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Orthopadie (Heidelberg, Germany) Nov 2023Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis...
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
Topics: Adult; Humans; Spondylolisthesis; Lumbar Vertebrae; Low Back Pain; Spinal Cord
PubMed: 37792012
DOI: 10.1007/s00132-023-04443-w -
Journal of Neurosurgery. Spine Oct 2023Relatively little evidence exists on predictive factors for the spontaneous regression of lumbar disc herniation (LDH), although it is a well-documented phenomenon.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Relatively little evidence exists on predictive factors for the spontaneous regression of lumbar disc herniation (LDH), although it is a well-documented phenomenon. Therefore, current care is not optimized to identify those who would benefit from early surgery versus those who could avoid surgical risks and pursue nonsurgical therapy. In this study, the authors aimed to analyze and summarize all literature to date on predictive factors for spontaneous LDH regression as well as suggest future research strategies to aid in the decision-making for this cohort.
METHODS
A literature search was conducted of the Cochrane, Embase, and MEDLINE databases for articles that described LDH in terms of the North American Spine Society task force definitions: bulging, protruded, extruded, and sequestered disc morphologies. All articles described a nonsurgical primary symptomatic LDH cohort with at least two MR images to assess regression. Those with concomitant spinal disease were excluded. The primary outcome was to assess the probability of disc regression for each disc morphology, with a secondary analysis for any other predictive factors identified. The authors synthesized their results with the only previous review (examining articles published before March 2014) to comprehensively describe the literature. A qualitative analysis of the wider literature was also performed for those studies with differing definitions of LDH but meeting all remaining inclusion criteria.
RESULTS
Sixteen articles describing 360 cases of LDH were identified. Participants tended to be younger and male and presented with radiculopathy and L4-5 or L5-S1 LDH. The mean time to follow-up imaging was 11.5 months. The probabilities of spontaneous regression with bulging, protruded, extruded, and sequestered discs were 13.3%, 52.5%, 70.4%, and 93.0%, respectively (χ2 = 126.01, p < 0.001). Extruded and sequestered discs were also significantly more likely to completely regress than smaller morphologies. Other predictors of regression were larger baseline herniation volume (1260.16 vs 1006.71 mm3, p < 0.002), transligamentous herniation (χ2 = 13.321, p < 0.001), and higher Komori types (χ2 = 14.5132, p < 0.001). The authors also found similar trends in qualitative data as well as confirmed that symptom improvement was associated with disc regression.
CONCLUSIONS
This study shows further evidence of the influence of disc morphology on predicting LDH regression as well as provides the first meta-analysis of data indicating additional predictive factors. Further investigation of predictive factors for early (< 6 months) LDH regression is suggested to optimize clinical use.
Topics: Humans; Male; Intervertebral Disc Displacement; Intervertebral Disc; Lumbar Vertebrae; Radiculopathy; Spinal Diseases
PubMed: 37486886
DOI: 10.3171/2023.6.SPINE23367 -
Neurosurgery Clinics of North America Oct 2023Lumbar interbody fusion (LIF) is a well-established approach in treating spinal deformity and degenerative conditions of the spine. Since its inception in the 20th... (Review)
Review
Lumbar interbody fusion (LIF) is a well-established approach in treating spinal deformity and degenerative conditions of the spine. Since its inception in the 20th century, LIF has continued to evolve, allowing for minimally invasive approaches, high fusion rates, and improving disability scores with favorable complication rates. The anterior to the psoas (ATP) approach utilizes a retroperitoneal pathway medial to the psoas muscle to access the L1-S1intervertebral disc spaces. In contrast to the transpsoas arppoach, its primary advantage is avoiding transgressing the psoas muscle and the contained lumbar plexus, which potentially decreases the risk of injury to the lumbar plexus. Avoiding transgression of the psoas may minimize the risk of transient or permanent neurological deficits secondary to lumbar plexus injury. Indications for ATP approaches may expand as it is shown to be a safe and effective method of achieving spinal arthrodesis.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Spinal Fusion; Adenosine Triphosphate
PubMed: 37718108
DOI: 10.1016/j.nec.2023.06.009 -
Radiology Jul 2023Postoperative MRI of the lumbar spine is a mainstay for detailed anatomic assessment and evaluation of complications related to decompression and fusion surgery. Key... (Review)
Review
Postoperative MRI of the lumbar spine is a mainstay for detailed anatomic assessment and evaluation of complications related to decompression and fusion surgery. Key factors for reliable interpretation include clinical presentation of the patient, operative approach, and time elapsed since surgery. Yet, recent spinal surgery techniques with varying anatomic corridors to approach the intervertebral disc space and implanted materials have expanded the range of normal (expected) and abnormal (unexpected) postoperative changes. Modifications of lumbar spine MRI protocols in the presence of metallic implants, including strategies for metal artifact reduction, provide important diagnostic information. This focused review discusses essential principles for the acquisition and interpretation of MRI after lumbar spinal decompression and fusion surgery, highlights expected postoperative changes, and describes early and delayed postoperative complications with examples.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Decompression, Surgical; Postoperative Complications; Spinal Fusion; Treatment Outcome; Spinal Stenosis
PubMed: 37404146
DOI: 10.1148/radiol.222732 -
Spine Deformity Sep 2023Vertebral body tethering (VBT) is a fusionless spinal growth modulation technique, which shows promise for pediatric idiopathic scoliosis (IS) curve correction. This...
