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Verhaegen JCF, Alves Batista N, Foster R, Graham R, Phan P, Grammatopoulos G. What patient parameters influence lumbar stiffness in patients with hip pathology? J Orthop Res 2024; 42:1054-1065. [PMID: 37997704 DOI: 10.1002/jor.25749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case-cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep-seated radiographic assessment to measure lumbar lordosis (∆LL) (stiffness: ∆LL < 20°), hip flexion (∆PFA: pelvic femoral angle), and degree of degenerative-disc-disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor- and extensor-muscle atrophy (Goutallier classification). Mean ∆LL was 45° (range: 11°-72°) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ∆LL than those with no/single level (n = 43) DDD (34° [range: 11°-53°] vs. 51° [21°-72°]; p < 0.001). Number of DDD levels correlated strongly with ∆LL (ρ = -0.642; p < 0.001). Spinal stiffness was only seen in patients with ≥4 DDD levels. There was no correlation between ∆LL and facet orientation (p > 0.05). ∆LL correlated strongly with extensor atrophy at L3-L4 (ρ = -0.473), L4-L5 (ρ = -0.520), and L5-S1 (ρ = -0.473) and poorly with flexors at L4-L5 (ρ = -0.134) and L5-S1 (ρ = -0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification ≥4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series.
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Affiliation(s)
- Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Orthopaedics & Traumatology, University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | - Nuno Alves Batista
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ryan Foster
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ryan Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Philippe Phan
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Miao L, Jin B, Ning M, Zhang X, Wang Z, Mai R, Cai L, Wang Y. The Effect of Unintended Facet Arthrodesis on the Treatment Outcome of Dynamic Neutralization System for Lumbar Degenerative Diseases. Indian J Orthop 2024; 58:271-277. [PMID: 38425823 PMCID: PMC10899546 DOI: 10.1007/s43465-023-01088-x] [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: 07/15/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024]
Abstract
Purpose This study aimed to examine the influence of unintended facet arthrodesis on the therapeutic effectiveness of the dynamic neutralization system (Dynesys). Methods This retrospective study enrolled consecutive patients who underwent posterior decompression and dynamic stabilization for lumbar spondylosis or spinal stenosis. Follow-up assessments included lumbar radiography, lumbar vertebral computerized tomography (CT), visual analog scale (VAS), and Oswestry disability index (ODI). Patients were classified into the facet fusion and non-fusion groups. The differences in the VAS scores for back pain and leg pain, ODI, intervertebral range of motion (ROM) at the surgical segments, and upper adjacent segments were assessed before and after treatment. Results A total of 49 patients (29 males and 20 females) aged 31-65 years were enrolled and followed-up for over 40 months. Among the patients, 16 (32.7%) experienced unintended facet arthrodesis and were assigned to the fusion group, whereas the remaining patients were assigned to the non-fusion group. There was a significant increase in the incidence of facet arthrodesis in the surgical segments over time post-surgery (χ2 = 6.2, p < 0.05). The ROM of the surgical and upper adjacent segments, VAS scores for back pain and leg pain, and ODI were all significantly different before and after the operation (p < 0.05), but not between the fusion and non-fusion groups (p > 0.05). Conclusion Although unintended facet arthrodesis is common after Dynesys procedure, the presence of facet arthrodesis does not significantly affect the efficacy of Dynesys in treating lumbar degenerative diseases.
