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Yoo SC, Chough CK. Reliability of facet fluid on preoperative MRI for prediction of segmental instability after decompression surgery for degenerative lumbar spinal stenosis. J Neurosurg Sci 2024; 68:453-458. [PMID: 35380205 DOI: 10.23736/s0390-5616.22.05654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to determine whether preoperative facet fluid on MRI can help predict segmental instability (SI) after decompression surgery. METHODS We analyzed 34 patients (14 men and 20 women, a total of 37 segments) who underwent decompression for degenerative lumbar spinal stenosis from June 2011 to August 2019 at a single institution. Mean age at the time of operation was 67.8. Postoperative assessment was performed uniformly 12 months (11~15 months) after the surgery. Preoperative facet fluid on MRI, pre- and postoperative slip percentage, and segmental motion on lumbar lateral neutral and flexion-extension (LFE) radiographic images were measured. Visual Analog Scale (VAS) and necessities of interventional procedure or medication was also assessed for clinical outcomes. RESULTS No significant association was found between preoperative facet fluid indices and pre- or postoperative slip percentage (P=0.134) and segmental motion (P=0.936). There were no significant association also between facet fluid indices and VAS of back or leg (P=0.997 and P=0.437 respectively). CONCLUSIONS Preoperative facet fluid is not a predictive index of postoperative segmental instability or clinical outcome. Without segmental instability on LFE radiographic images, the presence of facet fluid in MRI is not an absolute indication for fusion.
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Affiliation(s)
- Seung-Chan Yoo
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Chung-Kee Chough
- Department of Neurosurgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea -
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Kosterhon M, Müller A, Rockenfeller R, Aiyangar AK, Gruber K, Ringel F, Kantelhardt SR. Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis. Front Bioeng Biotechnol 2024; 11:1281119. [PMID: 38260753 PMCID: PMC10801739 DOI: 10.3389/fbioe.2023.1281119] [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: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases. Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality. Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior-posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM. Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications.
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Affiliation(s)
- M. Kosterhon
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - A. Müller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Mathematics and Natural Science, Institute of Sports Science, University Koblenz, Koblenz, Germany
| | - R. Rockenfeller
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
- Department of Mathematics and Natural Science, Mathematical Institute, University Koblenz, Koblenz, Germany
| | - A. K. Aiyangar
- Mechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, Switzerland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Faculty of Engineering and Sciences, University of Adolfo Ibanez, Vina del Mar, Chile
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - K. Gruber
- Institute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, Germany
| | - F. Ringel
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
| | - S. R. Kantelhardt
- Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, Germany
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Elmose SF, Andersen GO, Carreon LY, Sigmundsson FG, Andersen MO. Radiological Definitions of Sagittal Plane Segmental Instability in the Degenerative Lumbar Spine - A Systematic Review. Global Spine J 2023; 13:523-533. [PMID: 35606897 PMCID: PMC9972266 DOI: 10.1177/21925682221099854] [Citation(s) in RCA: 3] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To collect and group definitions of segmental instability, reported in surgical studies of patients with lumbar spinal stenosis (LSS) and/or lumbar degenerative spondylolisthesis (LDS). To report the frequencies of these definitions. To report on imaging measurement thresholds for instability in patients and compare these to those reported in biomechanical studies and studies of spine healthy individuals.To report on studies that include a reliability study. METHODS This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies eligible for inclusion were clinical and biomechanical studies on adult patients with LDS and/or LSS who underwent surgical treatment and had data on diagnostic imaging. A systematic literature search was conducted in relevant literature databases. Full text screening inclusion criteria was definition of segmental instability or any synonym. Two reviewers independently screened articles in a two-step process. Data synthesis presented by tabulate form and narrative synthesis. RESULTS We included 118 studies for data extraction, 69% were surgical studies with decompression or fusion as interventions, 31% non-interventional studies. Grouping the definitions of segmental instability according similarities showed that 24% defined instability by dynamic sagittal translation, 26% dynamic translation and dynamic angulation, 8% used a narrative definition. Comparison showed that non-interventional studies with a healthy population more often had a narrative definition. CONCLUSION Despite a reputation of non-consensus, segmental instability in the degenerative lumbar spine can radiologically be defined as > 3 mm dynamic sagittal translation.
