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Lee S, Kim DY, Han J, Kim K, You AH, Kang HY, Park SW, Kim MK, Kim JE, Choi JH. Hemodynamic changes in the prone position according to fluid loading after anaesthesia induction in patients undergoing lumbar spine surgery: a randomized, assessor-blind, prospective study. Ann Med 2024; 56:2356645. [PMID: 38794845 PMCID: PMC11133492 DOI: 10.1080/07853890.2024.2356645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes. PATIENTS AND METHODS This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated. RESULTS Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2-3 time points for SVV and PPV. Other outcomes did not differ between the two groups. CONCLUSION Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position. TRIAL NUMBER KCT0008294 (date of registration: 16 March 2023).
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Affiliation(s)
- Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Doh Yoon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jihoon Han
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Kyungmi Kim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Wook Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
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Lee Y, Heard JC, McCurdy MA, Lambrechts MJ, Fras SI, Purtill W, Millar B, Kolowrat S, Issa TZ, D'Antonio ND, Rihn JA, Kurd MF, Kaye ID, Canseco JA, Vaccaro AR, Hilibrand AS, Kepler CK, Schroeder GD. Radiographic and Patient-Reported Outcomes in Anteriorly Placed Transforaminal Lumbar Interbody Fusion Cage Versus Anterior Lumbar Interbody Fusion With Posterior Instrumentation. Spine (Phila Pa 1976) 2024; 49:1078-1084. [PMID: 37737684 DOI: 10.1097/brs.0000000000004833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare outcomes in anteriorly placed transforaminal lumbar interbody fusions (TLIFs) and anterior lumbar interbody fusions (ALIFs). SUMMARY OF BACKGROUND DATA TLIF and ALIF are surgical techniques that have become more prevalent in recent years. Although studies have compared the two, none have considered TLIFs with anteriorly placed cages, which may serve as a better comparison to ALIFs. PATIENTS AND METHODS Patients undergoing TLIF or ALIF with posterior instrumentation from 2010 to 2020 at a tertiary care institution were retrospectively identified. TLIF cage position was assessed and those with anterior placement were included. Electronic medical records were reviewed to identify patient characteristics and patient-reported outcomes. Radiographic outcomes included posterior disc height (DH), lumbar lordosis (LL), sacral slope, pelvic incidence, and pelvic tilt. Statistical analysis was performed to compare the two groups. RESULTS Of the 351 patients, 108 had ALIF with posterior instrumentation and 207 had a TLIF. Preoperatively, patients undergoing TLIF had less LL (53.7° vs . 60.6°, P < 0.001), sacral slope (38.3° vs . 43.7°, P < 0.001), and pelvic incidence (60.1° vs . 66.1°, P < 0.001), all of which remained significant at 1-year and long-term follow-up ( P < 0.001). The TLIF group had less ∆DH (1.51° vs . 5.43°, P < 0.001), ∆LL (1.8° vs . 2.97°, P = 0.038), and ∆segmental lordosis (0.18° vs . 4.40°, P < 0.001) at 1 year postoperatively. At 2 to 3 years, ∆DH ( P < 0.001) and ∆segmental lordosis ( P = 0.001) remained significant, but ∆LL ( P = 0.695) did not. Patients in the TLIF group had higher Visual Analog Scale-Back scores 1 year postoperatively (3.68 vs . 2.16, P = 0.008) and experienced less improvement in Oswestry Disability Index (-17.1 vs . -28.6, P = 0.012) and Visual Analog Scale-Back (-2.67 vs . -4.50, P = 0.008) compared with patients undergoing ALIF. CONCLUSIONS Our findings suggest that ALIF with posterior instrumentation performed superiorly in radiographic outcomes and patient-reported outcomes compared with anteriorly placed TLIFs. Anteriorly placed TLIF cages may not achieve the same results as those of ALIF cages.
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Affiliation(s)
- Yunsoo Lee
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeremy C Heard
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michael A McCurdy
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mark J Lambrechts
- Department of Orthopedic Surgery, Washington University Hospital, St. Louis, MO
| | - Sebastian I Fras
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - William Purtill
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ben Millar
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Samantha Kolowrat
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Jeffrey A Rihn
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mark F Kurd
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Bock LM, Rauschmann M, Heck V, Sellei R, Vinas-Rios JM. Comparison of ALIF and PLIF in Isthmic Lumbosacral Spondylolisthesis. A Multicenter Surveillance Study of 602 cases from the German Spine Registry (DWG Register). J Neurol Surg A Cent Eur Neurosurg 2024; 85:349-354. [PMID: 37429333 DOI: 10.1055/s-0043-1770357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Isthmic spondylolisthesis most commonly occurs in the lumbosacral junction and can cause backpain and radicular pain as well as stiffness with progressive immobilization, with a negative impact on an individual's ability to work and quality of life. Multiple operative treatments are currently available. This study aims to compare complications, demography, and clinical features between anterior lumbar interbody fusion (ALIF) and posterior lumber body fusion (PLIF) in the operative treatment in isthmic spondylolisthesis. METHODS An analysis of data from the German spine registry (Deutsche Wirbelsäulengesellschaft [DWG]-Register) of patients who underwent operative treatment (PLIF and ALIF) for isthmic spondylolisthesis in the sacrolumbar junction in 170 departments between January 2017 and May 2021 was performed. Age, gender, American Society of Anesthesiologists (ASA) score, surgical approach, smoker/nonsmoker, as well as severeness of the spondylolisthesis according to the Meyerding classification were evaluated. RESULTS In total, 602 patients undergoing fusion in L5/S1 were identified in the registry, n = 570 PLIF (group 1) and n = 32 ALIF (group 2). A significant difference in the ASA score between the two groups was noted; group 1 had more patients suffering a more debilitating disease in comparison to group 2. There was no significant difference in gender, grade of spondylolisthesis, age, or smoking status. Significant differences were found in operative and postoperative variables and complications (fusion material, dura injury). CONCLUSION No difference was found between the two procedures in terms of symptomatic benefit of patients who underwent either ALIF or PLIF. According to the DWG Register, PLIF was the preferred method to treat isthmic spondylolisthesis in the sacrolumbar junction in Germany. To compare these two spine fusion techniques, further studies with an adequate sample size and follow-up period are required.
