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Massaad E, Mitchell TS, Duerr E, Kiapour A, Cha TD, Coumans JVC, Groff MW, Hershman SH, Kang JD, Lipa SA, Small L, Tobert DG, Schoenfeld AJ, Shankar GM, Zaidi HA, Shin JH, Williamson T. Disparities in Surgical Intervention and Health-Related Quality of Life Among Racial/Ethnic Groups With Degenerative Lumbar Spondylolisthesis. Neurosurgery 2024; 95:576-583. [PMID: 39145650 DOI: 10.1227/neu.0000000000002925] [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: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Racial and socioeconomic disparities in spine surgery for degenerative lumbar spondylolisthesis persist in the United States, potentially contributing to unequal health-related quality of life (HRQoL) outcomes. This is important as lumbar spondylolisthesis is one of the most common causes of surgical low back pain, and low back pain is the largest disabler of individuals worldwide. Our objective was to assess the relationship between race, socioeconomic factors, treatment utilization, and outcomes in patients with lumbar spondylolisthesis. METHODS This cohort study analyzed prospectively collected data from 9941 patients diagnosed with lumbar spondylolisthesis between 2015 and 2020 at 5 academic hospitals. Exposures were race, socioeconomic status, health coverage, and HRQoL measures. Main outcomes and measures included treatment utilization rates between racial groups and the association between race and treatment outcomes using logistic regression, adjusting for patient characteristics, socioeconomic status, health coverage, and HRQoL measures. RESULTS Of the 9941 patients included (mean [SD] age, 67.37 [12.40] years; 63% female; 1101 [11.1%] Black, Indigenous, and People of Color [BIPOC]), BIPOC patients were significantly less likely to use surgery than White patients (odds ratio [OR] = 0.68; 95% CI, 0.62-0.75). Furthermore, BIPOC race was associated with significantly lower odds of reaching the minimum clinically important difference for physical function (OR = 0.74; 95% CI, 0.60; 0.91) and pain interference (OR = 0.77; 95% CI, 0.62-0.97). Medicaid beneficiaries were significantly less likely (OR = 0.65; 95% CI, 0.46-0.92) to reach a clinically important improvement in HRQoL when accounting for race. CONCLUSION This study found that BIPOC patients were less likely to use spine surgery for degenerative lumbar spondylolisthesis despite reporting higher pain interference, suggesting an association between race and surgical utilization. These disparities may contribute to unequal HRQoL outcomes for patients with lumbar spondylolisthesis and warrant further investigation to address and reduce treatment disparities.
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Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taylor S Mitchell
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emmy Duerr
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ali Kiapour
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jean-Valery C Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shaina A Lipa
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lianne Small
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hasan A Zaidi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
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Kaidi AC, Du JY, Subramanian T, Amen T, Asada T, Qureshi SA, Iyer S. Isolated decompression for degenerative spondylolisthesis is less costly than fusion even with high revision rates. Spine J 2024; 24:1690-1696. [PMID: 38849052 DOI: 10.1016/j.spinee.2024.05.004] [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: 11/08/2023] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND CONTEXT Isolated decompression and decompression with instrumented fusion are accepted surgical treatments for lumbar spondylolisthesis. Although isolated decompression is a less costly solution with similar patient-reported outcomes, it is associated with higher rates of reoperation than primary fusion. PURPOSE To determine the costs associated with primary decompression, primary fusion, and decompression and fusion for degenerative spondylolisthesis. We further sought to establish at what revision rate is primary decompression still a less costly surgical treatment for degenerative lumbar spondylolisthesis. STUDY DESIGN/SETTING A retrospective database study of the Medicare Provider Analysis and Review (MEDPAR) limited data set. PATIENT SAMPLE Patients who underwent single-level fusion or decompression for degenerative spondylolisthesis. OUTCOME MEASURES Cost of surgical care. METHODS All inpatient stays that underwent surgery for single-level lumbar/lumbosacral degenerative spondylolisthesis in the 2019 calendar year (n=6,653) were queried from the MEDPAR limited data set. Patients were stratified into three cohorts: primary decompression (n=300), primary fusion (n=5,757), and revision fusion (n=566). Univariate analysis was conducted to determine cost differences between these groups and results were confirmed with multivariable regression. An economic analysis was then done to determine at what revision rate would primary decompression still be a less costly treatment choice. RESULTS on univariate analysis, the cost of primary single-level decompression for spondylolisthesis was $14,690±9,484, the cost of primary single-level fusion was $26,376±11,967, and revision fusion was $26,686±11,309 (p<0.001). on multivariate analysis, primary fusion was associated with an increased cost of $3,751, and revision fusion was associated with increased cost of $7,502 (95%ci: 2,990-4,512, p<0.001). economic analysis found that a revision rate less than or equal to 43.8% would still result in primary decompression being less costly for a practice than primary fusion for all patients. CONCLUSIONS Isolated decompression for degenerative lumbar spondylolisthesis is a less costly treatment choice even with rates of revision fusion as high as 43.8%. This was true even with an assumed revision rate of 0% after primary fusion. This study solely looks at cost data, however, and many patients may still benefit from primary fusion when appropriately indicated.
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Affiliation(s)
| | - Jerry Y Du
- Hospital for Special Surgery, New York, NY, USA
| | | | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
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Li XB, Wang L, Deng Q, Wang B, Wang ZR, Zhao CM, Li XJ, Huang AB. What are the differences in paraspinal muscle morphometry among degenerative spondylolisthesis patients, isthmic spondylolisthesis patients, and healthy individuals? A propensity score matching analysis. BMC Musculoskelet Disord 2024; 25:410. [PMID: 38783277 PMCID: PMC11118113 DOI: 10.1186/s12891-024-07532-9] [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: 08/06/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To compare the morphometry of paraspinal muscles in patients with degenerative spondylolisthesis (DS), isthmic spondylolisthesis (IS), and healthy individuals. METHODS Thirty-seven pairs of DS patients were selected using propensity score matching with IS patients, while 37 healthy individuals matched for age, sex, and BMI were selected as controls. The relative cross-sectional area (rCSA), and relative functional cross-sectional area (rfCSA) of paraspinal muscles were measured, and the degree of fatty infiltration (FI) was calculated. Based on occupational differences, the patients were also divided into worker and farmer groups, and the same measurements were taken on them. RESULTS At the L3/L4 level, the multifidus (MF) FI was greater in the DS and IS groups than in the control group, the erector spinae (ES) rfCSA was higher in the IS group than in the DS and control groups. At the L4/L5 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS and control groups. At the L5/S1 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS group. At the L3/L4, L4/L5 level, MF rfCSA were higher in the worker group than in the farmer group (p < 0.05). CONCLUSION The morphological changes in paraspinal muscles in patients with DS were dominated by selective atrophy of the MF, while in patients with IS, the morphological changes in paraspinal muscle showed selective atrophy of the MF accompanied by compensatory hypertrophy of the ES. The surgeon should consider the morphological differences in paraspinal muscle between different types of lumbar spondylolisthesis when establishing the appropriate surgical program.
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Affiliation(s)
- Xing-Bin Li
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, 116000, China
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
| | - Lu Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, 116000, China
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
| | - Qian Deng
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
- Postgraduate School, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210000, China
| | - Bang Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, 116000, China
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
| | - Zhao-Rui Wang
- Postgraduate School, Dalian Medical University, Dalian, Liaoning, 116000, China
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
| | - Chun-Ming Zhao
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China
| | - Xiao-Jing Li
- Department of Anesthesiology, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China.
| | - Ai-Bing Huang
- Department of Spine Surgery, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, Jiangsu, 225300, China.
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Hey HWD, Low TL, Soh HL, Tan KA, Tan JH, Tan TH, Thomas AC, Ka-Po Liu G, Wong HK, Tan JHJ. Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine - An EOS Study Using Updated Radiographic Parameters. Global Spine J 2024; 14:1137-1147. [PMID: 36749604 PMCID: PMC11289555 DOI: 10.1177/21925682221134044] [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] [Indexed: 02/08/2023] Open
Abstract
STUDY DESIGN Single centre, cross-sectional study. OBJECTIVES The objective is to report the prevalence of spondylolisthesis and retrolisthesis, analyse both conditions in terms of the affected levels and severity, as well as identify their risk factors. METHODS A review of clinical data and radiographic images of consecutive spine patients seen in outpatient clinics over a 1-month period is performed. Images are obtained using the EOS® technology under standardised protocol, and radiographic measurements were performed by 2 independent, blinded spine surgeons. The prevalence of both conditions were shown and categorised based on the spinal level involvement and severity. Associated risk factors were identified. RESULTS A total of 256 subjects (46.1% males) with 2304 discs from T9/10 to L5/S1 were studied. Their mean age was 52.2(± 18.7) years. The overall prevalence of spondylolisthesis and retrolisthesis was 25.9% and 17.1% respectively. Spondylolisthesis occurs frequently at L4/5(16.3%), and retrolisthesis at L3/4(6.8%). Majority of the patients with spondylolisthesis had a Grade I slip (84.3%), while those with retrolisthesis had a Grade I slip. The presence of spondylolisthesis was found associated with increased age (P < .001), female gender (OR: 2.310; P = .005), predominantly sitting occupations (OR:2.421; P = .008), higher American Society of Anaesthesiology grades (P = .001), and lower limb radiculopathy (OR: 2.175; P = .007). Patients with spondylolisthesis had larger Pelvic Incidence (P < .001), Pelvic Tilt (P < .001) and Knee alignment angle (P = .011), but smaller Thoracolumbar junctional angle (P = .008), Spinocoxa angle (P = .007). Retrolisthesis was associated with a larger Thoracolumbar junctional angle (P =.039). CONCLUSION This is the first study that details the prevalence of spondylolisthesis and retrolisthesis simultaneously, using the EOS technology and updated sagittal radiographic parameters. It allows better understanding of both conditions, their mutual relationship, and associated clinical and radiographic risk factors.
