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Tang SN, Li CY, Leung JCS, Kwok AWL, Kwok TCY, Wáng YXJ. Fewer spine degenerations among Southeast Asians than among Southern Chinese suggests populations from a warmer climate have inherently better spine health. Quant Imaging Med Surg 2024; 14:6922-6933. [PMID: 39281176 PMCID: PMC11400640 DOI: 10.21037/qims-24-1533] [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: 07/09/2024] [Accepted: 08/06/2024] [Indexed: 09/18/2024]
Abstract
Background Compared with older Caucasians, older Chinese have remarkably lower prevalence and lower severity of spine degenerative changes. There have been few studies on Southeast East populations. This study aims to compare radiographic spine degeneration features among older Hong Kong (HK) Chinese, older Thais, and older Indonesians. Methods This study included 195 Thai women (mean: 73.6 years), 202 Thai men (mean: 73.7 years), 227 Indonesian women (mean: 70.5 years), and 174 Indonesian men (mean: 70.2 years), as well as same number of gender- and age-matched HK Chinese. The recruitment plan was that the participants would represent the general older population of their respective communities. With spine radiograph, spine hyper-kyphosis, osteoarthritic wedging (OAw), acquired short vertebrae (SVa), general osteophyte formation, lumbar disc space narrowing, and lumbar spondylolisthesis were assessed. Results Compared with Southeast Asians (Thais and Indonesian data together), Chinese women and men had a higher prevalence of hyper-kyphosis (24.9% vs. 16.4%), OAw (2.4% vs. 0.9%), general osteophyte formation (15.3% vs. 10.5%), lumber disc space narrowing (27.6% vs. 20.3%), and lumbar spondylolisthesis (20.7% vs. 15.3%). The trends were also consistent for sub-group data analyses. An even lower prevalence was noted among Indonesian women and men than among Thais in general osteophyte formation (5.9% vs. 14.1%), lumbar disc space narrowing (18.3% vs. 24.1%), and lumbar spondylolisthesis (11.4% vs. 19.3%). Conclusions This study showed a lower prevalence of spine degeneration changes among older Thais and older Indonesians than among older Chinese. Indonesians, who inhabit an even warmer climate, show even fewer spine degeneration changes than Thais.
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Affiliation(s)
- Sheng-Nan Tang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cai-Ying Li
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W L Kwok
- School of Medical and Health Science, Tung Wah College, Hong Kong SAR, China
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ekşi MŞ, Öztaş UO, Topaloğlu F, Yeşilyurt SC, Duymaz UC, Osama M, Özcan-Ekşi EE. Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or conservative management. 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 2024:10.1007/s00586-024-08341-3. [PMID: 38809440 DOI: 10.1007/s00586-024-08341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/02/2024] [Accepted: 05/26/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE In this study we aimed to identify whether paraspinal muscle morphology could play a role in surgical decision-making in patients with lumbar spondylolisthesis. METHODS We conducted a cross-sectional analysis of a prospectively collected database between January 2013 and May 2023. Consecutive women and men, who visited our outpatient clinics with chronic LBP, neurogenic claudication, and had lumbar spine magnetic resonance imaging (MRI) for their complaints were included into the preliminary dataset. We compared the patients who had conservative management (conservative group) or underwent surgery for lumbar spondylolisthesis (surgical group) in terms of intervertebral disc degeneration, end-plate changes, fatty infiltration in the paraspinal muscles and spinopelvic parameters. RESULTS Conservative and surgical groups were similar in terms of severe IVDD and Modic changes at any lumbar level. Surgical group had significantly fattier erector spinae compared to the conservative group. Regression analysis and ROC analysis revealed an OR of 1.088 and a cut-off value of 17 points for fatty infiltration in the erector spinae to predict which patient could undergo surgery for lumbar spondylolisthesis. CONCLUSION Each 1-point increment in fatty infiltration in the erector spinae at any lumbar level increased the likelihood of surgery by 8%. Lumbar spondylolisthesis patients with fatty infiltration score for erector spinae at or above 17 were more likely to have surgery. We recommend clinicians to focus on improving erector spinae muscles in patients with lumbar spondylolisthesis.
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Affiliation(s)
- Murat Şakir Ekşi
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Türkiye, Turkey.
- Department of Neurosurgery, Health Sciences University, Istanbul, Türkiye, Turkey.
- Göztepe Mah. Mesire Sok, Tütüncü Mehmet Efendi Cad. No: 3/34 Kadıkoy, Istanbul, Turkey.
| | - Uğur Ozan Öztaş
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Türkiye, Turkey
| | - Fatma Topaloğlu
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Türkiye, Turkey
| | - Sidar Cenk Yeşilyurt
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Türkiye, Turkey
| | - Umut Can Duymaz
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Türkiye, Turkey
| | - Mahmoud Osama
- Nasser Institute for Research and Treatment, Department of Neurosurgery, Cairo, Egypt
| | - Emel Ece Özcan-Ekşi
- Physical Medicine and Rehabilitation, Acıbadem Bağdat Caddesi Medical Center, Istanbul, Türkiye, Turkey
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Hey HWD, Low TL, Soh HL, Tan KA, Tan JH, Tan TH, Thomas AC, Ka-Po Liu G, Wong HK, Tan JHJ. Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine - An EOS Study Using Updated Radiographic Parameters. Global Spine J 2024; 14:1137-1147. [PMID: 36749604 PMCID: PMC11289555 DOI: 10.1177/21925682221134044] [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: 02/08/2023] Open
Abstract
STUDY DESIGN Single centre, cross-sectional study. OBJECTIVES The objective is to report the prevalence of spondylolisthesis and retrolisthesis, analyse both conditions in terms of the affected levels and severity, as well as identify their risk factors. METHODS A review of clinical data and radiographic images of consecutive spine patients seen in outpatient clinics over a 1-month period is performed. Images are obtained using the EOS® technology under standardised protocol, and radiographic measurements were performed by 2 independent, blinded spine surgeons. The prevalence of both conditions were shown and categorised based on the spinal level involvement and severity. Associated risk factors were identified. RESULTS A total of 256 subjects (46.1% males) with 2304 discs from T9/10 to L5/S1 were studied. Their mean age was 52.2(± 18.7) years. The overall prevalence of spondylolisthesis and retrolisthesis was 25.9% and 17.1% respectively. Spondylolisthesis occurs frequently at L4/5(16.3%), and retrolisthesis at L3/4(6.8%). Majority of the patients with spondylolisthesis had a Grade I slip (84.3%), while those with retrolisthesis had a Grade I slip. The presence of spondylolisthesis was found associated with increased age (P < .001), female gender (OR: 2.310; P = .005), predominantly sitting occupations (OR:2.421; P = .008), higher American Society of Anaesthesiology grades (P = .001), and lower limb radiculopathy (OR: 2.175; P = .007). Patients with spondylolisthesis had larger Pelvic Incidence (P < .001), Pelvic Tilt (P < .001) and Knee alignment angle (P = .011), but smaller Thoracolumbar junctional angle (P = .008), Spinocoxa angle (P = .007). Retrolisthesis was associated with a larger Thoracolumbar junctional angle (P =.039). CONCLUSION This is the first study that details the prevalence of spondylolisthesis and retrolisthesis simultaneously, using the EOS technology and updated sagittal radiographic parameters. It allows better understanding of both conditions, their mutual relationship, and associated clinical and radiographic risk factors.
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Affiliation(s)
- Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Tian Ling Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Ling Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kimberly-Anne Tan
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Jun-Hao Tan
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Tuan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Gabriel Ka-Po Liu
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Hee-Kit Wong
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
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Chen Q, Li Z, Deng M, Peng J, Zhu X, Zhang C. Quantitative Evaluation of the Lumbar Multifidus Muscle by Shear Wave Dispersion in Healthy Adults: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:863-872. [PMID: 38240408 DOI: 10.1002/jum.16416] [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: 10/05/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To investigate the application value of shear wave dispersion (SWD) in healthy adults with the lumbar multifidus muscle (LMM), to determine the range of normal reference values, and to analyze the influences of factors on the parameter. METHODS Ninety-five healthy volunteers participated in the study, from whom 2-dimensional, shear wave elastography (SWE), and SWD images of the bilateral LMM were acquired in three positions (prone, standing, and anterior flexion). Subcutaneous fat thickness (SFH), SWE velocity, and SWD slope were measured accordingly for analyses. RESULTS The mean SWD slope of the bilateral LMM in the prone position was as follows: left: 14.8 ± 3.1 (m/second)/kHz (female) and 13.0 ± 2.5 (m/second)/kHz (male); right: 14.8 ± 3.7 (m/second)/kHz (female) and 14.2 ± 3.4 (m/second)/kHz (male). In the prone position, there was a weak negative correlation between the bilateral LMM SWD slope of activity level 2 and level 1 (β = -1.5 (2 versus 1, left), -1.9 (2 versus 1, right), all P < .05), and between the left SWD slope of activity level 3 and level 1 (β = -2.3 [3 versus 1, left], P < .05). The correlation between SWE velocity and SWD slope value changed with the position: there was a weak positive correlation in the prone position (r = 0.3 [left], 0.37 [right], both P < .05), and a moderate positive correlation in the standing and anterior flexed positions (r = 0.49-0.74, both P < .001). SFH was moderately negatively correlated with bilateral SWD slope values in the anterior flexion (left: r = -0.4, P = .01; right: r = -0.7, P < .01). CONCLUSIONS SWD imaging can be used as an adjunct tool to aid in the assessment of viscosity in LMM. Further, activity level, and position are influencing factors that should be considered in clinical practice.
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Affiliation(s)
- Qiuxiang Chen
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhenzhou Li
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Meifang Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jiayu Peng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiangming Zhu
- Department of Ultrasound, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, China
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Fedorchuk CA, Fedorchuk CG, Lightstone DF. Improvement in Pain, Quality of Life, and Urinary Dysfunction following Correction of Lumbar Lordosis and Reduction in Lumbar Spondylolistheses Using Chiropractic BioPhysics ® Structural Spinal Rehabilitation: A Case Series with >1-Year Long-Term Follow-Up Exams. J Clin Med 2024; 13:2024. [PMID: 38610790 PMCID: PMC11012333 DOI: 10.3390/jcm13072024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68-71 years showing improvements in back pain, quality of life (QOL), and urinary dysfunction following correction of lumbar spondylolistheses using CBP® spinal rehabilitation. Pre-treatment radiographs showed lumbar hyperlordosis (-49.6°, ideal is -40°) and anterolisthesis (14.5 mm, ideal is 0 mm). Pre-treatment patient-reported outcome measures (PROMs) included a numeric rating scale (NRS) for back pain (7.3/10, ideal is 0), urinary urgency (8/10, ideal is 0), and SF-36 physical (PCS) and mental component score (MCS) (29.8 and 46.6, ideal is 46.8 and 52.8). Patients underwent 2-3 CBP® sessions per week to correct lumbar hyperlordosis and lumbar anterolistheses. (3) Results: Post-treatment radiographs showed improvements in lumbar curvature (-42.8°) and anterolisthesis (4.2 mm). Post-treatment PROMs showed improvements in NRS for back pain (1/10), urinary urgency (2.3/10), and SF-36 PCS and MCS (50.2 and 57.7). Long-term follow-up radiographs and PROMs showed maintained improvements. (4) Conclusions: This series documents the first-recorded long-term corrections of lumbar spondylolisthesis and concomitant improvements in back pain, urinary urgency, and QOL using CBP®. This series provides evidence for CBP® as a non-surgical approach to lumbar spinal rehabilitation and the possible impacts of spinal alignment on pain, urinary dysfunction, and QOL.
