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Liu J, Zhang X, Zhang H, Zhang J, Wang Q, Li G. Prevalence, Features, and Predictive Factors of Spontaneous Spinal Arthrodesis in Posttraumatic Thoracolumbar Kyphosis. World Neurosurg 2024; 185:e676-e682. [PMID: 38417620 DOI: 10.1016/j.wneu.2024.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Spontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in posttraumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features, and predictive factors of SSA in patients with PTK. METHODS In this retrospective study, 70 patients with PTK were included. Data on the clinical and radiologic parameters were obtained and evaluated. According to whether there was SSA or not, patients were divided into an SSA group (n = 45) or a non-SSA group (n = 25). A binary logistic regression analysis was used to identify the predictive factors for SSA. RESULTS The incidence of SSA in PTK was 64%. Among 45 patients with PTK with SSA, SSA was present as a solid bridging anterior osteophyte along the vertebral bodies in 11 patients, posterior contiguous bony growth through the facet joints bilaterally in 13 patients, bony formation in both anterior and posterior elements in 18 patients, and direct contiguous bony formation from the injured vertebral body to the adjacent one in 3 patients. Patients with longer disease duration, larger local Cobb angle, and anterior wall height loss (AWHL) ratio of injured vertebral body, and less kyphosis flexibility index were significantly more likely to develop SSA. The parameter of AWHL remained significant in binary logistic regression analysis. CONCLUSIONS SSA in PTK was common, and the SSA sign presented in various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.
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Affiliation(s)
- Jincheng Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Department of Orthopaedics, Xichang People's Hospital, Xichang, China
| | - Xiaofei Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Goel A, Prasad A, Shah A, Maheshwari S, Vutha R. "Only fixation" in cases with failed decompression for lumbar canal stenosis - Analysis of outcome in 14 cases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:330-335. [PMID: 38268683 PMCID: PMC10805158 DOI: 10.4103/jcvjs.jcvjs_151_23] [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: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Aim The rationale of "only fixation" of affected spinal segments without any form of bone or soft-tissue decompression in cases with failed decompressive laminectomy for lumbar canal stenosis is discussed on the basis of an experience with 14 cases. Materials and Methods During the period between 2010 and 2022, 14 patients who symptomatically worsened or did not improve following a long-segment "wide" decompressive laminectomy for multisegmental lumbar canal stenosis were identified. All patients were treated by segmental spinal stabilization aimed at arthrodesis by facetal distraction by Goel's facetal spacers (6 cases) or Camille's transarticular facetal fixation (8 cases). No bone, soft tissue, or disc resection was done for spinal or neural canal "decompression." Oswestry Disability Index and Visual Analog Scale were used to clinically assess the patients before and after the surgery and at follow-up. In addition, video recordings of patient's self-assessment of clinical outcome were used to monitor the outcome. Results During the average period of follow-up of 71 months (range 6 months to 16 years), all patients recovered in majority of their major symptoms, the recovery was observed in the immediate postoperative period. During the period of follow-up, none of the patients complained of recurrent symptoms or needed any additional surgery. There was firm stabilization and evidences of bone fusion of the treated spinal segments in all patients. There were no infections or implant failure. No patient worsened after treatment. Conclusions Instability of the spinal segments is the primary issue in cases with lumbar canal stenosis and stabilization in the treatment.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
- Department of Neurosurgery, R. N. Cooper Hospital and Medical College, Mumbai, Maharashtra, India
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
- K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, Maharashtra, India
| | - Apurva Prasad
- Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India
- Department of Neurosurgery, Bhatia Hospital, Mumbai, Maharashtra, India
| | - Abhidha Shah
- K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, Maharashtra, India
- Department of Neurosurgery, Seth G.S. Medical College, K.E.M Hospital, Mumbai, Maharashtra, India
- Department of Neurosurgery, Apollo Hospitals, Mumbai, Maharashtra, India
| | - Shradha Maheshwari
- Department of Neurosurgery, R. N. Cooper Hospital and Medical College, Mumbai, Maharashtra, India
| | - Ravikiran Vutha
- K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, Maharashtra, India
- Department of Neurosurgery, Apollo Hospitals, Mumbai, Maharashtra, India
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Goel A. Commentary on “Classification(s) of Cervical Deformity”. Neurospine 2023; 20:405-407. [PMID: 37016889 PMCID: PMC10080417 DOI: 10.14245/ns.2346042.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Atul Goel
