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Peng YJ, Fan ZY, Wang QL, Dai J, Zhang QZY, Cao JY, Liu XF, Yan J. Comparison of the total and hidden blood loss in patients undergoing single-level open and unilateral biportal endoscopic transforaminal lumbar interbody fusion: a retrospective case control study. BMC Musculoskelet Disord 2023; 24:295. [PMID: 37060012 PMCID: PMC10103431 DOI: 10.1186/s12891-023-06393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE This study aimed to compare total blood loss (TBL) and hidden blood loss (HBL) in patients undergoing single-level open transforaminal lumbar interbody fusion (O-TLIF) and unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF). METHODS A total of 53 patients who underwent ULIF and 53 patients who underwent O-TLIF from March 2020 to July 2022 were retrospectively reviewed. The Nadler's formula was employed to estimate the patient's blood volume (PBV), Gross's formula to estimate TBL, and Sehat's formula to estimate HBL. The obtained data were then analyzed with independent t test, chi-squared test, and analysis of covariance. RESULTS TBL and measured blood loss (MBL) in ULIF group (326.86 ± 223.45 ml, 99.00 ± 72.81 ml) was significantly lower than O-TLIF group (427.97 ± 280.52 ml, 270.66 ± 102.34 ml). Nevertheless, the HBL in ULIF group was higher than that in O-TLIF group (227.86 ± 221.75 ml vs 157.31 ± 268.08 ml), however this was not statistically significant (p = 0.143). The HBL was 69.71 ± 23.72% of TBL in ULIF group and 36.76 ± 18.79% of TBL in O-TLIF group. Patients in ULIF group had lower TBL and MBL, shorter duration of drainage, lower postoperative anemia, and shorter postoperative hospital stay compared to those in O-TLIF group. CONCLUSIONS Perioperative HBL should not be neglected in patients undergoing ULIF or O-TILF, as it accounts for a large percentage of TBL in both groups. ULIF is associated with lower TBL and MBL, postoperative anemia, shorter postoperative hospital stays compared with O-TLIF.
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Affiliation(s)
- Yu-Jian Peng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Zhi-Ying Fan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qian-Liang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun Dai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qian-Zhong-Yi Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun-Yin Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Xiao-Feng Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.
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Basindwah S, AlHamzah M, Balsharaf F, AlRajhi B, Sewaralthahab S, Altoijry A, Altuwaijri T, Al-Habib A. Prevalence of Asymptomatic Deep Vein Thrombosis in Preoperative State of Spine Surgeries. World Neurosurg 2023; 170:e737-e743. [PMID: 36442779 DOI: 10.1016/j.wneu.2022.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep venous thrombosis (DVT) is considered the most common cause of preventable death among hospitalized patients. A few studies have investigated the risk of venous thromboembolic events in patients undergoing elective spine surgery and reported varying incidences. We aim to assess the incidence of preoperative lower limb DVT in patients with lumbar degenerative disease undergoing elective surgery. METHODS This is a retrospective review of prospectively collected data on adult patients with lumbar degenerative spine diseases (lumbar stenosis [LST], lumbar spondylolisthesis [SPL], or lumbar disc herniation) who were scheduled for operative management. Each patient underwent a preoperative lower limb venous Duplex (LLVD). Incidence of DVT, risk factors, and clinical course of patients were reported. RESULTS Forty-nine patients (32 females; 65%) were included. All patients were diagnosed clinically and radiologically with lumbar degenerative diseases; LST (44.9%), SPL (36.7%), and lumbar disc herniation (18.4%), requiring surgical management. Three patients (6.1%) were found to have positive DVT studies, leading to the cancellation or rescheduling of their procedures (P < 0.01). These included 1 patient with LST (P = 0.045) and 2 patients with SPL (P = 0.006). Among patients with LST and SPL, higher disability (modified Rankin scale ≥3) was significantly associated with positive LLVD (P = 0.035). CONCLUSION Patients with LST or SPL with higher preoperative disability scores were at higher risk to have preoperative DVT. Further research is needed to evaluate the feasibility and value of preoperative LLVD to detect DVT in patients planned for lumbar degenerative surgery.
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Affiliation(s)
- Sarah Basindwah
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Musaad AlHamzah
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatima Balsharaf
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Balqes AlRajhi
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sarah Sewaralthahab
- Division of Hematology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Xu W, Ran B, Zhao J, Luo W, Gu R. Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease. BMC Musculoskelet Disord 2022; 23:1141. [PMID: 36585650 PMCID: PMC9805251 DOI: 10.1186/s12891-022-06066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the growing number of traditional posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. We aimed to investigate the incidence and risk factors for FBSS following open posterior lumbar surgery for degenerative lumbar disease (DLD). METHOD A multivariable regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed. RESULT 16.8% of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariable logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71-0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10-4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75-9.47, P = 0.001) and waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54-27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00-17.04, P < 0.001), MCs (OR: 3.41, 95%CI: 1.73-6.71, P < 0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13-6.12, P = 0.024) were risk factors for FBSS. CONCLUSION Open posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.
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Affiliation(s)
- Wenbo Xu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Bingbing Ran
- grid.478174.9Departments of Medical Cosmetology, Jilin Province People’s Hospital, No. 1183, Gongnong Road, Changchun, 130021 Jilin P.R. China
| | - Jianhui Zhao
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Wenqi Luo
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Rui Gu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
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Lang Z, Ge T, Wu J, Yuan Q, Sun Y. Comparison of transfacet and pedicle screws in oblique lateral interbody fusion for single-level degenerative lumbar spine diseases: a retrospective propensity score-matched analysis. BMC Surg 2022; 22:429. [PMID: 36522754 PMCID: PMC9753392 DOI: 10.1186/s12893-022-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To perform a comparative assessment of percutaneous transfacet screws (TFS) and percutaneous bilateral pedicle screws (BPS) in oblique lateral interbody fusion (OLIF) for the treatment of single-level degenerative lumbar spine diseases in terms of radiological examinations and clinical outcomes. METHODS Sixty-six patients who received single-level OLIF with percutaneous supplementary fixation assisted by the robot for the treatment of degenerative lumbar spine diseases were selected. There were 16 cases of OLIF with TFS and 50 cases of OLIF with BPS. The propensity score matching method selected 11 patients in each group with matched characteristics to perform a clinical comparison. RESULTS The estimated blood loss was 68.2 ± 25.2 ml in the OLIF with TFS group compared to 113.6 ± 39.3 ml in the OLIF with BPS group (P < 0.05). The intervertebral disc height raised from 8.6 to 12.9 mm in the TFS group and from 8.9 to 13.9 mm in the BPS group in the immediate postoperative period, and dropped to 10.8 and 12.9 mm at the twelfth month, respectively (P < 0.05). The fusion rates were 91% and 100% for TFS and BPS groups (P > 0.05). Quantitative assessments of back/leg pain of the two groups reached a healthy level in the late period of the follow-up. CONCLUSION Both TFS and BPS techniques for the OLIF surgery relieve back pain caused by degenerative lumbar spine diseases. The TFS technique exhibits less blood loss compared with the BPS. A moderate cage subsidence is present in TFS but no complication is reported.
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Affiliation(s)
- Zhao Lang
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Tenghui Ge
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Jingye Wu
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Qiang Yuan
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Yuqing Sun
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
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Kato S, Nakamoto H, Matsubayashi Y, Taniguchi Y, Doi T, Yoshida Y, Higashikawa A, Takeshita Y, Fukushima M, Ono T, Hara N, Okazaki R, Iwai H, Oshina M, Sugita S, Hirai S, Masuda K, Tanaka S, Oshima Y. Postoperative outcomes after degenerative lumbar spine surgery in rheumatoid arthritis patients -a propensity score-matched analysis. BMC Musculoskelet Disord 2022; 23:380. [PMID: 35459151 PMCID: PMC9034588 DOI: 10.1186/s12891-022-05326-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis. Methods Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups. Results Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids. Conclusions RA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.
