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Otsuki B, Fujibayashi S, Shimizu T, Murata K, Masuda S, Matsuda S. Minimally invasive LLIF surgery to decrease the occurrence of adjacent-segment disease compared to conventional open TLIF. 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; 32:3200-3209. [PMID: 37314580 DOI: 10.1007/s00586-023-07806-1] [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: 01/05/2023] [Revised: 04/27/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Lateral lumbar interbody fusion with percutaneous pedicle screw fixation (Mis-LLIF) can establish indirect decompression by lifting the vertebra with a large intervertebral cage, which causes less damage to the posterior elements. Thus, Mis-LLIF is expected to reduce the incidence of adjacent segment disease (ASD). The aim of the study was to compare the occurrence of ASD between Mis-LLIF and conventional open transforaminal interbody fusion (TLIF). METHODS A total of 156 patients (TLIF group = 88, Mis-LLIF group = 68) who underwent single-level lumbar interbody fusion (L2/3, L3/4, or L4/5) at a single institution between 2003 and 2018 with minimum 2-year follow-up were retrospectively reviewed. The incidence of symptomatic ASD requiring reoperation (S-ASD) and radiological adjacent segment degeneration (R-ASD) 2 years postoperatively were investigated between 51 paired patients from both groups who were propensity score (PS) matched by demographic and baseline clinical data. The effect of characteristics arising from differences in surgical methods between Mis-LLIF and TLIF, such as the amount of distraction of the index fused level (∆H), on S-ASD and R-ASD was also examined. RESULTS There were no significant differences in the incidence of S-ASD between the Mis-LLIF and TLIF groups (adjusted OR 1.3; 95% CI 0.41-3.9). There was no significant difference in the incidence of R-ASD between the Mis-LLIF and TLIF groups both at the cranial (adjusted OR 1.0; 95% CI 0.22-4.5) and caudal level (adjusted OR 1.5; 95% CI 0.44-5.3). On the other hand, ∆H was significantly higher in the Mis-LLIF group than in the TLIF group (3.6 mm vs. 1.7 mm, respectively, P < 0.0001), and was extracted as a significant independent risk factor for S-ASD (adjusted HR 2.7; 95% CI 1.1-6.3) and R-ASD at the cranial side (adjusted HR 6.4; 95% CI 1.7-24) in multivariable analysis with PS adjustment. CONCLUSIONS The incidence of R-ASD or S-ASD was not significantly reduced in the Mis-LLIF group compared to the TLIF group, with greater ∆H potentially being a contributing factor. Using a thin cage in both TLIF and Mis-LLIF may decrease the occurrence of ASD.
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Affiliation(s)
- Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto city, Kyoto, Japan
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Lai O, Zhang X, Hu Y, Sun X, Zhu B, Dong W, Yuan Z. Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord 2022; 23:160. [PMID: 35177064 PMCID: PMC8855549 DOI: 10.1186/s12891-022-05109-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background To retrospectively compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 years were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. Results The mean operative time and blood loss were 89.71 ± 7.62 min and 143.75 ± 42.51 ml for SSFK group, respectively; 111.69 ± 12.25 min (P < 0.01) and 259.38 ± 49.05 ml (P < 0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, significant loss of Cobb angle and AVH ratio were observed for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. Conclusions Both SSFK and LF are safe and effective for treatment of OTBF. Comparatively, SSFK is less invasive and can preserve more motion segments, which may be a more valuable surgical option in some elderly patients. A high-quality randomized controlled study is required to confirm our finding in the future.
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Affiliation(s)
- Oujie Lai
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Xinliang Zhang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China.
