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Han C, Hai Y, Zhou C, Yin P, Guo R, Wang H, Wang W, Cha T, Li G. Investigation of in vivo three-dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis. JOR Spine 2021; 4:e1151. [PMID: 34611586 PMCID: PMC8479520 DOI: 10.1002/jsp2.1151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the three-dimensional (3D) changes of the spinal canal length (SCL) after corrective surgeries and their association with the radiographic and clinical outcomes of idiopathic scoliosis patients. The length of the spinal cord has been demonstrated to be strongly correlated with the SCL. Understanding the changes in SCL could help determine the morphologic changes in the spinal cord to prevent spinal cord injury. METHODS Twenty-seven scoliotic patients' 3D spinal canal were investigated using computed tomography images. The SCL between the upper and lower end vertebrae (U/L-EV) was measured at five locations. The radiographic parameters of each patient and the patient-reported outcomes (PROs) scores were also collected. The correlations of the changes of the SCLs with the other factors were analyzed. RESULTS The SCL between the U/L-EV changed non-uniformly at different locations. The post-operative SCLs were significantly elongated by 7.5 ± 3.5 mm (6.0 ± 2.5%, P < .001) at the concave side and compressed by -2.6 ± 2.6 mm (-1.9 ± 1.9%, P < .001) at the convex side. The elongations of the SCL at the concave and posterior locations were correlated with the radiographic parameters including the pre-operative main Cobb angles (r = .511, P = .006; r = .613, P = .001) and apical vertebral translation (AVT) (r = .481, P = .011; r = .684, P = .000). No PRO scores were found to correlate with the SCL changes. CONCLUSION The corrective surgeries elongated the spinal canal mainly at the concave side and compressed at the convex side. The main thoracic Cobb angle, the changes of AVT, and Cobb angles were moderately associated with the changes of the SCLs, but no PRO score was found to associate with the changes of the SCLs. The data could be instrumental for the improvement of corrective surgeries that are aimed to maximize the correction of scoliosis and minimize the negative effect on the spinal cord to prevent neurological complications.
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Affiliation(s)
- Chaofan Han
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
| | - Yong Hai
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Chaochao Zhou
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
| | - Peng Yin
- Department of OrthopaedicBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Runsheng Guo
- First Affiliated Hospital of Nanchang UniversityNanchangChina
| | | | | | - Thomas Cha
- Orthopaedic Spine CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Guoan Li
- Department of Orthopaedic Surgery, Bioengineering Research CenterNewton‐Wellesley Hospital, Harvard Medical SchoolNewtonMassachusettsUSA
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Song Y, Wen WQ, Xu J, Zhang ZP, Han Y, Li KP, Wang XD, Xu HX, Liu J, Miao J. Kinematic Characteristics and Biomechanical Changes of Lower Lumbar Facet Joints Under Different Loads. Orthop Surg 2021; 13:1047-1054. [PMID: 33709625 PMCID: PMC8126911 DOI: 10.1111/os.12894] [Citation(s) in RCA: 3] [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: 10/31/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/05/2022] Open
Abstract
Objective To explore the kinematic biomechanical changes and symmetry in the left and right sides of the facet joints of lumbar spine segments under different functional loads. Methods Participants (n = 10) performing standing flexion and extension movements were scanned using computed tomography (CT) and dual fluoroscopy imagine system. Instantaneous images of the L3–S1 vertebrae were captured, and by matching a three‐dimensional CT model with contours from dual fluoroscopy images, in vivo facet joint movements were reproduced and analyzed. Translations and rotations of lumbar vertebral (L3 and L4) facet joints of data were compared for different loads (0, 5, 10 kg). The participants performed flexion and extension movements in different weight‐bearing states, the translations and angles changes were calculated respectively. Results From standing to extension, there were no statistical differences in rotation angles for the facet joint processes of different vertebral segment levels under different