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Affiliation(s)
| | | | - Douglas F. Lightstone
- Institute of Spinal Health and Performance, Cumming, GA 30041, USA; (C.A.F.); (C.G.F.)
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Xu W, Liu X, Wu L, Liang S, Zhang Y, Huang J, Zeng X, Li S, Xu F, Xiong Y. Fatty Infiltration of Multifidus Muscles: An Easily Overlooked Risk Factor for the Severity of Osteoporotic Vertebral Fractures. Orthop Surg 2024; 16:585-593. [PMID: 38238249 PMCID: PMC10925513 DOI: 10.1111/os.13990] [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: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES Osteoporotic vertebral fractures (OVFs) are a critical public health concern requiring urgent attention, and severe OVFs impose substantial health and economic burdens on patients and society. Analysis of the risk factors for severe OVF is imperative to actively prevent the occurrence of this degenerative disorder. This study aimed to investigate the risk factors associated with the severity of OVF, with a specific focus on changes in the paraspinal muscles. METHODS A total of 281 patients with a first-time single-level acute OVF between January 2016 and January 2023 were enrolled in the study. Clinical and radiological data were collected and analyzed. The cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles, including the multifidus muscles (MFMs), erector spinae muscles (ESMs), and psoas major muscles (PSMs), were measured by magnetic resonance imaging (MRI) of the L4/5 intervertebral discs. According to the classification system of osteoporotic fractures (OF classification) and recommended treatment plan, OVFs were divided into a low-grade OF group and a high-grade OF group. Univariate and multivariate logistic regression analyse s were performed to identify risk factors associated with the severity of OVF. RESULTS Ninety-eight patients were included in the low-grade OF group, and 183 patients were included in the high-grade OF group. Univariate analysis revealed a significantly higher incidence of a high degree of FI of MFMs (OR = 1.71, p = 0.002) and ESMs (OR = 1.56, p = 0.021) in the high-grade OF group. Further multivariate logistic regression analysis demonstrated that a high degree of FI of the MFMs (OR = 1.71, p = 0.002) is an independent risk factor for the severity of OVF. CONCLUSION A high degree of FI of the MFMs was identified as an independent risk factor for the severity of OVF. Decreasing the degree of FI in the MFMs might lower the incidence of the severity of OVF, potentially reducing the necessity for surgical intervention in OVF patients.
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Affiliation(s)
- Wuyan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xiaowen Liu
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
| | - Li Wu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Shaohua Liang
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Ye Zhang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Junbing Huang
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Xuwen Zeng
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Siming Li
- Department of OrthopedicsGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Fan Xu
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
| | - Yuchao Xiong
- Department of RadiologyGuangzhou Red Cross Hospital of Jinan UniversityGuangzhouChina
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Fong AM, Duculan R, Endo Y, Carrino JA, Cammisa FP, Hughes AP, Lebl DR, Farmer JC, Huang RC, Sandhu HS, Mancuso CA, Girardi FP, Sama AA. Differences in imaging and clinical characteristics are associated with higher rates of decompression-fusion versus decompression-alone in women compared to men for lumbar degenerative spondylolisthesis. 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; 32:4184-4191. [PMID: 37796286 DOI: 10.1007/s00586-023-07958-0] [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: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The goals were to ascertain if differences in imaging/clinical characteristics between women and men were associated with differences in fusion for lumbar degenerative spondylolisthesis. METHODS Patients had preoperative standing radiographs, CT scans, and intraoperative fluoroscopic images. Symptoms and comorbidity were obtained from patients; procedure (fusion-surgery or decompression-alone) was obtained from intraoperative records. With fusion surgery as the dependent variable, men and women were compared in multivariable logistic regression models with clinical/imaging characteristics as independent variables. The sample was dichotomized, and analyses were repeated with separate models for men and women. RESULTS For 380 patients (mean age 67, 61% women), women had greater translation, listhesis angle, lordosis, and pelvic incidence, and less diastasis and disc height (all p ≤ 0.03). The rate of fusion was higher for women (78% vs. 65%; OR 1.9, p = 0.008). Clinical/imaging variables were associated with fusion in separate models for men and women. Among women, in the final multivariable model, less comorbidity (OR 0.5, p = 0.05), greater diastasis (OR 1.6, p = 0.03), and less anterior disc height (OR 0.8, p = 0.0007) were associated with fusion. Among men, in the final multivariable model, opioid use (OR 4.1, p = 0.02), greater translation (OR 1.4, p = 0.0003), and greater diastasis (OR 2.4, p = 0.0002) were associated with fusion. CONCLUSIONS There were differences in imaging characteristics between men and women, and women were more likely to undergo fusion. Differences in fusion within groups indicate that decisions for fusion were based on composite assessments of clinical and imaging characteristics that varied between men and women.
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Affiliation(s)
- Alex M Fong
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Roland Duculan
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Yoshimi Endo
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - John A Carrino
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Frank P Cammisa
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | | | - Darren R Lebl
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - James C Farmer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Russel C Huang
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | | | - Carol A Mancuso
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | | | - Andrew A Sama
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1430. [PMID: 37629720 PMCID: PMC10456558 DOI: 10.3390/medicina59081430] [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: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.
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Affiliation(s)
- Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Bartłomiej Kulesza
- Department of Medical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Natalia Gołębiowska
- Department of Neurosurgery and Spine Surgery, Regional Hospital in Kielce, 25-736 Kielce, Poland
| | - Bartłomiej Tyzo
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
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Atalay B, Gadjradj PS, Sommer FS, Wright D, Rawanduzy C, Ghogawala Z, Härtl R. Natural History of Degenerative Spondylolisthesis: A Systematic Review and Meta-analysis. World Neurosurg 2023; 176:e634-e643. [PMID: 37271258 DOI: 10.1016/j.wneu.2023.05.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The optimal treatment algorithm for patients with degenerative lumbar spondylolisthesis has not been clarified. Part of the reason for this is that the natural history of degenerative spondylolisthesis (DS) has not been sufficiently studied. Comprehension of the natural history is essential for surgical decision making. We aimed to determine 1) the proportion of patients that develop de novo DS during follow-up; and 2) the proportion of patients with progression of preexistent DS by conducting a systematic review and meta-analysis of the literature. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Ovid, EMBASE, and the Cochrane Library were searched from their inception through April 2022. Demographic values of the study populations, grade of slip, rate of slippage before and after the follow-up period, and percentage of patients with slip in the populations at baseline and after follow-up were the extracted parameters. RESULTS Of the 1909 screened records, eventually 10 studies were included. Of these studies, 5 reported the development of de novo DS and 9 reported on the progression of preexistent DS. Proportions of patients developing de novo DS ranged from 12% to 20% over a period ranging from 4 to 25 years. The proportion of patients with progression of DS ranged from 12% to 34% over a period ranging from 4 to 25 years. CONCLUSIONS Systematic review and metanalysis of DS on the basis of radiologic parameters revealed both an increasing incidence over time and an increasing progression of the slip rate in up to a third of the patients older than 25 years, which is important for counseling patients and surgical decision making. Importantly, two thirds of patients did not experience slip progression.
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Affiliation(s)
- Basar Atalay
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA; Department of Neurological Surgery, Beth Israel Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA.
| | - Pravesh S Gadjradj
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Fabian S Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Drew Wright
- Weill Cornell Medical Library, Weill Cornell Medicine, New York, New York, USA
| | - Cameron Rawanduzy
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Zoher Ghogawala
- Department of Neurological Surgery, Beth Israel Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
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10
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Sun Y, Jin M, Yu T, Zhang J. Cardiovascular risk factors mediating the protective effect of education on cervical spondylosis risk. Sci Rep 2023; 13:936. [PMID: 36650225 PMCID: PMC9845322 DOI: 10.1038/s41598-023-28153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
The causal association between education and cervical spondylosis may be mediated partly through risk factors of cardiovascular disease. The identification of the protective effect of education and the evaluation of risk factors will help to optimize disease prevention at both clinical and public health levels. In this study, we applied several different Mendelian randomization (MR) methods to identify which cardiovascular factors underlie the clustering of cervical spondylosis with cardiovascular disease, and the degree to which these mediate an effect of education. Univariable MR analyses provided evidence supporting a protective effect of genetically predicted education on cervical spondylosis risk, and MVMR further identified the direct effect of education level. Our results also provided evidence supporting the detrimental effects of BMI and smoking on cervical spondylosis risk, with evidence that the effect of education is mediated through BMI and smoking. The proportions of the effect of education mediated through BMI and smoking were 12% and 3%, respectively. These findings highlight education, obesity, and smoking as common mechanisms underlying the clustering of cervical spondylosis with risk factors of cardiovascular disease, which might represent clinical and public health targets for reducing multi-morbidity and the burden of these common conditions.
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Affiliation(s)
- Yang Sun
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China
| | - Manqiu Jin
- Department of Plastic Surgery, The First Hospital of Jilin University, Jilin Changchun, China
| | - Tiecheng Yu
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China
| | - Jiting Zhang
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China.
