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Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction. INTERNATIONAL ORTHOPAEDICS 2023; 47:1303-1313. [PMID: 36933036 DOI: 10.1007/s00264-023-05774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction. METHODS A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up. RESULTS All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05). CONCLUSION TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.
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Periarticular multimodal analgesia in decreasing perioperative pain in tibial plateau fractures: A double blind randomized controlled pilot study. Injury 2022; 53:4123-4128. [PMID: 36207154 DOI: 10.1016/j.injury.2022.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The use of periarticular multimodal analgesia injections is increasing and has become commonplace in some surgeries. However, there is no data on the effectiveness of local periarticular multimodal analgesia for tibial plateau fractures. We hypothesized that closed tibial plateau fracture patients receiving the local multimodal analgesic medications would experience a decrease in VAS pain scores. METHODS Patients aged between 18 and 79 with an isolated closed tibial plateau fracture (AO 41-B and C) were prospectively enrolled and randomized in a 1:1 double blinded fashion to either a placebo or active medication treatment arm. After ORIF, gel-foam sponges soaked in either multimodal analgesic solution or normal saline. Patients were followed for 24 h post-operatively with Visual Analog pain Scores (VAS). Patients were monitored post-operatively for complications including compartment syndrome, infection, and non-union. RESULTS The planned study was terminated prior to completion due to higher than anticipated rates of infection (18%), distributed equally among active (3) and placebo (2) groups, raising concerns that this may have been due to the presence of the delivery device. Twenty-eight patients were enrolled, 15 in the active group and 13 in the placebo group. Patients in the active medication group had significantly decreased pain scores at hours 4 (p = 0.005, 4.2 vs 6.9), 8 (p = 0.05, 5 vs 7), and 12 (p = 0.02, 3.8 vs 6.2). Pain scores at hours 16 (p = 0.10, 4.5 vs 6.5), 20 (p = 0.08, 4.6 vs 6.4), and 24 (p = 0.10, 4.8 vs 6.5) were also decreased but did not reach significance. DISCUSSION The use of local multimodal periarticular analgesic for closed tibial plateau fractures appears to be beneficial for short-term pain control post-operatively. Concerns regarding an implantable delivery vehicle leading to infection has warranted a change in method of drug administration. Completion of the full study will permit us to validate or refute these findings. LEVEL OF EVIDENCE Therapeutic Level 1.
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Hu W, Song Y, Ma H, Wang H, Zhang K, Gao Y. Correlation Analysis of the Characteristics of Spino-Pelvic Parameters and Health-Related Quality of Life After Long-Segment Fixation for Lenke–Silva Type 5 or 6 Degenerative Scoliosis. J Pain Res 2022; 15:2171-2179. [PMID: 35942118 PMCID: PMC9356707 DOI: 10.2147/jpr.s368142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To retrospectively evaluate the characteristics of spino-pelvic parameters after long-segment fixation in patients with Lenke–Silva type 5 or 6 adult degenerative scoliosis and analyze the correlation between spino-pelvic parameters and health-related quality of life (HRQL). Methods Thirty-two patients with degenerative scoliosis underwent long-segment posterior fixation were included. The spino-pelvic parameters were evaluated after surgery, and the HRQL scores were determined using the Scoliosis Research Society-22 (SRS-22), Oswestry Disability Index (ODI), and visual analog scale (VAS). Linear regression was used to analyze the correlation between changes in spino-pelvic parameters and improvements in HRQL. Results Except for PI and TK, the other parameters showed significant differences after surgery (P < 0.05). All the scores of HRQL showed significant differences after surgery. The coefficient of correlation between ΔSVA and ΔVAS is 0.687 (P = 0.003), the coefficient of correlation between ΔSVA and ΔODI is 5.828 (P < 0.001). The coefficient of correlation between ΔLL and ΔVAS is −0.089 (P < 0.001), the coefficient of correlation between ΔLL and ΔODI is −1.553 (P = 0.003). The VAS score between the SVA ≥ 4cm and SVA < 4cm group have no significant difference, but have a significant difference in ODI. In PI-LL ≥ 20°and PI-LL < 20°group, the VAS and ODI all have a significant difference between the two groups. Conclusion SVA and LL have an important role in maintaining the overall balance of the spine and closely related to the postoperative HRQL, better HRQL may be achieved by reducing SVA and increasing LL. Good preoperative design will help achieve the best clinical efficacy.