weight loads (P > 0.05). Mediolateral axis and cranio‐caudal translations under different weight loads were not statistically different for vertebral segment levels (P > 0.05). Anteroposterior translations for L3 (1.4 ± 0.1 mm) were greater than those for L4 (1.0 ± 0.1 mm) under the different load conditions (P = 0.04). Bilaterally, mediolateral, anteroposterior, and cranio‐caudal translations of the facet joints under different weights (0, 10 kg) for each segment level (L3 and L4) were symmetric (P > 0.05). From flexion to standing, there were no statistical differences in rotation angles for different weights (0, 5, 10 kg) for each level (L3 and L4) (P > 0.05). There were no statistical differences between mediolateral, anteroposterior, and cranio‐caudal translations at each segment level (L3 and L4) under different loads (P > 0.05). Under the condition of no weight (0 kg), L3 mediolateral translations on the left side (1.7 ± 1.6 mm) were significantly greater (P = 0.03) than those on the right side (1.6 ± 1.6 mm). Left side (1.0 ± 0.7 mm) L4 mediolateral translations were significantly smaller (P = 0.03) than those on the right side (1.1 ± 0.7 mm). There were no statistical differences between different weights for either anteroposterior and cranio‐caudal translations (P > 0.05). There were no statistical differences for mediolateral, anteroposterior, and cranio‐caudal translations for 10 kg (P > 0.05). Conclusion Lumbar spine facet joint kinematics did not change significantly with increased loads. Anteroposterior translations for L3 were greater than those for L4 of the vertebral segments are related to the coronal facet joint surface. Changes in facet surface symmetry indicates that the biomechanical pattern between facet joints may change.
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Affiliation(s)
- Yang Song
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China.,Department of orthopaedics, Chifeng City Hospital, Inter Mongolia, China
| | - Wang-Qiang Wen
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Jin Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Ze-Pei Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Ye Han
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Ke-Peng Li
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Xiao-Dong Wang
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Hao-Xiang Xu
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China
| | - Jianan Liu
- Department of Graduate Institute, Tianjin Medical University, Tianjin, China.,Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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Abstract
Aims To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine. Methods A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion. Results The mean changes in segmental lordosis and global lordosis were 7.1° (SD 6.7°) and 2.9° (SD 9.9°) respectively for the interbody fusion group, and 0.8° (SD 5.1°) and -0.4° (SD 10.1°) respectively for the posterolateral fusion-only group. Segmental lordosis (ρ = 0.794, p < 0.001) corrected by interbody fusion correlated best with prone traction radiographs. Global lumbar lordosis (ρ = 0.788, p < 0.001) correlated best with the interbody fusion group and preoperative lateral standing radiographs. The least difference in slip distance (-0.3 mm (SD 1.7 mm), p < 0.001), slip angle (0.9° (SD 5.2°), p < 0.001), and disc height (0.02 mm (SD 2.4 mm), p < 0.001) was seen between prone traction and postoperative radiographs. Regression analyses suggested that prone traction parameters best predicted correction of slip distance (Corrected Akaike’s Information Criterion (AICc) = 37.336) and disc height (AICc = 58.096), while correction of slip angle (AICc = 26.453) was best predicted by extension radiographs. Receiver operating characteristic (ROC) cut-off showed, with 68.3% sensitivity and 64.5% specificity, that to achieve a 3.0° increase in segmental lordotic angle, patients with a prone traction disc height of 8.5 mm needed an interbody fusion. Conclusion Prone traction radiographs best predict the slip distance and disc height correction achieved by interbody fusion for lumbar degenerative spondylolisthesis. To achieve this maximum correction, interbody fusion should be undertaken if a disc height of more than 8.5 mm is attained on preoperative prone traction radiographs. Level of Evidence: Level II Prognostic Study Cite this article: Bone Joint J 2020;102-B(8):1062–1071.
