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Hipp J, Grieco T, Newman P, Patel V, Reitman C. Reference Data for Diagnosis of Spondylolisthesis and Disc Space Narrowing Based on NHANES-II X-rays. Bioengineering (Basel) 2024; 11:360. [PMID: 38671782 PMCID: PMC11048070 DOI: 10.3390/bioengineering11040360] [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: 03/08/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Robust reference data, representing a large and diverse population, are needed to objectively classify measurements of spondylolisthesis and disc space narrowing as normal or abnormal. The reference data should be open access to drive standardization across technology developers. The large collection of radiographs from the 2nd National Health and Nutrition Examination Survey was used to establish reference data. A pipeline of neural networks and coded logic was used to place landmarks on the corners of all vertebrae, and these landmarks were used to calculate multiple disc space metrics. Descriptive statistics for nine SPO and disc metrics were tabulated and used to identify normal discs, and data for only the normal discs were used to arrive at reference data. A spondylolisthesis index was developed that accounts for important variables. These reference data facilitate simplified and standardized reporting of multiple intervertebral disc metrics.
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Affiliation(s)
- John Hipp
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | - Trevor Grieco
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | | | - Vikas Patel
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Charles Reitman
- Medical University of South Carolina, Charleston, SC 29425, USA;
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Kanchiku T, Taguchi T, Sekiguchi M, Toda N, Hosono N, Matsumoto M, Tanaka N, Akeda K, Hashizume H, Kanayama M, Orita S, Takeuchi D, Kawakami M, Fukui M, Kanamori M, Wada E, Kato S, Hongo M, Ando K, Iizuka Y, Ikegami S, Kawamura N, Takami M, Yamato Y, Takahashi S, Watanabe K, Takahashi J, Konno S, Chikuda H. Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100269. [PMID: 37731461 PMCID: PMC10507637 DOI: 10.1016/j.xnsj.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Background The choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis. Methods Seventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis. Results Sixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01). Conclusions Preoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.
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Affiliation(s)
- Tsukasa Kanchiku
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Toshihiko Taguchi
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Naofumi Toda
- Department of Orthopaedic Surgery, Gunma Spine Center (Harunaso Hospital), 828-1 Kamitoyooka-cho, Takasaki City, Gunma Prefecture 370-0871, Japan
| | - Noboru Hosono
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukusima, Fukushima-ku, Osaka City, Osaka Prefecture 553-0003, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo Prefecture 160-8582, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, 1-36 Niyonosato, Hiroshimahigasi-ku, Hiroshima Prefecture 732-0057, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Masahiro Kanayama
- The Spine Center, Hakodate Central General Hospital, 33-2 Motomachi, Hakodate City, Hokkaido Prefecture 040-8585, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Chiba, Japan, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohara, Chuo-ku, Chiba City, Chiba Prefecture 260-8677, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Nasu Red-Cross Hospital, 1081-4 Nakatahara, Otahara City, Tochigi Prefecture 324-0062, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Junibancho, Wakayama City, Wakayama Prefecture 640-8158, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka Metropolitan University Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama Prefecture 930-0194, Japan
| | - Eiji Wada
- Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka City, Osaka Prefecture 543-0035, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo Prefecture 113-8655, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 44-2 Hasunuma Hiroomote, Akita City, Akita Prefecture 010-8543, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myokencho, Syowa-ku, Nagoya City, Aichi Prefecture 466-8650, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo Prefecture 150-8935, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka Prefecture 431-3192, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 754 Asahimachidoriichibancho, Chuo-ku, Niigata City, Niigata Prefecture 951-5820, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
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Giordan E, Drago G, Zanata R, Marton E, Verme JD. The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study. Int J Spine Surg 2023; 17:627-637. [PMID: 37802654 PMCID: PMC10623666 DOI: 10.14444/8531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The relationship between paraspinal muscle degeneration and low back pain (LBP), disability, and structural changes has been investigated in the literature, but it is still a matter of debate. We differentiated paraspinal muscle magnetic resonance imaging by quality and quantity, focusing on fatty infiltration (FI) and paraspinal muscles cross-sectional area (CSA) from T12 to S1 in patients with and without chronic LBP. We aimed to determine whether paraspinal muscle quantity (CSA) and quality (FI) are positively associated with LBP or degenerative/spinopelvic changes in the spine. METHODS Between 2018 and 2021, we prospectively enrolled 205 patients aged between 18 to 65 years, of whom 153 patients had chronic back pain (back pain group) and 52 patients did not have chronic back pain (no back pain group), and collected clinicodemographic, structural, and spinopelvic data. We correlated these data with paraspinal muscle FI and CSA from T12 to S1. Multivariate models were run to highlight associations between pain, disability, or degenerative and spinopelvic parameters. RESULTS Age was not associated with increased FI but consistently with decreased CSA values. After adjusting for age, sex, and body mass index, FI was associated with an increased risk of back pain (OR, 8.80; 95% CI, 1.9-39.79; P = 0.006) and high disability scores (OR, 3.41; 95% CI, 1.12-10.30; P = 0.030). Decreased CSA was associated with reduced disc height (P < 0.001), while FI and CSA did not associate with abnormal spinopelvic parameters. CONCLUSIONS FI on paraspinal muscle highly correlates with back pain and disability but was not found in structural and degenerative changes in the lower back. CLINICAL RELEVANCE Findings from this study are clinically relevant for patient counseling and rehabilitation strategies. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Enrico Giordan
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Giacomo Drago
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Roberto Zanata
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | | | - Jacopo Del Verme
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
