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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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Ferdinandov D, Yankov D, Trandzhiev M. Common differential diagnosis of low back pain in contemporary medical practice: a narrative review. Front Med (Lausanne) 2024; 11:1366514. [PMID: 38379555 PMCID: PMC10876847 DOI: 10.3389/fmed.2024.1366514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
With a wide range of etiologies, low back pain (LBP) presents a true clinical challenge, finding its origins both in intrinsic spinal and systemic conditions, as well as referred ones. This review categorizes the LBP into these three groups and aims to offer a comprehensive look at the tools required to diagnose and differentiate them. The intrinsic etiologies are based on conditions that affect the musculoskeletal components of the lumbar spine, such as intervertebral disc disease, stenosis, muscular imbalance, and facet joint degeneration. The systemic causes usually extend beyond local structures. Such are the cases of neoplasia, infections, and chronic inflammation. The diagnosis is rendered even more complex by adding the referred pain, which only manifests in the lower back yet arises in more distant locations. By synthesizing the literature that encompasses the problem, this review aims to augment the understanding of the differential diagnoses of LBP by showcasing the subject's nuances. This categorization provides a structured approach to a patient-centered diagnosis, which could facilitate the medical practitioners' efforts to navigate this pathology more effectively.
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Affiliation(s)
- Dilyan Ferdinandov
- Department of Neurosurgery, Medical University of Sofia, Sofia, Bulgaria
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dimo Yankov
- Department of Neurosurgery, Medical University of Sofia, Sofia, Bulgaria
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
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Farooque M. Specific and Nonspecific Low Back Pain-Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist. Spine J 2023:S1529-9430(23)00170-5. [PMID: 37116719 DOI: 10.1016/j.spinee.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mustafa Farooque
- Department of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Suite 310, Milwaukee, WI.
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Alomari S, Judy B, Sacino AN, Porras JL, Tang A, Sciubba D, Witham T, Theodore N, Bydon A. Isthmic spondylolisthesis in adults… A review of the current literature. J Clin Neurosci 2022; 101:124-130. [PMID: 35597059 DOI: 10.1016/j.jocn.2022.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/30/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
Isthmic spondylolisthesis can be defined as the anterior translation of a vertebral body relative to the one subjacent to it and secondary to an abnormality of the pars interarticularis. Isthmic spondylolisthesis is usually asymptomatic and discovered as an incidental radiographic finding. However, it can be symptomatic due to its biomechanical effects on the adjacent neural structures and patients may present with low back and/or radicular leg pain. Standing plain radiographs can be obtained to confirm the presence or assess the degree of isthmic spondylolisthesis. Computed tomography (CT) clearly shows the pars defect and provides a better assessment of the pathology. Magnetic resonance imaging (MRI) is indicated in patients with neurologic manifestations and can be used to assess the degree of foraminal or central stenosis. Conservative management including oral anti-inflammatory medication, physical therapy, and/or transforaminal epidural corticosteroid injections can be utilized initially. Surgery can be considered in the setting of persistent symptoms unrelieved with conservative management or significant neurologic compromise. Several surgical methods and techniques are available in the management of isthmic spondylolisthesis. There has been a significant national increase in the use of interbody fusion posteriorly for the management of isthmic spondylolisthesis. Reports have suggested that interbody fusion can be a cost-effective technique in selected patients with isthmic spondylolisthesis. Future studies are encouraged to further characterize the specific indications of various surgical modalities in patients with isthmic spondylolisthesis.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda N Sacino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony Tang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Identifying Acute Lumbar Spondylolysis in Young Athletes with Low Back Pain: Retrospective Classification and Regression Tree Analysis. Spine (Phila Pa 1976) 2021; 46:E1292. [PMID: 34747911 DOI: 10.1097/brs.0000000000004236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Inculet C, Urquhart JC, Rasoulinejad P, Hall H, Fisher C, Attabib N, Thomas K, Ahn H, Johnson M, Glennie A, Nataraj A, Christie SD, Stratton A, Yee A, Manson N, Paquet J, Rampersaud YR, Bailey CS. Factors associated with using an interbody fusion device for low-grade lumbar degenerative versus isthmic spondylolisthesis: a retrospective cohort study. J Neurosurg Spine 2021; 35:299-307. [PMID: 34214985 DOI: 10.3171/2020.11.spine201261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many studies have utilized a combined cohort of patients with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) to evaluate indications and outcomes. Intuitively, these are very different populations, and rates, indications, and outcomes may differ. The goal of this study was to compare specific patient characteristics associated with the utilization of a posterior lumbar interbody device between cohorts of patients with DS and IS, as well as to compare rates of interbody device use and patient-rated outcomes at 1 year after surgical treatment. METHODS The authors included patients who underwent posterior lumbar interbody fusion or instrumented