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Wang S, Shi J. Three Stages on Magnetic Resonance Imaging of Lumbar Degenerative Spine. World Neurosurg 2024; 187:e598-e609. [PMID: 38679375 DOI: 10.1016/j.wneu.2024.04.133] [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: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
PURPOSES To propose a new lumbar degenerative staging system using the current radiological classification system. METHODS A cross-sectional analysis of retrospective databases between January 2018 and December 2022 was performed. Total of 410 patients for Modic changes, paravertebral muscle fat infiltration, disc degeneration, articular process degeneration, vertebral endplate degeneration and other structures, and disc displacement, Spondylolisthesis, and stenosis, and grouped patients according to stage were assessed. Visual analog scale, Japanese Orthopaedic Association, and Oswestry Disability Index scores were used to assess low back pain strength, neurological function, and quality of life, respectively. RESULTS The lumbar degeneration staging system consists of 8 variables, which can be divided into 3 steps: early, middle and late, and the correlation between each variable is strong (P < 0.05). The later the staging, the worse the Japanese Orthopaedic Association, visual analog scale, and Oswestry Disability Index scores. CONCLUSIONS Patients with later stages have worse clinical scores. This staging system recommends a uniform classification to assess lumbar degeneration.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China; 910 Hospital of China Joint Logistics Support Force, Quanzhou City, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
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Chang SY, Kang DH, Cho SK. Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review. Asian Spine J 2024; 18:444-457. [PMID: 38146053 PMCID: PMC11222887 DOI: 10.31616/asj.2023.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023] Open
Abstract
This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul,
Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Ho Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Seoul,
Korea
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
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Rickert M, Fennema P, Wehner D, Rahim T, Hölper B, Eichler M, Makowski M, Meurer A, Brenneis M. Postoperative cage migration and subsidence following TLIF surgery is not associated with bony fusion. Sci Rep 2023; 13:12597. [PMID: 37537231 PMCID: PMC10400549 DOI: 10.1038/s41598-023-38801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Pseudarthrosis following transforaminal interbody fusion (TLIF) is not infrequent. Although cage migration and subsidence are commonly regarded as evidence of the absence of solid fusion, there is still no evidence of the influence of cage migration and subsidence on fusion. This study aimed to evaluate cage migration and subsidence using computed tomography (CT) DICOM data following lumbar interbody fusion. The effects of cage migration and subsidence on fusion and clinical outcomes were also assessed. A postoperative CT data set of 67 patients treated with monosegmental TLIF was analyzed in terms of cage position. To assess the effects of cage migration and subsidence on fusion, 12-month postoperative CT scans were used to assess fusion status. Clinical evaluation included the visual analog scale for pain and the Oswestry Disability Index. Postoperative cage migration occurred in 85.1% of all patients, and cage subsidence was observed in 58.2%. Radiological signs of pseudarthrosis was observed in 7.5% of the patients Neither cage migration nor subsidence affected the clinical or radiographic outcomes. No correlation was found between clinical and radiographic outcomes. The incidence of cage migration was considerable. However, as cage migration and subsidence were not associated with bony fusion, their clinical significance was considered limited.
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Affiliation(s)
- Marcus Rickert
- Spine Department, Schön Klinik Lorsch, Wilhelm Leuschner Strasse 10, Lorsch, Germany.
| | - Peter Fennema
- ARM Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
| | - Diana Wehner
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Tamim Rahim
- Asklepios Klinik Wiesbaden GmbH, Geisenheimer Straße 10, 65197, Wiesbaden, Germany
| | - Bernd Hölper
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Michael Eichler
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Marcus Makowski
- Department of Radiology, MRI TU Munich, Klinikum rechts der isar der TU München, Ismaninger Strasse 22, Munich, Germany
| | - Andrea Meurer
- Department of Orthopedics, Orthopadische Universitatsklinik Friedrichsheim gGmbH, Frankfurt am Main, Hessen, Germany
| | - Marco Brenneis
- Department of Trauma and Orthopaedic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Levy HA, Karamian BA, Yalla GR, Canseco JA, Vaccaro AR, Kepler CK. Impact of surface roughness and bulk porosity on spinal interbody implants. J Biomed Mater Res B Appl Biomater 2023; 111:478-489. [PMID: 36075112 DOI: 10.1002/jbm.b.35161] [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: 08/11/2021] [Revised: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
Spinal fusion surgeries are performed to treat a multitude of cervical and lumbar diseases that lead to pain and disability. Spinal interbody fusion involves inserting a cage between the spinal vertebrae, and is often utilized for indirect neurologic decompression, correction of spinal alignment, anterior column stability, and increased fusion rate. The long-term success of interbody fusion relies on complete osseointegration between the implant surface and vertebral end plates. Titanium (Ti)-based alloys and polyetheretherketone (PEEK) interbody cages represent the most commonly utilized materials and provide sufficient mechanics and biocompatibility to assist in fusion. However, modification to the surface and bulk characteristics of these materials has been shown to maximize osseointegration and long-term stability. Specifically, the introduction of intrinsic porosity and surface roughness has been shown to affect spinal interbody mechanics, vascularization, osteoblast attachment, and ingrowth potential. This narrative review synthesizes the mechanical, in vitro, in vivo, and clinical effects on fusion efficacy associated with introduction of porosity in Ti (neat and alloy) and PEEK intervertebral implants.