| | - Xiaoyang Sun
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Binke Zhu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Weixin Dong
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Zhenshan Yuan
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
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Miyahara J, Yoshida Y, Nishizawa M, Nakarai H, Kumanomido Y, Tozawa K, Yamato Y, Iizuka M, Yu J, Sasaki K, Oshina M, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Higashikawa A, Takeshita Y, Ono T, Hara N, Azuma S, Kawamura N, Tanaka S, Oshima Y. Treatment of restenosis after lumbar decompression surgery: decompression versus decompression and fusion. J Neurosurg Spine 2022:1-8. [PMID: 34996037 DOI: 10.3171/2021.10.spine21728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare perioperative complications and postoperative outcomes between patients with lumbar recurrent stenosis without lumbar instability and radiculopathy who underwent decompression surgery and those who underwent decompression with fusion surgery. METHODS For this retrospective study, the authors identified 2606 consecutive patients who underwent posterior surgery for lumbar spinal canal stenosis at eight affiliated hospitals between April 2017 and June 2019. Among these patients, those with a history of prior decompression surgery and central canal restenosis with cauda equina syndrome were included in the study. Those patients with instability or radiculopathy were excluded. The patients were divided between the decompression group and decompression with fusion group. The demographic characteristics, numerical rating scale score for low-back pain, incidence rates of lower-extremity pain and lower-extremity numbness, Oswestry Disability Index score, 3-level EQ-5D score, and patient satisfaction rate were compared between the two groups using the Fisher's exact probability test for nominal variables and the Student t-test for continuous variables, with p < 0.05 as the level of statistical significance. RESULTS Forty-six patients met the inclusion criteria (35 males and 11 females; 19 patients underwent decompression and 27 decompression and fusion; mean ± SD age 72.5 ± 8.8 years; mean ± SD follow-up 18.8 ± 6.0 months). Demographic data and perioperative complication rates were similar. The percentages of patients who achieved the minimal clinically important differences for patient-reported outcomes or satisfaction rate at 1 year were similar. CONCLUSIONS Among patients with central canal stenosis who underwent revision, the short-term outcomes of the patients who underwent decompression were comparable to those of the patients who underwent decompression and fusion. Decompression surgery may be effective for patients without instability or radiculopathy.
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Affiliation(s)
- Junya Miyahara
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yuichi Yoshida
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Mitsuhiro Nishizawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Hiroyuki Nakarai
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Yudai Kumanomido
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Keiichiro Tozawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Yukimasa Yamato
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Masaaki Iizuka
- 2University of Tokyo Spine Group (UTSG), Tokyo.,6Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo
| | - Jim Yu
- 2University of Tokyo Spine Group (UTSG), Tokyo.,7Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo
| | - Katsuyuki Sasaki
- 2University of Tokyo Spine Group (UTSG), Tokyo.,8Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama; and
| | - Masahito Oshina
- 2University of Tokyo Spine Group (UTSG), Tokyo.,9Spine Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - So Kato
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Toru Doi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yuki Taniguchi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yoshitaka Matsubayashi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Akiro Higashikawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Yujiro Takeshita
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Takashi Ono
- 2University of Tokyo Spine Group (UTSG), Tokyo.,6Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo
| | - Nobuhiro Hara
- 2University of Tokyo Spine Group (UTSG), Tokyo.,7Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo
| | - Seiichi Azuma
- 2University of Tokyo Spine Group (UTSG), Tokyo.,8Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama; and
| | - Naohiro Kawamura
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Sakae Tanaka
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo
| | - Yasushi Oshima
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
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Hiyama A, Katoh H, Sakai D, Sato M, Watanabe M. Radiographic and clinical evaluation of single-level lateral interbody fusion in patients with severe stenosis analyzed using cluster analysis. Medicine (Baltimore) 2021; 100:e27775. [PMID: 34964738 PMCID: PMC8615319 DOI: 10.1097/md.0000000000027775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/25/2021] [Indexed: 01/05/2023] Open
Abstract
This study was a retrospective review of patients treated in a single institution. We performed a cluster analysis of the degree of preoperative stenosis to investigate the effect of indirect neural decompression in single-level lateral lumbar interbody fusion (LLIF). Surgery is generally indicated for patients with severe stenosis. On the other hand, severe lumbar spinal stenosis is a relative contraindication to LLIF and is excluded in most studies. If LLIF, which is less invasive to treatment, can be applied to severe stenosis patients, it may help treatment. Cluster analysis classified 80 patients into 3 groups based on preoperative central canal area (CCA), preoperative canal diameter (CD), and preoperative Schizas grade: group 1 with severe stenosis (n = 43); group 2 with moderate stenosis (n = 27); and group 3 with mild stenosis (n = 10). Preoperative and immediately postoperative CCA and CD in magnetic resonance imaging were compared between groups. Disc angle (DA) and anterior, posterior, and average disc heights (AvDH) (anterior disc height, posterior disc height, average disc height AvDH) were measured using standing lateral plain radiographs. For clinical analysis, a numeric rating scale was used to evaluate clinical outcomes. DA, anterior disc height, posterior disc height, and AvDH increased significantly after the operation in all groups, but the average changes in these factors did not differ. Mean midsagittal CD and axial CCA on MRI magnetic resonance imaging increased significantly in all groups, but as with DA and DH, the changes in axial CCA and midsagittal CD did not differ between groups. The numeric rating scale score did not differ between groups at any time. The cluster analysis results suggested that postoperative changes in indirect neural decompression for severe stenosis after LLIF similar for moderate and mild stenosis and that pain did not differ according to the severity of stenosis after surgery.
