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Orthopaedics & Traumatology, Surgery &... Feb 2020An anterior approach to the lumbar spine is increasingly used in performing fusion. Depending on the level to be treated, several approaches have been developed to deal... (Review)
Review
An anterior approach to the lumbar spine is increasingly used in performing fusion. Depending on the level to be treated, several approaches have been developed to deal with the anatomic obstacles encountered: pure anterior, oblique anterior or lateral, and trans- or pre-psoas. Conventional techniques incur risk of muscle lesion and severe bleeding, and have been replaced by minimally invasive approaches, often with video assistance after rapid closure of laparoscopic approaches with gas insufflation. There has, in parallel, been great progress in anterior spinal instrumentation systems. Non-existent when these techniques were first developed, they have become increasingly sophisticated, and now employ a variety of stand-alone or not cages and anterior screwed plate that can be associated together or to posterior fixation. Each approach and type of fixation has its specific technical requirements that need to be fully mastered so as to minimize risk, especially regarding vessels, and to enable the patient to enjoy the benefit of their very low morbidity. We shall therefore detail here each step of the pure anterior approach, which is most often used for L5S1, the oblique and lateral approaches, mainly used for L2L5, and also the preparation of the lumbar spine for anterior interbody fusion, with the respective instrumentations. We shall then consider the pros, cons and risks, and also spinal or general contraindications that may sometimes preclude this option. From this, we shall derive the specific optimal and wrong indications for anterior lumbar surgery, to help decision-making when fusion is indicated.
Topics: Humans; Lumbar Vertebrae; Neurosurgical Procedures; Radiography; Spinal Diseases; Spinal Fusion
PubMed: 31818690
DOI: 10.1016/j.otsr.2019.05.024 -
Seminars in Musculoskeletal Radiology Jun 2022Management of patients after lumbar spine surgery or interventional radiology can be complex, and postoperative imaging patterns are often poorly understood by...
Management of patients after lumbar spine surgery or interventional radiology can be complex, and postoperative imaging patterns are often poorly understood by nonspecialized radiologists. This article focuses on postoperative imaging features of the lumbar spine in five clinical settings (with corresponding interventions): vertebral osteoporotic fractures (percutaneous vertebroplasty and vertebral augmentation), lumbar disk herniation (surgical diskectomy and percutaneous interventional radiology), lumbar spinal stenosis (surgical decompression), lumbar spondylolisthesis (surgical decompression and fusion), and degenerative scoliosis (techniques of osteotomies).For each intervention, we discuss imaging indications, depending if the patient is asymptomatic or if there are suspected complications, describe normal and pathologic imaging features, and present key points.
Topics: Humans; Lumbar Vertebrae; Spinal Fractures; Spinal Fusion; Spinal Stenosis; Spondylolisthesis
PubMed: 35654097
DOI: 10.1055/s-0041-1740381 -
Neurosurgery Clinics of North America Jan 2020Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that allows access to the lumbar spine from L1/2 to L4/5 for placement of wide interbody... (Review)
Review
Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that allows access to the lumbar spine from L1/2 to L4/5 for placement of wide interbody devices. This technique is used in the treatment of degenerative conditions, deformity, and infectious, neoplastic, and traumatic thoracolumbar pathology. LLIF allows placement of interbody devices across the apophysis, which leads to powerful coronal deformity correction and indirect decompression from restoration of disk height. Literature shows equivalent to superior outcomes of the LLIF technique to anterior or posterior techniques in the treatment of degenerative conditions while avoiding the complications associated with larger procedures.
Topics: Decompression, Surgical; Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Neurosurgical Procedures; Spinal Fusion; Spine
PubMed: 31739927
DOI: 10.1016/j.nec.2019.08.004 -
Ugeskrift For Laeger Feb 2023Magnetic resonance imaging (MRI) is commonly used in the management of low back pain (LBP). This review provides an overview of the clinical relevance of degenerative... (Review)
Review
Magnetic resonance imaging (MRI) is commonly used in the management of low back pain (LBP). This review provides an overview of the clinical relevance of degenerative MRI findings in the lumbar spine. The association between degenerative MRI findings and LBP is relatively consistent at population level, but very little research exists on the prognostic value of MRI findings and based on the current evidence, MRI cannot be used to guide treatment. Lumbar spine MRI is only recommended for patients with progressive neurological deficits, suspicion of specific pathology or in absence of progress of conservative treatment.