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Affiliation(s)
- Lore Marie Bock
- Department of Traumatology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Michael Rauschmann
- Department of Spine Surgery, Sana Klinikum Offenbach GmbH, Offenbach, Hessen, Germany
| | - Vincent Heck
- Department of Spine Surgery, University Hospital Cologne Clinic and Polyclinic for Orthopaedics and Emergency Surgery, Koln, Nordrhein-Westfalen, Germany
| | - Richard Sellei
- Department of Traumatology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Juan Manuel Vinas-Rios
- Department of Spine Surgery, University Hospital Cologne Clinic and Polyclinic for Orthopaedics and Emergency Surgery, Koln, Nordrhein-Westfalen, Germany
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Mehren C, Ostendorff N, Schmeiser G, Papavero L, Kothe R. Do TLIF and PLIF Techniques Differ in Perioperative Complications? - Comparison of Complications Rates of Two High Volume Centers. Global Spine J 2024:21925682241248095. [PMID: 38631328 DOI: 10.1177/21925682241248095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
STUDY DESIGN Retrospective bicentric Cohort Study. OBJECTIVE Posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF) have been clinically proven for the surgical treatment of degenerative spinal disorders. Despite many retrospective studies, the superiority of either technique has not been proven to date. In the literature, the complication rate of the conventional PLIF technique is reported to be significantly higher, but with inconsistent complication recording. In this retrospective bicentric study, a less invasive PLIF technique was compared with the conventional TLIF technique and complications were recorded using the validated SAVES V2 classification system. METHODS 1142 patients underwent PLIF (702) or TLIF (n = 440) up to 3 levels in two specialized centers. Epidemiological data, intra- and postoperative complications during hospitalization and after discharge were analyzed according to SAVES V2. RESULTS The overall complication rate was 13.74%. TLIF-patients had slightly significant more complications than PLIF-patients (TLIF = 16.6%/PLIF = 11.9%, P = .0338). Accordingly, complications during revision surgeries were more frequent in the first cohort (TLIF = 20.9%/PLIF = 12.6%; P = .03252). In primary interventions, the surgical technique did not correlate with the complication rate (TLIF = 12.4%/PLIF = 11.7%). There were no significant differences regarding severity of complications. CONCLUSIONS An important component of this work is the complication recording according to a uniform classification system (SAVES V2). In contrast to previous literature, we could demonstrate that there is not a significant difference between the two surgical techniques.
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Affiliation(s)
- Christoph Mehren
- Spine Center, Schoen Clinic Munich-Harlaching, Munich, Germany
- Academic Teaching Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Academic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University (PMU) Salzburg, Salzburg, Austria
| | - Nicolas Ostendorff
- Clinic for Spinal Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Gregor Schmeiser
- Clinic for Spinal Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Luca Papavero
- Clinic for Spinal Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Ralph Kothe
- Clinic for Spinal Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
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Wu X, Liu W, Xiao X, Fan Y, Gu G, Yu S, Yan H, Wang X, Li X, Zhao Y, Ni H, He S. Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1120-1128. [PMID: 38347273 DOI: 10.1007/s00586-023-08096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This research aims to compare the clinical outcomes of VBE-TLIF and MIS-TLIF for the treatment of patients with single-level degenerative lumbar diseases. METHODS Ninety patients were enrolled in this study. The estimated blood loss, operation time, postoperative hospitalization days, time to functional exercise, amount of surgical drain and inflammatory index were recorded. The visual analog scale, Oswestry dysfunction index and modified MacNab criteria were used to assessed the patient's back and leg pain, functional status and clinical satisfaction rates. RESULTS The average operation time of the VBE-TLIF group was longer than that of the MIS-TLIF group. The time for functional exercise, length of hospital stay, estimated blood loss and amount of surgical drain in the VBE-TLIF group were relative shorter than those in the MIS-TLIF group. Additionally, the levels of CRP, neutrophil, IL-6 and CPK in the VBE-TLIF group were significantly lower than those in the MIS-TLIF group at postoperative days 1 and 3, respectively (P < 0.001). Patients undergoing VBE-TLIF had significantly lower back VAS scores than those in the MIS-TLIF group on postoperative days 1 and 3 (P < 0.001). No significant differences were found in the clinical satisfaction rates (95.83 vs. 95.24%, P = 0.458) or interbody fusion rate (97.92 vs. 95.24%, P = 0.730) between these two surgical procedures. CONCLUSIONS Both VBE-TLIF and MIS-TLIF are safe and effective surgical procedures for patients with lumbar diseases, but VBE-TLIF technique is a preferred surgical procedure with merits of reduced surgical trauma and quicker recovery.
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Affiliation(s)
- Xinbo Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Wei Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiao Xiao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yunshan Fan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Guangfei Gu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shunzhi Yu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Huang Yan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiang Wang
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xifan Li
- Department of Radiological, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yingchuan Zhao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Haijian Ni
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shisheng He
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China.
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Huang F, Huang G, Jia J, Lu S, Li J. Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study. J Orthop Surg Res 2024; 19:143. [PMID: 38365801 PMCID: PMC10870541 DOI: 10.1186/s13018-024-04550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The capsule of the zygapophyseal joint plays an important role in motion segmental stability maintenance. Iatrogenic capsule injury is a common phenomenon in posterior approach lumbar interbody fusion operations, but whether this procedure will cause a higher risk of adjacent segment degeneration acceleration biomechanically has yet to be identified. METHODS Posterior lumbar interbody fusion (PLIF) with different grades of iatrogenic capsule injury was simulated in our calibrated and validated numerical model. By adjusting the cross-sectional area of the capsule, different grades of capsule injury were simulated. The stress distribution on the cranial motion segment was computed under different loading conditions to judge the potential risk of adjacent segment degeneration acceleration. RESULTS Compared to the PLIF model with an intact capsule, a stepwise increase in the stress value on the cranial motion segment can be observed with a step decrease in capsule cross-sectional areas. Moreover, compared to the difference between models with intact and slightly injured capsules, the difference in stress values was more evident between models with slight and severe iatrogenic capsule injury. CONCLUSION Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically, and iatrogenic capsule damage on the cranial motion segment should be reduced to optimize patients' long-term prognosis.
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Affiliation(s)
- Fei Huang
- Department of Orthopedics, Meishan Hospital of Traditional Chinese Medicine, Meishan, China
| | - Gang Huang
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Junpengli Jia
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Shihao Lu
- Department of Orthopedics, Changzheng Hospital Affiliated to the Naval Medical University, Xiangyin Road, Shanghai, 200433, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Longmatan District, Luzhou, 646000, Sichuan Province, People's Republic of China.
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
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Wu J, Miao J, Chen G, Xu H, Wen W, Xu H, Liu L. Finite element biomechanical analysis of 3D printed intervertebral fusion cage in osteoporotic population. BMC Musculoskelet Disord 2024; 25:129. [PMID: 38347518 PMCID: PMC10860281 DOI: 10.1186/s12891-024-07221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To study the biomechanical characteristics of each tissue structure when using different 3D printing Cage in osteoporotic patients undergoing interbody fusion. METHODS A finite element model of the lumbar spine was reconstructed and validated with regarding a range of motion and intervertebral disc pressure from previous in vitro studies. Cage and pedicle screws were implanted and part of the lamina, spinous process, and facet joints were removed in the L4/5 segment of the validated mode to simulate interbody fusion. A 280 N follower load and 7.5 N·m moment were applied to different postoperative models and intact osteoporotic model to simulate lumbar motion. The biomechanical characteristics of different models were evaluated by calculating and analyzing the range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment. RESULTS After rigid fixation, the range of motion of the fixed segment of model A-C decreased significantly, which was much smaller than that of the osteoporotic model. And with the increase of the axial area of the interbody fusion cages, the fixed segment of model A-C tended to be more stable. The range of motion and intradiscal pressure of the spinal models with different interbody fusion cages were higher than those of the complete osteoporosis model, but there was no significant difference between the postoperative models. On the other hand, the L5 upper endplate stress and screw-rod system stress of model A-C show a decreasing trend in different directions of motion. The stress of the endplate is the highest during flexion, which can reach 40.5 MPa (model A). The difference in endplate stress between models A-C was the largest during lateral bending. The endplate stress of models A and B was 150.5% and 140.9% of that of model C, respectively. The stress of the screw-rod system was the highest during lateral bending (model A, 102.0 MPa), which was 108.4%, 102.4%, 110.4%, 114.2% of model B and 158.5%, 110.1%, 115.8%, 125.4% of model C in flexion, extension, lateral bending, and rotation, respectively. CONCLUSIONS For people with osteoporosis, no matter what type of cage is used, good immediate stability can be achieved after surgery. Larger cage sizes provide better fixation without significantly increasing ROM and IDP in adjacent segments, which may contribute to the development of ASD. In addition, larger cage sizes can disperse endplate stress and reduce stress concentration, which is of positive significance in preventing cage subsidence after operation. The cage and screw rod system establish a stress conduction pathway on the spine, and a larger cage greatly enhances the stress-bearing capacity of the front column, which can better distribute the stress of the posterior spine structure and the stress borne by the posterior screw rod system, reduce the stress concentration phenomenon of the nail rod system, and avoid exceeding the yield strength of the material, resulting in the risk of future instrument failure.
