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Guo T, Ding F, Fu B, Yang Z, Yang Y, Liu A, Wang P. Efficacy and Safety of Enhanced Recovery After Surgery (ERAS) Protocols for Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:199-210.e1. [PMID: 38810875 DOI: 10.1016/j.wneu.2024.05.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative disease (LDD). METHODS Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Clinical Trials.gov, etc. were searched from inception to October 2023. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing ERAS program with traditional protocol of MIS-TLIF for LDD were included. RESULTS A total of 11 studies were included for final analysis. The pooled results of RCTs showed that compared with MIS-TLIF, the ERAS program used in MIS-TLIF could reduce the length of hospital stay, operation time, intraoperative blood loss and incidence of postoperative complications, decrease visual analog scale and Oswestry Disability Index (ODI) score, and improve patient satisfaction (P < 0.05). However, the pooled results of CSs revealed no statistical difference in the ODI score, fusion rate, operation time, and incidence of complications between the two groups (P > 0.05). CONCLUSIONS Compared with MIS-TLIF, the ERAS program used in MIS-TLIF could effectively shorten the length of hospital stay, operation time, decrease intraoperative blood loss, and incidence of postoperative complications, promote postoperative pain relief, functional recovery, and patient satisfaction. This study confirmed the value of ERAS in MIS-TLIF surgery and provided evidence for the standardization of ERAS in the future. Considering that the pooled results of RCTs and CSs are not completely consistent, more high-quality studies are needed to confirm these conclusions.
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Affiliation(s)
- Tianci Guo
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Fenfang Ding
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bifeng Fu
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhenghui Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuhang Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Aifeng Liu
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ping Wang
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
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Li P, Shi Z, Jiang Y, Peng Z, Wang Y. Clinical Observation of 10-mm Endoscopic Minimally Invasive Interlaminar Decompression in the Treatment of Ossified Lumbar Spinal Stenosis. World Neurosurg 2024; 187:e129-e135. [PMID: 38621501 DOI: 10.1016/j.wneu.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aims to observe the safety and effectiveness of 10-mm endoscopic minimally invasive interlaminar decompression in the treatment of ossified lumbar spinal stenosis. METHODS The clinical data of 50 consecutive patients with ossified lumbar spinal stenosis were retrospectively analyzed. All patients underwent minimally invasive interlaminar decompression with 10-mm endoscope. Patient demographics, perioperative data, and clinical outcomes were recorded. Visual analog scale scores, Oswestry disability index scores, and modified Macnab criteria were used to assess clinical outcomes. The lateral recess angle, real spinal canal area, and effective intervertebral foramen area were used to assess the effect of decompression. RESULTS The mean age of all patients was 59.0 ± 12.3 years. The mean operative time and intraoperative blood loss were 43.7 ± 8.7 minutes and <20 ml, respectively. Two years after surgery, the leg pain Visual analog scale score decreased from 7.4 ± 1.0 to 1.6 ± 0.6 (P < 0.05) and the Oswestry disability index score decreased from 63.8 ± 7.6 to 21.7 ± 3.4 (P < 0.05). The lateral recess angle, real spinal canal area and effective intervertebral foramen area were significantly larger than before surgery (P < 0.05). The overall excellent and good rate at the last follow-up was 92.0% according to the modified Macnab criteria. CONCLUSIONS The 10-mm endoscopic minimally invasive interlaminar decompression can safely and effectively remove the ossification in the spinal canal and achieve adequate decompression in patients with ossified lumbar spinal stenosis.
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Affiliation(s)
- Pengfei Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhen Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yunduo Jiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhibin Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yansong Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China; NHC Key Laboratory of Cell Transplantation, Harbin Medical University, Harbin, China; Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, Harbin Medical University, Harbin, China.
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Daher M, Nassar JE, Ikwuazom CP, Balmaceno-Criss M, Callanan TC, Diebo BG, Daniels AH. Cortical Trajectory versus Traditional Pedicle Screw Trajectory in Open Transforaminal Lumbar Interbody Fusion: Meta-Analysis of Complications and Clinical Outcomes. World Neurosurg 2024; 189:212-219. [PMID: 38885740 DOI: 10.1016/j.wneu.2024.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Lumbar degenerative disease imposes a substantial burden on global health care expenditures. Transforaminal lumbar interbody fusion (TLIF) using either traditional trajectory (TT) pedicle screws or cortical bone trajectory (CBT) pedicle screws has become increasingly common. This meta-analysis evaluated outcomes and safety of open TLIF with TT compared with CBT. METHODS PubMed, Cochrane, and Google Scholar were searched up to April 2024. The studied outcomes included complications, revision surgeries, operating room time, estimated blood loss, length of hospital stay (LOS), incision length, Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopedic Association. RESULTS This meta-analysis included 5 studies; 770 patients undergoing TLIF were included, with 415 in the CBT group and 355 in the TT group. No statistically significant differences were found in the rate of overall complications, including specific complications, rate of revision surgeries, patient-reported outcome measures, operating room time, and estimated blood loss. However, the CBT group demonstrated shorter LOS (P = 0.05) and shorter incision lengths (P < 0.001) compared with the TT group. CONCLUSIONS TT and CBT in TLIF procedures demonstrated comparable rates of complications, reoperations, and patient-reported outcome measures. Despite similar operating room times and estimated blood loss, the CBT group exhibited shorter incision lengths and shorter LOS than the TT group. Both CBT and TT pedicle screws are safe and effective options for TLIF. There are potential benefits to CBT such as shorter incision and LOS, although TT remains an essential tool for spinal instrumentation techniques.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph E Nassar
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chibuokem P Ikwuazom
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tucker C Callanan
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Zhang Q, Chen G, Zhu Q, Liu Z, Li Y, Li R, Zhao T, Liu X, Zhu Y, Zhang Z, Li H. Construct validation of machine learning for accurately predicting the risk of postoperative surgical site infection following spine surgery. J Hosp Infect 2024; 146:232-241. [PMID: 38029857 DOI: 10.1016/j.jhin.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the risk factors for machine learning (ML) algorithms in predicting postoperative surgical site infection (SSI) following spine surgery. METHODS This prospective cohort study included 986 patients who underwent spine surgery at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2015 to October 2022. Supervised ML algorithms included support vector machine, logistic regression, random forest, XGboost, decision tree, k-nearest neighbour, and naïve Bayes (NB), which were tested and trained to develop a predicting model. The ML model performance was evaluated from the test dataset. We gradually analysed their accuracy, sensitivity, and specificity, as well as the positive predictive value, negative predictive value, and area under the curve. RESULTS The rate of SSI was 9.33%. Using a backward stepwise approach, we identified that the remarkable risk factors predicting SSI in the multi-variate Cox regression analysis were age, body mass index, smoking, cerebrospinal fluid leakage, drain duration and pre-operative albumin level. Compared with other ML algorithms, the NB model had the highest performance in seven ML models, with an average area under the curve of 0.95, sensitivity of 0.78, specificity of 0.88, and accuracy of 0.87. CONCLUSIONS The NB model in the ML algorithm had excellent calibration and accurately predicted the risk of SSI compared with the existing models, and might serve as an important tool for the early detection and treatment of SSI following spinal infection.