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Affiliation(s)
- Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Tian Ling Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Ling Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kimberly-Anne Tan
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Jun-Hao Tan
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Tuan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Gabriel Ka-Po Liu
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
| | - Hee-Kit Wong
- Department of Orthopaedic Surgery, National University Hospital (NUH), Singapore
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Morimoto T, Kobayashi T, Fukuda M, Hirata H, Otani K, Sekiguchi M, Yamauchi K, Tsukamoto M, Nagamine S, Haro H. Comparison of Gender Diversity Among Spine Surgeons in the Japanese Society for Spine Surgery and Related Research and the Neurospinal Society of Japan: A Descriptive Study Through Secondary Analysis of Aggregated Data. Cureus 2024; 16:e61152. [PMID: 38803408 PMCID: PMC11129104 DOI: 10.7759/cureus.61152] [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] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
STUDY DESIGN This was a descriptive study through secondary analysis of aggregated data. PURPOSE This study aimed to describe changes in women's membership in the Japanese Society for Spine Surgery and Related Research (JSSR) for orthopedic surgery and the Neurospinal Society of Japan (NSJ) for neurosurgery over the past decade and make predictions for the future. OVERVIEW OF LITERATURE Although the ratio of women physicians in the field of spine surgery is known to be low worldwide, there is a lack of detailed surveys in Japan. METHODS We sent emails to the JSSR and NSJ secretariats to verify membership information (gender and age) from 2013 to 2022. Using ordinary least squares, we projected the years it would take for the JSSR and NSJ to achieve a gender diversity ratio of 30%. RESULTS In 2013, the percentage of women in JSSR and NSJ was 2.3% and 2.7%, respectively. However, after 2018, the percentage of women in NSJ will be higher than in JSSR, rising to 2.7% in JSSR and 4.7% in NSJ by 2022. It would require 101 years for the NSJ and more than 1,000 years for the JSSR to realize 30% gender diversity. CONCLUSIONS JSSR and NSJ have low percentages of women. Improving gender diversity is an important issue for both societies, and they may collaborate on finding a good solution. Both the JSSR and NSJ societies need to actively address gender diversity and become more attractively represented in society for the next generation of spine surgeons.
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Affiliation(s)
| | | | - Miyuki Fukuda
- Neurological Surgery, Shin-Aikai Spine Center, Katano Hospital, Katano, JPN
| | | | - Koji Otani
- Orthopedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Miho Sekiguchi
- Orthopedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Kazuyo Yamauchi
- Community-Oriented Medical Education, Graduate School of Medicine, Chiba University, Chiba, JPN
| | | | | | - Hirotaka Haro
- Orthopedic Surgery, University of Yamanashi, Chuo, JPN
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Hipp J, Grieco T, Newman P, Patel V, Reitman C. Reference Data for Diagnosis of Spondylolisthesis and Disc Space Narrowing Based on NHANES-II X-rays. Bioengineering (Basel) 2024; 11:360. [PMID: 38671782 PMCID: PMC11048070 DOI: 10.3390/bioengineering11040360] [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: 03/08/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Robust reference data, representing a large and diverse population, are needed to objectively classify measurements of spondylolisthesis and disc space narrowing as normal or abnormal. The reference data should be open access to drive standardization across technology developers. The large collection of radiographs from the 2nd National Health and Nutrition Examination Survey was used to establish reference data. A pipeline of neural networks and coded logic was used to place landmarks on the corners of all vertebrae, and these landmarks were used to calculate multiple disc space metrics. Descriptive statistics for nine SPO and disc metrics were tabulated and used to identify normal discs, and data for only the normal discs were used to arrive at reference data. A spondylolisthesis index was developed that accounts for important variables. These reference data facilitate simplified and standardized reporting of multiple intervertebral disc metrics.
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Affiliation(s)
- John Hipp
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | - Trevor Grieco
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | | | - Vikas Patel
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Charles Reitman
- Medical University of South Carolina, Charleston, SC 29425, USA;
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Konieczny MR, Jäger M. [Spondylolisthesis]. Schmerz 2024; 38:157-166. [PMID: 38446187 DOI: 10.1007/s00482-024-00804-2] [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] [Indexed: 03/07/2024]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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Fedorchuk CA, Fedorchuk CG, Lightstone DF. Improvement in Pain, Quality of Life, and Urinary Dysfunction following Correction of Lumbar Lordosis and Reduction in Lumbar Spondylolistheses Using Chiropractic BioPhysics ® Structural Spinal Rehabilitation: A Case Series with >1-Year Long-Term Follow-Up Exams. J Clin Med 2024; 13:2024. [PMID: 38610790 PMCID: PMC11012333 DOI: 10.3390/jcm13072024] [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: 03/11/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68-71 years showing improvements in back pain, quality of life (QOL), and urinary dysfunction following correction of lumbar spondylolistheses using CBP® spinal rehabilitation. Pre-treatment radiographs showed lumbar hyperlordosis (-49.6°, ideal is -40°) and anterolisthesis (14.5 mm, ideal is 0 mm). Pre-treatment patient-reported outcome measures (PROMs) included a numeric rating scale (NRS) for back pain (7.3/10, ideal is 0), urinary urgency (8/10, ideal is 0), and SF-36 physical (PCS) and mental component score (MCS) (29.8 and 46.6, ideal is 46.8 and 52.8). Patients underwent 2-3 CBP® sessions per week to correct lumbar hyperlordosis and lumbar anterolistheses. (3) Results: Post-treatment radiographs showed improvements in lumbar curvature (-42.8°) and anterolisthesis (4.2 mm). Post-treatment PROMs showed improvements in NRS for back pain (1/10), urinary urgency (2.3/10), and SF-36 PCS and MCS (50.2 and 57.7). Long-term follow-up radiographs and PROMs showed maintained improvements. (4) Conclusions: This series documents the first-recorded long-term corrections of lumbar spondylolisthesis and concomitant improvements in back pain, urinary urgency, and QOL using CBP®. This series provides evidence for CBP® as a non-surgical approach to lumbar spinal rehabilitation and the possible impacts of spinal alignment on pain, urinary dysfunction, and QOL.
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Affiliation(s)
| | | | - Douglas F. Lightstone
- Institute of Spinal Health and Performance, Cumming, GA 30041, USA; (C.A.F.); (C.G.F.)
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Ray BM, Washington L, Thompson BL, Kelleran K. An exploration of low back pain beliefs held by health care professionals in Northern America. Musculoskeletal Care 2024; 22:e1877. [PMID: 38520493 DOI: 10.1002/msc.1877] [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: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. METHODS Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. RESULTS One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. CONCLUSIONS These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Leah Washington
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Bronwyn Lennox Thompson
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand, USA
| | - Kyle Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York, USA
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Khalid SI, Mirpuri P, Massaad E, Thomson KB, Kiapour A, Shin JH, Adogwa O. The Impact of Preoperative Spinal Injection Timing on Postoperative Complications of Lumbar Decompression Surgery. Neurosurgery 2024:00006123-990000000-01060. [PMID: 38376173 DOI: 10.1227/neu.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epidural steroid injections (ESIs) are commonly used for lower back pain management. The effect of these injections on lumbar decompression surgery outcomes is hitherto underexplored. The study objective was to determine the impact of ESIs on postoperative rates of medical and surgical complications and to define the appropriate interval before lumbar decompression surgery. METHODS This retrospective all-payer database analysis identified 587 651 adult patients undergoing one- to three-level laminectomies from January 2010 to October 2021. A 2:1 propensity score match accounting for comorbidities, levels of surgery, and demographics was performed to create two cohorts: (1) 43 674 patients who had received an ESI in the 90 days before laminectomy and (2) 87 348 patients who had not received an ESI. The primary outcome was the rates of medical and surgical complications between groups at 30 days postoperatively. Patients were divided into five cohorts based on injection time before surgery: 1 to 30 days, 31 to 45 days, 46 to 60 days, 61 to 75 days, and 76 to 90 days. Logistic regression was performed between groups to identify temporal associations of complication rates. Confidence intervals of 95% are provided when appropriate. P values < .01 were considered significant. RESULTS Rates of medical complications within 30 days of surgery were significantly higher in those with ESI compared with control (4.83% vs 3.9%, P < .001). Cerebrospinal fluid (CSF) leak rates were increased in the ESI group at 0.28% vs 0.1% (P < .001), but surgical site infection rates were not significantly different between groups (1.31% vs 1.42% P = .11). ESI performed within 30 days was associated with increased odds of CSF leak (OR: 5.32, 95% CI: 3.96-7.15). CONCLUSION Preoperative ESI increases the risk of CSF leak and medical complications after lumbar decompression. Because these complications were significantly associated with ESIs given 1 to 30 days before surgery, avoiding ESIs at least 30 days before surgery may be advisable.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Ali Kiapour
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
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Turcotte JJ, Brennan JC, Rana P, Johnson AH, Patton C. Outcomes in Lumbar Fusion Patients Stratified by the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification System. Cureus 2024; 16:e54177. [PMID: 38496088 PMCID: PMC10941802 DOI: 10.7759/cureus.54177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective The Meyerding classification system remains the most common classification system for spondylolisthesis based on the percentages of vertebral translation. However, the majority of patients with degenerative disease fall into Grade 1, limiting its utility in this subset of patients. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system provides a simple radiographic framework for classifying degenerative lumbar spondylolisthesis (DLS) patients by incorporating disc height, kyphosis, and anterior translation. The purpose of this study was to evaluate how clinical characteristics, treatments, and outcomes vary across different CARDS groups in patients undergoing one- or two-level lumbar fusion for DLS. Methods The patients were classified into one of the following four CARDS groups - Type A: advanced disc space collapse with no evidence of kyphosis; Type B: partially preserved disc space with less than 5.0 mm of translation; Type C: partially preserved disc space with greater than 5.0 mm of translation; and Type D: kyphotic alignment. Univariate analyses were performed to compare demographics, symptoms, clinical outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) physical (PH) and mental health (MH) scores across groups. Results Ninety-one patients were included in the study. Based on the CARDS classification, there were three (3%) Type A patients, 25 (28%) Type B, 58 (64%) Type C, and five (5%) Type D. No significant differences in baseline demographics, symptom duration, or PROMIS scores were observed across groups. Interbody utilization varied, ranging from 19% in CARDS C (n=11) to 60% in CARDS B (n=15) and D (n=3) patients (p=0.005). Thirty-day clinical outcomes were similar across groups. At an average follow-up of 8.9 months, improvements in PROMIS PH and MH scores and rates of clinically significant improvement were similar across groups. Conclusions Based on our findings, patients undergoing lumbar fusion for DLS present with similar demographic and clinical characteristics and experience similar clinical and patient-reported outcomes when stratified using the CARDS classification system. Posterolateral fusion (PLF) can be effective for various radiographic presentations of DLS. Further research is warranted to assess the utility of CARDS in preoperative planning.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Chad Patton
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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12
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Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
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Kim DC, Laskay N, Alcala C, Schwender J. Minimally Invasive Decompression With Noninstrumented Facet Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Stenosis Associated With Grade 1 Lumbar Degenerative Spondylolisthesis. Clin Spine Surg 2023; 36:E416-E422. [PMID: 37348064 DOI: 10.1097/bsd.0000000000001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN Retrospective matched cohort study. SUMMARY OF BACKGROUND DATA With a growing interest in minimally invasive spine surgery (MIS), the question of which technique is the most advantageous for patients with low-grade degenerative lumbar spondylolisthesis (DLS) still remains unclear. OBJECTIVE To compare patient-reported outcomes, perioperative morbidity, and rates of reoperation between MIS decompression with either unilateral noninstrumented facet fusion (MIS-F) or with transforaminal interbody fusion (MIS-T) for grade 1 DLS. METHODS Twenty patients who underwent MIS-T and 20 patients with MIS-F were matched based on age, sex, and preoperative ODI, VAS back, and VAS leg. All patients had DLS with at least 4 millimeters of translation on standing radiographs. Exclusion criteria included prior level surgery, multilevel instability, disk impinging on the exiting nerve root, spondylolisthesis from significant facet arthropathy, or foraminal compromise from disk collapse. ODI, VAS back, VAS leg, and patient satisfaction measured by the North American Spine Society questionnaire were tracked at 3, 6, 12, and 24 months postoperatively. Minimum clinically important differences and substantial clinical benefits were calculated. RESULTS MIS-F and MIS-T resulted in decreased ODI at 3, 6, and 12 months following the index procedure. Sixty percent of MIS-F and 83% of MIS-T patients reached minimum clinically important difference at 1 year postoperatively; however, using the threshold of 30% ODI reduction from baseline, 67% of MIS-F and 83% MIS-T ( P = 0.25) achieved this goal. Forty-three percent of MIS-F and 59% of MIS-T patients met substantial clinical benefits. Satisfaction at 1 year, measured by a score of 1 or 2 on the North American Spine Society questionnaire, was 64% for MIS-F and 83% for MIS-T. CONCLUSIONS MIS-F and MIS-T are effective treatment options for spinal stenosis associated with low-grade DLS. Both techniques result in comparable patient-reported outcomes and satisfaction up to 2 years and have similar long-term reoperation rates. More evidence is required to delineate optimal selection characteristics for MIS-F versus MIS-T.
