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BioMed Research International 2020To evaluate the clinical significance of spinal decompression and fusion for lumbar spinal stenosis in old patients under Roussouly classification, 160 old patients (>60...
To evaluate the clinical significance of spinal decompression and fusion for lumbar spinal stenosis in old patients under Roussouly classification, 160 old patients (>60 year old) with lumbar spinal stenosis underwent spinal decompression, and fusion were retrospectively studied. According to Roussouly classification, patients were divided into 4 groups, in which Roussouly types I, II, and IV were the nonstandard group and Roussouly type III was the standard group. Visual analog scale (waist, leg) and Oswestry disability index (ODI) scores were recorded before operation and at the final follow-up. All patients improved the sagittal curvature: for patients in Roussouly types I and II, there were statistically significant differences in terms of postoperative global lordosis (GL), global kyphosis (GK), sacral slope (SS), sagittal vertical axis (SVA), and pelvic tilt (PT) compared with that before surgery (all < 0.001); patients in Roussouly type IV obtained similar results with type III after surgery. The four groups showed significant improvement in ODI and VAS scores at final follow-up (all < 0.001). After regrouping at the final follow-up, the proportion of the standard type (Roussouly type III) patients was increased compared with preoperative. In conclusion, Roussouly classification has important guiding significance in spinal decompression and fusion for old patients (>60 years) with lumbar spinal stenosis.
Topics: Aged; Decompression, Surgical; Female; Humans; Kyphosis; Lumbar Vertebrae; Male; Middle Aged; Posture; Retrospective Studies; Spinal Fusion; Spinal Stenosis
PubMed: 32462019
DOI: 10.1155/2020/8078641 -
BioMed Research International 2022To compare the biomechanical stability of two-level PLIF constructs with unilateral and bilateral pedicle screw fixations.
OBJECTIVES
To compare the biomechanical stability of two-level PLIF constructs with unilateral and bilateral pedicle screw fixations.
METHODS
Six cadaveric lumbar segments were evaluated to assess biomechanical stability in response to pure moment loads applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Each specimen was tested in six sequential configurations: (1) intact baseline; (2) facetectomy; (3) unilateral pedicle screws (UPS); (4) bilateral pedicle screws (BPS); (5) unilateral pedicle screws and cage (UPSC); and (6) bilateral pedicle screws and cage (BPSC).
RESULTS
Significant reductions in motion were observed when comparing all instrumented conditions to the intact and facetectomy stages of testing. No significant differences in motion between UPS, BPS, UPSC, or BPSC were observed in response to FE range of motion (ROM) or neutral zone (NZ). ROM was significantly higher in the UPS stage compared to BPS in response to LB and AT loading. ROM was significantly higher in UPSC compared to BPSC in response to LB loading only. Similarly, NZ was significantly higher in UPSC compared to BPSC in response to only LB loading. In response to AT loading, ROM was significantly higher during UPS than BPS or BPSC; however, no significant differences were noted between UPSC and BPSC with respect to AT ROM or NZ.
CONCLUSION
BPS fixation is biomechanically superior to UPS fixation in multilevel PLIF constructs. This was most pronounced during both LB loading. Interbody support did contribute significantly to immediate stability.
Topics: Biomechanical Phenomena; Cadaver; Humans; Lumbar Vertebrae; Pedicle Screws; Range of Motion, Articular; Rotation; Spinal Fusion
PubMed: 35996543
DOI: 10.1155/2022/7081238 -
Arthritis and Rheumatism Jan 2013
Topics: Female; Humans; Lumbar Vertebrae; Radiography; Spinal Dysraphism; Young Adult
PubMed: 23044899
DOI: 10.1002/art.37731 -
Orthopaedic Surgery Feb 2011Lumbar posterior ring apophysis fracture (PRAF) is an uncommon cause of low back pain in the pediatric age group, and a detailed understanding of this disease is... (Review)
Review
Lumbar posterior ring apophysis fracture (PRAF) is an uncommon cause of low back pain in the pediatric age group, and a detailed understanding of this disease is important for the orthopaedic surgeon because it is easily misdiagnosed. However, to date no comprehensive review of PRAF has been published. The majority of published reports are in the form of cases report generally targeted at either diagnosis or therapy, or both. In this essay, we comprehensively review the pathogenesis, clinical presentation, diagnosis and treatment of PRAF.