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Ulrich NH, Burgstaller JM, Valeri F, Pichierri G, Betz M, Fekete TF, Wertli MM, Porchet F, Steurer J, Farshad M. Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis. JAMA Netw Open 2022; 5:e2223803. [PMID: 35881393 PMCID: PMC9327572 DOI: 10.1001/jamanetworkopen.2022.23803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Only limited data derived from large prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for degenerative lumbar spinal stenosis (DLSS). OBJECTIVE To assess the cumulative incidence of revision surgery after 2 types of index operations-decompression alone or decompression with fusion-among patients with DLSS. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a multicenter, prospective cohort study, the Lumbar Stenosis Outcome Study, which included patients aged 50 years or older with DLSS at 8 spine surgery and rheumatology units in Switzerland between December 2010 and December 2015. The follow-up period was 3 years. Data for this study were analyzed between October and November 2021. EXPOSURES All patients underwent either decompression surgery alone or decompression with fusion surgery for DLSS. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in the following patient-reported outcome measures: Spinal Stenosis Measure (SSM) symptom severity (higher scores indicate more pain) and physical function (higher scores indicate more disability) subscale scores and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score (lower scores indicate worse quality of life). RESULTS A total of 328 patients (165 [50.3%] men; median age, 73.0 years [IQR, 66.0-78.0 years]) were included in the analysis. Of these, 256 (78.0%) underwent decompression alone and 72 (22.0%) underwent decompression with fusion. The cumulative incidence of revisions after 3 years of follow-up was 11.3% (95% CI, 7.4%-15.1%) for the decompression alone group and 13.9% (95% CI, 5.5%-21.5%) for the fusion group (log-rank P = .60). There was no significant difference in the need for revision between the 2 groups over time (unadjusted absolute risk difference, 2.6% [95% CI, -6.3% to 11.4%]; adjusted absolute risk difference, 3.9% [95% CI, -5.2% to 17.0%]; adjusted hazard ratio, 1.40 [95% CI, 0.63-3.13]). The number of revisions was significantly associated with higher SSM symptom severity scores (β, 0.171; 95% CI, 0.047-0.295; P = .007) and lower EQ-5D-3L summary index scores (β, -0.061; 95% CI, -0.105 to -0.017; P = .007) but not with higher SSM physical function scores (β, 0.068; 95% CI, -0.036 to 0.172; P = .20). The type of index operation was not significantly associated with the corresponding outcomes. CONCLUSIONS AND RELEVANCE This cohort study showed no significant association between the type of index operation for DLSS-decompression alone or fusion-and the need for revision surgery or the outcomes of pain, disability, and quality of life among patients after 3 years. Number of revision operations was associated with more pain and worse quality of life.
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Affiliation(s)
- Nils H. Ulrich
- University Spine Centre Zurich, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Jakob M. Burgstaller
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Pichierri
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
| | - Michael Betz
- University Spine Centre Zurich, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Tamas F. Fekete
- Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Maria M. Wertli
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
- Division of General Internal Medicine, Bern University Hospital, Bern University, Bern, Switzerland
| | - François Porchet
- Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Johann Steurer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Centre Zurich, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
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Liang Z, Xu X, Rao J, Chen Y, Wang R, Chen C. Clinical Evaluation of Paraspinal Mini-Tubular Lumbar Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis Grade I with Lumbar Spinal Stenosis: A Cohort Study. Front Surg 2022; 9:906289. [PMID: 35620194 PMCID: PMC9127301 DOI: 10.3389/fsurg.2022.906289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the clinical outcome data and difference in efficacy between paraspinal mini-tubular lumbar decompression (PMTD) and minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis (DLS-I-LSS).MethodsPatients with DLS-I-LSS, who underwent PMTD or MIS TLIF from September 2017 to March 2020, were included retrospectively. The follow-up period was 24 months after surgery. Outcome measurements included the Oswestry disability index (ODI) score, visual analog scale (VAS) low back pain score, VAS leg pain score, surgical data, and adverse events.ResultsA total of 104 patients with DLS-I-LSS were included in this study. The average improvement in ODI at 12 months (2.0%, 95% CI, −5.7% to 1.8%; p = 0.30) and 24 months (1.7%, 95% CI, −2.7% to 6.1%; p = 0.45) after surgery between the two groups were not statistically significant. The improvement in VAS low back pain score after 24 months and improvement in VAS leg pain score were not significantly different between the two groups. Compared with the PMTD group, the MIS TLIF group had more estimated blood loss and longer hospital stays. The cumulative reoperation rates were 5.66% and 1.96% in the MIS TLIF and PMTD groups, respectively (p = 0.68). The results of multivariate analysis showed that BMI, diabetes, and baseline ODI score were the main factors influencing the improvement in ODI in patients with DLS-I-LSS after minimally invasive surgery, accounting for 50.5% of the total variance.ConclusionsThe clinical effectiveness of PMTD was non-inferior to that of MIS TLIF for DLS-I-LSS; however, there was a reduced duration of hospital stay, operation time, blood loss, and hospitalization costs in the PMTD group. BMI, presence or absence of diabetes and baseline ODI score were influencing factors for the improvement of ODI (Trial Registration: ChiCTR2000040025).
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Affiliation(s)
| | | | | | | | - Rui Wang
- Correspondence: Rui Wang Chunmei Chen
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Giordan E, Billeci D, Del Verme J, Varrassi G, Coluzzi F. Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis. Pain Ther 2021; 10:1481-1495. [PMID: 34490586 PMCID: PMC8586101 DOI: 10.1007/s40122-021-00309-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/13/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic pain after arthrodesis or previous spinal surgery. METHODS Multiple databases were searched for studies published in the English language, involving patients > 18 years old who underwent endoscopic foraminotomy. Outcomes included the rate of patients who showed "excellent" and "good" postoperative improvement, decreased leg pain, and improved Oswestry Disability Index (ODI) scores. Adverse events considered in the analysis included nerve root damage and intraoperative dural tear, the proportion of patients requiring revision surgery or recurrences, and infections. RESULTS A total of 14 studies, encompassing 600 patients, were identified. Approximately 85% of patients improved significantly after TELF, without significant differences among different groups (85% vs. 78%, respectively). Mean leg pain decreased an average of 5.2 points, and ODI scores improved by 41.2%. Patients with previous spine surgery or failed back surgery syndrome had higher postoperative leg dysesthesia rates after TELF (14% vs. 1%, respectively). CONCLUSION TELF is a useful and safe method to achieve decompression in foraminal stenosis. This technique is indicated in the elderly or patients with comorbidities. Preoperative planning is paramount in determining the foraminal size and endoscope trajectory. A diamond burr is recommended because it has an advantage over the regular endoscopic shaver in bleeding control and complication avoidance.