posterolateral fusion for grade I or II DS or IS and had been enrolled in the Canadian Spine Outcomes and Research Network registry from 2009 to 2016. The outcome measures were score on the Oswestry Disability Index, scores for back pain and leg pain on the numeric rating scale, and mental component summary (MCS) score and physical component summary score on the 12-Item Short-Form Health Survey. Descriptive statistics were used to compare spondylolisthesis groups, logistic regression was used to compare interbody device use, and the chi-square test was used to compare the proportions of patients who achieved a minimal clinically important difference (MCID) at 1 year after surgery. RESULTS In total, 119 patients had IS and 339 had DS. Patients with DS were more commonly women, older, less likely to smoke, and more likely to have neurogenic claudication and comorbidities, whereas patients with IS more commonly had radicular pain, neurological deficits, and worse back pain. Spondylolisthesis was more common at the L4-5 level in patients with DS and at the L5-S1 level in patients with IS. Similar proportions of patients had an interbody device (78.6% of patients with DS vs 82.4% of patients with IS, p = 0.429). Among patients with IS, factors associated with interbody device utilization were BMI ≥ 30 kg/m2 and increased baseline leg pain intensity. Factors associated with interbody device utilization in patients with DS were younger age, increased number of total comorbidities, and lower baseline MCS score. For each outcome measure, similar proportions of patients in the surgical treatment and spondylolisthesis groups achieved the MCID at 1 year after surgery. CONCLUSIONS Although the demographic and patient characteristics associated with interbody device utilization differed between cohorts, similar proportions of patients attained clinically meaningful improvement at 1 year after surgery.
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Affiliation(s)
- Clayton Inculet
- 1Division of Orthopaedics, Department of Surgery, Western University/London Health Sciences Centre, London, Ontario
| | | | - Parham Rasoulinejad
- 1Division of Orthopaedics, Department of Surgery, Western University/London Health Sciences Centre, London, Ontario
- 2Lawson Health Research Institute, London, Ontario
| | - Hamilton Hall
- 3Department of Surgery, University of Toronto, Ontario
| | - Charles Fisher
- 4Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | - Najmedden Attabib
- 5Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick
| | | | - Henry Ahn
- 3Department of Surgery, University of Toronto, Ontario
| | - Michael Johnson
- 7Department of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba
| | - Andrew Glennie
- 8Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, Nova Scotia
| | - Andrew Nataraj
- 11Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sean D Christie
- 8Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, Nova Scotia
| | | | - Albert Yee
- 3Department of Surgery, University of Toronto, Ontario
| | - Neil Manson
- 5Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick
| | - Jérôme Paquet
- 10Department of Surgery, Laval University, Quebec City, Quebec; and
| | | | - Christopher S Bailey
- 1Division of Orthopaedics, Department of Surgery, Western University/London Health Sciences Centre, London, Ontario
- 2Lawson Health Research Institute, London, Ontario
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Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother 2021; 11:19. [PMID: 34372944 PMCID: PMC8351422 DOI: 10.1186/s40945-021-00113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures. PURPOSE AND IMPORTANCE TO PRACTICE The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations. CLINICAL IMPLICATIONS This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions. FUTURE RESEARCH PRIORITIES Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrew A. Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA 22030 USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
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Bonfim IDS, Corrêa LA, Nogueira LAC, Meziat-Filho N, Reis FJJ, de Almeida RS. 'Your spine is so worn out' - the influence of clinical diagnosis on beliefs in patients with non-specific chronic low back pain - a qualitative study'. Braz J Phys Ther 2021; 25:811-818. [PMID: 34348864 DOI: 10.1016/j.bjpt.2021.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/27/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients' beliefs have an important influence on the clinical management of low back pain and healthcare professionals should be prepared to address these beliefs. There is still a gap in the literature about the influence of patients' perceptions of their clinical diagnosis on the severity of their pain experience and disability. OBJECTIVES To identify the perceptions of patients with chronic non-specific low back pain regarding the influence of their clinical diagnosis on pain, beliefs, and daily life activities. METHODS Qualitative study of 70 individuals with chronic non-specific low back pain. A semi structured interview was conducted about patients' beliefs and perceptions regarding the influence of clinical diagnosis on their daily activities and pain intensity. RESULTS Most participants believed that higher number of different clinical diagnoses for the same individual may be associated with high pain intensity and disability for daily activities and that pain and injury are directly related. Patients beliefs were grouped into four main themes: (1) pain has multifactorial explanation in physical dimension; (2) improvement expectation is extremely low in patients with chronic pain; (3) clinical diagnosis influences pain and disability levels; (4) clinical diagnosis is extremely valued by patients. CONCLUSIONS Patients believe that there is a strong relationship between structural changes in the lower back, pain, and daily life activities; thus, providing evidence of a strong influence of the biomedical model on their beliefs.
