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Guan J, Feng N, Yu X, Yang K. Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies. Syst Rev 2024; 13:170. [PMID: 38970142 PMCID: PMC11227242 DOI: 10.1186/s13643-024-02600-6] [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: 07/26/2023] [Accepted: 06/30/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND As an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence. OBJECTIVE We aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease. METHODS We systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS Our search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher "clinically acceptable" accuracy than FG (RR: 1.0382, 95% CI: 1.0273-1.0493). And RA had 1.12-folds higher "perfect" accuracy than FG group (RR: 1.1167, 95% CI: 1.0726-1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391-0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756-4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265-0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238-3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357-0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953-1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592-1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results. CONCLUSION In TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023441600.
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Affiliation(s)
- Jianbin Guan
- Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
- Shannxi Key Laboratory of Spine Bionic Treatment, Xi'an, China
| | - Ningning Feng
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Kaitan Yang
- Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
- Truma Rehabilitation Department, Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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Creighton D, Fausone D, Swanson B, Young W, Nolff S, Ruble A, Hassan N, Soley E. Myofascial and discogenic origins of lumbar pain: A critical review. J Man Manip Ther 2023; 31:435-448. [PMID: 37503571 PMCID: PMC10642329 DOI: 10.1080/10669817.2023.2237739] [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: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
The purpose of this three-part narrative review is to examine the anatomy of, and the research which supports, either the lumbar myofascia or intervertebral disc (IVD) as principal sources of our patient's low back pain. A comprehensive understanding of anatomical lumbar pain generators in combination with the current treatment-based classification system will further improve and enhance clinical decision-making skills. Section I reviews the anatomy of the spinal myofascia, myofascial sources of lumbar pain, and imaging of myofascial tissues. Part II reviews the anatomy of the IVD, examines the IVD as a potential lumbar pain generator, and includes detailed discussion on Nerve Growth Factor, Inflammatory Cytokines, Vertebral End Plates and Modic change, Annular tears, and Discogenic instability. Part III looks at the history of myofascial pain, lab-based research and myofascial pain, and various levels of discogenic pain provocation research including animal, laboratory and human subjects. Our review concludes with author recommendations on developing a comprehensive understanding of altered stress concentrations affecting the posterior annulus fibrosis, neo-innervation of the IVD, inflammatory cytokines, discogenic instability, and how this knowledge can complement use of the Treatment-Based Classification System.
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Creighton D. Treating Discogenic Low Back Pain in the Home Care Setting. Home Healthc Now 2023; 41:343-345. [PMID: 37922139 DOI: 10.1097/nhh.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
- Doug Creighton
- Doug Creighton, PT, MS, DPT, OMPT, is an Associate Professor, Physical Therapy Program, School of Health Sciences, Oakland University, Rochester, Michigan
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Quirk DA, Johnson ME, Anderson DE, Smuck M, Sun R, Matthew R, Bailey J, Marras WS, Bell KM, Darwin J, Bowden AE. Biomechanical Phenotyping of Chronic Low Back Pain: Protocol for BACPAC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S48-S60. [PMID: 36315101 PMCID: PMC10403313 DOI: 10.1093/pm/pnac163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Biomechanics represents the common final output through which all biopsychosocial constructs of back pain must pass, making it a rich target for phenotyping. To exploit this feature, several sites within the NIH Back Pain Consortium (BACPAC) have developed biomechanics measurement and phenotyping tools. The overall aims of this article were to: 1) provide a narrative review of biomechanics as a phenotyping tool; 2) describe the diverse array of tools and outcome measures that exist within BACPAC; and 3) highlight how leveraging these technologies with the other data collected within BACPAC could elucidate the relationship between biomechanics and other metrics used to characterize low back pain (LBP). METHODS The narrative review highlights how biomechanical outcomes can discriminate between those with and without LBP, as well as among levels of severity of LBP. It also addresses how biomechanical outcomes track with functional improvements in LBP. Additionally, we present the clinical use case for biomechanical outcome measures that can be met via emerging technologies. RESULTS To answer the need for measuring biomechanical performance, our "Results" section describes the spectrum of technologies that have been developed and are being used within BACPAC. CONCLUSION AND FUTURE DIRECTIONS The outcome measures collected by these technologies will be an integral part of longitudinal and cross-sectional studies conducted in BACPAC. Linking these measures with other biopsychosocial data collected within BACPAC increases our potential to use biomechanics as a tool for understanding the mechanisms of LBP, phenotyping unique LBP subgroups, and matching these individuals with an appropriate treatment paradigm.