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Dural Tear Does not Increase the Rate of Venous Thromboembolic Disease in Patients Undergoing Elective Lumbar Decompression with Instrumented Fusion. World Neurosurg 2021; 154:e649-e655. [PMID: 34332152 DOI: 10.1016/j.wneu.2021.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evaluate if dural tears (DTs) are an indirect risk factor for venous thromboembolic disease through increased recumbency in patients undergoing elective lumbar decompression and instrumented fusion. METHODS This was a retrospective cohort study of consecutive patients undergoing elective lumbar decompression and instrumented fusion at a single institution between 2016 and 2019. Patients were divided into cohorts: those who sustained a dural tear and those who did not. The cohorts were compared using Student's t-test or Wilcoxon Rank Sum for continuous variables and Fisher exact or chi-squared test for nominal variables. RESULTS Six-hundred and eleven patients met inclusion criteria, among which 144 patients (23.6%) sustained a DT. The DT cohort tended to be older (63.6 vs. 60.6 years, P = 0.0052) and have more comorbidities (Charlson Comorbidity Index 2.75 vs. 2.35, P = 0.0056). There was no significant difference in the rate of symptomatic deep vein thrombosis (2.1% vs. 2.6%, P = 1.0) or pulmonary embolus (1.4% vs. 1.50%, P = 1.0). Intraoperatively, DT was associated with increased blood loss (754 mL vs. 512 mL, P < 0.0001), operative time (224 vs. 195 minutes, P < 0.0001), and rate of transfusion (19.4% vs. 9.4%, P = 0.0018). Postoperatively, DT was associated with increased time to ambulation (2.6 vs. 1.4 days, P < 0.0001), length of stay (5.8 vs. 4.0 days, P < 0.0001), and rate of discharge to rehab (38.9 vs. 25.3%, P = 0.0021). CONCLUSIONS While DTs during elective lumbar decompression and instrumentation led to later ambulation and longer hospital stays, the increased recumbency did not significantly increase the rate of symptomatic venous thromboembolic disease.
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Yagi K, Suzuki N, Mizutani J, Kato K, Kondo A, Waseda Y, Goto Y, Murakami H. Segmental Arteries and Veins at Higher Lumbar Levels Can Intersect the Adjacent Caudal Intervertebral Disc in the Anterior Part of the Spinal Column: A Cadaveric Analysis. Asian Spine J 2021; 16:1-8. [PMID: 33940773 PMCID: PMC8874001 DOI: 10.31616/asj.2020.0435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design A cadaveric study. Purpose To investigate the anatomical features of segmental arteries and veins in the anterior part of the spinal column to prevent segmental vessel injury. Overview of Literature The lateral transpsoas approach to the lumbar intervertebral discs (IVD) is associated with the risk of segmental vessel injury. Previous studies have described the vascular anatomy on the lateral part of the vertebral body. However, there are no studies that describe the segmental vessels on its anterior aspect. Here, we report the important anatomical features of the segmental arteries and veins that can intersect the anterior part of the IVD. These vessels are considered at risk of vascular injury when placing the anterior retractors during lateral lumbar interbody fusion or cutting the anterior longitudinal ligament during anterior column realignment. Methods Five formalin-embalmed human cadavers were used. We assessed the proportion of segmental arteries and veins that intersected the IVD in the L2–L5 range and their course on the anterior part of the spinal column. Results The segmental arteries and veins commonly intersect the anterior part of the IVD (artery, 28.1%; vein, 42.1%). Seven of 10 (70%) segmental arteries at L2 intersected the IVD, but only one artery intersected the IVD at L3 and L4. The proportions of segmental veins that intersected the IVD were 60%, 50%, and 16.7% at L2, L3, and L4, respectively. Conclusions The segmental arteries and veins frequently intersect the IVD in the anterior part of the spinal column. Therefore, it is necessary to consider these individual anatomical features to prevent vascular damage during lateral lumbar interbody fusion surgery.