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Affiliation(s)
- So Kato
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichi Yoshida
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukue-Chō, Kōhoku-Ku, Yokohama, 222-0036, Japan
| | - Masayoshi Fukushima
- Spine Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashino, Tokyo, 180-8610, Japan
| | - Rentaro Okazaki
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Hiroki Iwai
- Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo, 133-0056, Japan
| | - Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Shurei Sugita
- Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shima Hirai
- Department of Orthopedic Surgery, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan
| | - Kazuhiro Masuda
- Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Khan I, Parker SL, Bow H, Sivaganesan A, Pennings JS, Stephens II BF, Steinle AM, Gupta R, Devin CJ. Clinical and Cost-Effectiveness of Lumbar Interbody Fusion Using Tritanium Posterolateral Cage (vs. Propensity-Matched Cohort of PEEK Cage). Spine Surg Relat Res 2022; 6:671-680. [PMID: 36561152 PMCID: PMC9747220 DOI: 10.22603/ssrr.2021-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/05/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Surgical management of degenerative lumbar spine disorders is effective at improving patient pain, disability, and quality of life; however, obtaining a durable posterolateral fusion after decompression remains a challenge. Interbody fusion technologies are viable means of improving fusion rates in the lumbar spine, specifically various graft materials including autograft, structural allograft, titanium, and polyether ether ketone. This study assesses the effectiveness of Tritanium posterolateral cage in the treatment of degenerative disk disease. Methods Nearest-neighbor 1:1 matched control transforaminal lumbar interbody fusion with PEEK vs. Tritanium posterior lumbar (PL) cage interbody fusion patients were identified using propensity scoring from patients that underwent elective surgery for degenerative disk diseases. Line graphs were generated to compare the trajectories of improvement in patient-reported outcomes (PROs) from baseline to 3 and 12 months postoperatively. The nominal data were compared via the χ2 test, while the continuous data were compared via Student's t-test. Results The two groups had no difference regarding either the 3- or 12-month Euro-Qol-5D (EQ-5D), numeric rating scale (NRS) leg pain, and NRS back pain; however, the Tritanium interbody cage group had better Oswestry Disability Index (ODI) scores compared to the control group of the PEEK interbody cage at both 3 and 12 months (p=0.013 and 0.048). Conclusions Our results indicate the Tritanium cage is an effective alternative to the previously used PEEK cage in terms of PROs, surgical safety, and radiological parameters of surgical success. The Tritanium cohort showed better ODI scores, higher fusion rates, lower subsidence, and lower indirect costs associated with surgical management, when compared to the propensity-matched PEEK cohort.
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Affiliation(s)
- Inamullah Khan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Scott L. Parker
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Hansen Bow
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Jacquelyn S. Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Byron F. Stephens II
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Anthony M. Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Rishabh Gupta
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States,University of Minnesota Medical School, Minneapolis, United States
| | - Clinton J. Devin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, United States
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Zhao YS, Li Q, Wang Y, Zhang CS. [Analysis of early and middle stage efficacy and complications of oblique lumbar interbody fusion in treating degenerative lumbar diseases]. Zhongguo Gu Shang 2022; 35:142-147. [PMID: 35191266 DOI: 10.12200/j.issn.1003-0034.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the early and middle stage efficacy and complications of minimally invasive extraperitoneal oblique lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar diseases. METHODS The clinical data of 22 patients with degenerative lumbar diseases underwent OLIF from October 2017 to March 2019 were retrospectively analyzed, including 14 males and 8 females, aged from 51 to 72 years with an average of (63.15±7.22) years. There were 6 cases of lumbar spinal stenosis, 5 cases of lumbar spondylolisthesis, 4 cases of adjacent vertebral disease, 3 cases of degenerative lumbar scoliosis, 3 cases of discogenic low back pain, and 1 case of recurrence after posterior lumbar decompression. Posterior minimally invasive pedicle screw fixation was performed in 13 cases and Stand-alone fixation in 9 cases. Intraoperative blood loss, operation time, postoperative drainage volume, landing time were recorded. The intervertebral disc height(IDH), intervertebral foramen height(IFH), intervertebral foramen area( IFA), canal diameter(CD), canal area(CA) were measured before and after operation. The imaging changes (including location of fusion cage, interbody fusion, and cage subsidence) and complications were observed. Oswestry Disability Index (ODI), numerical rating scales (NRS) and Japanese Orthopaedic Association (JOA) scores were compared before and 3, 6, 12 months after operation. RESULTS All 22 patients successfully completed the operation. The intraoperative blood loss was 25 to 280 ml with an average of (95.45±79.07) ml and that of simple anterior approach was 25 to 70 ml with an average of (45.71±15.42) ml. The operation time was 75 to 210 min with an average of (137.72±37.66) min, and the simple anterior operation time was 75 to 105 min with an average of (91.40±15.96) min. The total drainage volume was 10 to 110 ml with an average of (56.23±31.15) ml, and the time to go down to the ground was 24 to 72 hours (54.48±18.24) hours after operation. Postoperative IDH improved (6.63±2.61)mm(P<0.05), the IFH improved (5.35±2.47)mm (P<0.05), the IFA improved (97.67±33.58)mm2(P<0.05), the CD improved (3.31±1.61) mm(P<0.05), the CA improved (57.52±31.39) mm2(P<0.05). Five patients got interbody fusion at 6 months after operation and all 22 patients got interbody fusion at 12 months after operation. There was 5 cases of fusion cage subsidence, all of which occurred in the cases without posterior fixation(using Stand-alone fixation). There was no serious complication such as big blood vessel injury, ureter injury, dural sac injury and nerve root injury. Peritoneal injury occurred in 1 case, postoperative transient thigh pain, decrease of quadriceps femoris muscle strength in 4 cases and sympathetic nerve injury in 1 case. The symptoms of lumbago and radicular pain of lower extremities were alleviated obviously 3 days after operation. The ODI, NRS and JOA scores at 6, 12 months after operation were significantly improved(P<0.05). CONCLUSION The treatment of lumbar degenerative diseases with definite indications by OLIF can achieve satisfactory clinical results, and it has advantages of less intraoperative bleeding, fast time to land, less complications, good imaging improvement and indirect decompression. But the operation time and fluoroscopy time are longer in the early stage, and complications such as peritoneal injury and lumbar plexus over traction may occur. The long-term incidence of settlement of fusion cage with Stand-alone technology is higher.
