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Sakaguchi T, Gunjotikar S, Tanaka M, Komatsubara T, Latka K, Ekade SJ, Prabhu SP, Takamatsu K, Yasuda Y, Nakagawa M. Evaluation and Rehabilitation after Adult Lumbar Spine Surgery. J Clin Med 2024; 13:2915. [PMID: 38792457 PMCID: PMC11122457 DOI: 10.3390/jcm13102915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.
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Affiliation(s)
- Tomoyoshi Sakaguchi
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Sharvari Gunjotikar
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Kajetan Latka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Shashank J. Ekade
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Shrinivas P. Prabhu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (S.G.); (T.K.); (K.L.); (S.J.E.); (S.P.P.)
| | - Kazuhiko Takamatsu
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Yosuke Yasuda
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
| | - Masami Nakagawa
- Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan; (T.S.); (K.T.); (Y.Y.); (M.N.)
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Chong EY, Tong Tan LY, Chong CS, Yeo W, Siang Koh DT, Jiang L, Guo CM, Cheong Soh RC. Radiological and Clinical Outcomes comparing 2-level MIS Lateral and MIS Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spinal Stenosis. Global Spine J 2024; 14:986-997. [PMID: 36202133 PMCID: PMC11192119 DOI: 10.1177/21925682221132745] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To compare early postoperative radiological and clinical outcomes between 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. METHODS Fifty three consecutive patients undergoing 2-level lumbar interbody fusion from L3-L5 for degenerative lumbar spinal stenosis were enrolled. Twenty four patients underwent LLIF and 29 underwent TLIF. RESULTS Operative time and length of stay were similar between LLIF and TLIF (272.8 ± 82.4 vs 256.1 ± 59.4 minutes; 5.5 ± 2.8 vs 4.7 ± 3.3 days, P > .05), whereas blood loss was lower for LLIF (229.0 ± 125.6 vs 302.4 ± 97.1mls, P = .026). Neurological deficits were more common in LLIF (9 vs 3, P = .025), whereas persistent deficits were rare for both (1 vs 1, P = 1). For both groups, all patient reported outcomes visual analogue scale (VAS back pain, VAS leg pain, ODI, SF-36 physical) improved from preoperative to 2-years postoperative (P < .05), with both groups showing no significant differences in extent of improvement for any outcome. Lateral lumbar interbody fusion demonstrated superior restoration of disc height (L3-L4: 4.1 ± 2.4 vs 1.2 ± 1.9 mm, P < .001; L4-L5: 4.6 ± 2.4 vs .8 ± 2.8 mm, P < .001), foraminal height (FH) (L3-L4: 3.5 ± 3.6 vs 1.0 ± 3.6 mm, P = .014; L4-L5: 3.0 ± 3.5 vs -.1 ± 4.4 mm, P = .0080), segmental lordosis (4.1 ± 6.4 vs -2.1 ± 8.1°, P = .005), lumbar lordosis (LL) (4.1 ± 7.0 vs -2.3 ± 12.6°, P = .026) and pelvic incidence-lumbar lordosis (PI-LL) mismatch (-4.1 ± 7.0 vs 2.3 ± 12.6°, P = .019) at 2-years follow-up. CONCLUSION The superior radiological outcomes demonstrated by 2-level trans-psoas LLIF did not translate into difference in clinical outcomes compared to 2-level TLIF at the 2-years follow-up, suggesting both approaches are reasonable for 2-level lumbar interbody fusion in degenerative lumbar spinal stenosis.
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Affiliation(s)
- Elliot Yeung Chong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Lenice Yue Tong Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Christoph Sheng Chong
- Lee Kong Chian School of Medicine, National Technological University (NTU), Singapore
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General Hospital (SGH), Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
| | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
| | - Chang Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital (SGH), Singapore
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Amaral R, Pokorny G, Marcelino F, Moriguchi R, Pokorny J, Barreira I, Mizael W, Yozo M, Fragoso S, Pimenta L. Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent literature. 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; 32:1655-1677. [PMID: 36917302 DOI: 10.1007/s00586-023-07619-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 02/18/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF. MATERIAL AND METHODS This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample. RESULTS Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05). CONCLUSION Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.
