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Ma M, Ma G, Zhang C, Wang Y, He X, Kang X. Identification of Autophagy-Related Genes Involved in Intervertebral Disc Degeneration by Microarray Data Analysis. World Neurosurg 2024; 188:e1-e17. [PMID: 38782255 DOI: 10.1016/j.wneu.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND Nucleus pulposus cells survive in a hypoxic, acidic, nutrient-poor, and hypotonic microenvironment. Consequently, they maintain low proliferation and undergo autophagy to protect themselves from cellular stress. Therefore, we aimed to identify autophagy-related biomarkers involved in intervertebral disc degeneration pathogenesis. METHODS Autophagy-related differentially expressed genes were derived from the intersection between the public GSE147383 microarray data set to identify differentially expressed genes and online databases to identify autophagy-related genes. Furthermore, we assessed their biological functions with gene annotation and enrichment analysis in the Metscape portal. Then, the STRING database and Cytoscape software allowed inferring a protein-protein interaction (PPI) network and identifying hub genes. In addition, to predict transcription factors that may regulate the hub genes, we used the GeneMANIA website. Finally, the competing endogenous RNA prediction tools and Cytoscape were also used to construct an mRNA-miRNA-lncRNA network. RESULTS A total of 123 autophagy-related differentially expressed genes were identified, they were mainly involved in phosphoinositide 3-kinase-Akt signaling, autophagy animal, and apoptosis pathways. Nine were identified as hub genes (PTEN, MYC, CTNNB1, JUN, BECN1, ERBB2, FOXO3, ATM, and FN1) and 36 transcription factors were associated with them. Finally, an autophagy-associated competing endogenous RNA network was constructed based on the 9 hub genes. CONCLUSIONS Nine hub genes were identified and a network of competing endogenous RNA associated with autophagy was established. They can be used as autophagy-related biomarkers of intervertebral disc degeneration and for further exploration.
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Affiliation(s)
- Miao Ma
- Department of Orthopedics, The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Guifu Ma
- Department of Orthopedics, Gansu Provincial People's Hospital, Lanzhou, China
| | - Chao Zhang
- Department of Orthopedics, Gansu Provincial People's Hospital, Lanzhou, China
| | - Yajun Wang
- Breast Department, Zhangye People's Hospital Affiliated to Hexi University, Zhangye, China
| | - Xuegang He
- Department of Orthopedics, The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuewen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China.
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2
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Kuo CC, Soliman MAR, Baig RA, Aguirre AO, Ruggiero N, Donnelly BM, Siddiqi M, Khan A, Quiceno E, Mullin JP, Pollina J. Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion. Neurosurgery 2024; 95:284-296. [PMID: 38334396 DOI: 10.1227/neu.0000000000002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVE With lumbar spine fusion being one of the most commonly performed spinal surgeries, investigating common complications such as adjacent segment disease (ASD) is a high priority. To the authors' knowledge, there are no previous studies investigating the utility of the preoperative magnetic resonance imaging-based vertebral bone quality (VBQ) score in predicting radiographic and surgical ASD after lumbar spine fusion. We aimed to investigate the predictive factors for radiographic and surgical ASD, focusing on the predictive potential of the VBQ score. METHODS A single-center retrospective analysis was conducted of all patients who underwent 1-3 level lumbar or lumbosacral interbody fusion for lumbar spine degenerative disease between 2014 and 2021 with a minimum 12 months of clinical and radiographic follow-up. Demographic data were collected, along with patient medical, and surgical data. Preoperative MRI was assessed in the included patients using the VBQ scoring system to identify whether radiographic ASD or surgical ASD could be predicted. RESULTS A total of 417 patients were identified (mean age, 59.8 ± 12.4 years; women, 54.0%). Eighty-two (19.7%) patients developed radiographic ASD, and 58 (13.9%) developed surgical ASD. A higher VBQ score was a significant predictor of radiographic ASD in univariate analysis (2.4 ± 0.5 vs 3.3 ± 0.4; P < .001) and multivariate analysis (odds ratio, 1.601; 95% CI, 1.453-1.763; P < .001). For surgical ASD, a significantly higher VBQ score was seen in univariate analysis (2.3 ± 0.5 vs 3.3 ± 0.4; P < .001) and served as an independent risk factor in multivariate analysis (odds ratio, 1.509; 95% CI, 1.324-1.720; P < .001). We also identified preoperative disk bulge and preoperative existence of adjacent segment disk degeneration to be significant predictors of both radiographic and surgical ASD. Furthermore, 3-level fusion was also a significant predictor for surgical ASD. CONCLUSION The VBQ scoring system might be a useful adjunct for predicting radiographic and surgical ASD.
