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Orthopaedics & Traumatology, Surgery &... Oct 2020L5 burst fractures represent a small percentage of all spine fractures. Treatment strategy has not yet been standardized. Anatomical features and their biomechanical... (Review)
Review
Isolated unstable burst fractures of the fifth lumbar vertebra: functional and radiological outcome after posterior stabilization with reconstruction of the anterior column: About 6 cases and literature review.
INTRODUCTION
L5 burst fractures represent a small percentage of all spine fractures. Treatment strategy has not yet been standardized. Anatomical features and their biomechanical characteristics create fracture patterns which differ from those at the thoracolumbar junction. The objective of this study was to evaluate L5 burst fracture surgical treatment outcomes after posterior stabilization and reconstruction of the anterior column.
PATIENTS AND METHODS
Six patients with fifth lumbar isolated unstable burst fractures were analyzed. Medical records, radiographs, and clinical scores were obtained. The results were evaluated based on restoration of vertebral body height, spinal lordosis/kyphosis, canal compromise and sagittal alignment at several phases of treatment.
RESULTS
No patient showed neurologic deterioration, regardless of treatment. The median preoperative anterior vertebral height was 41mm and postoperative was 48mm. The median preoperative kyphotic angle as measured by Cobb angle (local and regional) was 21.5 degrees and 33 degrees which improved respectively by 7.5 and 5.5 degrees following instrumentation. The median amount of backward protrusion of bony fragment into the canal was measured at 67% preoperatively and at 35% postoperatively. There were no pseudarthrosis and anterior arthrodesis solid fusion was visible in all cases. There were a sagittal alignment restoration. At one year of follow up, fusion was obtained in all the cases, all patients had minimal to moderate disability using Oswestry Disability Index. The ability to return to work revealed a good-to-excellent long-term result.
DISCUSSION
The results of treatment of 5th lumbar unstable burst fractures with posterior stabilization and reconstruction of the anterior column show benefit on durable functional outcome, spine stabilization and radiologic parameters.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Fracture Fixation, Internal; Fractures, Compression; Humans; Lumbar Vertebrae; Retrospective Studies; Spinal Fractures; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 32354682
DOI: 10.1016/j.otsr.2020.03.014 -
Mathematical Biosciences and... Jan 2023In lumbar puncture surgery, compared with the conventional methodologies like computed tomography and magnetic resonance imaging, ultrasound imaging offers the...
In lumbar puncture surgery, compared with the conventional methodologies like computed tomography and magnetic resonance imaging, ultrasound imaging offers the advantages of being low cost, no radiation and real-time image generation. However, the use of ultrasound equipment in lumbar puncture involves a cumbersome and time-consuming process for the subjective imaging of the overall structure of the lumbar spine in order to determine the exact puncture point and path. Meanwhile, the robotic arm puncture system has the advantages of high precision, good stability and simple and efficient operation. As a result, robotic-assisted ultrasound scanning is valuable for the assessment of a puncture path in spinal tap surgery. In this pursuit, based on the official URSDK development package for a robot arm and the Transmission Control Protocol/Internet Protocol, the system proposed in the present study involves a program to control the robot arm to clamp down onto an ultrasonic probe to enable automatic scanning and acquisition of images. A three-dimensional reconstruction program based on the visualization toolkit was designed, and a lumbar spine experiment was conducted with this system. A total of 136 two-dimensional ultrasound images were collected in the lumbar spine model experiment by enhancing contrast of and denoising the original ultrasound images, and a linear interpolation algorithm was used to perform the three-dimensional reconstruction of the lumbar spine model. The reconstructed structure was defective, but the location of the spinous process gap was determined with the sagittal and coronal images. The feasibility of the system was verified by the reconstruction results, which can provide a reference for determining the puncture point and path planning in the lumbar puncture surgery.
Topics: Spinal Puncture; Lumbar Vertebrae; Ultrasonography; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 36650781
DOI: 10.3934/mbe.2023028 -
Journal of Medical Case Reports Feb 2023Primary lymphoma of the spinal vertebrae (PLSV) is an exceedingly rare disease with an unclear optimal treatment plan. We analyzed the clinical features of PLSV in the... (Review)
Review
BACKGROUND
Primary lymphoma of the spinal vertebrae (PLSV) is an exceedingly rare disease with an unclear optimal treatment plan. We analyzed the clinical features of PLSV in the patient to strengthen our understanding of the disease and to review the literature.
