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Karadag MK, Akgun MY, Basak AT, Ates O, Tepebasili MA, Gunerbuyuk C, Oktenoglu T, Sasani M, Ozer AF. Clinical and radiological analysis of the effects of three different lumbar transpedicular dynamic stabilization system on disc degeneration and regeneration. Front Surg 2023; 10:1297790. [PMID: 38162089 PMCID: PMC10757836 DOI: 10.3389/fsurg.2023.1297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Objective This study aims to assess the clinical outcomes of three transpedicular dynamic systems in treating degenerative disc disease and evaluate their impact on both clinical and radiological aspects of the operated and adjacent segments. Materials and methods A total of 111 patients who underwent posterior transpedicular short-segment dynamic system procedures for treatment of degenerative disc disease were included. The patients were categorized into three groups, namely, Group 1 (Dynesys system, n = 38), Group 2 (Safinaz screw + PEEK rod, n = 37), and Group 3 (Safinaz screw + titanium rod, n = 36). Disc regeneration in the operated segment and disc degeneration in the operated, upper, and lower adjacent segments were assessed using the Pfirrmann Classification. Results Postoperatively, a statistically significant difference was observed in visual analog scale and Oswestry Disability Index scores (p < 0.001). However, no statistically significant difference was seen in disc degeneration/regeneration and degeneration scores of the upper and lower adjacent segments between the preoperative and postoperative groups (p = 0.763, p = 0.518, p = 0.201). Notably, a positive effect on disc regeneration at the operated level (32.4%) was observed. No significant differences were found between the groups in terms of operation rates, screw loosening, and screw breakage after adjacent segment disease (p > 0.05). Conclusion In patients without advanced degeneration, all three dynamic systems demonstrated the ability to prevent degeneration in the adjacent and operated segments while promoting regeneration in the operated segment. Beyond inhibiting abnormal movement in painful segments, maintaining physiological motion and providing axial distraction in the operated segment emerged as key mechanisms supporting regeneration.
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Affiliation(s)
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | | | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
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Karadağ MK, Akıncı AT, Başak AT, Hekimoğlu M, Yıldırım H, Akyoldaş G, Aydın AL, Ateş Ö, Öktenoğlu T, Sasani M, Akgün MY, Günerbüyük C, Özer AF. Preoperative Magnetic Resonance Imaging Abnormalities Predictive of Lumbar Herniation Recurrence After Surgical Repair. World Neurosurg 2022; 165:e750-e756. [PMID: 35803567 DOI: 10.1016/j.wneu.2022.06.143] [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: 04/11/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are currently no standard criteria for evaluating the risk of recurrent disk herniation after surgical repair. This study investigated the predictive values of 5 presurgical imaging parameters: paraspinal muscle quality, annular tear size, Modic changes, modified Phirrmann disk degeneration grade, and presence of sacralization or fusion. METHODS Between 2015 and 2018, 188 patients (89 female, 99 male, median age 50) receiving first corrective surgery for lumbar disk herniation were enrolled. Microdiskectomy was performed in 161 of these patients, and endoscopic translaminar diskectomy approach was performed in 27 patients. Clinical status was evaluated before surgery and 4, 12, and 24 months post surgery using a visual analog scale, Oswestry Disability Index, and Short Form 36. RESULTS Recurrent disk herniation was observed in 21 of 188 patients. Seventeen of the recurrent disk herniations were seen in those who underwent microdiskectomy and 4 in those who underwent endoscopic translaminar diskectomy. There were significant differences in visual analog scale, Oswestry Disability Index, and Short Form 36 scores at 4, 12, and 24 months between patients with recurrence and the 167 no-recurrence patients. The median annular tear length was significantly greater in patients with recurrence than without recurrence. In addition, there were significant differences in recurrence rate according to Modic change type distribution, sacralization or fusion presence, Pfirmann disk; degeneration grade distribution, dichotomized annular tear size, dichotomized Modic change; and type and simplified 3-tier muscle degeneration classification distribution. CONCLUSIONS Patients with poor clinical scores and recurrence exhibited additional radiologic abnormalities before surgery, such as poor paraspinal muscle quality, longer annular tears, higher Modic change type, higher modified Phirrmann disk degeneration grade, and sacralization or fusion. This risk evaluation protocol may prove valuable for patient selection, surgical planning, and choice of postoperative recovery regimen.