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Affiliation(s)
- Igor da Silva Bonfim
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil.
| | - Leticia Amaral Corrêa
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Leandro Alberto Calazans Nogueira
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil; Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil
| | - Ney Meziat-Filho
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil
| | - Felipe José Jandre Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil; Postgraduation Programme in Medical Sciences, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Renato Santos de Almeida
- Post Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil; Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, Brazil
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Oshima Y, Inanami H, Iwai H, Koga H, Takano Y, Oshina M, Oka H, Tanaka S. Is Microendoscopic Discectomy Effective for Patients With Concomitant Lumbar Disc Herniation and Spondylolysis? Global Spine J 2020; 10:700-705. [PMID: 32707024 PMCID: PMC7383789 DOI: 10.1177/2192568219868970] [Citation(s) in RCA: 4] [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] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE Although it is controversial whether to choose only discectomy or fusion surgery in patients with disc herniation and spondylolysis, we expected that aggravation of the spondylolysis may be prevented if posterior supporting muscles can be well-preserved without extensive exploration. The purpose of this study was to investigate the influence of L5 spondylolysis on surgical outcomes following microendoscopic discectomy (MED) in patients with concomitant lumbar disc herniation and spondylolysis. METHODS We reviewed 811 patients who underwent MED for L4/5 or L5/S1 disc herniation. Patients with spondylolisthesis were excluded. We compared surgical outcomes of patients with and without L5 spondylolysis, whose age, sex, and surgical level were matched. RESULTS A total of 655 patients (80.7%) with complete data were considered eligible for the study. MED was performed at L4/5 and L5/S1 in 338 and 317 patients, respectively. A total of 20 patients (3.1%) had concomitant L5 spondylolysis and disc herniation at L4/5 (9 patients) or L5S1 (11 patients). As we compared each outcome of the 20 patients having L5 spondylolysis with 40 matched patients without L5 spondylosis, there were no significant differences in preoperative or postoperative outcomes between the 2 groups, and no patient with spondylolysis had undergone additional surgery during the mean follow-up period of 24 months. CONCLUSIONS MED demonstrated good surgical results regardless of the presence or absence of spondylolysis. In patients with sciatica with concomitant disc herniation and spondylolysis, but without spondylolisthesis, fusion surgery may not be always necessary.
