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Ifthekar S, Ahuja K, Mittal S, Yadav G, Chaturvedi J, Sarkar B, Kandwal P. Outcomes of Dorsolumbar and Lumbar Spinal Tuberculosis Treated by Minimally Invasive and Open Techniques: A Prospective Comparative Study. Indian J Orthop 2024; 58:558-566. [PMID: 38694702 PMCID: PMC11058730 DOI: 10.1007/s43465-024-01123-5] [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] [Received: 05/31/2023] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Purpose of Study To compare the outcomes of minimally invasive and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB). Methods Skeletally mature patients with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included. Healed and mechanically stable STB, patients having severe hepatic and renal impairment, coexisting spinal conditions such as ankylosing spondylitis and rheumatoid arthritis, and patients unwilling to participate were excluded from the study. The patients were divided in to two groups, group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 24 months. Results A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs 742 ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (16° vs 33.25°) was significantly better in group B. Rest of the parameters such as duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups. Conclusion MIS stabilization when compared to open techniques is associated with significant improvement in immediate post-operative VAS scores. The MIS approaches at 2-year follow-up have functional results similar to open techniques. MIS is inferior to open techniques in kyphosis correction and may be associated with complications.
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Affiliation(s)
- Syed Ifthekar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- BLK Max Speciality Hospital, Delhi, India
| | - Gagandeep Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Jiitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
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Kose HC, Aydin SO. Magnetic Resonance Imaging Evaluation of Multifidus Muscle in Patients with Low Back Pain after Microlumbar Discectomy Surgery. J Clin Med 2023; 12:6122. [PMID: 37834767 PMCID: PMC10573099 DOI: 10.3390/jcm12196122] [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: 08/22/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Cross-sectional area (CSA) and signal intensity ratio (SIR) of the multifidus muscle (MFM) on magnetic resonance imaging (MRI) was used to evaluate the extent of injury and atrophy of the MFM in patients with negative treatment outcomes following microlumbar discectomy (MLD). Negative treatment outcome was determined by pain score improvement of <50% compared to baseline. Patients in groups 1, 2, and 3 were evaluated at <4 weeks, 4-24 weeks, and >24 weeks postoperatively, respectively. The associations between the follow-up, surgery time and the changes in the MFM were evaluated. A total of 79 patients were included, with 22, 27, and 30 subjects in groups 1, 2, and 3, respectively. The MFM SIR of the ipsilateral side had significantly decreased in groups 2 (p = 0.001) and 3 (p < 0.001). The ipsilateral MFM CSA significantly decreased postoperatively in groups 2 (p = 0.04) and 3 (p = 0.006). The postoperative MRI scans found significant MFM changes on the ipsilateral side in patients with negative treatment outcomes regarding pain intensity following MLD. As the interval to the postoperative MRI scan increased, the changes in CSA of the MFM and change in T2 SIR of the MFM showed a tendency to increase.
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Affiliation(s)
- Halil Cihan Kose
- Department of Pain Medicine, Health Science University Kocaeli City Hospital, 41060 Kocaeli, Turkey
| | - Serdar Onur Aydin
- Department of Neurosurgery, Health Science University Dr. Lutfi Kirdar Training and Research Hospital, 34120 Istanbul, Turkey
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Bongetta D, de Laurentis C, Bruno R, Versace A, Colombo EV, Giussani CG, Assietti R. Is Advanced Age a Factor That Influences the Clinical Outcome of Single- or Double-Level MIS-TLIF? A Single-Center Study with a Minimum Two-Year Follow-Up on 103 Consecutive Cases. Life (Basel) 2023; 13:1401. [PMID: 37374183 DOI: 10.3390/life13061401] [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: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
As life expectancy rises, more elderly people undergo spinal fusion surgery to treat lumbar degenerative diseases. The MIS-TLIF technique, which minimizes soft tissue manipulation, is a promising fusion technique for frailer patients. The aim of this study was to investigate if older age is a significant factor in the clinical outcome of single- or double-level MIS-TLIF. A cross-sectional study was conducted on 103 consecutive patients. Data were compared between younger (<65 y.o.) and older (≥65 y.o.) patients. We observed no significant differences between baseline characteristics of the two groups apart from the frequency of disk space treated, with a relative predominance of L3-L4 space treated in the elderly (10% vs. 28%, p = 0.01) and L5-S1 space in younger patients (36% vs. 5%, p = 0.006). There was no significant difference in complication rate, surgical satisfaction, EQ 5D-5L, or Oswestry Disability Index (ODI) global or specific scores, with the exception of the EQ 5D-5L "mobility" score, where older patients fared worse (1.8 ± 1.1 vs. 2.3 ± 1.4; p = 0.05). The minimal invasiveness of the surgical technique, age-related specific outcome expectations, and biomechanical issues are all potential factors influencing the lack of age group differences in outcome scores.
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Affiliation(s)
- Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, 20121 Milano, Italy
| | - Camilla de Laurentis
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, 20121 Milano, Italy
- Neurosurgery Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, Università degli Studi di Milano Bicocca, 20126 Milano, Italy
| | - Raffaele Bruno
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, 20121 Milano, Italy
- Neurosurgery Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, Università degli Studi di Milano Bicocca, 20126 Milano, Italy
| | - Alessandro Versace
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, 20121 Milano, Italy
- Neurosurgery Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Carlo Giorgio Giussani
- Neurosurgery Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, Università degli Studi di Milano Bicocca, 20126 Milano, Italy
| | - Roberto Assietti
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, 20121 Milano, Italy
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Schermann H, Hochberg U, Regev GJ, Salame K, Ofir D, Ankori R, Lidar Z, Khashan M. The effect of subcutaneous fat and skin-to-lamina distance on complications and functional outcomes of minimally invasive lumbar decompression. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05852-4. [PMID: 37249629 DOI: 10.1007/s00264-023-05852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Minimally invasive lumbar decompression (MIS) in obese pzatients is technically challenging due to the use of longer tube retractors. The purpose of this study was to evaluate the impact of the thickness of the soft tissue and subcutaneous fat on complications, revisions, and patient-reported functional outcomes after MIS. METHODS This is a retrospective analysis of 148 consecutive patients who underwent minimally invasive lumbar decompression at our institute between 2013 and 2017 and had at least one year of follow-up. Analysis was performed five times, each time the study group was defined by another measure of adiposity: BMI > 30, skin to lamina distance at the site of surgery and at L4 > 6 cm, and subcutaneous fat thickness at the site of surgery and at L4 > 3 cm. Outcomes included intraoperative complications (durotomy or neurological deficit), possibly inadequate decompression (residual disc, reoperation), length of stay, return to the emergency room or readmission, postoperative medical complications, and functional outcomes: visual analog scores for back and leg pain, and Oswestry Disability Index (ODI). RESULTS Patients with a thicker layer soft tissue had a significantly higher burden of comorbidities than controls, including higher prevalence of cardiovascular disease (p = 0.002), diabetes (p < 0.001), hypertension (p < 0.001) and higher ASA scores (p = 0.002). Nevertheless, there was no significant difference between the patient groups in surgical and medical complications, functional outcomes, and other assessed outcomes. CONCLUSION Our results indicate that minimally invasive lumbar decompression is safe and effective for patients with a thick layer of soft tissue and subcutaneous fat.
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Affiliation(s)
- Haggai Schermann
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Uri Hochberg
- Pain Clinic, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Gilad J Regev
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Dror Ofir
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Ankori
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Zvi Lidar
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Morsi Khashan
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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Kameyama K, Ohba T, Endo T, Katsu M, Koji F, Kensuke K, Oda K, Tanaka N, Haro H. Radiological Assessment of Postoperative Paraspinal Muscle Changes After Lumbar Interbody Fusion With or Without Minimally Invasive Techniques. Global Spine J 2023; 13:295-303. [PMID: 33657897 PMCID: PMC9972276 DOI: 10.1177/2192568221994794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. BACKGROUND Percutaneous pedicle screws (PPS) have the advantage of being able to better preserve the paraspinal muscles when compared with a traditional open approach. However, the nature of changes in postoperative paraspinal muscle after damage by lumbar fusion surgery has remained largely unknown. It is clinically important to clarify and compare changes in paraspinal muscles after the various surgeries. OBJECTIVE (1) To determine postoperative changes of muscle density and cross-sectional area using computed tomography (CT), and (2) to compare paraspinal muscle changes after posterior lumbar interbody fusion (PLIF) with traditional open approaches and minimally invasive lateral lumbar interbody fusions (LLIF) with PPS. METHODS We included data from 39 consecutive female patients who underwent open PLIF and 23 consecutive patients who underwent single-staged treatment with LLIF followed by posterior PPS fixation at a single level (L4-5). All patients underwent preoperative, 6 months postoperative, and 1-year postoperative CT imaging. Measurements of the cross-sectional area (CSA) and muscle densities of paraspinal muscles were obtained using regions of interest defined by manual tracing. RESULTS We did not find any decrease of CSA in any paraspinal muscles. We did find a decrease of muscle density in the multifidus at 1 year after surgery in patients in the PILF group, but not in those in LLIF/PPS group. CONCLUSIONS One year after surgery, a significant postoperative decrease of muscle density of the multifidi was observed only in patients who underwent open PLIF, but not in those who underwent LLIF/PPS.