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Affiliation(s)
- Jason P. Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ho Ken Fong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence W. H. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Kunze KN, Lilly DT, Khan JM, Louie PK, Ferguson J, Basques BA, Nolte MT, Dewald CJ. High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management. Int J Spine Surg 2020; 14:327-340. [PMID: 32699755 DOI: 10.14444/7044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS. Methods Literature review. Results HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others. Conclusions HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spino-pelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph Ferguson
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Christopher J Dewald
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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In vivo deformation of the spine canal before and after surgical corrections of severe and rigid kyphoscoliosis. J Orthop Translat 2020; 23:1-7. [PMID: 32514391 PMCID: PMC7264988 DOI: 10.1016/j.jot.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Ponte osteotomy and posterior vertebral column resection (PVCR) are two popular surgical techniques in treatment of severe and rigid kyphoscoliosis. However, quantitative effects of the two surgeries on spinal cord deformation are unclear. This information is critical for improvement of the treatment methods that can maximally correct the spinal deformity and prevent neurological complications. Methods Ten patients with severe kyphoscoliosis were investigated. X-ray and CT images of full spine of all patients were acquired before and 6–24 months after surgical treatment using either Ponte osteotomy or PVCR. A 3D model of the spine was constructed for each patient using the CT images that included the spinal canal between T2 and L2 vertebrae. The spinal canal length (SCL) was determined at 5 locations on the cross section of the canal: anterior, posterior, left, right (concave or convex side) and centre positions. The perpendicular distances between the T2 and L2 vertebrae, COBB angles and patient reported outcome measures before and after operations were determined. Results For patients treated with Ponte osteotomy, the SCLs were elongated by 12.7 ± 9.5 mm (5.4 ± 3.9%) at the concave side and 3.2 ± 6.8 mm (1.3 ± 2.8%) at the convex side. The COBB angle was corrected by 55.8% and the T2-L2 distance was increased by 66.1 ± 12.0 mm (68.4 ± 15.9%). For patients treated using PVCR, the SCLs were shortened by −5.5 ± 5.3 mm (−2.3 ± 2.2%) at the concave side and −14.0 ± 6.6 mm (−5.2 ± 2.6%) at the convex side. The COBB angle was corrected by 60.0% and the T2-L2 distance was increased by 41.5 ± 12.4 mm (32.1 ± 23.0%). The patient reported outcome scores were improved using both surgeries (p < 0.05). Conclusion Ponte and PVCR surgeries caused significant changes of the SCL in scoliosis patients in different ways. The Ponte osteotomy mainly caused elongation of the SCL at concave side and the PVCR caused compression of the SCL at the convex side. Both surgeries partially improved the spinal deformity. The data provide insights for development of new surgical techniques that integrates the advantages of both Ponte and PVCR osteotomies to maximally correct the spine deformity and prevent neurological complications. The translational potential of this article The methodology and the data presented in this paper could be instrumental for development of computer assisted surgical techniques that can maximally correct the spinal deformity and minimize the effect on the spinal cord in scoliosis patients.
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Sun K, Liang L, Yin H, Yu J, Feng M, Zhan J, Jin Z, Yin X, Wei X, Zhu L. Manipulation for treatment of degenerative lumbar spondylolisthesis: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18135. [PMID: 31804324 PMCID: PMC6919453 DOI: 10.1097/md.0000000000018135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis (DLS) is one of the common orthopedic diseases which causes low back pain in patients, which seriously affects people's daily life and work. As a method of conservative treatment of this disease, manipulation is widely used in clinical practice. We will summarize the current published evidence of manipulation in the treatment of DLS, and evaluate the effectiveness and safety of manipulation through systematic review and meta-analysis, so as to provide more reliable evidence for future clinical practice. METHODS We will conduct a comprehensive search of the following 9 databases until January 2019: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, Wan Fang Database, and Chinese Biomedical Database. The 2 researchers will independently search, screen, extract data, and evaluate the quality of the literatures. The primary outcomes include clinical effectiveness, Japanese Orthopaedic Association scores, and the secondary outcomes include visual analog scale scores, symptom scores, and adverse events. Bias risk tools provided by Cochrane Collaboration will be used for literature quality assessment, and RevMan 5.3 software will be used for meta-analysis. RESULTS The results of this study will systematically evaluate the effectiveness and safety of manipulation intervention for people with DLS, especially in improving lumbar function scores and pain scores. CONCLUSION The systematic review of this study will summarize the current published evidence of manipulation for the treatment of DLS, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION This study does not require ethical approval and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019139933.