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Affiliation(s)
| | | | | | | | | | - Igor Barreira
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | - Weby Mizael
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | - Marcelo Yozo
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
| | | | - Luiz Pimenta
- Instituto de Patologia da Coluna, São Paulo, SP, Brazil
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Tran KS, Lambrechts MJ, Issa TZ, Tecce E, Corr A, Toci GR, Wong A, DiMaria S, Kirkpatrick Q, Chu J, Gilmore G, Kurd MF, Rihn JA, Woods BI, Kaye ID, Canseco JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Modified Frailty Index Does Not Provide Additional Value in Predicting Outcomes in Patients Undergoing Elective Transforaminal Lumbar Interbody Fusion. World Neurosurg 2023; 170:e283-e291. [PMID: 36356842 DOI: 10.1016/j.wneu.2022.11.011] [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: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the predictive value of the modified Frailty Index (mFI) in evaluating sarcopenia and clinical outcomes in patients undergoing 1-level or 2-level transforaminal lumbar interbody fusion (TLIF). METHODS Patients who underwent a 1-level or 2-level TLIF between 2012 and 2020 were retrospectively identified. Frailty was compared among groups using mFI, and sarcopenia was classified by the psoas muscle cross-sectional area. Bivariate statistics compared demographics, comorbidities, and clinical outcomes. A linear regression model was developed using the Charlson Comorbidity Index (CCI) or mFI as independent variables to determine potential predictors for improvement in 1-year patient-reported outcomes. RESULTS Of 488 included patients, 60 were severely frail and 60 patients had sarcopenia, but sarcopenia was not associated with patient frailty (P = 0.469). Severely frail patients had worse baseline Oswestry Disability Index (ODI) (P < 0.001), Mental Component Score-12 (P = 0.001), and Physical Component Score-12 (P < 0.001), and worse improvement in ODI (P = 0.037), Physical Component Score-12 (P < 0.001), and visual analog scale (VAS) back (P = 0.007). mFI was an independent predictor of poorer improvement in VAS back and ODI, whereas age + CCI in addition predicted poorer improvement in VAS leg. Patients with higher mFI experienced longer length of stay, less frequent home discharge, and higher rates of complications, but similar readmission and reoperation rates. CONCLUSIONS Frailer patients experience poorer improvement in back pain, physical functioning, and disability after TLIF. mFI and the combination of age and CCI comparably predict patient-reported outcomes but do not correlate to baseline sarcopenia. Frailty increased the risk of complications, length of hospital stay, and risk of nonhome discharge.
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Affiliation(s)
- Khoa S Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Corr
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashley Wong
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen DiMaria
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Quinn Kirkpatrick
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Justin Chu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Griffin Gilmore
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffery A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Establishing minimum clinically important difference for patient-reported outcome measures in patients undergoing lateral lumbar interbody fusion. Acta Neurochir (Wien) 2023; 165:325-334. [PMID: 36602614 DOI: 10.1007/s00701-022-05428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The minimum clinically important difference (MCID) has not been established in lateral lumbar interbody fusion (LLIF). Our study aims to establish MCID for patient-reported outcome measures (PROMs) of physical function and pain for LLIF through anchor-based and distribution-based approaches. METHODS Patients undergoing LLIF with preoperative and 6-month postoperative Oswestry Disability Index (ODI) scores were identified. PROMs of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Veterans RAND 12-Item Short Form Physical Component Score (VR-12 PCS), visual analog scale (VAS) back, and VAS leg were collected at preoperative and 6-month postoperative time points. Anchor-based MCID calculations were average change, minimal detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis using ODI as the anchor. Distribution-based calculations were standard error of measurement, reliable change index, effect size, and 0.5 ∗ ΔSD. RESULTS Fifty patients were included. Anchor-based approaches MCID ranges were PROMIS-PF 1.1-9.6, SF-12 PCS 6.4-16.5, VR-12 PCS 5.9-12.9, VAS Back 1.4-4.6, and VAS Leg 1.3-4.3. The area under curve for receiver operating characteristics (ROC) analysis ranged from 0.63 to 0.71. Distribution-based MCID ranges were PROMIS-PF 1.4-4.5, SF-12 PCS 1.9-12.7, VR-12 PCS 2.0-6.6, VAS Back 0.4-1.4, and VAS Leg 0.5-2.0. CONCLUSION MCID thresholds varied widely depending on the calculation method. The closest to (0,1) ROC approach was the most clinically appropriate MCID calculation. The corresponding MCID values for LLIF were PROMIS-PF at 7.8, SF-12 PCS at 6.4, VR-12 PCS at 9.3, VAS Back at 4.6, and VAS Leg at 4.3.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA.
