1
|
Kgomotso EL, Hellum C, Fagerland MW, Solberg T, Brox JI, Storheim K, Hermansen E, Franssen E, Weber C, Brisby H, Algaard KRH, Furunes H, Banitalebi H, Ljøstad I, Indrekvam K, Austevoll IM. Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial. BMJ 2024; 386:e079771. [PMID: 39111800 DOI: 10.1136/bmj-2024-079771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis. DESIGN Five year follow-up of a randomised, multicentre, non-inferiority trial (Nordsten-DS). SETTING 16 public orthopaedic and neurosurgical clinics in Norway. PARTICIPANTS Patients aged 18-80 years with symptomatic lumbar spinal stenosis and a spondylolisthesis of 3 mm or more at the stenotic level. INTERVENTIONS Decompression surgery alone and decompression with additional instrumented fusion (1:1). MAIN OUTCOME MEASURES The primary outcome was a 30% or more reduction in Oswestry disability index from baseline to five year follow-up. The predefined non-inferiority margin was a -15 percentage point difference in the proportion of patients who met the primary outcome. Secondary outcomes included the mean change in Oswestry disability index, Zurich claudication questionnaire, numeric rating scale for leg and back pain, and EuroQol Group 5-Dimension (EQ-5D-3L) questionnaire. RESULTS From 12 February 2014 to 18 December 2017, 267 participants were randomly assigned to decompression alone (n=134) and decompression with instrumented fusion (n=133). Of these, 230 (88%) responded to the five year questionnaire: 121 in the decompression group and 109 in the fusion group. Mean age at baseline was 66.2 years (SD 7.6), and 69% were women. In the modified intention-to-treat analysis with multiple imputation of missing data, 84 (63%) of 133 people in the decompression alone group and 81 (63%) of 129 people in the fusion group had a at least a 30% reduction in Oswestry disability index, a difference of 0.4 percentage points. (95% confidence interval (CI) -11.2 to 11.9). The respective results of the per protocol analysis were 65 (65%) of 100 in the decompression alone group and 59 (66%) of 89 in the fusion group, a difference of -1.3 percentage points (95% CI -14.5 to 12.2). Both 95% CIs were higher than the predefined non-inferiority margin of -15%. The mean change in Oswestry disability index from baseline to five years was -17.8 in both groups (mean difference 0.02 (95% CI -3.8 to 3.9)). Results of the other secondary outcomes were in the same direction as the primary outcome. From two to five year follow-up, a new lumbar operation occurred in six (5%) of 123 people in the decompression group and 11 (10%) of 113 people in the fusion group, with a total from baseline to five years of 21 (16%) of 129 people and 23 (18%) of 125, respectively. CONCLUSIONS In participants with degenerative spondylolisthesis, decompression alone was non-inferior to decompression with instrumented fusion five years after primary surgery. Proportions of subsequent surgeries at the index level or an adjacent lumbar level were no different between the groups. TRIAL REGISTRATION ClinicalTrials.gov NCT02051374.
Collapse
Affiliation(s)
- Eric Loratang Kgomotso
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
| | - Tore Solberg
- Institute of clinical medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- The Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Institute of Health Sciences, Norwegian University of Technology and Science, Ålesund, Norway
| | - Eric Franssen
- Orthopaedic Department, Stavanger University Hospital, Stavanger, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Helena Brisby
- Spine Surgery Team, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenborg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Håvard Furunes
- Medical Faculty, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Gjøvik, Norway
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Ljøstad
- Member of the Norwegian Back and Spine Patients Association
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Moradi F, Bagheri SR, Ataee M, Alimohammadi E. Can magnetic resonance imaging findings effectively diagnose the instability observed on radiographs in patients with degenerative lumbar spinal stenosis? J Orthop Surg Res 2024; 19:459. [PMID: 39095870 PMCID: PMC11297733 DOI: 10.1186/s13018-024-04963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs. METHODS We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups. RESULTS A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27-3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68-3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32-2.84; P = 0.021) were identified as factors associated with instability. CONCLUSIONS Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.