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Affiliation(s)
- Kai Sun
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Long Liang
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - He Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Jie Yu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Minshan Feng
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine
| | | | - Zhefeng Jin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xunlu Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xu Wei
- Office of Academic Research, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine
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Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review. Ann Biomed Eng 2019; 47:1491-1522. [DOI: 10.1007/s10439-019-02252-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023]
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Xu H, Liu J, Li H, Wei D, Miao J, Xia Q. [Vertebral three-dimensional motion characteristics of adjacent segments in patients with isthmic spondylolisthesis in vivo]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1560-1566. [PMID: 30569684 DOI: 10.7507/1002-1892.201807026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To observe vertebral three-dimensional motion characteristics of adjacent segments in patients with symptomatic L 4 isthmic spondylolisthesis (IS). Methods Fourteen symptomatic L 4 IS patients who underwent surgery treatment (trial group) and 15 asymptomatic volunteers without back pain and other lesions of spine (control group) were recruited. There was no significant difference in gender, age, body mass index, and bone mineral density between the two groups ( P>0.05). The three-dimensional reconstruction model of lumbar spine was acquired from the thin slice CT of the lumbar spine of the subjects by combining dual-X-ray fluoroscopy imaging system with spiral CT examination. The model was matched to the double oblique X-ray fluoroscopy images captured by dual-X-ray fluoroscopy imaging system at different active positions of the lumbar spine to reproduce the three-dimensional instantaneous of lumbar spondylolisthesis at different state of motion. The motion and relative displacement of adjacent segments (L 3, 4 and L 5, S 1) of spondylolisthesis were measured quantitatively by establishing a three-dimensional coordinate system at the geometric center of the vertebral body. The results were compared with those of the control group. Results When L 3, 4 in the control group were flexed flexion-extension, left-right twisting, and left-right bending, and when L 5, S 1 in the control group were flexed left-right twisting and left-right bending, the activity along the main axis of motion (main axis of motion) tended to increase compared with that along the corresponding coupled axis of motion (secondary axis of motion); however, this trend disappeared in the trial group, and the main and secondary movements were disordered. Because of the coronal orientation of the facet joints of L 5, S 1, the degree of motion along the main axis of motion decreased during flexion and extension, but this trend disappeared in the trial group. Compared with the control group, L 3, 4 in the trial group exhibited displacement instability in flexion-extension, left-right twisting, and left-right bending ( P<0.05); there was no significant difference in the relative displacement of L 5, S 1 intervertebral bodies along x, y, and z axes between the trial group and the control group in flexion-extension, left-right twisting, and left-right bending curvature ( P>0.05). Conclusion Patients with symptomatic L 4 IS have disorders of primary and secondary movement patterns in adjacent segments, while IS showed significantly displacement instability in L 3, 4 and significantly decreased motion in L 5, S 1.
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Affiliation(s)
- Hongda Xu
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Jianan Liu
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Hongda Li
- Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, 300162, P.R.China
| | - Dong Wei
- Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, 300162, P.R.China
| | - Jun Miao
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211,
| | - Qun Xia
- Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, 300162, P.R.China
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Paholpak P, Nazareth A, Khan YA, Khan SU, Ansari F, Tamai K, Buser Z, Wang JC. Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:17-23. [PMID: 30054742 DOI: 10.1007/s00590-018-2276-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the kinematic change of cross-sectional area of lumbar intervertebral foramen in degenerative lumbar spondylolisthesis patients using multi-positional MRI. METHODS Multi-positional MRI was performed on 31 patients diagnosed with single or multilevel degenerative lumbar spondylolisthesis and 31 control patients without degenerative lumbar spondylolisthesis. Foraminal area (FA) was measured at the lumbar spondylolisthesis level in degenerative lumbar spondylolisthesis group and at L3-4, L4-5, and L5-S1 level in the control group. FA was measured bilaterally in neutral, flexion, and extension positions. The difference in FA between the groups was analyzed using Mann-Whitney U test, and the difference between positions within groups was analyzed using Wilcoxon signed-rank test. RESULTS Degenerative lumbar spondylolisthesis group showed significantly smaller FA on both sides and on average in all three positions compared to the control group (p < 0.05 all). From neutral to flexion position, the change in FA was significantly smaller in the degenerative lumbar spondylolisthesis group than in the control group on both sides and on average (p < 0.005 all). In degenerative lumbar spondylolisthesis group, the FA showed no significant change from neutral to flexion, but showed significant change from neutral to extension (p < 0.005 all). CONCLUSIONS FA in the degenerative lumbar spondylolisthesis group was smaller than in the control group. There was no difference in FA in degenerative lumbar spondylolisthesis group from neutral to flexion, only from neutral to extension. Patients with degenerative lumbar spondylolisthesis have a higher chance of developing foraminal stenosis.