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Affiliation(s)
| | - Nicholas Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
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14
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Thompson AR, Montgomery TP, Gillis C, Smith SG, Carlson NL, Ensrud ER, Carlson HL, Marshall LM, Yoo JU. How Do Standing Neutral, Supine Lateral, Standing Flexion, and Standing Extension Radiographs Compare in Detecting the Presence and Magnitude of Stable and Dynamic Spondylolisthesis? Clin Orthop Relat Res 2023; 481:2459-2468. [PMID: 37201553 PMCID: PMC10642867 DOI: 10.1097/corr.0000000000002695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/18/2023] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Clinical guidelines recommend standing radiographs as the most appropriate imaging for detecting degenerative spondylolisthesis, although reliable evidence about the standing position is absent. To our knowledge, no studies have compared different radiographic views and pairings to detect the presence and magnitude of stable and dynamic spondylolisthesis. QUESTIONS/PURPOSES (1) What is the percentage of new patients presenting with back or leg pain with stable (3 mm or greater listhesis on standing radiographs) and dynamic (3 mm or greater listhesis difference on standing-supine radiographs) spondylolisthesis? (2) What is the difference in the magnitude of spondylolisthesis between standing and supine radiographs? (3) What is the difference in the magnitude of dynamic translation among flexion-extension, standing-supine, and flexion-supine radiographic pairs? METHODS This cross-sectional, diagnostic study was performed at an urban, academic institution between September 2010 and July 2016; 579 patients 40 years or older received a standard radiographic three-view series (standing AP, standing lateral, and supine lateral radiographs) at a new patient visit. Of those individuals, 89% (518 of 579) did not have any of the following: history of spinal surgery, evidence of vertebral fracture, scoliosis greater than 30°, or poor image quality. In the absence of a reliable diagnosis of dynamic spondylolisthesis using this three-view series, patients may have had flexion and extension radiographs, and approximately 6% (31 of 518) had flexion and extension radiographs. A total of 53% (272 of 518) of patients were female, and the patients had a mean age of 60 ± 11 years. Listhesis distance (in mm) was measured by two raters as displacement of the posterior surface of the superior vertebral body in relation to the posterior surface of the inferior vertebral body from L1 to S1; interrater and intrarater reliability, assessed with intraclass correlation coefficients, was 0.91 and 0.86 to 0.95, respectively. The percentage of patients with and the magnitude of stable spondylolisthesis was estimated on and compared between standing neutral and supine lateral radiographs. The ability of common pairs of radiographs (flexion-extension, standing-supine, and flexion-supine) to detect dynamic spondylolisthesis was assessed. No single radiographic view or pair was considered the gold standard because stable or dynamic listhesis on any radiographic view is often considered positive in clinical practice. RESULTS Among 518 patients, the percentage of patients with spondylolisthesis was 40% (95% CI 36% to 44%) on standing radiographs alone, and the percentage of patients with dynamic spondylolisthesis was 11% (95% CI 8% to 13%) on the standing-supine pair. Standing radiographs detected greater listhesis than supine radiographs did (6.5 ± 3.9 mm versus 4.9 ± 3.8 mm, difference 1.7 mm [95% CI 1.2 to 2.1 mm]; p < 0.001). Among 31 patients, no single radiographic pairing identified all patients with dynamic spondylolisthesis. The listhesis difference detected between flexion-extension was no different from the listhesis difference detected between standing-supine (1.8 ± 1.7 mm versus 2.0 ± 2.2 mm, difference 0.2 mm [95% CI -0.5 to 1.0 mm]; p = 0.53) and flexion-supine (1.8 ± 1.7 mm versus 2.5 ± 2.2 mm, difference 0.7 mm [95% CI 0.0 to 1.5]; p = 0.06). CONCLUSION This study supports current clinical guidelines that lateral radiographs should be obtained with patients in the standing position, because all cases of stable spondylolisthesis of 3 mm or greater were detected on standing radiographs alone. Each radiographic pair did not detect different magnitudes of listhesis, and no single pair detected all cases of dynamic spondylolisthesis. Clinical concern for dynamic spondylolisthesis may justify standing neutral, supine lateral, standing flexion, and standing extension views. Future studies could identify and evaluate a set of radiographic views that provides the greatest capacity to diagnose stable and dynamic spondylolisthesis. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Austin R. Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Tyler P. Montgomery
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cai Gillis
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Sawyer G. Smith
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Nels L. Carlson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Erik R. Ensrud
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Hans L. Carlson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Lynn M. Marshall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung U. Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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15
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Konieczny MR, Jäger M. [Spondylolisthesis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:931-940. [PMID: 37792012 DOI: 10.1007/s00132-023-04443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/05/2023]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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16
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Robinson D, Biswas S, Torrie C, MacArthur J, Snowdon E, Sial M, Sarkar V, George KJ. Determining the risk of spinal pathology progression in neurofibromatosis type 1 patients - a national tertiary neurofibromatosis type 1 centre study. Clin Neurol Neurosurg 2023; 234:107985. [PMID: 37778105 DOI: 10.1016/j.clineuro.2023.107985] [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: 08/11/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) gives rise to a variety of spinal pathologies that include dural ectasia (DE), vertebral malalignments (VMA), spinal deformities (SD), syrinx, meningoceles, spinal nerve root tumours (SNRT), and spinal plexiform tumours (SPT). The relationship between these and the progression of these pathologies has not been explored before in detail and this paper aims to address this. METHODS Data was retrospectively collected from adult NF1 multi-disciplinary team meetings from 2016 to 2022 involving a total of 593 patients with 20 distinct predictor variables. Data were analyzed utilizing; Chi-Square tests, binary logistic regression, and Kaplan-Meier analysis. RESULTS SNRT (19.9%), SD (18.6%), and (17.7%) of VMA had the highest rates of progression. SD was significantly associated (p < 0.02) with the presence and progression of all spinal pathologies except for SPT. Statistically significant predictors of SD progression included the presence of DVA, VMA, syrinx, meningocele, and SNRT. Kaplan-Meier analysis revealed no statistically significant difference between the times to progression for SD (85 days), SNRT (1196 days), and VMA (2243 days). CONCLUSION This paper explores for the first time in detail, the progression of various spinal pathologies in NF1. The presence and progression of SD is a key factor that correlated with the progression of different spinal pathologies. Early identification of SD may help support clinical decision-making and guide radiological follow-up protocols and treatment.
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Affiliation(s)
- Daniel Robinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK
| | - Sayan Biswas
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK.
| | - Christopher Torrie
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK
| | - Joshua MacArthur
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK
| | - Ella Snowdon
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK
| | - Moska Sial
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, UK
| | - Ved Sarkar
- College of Letters and Sciences, University of California, Berkeley, California 94720, United States
| | - K Joshi George
- Department of Neurosurgery, Salford Royal Hospital, Manchester, England, UK
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17
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Zhang B, Ma JS, Feng P, Hu Y, Liu JL, Kong QQ. Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of II° lumbar isthmic spondylolisthesis: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35420. [PMID: 37800840 PMCID: PMC10553201 DOI: 10.1097/md.0000000000035420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is not suitable for high-grade isthmic spondylolisthesis, whether MIS-TLIF can treat II° lumbar isthmic spondylolisthesis (IS) is still controversial. This retrospective cohort study compared the clinical efficacy of MIS-TLIF and open transforaminal lumbar interbody fusion (OPEN-TLIF) in the treatment of II° lumbar IS. From January 2017 to January 2023, 101 patients with II° lumbar IS were diagnosed in our hospital and underwent surgical treatment, of which 53 received MIS-TLIF surgery and 48 received OPEN-TLIF surgery. The operation time, blood loss and surgical complications were compared between the 2 groups. The pain, function, reduction rate and fusion rate of the patients were evaluated during follow-up. The amount of intraoperative blood loss, postoperative drainage, and postoperative hospital stay in the MIS-TLIF group were significantly lower than those in the OPEN-TLIF group were (P < .01). In the MIS-TLIF group, there were 1 case of dural sac injury and 3 cases of lower limb paralysis. The complication rate of MIS-TLIF was lower than the OPEN-TLIF group (P = .032). In the visual analog scale score of low back pain, the MIS-TLIF group was lower than the OPEN-TLIF group after operation and at the last follow-up. There were no significant differences in postoperative leg pain score, slippage rate, and fusion rate between the 2 groups. Compared with OPEN-TLIF, MIS-TLIF has the advantages of better low back pain relief, less trauma, less bleeding and faster recovery, and is worthy of clinical promotion.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Jun-Song Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Jun-Lin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Qing-Quan Kong
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1430. [PMID: 37629720 PMCID: PMC10456558 DOI: 10.3390/medicina59081430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.