- Department of Neurosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai, India
- Department of Neurosurgery, R.N Cooper Hospital and Medical College, Mumbai, India
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
- Corresponding Author Atul Goel Department of Neurosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai, India
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[Research progress of spontaneous facet fusion after lumbar spine surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:500-504. [PMID: 35426292 PMCID: PMC9011065 DOI: 10.7507/1002-1892.202111097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the research progress on spontaneous facet fusion (SFF) after lumbar spine surgery, and provide reference for further research on SFF. METHODS The definition, development, clinical significance, and related influence factors of SFF were throughout reviewed by referring to relevant domestic and foreign literature in recent years. RESULTS SFF is a phenomenon of joint space disappearance and fusion of upper and lower articular processes, which starts in a ring shape from the outermost edges to the central regions. Currently reported SFF occurred after posterior lumbar pedicle screw fixation. SFF may increase the stability of surgical segments and relieve clinical symptoms of patients. SFF is closely related to the method of lumbar internal fixation, facet osteoarthritis, interbody fusion, age, body mass index, type B fracture (according to AO classification), and the operative segment. CONCLUSION Most reported SFF occur after posterior lumbar pedicle screw fixation, which can increase lumbar stability, but the mechanism and influencing factors remain to be further clarified.
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Sakti YM, Saraswaty RW, Pratama BY, Putra AC, Susanto DB, Mafaza A, Baskara AANN, Magetsari R. Functional outcomes following surgical treatment in patient with primary degenerative adult scoliosis. Int J Surg Case Rep 2021; 84:106095. [PMID: 34216917 PMCID: PMC8258862 DOI: 10.1016/j.ijscr.2021.106095] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction Primary adult degenerative scoliosis is one of the adult scoliosis group that presents in adult patient without history of scoliosis during childhood or adolescence. This condition may be asymptomatic, mild low back pain, radiculopathy symptoms, or may be causing severe low back pain and major neurological symptoms including weakness and numbness of the lower extremities which can affect the patient quality of life. Case presentation In this study, we presented seven cases of primary degenerative adult scoliosis that was treated either with decompression alone, decompression with short segment fusion and deformity correction, and decompression with long segment fusion and deformity correction. The parameters measured in this study were lumbar regional angle, Cobb angle, and pelvic parameters. The functional status of the patient was measured using Oswestry Disability Index (ODI). Discussion The main purpose for surgical treatment in primary degenerative adult scoliosis depends on the clinical presentation and also the patient's expectations .From the study, we found that all patient underwent surgery had improvement of functional status that measured with ODI score. The mean of pre operative ODI score was 49.70 (± 13.61 SD) (severe disability) and for post operative was 21.8 (± 13.40 SD) (moderate disability). Surgery decompressed the neural element and stabilize the spine. Conclusion Surgery treatment in patients with degenerative adult scoliosis was shown to have better functional outcomes regardless of the technique used. Further study with bigger sample with corresponding statistical analytic is mandatory. Symptoms of primary adult degenerative scoliosis range from asymptomatic to severe low back pain with neurological symptoms. Surgical options available range from decompression to decompression with long segment fusion and deformity correction. Surgical treatment was shown to have better functional outcomes regardless of the technique used.
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Affiliation(s)
- Yudha Mathan Sakti
- Staff of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Rezky Winda Saraswaty
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Bagus Yudha Pratama
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Aristida Cahyono Putra
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Dwi Budhi Susanto
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Akbar Mafaza
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Anak Agung Ngurah Nata Baskara
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Rahadyan Magetsari
- Staff of Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
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Goel A. Spinal deformities - Is direct "correction" surgery necessary? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:1-3. [PMID: 33850374 PMCID: PMC8035584 DOI: 10.4103/jcvjs.jcvjs_8_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Bandra (E), Mumbai, Maharashtra, India
- Lilavati Hospital and Research Centre, Bandra (E), Mumbai, Maharashtra, India
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