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Affiliation(s)
- Jincheng Wu
- Department of Emergency Trauma Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China, 48 Baishuitang Road, Longhua District, 571700
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
| | | | - Hanpeng Xu
- Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangqiang Wen
- The First Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China
| | - Haoxiang Xu
- The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Lizhu Liu
- Department of Emergency Trauma Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China, 48 Baishuitang Road, Longhua District, 571700.
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Rahimzadeh P, Imani F, Farahmand Rad R, Faiz SHR. Comparing the Efficacy of Transforaminal and Caudal Epidural Injections of Calcitonin in Treating Degenerative Spinal Canal Stenosis: A Double-Blind Randomized Clinical Trial. Anesth Pain Med 2024; 14:e142822. [PMID: 38725918 PMCID: PMC11078236 DOI: 10.5812/aapm-142822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
Background Lumbar spinal stenosis (LSS) is the most common indication for lumbar surgery in elderly patients. Epidural injections of calcitonin are effective in managing LSS. Objectives This study aimed to compare the efficacy of transforaminal and caudal injections of calcitonin in patients with LSS. Methods In this double-blind randomized clinical trial, LSS patients were divided into two equal groups (N = 20). The first group received 50 IU (international units) of calcitonin via caudal epidural injection (CEI), and the second group received 50 IU of calcitonin via transforaminal epidural injection (TEI). The Visual Analogue Scale (VAS) and Oswestry Low Back Pain Disability Questionnaire (ODI) were used to assess the patient's pain and ability to stand, respectively. Visual Analogue Scale and ODI scores were recorded and analyzed. Results The results showed that caudal and TEIs of calcitonin significantly improved pain and ability to stand during follow-up compared to before intervention (P < 0.05). Additionally, CEI of calcitonin after 6 months significantly reduced pain in LSS patients compared to TEI of calcitonin (P < 0.05). However, no significant difference was observed between the two epidural injection techniques in improving the patient's ability to stand (P > 0.05). Conclusions The results of the study indicate that epidural injection of calcitonin in long-term follow-up (6 months) had a significant effect on improving pain intensity and mobility in patients with LSS, and its effect on pain in the TEI method was significantly greater than that in the CEI method.
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Affiliation(s)
- Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Farahmand Rad
- Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Department of Anesthesiology and Pain Medicine, Minimally Invasive Surgery Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Liu Y, Li NH. Factors associated with intervertebral cage subsidence in posterior lumbar fusion. J Orthop Surg Res 2024; 19:7. [PMID: 38166951 PMCID: PMC10763192 DOI: 10.1186/s13018-023-04479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The interbody fusion apparatus is a key component of the operation and plays a key role in the postoperative efficacy. Cage subsidence is one of the common complications after lumbar fusion and internal fixation. Clinical studies on the risk factors of cage subsidence are incomplete and inaccurate, especially paravertebral muscle atrophy and intervertebral bone fusion time. METHODS Among the patients who underwent PLIF surgery in our hospital from January 2016 to January 2019, 30 patients with cage subsidence and 30 patients without cage subsidence were randomly selected to be included in this study. The differences between the two groups were compared, and the relevant factors of cage subsidence were explored by single factor comparison and multiple logistic regression analysis. RESULTS Bone mineral density (T) of the subsidence group [(- 1.84 ± 1.81) g/cm2 vs (- 0.87 ± 1.63) g/cm2, P = 0.018] was significantly lower than that of the normal group. There were 4 patients with end plate injury in the subsidence group (P = 0.038). Preoperative end plate Modic changes [I/II/III, (7/2/2) vs (2/5/8), P = 0.043] were significantly different between the two groups. In the subsidence group, preoperative rCSA of psoas major muscle [(1.43 ± 0.40) vs (1.64 ± 0.41), P = 0.043], CSA of paravertebral muscle [(4530.25 ± 776.55) mm2 vs (4964.75 ± 888.48) mm2, P = 0.047], paravertebral muscle rCSA [(3.03 ± 0.72) vs (3.84 ± 0.73), P < 0.001] and paravertebral muscle rFCSA [(2.29 ± 0.60) vs (2.89 ± 0.66), P < 0.001] were significantly lower than those in normal group. In the subsidence group, the vertebral body area [(1547.81 ± 309.89) mm2 vs (1326.48 ± 297.21) mm2, P = 0.004], the height of the immediately corrected vertebral space [(2.86 ± 1.10) mm vs (1.65 ± 1.02) mm, P = 0.020], immediately SL corrective Angle [(5.81 + 4.71)° vs (3.24 + 3.57) °, P = 0.009), postoperative PI-LL [(11.69 + 6.99)° vs (6.66 + 9.62) °, P = 0.029] and intervertebral fusion time [(5.38 ± 1.85) months vs (4.30 ± 1.49) months, P = 0.023] were significantly higher than those in the normal group. Multivariate logistic regression analysis showed that the time of intervertebral fusion (OR = 1.158, P = 0.045), the height of immediate intervertebral space correction (OR = 1.438, P = 0.038), and the Angle of immediate SL correction (OR = 1.101, P = 0.019) were the risk factors for cage subsidence. Bone mineral density (OR = 0.544, P = 0.016) and preoperative paravertebral muscle rFCSA (OR = 0.525, P = 0.048) were protective factors. CONCLUSION Intervertebral fusion time, correctable height of intervertebral space, excessive Angle of immediate SL correction, bone mineral density and preoperative paravertebral muscle rFCSA are risk factors for cage subsidence after PLIF.
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Affiliation(s)
- Yan Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nian-Hu Li
- Shandong University of Traditional Chinese Medicine, Jinan, China.
