1
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Wang D, Wang W, Han D, Muthu S, Cabrera JP, Hamouda W, Ambrosio L, Cheung JPY, Le HV, Vadalà G, Buser Z, Wang JC, Cho S, Yoon ST, Lu S, Chen X, Diwan AD. Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. 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 2024; 33:1748-1761. [PMID: 38043128 DOI: 10.1007/s00586-023-08041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). METHODS The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. RESULTS Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. CONCLUSION While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Waeel Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt
- Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia.
- St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia.
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2
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Konieczny MR, Jäger M. [Spondylolisthesis]. Schmerz 2024; 38:157-166. [PMID: 38446187 DOI: 10.1007/s00482-024-00804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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3
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Kong C, Wang D, Wang W, Wang Y, Lu S. Fusion with and without lever reduction in degenerative lumbar spondylolisthesis: a retrospective study. J Orthop Surg Res 2024; 19:17. [PMID: 38167006 PMCID: PMC10763449 DOI: 10.1186/s13018-023-04507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The reduction of slipped vertebra is often performed during surgery for degenerative lumbar spondylolisthesis (DLS). This approach, while potentially improving clinical and radiological outcomes, also carries a risk of increased complications due to the reduction process. To address this, we introduced an innovative lever reduction technique for DLS treatment. This study aims to investigate the clinical efficacy, radiological outcomes, and complications of fusion with or without lever reduction. METHODS We conducted a retrospective review of prospectively collected data from a registry of patients who underwent lumbar fusion surgery for DLS, with a follow-up of at least 24 months. Self-reported measures included visual analog scale (VAS) for back or leg pain, Oswestry Disability Index (ODI), and the achievement of minimal clinically important difference (MCID). Radiological assessments encompassed spondylolisthesis percentage (SP), focal lordosis (FL), and lumbar lordosis (LL). Complications were categorized using the modified Clavien-Dindo classification (MCDC) scheme. Patients were assigned to the reduction group (RG) and non-reduction group (NRG) based on the application of the lever reduction technique. Clinical and radiological outcomes at baseline, immediately after surgery, and at the last follow-up were compared. RESULTS A total of 281 patients were analyzed (123 NRG, 158 RG). Baseline patient demographics, comorbidities, and surgical characteristics were similarly distributed between groups except for operating time (NRG 129.25 min, RG 138.04 min, P = .009). Both groups exhibited significant clinical improvement after surgery (all, P = .000), with no substantial difference between groups (VAS, ODI, or the ability to reach MCID). Patients in RG showed statistically lower SP and higher FL during follow-up (all, P = .000). LL was comparable at different time points within each group or at the same time point between the two groups (all, P > .050). The overall complication rate (NRG 38.2%, RG 27.2%, P = .050) or specific complication rates per MCDC were similar between groups (all, P > .050). Patients in RG were predisposed to a lower risk of adjacent segment degeneration (ASDeg) (NRG 9.8%, RG 6.3%, P = .035). CONCLUSIONS There were no significant differences in postoperative measures such as VAS scores for back and leg pain, ODI, the ability to reach MCID, overall complication rate, or specific complication rates per MCDC between surgical approaches. However, fusion with lever reduction demonstrated a notable advantage in restoring segmental spinal sagittal alignment and reducing the occurrence of ASDeg compared to in situ fusion.
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Affiliation(s)
- Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.
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4
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Konieczny MR, Jäger M. [Spondylolisthesis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:931-940. [PMID: 37792012 DOI: 10.1007/s00132-023-04443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/05/2023]
Abstract
Spondylolisthesis is a frequent disease that is found in 20% of the adult population and is particularly accompanied by lumbar back pain. Degenerative spondylolisthesis develops in adulthood and is most often found in the L4/5 segment, in contrast to nondegenerative spondylolisthesis which is most often situated in the L5/S1 segment. Prior to every treatment the heterogeneous disease pattern has to be classified according to the severity grade of the olisthesis and to the Spinal Deformity Study Group (SDSG) classification. High-grade spondylolisthesis should preferably be surgically treated and low-grade spondylolisthesis should preferably be treated conservatively. In approximately 50% of all recently acquired spondylolistheses healing of the lysis can be achieved by a consequently carried out conservative treatment.