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Affiliation(s)
- Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Bartłomiej Kulesza
- Department of Medical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Natalia Gołębiowska
- Department of Neurosurgery and Spine Surgery, Regional Hospital in Kielce, 25-736 Kielce, Poland
| | - Bartłomiej Tyzo
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
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Atalay B, Gadjradj PS, Sommer FS, Wright D, Rawanduzy C, Ghogawala Z, Härtl R. Natural History of Degenerative Spondylolisthesis: A Systematic Review and Meta-analysis. World Neurosurg 2023; 176:e634-e643. [PMID: 37271258 DOI: 10.1016/j.wneu.2023.05.112] [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: 04/26/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The optimal treatment algorithm for patients with degenerative lumbar spondylolisthesis has not been clarified. Part of the reason for this is that the natural history of degenerative spondylolisthesis (DS) has not been sufficiently studied. Comprehension of the natural history is essential for surgical decision making. We aimed to determine 1) the proportion of patients that develop de novo DS during follow-up; and 2) the proportion of patients with progression of preexistent DS by conducting a systematic review and meta-analysis of the literature. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Ovid, EMBASE, and the Cochrane Library were searched from their inception through April 2022. Demographic values of the study populations, grade of slip, rate of slippage before and after the follow-up period, and percentage of patients with slip in the populations at baseline and after follow-up were the extracted parameters. RESULTS Of the 1909 screened records, eventually 10 studies were included. Of these studies, 5 reported the development of de novo DS and 9 reported on the progression of preexistent DS. Proportions of patients developing de novo DS ranged from 12% to 20% over a period ranging from 4 to 25 years. The proportion of patients with progression of DS ranged from 12% to 34% over a period ranging from 4 to 25 years. CONCLUSIONS Systematic review and metanalysis of DS on the basis of radiologic parameters revealed both an increasing incidence over time and an increasing progression of the slip rate in up to a third of the patients older than 25 years, which is important for counseling patients and surgical decision making. Importantly, two thirds of patients did not experience slip progression.
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Affiliation(s)
- Basar Atalay
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA; Department of Neurological Surgery, Beth Israel Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA.
| | - Pravesh S Gadjradj
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Fabian S Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Drew Wright
- Weill Cornell Medical Library, Weill Cornell Medicine, New York, New York, USA
| | - Cameron Rawanduzy
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
| | - Zoher Ghogawala
- Department of Neurological Surgery, Beth Israel Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital OCH SPINE, New York, New York, USA
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20
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Tang AR, Chanbour H, Steinle AM, Jonzzon S, Roth SG, Gardocki RJ, Stephens BF, Abtahi AM, Zuckerman SL. Transforaminal Lumbar Interbody Fusion Versus Posterolateral Fusion Alone in the Treatment of Grade 1 Degenerative Spondylolisthesis. Neurosurgery 2023; 93:186-197. [PMID: 36848669 DOI: 10.1227/neu.0000000000002402] [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: 09/21/2022] [Accepted: 12/11/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) alone are two operations performed to treat degenerative lumbar spondylolisthesis. To date, it is unclear which operation leads to better outcomes. OBJECTIVE To compare TLIF vs PLF alone regarding long-term reoperation rates, complications, and patient-reported outcome measures (PROMs) in patients with degenerative grade 1 spondylolisthesis. METHODS A retrospective cohort study using prospectively collected data between October 2010 and May 2021 was undertaken. Inclusion criteria were patients aged 18 years or older with grade 1 degenerative spondylolisthesis undergoing elective, single-level, open posterior lumbar decompression and instrumented fusion with ≥1-year follow-up. The primary exposure was presence of TLIF vs PLF without interbody fusion. The primary outcome was reoperation. Secondary outcomes included complications, readmission, discharge disposition, return to work, and PROMs at 3 and 12 months postoperatively, including Numeric Rating Scale-Back/Leg and Oswestry Disability Index. Minimum clinically important difference of PROMs was set at 30% improvement from baseline. RESULTS Of 546 patients, 373 (68.3%) underwent TLIF and 173 underwent (31.7%) PLF. Median follow-up was 6.1 years (IQR = 3.6-9.0), with 339 (62.1%) >5-year follow-up. Multivariable logistic regression showed that patients undergoing TLIF had a lower odds of reoperation compared with PLF alone (odds ratio = 0.23, 95% CI = 0.54-0.99, P = .048). Among patients with >5-year follow-up, the same trend was seen (odds ratio = 0.15, 95% CI = 0.03-0.95, P = .045). No differences were observed in 90-day complications ( P = .487) and readmission rates ( P = .230) or minimum clinically important difference PROMs. CONCLUSION In a retrospective cohort study from a prospectively maintained registry, patients with grade 1 degenerative spondylolisthesis undergoing TLIF had significantly lower long-term reoperation rates than those undergoing PLF.
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Affiliation(s)
- Alan R Tang
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony M Steinle
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Wu TM, Kim MC, Hwang JH, Choi DJ. Enhancing endoscopic foraminal decompression in adult isthmic spondylolisthesis: the potential influence of lateral recess isthmic spur and our case series of an innovative craniocaudal interlaminar approach via unilateral biportal endoscopic spinal surgery. BMC Musculoskelet Disord 2023; 24:426. [PMID: 37244983 DOI: 10.1186/s12891-023-06544-1] [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: 02/08/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The NASS guideline cannot recommend any of the surgical treatment options toward adult isthmic spondylolisthesis (AIS) since 2014. After the introduction of endoscopic decompression, instead of treating the spondylolysis itself, treatment can specifically target the refractory radicular pain developed during the degeneration progress without devastating the peripheral soft tissue. However, we noticed that endoscopic transforaminal decompression seems to be less effective in AIS compared to other types of degenerative spondylolisthesis. Thus, we came up with a novel craniocaudal interlaminar approach, utilizing the proximal adjacent interlaminar space to perform bilateral decompression and observed the pathoanatomy of pars defect directly and tried to identify the cause of decompression failure. METHODS From January 2022 to June 2022, 13 patients with AIS underwent endoscopic decompression via the endoscopic craniocaudal interlaminar approach and were followed up for at least 6 months. Visual Analogue Scale, Oswestry Disability Index and MacNab scores were recorded to monitor patients' clinical recovery. All endoscopic procedures were recorded and reviewed to illustrate the pathoanatomy. RESULTS Four patients required minor revision via the same technique. One of them required it due to incomplete isthmic spur resection, two due to neglected disc protrusion, and the other due to root subpedicular kinking in higher grade anterolisthesis. All patients' clinical condition improved significantly subsequently. After reviewing the endoscopic video, we have observed that the hook-like, ragged spur originating from the isthmic defect extends beyond the region around the foramen. Instead, it extends proximally into the adjacent lateral recess, resulting in impingement along the fracture edge above the index foramen and, in some cases, even in the extraforaminal area. CONCLUSIONS The broad spanning isthmic spur extending to the proximal adjacent lateral recess might be the reason why the transforaminal approach yielded less satisfactory results due to the incomplete decompression result from approach related restriction. Our study demonstrated an optimistic outcome by applying decompression from the upper level. Therefore, we propose that the craniocaudal interlaminar approach might be a better route for decompression in adult isthmic spondylolisthesis.
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Affiliation(s)
- Tsung-Mu Wu
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (R.O.C.)
| | - Moon-Chan Kim
- Spine Center, Himnaera Hospital, 85, Boemil-Ro, Dong-Gu, Busan, Korea
| | - Jin-Ho Hwang
- Spine Center, Himnaera Hospital, 85, Boemil-Ro, Dong-Gu, Busan, Korea
| | - Dae-Jung Choi
- Spine Center, Himnaera Hospital, 85, Boemil-Ro, Dong-Gu, Busan, Korea.
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22
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van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. 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 2023; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
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Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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23
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Farooque M. Specific and Nonspecific Low Back Pain-Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist. Spine J 2023:S1529-9430(23)00170-5. [PMID: 37116719 DOI: 10.1016/j.spinee.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mustafa Farooque
- Department of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Suite 310, Milwaukee, WI.
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24
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Imaging analysis and predictive nomogram construction for degenerative lumbar spondylolisthesis with severe clinical symptom based on propensity score matching. Sci Rep 2023; 13:4161. [PMID: 36914738 PMCID: PMC10011391 DOI: 10.1038/s41598-023-31224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Intervertebral disc degeneration, local lumbar segmental morphology changes, and atrophy of multifidus muscle have been considered to be associated with degenerative lumbar spondylolisthesis. However, there remains a great deal of controversy. To further investigate their relationship with degenerative lumbar spondylolisthesis, we conducted a retrospective study that included 67 patients with degenerative spondylolisthesis and 182 control subjects. Propensity score matching was employed to match the case group and the control group. Disc height was evaluated by the anterior disc height index (DHIA) and posterior disc height index (DHIP). Local lumbar segmental morphology was assessed by segmental lordosis (SL). The fatty infiltration and atrophy of multifidus muscle was evaluated by multifidus muscle net content (MFNC). Our results indicate that DHIA, DHIP, SL, and MFNC in the case group were significantly lower than in the control group. Furthermore, the DHIA, DHIP, and MFNC of the slipped segment (L4/5) were lower than those of the non-slipped segment (L3/4). Correlation analysis showed a high relationship between DHIA and MFNC and the degree of degenerative lumbar spondylolisthesis. Logistic regression analysis revealed that DHIA and MFNC might act as protective factors against the development of degenerative lumbar spondylolisthesis. Additionally, a prognostic nomogram was developed and validated to assess the likelihood of patients with severe symptoms requiring surgical intervention.