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Affiliation(s)
- Signe F. Elmose
- Center for Spine Surgery and
Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
- Signe F. Elmose, Center for Spine Surgery
and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Oestre
Hougvej 55, Middelfart DK-5500, Denmark.
| | - Gustav O. Andersen
- Center for Spine Surgery and
Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Leah Yacat Carreon
- Center for Spine Surgery and
Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | | | - Mikkel O. Andersen
- Center for Spine Surgery and
Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
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Li C, Liu W, Luo W, Zhang H, Zhao J, Gu R. Lumbar Facet Joint Effusion on Magnetic Resonance Imaging: Do Different Joint Effusion Images Have Different Clinical Values? World Neurosurg 2022; 167:e406-e412. [PMID: 35964904 DOI: 10.1016/j.wneu.2022.08.029] [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: 06/14/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of the study was to explore the significance of the distribution of lumbar facet joint effusion (unilateral or bilateral) and the amount of joint effusion in the process of lumbar degeneration. METHODS A total of 142 patients with L4-5 lumbar facet joint effusion in our hospital from December 2020 to December 2021 were analyzed retrospectively, including 69 cases of unilateral facet joint effusion and 73 cases of bilateral facet joint effusion. The correlation between joint effusion width, effusion area and lumbar stability, facet joint degeneration grade, lumbar intervertebral disc degeneration index, and lumbosacral angle (LSA) was analyzed. To study the significance of the distribution of joint effusion, the patients were divided into unilateral and bilateral effusion groups. RESULTS The size of the LSA in the bilateral effusion group was significantly larger than that in the unilateral effusion group (t = 3.6634, P < 0.05). There was a significant difference in the proportion of stability between both groups (P < 0.05). The width of the joint effusion was positively correlated with lumbar stability and the LSA. When the width of the joint effusion was 2 mm, the probability of lumbar instability was 58.1%. The area of joint effusion was positively correlated with lumbar stability and the LSA. When the area of effusion was 0.2 cm2, the probability of lumbar instability was 58.9%. CONCLUSIONS A bilateral effusion signal is more likely to indicate lumbar instability than a unilateral effusion signal. The distribution width and area of effusion were positively correlated with lumbar stability and LSA.
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Affiliation(s)
- Chaoyuan Li
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Wanguo Liu
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Wenqi Luo
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Hongchao Zhang
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Jianhui Zhao
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Rui Gu
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China.
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Wei FL, Zhou CP, Gao QY, Du MR, Gao HR, Zhu KL, Li T, Qian JX, Yan XD. Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis. EClinicalMedicine 2022; 51:101559. [PMID: 35865739 PMCID: PMC9294267 DOI: 10.1016/j.eclinm.2022.101559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clinically, there are substantive practice variations in surgical management of degenerative lumbar spondylolisthesis. We aimed at evaluating whether decompression alone outcomes for patients with degenerative lumbar spondylolisthesis are comparable to those of decompression with fusion. METHODS In this meta-analysis, the Embase, PubMed, and Cochrane Library databases were searched from inception to February 16th, 2022. Randomised controlled trials (RCTs) and cohort studies comparing decompression alone with decompression and fusion for patients with degenerative lumbar spondylolisthesis were included in this study. There were no language limitations. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) were used to report results in the random-effects model. Main outcomes included Oswestry disability index (ODI), pain, clinical satisfaction, complication and reoperation rates. The study protocol was published in PROSPERO (CRD42022310645). FINDINGS Thirty-three studies (6 RCTs and 27 cohort studies) involving 94 953 participants were included. Differences in post-operative ODI between decompression alone and decompression with fusion were not significant. A small difference for back (MD, 0.13; [95% CI, 0.08 to 0.18]; I 2:0.00%) and leg pain (MD, 0.30; [95% CI, 0.09 to 0.51]; I 2:48.35%) was observed on the 3rd post-operative month. The results did not reveal significant differences in leg pain and back pain between decompression alone and fusion groups on the 6th, 12th, and 24th post-operative months. Difference in clinical satisfaction between decompression alone and decompression with fusion were not significant from RCTs (OR, 0.26; [95% CI, 0.03 to 1.92]; I 2:83.27%). Complications (OR, 1.54; [95% CI, 1.16 to 2.05]; I 2:48.88%), operation time (MD, 83.39; [95% CI, 55.93 to 110.85]; I 2:98.75%), intra-operative blood loss (MD, 264.58; [95% CI, 174.99 to 354.16]; I 2:95.61%) and length of hospital stay (MD, 2.85; [95% CI, 1.60 to 4.10]; I 2:99.49%) were higher with fusion. INTERPRETATION Clinical effectiveness of decompression alone was comparable to that of decompression with fusion for degenerative lumbar spondylolisthesis. Decompression alone is recommended for patients with degenerative lumbar spondylolisthesis. FUNDING This work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei), Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265) and Social Talent Fund of Tangdu Hospital (No.2021SHRC034).