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Affiliation(s)
- Yasushi Oshima
- The University of Tokyo, Tokyo, Japan
- Yasushi Oshima, Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | | | - Hiroki Iwai
- Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | | | | | | | - Hiroyuki Oka
- 22nd Century Medical & Research Center, The University of Tokyo, Tokyo, Japan
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Guan F, Yin H, Zhu L, Zhang Z, Gao Q, Shao T, Tang W, Guan G, Chen M, Chi Z, Gu J, Yu Z. Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study. J Int Med Res 2019; 48:300060519890791. [PMID: 31852286 PMCID: PMC7607220 DOI: 10.1177/0300060519890791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the risk factors of postoperative low back pain (LBP)
following posterior lumbar interbody fusion (PLIF) surgery for low-grade
isthmic spondylolisthesis (IS). Methods This retrospective study enrolled patients with IS that underwent PLIF
between January 2011 and January 2016. Demographic, clinical, surgical and
radiological characteristics were analysed to determine associations between
these characteristics and LBP as measured using a visual analogue scale
(VAS) pain score. Results A total of 192 patients were enrolled in the study. The mean VAS pain score
of LBP decreased significantly after surgery. The mean preoperative VAS pain
score was significantly greater in patients with symptoms of ≤3 years
duration compared with those with symptoms lasting >3 years. The
postoperative VAS pain score was significantly lower in patients with grade
1 slippage compared with those with grade 2 slippage. There was a
significant correlation between preoperative to postoperative change of VAS
pain score and postoperative disc height (r = 0.99). Conclusion PLIF significantly improved LBP in patients with low-grade IS, although
patients still reported some postoperative LBP. The grade of slippage was a
risk factor for postoperative LBP. Restoring the disc height appeared to
improve LBP.
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Affiliation(s)
- Fulin Guan
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Hongna Yin
- Department of Rehabilitation, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjaing Province, China.,Department of Acupuncture, Heilongjiang University of Chinese Medicine, Harbin, Heilongjaing Province, China
| | - Lin Zhu
- Department of Epidemiology, Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Zhizhuang Zhang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Qichang Gao
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Tuo Shao
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Weilong Tang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Guofa Guan
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Ming Chen
- Department of Rehabilitation, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Zhiyong Chi
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Jiaao Gu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Zhange Yu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
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Ferrari S, Striano R, Lucking E, Pillastrini P, Monticone M, Vanti C. Does the awareness of having a lumbar spondylolisthesis influence self-efficacy and kinesiophobia? A retrospective analysis. Arch Physiother 2019; 9:16. [PMID: 31890291 PMCID: PMC6913011 DOI: 10.1186/s40945-019-0070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/15/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High pain self-efficacy and low kinesiophobia seem related to a better prognosis in patients complaining of low back pain (LBP). The literature stresses the potential negative effects of anatomical defect diagnosis (e.g. lumbar spondylolisthesis) on the psychological profile. The aim of this study is to investigate the relationships between awareness of having a spondylolisthesis, pain self-efficacy and kinesiophobia. METHODS A secondary retrospective analysis was done. Ninety-eight subjects with subacute and chronic LBP were included: 49 subjects with diagnosed symptomatic lumbar spondylolisthesis and 49 subjects with diagnosed non-specific LBP. The pain self-efficacy measured with the Pain Self-Efficacy Questionnaire and the fear of movement measured with the Tampa Scale of Kinesiophobia were considered variables to investigate, whereas diagnosis and demographic/clinical variables were considered predictors or potential confounders. RESULTS By comparing the two groups, the awareness of having a spondylolisthesis did not significantly influence neither pain self-efficacy (p = 0.82), nor kinesiophobia (p = 0.75). Higher perceived pain reduces pain self-efficacy and increases kinesiophobia in both groups (p = 0.002 and p = 0,031 respectively). CONCLUSIONS It seems that the awareness of an anatomical defect as spondylolisthesis does not significantly affect the beliefs of carry out activities and movements despite the pain. Other studies with wider samples are required, to confirm these preliminary results.