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Affiliation(s)
- Keigo Kameyama
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan,Tetsuro Ohba, MD, PhD, Department of
Orthopaedics, University of Yamanashi, Shimokato, Chuo, Yamanashi 409-3898,
Japan.
| | - Tomoka Endo
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Marina Katsu
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Fujita Koji
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Koyama Kensuke
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery,
University of Yamanashi, Yamanashi, Japan
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Yang F, Liu Z, Zhu Y, Zhu Q, Zhang B. Imaging of muscle and adipose tissue in the spine: A narrative review. Medicine (Baltimore) 2022; 101:e32051. [PMID: 36626484 PMCID: PMC9750571 DOI: 10.1097/md.0000000000032051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
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Affiliation(s)
- Fan Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhengang Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingsan Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Boyin Zhang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
- * Correspondence: Boyin Zhang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China (e-mail: )
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Chen G, Li LB, Shangguan Z, Wang Z, Liu W, Li J. Clinical Effect of Minimally Invasive Microendoscopic-Assisted Transforaminal Lumbar Interbody Fusion for Single-Level Lumbar Disc Herniation. Orthop Surg 2022; 14:3300-3312. [PMID: 36303440 PMCID: PMC9732619 DOI: 10.1111/os.13443] [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: 01/28/2021] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This retrospective study aimed to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach (W-TLIF) vs minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion (ME-TLIF) in single-segment lumbar disc herniation (LDH). METHODS A retrospective study was conducted to study the differences in specific clinical outcomes between single-segment LDH patients receiving W-TLIF and ME-TLIF. Single-segment LDH patients admitted to the Fujian Medical University Union Hospital from March 2015 to June 2018 were included. All the participants were divided into the ME-TLIF group or the W-TLIF group according to their TLIF surgery types. Demographic characteristics, the visual analog score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scale, blood loss volume, postoperative drainage, ambulated time, initial postoperative back pain, hospitalization duration, expenses, and improvement rates of patients in the two groups were collected for analysis. Radiographic fusion was ultimately assessed via the Bridwell interbody fusion grading system. All selected patients with TLIF were followed up for 1 year. RESULTS Fifty-seven patients were selected, with 26 in the ME-TLIF group and 31 in the W-TLIF group, both of whom were followed up for 1 year. The mean age of the included patients was 53.75 ± 9.313 years, and the sex ratio was indiscrimination. There was no significant difference in demographic data or operating time between the two groups prior to surgery. The blood loss volume (ME-TLIF: 228.5 vs W-TLIF: 681.3), postoperative drainage (ME-TLIF:82.1 ± 23.5 vs W-TLIF: 345.8 ± 65.2), initial postoperative back pain (ME-TLIF: VAS_3 days: 1.96 ± 0.60 VAS_7 days: 1.73 ± 0.53, W-TLIF: VAS_3 days: 2.48 ± 0.51 VAS_7 days: 1.87 ± 0.43), and hospitalization duration (ME-TLIF: 9.04 vs. W-TLIF: 11.29) were all significantly lower in the ME-TILF group (p < 0.05). However, there were no statistical differences between the two groups in VAS, ODI, and JOA at 1 month, 3 months, 6 months, and 1 year postoperatively (p > 0.05). The fusion rates of the two groups showed no notable difference (p > 0.05), while the X-ray exposure time in the ME-TLIF group was significantly longer than in the W-TLIF group (p < 0.05). CONCLUSIONS ME-TLIF surgery was an effective and satisfactory surgical technique to manage LDH. Although ME-TLIF increased the operation time and intraoperative fluoroscopic irradiation volume, it could effectively relieve low back pain from early postoperative onset and promote early postoperative recovery compared with W-TLIF.
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Affiliation(s)
- Gang Chen
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
| | - Long Biao Li
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
| | - Zhitao Shangguan
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
| | - Zhenyu Wang
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
| | - Wenge Liu
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
| | - Jiandong Li
- Department of OrthopaedicsFujian Medical University Union HospitalFuzhouChina,Fujian Medical UniversityFuzhouChina,Department of Interventional MedicineNingde Municipal Hospital of Ningde Normal UniversityNingdeChina,Ningde Normal UniversityNingdeChina
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8
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Perez-Roman RJ, Basil GW, Boddu JV, Bashti M, Wang MY. Size matters - From the working channel to the wavelength of light: Optimizing visualization in endoscopic spine surgery. J Clin Neurosci 2022; 105:73-78. [PMID: 36113245 DOI: 10.1016/j.jocn.2022.08.024] [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: 06/20/2022] [Revised: 08/18/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive surgery bases many of its benefits on decreasing tissue disruption. Endoscopic spine surgery has continued to push the boundaries to accomplish successful clinical outcomes through the evolution of the endoscope and working channel. As the indications for endoscopic spine surgery increase, a more profound discussion of cannula size selection for endoscopic spine surgery is required. The intimate relationship between the working channel, the endoscope and how these choices affect workflow and visualization are paramount to maximize outcomes. METHODS The authors review the nuances of the endoscopic approaches to the various regions of the spine as it relates to the selection of the working channel. The advantages and limitations of various endoscopic working channels were analyzed as to how they address anatomic regional considerations as well as ultimate goals of surgery. RESULTS In addition to anatomic regional differences and the goals of the surgery other key elements in endoscopic working channel selection included the amount of tissue disruption, regional risk to the neural elements, impact on visualization, optical physics, and the implications for surgical maneuverability/dexterity. CONCLUSION Understanding the role and use of the endoscope-working channel combination with its effects on visualization is essential for any surgeon aspiring to perform safe and efficient full endoscopic spine surgery.
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Affiliation(s)
- Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gregory W Basil
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James V Boddu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Malek Bashti
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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9
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Jain M, Sahoo A, Naik S, Kumar P, Mishra D. Assessment of the psoas muscle changes following the oblique lateral interbody fusion (OLIF) approach: A prospective observational study. J Orthop 2022; 33:60-65. [PMID: 35864925 PMCID: PMC9294652 DOI: 10.1016/j.jor.2022.07.007] [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] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Traditional open posterior fusion techniques involve stripping of the posterior paraspinal muscles with protracted retraction, which can lead to ischemia and denervation. This may result in poor clinical outcomes despite a well-performed surgery. Oblique lumbar interbody fusion (OLIF) is a minimally invasive modified retroperitoneal anterior approach in the corridor between the psoas major (PM) and great vessels. The purpose of this research was to study changes in psoas properties and clinical outcomes in terms of the loss of hip flexion in patients undergoing OLIF surgery. Methods Patients with lumbar pathologies who underwent instrumented OLIF at our center were included. These patients were examined clinically at baseline and 6 months postoperatively. The Oswestry disability index (ODI) and visual analog scale (VAS) scores for back pain and leg pain were noted. Magnetic resonance imaging (MRI) scans were obtained preoperatively and postoperatively (minimum 6 months) to compare the cross-sectional areas (CSAs) of the PM. Results In total, 17 patients (male: female = 8:9) with a mean age of 46.06 ± 10.49 years were included. The operation time was 154.94 ± 32.33 min, estimated blood loss was 190 ± 56 mL, and mean CSAs of the right and left psoas were, respectively, 9.94 ± 3.19 and 10.65 ± 3.74 cm2 preoperatively and 10.00 ± 3.06 and 8.53 ± 2.81 cm2 at follow-up. Qualitative measurements revealed that muscle atrophy on the left side (approach side) was 19.12% ± 3.14% and fatty degeneration had occurred in 13 of 17 (76.5%) patients. Postoperatively, all patients had significant improvement in the VAS (back and leg) and ODI scores. Furthermore, 3 of 17 (17.6%) patients had mild hip weakness (4/5) on the left side immediately postoperatively, but it resolved in 6 months. Moreover, 2 of 17 (11.8%) patients complained of paraesthesia. Conclusion OLIF does cause injury to the PM but it is clinically insignificant according to MRI scans and clinical evaluations.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Auroshish Sahoo
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Suprava Naik
- Department of Radiology, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Pankaj Kumar
- Department of Surgery, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Dipun Mishra
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
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10
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Fayed I, Tai A, Triano MJ, Weitz D, Sayah A, Voyadzis JM, Sandhu FA. Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy. J Neurosurg Spine 2022; 37:112-120. [PMID: 35120316 DOI: 10.3171/2021.12.spine211176] [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: 09/02/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Single-position lateral lumbar interbody fusion (SP-LLIF) has recently gained significant popularity due to increased operative efficiency, but it remains technically challenging. Robot-assisted percutaneous pedicle screw (RA-PPS) placement can facilitate screw placement in the lateral position. The authors have reported their initial experience with SP-LLIF with RA-PPS placement in the lateral position, and they have compared this accuracy with that of RA-PPS placement in the prone position. METHODS The authors reviewed prospectively collected data from their first 100 lateral-position RA-PPSs. The authors graded screw accuracy on CT and compared it to the accuracy of all prone-position RA-PPS procedures during the same time period. The authors analyzed the effect of several demographic and perioperative metrics, as a whole and specifically for lateral-position RA-PPS placement. RESULTS The authors placed 99 lateral-position RA-PPSs by using the ExcelsiusGPS robotic platform in the first 18 consecutive patients who underwent SP-LLIF with postoperative CT imaging; these patients were compared with 346 prone-position RA-PPSs that were placed in the first consecutive 64 patients during the same time period. All screws were placed at L1 to S1. Overall, the lateral group had 14 breaches (14.1%) and the prone group had 25 breaches (7.2%) (p = 0.032). The lateral group had 5 breaches (5.1%) greater than 2 mm (grade C or worse), and the prone group had 4 (1.2%) (p = 0.015). The operative level had an effect on the breach rate, with breach rates (grade C or worse) of 7.1% at L3 and 2.8% at L4. Most breaches were grade B (< 2 mm) and lateral, and no breach had clinical sequelae or required revision. Within the lateral group, multivariate regression analysis demonstrated that BMI and number of levels affected accuracy, but the side that was positioned up or down did not. CONCLUSIONS RA-PPSs can improve the feasibility of SP-LLIF. Spine surgeons should be cautious and selective with this technique owing to decreased accuracy in the lateral position, particularly in obese patients. Further studies should compare SP-LLIF techniques performed while the patient is in the prone and lateral positions.
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Affiliation(s)
- Islam Fayed
- 1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Alexander Tai
- 1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | | | - Daniel Weitz
- 2Georgetown University School of Medicine, Washington, DC; and
| | - Anousheh Sayah
- 3Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - Jean-Marc Voyadzis
- 1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Faheem A Sandhu
- 1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
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11
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Cofano F, Perna GD, Bongiovanni D, Roscigno V, Baldassarre BM, Petrone S, Tartara F, Garbossa D, Bozzaro M. Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches? Global Spine J 2022; 12:1214-1230. [PMID: 34128419 PMCID: PMC9210241 DOI: 10.1177/21925682211022313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. METHODS Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. RESULTS A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). CONCLUSION Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.
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Affiliation(s)
- Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy,Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Daria Bongiovanni
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Vittoria Roscigno
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Salvatore Petrone
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy,Salvatore Petrone, Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Fulvio Tartara
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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Xin J, Wang Y, Zheng Z, Wang S, Na S, Zhang S. Treatment of Intervertebral Disc Degeneration. Orthop Surg 2022; 14:1271-1280. [PMID: 35486489 PMCID: PMC9251272 DOI: 10.1111/os.13254] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self-renew and differentiate into a variety of tissues. Moreover, the non-coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD.
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Affiliation(s)
- Jingguo Xin
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Yongjie Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Zhi Zheng
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Shuo Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shibo Na
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Shaokun Zhang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China.,Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
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Taha MM, Taha MM, Al Awamry A. A less-invasive technique for posterior spinal fusion using intermittent retraction during pedicle screw insertion: A technical note. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buis N, Esfandiari H, Hoch A, Fürnstahl P. Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review. Front Surg 2022; 8:771275. [PMID: 35155547 PMCID: PMC8825480 DOI: 10.3389/fsurg.2021.771275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures. Methods We performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time. Results The final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on. Discussion An ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.