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Affiliation(s)
- Lei Miao
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
| | - Bo Jin
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
| | - Ma Ning
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
| | - Xi Zhang
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Zhaowei Wang
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
- The Third School of Clinical Medicine, Ningxia Medical University, Ningxia, China
| | - Ruopeng Mai
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
| | - Lijun Cai
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
| | - Yinong Wang
- Department of Spinal Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, 301 North Zhengyuan Road, Yinchuan, 750002 Ningxia China
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Subramaniam MH, Moirangthem V, Ramakrishnan BS, Venkatesan M. A Clinically Applicable Predictive Score in Lumbar Disc Disease for Formulating a Surgical Plan. Global Spine J 2024; 14:676-686. [PMID: 36148599 PMCID: PMC10802544 DOI: 10.1177/21925682221121093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Case control study. OBJECTIVE Micro-lumbar discectomy or Interbody fusion procedure are work-horse surgical procedures in management of lumbar disc disease. Spine surgeon in their early years of practice gets confused in choosing ideal surgical plan when dealing with a complex scenario. A clinical score is needed to guide spine surgeons in choosing an optimal surgical plan. MATERIALS AND METHODS Study was done with research grant approval from AO Spine. A predictive score was formulated as per hypothesis following a pilot study. Two fellowship trained spine surgeons-one using the score (Group A) and other not using score (Group B-control) treated 40 patients included in their respective group. All patients were analysed preoperatively, post-surgery at 12 months follow-up with Visual analog scale score for back pain, leg pain, Oswestry disability index score, SF-36 score. Change in parameters at 12 months follow-up were analysed statistically. P ≤ .05 was considered statistically significant. Success rate of individual surgeon who managed respective group of patients and Difficulty index of surgeon who managed without using score was evaluated at 12 months follow-up. RESULTS Success rate of Group A-surgeon was higher than Group B-surgeon .15% of Group B patients had poor surgical outcome at follow-up. Statistically significant improvement in Group A patients were seen in all 3 evaluated parameters when compared to Group B patients at 12 months of follow-up (P ≤ .05). Difficulty index of surgeon who didn't use the score was 15%. CONCLUSION The proposed predictive score comprising all risk factors, can be used by spine surgeons when they are confronted with difficult scenario in decision-making. Accuracy, reliability and validity of the score needs to be evaluated in a larger scale. LEVEL OF EVIDENCE Ⅲ.
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Abudouaini H, Yang J, Lin K, Meng Y, Zhang H, Wang S. A possible correlation between facet orientation and development of degenerative cervical spinal stenosis. BMC Musculoskelet Disord 2024; 25:181. [PMID: 38413918 PMCID: PMC10900644 DOI: 10.1186/s12891-024-07279-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied. METHODS One hundred twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. RESULTS The facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p < 0.05). CONCLUSIONS Our study demonstrated that patients with CSS have smaller axial cervical facet joint angles compared to the healthy individuals. Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Junsong Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kaiyuan Lin
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yibing Meng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hong Zhang
- Department of Ultrasound Medical Center, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Sibo Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
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Su C, Liu X, Shao Y, Wang W, Yang G, Sun J, Cui X. Specific foraminal changes originate from degenerative spondylolisthesis on computed tomographic images. 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 2023; 32:1077-1086. [PMID: 36732420 DOI: 10.1007/s00586-023-07557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Operative treatment for degenerative spondylolisthesis (DS) is accompanied by the high incidence of nerve injury. Foraminal structures, especially the hypertrophied facet joints, have significant impacts on the adjacent nerve. This study aims to identify the specific foraminal changes relating to DS and nerve injury. METHODS The CT images of 70 patients with DS and 50 patients without lumbar disease were collected. The length and height of the foraminal structure were measured horizontally and vertically on sagittally reconstructed images. Horizontal stenosis, meaning to pending compression to nerve root after complete reduction, was evaluated on the image located to the middle of the foramen. Chi-square test or T-test were carried out using SPSS 26.0. RESULTS The hyperplasia of the superior articular process (SAP) and articular capsule (Ac) incidence rates in DS group was significantly more common than that of the control group (9.2 vs 0.0%, 42.9 vs 2.0%). The height and width of the SAP and Ac in vertical and horizontal directions were significantly greater than those in the control group (4.95 mm vs - 0.47 mm, P < 0.0001; 3.28 vs 0.02 mm, P < 0.0001; 5.27 vs3.44 mm, P < 0.0001; 2.60 vs 0.37 mm, P < 0.0001). In the DS group, hyperplasia of the SAP and Ac accounted for 9 and 43% respectively, 85 and 45% of which were accompanied by horizontal stenosis of the intervertebral foramen. CONCLUSION DS is usually characterized of excessive hyperplasia of the SAP and Ac, both of which are possible elements of nerve root injury after complete reduction in operation and should be focused on during surgery.