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11
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Lee JH, Woo H, Jang JS, Kim JI, Na YC, Kim KR, Cho E, Lee JH, Park TY. Comparison of Concordance between Chuna Manual Therapy Diagnostic Methods (Palpation, X-ray, Artificial Intelligence Program) in Lumbar Spine: An Exploratory, Cross-Sectional Clinical Study. Diagnostics (Basel) 2022; 12:2732. [PMID: 36359575 PMCID: PMC9689192 DOI: 10.3390/diagnostics12112732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 10/15/2023] Open
Abstract
Before Chuna manual therapy (CMT), a manual therapy applied in Korean medicine, CMT spinal diagnosis using palpation or X-ray is performed. However, studies on the inter-rater concordance of CMT diagnostic methods, concordance among diagnostic methods, and standard CMT diagnostic methods are scarce. Moreover, no clinical studies have used artificial intelligence (AI) programs for X-ray image-based CMT diagnosis. Therefore, this study sought a feasible and standard CMT spinal diagnostic method and explored the clinical applicability of the CMT-AI program. One hundred participants were recruited, and the concordance within and among different diagnostic modalities was analyzed by dividing them into manual diagnosis (MD), X-ray image-based diagnosis (XRD) by experts and non-experts, and XRD using a CMT-AI program by non-experts. Regarding intra-group concordance, XRD by experts showed the highest concordance (used as a gold standard when comparing inter-group concordance), followed by XRD using the AI program, XRD by non-experts, and then MD. Comparing diagnostic results between the groups, concordance with the gold standard was the highest for XRD using the AI program, followed by XRD by non-experts, and MD. Therefore, XRD is a more reasonable CMT diagnostic method than MD. Furthermore, the clinical applicability of the CMT-AI program is high.
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Affiliation(s)
- Jin-Hyun Lee
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary’s Hospital, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Hyeonjun Woo
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Jun-Su Jang
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Joong Il Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Eunbyul Cho
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Jung-Han Lee
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Tae-Yong Park
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary’s Hospital, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
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12
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Li C, Wang L, Wang Z, Li D, Ibrahim Y, Tian Y, Yuan S, Liu X. Radiological Changes of Paraspinal Muscles: A Comparative Study of Patients with Isthmic Spondylolisthesis, Patients with Degenerative Lumbar Spondylolisthesis, and Healthy Subjects. J Pain Res 2022; 15:3563-3573. [PMID: 36394059 PMCID: PMC9664928 DOI: 10.2147/jpr.s376575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the differences, correlations, and clinical significance of the paraspinal muscles among patients with isthmic spondylolisthesis (IS), degenerative lumbar spondylolisthesis (DLS), and age-matched healthy subjects. Methods This study involved 159 age-matched patients with L4 anterior spondylolisthesis. The patients were divided into the IS group (n = 81) and DLS group (n = 78). Eighty-four age-matched healthy adults were enrolled as the control group. The cross-sectional area (CSA) of paraspinal muscles (multifidus [MF], erector spinae [ES], and psoas [PS]) and the relative CSA of the paraspinal muscles (paraspinal muscle CSA/vertebral CSA) were measured in the IS group, DLS group, and control group. The degree of fat infiltration was simultaneously observed. Results There was no significant difference in age or sex among the three groups. The relative CSA of the MF and PS was higher in control group than in IS and DLS groups (p < 0.05). The relative CSA of ES was higher in IS and control groups than in DLS group (p < 0.05). The relative CSA of total paraspinal muscles decreased in the order of control group > IS group > DLS group (p < 0.05). Logistic regression analysis showed that the relative CSA of MF, and the degree of fat infiltration of ES were independent protective factors for IS (odds ratio < 1, p < 0.05). The relative CSA of MF was an independent protective factor for DLS (odds ratio < 1, p < 0.05), whereas BMI and the degree of fat infiltration of MF were independent risk factor for DLS (odds ratio > 1, p < 0.05). Conclusion Compared with the control group, patients with IS and DLS showed varying degrees of degeneration, and the degree of degeneration in patients with DLS was more severe at the same age. Lower fat infiltration and higher paraspinal muscle CSA are protective factors for IS and DLS, whereas the higher BMI is risk factor for DLS.
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Affiliation(s)
- Chao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Zheng Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Donglai Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
- Correspondence: Xinyu Liu, Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People’s Republic of China, Tel +86-18560082585, Fax +86-531-8216-9423, Email
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13
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Lam WWK, Yuen Loke A, Wong CK, Luk BHK. Information needs, expectations, and treatment preference of patients considering spinal surgery: A case-control survey. Int J Orthop Trauma Nurs 2022; 47:100979. [PMID: 36455471 DOI: 10.1016/j.ijotn.2022.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
STUDY DESIGN Case-control survey. OBJECTIVES To explore intrapersonal factors associated with decision of patients with degenerative back pain for surgery. METHODS From September 2018 to May 2019 patients were invited to complete a questionnaire. Patients who decided on (case) and declined surgery (control) were later confirmed from medical records. RESULTS Seventy-five patients were recruited. Male patients (75.0%, p = 0.019), those who were married (78.7%, p = 0.0045), and had spousal care-givers (89.2%, p < 0.0001) were more likely to decide for surgery. All patients who decided on surgery expressed need for information on "the severity of their spine conditions" (p = 0.039). Those who decided on surgery did not have as the high expectation on "to sleep more comfortably" as those who declined (4.71 vs. 4.91, p = 0.022). The predictive factors for surgery decision by logistic regression analysis were: male gender (OR = 3.23, 95% CI: 1.19-8.77, p = 0.021); married (OR = 5.231, 95% CI: 1.87-14.61, p = 0.002); with available spousal care-giver (OR = 1.85, 95% CI: 0.198-3.89, p = 0.031); and those who preferred to treat/cure the spine disorder by pharmacological treatment (OR = 2.77, 95% CI: 1.02-7.50, p = 0.045). CONCLUSION Patients who decided on surgery were likely to indicate need of medical information related to their condition. Patients were in hope of better relief of physical symptoms, especially related to sleep comfort. Patients would escalate their treatment from conservative to surgery when conservative treatments were no longer effective.
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Affiliation(s)
- William Wing-Kuen Lam
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
| | - Alice Yuen Loke
- Department of Nursing, Hong Kong Adventist College; School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.
| | - Chun-Kwan Wong
- Orthopaedic and Traumatology Department, United Christian Hospital, Hong Kong, China.
| | - Bronya Hi-Kwan Luk
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
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14
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Duculan R, Fong AM, Carrino JA, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Farmer JC, Huang RC, Sandhu HS, Mancuso CA, Girardi FP. Quantitative CT for Preoperative Assessment of Lumbar Degenerative Spondylolisthesis: The Unique Impact of L4 Bone Mineral Density on Single-Level Disease. HSS J 2022; 18:469-477. [PMID: 36263284 PMCID: PMC9527540 DOI: 10.1177/15563316221096675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
Background: Quantitative computed tomography (qCT) efficiently measures 3-dimensional vertebral bone mineral density (BMD), but its utility in measuring BMD at various vertebral levels in patients with lumbar degenerative spondylolisthesis (LDS) is unclear. Purpose: We sought to determine whether qCT could differentiate BMD at different levels of LDS, particularly at L4-L5, the most common single level for LDS. In addition, we sought to describe patterns of BMD for single-level and multiple-level LDS. Methods: We conducted a study of patients undergoing surgery for LDS who were part of a larger longitudinal study comparing preoperative and intraoperative images. Preoperative patients were grouped as single-level or multiple-level LDS, and qCT BMD was obtained for L1-S1 vertebrae. Mean BMD was compared with literature reports; in multivariable analyses, BMD of each vertebra was assessed according to the level of LDS, controlling for covariates and for BMD of other vertebrae. Results: Of 250 patients (mean age: 67 years, 64% women), 22 had LDS at L3-L4 only, 170 at L4-L5 only, 13 at L5-S1 only, and 45 at multiple levels. Compared with other disorders reported in the literature, BMD in our sample similarly decreased from L1 to L3 then increased from L4 to S1, but mean BMD per vertebra in our sample was lower. Nearly half of our sample met criteria for osteopenia. In multivariable analysis controlling for BMD at other vertebrae, lower L4 BMD was associated with LDS at L4-L5, greater pelvic incidence minus lumbar lordosis, and not having diabetes. In contrast, in similar multivariable analysis, greater L4 BMD was associated with LDS at L3-L4. Bone mineral density of L3 and L5 was not associated with LDS levels. Conclusion: In our sample of preoperative patients with LDS, we observed lower BMD for LDS than for other lumbar disorders. L4 BMD varied according to the level of LDS after controlling for covariates and BMD of other vertebrae. Given that BMD can be obtained from routine imaging, our findings suggest that qCT data may be useful in the comprehensive assessment of and strategy for LDS surgery. More research is needed to elucidate the cause-effect relationships among spinopelvic alignment, LDS, and BMD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carol A. Mancuso
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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15
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village. PLoS One 2022; 17:e0270282. [PMID: 35763521 PMCID: PMC9239436 DOI: 10.1371/journal.pone.0270282] [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: 11/01/2021] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Lumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study. Methods A total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0–2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG). Results Intra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82–0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP. Conclusion The novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.