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Quan-You Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, 710032, Xi'an, China
- Corresponding author at: School of Basic Medicine, Fourth Military Medical University, No. 169 Changle Rd, Xi'an 710032, China.
| | - Ji-Xian Qian
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
| | - Xiao-Dong Yan
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
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Iwata S, Eguchi Y, Takaoka H, Koroki J, Orita S, Inage K, Shiga Y, Furuya T, Maki S, Nakamura J, Hagiwara S, Watanabe A, Aoki Y, Inoue M, Koda M, Takahashi H, Akazawa T, Ohtori S. MRI T2-mapping of lumbar facet joints is effective for quantitative evaluation of lumbar instability in patients with degenerative lumbar disorders. 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 2022; 31:1479-1486. [PMID: 35089419 DOI: 10.1007/s00586-022-07119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 12/31/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
PURPOSES To analyze T2 relaxation times of the facet joint by MRI T2-mapping in patients with degenerative lumbar disorders (DLD), and to determine the correlation with lumbar instability in radiographs. METHODS We conducted a T2-mapping of the lumbar facet joint using a 1.5 T MRI system. We classified patients with degenerative lumbar disorders scheduled to undergo decompression surgery into groups with stability and instability using radiographs, and compared the T2 relaxation times of the lumbar facet. Lumbar instability was defined as the presence of anterior translation ratio > 5% or disk range of motion (ROM) > 5° in the sagittal plane of SLFE radiographs. RESULTS Inclusion criteria were met by 22 patients (45 levels, mean age 64.3 years). Facet effusions had high sensitivity (90%) but had low specificity (28%) for diagnosis of lumbar instability. Mean T2 relaxation times of right and left facet joints are significantly longer (98.4 ms) in the instability group than they are (87.6 ms) in the stability group (p < 0.001). Anterior translation ratio was positively correlated with mean T2 relaxation times of facet joint (R2 = 0.493, p < 0.05). From a ROC analysis, the cutoff value of T2 relaxation times for lumbar instability was 98.65 ms (sensitivity 60.0%, specificity 95.7%, AUC 0.763). CONCLUSIONS The T2 relaxation times were positively correlated with lumbar instability. This new quantitative evaluation of lumbar facet joint using MRI T2-mapping might be useful to determine lumbar instability.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Orthopaedic Surgery, Shimoshizu National Hospital, Shikawatashi, Yotsukaido, Chiba, 934-5284-0003, Japan
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Junya Koroki
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Shikawatashi, Yotsukaido, Chiba, 934-5284-0003, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Chiba University Center for Frontier Medical, Engineering 1-33 Yayoi-cho, CFME room#B201, Inage-ku, Chiba, 263-8522, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki, 305-8575, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1Miyamae-ku, SugaoKawasaki, Kanagawa, 216-8511, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Yamada K, Toyoda H, Takahashi S, Tamai K, Suzuki A, Hoshino M, Terai H, Nakamura H. Facet Joint Opening on Computed Tomography Is a Predictor of Poor Clinical Outcomes After Minimally Invasive Decompression Surgery for Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2022; 47:405-413. [PMID: 34618791 DOI: 10.1097/brs.0000000000004262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective longitudinal cohort study. OBJECTIVE To investigate the impact of facet joint opening (FJO) on clinical outcomes after minimally invasive decompression surgery for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA Although FJOs have previously been identified as indicators of segmental spinal instability, their impact on clinical outcomes after decompression alone surgery has yet to be investigated. METHODS This study included 296 patients from a single institution who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥5 years. Our analysis focused on identifying FJOs at the index decompression level (d-FJO) and at multiple levels (m-FJO) (i.e., ≥3 levels within the lumbar segment) using preoperative computed tomography. Clinical outcomes including reoperations, improvement ratio for Japanese Orthopaedic Association score, and achievement of a minimal clinically important difference in visual analogue scale scores for low back pain or leg pain at 5 years were compared between patients with and without d-FJO or m-FJO. RESULTS There were 129 (44%) and 62 (21%) patients with d-FJO (more common with lateral olisthesis) and m-FJO (less common with spondylolisthesis), respectively. Reoperations were more common in patients with d-FJO than in those without (16% vs. 5%). On Cox proportional hazards analysis, d-FJO was identified as a predictor for revision at the index decompression level (hazard ratio 4.04, P = 0.03), whereas m-FJO was a predictor for revision at other lumbar levels (hazard ratio 3.71, P = 0.03). Patients with m-FJO had slightly lower rates of achieving minimal clinically important difference in visual analogue scale scores for low back pain (34% vs. 52%, P = 0.03) and poorer improvement ratio for Japanese Orthopaedic Association scores (74% vs. 80%, P = 0.03) than those without. CONCLUSION FJO at both index decompression level and multiple level were predictors of poor outcomes; patients with FJOs require careful surgical planning or special follow-up.Level of Evidence: 3.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, PL Hospital, Tondabayashi City, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