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Affiliation(s)
- Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100, Treviso, Veneto, Italy.
| | - Domenico Billeci
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100 Treviso, Veneto Italy
| | - Jacopo Del Verme
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100 Treviso, Veneto Italy
| | | | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy ,Sant’Andrea University Hospital, Rome, Italy
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Läubli R, Brugger R, Pirvu T, Hoppe S, Sieroń D, Szyluk K, Albers CE, Christe A. Disproportionate Vertebral Bodies and Their Impact on Lumbar Disc Herniation. J Clin Med 2021; 10:3174. [PMID: 34300340 PMCID: PMC8307056 DOI: 10.3390/jcm10143174] [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: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether the presence of disproportionate vertebral bodies is a risk factor for disc herniation (DH). METHODS Sixty-seven consecutive patients (m: 31 f: 36) who underwent lumbar discectomy for symptomatic DH at one level between L3 and S1 were retrospectively included. The last three motion segments (3 × 67 = 201) were assessed on sagittal MRI scans. A disproportionate motion segment was defined as the difference of more than 10% of the antero-posterior diameter of two adjacent endplates. RESULTS DH was present in 6/67 (9%), 26/67 (38.8%), and 35/67 (52.2%) patients at L3/4, L4/5, and L5/S1, respectively. A total of 14 of 67 patients demonstrated a disproportionate motion segment at the discectomy level (20.9%). A total of 23 of the 201 (11.4%) investigated motion segments met our criteria for a disproportionate motion segment. In our study population, when one of the 201 segments was disproportionate, the positive predictive value (PPV) for DH increased toward the lower segments: the PPV at the L5/S1 level was 83.0%. The odds ratio of disproportion for DH was the highest at the L5/S1 level, with 6.0 ± 0.82 (p = 0.017). CONCLUSIONS The presence of a disproportionate motion segment in the lower spine may lead to a significant higher risk for DH in patients undergoing discectomy.
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Affiliation(s)
- Ralph Läubli
- Orthopedic Surgery, Interlaken Hospital FMI, Weissenaustrasse 27, 3800 Unterseen, Switzerland; (R.L.); (R.B.); (T.P.)
| | - Robin Brugger
- Orthopedic Surgery, Interlaken Hospital FMI, Weissenaustrasse 27, 3800 Unterseen, Switzerland; (R.L.); (R.B.); (T.P.)
| | - Tatiana Pirvu
- Orthopedic Surgery, Interlaken Hospital FMI, Weissenaustrasse 27, 3800 Unterseen, Switzerland; (R.L.); (R.B.); (T.P.)
| | - Sven Hoppe
- Wirbelsäulenmedizin Bern, Hirslanden Salem-Spital, Schänzlistrasse 39, 3000 Bern, Switzerland;
- Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland;
| | - Dominik Sieroń
- Silesian Center for Heart Diseases, Division of Magnetic Resonance Imaging, 41-800 Zabrze, Poland
| | - Karol Szyluk
- I Departament of Trauma and Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940 Piekary Śląskie, Poland;
| | - Christoph E. Albers
- Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland;
| | - Andreas Christe
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland;
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Nguyen TP, Chae DS, Park SJ, Kang KY, Yoon J. Deep learning system for Meyerding classification and segmental motion measurement in diagnosis of lumbar spondylolisthesis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Arjun Sharma J, Gadjradj PS, Peul WC, van Tulder MW, Moojen WA, Harhangi BS. SIZE study: study protocol of a multicentre, randomised controlled trial to compare the effectiveness of an interarcuair decompression versus extended decompression in patients with intermittent neurogenic claudication caused by lumbar spinal stenosis. BMJ Open 2020; 10:e036818. [PMID: 33028548 PMCID: PMC7539610 DOI: 10.1136/bmjopen-2020-036818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Intermittent neurogenic claudication (INC) is often caused by lumbar spinal stenosis (LSS). Laminectomy is considered a frequently used surgical technique for LSS. Previous studies have shown that laminectomy can potentially cause lumbar instability. Less invasive techniques, preserving midline structures including the bilateral small size interarcuair decompression, are currently applied. Due to lack of evidence and consensus, surgeons have to rely on their training and own experiences to choose the best surgical techniques for their patients. Hence, an observer and patient blinded multicentre, randomised controlled trial was designed to determine the effectiveness and cost-effectiveness of bilateral interarcuair decompression versus laminectomy for LSS. METHODS AND ANALYSIS 174 patients above 40 years with at least 12 weeks of INC will be recruited. Patients are eligible for inclusion if they have a clinical indication for surgery for INC with an MRI showing signs of LSS. Patients will be randomised to laminectomy or bilateral interarcuair decompression. The primary outcome is functional status measured with the Roland-Morris Disability Questionnaire at 12 months. Secondary outcomes consist of pain intensity, self-perceived recovery, functional status measured with the Oswestry Disability Index and a physical examination. Outcome measurement moments will be scheduled at 3 and 6 weeks, and at 3, 6, 12, 18, 24, 36 and 48 months after surgery. Physical examination will be performed at 6 weeks, and 12, 24 and 48 months. An economic evaluation will be performed and questionnaires will be used to collect cost data. ETHICS AND DISSEMINATION The Medical Ethical Committee of the Erasmus Medical Centre Rotterdam approved this study (NL.65826.078.18). The results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03480893). IRB APPROVAL STATUS MEC-2018-093.