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25
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Khalid SI, Chilakapati S, Mirpuri P, Eldridge C, Burton M, Adogwa O. The Impact of Cognitive Impairment on Postoperative Complications After Spinal Surgery: A Matched Analysis. World Neurosurg 2023; 171:e172-e185. [PMID: 36574568 DOI: 10.1016/j.wneu.2022.11.114] [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: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The coprevalence of age-related comorbidities such as cognitive impairment and spinal disorders is increasing. No studies to date have assessed the postoperative spine surgery outcomes of patients with mild cognitive impairment (MCI) or severe cognitive impairment (dementia) compared with those without preexisting cognitive impairment. METHODS Using all-payer claims database, 235,123 persons undergoing either cervical or lumbar spine procedures between January 2010 and October 2020 were identified. Exact 1:1:1 matching based on baseline patient demographics and comorbidities was used to create a dementia group, MCI group, and control group without MCI/dementia (n = 3636). The primary outcome was the rate of any 30-day major postoperative complications. Secondary outcomes included the rates of revision surgery, readmission rates within 30 days, and health care costs within 1 year postoperatively. RESULTS Compared with the control group, patients with dementia had an 8-fold and 5.4-fold increase in all-cause 30-day complications after undergoing cervical and lumbar spine procedures, respectively. Similarly, patients with MCI had a 3.1-fold and 2.2-fold increase in all-cause 30-day complications, respectively. Patients with either MCI or dementia had increased rates of pneumonia and urinary tract infection after either spine procedure compared with control (P < 0.01). Odds of revision surgery were increased in the lumbar surgery cohort for dementia (3.43; 95% confidence interval, 1.69-6.95) and for MCI (2.41; 95% confidence interval, 1.14-5.05). CONCLUSIONS This is the first study to characterize the postoperative complications profile of patients with preexisting dementia or MCI undergoing cervical and lumbar spine surgery. Both dementia and MCI are associated with increased postoperative complications within 30 days.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Sai Chilakapati
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Cody Eldridge
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Michael Burton
- Department of Neuroscience, University of Texas at Dallas, Richardson, Texas, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
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26
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Factors influencing the long-term outcomes of instrumentation surgery for degenerative lumbar spondylolisthesis: a post-hoc analysis of a prospective randomized study. Spine J 2023; 23:799-804. [PMID: 36774998 DOI: 10.1016/j.spinee.2023.02.002] [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: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one of the most common indications for spinal surgery. However, the factors that influence its long-term (>10 years) outcomes remain unknown. DESIGN This is a post-hoc analysis of a prospective randomized study. PURPOSE This study aimed to determine factors that influence the long-term outcomes of instrumentation surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis. PATIENT SAMPLE Patients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals between May 1, 2003, and April 30, 2012; the final follow-up examination was on May 20, 2021. OUTCOME MEASURES The following data were collected: modified Japanese Orthopedic Association (JOA) score, JOA score recovery rate, visual analog scale (VAS) score for lower back and leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and at the final follow-up examination. METHODS Spearman's correlation analysis and univariate and multivariate regression analyses were used to examine preoperative factors that affect the JOA score recovery rate in patients who underwent instrumentation surgery for lumbar spinal canal stenosis at the L4/5 level due to degenerative lumbar spondylolisthesis. RESULTS A total of 42 patients who underwent instrumentation surgery for degenerative lumbar spondylolisthesis and had a long-term follow-up period were included. Of these, 25 and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed that the long-term recovery rate was correlated with the preoperative VAS score for low back pain. In the univariate regression analysis, sex, preoperative VAS score for low back pain, and the SF-36 general health score were significantly associated with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate. CONCLUSIONS This study identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate following instrumentation surgery for degenerative lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf stabilization for degenerative lumbar spondylolisthesis, attention should be paid to the intensity of preoperative low back pain and considerations should be given to whether these procedures can improve the patient's symptoms in the long term.
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27
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Gök H, Mraja HM, Daadour IMF, Ulusoy OL, Karadereler S, Enercan M, Hamzaoğlu A. Transdiscal Screw Fixation in L5-S1 Adult Spondylolisthesis: Technical Note and Midterm Outcomes of a Case Series. World Neurosurg 2023; 170:e840-e846. [PMID: 36481443 DOI: 10.1016/j.wneu.2022.11.131] [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: 10/03/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Spondylolisthesis changes the pelvic morphology and sagittal spinopelvic alignment with abnormality compared to individuals with similar pelvic morphology. There are many treatment options including a combination of decompression and fusion. In spondylolisthesis patients with high-grade spondylolisthesis, bone to bone contact (closed intradiscal space), and high-grade disc degeneration with disc collapse, fusion is challenging. METHODS From 2011 through 2020, an analysis of L5-S1 spondylolisthesis patients who had L5-S1 transdiscal screw fixation with a minimum follow-up of 2 years was performed. Radiological evaluation and clinical measures were compared preoperatively and postoperatively. Postoperative complications were analyzed. Also, L5-S1 degree fusion was analyzed using a computed tomography scan. RESULTS Eight patients of L5-S1 spondylolisthesis with a mean follow-up of 69 (25-122) months. All patients were female; the average age was 58 (43-78) years. 4 patients presented with high-grade spondylolisthesis (Meyerding grade III). Among the patients, 3 patients were undergoing revision surgery. Only 5 patients had interbody fusion for their adjacent levels. In the postoperative follow-up, none of the patients had neurological deficits. Radiological evaluations of L5-S1 level showed fusion in all patients. Only 1 patient had rod failure and was advised for revision surgery. CONCLUSIONS L5-S1 transdiscal screw fixation may provide a satisfactory rigid fixation and fusion at the L5-S1 level in cases of spondylolisthesis. This technique requires a surgeon's experience. Despite the challenge of this technique, it can provide a safe option for acquiring rigid stabilization.
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Affiliation(s)
- Halil Gök
- Scoliosis - Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey
| | - Hamisi Mwarindano Mraja
- Scoliosis - Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey.
| | | | - Onur Levent Ulusoy
- Radiology Department, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey
| | - Selhan Karadereler
- Scoliosis - Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey
| | - Meriç Enercan
- Scoliosis - Spine Center Istanbul, Demiroglu Bilim University, Istanbul, Turkey
| | - Azmi Hamzaoğlu
- Scoliosis - Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Sisli, Istanbul, Turkey
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28
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Degulmadi D, Dave B, Krishnan A, Rai RR, Mayi S, Chintam CR. 'Higher the grade-smaller the pedicle': a study of pedicle dimensional variations in 100 cases of high grade lytic spondylolisthesis. 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 2023; 32:455-461. [PMID: 35767112 DOI: 10.1007/s00586-022-07277-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the pedicle dimensions in high grade lytic spondylolisthesis (HGL) and to classify them, which helps the spine surgeon in proper selection of pedicle screws. METHODS A study of CT scans in 100 consecutive patients between Jan 2017 and April 2021 diagnosed as single-level HGL on standing radiographs. Pedicle height (PH), Pedicle width (PW), Differential pedicle height (DPH), Screw length (SL) and Transverse pedicle angle (TPA) were measured and analyzed. PH and PW were classified into four grades as-grade A less than 5.0 mm, grade B between 5.0 and 6.0 mm, grade C between 6.0 and 7.0 mm, and grade D above 7.0 mm. RESULTS 5 males and 95 females with mean age of 49.1 years. PH in 44% lytic vertebra were grade A, B (less than 6 mm) and the rest 56% had grade C, D (greater than 6 mm). PH averaged 6.6 mm in grade 3 HGL, 5.61 mm in grade 4 HGL. Change in PW, SL and TPA was not statistically significant with regards to grade or level of listhesis. A total of 37 cases were noted to have DPH (25 cases had a difference < 2 mm and 12 had a difference > 2 mm). CONCLUSION 44% of the PH in lytic vertebra was grade A and B (less than 6 mm) that stresses the importance of pre-op CT assessment and planning the appropriate screw dimensions. Change in PH was statistically significant with regards to the grade of listhesis (P-value < 0.01). Differential pedicle height also need to be looked for.
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Affiliation(s)
| | - Bharat Dave
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Ajay Krishnan
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Ravi Ranjan Rai
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Shivanand Mayi
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
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29
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Fan G, Li Y, Yang S, Qin J, Huang L, Liu H, He S, Liao X. Research topics and hotspot trends of lumbar spondylolisthesis: A text-mining study with machine learning. Front Surg 2023; 9:1037978. [PMID: 36684199 PMCID: PMC9852633 DOI: 10.3389/fsurg.2022.1037978] [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: 09/06/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives The study aimed to conduct a bibliometric analysis of publications concerning lumbar spondylolisthesis, as well as summarize its research topics and hotspot trends with machine-learning based text mining. Methods The data were extracted from the Web of Science Core Collection (WoSCC) database and then analyzed in Rstudio1.3.1 and CiteSpace5.8. Annual publication production and the top-20 productive authors over time were obtained. Additionally, top-20 productive journals and top-20 influential journals were compared by spine-subspecialty or not. Similarly, top-20 productive countries/regions and top-20 influential countries/regions were compared by they were developed countries/regions or not. The collaborative relationship among countries and institutions were presented. The main topics of lumbar spondylolisthesis were classified by Latent Dirichlet allocation (LDA) analysis, and the hotspot trends were indicated by keywords with strongest citation bursts. Results Up to 2021, a total number of 4,245 articles concerning lumbar spondylolisthesis were finally included for bibliometric analysis. Spine-subspecialty journals were found to be dominant in the productivity and the impact of the field, and SPINE, EUROPEAN SPINE JOURNAL and JOURNAL OF NEUROSURGERY-SPINE were the top-3 productive and the top-3 influential journals in this field. USA, Japan and China have contributed to over half of the publication productivity, but European countries seemed to publish more influential articles. It seemed that developed countries/regions tended to produce more articles and more influential articles, and international collaborations mainly occurred among USA, Europe and eastern Asia. Publications concerning surgical management was the major topic, followed by radiographic assessment and epidemiology for this field. Surgical management especially minimally invasive technique for lumbar spondylolisthesis were the recent hotspots over the past 5 years. Conclusions The study successfully summarized the productivity and impact of different entities, which should benefit the journal selection and pursuit of international collaboration for researcher who were interested in the field of lumbar spondylolisthesis. Additionally, the current study may encourage more researchers joining in the field and somewhat inform their research direction in the future.