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Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis. Medicina (B Aires) 2021; 57:medicina57111270. [PMID: 34833488 PMCID: PMC8622409 DOI: 10.3390/medicina57111270] [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: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally invasive (MIS) tubular decompression without arthrodesis in patients suffering from LSS with or without concomitant stable low-grade degenerative spondylolisthesis. Materials and Methods: This study is a retrospective review of prospectively collected data. Ninety-six consecutive patients who underwent elective MIS lumbar decompression with a mean follow-up of 27.5 months were included in the study. The spondylolisthesis (S) group comprised 53 patients who suffered from LSS with stable degenerative spondylolisthesis, and the control (N) group included 43 patients suffering from LSS without spondylolisthesis. Outcome measures included complications and revision surgery rates. Pre- and post-operative visual analog scale (VAS) for both back and leg pain was analyzed, and the Oswestry Disability Index (ODI) was used to evaluate functional outcome. Results: The two groups were comparable in most demographic and preoperative variables. VAS for back and leg pain improved significantly following surgery in both groups. Both groups showed significant improvement in their ODI scores, at one and two years postoperatively. The average length of hospital stay was significantly higher in patients with spondylolisthesis (p-value< 0.01). There was no significant difference between the groups in terms of post-operative complications rates or re-operation rates. Conclusions: Our results indicate that MIS tubular decompression may be an effective and safe procedure for patients suffering from LSS, with or without degenerative stable spondylolisthesis.
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16
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Rasmussen J, Iversen K, Engelund BK, Rasmussen S. Biomechanical Evaluation of the Effect of Minimally Invasive Spine Surgery Compared with Traditional Approaches in Lifting Tasks. Front Bioeng Biotechnol 2021; 9:724854. [PMID: 34733828 PMCID: PMC8558419 DOI: 10.3389/fbioe.2021.724854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Fusion of spinal vertebrae can be accomplished by different surgical approaches. We investigated Traditional Open Spine Surgery (TOSS) versus Minimally Invasive Spine Surgery (MISS). While TOSS sacrifices spine muscles originating or inserting on the affected vertebrae, MISS seeks to minimize the approach-related morbidity and preserve the tendon attachments of the muscles in the area. We captured 3-D motions of the full body of one healthy subject performing a variety of 10 kg box lifting operations representing activities-of-daily-living that are likely to challenge the spine biomechanically. The motion data were transferred to a full-body biomechanical model with a detailed representation of the biomechanics of the spine, and simulations of the internal spine loads and muscle forces were performed under a baseline configuration and muscle configurations typical for TOSS respectively MISS for the cases of L3/L4, L4/L5, L5/S1, L4/S1 and L3/L5 fusions. The computational model was then used to investigate the biomechanical differences between surgeries. The simulations revealed that joint reaction forces are more affected by both surgical approaches for lateral lifting motions than for sagittal plane motions, and there are indications that individuals with fused joints, regardless of the approach, should be particularly careful with asymmetrical lifts. The MISS and TOSS approaches shift the average loads of different muscle groups in different ways. TOSS generally leads to higher post-operative muscle loads than MISS in the investigated cases, but the differences are smaller than could be expected, given the differences of surgical technique.
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Affiliation(s)
- John Rasmussen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | | | | | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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17
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Carroll AH, Dowlati E, Molina E, Zhao D, Altshuler M, Mueller KB, Sandhu FA, Voyadzis JM. Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries. J Neurosurg Spine 2021; 35:460-470. [PMID: 34271544 DOI: 10.3171/2021.1.spine201785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The effect of obesity on outcomes in minimally invasive surgery (MIS) approaches to posterior lumbar surgery is not well characterized. The authors aimed to determine if there was a difference in operative variables and complication rates in obese patients who underwent MIS versus open approaches in posterior spinal surgery, as well as between obese and nonobese patients undergoing MIS approaches. METHODS A retrospective review of all consecutive patients who underwent posterior lumbar surgery from 2013 to 2016 at a single institution was performed. The primary outcome measure was postoperative complications. Secondary outcome measures included estimated blood loss (EBL), operative time, the need for revision, and hospital length of stay (LOS); readmission and disposition were also reviewed. Obese patients who underwent MIS were compared with those who underwent an open approach. Additionally, obese patients who underwent an MIS approach were compared with nonobese patients. Bivariate and multivariate analyses were carried out between the groups. RESULTS In total, 423 obese patients (57.0% decompression and 43.0% fusion) underwent posterior lumbar MIS. When compared with 229 obese patients (56.8% decompression and 43.2% fusion) who underwent an open approach, patients in both the obese and nonobese groups who underwent MIS experienced significantly decreased EBL, LOS, operative time, and surgical site infections (SSIs). Of the nonobese patients, 538 (58.4% decompression and 41.6% fusion) underwent MIS procedures. When compared with nonobese patients, obese patients who underwent MIS procedures had significantly increased LOS, EBL, operative time, revision rates, complications, and readmissions in the decompression group. In the fusion group, only LOS and disposition were significantly different. CONCLUSIONS Obese patients have poorer outcomes after posterior lumbar MIS when compared with nonobese patients. The use of an MIS technique can be of benefit, as it decreased EBL, operative time, LOS, and SSIs for posterior decompression with or without instrumented fusion in obese patients.
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Affiliation(s)
| | - Ehsan Dowlati
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
| | | | - David Zhao
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
| | - Marcelle Altshuler
- 3Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyle B Mueller
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
| | - Faheem A Sandhu
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
| | - Jean-Marc Voyadzis
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and
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Jin YM, Chen Q, Chen CY, Lyu J, Shi B, Yang C, Xia C. Clinical Research and Technique Note of TLIF by Wiltse Approach for the Treatment of Degenerative Lumbar. Orthop Surg 2021; 13:1628-1638. [PMID: 34152699 PMCID: PMC8313142 DOI: 10.1111/os.13055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the clinical efficacy and share the technique notes of Wiltse Approach TLIF for the treating single segment degenerative lumbar spinal disease. Method In this retrospective controlled study, 780 patients with single segment degenerative lumbar disease who were operated in our hospital from January 2016 to December 2020 were analyzed retrospectively. The patients were randomly assigned to Wiltse approach group (group A, 410 cases) and conventional open approach group (group B, 370 cases). Patient's assessment of pain and disability were evaluated by the visual analogue scale (VAS) and the Oswestry disability index (ODI) before and after surgery. The incision length, operative time, exposure time, intraoperative blood loss, hidden blood loss, time to ambulation, total length of hospitalization, serum creatine kinase, X‐rays, CT and MRI were also evaluated. Results There were no differences in sex, age, pre‐operative ODI score, VAS score between the two groups (P > 0.05). The Wiltse approach group had a shorter incision length with 7.69 ± 0.44 cm compared to the conventional group with 11.13 ± 0.36 cm (P < 0.01). The average operative time was 119.20 ± 14.64 min with exposure time of 16.20 ± 3.42 min in the Wiltse approach group and 145.65 ± 16.98 min with 29.20 ± 3.42 min in the conventional group (P < 0.05, P < 0.01). Comparing the intraoperative blood loss, hidden blood loss, serum creatine kinase, time to ambulation, total length of hospitalization, the Wiltse approach group was less than the conventional open approach group (P < 0.05). The VAS score of the two groups decreased significantly with time, and the VAS score of the Wiltse group was significantly lower than that of the conventional open approach group (P < 0.05). At last investigation after operation, ODI scores of the two groups were significantly decreased compared with that before operation. Wiltse approach group was significantly lower than that of the conventional open approach group (P < 0.05). The multifidus of the two groups of patients had a certain degree of atrophy. But the Wiltse approach group multifidus muscle atrophy rate is significantly lower than the conventional open approach group. Conclusion The Wiltse approach TLIF significantly reduces the damage to the paravertebral muscles and the postoperative incidence of chronic low back pain.
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Affiliation(s)
- Yong-Ming Jin
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Qi Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Chu-Yong Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jun Lyu
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Binbin Shi
- Department of Orthopaedic Surgery, Tongxiang First People's Hospital, Tongxiang, China
| | - Chen Yang
- Department of Orthopaedic Surgery, The First People's Hospital of Akesu, Akesu, China
| | - Chen Xia
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
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Gosal JS, Ruparelia J, Garg M, Bhaskar S, Singh S, Jha DK. Modified Taylor Retractor in Unilateral Subperiosteal Lumbar Microdiscectomy: A Frugal Alternative to the Tubular Retractor. World Neurosurg 2021; 152:44-55. [PMID: 34098143 DOI: 10.1016/j.wneu.2021.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To do a comparative surgical outcome and cost-benefit analysis of our simple modified Taylor retractor with both open and tubular techniques in lumbar discectomy. METHODS We retrospectively divided 52 lumbar disc patients operated by 2 different techniques between January 2019 and June 2020 into 2 groups- group 1 (n = 20): standard open macrodiscectomy (4-5 cm incision); group 2 (n = 32): unilateral translaminar microdiscectomy using our modified Taylor retractor with a small incision (18-20 mm, comparable to the tubular retractor). We compared both groups in terms of surgical outcomes and cost-benefit analysis. In addition, a cost-benefit comparison between our modified Taylor technique and that of the already published tubular microdiscectomy cohort was done. RESULTS Complete symptom resolution occurred in 85% group 1 and 84.4% group 2 patients, with no difference in complication rates. Mean hospital stay was significantly less in group 2 (1.2 ± 0.37 days) as compared with group 1 (2.4 ± 1.15, P < 0.001). The mean total cost per patient was $2253.17 ± 69.16 in the modified Taylor microdiscectomy group compared with $2495.76 ± 214.85 (P < 0.001) in standard macrodiscectomy. Compared with the previously published tubular microdiscectomy cohort ($3069.91 ± 69.16), the modified Taylor retractor was $816.74 cheaper per patient with similar length of incision, surgical outcome, and hospital stay. CONCLUSIONS Similar clinical outcomes at decreased costs are obtained using the modified Taylor retractor compared with the tubular retractor. The modified Taylor retractor has a simple design, is user-friendly, and frugal alternative to the tubular retractor system for microscopic discectomy, especially in the resource-constrained countries.