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Affiliation(s)
- Permsak Paholpak
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.,Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Alexander Nazareth
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA
| | | | | | | | - Koji Tamai
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.,Department of Orthopedics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA.
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-2509N, Mail Code: 9601, Los Angeles, CA, 90033, USA
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Anterior Trunk Mobility Does Not Predict Disability in Elderly Women With Acute Low Back Pain: Brazilian Back Complaints in the Elders (BACE-Brazil) Study Results. Spine (Phila Pa 1976) 2017; 42:1552-1558. [PMID: 28296815 DOI: 10.1097/brs.0000000000002151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, ancillary study of an international multicenter epidemiological study. OBJECTIVE To investigate the relationship of the anterior trunk mobility with self-report and physical performance measures in elderly women with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA LBP is one of the most prevalent pain complaints in the elderly population. It is postulated that the increased range of motion of limited joints of the trunk may improve LBP and functionality of patients. Recent studies have, however, questioned the association between trunk range of motion and the functional status. METHODS The present study included a convenience sample of elderly women from the community aged 60 years and older who presented with a new (acute) episode of LBP. Volunteers with severe diseases and visual, hearing and mobility losses, or cognitive impairment were excluded. Trunk mobility was assessed by the fingertip-to-floor test. Functionality was assessed by the Roland-Morris Questionnaire (RMQ) and gait speed test. Statistical analysis was performed by using hierarchical linear regression model. RESULTS Data from 459 elderly women, mean age of 69.0 (6.1) years old, were used to describe this report. The additional predictive value for the inclusion of independent variable trunk mobility was only 4.4% in the RMQ score and 1.5% in the gait speed test, respectively. A reduced hierarchical linear regression model showed that the significant predictors for RMQ and gait speed test were body mass index, pain intensity, and trunk mobility. CONCLUSION This was the first study to investigate the relationship between trunk mobility and functionality in elderly women with acute LBP. The results suggest that these clinical parameters are independent from each other. LEVEL OF EVIDENCE N/A.
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Long RG, Torre OM, Hom WW, Assael DJ, Iatridis JC. Design Requirements for Annulus Fibrosus Repair: Review of Forces, Displacements, and Material Properties of the Intervertebral Disk and a Summary of Candidate Hydrogels for Repair. J Biomech Eng 2016; 138:021007. [PMID: 26720265 DOI: 10.1115/1.4032353] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Indexed: 02/02/2023]
Abstract
There is currently a lack of clinically available solutions to restore functionality to the intervertebral disk (IVD) following herniation injury to the annulus fibrosus (AF). Microdiscectomy is a commonly performed surgical procedure to alleviate pain caused by herniation; however, AF defects remain and can lead to accelerated degeneration and painful conditions. Currently available AF closure techniques do not restore mechanical functionality or promote tissue regeneration, and have risk of reherniation. This review determined quantitative design requirements for AF repair materials and summarized currently available hydrogels capable of meeting these design requirements by using a series of systematic PubMed database searches to yield 1500+ papers that were screened and analyzed for relevance to human lumbar in vivo measurements, motion segment behaviors, and tissue level properties. We propose a testing paradigm involving screening tests as well as more involved in situ and in vivo validation tests to efficiently identify promising biomaterials for AF repair. We suggest that successful materials must have high adhesion strength (∼0.2 MPa), match as many AF material properties as possible (e.g., approximately 1 MPa, 0. 3 MPa, and 30 MPa for compressive, shear, and tensile moduli, respectively), and have high tensile failure strain (∼65%) to advance to in situ and in vivo validation tests. While many biomaterials exist for AF repair, few undergo extensive mechanical characterization. A few hydrogels show promise for AF repair since they can match at least one material property of the AF while also adhering to AF tissue and are capable of easy implantation during surgical procedures to warrant additional optimization and validation.