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Affiliation(s)
- Q Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - G Chen
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - Q Zhu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Liu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Y Li
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - R Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - T Zhao
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - X Liu
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Y Zhu
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - H Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China.
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Haibier A, Yusufu A, Hang L, Abudurexiti T. Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:92. [PMID: 38281015 PMCID: PMC10821211 DOI: 10.1186/s13018-024-04549-7] [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: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making. METHODS We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay. RESULTS ① Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients-493 in the Endo-TLIF group and 522 in the MIS-TLIF group. ② Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = - 76.75, 95% CI - 111.59, - 41.90, P < 0.0001), a shorter hospital stay (MD = - 2.15, 95% CI - 2.95, - 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = - 1.12, 95% CI - 1.53, - 0.71, P < 0.00001) compared to the MIS-TLIF group. CONCLUSION Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.
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Affiliation(s)
- Abuduwupuer Haibier
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Alimujiang Yusufu
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Lin Hang
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Tuerhongjiang Abudurexiti
- XinJiang Medical University, Urumqi, 830054, Xinjiang Uygur Autonomous Region, People's Republic of China.
- Department of Orthopedics of Trauma, The Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, 830002, Xinjiang Uygur Autonomous Region, People's Republic of China.
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Zhu J, Wu Z, Huang G, Zhong Y, Peng C. Effect of Erector Spinae Plane Block in Terms of Analgesic Efficacy in Elderly Patients Undergoing Posterior Lumbar Spine Surgery: A Retrospective, Propensity-Score Matched Study. Pain Ther 2023; 12:1027-1037. [PMID: 37266909 PMCID: PMC10289959 DOI: 10.1007/s40122-023-00527-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION For preoperative analgesia during a variety of operations, the erector spinae plane block (ESPB) has grown in popularity. However, its effectiveness in lumbar surgery is still unknown. The purpose of this study was to investigate the potential benefits of ESPB in enhancing analgesic efficacy in elderly individuals following posterior lumbar spine surgery. METHODS Patients aged 65 years or older who underwent elective posterior lumbar instrumented fusion (with or without decompression) at our institution between January 2019 and June 2022 were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for control and ESPB groups. The primary outcome was opioid consumption at 24 h after surgery. Secondary outcomes was visual analog scale (VAS) pain scores at rest in the first 24 h. Additional secondary outcomes included number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia, and length of stay. RESULTS A total of 382 patients were included, of whom 119 received ESPB. The mean age of the study patients was 70.6 years old, and 254 (66.5%) were male. After PSM, each group comprised 115 patients. Patients in the ESPB group showed a significantly lower opioid consumption at 24 h after surgery. Compared with the control group, VAS pain scores at rest in the first 24 h, number of patient-controlled intravenous analgesia (PCIA) pump compressions, ratio of patients requesting rescue analgesia, incidence of nausea and vomiting, and length of stay were significantly reduced in the ESPB group. There were no significant differences between the two groups regarding safety outcomes. CONCLUSIONS ESPB reduces short-term opioid consumption while providing safe and effective analgesia in elderly patients undergoing posterior lumbar surgery.
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Affiliation(s)
- Jianqin Zhu
- Department of Sleep Medicine, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Zhenjun Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530023, China
| | - Guiming Huang
- Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Yuting Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Cheng Peng
- Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, China.
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Rushton AB, Jadhakhan F, Verra ML, Emms A, Heneghan NR, Falla D, Reddington M, Cole AA, Willems PC, Benneker L, Selvey D, Hutton M, Heymans MW, Staal JB. Predictors of poor outcome following lumbar spinal fusion surgery: a prospective observational study to derive two clinical prediction rules using British Spine Registry data. 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 2023; 32:2303-2318. [PMID: 37237240 DOI: 10.1007/s00586-023-07754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/14/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Lumbar spinal fusion surgery (LSFS) is common for lumbar degenerative disorders. The objective was to develop clinical prediction rules to identify which patients are likely to have a favourable outcome to inform decisions regarding surgery and rehabilitation. METHODS A prospective observational study recruited 600 (derivation) and 600 (internal validation) consecutive adult patients undergoing LSFS for degenerative lumbar disorder through the British Spine Registry. Definition of good outcome (6 weeks, 12 months) was reduction in pain intensity (Numerical Rating Scale, 0-10) and disability (Oswestry Disability Index, ODI 0-50) > 1.7 and 14.3, respectively. Linear and logistic regression models were fitted and regression coefficients, Odds ratios and 95% CIs reported. RESULTS Lower BMI, higher ODI and higher leg pain pre-operatively were predictive of good disability outcome, higher back pain was predictive of good back pain outcome, and no previous surgery and higher leg pain were predictive of good leg pain outcome; all at 6 weeks. Working and higher leg pain were predictive of good ODI and leg pain outcomes, higher back pain was predictive of good back pain outcome, and higher leg pain was predictive of good leg pain outcome at 12 months. Model performance demonstrated reasonable to good calibration and adequate/very good discrimination. CONCLUSIONS BMI, ODI, leg and back pain and previous surgery are important considerations pre-operatively to inform decisions for surgery. Pre-operative leg and back pain and work status are important considerations to inform decisions for management following surgery. Findings may inform clinical decision making regarding LSFS and associated rehabilitation.