CASE PRESENTATION
A 65-year-old Persian man was admitted to our hospital with severe low back pain. The patient underwent radiological examinations including computed tomography (CT) scan, magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT). These examinations revealed a lesion in the L3 vertebra. Histological analysis showed a high-grade lymphoma. The patient underwent an L3 corpectomy with expandable cage placement, followed by an L2-L4 lateral screw placement with rod fixation. Also, facetectomy, laminectomy, and total spondylectomy were performed. Pedicle screws were inserted from L1 to L5. Titanium mesh was placed on the post-laminectomy defect. The treatment continued with local radiotherapy and chemotherapy. Post-treatment, the patient showed no new neurological deficit, and in the final follow-up, the patient had achieved a good recovery.
CONCLUSION
To our knowledge, no prior published literature has revealed a primary lymphoma of the lumbar vertebrae. Here, we report this case of PLSV for the first time and provide a brief review of the literature.
Topics: Male; Humans; Aged; Lumbar Vertebrae; Spinal Fusion; Radiography; Laminectomy; Lymphoma
PubMed: 36774514
DOI: 10.1186/s13256-022-03725-9 -
Clinical Spine Surgery May 2019The use of intraoperative multimodal monitoring (IOM) in spinal deformity surgeries is well documented. In particular, pedicle subtraction osteotomy (PSO), a corrective... (Review)
Review
The use of intraoperative multimodal monitoring (IOM) in spinal deformity surgeries is well documented. In particular, pedicle subtraction osteotomy (PSO), a corrective procedure for sagittal deformity of the spine, often involves IOM usage. By providing immediate feedback to the operating surgeon, IOM has the potential to eliminate or at least minimize the risk of iatrogenic neurological injury. However, despite the widespread usage of IOM, there is currently no standardization of IOM usage in complex spine surgeries, including lumbar PSOs, and decisions concerning IOM utilization are often driven by surgeon experience and preference. This creates a state of clinical equipoise, which is further complicated by the varying degrees of benefit that IOM has on patient outcomes depending on the operation and spinal levels involved. For instance, while IOM use in thoracic PSOs has been shown to be effective, there is no established consensus on the net impact of IOM use in PSOs of the lumbar spine. Although IOM has the potential to mitigate neurological damage, it also increases operation time and cost; thus, it should only be used in operations where it will have a net positive impact on patient outcomes. The question thus becomes whether PSO of the lumbar spine is one such operation. To address this, we examine the most frequently used IOM modalities and evaluate their current usage and efficacy in lumbar PSOs. Furthermore, we will also examine the utility of IOM for other surgeries of the lumbar spine, including corrective procedures for idiopathic scoliosis and degenerative scoliosis, and routine lumbar procedures, such as discectomies and decompression surgeries for foraminal and canal stenosis.
Topics: Evoked Potentials, Motor; Humans; Lumbar Vertebrae; Monitoring, Intraoperative; Osteotomy; Pedicle Screws
PubMed: 30407261
DOI: 10.1097/BSD.0000000000000740 -
European Review For Medical and... May 2023The aim of this study was to assess the clinical efficacy of oblique lateral interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) for lumbar brucellosis... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study was to assess the clinical efficacy of oblique lateral interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) for lumbar brucellosis spondylitis.
PATIENTS AND METHODS
Between April 2018 and December 2021, 80 cases of lumbar brucellosis spondylitis admitted to our institution were evaluated for eligibility and randomly assigned to either PLIF (group A, lesion removal by posterior approach + interbody fusion + percutaneous pedicle screw internal fixation) or OLIF (group B, lesion removal by anterior approach + interbody fusion + percutaneous pedicle screw internal fixation). The outcome measures included operative time, intraoperative bleeding, hospital stay, preoperative and postoperative visual analogue scale (VAS) ratings, American Spinal Injury Association (ASIA) classification, Cobb angle, and interbody fusion time.