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Affiliation(s)
- Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo , Egypt
| | - Rehman Ali Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Jeffrey P Mullin
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - John Pollina
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
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Shang Q, Luan H, Peng C, Song X. Comparative effectiveness of cortical bone trajectory screws and pedicle screws in the treatment of adjacent segment degeneration after lumbar fusion surgery: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:380. [PMID: 38943143 PMCID: PMC11212258 DOI: 10.1186/s13018-024-04865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. METHODS This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. RESULTS A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005]. CONCLUSION Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period.
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Affiliation(s)
- Qisong Shang
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Haopeng Luan
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Cong Peng
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Xinghua Song
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China.
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Li K, Cao S, Chen J, Qin J, Yuan B, Li J. Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis. BMC Musculoskelet Disord 2024; 25:197. [PMID: 38443904 PMCID: PMC10913564 DOI: 10.1186/s12891-024-07322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND A reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an ideal adjacent segment ROM to guide postoperative waist activities and further delay adjacent segment degeneration (ASD). METHODS An intact L1-S1 finite element model was constructed and validated. Based on this, a surgical model was created to allow the simulation of L4/5 transforaminal lumbar interbody fusion (TLIF). Under the maximum total L1-S1 ROM, the ROM, IDP, and FJF of each adjacent segment between the intact and TLIF models were compared to explore the biomechanical influence of lumbar fusion on adjacent segments. Subsequently, the functional relationship between total L1-S1 ROM and IDP or total L1-S1 ROM and FJF was fitted in the TLIF model to calculate the relative total L1-S1 ROMs without an increase in IDP and FJF. RESULTS Compared with those of the intact model, the ROM, IDP, and FJF of the adjacent segments in the TLIF model increased by 12.6-28.9%, 0.1-6.8%, and 0-134.2%, respectively. As the total L1-S1 ROM increased, the IDP and FJF of each adjacent segment increased by varying degrees. The relative total L1-S1 ROMs in the TLIF model were 11.03°, 12.50°, 12.14°, and 9.82° in flexion, extension, lateral bending, and axial rotation, respectively. CONCLUSIONS The relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.
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Affiliation(s)
- Ke Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, Shaanxi Province, 710004, China
| | - Shuai Cao
- Department of Orthopedics, Civil Aviation General Hospital, No. 1, Gaojing Stress, Chaoyang District, Beijing, 100123, China
| | - Jing Chen
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, Shaanxi Province, 710004, China
| | - Jie Qin
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, Shaanxi Province, 710004, China
| | - Bo Yuan
- Department of Orthopedics, Civil Aviation General Hospital, No. 1, Gaojing Stress, Chaoyang District, Beijing, 100123, China
| | - Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, Shaanxi Province, 710004, China.
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Song H, Guo C, Wu Y, Liu Y, Kong Q, Wang Y. Therapeutic factors and biomaterial-based delivery tools for degenerative intervertebral disc repair. Front Cell Dev Biol 2024; 12:1286222. [PMID: 38374895 PMCID: PMC10875104 DOI: 10.3389/fcell.2024.1286222] [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: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
Intervertebral disc degeneration (IDD) is the main cause of low back pain (LBP), which significantly impacts global wellbeing and contributes to global productivity declines. Conventional treatment approaches, encompassing conservative and surgical interventions, merely serve to postpone the advancement of IDD without offering a fundamental reversal. Consequently, there is an urgent demand for an effective approach to prevent the progression of IDD. Recent investigations focusing on the treatment of IDD utilizing diverse bioactive substances integrated within various biomaterials have exhibited promising outcomes. Various bioactive substances, encompassing conventional small molecule drugs, small molecule nucleic acids, and cell therapies, exhibit distinct capacities for repairing IDD. Additionally, various biological material delivery systems, such as nano micelles, microspheres, and hydrogels, possess diverse biological and release characteristics. Consequently, these diverse materials and drugs hold promise for advancing the treatment of IDD. This article aims to provide a concise overview of the IDD process and investigate the research advancements in biomaterials and bioactive substances for IDD treatment, delving into their mechanisms.
