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Pang L, Gao Z, Ma L, Li Y, Lu Z, Zhang L, Li P, Wu L. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis. Open Med (Wars) 2024; 19:20240983. [PMID: 38911257 PMCID: PMC11193356 DOI: 10.1515/med-2024-0983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
The bleeding time and amount in the short-segment group were shorter than in the long-segment group, and the bleeding volume was less than in the long-segment group. The Japanese Orthopaedic Association low back pain score, Oswestry Dysfunction Index, and lumbar spine stiffness disability index score of the two groups were significantly improved preoperatively, postoperatively, and at 6 months, 1 year, and 2 years post-operation. The differences were statistically significant at different time points within the groups. Neurological function improved to varying degrees postoperatively. The Cobb angle was significantly higher in both groups (P < 0.05). Adjacent vertebral disease occurred in 10 of 64 patients with short-segment fixation, with a prevalence of 15.6%. Preoperative pelvic tilt angle, preoperative pelvic projection angle (PPA), preoperative degree of matching of PPA to LL (PI-LL), and preoperative coronal Cobb angle were higher in patients with adjacent vertebral disease. There were varying degrees of improvement in low back pain and spinal function after short-segment decompression and fusion internal fixation. However, the patients are generally elderly and at risk of persistent low back pain and accelerated degeneration of adjacent segments.
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Affiliation(s)
- Long Pang
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Zhihui Gao
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Long Ma
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yaping Li
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Zhidong Lu
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Liang Zhang
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Peng Li
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Long Wu
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
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Issa TZ, Toci GR, Lambrechts MJ, Lee Y, Sherman M, Brush PL, Siegel N, Trenchfield D, Lambo D, Parson J, Kim E, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision? Clin Spine Surg 2023; 36:E435-E441. [PMID: 37482629 DOI: 10.1097/bsd.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the effects of discontinuity in care by changing surgeons, health systems, or increased time to revision surgery on revision spine fusion surgical outcomes and patient-reported outcomes. SUMMARY OF BACKGROUND INFORMATION Patients undergoing revision spine fusion experience worse outcomes than those undergoing primary lumbar surgery. Those requiring complex revisions are often transferred to tertiary or quaternary referral centers under the assumption that those institutions may be more accustomed at performing those procedures. However, there remains a paucity of literature assessing the impact of discontinuity of care in revision spinal fusions. METHODS Patients who underwent revision 1-3 level lumbar spine fusion 2011-2021 were grouped based on (1) revision performed by the index surgeon versus a different surgeon, (2) revision performed within the same versus different hospital system as the index procedure, and (3) length of time from index procedure. Multivariate regression for outcomes controlled for confounding differences. RESULTS A total of 776 revision surgeries were included. An increased time interval between the index procedure and the revision surgery was predictive of a lower risk for subsequent revision procedure (odds ratio: 0.57, P =0.022). Revision surgeries performed by the same surgeon predicted a reduced length of hospital stay (β: -0.14, P =0.001). Neither time to revision nor undergoing by the same surgeon or same practice predicted 90-day readmission rates. Patients are less likely to report meaningful improvement in Mental Component Score-12 or Physical Component Score-12 if revision surgery was performed at a different hospital system. CONCLUSIONS Patients who have revision lumbar fusions have similar clinical outcomes regardless of whether their surgeon performed the index procedure. However, continuity of care with the same surgeon may reduce hospital length of stay and associated health care costs. The length of time between primary and revision surgery does not significantly impact patient-reported outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Okubo T, Nagoshi N, Tsuji O, Nishimura S, Suzuki S, Nori S, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment. Global Spine J 2023; 13:1745-1753. [PMID: 34620008 PMCID: PMC10556912 DOI: 10.1177/21925682211047460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. METHODS Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). RESULTS In all cases, the various GSSA parameters (sagittal vertical axis, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12-L2 kyphosis, or LL did not affect the postoperative changes in T12-L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. CONCLUSIONS Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Soraya Nishimura
- Department of Orthopaedics Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Baranowska-Kijewska J, Baranowski P, Baranowska A, Jarzyński T, Rybarczyk M. Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease. Arch Med Sci 2023; 19:1154-1161. [PMID: 37560744 PMCID: PMC10408031 DOI: 10.5114/aoms/165859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION The number of reoperations increases with the growing number of operations performed. METHODS The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. RESULTS The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. CONCLUSIONS Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.