RESULTS
PLIF resulted in shorter operative time and hospital stay and less intraoperative bleeding vs. OLIF (p<0.05). All eligible patients showed significantly lower VAS scores, and smaller ESR values and Cobb angles after treatment (p<0.05), but no significant intergroup differences were observed (p>0.05). The two groups showed similar preoperative ASIA (American Spinal Injury Association) classification and interbody fusion time (p>0.05). PLIF was associated with better ASIA classification at three months postoperatively vs. OLIF (p<0.05).
CONCLUSIONS
Both surgical techniques are efficient at removing the lesion, relieving pain, maintaining spinal stability, promoting implant fusion, and facilitating prognostic inflammation control. PLIF features a shorter surgical duration and hospital stay, less intraoperative bleeding, and greater neurological improvement vs. OLIF. Nevertheless, OLIF outperforms PLIF in the excision of peri-vertebral abscesses. PLIF is indicated for posterior spinal column lesions, particularly those with spinal nerve compression in the spinal canal, whereas OLIF is indicated for structural bone deterioration in the anterior column, particularly for those with perivascular abscesses.
Topics: Humans; Abscess; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion; Spondylitis; Treatment Outcome
PubMed: 37203810
DOI: 10.26355/eurrev_202305_32291 -
The Journal of International Medical... 2009Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far... (Review)
Review
Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.
Topics: Bone Transplantation; Contraindications; Humans; Lumbar Vertebrae; Prostheses and Implants; Radiography; Spinal Fusion
PubMed: 19589277
DOI: 10.1177/147323000903700337 -
Neurology India 2022Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by...
BACKGROUND
Complete subluxation of >100% of one vertebral body with respect to the adjacent vertebra is defined as spondyloptosis. It is the severest form of injury caused by high-energy trauma. Pediatric patients with a traumatic spine injury, particularly spondyloptosis are surgically demanding as reduction and achieving realignment of the spinal column requires diligent planning and execution.
OBJECTIVE
To enlighten readers about this rare but severest form of thoracolumbar spine injury and its management.
METHODS
Retrospective analysis of patients treated here with spondyloptosis between 2008 and 2016 was done.
RESULTS
Seven children, ranging from 9 to 18 years (mean years) age were included in the study. Five patients had spondyloptosis at thoracolumbar junction and one each in the lumbar and thoracic spine. All patients underwent single-stage posterior surgical reduction and fixation except one patient who refused surgery. Intraoperatively, cord transection was seen in five patients while dura was intact in one patient. The mean follow-up period was 17 months (1-36 months) during which one patient expired due to complications arising from bedsores. All patients remained American Spinal Injury Association (ASIA) A neurologically.
CONCLUSIONS
Traumatic spondyloptosis is a challenging proposition to treat and the aim of surgery is to stabilize the spine. Rehabilitation remains the most crucial but the neglected part and dearth of proper rehabilitation centers inflict high mortality and morbidity in developing countries.
Topics: Humans; Adolescent; Child; Thoracic Vertebrae; Retrospective Studies; Lumbar Vertebrae; Spondylolisthesis; Spinal Injuries
PubMed: 36412366
DOI: 10.4103/0028-3886.360921 -
The Journal of International Medical... Feb 2018Objective Exercise has a positive effect on physical fitness. Tai Chi Chuan is a traditional Chinese aerobic exercise. We assessed the effect of Tai Chi on the...
Objective Exercise has a positive effect on physical fitness. Tai Chi Chuan is a traditional Chinese aerobic exercise. We assessed the effect of Tai Chi on the degeneration of lumbar vertebrae and lumbar discs with magnetic resonance images. Methods This retrospective cohort study involved 2 groups of participants: 27 Tai Chi practitioners with more than 4 years of experience with regular Tai Chi exercise and 24 sex- and age-matched participants without Tai Chi experience. The lumbar magnetic resonance images of all participants were collected. The numbers of degenerated lumbar vertebrae and lumbar discs were evaluated by the same radiologist, who was blind to the grouping. Results The Tai Chi practitioners had significantly fewer degenerated lumbar vertebrae (1.9) and lumbar discs (2.3) than the control group (2.6 and 2.9, respectively). The most severely affected lumbar vertebrae and discs were L5 and L4/L5, respectively. Conclusion Regular performance of the simplified Tai Chi 24 form could possibly retard the degeneration of lumbar vertebrae and lumbar discs in middle-aged and aged people.