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Affiliation(s)
| | - Ahmet Tolgay Akıncı
- Neurosurgery Department, Trakya University School of Medicine, Edirne, Turkey
| | | | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Hakan Yıldırım
- Radiology Department, American Hospital, Istanbul, Turkey
| | - Göktuğ Akyoldaş
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Özkan Ateş
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Yiğit Akgün
- Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
| | - Caner Günerbüyük
- Orthopedics Department, Koc University School of Medicine, Istanbul, Turkey
| | - Ali Fahir Özer
- Neurosurgery Department, American Hospital, Istanbul, Turkey; Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey.
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The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine. Sci Rep 2022; 12:9939. [PMID: 35705718 PMCID: PMC9200777 DOI: 10.1038/s41598-022-14244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion–extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.
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Applebaum A, Nessim A, Cho W. Modic Change: An Emerging Complication in the Aging Population. Clin Spine Surg 2022; 35:12-17. [PMID: 33769981 DOI: 10.1097/bsd.0000000000001168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
STUDY DESIGN This was a literature review. OBJECTIVE The objective of this study was to review the pathogenesis, prevalence, clinical associations, diagnostic modalities, and treatment options for patients with lower back pain (LBP) associated with Modic change (MC). SUMMARY OF BACKGROUND DATA Vertebral body endplates are located between the intervertebral disk and adjacent vertebral body. Despite their crucial roles in nutrition and biomechanical stability, vertebral endplates are extremely susceptible to mechanical failure. Studies examining the events leading to disk degeneration have shown that failure often begins at the endplates. Endplate degeneration with subchondral bone marrow changes were originally noticed on magnetic resonance imaging. These magnetic resonance imaging signal changes were classified as MC. METHODS A literature review was conducted on the history, etiology, risk factors, diagnostic modalities, and treatment of LBP with MC. RESULTS Type 1 MC refers to the presence of increased vascularization and bone marrow edema within the vertebral body. Type 2 MC involves fatty marrow replacement within the vertebral body. Type 3 MC reflects subchondral bone sclerosis. Despite the original classification, research has supported the notion that MCs possess a transitional nature. Furthermore, type 1 MCs have been strongly associated with inflammation and severe LBP, while types 2 and 3 tend to be more stable and demonstrate less refractory pain. With a strong association to LBP, understanding the etiology of MC is crucial to optimal treatment planning. Various etiologic theories have been proposed including autoimmunity, mechanics, infection, and genetic factors. CONCLUSIONS With the aging nature of the population, MC has emerged as an extremely prevalent issue. Research into the pathogenesis of MC is important for planning preventative and therapeutic strategies. Such strategies may include rehabilitation, surgical fixation, stabilization, steroid or cement injection, or antibiotics. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from MC, plan early intervention, and hasten return to functioning.
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Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Song KC, Kim H, Seo JY, Kim KW, Cho JH, Song MY, Chung WS. Clinical outcomes according to Modic changes of lumbar sprain due to traffic accidents following treatment with Korean Medicine. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shahmohammadi MR, Behrouzian S. Effect of Preoperative Modic Change in the Outcome of Patients with Low Back Pain Following Posterior Spinal Fusion or Laminectomy. Asian J Neurosurg 2019; 14:432-435. [PMID: 31143258 PMCID: PMC6516000 DOI: 10.4103/ajns.ajns_41_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Modic changes (MC), visible on magnetic resonance imaging (MRI) are associated with chronic low back pain (LBP). It is reported that different MC types could affect the surgical outcome in patients with LBP. Objective In this study, we evaluated the effect of MC Type I and II on patients with LBP and degenerative disc disease following posterior spinal fusion (PSF) or laminectomy. Materials and Methods We evaluated the outcome of 162 patients with LBP and MC Type I and II who underwent laminectomy (n = 72) or PSF (n = 90). Preoperative MRI was used to define MC types. Visual analog scale (VAS) was used to evaluate the pain intensity before and 3 months after surgery. Results Patients had MC Type I in 46.3% and Type II in 53.7%. Pain VAS significantly decreased following surgery (7.93 ± 1.27-5.98 ± 1.57, P < 0.001). There was no difference between MC Type I and II in pain VAS before (P = 0.51) and after treatment (P = 0.51). Among MC Type I, PSF compared to laminectomy had significantly more improvement in pain VAS (P = 0.01), but the changes in modic Type II were similar between groups (P = 0.89). Conclusion Surgical treatment in patients with LBP with MC accompanies with significant improvement in pain. PSF seems better treatment in patients with MC Type I.