Collapse
Affiliation(s)
- Farid Moradi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Mohammadali Ataee
- Department of Radiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Alimohammadi
- Department of Neurosurgery, Neuroscience Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
3
|
Huang Y, Wang W, Zhang L, Teng Y, Zhan Z, Yang H, Yang P. The Relationship Between MRI Findings of Posterior Ligamentous Complex and Lumbar Instability in Degenerative Spondylolisthesis. Int J Gen Med 2024; 17:2279-2287. [PMID: 38799204 PMCID: PMC11116808 DOI: 10.2147/ijgm.s452735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Background To determine the factors in posterior ligamentous complex indicating lumbar instability in patients diagnosed with degenerative spondylolisthesis on conventional magnetic resonance imaging (MRI). Methods We retrospectively analyzed patients who underwent PLIF surgery for degenerative spondylolisthesis at our institution between 2018 and 2020 and who had complete eligible preoperative imaging data for review and study, including lumbar MRI and anteroposterior and flexion-extension radiographs. Results Fifty-three patients were confirmed to have lumbar instability (Unstable Group, 44%), while sixty-seven patients (Stable Group, 56%) did not have instability on radiographs. The patients in the stable group had more advanced status of the degeneration of intervertebral disc than in the unstable group (p<0.05). The degeneration of supraspinous ligament (SSL) was more severe in the unstable group (p<0.05). Compared with the patients with rotatory instability, advanced degeneration of interspinous ligament (ISL) and SSL was observed in patients with translatory instability (p<0.05). However, there was no significant difference with regard to the height of the spinous process and the interspinous distance in patients with or without instability. Conclusion This MRI analysis showed that abnormal segmental motion is closely associated with the pathological characteristics of supraspinal ligament. Advanced degeneration of SSL in patients with degenerative spondylolisthesis should raise the suspicion for lumbar instability and additional evaluations. The status of ISL and ligamentum flavum (LF) may not be helpful for the diagnosis of lumbar instability. Functional radiographs combined with MRI may provide valuable information when diagnosing lumbar instability in patients with mechanical back pain.
Collapse
Affiliation(s)
- Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Linlin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zihao Zhan
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Peng Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| |
Collapse
|
4
|
Schönnagel L, Caffard T, Zhu J, Tani S, Camino-Willhuber G, Amini DA, Haffer H, Muellner M, Guven AE, Chiapparelli E, Arzani A, Amoroso K, Shue J, Duculan R, Zippelius T, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5. Spine (Phila Pa 1976) 2024; 49:261-268. [PMID: 37318098 DOI: 10.1097/brs.0000000000004748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected data. OBJECTIVE To report the decision-making process for decompression alone (DA) and decompression and fusion (DF) at a tertiary orthopedic center and compare the operative outcomes between both groups. BACKGROUND Controversy exists around the optimal operative treatment for DLS, either with DF or DA. Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed. MATERIALS AND METHODS Patients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical data set. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical data set with a receiver operating characteristic (ROC) analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (Numeric Analog Scale), and patient satisfaction were compared between the DF and DA groups. RESULTS A total of 124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The area under the curve of the decision-making score was 0.84. At a cutoff of three points indicating DF, the accuracy was 80.6%. CONCLUSIONS The two-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.
Collapse
Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Dominik A Amini
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Timo Zippelius
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| |
Collapse
|
5
|
Lee Y, Heard JC, Lambrechts MJ, Kern N, Wiafe B, Goodman P, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Rihn JA. Significance of Facet Fluid Index in Anterior Cervical Degenerative Spondylolisthesis. Asian Spine J 2024; 18:94-100. [PMID: 38287666 PMCID: PMC10910141 DOI: 10.31616/asj.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on. OVERVIEW OF LITERATURE The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis. METHODS Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and manual chart review. Radiographic measurements were made on preoperative MRIs for all vertebral levels diagnosed with spondylolisthesis and adjacent undiagnosed levels between C3 and C6. The facet fluid index was calculated by dividing the facet fluid measurement by the width of the facet. Bivariate analysis was conducted to compare facet characteristics based on radiographic spondylolisthesis and spondylolisthesis stability. RESULTS We included 154 patients, for whom 149 levels were classified as having spondylolisthesis and 206 levels did not. The average facet fluid index was significantly higher in patients with spondylolisthesis (0.26±0.07 vs. 0.23±0.08, p <0.001). In addition, both fluid width and facet width were significantly larger in patients with spondylolisthesis (p <0.001 each). Cervical levels in the fusion construct demonstrated a greater facet fluid index and were more likely to have unstable spondylolisthesis than stable spondylolisthesis (p <0.001 each). CONCLUSIONS Facet fluid index is associated with cervical spondylolisthesis and an increased facet size and fluid width are associated with unstable spondylolisthesis. While cervical spondylolisthesis continues to be an inconclusive finding, vertebral levels with spondylolisthesis, especially the unstable ones, were more likely to be included in the fusion procedure than those without spondylolisthesis.