Topics: Aged; Case-Control Studies; China; Cross-Sectional Studies; Female; Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tai Ji
PubMed: 28984177
DOI: 10.1177/0300060517734115 -
Medicine Oct 2022Magnetic resonance imaging (MRI) has been extensively used in the management of patients with a herniated lumbar disc. Nevertheless, immediate postoperative MRI has not...
Magnetic resonance imaging (MRI) has been extensively used in the management of patients with a herniated lumbar disc. Nevertheless, immediate postoperative MRI has not become a standard procedure, with limited research suggesting that the findings are often similar to preoperative MRI in both symptomatic and asymptomatic patients. This study aimed to determine the benefits of immediate postoperative MRI in patients with or without postoperative symptoms and its correlation with these symptoms. A total of 172 patients who underwent lumbar spine microdiscectomy at our institution between 2014 and 2021 were included. Patients who had previous spinal surgery and lumbar fusion were excluded. Patient data were collected from medical records. MRI was performed 3 days after surgery and assessed by 2 neurosurgeons to minimize bias. Immediate postoperative MRI results showed dural sac compression or foraminal stenosis in 29 patients (16.86%), of which 10 had postoperative pain and 19 were pain free. Among the 143 patients (83.14%) without these findings on MR imaging, 38 had postoperative pain. Immediate postoperative MRI did not correlate with postoperative pain (P = .421/.357). Intraoperative bleeding and the Charlson comorbidity index (CCI) showed significant correlations with postoperative pain (P = .018 and .002, respectively). In a multivariate analysis, intraoperative blood loss and CCI independently correlated with postoperative pain (P = .001 and .001, respectively). Based on our findings, intraoperative blood loss and CCI appear to be the factors that may predict the persistence of postoperative pain, despite normal findings on MRI.
Topics: Humans; Blood Loss, Surgical; Lumbar Vertebrae; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Pain, Postoperative
PubMed: 36316946
DOI: 10.1097/MD.0000000000031287 -
European Spine Journal : Official... Dec 2013Development of a dynamic stabilization system often involves costly and time-consuming design iterations, testing and computational modeling. The aims of this study were...
PURPOSE
Development of a dynamic stabilization system often involves costly and time-consuming design iterations, testing and computational modeling. The aims of this study were (1) develop a simple parametric model of lumbar flexion instability and use this model to identify the appropriate stiffness of a flexion restricting stabilization system (FRSS), and (2) in a cadaveric experiment, validate the predictive value of the parametric model.
METHODS
Literature was surveyed for typical parameters of intact and destabilized spines: stiffness in the high flexibility zone (HFZ) and high stiffness zone, and size of the HFZ. These values were used to construct a bilinear parametric model of flexion kinematics of intact and destabilized lumbar spines. FRSS implantation was modeled by iteratively superimposing constant flexion stiffnesses onto the parametric model. Five cadaveric lumbar spines were tested intact; after L4-L5 destabilization (nucleotomy, midline decompression); and after FRSS implantation. Specimens were loaded in flexion/extension (8 Nm/6 Nm) with 400 N follower load to characterize kinematics for comparison with the parametric model.
RESULTS
To accomplish the goal of reducing ROM to intact levels and increasing stiffness to approximately 50 % greater than intact levels, flexion stiffness contributed by the FRSS was determined to be 0.5 Nm/deg using the parametric model. In biomechanical testing, the FRSS restored ROM of the destabilized segment from 146 ± 13 to 105 ± 21 % of intact, and stiffness in the HFZ from 41 ± 7 to 135 ± 38 % of intact.
CONCLUSIONS
Testing demonstrated excellent predictive value of the parametric model, and that the FRSS attained the desired biomechanical performance developed with the model. A simple parametric model may allow efficient optimization of kinematic design parameters.
Topics: Adult; Biomechanical Phenomena; Cadaver; Decompression, Surgical; Equipment Design; Humans; Joint Instability; Lumbar Vertebrae; Middle Aged; Models, Anatomic; Pliability; Predictive Value of Tests; Prostheses and Implants; Range of Motion, Articular; Spinal Fusion; Weight-Bearing
PubMed: 23955312
DOI: 10.1007/s00586-013-2934-y