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Affiliation(s)
- Silvano Ferrari
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Rosa Striano
- Progetto Persona Onlus, Korian Group, Milan, Italy
| | | | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Li P, Zhao Z, Jia N, Wang L, Sun Z, Jin X. A ball-slide-type interbody distractor is effective in posterior reduction and internal fixation for patients with mid- to high-grade isthmic spondylolisthesis enrolled in a randomized clinical trial. Medicine (Baltimore) 2019; 98:e17947. [PMID: 31764794 PMCID: PMC6882592 DOI: 10.1097/md.0000000000017947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Clinical and radiographic results of a randomized, controlled, double-blind clinical trial OBJECTIVE:: To investigate the clinical applicability of a ball-point slide-type interbody distractor in posterior reduction and internal fixation for mid- to high-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA Posterior reduction and internal fixation is the effective treatment for spondylolisthesis. However, for the mid and high-grade isthmic spondylolisthesis patients with the conditions of vertebral osteoporosis and extremely narrow intervertebral space, the reduction is difficult; post-surgery intervertebral space height lost becomes serious; the fracture and loosening rate of fixation system is higher. No study regarding the prevention of these adverse outcomes in this technique is reported. METHODS A total of 59 patients of mid and high-grade isthmic spondylolisthesis were randomly divided into random groups (investigational group and control group) applying simple randomized method in this study. In addition, 30 patients received posterior reduction and internal fixation as control. Twenty-nine patients received posterior reduction and internal fixation by ball-point slide-type interbody distractor were assigned to the investigational group. X-ray examination was performed before and after operation. The degree of reduction, height of intervertebral space were compared. The preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated. Additionally, rate of the fixation system fracture was also assessed. RESULTS Before treatment, there were no significant differences in ISH (P = .72), DR (P = .85), VAS of back pain (P = .55), VAS of leg pain (P = .83) and ODI (P = .68) were found between 2 groups. After 12-month treatment, there were no significant differences in ISH (P = .26), VAS of back pain (P = .09) and VAS of leg pain (P = .96) between two groups. Significant differences of DR (P = .02), ODI (P = .03) and adverse events (P = .00) were found between 2 groups. CONCLUSIONS The results of this prospectively study showed that the ball-point slide-type interbody distractor in the posterior reduction and internal fixation produced good outcomes after 12-month treatment. More high quality randomized controlled trials and cases should still be needed to warrant the results of this study.
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Affiliation(s)
- Pengfei Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang
- Department of Orthopaedics, Harrison International Peace Hospital of Hebei Medical University, Hengshui
| | - Zongmao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang
- Neuroscience Research Center, Hebei Medical University, Shijiazhuang
| | - Nan Jia
- Department of Orthopaedics, Harrison International Peace Hospital of Hebei Medical University, Hengshui
| | - Litao Wang
- Department of Orthopaedics, Harrison International Peace Hospital of Hebei Medical University, Hengshui
| | - Zhaosheng Sun
- Department of Neurosurgery, Harrison International Peace Hospital of Hebei Medical University, Hengshui, Hebei, China
| | - Xianhui Jin
- Department of Orthopaedics, Harrison International Peace Hospital of Hebei Medical University, Hengshui
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Fatty Infiltrate of the Lumbar Multifidus Muscles Predicts Return to Play in Young Athletes With Extension-Based Low Back Pain. Clin J Sport Med 2019; 29:37-42. [PMID: 28817410 DOI: 10.1097/jsm.0000000000000483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the predictive value of fatty infiltrate of the lumbar multifidus muscles (LMM) for return to play in young athletes with extension-based low back pain (EB LBP). DESIGN Retrospective cohort study. SETTING Hospital-based sports medicine practice. PATIENTS Sixty-two athletes, 61.3% female, and 38.7% male, mean age 14.8 years, with a primary complaint of EB LBP who underwent magnetic resonance imaging (MRI); 46.8% had a pars interarticularis stress reaction or fracture and 53.2% were MRI negative. INTERVENTIONS A musculoskeletal fellowship-trained radiologist reviewed MRI for all subjects and graded the degree of fatty infiltrate of the LMM, using the Goutallier classification system (GCS), at the L4/L5 and L5/S1 levels. MAIN OUTCOME MEASURE Days to return to play after first MD visit were correlated with the amount of fatty infiltrate in the LMM measured on MRI for each subject. RESULTS When the level of fatty infiltrate increased to a 2 or 3 on the GCS (greater than fatty streaks in the muscle), the predicted probability of return to sport decreased significantly. CONCLUSION Our study demonstrated that athletes with EB LBP and fatty infiltrate in the LMM had lower odds of return to sport compared with athletes with normal muscle. LEVEL OF EVIDENCE II B. CLINICAL RELEVANCE This study provides sports medicine clinicians with a prognostic tool to help manage young athletes with EB LBP. Clinicians can make decisions regarding rehabilitation and return to play based on MRI findings.
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Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018; 26:48. [PMID: 30479744 PMCID: PMC6247638 DOI: 10.1186/s12998-018-0217-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.