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17
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Inose H, Kato T, Sasaki M, Matsukura Y, Hirai T, Yoshii T, Kawabata S, Hirakawa A, Okawa A. Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study. Spine J 2022; 22:747-755. [PMID: 34963630 DOI: 10.1016/j.spinee.2021.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/20/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar canal stenosis due to degenerative lumbar spondylolisthesis is one of the most common indications for lumbar spinal surgery. However, from a long-term perspective, it is still unclear which of these procedures should be performed: decompression, decompression plus fusion, or decompression plus stabilization. PURPOSE This study aimed to present the long-term results of a randomized controlled trial of surgery for degenerative spondylolisthesis. STUDY DESIGN/SETTING This is a long-term follow-up of a previously reported randomized controlled trial. PATIENT SAMPLE Patients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis were enrolled at two hospitals from May 1, 2003, to April 30, 2012; the final follow-up was on May 20, 2021. OUTCOME MEASURES The following data were collected: modified Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score for lower back pain, leg pain, and numbness, and scores from eight Short-Form 36 (SF-36) subscales preoperatively, 1 year postoperatively, 5 years postoperatively, and at the final follow-up. METHODS Patients were randomized to undergo decompression alone, decompression plus fusion, or decompression plus stabilization. The primary outcome measure was the change in VAS for lower back pain with secondary outcomes including the modified JOA score, VAS for leg pain, VAS for leg numbness, eight SF-36 subscale scores, and occurrence of reoperation at the last follow-up. RESULTS Among 85 patients who were randomized, 66 responded to the current survey. The mean follow-up period was 12.3 years. The VAS score for low back pain improvement was not significantly different between the decompression and fusion groups at the mean follow-up of 12.3 years. Of the 12 secondary outcomes, 8 showed no significant difference between decompression and fusion, 12 showed no significant difference between decompression and stabilization, and 10 showed no significant difference between fusion and stabilization. CONCLUSIONS Although additional instrumentation surgery did not significantly improve low back pain at the mean follow-up of 12.3 years compared with decompression alone, fusion surgery provided clinically meaningful improvements in patient-reported vitality, social functioning, role limitations due to personal or emotional problems, and mental health compared with decompression alone. TRIAL REGISTRATION UMIN000028114.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Tsuyoshi Kato
- Department of Orthopaedics, Ome Municipal General Hospital, 4-16-5 Higashiome, Ome-shi, Tokyo 198-0042, Japan
| | - Masanao Sasaki
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo113-8519, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shigenori Kawabata
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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18
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Shi A, Sun J, Chhabra A, Thakur U, Xi Y, Kohli A, Wells J. Functional outcomes are preserved in adult acetabular dysplasia with radiographic evidence of lumbosacral spine anomalies: an investigation in hip-spine syndrome. BMC Musculoskelet Disord 2022; 23:385. [PMID: 35468787 PMCID: PMC9040209 DOI: 10.1186/s12891-022-05334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Acetabular dysplasia (AD) is a debilitating condition which results in impaired hip function, leading to hip-spine syndrome with anomalies identifiable on plain radiographs. However, no study to date has investigated the association between radiographic spine anomalies and functional outcomes in AD. We hypothesize that AD patients with radiographic evidence of lumbar spine anomalies are associated with decreased function in comparison to those without such radiographic findings. Patients and methods One hundred thirty-five hips underwent a full four-view hip radiograph series, and two observers analyzed hip and spine variables using standard radiographs and obtained Castellvi grade, assessment of spondylolisthesis, and L4-S1 interpedicular distance. A comprehensive hip questionnaire was administered which included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) to assess patient function. Correlations between HHS and HOOS and radiographic spinal measurements were calculated, and p-values were corrected for multiple comparison using the Holm’s method. Results Out of 135 patients, 119 were female (88.1%) and 16 were male (11.9%). Average age of presentation was 34.2 years, and average BMI was 26. There was no statistically significant correlation between Castellvi grade, presence of spondylolisthesis, or L4-S1 interpedicular distance and the patient-reported outcome measures HHS or HOOS. Conversely, a significant correlation was observed between Femoro-Epiphyseal Acetabular Roof (FEAR) index and HOOS of the contralateral hip (correlation coefficient = 0.38, adjusted p = 0.03) and Tönnis angle of AD severity and HHS of the contralateral hip (correlation coefficient = − 0.33, adjusted p = 0.04). Conclusion Severity of spinal anomalies measured by Castellvi grade and spondylolisthesis in patients with AD was not associated with decreased patient function in the ipsilateral diseased hip. To our knowledge, this is the first study to date to report the relationship between radiographically identifiable lumbosacral abnormalities and hip function in AD.
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Affiliation(s)
- Aaron Shi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joshua Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Uma Thakur
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Yin Xi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Ajay Kohli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.
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19
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Wáng YXJ, Deng M, Griffith JF, Kwok AWL, Leung JCS, Lam PMS, Yu BWM, Leung PC, Kwok TCY. 'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies. Quant Imaging Med Surg 2022; 12:2090-2105. [PMID: 35284274 PMCID: PMC8899940 DOI: 10.21037/qims-2021-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 08/09/2023]
Abstract
For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W. L. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patti M. S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Blanche Wai Man Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Fedorchuk C, Himel B, Lightstone DF. Improved Pain and Quality of Life with Corrected Thoracic and Lumbosacral Spondylolisthesis Subluxations Using CBP ®: A Case Study and 1-Year Follow-Up. J Radiol Case Rep 2022; 16:21-38. [PMID: 35586358 PMCID: PMC9063820 DOI: 10.3941/jrcr.v16i2.4413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Objective Discuss non-surgical spinal rehabilitation for a 27-year-old male with thoracic and lumbosacral spondylolistheses. A selective literature review and discussion are provided. Clinical Features A 27-year-old male presented with severe, 8/10 mid and low back pain. Initial lateral thoracic and lumbar x-rays revealed grade 1 spondylolistheses at T9-T10 and L5-S1 measuring -5.3 mm and -6.8 mm. Interventions and Outcomes The patient completed 60 sessions of Mirror Image® spinal adjustments, exercises, and traction over 30 weeks. Post-treatment x-rays showed correction in translations at T9-T10 and L5-S1 from -5.3 mm to 0.0 mm and -6.8 mm to -1.0 mm, within normal limits. 1-year follow-up x-rays showed maintained correction. Conclusions This case is the first documented evidence of non-surgical or chiropractic treatment for thoracic and lumbosacral spondylolistheses where spinal alignment was corrected. More research is needed to investigate the clinical implications and applications.
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Affiliation(s)
| | - Blake Himel
- Institute for Spinal Health & Performance, Cumming, GA, USA
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Zhao Y, Wang H, Li Z, Wang Z, Huo Y, Yang S, Ding W. Lumbar Disk Degeneration in Female Patients with and without Ovariectomy: A Case-Control Study. World Neurosurg 2021; 156:68-75. [PMID: 34571241 DOI: 10.1016/j.wneu.2021.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to provide clinical evidence of the potential influence of ovariectomy (OVX) on intervertebral disk degeneration. METHODS We retrospectively reviewed patients with a history of OVX who visited our hospital for lower back pain. In addition, 60 age-matched patients without OVX were randomly selected as control subjects. Next, the following demographic data were recorded and compared among groups: age, body mass index, duration of OVX, history of smoking, alcohol use, hypertension, diabetes, cardiocerebrovascular disease, hyperlipemia, osteoporosis, and degenerative spondylolisthesis. Next, the severity of lumbar disk degeneration, evaluated by the modified Pfirrmann grading system, was compared between groups. Data analyses were performed with SPSS 20.0. software. RESULTS A total of 15 OVX (unilateral, n = 10; bilateral, n = 5) patients were included with a mean age of 62.40 ± 10.64. The average durations of OVX were 21.33 ± 9.24 years. There existed no remarkable intergroup differences in the demographic data (P > 0.05). Overall, the average Pfirrmann grading scores from L1/2 to L5/S1 presented as L1/2 < L2/3 < L3/4 ≤ L5/S1 ≤ L4/5, with no marked differences between groups (P > 0.05). Nevertheless, OVX groups displayed a relatively higher score at each level than non-OVX group. Moreover, the scores from L3/4 to L5/S1 were higher in the bilateral OVX group relative to the unilateral OVX group while they were equal at L1/2 and L2/3. CONCLUSIONS Our findings demonstrated that OVX contributed to the progression of lumbar disk degeneration to some extent, but it appeared to be a long-term event.
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Affiliation(s)
- Yachao Zhao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Haidong Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Zhaohui Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Zhiwei Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Yachong Huo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei Province, P. R. China.
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Li Z, Chen DJ, Liu Z, Tang B, Zhong Y, Li G, Wan Z. Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study. Clin Biomech (Bristol, Avon) 2021; 88:105419. [PMID: 34303068 DOI: 10.1016/j.clinbiomech.2021.105419] [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] [Received: 11/02/2020] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence. METHODS A total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3-S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed. FINDINGS At the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°). INTERPRETATION The anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4-5 and L5-S1 segments.
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Affiliation(s)
- Zhiyun Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - De-Jian Chen
- Department of Orthopedics, The Affiliated Nanjing Jiangbei Hospital of Nantong University, Nanjing, Jiangsu 210048, PR China
| | - Zhang Liu
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Benyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Guoan Li
- Bioengineering Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA.
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China.
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Patel T, Watterson C, McKenzie-Brown AM, Spektor B, Egan K, Boorman D. Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study. J Pain Res 2021; 14:1193-1200. [PMID: 33976569 PMCID: PMC8104986 DOI: 10.2147/jpr.s310238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a denervation therapy commonly performed for pain of facet etiology. Degenerative spondylolisthesis, a malalignment of the spinal vertebrae, may be a co-existing condition contributing to pain; yet the effect of RFA on advancing listhesis is unknown. To the extent that denervating RFA may weaken paraspinal muscles that provide stability to the spine, the therapy can potentially contribute to progressive spinal instability. METHODS Single-center, prospective, observational pilot study in an interventional pain practice to test the hypothesis that RFA of painful facets in the setting of spondylolisthesis may contribute to advancement of further degenerative spondylolisthesis. Fifteen participants with pre-existing degenerative Grade I or Grade II spondylolisthesis and coexisting axial lumbar pain underwent lumbar RFA encompassing spondylolisthesis level and followed with post-RFA imaging at 12 months and beyond to measure percent change in spondylolisthesis. RESULTS The primary outcome was the percent advancement of spondylolisthesis per year measured on post-RFA lateral lumbar spine imaging compared with non-intervention inferred baseline advancement of 2% per very limited observational studies. Among the 15 participants enrolled, 14 completed the study (median age 66; 64.3% women; median BMI 33.5; mean follow-up time 23.9 months). The mean advancement of spondylolisthesis per year after RFA was 1.30% (95% CI -0.14 to 2.78%), with 9/14 below 1.25%. CONCLUSION Among patients with lumbar pain originating from facets in the setting of degenerative spondylolisthesis who underwent lumbar RFA, the observed advancement of spondylolisthesis is clinically similar to the estimated maximum baseline of 2% per year change. The study findings did not find a destabilizing effect of lumbar RFA in advancing spondylolisthesis in this patient population.
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Affiliation(s)
- Trusharth Patel
- Department of Anesthesiology, Division of Pain Management, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - Christopher Watterson
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | | | - Boris Spektor
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - Katherine Egan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
| | - David Boorman
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30308, USA
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Influence of sagittal degenerative spondylolisthesis on anteversion of the acetabular component in total hip arthroplasty. DER ORTHOPADE 2021; 50:664-673. [PMID: 33580282 DOI: 10.1007/s00132-021-04069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis (DSPL), as opposed to other degenerative spinal conditions, is disregarded in the assessment of hip stability after total hip arthroplasty (THA). This study aimed to determine whether patients with DSPL have different acetabular anteversion compared to patients with normal spine before and following THA. METHODS Preoperative and postoperative 6‑month lateral pelvic radiographs in standing and sitting positions from 91 patients who underwent primary THA were retrospectively compared for spinopelvic parameters between patients with DSPL (n = 31) and with normal spine (n = 34). RESULTS Compared to control patients in the standing position, patients with DSPL had significantly increased preoperative pelvic tilt (24° in DSPL vs. 8° in controls; p < 0.01), pelvic-femoral angle (194° in DSPL vs. 174° in controls; p < 0.05), decreased lumbar lordosis (35° in DSPL vs. 43° in controls; p < 0.05), increased postoperative pelvic tilt (22° in DSPL vs. 7° in controls; p < 0.01), pelvic-femoral angle (187° in DSPL vs. 179° in controls; p < 0.05), and acetabular anteversion (31° in DSPL vs. 23° in controls; p < 0.05). Preoperative (p = 0.181) and postoperative (p = 0.201) sitting pelvic tilt did not differ. There were positive correlations between preoperative standing pelvic tilt and postoperative standing acetabular anteversion, pelvic-femoral angle, and combined sagittal index (CSI) in DSPL (R2 = 0.8416; R2 = 0.9180; R2 = 0.9459, respectively, p < 0.01) and in controls (R2 = 0.6872; R2 = 0.6176; R2 = 0.7129, respectively, p < 0.01). CONCLUSION While the imbalance of seated sagittal plane is usually insignificant and compensable, the mechanism by which DSPL patients achieve a standing posture is different from control patients, with more hip extension and posterior tilt of the pelvis. Special attention should be paid to the risk of impingement caused by the increase of acetabular anteversion in the postoperative standing position.