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Affiliation(s)
| | | | | | | | - Qingquan Kong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Dantas FL, Dantas F, Caires AC, Cariri GA, Fonseca Filho GA, Botelho RV. Adjacent segment degeneration after posterolateral lumbar fusion: results and complications of posterior revision surgery. J Neurosurg Sci 2023; 67:446-453. [PMID: 34114431 DOI: 10.23736/s0390-5616.21.05315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lumbar fusion is an important technique for the treatment of degenerative pathologies. Adjacent segment degeneration is a known complication after lumbar fusion that causes significant morbidity. Our objective was to evaluate the demographics, risk factors, type of surgery, and surgical complications in patients who underwent reoperation through a posterior route due to adjacent segment degeneration. METHODS We performed a retrospective analysis of all patients who underwent instrumented posterolateral fusion in the lumbar spine for the treatment of degenerative diseases from January 2000 to December 2015 at a single institution. Patients who developed symptomatic adjacent segment degeneration requiring a second surgery were noted and compared with patients who did not develop adjacent segment degeneration. RESULTS A total of 750 patients with degenerative pathologies who underwent fusion with instrumentation were identified. Forty-five patients (6%) required a second surgery for symptomatic adjacent segment degeneration. The average onset of adjacent segment degeneration symptoms after fusion was 5.89 years. Adjacent segment degeneration occurred above the level of fusion in 40 cases and below in 5 cases. The risk factor identified in our series was L5-S1 fusion. The main complication seen after the second surgery was infection in 5 cases (11%). CONCLUSIONS This study identifies the L5-S1 fusion as a possible risk factor for adjacent segment degeneration. Reoperation through a posterior route is a therapeutic option but is associated with considerable morbidity. Further studies are necessary to elucidate this pathology and the best options for its management.
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Affiliation(s)
- Fernando L Dantas
- Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil -
- Postgraduation in Health Sciences - IAMSPE, São Paulo, Brazil -
| | - François Dantas
- Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil
- Feluma Postgraduation Program, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
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Baranowska-Kijewska J, Baranowski P, Baranowska A, Jarzyński T, Rybarczyk M. Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease. Arch Med Sci 2023; 19:1154-1161. [PMID: 37560744 PMCID: PMC10408031 DOI: 10.5114/aoms/165859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction The number of reoperations increases with the growing number of operations performed. Methods The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. Results The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. Conclusions Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.
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Affiliation(s)
| | - Paweł Baranowski
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Alicja Baranowska
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Tobiasz Jarzyński
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Department of Descriptive and Clinical Anatomy, the Medical University of Warsaw, Warsaw, Poland
| | - Marek Rybarczyk
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
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Burrows KR, Henzell IS, Martin G, Chisholm CV, Carstens A, Hodgson BF. Long-term adjacent segment degeneration at average 21-year follow-up of posterior instrumented fusion for adolescent idiopathic scoliosis. Spine Deform 2023; 11:933-941. [PMID: 36807104 DOI: 10.1007/s43390-023-00652-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Posterior instrumented fusion for progressive adolescent idiopathic scoliosis (AIS) is generally considered to have good outcomes, but very long-term reviews are rare. Data on adjacent segment degeneration (ASD) following posterior instrumented thoracic fusion for AIS are lacking. The primary aim was to assess the incidence of ASD and to correlate this with radiographic measures and patient-reported outcome measures (PROMs). The secondary aim was to assess maintenance of curve correction at very long-term follow-up. METHODS This single-surgeon consecutive case series of 47 AIS patients was identified from a prospectively collated dataset. As the primary outcome, ASD was assessed radiographically using the Mimura grading system. Pulmonary function tests and PROMs were assessed along with secondary radiographic outcome measures. RESULTS Radiographic follow-up was achieved in 77% (36/47) of patients at an average of 21 years (range, 16.5-26.5 years) after surgery. Radiographic evidence of ASD was seen in 64%. PROMs showed a mean Oswestry disability index of 12.1% with an overall Scoliosis Research Society 22 score averaging at 3.7 out of 5. The Coronal Cobb Angle was corrected from an average of 57° preoperatively to 19° immediately postoperatively, deteriorating to 22° at final review, maintaining a 61% curve correction. CONCLUSIONS Radiographic evidence of ASD was found in 64% of the cohort. The patient-reported outcome measures were good, with few limitations to activities.