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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10
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Yang W, Cai Z, Liu X, Yuan W, Ma R, Chen Z, Zhang J, Wu P, Ge Z. Imaging study of the effect of postural changes on the retroperitoneal oblique corridor in degenerative lumbar scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3659-3665. [PMID: 37249664 DOI: 10.1007/s00586-023-07788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate the effect of postural changes on access for the OLIF of L2 to L5 in patients with degenerative lumbar scoliosis. METHODS Twenty-one individuals with degenerative lumbar scoliosis were chosen at random, 11 with left-sided convexity and 10 with left-sided concavity. Axial T2-weighted images were used to measure the following variables: (1) the distance between the left psoas major muscle and the abdominal aorta; (2) the angle of the surgical access; (3) the distance between the psoas major muscle attachment point and the vertebral body's transverse axis; (4) the region of the psoas major muscle above the vertebrae; and (5) the width-to-thickness ratio. A statistical analysis of the measured parameters was done. RESULTS The L2-5 segment in the supine position had a significantly longer window distance in the left convex and left concave groups than in the right lateral recumbent posture (P < 0.05). In all segments, the left concave group outperformed the left convex group, which was substantially higher in the right lateral recumbent posture than in the supine position (P < 0.05). After the position change, the spanning area was significantly higher compared to the same segment in the supine position. The psoas major muscle's morphology was stretched. CONCLUSIONS The right lateral recumbent position limits access to OLIF for degenerative lumbar scoliosis, and the "safety window" for OLIF operation in the parietal region is smaller in the left convex group compared to the left concave group, posing a higher risk of intraoperative vascular and neurological injury.
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Affiliation(s)
- Wei Yang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zecheng Cai
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Xiaoyin Liu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Wenqi Yuan
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Rong Ma
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Zhen Chen
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianqun Zhang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Peng Wu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China
| | - Zhaohui Ge
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, Ningxia, China.
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Wang YL, Li XY, Liu L, Li SF, Han PF, Li XD. Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:100. [PMID: 37119422 PMCID: PMC10148790 DOI: 10.1007/s10143-023-02009-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/20/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases. A computer search for the published literature on OLIF and MIS-TLIF for the treatment of lumbar degenerative diseases in the PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, and other databases was performed, from which 522 related articles were retrieved and 13 were finally included. Two reviewers independently extracted data from the included studies and analyzed them using RevMan 5.4. The quality of the studies was assessed using the Cochrane systematic analysis and the Newcastle-Ottawa scale. Meta-analysis showed that the blood loss [95% confidence intervals (CI) (- 121.01, - 54.56), [Formula: see text]], hospital stay [95% CI (- 1.98, - 0.85), [Formula: see text]], postoperative fusion rate [95%CI (1.04, 3.60), [Formula: see text]], postoperative disc height [95% CI (0.50, 3.63), [Formula: see text]], and postoperative foraminal height [95% CI (0.96, 4.13), [Formula: see text]] were all better in the OLIF group; however, the complication rates were significantly lower in the MIS-TLIF group [95% CI (1.01, 2.06), [Formula: see text]]. However, there were no significant differences between the two in terms of surgery time, patient satisfaction, or postoperative functional scores. The OLIF group had the advantages of lower blood loss, a shorter hospital stay, a higher postoperative fusion rate, and better recovery of the disc and foraminal heights, whereas MIS-TLIF had a relatively lower complication rate.
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Affiliation(s)
- Yun-Lu Wang
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Xi-Yong Li
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Lun Liu
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, People's Republic of China.
| | - Xiao-Dong Li
- Department of Orthopaedics, The Second People's Hospital of Changzhi City, Changzhi, People's Republic of China.
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Wu J, Feng Q, Yang D, Xu H, Wen W, Xu H, Miao J. Biomechanical evaluation of different sizes of 3D printed cage in lumbar interbody fusion-a finite element analysis. BMC Musculoskelet Disord 2023; 24:85. [PMID: 36726086 PMCID: PMC9890703 DOI: 10.1186/s12891-023-06201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To study the biomechanical characteristics of various tissue structures of different sizes of 3D printed Cage in lumbar interbody fusion. METHODS A finite element model of normal spine was reconstructed and verified. Pedicle screws and Cage of different sizes were implanted in the L4/5 segment to simulate lumbar interbody fusion. The range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment were calculated and analyzed. RESULTS The range of motion and intervertebral disc pressure of the adjacent segment of each postoperative model were larger than those of the intact model, but there was not much difference between them. The stress of cage-endplate interface was also larger than that of the intact model. However, the difference is that the stress of the endplate and the screw-rod system has a tendency to decrease with the increase of the axial area of cage. CONCLUSIONS Cage with larger axial area in lumbar interbody fusion can reduce the stress of internal fixation system and endplate, but will not increase the range of motion and intervertebral disc pressure of adjacent segment. It has a certain effect in preventing the cage subsidence, internal fixation system failure and screw rod fracture.
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Affiliation(s)
- Jincheng Wu
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Qing Feng
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Dongmei Yang
- grid.284723.80000 0000 8877 7471Southern Medical University, Guangzhou City, Guangdong China
| | - Hanpeng Xu
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Wangqiang Wen
- grid.443397.e0000 0004 0368 7493The First Affiliated Hospital of Hainan Medical University, Haikou City, Hainan China
| | - Haoxiang Xu
- The Second People’s Hospital of Hefei, Hefei, Anhui China
| | - Jun Miao
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
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Wang YT, Li BX, Wang SJ, Li CD, Sun HL. Radiological and clinical outcomes of midline lumbar fusion on sagittal lumbar-pelvic parameters for degenerative lumbar diseases. World J Clin Cases 2022; 10:12880-12889. [PMID: 36569025 PMCID: PMC9782960 DOI: 10.12998/wjcc.v10.i35.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes. The impact of midline lumbar fusion (MIDLF) on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.
AIM To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on sagittal lumbar-pelvic parameters.
METHODS We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF. The imaging data of patients were collected before surgery and at the final follow-up. The radiological sagittal parameters included the lumbar lordosis (LL), lower LL, L4 slope (L4S), L5 slope (L5S), L5 incidence (L5I), L1 axis and S1 distance (LASD), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL mismatch (PI-LL). Additionally, the clinical outcomes, including lower back and leg pain visual analog scale (VAS) and Oswestry disability index (ODI) scores, were also analyzed.
RESULTS In both groups, LL and Lower LL significantly increased, while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation (P < 0.05). In the MIDLF group, L4S significantly decreased compared to that recorded prior to operation (P < 0.05), while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation (P < 0.05). In the MIS-TLIF group, SS slightly increased and the mean PT value decreased compared to that recorded prior to operation, but without a statistically significant difference (P > 0.05). However, the PI-LL in both groups was significantly reduced compared to that recorded prior to operation (P < 0.05). There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up (P > 0.05). In addition, the change in sagittal lumbar-pelvic parameters did not differ significantly, except for ΔLASD within the two groups (P > 0.05). The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up. Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group, there was no significant difference between the two groups at the final follow-up.
CONCLUSION Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL, Lower LL, L5I, and LASD in the treatment of lumbar degenerative diseases. However, MIDLF had a larger impact on pelvic parameters than MIS-TLIF.