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Affiliation(s)
| | - Pravesh S Gadjradj
- Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and The Hague Medical Center, Leiden, The Netherlands, Leiden, The Netherlands
| | - Wilco C Peul
- Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and The Hague Medical Center, Leiden, The Netherlands, Leiden, The Netherlands
| | | | - Wouter A Moojen
- Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and The Hague Medical Center, Leiden, The Netherlands, Leiden, The Netherlands
- Neurosurgery, Medical Centre Haaglanden, Den Haag, The Netherlands
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Long-term Results After Surgical or Nonsurgical Treatment in Patients With Degenerative Lumbar Spinal Stenosis: A Prospective Multicenter Study. Spine (Phila Pa 1976) 2020; 45:1030-1038. [PMID: 32675604 DOI: 10.1097/brs.0000000000003457] [Citation(s) in RCA: 9] [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 Prospective, multicenter cohort study. OBJECTIVE The aim of our study was to assess the course of patients over a period of 3 years undergoing surgical or nonsurgical treatments for degenerative lumbar spinal stenoses (DLSS) based on data from the Lumbar Stenosis Outcome Study (LSOS), prospectively performed in eight hospitals. SUMMARY OF BACKGROUND DATA The optimal treatment strategy for patients with DLSS is still debated. METHODS The outcomes of patients with verified DLSS were quantified by Spinal Stenosis Measure (SSM) symptoms- and SSM function-scores, and EQ-5D-3L (quality of life) summary index (SI) over time (up to 36-month follow-up), and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and EQ-5D-3L SI from baseline to 36-month follow-up. RESULTS For this study, 601 patients met the inclusion criteria; 430 underwent surgery, 18 of them only after more than a year after enrolment, 171 received nonsurgical treatment only. At baseline, patients in the surgical and nonsurgical groups had similar values for the SSM symptoms and SSM function scores, but patients in the surgical group suffered significantly more from buttocks pain and reported more worsening symptoms over the last 3 months before enrollment in the study. Surgically treated patients (except changers) performed significantly better in all clinical outcome measures (P < 0.001) with a plateau at 12-month follow-up staying constant until the follow-up ended. Further, two-thirds of patients in the surgical group had a relevant improvement in function, symptoms, and quality of life, compared with only about half of those in terms of symptoms and even less in terms of function and quality of life with nonsurgical treatment. CONCLUSIONS Surgical treatment of DLSS results in more favorable clinical outcomes with a sustained effect over time, compared to nonsurgical treatment. LEVEL OF EVIDENCE 3.
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Tacconi L, Spinelli R, Serra G, Signorelli F, Giordan E. Full-Endoscopic Removal of Lumbar Juxtafacet Cysts: A Prospective Multicentric Study. World Neurosurg 2020; 141:e414-e422. [PMID: 32461174 DOI: 10.1016/j.wneu.2020.05.166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lumbar juxtafacet cysts are benign lesions that grow at the level of facet joints or within neighboring structures. Recently, there is an ongoing trend toward less invasive procedures for treating degenerative spine diseases. Here we report a multicenter study of full-endoscopic surgery for juxtafacet cyst removal. METHODS We prospectively collected patients with a diagnosis of lumbar juxtafacet cyst surgically treated in 3 institutions between January 2017 and August 2019. Patients of any sex and age were eligible if they had a single level unilateral lumbar juxtafacet cyst, invalidating radicular pain lasting >6 weeks, adequate imaging, and failed percutaneous or conservative treatment. Age at diagnosis; sex; preoperative, postoperative, and 6-month leg pain; surgical and medical complications; spine instability (preoperatively and at 6 and 12 months); and follow-up time were collected. RESULTS Thirty-five patients were enrolled. Median operative time was 78 minutes, and mean leg pain went from a preoperative value of 6.8 (standard deviation [SD] = 1.2) to a postoperative value of 3.4 (SD = 1.1, P < 0.001) to 2.1 (SD = 1.7, P < 0.001) at 6 months. At a median follow-up of 15 months, approximately 89% of patients were pain-free or improved. We had 2 recurrences of radicular pain, treated conservatively. Only 2 surgical complications (6%) occurred: 2 small dural tears, both resolved without further intervention. CONCLUSIONS Full-endoscopic surgery is feasible and safe for juxtafacet cyst removal. Our results are consistent with findings from recent full-endoscopic and series, with outcomes overlapping those reported for open or tubular techniques.
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Affiliation(s)
- Leonello Tacconi
- Neurosurgical Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Friuli Venezia Giulia, Italy
| | - Roberto Spinelli
- Neurosurgical Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Friuli Venezia Giulia, Italy
| | - Gerardo Serra
- Anesthesia and Analgesic Therapy Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Enrico Giordan
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy.
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Two-year outcome comparison of decompression in 14 lipomatosis cases with 169 degenerative lumbar spinal stenosis cases: a Swiss prospective multicenter cohort study. 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 2020; 29:2243-2253. [PMID: 32409888 DOI: 10.1007/s00586-020-06449-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/09/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Spinal epidural lipomatosis (SEL) is defined as an abnormal and extensive accumulation of unencapsulated adipose tissue within the spinal epidural space. To date, there is a lack of high-level evidence studies reporting the outcome of surgical treatment of symptomatic SEL in patients with lumbar spinal stenosis (LSS). The aim was to compare clinical outcomes in patients with symptomatic LSS with and without SEL who underwent decompression surgery alone at the 12- and 24-month follow-up. METHODS One hundred and eighty-three patients met the inclusion criteria, of which 14 had mainly SEL on at least one level operated in addition to possible degenerative changes on other levels and 169 degenerative LSS only. The main outcomes were pain (Spinal Stenosis Measure (SSM) symptoms), disability (SSM function), and quality of life [EQ-5D-3L summary index (SI)] at 24-month follow-up, and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and EQ-5D-3L SI. RESULTS The multiple regression linear models showed that SEL was associated with worse SSM symptoms (p = 0.045) and EQ-5D-3L SI scores (p = 0.026) at 24-month follow-up, but not with worse SSM function scores. Further, depression (in all models) was negatively associated with better clinical outcomes at 24-month follow-up. In the outcomes SSM symptoms and EQ-5D-3L SI, distinctly more patients in the classical LSS group reached MCID than in the SEL group (71.3% and 62.3% vs. 50.0% and 42.9%). CONCLUSIONS Our study demonstrated that decompression alone surgery was associated with significant improvement in disability in both groups at 2 years, but not in pain and quality of life in patients with SEL.