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Affiliation(s)
- Weiran Hu
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yuepeng Song
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Henan University, Zhengzhou, Henan, People’s Republic of China
| | - Haohao Ma
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Hongqiang Wang
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Kai Zhang
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yanzheng Gao
- Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
- Department of Spinal Cord Surgery, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Correspondence: Yanzheng Gao, Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, No. 7 Wei Wu Road, Zhengzhou, 450003, People’s Republic of China, Email
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Wang S, Wang B, Yu X, Ma T, Ntambale MC, Yan J, Ding Q, Zhang R, Wu H, Liu C. Efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion: a comparative study. BMC Musculoskelet Disord 2021; 22:660. [PMID: 34362341 PMCID: PMC8343912 DOI: 10.1186/s12891-021-04541-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative diseases. METHODS We retrospectively reviewed patients who underwent TLIF in our department between August 2018 and January 2020. Patients were divided to ropivacaine group and saline group. A ropivacaine group whom received gelatin sponge impregnated with ropivacaine during operation, and a saline group whom were intraoperatively administered by gelatin sponge impregnated with saline. The two groups were compared in reference to postoperative hospital stay, postoperative complications and visual analog scale (VAS) scores. The consumption of postoperative diclofenac sodium suppository use was also recorded. The Oswestry Disability Index (ODI) scores and Japanese Orthopedic Association (JOA) scores were used for functional evaluation at 1 year postoperatively. RESULT A total of 127 patients were evaluated in this retrospective study. The mean postoperative hospital stay in the ropivacaine group was significantly lower than saline group. The VAS score was significantly lower in patients receiving gelatin sponge impregnated with ropivacaine as compared with patients in saline group on postoperative day 1, 2, 3 and 4. The number of patients who need the administration of diclofenac sodium suppository and the mean consumption of postoperative diclofenac sodium suppository was significantly lower in the ropivacaine group as compared with saline group. CONCLUSION The application of gelatin sponge impregnated with ropivacaine around the nerve root in patients undergoing TLIF can effectively control the postoperative pain and reduce postoperative hospital stay.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Bo Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Tian Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Mubotu C Ntambale
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Jiyuan Yan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Qing Ding
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Ruizhuo Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
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Weiner JA, McCarthy MH, Swiatek P, Louie PK, Qureshi SA. Narrative review of intraoperative image guidance for transforaminal lumbar interbody fusion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:89. [PMID: 33553382 PMCID: PMC7859762 DOI: 10.21037/atm-20-1971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent advancements in imaging technology have changed the landscape of transforaminal lumbar interbody fusion (TLIF) with the objective of improving safety and efficacy for the patient and surgical team. Spine surgery, and specifically TLIFs, involve challenging anatomy and command precise surgical accuracy, creating an essential role for intraoperative imaging, navigation, and robotics. Traditionally, surgeons have relied upon fluoroscopy for pedicle screw and interbody placement. More recently, intraoperative 3-dimensional navigation (ION) has risen in popularity in TLIF surgery. This technology utilizes intra-operative advanced imaging, such as computed tomography (CT) and 3D-fluroscopy, to accurately track instruments and implants in relation to the patient’s anatomy. ION has demonstrated improved accuracy of pedicle screw placement, decreased operating room times, and lower radiation exposure to the surgeon and staff. However, conventional fluoroscopy, 3D fluoroscopy, intraoperative CT, image-guided navigation, and robot-assisted surgery all have a role in TLIF surgery. Numerous studies have been published regarding the benefits and pitfalls of these intraoperative tools in spine surgery, but there is a relative lack of research regarding some of the newer technologies surrounding TLIF. As future studies are published, and technology continues to evolve, surgeons must stay abreast of novel techniques to maximize patient safety and outcomes. Over the coming decade, we can expect intraoperative navigation and robotics to play a more significant role in spine surgery.