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Affiliation(s)
- Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Jigish Ruparelia
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Deepak Kumar Jha
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
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Molina E, Zhao D, Dowlati E, Carroll AH, Mueller KB, Sandhu FA, Voyadzis JM. Minimally invasive posterior lumbar surgery in the morbidly obese, obese and non-obese populations: A single institution retrospective review. Clin Neurol Neurosurg 2021; 207:106746. [PMID: 34144463 DOI: 10.1016/j.clineuro.2021.106746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/20/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of information regarding outcomes in minimally invasive surgical (MIS) approaches to posterior lumbar surgery in morbidly obese patients. We seek to determine if there are differences in operative variables and early complication rates in morbidly obese patients undergoing MIS posterior lumbar surgery compared to obese and non-obese patients. METHODS A single institution retrospective review of patients undergoing MIS posterior lumbar surgery (decompression and/or fusion) between 2013 and 2016 was performed. Morbidly obese patients (BMI ≥ 40) were compared to obese (BMI 30-39.9) and non-obese (BMI < 30) cohorts. Postoperative complication rates and perioperative variables including estimated blood loss, operative time, and outcome measures including length of stay (LOS), in-hospital complications, readmission, and disposition were assessed. RESULTS 47 morbidly obese, 135 obese and 224 non-obese patients underwent posterior MIS instrumented fusion. 59 morbidly obese, 182 obese and 314 non-obese patients underwent posterior MIS decompression. The morbidly obese group experienced a greater rate of deep vein thrombosis and had an increased hospital LOS (p < 0.05). Morbidly obese patients who underwent MIS decompression experienced increased postoperative complications (p < 0.01), and increased LOS (p < 0.0001) compared to obese and non-obese patients. There were no differences in revision rates, readmissions, and other complications including surgical site infection. Morbid obesity was an independent predictor of overall complications and increased LOS on multivariate analysis. CONCLUSION Morbidly obese patients undergoing posterior MIS fusion had a higher rate of complications and increased LOS. While weight loss should be encouraged, complication rates remains acceptably low in morbidly obese patients and MIS posterior lumbar surgery should still be offered.
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Affiliation(s)
- Esteban Molina
- Georgetown University School of Medicine, Washington, DC, USA
| | - David Zhao
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
| | | | - Kyle B Mueller
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
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Roberti F, Arsenault KL. Minimally invasive tubular laminectomies in multilevel spine surgery-an illustrative case-based review of techniques and combined approaches. JOURNAL OF SPINE SURGERY 2021; 7:83-99. [PMID: 33834131 DOI: 10.21037/jss-20-635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive techniques have become part of the spine surgeons' armamentarium and are currently utilized to treat many conditions involving the cervical, thoracic, lumbar and sacral spine. Surgical treatment of severe degenerative conditions such as multilevel spinal stenosis, tandem stenosis, combination of stenosis or disk herniation and spondylolisthesis at adjacent spinal levels, as well as extensive infections or hematomas, may require a multilevel tailored approach with all the challenges that such surgical planning entails. Although the use of minimally invasive tubular decompressive procedures has gained widespread popularity in the recent years, the adoption of such techniques during multilevel spine surgery can be at times challenging. A careful tailored selection of the surgical approach that better fits needs and expectations of the patient is therefore consequential to achieve good clinical and radiological outcome without compromising efficiency and results. Many surgical techniques have been described in literature but very few reports on the use of combined tubular approached are currently present. We therefore present an illustrative review of techniques for tubular laminectomies and combined approaches that can be utilized in the surgical treatment of multilevel spinal conditions. Illustrative cases documenting common and less common indications for the use of minimally invasive laminectomies are also presented.
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Affiliation(s)
- Fabio Roberti
- Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA.,Department of Neurological Surgery, The George Washington University, Washington, DC, USA
| | - Katie L Arsenault
- Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA
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Wang Y, Zhang Y, Chong F, Zhou Y, Huang B. Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor. J Int Med Res 2021; 48:300060520920090. [PMID: 32367755 PMCID: PMC7218951 DOI: 10.1177/0300060520920090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the feasibility and clinical results of microscopic minimally
invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a novel
tapered tubular retractor that preserves the multifidus. Method A total of 122 patients underwent MIS-TLIF using a tapered tubular retractor
system from March 2016 to August 2017. Perioperative parameters and
follow-up outcomes were reviewed. Results The follow-up period was 23.95 ± 1.43 months. The operative time averaged
130.48 ± 34.44 minutes. The estimated blood loss was 114.10 ± 96.70 mL. The
mean time until ambulation was 16.33 ± 6.29 hours. The average visual
analogue scale (leg/waist) and Oswestry Disability Index scores
(preoperative to last follow-up) improved from 4.93 ± 2.68/3.74 ± 2.28 to
0.34 ± 0.77/0.64 ± 0.74 and from 59.09% ± 22.34 to 17.04% ± 8.49,
respectively. At the last follow-up, 98.36% of the patients achieved solid
fusion. Cerebrospinal fluid leakage occurred in two cases. The asymptote of
the surgeon’s learning curve occurred at the 25th case. There were no
significant differences between the preoperative qualitative and
quantitative analyses of multifidus muscle fatty infiltration and those at
the final follow-up. Conclusion MIS-TLIF can be performed safely and effectively using this tapered tubular
retractor system, which helps preserve the multifidus.
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Affiliation(s)
- Yan Wang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Fanli Chong
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Kim JS, Park CW, Yeung YK, Suen TK, Jun SG, Park JH. Unilateral Bi-portal Endoscopic Decompression via the Contralateral Approach in Asymmetric Spinal Stenosis: A Technical Note. Asian Spine J 2020; 15:688-700. [PMID: 33189115 PMCID: PMC8561150 DOI: 10.31616/asj.2020.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
We discuss the technical details and operative advantages of approaching pathologies from the contralateral side in cases of asymmetric spinal stenosis. The contralateral approach offers better manipulative freedom and a more accessible target approach along the plane of the pathology, allowing safer decompression and facet preservation; further, this approach is ergonomic for surgeons. We recommend the adoption of this approach in decompressing asymmetric spinal stenosis.
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Affiliation(s)
- Jin-Sung Kim
- Department of Neurosurgery, Spine Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol-Woong Park
- Department of Spinal Surgery, Daejeon Woori Hospital, Daejeon, Korea
| | - Yip-Kan Yeung
- Department of Orthopaedics and Traumatology, Caritas Medical Centre, Kowloon, Hong Kong
| | - Tsz-King Suen
- Department of Orthopaedics and Traumatology, Hong Kong Baptist Hospital, Kowloon, Hong Kong
| | - Su Gi Jun
- Department of Spinal Surgery, Daejeon Woori Hospital, Daejeon, Korea
| | - Jung-Hoon Park
- Department of Spinal Surgery, Daejeon Woori Hospital, Daejeon, Korea
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Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach. Minim Invasive Surg 2020; 2020:5346805. [PMID: 33178457 PMCID: PMC7648676 DOI: 10.1155/2020/5346805] [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: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
We present an illustrative report on the use of a minimally invasive, muscle-sparing, direct pars defect decompression with transforaminal lumbar interbody fusion (TLIF) and instrumentation for the treatment of low-grade adult isthmic spondylolysis with spondylolisthesis and discuss the surgical challenges and nuances associated with the technique.
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25
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Fayed I, Tai A, Triano M, Sayah A, Makariou E, Voyadzis JM, Sandhu FA. Robot-Assisted Percutaneous Pedicle Screw Placement: Evaluation of Accuracy of the First 100 Screws and Comparison with Cohort of Fluoroscopy-guided Screws. World Neurosurg 2020; 143:e492-e502. [DOI: 10.1016/j.wneu.2020.07.203] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
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Comparison of paraspinal muscle degeneration and decompression effect between conventional open and minimal invasive approaches for posterior lumbar spine surgery. Sci Rep 2020; 10:14635. [PMID: 32884010 PMCID: PMC7471290 DOI: 10.1038/s41598-020-71515-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/02/2020] [Indexed: 01/07/2023] Open
Abstract
Laminotomy and transforaminal lumbar interbody fusion (TLIF) is usually used to treat unstable spinal stenosis. Minimally invasive surgery (MIS) can cause less muscle injury than conventional open surgery (COS). The purpose of this study was to compare the degree of postoperative fatty degeneration in the paraspinal muscles and the spinal decompression between COS and MIS based on MRI. Forty-six patients received laminotomy and TLIF (21 COS, 25 MIS) from February 2016 to January 2017 were included in this study. Lumbar MRI was performed within 3 months before surgery and 1 year after surgery to compare muscle-fat-index (MFI) change of the paraspinal muscles and the dural sac cross-sectional area (DSCAS) change. The average MFI change at L2–S1 erector spinae muscle was significantly greater in the COS group (27.37 ± 21.37% vs. 14.13 ± 19.19%, P = 0.044). A significant MFI change difference between the COS and MIS group was also found in the erector spinae muscle at the caudal adjacent level (54.47 ± 37.95% vs. 23.60 ± 31.59%, P = 0.016). DSCSA improvement was significantly greater in the COS group (128.15 ± 39.83 mm2 vs. 78.15 ± 38.5 mm2, P = 0.0005). COS is associated with more prominent fatty degeneration of the paraspinal muscles. Statically significant post-operative MFI change was only noted in erector spinae muscle at caudal adjacent level and L2–S1 mean global level. COS produces a greater area of decompression on follow up MRI than MIS with no statistical significance on clinical grounds.
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Complexities of spine surgery in obese patient populations: a narrative review. Spine J 2020; 20:501-511. [PMID: 31877389 PMCID: PMC7136130 DOI: 10.1016/j.spinee.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 02/03/2023]
Abstract
The obese population is particularly challenging to the spine surgeon in all phases of care. A narrative literature review was performed to review difficulties in spine surgery on the obese patient population and techniques for mitigation. We specifically aimed to assess several topics with regard to this population: patient selection and preoperative care; intraoperative and surgical techniques; and postoperative care, outcomes, and complications. The literature review demonstrated that obese patients are at increased surgical risk with spine surgery due to a variety of factors at all stages of intervention. Preoperatively, obese patients have worse outcomes with physical therapy and present technical difficulties for injections. Transport to a hospital, imaging, resuscitation, and intubation are all challenged by increased body habitus. Intraoperatively, obese patients have increased operative times, blood loss, surgical site infections, and nerve palsies. Patient positioning and intraoperative imaging may be limited. Surgery itself may be technically challenging due to body habitus and minimally invasive techniques are becoming more prevalent in this population. Postoperatively, several studies demonstrate that obese patients have inferior outcomes compared with nonobese counterparts. Patient selection is a key for elective interventions, and appropriate infrastructure aids in the ultimate outcomes for both elective and nonelective surgical treatments. Overall, obese patients present several challenges to the spine surgeon, and certain precautions can be undertaken preoperatively, intraoperatively, and postoperatively to mitigate the associated risks to optimize outcomes.