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Affiliation(s)
- Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Feroz Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Martin L Verra
- Department of Physiotherapy, Berne University Hospital, Bern, Switzerland
| | - Andrew Emms
- Department of Physiotherapy, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Michael Reddington
- Physiotherapy Department, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Ashley A Cole
- Department of Orthopaedics and Trauma, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul C Willems
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lorin Benneker
- Department of Orthopaedic Surgery Inselspital, University of Bern, Bern, Switzerland
| | - David Selvey
- Amplitude Clinical, Host of the British Spine Registry, Droitwich, UK
| | - Michael Hutton
- Princess Elizabeth Orthopaedic Centre (PEOC), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Hamed M, Asoglu H, Lampmann T, Winkelmann LM, Salemdawod A, Müller M, Vatter H, Banat M, Eichhorn L. Pain management with epidural catheter and epidural analgesia after spinal dorsal instrumentation of lumbar spine. Medicine (Baltimore) 2023; 102:e32902. [PMID: 36800634 PMCID: PMC9936043 DOI: 10.1097/md.0000000000032902] [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] [Indexed: 02/19/2023] Open
Abstract
Spinal dorsal instrumentation (SDI) is an established treatment for degenerative spinal diseases. Adequate and immediate postoperative pain control is important for patient recovery and may be compromised by uncertainty about its efficacy and concern about early postoperative surgical complications or adverse events. The aim of the current study was to compare the use of epidural analgesia (EA) with systemic analgesia (SA) as regards pain reduction and early postoperative complications after SDI. Pain management with epidural or systemic analgesia in patients undergoing SDI by posterior approach between January 2019 and July 2020 was evaluated by clinical functional testing, measuring total opioid amounts used, and evaluating numerical rating scale values 24 and 96 hours postoperatively. The following were also monitored: demographic data, number of affected segments, length of hospital stay, inflammatory markers (leukocytes and serum C-reactive protein), early postoperative surgical complication rates, and adverse events. In total 79 patients were included (33 in the EA and 46 in the SA group). The SA group had significantly lower numerical rating scale values at days 1 to 4 after surgery (P ≤ .001) and lower cumulative opioid use than the EA group (P < .001). We found no difference in infection parameters, length of hospital stay or surgery-related complication rates. Our data demonstrate that epidural anesthesia was inferior to an opioid-based SA regime in reducing postoperative pain in patients undergoing spinal surgery. There is no benefit to the use of epidural catheters.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Harun Asoglu
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Lena Marie Winkelmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Abdallah Salemdawod
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Center for Advanced Imaging Research, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum, Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- * Correspondence: Mohammed Banat, Department of Neurosurgery, University Hospital Bonn, Bonn, Germany (e-mail: )
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Clinic for Anesthesiology and Intensive Care Medicine, Helios Klinikum Bonn/Rhein-Sieg, Bonn, Germany
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Hamed M, Brandecker S, Lampmann T, Asoglu H, Salemdawod A, Güresir E, Vatter H, Banat M. Early fusion outcome after surgical treatment of single-level and multi-level pyogenic spondylodiscitis: experience at a level 1 center for spinal surgery-a single center cohort study. J Orthop Surg Res 2023; 18:107. [PMID: 36793045 PMCID: PMC9930249 DOI: 10.1186/s13018-023-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
STUDY DESIGN Retrospective single center cohort study. PURPOSE Spinal instrumentation in combination with antibiotic therapy is a treatment option for acute or chronic pyogenic spondylodiscitis (PSD). This study compares the early fusion outcome for multi-level and single-level PSD after urgent surgical treatment with interbody fusion in combination with fixation. METHODS This is a retrospective cohort study. Over a 10 year period at a single institution, all surgically treated patients received surgical debridement, fusion und fixation of the spine to treat PSD. Multi-level cases were either adjacent to each other on the spine or distant. Fusion rates were assessed at 3 and 12 months after surgery. We analyzed demographic data, ASA status, duration of surgery, location and length of spine affected, Charlson comorbidity index (CCI), and early complications. RESULTS A total of 172 patients were included. Of these, 114 patients suffered from single-level and 58 from multi-level PSD. The most frequent location was the lumbar spine (54.0%) followed by the thoracic spine (18.0%). The PSD was adjacent in 19.0% and distant in 81.0% of multi-level cases. Fusion rates at the 3 month follow-up did not differ among the multi-level group (p = 0.27 for both adjacent and distant sites). In the single-level group, sufficient fusion was achieved in 70.2% of cases. Pathogen identification was possible 58.5% of the time. CONCLUSIONS Surgical treatment of multi-level PSD is a safe option. Our study demonstrates that there was no significant difference in early fusion outcomes between single-level and multi-level PSD, whether adjacent or distant.
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Affiliation(s)
- Motaz Hamed
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Simon Brandecker
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Tim Lampmann
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Harun Asoglu
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Abdallah Salemdawod
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany ,grid.411024.20000 0001 2175 4264Center for Advanced Imaging Research, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum, Comprehensive Cancer, Center University of Maryland, Baltimore, USA
| | - Erdem Güresir
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Hartmut Vatter
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany.
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Relationship between lumbar lordosis, pelvic parameters, PI-LL mismatch and outcome after short fusion surgery for lumbar degenerative disease. Literature review, rational and presentation of public study protocol: RELApSE study (registry for evaluation of lumbar artrodesis sagittal alignEment). World Neurosurg X 2023; 18:100162. [PMID: 36818735 PMCID: PMC9932215 DOI: 10.1016/j.wnsx.2023.100162] [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: 10/31/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
Background Vertebral arthrodesis for degenerative pathology of the lumbar spine still remains burdened by clinical problems with significant negative results. The introduction of the sagittal balance assessment with the evaluation of the meaning of pelvic parameters and spinopelvic (PI-LL) mismatch offered new evaluation criteria for this widespread pathology, but there is a lack of consistent evidence on long-term outcome. Methods The authors performed an extensive systematic review of literature, with the aim to identify all potentially relevant studies about the role and usefulness of the restoration or the assessment of Sagittal balance in lumbar degenerative disease. They present the study protocol RELApSE (NCT05448092 ID) and discuss the rationale through a comprehensive literature review. Results From the 237 papers on this topic, a total of 176 articles were selected in this review. The analysis of these literature data shows sparse and variable evidence. There are no observations or guidelines about the value of lordosis restoration or PI-LL mismatch. Most of the works in the literature are retrospective, monocentric, based on small populations, and often address the topic evaluation partially. Conclusions The RELApSE study is based on the possibility of comparing a heterogeneous population by pathology and different surgical technical options on some homogeneous clinical and anatomic-radiological measures aiming to understanding the value that global lumbar and segmental lordosis, distribution of lordosis, pelvic tilt, and PI-LL mismatch may have on clinical outcome in lumbar degenerative pathology and on the occurrence of adjacent segment disease.