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Affiliation(s)
- Yue-Tian Wang
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Bing-Xu Li
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Shi-Jun Wang
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Chun-De Li
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-Lin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
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McCluskey LC, Angelov I, Wu VJ, Gupta S, Saifi C, Cyriac M. Anterior lumbar spinal fusion surgery associated with lower risk of stroke, pneumonia, and infection compared to posterior lumbar spinal fusion surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100182. [PMID: 36439895 PMCID: PMC9694372 DOI: 10.1016/j.xnsj.2022.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Prior studies, comparing anterior and posterior approaches to lumbar fusion surgery, found similar fusion rates and clinical outcomes, but are limited by sample size. Further evaluation of the postoperative complications of each approach is necessary. METHODS The MSpine database by PearlDiver was queried using ICD-9, ICD-10, and CPT codes to identify patients who had undergone single-level anterior or posterior lumbar interbody fusion surgery. Readmission rates, ileus, lower extremity DVT, infection, pneumonia, and stroke were used to compare post-operative complications of an anterior vs. posterior approach. RESULTS 112,023 patients were included in this study, with 38,529 (34.4%) in the anterior group (ALIF/LLIF) and 73,494 (65.6%) in the posterior group (PLIF/TLIF). At both 30 and 90-days postoperative, patients undergoing an anterior approach to lumbar interbody fusion had a higher odds ratio of lower extremity DVT (30-day OR: 1.19, 90-day OR: 1.16; P<0.05) and ileus complication (30-day OR: 1.87, P= <.05; 90-day OR: 1.81, P<.05). At both 30 and 90-days postoperative, patients undergoing a posterior approach had a higher odds ratio of stroke (30-day: OR: 0.79, 90-day OR: 0.87; P<0.05), transfusion (30-day OR: 0.66, 90-day OR: 0.69; P<.05), infection (30-day OR: 0.88, 90-day OR: 0.91; P <.05), and pneumonia (30-day OR: 0.85, 90-day OR: 0.90; P<.05). There was no statistically significant difference in myocardial infarction or pulmonary embolism between both approaches at 30 and 90-days postoperative. CONCLUSIONS Anterior and posterior approaches for lumbar interbody fusion were associated with differences in postoperative complications at 30 and 90-days. The complication profiles associated with each approach can inform surgeon treatment decisions based on patient profiles.
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Affiliation(s)
| | - Ivan Angelov
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital
| | - Victor J. Wu
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center - Houston
| | - Sanchita Gupta
- Department of Orthopaedic Surgery, Tulane University School of Medicine
| | - Comron Saifi
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital
| | - Mathew Cyriac
- Department of Orthopaedic Surgery, Tulane University School of Medicine
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[Research progress of effect of cage height on outcomes of lumbar interbody fusion surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1440-1444. [PMID: 36382465 PMCID: PMC9681583 DOI: 10.7507/1002-1892.202205096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To summarize the effect of cage height on outcomes of lumbar interbody fusion surgery and the importance of the cage height selection. METHODS The related literature was widely reviewed to summarize the research progress on the complications caused by inappropriate height of the cage and the methods of selecting cage height. RESULTS Inappropriate height of the cage can lead to endplate injury, cage subsidence, internal fixation failure, adjacent segmental degeneration, over-distraction related pain, insufficient indirect decompression, instability of operation segment, poor interbody fusion, poor sequence of spine, and cage displacement. At present, the selection of the cage height is based on the results of the intraoperative model test, which is reliable but high requirements for surgical experience and hard to standardize. CONCLUSION The inappropriate height of the cage may have an adverse impact on the postoperative outcome of patients. It is important to develop a selection standard of the cage height by screening the related influential factors.
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Wang W, Xiao B, Huang X, Yu J, Xi Y, Xu G, Ye X. Diagnosis and treatment of left ureteral injury as a rare complication of oblique lumbar interbody fusion surgery: a case report and literature review. BMC Urol 2022; 22:146. [PMID: 36076193 PMCID: PMC9461179 DOI: 10.1186/s12894-022-01070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Background Oblique lumbar interbody fusion (OLIF) surgery has been performed as a minimally invasive lateral lumbar fusion technique in recent years. Reports of operative complications of OLIF are limited, and there are fewer reports of ureteral injuries. Case presentation A 62-year-old Chinese woman diagnosed with "lumbar spondylolisthesis (L4 forward slip, I degree)" underwent OLIF treatment. The surgical decompression process was smooth, and the cage was successfully placed. After the expansion sleeve of OLIF was removed, clear liquid continuous outflow from the peritoneum was found. The patient was diagnosed with a ureteral injury. The urological surgeon expanded the original incision, and left ureteral injury anastomosis and ureteral stent implantation were performed. The patient was changed to the prone position and a percutaneous pedicle screw was placed in the corresponding vertebral body. The patient was indwelled with a catheter for 2 weeks, and regular oral administration of levofloxacin to prevent urinary tract infection. After 2 months, the double J tube was removed using a cystoscope. One year after surgery, the symptoms of lumbar back were significantly improved, and there were no urinary system symptoms. However, the patient needed an annual left ureter and kidney B-ultrasound. Conclusion Ureteral injury is a rare complication and is easily missed in OLIF surgery. If the diagnosis is missed, the consequences can be serious. Patients should undergo catheterization before the operation and hematuria should be observed during the operation. We emphasize the careful use of surgical instruments to prevent intraoperative complications. In addition, after withdrawing the leaf in the operation, it is necessary to carefully observe whether a clear liquid continues to leak. If ureteral injury is found, one-stage ureteral injury repair operation should be performed to prevent ureteral stricture.
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Affiliation(s)
- Weiheng Wang
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Bing Xiao
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Xiaodong Huang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, 510140, China
| | - Jiangming Yu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yanhai Xi
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Guohua Xu
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
| | - Xiaojian Ye
- Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China. .,Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Schnadthorst PG, Lankes C, Schulze C. [Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022:10.1007/s00113-022-01195-8. [PMID: 35849146 DOI: 10.1007/s00113-022-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
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Affiliation(s)
| | - Celine Lankes
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Christoph Schulze
- Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
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Du Y, Jiang F, Zheng H, Yao X, Yan Z, Liu Y, Wang L, Zhang X, Chen L. Full Endoscopic Posterolateral Transarticular Lumbar Interbody Fusion Using Transparent Plastic Working Tubes: Technical Note and Preliminary Clinical Results. Front Surg 2022; 9:884794. [PMID: 35769154 PMCID: PMC9234521 DOI: 10.3389/fsurg.2022.884794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A series of full-endoscopic lumbar interbody fusions have been reported, but special fusion cages or operating instruments are often needed, and there are many complications in the operation and the learning curve is long. We have used a single portal endoscopic system for lumbar interbody fusion in a novel posterolateral transarticular approach, which will take advantage of the incision for pedicle screw insertion and avoid nerve root damage by using a transparent plastic working tube. The purpose of this study was to present the surgical technique of full endoscopic posterolateral transarticular lumbar interbody fusion (FE-PTLIF) and to analyze the preliminary clinical results. Methods A total of 39 patients (17 men and 22 women; mean age [x̅ ± s] 55.2 ± 12.2 years) have been enrolled in this retrospective study between March 2019 and January 2021 in the Second Affiliated Hospital of Chongqing Medical University. All patients were treated with full endoscopic lumbar interbody fusion via posterolateral transarticular approach with a transparent plastic working tube. Demographic characteristics, diagnosis, operative time, and estimated blood loss were evaluated. Intraoperative photo and perioperative imaging were recorded. The preoperative and postoperative clinical data were collected for statistical analysis. Results The preliminary clinical follow-up data achieved good results. No patients had serious postoperative complications and none of these patients required revision surgery during the perioperative or follow-up period. We compared the visual analogue scale and Oswestry disability index scores before and after surgery. The differences were statistically significant (P < 0.05). The mean total blood loss (including drainage blood) was 54.4 ± 20.3 ml. The mean operative time was 130.5 ± 23.8 min. At the last follow-up, the fusion rate of the lumbar intervertebral space was 100%. Conclusions This novel posterolateral transarticular approach and transparent plastic working tube can reduce the difficulty of the operation, so that the conventional intervertebral fusion cage [bullet-shaped polyetheretherketone (PEEK) nonexpandable fusion cage] and surgical instruments can be used in the full endoscopic lumbar intervertebral fusion surgery, which can reduce the cost and improve the efficiency of the operation.