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Inoue M, Orita S, Inage K, Fujimoto K, Shiga Y, Kanamoto H, Abe K, Kinoshita H, Norimoto M, Umimura T, Sato T, Sato M, Suzuki M, Enomoto K, Eguchi Y, Aoki Y, Akazawa T, Ohtori S. Radiological Assessment of Damage to the Iliopsoas Muscle by the Oblique Lateral Interbody Fusion Approach. Spine Surg Relat Res 2019; 4:152-158. [PMID: 32405562 PMCID: PMC7217679 DOI: 10.22603/ssrr.2019-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION There are several reports about invasive muscle injury during posterior spinal surgery. However, few reports have evaluated the association between the clinical symptoms and changes in the physical properties of the psoas major after oblique lateral interbody fusion (OLIF). Therefore, the current study aimed to investigate the relationship between the clinical symptoms and changes in the psoas major muscle before and after OLIF. METHODS Twenty-seven patients who underwent single-level OLIF following the diagnosis of degenerative lumbar disease were included in the study. The cross-sectional areas (CSAs) of the psoas major on the approaching and contralateral sides were measured in the axial computed tomography view of the surgical intervertebral space preoperatively and postoperatively at 1 week and 3, 6, and 12 months. The preoperative and postoperative changes in the CSAs were compared. Muscle degeneration was evaluated using axial magnetic resonance images at the same level as that in the CSA evaluation preoperatively and at 12 months postoperatively. Additionally, the relationship between these parameters and postoperative lower limb symptoms was investigated. RESULTS Significant swelling of the psoas major on the approach side was observed 1 week postoperatively (p < 0.05). No postoperative muscle degeneration was observed. Three cases of paresthesia in the front of the thigh were observed, but no association was found with changes in CSA in any of the cases. CONCLUSIONS The OLIF approach caused swelling of the psoas major 1 week postoperatively with no more muscle degeneration in the mid-term. Although numbness of the lower limbs was found in some cases, no association was found with changes in CSA. Our study findings suggest that the OLIF approach causes temporary injury or swelling of the psoas major, but the long-term damage to the muscle is not significant.
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Affiliation(s)
- Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic surgery, Saiseikai Narashino Hospital, Narashino, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirohito Kanamoto
- Department of Orthopaedic surgery, Kanamoto Orthopaedics Clinic, Numazu, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Senker W, Stefanits H, Gmeiner M, Trutschnig W, Radl C, Gruber A. The influence of age on the peri- and postoperative clinical course in patients undergoing minimally invasive transforaminal lumbar interbody fusion techniques of the lumbar spine. Clin Neurol Neurosurg 2019; 182:25-31. [PMID: 31059940 DOI: 10.1016/j.clineuro.2019.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/21/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE As a result of continuously increasing life expectancy, the number of requests for surgery to treat degenerative diseases of the spine in the elderly population will increase. Since older age is associated with the occurrence of medical comorbidities, the demand for less extensive surgical approaches is growing. The aim of this study is to establish whether minimally invasive fusion techniques are a safe and adequate tool for use in elderly patients. PATIENTS AND METHODS We analyzed 187 patients who underwent minimally invasive surgery (MIS) in the form of one- to four-level fusion procedures. In 146 patients, additional widening of the spinal canal was performed. The subjects were grouped into four age categories of approximately equal size (33-56, 56-66, 66-74 and 74-85). The effect of age on the incidence of peri- and postoperative complications was investigated and compared between the age groups. RESULTS Older age was not associated with the occurrence of perioperative complications, which include wound healing disorders, hematomas, wound traction-blisters and cerebrospinal fluid leakage. Fourteen patients (7.49%) encountered distinct surgical technique related complications, making surgical revision necessary in eight patients (4.28%). Furthermore, increasing age didn't elevate the risk of postoperative adverse events, i.e. pulmonary embolism, ischemic heart attack or pneumonia, among others. However, older patients were found to stay in hospital longer than younger patients, especially when more than one level was fused. CONCLUSIONS Minimally invasive surgery techniques are safe in elderly patients. The small-scale surgical approach guarantees a low incidence of infections and wound healing disorders. However, a longer hospital stay must be expected in older patients.
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Affiliation(s)
- Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria.
| | - Harald Stefanits
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria.
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria.
| | | | - Christian Radl
- Department of Mathematics, University of Salzburg, Austria.
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria.
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Zhao H, Gao H, Zhou C, Qian S, Yuan Y, Xue W, Qian J. A randomized controlled trial with ≥5 years of follow-up comparing minimally invasive and open transforaminal lumbar interbody fusion in disc herniation at single level. Exp Ther Med 2019; 17:3614-3620. [PMID: 30988744 PMCID: PMC6447782 DOI: 10.3892/etm.2019.7368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022] Open
Abstract
Minimally invasive transforaminal lumbar interbody fusion (m-TLIF) using transpedicular screws has various advantages over classical open (c-) TLIF. Up to date, comparative analyses of the TLIF procedures were following patients for <5 years. The objective of the present study was to compare the clinical effectiveness and complications of m- and c-TLIF in patients with single-level disc herniation with ≥5 years follow-up. Between June 2008 to July 2010, 91 patients with single-level lumbar degeneration were recruited and were randomly divided into two groups: m-TLIF and c-TLIF. The analyzed outcome measurements included: Surgery duration, intraoperative blood loss, X-ray exposure time, T2 relaxation time in magnetic resonance imaging (MRI), visual analogue scale (VAS) scores, Japanese orthopedic association (JOA) scores, fusion rate and complications during follow-up. No significant differences between m- and c-TLIF were observed with respect to surgery duration (P=0.077), volume of blood loss (P=0.115), complications and the need for an additional surgery (P=0.632). Significant differences between the groups were observed for X-ray exposure time (P<0.001) and MRI T2 relaxation times at 3 months post-surgery (P<0.001). At day 7 post surgery, recorded VAS and JOA scores were significantly improved in the m-TLIF compared with the c-TLIF group and non-significant differences between the groups were observed at >1 month follow-up. m-TLIF was a safe and effective tool in treating single-level lumbar disc herniation. However, careful attention to the surgical technique and precise anatomical knowledge were required. Further studies and refinement of the surgical techniques are necessary prior to treating multiple or more extensive lesions using the m-TLIF method.
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Affiliation(s)
- Haien Zhao
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Haoran Gao
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Chengpei Zhou
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Shu Qian
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Yifang Yuan
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Weigao Xue
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jixian Qian
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
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Chou D, Mundis G, Wang M, Fu KM, Shaffrey C, Okonkwo D, Kanter A, Eastlack R, Nguyen S, Deviren V, Uribe J, Fessler R, Nunley P, Anand N, Park P, Mummaneni P. Minimally Invasive Surgery for Mild-to-Moderate Adult Spinal Deformities: Impact on Intensive Care Unit and Hospital Stay. World Neurosurg 2019; 127:e649-e655. [PMID: 30947010 DOI: 10.1016/j.wneu.2019.03.237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare circumferential minimally invasive (cMIS) versus open surgeries for mild-to-moderate adult spinal deformity (ASD) with regard to intensive care unit (ICU) and hospital lengths of stay (LOS). METHODS A retrospective review of 2 multicenter ASD databases with 426 ASD (sagittal vertical axis <6 cm) surgery patients with 4 or more fusion levels and 2-year follow-up was conducted. ICU stay, LOS, and estimated blood loss (EBL) were compared between open and cMIS surgeries. RESULTS Propensity matching resulted in 88 patients (44 cMIS, 44 open). cMIS were older (61 vs. 53 years, P = 0.005). Mean levels fused were 6.5 in cMIS and 7.1 in open (P = 0.368). Preoperative lordosis was higher in open than in cMIS (42.7° vs. 40.9°, P = 0.016), and preoperative visual analog score back pain was greater in open than in cMIS (7 vs. 6.2, P = 0.033). Preoperative and postoperative spinopelvic parameters and coronal Cobb angles were not different. EBL was 534 cc in cMIS and 1211 cc in open (P < 0.001). Transfusions were less in cMIS (27.3% vs. 70.5%, P < 0.001). ICU stay was 0.6 days for cMIS and 1.2 days for open (P = 0.009). Hospital LOS was 7.9 days for cMIS versus 9.6 for open (P = 0.804). CONCLUSIONS For patients with mild-to-moderate ASD, cMIS surgery had a significantly lower EBL and shorter ICU stay. Major and minor complication rates were lower in cMIS patients than open patients. Overall LOS was shorter in cMIS patients, but did not reach statistical significance.
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Affiliation(s)
- Dean Chou
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
| | - Gregory Mundis
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA
| | - Michael Wang
- Department of Neurousrgery, University of Miami, Coral Gables, Florida, USA
| | - Kai-Ming Fu
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA
| | | | - David Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburg, Pennsylvania, USA
| | - Adam Kanter
- Department of Neurosurgery, University of Pittsburgh, Pittsburg, Pennsylvania, USA
| | - Robert Eastlack
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA
| | - Stacie Nguyen
- Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Juan Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Richard Fessler
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Pierce Nunley
- Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana, USA
| | - Neel Anand
- Department of Orthopedic Surgery, Cedars Sinai Hospital, Los Angeles, California, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Praveen Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
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Soriano-Baron H, Newcomb AGUS, Malhotra D, Martinez Del Campo E, Palma AE, Theodore N, Crawford NR, Kelly BP, Kaibara T. Biomechanical Effects of an Oblique Lumbar PEEK Cage and Posterior Augmentation. World Neurosurg 2019; 126:e975-e981. [PMID: 30876999 DOI: 10.1016/j.wneu.2019.02.200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Lumbar interbody spacers are widely used in lumbar spinal fusion. The goal of this study is to analyze the biomechanics of a lumbar interbody spacer (Clydesdale Spinal System, Medtronic Sofamor Danek, Memphis, Tennessee, USA) inserted via oblique lumbar interbody fusion (OLIF) or direct lateral interbody fusion (DLIF) approaches, with and without posterior cortical screw and rod (CSR) or pedicle screw and rod (PSR) instrumentation. METHODS Lumbar human cadaveric specimens (L2-L5) underwent nondestructive flexibility testing in intact and instrumented conditions at L3-L4, including OLIF or DLIF, with and without CSR or PSR. RESULTS OLIF alone significantly reduced range of motion (ROM) in flexion-extension (P = 0.005) but not during lateral bending or axial rotation (P ≥ 0.63). OLIF alone reduced laxity in the lax zone (LZ) during flexion-extension (P < 0.001) but did not affect the LZ during lateral bending or axial rotation (P ≥ 0.14). The stiff zone (SZ) was unaffected in all directions (P ≥ 0.88). OLIF plus posterior instrumentation (cortical, pedicle, or hybrid) reduced the mean ROM in all directions of loading but only significantly so with PSR during lateral bending (P = 0.004), without affecting the compressive stiffness (P > 0.20). The compressive stiffness with the OLIF device without any posterior instrumentation did not differ from that of the intact condition (P = 0.97). In terms of ROM, LZ, or SZ, there were no differences between OLIF and DLIF as standalone devices or OLIF and DLIF with posterior instrumentation (CSR or PSR) (P > 0.5). CONCLUSIONS OLIF alone significantly reduced mobility during flexion-extension while maintaining axial compressive stiffness compared with the intact condition. Adding posterior instrumentation to the interbody spacer increased the construct stability significantly, regardless of cage insertion trajectory or screw type.