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Affiliation(s)
- Hazel J Jenkins
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Aron S Downie
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Craig S Moore
- 2Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Simon D French
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.,3School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
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Legaye J. Radiographic analysis of the listhesis associated with lumbar isthmic spondylolysis. Orthop Traumatol Surg Res 2018; 104:569-573. [PMID: 29807187 DOI: 10.1016/j.otsr.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/03/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In cases of spondylolysis, hypoplasia of L5 mimicking spondylolisthesis has been described, mainly based on MRI; however, the treatment implications have not been analyzed specifically. OBJECTIVE Assess the impact of hypoplasia of the L5 vertebral body in the constitution of the spondylolisthesis associated with isthmic spondylolysis. MATERIAL AND METHODS A retrospective radiographic study in the standing position was performed with 104 patients with L5 isthmic spondylolysis and 24 control subjects. RESULTS Measurements of vertebral endplate length showed that the standard apparent posterior listhesis (APL) is made up of true listhesis (TL) and false listhesis (FL). FL is induced by hypoplasia of the L5 vertebral body relative to the S1 endplate. TL results from disk failure and leads to anterior listhesis (AL), which alters the balance of spinal curvatures. CONCLUSIONS By integrating the potential for false listhesis into the classification systems for spondylolisthesis, we can adapt the treatment algorithms. TYPE OF STUDY Retrospective radiography study. LEVEL OF EVIDENCE IV Retrospective review of cases.
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Affiliation(s)
- Jean Legaye
- Département de chirurgie orthopédique, hôpital universitaire UCL Mont-Godinne, 5530 Yvoir, Belgium.
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Winslow JJ, Jackson M, Getzin A, Costello M. Rehabilitation of a Young Athlete With Extension-Based Low Back Pain Addressing Motor-Control Impairments and Central Sensitization. J Athl Train 2018; 53:168-173. [PMID: 29350556 DOI: 10.4085/1062-6050-238-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the conservative management of a young athlete with extension-based (EB) low back pain (LBP). BACKGROUND We present the case of a 15-year-old female high school gymnast with a 4-year history of EB LBP. Magnetic resonance imaging revealed a healed spondylolysis and significant atrophy with fatty infiltrate of the lumbar multifidi muscles (LMM). She had several courses of outpatient orthopaedic rehabilitation that focused on core muscle strengthening (improving activation and strength of the LMM and transversus abdominus muscle in a neutral pelvic position) without long-lasting improvement. She was unable to tolerate higher levels of training or compete. DIFFERENTIAL DIAGNOSIS The LMM are rich in muscle spindles and provide continuous feedback to the central nervous system about body position. Atrophy and fatty infiltrate of the LMM can compromise neuromuscular function and contribute to dysfunctional movement patterns that place a greater demand on lumbar spine structures. Ongoing motor-control impairments perpetuate nociceptive input, leading to central sensitization. TREATMENT The athlete had difficulty controlling trunk extension during sport-specific activities; she moved early and to a greater extent in the lumbar spine. The aim of the treatment was to teach the athlete how to control her tendency to overload her lumbar spine when bending backward, thus reducing nociceptive input from lumbar spine structures and desensitizing the nervous system. UNIQUENESS Treating EB LBP by addressing motor-control impairments and cognitive-affective factors as opposed to core strengthening. CONCLUSIONS Activity modification, bracing, and traditional core-strengthening exercises may not be the most appropriate treatment for athletes experiencing EB LBP. Addressing cognitive-affective factors in addition to correcting maladaptive motor behavior and moving in a pain-free range reduces nociceptive input, desensitizes the nervous system, and allows athletes to gain control over their pain.
