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Li Q, Long X, Wang R, Niu P, Cai L, Wang L, Song Y. Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle. Front Endocrinol (Lausanne) 2024; 15:1391970. [PMID: 38962678 PMCID: PMC11220226 DOI: 10.3389/fendo.2024.1391970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To investigate the relationship between degeneration of cervical intervertebral disc and degeneration of paravertebral muscles[multifidus (MF), cervical semispinalis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL)]. Methods 82 patients with chronic neck pain were randomly selected, including 43 males and 39 females, with 50.73 0.7.51 years old. All patients were scanned by 3.0T MRI Philips Ingenia performed conventional MRI sequence scanning and fat measurement sequence mDIXON-Quant scanning of cervical. Fat infiltration (FI) and cross-sectional area (CSA) of cervical paravertebral muscle (MF, SCer, SCap and SPL) at central level of C5-6 disc were measured by Philips 3.0T MRI image post-processing workstation. According to Pfirrmann grading system, there was no grade I in the included cases. The number of grade IIr IV cases were n=16, 40, 19 and 7 respectively. CSA and FI of cervical paravertebral muscles were compared with t test or one-way ANOVA, Spearman correlation analysis was used to evaluate the correlation between age, disc degeneration, and CSA, FI of cervical paravertebral muscles, and multiple linear regression analysis was used to analyze the independent influencing factors of CSA and FI. Results CSA of cervical paravertebral muscles in male patients was significantly higher than that in female patients (all P<0.001), but there was no significant difference in FI (all P>0.05). Age was weakly correlated with CSA of MF+SCer, moderately correlated with CSA of SCap and SPL (r=-0.256, -0.355 and -0.361, P<0.05), weakly correlated with FI of SCap and SPL (r= 0.182 and 0.264, P<0.001), moderately correlated with FI of MF+SCer (r=0.408, P<0.001). There were significant differences in FI with disc degeneration (P<0.001, P=0.028 and P=0.005). Further correlation analysis showed that disc degeneration was strongly correlated with FI of MF+SCer (r=0.629, P<0.001), and moderately correlated with FI of SCap and SPL (r=0.363, P=0.001; r=0.345, P=0.002). Multiple linear regression analysis showed that sex and age were the influencing factors of CSA of SCap and SPL, sex was the independent influencing factor of CSA of MF+SCer, and disc degeneration was the independent influencing factor of FI. Conclusions Age is negatively correlated with CSA and positively correlated with FI. Disc degeneration was correlated with FI of paravertebral muscles, especially with FI of MF and SCer. Sex and age were the influencing factors of CSA, while disc degeneration was the independent influencing factor of FI.
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Affiliation(s)
- Qiujiang Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xingxia Long
- Department of Thoracic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Wang
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Pengying Niu
- Medical Center, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lei Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Ding Y, Zhang H, Jiang Q, Li T, Liu J, Lu Z, Yang G, Cui H, Lou F, Dong Z, Shuai M, Ding Y. Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases. Front Bioeng Biotechnol 2024; 12:1393005. [PMID: 38903190 PMCID: PMC11186988 DOI: 10.3389/fbioe.2024.1393005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction: For severe degenerative lumbar spinal stenosis (DLSS), the conventional percutaneous endoscopic translaminar decompression (PEID) has some limitations. The modified PEID, Cross-Overtop decompression, ensures sufficient decompression without excessive damage to the facet joints and posterior complex integrity. Objectives: To evaluate the biomechanical properties of Cross-Overtop and provide practical case validation for final decision-making in severe DLSS treatment. Methods: A finite element (FE) model of L4-L5 (M0) was established, and the validity was verified against prior studies. Endo-ULBD (M1), Endo-LOVE (M2), and Cross-Overtop (M3) models were derived from M0 using the experimental protocol. L4-L5 segments in each model were evaluated for the range of motion (ROM) and disc Von Mises stress extremum. The real clinical Cross-Overtop model was constructed based on clinical CT images, disregarding paraspinal muscle influence. Subsequent validation using actual FE analysis results enhances the credibility of the preceding virtual FE analysis. Results: Compared with M0, ROM in surgical models were less than 10°, and the growth rate of ROM ranged from 0.10% to 11.56%, while those of disc stress ranged from 0% to 15.75%. Compared with preoperative, the growth rate of ROM and disc stress were 2.66%-11.38% and 1.38%-9.51%, respectively. The ROM values in both virtual and actual models were less than 10°, verifying the affected segment stability after Cross-Overtop decompression. Conclusion: Cross-Overtop, designed for fully expanding the central canal and contralateral recess, maximizing the integrity of the facet joints and posterior complex, does no significant effect on the affected segmental biomechanics and can be recommended as an effective endoscopic treatment for severe DLSS.