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Affiliation(s)
- Kiyoshi Yagi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Jun Mizutani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Akira Kondo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yuya Waseda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yuta Goto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Lai O, Chen Y, Chen Q, Hu Y, Ma W. Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation. BMC Musculoskelet Disord 2021; 22:280. [PMID: 33722233 PMCID: PMC7962251 DOI: 10.1186/s12891-021-04151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/08/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations. METHODS Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2-5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS). RESULTS Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP. CONCLUSIONS The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.
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Affiliation(s)
- Oujie Lai
- Department of Spine Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, 315040, People's Republic of China
| | - Yunlin Chen
- Department of Spine Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, 315040, People's Republic of China
| | - Qixin Chen
- Department of Spine Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China.
| | - Yong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, 315040, People's Republic of China
| | - Weihu Ma
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, 315040, People's Republic of China
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Quan M, Hwang WH, Kim JH, Kim YY. Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague-Dawley rats. BMC Musculoskelet Disord 2021; 22:16. [PMID: 33402133 PMCID: PMC7786924 DOI: 10.1186/s12891-020-03920-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Epidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is reported that the specific members of the mitogen – activated protein kinases (MAPK) family might mediate neuropathic pain. However, roles of epidural fibrosis caused by repeated spinal surgeries and pain-related proteins in causing the post spinal surgery syndrome remain unknown. Using a rat spinal surgery epidural fibrosis and adhesion model, in this study, we evaluated and investigated the relationship between pain markers and epidural fibrosis. Methods Sprague–Dawley rats that underwent the spinal surgery were divided into three groups: group A (single laminectomy), group B (two repeated surgeries) and group C (three repeated surgeries). Dural thickness was measured in each experimental group, and immunohistochemical analysis and western blotting of mitogen-activated protein kinases were performed (ERK, p38 and JNK) using the spine cord. Results Dural thickness was 6.363 ± 1.911 μm in group A, 13.238 ± 2.123 μm in group B and 19.4 ± 2.115 μm in group C, respectively. In the western blotting, phosphorylated ERK expression gradually increased with the number of repeated surgeries, and expression in groups B (1.77-fold) and C (2.42-fold) increased as compared to expression in group A. Phosphorylated p38 showed an increasing trend with the number of repeated surgeries, and groups B (1.17-fold) and C (1.33-fold) expression increased compared with group A. However, phosphorylated JNK expression did not gradually increase with the number of repeated surgeries, and groups B (1.62-fold) and C (1.43-fold) expression increased compared with group A. Excluding phosphorylated JNK, immunohistochemical analysis revealed that phosphorylated ERK and p38 expression gradually increased with the number of repeated surgeries in the spine dorsal horn, as evidenced by western blotting. Conclusions Repeated spinal surgeries may increase dural thickness and expression of phosphorylated ERK and p38 in the spinal dorsal horn, and it suggests that the neuropathic pain is likely induced by epidural fibrosis and that the pain increases with the number of repeated surgeries. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03920-z.
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Affiliation(s)
- Meiling Quan
- Department of Pathophysiology, School of Basic Medical Sciences, Beihua University, Jilin, 132021, China.,Department of Orthopedics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Won-Ha Hwang
- Department of Orthopedics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Jae-Hoon Kim
- Department of Orthopedics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Young-Yul Kim
- Department of Orthopedics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
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Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine J 2020; 14:694-701. [PMID: 33108835 PMCID: PMC7595822 DOI: 10.31616/asj.2020.0384] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.
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Affiliation(s)
- Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Taek Kwon
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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