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Affiliation(s)
- Cheng Su
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
| | - Xiaoyang Liu
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Yuandong Shao
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Binzhou People's Hospital, Binzhou, 256600, Shandong, China
| | - Wenchao Wang
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Guihe Yang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China.
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Akar E, Toprak F, Öğrenci A. The relationship between bone canal diameter and facet tropism in cases of lumbar spinal stenosis. J Neurosci Rural Pract 2022; 13:641-646. [PMID: 36743774 PMCID: PMC9894327 DOI: 10.25259/jnrp-2022-7-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Lumbar spinal stenosis (LSS) is a condition that increases in frequency with the aging of the spine and has adverse effects on the quality of life of individuals. Facet tropism (FT) refers to the difference in the orientation of the facet joints relative to each other in the sagittal plane. This situation may be due to a developmental defect or different stimuli. In many biomechanical studies in the literature, the relationship between FT and lumbar degenerative disorders has been investigated. In this study, we aimed to investigate whether there is a relationship between anteroposterior bone canal diameter and FT in LSS cases. Materials and Methods We retrospectively evaluated the CT and T2-weighted axial and sagittal magnetic resonance imaging of the lumbar region of 100 LSS patients who were operated on in our clinic between 2015 and 2017. For each patient, the facet joint angles, the degree of FT, and the AP diameter of the spinal canal were determined. Results The cases were grouped according to FT types and no correlation was found between midsagittal bone spinal canal measurement and FT types. According to the results, no significant difference was found. Conclusion As a result, because of there is no relationship between midsagittal bone canal diameter and FT, we thought that FT may be both a part of the degenerative process and a congenital origin.
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Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fatih Toprak
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Medicana Ataşehir Hospital, Istanbul, Turkey
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Han Y, Li K, Wang X, Wang J, Sun S, Xia X, Wang J, Miao J. 3D kinematic characteristics of lumbar facet joints in sitting position. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1289-1295. [PMID: 35962832 DOI: 10.1007/s00276-022-03005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Recognizing the kinematic characteristics of lumbar facet joints is important for the prevention and treatment of lumbar degenerative diseases. Previous studies have been conducted in either the supine or standing position, and there are no measurements regarding the kinematic characteristics of the lumbar facet joints while sitting. The aim of this study was to measure and analyze lumbar facet joint motion characteristics while sitting. METHODS Ten subjects (5 males and 5 females) performed the movements of flexion-extension, left bending-right bending, and left rotation-right rotation in a sitting position. Dual Fluoroscopic Image System and computed tomography technique were used to measure the displacement and rotation angle of the lumbar facet joints of the subjects for analysis. The movement characteristics of L3-S1 were measured. RESULTS When the subjects were in sitting position, the lumbar vertebra mainly changed in Z-axis and α, β angle when they performed flexion-extension activities. The displacement of the left facet joint was 4.65 ± 1.99 mm at L3-4, 1.89 ± 2.99 mm at L4-5, and 0.80 ± 2.27 mm at L5-S1 in the Z-axis, and the displacement of the right facet joint was 3.20 ± 2.61 mm at L3-4, 1.71 ± 3.00 mm at L4-5, and 0.31 ± 1.69 mm at L5-S1 in the Z-axis. The rotation in the α angle was 6.00 ± 4.49° at L3-4, 3.51 ± 5.24° at L4-5, and 0.97 ± 4.13° at L5-S1, which was significant different. The rotation in the β angle was 2.30 ± 2.94°at L3-4, 0.16 ± 2.06° at L4-5, and 0.35 ± 1.74°at L5-S1, which was significant different. When the lumbar spine performed the activity of left bending-right bending, there were changes in rotation mainly in the Z-axis and β angle. The displacement of left facet joint in the Z-axis was 1.34 ± 2.84 mm at L3-4, 2.11 ± 0.88 mm at L4-5, and 0.72 ± 0.81 mm at L5-S1; the rotation in the β angle was 5.66 ± 2.70°at L3-4, 7.89 ± 2.59° at L4-5, and 1.28 ± 2.07° at L5-S1; when the lumbar spine performed the activity of left rotation-right rotation, there were changes in the β angle. The rotation of β angle was 4.09 ± 2.86° at L3-4, 2.14 ± 3.38° at L4-5, and 0.63 ± 1.85° at L5-S1. CONCLUSION The lumbar facet joint motion in sitting position is different in each mode of motion. The horizontal displacement and rotation are predominant during flexion and extension activities, while there are different rotation in bending and rotation. The study shows the coupled motion of the lumbar facet joints while sitting, providing a new perspective on the kinematics of the lumbar spine and the etiology of lumbar degenerative diseases.