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He D, Li ZC, Zhang TY, Cheng XG, Tian W. Prevalence of Lumbar Spondylolisthesis in Middle-Aged People in Beijing Community. Orthop Surg 2021; 13:202-206. [PMID: 33438343 PMCID: PMC7862163 DOI: 10.1111/os.12871] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Lumbar spondylolisthesis (LS) is a common lumbar disease, and the prevalence of LS in different countries or regions was not consistent in the past. This study intends to make statistics on the prevalence of lumbar spondylolisthesis in middle-aged people in Beijing community. METHODS This is an epidemiological study. 4548 people in Beijing community aged 50 to 64 years were recruited from the local communities by advertisements placed in housing estates and community centres for people to take part in a prospective cohort study from August from September 2013 to March 2014. There is no intervention on the subjects. RadiAnt DICOM Viewer is adopted to read the lateral CT positioning images of all the studied objects, adjust the image as bone window, observe and evaluate the slide of L1 to L5 vertebra in the lateral CT positioning image. RESULTS Among the 4,548 subjects included in the study, 2,490 (54.75%) were male and 2,058 (45.25%) were female. A total of 785 subjects had lumbar spondylolisthesis, with a total incidence of 17.26%. There was no significant difference between prevalence of males and females in the subgroup 50-54 years old (13.55% males / 12.53% females) and 55-59 years old (14.77% males / 14.93% females). But the prevalence of LS in 60-64 years old females (28.57%) increased significantly, compared with 55-59 years old females (14.93%) and 60-64 years old males (18.76%). There were 847 levels that had slipped, L5S1 > L4/5 > L3/4 > L2/3 > L1/2. The retrolisthesis was the most, accounting for 61.51% (521/847), and the anterolisthesis was 38.49% (326/847), including anterolisthesis gradeI for 95.71% (312/326), anterolisthesis gradeII for 4.29% (14/326). Neither of anterolisthesis and retrolisthesis presented more than grade III. Among all the subjects, 318 had anterolisthesis, with a total incidence of 6.99%, and 467 subjects only had retrolisthesis. CONCLUSION The total prevalence of LS in the middle-aged people in Beijing community was 17.26%, 15.98% in males and 18.80% in females, and women are more likely to suffer from LS after 60 years old.
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Affiliation(s)
- Da He
- Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
| | - Zu-Chang Li
- Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
| | - Tian-Yu Zhang
- Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
| | - Xiao-Guang Cheng
- Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, López Zúñiga D. The role of radiography in the study of spinal disorders. Quant Imaging Med Surg 2020; 10:2322-2355. [PMID: 33269230 DOI: 10.21037/qims-20-1014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the growing use of computed tomography (CT) and magnetic resonance imaging (MRI) in the study of spinal disorders, radiography still plays an important role in many conditions affecting the spine. However, the study and interpretation of spine radiograph is receiving less attention and radiologists are increasingly unfamiliar with the typical findings in normal and pathologic conditions of the spine. The aim of this article is to review the radiologic indications of radiograph in different pathologic conditions that affect the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumour disorders, as well as their main radiographic manifestations.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | | | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Daniel López Zúñiga
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Surgical treatment of high-grade spondylolisthesis: Technique and results. J Orthop 2020; 22:383-389. [PMID: 32952331 DOI: 10.1016/j.jor.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Surgical management of high-grade spondylolisthesis is not only challenging but also controversial, from in situ fusion to complete reduction. We report our results of a safe three-stage spinal procedure in a single surgical session with seven patients diagnosed high-grade spondylolisthesis. Hypothesis Posterior fixation combined with interbody fusion is effective on reduction, ossification and clinical outcomes in high-grade spondylolisthesis. Patients and methods This study is a retrospective review of patients who underwent surgery between 2016 and 2018. The surgical method involved specific installation for deformity reduction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, gradual reduction of the deformity, and sometimes maintenance of the reduction with interbody fusion. Patients were checked out at 2, 6 and 12 months and yearly after the procedure. Clinical, radiological, Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI) outcomes measures were collected. Results Seven patients with high-grade spondylolisthesis at L5-S1 (2 patients grade II, 4 patients grade IV and 1 patient grade V), with a median age of 37 years [17; 72] were included. Median follow-up was 24 months [12; 25 months]. All patients have a fused joint at 6 months except one. Median lumbosacral angle (LSA) improved from 76°[59; 85] to 94°[76; 104]. Meyerding grade of 2 cases was stable after surgery, 3 cases with loss of two ranks and 2 cases with loss of one rank. The radiological parameters showed statistically significant difference (p = 0.036) postoperatively. There was not deep infection. Medians VAS and ODI showed improved pain and disability scores. Conclusion This procedure allows correct reduction rate of high-grade spondylolisthesis with good clinic-radiologic outcomes. Though surgically demanding, it was safe and reproducible. Level of evidence IV, retrospective.
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Zhou QS, Sun X, Chen X, Xu L, Qian BP, Zhu ZZ, Wang B, Qiu Y. How does sagittal spinopelvic alignment of lumbar multisegmental spondylolysis differ from monosegmental spondylolysis? J Neurosurg Spine 2020; 33:211-218. [PMID: 32302981 DOI: 10.3171/2020.2.spine191415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate sagittal alignment and compensatory mechanisms in patients with monosegmental spondylolysis (mono_lysis) and multisegmental spondylolysis (multi_lysis). METHODS A total of 453 adult patients treated for symptomatic low-grade spondylolytic spondylolisthesis were retrospectively studied at a single center. Patients were divided into 2 subgroups, the mono_lysis group and the multi_lysis group, based on the number of spondylolysis segments. A total of 158 asymptomatic healthy volunteers were enrolled in this study as the control group. Radiographic parameters measured on standing sagittal radiographs and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (L4-S1 SL/LL) and pelvic tilt to pelvic incidence (PT/PI) were compared between all experimental groups. RESULTS There were 51 patients (11.3%) with a diagnosis of multi_lysis in the spondylolysis group. When compared with the control group, the spondylolysis group exhibited larger PI (p < 0.001), PT (p < 0.001), LL (p < 0.001), and L4-S1 SL (p = 0.025) and a smaller L4-S1 SL/LL ratio (p < 0.001). When analyzing the specific spondylolysis subgroups, there were no significant differences in PI, but the multi_lysis group had a higher L5 incidence (p = 0.004), PT (p = 0.018), and PT/PI ratio (p = 0.039). The multi_lysis group also had a smaller L4-S1 SL/LL ratio (p = 0.012) and greater sagittal vertical axis (p < 0.001). CONCLUSIONS A high-PI spinopelvic pattern was involved in the development of spondylolytic spondylolisthesis, and a larger L5 incidence might be associated with the occurrence of consecutive multi_lysis. Unlike patients with mono_lysis, individuals with multi_lysis were characterized by an anterior trunk, insufficiency of L4-S1 SL, and pelvic retroversion.
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Affiliation(s)
| | - Xu Sun
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Xi Chen
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Liang Xu
- 2Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Ze-Zhang Zhu
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Bin Wang
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
| | - Yong Qiu
- 1Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing; and
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Goh GS, Tay YWA, Yue WM, Guo CM, Tan SB, Chen JLT. What Are the Patient-reported Outcomes, Complications, and Radiographic Results of Lumbar Fusion for Degenerative Spondylolisthesis in Patients Younger Than 50 Years? Clin Orthop Relat Res 2020; 478:1880-1888. [PMID: 32732571 PMCID: PMC7371040 DOI: 10.1097/corr.0000000000001252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of young patients with degenerative lumbar spondylosis is expected to increase, and with it, the number of younger patients seeking surgical treatment is likely to rise. The goals of young patients with degenerative spondylolisthesis may differ from those of older patients, but little is known about the levels of pain and function, complication rates, or radiographic union that young patients achieve after interbody fusion. QUESTIONS/PURPOSES (1) How likely were patients younger than 50 years to achieve a minimal clinically important difference (MCID) in improvement on any of several validated patient-reported outcomes scores after transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a minimum of 2 years after surgery? (2) What proportion developed complications or underwent reoperations? (3) What proportion achieved radiographic fusion or developed adjacent-segment degeneration? METHODS Longitudinally maintained institutional registry data of patients undergoing primary, single-level, transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a single institution from 2006 to 2013 were studied in this retrospective case series. Of the 96 patients who met inclusion criteria, 14% (13 of 96) were missing follow-up data, leaving 83 patients younger than 50 years with complete clinical and radiological data at a minimum of 2 years (97%, 93 of 96 had sufficient data to assess complications and radiographic fusion). The mean age of the cohort was 44 ± 7 years. Radiological parameters for each patient with spondylolisthesis were recorded. Clinical outcomes such as the numeric rating scale for back pain and leg pain, Oswestry Disability Index (ODI) and SF-36 were assessed preoperatively and postoperatively at 1, 3, 6 months and 2 years. The proportion of patients who had an improvement greater than the MCID of each outcome instrument was then calculated. The occurrence of any medical, surgical or wound complications, and reoperations for any reason were recorded. Radiographic fusion using Bridwell grading and adjacent-segment degeneration were assessed by an independent observer not involved in clinical care. The mean follow-up was 5 ± 3 years. RESULTS The proportions of patients younger than 50 years who achieved the MCID for the various patient-reported outcomes were 82% (68 of 83) for leg pain, 75% (62 of 83) for back pain, 87% (72 of 83) for ODI and 71% (59 of 83) for SF-36 physical component summary at 2 years. Two perioperative complications occurred, and two reoperations were performed for implant-related complications. A total of 85% (79 of 93) of young patients achieved stable fusion, 8% (seven of 93) had radiologic adjacent-segment degeneration, and one patient underwent a revision procedure. CONCLUSIONS Young patients with lumbar degenerative spondylolisthesis commonly, but do not always, experience clinically meaningful gains in pain relief, function, and quality of life after transforaminal lumbar interbody fusion. A low risk of complications, reoperations, nonunion and adjacent-segment degeneration were also noted in this population. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Graham S Goh
- G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - You Wei Adriel Tay
- G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Wai-Mun Yue
- W.-M. Yue, The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore
| | - Chang-Ming Guo
- G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seang-Beng Tan
- S.-B. Tan, Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore
| | - John Li-Tat Chen
- G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Fujihara R, Komatsubara S, Arima N, Yamamoto T. Scoliosis, diabetes mellitus and total laminectomy at the 4th lumbar vertebra are independent risk factors for post-laminectomy fracture around the isthmus. Neurochirurgie 2020; 66:232-239. [PMID: 32502562 DOI: 10.1016/j.neuchi.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/14/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We aimed to identify the risk factors and clinical outcomes for post-laminectomy fracture around the isthmus, which can cause back pain or radiculopathy. METHODS We performed a retrospective cohort study involving all patients who underwent laminectomy splitting the spinous process for lumbar spinal stenosis between 2010 and 2014. The primary outcome measure was post-laminectomy fracture around the isthmus. Clinical outcomes were evaluated based on reoperation rate. To evaluate risk factors for fracture, the following parameters were collected: (1) patient characteristics and concomitant diabetes mellitus, (2) lumbar scoliosis and sagittal alignment parameters, and (3) surgical data, such as rate of total laminectomy. Logistic regression analysis was performed to identify the independent risk factors for post-laminectomy fracture. RESULTS Twelve of the 92 patients suffered a post-laminectomy fracture around the isthmus. Logistic regression analysis revealed that diabetes mellitus (odds ratio [OR]: 15.41; 95% confidence interval [CI]: 2.93-80.98; P=0.001), L4 total laminectomy (OR: 14.68; 95% CI: 1.51-142.76; P=0.021), and lumbar scoliosis (OR: 5.72; 95% CI: 1.16-28.21; P=0.032) were independent risk factors. The fracture group included 2 patients (16.7%) who required reoperation at the decompression level for recurrent leg pain, whereas the non-fracture group included 2 (2.5%) who underwent reoperation at a level different from the index procedure. CONCLUSIONS Post-laminectomy fractures around the isthmus were significantly associated with scoliosis, diabetes mellitus, and total laminectomy at L4. Total laminectomy at L4 is best avoided to reduce the risk of post-laminectomy fracture in patients with scoliosis or diabetes mellitus.