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Affiliation(s)
- Joseph A Weiner
- Northwestern University Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Michael H McCarthy
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
| | - Peter Swiatek
- Northwestern University Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Philip K Louie
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery Department of Orthopedic Surgery, New York, NY, USA
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Du J, Huang D, Yan L, Shan L, Fan Y, Wang W, Yang J, Hao D. In Reply to the Letter to the Editor Regarding "Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: A Systematic Review and Meta-Analysis". World Neurosurg 2020; 138:598-599. [PMID: 32545017 DOI: 10.1016/j.wneu.2020.03.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Lequn Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Yong Fan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Wentao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Jongsong Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China.
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Staub BN, Sadrameli SS. The use of robotics in minimally invasive spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S31-S40. [PMID: 31380491 DOI: 10.21037/jss.2019.04.16] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The field of spine surgery has changed significantly over the past few decades as once technological fantasy has become reality. The advent of stereotaxis, intra-operative navigation, endoscopy, and percutaneous instrumentation have altered the landscape of spine surgery. The concept of minimally invasive spine (MIS) surgery has blossomed over the past ten years and now robot-assisted spine surgery is being championed by some as another potential paradigm altering technological advancement. The application of robotics in other surgical specialties has been shown to be a safe and feasible alternative to the traditional, open approach. In 2004 the Mazor Spine Assist robot was approved by FDA to assist with placement of pedicle screws and since then, more advanced robots with promising clinical outcomes have been introduced. Currently, robotic platforms are limited to pedicle screw placement. However, there are centers investigating the role of robotics in decompression, dural closure, and pre-planned osteotomies. Robot-assisted spine surgery has been shown to increase the accuracy of pedicle screw placement and decrease radiation exposure to surgeons. However, modern robotic technology also has certain disadvantages including a high introductory cost, steep learning curve, and inherent technological glitches. Currently, robotic spine surgery is in its infancy and most of the objective evidence available regarding its benefits draws from the use of robots in a shared-control model to assist with the placement of pedicle screws. As artificial intelligence software and feedback sensor design become more sophisticated, robots could facilitate other, more complex surgical tasks such as bony decompression or dural closure. The accuracy and precision afforded by the current robots available for use in spinal surgery potentially allow for even less tissue destructive and more meticulous MIS surgery. This article aims to provide a contemporary review of the use of robotics in MIS surgery.
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Affiliation(s)
| | - Saeed S Sadrameli
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
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Du JP, Fan Y, Hao DJ, Huang YF, Zhang JN, Yuan LH. Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block to Promote Early Postoperative Recovery of Lumbar Disc Herniation. World Neurosurg 2018; 114:e1168-e1173. [PMID: 29614356 DOI: 10.1016/j.wneu.2018.03.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To observe effect of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block to promote early postoperative recovery of lumbar disc herniation. METHODS Retrospective analysis was performed of 265 patients with single-level lumbar disc herniation from January 2013 to October 2017. Patients were divided into intervention and control groups based on intraoperative application of gelatin sponge impregnated with a mixture of 3 drugs. All patients underwent unilateral minimally invasive surgical transforaminal lumbar interbody fusion. Clinical data, including bedridden period, postoperative hospital stay, visual analog scale scores for low back pain and leg pain, Japanese Orthopaedic Association score, postoperative satisfaction questionnaire results, and therapeutic effect, were collected. RESULTS There were 136 cases in the intervention group and 129 cases in the control group. The intervention group had significantly shorter bedridden period and postoperative hospital stay than control group (P < 0.05). Visual analog scale scores for low back pain and leg pain at postoperative days 1-10 were significantly lower in the intervention group compared with control group (P < 0.05). The Japanese Orthopaedic Association score at postoperative day 6 and satisfaction at 72 hours postoperatively were significantly higher in the intervention group than in control group (P < 0.05). Clinical effect at postoperative day 6 was significantly better in the intervention group than control group (P < 0.05). CONCLUSIONS Application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block can significantly promote early postoperative recovery of lumbar disc herniation and has great short-term clinical efficacy.
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Affiliation(s)
- Jin Peng Du
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China; Medical College, Yan'an University, Yan'an City, Shaanxi Province, China
| | - Yong Fan
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China
| | - Ding Jun Hao
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China; Medical College, Yan'an University, Yan'an City, Shaanxi Province, China.
| | - Yun Fei Huang
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China
| | - Jia Nan Zhang
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China
| | - Lei Hong Yuan
- Department of Spine Surgery, Xi'an Jiao Tong University-affiliated Hong Hui Hospital, Xi'an City, Shaanxi Province, China
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