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Affiliation(s)
- Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, China,Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yufeng Li
- Department of Sports Medicine, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Sheng Yang
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China,Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Qin
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Longfei Huang
- Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Shisheng He
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China,Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China,Correspondence: Shisheng He Xiang Liao
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, China,Correspondence: Shisheng He Xiang Liao
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30
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Chan AK, Bydon M, Bisson EF, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Michalopoulos GD, Guan J, Haid RW, Agarwal N, Park C, Chou D, Mummaneni PV. Minimally invasive versus open transforaminal lumbar interbody fusion for grade I lumbar spondylolisthesis: 5-year follow-up from the prospective multicenter Quality Outcomes Database registry. Neurosurg Focus 2023; 54:E2. [PMID: 36587409 DOI: 10.3171/2022.10.focus22602] [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: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been used to treat degenerative lumbar spondylolisthesis and is associated with expedited recovery, reduced operative blood loss, and shorter hospitalizations compared to those with traditional open TLIF. However, the impact of MI-TLIF on long-term patient-reported outcomes (PROs) is less clear. Here, the authors compare the outcomes of MI-TLIF to those of traditional open TLIF for grade I degenerative lumbar spondylolisthesis at 60 months postoperatively. METHODS The authors utilized the prospective Quality Outcomes Database registry and queried for patients with grade I degenerative lumbar spondylolisthesis who had undergone single-segment surgery via an MI or open TLIF method. PROs were compared 60 months postoperatively. The primary outcome was the Oswestry Disability Index (ODI). The secondary outcomes included the numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EQ-5D, North American Spine Society (NASS) satisfaction, and cumulative reoperation rate. Multivariable models were constructed to assess the impact of MI-TLIF on PROs, adjusting for variables reaching p < 0.20 on univariable analyses and respective baseline PRO values. RESULTS The study included 297 patients, 72 (24.2%) of whom had undergone MI-TLIF and 225 (75.8%) of whom had undergone open TLIF. The 60-month follow-up rates were similar for the two cohorts (86.1% vs 75.6%, respectively; p = 0.06). Patients did not differ significantly at baseline for ODI, NRS-BP, NRS-LP, or EQ-5D (p > 0.05 for all). Perioperatively, MI-TLIF was associated with less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 ml, p < 0.001) and longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 minutes, p < 0.001) but had similar lengths of hospitalizations (MI-TLIF 2.9 ± 1.8 vs open TLIF 3.3 ± 1.6 days, p = 0.08). Discharge disposition to home or home health was similar (MI-TLIF 93.1% vs open TLIF 91.1%, p = 0.60). Both cohorts improved significantly from baseline for the 60-month ODI, NRS-BP, NRS-LP, and EQ-5D (p < 0.001 for all comparisons). In adjusted analyses, MI-TLIF, compared to open TLIF, was associated with similar 60-month ODI, ODI change, odds of reaching ODI minimum clinically important difference, NRS-BP, NRS-BP change, NRS-LP, NRS-LP change, EQ-5D, EQ-5D change, and NASS satisfaction (adjusted p > 0.05 for all). The 60-month reoperation rates did not differ significantly (MI-TLIF 5.6% vs open TLIF 11.6%, p = 0.14). CONCLUSIONS For symptomatic, single-level grade I degenerative lumbar spondylolisthesis, MI-TLIF was associated with decreased blood loss perioperatively, but there was no difference in 60-month outcomes for disability, back pain, leg pain, quality of life, or satisfaction between MI and open TLIF. There was no difference in cumulative reoperation rates between the two procedures. These results suggest that in appropriately selected patients, either procedure may be employed depending on patient and surgeon preferences.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Steven D Glassman
- 4Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky
| | - Kevin T Foley
- 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- 6Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 7Neurosurgery, Goodman Campbell Brain and Spine, Indianapolis, Indianapolis
| | - Mark E Shaffrey
- 8Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John J Knightly
- 10Neurosurgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 11Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Jonathan R Slotkin
- 13Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania
| | - Anthony L Asher
- 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S Virk
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Jian Guan
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 14Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Christine Park
- 16Duke University School of Medicine, Durham, North Carolina
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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Emerging innovations for lumbar spondylolisthesis management: a systematic review of active and prospective clinical trials. Neurosurg Rev 2022; 45:3629-3640. [DOI: 10.1007/s10143-022-01889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/20/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
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Li C, Wang L, Wang Z, Li D, Ibrahim Y, Tian Y, Yuan S, Liu X. Radiological Changes of Paraspinal Muscles: A Comparative Study of Patients with Isthmic Spondylolisthesis, Patients with Degenerative Lumbar Spondylolisthesis, and Healthy Subjects. J Pain Res 2022; 15:3563-3573. [PMID: 36394059 PMCID: PMC9664928 DOI: 10.2147/jpr.s376575] [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: 05/28/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the differences, correlations, and clinical significance of the paraspinal muscles among patients with isthmic spondylolisthesis (IS), degenerative lumbar spondylolisthesis (DLS), and age-matched healthy subjects. Methods This study involved 159 age-matched patients with L4 anterior spondylolisthesis. The patients were divided into the IS group (n = 81) and DLS group (n = 78). Eighty-four age-matched healthy adults were enrolled as the control group. The cross-sectional area (CSA) of paraspinal muscles (multifidus [MF], erector spinae [ES], and psoas [PS]) and the relative CSA of the paraspinal muscles (paraspinal muscle CSA/vertebral CSA) were measured in the IS group, DLS group, and control group. The degree of fat infiltration was simultaneously observed. Results There was no significant difference in age or sex among the three groups. The relative CSA of the MF and PS was higher in control group than in IS and DLS groups (p < 0.05). The relative CSA of ES was higher in IS and control groups than in DLS group (p < 0.05). The relative CSA of total paraspinal muscles decreased in the order of control group > IS group > DLS group (p < 0.05). Logistic regression analysis showed that the relative CSA of MF, and the degree of fat infiltration of ES were independent protective factors for IS (odds ratio < 1, p < 0.05). The relative CSA of MF was an independent protective factor for DLS (odds ratio < 1, p < 0.05), whereas BMI and the degree of fat infiltration of MF were independent risk factor for DLS (odds ratio > 1, p < 0.05). Conclusion Compared with the control group, patients with IS and DLS showed varying degrees of degeneration, and the degree of degeneration in patients with DLS was more severe at the same age. Lower fat infiltration and higher paraspinal muscle CSA are protective factors for IS and DLS, whereas the higher BMI is risk factor for DLS.
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Affiliation(s)
- Chao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Zheng Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Donglai Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People’s Republic of China
- Correspondence: Xinyu Liu, Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People’s Republic of China, Tel +86-18560082585, Fax +86-531-8216-9423, Email
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Salmons HI, Baird MD, Dearden ME, Wagner SC, Sebastian AS. Prone Versus Lateral Decubitus Positioning for Direct Lateral Interbody Fusion. Clin Spine Surg 2022; 35:351-353. [PMID: 34966037 DOI: 10.1097/bsd.0000000000001293] [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: 07/19/2021] [Accepted: 12/01/2021] [Indexed: 01/25/2023]
Affiliation(s)
| | - Michael D Baird
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Marissa E Dearden
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott C Wagner
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Outcomes Following Direct Versus Indirect Decompression Techniques for Lumbar Spondylolisthesis: A Propensity-Matched Analysis. Spine (Phila Pa 1976) 2022; 47:1443-1451. [PMID: 35867585 DOI: 10.1097/brs.0000000000004396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim was to compare outcomes at 3 and 12 months for patients with lumbar spondylolisthesis treated with direct decompression (DD) versus indirect decompression (ID) techniques. SUMMARY OF BACKGROUND DATA Debate persists regarding the optimal surgical strategy to treat lumbar spondylolisthesis. Novel techniques relying on ID have shown superior radiographic outcomes compared to DD, however, doubt remains regarding their effectiveness in achieving adequate decompression. Currently, there is a paucity of data comparing the clinical efficacy of DD to ID. METHODS The Quality Outcomes Database (QOD), a national, multicenter prospective spine registry, was queried for patients who underwent DD and ID between April 2013 and January 2019. Propensity scores for each treatment were estimated using logistic regression dependent on baseline covariates potentially associated with outcomes. The propensity scores were used to exclude nonsimilar patients. Multivariable regression analysis was performed with the treatment and covariate as independent variables and outcomes as dependent variables. RESULTS A total of 4163 patients were included in the DD group and 86 in the ID group. The ID group had significantly lower odds of having a longer hospital stay and for achieving 30% improvement in back and leg pain at 3 months. These trends were not statistically significant at 12 months. There were no differences in ED5D scores or Oswestry disability index 30% improvement scores at 3 or 12 months. ID patient had a significantly higher rate of undergoing a repeat operation at 3 months (4.9% vs. 1.5%, P =0.015). CONCLUSION Our study suggests that both DD and ID for the treatment of lumbar spondylolisthesis result in similar clinical outcomes, with the exception that those treated with ID experienced a lower reduction in back and leg pain at 3 months and a higher 3-month reoperation rate. This data can provide surgeons with additional information when counseling patients on the pros and cons of ID versus DD surgery.
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Karamian BA, Lambrechts MJ, Mao J, D'Antonio ND, Conaway W, Canseco JA, Thandoni A, Singh A, Harlamova D, Kaye ID, Kurd M, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Adult Isthmic Spondylolisthesis: A Radiographic and Outcomes Analysis Comparing Circumferential Fusions Versus TLIF Procedures. Clin Spine Surg 2022; 35:E660-E666. [PMID: 35385406 DOI: 10.1097/bsd.0000000000001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to compare radiographic and patient-reported outcome measures (PROMs) between circumferential fusions and transforaminal lumbar interbody fusion (TLIF) for adult isthmic spondylolisthesis (IS). SUMMARY OF BACKGROUND DATA Definitive management of adult IS typically requires decompression and fusion. Multiple fusion techniques have been described, but literature is sparse in identifying the optimal technique. METHODS Patients with IS undergoing single-level or 2-level circumferential fusion or TLIF with a minimum 1-year follow-up were included. Patient demographics, surgical characteristics, and PROMs were extracted from patients' electronic medical records. Descriptive statistics and multivariate regression analysis compared outcomes with significance set at P -value <0.05. RESULTS A total of 78 circumferential fusions (48 open decompression and fusions and 30 circumferential fusions utilizing posterior percutaneous instrumentation) and 50 TLIF procedures were included. Length of stay was significantly longer when comparing circumferential procedures (3.56±0.96 d) versus TLIFs (2.88±1.14 d) ( P =0.002). The circumferential fusion group resulted in greater postoperative improvement in segmental lordosis [anterior/posterior (A/P): 6.45, TLIF: -1.99, P <0.001], posterior disk height (A/P: 12.6 mm, TLIF: 8.9 mm, P <0.001), and ∆disk height (A/P: 7.7 mm, TLIF: 3.6 mm, P <0.001). Both groups significantly improved in all PROMs ( P <0.001). While the circumferential fusion group had a significantly higher rate of perioperative surgical complications (12.82% vs. 2.00%, P =0.049), there was no difference in the rate of 30-day readmissions ( P =0.520) or revision surgeries between techniques ( P =0.057). CONCLUSIONS Circumferential fusions are associated with improvements in radiographic outcomes compared with TLIFs, but this is at the expense of longer hospital length of stay and increased risk for perioperative complications. The surgical technique did not result in superior postoperative PROMs or differences in readmissions or revisions.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Jennifer Mao
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - William Conaway
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | | | - Akash Singh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Daria Harlamova
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital
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Choi JH, Ochoa JK, Lubinus A, Timon S, Lee YP, Bhatia NN. Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases. Spine J 2022; 22:1628-1633. [PMID: 35504566 DOI: 10.1016/j.spinee.2022.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Symptomatic spondylolysis can be successfully treated conservatively, but there is currently a limited consensus on treatment modalities and a lack of large-scale clinical trials. PURPOSE The purpose of the present study was to investigate the optimal treatment algorithm for symptomatic spondylolysis in adolescent athletes and evaluate the functional outcomes of those undergoing the nonoperative treatment. STUDY DESIGN A retrospective review. PATIENT SAMPLE Two hundred one adolescent patients ranging from age 10 to 19 involved in athletics OUTCOME MEASURES: Injury characteristics (age, mechanism, time), sports played, bone stimulator use, bony healing at 3 months on computed tomography (CT) scans, return to sports, corticosteroid injection use. METHODS Two hundred one adolescent athlete patients (62 females and 139 males) diagnosed with spondylolysis between 2007 and 2019 were retrospectively reviewed. Diagnosis was based on plain radiography followed by magnetic resonance imaging. All patients were treated conservatively with cessation of sports activity, thoracolumbosacral orthosis, and external bone stimulator for three months after diagnosis. CT scans were obtained for the 3-month follow-up visits to assess bony healing. Subsequently the patients received 6 weeks of rehabilitation focused on core strengthening. Symptomatic patients after the treatment were referred for steroid injections and continued with the rehabilitation protocol. RESULTS The most common age of injury was 15 years old, following a strong normal distribution. The most commonly played sport was football, followed by baseball/softball. The primary mechanism of injury was weight training closely followed by a football injury. The first quarter of the calendar year had the highest incidence of injuries with the most injuries occurring in March and the least occurring in December. One hundred fifty-two athletes reported using bone stimulators as prescribed, and these patients showed a significantly higher rate of bony healing on follow-up CT scans than those who did not use bone stimulators. One hundred ninety-seven patients (98%) returned to sports or similar level of activities. Thirty-seven patients (18%) received facet or epidural steroid injections due to continued pain and one patient underwent a surgical procedure. Follow-up CT scans showed 49.8% bony healing. CONCLUSIONS Conservative treatment of spondylolysis in adolescent athletes with cessation of sports, thoracolumbosacral orthosis, and bone stimulator followed by rehabilitation was associated with excellent outcomes in terms of return to sports.