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Chu C, Belavý DL, Armbrecht G, Bansmann M, Felsenberg D, Zheng G. Fully Automatic Localization and Segmentation of 3D Vertebral Bodies from CT/MR Images via a Learning-Based Method. PLoS One 2015; 10:e0143327. [PMID: 26599505 PMCID: PMC4658120 DOI: 10.1371/journal.pone.0143327] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
Abstract
In this paper, we address the problems of fully automatic localization and segmentation of 3D vertebral bodies from CT/MR images. We propose a learning-based, unified random forest regression and classification framework to tackle these two problems. More specifically, in the first stage, the localization of 3D vertebral bodies is solved with random forest regression where we aggregate the votes from a set of randomly sampled image patches to get a probability map of the center of a target vertebral body in a given image. The resultant probability map is then further regularized by Hidden Markov Model (HMM) to eliminate potential ambiguity caused by the neighboring vertebral bodies. The output from the first stage allows us to define a region of interest (ROI) for the segmentation step, where we use random forest classification to estimate the likelihood of a voxel in the ROI being foreground or background. The estimated likelihood is combined with the prior probability, which is learned from a set of training data, to get the posterior probability of the voxel. The segmentation of the target vertebral body is then done by a binary thresholding of the estimated probability. We evaluated the present approach on two openly available datasets: 1) 3D T2-weighted spine MR images from 23 patients and 2) 3D spine CT images from 10 patients. Taking manual segmentation as the ground truth (each MR image contains at least 7 vertebral bodies from T11 to L5 and each CT image contains 5 vertebral bodies from L1 to L5), we evaluated the present approach with leave-one-out experiments. Specifically, for the T2-weighted MR images, we achieved for localization a mean error of 1.6 mm, and for segmentation a mean Dice metric of 88.7% and a mean surface distance of 1.5 mm, respectively. For the CT images we achieved for localization a mean error of 1.9 mm, and for segmentation a mean Dice metric of 91.0% and a mean surface distance of 0.9 mm, respectively.
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Affiliation(s)
- Chengwen Chu
- Institution for Surgical Technology and Biomechanics, University of Bern, 3014 Bern, Switzerland
| | - Daniel L. Belavý
- Charité - University Medicine Berlin, Centre of Muscle and Bone Research, Campus Benjamin Franklin, Free University & Humboldt-University Berlin, 12200 Berlin, Germany
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Burwood Campus, Burwood VIC 3125, Australia
| | - Gabriele Armbrecht
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Burwood Campus, Burwood VIC 3125, Australia
| | - Martin Bansmann
- Institut für Diagnostische und Interventionelle Radiologie, Krankenhaus Porz Am Rhein gGmbH, 51149 Köln, Germany
| | - Dieter Felsenberg
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Burwood Campus, Burwood VIC 3125, Australia
| | - Guoyan Zheng
- Institution for Surgical Technology and Biomechanics, University of Bern, 3014 Bern, Switzerland
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Ferrari S, Vanti C, Piccarreta R, Monticone M. Pain, disability, and diagnostic accuracy of clinical instability and endurance tests in subjects with lumbar spondylolisthesis. J Manipulative Physiol Ther 2014; 37:647-59. [PMID: 25282678 DOI: 10.1016/j.jmpt.2014.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aims of this study were (1) to investigate the relationship between the main clinical tests to detect spinal instability, the perceived pain and disability, and symptomatic spondylolisthesis (SPL) characteristics, (2) to investigate the relationship between endurance and instability tests, and (3) to measure the diagnostic accuracy of these tests in unstable SPL diagnosed against dynamic radiographs. METHODS Four instability tests were evaluated on 119 subjects: aberrant movements, active straight leg raising (ASLR), prone instability test, and passive lumbar extension test (PLE); and 2 endurance tests, prone bridge test and supine bridge test (SBT). The results were compared with the numeric rating scale for pain and the Oswestry Disability Index for disability. These tests were used as index tests and compared with dynamic radiographs as reference standard on 64 subjects. RESULTS A significant relationship between disability and all the clinical tests but ASLR was observed. The relation between tests and pain was weaker, not significant for prone instability test and aberrant movement and critical for ASLR (P = .05). There was a low relationship between endurance tests and instability tests. Only PLE showed a significant association with dynamic radiographs (P = .017). CONCLUSION Endurance and instability tests appear to be weakly related to the amount of pain but significantly related to the disability in symptomatic SPL. Of the tests evaluated, PLE exhibited the best ability to predict positive dynamic radiographs.