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Robotic-assisted spine surgery allows for increased pedicle screw sizes while still improving safety as indicated by elevated triggered electromyographic thresholds. J Robot Surg 2022; 17:1007-1012. [DOI: 10.1007/s11701-022-01493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
AbstractThe present study used triggered electromyographic (EMG) testing as a tool to determine the safety of pedicle screw placement. In this Institutional Review Board exempt review, data from 151 consecutive patients (100 robotic; 51 non-robotic) who had undergone instrumented spinal fusion surgery of the thoracic, lumbar, or sacral regions were analyzed. The sizes of implanted pedicle screws and EMG threshold data were compared between screws that were placed immediately before and after adoption of the robotic technique. The robotic group had significantly larger screws inserted that were wider (7 ± 0.7 vs 6.5 ± 0.3 mm; p < 0.001) and longer (47.8 ± 6.4 vs 45.7 ± 4.3 mm; p < 0.001). The robotic group also had significantly higher stimulation thresholds (34.0 ± 11.9 vs 30.2 ± 9.8 mA; p = 0.002) of the inserted screws. The robotic group stayed in the hospital postoperatively for fewer days (2.3 ± 1.2 vs 2.9 ± 2 days; p = 0.04), but had longer surgery times (174 ± 37.8 vs 146 ± 41.5 min; p < 0.001). This study demonstrated that the use of navigated, robot-assisted surgery allowed for placement of larger pedicle screws without compromising safety, as determined by pedicle screw stimulation thresholds. Future studies should investigate whether these effects become even stronger in a later cohort after surgeons have more experience with the robotic technique. It should also be evaluated whether the larger screw sizes allowed by the robotic technology actually translate into improved long-term clinical outcomes.
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Han Z, Ma C, Li B, Ren B, Liu J, Huang Y, Qiao L, Mao K. Biomechanical studies of different numbers and positions of cage implantation on minimally invasive transforaminal interbody fusion: A finite element analysis. Front Surg 2022; 9:1011808. [PMID: 36420402 PMCID: PMC9676234 DOI: 10.3389/fsurg.2022.1011808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The position and number of cages in minimally invasive transforaminal interbody fusion (MIS-TLIF) are mainly determined by surgeons based on their individual experience. Therefore, it is important to investigate the optimal number and position of cages in MIS-TLIF. METHODS The lumbar model was created based on a 24-year-old volunteer's computed tomography data and then tested using three different cage implantation methods: single transverse cage implantation (model A), single oblique 45° cage implantation (model B), and double vertical cage implantation (model C). A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models' range of motion (ROM), ROM ratio, peak stress of the internal fixation system, and cage were assessed. RESULTS The ROM ratios of models A, B, and C were significantly reduced by >71% compared with the intact model under all motions. Although there were subtle differences in the ROM ratio for models A, B, and C, the trends were similar. The peak stress of the internal fixation system appeared in model B of 136.05 MPa (right lateral bending), which was 2.07 times that of model A and 1.62 times that of model C under the same condition. Model C had the lowest cage stress, which was superior to that of the single-cage model. CONCLUSION In MIS-TLIF, single long-cage transversal implantation is a promising standard implantation method, and double short-cage implantation is recommended for patients with severe osteoporosis.
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Affiliation(s)
- Zhenchuan Han
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Chao Ma
- Key Laboratory of Modern Measurement and Control Technology, Ministry of Education, Beijing Information Science and Technology University, Beijing, China
| | - Bo Li
- Department of Orthopedics, Weihai Municipal Third Hospital, Weihai, China
| | - Bowen Ren
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jianheng Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Orthopedics, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lin Qiao
- Department of Orthopedics, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Keya Mao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Gao QY, Wei FL, Li T, Zhu KL, Du MR, Heng W, Yang F, Gao HR, Qian JX, Zhou CP. Oblique Lateral Interbody Fusion vs. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:829426. [PMID: 35665352 PMCID: PMC9160969 DOI: 10.3389/fmed.2022.829426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an effective surgical option for lumbar spinal stenosis (LSS) with spondylolisthesis. However, few studies have discussed oblique lateral interbody fusion (OLIF) with MIS-TLIF.ObjectiveTo evaluate postoperative improvements, complications, and reoperation rates between patients with LSS undergoing OLIF or MIS-TLIF.MethodsWe retrospectively studied 113 LLS patients who underwent OLIF (53) or MIS-TLIF (60) with percutaneous pedicle screw fixation between January 2016 and December 2018. We measured estimated blood loss, operative time, hospital stay, reoperation, and complication incidence, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA), and Short Form-36 (SF-36) scores, discal and foraminal height and lumbar lordotic angle.ResultsThe mean age was 58.81 ± 0.9 years. The TLIF group had increased operation time, blood loss, and hospital stays (p = 0.007, 0.001, and 0.016, respectively). Postoperatively, VAS and ODI scores significantly decreased while JOA and SF-36 scores significantly increased. The postoperative differences in main outcomes between the groups were insignificant (all p > 0.05). The OLIF group had the lowest rates of overall (9.8% OLIF vs. 12.9% MIS-TLIF), intraoperative (3.9% OLIF vs. 4.8% MIS-TLIF), and postoperative complications (5.9% OLIF vs. 8.1% MIS-TLIF), but the differences were insignificant (p = 0.607, 0.813, and 0.653, respectively). The reoperation rate did not differ significantly (3.8% OLIF vs. 3.3% MIS-TLIF) (p = 0.842). OLIF restored disc height (74.4 vs. 32.0%), foraminal height (27.4 vs. 18.2%), and lumbar lordotic angle (3.5 vs. 1.1%) with greater success than did MIS-TLIF.ConclusionPatients undergoing OLIF with LSS improved similarly to MIS-TLIF patients. OLIF restored disc height, foraminal height and lumbar lordotic angle more successfully than did MIS-TLIF.