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Automatic spondylolisthesis grading from MRIs across modalities using faster adversarial recognition network. Med Image Anal 2019; 58:101533. [DOI: 10.1016/j.media.2019.101533] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
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Peng P, Chen K, Chen H, Zhang K, Sun J, Yang P, Zhou F, Liu Y, Yang H, Mao H. Comparison of O-arm navigation and microscope-assisted minimally invasive transforaminal lumbar interbody fusion and conventional transforaminal lumbar interbody fusion for the treatment of lumbar isthmic spondylolisthesis. J Orthop Translat 2019; 20:107-112. [PMID: 31908941 PMCID: PMC6939115 DOI: 10.1016/j.jot.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/07/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of this study is to compare the clinical efficacy of O-arm navigation and microscope-assisted minimally invasive transforaminal lumbar interbody fusion (modified MIS-TLIF) versus conventional TLIF in the lumbar isthmic spondylolisthesis. Materials and methods Forty patients with 1-level lumbar isthmic spondylolisthesis were enrolled in the study. Perioperative indexes including operation time, intraoperative bleeding, bed rest time, time of hospitalisation stay and the accuracy rate of screw placement were analysed. Preoperative and postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed. Results The operation time in the modified MIS-TLIF group was longer than the conventional TLIF group (p < 0.05). However, intraoperative blood loss in the modified MIS-TLIF group was less than the comparative group (p < 0.05). The average bed rest time and hospitalisation stay in the modified MIS-TLIF group was shorter than conventional TLIF group (p < 0.05). The screw placement in the modified MIS-TLIF group was more precisely than that in the conventional TLIF group (p < 0.05). Meanwhile, the improvement of VAS and ODI in the modified MIS-TLIF group were lower than that in the conventional TLIF group 1 and 6 months after operation (p < 0.05). There was no difference in the VAS and ODI score between the two group at the last follow-up (p > 0.05). Conclusion Navigation and microscope-assisted MIS-TLIF is safe and reliable for treatment of lumbar isthmic spondylolisthesis (Meyerding degree I or II) with potential advantages including less injury, less blood loss, higher screw accuracy and faster recovery after operation. The translational potential of this article Compared with conventional transforaminal lumbar interbody fusion, O-arm navigation and microscope-assisted minimally invasive transforaminal lumbar interbody fusion has a huge advantage in surgery treatment of lumbar isthmic spondylolisthesis. Hence, this article provided a better surgery method to deal with lumbar isthmic spondylolisthesis, and robot-assisted minimally invasive transforaminal lumbar interbody fusion will be adopted in the future.
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Affiliation(s)
- Peng Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Hao Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Kai Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Jiajia Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Peng Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Feng Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Yu Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, China
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Hsu HC, Chang CJ, Tung HH, Wang TJ. Disability, emotional distress and well-being among patients with lumbar spondylolisthesis. J Clin Nurs 2019; 28:3866-3878. [PMID: 31294503 DOI: 10.1111/jocn.14992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
AIM AND OBJECTIVE To explore the disability, emotional distress and well-being of patients with lumbar spondylolisthesis. BACKGROUND Few studies have investigated the correlations between disability, emotional distress and well-being of patients with lumbar spondylolisthesis. DESIGN This study used a cross-sectional research design. METHODS Participants were 133 patients aged over 50 years who were experiencing lumbar spondylolisthesis. The research instruments included a demographic information questionnaire; the Numeric Rating Scale (NRS); the Charlson Comorbidity Index (CCI); the Chinese versions of the Oswestry Disability Index (ODI), State-Trait Anxiety Inventory-State (STAI-S) and Center for Epidemiological Study-Depression (CES-D); and the Psychological Well-being (PWB) Scale. Emotional distress was measured by the STAI-S and CES-D. Pearson's correlations coefficient, multiple linear regression and a mediating effect model were introduced to explore correlations between the variables and predictors of psychological well-being, and details of the methods are reported in coherence to STROBE criteria. RESULTS Eighty-six participants (64.6%) had moderate and severe anxiety, and 42 (31.6%) experienced depression. Participants reported medium to high levels of well-being; "satisfaction with interpersonal relationships" was rated the highest and "physical and mental health" the lowest. Disability, depression and anxiety had significant negative correlations with well-being. Depression and anxiety mediated the relationship between disability and well-being. Moreover, depression, family support, educational background and anxiety were predictors of well-being, accounting for 39.1% of the total variance. CONCLUSIONS Disability and emotional distress among patients with lumbar spondylolisthesis had a negative impact on well-being. Anxiety and depression were closely correlated with and substantially influenced well-being. RELEVANCE TO CLINICAL PRACTICE Health professionals will enhance the understanding of important factors influencing well-being among patients with lumbar spondylolisthesis. This study suggests the conduct of depression and anxiety evaluations at outpatient clinics and prior to surgery, so that clinicians will be aware of the emotional distress status of patients with lumbar spondylolisthesis and, therefore, enhance their well-being.