Collapse
Affiliation(s)
- Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO,
USA
| | - Nathaniel Kern
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Bright Wiafe
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Perry Goodman
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - John J. Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| |
Collapse
|
6
|
Park J, Park SM, Han S, Jeon Y, Hong JY. Factors affecting successful immediate indirect decompression in oblique lateral interbody fusion in lumbar spinal stenosis patients. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100279. [PMID: 37869545 PMCID: PMC10587750 DOI: 10.1016/j.xnsj.2023.100279] [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: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023]
Abstract
Background Oblique lumbar interbody fusion (OLIF) offers indirect decompression of stenotic lesions of the spinal canal and foramen through immediate disc height restoration. Only a few studies have reported the effect of cage position and associated intraoperatively modifiable factors for successful immediate indirect decompression following OLIF surgery. This study aimed to investigate the intraoperatively modifiable factors for successful radiological outcomes of OLIF. Methods This study included 46 patients with 80 surgical levels who underwent OLIF without direct posterior decompression. Preoperative and postoperative radiological parameters were evaluated and intraoperatively modifiable radiologic parameters for successful immediate radiologic decompression on magnetic resonance image (MRI) were determined. Radiologic parameters were preoperative and postoperative radiological parameters including anterior disc height (ADH), posterior disc height (PDH) lumbar lordotic angle (LLA), segmental lordotic angle (SLA), foraminal height (FH), cage position, cross-sectional area (CSA) of the thecal sac, cross-sectional foraminal area (CSF), facet distance (FD). Results All radiologic outcomes significantly improved. Comparing preoperative and postoperative values, mean CSA increased from 99.63±40.21 mm2 to 125.02±45.90 mm2 (p<.0001), and mean left CSF increased from 44.54±12.90 mm2 to 69.91±10.80 mm2 (p<.0001). FD also increased from 1.40±0.44 to 1.92±0.71 mm (p<.0001). FH increased from 16.31±3.3 to 18.84±3.47 mm (p<.0001). ADH and PDH also significantly increased (p<.0001). Immediate postoperative CSF and FH improvement rate (%) were significantly correlated with posterior disc height restoration rate (%) (p=.0443, and p=.0234, respectively). In addition, the patients with a cage positioned in the middle of the vertebral body experienced a greater FH improvement rate (%) compared to the patients with a cage positioned anteriorly. Finally, Visual analogue scale (VAS) for leg pain was improved immediately. Conclusions OLIF provided satisfactory immediate indirect decompression in central and foraminal spinal stenosis. Moreover, intraoperative surgical technique for successful radiologic CSF and FH improvement included restoration of the PDH and placement of the cage in the middle.
Collapse
Affiliation(s)
- Jiwon Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Republic of Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yeong Jeon
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Republic of Korea
| |
Collapse
|
7
|
Hebda PW, Majewski O. Minimally invasive fenestration for decompression of C2-C3 spinal stenosis. BMJ Case Rep 2023; 16:e254174. [PMID: 37963660 PMCID: PMC10649468 DOI: 10.1136/bcr-2022-254174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Conventional techniques in neurosurgery such as laminectomy have been extensively displaced by minimally invasive types, owing to the character of complexity of cervical spinal region. Spinal canal stenosis at C2-C3 level is documented in the literature with the majority being caused by intervertebral disc herniations.This case reports a patient who presented with classical myelopathy symptoms and significant thickening of ligamentum flavum, while minimal spondylosis was detected at C2-C3 level. The decompression was performed from posterior approach and limited to the removal of ligamentum flavum with minimal resection of adjacent laminae, no fixation and no disc evacuation. After surgery, there was a significant improvement with preserved spinal stability.Although the anterior approach is more common for cervical spine, universal access site has not been defined in literature. We suggest that minimal decompression produces desirable effects with no need for fusion and preserving adequate stability of spinal complex.
Collapse
Affiliation(s)
- Patrycja Weronika Hebda
- Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
| | - Olaf Majewski
- Neurosurgery, Szpital Specjalistyczny im Edmunda Biernackiego w Mielcu, Mielec, Poland
| |
Collapse
|
8
|
Singh K, Hislop T, Lahiri A, Tekke P. Lumbar Facet Joint Fluid: A Reliable Sign of Lumbar Instability. Cureus 2023; 15:e39332. [PMID: 37378136 PMCID: PMC10292094 DOI: 10.7759/cureus.39332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Lumbar degenerative spondylolisthesis (LDS) is a prevalent condition among the elderly population. Magnetic resonance imaging (MRI) is often the first investigative modality if indicated clinically. However, the standard supine position used during an MRI may fail to detect dynamic instability. In such cases, the presence of facet joint fluid is a reliable sign, and further investigation, such as stress radiographs, should be conducted to confirm dynamic instability. Here, we present a typical case demonstrating the importance of this finding. A patient presented with neurological claudication, and an MRI was initially unremarkable except for the presence of lumbar facet joint fluid. This finding prompted us to conduct stress radiographs, which eventually confirmed dynamic instability.