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA.
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Mohanty S, Barchick S, Kadiyala M, Lad M, Rouhi AD, Vadali C, Albayar A, Ozturk AK, Khalsa A, Saifi C, Casper DS. Should patients with lumbar stenosis and grade I spondylolisthesis be treated differently based on spinopelvic alignment? A retrospective, two-year, propensity matched, comparison of patient-reported outcome measures and clinical outcomes from multiple sites within a single health system. Spine J 2023; 23:92-104. [PMID: 36064091 DOI: 10.1016/j.spinee.2022.08.020] [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: 05/11/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis is one of the most common pathologies addressed by surgeons. Recently, data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. However, given not all degenerative spondylolistheses are clinically comparable, the best treatment option may depend on multiple parameters. Specifically, the impact of spinopelvic alignment on patient reported and clinical outcomes following fusion versus decompression for grade I spondylolisthesis has yet to be explored. PURPOSE This study assessed two-year clinical outcomes and one-year patient reported outcomes following laminectomy with concomitant fusion versus laminectomy alone for management of grade I degenerative spondylolisthesis and stenosis. The present study is the first to examine the effect of spinopelvic alignment on patient-reported and clinical outcomes following decompression alone versus decompression with fusion. STUDY DESIGN/SETTING Retrospective sub-group analysis of observational, prospectively collected cohort study. PATIENT SAMPLE 679 patients treated with laminectomy with fusion or laminectomy alone for grade I degenerative spondylolisthesis and comorbid spinal stenosis performed by orthopaedic and neurosurgeons at three medical centers affiliated with a single, tertiary care center. OUTCOME MEASURES The primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and post-operatively at 4-6 and 10-12 months postoperatively. Secondary outcomes included operative parameters (estimated blood loss and operative time), and two-year clinical outcomes including reoperations, duration of postoperative physical therapy, and discharge disposition. METHODS Radiographs/MRIs assessed stenosis, spondylolisthesis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt; from this data, two cohorts were created based on pelvic incidence minus lumbar lordosis (PILL), denoted as "high" and "low" mismatch. Patients underwent either decompression or decompression with fusion; propensity score matching (PSM) and coarsened exact matching (CEM) were used to create matched cohorts of "cases" (fusion) and "controls" (decompression). Binary comparisons used McNemar test; continuous outcomes used Wilcoxon rank-sum test. Between-group comparisons of changes in PROMIS GPH and GMH scores were analyzed using mixed-effects models; analyses were conducted separately for patients with high and low pelvic incidence-lumbar lordosis (PILL) mismatch. RESULTS 49.9% of patients (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. In the high PLL mismatch cohort at 10-12 months postoperatively, fusion-treated patients reported improved PROs, including GMH (26.61 vs. 20.75, p<0.0001) and GPH (23.61 vs. 18.13, p<0.0001). They also required fewer months of outpatient physical therapy (1.61 vs. 3.65, p<0.0001) and had lower 2-year reoperation rates (12.63% vs. 17.89%, p=0.0442) compared to decompression-only patients. In contrast, in the low PLL mismatch cohort, fusion-treated patients demonstrated worse endpoint PROs (GMH: 18.67 vs. 21.52, p<0.0001; GPH: 16.08 vs. 20.74, p<0.0001). They were also more likely to require skilled nursing/rehabilitation centers (6.86% vs. 0.98%, p=0.0412) and extended outpatient physical therapy (2.47 vs. 1.34 months, p<0.0001) and had higher 2-year reoperation rates (25.49% vs. 14.71%,p=0.0152). CONCLUSIONS Lumbar laminectomy with fusion was superior to laminectomy in health-related quality of life and reoperation rate at two years postoperatively only for patients with sagittal malalignment, represented by high PILL mismatch. In contrast, the addition of fusion for patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony (low PILL mismatch) resulted in worse quality of life outcomes and reoperation rates.