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Affiliation(s)
- Yong-Sheng Zhao
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China
| | - Qiang Li
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China
| | - Yang Wang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China
| | - Cheng-Shao Zhang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China
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Steinhaus ME, Vaishnav AS, Shah SP, Clark NJ, Chaudhary CB, Othman YA, Urakawa H, Samuel AM, Lovecchio FC, Sheha ED, McAnany SJ, Qureshi SA. Does loss of spondylolisthesis reduction impact clinical and radiographic outcomes after minimally invasive transforaminal lumbar interbody fusion? Spine J 2022; 22:95-103. [PMID: 34118417 DOI: 10.1016/j.spinee.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/10/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is a common operative approach to address degenerative lumbar stenosis and spondylolisthesis which has failed nonoperative care. Compared to open TLIF, MI-TLIF relies to a greater extent on indirect decompression resulting in a heightened awareness of spondylolisthesis reduction among MI surgeons. To what extent intraoperative reduction is achieved as well as the rate and clinical impact of loss or reduction and slip recurrence remain unknown. PURPOSE To determine the rate and clinical impact of slip recurrence after MI-TLIF with expandable cage technology STUDY DESIGN/SETTING: Retrospective Cohort Study PATIENT SAMPLE: Patients undergoing MI-TLIF for degenerative spondylolisthesis using an articulating, expandable cage OUTCOME MEASURES: Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back/leg pain, Short Form-12 (SF-12), and PROMIS Physical Function (PF) METHODS: Patients undergoing MI-TLIF for degenerative spondylolisthesis using articulating, expandable cages from 2017 to 2019 were retrospectively studied. Lateral radiographs were reviewed and evaluated for the presence or absence of spondylolisthesis preoperatively, intraoperatively, and at follow-up times including 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Spondylolisthesis was measured from the posterior inferior corner of the cephalad vertebra to the posterior superior corner of the caudal vertebra, with any measurement >1 mm classified as spondylolisthesis, and Meyerding grade was noted. Intraoperative reduction was measured, and loss of reduction was defined as >1 mm increase in spondylolisthesis comparing follow-up imaging to intraoperative films. PROMs were recorded at the preoperative and follow-up time points. Fusion was assessed at 1 year postoperatively via CT. RESULTS A total of 63 patients and 70 levels were included, with mean age 59.8 years (SD,13.8). 19 levels (27.1%) had complete reduction intraoperatively, 40 (57.1%) had partial reduction, and 11 (15.7%) had no reduction. Of the 30 levels with loss of reduction (50.8%), 20 (66.7%) occurred by 2 weeks postoperatively and 28 (93.3%) occurred by 12 weeks postoperatively. At 6 months, there were significant differences between those who had loss of reduction and those who did not in VAS back pain (3.0 vs. 0.9, p = .017) and SF-12 PCS (41.5 vs. 50.0, p = .035), but no differences were found between the groups for any instruments at any other time points. The overall fusion rate was 82.1% (32/39) at 1 year postoperatively. There was no significant difference in fusion rate between the loss of reduction (16/20) and no loss of reduction (20/23) groups. Patients with loss of reduction had no difference in reoperation rate (1/28) compared to those without loss of reduction (2/24). CONCLUSIONS While a majority of patients demonstrated reduction intraoperatively, 51% had loss of reduction, most commonly in the acute postoperative period. There were few differences in PROMs between patients who had loss of reduction and those who did not, suggesting that radiographic loss of reduction after MI-TLIF in the setting of degenerative spondylolisthesis may not be clinically meaningful.
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Affiliation(s)
- Michael E Steinhaus
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Avani S Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sachin P Shah
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Nicholas J Clark
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Chirag B Chaudhary
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yahya A Othman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Hikari Urakawa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andre M Samuel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Francis C Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Steven J McAnany
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
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Heemskerk JL, Oluwadara Akinduro O, Clifton W, Quiñones-Hinojosa A, Abode-Iyamah KO. Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis. Spine J 2021; 21:2049-2065. [PMID: 34273567 DOI: 10.1016/j.spinee.2021.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/16/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) was developed in addition to open-TLIF to minimize iatrogenic soft-tissue damage. A potential disadvantage of MIS-TLIF is inadequate visualization, which may lead to incomplete neural decompression and a less robust arthrodesis. This may cause long-term problems and result in decreased patient satisfaction. PURPOSE To evaluate the long-term clinical outcome, measured by patient-reported outcomes (PROMs), of patients with degenerative lumbar diseases treated with single-level TLIF (open vs. minimally invasive) with a minimum follow-up of 2-years. STUDY DESIGN Meta-analysis. METHODS The systematic review was conducted according to the PRISMA guidelines. Relevant studies were identified from Pubmed, MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL from the date of inception to August 2019. The inclusion criteria were (1) longitudinal comparative studies of MIS-TLIF versus open-TLIF approach for degenerative spine disease (2) outcomes reported as PROMs, (3) minimum follow-up of 2-years. RESULTS Sixteen studies were included in the analysis. In total, 1,321 patients were included (660 MIS-TLIF& 661 open-TLIF). The following PROMS were analyzed: EQ-5D, SF, ODI, and VAS. Both techniques resulted in significant improvement in PROM, which remained significant at 2-years follow-up. However, no significant differences were found in all PROMs at 2-years follow-up. Both treatments resulted in a high rate of spinal fusion (80.5% vs. 91.1%; p=.29) and low rate of reoperation (3.0% vs. 2.4%; p=.50) or adjacent segment disease (12.6% vs. 12.40%; p=.50). CONCLUSIONS MIS-TLIF and open-TLIF have comparable long-term clinical outscomes. Both operations can significantly reduce pain and positively improve PROMs. No significant differences were found between both treatments in clinical outcomes at a follow-up of minimal 2-years. Therefore, MIS-TLIF seems to be an effective and safe alternative to traditional open-TLIF in the long-term.
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Affiliation(s)
- Johan L Heemskerk
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL 32224 USA; Department of Orthopedic Surgery, OLVG, Amsterdam, Netherlands
| | | | - William Clifton
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL 32224 USA
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Xue YD, Diao WB, Ma C, Li J. Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study. J Orthop Surg Res 2021; 16:696. [PMID: 34838078 PMCID: PMC8626985 DOI: 10.1186/s13018-021-02841-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). Materials and methods We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. Results There was no significant difference between the two groups in complication rate. The operative time in the PETLIF group was significantly less than that in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. Conclusions Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02841-4.
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Affiliation(s)
- You-Di Xue
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Wen-Bo Diao
- Department of Orthopaedics, Zhoukou Orthopedic Hospital, Zhoukou, 466000, Henan, People's Republic of China
| | - Chao Ma
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Jie Li
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Clinical College of Nanjing Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China.
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11
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Jin YM, Chen Q, Chen CY, Lyu J, Shi B, Yang C, Xia C. Clinical Research and Technique Note of TLIF by Wiltse Approach for the Treatment of Degenerative Lumbar. Orthop Surg 2021; 13:1628-1638. [PMID: 34152699 PMCID: PMC8313142 DOI: 10.1111/os.13055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the clinical efficacy and share the technique notes of Wiltse Approach TLIF for the treating single segment degenerative lumbar spinal disease. Method In this retrospective controlled study, 780 patients with single segment degenerative lumbar disease who were operated in our hospital from January 2016 to December 2020 were analyzed retrospectively. The patients were randomly assigned to Wiltse approach group (group A, 410 cases) and conventional open approach group (group B, 370 cases). Patient's assessment of pain and disability were evaluated by the visual analogue scale (VAS) and the Oswestry disability index (ODI) before and after surgery. The incision length, operative time, exposure time, intraoperative blood loss, hidden blood loss, time to ambulation, total length of hospitalization, serum creatine kinase, X‐rays, CT and MRI were also evaluated. Results There were no differences in sex, age, pre‐operative ODI score, VAS score between the two groups (P > 0.05). The Wiltse approach group had a shorter incision length with 7.69 ± 0.44 cm compared to the conventional group with 11.13 ± 0.36 cm (P < 0.01). The average operative time was 119.20 ± 14.64 min with exposure time of 16.20 ± 3.42 min in the Wiltse approach group and 145.65 ± 16.98 min with 29.20 ± 3.42 min in the conventional group (P < 0.05, P < 0.01). Comparing the intraoperative blood loss, hidden blood loss, serum creatine kinase, time to ambulation, total length of hospitalization, the Wiltse approach group was less than the conventional open approach group (P < 0.05). The VAS score of the two groups decreased significantly with time, and the VAS score of the Wiltse group was significantly lower than that of the conventional open approach group (P < 0.05). At last investigation after operation, ODI scores of the two groups were significantly decreased compared with that before operation. Wiltse approach group was significantly lower than that of the conventional open approach group (P < 0.05). The multifidus of the two groups of patients had a certain degree of atrophy. But the Wiltse approach group multifidus muscle atrophy rate is significantly lower than the conventional open approach group. Conclusion The Wiltse approach TLIF significantly reduces the damage to the paravertebral muscles and the postoperative incidence of chronic low back pain.