Topics: Humans; Clinical Relevance; Low Back Pain; Lumbar Vertebrae; Prognosis; Magnetic Resonance Imaging
PubMed: 36892230
DOI: No ID Found -
Zeitschrift Fur Orthopadie Und... Aug 2021The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In... (Review)
Review
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.
Topics: Biomechanical Phenomena; Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Vertebrae
PubMed: 32392598
DOI: 10.1055/a-1144-3846 -
The Orthopedic Clinics of North America Oct 2021Thoracolumbar spine trauma can result in potentially life-threatening consequences and requires careful management to ensure good outcomes. The purpose of this chapter... (Review)
Review
Thoracolumbar spine trauma can result in potentially life-threatening consequences and requires careful management to ensure good outcomes. The purpose of this chapter is to discuss the anatomy, diagnostic tools, non-operative, and operative treatments important when addressing thoracolumbar trauma.
Topics: Humans; Lumbar Vertebrae; Osteoporotic Fractures; Spinal Fractures; Spinal Injuries; Thoracic Vertebrae; Trauma Severity Indices; Trauma, Nervous System
PubMed: 34538355
DOI: 10.1016/j.ocl.2021.05.014 -
Bulletin of the Hospital For Joint... Mar 2021Endoscopic spine surgery (ESS) is growing in popularity as a minimally invasive approach to a variety of spinal conditions. Similar to other types of minimally invasive... (Review)
Review
Endoscopic spine surgery (ESS) is growing in popularity as a minimally invasive approach to a variety of spinal conditions. Similar to other types of minimally invasive spine surgery (MISS), ESS aims to address the underlying pathology while minimizing surrounding tissue disruption. Its use in the lumbar spine has progressed over the past 50 years and is now routinely used in cases of lumbar disc herniations and stenosis. This review defines common terminology, highlights important developments in the history of ESS, and discusses its current and future application in the lumbar spine.
Topics: Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Minimally Invasive Surgical Procedures
PubMed: 33704036
DOI: No ID Found -
Deutsches Arzteblatt International Oct 2021The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have...
BACKGROUND
The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have not been defined clearly or uniformly. In this article, we present the current state of the evidence on the diagnosis and conservative treatment of osteoporotic fractures of the thoracic and lumbar vertebrae.
METHODS
A systematic review of the literature up to May 2020 was carried out in the PubMed and Web of Science Core Collection databases. 549 articles were identified, of which 36 were suitable for inclusion in the review. Articles were sought in the areas of diagnosis, provision of physical aids, pharmacotherapy, physiotherapy, and treatments from the realm of alternative medicine.
RESULTS
The primary diagnostic technique was conventional x-ray in two planes (with the patient standing, if possible), which had 51.3% sensitivity and 75% specificity. If a fracture was suspected, magnetic resonance imaging (MRI) of the entire spine and regional computed tomography (CT) were carried out. The overall state of the evidence on treatment is poor; the best available evidence is for exercise therapy and physiotherapy, which are supported by three level I and four level II studies. Improvements were seen mainly in mobility and a reduced fear of falling. The use of an active orthosis can be useful as well. No evidence was found on the use of drugs or alternative medicine exclusively in the conservative treatment of osteoporotic vertebral body fractures.
CONCLUSION
It is reasonable to evaluate instability with imaging repeatedly, at regular intervals, over a period of six months. There is still a lack of reliable data on the optimal intensity and duration of physiotherapy, and on the use of orthoses.
Topics: Accidental Falls; Conservative Treatment; Fear; Humans; Lumbar Vertebrae; Osteoporotic Fractures; Spinal Fractures
PubMed: 34342263
DOI: 10.3238/arztebl.m2021.0295 -
The Journal of the American Academy of... Mar 2020Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may... (Review)
Review
Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.
Topics: Cervical Vertebrae; Humans; Lumbar Vertebrae; Physical Examination; Spinal Stenosis
PubMed: 31663913
DOI: 10.5435/JAAOS-D-18-00726 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2021This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior... (Review)
Review
This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.
Topics: Humans; Lordosis; Lumbar Vertebrae; Lumbosacral Region; Spinal Fusion; Technology
PubMed: 34128070
DOI: 10.1093/ons/opaa342