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Yamada K, Toyoda H, Takahashi S, Tamai K, Suzuki A, Hoshino M, Terai H, Nakamura H. Relationship between facet joint opening on CT and facet joint effusion on MRI in patients with lumbar spinal stenosis: analysis of a less invasive decompression procedure. J Neurosurg Spine 2021:1-9. [PMID: 34678767 DOI: 10.3171/2021.6.spine21721] [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: 05/22/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Both facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI are reportedly indicators of segmental instability in the lumbar facet joints of patients with lumbar spinal stenosis (LSS). However, no study has investigated both parameters simultaneously. Therefore, the association between these findings and which parameter is better for predicting clinical outcomes after surgical treatment remains unclear. The purpose of this study was to investigate the relationship between FJO and FJE in patients who underwent less invasive decompression procedures for LSS and to investigate the impact of these findings on clinical outcomes. METHODS This study included 1465 lumbar levels (L1-2 to L5-S1) in 293 patients who underwent less invasive surgery for LSS and had ≥ 5 years of follow-up. FJO was defined as joint space widening ≥ 2 mm on preoperative axial CT images. FJE was defined as fluid effusion in the facet joint on preoperative axial T2-weighted MR images. The characteristics and distributions of FJO and FJE were investigated with other preoperative radiological findings. The association between need for further surgery and FJO/FJE was analyzed according to intervertebral level. RESULTS FJO was observed at 402 levels (27%), and FJE was found at 306 levels (21%). The correspondence rate between FJO and FJE was 70% (kappa 0.195, p < 0.01). One hundred thirty-seven levels (9%) had both FJO and FJE. Levels with both FJO and FJE more commonly had lateral olisthesis, lateral wedging, and axial intervertebral rotation than other levels (p < 0.001). Levels with both FJO and FJE were more likely than other levels to need further surgery (OR 2.42, p = 0.027). CONCLUSIONS The correspondence rate between FJO and FJE was not high. However, multivariate analysis showed that levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings, such as lateral olisthesis, lateral wedging, and axial intervertebral rotation. Patients with levels with both FJO and FJE need careful long-term follow-up after undergoing a less invasive decompression procedure.
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Affiliation(s)
- Kentaro Yamada
- 1Department of Orthopaedic Surgery, PL Hospital, Tondabayashi City, Osaka, Japan; and.,2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hiromitsu Toyoda
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Shinji Takahashi
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Koji Tamai
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Akinobu Suzuki
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Masatoshi Hoshino
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hidetomi Terai
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
| | - Hiroaki Nakamura
- 2Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
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Chou SH, Lin SY, Shen PC, Tu HP, Huang HT, Shih CL, Lu CC. Pain Control Affects the Radiographic Diagnosis of Segmental Instability in Patients with Degenerative Lumbar Spondylolisthesis. J Clin Med 2021; 10:3984. [PMID: 34501429 PMCID: PMC8432229 DOI: 10.3390/jcm10173984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diagnosing intervertebral instability is crucial for the treatment of degenerative lumbar spondylolisthesis (DLS). Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. We hypothesized that adequate analgesia could alter the flexion/extension exam performance, and thus increase the diagnostic accuracy of segmental instability. MATERIALS AND METHODS One hundred patients with low-grade DLS were prospectively enrolled in the before-after cohort study. Standing lateral flexion/extension radiographs of lumbar spines were examined and analyzed before and after intramuscular injections of 30 mg ketorolac. RESULTS Pain score decreased significantly after analgesic injections (p < 0.001). Dynamic slip (DS), dynamic segmental angle (DA), dynamic lumbar lordosis, and slip percentage (SP) were significantly increased after pain reduction (all p < 0.001). According to the diagnostic criteria for segmental instability (DS > 4.5 mm, DA > 15°, or SP > 15%), there were 4%, 4%, and 0.7% of total motion segments fulfilling the criteria which markedly increased to 42%, 32%, and 16.7% after analgesia was administered. The incidence of instability also increased from 6% to 38% after analgesia. CONCLUSIONS The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability.
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Affiliation(s)
- Shih-Hsiang Chou
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Sung-Yen Lin
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Po-Chih Shen
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Hsuan-Ti Huang
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chia-Lung Shih
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan;
| | - Cheng-Chang Lu
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.C.); (S.-Y.L.); (P.-C.S.); (H.-T.H.)
- Orthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Axially Loaded Magnetic Resonance Imaging Identification of the Factors Associated with Low Back-Related Leg Pain. J Clin Med 2021; 10:jcm10173884. [PMID: 34501338 PMCID: PMC8432049 DOI: 10.3390/jcm10173884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective observational study was conducted to identify factors associated with low back-related leg pain (LBLP) using axially loaded magnetic resonance imaging (AL-MRI). Ninety patients with low back pain (LBP) underwent AL-MRI of the lumbar spine. A visual analog scale and patient pain drawings were used to evaluate pain intensity and location and determine LBLP cases. The values of AL-MRI findings were analyzed using a logistic regression model with a binary dependent variable equal to one for low back-related leg pain and zero otherwise. Logistic regression results suggested that intervertebral joint effusion (odds ratio (OR) = 4.58; p = 0.035), atypical ligamenta flava (OR = 5.77; p = 0.003), and edema of the lumbar intervertebral joint (OR = 6.41; p = 0.003) were more likely to be present in LBLP patients. Advanced disc degeneration (p = 0.009) and synovial cysts (p = 0.004) were less frequently observed in LBLP cases. According to the AL-MRI examinations, the odds of having LBLP are more likely if facet effusion, abnormal ligamenta flava, and lumbar facet joint edema are present on imaging than if not. The assessment of lumbar spine morphology in axial loaded MRI adds value to the potential understanding of LBLP, but further longitudinal and loaded–unloaded comparative studies are required to determine the role of acute dynamic changes and instability in LBLP development.
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Reitman CA, Cho CH, Bono CM, Ghogawala Z, Glaser J, Kauffman C, Mazanec D, O'Brien D, O'Toole J, Prather H, Resnick D, Schofferman J, Smith MJ, Sullivan W, Tauzell R, Truumees E, Wang J, Watters W, Wetzel FT, Whitcomb G. Management of degenerative spondylolisthesis: development of appropriate use criteria. Spine J 2021; 21:1256-1267. [PMID: 33689838 DOI: 10.1016/j.spinee.2021.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Outcomes of treatment in care of patients with spinal disorders are directly related to patient selection and treatment indications. However, for many disorders, there is absence of consensus for precise indications. With the increasing emphasis on quality and value in spine care, it is essential that treatment recommendations and decisions are optimized. PURPOSE The purpose of the North American Spine Society Appropriate Use Criteria was to determine the appropriate (ie reasonable) multidisciplinary treatment recommendations for patients with degenerative spondylolisthesis across a spectrum of more common clinical scenarios. STUDY DESIGN A Modified Delphi process was used. METHODS The methodology was based on the Appropriate Use Criteria development process established by the Research AND Development Corporation. The topic of degenerative spondylolisthesis was selected by the committee, key modifiers determined, and consensus reached on standard definitions. A literature search and evidence analysis were completed by one work group simultaneously as scenarios were written, reviewed, and finalized by another work group. A separate multidisciplinary rating group was assembled. Based on the literature, provider experience, and group discussion, each scenario was scored on a nine-point scale on two separate occasions, once without discussion and then a second time following discussion based on the initial responses. The median rating for each scenario was then used to determine if indications were rarely appropriate (1 - 3), uncertain (4-6), or appropriate (7-9). Consensus was not mandatory. RESULTS There were 131 discrete scenarios. These addressed questions on bone grafting, imaging, mechanical instability, radiculopathy with or without neurological deficits, obesity, and yellow flags consisting of psychosocial and medical comorbidities. For most of these, appropriateness was established for physical therapy, injections, and various forms of surgical intervention. The diagnosis of spondylolisthesis should be determined by an upright x-ray. Scenarios pertaining to bone grafting suggested that patients should quit smoking prior to surgery, and that use of BMP should be reserved for patients who had risk factors for non-union. Across all clinical scenarios, physical therapy (PT) had an adjusted mean of 7.66, epidural steroid injections 5.76, and surgery 4.52. Physical therapy was appropriate in most scenarios, and most appropriate in patients with back pain and no neurological deficits. Epidural steroid injections were most appropriate in patients with radiculopathy. Surgery was generally more appropriate for patients with neurological deficits, higher disability scores, and dynamic spondylolisthesis. Mechanical back pain and presence of yellow flags tended to be less appropriate, and obesity in general had relatively little influence on decision making. Decompression alone was more strongly considered in the presence of static versus dynamic spondylolisthesis. On average, posterior fusion with or without interbody fusion was similarly appropriate, and generally more appropriate than stand-alone interbody fusion which was in turn more appropriate than interspinous spacers. CONCLUSIONS Multidisciplinary appropriate treatment criteria were generated based on the Research AND Development methodology. While there were consistent and significant differences between surgeons and non-surgeons, these differences were generally very small. This document provides comprehensive evidence-based recommendations for evaluation and treatment of degenerative spondylolisthesis. The document in its entirety will be found on the North American Spine Society website (https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Appropriate-Use-Criteria).