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Affiliation(s)
- Yiwei Ding
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hanshuo Zhang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Qiang Jiang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Tusheng Li
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiang Liu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Zhengcao Lu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Guangnan Yang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongpeng Cui
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Fengtong Lou
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zhifeng Dong
- Mechanical and Electronic Engineering Department, China University of Mining and Technology, Beijing, China
| | - Mei Shuai
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yu Ding
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
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Takeda H, Abe Y, Imai T, Rashid MZM, Ikeda D, Kawabata S, Nagai S, Hachiya K, Fujita N, Kaneko S. Elucidation of the Mechanism of Occasional Anterior Longitudinal Ligament Rupture with Posterior Correction Procedure for Adult Spinal Deformity Using LLIF-Finite Element Analysis of the Impact of the Lordotic Angle of Intervertebral LLIF Cage. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1569. [PMID: 37763688 PMCID: PMC10532993 DOI: 10.3390/medicina59091569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic cages were available and ALL rupture was more frequently experienced compared with later periods when more lordotic cages were available. We performed finite element analysis (FEA) regarding the mechanism of ALL rupture during a posterior correction procedure. Methods: A spring (which mimics ALL) was introduced at the location of ALL in the FEA and an LLIF cage with two different lordotic angles, 6 and 12 degrees (6DC/12DC), was employed. To assess the extent of burden on the ALL, the extension length of the spring during the correction procedure was measured and the location of the rotation center was examined. Results: We observed a significantly higher degree of length extension of the spring during the correction procedure in the FEA model with 6DC compared with that of 12DC. We also observed that the location of the rotation center was shifted posteriorly in the FEA model with 6DC compared with that of 12DC. Conclusions: It is considered that the posterior and rostral edge of the less lordotic angle cage became a hinge, and the longer lever arm increased the burden on ALL as the principle of leverage. It is important to use an LLIF cage with a sufficient lordotic angle, that is compatible with the degree of posterior osteotomy in ASD correction.
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Affiliation(s)
- Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Yuichiro Abe
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
- Department of Orthopedic Surgery, Eniwa Hospital, Eniwa 061-1373, Japan
| | - Takaya Imai
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Mohd Zaim Mohd Rashid
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Daiki Ikeda
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Soya Kawabata
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Sota Nagai
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kurenai Hachiya
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
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Cui H, Chang Z, Yu X. Treatment of lumbar brucella spondylitis with negative pressure wound therapy via extreme lateral approach: A case report. Front Surg 2022; 9:974931. [PMID: 36386539 PMCID: PMC9643386 DOI: 10.3389/fsurg.2022.974931] [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: 06/21/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022] Open
Abstract
Brucella spondylitis (BS) is a specific spinal infection. Surgical treatment is required for Brucella spondylitis that has caused neurological symptoms in the lower extremities and developed an intraspinal abscess. The main purpose of surgery is to remove the lesion and restore the stability of the spine. However, both the anterior approach and the posterior approach cannot completely remove the lesions, resulting in a low cure rate and a certain recurrence rate. Although anterior or posterior debridement is more thorough, it is unbearable for some patients with poor general condition. In this study, for the first time, a negative pressure wound therapy (NPWT) device was introduced into the intervertebral space through the extreme lateral approach to treat a patient with Brucella spondylitis. We summarize the treatment process, and discuss the feasibility and effectiveness of this surgical approach through 1-year follow-up.