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Affiliation(s)
- R Fujihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
| | - S Komatsubara
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - N Arima
- Department of Orthopaedic Surgery, Sanuki Municipal Hospital, 387-1, Ishidahigashi-kou, Sangawa-cho, Sanuki, Kagawa 769-2393, Japan
| | - T Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Development and Validation of Machine Learning Algorithms for Predicting Adverse Events After Surgery for Lumbar Degenerative Spondylolisthesis. World Neurosurg 2020; 140:627-641. [PMID: 32344139 DOI: 10.1016/j.wneu.2020.04.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preoperative prognostication of adverse events (AEs) for patients undergoing surgery for lumbar degenerative spondylolisthesis (LDS) can improve risk stratification and help guide the surgical decision-making process. The aim of this study was to develop and validate a set of predictive variables for 30-day AEs after surgery for LDS. METHODS The American College of Surgeons National Surgical Quality Improvement Program was used for this study (2005-2016). Logistic regression (enter, stepwise, and forward) and LASSO (least absolute shrinkage and selection operator) methods were performed to identify and select variables for analyses, which resulted in 26 potential models. The final model was selected based on clinical criteria and numeric results. RESULTS The overall 30-day rate of AEs for 80,610 patients who underwent surgery for LDS in this database was 4.9% (n = 3965). The median age of the cohort was 58.0 years (range, 18-89 years). The model with the following 10-predictive factors (age, gender, American Society of Anesthesiologists grade, autogenous iliac bone graft, instrumented fusion, levels of surgery, surgical approach, functional status, preoperative serum albumin [g/dL] and serum alkaline phosphatase [IU/L]) performed well on the discrimination, calibration, Brier score, and decision analyses to develop machine learning algorithms. Logistic regression showed higher areas under the curve than did LASSO methods across the different models. The predictive probability derived from the best model is uploaded on an open-access Web application, which can be found at: https://spine.massgeneral.org/drupal/Lumbar-Degenerative-AdverseEvents. CONCLUSIONS It is feasible to develop machine learning algorithms from large datasets to provide useful tools for patient counseling and surgical risk assessment.
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Lam WWK, Loke AY, Wong CK. Personal and physical factors affecting the decision of patients to opt for spinal surgery: A case-control study. Int J Orthop Trauma Nurs 2020; 37:100753. [PMID: 32014468 DOI: 10.1016/j.ijotn.2020.100753] [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: 07/27/2019] [Revised: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVES To explore the personal and physical factors influencing the decision of patients to opt for spinal surgery. METHODS The medical records of patients who attended the Spine Nurse Clinic of a hospital in Hong Kong in the year 2017 were retrieved and reviewed. Comparisons were made of the physical symptoms, myelopathy, sensory deficits, and level of disability of patients who decided to undergo spinal surgery (case) and those who did not (control). RESULTS Among the 122 medical records that were reviewed, it was found that 102 (83.6%) patients decided to undergo spinal surgery (case) while 20 (16.4%) chose not to (control). The patients in the case group were more likely to be unemployed than those in the control group (67% vs. 35%, p = 0.01), to have higher scores in primary pain (4.75 vs. 2.6, p = 0.003), higher scores in radiated pain (4.4 vs. 2.55, p = 0.021), a higher level of disability as reflected in a higher Oswestry Disability Index (ODI) score (41.6 vs. 30.9, p = 0.021), and a lower Japanese Orthopedic Association (JOA) score (13.7 vs. 15.6, p = 0.008). Point biserial correlation showed that exercise tolerance was associated with the decision to undergo the surgery. A multiple regression analysis of the factors predictive of the decision to opt for spinal surgery showed that these factors were: unemployment (OR = 5.42, 95% CI: 1.689-17.44, p = 0.005); severe primary pain (OR = 3.83, 95% CI: 1.241-11.832, p = 0.02); and the presence of radicular symptoms (OR = 5.372, 95% CI: 1.704-16.93, p = 0.004). CONCLUSION The results of this study showed that besides physical factors such as pain radiation and disability level, which influenced the decision of patients to take the surgical option, patients who were unemployed were also more likely to choose surgery. This indicates that patients were worried about the possible impact of surgery on their employment, or on their ability to continue to work. It is important that patients be given a clear picture of the expected outcomes of their surgery, and that the information needs of patients regarding the surgery be explored and addressed.
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Affiliation(s)
- William Wing-Kuen Lam
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region.
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong Special Administrative Region.
| | - Chun-Kwan Wong
- Deputizing Department Operations Manager, Orthopaedic and Traumatology Department, United Christian Hospital, Hong Kong, Hong Kong Special Administrative Region.
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Ishimoto Y, Cooper C, Ntani G, Yamada H, Hashizume H, Nagata K, Muraki S, Tanaka S, Yoshida M, Yoshimura N, Walker-Bone K. Is radiographic lumbar spondylolisthesis associated with occupational exposures? Findings from a nested case control study within the Wakayama spine study. BMC Musculoskelet Disord 2019; 20:618. [PMID: 31878917 PMCID: PMC6933670 DOI: 10.1186/s12891-019-2994-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background To explore the relationship between radiographic spondylolisthesis and occupational factors in a case-control study nested within the Wakayama Spine Study (WSS). Methods The WSS is a cross-sectional observational study amongst Japanese adults. All participants completed a lifetime occupational history and underwent X-rays of the lumbar spine (L1-S1) according to a pre-defined protocol. One trained surgeon graded the presence of a spondylolisthesis based upon ≥5% anterior or posterior slip at one or more levels. Cases, with lumbar spondylolisthesis, were compared with controls without, for their principal occupation and occupational exposures. Results In total, data were available for 722 adults (245 men and 477 women), mean age 70.1 (range 53–93) years. According to the pre-defined radiographic criteria, 117 were defined with spondylolisthesis (cases), leaving 605 controls. Cases were not significantly different from controls for age, gender, BMI, smoking or alcohol intake. However, cases were more than twice as likely to report occupational driving ≥4 h/day (OR 2.39, 95% CI 1.08–5.27) after adjustment for age, gender and BMI. Additionally, after stratification by age using 75 years as a cut-point, cases were more than 3-fold more likely to report having worked in the agricultural/ fishing industries (OR 3.47, 95% CI 1.29–9.29) among those aged < 75 years. A reduced risk of being a case was associated with climbing slopes/steps and walking. Conclusions A history of occupational driving and working in the agricultural/fishing industry were associated with radiographic spondylolisthesis in this cross-sectional population study. This finding requires further evaluation in longitudinal studies.
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Affiliation(s)
- Yuyu Ishimoto
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK. .,Orthopedic surgery, Wakayama Medical University, Wakayama city, Wakayama prefecture, Japan. .,Orthopedic surgery, Kinan Hospital, Tanabe city, Wakayama prefecture, 646-8588, Japan. .,Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Work and Health, Southampton General Hospital, Southampton, Hampshire, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Work and Health, Southampton General Hospital, Southampton, Hampshire, UK
| | - Hiroshi Yamada
- Orthopedic surgery, Wakayama Medical University, Wakayama city, Wakayama prefecture, Japan
| | - Hiroshi Hashizume
- Orthopedic surgery, Wakayama Medical University, Wakayama city, Wakayama prefecture, Japan
| | - Keiji Nagata
- Orthopedic surgery, Wakayama Medical University, Wakayama city, Wakayama prefecture, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Munehito Yoshida
- Orthopedic surgery, Wakayama Medical University, Wakayama city, Wakayama prefecture, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Work and Health, Southampton General Hospital, Southampton, Hampshire, UK
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Zheng C, Lin X, Liu H, Lu W, Xu X, Wang D, Gao B, Wang C, Zhou J, Fan J, Hu Y, Jie Q, Chen D, Yang L, Luo Z. Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis. FASEB J 2019; 34:720-734. [PMID: 31914611 DOI: 10.1096/fj.201901040rr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
Abstract
Confusion persists over pathogenesis of spondylolysis. To confirm pathogenicity of the previously identified causative mutation of spondylolysis and investigate the genetic etiology, we generate a new mouse line harboring D673V mutation in the Slc26a2 gene. D673V mutation induces delayed endochondral ossification characterized by transiently reduced chondrocyte proliferation in mice at the early postnatal stage. Adult D673V homozygotes exhibit dysplastic isthmus and reduced bone volume of the dorsal vertebra resembling the detached vertebral bony structure when spondylolysis occurs, including the postzygopophysis, vertebral arch, and spinous process, which causes biomechanical alterations around the isthmic region of L4-5 vertebrae indicated by finite element analysis. Consistently, partial ablation of Slc26a2 in vertebral skeletal cells using Col1a1-Cre; Slc26a2 fl/fl mouse line recapitulates a similar but worsened vertebral phenotype featured by lamellar isthmus. In addition, when reaching late adulthood, D673V homozygotes develop an evident bone-loss phenotype and show impaired osteogenesis. These findings support a multifactorial etiology, involving congenitally predisposed isthmic conditions, altered biomechanics, and age-dependent bone loss, which leads to SLC26A2-related spondylolysis.