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Affiliation(s)
- Kenan R Burrows
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand.
| | - Isobella S Henzell
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Ginny Martin
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Carl V Chisholm
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Alan Carstens
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
- Mercy Hospital, 72 Newington Avenue, Maori Hill, Dunedin, 9010, New Zealand
| | - Bruce F Hodgson
- Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
- Mercy Hospital, 72 Newington Avenue, Maori Hill, Dunedin, 9010, New Zealand
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Stolzenberg D, Kitei PM, Tran D, Pfeifer R. Intracept technique at adjacent levels to fusions with pedicle screws. INTERVENTIONAL PAIN MEDICINE 2023; 2:100261. [PMID: 39238666 PMCID: PMC11372909 DOI: 10.1016/j.inpm.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 09/07/2024]
Affiliation(s)
- David Stolzenberg
- Department of Physical Medicine & Rehabilitation, Rothman Orthopaedic Institute, Philadelphia, PA, 19107, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Paul M Kitei
- Department of Physical Medicine & Rehabilitation, Rothman Orthopaedic Institute, Philadelphia, PA, 19107, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - David Tran
- Axion Spine and Neurosurgery, Alpharetta, GA, 30005, USA
| | - Ryan Pfeifer
- Department of Physical Medicine & Rehabilitation, Rothman Orthopaedic Institute, Philadelphia, PA, 19107, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Zhou LP, Zhang RJ, Wang JQ, Zhang HQ, Shang J, Gao Y, Jia CY, Ding JY, Zhang L, Shen CL. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg 2023; 23:46. [PMID: 36855117 PMCID: PMC9976523 DOI: 10.1186/s12893-023-01943-6] [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: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Dynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial. OBJECTIVE To compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years. METHODS We conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. RESULTS Seventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group. CONCLUSION DS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.
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Affiliation(s)
- Lu-Ping Zhou
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Ren-Jie Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jia-Qi Wang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Hua-Qing Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jin Shang
- grid.411395.b0000 0004 1757 0085Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, 107 Huanhudong Road, Hefei, 230031 Anhui China
| | - Yang Gao
- grid.488137.10000 0001 2267 2324Outpatient Department, The 55th Retired Cadres of the Beijing Garrison of PLA, 4 Wanshou Road, Beijing, 100036 China
| | - Chong-Yu Jia
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Jing-Yu Ding
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Lai Zhang
- grid.412679.f0000 0004 1771 3402Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China.
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Vargas E, Mummaneni PV, Rivera J, Kolluri K, Berven S, Chou D. Adjacent Segment Vertebral Body Bone Density Changes as Measured By Hounsfield Units After Lumbar Spine Fusion. World Neurosurg 2022; 167:e464-e468. [PMID: 35964902 DOI: 10.1016/j.wneu.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate Hounsfield units (HU) at the adjacent segment after single-level transforaminal lumbar interbody fusion (TLIF) with preoperative and postoperative computed tomography scans. METHODS We performed a retrospective study on a series of patients who underwent L4-5 TLIF, from 2007 to 2017, by 3 spine surgeons at our institution. One-hundred and forty-three total patients were identified, and 41 patients with minimum 1-year follow-up met inclusion criteria. HU values were measured on preoperative and postoperative computed tomography at the adjacent L3 segment and at L1 as a control arm. Lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and sagittal vertical axis were also collected preoperatively and postoperatively. RESULTS Mean preoperative HU value at L3 did not differ from the postoperative value (134.11 ± 47.14 mg/cm3 vs. 141.21 ± 55.14 mg/cm3, P = 0.34). Similarly, the mean preoperative HU value at the L1 control level region of interest did not differ from the postoperative value (150.17 ± 53.91 mg/cm3 vs. 145.78 ± 58.34 mg/cm3, P = 0.634). The interrater reliability of HU measurements was satisfactory with a resulting intraclass correlation coefficient of 0.76. CONCLUSIONS As measured by HU, we did not observe a change in bone density or other signs of adjacent segment disease at the L3 vertebral body 12 months after L4-5 TLIF. Spinopelvic parameters were not shown to be correlated with HU changes.
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Affiliation(s)
- Enrique Vargas
- Department of Neurosurgery, University of California, San Francisco, California, USA.