Collapse
Affiliation(s)
- Kulvinder Singh
- Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Trudy Hislop
- Department of Physiotherapy, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Ashim Lahiri
- Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Praveen Tekke
- Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| |
Collapse
|
9
|
Lin F, Zhou Z, Li Z, Shan B, Zhou Z, Sun Y, Zhou X. Utility of a fulcrum for positioning support during flexion-extension radiographs for assessment of lumbar instability in patients with degenerative lumbar spondylolisthesis. J Neurosurg Spine 2022; 37:535-540. [PMID: 35523252 DOI: 10.3171/2022.3.spine22192] [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: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated a new standardized technique for evaluating lumbar stability in lumbar lateral flexion-extension (LFE) radiographs. For patients with lumbar spondylolisthesis, a three-part fulcrum with a support platform that included a semiarc leaning tool with armrests, a lifting platform for height adjustment, and a base for stability were used. Standard functional radiographs were used for comparison to determine whether adequate flexion-extension was acquired through use of the fulcrum method. METHODS A total of 67 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were enrolled in the study. The authors analyzed LFE radiographs taken with the patient supported by a fulcrum (LFEF) and without a fulcrum. Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), change in lumbar lordosis (CLL), and lumbar instability (LI) were measured for comparison using functional radiographs. RESULTS The average value of SA was 5.76° ± 3.72° in LFE and 9.96° ± 4.00° in LFEF radiographs, with a significant difference between them (p < 0.05). ST and PO were also significantly greater in LFEF than in LFE. The detection rate of instability was 10.4% in LFE and 31.3% in LFEF, and the difference was significant. The CLL was 27.31° ± 11.96° in LFE and 37.07° ± 12.963.16° in LFEF, with a significant difference between these values (p < 0.05). CONCLUSIONS Compared with traditional LFE radiographs, the LFEF radiographs significantly improved the detection rate of LI. In addition, this method may reduce patient discomfort during the process of obtaining radiographs.
Collapse
Affiliation(s)
| | | | - Zhiwei Li
- 2Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | | | | | | | | |
Collapse
|
10
|
Hung ND, Duc NM, Hang NT, Anh NTH, Minh ND, Hue ND. The efficacy of quantitative magnetic resonance imaging in the diagnosis of unstable L4/L5 degenerative spondylolisthesis. Biomed Rep 2022; 17:67. [PMID: 35815186 PMCID: PMC9260153 DOI: 10.3892/br.2022.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022] Open
Abstract
Lumbar degenerative spondylolisthesis (LDS) is a common degenerative disease that particularly affects the elderly. LDS can occur in any segment of the spine but is most commonly found in the L4/L5 segment. In the present study, a quantitative study of lumbar MRI measurements was conducted to identify predisposing factors indicative of spinal instability in patients with L4/L5 LDS. In total, 81 patients [58 patients in the stable group (SG) and 23 patients in the unstable group (UG)] who were diagnosed with L4/L5 LDS on X-ray and MRI between January 2021 and January 2022 were included in this study. Disk height, disk signal intensity on T1-weighted (T1W) and T2-weighted (T2W) images, facet joint fluid thickness, and ligamentum flavum thickness were measured on MRI, and the differences in these parameters between the two groups were evaluated. The receiver operating characteristic curve was generated, and the area under the curve (AUC), cut-off value, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were calculated for parameters found to be significantly different between the two groups. The facet joint fluid was significantly thicker in the UG than in the SG (P<0.01), and a cut-off value of 1.45 mm was found to have an AUC of 0.77 and an SE, SP, PPV, and NPV of 73.9, 67.2, 69.3, and 69.77%, respectively. No significant differences were identified between the two groups for mean disk height, ligamentum flavum thickness, or disk signal intensity on T1W or T2W images. The facet joint fluid thickness on axial T2W images may represent a useful predictor of spinal instability in patients with LDS. Therefore, spinal instability should be assessed, and additional evaluation methods, such as standing lateral flexion-extension radiographs, should be performed when facet fluid is detected on lumbar MRI.