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Affiliation(s)
- Hui-Chen Hsu
- Department of Nursing, Cathay General Hospital, Taipei City, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.,Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan
| | - Chih-Ju Chang
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan.,Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Mechanical Engineering, National Central University, Taoyuan County, Taiwan
| | - Heng-Hsin Tung
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:148. [PMID: 31122245 PMCID: PMC6533736 DOI: 10.1186/s13018-019-1197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
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Ulrich NH, Burgstaller JM, Gravestock I, Pichierri G, Wertli MM, Steurer J, Farshad M, Porchet F. Outcome of unilateral versus standard open midline approach for bilateral decompression in lumbar spinal stenosis: is "over the top" really better? A Swiss prospective multicenter cohort study. J Neurosurg Spine 2019; 31:236-245. [PMID: 31026821 DOI: 10.3171/2019.2.spine181309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this retrospective analysis of a prospective multicenter cohort study, the authors assessed which surgical approach, 1) the unilateral laminotomy with bilateral spinal canal decompression (ULBD; also called "over the top") or 2) the standard open bilateral decompression (SOBD), achieves better clinical outcomes in the long-term follow-up. The optimal surgical approach (ULBD vs SOBD) to treat lumbar spinal stenosis remains controversial. METHODS The main outcomes of this study were changes in a spinal stenosis measure (SSM) symptoms score, SSM function score, and quality of life (sum score of the 3-level version of the EQ-5D tool [EQ-5D-3L]) over time. These outcome parameters were measured at baseline and at 12-, 24-, and 36-month follow-ups. To obtain an unbiased result on the effect of ULBD compared to SOBD the authors used matching techniques relying on propensity scores. The latter were calculated based on a logistic regression model including relevant confounders. Additional outcomes of interest were raw changes in main outcomes and in the Roland and Morris Disability Questionnaire from baseline to 12, 24, and 36 months. RESULTS For this study, 277 patients met the inclusion criteria. One hundred forty-nine patients were treated by ULBD, and 128 were treated by SOBD. After propensity score matching, 128 patients were left in each group. In the matched cohort, the mean (95% CI) estimated differences between ULBD and SOBD for change in SSM symptoms score from baseline to 12 months were -0.04 (-0.25 to 0.17), to 24 months -0.07 (-0.29 to 0.15), and to 36 months -0.04 (-0.28 to 0.21). For change in SSM function score, the estimated differences from baseline to 12 months were 0.06 (-0.08 to 0.21), to 24 months 0.08 (-0.07 to 0.22), and to 36 months 0.01 (-0.16 to 0.17). Differences in changes between groups in EQ-5D-3L sum scores were estimated to be -0.32 (-4.04 to 3.40), -0.89 (-4.76 to 2.98), and -2.71 (-7.16 to 1.74) from baseline to 12, 24, and 36 months, respectively. None of the group differences between ULBD and SOBD were statistically significant. CONCLUSIONS Both surgical techniques, ULBD and SOBD, may provide effective treatment options for DLSS patients. The authors further determined that the patient outcome results for the technically more challenging ULBD seem not to be superior to those for the SOBD even after 3 years of follow-up.
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Affiliation(s)
- Nils H Ulrich
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
| | - Jakob M Burgstaller
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
| | - Isaac Gravestock
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
| | - Giuseppe Pichierri
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
| | - Maria M Wertli
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
- 2Division of General Internal Medicine, Bern University Hospital, Bern University, Bern
| | - Johann Steurer
- 1Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich
| | - Mazda Farshad
- 3University Spine Centre Zurich, Balgrist University Hospital, University of Zurich; and
| | - François Porchet
- 4Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
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Cheaney B, Krause KL, Jung E, Than KD. Treatment of L5-S1 spondyloptosis with stand-alone anterior lumbar interbody fusion in a patient with neurofibromatosis. Br J Neurosurg 2019:1-6. [DOI: 10.1080/02688697.2019.1572868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Barry Cheaney
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Katie L. Krause
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Enjae Jung
- Division of Vascular Surgery, Department of Surgery,Oregon Health & Science University, Portland, OR, USA
| | - Khoi D. Than
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
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Legaye J. Radiographic analysis of the listhesis associated with lumbar isthmic spondylolysis. Orthop Traumatol Surg Res 2018; 104:569-573. [PMID: 29807187 DOI: 10.1016/j.otsr.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/03/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In cases of spondylolysis, hypoplasia of L5 mimicking spondylolisthesis has been described, mainly based on MRI; however, the treatment implications have not been analyzed specifically. OBJECTIVE Assess the impact of hypoplasia of the L5 vertebral body in the constitution of the spondylolisthesis associated with isthmic spondylolysis. MATERIAL AND METHODS A retrospective radiographic study in the standing position was performed with 104 patients with L5 isthmic spondylolysis and 24 control subjects. RESULTS Measurements of vertebral endplate length showed that the standard apparent posterior listhesis (APL) is made up of true listhesis (TL) and false listhesis (FL). FL is induced by hypoplasia of the L5 vertebral body relative to the S1 endplate. TL results from disk failure and leads to anterior listhesis (AL), which alters the balance of spinal curvatures. CONCLUSIONS By integrating the potential for false listhesis into the classification systems for spondylolisthesis, we can adapt the treatment algorithms. TYPE OF STUDY Retrospective radiography study. LEVEL OF EVIDENCE IV Retrospective review of cases.
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Affiliation(s)
- Jean Legaye
- Département de chirurgie orthopédique, hôpital universitaire UCL Mont-Godinne, 5530 Yvoir, Belgium.
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Finkenstaedt T, Del Grande F, Bolog N, Ulrich NH, Tok S, Burgstaller JM, Steurer J, Chung CB, Andreisek G, Winklhofer S. Correlation of listhesis on upright radiographs and central lumbar spinal canal stenosis on supine MRI: is it possible to predict lumbar spinal canal stenosis? Skeletal Radiol 2018; 47:1269-1275. [PMID: 29651713 DOI: 10.1007/s00256-018-2935-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether upright radiographs can predict lumbar spinal canal stenosis using supine lumbar magnetic resonance imaging (MRI) and to investigate the detection performance for spondylolisthesis on upright radiographs compared with supine MRI in patients with suspected lumbar spinal canal stenosis (LSS). MATERIALS AND METHODS In this retrospective study, conventional radiographs and MR images of 143 consecutive patients with suspected LSS (75 female, mean age 72 years) were evaluated. The presence and extent of listhesis (median ± interquartile range) were assessed on upright radiographs and supine MRI of L4/5. In addition, the grade of central spinal stenosis of the same level was evaluated on MRI according to the classification of Schizas and correlated with the severity/grading of anterolisthesis on radiographs. RESULTS Anterolisthesis was detected in significantly more patients on radiographs (n = 54; 38%) compared with MRI (n = 28; 20%), p < 0.001. Pairwise comparison demonstrated a significantly larger extent of anterolisthesis on radiographs (9 ± 5 mm) compared with MRI (5 ± 3 mm), p < 0.001. A positive correlation was found regarding the extent of anterolisthesis measured on radiographs and the grade of stenosis on MRI (r = 0.563, p < 0.001). Applying a cutoff value of ≥5 mm anterolisthesis on radiographs results in a specificity of 90% and a positive predictive value of 78% for the detection of patients with LSS, as defined by the Schizas classification. CONCLUSION Upright radiographs demonstrated more and larger extents of anterolisthesis compared with supine MRI. In addition, in patients with suspected LSS, the extent of anterolisthesis on radiographs (particularly ≥5 mm) is indicative of LSS and warrants lumbar spine MRI.