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Affiliation(s)
- Chao Zheng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xisheng Lin
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - He Liu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weiguang Lu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaolong Xu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Di Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bo Gao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng Wang
- School of Biomedical Sciences, University of Hong Kong, Hong Kong, China
| | - Jinru Zhou
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Fan
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yaqian Hu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qiang Jie
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, China
| | - Di Chen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
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Hsu HC, Chang CJ, Tung HH, Wang TJ. Disability, emotional distress and well-being among patients with lumbar spondylolisthesis. J Clin Nurs 2019; 28:3866-3878. [PMID: 31294503 DOI: 10.1111/jocn.14992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
AIM AND OBJECTIVE To explore the disability, emotional distress and well-being of patients with lumbar spondylolisthesis. BACKGROUND Few studies have investigated the correlations between disability, emotional distress and well-being of patients with lumbar spondylolisthesis. DESIGN This study used a cross-sectional research design. METHODS Participants were 133 patients aged over 50 years who were experiencing lumbar spondylolisthesis. The research instruments included a demographic information questionnaire; the Numeric Rating Scale (NRS); the Charlson Comorbidity Index (CCI); the Chinese versions of the Oswestry Disability Index (ODI), State-Trait Anxiety Inventory-State (STAI-S) and Center for Epidemiological Study-Depression (CES-D); and the Psychological Well-being (PWB) Scale. Emotional distress was measured by the STAI-S and CES-D. Pearson's correlations coefficient, multiple linear regression and a mediating effect model were introduced to explore correlations between the variables and predictors of psychological well-being, and details of the methods are reported in coherence to STROBE criteria. RESULTS Eighty-six participants (64.6%) had moderate and severe anxiety, and 42 (31.6%) experienced depression. Participants reported medium to high levels of well-being; "satisfaction with interpersonal relationships" was rated the highest and "physical and mental health" the lowest. Disability, depression and anxiety had significant negative correlations with well-being. Depression and anxiety mediated the relationship between disability and well-being. Moreover, depression, family support, educational background and anxiety were predictors of well-being, accounting for 39.1% of the total variance. CONCLUSIONS Disability and emotional distress among patients with lumbar spondylolisthesis had a negative impact on well-being. Anxiety and depression were closely correlated with and substantially influenced well-being. RELEVANCE TO CLINICAL PRACTICE Health professionals will enhance the understanding of important factors influencing well-being among patients with lumbar spondylolisthesis. This study suggests the conduct of depression and anxiety evaluations at outpatient clinics and prior to surgery, so that clinicians will be aware of the emotional distress status of patients with lumbar spondylolisthesis and, therefore, enhance their well-being.
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Affiliation(s)
- Hui-Chen Hsu
- Department of Nursing, Cathay General Hospital, Taipei City, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.,Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan
| | - Chih-Ju Chang
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan.,Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Mechanical Engineering, National Central University, Taoyuan County, Taiwan
| | - Heng-Hsin Tung
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
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Ko MJ, Park SW, Kim YB. Correction of Spondylolisthesis by Lateral Lumbar Interbody Fusion Compared with Transforaminal Lumbar Interbody Fusion at L4-5. J Korean Neurosurg Soc 2019; 62:422-431. [PMID: 31064044 PMCID: PMC6616989 DOI: 10.3340/jkns.2018.0143] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022] Open
Abstract
Objective In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS.
Methods We enrolled patients with symptomatic DS at L4–5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods.
Results Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA (18.9° and 15.6°) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively.
Conclusion LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.
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Affiliation(s)
- Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Eghbal K, Pourabbas B, Abdollahpour HR, Mousavi R. Clinical, Functional, and Radiologic Outcome of Single- and Double-Level Transforaminal Lumbar Interbody Fusion in Patients with Low-Grade Spondylolisthesis. Asian J Neurosurg 2019; 14:181-187. [PMID: 30937032 PMCID: PMC6417314 DOI: 10.4103/ajns.ajns_156_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The main objective is to determine the functional, clinical, and radiological outcome of patients with low-grade spondylolisthesis undergoing single- or double-level transforaminal lumbar interbody fusion (TLIF). Materials and Methods: This quasi-interventional study was conducted during a 2-year period from 2016 to 2018 in Shiraz, Southern Iran. We included all the adult (≥18 years) patients with low-grade spondylolisthesis (Meyerding Grade I and II) who underwent single- or double-level TLIF in our center. The spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and segmental LL (SLL) were measured. The pain intensity and disability were measured utilizing the visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI), respectively, after 1 year. Results: Overall, we included a total number of 50 patients with mean age of 54.1 ± 10.48 years. After the surgery, the PI (P = 0.432), PT (P = 0.782), and SS (P = 0.466) were not found to be statistically changed from the baseline. However, we found that single- or double-level TLIF was associated with increased LL (P < 0.001) and SLL (P < 0.001). Regarding the clinical outcome measures, both back (P = 0.001) and leg (P < 0.001) VAS improved after the surgery significantly. In addition, we found that improved leg VAS was positively correlated with improved ODI (r = 0. 634; P < 0.001). Conclusion: Single- or double-level TLIF is associated with increased global and SLL along with improved leg and back pain and disability in patients with low-grade spondylolisthesis. Interestingly, improved leg pain is correlated to improved disability in these patients.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pourabbas
- Department of Orthopedics, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Mousavi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Härtl R, Bisson E, Park KB, Shrime MG. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume. Global Spine J 2018; 8:784-794. [PMID: 30560029 PMCID: PMC6293435 DOI: 10.1177/2192568218770769] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Meta-analysis-based calculation. OBJECTIVES Lumbar degenerative spine disease (DSD) is a common cause of disability, yet a reliable measure of its global burden does not exist. We sought to quantify the incidence of lumbar DSD to determine the overall worldwide burden of symptomatic lumbar DSD across World Health Organization regions and World Bank income groups. METHODS We used a meta-analysis to create a single proportion of cases of DSD in patients with low back pain (LBP). Using this information in conjunction with LBP incidence rates, we calculated the global incidence of individuals who have DSD and LBP (ie, their DSD has neurosurgical relevance) based on the Global Burden of Disease 2015 database. RESULTS We found that 266 million individuals (3.63%) worldwide have DSD and LBP each year; the highest and lowest estimated incidences were found in Europe (5.7%) and Africa (2.4%), respectively. Based on population sizes, low- and middle-income countries have 4 times as many cases as high-income countries. Thirty-nine million individuals (0.53%) worldwide were found to have spondylolisthesis, 403 million (5.5%) individuals worldwide with symptomatic disc degeneration, and 103 million (1.41%) individuals worldwide with spinal stenosis annually. CONCLUSIONS A total of 266 million individuals (3.63%) worldwide were found to have DSD and LBP annually. Significantly, data quality is higher in high-income countries, making overall quantification in low- and middle-income countries less complete. A global effort to address degenerative conditions of the lumbar spine in regions with high demand is important to reduce disability.
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Affiliation(s)
| | | | - Abbas Rattani
- Harvard Medical School, Boston, MA, USA
- Meharry Medical College, Nashville, TN, USA
| | - Michael C. Dewan
- Harvard Medical School, Boston, MA, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger Härtl
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY,
USA
| | | | | | - Mark G. Shrime
- Harvard Medical School, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Degenerative spondylolisthesis: a prospective cross-sectional cohort study on the role of weakened anterior abdominal musculature on causation. 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 2018; 28:1406-1412. [PMID: 30218167 DOI: 10.1007/s00586-018-5758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Degenerative spondylolisthesis (DS) is a degenerative condition of the spine which, unlike others, is more common in a female population. Previous studies have highlighted possible causative factors such as facet tropism and pregnancy as reasons for this. This study sets out to assess the possible link between abdominal musculature and DS. METHOD A prospective cross-sectional cohort study in a single surgeon practice assessed all patients aged over 50 years attending for degenerative lumbar spinal complaints. Patient demographics, as well as the number of pregnancies, children, abdominal surgical procedures, were recorded. RESULTS We found 205 patients that met our inclusion criteria (98 Males/107 Females). Women with multiple pregnancies (p = 0.036) and abdominal surgeries (p = 0.021) were more likely to develop DS. Males with ventral hernias were more likely to have developed DS (p = 0.004). CONCLUSION This study highlights the important role that the abdominal musculature plays in stabilization of the spine and highlights its potential role as a factor in the development of DS. These slides can be retrieved under Electronic Supplementary Material.
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Wáng YXJ, Wu AM, Ruiz Santiago F, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat 2018; 15:21-34. [PMID: 30258783 PMCID: PMC6148737 DOI: 10.1016/j.jot.2018.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
Most patients with acute low back pain (LBP), with or without radiculopathy, have substantial improvements in pain and function in the first 4 weeks, and they do not require routine imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their LBP. It is also considered for those patients presenting with suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture and infection. In western country primary care settings, the prevalence has been suggested to be 0.7% for metastatic cancer, 0.01% for spinal infection and 0.04% for cauda equina syndrome. Of the small proportion of patients with any of these conditions, almost all have an identifiable risk factor. Osteoporotic vertebral compression fractures (4%) and inflammatory spine disease (<5%) may cause LBP, but these conditions typically carry lower diagnostic urgency. Imaging is an important driver of LBP care costs, not only because of the direct costs of the test procedures but also because of the downstream effects. Unnecessary imaging can lead to additional tests, follow-up, referrals and may result in an invasive procedure of limited or questionable benefit. Imaging should be delayed for 6 weeks in patients with nonspecific LBP without reasonable suspicion for serious disease. The translational potential of this article: Diagnostic imaging studies should be performed only in patients who have severe or progressive neurologic deficits or are suspected of having a serious or specific underlying condition. Radiologists can play a critical role in decision support related to appropriateness of imaging requests, and accurately reporting the potential clinical significance or insignificance of imaging findings.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou, China
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Gezer NS, Balcı A, Kalemci O, Köremezli N, Başara Akın I, Ur K. Vertebral body bone mineral density in patients with lumbar spondylolysis: a quantitative CT study. Diagn Interv Radiol 2018; 23:385-389. [PMID: 28765098 DOI: 10.5152/dir.2017.16463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Spondylolysis is known to be a part of a disease process, which describes a defect in the pars interarticularis of vertebra. We aimed to use quantitative computed tomography (QCT) to measure vertebral body bone mineral density (BMD) in patients with lumbar spondylolysis and compare it with readings in controls. METHODS Forty symptomatic patients with lumbar spondylolysis aged 18-52 years and 40 matched controls of same sex and approximate age (±2 years) were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5 and mean BMD was calculated for each case. RESULTS Of 40 patients, 22 (55%) demonstrated L5 spondylolysis, 14 (35%) L4 spondylolysis, three (7.5%) L3 spondylolysis, and one (2.5%) L2 spondylolysis. Spondylolisthesis was found in 29 patients (73%). Patients with spondylolisthesis were significantly older than patients without spondylolisthesis (42±6.9 vs. 37.2±5.4, P = 0.024). Mean BMD value of the patient group was significantly lower than that of the controls (105±24 mg/cm³ vs. 118.7±25.6 mg/cm³, P = 0.015). Subgroup analysis of 19 patients and 19 controls under the age of 40 revealed that the mean BMD value of the patients was significantly lower than that of the controls in the younger age group as well (108.7±23.5 mg/cm³ vs. 130±25.8 mg/cm³, P = 0.009). CONCLUSION This study demonstrated that patients with spondylolysis had significantly lower mean vertebral body BMD compared with controls.