Collapse
Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
| | - Nguyen-Thi Hang
- Department of Radiology, Hai Phong International Hospital, Hai Phong 180000, Vietnam
| | - Nguyen-Thi Hai Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Dinh Minh
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen Duy Hue
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| |
Collapse
|
11
|
Miyahara J, Yoshida Y, Nishizawa M, Nakarai H, Kumanomido Y, Tozawa K, Yamato Y, Iizuka M, Yu J, Sasaki K, Oshina M, Kato S, Doi T, Taniguchi Y, Matsubayashi Y, Higashikawa A, Takeshita Y, Ono T, Hara N, Azuma S, Kawamura N, Tanaka S, Oshima Y. Treatment of restenosis after lumbar decompression surgery: decompression versus decompression and fusion. J Neurosurg Spine 2022:1-8. [PMID: 34996037 DOI: 10.3171/2021.10.spine21728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare perioperative complications and postoperative outcomes between patients with lumbar recurrent stenosis without lumbar instability and radiculopathy who underwent decompression surgery and those who underwent decompression with fusion surgery. METHODS For this retrospective study, the authors identified 2606 consecutive patients who underwent posterior surgery for lumbar spinal canal stenosis at eight affiliated hospitals between April 2017 and June 2019. Among these patients, those with a history of prior decompression surgery and central canal restenosis with cauda equina syndrome were included in the study. Those patients with instability or radiculopathy were excluded. The patients were divided between the decompression group and decompression with fusion group. The demographic characteristics, numerical rating scale score for low-back pain, incidence rates of lower-extremity pain and lower-extremity numbness, Oswestry Disability Index score, 3-level EQ-5D score, and patient satisfaction rate were compared between the two groups using the Fisher's exact probability test for nominal variables and the Student t-test for continuous variables, with p < 0.05 as the level of statistical significance. RESULTS Forty-six patients met the inclusion criteria (35 males and 11 females; 19 patients underwent decompression and 27 decompression and fusion; mean ± SD age 72.5 ± 8.8 years; mean ± SD follow-up 18.8 ± 6.0 months). Demographic data and perioperative complication rates were similar. The percentages of patients who achieved the minimal clinically important differences for patient-reported outcomes or satisfaction rate at 1 year were similar. CONCLUSIONS Among patients with central canal stenosis who underwent revision, the short-term outcomes of the patients who underwent decompression were comparable to those of the patients who underwent decompression and fusion. Decompression surgery may be effective for patients without instability or radiculopathy.
Collapse
Affiliation(s)
- Junya Miyahara
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yuichi Yoshida
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Mitsuhiro Nishizawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Hiroyuki Nakarai
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Yudai Kumanomido
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Keiichiro Tozawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Yukimasa Yamato
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Masaaki Iizuka
- 2University of Tokyo Spine Group (UTSG), Tokyo.,6Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo
| | - Jim Yu
- 2University of Tokyo Spine Group (UTSG), Tokyo.,7Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo
| | - Katsuyuki Sasaki
- 2University of Tokyo Spine Group (UTSG), Tokyo.,8Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama; and
| | - Masahito Oshina
- 2University of Tokyo Spine Group (UTSG), Tokyo.,9Spine Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - So Kato
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Toru Doi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yuki Taniguchi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Yoshitaka Matsubayashi
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| | - Akiro Higashikawa
- 2University of Tokyo Spine Group (UTSG), Tokyo.,4Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa
| | - Yujiro Takeshita
- 2University of Tokyo Spine Group (UTSG), Tokyo.,5Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa
| | - Takashi Ono
- 2University of Tokyo Spine Group (UTSG), Tokyo.,6Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo
| | - Nobuhiro Hara
- 2University of Tokyo Spine Group (UTSG), Tokyo.,7Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo
| | - Seiichi Azuma
- 2University of Tokyo Spine Group (UTSG), Tokyo.,8Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama; and
| | - Naohiro Kawamura
- 2University of Tokyo Spine Group (UTSG), Tokyo.,3Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo
| | - Sakae Tanaka
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo
| | - Yasushi Oshima
- 1Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo.,2University of Tokyo Spine Group (UTSG), Tokyo
| |
Collapse
|
12
|
De C, De C. Impact of Concomitant Spinal Canal Stenosis on Clinical Presentation of Adult Onset Degenerative Lumbar Spondylolisthesis: A Study Combining Clinical and Imaging Spectrum. Cureus 2021; 13:e19536. [PMID: 34804749 PMCID: PMC8592293 DOI: 10.7759/cureus.19536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Aim Degenerative lumbar spondylolisthesis (DSL) is one of the reasons behind adult-onset backache due to degenerative spinal pathology. Clinical manifestations of this can range from asymptomatic patients to widely variable clinical signs and symptoms. Spinal canal stenosis (SCS) is the most common associated degenerative condition in the MRI of DSL. Moreover, other associated degenerative conditions may contribute significantly towards the clinical presentation. We have tried to assess the impact of SCS on the clinical symptomatology and presentation of the DSL by correlating the clinical and imaging findings. Methods This single-center prospective observational study has analysed 48 patients who were symptomatic due to DSL. The data was collected over a period of 18 months from January 2015 to June 2016 by screening through the adult patients presenting at the orthopaedic or spinal clinics with features suggestive of degenerative lumbar spine disease. Particular inclusion and exclusion criteria were developed as a screening tool and selected patients underwent imaging investigations. Patients had lumbar spine radiographs, both standing and flexion-extension view, and MRI of the lumbar spine. The presenting clinical features were documented. Their clinical and neurological assessment was done thoroughly by two qualified clinicians independently. Results The study population included 29 female (60.5%) and 19 male (39.5%) patients. The mean age of the study population was 49.5 years (SD 9.2 years). As per the radiological diagnostic criteria, 28 patients (58.3%) had features of SCS together with DSL and the rest of the 20 patients (41.7%) had DSL without SCS. Axial back pain and claudication had a statistically significant association with imaging findings. Similarly, patients with associated canal stenosis had statistically significant sensory and motor deficits, altered deep tendon reflexes. Facet joint angle more than 45 degrees at the level of the slip had a higher incidence of indicative presenting symptoms. However, this was not statistically proven. Conclusion DSL is a heterogeneous condition with the simultaneous presence of different degenerative processes in the lumbar spine at various stages. Hence, clinical presentations are widely variable. The concomitant presence of SCS significantly influences the clinical symptomatology with correlation to the MRI findings. Therefore, a judicious weighing of the clinical and imaging findings is crucial for prudent management planning for cases of DSL.