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Affiliation(s)
- Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Radiology, University of California, San Diego, School of Medicine, La Jolla, CA, 92093, USA
| | - Filippo Del Grande
- Institute of Diagnostic and Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Nils H Ulrich
- Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Sina Tok
- Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Jakob M Burgstaller
- Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Johann Steurer
- Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, School of Medicine, La Jolla, CA, 92093, USA
| | - Gustav Andreisek
- Department of Radiology, Kantonsspital Muensterlingen, Münsterlingen, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Ulrich NH, Gravestock I, Held U, Schawkat K, Pichierri G, Wertli MM, Winklhofer S, Farshad M, Porchet F, Steurer J, Burgstaller JM. Does Preoperative Degenerative Spondylolisthesis Influence Outcome in Degenerative Lumbar Spinal Stenosis? Three-Year Results of a Swiss Prospective Multicenter Cohort Study. World Neurosurg 2018; 114:e1275-e1283. [DOI: 10.1016/j.wneu.2018.03.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
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Goyal A, Kerezoudis P, Alvi MA, Goncalves S, Bydon M. Outcomes following minimally invasive lateral transpsoas interbody fusion for degenerative low grade lumbar spondylolisthesis: A systematic review. Clin Neurol Neurosurg 2018; 167:122-128. [DOI: 10.1016/j.clineuro.2018.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/24/2022]
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Sleem A, Marzouk A. Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis. Int J Spine Surg 2018; 12:70-75. [PMID: 30280086 DOI: 10.14444/5012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A retrospective study of patients treated by transforaminal lumbar interbody fusion (TLIF) with local bone graft alone for single-level isthmic spondylolisthesis (IS) between April 2009 and July 2014 in a single facility. Methods Demographic and operative data, complications, preoperative and postoperative clinical records, and radiographs were revised. The Visual Analogue Scale (VAS) and Denis Work Scale were used for clinical and functional assessment. Modified Lee et al. classification was used for assessment of union. Results Twenty-three patients with mean age of 45.04 ± 7.19 years had single-level TLIF with local bone graft alone for symptomatic IS with mean follow-up period of 28.39 ± 4.01 months and mean operative time of 170.09 ± 11.22 minutes. The VAS and Denis Work Scale improved from 8.48 ± 0.58 and 4.67 ± 0.47 preoperative to 2.91 ± 1.25 and 1.33 ± 0.58 at the latest follow up, respectively. Anterior vertebral translation improved from 27.22 ± 9.54% preoperatively to 8.38 ± 3.63% postoperatively and 10.39 ± 3.49 at the latest follow up. Disc space height was 9.67 ± 5.55% preoperatively, 21.60 ± 4.11% postoperative, and 16.24 ± 4.02% at the latest follow up. Lumbar lordosis improved from 29.39 ± 10.33° to 45.13 ± 6.84° postoperatively and 39.96 ± 7.52° at the latest follow up. Eighteen patients had definitive union, 4 patients with possible union, 1 patient with possible pseudoarthrosis. Conclusions Transforaminal lumbar interbody fusion with local bone graft alone is an appropriate option for single-level IS, yet we do not recommend it for higher grades of slippage with anterior vertebral translation more than 25%.
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Affiliation(s)
- Ahmed Sleem
- Orthopedic Department, Sohag University Hospital, Egypt
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Modified Lumbosacral Angle and Modified Pelvic Incidence as New Parameters for Management of Pediatric High-grade Spondylolisthesis. Clin Spine Surg 2018; 31:E133-E139. [PMID: 29112006 DOI: 10.1097/bsd.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE We aimed to introduce new parameters that can better describe the pelvic morphology and lumbosacral segmental deformity in children with high-grade spondylolisthesis of the L5 vertebra: modified pelvic incidence (mPI) and modified lumbosacral angle (mLSA). Also, we aimed to establish the mLSA as a convenient, reliable measurement method and criteria to evaluate the reduction of L5 vertebral slippage. SUMMARY OF BACKGROUND DATA Numerous parameters and methods exist to evaluate segmental deformity and reduction of L5 vertebral slippage, but no definitive standard for accurately and conveniently describing lumbosacral kyphosis and degree of reduction exists. METHODS A total of 24 children with high-grade spondylolisthesis (S group) and 152 children without spondylolisthesis (non-S group) underwent standard lateral radiography of the spine in our hospital between June 2009 and June 2014. We compared mPI and mLSA between the S and non-S groups. The agreement and repeatability of mPI and mLSA were also assessed. Preoperative and postoperative Japanese Orthopaedic Association (JOA) and Scoliosis Research Society (SRS)-22 scores were compared to assess clinical outcomes in the S group. The correlations between modified parameter applications and clinical outcomes were also assessed. RESULTS While mPI did not differ between groups, mLSA differed significantly. In the non-S group, mLSA was lordotic (25.51±6.41 degrees). In the S group, mLSA was kyphotic (25.85±5.17 degrees) before surgery and lordotic (20.74±7.04 degrees) postoperatively. The agreement and repeatability of mPI and mLSA were good, and clinical outcomes of the S group were satisfactory. Positive correlations were found between modified parameter applications and the improvement rates of JOA scores. CONCLUSIONS mPI and mLSA can better describe the pelvic morphology and local deformity of pediatric high-grade L5 spondylolisthesis, and mLSA can serve as a useful index for correcting lumbosacral kyphosis, rebalancing the sagittal spinal profile and predicting clinical outcomes.