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Affiliation(s)
- Yu Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Xintai Zhang Liang Chen
| | - Fuling Jiang
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital,Army Medical University (Third Military Medical University), Chongqing, China
- Correspondence: Xintai Zhang Liang Chen
| | - Haiyan Zheng
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Xudong Yao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjian Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liyuan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xintai Zhang
- Department of Orthopedic Surgery, Nan’an District People’s Hospital, Chongqing, China
| | - Liang Chen
- Department of Bone and Soft Tissue Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Tan R, Lv X, Wu P, Li Y, Dai Y, Jiang B, Ren B, Lv G, Wang B. Learning Curve and Initial Outcomes of Full-Endoscopic Posterior Lumbar Interbody Fusion. Front Surg 2022; 9:890689. [PMID: 35574552 PMCID: PMC9096087 DOI: 10.3389/fsurg.2022.890689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Study DesignThis was a retrospective cohort study.ObjectiveWe evaluated the feasibility, safety, and accuracy of full-endoscopic posterior lumbar interbody fusion (FE-PLIF) by assessing the learning curve and initial clinical outcomes.Summary of Background DataLow back pain is one of the crucial medical conditions worldwide. FE-PLIF has been reported to be a minimally invasive method to treat mechanical low back pain, but there lacks a thorough evaluation on this new technique.MethodsThe patients were divided into three groups in the order of operating date, implying that Group A consisted of the initial 12 cases, Group B the subsequent 12 cases, and Group C the last 12 cases. The data of patients were reviewed for gender, age, preoperative symptoms, satisfaction, as well as clinical outcomes demonstrated by visual analog scale (VAS). The operative time and intraoperative fluoroscopy were recorded to demonstrate the learning curve and the extent of radiographic exposure. Statistical significance was set at a p < 0.05 (two-sided).ResultsThe patients enrolled in this study were followed up at an average of 1.41 ± 0.24 years. Overall, patients were satisfied with the surgery. The average number of intraoperative fluoroscopy was 6.97 ± 0.74. A significant improvement was observed in the VAS of both lumbar pain and leg pain. The overall fusion rate was 77.7%. Complications were reported in two patients in Group A, one in Group B, and none in Group C. The average operative time showed a trend of gradual decline. The learning curve was characterized using a cubic regression analysis as y = –27.07x + 1.42x2–0.24x3 + 521.84 (R2 = 0.617, p = 0.000).ConclusionsFE-PLIF is an effective and safe method for treating low back pain caused by short-segmental degenerative diseases. The learning curve of this technique is steep at the initial stage but acceptable and shows great potential for improvement.
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Oezel L, Okano I, Hughes AP, Sarin M, Shue J, Sama AA, Cammisa FP, Girardi FP, Soffin EM. Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database. World Neurosurg 2022; 164:e183-e193. [PMID: 35472646 DOI: 10.1016/j.wneu.2022.04.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF) or anterior lumbar interbody fusion/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between 2 time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the 2 procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as P < 0.05. RESULTS For both approaches, there was an increase in age and American Society of Anesthesiologists class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; P < 0.001), and more patients were rated American Society of Anesthesiologists class 3 (DID: -2.4%; P = 0.033) in the ALIF/LLIF cohort than in the PLIF/TLIF cohort. Length of stay declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF than for patients who underwent PLIF/TLIF (DID: 0.2%; P = 0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; P = 0.080; ALIF/LLIF DID: -0.2%; P = 0.696). CONCLUSIONS Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and length of stay, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF-specific care than in PLIF/TLIF.
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Affiliation(s)
- Lisa Oezel
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Ichiro Okano
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Michele Sarin
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Shue
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Federico P Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ellen M Soffin
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.
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21
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Taha MM, Taha MM, Al Awamry A. A less-invasive technique for posterior spinal fusion using intermittent retraction during pedicle screw insertion: A technical note. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Wang Z, Zhuang C, Chen W, Li Z, Li J, Lin H, Dong J. The Effect of Daily Teriparatide versus One-Time Annually Zoledronic Acid Administration After Transforaminal Lumbar Interbody Fusion in Osteoporotic Patients. Clin Interv Aging 2021; 16:1789-1799. [PMID: 34934310 PMCID: PMC8678629 DOI: 10.2147/cia.s333207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose The research aimed to compare the therapeutic effect of teriparatide (TPTD) and zoledronic acid (ZOL) therapy on bone formation and spinal fusion in patients with osteoporosis (OP) who underwent transforaminal lumbar interbody fusion (TLIF). Methods On the basis of different anti-OP treatment options, the TPTD group was treated daily with TPTD (20 μg. ih. qd) for at least 6 months, while the ZOL group was treated with a single dose of ZOL (5 mg. ivgtt. st) postoperatively. The visual analogue scale (VAS), Oswestry Disability Index (ODI), bone mineral density (BMD), and concentration of bone turnover markers before, 6, and 12 months after surgery were evaluated. X-ray and three-dimensional computed tomography scans were performed at 6 and 12 months postoperatively to assess interbody fusion. Results The number of patients in the TPTD and ZOL groups was 29 and 38 patients, respectively. The VAS and ODI scores in both groups were significantly reduced at 6 and 12 months after TLIF. Compared with that of baseline, the lumbar spine BMD of TPTD patients increased significantly from 0.716±0.137 g/cm2 to 0.745±0.124 g/cm2 and 0.795±0.123 g/cm2 at 6 and 12 months, respectively, and was significantly higher than that of the ZOL group at 12 months (0.720±0.128 g/cm2). The bone formation marker, P1NP, in the TPTD group increased significantly (145.48±66.64 ng/mL and 119.55±88.27 ng/mL) compared with baseline (44.67±25.15 ng/mL) and in the ZOL group (28.82±19.76 ng/mL and 29.94±20.67 ng/mL) at 6 and 12 months, respectively. The fusion rates in the TPTD and ZOL groups were 57% and 45% at 6 months, without statistical significance. However, TPTD had a more statistically significant positive influence on fusion rate than ZOL at 12 months (86% vs 70%). Conclusion TPTD was more efficient than ZOL in bone formation and spinal fusion in OP patients who underwent TLIF.