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Affiliation(s)
- Charles A Reitman
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Charles H Cho
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Tufts University School of Medicine, Lahey Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - John Glaser
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | - Heidi Prather
- Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Resnick
- Department of Neurosurgery, University of Wisconsin Medical School, Madison, WI, USA
| | | | | | | | - Ryan Tauzell
- Choice Physical Therapy & Wellness, Christiansburg, VA, USA
| | - Eeric Truumees
- Seton Spine and Scoliosis Center, Brackenridge University Hospital & Seton Medical Center, Austin, TX, USA
| | - Jeffrey Wang
- Department of Orthopaedic Surgery and Neurosurgery, USC Spine Center, Los Angeles, CA, USA
| | - William Watters
- University of Texas Medical Branch, Baylor School of Medicine, Houston, TX, USA
| | - F Todd Wetzel
- Department of Orthopaedic Surgery & Sports Medicine; Department of Neurosurgery, Temple University School of Medicine, Philadelphia, PA, USA
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Charest-Morin R, Zhang H, Shewchuk JR, Wilson DR, Phillips AE, Bond M, Street J. Dynamic morphometric changes in degenerative lumbar spondylolisthesis: A pilot study of upright magnetic resonance imaging. J Clin Neurosci 2021; 91:152-158. [PMID: 34373021 DOI: 10.1016/j.jocn.2021.06.027] [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: 02/08/2021] [Revised: 05/19/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
The objectives of this study were to (a) develop a standing MRI imaging protocol, tolerable to symptomatic patients with degenerative spondylolisthesis (DLS), and (b) to evaluate the morphometric changes observed in DLS patients in both supine and standing postures. Patients with single level, Meyerding grade 1 DLS undergoing surgery at a single institution between November 2015 to May 2017 were consented. Patients were imaged in the supine and standing positions in a 0.5 T vertically open MRI scanner (MROpen, Paramed, Genoa, Italy) with sagittal and axial T2 images. The morphometric parameters measured were: cross-sectional area of the thecal sac (CSA), lateral recess height, disc height, degree of anterolisthesis, disc angle, lumbar lordosis, the presence of facet effusion and restabilization signs. Measures from both postures were compared using paired T-test. Associations of posture with the magnitude of change in the various measurements was determined using Pearson correlation or paired T-test when appropriate. All fourteen patients (mean age 64.4 years) included tolerated standing for the time required for image acquisition. All measurements with the exception of lumbar lordosis and disk height showed a statistically significant difference between the postures (p < 0.05). In the standing position, CSA and lateral recess height were reduced by 28% and 50%, respectively. There was no relationship between the change in CSA of the thecal sac and any measures. Standing images acquired in an upright MRI scanner demonstrated postural changes associated with Meyerding grade 1 DLS and images acquisition was tolerated in all patients.
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Affiliation(s)
- Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6(th) Floor, 818 West 10(th) Avenue, Vancouver, BC V5Z 1M9, Canada.
| | - Honglin Zhang
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Robert H.N. Ho Research, Centre 5th Floor, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Jason R Shewchuk
- Department of Radiology, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - David R Wilson
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Robert H.N. Ho Research, Centre 5th Floor, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Amy E Phillips
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Robert H.N. Ho Research, Centre 5th Floor, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Michael Bond
- Department of Orthopeadic Surgery, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - John Street
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6(th) Floor, 818 West 10(th) Avenue, Vancouver, BC V5Z 1M9, Canada.
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13
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Aggarwal A, Garg K. Lumbar Facet Fluid-Does It Correlate with Dynamic Instability in Degenerative Spondylolisthesis? A Systematic Review and Meta-Analysis. World Neurosurg 2021; 149:53-63. [PMID: 33607287 DOI: 10.1016/j.wneu.2021.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lumbar degenerative spondylolisthesis (LDS) is a common spinal disease. LDS has been differentiated into dynamic (unstable) and static (stable) spondylolisthesis. Standing flexion/extension lumbar spine radiographs are the best investigation to detect presence of dynamic spondylolisthesis. Magnetic resonance imaging is the investigation of choice to show lumbar canal stenosis and disc prolapse but it can miss dynamic LDS. Studies have shown good association between presence of facet fluid (FF) and dynamic spondylolisthesis. METHODS A systematic review and meta-analysis were performed. All studies describing the relationship between FF and degenerative spondylolisthesis as measured on dynamic radiographs or kinematic magnetic resonance imaging were included. RESULTS Fourteen articles met the inclusion criteria. A total of 1065 patients were included in the meta-analysis. Of the patients with unstable spondylolisthesis, 71% had FF, whereas only 22% of the patients with stable spondylolisthesis had FF. The combined pooled odds ratio for unstable spondylolisthesis in the presence of FF was 7.55 (3.61-15.08; P <0.00001). The pooled standard mean difference in the FF size in the patients with unstable and stable spondylolisthesis was 0.97 mm (0.38-1.57; P = 0.001). CONCLUSIONS FF has positive correlation with the presence of dynamic LDS and the probability of dynamic LDS increases as the size of FF increases. The probability of having a dynamic spondylolisthesis in patients with FF >1 mm is 8 times that of patients with no FF. Standing flexion extension radiographs should be performed in patients with FF >1 mm.