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Affiliation(s)
- Quan-You Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Heng
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fan Yang
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Hao-Ran Gao
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Ji-Xian Qian
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- *Correspondence: Cheng-Pei Zhou
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Finite Element Analysis of a Novel Fusion Strategy in Minimally Invasive Transforaminal Lumbar Interbody Fusion. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4266564. [PMID: 35601152 PMCID: PMC9117058 DOI: 10.1155/2022/4266564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 01/18/2023]
Abstract
Purpose To evaluate the biomechanics of a novel fusion strategy (hybrid internal fixation+horizontal cage position) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods MIS-TLIF finite element models for three fusion strategies were created based on computed tomography images, namely, Model-A, hybrid internal fixation (ipsilateral pedicle screw and contralateral translaminar facet screw fixation)+horizontal cage position; Model-B, bilateral pedicle screw (BPS) fixation+horizontal cage position; and Model-C, BPS fixation+oblique 45° cage position. A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models' range of motion (ROM), peak stress of the internal fixation system, and cage were assessed. Results The ROM for Models A, B, and C were not different (P > 0.05) but were significantly lower than the ROM of Model-INT (P < 0.0001). Although there were subtle differences in the ROM ratio for Models A, B, and C, the trend was similar. The peak stress of the internal fixation system was significantly higher in Model-A than that of Models B and C, but only the difference between Models A and B was significant (P < 0.05). The peak stress of the cage in Model-A was significantly lower than that of Models B and C (P < 0.01). Conclusion Hybrid internal fixation with horizontal single cage implantation can provide the same biomechanical stability as traditional fixation while reducing peak stress on the cage and vertebral endplate.
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Tan QC, Huang JF, Bai H, Liu ZX, Huang XY, Zhao X, Yang Z, Du CF, Lei W, Wu ZX. Effects of Revision Rod Position on Spinal Construct Stability in Lumbar Revision Surgery: A Finite Element Study. Front Bioeng Biotechnol 2022; 9:799727. [PMID: 35071208 PMCID: PMC8766337 DOI: 10.3389/fbioe.2021.799727] [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: 10/22/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Revision surgery (RS) is a necessary surgical intervention in clinical practice to treat spinal instrumentation–related symptomatic complications. Three constructs with different configurations have been applied in RS. One distinguishing characteristic of these configurations is that the revision rods connecting previous segments and revision segments are placed alongside, outside, or inside the previous rods at the level of facetectomy. Whether the position of the revision rod could generate mechanical disparities in revision constructs is unknown. The objective of this study was to assess the influence of the revision rod position on the construct after RS. A validated spinal finite element (FE) model was developed to simulate RS after previous instrumented fusion using a modified dual-rod construct (DRCm), satellite-rod construct (SRC), and cortical bone trajectory construct (CBTC). Thereafter, maximum von Mises stress (VMS) on the annulus fibrosus and cages and the ligament force of the interspinous ligament, supraspinous ligament, and ligamentum flavum under a pure moment load and a follower load in six directions were applied to assess the influence of the revision rod position on the revision construct. An approximately identical overall reducing tendency of VMS was observed among the three constructs. The changing tendency of the maximum VMS on the cages placed at L4-L5 was nearly equal among the three constructs. However, the changing tendency of the maximum VMS on the cage placed at L2-L3 was notable, especially in the CBTC under right bending and left axial rotation. The overall changing tendency of the ligament force in the DRCm, SRC, and CBTC was also approximately equal, while the ligament force of the CBTC was found to be significantly greater than that of the DRCm and SRC at L1-L2. The results indicated that the stiffness associated with the CBTC might be lower than that associated with the DRCm and SRC in RS. The results of the present study indicated that the DRCm, SRC, and CBTC could provide sufficient stabilization in RS. The CBTC was a less rigid construct. Rather than the revision rod position, the method of constructing spinal instrumentation played a role in influencing the biomechanics of revision.
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Affiliation(s)
- Quan-Chang Tan
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China.,Department of Orthopaedics, Air Force Hospital of Eastern Theater Command, Nanjing, China
| | - Jin-Feng Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Hao Bai
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zi-Xuan Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Xin-Yi Huang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Xiong Zhao
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zhao Yang
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Zi-Xiang Wu
- Department of Orthopaedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
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Poor Bone Quality, Multilevel Surgery, and Narrow and Tall Cages Are Associated with Intraoperative Endplate Injuries and Late-onset Cage Subsidence in Lateral Lumbar Interbody Fusion: A Systematic Review. Clin Orthop Relat Res 2022; 480:163-188. [PMID: 34324459 PMCID: PMC8673985 DOI: 10.1097/corr.0000000000001915] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND A major complication of lateral lumbar interbody fusion (LLIF) is cage subsidence, which may lead to clinical problems, including loss of disc height correction, altered spinal alignment, recurrent pain, and vertebral body fracture. A thorough review of the current knowledge about the risk factors for the two types of cage subsidence after LLIF-intraoperative endplate injury and late-onset cage subsidence-could bring attention to well-established risk factors for clinical consideration while identifying any incompletely characterized factors that require further research to clarify. QUESTIONS/PURPOSES We performed a systematic review to answer the following questions: (1) Are bone quality and surrogates for bone quality, such as patient age and sex, associated with an increased likelihood of cage subsidence? (2) Are implant-related factors associated with an increased likelihood of cage subsidence? METHODS Two independent reviewers comprehensively searched Medline, Embase, Cochrane Library, PubMed, and Web of Science from 1997 to 2020 to identify all potential risk factors for cage subsidence after LLIF. Discrepancies were settled through discussion during full-text screening. Search terms included "lateral" AND "interbody fusion" AND "subsidence" OR "settling" OR "endplate injury" OR "endplate violation" WITHOUT "cervical" OR "transforaminal" OR "biomechanical." Eligible studies were retrospective or prospective comparative studies, randomized controlled trials, and case series with sample sizes of 10 patients or more reporting risk factors for cage subsidence or endplate injury after LLIF. Studies that involved cervical interbody fusions and biomechanical and cadaveric experiments were excluded. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the studies' quality of evidence. The initial database review found 400 articles. Thirty-four articles with moderate- to very-low-quality evidence met the inclusion criteria for analysis. A total of 3233 patients (58% [1860] of whom were female) were included in this review. Two types of cage subsidence were reviewed: late-onset cage subsidence, which occurs gradually postoperatively, and intraoperative endplate injury, which is derived from iatrogenic endplate violation during endplate preparation or cage insertion. Among 20 studies with moderate quality of evidence according to the GRADE criteria, eight studies reported risk factors for cage subsidence related to bone mineral density and its surrogates and 12 studies focused on risk factors regarding implant factors, including cage dimension, cage material, construct length, and supplementary instrumentation. RESULTS Patients with a dual x-ray absorptiometry T-score of -1.0 or less, age older than 65 years, and female sex were considered to have a high risk of both types of cage subsidence. Regarding cage size, cage width ≥ 22 mm helped to avoid late-onset cage subsidence, and cage height ≤ 11 mm was recommended by some studies to avoid intraoperative endplate injuries. Studies recommended that multilevel LLIF should be conducted with extra caution because of a high risk of losing the effect of indirect decompression. Studies found that standalone LLIF might be sufficient for patients without osteoporosis or obesity, and supplementary instrumentation should be considered to maintain the postoperative disc height and prevent subsidence progression in patients with multiple risk factors. The effect of the bone graft, cage material, endplate condition, and supplementary instrumentation on cage subsidence remained vague or controversial. CONCLUSION Patients with poor bone density, patients who are older than 65 years, and female patients should be counseled about their high risk of developing cage subsidence. Surgeons should avoid narrow cages when performing LLIF to minimize the risk of late-onset cage subsidence, while being cautious of an aggressive attempt to restore disc height with a tall cage as it may lead to intraoperative endplate injury. For multilevel constructs, direct decompression approaches, such as posterior and transforaminal LIF, should be considered before LLIF, since the effect of indirect decompression may be difficult to maintain in multilevel LLIF because of high risks of cage subsidence. The effect of the cage material and supplementary instrumentation require stronger evidence from prospectively designed studies with larger sample size that randomly assign patients to polyetheretherketone (PEEK) or titanium cages and different fixation types. Future research on intraoperative endplate injuries should focus on the specific timing of when endplate violation occurs with the help of intraoperative imaging so that attempts can be made to minimize its occurrence. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Ma T, Zhou T, Gu Y, Zhang L, Che W, Wang Y. Efficacy and safety of percutaneous transforaminal endoscopic surgery (PTES) compared with MIS-TLIF for surgical treatment of lumbar degenerative disease in elderly patients: A retrospective cohort study. Front Surg 2022; 9:1083953. [PMID: 37139262 PMCID: PMC10149668 DOI: 10.3389/fsurg.2022.1083953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
Objectives To evaluate the efficacy and safety of PTES for surgical treatment of lumbar degenerative disease (LDD) including lumbar disc herniation, lateral recess stenosis, intervertebral foraminal stenosis and central spinal canal stenosis in elderly patients compared with MIS-TLIF. Methods From November 2016 to December 2018, 84 elderly patients (>70 years old) of single-level LDD with neurologic symptoms underwent the surgical treatment. 45 patients were treated using PTES under local anesthesia in group 1 and 39 patients treated using MIS-TLIF in group 2. Preoperative, postoperative back and leg pain were evaluated using Visual analog scale (VAS) and the results were determined with Oswestry disability index (ODI) at 2-year follow-up. All complications were recorded. Results PTES group shows significantly less operation time (55.6 ± 9.7 min vs. 97.2 ± 14.3 min, P < 0.001), less blood loss [11(2-32) ml vs. 70(35-300) ml, P < 0.001], shorter incision length (8.4 ± 1.4 mm vs. 40.6 ± 2.7 mm, P < 0.001), less fluoroscopy frequency [5(5-10) times vs. 7(6-11) times, P < 0.001] and shorter hospital stay[3(2-4) days vs. 7(5-18) days, P < 0.001] than MIS-TLIF group does. Although there was no statistical difference of leg VAS scores between two groups, back VAS scores in PTES group were significantly lower than those in MIS-TLIF group during follow-ups after surgery (P < 0.001). ODI of PTES group was also significantly lower than that of MIS-TLIF group at 2-year follow-up (12.3 ± 3.6% vs. 15.7 ± 4.8%, P < 0.001). Conclusion Both PTES and MIS-TLIF show favorable clinical outcomes for LDD in elderly patients. Compared with MIS-TLIF, PTES has the advantages including less damage of paraspinal muscle and bone, less blood loss, faster recovery, lower complication rate, which can be performed under local anesthesia.
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Affiliation(s)
- Tianle Ma
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Tianyao Zhou
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Correspondence: Yutong Gu
| | - Liang Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wu Che
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yichao Wang
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Banat M, Wach J, Salemdawod A, Bara G, Scorzin J, Vatter H. Indications for early revision surgery for material failure in spinal instrumentation: experience at a level 1 center for spinal surgery - a single-center study. Medicine (Baltimore) 2021; 100:e28410. [PMID: 34941186 PMCID: PMC8702034 DOI: 10.1097/md.0000000000028410] [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: 05/26/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Posterior instrumentation is an established treatment for a range of spinal disorders. Material failure is not uncommon, and the indications for a revision are very heterogeneous. This study aimed to evaluate the indications and timing for early revision spinal surgery due to material failure.In this retrospective, single-center cohort study, patients underwent spinal posterior instrumentation between January 2017 and July 2019. They were followed up at 3, 12, and 18 months postoperatively. The time of onset of material failure which led to revision surgery was analyzed. In addition, the relationship between the indications for revision surgery and independent variables was examined using a multivariate logistic regression model.A total of one hundred thirty-five patients were enrolled. Radiolucent zones were found in 30 patients (20%) after 3 months, whereas 48 patients (31%) had radiolucent zones after 12 months. Revision surgery was performed in 13 patients (8.5%). The peak time for revision due to instability was within the first four months of the primary surgery. Multivariate analysis revealed that location, pathology, ASA score, and smoking had no significant impact on the indication for revision surgery, and neither did BMI (P = .042). Non-fusion (P = .007) and radiolucent zones (P = .004), in combination with increased pain (P = .006), were predictors for revision.Our data show that the peak time for early revision of material failure after posterior instrumentation was within the first 4 months of primary surgery. The abnormalities (e.g., radiolucent zones) surrounding the screws without fusion, including persistence of pain, were predictors for revision surgery.