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Affiliation(s)
| | - Paweł Baranowski
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Alicja Baranowska
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Tobiasz Jarzyński
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Department of Descriptive and Clinical Anatomy, the Medical University of Warsaw, Warsaw, Poland
| | - Marek Rybarczyk
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
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Miękisiak G. Failed Back Surgery Syndrome: No Longer a Surgeon's Defeat-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1255. [PMID: 37512066 PMCID: PMC10384667 DOI: 10.3390/medicina59071255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The introduction of the term Persistent Spinal Pain Syndrome (PSPS-T1/2), replacing the older term Failed Back Surgery Syndrome (FBSS), has significantly influenced our approach to diagnosing and treating post-surgical spinal pain. This comprehensive review discusses this change and its effects on patient care. Various diagnostic methods are employed to elucidate the underlying causes of back pain, and this information is critical in guiding treatment decisions. The management of PSPS-T1/2 involves both causative treatments, which directly address the root cause of pain, and symptomatic treatments, which focus on managing the symptoms of pain and improving overall function. The importance of a multidisciplinary and holistic approach is emphasized in the treatment of PSPS-T1/2. This approach is patient-centered and treatment plans are customized to individual patient needs and circumstances. The review concludes with a reflection on the impact of the new PSPS nomenclature on the perception and management of post-surgical spinal pain.
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Affiliation(s)
- Grzegorz Miękisiak
- Institute of Medicine, University of Opole, 45-040 Opole, Poland
- Vratislavia Medica Hospital, 51-134 Wrocław, Poland
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Zhang B, Hu Y, Kong Q, Feng P, Liu J, Ma J. Comparison of Oblique Lumbar Interbody Fusion Combined with Posterior Decompression (OLIF-PD) and Posterior Lumbar Interbody Fusion (PLIF) in the Treatment of Adjacent Segmental Disease(ASD). J Pers Med 2023; 13:jpm13020368. [PMID: 36836602 PMCID: PMC9966658 DOI: 10.3390/jpm13020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND An unintended consequence following lumbar fusion is the development of adjacent segment disease (ASD). Oblique lumbar interbody fusion combined with posterior decompression (OLIF-PD) is another feasible option for ASD, and there is no literature report on this combined surgical strategy. METHODS A retrospective analysis was performed on 18 ASD patients requiring direct decompression in our hospital between September 2017 and January 2022. Among them, eight patients underwent OLIF-PD revision and ten underwent PLIF revision. There were no significant differences in the baseline data between the two groups. The clinical outcomes and complications were compared between the two groups. RESULTS The operation time, operative blood loss and postoperative hospital stay in the OLIF-PD group were significantly lower than those in the PLIF group. The VAS of low back pain in the OLIF-PD group was significantly better than that in the PLIF group during the postoperative follow-up. The ODI at the last follow-up in the OLIF-PD group and the PLIF group were significantly relieved compared with those before operation. The excellent and good rate of the modified MacNab standard at the last follow-up was 87.5% in the OLIF-PD group and 70% in the PLIF group. There was a statistically significant difference in the incidence of complications between the two groups. CONCLUSION For ASD requiring direct decompression after posterior lumbar fusion, compared with traditional PLIF revision surgery, OLIF-PD has a similar clinical effect, but has a reduced operation time, blood loss, hospital stay and complications. OLIF-PD may be an alternative revision strategy for ASD.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Qingquan Kong
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