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Affiliation(s)
- Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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14
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Calvert GC, VanBuren Huffmon G, Rambo WM, Smith MW, McEntire BJ, Bal BS. Clinical outcomes for lumbar fusion using silicon nitride versus other biomaterials. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:33-48. [PMID: 32309644 PMCID: PMC7154368 DOI: 10.21037/jss.2019.12.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND In lumbar fusion surgery, intervertebral spacer cages made of silicon nitride (Si3N4) ceramic are an available option among other biomaterials. While the surface chemistry of Si3N4 is known to favor bone fusion, large-scale clinical studies attesting to its efficacy are lacking. This multicenter retrospective study compared lumbar fusion outcomes for Si3N4 cages to previously reported data for other cage materials. METHODS Pre-operative patient demographics, comorbidities, changes in visual analog scale (ΔVAS) pain scores, complications, adverse events, and secondary surgical interventions (SSI) were compiled from the records of 450 patients who underwent Si3N4 lumbar spinal fusion at four separate U.S. surgical centers. For comparison, MEDLINE/PubMed and Google Scholar searches identified studies reporting similar outcomes for other biomaterials. A total of 1,025 patients from 26 cohorts reported in 14 publications met inclusion criteria for this control group. RESULTS Overall, the mean last-follow-up for all patients was 341±293 days (11.4±9.8 months), with the longest follow-up being 6.4 years. Patients with Si3N4 implants were similar in gender and age distribution to the control group but had higher BMI values (30.9±6.1 vs. 25.8±4.1, P<0.01) and lower tobacco use (15.8% vs. 30.0%, P<0.01). Both the Si3N4 and control groups showed significant improvements in VAS pain scores from preoperative to last follow-up. For the Si3N4 group, ΔVAS was 36.8±35.4 points compared to 37.6±22.5 points (P=0.63) for the metadata group. Complications and reoperations for the Si3N4 and the control groups were similar (i.e., 9.8% and 3.1% versus 12.4% and 2.9%, P=0.16 and P=0.84, respectively). CONCLUSIONS Lumbar fusion with Si3N4 spacers compared favorably with the improvements reported with other commonly used biomaterial cages.
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Shinto K, Minamide A, Hashizume H, Oka H, Matsudaira K, Iwahashi H, Ishimoto Y, Teraguchi M, Kagotani R, Asai Y, Muraki S, Akune T, Tanaka S, Kawaguchi H, Nakamura K, Yoshida M, Yoshimura N, Yamada H. Prevalence of Facet Effusion and Its Relationship with Lumbar Spondylolisthesis and Low Back Pain: The Wakayama Spine Study. J Pain Res 2020; 12:3521-3528. [PMID: 32021388 PMCID: PMC6946631 DOI: 10.2147/jpr.s227153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/10/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Facet effusion represents a magnetic resonance imaging finding suggesting accumulation of fluid in the facet joint, potentially predictive of lumbar spondylolisthesis and low back pain. However, its prevalence and epidemiological characteristics in the general population remain unclear, because previous studies only included patients or volunteers. The aim of the present study was to investigate the prevalence of facet effusion in the general population and to describe its potential relationship with spondylolisthesis and low back pain. Material and methods Our study enrolled 808 participants from the Wakayama Spine Study who underwent magnetic resonance imaging investigations in supine position. Facet effusion was defined as a measurable, curvilinear, high-intensity signal within the facet joint, closely matching that of cerebrospinal fluid on the axial T2 images. We used standing lateral radiographs to diagnose L4 spondylolisthesis. Results We found that the prevalence of facet effusion in the lumbar spine was 34.3%, which did not differ significantly between men and women (p=0.13) and did not tend to increase with age, either in men (p=0.81) or in women (p=0.65). Additionally, we found no significant association between facet effusion and low back pain (odds ratio, 1.04–1.49; 95% confidence interval, 0.57–2.64; p=0.17–0.85), or between facet effusion and L4 spondylolisthesis (odds ratio, 1.55; 95% confidence interval, 0.80–2.86; p=0.17). In a subset of participants with L4 spondylolisthesis, we also noted that facet effusion was not significantly associated with low back pain (odds ratio, 1.26; 95% confidence interval, 0.37–4.27; p=0.70). Discussion This is the first study of facet effusion employing a population-based cohort, and the findings are thus expected to accurately describe the relationship between facet effusion and low back pain in the general population. We are planning a follow-up survey of the Wakayama Spine Study cohort to clarify the natural history of facet effusion and its relationship with clinical symptoms.