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Ma Y, Huang P, Tu Z, Yao Z, Wang Z, Luo Z, Hu X. Associations between facet tropism and vertebral rotation in patients with degenerative lumbar disease. Eur J Med Res 2021; 26:149. [PMID: 34930499 PMCID: PMC8686366 DOI: 10.1186/s40001-021-00622-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
Background Vertebral rotation and facet tropism are very common in various lumbar degenerative diseases. Facet tropism means the presence of asymmetric angles on both sides of the facet joints. Studies have shown that facet tropism contributes to lumbar degenerative disease, and also inevitably leads to the asymmetry of movement and the imbalance of force, which may be possible to rotate the vertebral body. The aim of this study was to explore the correlation between lumbar vertebral rotation and facet tropism in patients with lumbar degenerative diseases. Methods A total of 198 patients with lumbar degenerative diseases from 2018 to 2019 were enrolled. Five hundred and seventy vertebral rotation angles and 1140 facet angles were measured. The vertebral bodies are divided into non-rotation group (Group A) and rotation group (Group B) with the vertebral rotation angle of 3° as the boundary. The information including gender, age, BMI (body mass index), bone mineral density, history of smoking, drinking, hypertension, diabetes, diagnosis, segment distribution, and degree of facet degeneration were also counted. Using inter-class correlation coefficients (ICC) to test the reliability of measurement results. Univariate and multivariate logistic regression analysis were used to analyze the relationship between vertebral rotation and facet tropism. Results The consistency of the ICC within the groups of the observers is above 0.8, with good agreement. The results of univariate analysis showed that facet tropism was significantly different between group A and group B (OR (odds ratio) = 3.30, 95% CI = 2.03–5.35, P < 0.0001). Other significant factors were included as adjustment variables into the multivariate regression model. Three models were analyzed separately (Model 1: non-adjusted. Model 2: adjust for age; facet degeneration; Model 3: adjust for age; disease distribution; segment distribution; facet degeneration). The results showed that after adjusting the confounders, the correlation between facet tropism and vertebral rotation did not change (Model 1: OR = 3.30, 95% CI = 2.03–5.35, P < 0.0001; Model 2: adjusted OR = 2.87, 95% CI = 1.66–4.97, P = 0.0002, Model 3: adjusted OR = 2.84, 95% CI = 1.56–5.17, P = 0.0006). Conclusion Current research demonstrates that there is an association between vertebral rotation and facet tropism, suggesting that vertebral rotation may also have a certain degree of correlation with lumbar degenerative diseases.
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Affiliation(s)
- Yachao Ma
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Peipei Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Zhipeng Tu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Zhou Yao
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Zhe Wang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Zhuojing Luo
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Xueyu Hu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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20
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Oliveira IOD, Lenza M, Antonioli E, Ferretti M. Lumbar Decompression Versus Spinal Fusion in a Private Outpatient Setting: A Retrospective Study with Three Years of Follow-up. Rev Bras Ortop 2021; 56:766-771. [PMID: 34900105 PMCID: PMC8651442 DOI: 10.1055/s-0041-1724083] [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] [Received: 07/24/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
Objective
To compare pain, function, quality of life and adverse events of lumbar decompression and spinal fusion in patients with degenerative spinal pathologies who participated in a second opinion program for spinal surgeries with a 36-month follow-up.
Methods
The data for this retrospective cohort were withdrawn from a private healthcare system between June 2011 and January 2014. The study sample consisted of 71 patients with a lumbar spine surgical referral. The outcomes for the comparisons between lumbar decompression and spinal fusion were quality of life (evaluated through the EuroQoL 5D), pain (measured by the Numerical Rating Scale) and function (assessed through the Roland Morris Disability Questionnaire) measured at baseline, and at 12 and 36 months after the surgical procedures. The definitions of recovery were established by the minimal clinically important difference (MCID). The baseline differences between the groups were analyzed by non-paired
t
-test, and the differences in instrument scores between time points, by generalized mixed models. The results were presented as mean values adjusted by the models and 95% confidence intervals.
Results
Concerning the surgical techniques, 22 patients were submitted to spinal fusion and 49 patients, to lumbar decompression. As for the comparisons of the findings before and after the surgical interventions, the MCID was achieved in all outcomes regarding quality of life, pain and function at both time points when compared to baseline scores Moreover, concerning the complication rates, only lumbar decompression presented a surgical rate of 4% (
n
= 3) for recurrence of lumbar disc hernia.
Conclusion
Patients with degenerative spinal pathologies present improvements in long-term outcomes of pain, function and quality of life which are clinically significant, no matter the surgical intervention.
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Affiliation(s)
- Isadora Orlando de Oliveira
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Instituto Wilson Mello, Campinas, SP, Brasil
| | - Mario Lenza
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Eliane Antonioli
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Mario Ferretti
- Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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21
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Zhuang C, Wang Z, Chen W, Tian B, Li J, Lin H. Osteoporosis and Endplate Damage Correlation Using a Combined Approach of Hounsfield Unit Values and Total Endplate Scores: A Retrospective Cross-Sectional Study. Clin Interv Aging 2021; 16:1275-1283. [PMID: 34262267 PMCID: PMC8275111 DOI: 10.2147/cia.s315213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/20/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Osteoporosis and endplate damage, two primary orthopedic disorders that have adverse effects on the quality of life of older adults, may have some previously unknown relationship. The purpose of this study was to determine the potential association between osteoporosis and endplate damage with two specific imaging scoring systems and analyze the underlying mechanisms. Patients and Methods A cross-sectional study including 156 patients with degenerative disc disease (DDD) who visited our department in 2018 was performed. Data including age, sex, body mass index, Hounsfield unit (HU) values utilizing computed tomography (CT), and total endplate scores (TEPSs) using magnetic resonance imaging (MRI) of all patients were retrospectively collected and analyzed. The average HU value and TEPS of L1–L4 were used to represent the degrees of bone mineral density (BMD) and endplate damage, respectively. Patients with an HU value < 110 were defined as having osteoporosis and placed in the low-BMD group; otherwise, they were placed in the normal-BMD group. Multivariate logistic regression models were used to determine the independent factors of endplate damage. Results The TEPSs in the low-BMD group were significantly higher (6.4 ± 1.6 vs 5.0 ± 0.9, p < 0.001) overall and in every segment of L1–L4 (p < 0.01). A significant negative correlation was found between TEPS and HU values (p < 0.001). The HU value (odds ratio [OR] 0.221; 95% confidence interval [CI], 0.148–0.295, p < 0.001), age (OR 0.047; 95% CI, 0.029–0.224, p < 0.001), and BMD (OR 3.796; 95% CI, 2.11–7.382, p < 0.05) were independent factors influencing endplate damage. Conclusion A significantly positive correlation was observed between osteoporosis and endplate damage, indicating the requirement for a more comprehensive therapeutic regimen for treating patients with DDD complicated with osteoporosis.