Collapse
Affiliation(s)
- Chiranjit De
- Trauma and Orthopaedics, Sandwell & West Birmingham NHS Trust, Birmingham, GBR
| | - Chinmay De
- Trauma and Orthopaedics, Burdwan Medical College, Bardhaman, IND
| |
Collapse
|
13
|
Naeem K, Nathani KR, Barakzai MD, Khan SA, Rai HH, Mubarak F, Enam SA. Modifications in lumbar facet joint are associated with spondylolisthesis in the degenerative spine diseases: a comparative analysis. Acta Neurochir (Wien) 2021; 163:863-871. [PMID: 33409741 DOI: 10.1007/s00701-020-04657-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is important in the assessment of degenerative spine disease. However, its role is limited in the identification of spinal instability; therefore, weight-bearing and dynamic studies like X-rays are required. The supine position eliminates the gravitational pull, corrects the vertebral slippage, and opens the facet joints leading to the collection of the synovial fluid into the joint space, which is detected on the MRI and can serve as a marker for instability. We aim to compare the facet fluid, facet hypertrophy, facet angle, and disc degenerative changes among the patients presenting with degenerative spondylolisthesis (DS) and those without. METHODS We performed a retrospective review for all the patients treated at our institution from January 2015 to December 2016. Facet Fluid Index (FFI) (ratio of facet fluid width and facet joint width) was calculated to assess the joint fluid. The percentage of spondylolisthesis was measured on X-rays. Each radiological parameter was compared between the two groups, i.e., patients with DS and patients without DS. A p value < 0.05 was considered significant. RESULTS In total, 61 patients, 28 with DS and 33 without DS, were enrolled. Baseline characteristics were similar in the two groups (p > 0.05). The average values of FFI, facet fluid width, and the difference between the superior and inferior facet were significantly higher in the group with instability (p < 0.05). Multivariate analysis demonstrated a 4.44 (95% confidence interval [CI] 2.03-5.365) times increase in the odds of instability with a unit increase in FFI, p < 0.0001. CONCLUSIONS We report a positive linear correlation between the facet joint effusion and facet hypertrophy on MRI and the percentage of vertebral translation on X-ray. Prospective studies will determine if these markers can play a role in predicting spinal instability.
Collapse
Affiliation(s)
- Komal Naeem
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Karim Rizwan Nathani
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | | | - Saad Akhtar Khan
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Hamid Hussain Rai
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Stadium Road, Karachi, Sindh, 74800, Pakistan.
| |
Collapse
|
14
|
Kitagawa T, Ogura Y, Kobayashi Y, Takahashi Y, Yonezawa Y, Yoshida K, Takahashi Y, Yasuda A, Shinozaki Y, Ogawa J. Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain. Global Spine J 2021; 11:212-218. [PMID: 32875871 PMCID: PMC7882817 DOI: 10.1177/2192568220905617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. METHODS We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. RESULTS LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. CONCLUSIONS Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.