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Affiliation(s)
- Ye Han
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Kepeng Li
- Department of Orthopedics, The Second Central Hospital of Baoding, Baoding, Hebei, China
| | - Xiaodong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Jianzhong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Shaosong Sun
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Xi Xia
- Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, China
| | - Jing Wang
- Department of Orthopedics, Gaoyang County Hospital, Baoding, Hebei, China
| | - Jun Miao
- Department of Orthopedics, Tianjin Hospital of Tianjin University, Tianjin, China.
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Wang Z, Rong Y, Tang P, Ye W, Ji C, Wang J, Ge X, Liu W, Li Q, Cai W. Prevalence and Predictive Factors of Asymptomatic Spondylotic Cervical Spinal Stenosis in Patients with Symptomatic Lumbar Spinal Stenosis. World Neurosurg 2021; 151:e1051-e1058. [PMID: 34033955 DOI: 10.1016/j.wneu.2021.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We performed a retrospective cohort study to investigate the prevalence of and risk factors for asymptomatic spondylotic cervical spinal stenosis (ASCSS) in the setting of lumbar spinal stenosis (LSS). METHODS A total of 114 patients with a diagnosis of LSS without cervical myelopathy and radiculopathy were grouped into ASCSS and non-ASCSS groups. The medical data and radiological parameters, including age, sex, body mass index, Charlson comorbidity index, symptom duration, redundant nerve roots, dural sac cross-sectional area (DCSA), facet joint angle, lumbar lordosis angle (LLA), pelvic incidence (PI), Torg-Pavlov ratio, and lumbosacral transitional vertebrae, were analyzed. The lumbar stenosis index and cervical stenosis index of the 114 patients were also analyzed. RESULTS ASCSS occurred in 70 of the 114 patients with LSS (61.4%). The two groups showed significant differences in symptom duration, redundant nerve roots, LLA, DCSA, and PI. On multivariate logistic regression analysis, an LLA >35.85° (P < 0.001) and a DCSA <84.50 mm2 (P = 0.003) were independently associated with ASCSS. The multi-index receiver operating characteristic curve showed that the area under the curve for predicted probability was 0.805 (P < 0.001). Linear regression analysis revealed that cervical stenosis index significantly and positively correlated with the lumbar stenosis index (r = 0.430; P < 0.001). CONCLUSIONS Our findings suggest that an LLA >35.85° and a DCSA <84.50 mm2 are risk factors for the development of ASCSS. For LSS patients with an enlarged LLA and reduced DSCA, a whole spinal magnetic resonance imaging examination should be performed.
