The impact of generalized joint laxity on the clinical and radiological outcomes of single-level posterior lumbar interbody fusion

Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation: A retrospective study

The aim of this study is to observe the therapeutic effect of percutaneous endoscopic discectomy and its influencing factors for lumbar disc herniation and compare the advantages and disadvantages of transforaminal and interlaminar of percutaneous endoscopy.Data from 143 patients with lumbar disc herniation were respectively collected, including demographic and clinical data. Study population were divided into curative effect group and poor curative effect group, and logistic regression was used to explore the influencing factors of curative effect. The operation data and pre-and post-operation scores were compared to explore the effect of transforaminal and interlaminar approach on surgery efficacy.The rate of curative effect was 93.7%. 120 patients were classified as curative group and 23 patients were categorized as poor effective group. Univariate analysis found that the patients in the curative effect group tended to receive the interlaminar approach (58.3% vs 34.8%, P = .038). Multivariate logistic regression did not find operation approach was not related to curative effect of operation (transforaminal and interlaminar). But age ≥45 (odd risk (OR) = 6.43, P = .016), course of disease >12 month (OR = 3.77, P = .003), back and leg pain (OR = 3.46, P = .026), history of trauma (OR = 3.88, P = .014), Pfirrmann level IV (OR = 4.84, P = .004), and pre-Visual Analogue Scale (VAS) <5.3 (OR = 3.63, P = .015) were associated with operation efficacy. Compared with transforaminal group, the interlaminar group has less operative time (P = .000), less fluoroscopy time (P = .000), less puncture time (P = .000), less blood loss (P = .011).The transforaminal or interlaminar did not affect the treatment efficacy of percutaneous endoscopic discectomy for lumbar disc herniation. The selection of surgery approach depended on anatomical structure and physiological characteristics. It should be noted that 45 years of age or older, in the course of more than 12 months, both lumbocrural pain and lumbar disc herniation with grade IV, with history of trauma, may have impact on the efficacy of surgery.

The Impact of L5 Sacralization on Fusion Rates and Clinical Outcomes After Single-level Posterior Lumbar Interbody Fusion (PLIF) at L4-L5 Level

STUDY DESIGN

Retrospective review of prospectively collected data.

OBJECTIVE

To determine the impact of L5 sacralization on fusion rates and clinical outcomes after single-level posterior lumbar interbody fusion (PLIF) surgery at the L4-L5 level.

SUMMARY OF BACKGROUND DATA

L5 sacralization can produce greater stress concentration at the adjacent segment (L4-L5); therefore, L4-L5 PLIF surgery in patients with L5 sacralization may negatively affect fusion rate and be associated with poor clinical outcomes. However, no study has examined the impact of L5 sacralization on fusion rates and clinical outcomes of patients who undergo L4-L5 PLIF surgery.

MATERIALS AND METHODS

Of 153 patients who underwent L4-L5 PLIF, data of 145 who met the study criteria were retrospectively reviewed. Among them, 31 patients had L5 sacralization (group A), whereas the remaining 114 patients did not (group B). The primary study endpoint was fusion rate evaluated using dynamic radiographs and computed tomographic scans. Secondary endpoints included (1) pain intensity in the lower back and radiating to the lower extremities on the visual analog scale; (2) clinical outcomes assessed using the Oswestry Disability Index and 12-item Short Form Health Survey; (3) surgical outcomes; and (4) complications.

RESULTS

Fusion rate evaluated using dynamic radiographs and computed tomographic scans at 6 months after surgery did not differ significantly between patients with and without sacralization (P=0.70 and 0.81, respectively), whereas fusion rate at 1 year after surgery did (P=0.04 and 0.04, respectively). In particular, patients with type II or III L5 sacralization had significantly lower fusion rates than those with other types of or no L5 sacralization. Pain intensity, clinical and surgical outcomes, and complications did not differ significantly between groups.

CONCLUSIONS

Patients with type II or III L5 sacralization may have worse fusion rates after L4-L5 PLIF surgery than those with type I or no sacralization.

Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation

Objectives:

Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach.

Materials and Methods:

From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient's Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films.

Results:

The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases.

Conclusion:

The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

The impact of generalized joint laxity (GJL) on the posterior neck pain, cervical disc herniation, and cervical disc degeneration in the cervical spine

BACKGROUND CONTEXT

Generalized joint laxity (GJL) can have a negative impact on lumbar spine pathology, including low back pain, disc degeneration, and disc herniation, but the relationship between GJL and cervical spine conditions remains unknown.

PURPOSE

To investigate the relationship between GJL and cervical spine conditions, including the prevalence of posterior neck pain (PNP), cervical disc herniation (CDH), and cervical disc degeneration (CDD), in a young, active population.

STUDY DESIGN

Retrospective 1:2 matched cohort (case-control) study from prospectively collected data PATIENT SAMPLE: Of a total of 1853 individuals reviewed, 73 individuals with GJL (study group, gruop A) and 146 without GJL (control group, Group B) were included in the study according to a 1:2 case-control matched design for age, sex, and body mass index.

OUTCOME MEASURE

The primary outcome measure was the prevalence and intensity of PNP at enrollment based on a visual analogue scale score for pain. The secondary outcome measures were (1) clinical outcomes as measured with the neck disability index (NDI) and 12-item short form health survey (SF-12) at enrollment, and (2) radiological outcomes of CDH and CDD at enrollment.

METHODS

We compared baseline data between groups. Descriptive statistical analyses were performed to compare the 2 groups in terms of the outcome measures.

RESULTS

The prevalence and intensity of PNP were significantly greater in group A (patients with GJL) than in group B (patients without GJL) (prevalence: p=.02; intensity: p=.001). Clinical outcomes as measured with NDI and SF-12 did not differ significantly between groups. For radiologic outcomes, the prevalence of CDD was significantly greater in group A than in group B (p=.04), whereas the prevalence of CDH did not differ significantly between groups (p=.91).

CONCLUSIONS

The current study revealed that GJL was closely related to the prevalence and intensity of PNP, suggesting that GJL may be a causative factor for PNP. In addition, GJL may contribute to the occurrence of CDD, but not CDH. Spine surgeons should screen for GJL in patientswith PNP and inform patients of its potential negative impact on disc degeneration of the cervical spine.