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Affiliation(s)
- Yong-Ming Jin
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Qi Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Chu-Yong Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jun Lyu
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Binbin Shi
- Department of Orthopaedic Surgery, Tongxiang First People's Hospital, Tongxiang, China
| | - Chen Yang
- Department of Orthopaedic Surgery, The First People's Hospital of Akesu, Akesu, China
| | - Chen Xia
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
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Tanaka J, Takamori Y, Shiokawa T, Shibata R, Nobutou S, Shirachi H, Yamamoto T. Drop foot due to lumbar degenerative disease: Painless drop foot is difficult to recover. Clin Neurol Neurosurg 2021; 206:106696. [PMID: 34059400 DOI: 10.1016/j.clineuro.2021.106696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the improvement of drop foot following lumbar decompression surgery and determine the prognostic factors that might influence the recovery of drop foot. SUMMARY AND BACKGROUND DATE Drop foot is a common but serious problem that can lead to deteriorate patient's daily activities. There are numerous studied regarding the prognostic factors for the recovery of drop foot. However a few reports have been described the pathophysiological etiology of not only drop foot but also Trendelenburg's sign due to the L5 nerve root palsy. Therefore, there is a possibility drop foot caused by peroneal nerve palsy is included. In addition, none have evaluated the presence or absence of radicular leg pain with drop foot patients. The purpose of this study was to evaluate the improvement of paretic leg muscles and determine the prognostic factors that might influence the recovery of drop foot. METHODS Fifty-five drop foot patients were included in the study. Prognostic factors were retrospectively studied.Patients were assessed in terms of 10 items: 1) age, 2) sex, 3) diagnosis (LDH or LSS), 4) muscle strength of tibialis anterior, 5) muscle strength of extensor halluces longus, 6) muscle strength of gluteus medius, 7) presence or absence of radicular leg pain, 8) duration before surgery, 9) surgical treatment (spinal fusion or not), 10) anamnesis of diabetes mellitus. RESULTS Thirty-two (58.2%) of 55 patients recovered from their drop foot (manual muscle test of tibialis anterior ≥ 4 at final follow-up), while 23 (41.8%) did not (manual muscle test of tibialis anterior ≤ 3 at final follow-up). The strength of all muscles that were innervated and controlled by the L5 nerve root had recovered at the final follow-up when evaluated as averages. Multivariate logistic regression analysis revealed significant differences in terms of 2 items: "duration before surgery" and "presence or absence of radicular leg pain". CONCLUSIONS "Duration before surgery" and "presence or absence of radicular leg pain" are important to predict the recovery of drop foot. Painless drop foot patients with lumbar degenerative disease are difficult to recover their paralysis.
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Affiliation(s)
- Jun Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Yoshihiro Takamori
- Takamori Orthop. Surg. & Int. Med. Clinic, 1-10-35 Hashimoto, Nishi-ku, Fukuoka 819-0031, Japan.
| | - Teruaki Shiokawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Ryo Shibata
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Shinri Nobutou
- Fukuoka Central Hospital, 2-6-11 Yakuin, Chuo-ku, Fukuoka 810-0022, Japan.
| | - Hitoshi Shirachi
- Takamori Orthop. Surg. & Int. Med. Clinic, 1-10-35 Hashimoto, Nishi-ku, Fukuoka 819-0031, Japan.
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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Ma CR, Chen HX, Li GJ, He XY, Wang LS, Huang T, Meng ZB. [Analysis of lumbosacral sagittal balance parameter variation in minimally invasive transforaminal lumbar interbody fusion with real-time 3D navigation techniques]. Zhongguo Gu Shang 2021; 34:315-20. [PMID: 33896128 DOI: 10.12200/j.issn.1003-0034.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the dynamic changes of lumbosacral sagittal parameters after real-time three-dimensional navigation assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open TLIF for treatment of lumbar degenerative disease. METHODS The clinical data of 61 patients with lumbar degenerative disease underwent single-segment surgery from September 2017 to September 2019 were retrospectively analyzed. Among them, 31 cases underwent MIS-TLIF with 3D navigation techniques (MIS-TLIF group) and another 30 cases underwent conventional open TLIF (traditional open TLIF group). The basic information, operative time and intraoperative blood loss were collected. The sagittal radiologic parameters were measured before surgery and 3 months after surgery, including lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), anterior disc height (ADH), posterior disc height(PDH).And the average disc height(DH) and pelvic incidence to lumbar lordosis mismatch (PI-LL) were calculated. RESULTS Operative time and intraoperative blood loss in MIS-TLIF group were significantly less than in traditional open TLIF group(P<0.05). In MIS-TLIF group, LL, SL, PI-LL, and DH were significantly improved at 3 months after surgery (P<0.05), while PI, PT, and SS were not statistically different from those before surgery (P>0.05). LL, PI-LL, and DH of patients in the traditional open TLIF group were significantly improved at 3 months after surgery (P<0.05), while the PI, PT, SS, and SL were not statistically different from those before surgery (P>0.05). LL change showed a significant correlation with SL change (r= 0.433, P<0.001). Change in SL closely correlated to change in ADH (r=0.621, P<0.05) and PDH(r=0.527, P<0.05). CONCLUSION Real-time navigation-assisted MIS-TLIF and traditional open TLIF can recover DH in a short term for lumbar degenerative diseases, improve LL and PI-LL, and make the arrangement of the sagittal plane of the lumbosacral region more coordinated after surgery. But only the navigation assisted MIS -TLIF can significantly improve SL. Compared with traditional open TLIF, real-time navigation assisted MIS-TLIF in the treatment of degenerative lumbar diseases has the advantages of short operation time and less intraoperative bleeding.
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Affiliation(s)
- Cheng-Rong Ma
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Huan-Xiong Chen
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Guo-Jun Li
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Xiao-Yuan He
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Liang-Sheng Wang
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Tao Huang
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
| | - Zhi-Bin Meng
- Department of Spine and Osteopathic Surgery, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan, China
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Sik Goh T, Hwan Park S, Suk Kim D, Ryu S, Min Son S, Sub Lee J. Comparison of endoscopic spine surgery and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar disease: A meta-analysis. J Clin Neurosci 2021; 88:5-9. [PMID: 33992203 DOI: 10.1016/j.jocn.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to compare the clinical outcomes of endoscopic spinal surgery (ESS) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar disease (DLD) through meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of ESS and MIS-TLIF in DLD, including visual analog scale (VAS) score for low back pain, VAS score for leg pain, Oswestry Disability Index (ODI), and complications published between January 2000 and August 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Four comparative studies were identified. No significant differences were found between the ESS and MIS-TLIF groups in terms of VAS score for back pain, VAS score for leg pain, and ODI, except for complication rate. The complication rate was higher in the ESS than in the MIS-TLIF group. A literature review identified four comparative studies reporting the clinical outcomes of ESS and MIS-TLIF for DLD. Despite the heterogeneity, a limited number of meta-analyses showed that the clinical outcomes between the two groups were not significantly different except for complication rate. Hence, further large-scale multicenter studies are required to validate our results.
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Altshuler M, Mueller K, MacConnell A, Wirth P, Sandhu F, Voyadzis JM. Does minimally invasive spine surgery reduce the rate of perioperative medical complications? A retrospective single-center experience of 1435 degenerative lumbar spine surgeries. Eur Spine J 2021; 30:122-7. [PMID: 32700125 DOI: 10.1007/s00586-020-06536-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It is unclear if minimally invasive techniques reduce the rate of perioperative complications when compared to traditional open approaches to the lumbar spine. Our aim was to evaluate perioperative complications in patients that underwent MIS and conventional open techniques for degenerative lumbar pathology. METHODS A retrospective review of a prospectively collected database identified 1435 patients that underwent surgery for degenerative lumbar pathology from January 2013-2016. We evaluated the rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and pneumonia. Groups were analyzed based on decompression alone as compared with decompression and fusion for both MIS and traditional open techniques. RESULTS Patients that underwent traditional open lumbar decompression surgery were more likely to develop a DVT (P = .01) than those undergoing MIS decompression. There was no significant difference in rates of PE (P = .99), UTI (P = .24), or pneumonia (P = .56). Patients that underwent traditional open lumbar fusion surgery compared to MIS fusion were also more likely to have a PE (P = .03). There was no significant difference in rates of DVT (P = .22), UTI (P = .43), or pneumonia (P = .24). CONCLUSION Minimally invasive spinal surgery was found to reduce the rate of DVT for decompression surgeries and reduce the rate of PE for fusion surgeries.