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Joshua Rivera
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Kamal Kolluri
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Sigurd Berven
- Department of Orthopedic Surgery, University of California, San Francisco, California, USA
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, California, USA
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12
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Zhang X, Shu S, Zhu Z, Gu Q, Liu Z, Qiu Y, Bao H. Proximal junctional kyphosis is a compensation for post-operative negative C2-FH in ASD patients: a cross-sectional study. J Orthop Surg Res 2022; 17:442. [PMID: 36207760 PMCID: PMC9547422 DOI: 10.1186/s13018-022-03336-6] [Citation(s) in RCA: 1] [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: 07/16/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies have found that C2-FH is close to 0 cm in both standing and sitting position for asymptomatic adults. We hypothesize that the thoracic spine may compensate with PJK when the immediate post-operative C2-FH was not ideally restored in adult spinal deformity (ASD). METHODS The inclusion criteria were as follows: ASD patients over 45 years old; Cobb angle > 30°; with posterior spinal correction surgery; at least 2 years follow-up. C2-FH was defined as the distance between the femoral heads to the C2 vertical line. All participants were divided into two groups according to the occurrence of PJK at the last follow-up: PJK group and non-PJK group. RESULTS 68 ASD patients, with a minimum follow-up of 2.5 years, were included. PJK was found in 24 patients (35.3%) while the rest 44 patients remained no sagittal malalignment. Immediately post-operative C2-FH showed significant difference between PJK group and non-PJK group (p = 0.015). However, at the last follow-up, C2-FH showed no significant difference between PJK and non-PJK group and the mean value of C2-FH in both groups was approximately - 1 cm, indicating that ASD patients could develop various compensatory mechanisms to maintain sagittal global balance. The AUC was 0.84 (95%CI 0.68-0.97), indicating the well effectiveness of ROC curve and cut-off value in predicting occurrence of PJK in ASD patients. Based on the ROC curve, the optimal cut-off value of C2-FH as indicators for occurrence of PJK was - 42.3 mm. CONCLUSION Immediate postoperative negative global malalignment (C2-FH < - 42.3 mm) may predict proximal junctional kyphosis in ASD patients. The normal value of C2-FH, - 1 cm, may be the target of global sagittal compensation, and PJK is a compensatory mechanism. TRIAL REGISTRATION 2021-LCYJ-DBZ-05, 2021.07, Retrospective study.
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Affiliation(s)
- Xin Zhang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shibin Shu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qi Gu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hongda Bao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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13
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Hood C, Zamani R, Akrami M. Impact of heterotopic ossification following lumbar total disk replacement: a systematic review. BMC Musculoskelet Disord 2022; 23:382. [PMID: 35461244 PMCID: PMC9034498 DOI: 10.1186/s12891-022-05322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND CONTEXT Lumbar total disc replacement (TDR) is an alternative to lumbar fusion in the treatment of lower back pain and reduces the risk of adjacent segment degeneration. Heterotopic ossification (HO) has been identified as a common complication following lumbar TDR. PURPOSE This systematic review aims to determine the prevalence, risk factors and clinical and radiological impact of HO following lumbar TDR. STUDY DESIGN Systematic Review. METHODS MEDLINE, Scopus, PubMed and Cochrane Central were searched for articles that referred to lumbar TDR and HO. The hits were assessed against inclusion and exclusion criteria. Data from each included study was extracted and analysed with respect to the study aims. RESULTS Twenty-six studies were included in this review and the pooled prevalence of HO was estimated to be between 13.2% (participants) and 15.3% (vertebral levels). TDR clinical outcomes were not found to be reduced by HO and there was insufficient data to identify a given impact upon radiological outcomes. Age and follow up time were identified as potential risk factors for HO. CONCLUSIONS This review was hampered by inconsistencies in the reporting of HO across the studies. We therefore recommend that a set of guidelines should be produced to aid future researchers and reduce the risk of bias.
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Affiliation(s)
- Colleen Hood
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Reza Zamani
- Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Mohammad Akrami
- Department of Engineering, University of Exeter, Exeter, UK.
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14
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P. Chu E, K. Lee L. Adjacent segment pathology of the cervical spine: A case report. J Family Med Prim Care 2022; 11:787-789. [PMID: 35360775 PMCID: PMC8963601 DOI: 10.4103/jfmpc.jfmpc_1380_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 11/25/2022] Open
Abstract
Adjacent segment pathology (ASP) refers to degenerative changes at segments immediately contiguous to previous spinal fusion. Its pathophysiology is hypothesized as being possibly due to altered biomechanical stresses on adjacent levels following spinal fusion or due to patient propensity to develop progressive degenerative change. This case report describes a 61-year-old female who presented with neck pain and cervical radiculopathy attributed to an anterior cervical discectomy and spinal fusion performed for degenerative disc disease 30 years earlier. ASP was seen on magnetic resonance imaging (MRI) and radiograph. Treatment consisted of cervical manipulation, soft-tissue mobilization, flexion-distraction decompression, and therapeutic ultrasound to release restriction and restore muscle strength. Following 34 sessions of chiropractic intervention, her symptoms were resolved. Patients with ASP will have ongoing shared care between general practitioners and secondary or tertiary care pain units. This report aims to build a shared understanding from the wider vision of ASP and help primary practitioners to manage ASP effectively.