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Affiliation(s)
- Jeffrey H Choi
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA.
| | - Jonathan K Ochoa
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
| | - Ariadna Lubinus
- All Star Orthopaedics and Sports Medicine, 910 E Southlake Blvd #155, Southlake, TX 76092, Southlake, TX, USA
| | - Stephen Timon
- All Star Orthopaedics and Sports Medicine, 910 E Southlake Blvd #155, Southlake, TX 76092, Southlake, TX, USA
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
| | - Nitin N Bhatia
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
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Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication. J Clin Med 2022; 11:jcm11195550. [PMID: 36233418 PMCID: PMC9572820 DOI: 10.3390/jcm11195550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/24/2022] Open
Abstract
Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < −15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.
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Musa G, Barrientos Castillo RE, Slabov MV, Chirwa K, Chmutin GE, Ramirez MDJE, Nurmukhametov R. Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review. Cureus 2022; 14:e29374. [PMID: 36284806 PMCID: PMC9584580 DOI: 10.7759/cureus.29374] [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] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction.
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Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia) 2022; 14:36917. [PMID: 35910544 DOI: 10.52965/001c.36917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
Abstract
Spondylolisthesis refers to the anterior, lateral, or posterior slippage of a superior vertebral disc over the adjacent inferior disc, and is often separated into categories based on the causative etiology. Spondylolisthesis is often asymptomatic but may present with low back pain and neurogenic claudication which is worsened with spinal extension and activity. A detailed history and physical exam, along with appropriate imaging tests are useful in making the diagnosis. Conservative therapy is first-line and includes pain management with physical therapy. Patients who fail conservative therapy may consider surgical decompression, stabilization, and fusion. This review aims to discuss the epidemiology, pathophysiology, presentation, and treatment options of spondylolisthesis.
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Affiliation(s)
| | | | | | | | | | - Alan Kaye
- Louisiana State University Shreveport
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Postural stability, body composition and functional ability of the lower extremity in patients with lumbar degenerative spondylolisthesis. TURKISH JOURNAL OF KINESIOLOGY 2022. [DOI: 10.31459/turkjkin.1108377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although patients accessing rehabilitation services had been reported to have better functional ability of the lower limbs, postural stability, and low cardiovascular disease risk factors, updated data from developing countries is however vital for clinical practices. Hence, the aim of this study was to present the association between lower extremity functional ability (LEFA), stability, and body composition profiles in rehabilitative lumbar degenerative spondylolisthesis (LDS) patients considering age and gender. One hundred and twenty-four participants (45 females, 79 males), with a mean age of 56.45±11.13 years, volunteered for the study. Weight, height body fat percent (BFP), visceral fat, body mass index (BMI), resting systolic and diastolic blood pressure, and resting heart rate were measured while functional ability and stability tests were conducted on the participants. 53.4% were at least overweight; LEFA was below average, stability of both dominant and nondominant legs was very poor, blood pressure and heart rate were high. Women had high total body fat and visceral fat. Significant differences were observed in BMI (p=0.044) and BFP (p=0.035) based on age classification as well as BMI (p=0.000), BFP (p=0.000) and visceral fat (p=0.000) by gender. Overweight, high blood pressure, poor LEFA, and postural stability are crucial comorbidities of Ghanaian LDS patients in this study. Educationally and pragmatically comprehensive healthy lifestyle interventions of regular exercise regimes, adequate and quality nutrition, and occupational stress reduction would play major complementary roles in chiropractic treatment.
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Bredow J, Meyer C, Oikonomidis S, Kernich C, Kernich N, Hofstetter CP, Heck VJ, Eysel P, Prasse T. Long-term Radiological and Clinical Outcome after Lumbar Spinal Fusion Surgery in Patients with Degenerative Spondylolisthesis: A Prospective 6-Year Follow-up Study. Orthop Surg 2022; 14:1607-1614. [PMID: 35711118 PMCID: PMC9363728 DOI: 10.1111/os.13350] [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: 07/31/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess which radiological alignment parameters are associated with a satisfactory long‐term clinical outcome after performing lumbar spinal fusion for treating degenerative spondylolisthesis. Methods This single‐center prospective study assessed the relation between radiological alignment parameters measured on standing lateral lumbar spine radiographs and the patient‐reported outcome using four different questionnaires (COMI, EQ‐5D, ODI and VAS) as primary outcome measures (level of evidence: II). The following spinopelvic alignment parameters were used: gliding angle, sacral inclination, anterior displacement, sagittal rotation, lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Furthermore, the length of stay and perioperative complications were documented. Only cases from 2013 to 2015 of low‐grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) were considered. The patients underwent open posterior lumbar fusion surgery by pedicle screw instrumentation and cage insertion. The operative technique was either a posterior lumbar interbody fusion (PLIF) or a transforaminal lumbar interbody fusion (TLIF) performed by three different senior orthopedic surgeons. Exclusion criteria were spine fractures, minimally invasive techniques, underlying malignant diseases or acute infections, previous or multisegmental spine surgery as well as preoperative neurologic impairment. Of 89 initially contacted patients, 17 patients were included for data analysis (11 males, six females). Results The data of 17 patients after mono‐ or bisegmental lumbar fusion surgery to treat low‐grade lumbar spondylolisthesis and with a follow‐up time of least 72 months were analyzed. The mean age was 66.7 ± 11.3 years. In terms of complications two dural tears and one intraoperative bleeding occurred. The average body mass index (BMI) was 27.6 ± 4.4 kg/m2 and the average inpatient length of stay was 12.9 ± 3.8 days (range: 8–21). The long‐term clinical outcome correlated significantly with the change of the pelvic tilt (rs = −0.515, P < 0.05) and the sagittal rotation (rs = −0.545, P < 0.05). The sacral slope was significantly associated with the sacral inclination (rs = 0.637, P < 0.01) and the pelvic incidence (rs = 0.500, P < 0.05). In addition, the pelvic incidence showed a significant correlation with the pelvic tilt (rs = 0.709, P < 0.01). The change of the different clinical scores over time also correlated significantly between the different questionnaires. Conclusions The surgical modification of the pelvic tilt and the sagittal rotation are the two radiological alignment parameters that can most accurately predict the long‐term clinical outcome after lumbar interbody fusion surgery.
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Affiliation(s)
- Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Carolin Meyer
- Center for Spinal Surgery, Helios Klinikum Bonn/Rhein-Sieg, Bonn, Germany
| | - Stavros Oikonomidis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | - Constantin Kernich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | - Nikolaus Kernich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | | | - Vincent J Heck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | - Peer Eysel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | - Tobias Prasse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany.,University of Washington, Department of Neurological Surgery, Seattle, Washington, USA
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Krenzlin H, Keric N, Ringel F, Kantelhardt SR. Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs. Front Surg 2022; 9:860865. [PMID: 36034353 PMCID: PMC9407032 DOI: 10.3389/fsurg.2022.860865] [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: 01/23/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose In this study, we compare different imaging modalities to find the most sensitive and efficient way of detecting instability in lumbar spondylolisthesis. Methods Patients presenting with spondylolisthesis from June 01, 2018 to May 31, 2020 with functional radiographs and either CT scans or MRI images were included in our single-center retrospective cohort study. The amount of translation, in millimeters, was measured on supine MRI images, CT scans, and radiographs of inclination while sitting, standing, or prone and reclination while standing using the Meyerding technique. The amount of translation was compared among the different modalities. Results A total of 113 patients with spondylolisthesis on 125 vertebral levels were included in this study. The mean patient age was 73.52 ± 12.59 years; 69 (60.5%) patients were females. The most affected level was L4/5 (62.4%), followed by L3/4 (16%) and L5/S1 (13.6%). The average translations measured on supine CT were 4.13 ± 5.93 mm and 4.42 ± 3.49 mm on MRI (p = 0.3 for the difference between MRI and CT). The difference of inclination while sitting radiograph to slice imaging was 3.37 ± 3.64 mm (p < 0.0001), inclination while standing to slice imaging was 2.67 ± 3.03 mm (p < 0.0001), reclination while standing to slice imaging was 1.6 ± 3.15 mm (p = 0.03), and prone to slice imaging was 2.19 ± 3.02 mm (p = 0.03). Conclusion We found that a single radiograph in either inclination, reclination, or prone position compared to a CT scan or an MRI image in supine position can detect instability in spondylolisthesis more efficiently than comparison of functional radiographs in any position.