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Affiliation(s)
- Naciye Sinem Gezer
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
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Frequency Evaluation of Early Pregnancy in Spondylolisthesis: A Cross Sectional Study on Iranian Females. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/archneurosci.15162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Melo‐Neto JSD, Vidotto LEL, Gomes FDC, Morais DFD, Tognola WA. Caracterização e aspectos clínicos de pacientes com traumatismo raquimedular submetidos a cirurgia. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fedorchuk C, Lightstone DF, McRae C, Kaczor D. Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature. J Radiol Case Rep 2017; 11:13-26. [PMID: 29299090 DOI: 10.3941/jrcr.v11i5.2924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. Clinical Features A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. Interventions and Outcomes The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. Conclusions This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.
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Affiliation(s)
| | | | - Christi McRae
- Private Practice, St. Thomas, US Virgin Islands, USA
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Karunanayake AL, Pathmeswaran A, Wijayaratne LS. Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study. Int J Rheum Dis 2017; 21:602-610. [PMID: 28205378 DOI: 10.1111/1756-185x.13026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study was done to determine the association between chronic low back pain and vertebral fractures, intervertebral disc space (IDS) narrowing, vertebral osteophytes and spondylolisthesis among adults. METHOD This case control study was done in Sri Lanka. Cases were patients with low back pain and controls were without low back pain. Postero-anterior and lateral radiographs of lumbar sacral spine of both groups were studied. To detect vertebral fractures in fourth and fifth lumbar vertebrae, anterior and posterior heights of vertebrae were measured using a Vernier caliper and antero-posterior ratio (A/P) was calculated. Having an A/P ratio value of < 0.89 was considered as a vertebral fracture. Presence of disc space narrowing, vertebral osteophytes and spondylolisthesis was assessed by two radiologists working independently. Bivariate and logistic regression analysis was done to find associations. RESULTS There were 140 cases and 140 controls. Mean (SD) age for cases was 51.6 (17) years. Mean (SD) age for controls was 50 (15) years. Females made up 62% of cases and controls. Fifth lumbar vertebral fracture (odds ratio [OR] = 10.2; P = 0.001), fourth lumbar vertebral fracture (OR = 2.5; P = 0.017) and IDS narrowing (OR = 4.15, P = 0.009) had a significant association with low back pain and vertebral osteophytes and spondylolisthesis did not have a significant association with low back pain. CONCLUSION Only vertebral fractures and IDS narrowing had a significant association with chronic low back pain.
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Sclafani JA, Constantin A, Ho PS, Akuthota V, Chan L. Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions, and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis Within Medicare Beneficiaries from 2000 to 2011. Spine (Phila Pa 1976) 2017; 42:240-246. [PMID: 28207664 PMCID: PMC5133200 DOI: 10.1097/brs.0000000000001724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, observational study. OBJECTIVE The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. SUMMARY OF BACKGROUND DATA Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. METHODS This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (ICD-9) diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. RESULTS A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) underwent spinal surgery, and one-third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. CONCLUSION Interventional techniques and physical therapy are frequently used treatment modalities for symptomatic degenerative spondylolisthesis. Understanding utilization of these techniques is important to determine relative clinical efficacies and to optimize future health care expenditures. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Joseph A. Sclafani
- Medstar Georgetown University/National Rehabilitation Hospital
- The National Institutes of Health
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Wang YXJ. Menopause as a potential cause for higher prevalence of low back pain in women than in age-matched men. J Orthop Translat 2017; 8:1-4. [PMID: 30035087 PMCID: PMC5987020 DOI: 10.1016/j.jot.2016.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 01/17/2023] Open
Abstract
Female sex hormones play an important role in the aetiology and pathophysiology of a variety of musculoskeletal degenerative diseases. Postmenopausal women show accelerated disc degeneration due to relative oestrogen deficiency, resulting in narrower intervertebral disc space in women than age-matched men, increased prevalence of spondylolisthesis, and increased prevalence of facet joint osteoarthritis. Postmenopausal women also show higher osteoporosis related spine fracture rate, particularly at the thoracic-lumbar junction site. I propose the concept that low back pain (LBP) is more prevalent in postmenopausal women than age-matched men and is associated with the physiological changes caused by the relatively lower level of sex hormones after menopause in women. Considering hormone replacement treatment (HRT)'s consistent efficacy reported with menopause-associated osteoarthritis, an in-depth understanding of the role of the gonadal hormones in LBP modulation warrants further study. HRT initiated at early postmenopausal phase may be protective for recurring LBP. If this is the case, further cost-benefit analysis should be performed for optimal HRT regimen in cases of women with high risk of recurring severe LBP.
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Affiliation(s)
- Yi Xiang J. Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region
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Melo-Neto JSD, Vidotto LEL, Gomes FDC, Morais DFD, Tognola WA. Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery. Rev Bras Ortop 2016; 52:479-490. [PMID: 28884108 PMCID: PMC5582819 DOI: 10.1016/j.rboe.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/28/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To identify the characteristics of patients with spinal cord injury (SCI) undergoing surgery. Methods Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. Results A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n = 92). The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. Conclusion These factors enable investments in prevention, rehabilitation, and treatment.
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Affiliation(s)
- João Simão de Melo-Neto
- Faculdade Ceres (FACERES), Departamento Morfofuncional, São José do Rio Preto, SP, Brazil
- Instituto Municipal de Ensino Superior de Catanduva (IMES), Catanduva, SP, Brazil
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Departamento de Neurociências, São José do Rio Preto, SP, Brazil
- Corresponding author.
| | | | - Fabiana de Campos Gomes
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Unidade de Pesquisa em Genética e Biologia Molecular, São José do Rio Preto, SP, Brazil
| | - Dionei Freitas de Morais
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Departamento de Neurociências, São José do Rio Preto, SP, Brazil
| | - Waldir Antonio Tognola
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Departamento de Neurociências, São José do Rio Preto, SP, Brazil
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Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat 2016; 11:39-52. [PMID: 29662768 PMCID: PMC5866399 DOI: 10.1016/j.jot.2016.11.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The epidemiology of lumbar degenerative spondylolisthesis (DS) remains controversial. We performed a systematic review with the aim of gaining a better understanding of the prevalence of DS in the general population. The results showed that the prevalence of DS is very gender- and age-specific. Few women and men develop DS before they are 50 years old. After 50 years of age, both women and men begin to develop DS, with women having a faster rate of development than men. For elderly Chinese (≥ 65 years, mean age: 72.5 years), large population-based studies MsOS (Hong Kong, females: n = 2000) and MrOS (Hong Kong, males: n = 2000) showed DS prevalence was 25.0% in women and 19.1% in men. The female:male (F:M) prevalence ratio was 1.3:1. The published data for MsOS (USA) and MrOS (USA) studies seem to show that elderly Caucasian Americans have a higher DS prevalence, being approximately 60-70% higher than elderly Chinese; however, the F:M prevalence ratio was similar to the elderly Chinese population. Patient data showed that female patients more often received surgical treatment than male and preliminary data showed the ratio of female to male patients receiving surgical treatment did not differ between Northeast Asians (Chinese, Japanese, and Korean), Europeans, and American Caucasians, being around 2:1 in the elderly population. The existing data also suggest that menopause may be a contributing factor for the accelerated development of DS in postmenopausal women. The translational potential of this article: A better understanding of epidemiology of lumbar degenerative spondylolisthesis can support patient consultation and treatment planning.
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Affiliation(s)
- Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Zoltán Káplár
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Jason C S Leung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
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Bai X, Chen J, Liu L, Li X, Wu Y, Wang D, Ruan D. Is reduction better than arthrodesis in situ in surgical management of low-grade spondylolisthesis? A system review and meta analysis. 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 2016; 26:606-618. [PMID: 27832362 DOI: 10.1007/s00586-016-4810-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/21/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the clinical and radiographic outcomes of arthrodesis in situ with arthrodesis after reduction in low-grade spondylolisthesis. METHODS We performed a comprehensive search of both observational and randomized clinical trials published up to April 2016 in PubMed, MEDLINE, Cochrane Library, and Embase databases. The outcomes included age, sex, operative time, blood loss, and at least 2 years clinical results of Oswestry disability index (ODI), visual analogue scale (VAS), lumbar lordosis, slippage, fusion rate, the rate of good and excellent and the complication rate. Two authors independently extracted the articles and the predefined data. RESULTS Seven eligible studies, involving four RCTs and three cohort studies were included in this systematic review and meta-analysis. Patients who underwent reduction did achieved better slippage correction comparing with arthrodesis in situ (P < 0.00001). However, there was no significant difference in the case of operative time, blood loss, VAS (P = 0.36), ODI (P = 0.50), lumbar lordosis (P = 0.47), the rate of good and excellent (P = 0.84), fusion rate (P = 0.083) and complication rate (P = 0.33) between the arthrodesis in situ group and the reduction group. CONCLUSIONS On the basis on this review, arthrodesis after reduction of low-grade spondylolisthesis potentially reduced vertebral slippage. Reduction was neither associated with a longer operative time nor more blood loss. There was no significant difference in the outcomes between reduction and arthrodesis in situ group. Both procedures could be expected to achieve good clinical result. LEVEL OF EVIDENCE Therapeutic Level IIa.
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Affiliation(s)
- Xuedong Bai
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Jiahai Chen
- Department of Orthopedics Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Liyang Liu
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Xiaochuan Li
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Yaohong Wu
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Deli Wang
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China
| | - Dike Ruan
- Department of Orthopedic Surgery, Navy General Hospital, No. 6 Fucheng Road, Beijing, 100048, China.
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