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Affiliation(s)
- Hector Soriano-Baron
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anna G U S Newcomb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Devika Malhotra
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Eduardo Martinez Del Campo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Atilio E Palma
- Department of Neurosurgery, Wake Forest Baptist Hospital, Winston Salem, North Carolina, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Taro Kaibara
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Learning Curve and Minimally Invasive Spine Surgery. World Neurosurg 2018; 119:472-478. [DOI: 10.1016/j.wneu.2018.06.094] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
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Tang P, Zhu R, Gu Y, Gu JM, Xie ZA, Xu JQ, Zhao XD, Huang KM, Wang JY, Jiang XS, Fan SW, Hu ZJ. Ascorbic Acid Attenuates Multifidus Muscles Injury and Atrophy After Posterior Lumbar Spine Surgery by Suppressing Inflammation and Oxidative Stress in a Rat Model. Spine (Phila Pa 1976) 2018; 43:E1249-E1259. [PMID: 29649092 DOI: 10.1097/brs.0000000000002669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A rat model of multifidus muscles injury and atrophy after posterior lumbar spine surgery. OBJECTIVE We determined the effect of ascorbic acid (AA) on the postoperative multifidus muscles in rat model. SUMMARY OF BACKGROUND DATA Previous studies show oxidative stress and inflammation are two main molecular mechanisms in multifidus muscle injury and atrophy after posterior lumbar surgery. AA may have a protective effect in postoperative multifidus muscles. METHODS Rats were divided into sham surgery, control surgery, and surgery plus AA groups. Multifidus muscles of the control and AA groups were excised from the osseous structures. The muscles were retracted continuously for 2 hours. In the sham and AA groups, AA was administered via oral gavage daily in the first week. In each group, the oxidative stress was evaluated by measuring malondialdehyde (MDA) and Total superoxide dismutase (T-SOD). The inflammation, fat degeneration, or fibrosis of multifidus muscle were evaluated by quantitative real-time polymerase chain reaction (q-PCR), histology, or immunohistochemical analysis. RESULTS T-SOD activity was significantly lower in the control group than that in the AA group in the first week. MDA levels were significantly higher in the AA group. Interleukin-6 and tumor necrosis factor-α in multifidus muscles also showed significant differences when treated with AA. The inflammation score on histology was significantly lower in the AA group postoperatively in the first week. In the long run, marker genes for fibrosis and fat degeneration, and fibrosis and fat degeneration scores, were significantly lower in the AA than the control group on days 14 and 28 postoperatively. CONCLUSION In conclusion, AA attenuated the oxidative stress and inflammation response in the postoperative multifidus muscles, and remarkable differences were observed from the histological assessment and related marker genes expression. Our results provided important insight into the anti-inflammatory and anti-oxidative effects of AA in the postoperative multifidus muscles. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Pan Tang
- Department of Orthopaedics, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China.,Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ren Zhu
- Department of Orthopaedics, Yiwu Chowzhou Hospital, Yiwu, China
| | - Yu Gu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Ming Gu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zi-Ang Xie
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Qi Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang-De Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kang-Mao Huang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ji-Ying Wang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Sheng Jiang
- Department of Orthopaedics, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Shun-Wu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Jun Hu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Regev GJ, Lador R, Salame K, Mangel L, Cohen A, Lidar Z. Minimally invasive spinal decompression surgery in diabetic patients: perioperative risks, complications and clinical outcomes compared with non-diabetic patients' cohort. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:55-60. [PMID: 30099670 DOI: 10.1007/s00586-018-5716-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/15/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Prior studies have documented an increased complication rate in diabetic patients undergoing spinal surgery. However, the impact of diabetes on the risk of postoperative complications and clinical outcome following minimally invasive spinal (MIS) decompression is not well understood. OBJECTIVES To compare complication rates and outcomes of MIS decompression in diabetic patients with a cohort of non-diabetic patients undergoing similar procedures. METHODS Medical records of 48 patients with diabetes and 151 control patients that underwent minimally invasive lumbar decompression between April 2009 and July 2014 at our institute were reviewed and compared. Past medical history, the American Society of Anesthesiologists score, perioperative mortality, complication and revision surgeries rates were analyzed. Patient outcomes included: the visual analog scale and the EQ-5D scores. RESULTS The mean age was 68.58 ± 11 years in the diabetic group and 51.7 ± 17.7 years in the control group. No major postoperative complications were recorded in either group. Both groups were statistically equivalent in their postoperative length of stay, minor complications and revision rates. Both groups showed significant improvement in their outcome scores following surgery. CONCLUSIONS Our results indicate that minimally invasive decompressive surgery is a safe and effective treatment for diabetic patients and does not pose an increased risk of complications. Future prospective studies are necessary to validate the specific advantages of the minimally invasive techniques in the diabetic population. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- G J Regev
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Lador
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Salame
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Mangel
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Cohen
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Lidar
- Spine Surgery Unit, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Weitzman 6, 64239, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Senker W, Stefanits H, Gmeiner M, Trutschnig W, Radl C, Gruber A. The impact of type 2 diabetes on the peri- and postoperative outcomes of minimally invasive fusion techniques in the lumbar spine. J Neurosurg Sci 2018; 64:509-514. [PMID: 30014687 DOI: 10.23736/s0390-5616.18.04467-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of diabetes on spinal surgery has been studied extensively, but very few studies have focused on minimal access spinal technologies (MAST) and complication rates in patients suffering from type 2 diabetes (T2DM). Diabetes increases the risk of wound healing disorders, complication rate and length of stay in the hospital. We focused on the peri- and postoperative complications of MAST in an unselected consecutive population of 187 patients suffering from degenerative disorders lumbar spine disorders. Since mostly older patients are affected by degenerative lumbar changes, we concentrated on T2DM. METHODS We evaluated perioperative and postoperative complication rates associated with MAST fusion techniques in lumbar spine surgery in patients suffering from T2DM compared to patients without diabetes. Lumbar fusion was performed using interbody and posterolateral fusion. RESULTS Eighteen female and sixteen male patients suffered from T2DM (15.65% and 22.22% respectively). No differences between patients with and without T2DM concerning surgery-related complications including infections, severe wound healing disorders or length of in-hospital stay were noted. Peri- or postoperative complication rates, as well as blood loss volumes, were evenly distributed between the two groups. CONCLUSIONS T2DM is not a risk factor for the occurrence of complications in MAST.
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Affiliation(s)
- Wolfgang Senker
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Johannes Kepler University, Linz, Austria -
| | - Harald Stefanits
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Johannes Kepler University, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Johannes Kepler University, Linz, Austria
| | | | - Christian Radl
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Johannes Kepler University, Linz, Austria
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Zhao Q, Hao D, Wang B. A novel, percutaneous, self-expanding, forceful reduction screw system for the treatment of thoracolumbar fracture with severe vertebral height loss. J Orthop Surg Res 2018; 13:174. [PMID: 29996932 PMCID: PMC6042226 DOI: 10.1186/s13018-018-0880-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Over the past decade, the techniques for minimally invasive spinal stabilization have improved significantly. The multiaxial screw utilized in minimally invasive operations is limited in restoring fracture height, reconstructing the anterior vertebral column, and improving kyphosis. Therefore, the percutaneous, minimally invasive approach is not recommended for a thoracolumbar fracture with severe vertebral height loss. We report our novel, percutaneous, self-expanding, forceful reduction screw system to address this problem. Methods Thirty-eight patients experiencing thoracolumbar fracture, with a vertebral height loss more than 50%, were treated with the novel, percutaneous, self-expanding, forceful reduction screw between March 2014 and June 2015. The patients’ charts and radiographs were reviewed. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), and Oswestry disability index (ODI) scores were obtained before and after the operation, as well as during the 2-year follow-up. The scoring results were compared using t tests. Results The operation was completed successfully in 38 patients. A total of 152 screws were placed. The average operation time was 90.7 ± 21.9 min, and the average intraoperative bleeding amount was 89.2 ± 31.9 ml. The patients were discharged at a mean of 3.2 ± 0.9 postoperative days, with a mean hospital stay of 4.8 ± 1.0 days. The VBI, HAMFV, VBA, and BCA scores were significantly improved after treatment with the novel screw system; there was a significant difference between pre- and postoperative parameters (p < 0.05). Although the decreases in all of the parameters were variable during the 2-year follow-up, there were no statistical differences between the postoperative imaging parameters and the last follow-up imaging parameters (p > 0.05). The ODI score at the last follow-up examination was 5.9 ± 2.7, which was significantly improved compared with the preoperative score of 44.6 ± 2.3 (p < 0.05). Conclusions We believe that the novel, percutaneous, self-expanding, forceful reduction screw system developed by us not only successfully expands the minimally invasive percutaneous surgery to the thoracolumbar fracture with severe vertebral height loss but also achieves significant vertebral height restoration and kyphosis correction.
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Affiliation(s)
- Qinpeng Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
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Menger R, Hefner MI, Savardekar AR, Nanda A, Sin A. Minimally invasive spine surgery in the pediatric and adolescent population: A case series. Surg Neurol Int 2018; 9:116. [PMID: 29963325 PMCID: PMC6000717 DOI: 10.4103/sni.sni_417_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background: There is scant literature evaluating the indications, techniques, and outcomes of minimally invasive spine (MIS) surgery undertaken for pediatric and adolescent spine pathology. Our study attempts to evaluate the safe and effective use of MIS techniques in pediatric and adolescent patients and to appreciate the technical nuances of MIS surgery for this age group. Methods: Consecutive pediatric and adolescent patients undergoing elective MIS lumbar procedures, from 2008 to 2016, were retrospectively analyzed from the practice of a single fellowship-trained academic spinal neurosurgeon. Information was retrieved regarding procedure and disease pathology. Descriptive data was obtained including age, sex, body mass index (BMI), insurance coverage, smoking status, and co-morbidities. Outcome measures were recorded including intraoperative complications, revision surgery, and return-to-function. Results: Sixteen patients underwent 17 surgeries. The median BMI was 29.2 (range, 20.8–41.5). Age ranged from 12 to 19 years. Nearly 20% of the patients in our series were smokers. Most patients underwent discectomy, with L5-S1 being the most common level. One patient underwent direct pars defect repair and another underwent recurrent discectomy. More than 90% of the patients were complication-free at follow-up period of 6 months. One patient had a recurrent disc herniation and another had a superficial wound infection. Overall, 82.4% patients enjoyed full return to sports such as weight lifting, gymnastics, and contact sports. One patient required pain management to help alleviate ongoing pain. Another patient required a course of outpatient rehabilitation to help with a “foot drop.” Conclusion: Our series illustrates the effective application of MIS techniques among carefully selected pediatric patients. Emphasis is on using a smaller (16 mm) tubular retractor and causing minimal disruption of paraspinal osseo-tendinous structures. MIS techniques can be successfully applied to the pediatric and adolescent age group.