Collapse
Affiliation(s)
- Takahiro Kitagawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan,Takahiro Kitagawa, Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-ku, Shizuoka 420-0853, Japan.
| | - Yoji Ogura
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yoshiomi Kobayashi
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | | | - Yoshiro Yonezawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Kodai Yoshida
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yohei Takahashi
- Fujita Health University, Dengakugakubo, Kutsukakecho, Toyoake, Aichi, Japan
| | - Akimasa Yasuda
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Yoshio Shinozaki
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| | - Jun Ogawa
- Japanese Red Cross Shizuoka Hospital, Ohtemachi, Aoi-ku, Shizuoka, Japan
| |
Collapse
|
15
|
Ren Z, Li Z, Li S, Xu D, Chen X. Modified Facet Joint Fusion for Lumbar Degenerative Disease: Case Series of a Fusion Technique, Clinical Outcomes, and Fusion Rate in 491 Patients. Oper Neurosurg (Hagerstown) 2020; 19:255-263. [PMID: 32469075 DOI: 10.1093/ons/opaa147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controversy still exists regarding the optimal fusion technique for the treatment of unstable lumbar spondylolisthesis. OBJECTIVE To evaluate the safety and efficacy of modified facet joint fusion (MFF). METHODS A total of 491 patients with unstable lumbar spondylolisthesis who underwent MFF were retrospectively reviewed. Computed tomography was used to evaluate the fusion rate of MFF at 6- and 12-mo follow-up postoperatively. Clinical outcomes included visual analog scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), and Oswestry Disability Index (ODI), all of which were obtained preoperatively and postoperatively at 1-, 3-, 6-, and 12-mo follow-up times. The clinical outcomes were determined to be excellent, good, fair, or poor according to the MacNab classification at the last follow-up time. RESULTS Of the 491 patients, the fusion rates at the 6-mo and 1-yr follow-up were 56.8% and 96.1%, respectively. Between baseline and 1-yr follow-up time, VAS-LP and VAS-LBP improved from 5.6 ± 0.9 to 0.4 ± 0.5 and 5.1 ± 1.2 to 1.5 ± 0.9, respectively (P < .001). JOA improved from 9.0 ± 2.0 to 27.7 ± 1.0, and ODI decreased from 64.0 ± 2.0 to 19 ± 1.0 (P < .001). At the final evaluation, 93.6% patients showed excellent or good results, and 3.2% showed fair results. There were no MFF technique-related complications. CONCLUSION MFF technique achieved satisfactory clinical outcomes and fusion rate and appears to be a promising alternative fusion technique for the treatment of unstable lumbar spondylolisthesis.
Collapse
Affiliation(s)
- Zhinan Ren
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Derong Xu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
16
|
Hellinger S, Lewandrowski KU. Clinical outcomes with endoscopic resection of lumbar extradural cysts. JOURNAL OF SPINE SURGERY 2020; 6:S133-S144. [PMID: 32195422 DOI: 10.21037/jss.2019.08.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Lumbar extradural cysts may be associated with sciatica-type back and leg pain. The symptoms of clinical pain syndrome from synovial cysts are sometimes difficult to differentiate from those of lumbar disc herniation or spinal canal stenosis and may be identified to be a pain source when visualized endoscopically. The authors analyzed the clinical outcomes with their endoscopic resection to better establish clinical indications and prognosticators of favorable results. Methods Two-year Macnab outcomes, VAS scores, and complications were analyzed in a series of 48 patients treated with the endoscopic removal of extradural cyst encountered during routine transforaminal and interlaminar decompression for foraminal and lateral recess stenosis causing lumbar radiculopathy. Results There were 26 female and 22 male patients. The extradural cysts were most commonly encountered at L4/5 level in 26 patients (72.2%) followed by the L5/S1 level in 8 patients (22.2%), and in 2 patients (5.6%) at the L3/4 level, respectively. One patient underwent T9/10 decompression. At minimum 2-year follow-up, all patients were improved. Excellent results according to the Macnab criteria were obtained in 19/48 (39.6%) patients, good in 18/48 (37.5%), and fair in 11/48 (22.9%), respectively. The average preoperative VAS score for leg pain was 8.06±1.57 and reduced at a statistically significant level (P<0.000) postoperatively to 1.92±1.49, and 1.77±1.32 at final follow-up, respectively. The percentage of patients with unlimited walking endurance had improved at a statistically significant level (P<0.0001) from 33.3% preoperatively (16/48) to 81.3% (39/48) postoperatively. One patient had a recurrent disc herniation, and another patient did not improve. Two patients underwent fusion during the follow-up period. Patients with Fair outcomes had a statistically significant association (P<0.001) with facet instability as suggested by axial T2-weighted magnetic resonance imaging (MRI) findings of thickened ligamentum flavum, facet joint hypertrophy, and bright white fluid-filled joint gap of >2 mm. Conclusions Endoscopic resection of extradural spinal cysts during routine decompression for symptomatic foraminal and lateral recess stenosis is feasible with favorable clinical outcomes in the majority of patients. Fair outcomes were associated with advanced instability of the involved lumbar facet joint complex.