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Affiliation(s)
- Silvano Ferrari
- Adjunct Professor of Manual Therapy, Department of Biomedical Sciences, University of Padova, Italy.
| | - Carla Vanti
- Adjunct Professor Manual Therapy, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Raffaella Piccarreta
- Tenured Researcher, Department of Decision Sciences, L. Bocconi University, Milan, Italy
| | - Marco Monticone
- Director, Operative Unit of Physical and Rehabilitation Medicine, Salvatore Maugeri Foundation, Istituto di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Lissone, Milan, Italy
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Biomechanical stability of lateral interbody implants and supplemental fixation in a cadaveric degenerative spondylolisthesis model. Spine (Phila Pa 1976) 2014; 39:E1138-46. [PMID: 24979274 DOI: 10.1097/brs.0000000000000485] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro cadaveric biomechanical study of lateral interbody cages and supplemental fixation in a degenerative spondylolisthesis (DS) model. OBJECTIVE To investigate changes in shear and flexion-extension stability of lateral interbody fusion constructs. SUMMARY OF BACKGROUND DATA Instability associated with DS may increase postoperative treatment complications. Several groups have investigated DS in cadaveric spines. Extreme lateral interbody fusion (XLIF) cages with supplemental fixation have not previously been examined using a DS model. METHODS Seven human cadaveric L4-L5 motion segments were evaluated using flexion-extension moments to ±7.5 N·m and anterior-posterior (A-P) shear loading of 150 N with a static axial compressive load of 300 N. Conditions were: (1) intact segment, (2) DS simulation with facet resection and lateral discectomy, (3) standalone XLIF cage, (4) XLIF cage with (1) lateral plate, (2) lateral plate and unilateral pedicle screws contralateral to the plate (PS), (3) unilateral PS, (4) bilateral PS, (5) spinous process plate, and (6) lateral plate and spinous process plate. Flexion-extension range of motion (ROM) data were compared between conditions and with results from a previous study without DS simulation. A-P shear displacements were compared between conditions. RESULTS Flexion-extension ROM after DS destabilization increased significantly by 181% of intact ROM. With the XLIF cage alone, ROM decreased to 77% of intact. All conditions were less stable than corresponding conditions with intact posterior elements except those including the spinous process plate. Under shear loading, A-P displacement with the XLIF cage alone increased by 2.2 times intact. Bilateral PS provided the largest reduction of A-P displacement, whereas the spinous process plate alone provided the least. CONCLUSION This is the first in vitro shear load testing of XLIF cages with supplemental fixation in a cadaveric DS model. The variability in sagittal plane construct stability, including significantly increased flexion-extension ROM found with most fixation conditions including bilateral PS may explain some clinical treatment complications in DS with residual instability. LEVEL OF EVIDENCE N/A.
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The basis of mechanical instability in degenerative disc disease: a cadaveric study of abnormal motion versus load distribution. Spine (Phila Pa 1976) 2014; 39:1032-43. [PMID: 24583744 DOI: 10.1097/brs.0000000000000292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical study in cadaveric lumbar spine. OBJECTIVE To establish the basis of mechanical stability in degenerative disc disease from the relationship between range of motion (ROM), neutral zone motion (NZ), intradiscal pressure profile, and instantaneous axis or rotation (IAR) in advancing grades of disc degeneration. SUMMARY OF BACKGROUND DATA The basis of mechanical instability in lumbar disc degeneration remains poorly understood. Controversy exists between abnormal motion and abnormal loading theories. METHODS Thirty-nine lumbar motion segments were graded for staging of disc degeneration with magnetic resonance scan. These specimens were tested for ROM and NZ in a 6 df spine simulator, with 7.5 N·m unconstrained, cyclical loading. Continuous tracking of IAR was derived from ROM data. Intradiscal pressure profiles were determined using needle-mounted pressure transducer, drawn across the disc space under constant loading. RESULTS The ROM showed insignificant change, but a trend of increase from grade I through III and a decrease with advanced degeneration. NZ increased significantly with advancing disc degeneration. Intradiscal pressure profile showed an even distribution of the load in normal discs but a depressurized nucleus and irregular spikes of excessive loading, with advancing degeneration. The IAR showed a smooth excursion in normal versus irregular jerky excursion in degenerated discs, without significant change in excursion. The center of rotation, derived from IAR, showed significantly increased vertical translation with advancing degeneration, indicating an abnormal quality of motion. CONCLUSION The study established a basis of mechanical instability in the lumbar spine with advancing disc degeneration as an abnormal quality of motion represented by variation in IAR and center of rotation, increased NZ motion without any increase in quantity of motion, and abnormal load distribution across the disc space with spikes of high load amidst depressurized nucleus. The study cannot identify clinical instability but finds an association between the abnormal motions and the abnormal load distribution in mechanical instability. LEVEL OF EVIDENCE N/A.