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Affiliation(s)
- Richard Menger
- Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
| | | | | | - Anil Nanda
- Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
| | - Anthony Sin
- Department of Neurosurgery, LSUHSC, Shreveport, Louisiana, USA
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Soriano-Baron H, Newcomb AG, Malhotra D, Palma AE, Martinez-del-Campo E, Crawford NR, Theodore N, Kelly BP, Kaibara T. Biomechanical Analysis of an Expandable Lumbar Interbody Spacer. World Neurosurg 2018; 114:e616-e623. [DOI: 10.1016/j.wneu.2018.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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Pishnamaz M, Schemmann U, Herren C, Horst K, Hildebrand F, Kobbe P, Pape HC. Limitations in clinical outcome after posterior stabilization of thoracolumbar fractures do not correlate with dynamic trunk muscle dysfunction: an ultrasound controlled prospective cohort study. Eur J Med Res 2018; 23:26. [PMID: 29793535 PMCID: PMC5968479 DOI: 10.1186/s40001-018-0323-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Posterior stabilization of the spine is associated with iatrogenic muscle damage. This is discussed to represent an important cause of postoperative pain, especially in open reduction and fixation. The aim of this study was to visualize muscular changes after open or percutaneous posterior stabilization of traumatic thoracolumbar spine fractures and to investigate whether or not these changes are related to the clinical outcome. METHODS This prospective cohort study was performed between 05/2012 and 10/2014. A group of posteriorly stabilized patients (study group; SG) with traumatic fractures (AOSpine Type A3 or A4) of the thoracolumbar junction (T11-L2) without neurological deficit were matched to a healthy control group (CG) by age, gender and body mass index. FOLLOW-UP 12 months after surgery. PARAMETERS muscle size, voluntary muscular activation (VMA) using a standardized ultrasound protocol and standardized questionnaires (VAS Spine Score; ODI; SF-36) were analyzed. STATISTICS SPSS (Version 20, 76 Chicago, IL, USA). T test, Chi squared test, analysis of variance and a correlation analysis were performed. Significance level was at p < 0.05. RESULTS Twenty-five patients (SG) and 23 control individuals (CG) were included. At follow-up, voluntary muscular activation of the lumbar multifidus (LM) as well as the transverse abdominis muscle (TrA) was diminished in all patients compared to the control group (VMA LM at level L3/4: SG 3.2%; CG 5.1%; p < 0.05; VMA TrA: SG 33.43%; CG 37.84%; p < 0.05). Concomitant interviews revealed health restrictions in all patients when compared with the control group. A correlation between muscle function and clinical outcome could not been demonstrated (rs > 0.07; NS). CONCLUSION In surgically treated A3 and A4 fractures, there is continuous muscular deficit 1 year after surgery as documented by ultrasound and clinical control. But, by means of our study we conclude that those muscular deficits alone seem not to be decisive for the clinical outcome 1 year after surgery.
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Affiliation(s)
- Miguel Pishnamaz
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Ulrike Schemmann
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany.,Division of Physical Therapy, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Christian Herren
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Decheng W, Hao S, Zhongwei W, Jiaming L, Bin Y, Yong H. Three-step Reduction Therapy of Integrated Chinese and Western Medicine for Thoracolumbar Burst Fracture. J INVEST SURG 2018; 32:536-541. [PMID: 29504820 DOI: 10.1080/08941939.2018.1442534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To investigate and compare the efficacy of three-step reduction (TSR) therapy of integrated Chinese and Western Medicine and posterior open (PO) surgery for thoracolumbar burst fracture. Methods: We selected 60 patients diagnosed with thoracolumbar burst fracture and received treatment in our hospital from December 2014 to March 2017. According to randomized digital table, they were randomly divided into TSR and PO groups. VAS pain grade, Oswestry disability index, height of centrum front, Cobb's angle of spine, bleeding, and complication of internal fixation of the two groups were compared. Results: Postoperative reduction of injured centrum, regained volume of canalis vertebralis, volume of bleeding, and early functional rehabilitation of TSR group were better than that of PO groups (P < 0.05). Conclusion: Through three-step reduction combined pedicle screw fixation surgery, we can achieve satisfied reduction of thoracolumbar burst fracture, rebuild the height of centrum, recover the biomechanics function of spine, and reduce bleeding. Three-step reduction therapy is an effective therapy for thoracolumbar burst fracture.
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Affiliation(s)
- Wang Decheng
- Department of Orthopedics, Tongzhou District traditional Chinese and Western medicine hospital, Beijing, China
| | - Shi Hao
- Department of Orthopedics, Tongzhou District traditional Chinese and Western medicine hospital, Beijing, China
| | - Wang Zhongwei
- Department of Orthopedics, Tongzhou District traditional Chinese and Western medicine hospital, Beijing, China
| | - Li Jiaming
- Department of Orthopedics, Tongzhou District traditional Chinese and Western medicine hospital, Beijing, China
| | - Yang Bin
- Department of Orthopedics, Tongzhou District traditional Chinese and Western medicine hospital, Beijing, China
| | - Hai Yong
- Department of Orthopedics, Beijing Chao-Yang hospital of Capital Medical University, Beijing, China
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Does Obesity Affect Perioperative and Postoperative Morbidity and Complication Rates After Minimal Access Spinal Technologies in Surgery for Lumbar Degenerative Disc Disease. World Neurosurg 2018; 111:e374-e385. [DOI: 10.1016/j.wneu.2017.12.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
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Tian W, Liu Y, Fan M, Zhao J, Jin P, Zeng C. CAMISS Concept and Its Clinical Application. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:31-46. [PMID: 30306470 DOI: 10.1007/978-981-13-1396-7_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This chapter intends to provide an overview of computer-assisted minimally invasive spine surgery (CAMISS) and its clinical application. Since minimally invasive spine surgery was first brought out, the concept of decreasing the damage to patient was soon become popular. However, without the proper surgical field, the spine surgery can be very dangerous. The minimally invasive concept was restricted in promotion until the computer-assisted navigation system break down the obstacles. The CAMISS technique achieves better clinical outcomes with the advantages of smaller invasion, less injury, and better recovery and also became the gold standard for spine surgery. The spatial distribution concept and the respiration-induced motion concept help in promoting the accuracy and safety of the CAMISS concept. The CAMISS concept also facilitated the developing of robotic techniques, which was considered as the future of orthopedic surgery.
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Affiliation(s)
- Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Peihao Jin
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Cheng Zeng
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
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Effectiveness of Transpedicular Dynamic Stabilization in Treating Discogenic Low Back Pain. World Neurosurg 2017; 111:e192-e198. [PMID: 29253701 DOI: 10.1016/j.wneu.2017.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/06/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess clinical outcomes after dynamic stabilization in discogenic low back pain. METHODS From April 2012 to January 2015, 23 patients with discogenic low back pain were treated with dynamic stabilization via the Wiltse approach. Main clinical assessments included visual analog scale, Oswestry Disability Index, and complications. Radiographs were evaluated for lumbar range of motion and intervertebral height. The Woodend classification was determined by magnetic resonance imaging. RESULTS There were 23 cases evaluated with a mean follow-up time of 39 months. At last follow-up, visual analog scale and Oswestry Disability Index scores improved significantly compared with preoperatively (P < 0.05). At the stabilized segments, the height of intervertebral discs was increased significantly after surgery (P < 0.05). At last follow-up, the height was reduced to the preoperative level. At the operated segment, 47.4% of the flexion/extension range of motion was retained. Six discs showed rehydration with 1 grade improvement on the Woodend classification. CONCLUSIONS Dynamic stabilization was a safe and effective treatment in carefully selected groups of patients with discogenic low back pain and promoted disc regeneration to some extent.
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A Comparison of Different Minimally Invasive and Open Posterior Spinal Procedures Using Volumetric Measurements of the Surgical Exposures. Clin Spine Surg 2017; 30:425-428. [PMID: 27231833 DOI: 10.1097/bsd.0000000000000390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A Prospective observational study. SUMMARY OF THE BACKGROUND DATA Minimally invasive (MI) spine surgery techniques strive to minimize the damage to paraspinal soft tissues. Previous studies used only the length of the surgical incision to quantify the invasiveness of certain MI procedures. However, this method does not take into account the volume of muscle tissue that is dissected and retracted from the spine to achieve sufficient exposure. To date, no simple method has been reported to measure the volume of the surgical exposure and to quantify the degree of surgery invasiveness. STUDY OBJECTIVES To obtain and compare volumetric measures of various MI and open posterior-approached spinal surgical exposures. METHODS The length, the depth, and the volume of the surgical exposure were obtained from 57 patients who underwent either open or MI posterior lumbar surgery. MI procedures included the following: tubular discectomy, laminotomy, and transforaminal interbody fusion. Open procedures included the following: discectomy, laminectomy, transforaminal interbody fusion, or posterior-lateral instrumented fusion. Four attending spine surgeons at our unit performed the surgeries. To reduce variability, only single-level procedures performed between L4 and S1 vertebrae were used. The volume of exposure was obtained by measuring the amount of saline needed to fill the surgical wound completely once the surgical retractors were deployed and opened. RESULTS The average volumes in mililiters of exposure for a single-level MI procedure ranged from 9.8±2.8 to 75±11.7 mL and were significantly smaller than the average volumes of exposure for a single level open procedures that ranged from 44± 21 to 277±47.9 P<0.001. The average skin-incision lengths for single-level MI procedures ranged from 1.7±0.2 to 7.7±1.6 cm and were significantly smaller than the average skin-incision lengths for open procedures [5.2±1.4 (Table 3) to 11.3±2 cm, P<0.001]. The measured surgical depths were similar in MI and open groups (P=0.138). MI decompression and posterior fusion procedures yielded 92% and 73% reductions in the volumes of exposure, respectively. However, absolute differences in exposure volumes were larger for fusion (202 mL) compared with decompression alone (110.7 mL). CONCLUSIONS Direct volumetric measurement of the surgical exposure is obtained easily by measuring the amount of saline needed to fill the exposed cavity. Using this method, the needed surgical exposure of different spinal procedures can be quantified and compared. This volumetric measurement combined with the measure of retraction force, the duration of retraction, and the impact on soft tissue vascularity can help build a model that assesses the relative invasiveness of different spinal procedures.