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Endler P, Ekman P, Möller H, Gerdhem P. Outcomes of Posterolateral Fusion with and without Instrumentation and of Interbody Fusion for Isthmic Spondylolisthesis: A Prospective Study. J Bone Joint Surg Am 2017; 99:743-752. [PMID: 28463918 DOI: 10.2106/jbjs.16.00679] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various methods for the treatment of isthmic spondylolisthesis are available. The aim of this study was to compare outcomes after posterolateral fusion without instrumentation, posterolateral fusion with instrumentation, and interbody fusion. METHODS The Swedish Spine Register was used to identify 765 patients who had been operated on for isthmic spondylolisthesis and had at least preoperative and 2-year outcome data; 586 of them had longer follow-up (a mean of 6.9 years). The outcome measures were a global assessment of leg and back pain, the Oswestry Disability Index (ODI), the EuroQol-5 Dimensions (EQ-5D) Questionnaire, the Short Form-36 (SF-36), a visual analog scale (VAS) for back and leg pain, and satisfaction with treatment. Data on additional lumbar spine surgery was searched for in the register, with the mean duration of follow-up for this variable being 10.6 years after the index procedure. Statistical analyses were performed with analysis of covariance or competing-risks proportional hazards regression, adjusted for baseline differences in the studied variables, smoking, employment status, and level of fusion. RESULTS Posterolateral fusion without instrumentation was performed in 102 patients; posterolateral fusion with instrumentation, in 452; and interbody fusion, in 211. At 1 year, improvement was reported in the global assessment for back pain by 54% of the patients who had posterolateral fusion without instrumentation, 68% of those treated with posterolateral fusion with instrumentation, and 70% of those treated with interbody fusion (p = 0.009). The VAS for back pain and reported satisfaction with treatment showed similar patterns (p = 0.003 and p = 0.017, respectively), whereas other outcomes did not differ among the treatment groups at 1 year. At 2 years, the global assessment for back pain indicated improvement in 57% of the patients who had undergone posterolateral fusion without instrumentation, 70% of those who had posterolateral fusion with instrumentation, and 71% of those treated with interbody fusion (p = 0.022). There were no significant outcome differences at the mean 6.9-year follow-up interval. There was an increased hazard ratio for additional lumbar spine surgery after interbody fusion (4.34; 95% confidence interval [CI] = 1.71 to 11.03) and posterolateral fusion with instrumentation (2.56; 95% CI = 1.02 to 6.42) compared with after posterolateral fusion without instrumentation (1.00; reference). CONCLUSIONS Fusion with instrumentation, with or without interbody fusion, was associated with more improvement in back pain scores and higher satisfaction with treatment compared with fusion without instrumentation at 1 year, but the difference was attenuated with longer follow-up. Fusion with instrumentation was associated with a significantly higher risk of additional spine surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter Endler
- 1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden 2Department of Clinical Sciences, Karolinska Institutet, Södersjukhuset, and Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden
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Lumbar Spondylolisthesis Progression and De Novo Spondylolisthesis in Elderly Chinese Men and Women: A Year-4 Follow-up Study. Spine (Phila Pa 1976) 2016; 41:1096-1103. [PMID: 26890951 DOI: 10.1097/brs.0000000000001507] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal follow-up study. OBJECTIVE This current study aimed to further assess progression, incidence, and risk factors of lumbar spondylolisthesis in these subjects at 4-year follow-up. SUMMARY OF BACKGROUND DATA A survey for osteoporotic fractures in Hong Kong during 2001 to 2003 represented the first large scale prospective population-based study on bone health in elderly (≥65 years) Chinese men and women. A follow-up study was performed at year-4. METHODS The lateral lumbar radiographs of 1519 male and 1546 female subjects at year-4 follow-up were analyzed using the Meyerding classification, and compared with the baseline findings. RESULTS Spondylolisthesis progressed in 13.0%, and de novo spondylolisthesis appeared in 12.4% in men. Spondylolisthesis progressed in 16.5%, and de novo spondylolisthesis appeared in 12.7% in women. In women, higher weight, body mass index, spine and hip bone mineral density (BMD), lower physical activity and lower grip strength were significant factors associated with spondylolisthesis progression, whereas only higher spine BMD was a marginally significant factor associated with spondylolisthesis progression for men. A weak association was noted between spondylolisthesis and lower back pain incidence in women, but not in men. CONCLUSION Lumbar spondylolisthesis progression in elderly Chinese at 4-year follow-up was characterized by this study. LEVEL OF EVIDENCE 3.
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European spine journal review: a survey of the "surgical and research" articles in the European spine journal, 2015. 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; 25:24-33. [PMID: 26733016 DOI: 10.1007/s00586-015-4334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 12/26/2022]
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Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "medical" articles in the European Spine Journal, 2015. 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; 25:14-23. [PMID: 26596729 DOI: 10.1007/s00586-015-4322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/08/2015] [Accepted: 11/08/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France.
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