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Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017; 18:188. [PMID: 28499364 PMCID: PMC5429540 DOI: 10.1186/s12891-017-1549-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Petersen
- Back Center Copenhagen, Mimersgade 41, 2200, Copenhagen N, Denmark.
| | - Mark Laslett
- PhysioSouth Ltd, 7 Baltimore Green, Shirley, Christchurch, 8061, New Zealand.,Southern Musculoskeletal Seminars, Christchurch, New Zealand
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Niels Andersen Vej 65, 2900, Hellerup, Denmark
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Liao S, Zhan Y, Dong Z, Yan R, Gong L, Zhou XS, Salganicoff M, Fei J. Automatic Lumbar Spondylolisthesis Measurement in CT Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1658-1669. [PMID: 26849859 DOI: 10.1109/tmi.2016.2523452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lumbar spondylolisthesis is one of the most common spinal diseases. It is caused by the anterior shift of a lumbar vertebrae relative to subjacent vertebrae. In current clinical practices, staging of spondylolisthesis is often conducted in a qualitative way. Although meyerding grading opens the door to stage spondylolisthesis in a more quantitative way, it relies on the manual measurement, which is time consuming and irreproducible. Thus, an automatic measurement algorithm becomes desirable for spondylolisthesis diagnosis and staging. However, there are two challenges. 1) Accurate detection of the most anterior and posterior points on the superior and inferior surfaces of each lumbar vertebrae. Due to the small size of the vertebrae, slight errors of detection may lead to significant measurement errors, hence, wrong disease stages. 2) Automatic localize and label each lumbar vertebrae is required to provide the semantic meaning of the measurement. It is difficult since different lumbar vertebraes have high similarity of both shape and image appearance. To resolve these challenges, a new auto measurement framework is proposed with two major contributions: First, a learning based spine labeling method that integrates both the image appearance and spine geometry information is designed to detect lumbar vertebrae. Second, a hierarchical method using both the population information from atlases and domain-specific information in the target image is proposed for most anterior and posterior points positioning. Validated on 258 CT spondylolisthesis patients, our method shows very similar results to manual measurements by radiologists and significantly increases the measurement efficiency.
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Incidence and Features of Vertebral Fractures After Scalp Avulsion Injuries. J Craniofac Surg 2015; 26:2217-20. [DOI: 10.1097/scs.0000000000002121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ahn K, Jhun HJ. New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion. BMC Musculoskelet Disord 2015; 16:97. [PMID: 25896607 PMCID: PMC4419388 DOI: 10.1186/s12891-015-0551-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/13/2015] [Indexed: 11/26/2022] Open
Abstract
Background Lumbar spondylolisthesis (LS) and lumbar instability (LI) are common disorders in patients with low back or lumbar radicular pain. However, few physical examination tests for LS and LI have been reported. In the study described herein, new physical examination tests for LS and LI were devised and evaluated for their validity. The test for LS was designated “low midline sill sign”, and that for LI was designated “interspinous gap change” during lumbar flexion-extension motion. Methods The validity of the low midline sill sign was evaluated in 96 patients with low back or lumbar radicular pain. Validity of the interspinous gap change during lumbar flexion-extension motion was evaluated in 73 patients with low back or lumbar radicular pain. The sensitivity, specificity, and positive and negative predictive values of the two tests were also investigated. Results The sensitivity and specificity of the low midline sill sign for LS were 81.3% and 89.1%, respectively. Positive and negative predictive values of the test were 78.8% and 90.5%, respectively. The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively. Positive and negative predictive values of the test were 77.1% and 68.0%, respectively. Conclusions The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.
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Affiliation(s)
- Kang Ahn
- Ahnkang Pain Free Hospital, CHA University, 323 Nonhyeon-Ro, 135-930, Kangnam-Ku, Seoul, Republic of Korea.
| | - Hyung-Joon Jhun
- Ahnkang Pain Free Hospital, CHA University, 323 Nonhyeon-Ro, 135-930, Kangnam-Ku, Seoul, Republic of Korea.
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Effects of shear force on intervertebral disc: an in vivo rabbit study. 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 2015; 24:1711-9. [PMID: 25784595 DOI: 10.1007/s00586-015-3816-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE A new in vivo rabbit model was developed to investigate the effects of shear force on intervertebral disc (IVD). METHODS Japanese white rabbits (n = 38) were used for this study. The L4/5 discs in Group A (n = 10) were subjected to a constant shear force (50 N) using a custom-made external loading device for 1 month; in Group B (n = 10) for 2 months; whereas in Group C (n = 10), loading device was attached to the spine but the discs remained unloaded. Group D (n = 8) was a non-operated intact control group. After loading, the loading devices were taken out and the animals were given X-ray and MRI examination. After X-ray and MRI examination, the animals were euthanized for histological analysis. RESULTS After 1 and 2 months of loading, radiographic findings showed significant disc height narrowing in L4/5 discs of the animals in loading groups, and slight lumbar spondylolisthesis in some animals of Group B. MRI showed a significant decrease in nucleus pulposus (NP) area and signal intensity from T2-weighted images. Histologically, loss of normal NP cells and disorganization of the architecture of the annulus occurred, and proteoglycan stain decreased. CONCLUSIONS The results of this study suggest that disc degeneration can be induced by hyper-physiological shear loading in the rabbit IVD. Long-term shear loading may result in structural disc failure inducing lumbar spondylolisthesis and progressive disc degeneration, which, however, has to be proven by further studies.
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