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Alomari S, Judy B, Sacino AN, Porras JL, Tang A, Sciubba D, Witham T, Theodore N, Bydon A. Isthmic spondylolisthesis in adults… A review of the current literature. J Clin Neurosci 2022; 101:124-130. [PMID: 35597059 DOI: 10.1016/j.jocn.2022.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/30/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
Isthmic spondylolisthesis can be defined as the anterior translation of a vertebral body relative to the one subjacent to it and secondary to an abnormality of the pars interarticularis. Isthmic spondylolisthesis is usually asymptomatic and discovered as an incidental radiographic finding. However, it can be symptomatic due to its biomechanical effects on the adjacent neural structures and patients may present with low back and/or radicular leg pain. Standing plain radiographs can be obtained to confirm the presence or assess the degree of isthmic spondylolisthesis. Computed tomography (CT) clearly shows the pars defect and provides a better assessment of the pathology. Magnetic resonance imaging (MRI) is indicated in patients with neurologic manifestations and can be used to assess the degree of foraminal or central stenosis. Conservative management including oral anti-inflammatory medication, physical therapy, and/or transforaminal epidural corticosteroid injections can be utilized initially. Surgery can be considered in the setting of persistent symptoms unrelieved with conservative management or significant neurologic compromise. Several surgical methods and techniques are available in the management of isthmic spondylolisthesis. There has been a significant national increase in the use of interbody fusion posteriorly for the management of isthmic spondylolisthesis. Reports have suggested that interbody fusion can be a cost-effective technique in selected patients with isthmic spondylolisthesis. Future studies are encouraged to further characterize the specific indications of various surgical modalities in patients with isthmic spondylolisthesis.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda N Sacino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony Tang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Liang Z, Xu X, Rao J, Chen Y, Wang R, Chen C. Clinical Evaluation of Paraspinal Mini-Tubular Lumbar Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis Grade I with Lumbar Spinal Stenosis: A Cohort Study. Front Surg 2022; 9:906289. [PMID: 35620194 PMCID: PMC9127301 DOI: 10.3389/fsurg.2022.906289] [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: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the clinical outcome data and difference in efficacy between paraspinal mini-tubular lumbar decompression (PMTD) and minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis (DLS-I-LSS).MethodsPatients with DLS-I-LSS, who underwent PMTD or MIS TLIF from September 2017 to March 2020, were included retrospectively. The follow-up period was 24 months after surgery. Outcome measurements included the Oswestry disability index (ODI) score, visual analog scale (VAS) low back pain score, VAS leg pain score, surgical data, and adverse events.ResultsA total of 104 patients with DLS-I-LSS were included in this study. The average improvement in ODI at 12 months (2.0%, 95% CI, −5.7% to 1.8%; p = 0.30) and 24 months (1.7%, 95% CI, −2.7% to 6.1%; p = 0.45) after surgery between the two groups were not statistically significant. The improvement in VAS low back pain score after 24 months and improvement in VAS leg pain score were not significantly different between the two groups. Compared with the PMTD group, the MIS TLIF group had more estimated blood loss and longer hospital stays. The cumulative reoperation rates were 5.66% and 1.96% in the MIS TLIF and PMTD groups, respectively (p = 0.68). The results of multivariate analysis showed that BMI, diabetes, and baseline ODI score were the main factors influencing the improvement in ODI in patients with DLS-I-LSS after minimally invasive surgery, accounting for 50.5% of the total variance.ConclusionsThe clinical effectiveness of PMTD was non-inferior to that of MIS TLIF for DLS-I-LSS; however, there was a reduced duration of hospital stay, operation time, blood loss, and hospitalization costs in the PMTD group. BMI, presence or absence of diabetes and baseline ODI score were influencing factors for the improvement of ODI (Trial Registration: ChiCTR2000040025).
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Affiliation(s)
| | | | | | | | - Rui Wang
- Correspondence: Rui Wang Chunmei Chen
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Fraiwan M, Audat Z, Fraiwan L, Manasreh T. Using deep transfer learning to detect scoliosis and spondylolisthesis from x-ray images. PLoS One 2022; 17:e0267851. [PMID: 35500000 PMCID: PMC9060368 DOI: 10.1371/journal.pone.0267851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022] Open
Abstract
Recent years have witnessed wider prevalence of vertebral column pathologies due to lifestyle changes, sedentary behaviors, or injuries. Spondylolisthesis and scoliosis are two of the most common ailments with an incidence of 5% and 3% in the United States population, respectively. Both of these abnormalities can affect children at a young age and, if left untreated, can progress into severe pain. Moreover, severe scoliosis can even lead to lung and heart problems. Thus, early diagnosis can make it easier to apply remedies/interventions and prevent further disease progression. Current diagnosis methods are based on visual inspection by physicians of radiographs and/or calculation of certain angles (e.g., Cobb angle). Traditional artificial intelligence-based diagnosis systems utilized these parameters to perform automated classification, which enabled fast and easy diagnosis supporting tools. However, they still require the specialists to perform error-prone tedious measurements. To this end, automated measurement tools were proposed based on processing techniques of X-ray images. In this paper, we utilize advances in deep transfer learning to diagnose spondylolisthesis and scoliosis from X-ray images without the need for any measurements. We collected raw data from real X-ray images of 338 subjects (i.e., 188 scoliosis, 79 spondylolisthesis, and 71 healthy). Deep transfer learning models were developed to perform three-class classification as well as pair-wise binary classifications among the three classes. The highest mean accuracy and maximum accuracy for three-class classification was 96.73% and 98.02%, respectively. Regarding pair-wise binary classification, high accuracy values were achieved for most of the models (i.e., > 98%). These results and other performance metrics reflect a robust ability to diagnose the subjects’ vertebral column disorders from standard X-ray images. The current study provides a supporting tool that can reasonably help the physicians make the correct early diagnosis with less effort and errors, and reduce the need for surgical interventions.
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Affiliation(s)
- Mohammad Fraiwan
- Department of Computer Engineering, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Ziad Audat
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Luay Fraiwan
- Department of Biomedical Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarek Manasreh
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
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Linton AA, Hsu WK. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Curr Rev Musculoskelet Med 2022; 15:259-271. [DOI: 10.1007/s12178-022-09760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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Lenz M, Oikonomidis S, Hartwig R, Gramse R, Meyer C, Scheyerer MJ, Hofstetter C, Eysel P, Bredow J. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Arch Orthop Trauma Surg 2022; 142:721-727. [PMID: 33372234 PMCID: PMC8994725 DOI: 10.1007/s00402-020-03697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. MATERIALS AND METHODS By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. RESULTS We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. CONCLUSION In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.
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Affiliation(s)
- Maximilian Lenz
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - S Oikonomidis
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - R Hartwig
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - R Gramse
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Meyer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Hofstetter
- Department of Neurological Surgery, UW Medicine Seattle, Seattle, WA, USA
| | - P Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - J Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Kang YN, Ho YW, Chu W, Chou WS, Cheng SH. Effects and Safety of Lumbar Fusion Techniques in Lumbar Spondylolisthesis: A Network Meta-Analysis of Randomized Controlled Trials. Global Spine J 2022; 12:493-502. [PMID: 33752459 PMCID: PMC9121149 DOI: 10.1177/2192568221997804] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Network meta-analysis of randomized controlled trials. OBJECTIVES Lumbar spondylolisthesis is a common indication for spinal fusion. Lumbar interbody fusion (LIF) is popular method to achieve arthrodesis, but previous syntheses usually used head-to-head comparison of 2 surgical methods, and no of them pooled analysis with high-quality. This network meta-analysis of randomized controlled trials was carried out to simultaneously compare fusion techniques in the treatment of lumbar spondylolisthesis. METHODS Three databases were searched for randomized controlled trials (RCTs) on this topic. After critical appraisal, fusion rate, overall adverse events, operative time, Oswestry Disability Index, and pain were extracted for analysis. We conduced network meta-analysis using contrast-based method. Primary outcomes were reported as risk ratio (RR) with 95% confidence interval (CI). RESULTS Fifteen RCTs (n = 992) met our eligibility criteria. The RCTs treated patients posterolateral fusion (PLF), posterior LIF (PLIF), transforaminal LIF (TLIF), minimally invasive (MIS) TLIF, extreme lateral LIF (XLIF), and circumferential fusion. The pooled estimate showed that circumferential fusion led to significantly higher fusion rate than PLF (RR = 2.15, 95%CI:1.41-3.28), PLIF (RR = 2.11, 95%CI:1.38-3.22), TLIF (RR = 2.13, 95%CI:1.39-3.27), MIS-TLIF (RR = 2.13, 95%CI:1.35-3.35), and XLIF (RR = 2.01, 95%CI: 1.25-3.22). Moreover, circumferential fusion exhibited the best balance in probability between fusion rate and adverse event rate. No evidence showed inconsistency or small-study effect in the results. CONCLUSIONS Collectively, circumferential fusion might be worth to be recommended because it exhibits the best balance between fusion rate and overall adverse event. PLF is still an inferior procedure and requires shorter operative time.
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Affiliation(s)
- Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Medical University Hospital, Taipei,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei,Cochrane Taiwan, Taipei Medical University, Taipei,Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei
| | - Yu-Wan Ho
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei
| | - William Chu
- Department of Orthopedics, Cheng Hsin General hospital, Taipei
| | - Wen-Shiang Chou
- Department of Orthopedics, Cheng Hsin General hospital, Taipei
| | - Shih-Hao Cheng
- Department of Orthopedics, Cheng Hsin General hospital, Taipei,Department of Orthopedics, Wan Fang Hospital, Medical University Hospital, Taipei,Shih-Hao Cheng, Department of Orthopedics, Cheng Hsin General Hospital, Taipei.
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Rault F, Briant AR, Kamga H, Gaberel T, Emery E. Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk? Neurosurg Rev 2022; 45:2385-2399. [PMID: 35243565 DOI: 10.1007/s10143-022-01756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023]
Abstract
Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complication rate was higher for elderly patients and to find confounding factors. We conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Nine hundred ninety-six patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. Of the patients, 5.2% presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI and accidental durotomies were independent risk factors for SC. Surgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complication risk is increased although an optimal preparation is the way to avoid them.
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Affiliation(s)
- Frédérick Rault
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France.
| | - Anaïs R Briant
- Unité de Biostatistique Et Recherche Clinique (UBRC), Avenue de la Côte de Nacre, 14000, Caen, France
| | - Hervé Kamga
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
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Wáng YXJ, Deng M, Griffith JF, Kwok AWL, Leung JCS, Lam PMS, Yu BWM, Leung PC, Kwok TCY. 'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies. Quant Imaging Med Surg 2022; 12:2090-2105. [PMID: 35284274 PMCID: PMC8899940 DOI: 10.21037/qims-2021-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 08/09/2023]
Abstract
For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W. L. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patti M. S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Blanche Wai Man Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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