414-1418. [PMID: 31650758 PMCID: PMC8337459 DOI: 10.7507/1002-1892.201812049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 09/10/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effect of percutaneous kyphoplasty (PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture (OVCF). METHODS According to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with single-segment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups ( P>0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group. RESULTS All patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP ( t=14.082, P=0.000); ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8% ( t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant ( P<0.05). In the observation group, the LL and SS significantly increased ( P<0.05) and PT significantly decreased ( P<0.05) at 1 month after operation when compared with preoperative ones, and PI decreased, but the difference was not significant ( P>0.05). In the control group, LL was positively correlated with PI and SS ( P<0.05); PI was positively correlated with PT and SS ( P<0.05). In the observation group, PI was positively correlated with SS ( P<0.05) before and after PKP. CONCLUSION OVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Shuiqiang Qiu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Zhigang Xu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Jisheng Gu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Zhendong Luo
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Desheng Wu
- Department of Spinal Surgery, Shanghai Oriental Hospital Affiliated to Tongji University, Shanghai, 200120, P. R.
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