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Affiliation(s)
- Sarthak Mohanty
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen Barchick
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Manasa Kadiyala
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Meeki Lad
- New Jersey Medical School; Rutgers University; 185 W S Orange Ave, Newark, NJ, 07103, USA
| | - Armaun D Rouhi
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Chetan Vadali
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Ahmed Albayar
- University of Pennsylvania Department of Neurosurgery; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Ali K Ozturk
- University of Pennsylvania Department of Neurosurgery; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Amrit Khalsa
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Comron Saifi
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine; 6445 Main St. 2500, Houston, TX, 77030, USA
| | - David S Casper
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA.
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Hiyama A, Katoh H, Nomura S, Sakai D, Sato M, Watanabe M. Treatment of Lumbar Degenerative Disease by Lateral Lumbar Interbody Fusion in Patients Under and Over 80 Years of Age. World Neurosurg 2022; 167:e747-e756. [PMID: 36030011 DOI: 10.1016/j.wneu.2022.08.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to compare clinical and radiological results of lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease in patients under the age of 80 years with those over the age of 80 years. METHODS One hundred two patients who underwent LLIF without direct decompression were enrolled, including 92 patients who were less than 80 years (group A) and 10 over 80 years (group B). All patients were evaluated using numerical evaluation scale scores for low back pain, leg pain, and leg numbness, as well as demographic data, surgical data, and imaging data before and after LLIF surgery. RESULTS Patients over the age of 80 years were found to have longer hospital stays (P = 0.006) and more postoperative muscle weakness (P = 0.011) and endplate injuries (P = 0.038). In addition, each numerical evaluation scale score improved significantly from preoperative to postoperative (P < 0.001). However, the changes in scores between preoperative and postoperative for each numerical evaluation scale were not significantly different between the 2 groups. Statistically significant increases in lumbar lordosis preoperatively compared with postoperatively were observed in patients under 80 years but did not change in those over 80 years. CONCLUSIONS These data suggest a need for awareness of intraoperative endplate injury and postoperative motor weakness. Critically, indirect decompression with LLIF in lumbar degenerative disease in patients over age 80 as well as those under age 80 has shown satisfactory clinical and radiological results. This study shows that age alone should not prevent older people from undergoing LLIF.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Hiyama A, Katoh H, Nomura S, Sakai D, Watanabe M. The Effect of Preoperative Neuropathic Pain and Nociceptive Pain on Postoperative Pain Intensity in Patients with the Lumbar Degenerative Disease Following Lateral Lumbar Interbody Fusion. World Neurosurg 2022; 164:e814-e823. [PMID: 35598851 DOI: 10.1016/j.wneu.2022.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze whether the type of preoperative pain affects the improvement in postoperative pain intensity in patients with a lumbar degenerative disease (LDD). METHODS We retrospectively reviewed 93 patients who underwent lateral lumbar interbody fusion (LLIF) without direct decompression. All patients were evaluated using Numeric Rating Scale (NRS) scores for low back pain (NRSLBP), leg pain (NRSLP), and leg numbness (NRSLN) and imaging data before and after LLIF surgery. Based on the Japanese version of the painDETECT scores, patients were classified into 3 groups: a neuropathic pain (NeP) group, a nociceptive pain (NocP) group, and an intermediate mixed pain group. RESULTS The Japanese version of the painDETECT identified NeP in 20.4% of patients with LDD prior to LLIF. Preoperative NRSLBP, NRSLP, and NRSLN scores were higher in the NeP group than those in the NocP group. All types of pain improved after LLIF surgery. The NRSLBP score 12 months after surgery was higher in the NeP group (3.8 ± 2.8) than that in the NocP group (1.9 ± 2.2) (P = 0.008). Similar results were obtained with NRSLP (NeP group = 3.1 ± 2.8, NocP group = 1.5 ± 2.0, P = 0.010). CONCLUSIONS Although LLIF was useful for relieving all types of preoperative pain in LDD patients, the NRS scores for preoperative pain were higher in the NeP group than those in the NocP group, and the postoperative NRSLBP and NRSLP score was significantly higher in the NeP group. Thus, controlling preoperative NeP may improve therapeutic efficacy.