PURPOSE
Vertebral body tethering (VBT) is a fusionless spinal growth modulation technique, which shows promise for pediatric idiopathic scoliosis (IS) curve correction. This technique, mainly used for thoracic curves, is increasingly being used to treat lumbar curves in order to preserve spine flexibility. It remains necessary to adequately define the cord tension to be applied during the operation and the instrumented levels to biomechanically predict correction over time for the lumbar spine.
METHODS
Twelve pediatric patients with lumbar IS, treated with lumbar-only or lumbar and thoracic VBT, were selected for this study. Three independent variables were tested alternately using a patient-specific finite element model (FEM), which includes an algorithm modeling vertebra growth and spine curve changes due to growth modulation for 24 months post-operatively according to the Hueter-Volkmann principle. Parameters included cable tensioning (150N/250N), upper instrumented level (actual UIV, UIV-1) and lower instrumented level (actual LIV, LIV + 1). Each FEM was personalized using 3D radiographic reconstruction and flexibility supine radiographs.
RESULT
An increase in cord tension (from 150 to 250N) had significant effects on main thoracic and thoraco-lumbar/lumbar Cobb angles, as well as on lumbar lordosis, after surgery (supplementary average correction of 3° and 8°, and increase of 1.4°, respectively) and after 24 months (4°, 10° and 1.1°) (p < 0.05). Adding a level to the actual UIV or LIV did not improve correction.
CONCLUSION
This parametric study showed that cord tension is the most important biomechanical parameter on the simulated immediate and 2-year increase in lumbar curve correction. Our preliminary model suggests that it is not advantageous to add additional instrumented levels.
LEVEL OF EVIDENCE
This computational study uses a retrospective validation cohort (level of evidence 3).
Topics: Animals; Humans; Child; Vertebral Body; Retrospective Studies; Lumbar Vertebrae; Scoliosis; Thoracic Vertebrae
PubMed: 37179281
DOI: 10.1007/s43390-023-00697-8 -
World Neurosurgery Jul 2023In a retrospective cohort study, we compared the outcomes among clinical and radiographic degenerative spondylolisthesis (CARDS) subtypes for patients undergoing...
Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System.
OBJECTIVE
In a retrospective cohort study, we compared the outcomes among clinical and radiographic degenerative spondylolisthesis (CARDS) subtypes for patients undergoing posterior lumbar decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF) and evaluated the CARDS system as a tool to guide clinical decisions regarding the treatment of degenerative spondylolisthesis (DS).
METHODS
Patients undergoing PLDF or TLIF for DS from 2010 to 2020 were identified. The patients were grouped by the preoperative CARDS classification. Multivariate analysis was used to determine the effects of the treatment approach on the 1-year patient-reported outcome measures (PROMs) and 90-day surgical outcomes.
RESULTS
A total of 1056 patients were included: 148 patients with type A DS, 323 with type B, 525 with type C, and 60 with type D. Patients with CARDS types A and C who underwent PLDF experienced a longer length of stay and were less likely to be discharged home. No differences were found in the incidence of revisions, complications, or readmissions between the surgical approaches. Patients with CARDS type A undergoing PLDF were less likely to achieve a minimal clinically important difference for back pain (36.8% vs. 76.7%; P = 0.013). No other significant differences were found in the PROMs among the CARDS subtypes. TLIF independently predicted for better leg pain improvement using the visual analog scale at 1 year of follow-up (β = -2.92; P = 0.017) for patients with CARDS type A. Multivariable analysis demonstrated no significant differences in PROMs by surgical approach among the other CARDS subtypes.
CONCLUSIONS
Patients with disc space collapse and endplate apposition (CARDS type A) appear to benefit from TLIF. However, patients with lumbar spondylolisthesis without disc space collapse or kyphotic angulation (CARDS types B and C) showed no benefit from additional interbody placement.