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15
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A comparison of long-term efficacy of K-rod-assisted non-fusion operation and posterior lumbar interbody fusion for single-segmental lumbar disc herniation. J Clin Neurosci 2021; 95:1-8. [PMID: 34929631 DOI: 10.1016/j.jocn.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/15/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
K-rod-assisted non-fusion surgery for the treatment of lumbar disc herniation has been proven to have short-term clinical efficacy. Meanwhile, its long-term effects have not been examined. To observed the long-term clinical efficacy of K-rod-assisted non-fusion operation, this study retrospectively analyzed 22 patients with lumbar disc (L4/5) herniation who underwent K-rod-assisted non-fusion operation (n = 13) or PLIF (n = 9). They were followed-up for more than 5 years. The operation times and blood loss were significantly reduced in the K-rod group compared to the PLIF group. At the last follow-up, the clinical outcomes of the K-rod group were improved compared to those of the PLIF group as observed by the VAS score, JOABPEQ, and ODI. Imaging outcomes at the last follow-up indicated that the loss of height in the L3/4 and L5/S1 intervertebral space, the ROM of L3/4 and L5/S1, and the incidence of adjacent segment degeneration in the PLIF group were significantly higher than those in the K-rod group. According to Pfirrmann grading, Modic changes, and UCLA grading, the incidence of adjacent segment degeneration was 55.6% in the PLIF group and 15.4% in the K-rod group. Changes in spino-pelvic parameters between the two groups were as follows: pelvic index remained unchanged, pelvic tilt angle increased, and lumbar lordosis and sacral slope decreased. Therefore, compared to PLIF, single-segment lumbar disc herniation using K-rod-assisted non-fusion surgery resulted in better long-term clinical efficacy. Our results demonstrate that this procedure can delay adjacent segment degeneration after lumbar surgery.
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16
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Jeong TS, Son S, Lee SG, Ahn Y, Jung JM, Yoo BR. Comparison of adjacent segment disease after minimally invasive versus open lumbar fusion: a minimum 10-year follow-up. J Neurosurg Spine 2021; 36:525-533. [PMID: 34740178 DOI: 10.3171/2021.7.spine21408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to compare, after a long-term follow-up, the incidence and features of adjacent segment disease (ASDis) following lumbar fusion surgery performed via an open technique using conventional interbody fusion plus transpedicular screw fixation or a minimally invasive surgery (MIS) using a tubular retractor together with percutaneous pedicle screw fixation. METHODS The authors conducted a retrospective chart review of patients with a follow-up period > 10 years who had undergone instrumented lumbar fusion at the L4-5 level between January 2004 and December 2010. The patients were divided into an open surgery group and MIS group based on the surgical method performed. Baseline characteristics and radiological findings, including factors related to ASDis, were compared between the two groups. Additionally, the incidence of ASDis and related details, including diagnosis, time to diagnosis, and treatment, were analyzed. RESULTS Among 119 patients who had undergone lumbar fusion at the L4-5 level in the study period, 32 were excluded according to the exclusion criteria. The remaining 87 patients were included as the final study cohort and were divided into an open group (n = 44) and MIS group (n = 43). The mean follow-up period was 10.50 (range 10.0-14.0) years in the open group and 10.16 (range 10.0-13.0) years in the MIS group. The overall facet joint violation rate was significantly higher in the open group than in the MIS group (54.5% vs 30.2%, p = 0.022). However, in terms of adjacent segment degeneration, there were no significant differences in corrected disc height, segmental angle, range of motion, or degree of listhesis of the adjacent segments between the two groups during follow-up. The overall incidence of ASDis was 33.3%, with incidences of 31.8% in the open group and 34.9% in the MIS group, showing no significant difference between the two groups (p = 0.822). Additionally, detailed diagnosis and treatment factors were not different between the two groups. CONCLUSIONS After a minimum 10-year follow-up, the incidence of ASDis did not differ significantly between patients who had undergone open fusion and those who had undergone MIS fusion at the L4-5 level.