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Feng Y, Cai F, Chen L, Gu Y, Geng DC, Yang HL, Tang TS. Excessive swelling of nerve roots : Important factor for recurring sciatica after lumbar surgery. Orthopade 2020; 49:502-509. [PMID: 31440788 DOI: 10.1007/s00132-019-03794-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the occurrence of unexpectedly swollen nerve roots and to investigate the relationship between nerve root edema and recurrent radicular pain. METHODS During the period from August 2010 to August 2015, a total of 462 patients with degenerative lumbar disease underwent surgery in this study group. Magnetic resonance imaging (MRI) was used to evaluate the details of the nerve root. Of the patients with recurring radiating pain 13 met the inclusion criteria of the study group and 24 patients without any complications volunteered as the control group. The visual analog scale (VAS), Oswestry Disability Index (ODI), and medical outcomes study item short form health survey (SF-36) were used to evaluate the clinical outcomes. RESULTS The preoperative diameter of the nerve root showed no significant difference between the two groups (P = 0.28). The postoperative nerve diameter of the study group was larger than that of the control group (P < 0.01). The initial operation improved the symptoms and the VAS was significantly decreased (P < 0.01). After recurrence of the neuralgia, the VAS score significantly increased (P < 0.01). The pain of the study group improved to the same level as that of the control group 4 weeks after subsequent surgery (P = 0.47), while the quality of life was still lower than that of the control group (P < 0.05). The scores collected 3 months after surgery showed that the clinical outcomes were not different between the two groups (P > 0.05). CONCLUSION In surgery for degenerative lumbar disease accompanied by nerve root edema, excessive nerve root swelling is an important factor for recurrent radiating pain. With a properly carried out intervention in the re-exploration, the recurrent symptoms can be gradually relieved.
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Affiliation(s)
- Yu Feng
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
| | - Feng Cai
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
| | - Liang Chen
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China.
| | - Yong Gu
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
| | - De-Chun Geng
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
| | - Tian-Si Tang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, 215006, Suzhou, China
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Mueller K, Altshuler M, Voyadzis JM, Sandhu FA. The incidence of symptomatic postoperative epidural hematoma after minimally invasive lumbar decompression: A single institution retrospective review. Clin Neurol Neurosurg 2020; 195:105868. [PMID: 32361024 DOI: 10.1016/j.clineuro.2020.105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Postoperative epidural hematoma (PEDH) after minimally invasive lumbar laminectomy (MILL) can lead to significant morbidity and healthcare cost. The incidence is not well characterized in the literature as compared with traditional open techniques. Our aim was to define the incidence of PEDH after MIS lumbar decompression procedures and evaluate strategies for reduction of PEDH. PATIENTS AND METHODS A retrospective review of a prospectively collected database was queried from January 2013 to September 2018 for all patients that underwent a minimally invasive lumbar laminectomy or laminotomy, with or without discectomy, for which the goal was decompression alone. Charts were reviewed to see the operation type and whether the patient developed a postoperative epidural hematoma. RESULTS 1004 cases were identified and reviewed. The overall PEDH rate was 1.4 % (14/1004). 78.5 % (11/14) of cases involved at least a single level laminectomy. 21.4 % (3/14) involved a laminotomy alone or with discectomy. 64.3 % (9/14) of patients presented with a neurological deficit. CONCLUSIONS The rate of PEDH after MIS lumbar decompression procedures is 1.4 %. A majority of patients presented with a neurological deficit.
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Affiliation(s)
- Kyle Mueller
- Medstar Georgetown University Hospital, Department of Neurosurgery, Washington, DC, United States
| | | | - Jean-Marc Voyadzis
- Medstar Georgetown University Hospital, Department of Neurosurgery, Washington, DC, United States
| | - Faheem A Sandhu
- Medstar Georgetown University Hospital, Department of Neurosurgery, Washington, DC, United States.
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Yahara Y, Yasuda T, Kawaguchi Y, Suzuki K, Seki S, Kondo M, Makino H, Kamei K, Kanamori M, Kimura T. Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis. BMC Musculoskelet Disord 2020; 21:93. [PMID: 32041573 PMCID: PMC7011504 DOI: 10.1186/s12891-020-3105-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/31/2020] [Indexed: 01/15/2023] Open
Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. Methods A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. Results The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH- group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. Conclusions Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.
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Affiliation(s)
- Yasuhito Yahara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Miho Kondo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Li HM, Zhang RJ, Shen CL. Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis. BMC Musculoskelet Disord 2019; 20:582. [PMID: 31801508 PMCID: PMC6894220 DOI: 10.1186/s12891-019-2972-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background In the current surgical therapeutic regimen for the degenerative lumbar disease, both oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) are gradually accepted. Thus, the objective of this study is to compare the radiographic and clinical outcomes of OLIF and LLIF for the degenerative lumbar disease. Methods We conducted an exhaustive literature search of MEDLINE, EMBASE, and the Cochrane Library to find the relevant studies about OLIF and LLIF for the degenerative lumbar disease. Random-effects model was performed to pool the outcomes about disc height (DH), fusion, operative blood loss, operative time, length of hospital stays, complications, visual analog scale (VAS), and Oswestry disability index (ODI). Results 56 studies were included in this study. The two groups of patients had similar changes in terms of DH, operative blood loss, operative time, hospital stay and the fusion rate (over 90%). The OLIF group showed slightly better VAS and ODI scores improvement. The incidence of perioperative complications of OLIF and LLIF was 26.7 and 27.8% respectively. Higher rates of nerve injury and psoas weakness (21.2%) were reported for LLIF, while higher rates of cage subsidence (5.1%), endplate damage (5.2%) and vascular injury (1.7%) were reported for OLIF. Conclusions The two groups are similar in terms of radiographic outcomes, operative blood loss, operative time and the length of hospital stay. The OLIF group shows advantages in VAS and ODI scores improvement. Though the incidence of perioperative complications of OLIF and LLIF is similar, the incidence of main complications is significantly different.
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Affiliation(s)
- Hui-Min Li
- Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Cai-Liang Shen
- Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.
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Kiyohara M, Arizono T, Inokuchi A, Hamada T, Nishida K, Imamura R. Anatomical Evaluation of Lumbar Arteries for Lateral Lumbar Interbody Fusion with Magnetic Resonance Imaging. Spine Surg Relat Res 2019; 4:69-73. [PMID: 32039300 PMCID: PMC7002069 DOI: 10.22603/ssrr.2019-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction Lateral lumbar interbody fusion (LLIF) is becoming a more common surgical treatment option for adult degenerative lumbar conditions. LLIF is a mini-open access technique with wound retractors, and postoperative hematoma due to segmental vessels injury is reported. Thus, it is considered that there is a need to conduct detailed preoperative examinations to identify where the lumbar vessels are. As far as we know, there are only a few studies investigating the location of the lumbar arteries. This study evaluates the anatomical position of lumbar arteries using magnetic resonance imaging (MRI). Methods We studied 101 MRIs of patients with lumbar disease. The length from the upper and lower end plates of the vertebra to the lumbar arteries was measured. The measurement was conducted with coronal MRI images of every quarter slice of L1 to L4 vertebrae. We also investigated sagittal MRI images to determine whether the lumbar vessels are located on intervertebral disc in each level from L1/2 to L5/S1. Results The lumbar vessels are not always located at the center of the vertebrae. Some lumbar vessels are located within 8 mm from the end plates. Especially in L4, the lumbar vessels tended to go down from the anterior cranial side to the posterior caudal side (P < 0.01). 8, 24, and 54 lumbar vessels are located at the anterior quarter, the center, and the posterior quarter slice of the vertebrae, respectively, in L4. There were seven lumbar vessels in total located on the vertebral disc level. Conclusions It is necessary to investigate where the lumbar arteries are located to prevent its injury in LLIF, because the lumbar artery is not always located at the center of a vertebra. MRIs may provide a valuable information to avoid vascular injury during LLIF.