Topics: Humans; Spondylolisthesis; Spinal Fusion; Retrospective Studies; Lumbar Vertebrae; Back Pain; Decompression; Treatment Outcome; Minimally Invasive Surgical Procedures
PubMed: 37075895
DOI: 10.1016/j.wneu.2023.04.036 -
Journal of Orthopaedic Surgery and... Nov 2023To compare the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and minimally invasive transforaminal lumbar... (Meta-Analysis)
Meta-Analysis
Comparing the efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in lumbar degenerative diseases: a systematic review and meta-analysis.
OBJECTIVE
To compare the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in lumbar degenerative diseases.
METHODS
This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023432460). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of unilateral BE-TLIF and MIS-TLIF in lumbar degenerative diseases from database establishment to May 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, postoperative drainage, Oswestry disability index, Visual analogue scale, lumbar lordosis, disk height, hospital length stay, fusion rate, and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library.
RESULTS
A total of 14 cohort studies with a total of 1007 patients were included in this study, including 472 patients in the BE-TLIF group and 535 patients in the MIS-TLIF group. The BE-TLIF group had lower intraoperative blood loss than the MIS-TLIF group [mean difference (MD) = - 78.72, 95% CI (- 98.47, - 58.97), P < 0.00001] and significantly reduced postoperative drainage than the MIS-TLIF group [MD = - 43.20, 95% CI (- 56.57, - 29.83), P < 0.00001], and the operation time was longer than that of the MIS-TLIF group [MD = 22.68, 95% CI (12.03, 33.33), P < 0.0001]. Hospital length stay in BE-TLIF group was significantly less than that in MIS-TLIF group [MD = - 1.20, 95% CI (- 1.82, - 0.57), P = 0.0002].
CONCLUSION
Compared with MIS-TLIF, BE-TLIF for lumbar degenerative diseases has the advantages of less intraoperative blood loss, less early postoperative low back and leg pain, shorter postoperative hospital length stay, and faster early functional recovery.
Topics: Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Blood Loss, Surgical; Treatment Outcome; Spinal Fusion; Retrospective Studies
PubMed: 37993948
DOI: 10.1186/s13018-023-04393-1 -
Annual International Conference of the... Jul 2023Most lumbar quantitative assessment methods can only analyze the image from one view and require laborious manual annotation. We aim to develop an unsupervised pipeline...
Most lumbar quantitative assessment methods can only analyze the image from one view and require laborious manual annotation. We aim to develop an unsupervised pipeline for 3D quantitative assessment of the lumbar spine that can assess the MRI with different views. We combine rule-based and deep learning methods to generate multi-tissue segmentation, and parameters can be measured from segmentation results using the anatomical and geometric prior. Preliminary testing demonstrates that our proposed method can generate accurate segmentation and measurement results.Clinical Relevance- The proposed unsupervised 3D lumbar quantitative assessment pipeline can significantly improve the efficiency and consistency of clinical diagnosis and surgical planning.
Topics: Magnetic Resonance Imaging; Lumbar Vertebrae
PubMed: 38557307
DOI: 10.1109/EMBC40787.2023.10485565 -
Forensic Science, Medicine, and... Sep 2023In this study, we aimed to assess the association between different parameters of the second and third lumbar vertebra with age, sex, and height in the Iranian...
In this study, we aimed to assess the association between different parameters of the second and third lumbar vertebra with age, sex, and height in the Iranian population. A total of 14 parameters of the L2 and L3 vertebra were measured from three-dimensional lumbar topography. The measured parameters included vertebral length, foramen diameter, foramen width, endplate depth, endplate width, spinal process height, spinal process length, transverse process distance, the height of the vertebral body, articular process height inferior, articular process height superior, pedicle height, pedicle width, and maximum distance between articular processes. A total of 100 patients, including 46 males (46%) and 54 females (54%), were enrolled in this study. Our findings showed that most L2 and L3 parameters could differentiate males from females, with the area under the curve between 0.620 and 0.888. The majority of L2 and L3 parameters were positively associated with height in both males and females. Regarding age, there was a significant positive association between the spinal process length of L2 and vertebral length, spinal process height, and spinal process length of L3 with age in males. Also, several parameters of L2 and L3 were associated with age in females. In conclusion, we demonstrated that the parameters of the second and third lumbar vertebra could be valuable in the determination of the age, height, and sex of the Iranian population. Our results could have practical implications in forensic anthropology in serious events like earthquakes.
Topics: Male; Female; Humans; Iran; Lumbar Vertebrae; Lumbosacral Region; Joints
PubMed: 36454380
DOI: 10.1007/s12024-022-00554-6 -
The Journal of Bone and Joint Surgery.... Mar 2024➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring...
➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.
Topics: Humans; Lordosis; Radiography; Lumbar Vertebrae; Spondylolisthesis; Lumbosacral Region; Spinal Fusion; Retrospective Studies
PubMed: 38271548
DOI: 10.2106/JBJS.23.00672