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Affiliation(s)
| | | | - Xiuchun Yu
- Correspondence: Zhengqi Chang Xiuchun Yu
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Wang X, Liu H, Wang W, Sun Y, Zhang F, Guo L, Li J, Zhang W. Comparison of Posterior Pedicle Screw Fixation and Lateral Fixation in the Extreme Lateral Interbody Fusion in Lumbar Degenerative Disease Patients with Osteopenia or Osteoporosis. Orthop Surg 2022; 14:3283-3292. [PMID: 36274218 PMCID: PMC9732588 DOI: 10.1111/os.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Nowadays, with the increasing proportion of osteoporosis in patients with lumbar degenerative diseases, doctors are facing the choice of intraoperative internal fixation methods. The purpose of this study was to compare and assess the clinical results of posterior bilateral pedicle screw fixation and lateral fixation in the extreme lateral interbody fusion (XLIF) in patients with osteopenia or osteoporosis. METHODS The retrospective review was performed on 67 degenerative lumbar diseases patients with osteopenia or osteoporosis who underwent XLIF in our hospital from January 2018 to July 2021. Patients in this study were classified into lateral screw (LS) group, lateral self-locking plate (LP) group, and bilateral pedicle screw (BPS) group. The functional evaluation factors containing Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of leg pain, and VAS of low back pain, radiological factors such as disc height (DH), lumbar lordotic (LL) angle, segmental lordotic (SL) angle, cage subsidence degree and interbody fusion degree were compared. RESULTS Primary outcomes: no differences were observed with regards to the incidence of complications among LS, LP and BS group (P < 0.05). The JOA and leg pain VAS were significantly improved after operation (P < 0.05) and all groups demonstrated similar improvements in the leg pain VAS and JOA score (P > 0.05). When comparing VAS of leg pain and JOA scores, no differences were identified among LS, LP and BPS groups (P > 0.05). There are four thigh sensory complaint, one hip flexor weakness and one thigh pain occurred and no death was observed. There were significantly better DH, LL angle, SL angle, cage subsidence degree and interbody fusion degree in the BPS group than in LS and LP groups 1 year after surgery (P < 0.05). The DH loss ratio, LL angle loss ratio, SL angle loss ratio in the BPS group was significantly lower than in the LP and LS groups (P < 0.05). The 12-month SL angle improvement rate in the BPS group was significantly higher than in the LP and LS groups (20.20 ± 14.69, 0.73 ± 4.68, 6.20 ± 12.31, P < 0.05). SECONDARY OUTCOMES the BPS patients had significantly worse intraoperative blood loss and operation time than LS and LP patients (P < 0.05). CONCLUSION In lumbar diseases patients with osteopenia or osteoporosis, the bilateral pedicle screw fixation has better orthopedic effect than lateral internal fixation, and can better maintain the stability of the spine in the long-term follow-up, which is a better choice in XLIF surgery.
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Affiliation(s)
- Xianzheng Wang
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Huanan Liu
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Weijian Wang
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yapeng Sun
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Fei Zhang
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lei Guo
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Jiaqi Li
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wei Zhang
- Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Nan C, Ma Z, Liu Y, Ma L, Li J, Zhang W. Impact of cage position on biomechanical performance of stand-alone lateral lumbar interbody fusion: a finite element analysis. BMC Musculoskelet Disord 2022; 23:920. [PMID: 36258213 PMCID: PMC9578219 DOI: 10.1186/s12891-022-05873-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to compare the biomechanical performance of various cage positions in stand-alone lateral lumbar interbody fusion(SA LLIF). Methods An intact finite element model of the L3-L5 was reconstructed. The model was verified and analyzed. Through changing the position of the cage, SA LLIF was established in four directions: anterior placement(AP), middle placement(MP), posterior placement(PP), oblique placement(OP). A 400 N vertical axial pre-load was imposed on the superior surface of L3 and a 10 N/m moment was applied on the L3 superior surface along the radial direction to simulate movements of flexion, extension, lateral bending, and axial rotation. Various biomechanical parameters were evaluated for intact and implanted models in all loading conditions, including the range of motion (ROM) and maximum stress. Results In the SA LLIF models, the ROM of L4-5 was reduced by 84.21–89.03% in flexion, 72.64–82.26% in extension, 92.5-95.85% in right and left lateral bending, and 87.22–92.77% in right and left axial rotation, respectively. Meanwhile, ROM of L3-4 was mildly increased by an average of 9.6% in all motion directions. Almost all stress peaks were increased after SA LLIF, including adjacent disc, facet joints, and endplates. MP had lower stress peaks of cage and endplates in most motion modes. In terms of the stress on facet joints and disc of the cephalad segment, MP had the smallest increment. Conclusion In our study, SA LLIF risked accelerating the adjacent segment degeneration. The cage position had an influence on the distribution of endplate stress and the magnitude of facet joint stress. Compared with other positions, MP had the slightest effect on the stress in the adjacent facet joints. Meanwhile, MP seems to play an important role in reducing the risk of cage subsidence.
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Affiliation(s)
- Chong Nan
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Zhanbei Ma
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Yuxiu Liu
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Liang Ma
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China.
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