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Affiliation(s)
- M R Konieczny
- Klinik für Wirbelsäulenchirurgie, Orthopädische Klinik Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter (Ruhr), Deutschland.
| | - M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, St. Marien Hospital Mülheim a. d. Ruhr, Mühlheim a. d. Ruhr, Deutschland
- Klinik für Orthopädie, Unfall- & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus, Essen, Deutschland
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5
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Zeinaddini-Meymand A, Baigi V, Mousavi-Nasab MM, Shool S, Sadeghi-Naini M, Azadmanjir Z, Jazayeri SB, Berchi Kankam S, Dashtkoohi M, Shakeri A, Fakharian E, Kouchakinejad-Eramsadati L, Pirnejad H, Sadeghi-Bazargani H, Bagheri L, Pourandish Y, Amiri M, Pour-Rashidi A, Harrop J, Rahimi-Movaghar V. Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran. Global Spine J 2023:21925682231202425. [PMID: 37732722 DOI: 10.1177/21925682231202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). METHODS The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. RESULTS In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). CONCLUSION These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.
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Affiliation(s)
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Shool
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Azadmanjir
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Dashtkoohi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Shakeri
- Department of Neurosurgery, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Homayoun Sadeghi-Bazargani
- Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yasaman Pourandish
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Amiri
- Department of Neurosurgery, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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6
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Chan AK, Mummaneni PV, Burke JF, Mayer RR, Bisson EF, Rivera J, Pennicooke B, Fu KM, Park P, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Wang MY, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Chou D. Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis? J Neurosurg Spine 2022; 36:177-184. [PMID: 34534963 DOI: 10.3171/2021.3.spine202059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors' aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to -2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John F Burke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Rory R Mayer
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Joshua Rivera
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Brenton Pennicooke
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Kai-Ming Fu
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Paul Park
- 4Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Mohamad Bydon
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Knoxville, Tennessee
- 8Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- 9Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 10Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Michael Y Wang
- 14Department of Neurological Surgery, University of Miami, Miami, Florida
| | | | - Anthony L Asher
- 12Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael S Virk
- 3Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mohammed A Alvi
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jian Guan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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7
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Lin YT, Su KC, Chen KH, Pan CC, Shih CM, Lee CH. Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method. BMC Musculoskelet Disord 2021; 22:879. [PMID: 34649557 PMCID: PMC8518150 DOI: 10.1186/s12891-021-04758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reduction of lumbar spondylolisthesis during spinal fusion surgery is important for improving the fusion rate and restoring the sagittal alignment. Despite the variety of reduction methods, the fundamental mechanics of lumbar spondylolisthesis reduction remain unclear. This study aimed to investigate the biomechanical behavior while performing spondylolisthesis reduction with the anterior and posterior lever reduction method. METHODS We developed an L4-L5 spondylolisthesis model using sawbones. Two spine surgeons performed the simulated reduction with a customized Cobb elevator. The following data were collected: the torque and angular motion of Cobb, displacement of vertebral bodies, change of lordotic angle between L4 and L5, total axial force and torque applied on the model, and force received by adjacent disc. RESULTS Less torque value (116 N-cm vs. 155 N-cm) and greater angular motion (53o vs. 38o) of Cobb elevator were observed in anterior lever reduction. Moreover, the total axial force received by the entire model was greater in the posterior lever method than that in the anterior lever method (40.8 N vs. 16.38 N). Besides, the displacement of both vertebral bodies was greater in the anterior lever method. CONCLUSIONS The anterior lever reduction is a more effort-saving method than the posterior lever reduction method. The existing evidence supports the biomechanical advantage of the anterior reduction method, which might be one of the contributing factors to successfully treating high-grade lumbar spondylolisthesis with short-segment instrumentation.
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Affiliation(s)
- Yu-Tsung Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
- National Chung Hsing University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing, and Management, Miaoli County, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- National Chung Hsing University, Taichung, Taiwan
- Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
- National Chung Hsing University, Taichung, Taiwan.
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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8
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Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021313. [PMID: 35075090 PMCID: PMC8823594 DOI: 10.23750/abm.v92i6.10526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
Degenerative spondylolisthesis (DS) is a condition leading to the slippage of one vertebral body over the one below due to degenerative changes resulting in spinal stenosis and producing neurogenic claudication, with or without low back pain. DS prevalence is age and gender specific. Other risk factors mainly include a history of occupational driving, intense manual activity and sedentary work. Diagnosis for patients with DS include detailed history, physical examination and imaging through standing lateral radiographs and MRI. Most patients with symptomatic DS and absence of neurologic deficits should perform better with conservative treatment, whereas, patients with neurological symptoms, are more prone to undergo progressive functional deterioration without surgery. There is a lack of agreement on the best surgical management in patients with DS and symptomatic stenosis. There is a contradictory data that does not permit for a recommendation for or against the addition of fusion to decompression. There is also controversy on which fusion technique is best. Spinal minimally invasive surgery is a promising approach for DS promoting early recovery and enhanced quality of life by reducing skin incision, muscular damage and perioperative pain with significant improvements in clinical results and high satisfaction rates.
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Affiliation(s)
- Ibrahim Akkawi
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy
| | - Hassan Zmerly
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy, Ludes Lugano Campus, Lugano, Switzerland
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