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Affiliation(s)
- Masato Kiyohara
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Takeshi Arizono
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Akihiko Inokuchi
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Takahiro Hamada
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Kenjiro Nishida
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Ryuta Imamura
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
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21
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McMordie JH, Chen EX, Ehlers LD, Gillis CC. Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Surgical Video. Oper Neurosurg (Hagerstown) 2019; 17:E53. [PMID: 30629236 DOI: 10.1093/ons/opy394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/24/2018] [Indexed: 11/12/2022] Open
Abstract
This operative video is a detailed look at minimally invasive transforaminal lumbar interbody fusion. We provide a step-by-step guide with appropriate narration and operative video to enhance the educational experience. We review clinical and radiographic evaluation, patient positioning, intraoperative navigation, localization, percutaneous pedicle screw placement, minimally invasive approach, disc space preparation, placement of interbody device, and closure. By presenting up-to-date minimally invasive and intraoperative navigation techniques, this video provides educational benefit to all neurosurgeons regardless of training level.
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Affiliation(s)
- Joseph H McMordie
- Division of Neurosurgery, Department of Surgery, University of Nebraska, Omaha, Nebraska
| | - Eric X Chen
- Division of Neurosurgery, Department of Surgery, University of Nebraska, Omaha, Nebraska
| | - Landon D Ehlers
- Division of Neurosurgery, Department of Surgery, University of Nebraska, Omaha, Nebraska
| | - Christopher C Gillis
- Division of Neurosurgery, Department of Surgery, University of Nebraska, Omaha, Nebraska
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Shenoy K, Stekas N, Donnally CJ 3rd, Zhao W, Kim YH, Lurie JD, Razi AE. Retrolisthesis and lumbar disc herniation: a postoperative assessment of outcomes at 8-year follow-up. Spine J 2019; 19:995-1000. [PMID: 30594668 DOI: 10.1016/j.spinee.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar disc herniation and retrolisthesis have been shown to be significant degenerative changes that can be associated with back pain. Current literature has shown evidence that retrolisthesis is associated with similar baseline function in patients with L5-S1 disc herniation, but worse postoperative outcomes 2 years after lumbar discectomy. However, literature comparing long-term postoperative outcomes at 8-year follow-up in patients with L5-S1 disc herniation with retrolisthesis is lacking. PURPOSE The purpose of the present study is to compare long-term postoperative outcomes at 8-year follow-up in patients with retrolisthesis and L5-S1 disc herniations to patients with L5-S1 disc herniations without retrolisthesis. STUDY DESIGN Retrospective review of prospectively collected data from the Spine Patients Outcomes Research Trial (SPORT) database. PATIENT SAMPLE Sixty-five patients who underwent lumbar discectomy for L5-S1 disc herniations with 8-year follow-up from the SPORT. OUTCOME MEASURES Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index, Sciatica Bothersomeness Index, and reoperation rate. METHODS Baseline surgical parameters, length of stay, complication rates, reoperation rates, and outcome measures were recorded in the SPORT database. Follow-up data were collected at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6 years, 7 years, and 8 years. Retrolisthesis was defined as posterior subluxation ≥8%. Patients with and without retrolisthesis were compared using a mixed-effects model of longitudinal regression. Outcomes were calculated as time-weighted averages over 8 years. Reoperation rates were compared using the log-rank test based on time to first reoperation. RESULTS One hundred-twenty five patients met inclusion criteria for the present study, including 29 patients with retrolisthesis (23.3%) and 96 patients who did not have retrolisthesis (76.7%). The greatest difference in clinical outcome measures was found at 2 years postoperatively. This was the only point at which both the Short Form-36 Bodily Pain scale (SF-36 BP) and PF showed significant differences between the retrolisthesis and nonretrolisthesis group. At 3 years, SF-36 BP was significantly lower in patients with retrolisthesis (39.9 vs. 52, p=.046). At 8-year follow-up, the presence of retrolisthesis in patients undergoing L5-S1 discectomy was not associated with worse outcome measure scores based on the area under the curve analysis for any metric investigated (SF-36 BP 41.4 vs. 47.1, p=.18; SF-36 Physical Function scale 38.9 vs. 45.4, p=.12; Oswestry Disability Index -39.4 vs. -34.8, p=.23; -11.6 vs. -10.4, p=.25) or a difference in reoperation rate (retrolisthesis group 10%, nonretrolisthesis group 17%, p=.41). CONCLUSIONS While retrolisthesis can contribute to low back pain and dysfunction in patients undergoing lumbar discectomy for L5-S1 herniated nucleus pulposus in early follow-up, no significant difference was found in postoperative outcomes after 3 years. Additionally, retrolisthesis was not found to be associated with different reoperation rates at 8 years postoperatively.
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Li HM, Zhang RJ, Shen CL. Radiographic and Clinical Outcomes of Oblique Lateral Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease. World Neurosurg 2018; 122:e627-e638. [PMID: 31108079 DOI: 10.1016/j.wneu.2018.10.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effects of oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have not been compared by a meta-analysis. The present study aimed to summarize the radiographic and clinical outcomes of OLIF and MI-TLIF for degenerative lumbar disease. METHODS We performed a systematic review of related studies and report the outcomes of OLIF and MI-TLIF for degenerative lumbar disease. The radiographic outcomes measures included disc height, segmental lordotic angle, lumbar lordotic angle, and fusion. The clinical and functional outcomes included operative blood loss, operative time, length of hospital stay, complications, visual analog scale, and Oswestry disability index. Data pooling and meta-analysis with the random effects model were performed to evaluate the results. RESULTS A total of 47 studies met the inclusion criteria. Similar changes in terms of disc height, segmental lordotic angle, lumbar lordotic angle, length of hospital stay, visual analog scale, Oswestry disability index, and radiological evidence of fusion of >90% were observed between the 2 groups. The OLIF group showed less operative blood loss and operative time. The incidence of intraoperative and postoperative complications was 9.5% and 19.9% for the OLIF group and 3.5% and 8.5% for the MI-TLIF group, respectively. CONCLUSIONS The radiographic and functional outcomes and length of hospital stay were similar between the 2 groups. The OLIF group showed advantages in operative blood loss and operative time; however, the incidence of complications in this technique was greater than that in the MI-TLIF group.
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Affiliation(s)
- Hui-Min Li
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui, China.
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Li A, Li X, Zhong Y. Is minimally invasive superior than open transforaminal lumbar interbody fusion for single-level degenerative lumbar diseases: a meta-analysis. J Orthop Surg Res 2018; 13:241. [PMID: 30236132 PMCID: PMC6148779 DOI: 10.1186/s13018-018-0941-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/06/2018] [Indexed: 01/27/2023] Open
Abstract
Background In recent years, the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly used to manage the lumbar degenerative disease. However, whether MI-TLIF was superior than open transforaminal lumbar interbody fusion (O-TLIF) was controversial. The aim of this meta-analysis was to compare the clinical outcomes between the MI-TLIF and O-TLIF in single-level degenerative lumbar diseases. Methods Two reviewers independently searched EMBASE, PubMed, Web of Science, and Google database from inception to February 2018 for studies comparing the MI-TLIF and O-TLIF approach for single-level lumbar degenerative disease. The data were extracted and analyzed for primary outcomes such as total blood loss, visual analog score (VAS), and other secondary outcomes (length of hospital stay, operation time, fluroscopic time, and Oswestry Disability Index (ODI)). Meta-analysis was performed by Stata 12.0. Results Seven RCTs were finally included in this meta-analysis. Compared with O-TLIF, MI-TLIF was associated with significantly less blood loss (weighted mean difference (WMD) = − 291.46; 95% confidence interval (CI) − 366.66 to − 216.47; P = 0.000,). There was no significant difference between the length of hospital stay, postoperative VAS, and ODI. Compared with O-TLIF, MI-TLIF was associated with an increase of the fluroscopic time (P < 0.05). Conclusion The MI-TLIF showed significantly less blood loss compared with O-TLIF and more fluroscopic time. There was no significant difference between the length of hospital stay, postoperative VAS, and ODI. More high-quality studies and subsequent meta-analyses are needed in the future.