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Affiliation(s)
- Mohammad Reza Shahmohammadi
- Neurofunctional Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Sima Behrouzian
- Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study. Pain Res Manag 2018; 2018:6857983. [PMID: 30186540 PMCID: PMC6112211 DOI: 10.1155/2018/6857983] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/04/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Background Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab's criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P < 0.01). As per Macnab's criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.
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Laustsen AF, Bech-Azeddine R. Do Modic changes have an impact on clinical outcome in lumbar spine surgery? A systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3735-3745. [DOI: 10.1007/s00586-016-4609-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/08/2016] [Accepted: 05/08/2016] [Indexed: 11/25/2022]
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Ozer AF, Suzer T, Sasani M, Oktenoglu T, Egemen E. Enlargement of Neural Foramina and Dynamic Stabilization in Spondylolisthesis without Restoring the Alignment: Technical Note. KOREAN JOURNAL OF SPINE 2016; 13:37-9. [PMID: 27123030 PMCID: PMC4844660 DOI: 10.14245/kjs.2016.13.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/05/2022]
Abstract
It is well known that the cause of radiculopathy is the compression of the nerve root within the foramina which is narrowed secondary to sliding of the corpus and reduced disc height. In some patients, unroofing the foramen does not resolve this problem. We described a new decompression technique using pedicle removal and transpedicular dynamic instrumentation to stabilization the spine. We performed this operation in 2 patients and achieved very good results.
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Tuncer Suzer
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Emrah Egemen
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
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Back pain's association with vertebral end-plate signal changes in sciatica. Spine J 2014; 14:225-33. [PMID: 24239802 DOI: 10.1016/j.spinee.2013.08.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/17/2013] [Accepted: 08/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with sciatica frequently experience disabling back pain. One of the proposed causes for back pain is vertebral end-plate signal changes (VESC) as visualized by magnetic resonance imaging (MRI). PURPOSE To report on VESC findings, changes of VESC findings over time, and the correlation between VESC and disabling back pain in patients with sciatica. STUDY DESIGN/SETTING A randomized clinical trial with 1 year of follow-up. PATIENTS SAMPLE Patients with 6 to 12 weeks of sciatica who participated in a multicenter, randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. OUTCOME MEASURES Patients were assessed by means of the 100-mm visual analog scale (VAS) for back pain (with 0 representing no pain and 100 the worst pain ever experienced) at baseline and 1 year. Disabling back pain was defined as a VAS score of at least 40 mm. METHODS Patients underwent MRI both at baseline and after 1 year follow-up. Presence and change of VESC was correlated with disabling back pain using chi-square tests and logistic regression analysis. RESULTS At baseline, 39% of patients had disabling back pain. Of the patients with VESC at baseline, 40% had disabling back pain compared with 38% of the patients with no VESC (p=.67). The prevalence of type 1 VESC increased from 1% at baseline to 35% 1 year later in the surgical group compared with an increase from 3% to 11% in the conservative group. The prevalence of type 2 VESC decreased from 40% to 29% in the surgical group while remaining almost stable in the conservative group at 41%. The prevalence of disabling back pain at 1 year was 12% in patients with no VESC at 1 year, 16% in patients with type 1 VESC, 11% in patients with type 2 VESC, and 3% in patients with both types 1 and 2 VESC (p=.36). Undergoing surgery was associated with increase in the extent of VESC (odds ratio [OR], 8.6; 95% confidence interval [CI], 4.7-15.7; p<.001). Patients who showed an increase in the extent of VESC after 1 year did not significantly report more disabling back pain compared with patients who did not show any increase (OR, 1.2; 95% CI, 0.6-2.6; p=.61). CONCLUSION In this study, undergoing surgery for sciatica was highly associated with the development of VESC after 1 year. However, in contrast with the intuitive feeling of spine specialists, those with and those without VESC reported disabling back pain in nearly the same proportion. Therefore, VESC does not seem to be responsible for disabling back pain in patients with sciatica.
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