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Affiliation(s)
- Zixiang Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Chenyang Zhuang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Weisin Chen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Zefang Li
- Department of Orthopedics, Qianjiang Central Hospital of Chongqing, Chongqing, 409000, People's Republic of China
| | - Juan Li
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Department of Orthopedics, Shanghai Geriatrics Medical Center, Fudan University, Shanghai, 201100, People's Republic of China
| | - Hong Lin
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Department of Orthopedics, Shanghai Geriatrics Medical Center, Fudan University, Shanghai, 201100, People's Republic of China
| | - Jian Dong
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
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Kamalapathy PN, Vatani J, Raso J, Hassanzadeh H, Li X. How old is too old?: Matched analysis of geriatric patients undergoing anterior lumbar interbody fusion. Clin Neurol Neurosurg 2021; 212:107090. [PMID: 34922291 DOI: 10.1016/j.clineuro.2021.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective Review INTRODUCTION/OBJECTIVE: The aim of this study is to utilize a national database to identify how age affects patient outcomes following anterior lumbar interbody fusion (ALIF). There are no established age guidelines for the geriatric population within the spine specialty, which makes patient selection challenging. Furthermore, there are conflicting studies for the risks of performing spine surgeries in the elderly. METHODS A retrospective review of the Mariner Claims Database was conducted on patients who underwent a single level ALIF (CPT 22558) between 2010 and 2018. Patients were separated into three groups by age: 50-64, 65-74, and 75-84 and matched with respect to gender, smoking, and comorbidity burden. Multivariable logistic regression was used to determine the independent effect of outpatient surgery on the postoperative outcomes after adjusting for demographic factors and pertinent comorbidities. Statistical significance was set at p < 0.05. RESULTS The study identified 8459 matched patients (3350 50-64; 3350 65-74; and 1759 75-84). Compared with patients aged 50-64, patients aged 65-74 and 75-84 had significantly increased risks of pneumonia (65-74: OR 1.53, 95% CI 1.06-2.24, p = 0.025; 75-84: OR 1.62, 95% CI 1.07-2.42, p = 0.022), sepsis (65-74: OR 2.20, 95% CI 1.36-3.76, p = 0.002; 75-84: OR 2.42, 95% CI 1.43-4.13, p = 0.001), and major complications (65-74: OR 1.35, 95% CI 1.05-1.74, p = 0.021; 75-84: OR 1.48, 95% CI 1.11-1.95, p = 0.006) (Table 2). There were no significant differences between patients aged 65-74 and 75-84 for risks of postoperative pneumonia, sepsis, and major complications (p > 0.05). There were no differences between any groups in terms of long-term outcomes such as pseudoarthrosis, implant related complications, or reoperation (p > 0.05) (Table 3). DISCUSSION/CONCLUSION The study showed that those older than 65 had a significant increase in risk of pneumonia, sepsis, and major complications following ALIF. In the two cohorts above the age of 65 (65-74 and 75-84) there was no significant differences in postoperative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jasmine Vatani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Han X, Chen X, Li K, Li Z, Li S. Finite analysis of stability between modified articular fusion technique, posterior lumbar interbody fusion and posteriorlateral lumbar fusion. BMC Musculoskelet Disord 2021; 22:1015. [PMID: 34863121 PMCID: PMC8645152 DOI: 10.1186/s12891-021-04899-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background It is not clear whether modified facet fusion (MFF) is biomechanically different from traditional fusion techniques such as posterior lateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF). Methods In this study, a healthy adult Chinese male volunteer was selected to perform 3D reconstruction of CT image data and simulate the successful fusion of L4–5 MFF, PLF and PLIF, respectively. The motion range of L4–5 segments of the model was simulated under 6 working conditions, including forward flexion, extension, lateral flexion and rotation under normal physiological conditions, and the stability of the three fusion procedures in the pathological segments of the lumbar spine was compared. Results There was no difference in range of motion between MFF model and PLF or PLIF model (P < 0.05). Also, the stiffness of the PLFand the MFF model were comparable (P > 0.05), but were smaller than the PLIF model (P < 0.05). Conclusions MFF provides reliable stability at the lumbar fixation fusion level and does not differ significantly from PLF and PLIF in terms of range of motion.
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Affiliation(s)
- Xiao Han
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Kuan Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
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Chen YN, Chang CW. Computational comparison of three different cage porosities in posterior lumbar interbody fusion with porous cage. Comput Biol Med 2021; 139:105036. [PMID: 34798396 DOI: 10.1016/j.compbiomed.2021.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
Porous interbody cages, manufactured using additive laser melting technology, have recently been used in lumbar fusion surgery. The major advantage of a porous cage is the presence of space inside the cage for bone ingrowth. However, the biomechanical effects of different porosities on the lumbar segment with and without bone fusion (ingrowth) are still unclear. Hence, the present study aimed to compare the biomechanical responses, including the stress and range of motion (ROM) of the lumbar L3-L4 segments with three different types of porous cages along with a posterior instrument (PI) with and without bone fusion using computer simulation. A lumbar L3-L4 segment model with a PI and porous cages was used in this study. Three different porosities, namely 12.5, 41.2, and 80.84% were used. The diameter of the pores of the porous cage was uniformly set to 0.5 mm. In addition, a traditional PEEK cage was used in this study. Two different bone statuses, with and without bone fusion (ingrowth into the pores of the porous cage and the inner space of the PEEK cage), were considered. The results indicated that although the contact pressure on the bone surface reduced, the cage stress increased with increasing cage porosity. Furthermore, cage stress and contact pressure also increased in cases with bone fusion compared with those without bone fusion. The contact pressure on the bone surface with a cage porosity of 80.8% decreased by 40% (from 943.1 to 575.5 MPa), 37.7% (from 133 to 82.9 MPa), 40.4% (from 690.8 to 412 MPa), and 34.2% (from 533 to 351.1 MPa), respectively, for flexion, extension, lateral bending, and rotation, respectively, compared with that with a cage porosity of 12.5%. The rotational ROM of the PEEK cage with bone fusion was clearly larger than those of the porous cages. Porous cages have recently become popular owing to improved manufacturing technology. This study provides scientific data on the strength and weakness of porous cages with different porosities for clinical use.
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Affiliation(s)
- Yen-Nien Chen
- Department of Physical Therapy, Asia University, Taichung, Taiwan.
| | - Chih-Wei Chang
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Liu B, Gan W, Jin Z, Wang M, Cui G, Zhang H, Wang H. The Role of miR-34c-5p in Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells. Int J Stem Cells 2021; 14:286-297. [PMID: 33906980 PMCID: PMC8429940 DOI: 10.15283/ijsc20188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/29/2021] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) plays a critical role in the success of lumbar spinal fusion with autogenous bone graft. This study aims to explore the role and specific mechanism of miR-34c-5p in osteogenic differentiation of BMSCs. Methods and Results Rabbit model of lumbar fusion was established by surgery. The osteogenic differentiation dataset of mesenchymal stem cells was obtained from the Gene Expression Omnibus (GEO) database, and differentially expressed miRNAs were analyzed using R language (limma package). The expressions of miR-34c-5p, miR-199a-5p, miR-324-5p, miR-361-5p, RUNX2, OCN and Bcl-2 were determined by qRT-PCR and Western blot. ELISA, Alizarin red staining and CCK-8 were used to detect the ALP content, calcium deposition and proliferation of BMSCs. The targeted binding sites between miR-34c-5p and Bcl-2 were predicted by the Target database and verified using dual-luciferase reporter assay. MiR-34c-5p expression was higher in rabbit lumbar fusion model and differentiated BMSCs than normal rabbit or BMSCs. The content of ALP and the deposition of calcium increased with the osteogenic differentiation of BMSCs. Upregulation of miR-34c-5p reduced cell proliferation and promoted ALP content, calcium deposition, RUNX2 and OCN expression compared with the control group. The effects of miR-34c-5p inhibitor were the opposite. In addition, miR-34c-5p negatively correlated with Bcl-2. Upregulation of Bcl-2 reversed the effects of miR-34c-5p on ALP content, calcium deposition, and the expressions of RUNX2 and OCN. Conclusions miR-34c-5p could promote osteogenic differentiation and suppress proliferation of BMSCs by inhibiting Bcl-2.