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Zhong Y, Ding Y, Fu B, Ma G, Cui H, Li M, Yu Y, Guan L. The effectiveness of postoperative exercise based on gait analysis compared with conventional exercise in patients with lumbar spinal stenosis: A randomized clinical trial. J Back Musculoskelet Rehabil 2023; 36:1399-1409. [PMID: 37482981 DOI: 10.3233/bmr-220409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Despite being used as a program of postoperative rehabilitation, few randomized controlled trials have compared the effectiveness of postoperative exercise based on gait analysis in patients with lumbar spinal stenosis (LSS). OBJECTIVE To investigate the effectiveness of postoperative exercise based on gait analysis in patients with LSS and to compare it with the effectiveness of conventional exercise. METHODS This was a double-blind, randomized clinical trial. Sixty-eight participants with LSS were randomly assigned to one of two groups. After receiving a standardized surgical procedure, the observation group received exercises based on 3-D gait analysis, and the control group received empirical physiotherapy containing 4 basic interventions. Both groups took a one-hour session twice daily for 2 weeks. The Oswestry Disability Index (ODI) scale and the Visual Analog Scale (VAS) were measured before and 2 weeks and 6 months after intervention. The gait indicators were measured before and 6 months after intervention. RESULTS At baseline, there were no significant differences in the ODI, VAS or absolute symmetry index (ASI) of the gait variables between the observation group and the control group. However, at 6 months, pain intensity, walking, standing, social life and summary scores of ODI and VAS of the leg demonstrated significant differences (p< 0.05, respectively) between groups, and the observation group had greater reductions in ASI of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with the control group (p< 0.05, respectively). CONCLUSIONS The postoperative rehabilitation scheme based on gait analysis resulted in significant short- to medium-term improvements in pain intensity, walking, standing, social life and the summary score of ODI, VAS of leg and symmetry of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with empirical exercise in patients with LSS.
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Affiliation(s)
- Yuxian Zhong
- Medical School of Chinese PLA, Beijing, China
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Ding
- Orthopedics of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bensheng Fu
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guanghao Ma
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongpeng Cui
- Orthopedics of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minyue Li
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Yu
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Guan
- Acupuncture Department of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
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Xiao X, Chen G, Wang S, Liu J, Lin E, Chen K, Xiang Y, Zhan K, Liu C, Yuan Z, Yang M, Zhong S, Zhen W, Yang D, Peng S. Efficacy of the Dynesys Hybrid Surgery for Patients with Multi-Segmental Lumbar Spinal Stenosis. Front Surg 2022; 9:849679. [PMID: 35711699 PMCID: PMC9195297 DOI: 10.3389/fsurg.2022.849679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The efficacy of hybrid (Dynesys and fusion) surgery and the traditional transforaminal lumbar interbody fusion surgery was compared in patients with multi-segmental lumbar spinal stenosis. Methods A total of 68 patients with multi-segmental lumbar spinal stenosis subjected to surgery were recruited between January 2013 and October 2020 in the First Affiliated Hospital of Southern University of Science and Technology. The patients were divided into a hybrid group (N = 33) and a TLIF group (N = 35) by surgery. After surgery, follow-up was conducted for 12 months. Between the two groups, the following parameters were compared: general conditions, clinical symptom scores, imaging parameters, and early complications. Results A statistically significant difference in the duration of surgery was noted between the two groups. After 12 months of follow-up, the range of motion disappeared in the TLIF group, while 63.53% was preserved in the hybrid group with statistically significant differences. A statistically significant difference was identified in the Oswestry Disability Index one week after surgery. Nonetheless, no statistically significant differences were observed at the 12-month post-surgical follow-up. Pfirrmann grade showed a 3.03% upper adjacent segment degeneration rate in the hybrid group (1/33) at 12-month follow-up and 2.86% (1/35) in the TLIF group. Notably, no early complications (screw loosening and wound infection) were identified in the two groups. Conclusion The Dynesys hybrid surgery combined the advantages of two systems of dynamic stabilization and rigid fusion. Besides, hybrid surgery is potentially a novel approach for the treatment of multi-segmental lumbar spinal stenosis.