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Affiliation(s)
- Kazunori Shinto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Iwahashi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons with Disabilities, Tokorozawa City, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | | | | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan.,Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama City, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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16
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Yavin D, Casha S, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 80:701-715. [PMID: 28327997 DOI: 10.1093/neuros/nyw162] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/01/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
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Affiliation(s)
- Daniel Yavin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Steven Casha
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Samuel Wiebe
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Thomas E Feasby
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Callie Clark
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Albert Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - R John Hurlbert
- Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Garnette R Sutherland
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
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Chen Z, Xie P, Feng F, Chhantyal K, Yang Y, Rong L. Decompression Alone Versus Decompression and Fusion for Lumbar Degenerative Spondylolisthesis: A Meta-Analysis. World Neurosurg 2017; 111:e165-e177. [PMID: 29248779 DOI: 10.1016/j.wneu.2017.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of decompression alone (D group) with decompression and fusion (DF group) for patients who were diagnosed with lumbar degenerative spondylolisthesis (LDS). METHODS Electronic databases were searched for relevant studies that compared decompression alone with decompression and fusion for LDS. Then, data extraction and quality assessment were conducted, and the extracted data were analyzed by using RevMan 5.3. We used the random effects model for studies that had heterogeneity between them, and for those without heterogeneity, the fixed model was used. RESULTS Four randomized controlled trials and 14 nonrandomized controlled studies involving 77,994 patients were included for this meta-analysis. Although the DF group was associated with a higher postoperative change score on a visual analog scale compared with the D group in terms of back (P = 0.02) and leg (P = 0.04), they failed to reach the minimum clinically important difference. Moreover, no significant differences were found in Oswestry Disability Index, European Quality of Life-5 Dimensions, Short-Form 36 physical and mental component summaries score, and patients' satisfaction (P > 0.05) between treatment groups. Complication rate and reoperation rate (P > 0.05) were similar in both groups. Data analysis also showed that the DF group was associated with longer operation time (P < 0.00001), more intraoperative blood loss (P < 0.00001), and longer length of hospital stay (P < 0.00001). CONCLUSIONS Among patients with LDS, decompression and fusion surgery did not yield better clinical outcomes than decompression alone surgery. Also, the complication rate and reoperation rate were comparable between treatment groups. However, patients who had undergone decompression alone had shorter operation time, less intraoperative blood loss, and shorter hospital stay.
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Affiliation(s)
- Zihao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kishor Chhantyal
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters. 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 2016; 26:353-361. [PMID: 27334492 DOI: 10.1007/s00586-016-4667-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of degenerative lumbar spinal canal stenosis (LSS) by magnetic resonance imaging (MRI). METHODS In this ethical board approved cross-sectional multicenter study, MRI of 100 randomly selected patients (median age 72.5 years, 48 % female) of the prospective Lumbar Stenosis Outcome Study (LSOS) were evaluated by two independent readers. A set of five previously published core imaging parameters as well as nine qualitative and five quantitative additional parameters regarding LSS and degenerative changes of the lumbar spine were assessed to calculate κ and intraclass correlation coefficients (ICC) for the inter-reader agreement. Additional repeated image evaluations were performed by one reader to calculate the intra-reader agreement. RESULTS κ values for the core image parameters ranged between 0.42 (compromise of the foraminal zone) and 0.77 (relation between fluid and cauda equina) for inter-reader agreement and between 0.59 (compromise of the foraminal zone) and 0.8 (compromise of the central zone) for intra-reader agreement. The inter-reader agreement for the non-core parameters showed κ values of 0.27-0.69 and ICC values of 0.46-0.85. The intra-reader agreement showed κ values of 0.53-0.69 and ICC values of 0.81-0.88. CONCLUSIONS The inter- and intra-reader agreement of commonly used quantitative and qualitative image parameters for the assessment of LSS showed quite a variability with previously defined core parameters having good to excellent inter- and intra-reader agreements.
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Sigmundsson FG, Jönsson B, Strömqvist B. Determinants of patient satisfaction after surgery for central spinal stenosis without concomitant spondylolisthesis: a register study of 5100 patients. 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 2016; 26:473-480. [DOI: 10.1007/s00586-016-4495-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
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