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Affiliation(s)
- Bin Liu
- Department of Spine Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
| | - Wei Gan
- Department of Spine Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
| | - Zhang Jin
- Department of Spine Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
| | - Meng Wang
- Department of Spine Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
| | - Guopeng Cui
- Department of Spine Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
| | - Hongyu Zhang
- Pharmacy College, Wenzhou Medical University, Wenzhou, China
| | - Huafu Wang
- Department of Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, China
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Hai Y, Liu J, Liu Y, Liu T, Zhang X, Pan A, Zhang Y, Ding H, Wu Y, Han B, Tang X. Expert Consensus on Clinical Application of Lateral Lumbar Interbody Fusion: Results From a Modified Delphi Study. Global Spine J 2021; 13:995-1004. [PMID: 34000874 DOI: 10.1177/21925682211012688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi study. OBJECTIVE The objective of this study was to establish expert consensus on the application of lateral lumbar interbody fusion (LLIF) by using the modified Delphi study. METHODS From June 2019 to March 2020, Members of the Chinese Study Group for Lateral Lumbar Spine Surgery were selected to collect expert feedback using the modified Delphi method where 65 spine surgeons from all over China agreed to participate. Four rounds were performed: 1 face-to-face meeting and 3 subsequent survey rounds. The consensus was achieved with ≥a 70.0% agreement for each question. The recommendation of grade A was defined as ≥90.0% of the agreement for each question. The recommendation of grade B was defined as 80.0-89.9% of the agreement for each question. The recommendation of grade C was defined as 70.0-79.9% of the agreement for each question. RESULTS A total of 65 experts formed a panelist group, and the number of questionnaires collected was 63, 59, and 62 in the 3 rounds. In total, 5 sections, 71 questions, and 382 items achieved consensus after the Delphi rounds including summary; preoperative evaluation; application at the lumbar spinal stenosis, lumbar disc herniation, lumbar spondylolisthesis, adult degenerative scoliosis, postoperative adjacent segmental degeneration, and revision surgery; complications; and postoperative follow-up evaluation of LLIF. CONCLUSION The modified Delphi method was utilized to ascertain an expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery to inform clinical decision-making in the application of LLIF. The salient grade A recommendations of the survey are enumerated.
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Affiliation(s)
- Yong Hai
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tie Liu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinuo Zhang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aixing Pan
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yiqi Zhang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuxuan Wu
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bo Han
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinli Tang
- Department of Orthopedic Surgery, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Konovalov NA, Stepanov IA, Beloborodov VA, Korolishin VA, Brinyuk ES. [Smoking as a risk factor of advanced heterotopic ossification in patients after lumbar total disk arthroplasty]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:19-27. [PMID: 33560617 DOI: 10.17116/neiro20218501119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty. MATERIAL AND METHODS A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease. RESULTS The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers. CONCLUSION Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.
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Affiliation(s)
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Clinic LLC, Irkutsk, Russia
| | | | | | - E S Brinyuk
- Burdenko Neurosurgery Center, Moscow, Russia
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Dias Pereira Filho AR. Technique for Exposing Lumbar Discs in Anterior Approach Using Steinmann Wires: Arthroplasties or Arthrodesis. World Neurosurg 2020; 148:189-195. [PMID: 33385594 DOI: 10.1016/j.wneu.2020.12.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to increasing longevity, the incidence of degenerative lumbar disc diseases has increased, and surgical treatment is often necessary. In this context, the anterior approach becomes an important technique. However, one of the main limitations of this method is the need for dedicated retractors, which requires larger incisions for its positioning and increases the cost of the procedure. The objective of the present study was to describe a technique for retracting abdominal structures by anterior approaches to the lumbar spine using Steinmann wires. METHODS This manuscript consists of a technique description of anterior approach for lumbar spine. RESULTS Surgical treatment of degenerative lumbar spine disease is often necessary when the patients have symptoms refractory to conservative treatments. Many of them will be candidates for surgical treatment with anterior approach, either for arthrodesis/anterior lumbar interbody fusion or arthroplasty. Small incisions are performed for positioning the modified Langenbeck retractors and the Steinmann wires. These retractors are easily positioned and provide good exposure of the lumbar discs making it possible to implant appropriate cages for restoring the necessary height, lordosis, and sagittal balance. CONCLUSIONS The technique described is safe, inexpensive, and reproducible. Simple and easily accessible instruments are required in most hospital complexes.
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Urits I, Amgalan A, Israel J, Dugay C, Zhao A, Berger AA, Kassem H, Paladini A, Varrassi G, Kaye AD, Miriyala S, Viswanath O. A comprehensive review of the treatment and management of Charcot spine. Ther Adv Musculoskelet Dis 2020; 12:1759720X20979497. [PMID: 33414850 PMCID: PMC7750571 DOI: 10.1177/1759720x20979497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
Charcot spine arthropathy (CSA), a result of reduced afferent innervation, is an occurrence of Charcot joint, a progressive, degenerative disorder in vertebral joints, related mostly to spinal cord injury. The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. CSA presents with back pain, spinal deformity and instability, and audible spine noises during movement. Autonomic dysfunction includes bowel and bladder dysfunction. It is slowly progressive and usually diagnosed at a late stage, usually, on average, 20 years after the first initial insult. Diagnosis is rarely clinical related to the nature of nonspecific symptoms and requires imaging with computed tomography (CT) and magnetic resonance imaging (MRI). Conservative management focuses on the prevention of fractures and the progression of deformities. This includes bed rest, orthoses, and braces. These could be useful in elderly or frail patients who are not candidates for surgical treatment, or in minimally symptomatic patients, such as patients with spontaneous fusion leading to a stable spine. Symptomatic treatment is offered for autonomic dysfunction, such as anticholinergics for bladder control. Most patients require surgical treatment. Spinal fusion is achieved with open, minimally-open (MOA) or minimally-invasive (MIS) approaches. The gold standard is open circumferential fusion; data is lacking to determine the superiority of open or MIS approaches. Patients usually improve after surgery; however, the rarity of the condition makes it difficult to estimate outcomes. This is a review of the latest and seminal literature about the treatment and chronic management of Charcot spine. The review includes the background of the syndrome, clinical presentation, and diagnosis, and compares the different treatment options that are currently available.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Ariunzaya Amgalan
- Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jacob Israel
- Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Chase Dugay
- Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alex Zhao
- Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amnon A Berger
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center of Florida, Miami, FL, USA
| | | | | | - Alan D Kaye
- Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, Louisiana, USA
| | - Sumitra Miriyala
- Department of Cellular Biology and Anatomy, LSUHSC School of Medicine, Shreveport, Louisiana, USA
| | - Omar Viswanath
- Department of Anesthesiology, LSUHSC School of Medicine, Shreveport, Louisiana, USA
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Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve. Acta Neurochir (Wien) 2019; 161:2415-2420. [PMID: 31650331 DOI: 10.1007/s00701-019-04079-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. METHODS The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. RESULTS Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). CONCLUSIONS In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.
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