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Affiliation(s)
- D Adam Quirk
- Harvard School of Engineering and Applied Science, Harvard University, Cambridge, Massachusetts
| | - Marit E Johnson
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis E Anderson
- Center for Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Robert Matthew
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
| | - Jeannie Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - William S Marras
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin M Bell
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, USA
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Fausone D, Doherty D, Creighton D, Roach VA. Variations of spinous and transverse process length in the human lumbar spine. J Man Manip Ther 2023; 31:93-97. [PMID: 35604056 PMCID: PMC10013557 DOI: 10.1080/10669817.2022.2077604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Some manual therapy schools of thought rely on palpation of vertebral position via bony processes prior to the application of directional manual interventions. It is feasible that malformation or asymmetry of the spinous processes (SPs) or transverse processes (TPs), if unknown, may influence the outcome of a diagnostic palpatory exam and the application of directional manual interventions. This study provides morphometric data for the lumbar spine, to assess the occurrence of length differences in lumbar SPs and TPs occurring between the right and left sides. METHODS The lumbar processes were measured bilaterally in 16 adult cadaveric specimens, 9 females and 7 males ranging in age from 68 to 89 years. A measurable difference in SP length, defined as ≥ 0.1 cm, was found in 72.4% of the population, and for TP lengthin 90.6% of the population. A mean SP length difference of 0.2 ± 0.2 cm and a mean TP length difference of 0.4 ± 0.3 cm were observed. Process length was longer on average for males, and the magnitude of process length difference increased with age. CONCLUSION These results indicate that a finding of a clinical positional fault of a vertebra through palpatory exam may be flawed.
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Affiliation(s)
- David Fausone
- Doctor of Physical Therapy (DPT) program, School of Health Sciences, Oakland University, IN, USA
| | - Deborah Doherty
- Doctor of Physical Therapy (DPT) program, School of Health Sciences, Oakland University, IN, USA
| | - Douglas Creighton
- Doctor of Physical Therapy (DPT) program, School of Health Sciences, Oakland University, IN, USA
| | - Victoria A Roach
- Division of Healthcare Simulation Science, Department of Surger, University of Washington, Seattle, USA
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Three-Dimensional Biomechanical Finite Element Analysis of Lumbar Disc Herniation in Middle Aged and Elderly. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7107702. [PMID: 35075391 PMCID: PMC8783749 DOI: 10.1155/2022/7107702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022]
Abstract
Lumbar intervertebral disc protrusion disease refers to the degeneration of intervertebral disc, rupture of fibrous ring, nucleus pulpous protrusion and stimulation or compression of nerve root. The import command in Mimics medical 3D reconstruction software was used to erase the irrelevant image data and obtain vertebral body images. The original 3D model of each vertebral body was built by 3D computing function. A three-dimensional finite element model was established to analyze the effect of different surgical methods on the mechanical distribution of the spine after disentomb. The stress distribution of the spine, intervertebral disc, and left and right articular cartilage at L4/L5 stage and the position shift of the fourth lumbar vertebra were analyzed under 7 working conditions of vertical, forward flexion, extension, left and right flexion, and left and right rotation. The results showed that the established model was effective, and the smaller the area of posterior laminar decompression was, the lesser the impact on spinal stability was. The PELD treatment of lumbar disc herniation had little impact on spinal biomechanics and could achieve good long-term biomechanical stability. Combining the clinical experiment method and finite element simulation, using the advantages of finite element software to optimize the design function can provide guidance for the design and improvement of medical devices and has important significance for the study of clinical mechanical properties and biomechanics.