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Li J, Xu TZ, Zhang N, Chen QX, Li FC. Predictors for second-stage posterior direct decompression after lateral lumbar interbody fusion: a review of five hundred fifty-seven patients in the past five years. INTERNATIONAL ORTHOPAEDICS 2022; 46:1101-1109. [PMID: 35132497 PMCID: PMC9001245 DOI: 10.1007/s00264-022-05313-4] [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] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the predictors for second-stage posterior direct decompression (PDD) after lateral lumbar interbody fusion (LLIF) procedure. METHODS We studied patients who underwent LLIF for degenerative lumbar spinal stenosis in the last five years, from July 2016 to June 2021. All surgical levels were grouped according to Schizas' central canal stenosis (CCS) classification, Pathria's facet joint degeneration (FJD) classification, Bartynski's lateral recess stenosis (LRS) classification, and Lee's foraminal stenosis (FS) classification. Second-stage PDD rates of each subgroup and their annual change were analyzed. Evaluation of risk factors associated with PDD was investigated. RESULTS A total of 901 segments from 557 patients were included. The overall PDD rate was 29.97%. An overall PDD rate of 75.21% for grade D CCS, 29.74% for grade C CCS, 41.67% for grade 3 FJD, 37.61% for grade 3 LRS, and 40.70% for grade 3 FS was shown. While there was a continuous decline in annual PDD rate in the past four years, the annual PDD rate for grade D remained at very high levels. Logistic regression analysis had shown grade D CCS as the utmost risk factor for PDD (OR = 17.77). And grade 3 LRS (OR = 4.63), grade 3 FS (OR = 2.42), grade C CCS (OR = 2.41), and grade 3 FJD (OR = 2.04) were also moderately correlated with PDD, which meant they only moderately increased the risk of PDD. CONCLUSION Extreme severe lumbar CCS (grade D) is the greatest determinant to perform the second-stage PDD procedure after LLIF.
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Affiliation(s)
- Jun Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
- Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China
| | - Tian-Zhen Xu
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
- Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China
| | - Ning Zhang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
- Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China
| | - Qi-Xin Chen
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
- Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China.
| | - Fang-Cai Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
- Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China.
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Hiyama A, Katoh H, Nomura S, Sakai D, Sato M, Watanabe M. Radiographs assessment of changes in the psoas muscle at L4-L5 level after single-level lateral lumbar interbody fusion in patients with postoperative motor weakness. J Clin Neurosci 2021; 90:165-170. [PMID: 34275544 DOI: 10.1016/j.jocn.2021.05.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/01/2022]
Abstract
The purposes of this study were (1) to investigate postoperative changes in cross-sectional area (CSA) and signal intensity (SI) of the psoas muscle (PS) using magnetic resonance imaging (MRI) and (2) to compare the CSA and SI of the PS between patients with and without motor weakness after single-level lateral lumbar interbody fusion (LLIF) at level L4-L5. Sixty patients were divided into two groups-those with postoperative motor weakness and those without-and the two groups were compared. Baseline demographics and clinical characteristics, such as operation time and blood loss, length of hospital stay, and postoperative complications, were recorded. The CSA and SI of the PS were obtained from the MRI regions of interest defined by manual tracing. Patients who developed motor weakness after surgery were significantly older (p = 0.040). The operation time (p = 0.868), LLIF operative time (p = 0.476), and estimated bleeding loss (p = 0.168) did not differ significantly between groups. In both groups, the CSA and SI of the left and right PS increased after surgery. The change in the CSA of the left PS was significantly higher in patients with weakness (247.6 ± 155.2 mm2) than without weakness (152.2 ± 133.1 mm2) (p = 0.036). The change in SI of the left PS did not differ between the two groups (p = 0.530). To prevent postoperative motor weakness regardless of the operation time, surgeons should be aware of the potential for surgical invasive of the PS during LLIF in older people.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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