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Affiliation(s)
- Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, USA
| | - Goutham R Yalla
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Effect of Core Stabilizing Training on Young Individuals Presenting Different Stages of Degenerative Disc Disease-Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073499. [PMID: 33800555 PMCID: PMC8036822 DOI: 10.3390/ijerph18073499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
The aim of this study was to assess the efficacy of stabilizing training for the deep core muscles of the lumbar spine in subjects with degenerative disc disease. This study was conducted on 38 participants. The participants were divided into two groups: the extrusion group (EXT, n = 17) and the protrusion group (PRO, n = 21). All the subjects underwent a four-week-long core stability exercise-based treatment (five sessions/week). Clinical outcome measures were assessed pre-intervention (pre), post-intervention (post) and four weeks after the intervention (follow-up). The primary outcome measures were the spinal range of motion (ROM; Spinal Mouse® device) and the Oswestry Disability Index (ODI). In the PRO group, the ROM decreased from 88.52° pre-intervention to 83.33° post-intervention and to 82.82° at follow-up (p = 0.01), while the ODI decreased from 16.14 points pre-intervention to 6.57 points post-intervention, with 9.42 points at follow-up (p < 0.01). In the EXT group, the ROM decreased from 81.00° pre-intervention to 77.05° post-intervention, then increased to 77.94° at follow-up (p = 0.03), while the ODI decreased from 22.58 points pre-intervention to 15.41 points post-intervention and to 14.70 points at follow-up (p < 0.001). Although the stabilizing exercise sessions improved the clinical outcomes in each group, we cannot make conclusions as to whether the type of intervertebral disc damage significantly affects the results of stabilizing exercise-based treatment.
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Philipp T, Radoslovich SS, Yoo JU. Risk Factors Associated With Femoral Ring Allograft Breakage in ALIF. Global Spine J 2021; 11:57-62. [PMID: 32875836 PMCID: PMC7734263 DOI: 10.1177/2192568219890294] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN This is a retrospective chart review. OBJECTIVES To identify the incidence of, and variables correlated with, femoral ring allograft (FRA) fracture following anterior lumbar interbody fusion (ALIF). METHODS All patients who underwent ALIF using FRAs at an academic institution over 10 years were included. Postoperative radiographs were reviewed by both the primary and senior authors; fracture and no-fracture groups were created for comparison. Patient and surgical characteristics were extracted from electronic medical records. Frequency data comparisons were performed using contingency table analysis; comparisons of means were analyzed for continuous variables. A multivariate linear regression model was developed using screw use, graft height <12 mm, index level, and weight as variables. RESULTS A total of 76 FRAs in 59 patients were identified, 13 (17%) of which fractured. Age, sex, smoking status, use of buttress screws, weight, index level, and presence of spondylolisthesis were not correlated with incidence of fracture (P > .05). There was a significant correlation between the height of FRA and incidence of fracture; 2% (1/52) of grafts ≥12 mm and 50% (12/24) of grafts <12 mm fractured (P < .0001). Using ordinary least-squares regression, this result was independent of patient weight, use of screws, and index level. Of 10 patients, 9 did not require revision surgery to achieve fusion. CONCLUSIONS Graft height was the only variable correlated with incidence of FRA fracture. Graft height <12 mm is an independent risk factor for FRA fracture in patients undergoing ALIF, and their use should be avoided in ALIF procedures.
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Affiliation(s)
| | - Stephanie S. Radoslovich
- Oregon Health & Science University, Portland, OR, USA,Stephanie S. Radoslovich, Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Jung U. Yoo
- Oregon Health & Science University, Portland, OR, USA
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Custom-made trabecular titanium implants for the treatment of lumbar degenerative discopathy via ALIF/XLIF techniques: rationale for use and preliminary results. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:314-320. [DOI: 10.1007/s00586-019-06191-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/07/2019] [Accepted: 10/13/2019] [Indexed: 11/25/2022]
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Hu J, Ou Y, Zhu Y, Luo W, Zhao Z, Du X, Li J. [Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:287-295. [PMID: 30874383 DOI: 10.7507/1002-1892.201807060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis. Methods A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated. Results There was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups ( P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups ( P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group ( P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones ( P<0.05), and no significant difference was found between 2 groups at each time point ( P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups ( P>0.05) and between 2 groups at each time point after operation ( P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation ( P<0.05). The VAS score in double-level group was higher than that in single-level group ( P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points ( P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively. Conclusion The n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.