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Affiliation(s)
- Xiao Xiao
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Gaoyang Chen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
| | - Song Wang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Junliang Liu
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Erhu Lin
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Ke Chen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Yucheng Xiang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Ke Zhan
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Congcong Liu
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Zhengbin Yuan
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Minjie Yang
- Department of Radiology, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Shuyuan Zhong
- Department of Radiology, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Wanxin Zhen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Dazhi Yang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
| | - Songlin Peng
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
- Correspondence: Peng Songlin
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Tobing SDAL, Winartomo A. Recurrent spinal stenoses after implant removal: A case report. Ann Med Surg (Lond) 2022; 78:103731. [PMID: 35734725 PMCID: PMC9206926 DOI: 10.1016/j.amsu.2022.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Cervical spinal stenoses is becoming more and more common due to the aging population. The degenerative changes in the spine including discopathy or spondylosis will constrict and narrow the spinal canal and the usual site for the stenoses is in the cervical and lumbar region. The mainstay of the treatment is surgical, however there still a controversy regarding which approach is the best for the patient with cervical stenoses. Case presentation In this case reports we present a case of 63-year-old male who came to our center due to weakness of arms and legs due to cervical spinal stenoses and underwent treatment after which the implant was removed, and the symptoms worsens. Clinical discussion We performed Anterior Cervical Discectomy and Fusion (ACDF) and insertion of a cages to stabilize the spine. ACDF associated with lower intraoperative blood loss, similar surgical duration, and complication rate compared with laminoplasty. From the radiological outcome, ACDF showed a better-preserved cervical lordosis, which could affects patient's quality of life. Conclusion ACDF is one of the viable methods for the treatment of the cervical stenoses with lower complication rate and good clinical outcomes. Cervical spinal stenoses is a common degenerative disease in aging population. There still a controversy regarding the best surgical approach for the patient. An option includes Anterior Cervical Discectomy and Fusion (ACDF). ACDF with insertion of cages provides less complication rate. ACDF with insertion of cages also result in better clinical outcomes.
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Tamagawa S, Nojiri H, Okuda T, Miyagawa K, Sato T, Takahashi R, Shimura A, Ishijima M. Trans-Sacral Epiduroscopic Ho:YAG Laser Ablation of the Ligamentum Flavum in a Live Pig. Spine Surg Relat Res 2022; 6:167-174. [PMID: 35478976 PMCID: PMC8995116 DOI: 10.22603/ssrr.2021-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction For the aging population, surgery for lumbar spinal canal stenosis (LSCS) requires minimally invasive procedures. Recently, trans-sacral epiduroscopic laser decompression for lumbar disc herniation has been reported with good results. In this study, we devised a new method to perform trans-sacral epiduroscopic laser ablation of the ligamentum flavum (LF), known to be the major cause of LSCS. Using a live pig, this study aims to evaluate the efficacy, safety, and drawbacks of this procedure. Methods Using an epiduroscope, we observed intra-spinal canal structures and then examined the feasibility and problems of a decompression procedure to ablate the LF using holmium:YAG (Ho:YAG) laser. The pig was observed for behavioral changes and neurological deficits after the procedure. Histological analysis was performed to evaluate the amount of tissue ablation and damage to surrounding tissues. Results Although it was possible to partially ablate the LF using the Ho:YAG laser under epiduroscopy, it was difficult to maintain a clear field of view, and freely decompressing the target lesion has been a challenge. After the first two experiments, the pig neither showed abnormal behavior nor any signs of pain or paresis. However, in the third experiment, the pig died during the operation. On autopsy, no thermal or mechanical injury was noted around the ablated site, including the dura mater and nerve root. Histological analysis showed that the LF and lamina were deeply ablated as the laser power increased, and no damage was noted on surrounding tissues beyond a depth of 500 μm. Conclusions Although Ho:YAG laser could ablate the ligamentum and bone tissues without causing damage to surrounding tissues, it was difficult to completely decompress the LF under epiduroscopy. This method is a potentially highly invasive procedure that requires caution in its clinical application and needs further improvement in terms of the instruments and techniques used.