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Affiliation(s)
- Aimin Li
- Department of Orthopedics, The 5th Central Hospital of Tianjin, Tianjin, 30000, People's Republic of China.
| | - Xiang Li
- Department of Orthopedics, The 5th Central Hospital of Tianjin, Tianjin, 30000, People's Republic of China
| | - Yang Zhong
- Department of Orthopedics, The 5th Central Hospital of Tianjin, Tianjin, 30000, People's Republic of China
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Peng J, Zhan Y, Liu Y, Zong Y, Mao Y. [Comparison of effectiveness of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 31:1341-1345. [PMID: 29798588 DOI: 10.7507/1002-1892.201706075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease. Methods Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group). There was no significant difference in age, gender, body mass index, preoperative diagnosis, lesion segment, and preoperative visual analogue scale (VAS) score, Oswestry dysfunction index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, bed rest time, length of hospital stay, serum creatine kinase (CK) concentration, total amount of diclofenac sodium, perioperative complications, ODI, VAS score, and interbody fusion rate were recorded and compared between 2 groups. Results All patients were followed up 12 months. The patients in trajectory screw group had a significantly less operation time, intraoperative blood loss, postoperative drainage, and serum CK concentration when compared with the patients in pedicle screw group ( P<0.05). Thirty-five patients (68.6%) in trajectory screw group and 46 patients (100%) in pedicle screw group were given diclofenac sodium within 48 hours after operation, showing significant difference between 2 groups ( χ2=89.334, P=0.000). There was no significant difference in the incidence of perioperative complications between trajectory screw group and pedicle screw group (3.9% vs. 8.7%, P=0.418). There was no significant difference in the VAS score, ODI, and interbody fusion rate at 12 months after operation between 2 groups ( P>0.05). Conclusion For the single segment degenerative lumbar disease, the use of CBTS or conventional pedicle screw for PLIF can obtain satisfactory clinical function and interbody fusion rate. But the former has the advantages of less blood loss, less intraoperative muscle damage, less perioperative pain, shorter length of hospital stay and bed rest time.
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Affiliation(s)
- Jun Peng
- Departmentof Orthopaedics, East Hospital of Shanghai Sixth People's Hospital, Shanghai, 201306,
| | - Yulin Zhan
- Departmentof Orthopaedics, East Hospital of Shanghai Sixth People's Hospital, Shanghai, 201306, P.R.China
| | - Yingjie Liu
- Departmentof Orthopaedics, East Hospital of Shanghai Sixth People's Hospital, Shanghai, 201306, P.R.China
| | - Yang Zong
- Departmentof Orthopaedics, East Hospital of Shanghai Sixth People's Hospital, Shanghai, 201306, P.R.China
| | - Yanjie Mao
- Departmentof Orthopaedics, East Hospital of Shanghai Sixth People's Hospital, Shanghai, 201306, P.R.China
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Cha JR, Kim YC, Yoon WK, Lee WG, Kim TH, Oh JK, Kim SW, Ohn SH, Cui JH. The recovery of damaged paraspinal muscles by posterior surgical treatment for patients with lumbar degenerative diseases and its clinical consequence. J Back Musculoskelet Rehabil 2018; 30:801-809. [PMID: 28372312 DOI: 10.3233/bmr-150455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Posterior lumbar surgery can lead to damage on paraspinal muscles. OBJECTIVE Our study aimed to examine the recovery in the denervated paraspinal muscles by posterior lumbar surgery and to determine that of improvement in the lower back pain (LBP). METHODS Depending on surgical treatments, the patients were divided into two groups: The group I (interspinous implantation with decompression) and II (posterior lumbar interbody fusion with decompression). The paraspinal mapping score was recorded for individual muscle. RESULTS In the group I, there was reinnervation in the denervated multifidus and erector spinae at the upper, surgical and lower levels at 12 months. In the group II, there was reinnervation in the denervated erector spinae at the upper, surgical and lower levels at 12 months. There was significant aggravation in the LBP in both groups at immediate postoperative. But there was significant improvement in it at 6 months in the group I and at 12 months in the group II. CONCLUSION There was reinnervation in not only denervated multifidus and erector spinae at 12 months following interspinous ligament stabilization but also in denervated erector spinae at 12 months following pedicle screw fixation with fusion.
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Affiliation(s)
- Jae-Ryong Cha
- Department of Orthopaedic Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, Ulsan, Korea
| | - Yong-Chan Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan-Keun Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Won-Gyu Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Jae-Keun Oh
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Seok-Woo Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University, Dongan-gu, Anyang-si, Korea
| | - Ji Hao Cui
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Epstein NE. Commentary on: The role of surgery for treatment of low back pain: Insights from the randomized controlled SPORT trials. Surg Neurol Int 2016; 7:S648-S651. [PMID: 27843678 PMCID: PMC5054639 DOI: 10.4103/2152-7806.191069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/17/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The SPORT trial database offered much useful information regarding the efficacy of surgical treatment for lumbar disc herniations, lumbar spinal stenosis, and degenerative spondylolisthesis. Data were obtained from 13 sites and included 2500 patients. METHODS The randomized trial for lumbar disc herniations was contaminated by the immense crossover of patients from surgical (50%) to non-surgical (30%) groups. Weinstein et al. concluded that they could not claim superiority of one treatment modality over the other. Weinstein's next SPORT study on lumbar discs, performed utilizing a prospective cohort of patients undergoing lumbar disc surgery (those that would not agree to be randomized), appeared to demonstrate better outcomes with vs. without surgery. RESULTS The follow-up study 8 years later again questioned the value of surgery vs. non-operative intervention. The other SPORT studies dealing with degenerative spondylolisthesis appeared to document the benefit of surgical decompression, but could not consistently substantiate the relative value of decompression alone vs. non-instrumented vs. instrumented fusion. The more recent SPORT study in 2015 on spinal stenosis treated with/without surgery indicated improvement in short term 4-year outcomes; however, the two arm-results (surgical vs. non-surgical) converged at 8 years. CONCLUSIONS Here, the 6 SPORT studies and short commentaries following each study indicate the pros, cons, and shortcomings of each investigation are presented. Notably, if surgeons better selected patients for surgery and avoided unnecessary procedures for "black discs alone" or pain alone, the results of the surgical intervention would likely be more clearly confirmed.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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Lozano-Álvarez C, Pérez-Prieto D, Saló-Bru G, Molina A, Lladó A, Cáceres E, Ramírez M. [Can epidemiological factors affect the 2-year outcomes after surgery for degenerative lumbar disease in terms of quality of life, disability and post-surgical pain?]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:78-84. [PMID: 24445154 DOI: 10.1016/j.recot.2013.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 10/24/2013] [Accepted: 11/09/2013] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the influence of epidemiological factors on the outcomes of surgery for degenerative lumbar disease in terms of quality of life, disability and chronic pain. MATERIAL AND METHOD A total of 263 patients who received surgery for degenerative lumbar disease (2005-2008) were included in the study. The epidemiological data collected were age, gender, employment status, and co-morbidity. The SF-36, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), and VAS score for lumbar and sciatic pain were measure before and 2 years after surgery. The correlation between epidemiological data and questionnaire results, as well as any independent prognostic factors, were assessed in the data analysis. RESULTS The mean age of the patients was 54.0 years (22-86), and 131 were female (49.8%). There were 42 (16%) lost to follow-up. Statistically significant correlations (P<.05) were observed between age, gender, co-morbidity, permanent sick leave, and pre-operative pain with changes in the ODI, COMI, physical and SF-36 mental scales, and lumbar and sciatic VAS. Linear regression analysis showed permanent sick leave and age as predictive factors of disability (β=14.146; 95% CI: 9.09 - 29.58; P<.01 and β=0.334; 95% CI: 0.40 - 0.98, P<.05, respectively), and change in quality of life (β=-8.568; 95% CI: -14.88 - -2.26; p<.01 and β=-0.228, IC 95% CI: -0.40 - -0.06, P<.05, respectively). CONCLUSION Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery.
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Abstract
BACKGROUND Decompression and fusion is considered as the 'gold standard' for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup. MATERIALS AND METHODS Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed. RESULTS Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84-3.19 ± 0.19 and 7.26 ± 0.76-3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%). CONCLUSION Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.