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Kwon YK, Jang JH, Lee CD, Lee SH. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation. J Neurosurg Spine 2014; 20:653-6. [PMID: 24725181 DOI: 10.3171/2014.3.spine121018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3-4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3-4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3-4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3-4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.
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Schwarzenberg R, Freisleben B, Nimsky C, Egger J. Cube-cut: vertebral body segmentation in MRI-data through cubic-shaped divergences. PLoS One 2014; 9:e93389. [PMID: 24705281 PMCID: PMC3976281 DOI: 10.1371/journal.pone.0093389] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
In this article, we present a graph-based method using a cubic template for volumetric segmentation of vertebrae in magnetic resonance imaging (MRI) acquisitions. The user can define the degree of deviation from a regular cube via a smoothness value Δ. The Cube-Cut algorithm generates a directed graph with two terminal nodes (s-t-network), where the nodes of the graph correspond to a cubic-shaped subset of the image’s voxels. The weightings of the graph’s terminal edges, which connect every node with a virtual source s or a virtual sink t, represent the affinity of a voxel to the vertebra (source) and to the background (sink). Furthermore, a set of infinite weighted and non-terminal edges implements the smoothness term. After graph construction, a minimal s-t-cut is calculated within polynomial computation time, which splits the nodes into two disjoint units. Subsequently, the segmentation result is determined out of the source-set. A quantitative evaluation of a C++ implementation of the algorithm resulted in an average Dice Similarity Coefficient (DSC) of 81.33% and a running time of less than a minute.
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Affiliation(s)
- Robert Schwarzenberg
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Bernd Freisleben
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University Hospital of Marburg, Marburg, Germany
| | - Jan Egger
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
- Department of Neurosurgery, University Hospital of Marburg, Marburg, Germany
- * E-mail:
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Motion characteristics of the lumbar spinous processes with degenerative disc disease and 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 2013; 22:2702-9. [PMID: 23903997 DOI: 10.1007/s00586-013-2918-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 06/23/2013] [Accepted: 07/14/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recently, interspinous process devices have attracted much attention since they can be implanted between the lumbar spinous processes (LSP) of patients with degenerative disc disease (DDD) and degenerative spondylolisthesis (DLS) using a minimally invasive manner. However, the motion characters of the LSP in the DLS and DDD patients have not been reported. This study is aimed at investigating the kinematics of the lumbar spinous processes in patients with DLS and DDD. METHODS Ten patients with DDD at L4-S1 and ten patients with DLS at L4-L5 were studied. The positions of the vertebrae (L2-L5) at supine, standing, 45° trunk flexion, and maximal extension positions were determined using MRI-based models and dual fluoroscopic images. The shortest ISP distances were measured and compared with those of healthy subjects that have been previously reported. RESULTS The shortest distance of the interspinous processes (ISP) gradually decreased from healthy subjects to DDD and to DLS patients when measured in the supine, standing, and extension positions. During supine-standing and flexion-extension activities, the changes in the shortest ISP distances in DDD patients were 2 ± 1.2 and 4.8 ± 2.1 mm at L4-L5; in DLS patients they were 0.5 ± 0.4 and 2.8 ± 1.7 mm at L4-L5, respectively. The range of motion is increased in DDD patients but decreased in DLS patients when compared with those of the healthy subjects. No significantly different changes were detected at L2-L3 and L3-L4 levels. CONCLUSION At the involved level, the hypermobility of the LSP was seen in DDD and hypomobility of the LSP in DLS patients. The data may be instrumental for improving ISP surgeries that are aimed at reducing post-operative complications such as bony fracture and device dislocations.
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