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Affiliation(s)
- Zhuanghui Wang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuluo Rong
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengyu Tang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wu Ye
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengyue Ji
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaxing Wang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuhui Ge
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Liu
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qingqing Li
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weihua Cai
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Clinical Efficacy and Rehabilitation of Microscopic "Over the Top" for Bilateral Decompression in Degenerative Lumbar Stenosis: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7174354. [PMID: 33490252 PMCID: PMC7787760 DOI: 10.1155/2020/7174354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022]
Abstract
Background Recently, “over the top” (also called ULBD; microscopic unilateral laminotomy for bilateral decompression) is a less invasive technique for symptomatic degenerative lumbar spinal stenosis (LSS), and this minimally invasive surgical technique has demonstrated favorable therapeutic outcomes. However, the risk of postoperative complications remains controversial. Objective This study is aimed at determining the clinical efficacy and complication and rehabilitation of the microscopic “over the top” for degenerative LSS in geriatric patients. Study Design. This was a retrospective study. Setting. All data were obtained from the People's Hospital of a University. Methods A retrospective analysis of 39 consecutive elderly patients treated for LSS by microscopic “over the top” between January 2016 and January 2018 was performed. A postoperative rehabilitation program for geriatric patients with restricted weight-bearing was instituted after the microscopic “over the top” treatment. Estimated blood loss, duration of operation, length of hospitalization, and total complications were also evaluated. The CT and MRI examinations of the lumbar spine were collected to evaluate the completeness of the nerve decompression. Clinical data were assessed at 6 months and 12 months after operation utilizing the visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short-Form Health Survey (SF-36). Preoperative comorbidities, complications, and revision surgery were also recorded. Results We enrolled a total of 39 degenerative LSS patients (27 male and 12 female patients, mean age of 75.8 ± 9.2 years). Twenty patients had one-level of degenerative LSS; thirteen patients had two-level of LSS; six patients had three-level of LSS. The average follow-up time in our study was 14.6 ± 7.8 months (range, 6-24 months). The overall complication rate was 10.2% (4/39), and the reoperation rates at one year were 2.5% (1/39). VAS back and leg pain score at 6 months were decreased to 1.8 ± 0.7 and 1.4 ± 0.6, respectively, and remained at 1.9 ± 0.3 and 1.2 ± 0.2 at 12 months, respectively. ODI scores improved significantly from 32.26 ± 6.82 to 11.44 ± 2.50 at 6 months and 10.56 ± 2.29 at 12 months. 36-Item Short-Form Health Survey scores revealed a significant improvement throughout follow-up. Postoperative complications included dural tear (n = 2), neurologic deficit (n = 1), and reoperation (n = 1). No infections or hematomas were reported. Limitation. Multicenter research is recommended to confirm our results and investigate the factors related to clinical and radiographic results. Conclusions Microscopic “over the top” technique is a safe, effective option in the therapy of degenerative LSS and obtained satisfactory functional outcomes when coupled with aggressive rehabilitation, with a long recurrence-free recovery.
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Abbas J, Peled N, Hershkovitz I, Hamoud K. Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2453503. [PMID: 32685454 PMCID: PMC7341411 DOI: 10.1155/2020/2453503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.
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Affiliation(s)
- Janan Abbas
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, Zefat, 13206, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias 1520800, Israel
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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Facet Sagittal Orientation: Possible Role in the Pathology of Degenerative Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2018; 43:955-958. [PMID: 29189570 DOI: 10.1097/brs.0000000000002493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE This study aimed to elucidate the association between facet joint orientation and degenerative lumbar spinal stenosis (DLSS). SUMMARY OF BACKGROUND DATA Many studies have demonstrated the relationship between sagittal facet orientation and degenerative lumbar spondylolisthesis. However, the associations between facet orientation and DLSS have rarely been studied. METHODS Ninety-one age-matched and sex-matched patients with DLSS (LSS group) and 91 control participants were consecutively enrolled. Their lumbar facet angles and the dural sac cross-sectional area at L2-L3, L3-L4, L4-L5, and L5-S1 were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. RESULTS The facet angles on the left side or right side of the LSS group were significantly smaller than the respective ones of the control group. Outcomes of the groups revealed significantly and consistently increasing facet angles from L2-L3 to L5-S1. The dural sac cross-sectional area of the LSS group had significantly smaller measurements values than that of the control group at L2-L3, L3-L4, L4-L5, and L5-S1. CONCLUSION Sagittalization of lumbar facet joints was considered to be a risk factor for DLSS and may play a role in the pathology of DLSS. LEVEL OF EVIDENCE 3.
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Clinical and Radiological Outcomes after Microscopic Bilateral Decompression via a Unilateral Approach for Degenerative Lumbar Disease: Minimum 5-Year Follow-Up. Asian Spine J 2017; 11:285-293. [PMID: 28443174 PMCID: PMC5401844 DOI: 10.4184/asj.2017.11.2.285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 11/08/2022] Open
Abstract
Study Design A retrospective study. Purpose To assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated. Overview of Literature Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation. Methods Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis). Results The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis. Conclusions Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.
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Abd Latif MJ, Jin Z, Wilcox RK. Biomechanical characterisation of ovine spinal facet joint cartilage. J Biomech 2012; 45:1346-52. [DOI: 10.1016/j.jbiomech.2012.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/09/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
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