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Affiliation(s)
- Jianyu Hu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Yunsheng Ou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016,
| | - Yong Zhu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Luo
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Zenghui Zhao
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Xing Du
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Jianxiao Li
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
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Is there any advantage of using stand-alone cages? A numerical approach. Biomed Eng Online 2019; 18:63. [PMID: 31113423 PMCID: PMC6530002 DOI: 10.1186/s12938-019-0684-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background Segment fusion using interbody cages supplemented with pedicle screw fixation is the most common surgery for the treatment of low back pain. However, there is still much controversy regarding the use of cages in a stand-alone fashion. The goal of this work is to numerically compare the influence that each surgery has on lumbar biomechanics. Methods A non-linear FE model of the whole lumbar spine was developed to compare between two types of cages (OLYS and NEOLIF) with and without supplementary fixation. The motion of the whole spine was analysed and the biomechanical environment of the adjacent segments to the operated one was studied. Moreover, the risk of subsidence of the cages was qualitatively evaluated. Results A great ROM reduction occurred when supplementary fixation was used. This stiffening increased the stresses at the adjacent levels. It might be hypothesised that the overloading of these segments could be related with the clinically observed adjacent disc degeneration. Meanwhile, the stand-alone cages allowed for a wider movement, and therefore, the influence of the surgery on adjacent discs was much lower. Regarding the risk of subsidence, the contact pressure magnitude was similar for both intervertebral cage designs and near the value of the maximum tolerable pressure of the endplates. Conclusions A minimally invasive posterior insertion of an intervertebral cage (OLYS or NEOLIF) was compared using a stand-alone design or adding supplementary fixation. The outcomes of these two techniques were compared, and although stand-alone cage may diminish the risk of disease progression to the adjacent discs, the spinal movement in this case could compromise the vertebral fusion and might present a higher risk of cage subsidence.![]() Electronic supplementary material The online version of this article (10.1186/s12938-019-0684-8) contains supplementary material, which is available to authorized users.
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Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, Teytelboym OM. ABCs of the degenerative spine. Insights Imaging 2018; 9:253-274. [PMID: 29569215 PMCID: PMC5893484 DOI: 10.1007/s13244-017-0584-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents. TEACHING POINTS • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury. • Spine degeneration is a biomechanically related continuum of alterations evolving over time.
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Affiliation(s)
- Sergiy V. Kushchayev
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mohamed Jarraya
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Karl H. Schuleri
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 West Thomas Rd, Phoenix, AZ USA
| | - Michael L. Brooks
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Oleg M. Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
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Phan K, Mobbs RJ. Evolution of Design of Interbody Cages for Anterior Lumbar Interbody Fusion. Orthop Surg 2016; 8:270-7. [PMID: 27627708 PMCID: PMC6584298 DOI: 10.1111/os.12259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/13/2016] [Indexed: 11/28/2022] Open
Abstract
Anterior lumbar interbody fusion (ALIF) is one of the surgical procedures for the relief of chronic back pain, radiculopathy and neurogenic claudication in patients with degenerative lumbar spine disease that is refractory to conservative therapy, low-grade spondylolisthesis and pseudo arthrosis. Over the past half century, both the surgical techniques and instrumentation required for ALIF have changed significantly. In particular, the designs of ALIF cage and the materials used have evolved dramatically, the common goal being to improve fusion rates and optimize clinical outcomes. The increasing popularity of ALIF is reflected by the increasing abundance of published studies reporting clinical outcomes, surgical techniques and grafting options for ALIF. Developments in cage designs include cylindrical Bagby and Kuslich, cylindrical ray, cylindrical mesh, lumbar-tapered, polyethyl-etherketone cage and integral fixation cages. Biologic implants include bone dowels and femoral ring allografts. Methods for optimization of cage design have included cage dimensions, use of novel composite cage materials and integral fixation technologies. However, the historical development and evolution of cages used for ALIF has not been extensively documented. This article therefore aims to provide an overview of the historical basis for the anterior approach, evolution in design of ALIF cage implants and potential future research directions.
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Affiliation(s)
- Kevin Phan
- Department of Neurosurgery, NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
- Department of Neurosurgery, University of New South Wales, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Ralph J Mobbs
- Department of Neurosurgery, NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.
- Department of Neurosurgery, University of New South Wales, Sydney, Australia.
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
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Takahashi T, Hanakita J, Ohtake Y, Funakoshi Y, Oichi Y, Kawaoka T, Watanabe M. Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis. Neurol Med Chir (Tokyo) 2016; 56:476-84. [PMID: 27169496 PMCID: PMC4987447 DOI: 10.2176/nmc.ra.2015-0350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed.
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Schmoelz W, Keiler A. Intervertebrale Cages aus biomechanischer Sicht. DER ORTHOPADE 2015; 44:132-7. [DOI: 10.1007/s00132-014-3071-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Richter M, Weidenfeld M, Uckmann F. Die ventrale lumbale interkorporelle Fusion. DER ORTHOPADE 2014; 44:154-61. [DOI: 10.1007/s00132-014-3056-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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