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Abstract
Minimally invasive spine surgery (MISS) seems to have many benefits for human patients and is currently used for various minor and major spine procedures. For MISS, a change in access strategy to the target location is necessary and it requires intraoperative imaging, special instrumentation, and magnification. Few veterinary studies have evaluated MISS for canine patients for spinal decompression procedures. This article discusses the general requirements for MISS and how these can be applied to veterinary spinal surgery. The current veterinary MISS literature is reviewed and suggestions are made on how to apply MISS to different spinal locations.
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Affiliation(s)
- Bianca F Hettlich
- Department of Small Animal Surgery, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, Bern 3012, Switzerland.
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Bin Y, De cheng W, wei WZ, Hui L. Muscle gap approach under a minimally invasive channel technique for treating long segmental lumbar spinal stenosis: A retrospective study. Medicine (Baltimore) 2017; 96:e7779. [PMID: 28796075 PMCID: PMC5556241 DOI: 10.1097/md.0000000000007779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the efficacy of muscle gap approach under a minimally invasive channel surgical technique with the traditional median approach.In the Orthopedics Department of Traditional Chinese and Western Medicine Hospital, Tongzhou District, Beijing, 68 cases of lumbar spinal canal stenosis underwent surgery using the muscle gap approach under a minimally invasive channel technique and a median approach between September 2013 and February 2016. Both approaches adopted lumbar spinal canal decompression, intervertebral disk removal, cage implantation, and pedicle screw fixation. The operation time, bleeding volume, postoperative drainage volume, and preoperative and postoperative visual analog scale (VAS) score and Japanese Orthopedics Association score (JOA) were compared between the 2 groups.All patients were followed up for more than 1 year. No significant difference between the 2 groups was found with respect to age, gender, surgical segments. No diversity was noted in the operation time, intraoperative bleeding volume, preoperative and 1 month after the operation VAS score, preoperative and 1 month after the operation JOA score, and 6 months after the operation JOA score between 2 groups (P > .05). The amount of postoperative wound drainage (260.90 ± 160 mL vs 447.80 ± 183.60 mL, P < .001) and the VAS score 6 months after the operation (1.71 ± 0.64 vs 2.19 ± 0.87, P = .01) were significantly lower in the muscle gap approach group than in the median approach group (P < .05). In the muscle gap approach under a minimally invasive channel group, the average drainage volume was reduced by 187 mL, and the average VAS score 6 months after the operation was reduced by an average of 0.48.The muscle gap approach under a minimally invasive channel technique is a feasible method to treat long segmental lumbar spinal canal stenosis. It retains the integrity of the posterior spine complex to the greatest extent, so as to reduce the adjacent spinal segmental degeneration and soft tissue trauma. Satisfactory short-term and long-term clinical results were obtained.
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Affiliation(s)
- Yang Bin
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Beijing University of Chinese Medicine
| | - Wang De cheng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Capital Medical University
| | - Wang Zong wei
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, North China Coal Medical College, Beijing
| | - Li Hui
- Department of Orthopedics, Xi’an Red Cross Hospital, Union Medical College, Xi’an, China
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Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature. Acta Neurochir (Wien) 2017; 159:1137-1146. [PMID: 28160064 DOI: 10.1007/s00701-017-3078-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Minimally invasive spine surgery (MISS) has been increasingly advocated during the last decade with new studies being reported every year. Minimally invasive spine procedures, such as minimally invasive transforaminal interbody fusion (MI-TLIF), have been introduced to reduce approach-related muscle trauma, to minimise blood loss, and to achieve faster wound healing, quicker ambulation and earlier patient discharge. METHODS The aim of this article was to give a comprehensive review of the available English literature comparing open TLIF with MI-TLIF techniques published or available online between 1990 and 2014 as identified by an electronic database search on http://www.ncbi.nlm.nih.gov/pubmed . Fourteen relevant studies comparing MI-TLIF and open TLIF cohorts could be identified. RESULTS AND CONCLUSION MI-TLIF seems to be a valid alternative to open TLIF. Both methods yield good clinical results with similar improvements of Oswestry Disability Index (ODI) and visual analogue scale (VAS) on follow-up. There seems to be no significant differences in clinical outcome and fusion rates on comparison. These results are consistent throughout all reported studies in this review. The most pronounced benefits of MI-TLIF are a significant reduction of blood loss, shorter lengths of hospital stay (LOHS) and lower surgical site infection rates. On the downside, MI-TLIF seems to be associated with significantly higher intraoperative radiation doses, a shallow learning curve, at least in the beginning, longer operating times and potentially more frequent implant failures/cage displacements and revision surgeries.
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Storheim K, Berg L, Hellum C, Gjertsen Ø, Neckelmann G, Espeland A, Keller A. Fat in the lumbar multifidus muscles - predictive value and change following disc prosthesis surgery and multidisciplinary rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up of a randomized trial. BMC Musculoskelet Disord 2017; 18:145. [PMID: 28376754 PMCID: PMC5381060 DOI: 10.1186/s12891-017-1505-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/29/2017] [Indexed: 01/12/2023] Open
Abstract
Background Evidence is lacking on whether fat infiltration in the multifidus muscles affects outcomes after total disc replacement (TDR) surgery and if it develops after surgery. The aims of this study were 1) to investigate whether pre-treatment multifidus muscle fat infiltration predicts outcome 2 years after treatment with TDR surgery or multidisciplinary rehabilitation, and 2) to compare changes in multifidus muscle fat infiltration from pre-treatment to 2-year follow-up between the two treatment groups. Methods The study is secondary analysis of data from a trial with 2-year follow-up of patients with chronic low back pain (LBP) and degenerative disc randomized to TDR surgery or multidisciplinary rehabilitation. We analyzed (aim 1) patients with both magnetic resonance imaging (MRI) at pre-treatment and valid data on outcome measures at 2-year follow-up (predictor analysis), and (aim 2) patients with MRI at both pre-treatment and 2-year follow-up. Outcome measures were visual analogue scale (VAS) for LBP, Oswestry Disability Index (ODI), work status and muscle fat infiltration on MRI. Patients with pre-treatment MRI and 2-year outcome data on VAS for LBP (n = 144), ODI (n = 147), and work status (n = 137) were analyzed for prediction purposes. At 2-year follow-up, 126 patients had another MRI scan, and change in muscle fat infiltration was compared between the two treatment groups. Three radiologists visually quantified multifidus muscle fat in the three lower lumbar levels on MRI as <20% (grade 0), 20–50% (grade 1), or >50% (grade 2) of the muscle cross-section containing fat. Regression analysis and a mid-P exact test were carried out. Results Grade 0 pre-treatment multifidus muscle fat predicted better clinical results at 2-year follow-up after TDR surgery (all outcomes) but not after rehabilitation. At 2-year follow-up, increased fat infiltration was more common in the surgery group (intention-to-treat p = 0.03, per protocol p = 0.08) where it was related to worse pain and ODI. Conclusions Patients with less fat infiltration of multifidus muscles before TDR surgery had better outcomes at 2-year follow-up, but findings also indicated a negative influence of TDR surgery on back muscle morphology in some patients. The rehabilitation group maintained their muscular morphology and were unaffected by pre-treatment multifidus muscle fat. Trial registration NCT 00394732 (retrospectively registered October 31, 2006).
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Affiliation(s)
- Kjersti Storheim
- Research and Communication unit for musculoskeletal disorders (FORMI), Oslo University Hospital Ullevål, Postbox 4956, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Postbox 1078, Blindern, 0316, Oslo, Norway.
| | - Linda Berg
- Department of Radiology, Haukeland University Hospital, Postbox 1400, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020, Bergen, Norway.,Department of Radiology, Nordland Hospital, Postbox 1480, 8092, Bodø, Norway.,Institute of Clinical Medicine, UiT, The Arctic University of Norway, Postbox 6050, Langnes, 9037, Tromsø, Norway
| | - Christian Hellum
- Department of Orthopaedics, Oslo University Hospital Ullevål, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - Øivind Gjertsen
- Department of Radiology and Nuclearmedicine, Oslo University Hospital Rikshospitalet, Postbox 4950, Nydalen, 0424, Oslo, Norway
| | - Gesche Neckelmann
- Department of Radiology, Haukeland University Hospital, Postbox 1400, 5021, Bergen, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Postbox 1400, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020, Bergen, Norway
| | - Anne Keller
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ullevål, Postbox 4956, Nydalen, 0424, Oslo, Norway.,Center for Rheumatology and Spine Diseases, National Hospital, 2600, Glostrup, Denmark
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Assessment of Paraspinal Muscle Cross-sectional Area After Lumbar Decompression: Minimally Invasive Versus Open Approaches. Clin Spine Surg 2017; 30:E162-E168. [PMID: 28323694 DOI: 10.1097/bsd.0000000000000038] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
STUDY DESIGN A retrospective, blinded analysis of imaging studies. SUMMARY OF BACKGROUND DATA To evaluate changes in paraspinal muscle cross-sectional area (CSA) after surgical treatment for lumbar stenosis and to compare these changes between minimally invasive and standard open approaches. The open approach to lumbar stenosis is effective, but it involves retraction and resection of muscle from the spinous process, which can result in ischemia and denervation of paraspinal musculature and may lead to muscle atrophy and pain. OBJECTIVE It is hypothesized that the microendoscopic decompression of stenosis (MEDS) technique will better preserve the paraspinal muscles compared with the open procedure. MATERIALS AND METHODS A total of 18 patients underwent a 1-level posterior decompression for lumbar stenosis, (9 open, 9 MEDS). Lumbar magnetic resonance imaging was obtained before surgery and after surgery (open approach average 16.3 mo; MEDS average 16.6 mo). CSA of paraspinal muscles were averaged over the distance of the surgical site. RESULTS The mean age of patients treated with the open and MEDS approaches were 55.2 and 66.4 years, respectively (P=0.07). Paraspinal muscle CSA decreased by an average of 5.4% (SD=10.6%; range, -24.5% to +7.7%) in patients treated with the open approach and increased by an average of 9.9% (SD=14.4%; range, -9.8% to +33.1%) in patients treated with MEDS (P=0.02). For the open approach, changes in CSA did not differ significantly between the left and right sides for erector spinae (P=0.35) or multifidus muscles (P=0.90). After the MEDS approach there were no significant differences between the dilated and contralateral sides with regard to change in CSA for erector spinae (P=0.85) or multifidus muscles (P=0.95). CONCLUSIONS Compared with the open approach for lumbar stenosis, MEDS had significantly less negative impact on the paraspinal muscle CSA. Previous reports have documented negative effects of paraspinal muscle injury, including weakness, disability, and pain. Collectively, these data suggest that the MEDS approach for lumbar decompression is less destructive to the paraspinous muscles than the open approach and may facilitate better clinical outcomes.
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