Collapse
Affiliation(s)
- Stefan Hellinger
- Department of Orthopedic Surgery, Isar Hospital, Munich, Germany
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, USA.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
| |
Collapse
|
17
|
Austevoll IM, Hermansen E, Fagerland M, Rekeland F, Solberg T, Storheim K, Brox JI, Lønne G, Indrekvam K, Aaen J, Grundnes O, Hellum C. Decompression alone versus decompression with instrumental fusion the NORDSTEN degenerative spondylolisthesis trial (NORDSTEN-DS); study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2019; 20:7. [PMID: 30611229 PMCID: PMC6320633 DOI: 10.1186/s12891-018-2384-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fusion in addition to decompression has become the standard treatment for lumbar spinal stenosis with degenerative spondylolisthesis (DS). The evidence for performing fusion among these patients is conflicting and there is a need for further investigation through studies of high quality. The present protocol describes an ongoing study with the primary aim of comparing the outcome between decompression alone and decompression with instrumented fusion. The secondary aim is to investigate whether predictors can be used to choose the best treatment for an individual. The trial, named the NORDSTEN-DS trial, is one of three studies in the Norwegian Degenerative Spinal Stenosis (NORDSTEN) study. METHODS The NORDSTEN-DS trial is a block-randomized, controlled, multicenter, non-inferiority study with two parallel groups. The surgeons at the 15 participating hospitals decide whether a patient is eligible or not according to the inclusion and exclusion criteria. Participating patients are randomized to either a midline preserving decompression or a decompression followed by an instrumental fusion. Primary endpoint is the percentage of patients with an improvement in Oswestry Disability Index version 2.0 of more than 30% from baseline to 2-year follow-up. Secondary outcome measurements are the Zürich Claudication Questionnaire, Numeric Rating Scale for back and leg pain, Euroqol 5 dimensions questionnaire, Global perceived effect scale, complications and several radiological parameters. Analysis and interpretation of results will also be conducted after 5 and 10 years. CONCLUSION The NORDSTEN/DS trial has the potential to provide Level 1 evidence of whether decompression alone should be advocated as the preferred method or not. Further on the study will investigate whether predictors exist and if they can be used to make the appropriate choice for surgical treatment for this patient group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02051374 . First Posted: January 31, 2014. Last Update Posted: February 14, 2018.
Collapse
Affiliation(s)
- Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Hagavik, N- 5217, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, N- 5007, Bergen, Norway.
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Hagavik, N- 5217, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, N- 5007, Bergen, Norway.,Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, N-6026, Ålesund, Norway
| | - Morten Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, N-0424, Oslo, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Hagavik, N- 5217, Bergen, Norway
| | - Tore Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, N-9019, Tromsø, Norway.,Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, N-9019, Tromsø, Norway.,The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, N-9038, Tromsø, Bodø, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, N-0424, Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, N-0424, Oslo, Norway
| | - Greger Lønne
- Department of Orthopedic Surgery, Innlandet Hospital Trust, N-2609, Lillehammer, Lillehammer, Norway
| | - Kari Indrekvam
- Department of Clinical Medicine, University of Bergen, N- 5007, Bergen, Norway.,Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, N-6026, Ålesund, Norway
| | - Jørn Aaen
- Department of Clinical Medicine, University of Bergen, N- 5007, Bergen, Norway.,Department of Research, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, N-1474, Lørenskog, Oslo, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital, N-0424, Oslo, Norway
| |
Collapse
|
18
|
Anand A, Pfiffner TJ, Mechtler L. The Role of Imaging in the Management of Cystic Formations of the Mobile Spine (CYFMOS). Curr Pain Headache Rep 2018; 22:70. [PMID: 30145776 DOI: 10.1007/s11916-018-0723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to give a better understanding of the pathogenesis of cystic formations of the mobile spine (CYFMOS) and the correlating imaging findings. This would help with medical decision-making, given the plethora of conservative, interventional, and surgical treatment options. RECENT FINDINGS There has been a general understanding that CYFMOS are associated with degenerative spine changes. More recent articles however have suggested that identifying detailed imaging characteristics can assist in determining outcomes when CYFMOS are treated with interventional percutaneous methods or surgical decompression with or without concomitant fusion. CYFMOS although uncommon are not a rare finding seen in the spine when there is a background of degenerative spine changes. These cystic lesions are generally symptomatic by exhibiting mass effect on adjacent structure. Most treatments are aimed at decompression by interventional percutaneous or surgical means. Various imaging characteristics of these CYFMOS described in this article including their signal intensity, presence of spinal instability, particular patterns of adjacent degenerative changes, and imaging changes following interventional treatments can help guide physicians when managing these cases.
Collapse
Affiliation(s)
- Amar Anand
- DENT Neurologic Institute, 3980 Sheridan Dr, Buffalo, NY, 14226, USA.
| | | | | |
Collapse
|