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Affiliation(s)
| | - Seong Son
- 2Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sang Gu Lee
- 2Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yong Ahn
- 2Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jong Myung Jung
- 2Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung Rhae Yoo
- 2Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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17
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Peng Y. CORR Insights®: A Dynamic Interbody Cage Improves Bone Formation in Anterior Cervical Surgery: A Porcine Biomechanical Study. Clin Orthop Relat Res 2021; 479:2559-2561. [PMID: 34491974 PMCID: PMC8510000 DOI: 10.1097/corr.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Yun Peng
- Staff Engineer, NuVasive Inc, Research and Testing, San Diego, CA, USA
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18
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Konovalov NA, Nazarenko AG, Asyutin DS, Brinyuk ES, Kaprovoy SV, Zakirov BA. [Degenerative lumbar spine stenosis: minimally invasive microsurgical methods of treatment]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:87-95. [PMID: 34463455 DOI: 10.17116/neiro20218504187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.
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Affiliation(s)
| | | | - D S Asyutin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - E S Brinyuk
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - B A Zakirov
- Burdenko Neurosurgical Center, Moscow, Russia
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19
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He K, Dong C, Wei H, Yang F, Ma H, Tang X, Tan M, Yi P. A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration. Clin Interv Aging 2021; 16:1403-1413. [PMID: 34321872 PMCID: PMC8313433 DOI: 10.2147/cia.s318525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Revision surgery for adjacent segment degeneration (ASD) commonly requires exposing and removing the original fixation. To minimize trauma and to reduce the operation time and blood loss, we introduced a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional (3D)-printed navigation templates. Methods From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All surgical data, including the operation time, blood loss, and incision length, were recorded. We evaluated the clinical efficacy using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and computed tomography (CT) scans were used to evaluate the stability of CBT screw fixation, the accuracy of screws, and the fusion rate. Results The mean follow-up was 22.4±4.7 months (12–31 months). The VAS, ODI, and JOA scores were analyzed by SPSS 21.0 and showed significant improvement at 2 weeks and the last follow-up compared with preoperative data (P<0.05). Seventy-six CBT screws were inserted with navigation templates; 2 screws were Grade B, and the other screws were Grade 0 or A. Changes in intervertebral height showed good stability of CBT screw fixation (P>0.05). All the patients exhibited satisfactory fusion results. Conclusion Revision surgery for ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with the advantages of a short operation time, a small incision, and less blood loss.
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Affiliation(s)
- Kun He
- Beijing University of Chinese Medicine, Beijing, 100029, People's Republic of China.,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Chunke Dong
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People's Republic of China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Feng Yang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Xiangsheng Tang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Mingsheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Ping Yi
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
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20
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Xia B, Xing J, Ai Q, Li H, Xu M, Hou T. [Expression profile of intervertebral disc degeneration-specific genes: a transcriptome sequencing-based analysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:883-890. [PMID: 34238741 DOI: 10.12122/j.issn.1673-4254.2021.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify new therapeutic targets for intervertebral disc degeneration (IDD) by analyzing gene variations in IDD. OBJECTIVE We analyzed surgical samples of intervertebral disc from 4 patients with IDD and 3 patients with non-IDD using RNA sequencing (RNA-seq) technology to identify significant differentially expressed genes (DEGs) in IDD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases were utilized for gene enrichment studies to acquire the key genes and signal pathways during IDD progression. The differential expressions of the identified genes in IDD were validated in clinical samples with qRT-PCR. OBJECTIVE The transcriptome profile revealed 512 significant DEGs, which were enriched in terms of keratinization, extracellular matrix (ECM) components, growth factor binding, and inflammatory chemotaxis in GO analysis. The top 10 terms of KEGG enrichment included amoebiasis, viral protein interaction with cytokine and cytokine receptor, ECM-receptor interaction, IL-17 signaling pathway, cytokine-cytokine receptor interaction, TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications, PI3K-Akt signaling pathway, chemokine signaling pathway and estrogen signaling pathway. Thirteen DEGs selected as the targets for qRT-PCR validation showed significant differential expressions in IDD (P < 0.001), and their expression trends were all consistent with the results of RNA-seq. Among these genes, 10 genes showed significant intergroup fold change (Log2FoldChange>1). OBJECTIVE ECM, growth factors, collagen components, inflammatory chemokines and such signal pathways as TNF-α and PI3K-Akt all have important contributions to IDD progression and may thus serve as new therapeutic targets for treatment of IDD.