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Tanveer F, Arslan SA, Darain H, Ahmad A, Gilani SA, Hanif A. Prevailing treatment methods for lumbar spondylolysis: A systematic review. Medicine (Baltimore) 2021; 100:e28319. [PMID: 34941130 PMCID: PMC8702222 DOI: 10.1097/md.0000000000028319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Aim of this study was to systematically review the prevailing treatment methods for lumbar spondylolysis. Methods: Manuscripts published between 1951 and 2020 were searched by using PubMed, Medline, Scopus, Springer, Web of Science databases. The study protocol was registered with PROSPERO (CRD42020218651). The inclusion criteria for all articles of prevailing treatment methods for spondylolysis were: Standards have been independently applied by using 2 reviewers and another author resolved disagreements. Results: Data extraction screened 12 full-length articles. Description, treatment, outcome, and findings were individually extracted and cross-referenced. Discussion: Current review has suggested that the noninvasive treatment method specifically low intensity pulsed ultrasound, electro acupuncture and pulsed electromagnetic filed is effective for bone union while operative treatment specifically pedicle screw fixation +/- interbody fusion depending the extent of disk degeneration and craniocaudal foraminal stenosis is effective for minimizing pain and functional disability in patients with spondylolysis. This review concluded that the noninvasive treatment method specifically low intensity pulsed ultrasound is effective for bone union. Review Registration: PROSPERO (CRD42020218651).
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Affiliation(s)
- Fahad Tanveer
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | | | - Haider Darain
- Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Public Health, University of Lahore, Lahore, Pakistan
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Li Y, Gao L, Meng C. The order of degeneration of lumbar intervertebral disc and lumbar facet joint and its correlation with age. Minerva Med 2021; 113:359-361. [PMID: 34477349 DOI: 10.23736/s0026-4806.21.07610-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yanming Li
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Longfei Gao
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chunyang Meng
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining, China -
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Surgical treatment of facet syndrome in segmental instability of the lumbar spine. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Danazumi MS, Bello B, Yakasai AM, Kaka B. Two manual therapy techniques for management of lumbar radiculopathy: a randomized clinical trial. J Osteopath Med 2021; 121:391-400. [PMID: 33705612 DOI: 10.1515/jom-2020-0261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Evidence has shown that spinal mobilization with leg movement (SMWLM) and progressive inhibition of neuromuscular structures (PINS) are individually effective in the management of lumbar radiculopathy. However, previous evidence reported data for only a short-term study period and did not investigate the effect of the combined manual therapy techniques. OBJECTIVES To compare the combined effects of two manual therapy techniques (SMWLM and PINS) with the individual techniques alone (SMWLM or PINS) in the management of individuals with lumbar radiculopathy. METHODS A total of 60 patients diagnosed with unilateral lumbar radiculopathy secondary to disc herniation were randomly allocated into three groups: 20 participants each in the SMWLM, PINS, and combined SMWLM + PINS groups. Each group attended two treatments per week for 30 min each, for three months. Participants were assessed at baseline, immediately posttreatment, and then at three, six, and nine months follow-up using the Visual Analog Scale (VAS), Rolland-Morris Disability Questionnaire (RMDQ), and Sciatica Bothersomeness Index (SBI). RESULTS Between-groups analyses using a two-way repeated-measures analysis of variance indicated significant interactions between groups and follow-up times for all outcomes (p=0.001). Participants receiving combined SMWLM + PINS treatment experienced greater improvement in leg pain, back pain, disability, and sciatica at all timelines (immediately posttreatment, and three, six, and nine months follow-up) than the participants receiving SMWLM or PINS alone (p<0.05). However, participants receiving SMWLM alone showed better improvement than the participants receiving PINS alone at all timelines (p<0.05). CONCLUSIONS A combined SMWLM + PINS treatment protocol showed greater improvement than the individual techniques alone in the management of individuals with LR in this study.
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Affiliation(s)
- Musa S Danazumi
- Department of Physiotherapy, Federal Medical Center, Nguru, Yobe State, Nigeria.,Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Bashir Bello
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Abdulsalam M Yakasai
- Medical Rehabilitation Therapists (Reg.) Board of Nigeria, North-West Zonal Office, Kano, Nigeria.,Department of Physiotherapy, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
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