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Affiliation(s)
- Mingyuan Yang
- Department of Orthopaedics, Changhai Hospital, Shanghai, China
| | - Chao Li
- Department of Orthopaedics, Changhai Hospital, Shanghai, China
| | - Ziqiang Chen
- Department of Orthopaedics, Changhai Hospital, Shanghai, China
| | - Yushu Bai
- Department of Orthopaedics, Changhai Hospital, Shanghai, China
| | - Ming Li
- Department of Orthopaedics, Changhai Hospital, Shanghai, China,Address for correspondence: Prof. Ming Li, Department of Orthopaedics, Changhai Hospital, 168 Changhai Street, Shanghai 200433, China. E-mail:
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Liao JC, Chen WJ, Chen LH, Niu CC, Fu TS, Lai PL, Tsai TT. Complications associated with instrumented lumbar surgery in patients with liver cirrhosis: a matched cohort analysis. Spine J 2013; 13:908-13. [PMID: 23541455 DOI: 10.1016/j.spinee.2013.02.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/31/2012] [Accepted: 02/15/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. PURPOSE To review the results of instrumented lumbar surgery in patients with liver cirrhosis and determine the surgical risk factors in this group of patients. STUDY DESIGN A retrospective study for comparison between two cohorts (liver cirrhosis vs. nonliver cirrhosis). PATIENT SAMPLE Fifty-eight patients. OUTCOME MEASURES Child-Turcotte-Pugh scale was used to assess the patients' hepatic functional reserve. The clinical outcomes were evaluated by the five-grade patient-centered general outcome assessment questionnaire. Any event that led to reoperation, requirement of intensive care, prolonging of the hospital stay (more than 14 days), or admission after discharge within 30 days of surgery was defined as a perioperative complication. METHODS Between 1997 and 2009, patients with liver cirrhosis who had undergone instrumented lumbar surgeries for degenerative lumbar disease were studied. All data were compared with those for gender-, age-, and diagnosis-matched nonliver cirrhosis patients. RESULTS Liver cirrhotic patients had significantly lower preoperative hemoglobin, white blood cell counts, platelets, and albumin levels and higher prothrombin time and bilirubin level. Instrumented lumbar surgery was associated with significantly more blood loss, a longer hospital stay, and more complications in patients with liver cirrhosis compared with control patients. The final satisfactory rate was higher in the control group but without statistical difference (85% vs. 65%, p=.240). In the cirrhotic group, 22 patients (76%) were Child Class A and 7 patients (24%) were Child Class B; 12 patients developed one or more complications. Patients with Child Class B had a significantly higher incidence of complications than those with Child Class A (p=.006). In patients with Child Class A, those with a score of 6 also had a significantly higher incidence of complications than those with a score of 5 (p<.001). Female gender (p=.035), a low level of albumin (p=.002), presence of ascites (p=.029), and increased blood loss (p=.044) were associated with a higher risk of complications. CONCLUSIONS The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
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Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Fu-Shin St, Kweishian, Taoyuan 333, Taiwan.
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Caputo AM, Michael KW, Chapman TM, Jennings JM, Hubbard EW, Isaacs RE, Brown CR. Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis. J Clin Neurosci 2013; 20:1558-63. [PMID: 23906522 DOI: 10.1016/j.jocn.2012.12.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 12/01/2012] [Accepted: 12/08/2012] [Indexed: 11/19/2022]
Abstract
Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels.
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Affiliation(s)
- Adam M Caputo
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 2807, 335 Baker House, 200 Trent Drive, Durham, NC 27710, USA.
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Kim JS, Lee HS, Shin DA, Kim KN, Yoon DH. Correction of Coronal Imbalance in Degenerative Lumbar Spine Disease Following Direct Lateral Interbody Fusion (DLIF). Korean J Spine 2012; 9:176-80. [PMID: 25983811 PMCID: PMC4430998 DOI: 10.14245/kjs.2012.9.3.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/04/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Abstract
Objective The authors have recently been using a surgical technique of minimally invasive direct lateral interbody fusion (DLIF) for correcting of coronal imbalance. The purpose of this study was to evaluate the surgical outcome and complication of DLIF. Methods We undertook retrospective analysis of a consecutive series of 8 DLIF procedures in Degenerative lumbar spine disease since May 2011. Four patients underwent DLIF only, and the others underwent combined DLIF and posterior fixation. Data on intra- and postoperative complications were collected. The pre- and postoperative X-rays were reviewed. We investigated coronal deformity, Cobb's angle, and apical vertebral translation (AVT). The mean follow-up period was months with a range of 2 to 8 months. Results A mean preoperative coronal Cobb's angle was 21.8° (range 11.5-32.4°). Following after DLIF, the mean Cobb's angle was decreased to 13.0° (range 2.9-21.5°). Following additional posterior screw fixation, mean Cobb's angle was further decreased to 7.4° (range 2.9-13.2°). A mean preoperative AVT was 2.0 cm(range 0.6-3.5 cm), and improved to 1.4 cm(range 0.3-2.4 cm) and 0.8 cm(range 0.2-1.8 cm) postoperatively (DLIF and, posterior fixation respectively). One patient (12.5%) showed cage migration during follow-up period. Two patients (25%) developed motor weakness, and 4 patients (50%) experienced postoperative thigh paresthesias or dysesthesias. During follow up period, motor weakness had resolved in 1 patient. Sensory symptoms were improved in all patients at the last follow-up. Conclusion Degenerative lumbar disease can be effectively corrected by DLIF with acceptable complications.
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Affiliation(s)
- Ju Seong Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, The Spine and Spinal Cord Institute, Seoul, Korea
| | - Hyo Sang Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, The Spine and Spinal Cord Institute, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, The Spine and Spinal Cord Institute, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, The Spine and Spinal Cord Institute, Seoul, Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, The Spine and Spinal Cord Institute, Seoul, Korea
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Kim YJ, Lee SG, Park CW, Son S, Kim WK. Long-term Follow-up (Minimum 5 Years) Study of Single-level Posterior Dynamic Stabilization in Lumbar Degenerative Disease; 'Interspinous U' & 'DIAM'. Korean J Spine 2012; 9:102-7. [PMID: 25983797 PMCID: PMC4432356 DOI: 10.14245/kjs.2012.9.2.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/10/2012] [Accepted: 06/25/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Recently posterior dynamic stabilizations (PDS) are increased in degenerative lumbar disease. But, some previous studies had doubts its long term prognosis. Long term clinical and radiological results of PDS using interspinous device (Interspinous U, DIAM) were analyzed. METHODS We have used the 'interspinous U' and 'DIAM' for patients with lumbar spinal stenosis. We included single level lumbar spinal stenosis patients who completed minimum 60 months follow-up evaluation. All patients checked plain lateral and flexion-extension views at immediately after the surgery and each follow-up. The clinical outcome was measured by Odom's criteria. Complications including post operative infection, bony erosion, device fracture, device malformations, and instabilities were surveyed. RESULTS We included 18 for 'Interspinous U' and 7 patients 'DIAM' groups. Mean follow-up durations for 'Interspinous U' and 'DIAM' were 74.6 and 62.6 months, respectively. Satisfactory groups were 50.0% and 42.9 % for 'Interspinous U' and 'DIAM' groups. In 'Interspinous U' group disc height ratio increased transiently in immediate postoperative period (from 0.18 to 0.21) and then, decreased significantly in last follow-up (0.18). In 'DIAM' group, disc height ratio increased transiently in immediate postoperative period (from 0.18 to 0.19), and then decreased significantly in the last follow-up (0.16). Three (16.7%) and two (28.6%) patients undergo on a re-operation due to severe back pain in 'Interspinous U' and 'DIAM' groups. CONCLUSION Long term follow up 'Interspinous U' and 'DIAM' group showed low patient satisfaction and poor radiological outcomes. To ascertain the benefit of PDS compare with posterior screw fixation, prospective analysis with larger population and multi-center study will be needed.
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Affiliation(s)
- Yeon Joon Kim
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Chan Woo Park
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Seong Son
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
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