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Affiliation(s)
- B Xia
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - J Xing
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Q Ai
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - H Li
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - M Xu
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - T Hou
- Department of Orthopedics, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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21
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Chang SY, Chae IS, Mok S, Park SC, Chang BS, Kim H. Can Indirect Decompression Reduce Adjacent Segment Degeneration and the Associated Reoperation Rate After Lumbar Interbody Fusion? A Systemic Review and Meta-analysis. World Neurosurg 2021; 153:e435-e445. [PMID: 34229099 DOI: 10.1016/j.wneu.2021.06.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to assess and compare the rate of adjacent segment degeneration (ASDeg), adjacent segment disease, and related reoperations between patients who underwent lumbar interbody fusion surgery using indirect or direct decompression. METHODS On the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis was performed to identify and analyze studies that compared the rate of ASDeg, adjacent segment disease, and related reoperations between indirect and direct decompression techniques. Indirect decompression included anterior lumbar interbody fusion, lateral lumbar interbody fusion, and oblique lateral interbody fusion, whereas direct decompression included posterior or transforaminal lumbar interbody fusion. RESULTS Seven studies including a total of 576 patients (indirect: 314; direct: 262) were identified. The pooled rates of ASDeg were 19.4% (45/232) and 34.9% (66/189) for indirect and direct decompression, respectively. A fixed-effects model showed 0.34 times lower odds of developing ASDeg in the indirect decompression group (odds ratio = 0.34, 95% confidence interval [CI] = 0.20, 0.57). The pooled incidence of reoperation was 2.5% (8/314) and 6.1% (16/262) for indirect and direct decompression, respectively. A fixed-effects model showed 0.40 times lower odds of reoperation from ASDeg in the indirect decompression group (odds ratio = 0.40, 95% CI = 0.18, 0.89). The pooled mean difference for the segmental lordosis angle was 1.80 degrees (95% CI = 0.74, 2.86) and 7.11 degrees (95% CI = 4.47, 9.74) for total lumbar lordosis angle, favoring indirect decompression. CONCLUSIONS Indirect decompression showed lower odds of developing ASDeg and undergoing reoperation for ASDeg after lumbar interbody fusion surgery in this meta-analysis. However, the limited number and quality of the included studies should be considered when interpreting the results.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ihn Seok Chae
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sujung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Cheol Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
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22
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Yasmeh S, Bernatz J, Garrard E, Bice M, Williams SK. Clinical and Radiographic Outcomes of Lateral Interbody Fusion for Adjacent Segment Degeneration. Int J Spine Surg 2021; 15:74-81. [PMID: 33900959 DOI: 10.14444/8010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Assessment of outcomes in patients undergoing lateral interbody fusion as part of the surgical treatment of adjacent segment deterioration after previous lumbar spine fusion. METHODS Adult patients with previous lumbar posterior spinal fusion who presented with adjacent segment degeneration and stenosis refractory to nonoperative treatment and who underwent lateral lumbar interbody fusion were retrospectively analyzed. Clinical and radiographic outcomes were assessed and comparisons made between preoperative baseline and postoperative values. RESULTS Thirty-six patients with symptomatic adjacent segment degeneration at 46 motion segments were included. Thirty (83.3%) of the 36 patients had complete relief of both preoperative lower extremity pain and back pain at the time of final follow-up. Six (16.7%) of the 36 patients had persistent pain, though in all 6 cases, the pain was less postoperatively than preoperatively. Oswestry Disability Index scores were improved significantly at final follow-up (P = .001). Compared with preoperative baseline parameters, initial and final postoperative radiographs had an increase in segmental lordosis (P < .001 and P < .001, respectively), increase in overall lumbar lordosis (P < .05 and P = .094, respectively), decrease in segmental coronal angulation (P = .63 and P < .01, respectively), decrease in overall coronal angulation (P = .063 and P = .009, respectively), and increase in intervertebral height (P < .001 and P < .001, respectively). CONCLUSION Lateral lumbar interbody fusion achieves favorable clinical and radiographic outcomes for the treatment of adjacent segment degeneration after previous lumbar fusion. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Siamak Yasmeh
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - James Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Eli Garrard
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Miranda Bice
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Seth K Williams
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin
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