Topics: Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 22009984
DOI: 10.1111/j.1757-7861.2010.00122.x -
Operative Neurosurgery (Hagerstown, Md.) Jun 2023There has been a widespread application of minimally invasive spinal surgery techniques in the past few years. Unilateral biportal endoscopic has been successfully used...
Transforaminal Interbody Fusion Using the Unilateral Biportal Endoscopic Technique Compared With Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spine Diseases: Analysis of Clinical and Radiological Outcomes.
BACKGROUND
There has been a widespread application of minimally invasive spinal surgery techniques in the past few years. Unilateral biportal endoscopic has been successfully used in a variety of lumbar spine diseases, but there are few studies on lumbar fusion assisted by unilateral biportal endoscopy.
OBJECTIVE
To compare the clinical and radiological outcomes of transforaminal interbody fusion using the unilateral biportal endoscopic technique (UBEIF) and transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disease.
METHODS
We studied 128 patients, 58 in the UBEIF group and 70 in the TLIF group. The Oswestry disability index, creatine kinase, visual analog score (VAS) for leg and back pain were used to assess clinical outcomes. Radiographic outcomes were assessed using the fusion rate, internal fixation loosening, and adjacent segment degeneration.
RESULTS
Back and leg pain VAS scores in both groups were significantly lower 3, 6, and 12 months after surgery ( P < .05). A significant reduction in Oswestry disability index in both groups was observed 6 and 12 months after surgery ( P < .05). Compared with the TLIF group at 1 week after surgery, UBEIF patients' VAS score for back pain significantly improved ( P < .05). There was no difference in fusion rate between the 2 groups (98.27% vs 98.57%).
CONCLUSION
UBEIF and TLIF have similar clinical and radiographic outcomes in the treatment of single-segment lumbar disease with lumbar instability, including improved back and leg pain, improved disability, and high fusion rates. Furthermore, with UBEIF, less blood is lost, there is better relief of early back pain, and hospital stays are shorter.
Topics: Humans; Spinal Fusion; Lumbar Vertebrae; Treatment Outcome; Endoscopy; Back Pain
PubMed: 36786763
DOI: 10.1227/ons.0000000000000641 -
BioMed Research International 2017The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. (Review)
Review
PURPOSE
The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use.
METHODS
A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015.
RESULTS
Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi.
CONCLUSION
Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.
Topics: Humans; Joint Instability; Lumbar Vertebrae; Radiography; Risk Factors; Spinal Diseases; Spinal Fusion
PubMed: 28831392
DOI: 10.1155/2017/2964529 -
BMJ Case Reports Mar 2022Nerve root morphological variability is often incompletely appreciated on preoperative imaging and can complicate intraoperative decision-making. This case demonstrates...
Nerve root morphological variability is often incompletely appreciated on preoperative imaging and can complicate intraoperative decision-making. This case demonstrates the utility of spinal endoscopy in the visualisation and manipulation of conjoined nerve roots and includes procedural images to promote better understanding and awareness of this anatomical anomaly. A woman in her 50s presented with 1 year of progressive left S1 radiculopathy refractory to non-operative modalities. History and examination were notable for S1 dermatomal paresthesias, positive ipsilateral straight leg raise and grade 4/5 gastrocnemius strength. MRI demonstrated an L5-S1 left paracentral disc herniation causing severe lateral recess stenosis. Endoscopic decompression revealed conjoined lumbosacral nerve roots. Laminotomies and discectomy provided circumferential decompression. The patient experienced immediate and sustained relief of her preoperative radiculopathy as manifested in patient-reported outcome measures. Evolving endoscopic spine platforms provide novel visualisation of nerve root anomalies yielding new insight on safe and effective decompressive techniques.