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Affiliation(s)
- Shota Tamagawa
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Hidetoshi Nojiri
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Takatoshi Okuda
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Kei Miyagawa
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Tatsuya Sato
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Ryosuke Takahashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Arihisa Shimura
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine
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Wnt/ β-Catenin Pathway Balances Scaffold Degradation and Bone Formation in Tissue-Engineered Laminae. Stem Cells Int 2021; 2021:8359582. [PMID: 34552633 PMCID: PMC8452400 DOI: 10.1155/2021/8359582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023] Open
Abstract
Tissue engineering provides a promising way for the regeneration of artificial vertebral laminae. Previous studies have confirmed the feasibility of reconstructing vertebral laminae via hydroxyapatite-collagen I scaffolds and mesenchymal stromal cells. However, there were no studies exploring the degradation of hydroxyapatite-collagen I scaffolds and the function of Wnt/β-catenin pathway in the process. In this study, tissue-engineered laminae (TEL) were constructed by nanohydroxyapatite/collagen I scaffolds and umbilical cord Wharton's Jelly mesenchymal stromal cells (WJ-MSCs). Cell attachment was observed by scanning electron microscopy, and cell viability was confirmed by Live/Dead staining. The rat models were randomly divided into control and β-catenin inhibition groups. Vertebral lamina defect rat models were made on the fifth lumbar vertebrate, and TEL was implanted into the defect site. After 14 weeks, the newborn laminae were harvested for microcomputed tomography, histology, or transcriptional profile analysis. We found that, for the control group, the newborn lamina formation matched with the scaffold degradation and complete newborn laminae formed at the 14th week; for the β-catenin inhibition group, the scaffold degradation rate overrated the lamina formation and no complete artificial laminae were formed at the 14th week. In addition, the osteoclastic genes, such as Cathepsin K or RANKL, in the control groups were significantly lower than the β-catenin inhibition group, and the antiosteoclastic gene, OPG, in the control group was significantly higher than the β-catenin inhibition group. In conclusion, inhibition of Wnt/β-catenin pathway led to speedy scaffold degradation and deferred artificial lamina formation. Wnt/β-catenin pathway played a critical role in maintaining the balance between scaffold degradation and bone formation in the process of vertebral lamina reconstruction.
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Pérez-López JC, Olivella G, Cartagena M, Nieves-Ríos C, Acosta-Julbe J, Ramírez N, Massanet-Volrath J, Montañez-Huertas J, Escobar E. Associated factors of patients with spinal stenosis who undergo reoperation after a posterior lumbar spinal fusion in a Hispanic-American population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1491-1499. [PMID: 34550474 DOI: 10.1007/s00590-021-03127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the associated factors of patients with LSS who undergo reoperation after a PLSF in a Hispanic-American population. METHODS A retrospective single-center review was performed from all non-age-related Hispanic-Americans with LSS who underwent one or two-level PLSF from 2008 to 2018. Baseline characteristics were analyzed between the reoperation and no-reoperation group using a bivariate and multivariate analyses. RESULTS Out of 425 patients who underwent PLSF, 38 patients underwent reoperation. At a two-year follow-up, the reoperation rate was 6.1% (26/425), mostly due to pseudoarthrosis (39.5%), recurrent stenosis (26.3%), new condition (15.8%), infection (10.5%), hematoma (5.3%), and dural tear (2.6%). Patients who underwent reoperation were more likely to have a preoperative history of epidural steroid injection (ESI) (OR 5.18, P = 0.009), four or more comorbidities (OR 2.69, P = 0.028), and operated only with a posterolateral fusion without intervertebral fusion (OR 2.15, P = 0.032). Finally, the multivariable analysis showed that ESI was the only independent associated factor in patients who underwent reoperation after a PLSF in our group. CONCLUSION Among this population who underwent surgery, a reoperation rate at two years of follow-up was less than ten percent. Our study did not find any associated factor inherent to Hispanic-Americans, as ethnic group, who were reoperated after LSS.
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Affiliation(s)
- José C Pérez-López
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Gerardo Olivella
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA.
| | - Miguel Cartagena
- Surgery Department, School of Medicine, Ponce Health Sciences University, Ponce, PR, 00716, USA
| | - Christian Nieves-Ríos
- Surgery Department, School of Medicine, Ponce Health Sciences University, Ponce, PR, 00716, USA
| | - José Acosta-Julbe
- School of Medicine, Medical Sciences Campus, UPR, San Juan, PR, 00936-5067, USA
| | - Norman Ramírez
- Pediatric Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, PR, 00681, USA
| | - José Massanet-Volrath
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - José Montañez-Huertas
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Enrique Escobar
- Orthopaedic Surgery Department, Medical Sciences Campus, UPR, PO Box 365067, San Juan, PR, 00936-5067, USA
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