General and current medical history.
Patient Chen***, female, 69 years old. She fell 2 years ago and landed on her buttocks, immediately felt pain in the lumbar region and had limited active activities. She was treated with bed braking treatment and gradually improved. 3 months ago, she gave up bed treatment because of farming, and felt that her lumbar pain had increased after farming. He then visited our outpatient clinic on 2015-12-3, and MRI examination of the lumbar spine (outside hospital) showed T11-L1 compression fracture changes and L4/5 disc herniation. The patient was admitted to the outpatient clinic with “thoracolumbar compression fracture” for further consultation and treatment. Since the injury, the patient was in good mental condition, general physical strength, good appetite, poor sleep, no significant change in weight, normal stool, normal urine. He Dawei, Department of Spine Surgery, Shanghai Changhai Hospital
Other disease conditions that still require treatment.
Hypertensive disease.
Therapeutic drugs still being taken before admission.
L-amlodipine tablets 2.5mg/day.
Past history.
Previous good general health, 3 years history of hypertension and 3 years history of mild cerebral infarction. The rest is not special.
Personal history.
No smoking or drinking habits, no history of drugs or smuggling (except for levloclodipine tablets for hypertension).
Marital and childbearing history.
Married at an appropriate age, with one son and three daughters, spouse and children in good health.
Family history.
Denied family history of hereditary and infectious diseases.
Specialized conditions.
He was assisted to the ward slowly, with T12,L1 vertebral spine pressure +, lumbar mobility significantly restricted, and sensory-motor restriction of both lower extremities. Skin sensation in the saddle area was not significantly diminished. Bilateral iliopsoas and quadriceps muscle strength was grade 3, bilateral knee tendon reflexes were diminished, and Achilles tendon reflexes were diminished. Pathological signs-, sensory and motor functions of both upper limbs were normal.
Ancillary tests.
2015-12-2 Lumbar MRI (our hospital): herniated L4/5 disc, compressive changes in T11-L1 vertebral body.
2015-11-4 Lumbar spine frontal and lateral radiographs (outside hospital): L1, T12 vertebral compression fractures.
Deep vein thrombosis assessment.
(3-4 points) Moderate risk
Relevant investigations were completed after admission and no obvious contraindications to surgery were observed.
Name of procedure to be performed.
Percutaneous minimally invasive vertebroplasty
Operators.
He Dawei (chief surgeon) Yang Changwei (first assistant) Wang Chang (second assistant) Huang Shuai Li
Surgical procedure.
Preoperatively, the puncture site is located, and after disinfection and spreading of the towel, the puncture needle is inserted.
Fine-tune the direction of the puncture needle to make it enter the proposed surgical puncture site accurately
Four puncture needles were inserted smoothly
Percutaneous puncture instruments used during the operation
The four puncture needles were inserted into the diseased vertebrae through the pedicle in the frontal and lateral views of the puncture
Bone cement was inserted through the puncture needles
Monitor the amount of cement injected and the site and extent of diffusion with fluoroscopic positioning during the cement injection
While waiting for the cement to set, Prof. He Dawei explained the key points and precautions of the operation to his assistant
The spine was repositioned satisfactorily, and the puncture point was sutured and bandaged after cement setting.
Operation time: 60 minutes
After the operation, the patient was sent to the wake-up room and woke up under cardiac monitoring. 15 minutes later, the patient woke up and returned to the ward.
Postoperative care: The patient was instructed to turn in the axial position, cefuroxime to prevent infection, and the wound was changed regularly. The patient was instructed to continue the original treatment plan to control blood pressure and treat osteoporosis. On the first postoperative day, the patient complained of significant relief of back pain compared with the preoperative period, and there was no significant discomfort at the surgical site. The patient was expected to be discharged on the 3rd postoperative day.