Topics: Decompression, Surgical; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Spinal Nerve Roots
PubMed: 35296497
DOI: 10.1136/bcr-2021-248680 -
Orthopaedics & Traumatology, Surgery &... Sep 2014Treatment of A3 thoraco-lumbar and lumbar spinal fractures nowadays remains a controversial issue. Percutaneous techniques are becoming very popular in the last few...
BACKGROUND
Treatment of A3 thoraco-lumbar and lumbar spinal fractures nowadays remains a controversial issue. Percutaneous techniques are becoming very popular in the last few years to reduce the approach-related morbidity associated with conventional techniques.
HYPOTHESIS
Purpose of the study was to analyze the clinical and radiological outcome of patients who underwent percutaneous posterior fixation without fusion for the treatment of thoraco-lumbar and lumbar A3 fractures.
MATERIALS AND METHODS
Sixty-three patients, having sustained a single-level thoraco-lumbar fracture, underwent short segment percutaneous instrumentation and were retrospectively analyzed. sagittal index (SI) was calculated in all patients. Clinical and functional outcome were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form General Health Status (SF-36).
RESULTS
Average operative blood loss was 82 mL (50-320). Mean pre-operative SI in the thoraco-lumbar segment was 13.3° decreased to 5.8° in the immediate postoperative with a mean deformity correction of 7.5. Mean pre-operative SI in the lumbar segment was 16.5° decreased to 11.3° in the immediate postoperative with a mean deformity correction of 5.2. Not statistically significant correction loss was registered at 1-year minimum follow-up. Constant clinical conditions improvement in the examined patients was observed.
CONCLUSION
Percutaneous pedicle screw fixation for A3 thoraco-lumbar and lumbar spinal fractures is a reliable and safe procedure.
LEVEL OF EVIDENCE
Level IV. Retrospective study.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Humans; Lumbar Vertebrae; Male; Middle Aged; Pedicle Screws; Radiography; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Visual Analog Scale; Young Adult
PubMed: 25108675
DOI: 10.1016/j.otsr.2014.06.003 -
BMC Musculoskeletal Disorders Dec 2021It is not clear whether modified facet fusion (MFF) is biomechanically different from traditional fusion techniques such as posterior lateral lumbar fusion (PLF) and...
BACKGROUND
It is not clear whether modified facet fusion (MFF) is biomechanically different from traditional fusion techniques such as posterior lateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF).
METHODS
In this study, a healthy adult Chinese male volunteer was selected to perform 3D reconstruction of CT image data and simulate the successful fusion of L4-5 MFF, PLF and PLIF, respectively. The motion range of L4-5 segments of the model was simulated under 6 working conditions, including forward flexion, extension, lateral flexion and rotation under normal physiological conditions, and the stability of the three fusion procedures in the pathological segments of the lumbar spine was compared.
RESULTS
There was no difference in range of motion between MFF model and PLF or PLIF model (P < 0.05). Also, the stiffness of the PLFand the MFF model were comparable (P > 0.05), but were smaller than the PLIF model (P < 0.05).
CONCLUSIONS
MFF provides reliable stability at the lumbar fixation fusion level and does not differ significantly from PLF and PLIF in terms of range of motion.
Topics: Adult; Biomechanical Phenomena; Humans; Lumbar Vertebrae; Lumbosacral Region; Male; Range of Motion, Articular; Spinal Fusion
PubMed: 34863121
DOI: 10.1186/s12891-021-04899-x -
Acta Cirurgica Brasileira Dec 2018To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP).
PURPOSE
To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP).
METHODS
TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described.
RESULTS
This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers.
CONCLUSION
This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.
Topics: Anatomic Landmarks; Animals; Cadaver; Diskectomy, Percutaneous; Endoscopy; Fluoroscopy; Lumbar Vertebrae; Models, Animal; Needles; Reference Standards; Reference Values; Reproducibility of Results; Swine
PubMed: 30624513
DOI: 10.1590/s0102-865020180120000005