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Affiliation(s)
- Chenyang Zhuang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zixiang Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Weisin Chen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Bo Tian
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Juan Li
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of Orthopedics, Shanghai Geriatrics Center, Fudan University, Shanghai, People's Republic of China
| | - Hong Lin
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of Orthopedics, Shanghai Geriatrics Center, Fudan University, Shanghai, People's Republic of China
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22
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Wei FL, Du MR, Li T, Zhu KL, Zhu YL, Yan XD, Yuan YF, Wu SD, An B, Gao HR, Qian JX, Zhou CP. Therapeutic Effect of Large Channel Endoscopic Decompression in Lumbar Spinal Stenosis. Front Surg 2021; 8:603589. [PMID: 34222312 PMCID: PMC8249583 DOI: 10.3389/fsurg.2021.603589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Percutaneous endoscopic decompression (PED) is a minimally invasive surgical technique that is now used for not only disc herniation but also lumbar spinal stenosis (LSS). However, few studies have reported endoscopic surgery for LSS. Therefore, we conducted this study to evaluate the outcomes and safety of large channel endoscopic decompression. Methods: Forty-one patients diagnosed with LSS who underwent PED surgery were included in the study. The estimated blood loss, operative time, length of hospital stay, hospital costs, reoperations, complications, visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, Japanese Orthopaedic Association (JOA) score and SF-36 physical-component summary scores were assessed. Preoperative and postoperative continuous data were compared through paired-samples t-tests. The significance level for all analyses was defined as p < 0.05. Results: A total of 41 consecutive patients underwent PED, including 21 (51.2%) males and 20 (48.8%) females. The VAS and ODI scores decreased from preoperatively to postoperatively, but the JOA and SF-36 physical component summary scores significantly increased. The VAS (lumbar) score decreased from 5.05 ± 2.33 to 0.45 ± 0.71 (P = 0.000); the VAS (leg) score decreased from 5.51 ± 2.82 to 0.53 ± 0.72 (P = 0.000); the ODI score decreased from 52.80 ± 20.41 to 4.84 ± 3.98 (P = 0.000), and the JOA score increased from 11.73 ± 4.99 to 25.32 ± 2.12 (P = 0.000). Only 1 patient experienced an intraoperative complication (2.4%; dural tear), and 1 patient required reoperation (2.4%). Conclusions: Surgical treatment for LSS is to sufficiently decompress and minimize the trauma and complications caused by surgery. This study did not reveal any obvious shortcomings of PED and suggested PED is a safe and effective treatment for LSS.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi-Li Zhu
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Xiao-Dong Yan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi-Fang Yuan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Sheng-Da Wu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Bo An
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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23
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Meng F, Xu S, Liang Y, Zhu Z, Wang K, Liu H. Cervical balance and clinical outcomes in cervical spondylotic myelopathy treated by three-level anterior cervical discectomy and fusion and hybrid cervical surgery: A CONSORT-compliant study with minimum follow-up period of 5 years. Medicine (Baltimore) 2021; 100:e25824. [PMID: 33950989 PMCID: PMC8104247 DOI: 10.1097/md.0000000000025824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/12/2021] [Indexed: 01/04/2023] Open
Abstract
As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic myelopathy. While studies on cervical alignment between 3-level HS and anterior cervical discectomy and fusion (ACDF) were seldom reported. The effects of cervical imbalance on its related clinical outcomes are yet undetermined as well.Patients with cervical spondylotic myelopathy, who underwent 3-level ACDF or HS, were included to compare cervical alignment parameters after surgery and then explore the relationship between cervical balance and clinical outcomes.Forty-one patients with HS (HS group) and 32 patients who with ACDF (ACDF group) were reviewed from February 2007 to September 2013 with the mean follow-up of 90.3 ± 25.5 (m) and 86.3 ± 28.9 (m), respectively. Cervical alignments parameters including the C2 to C7 cervical lordosis (CL), C2 to C7 sagittal vertical axis, T1 slope. and T1SCL (T1 slope minus CL), and the clinical outcomes like neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were measured and recorded preoperatively (PreOP), intraoperatively, and on the first preoperative day and the last follow-up (FFU). The balance and imbalance groupings were sorted based on the T1SCL: T1SCL≤20°,balance; T1SCL > 20°, imbalance.We found significant improvements (P < .001) in NDI and JOA at intraoperatively and FFU after ACDF and HS, and no difference on cervical alignment and clinical outcomes between the 2 procedures on the basis of intergroup comparisons. By between-subgroups comparisons, however, we found significant differences in CL and T1SCL at PreOP (P < .05). Nonetheless, there was no significant difference on the clinical outcomes between balance and imbalance subgroups at FFU at PreOP (P > .05), indicating that the change of T1SCL was not correlated to NDI and JOA at FFU.Both HS and ACDF groups showed significant clinical improvements after surgery. There was no correlation between cervical balance and clinical symptoms.
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24
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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25
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Li W, Huang C, Ma T, Wang J, Liu W, Yan J, Sheng G, Zhang R, Wu H, Liu C. Low-frequency electromagnetic fields combined with tissue engineering techniques accelerate intervertebral fusion. Stem Cell Res Ther 2021; 12:143. [PMID: 33597006 PMCID: PMC7890873 DOI: 10.1186/s13287-021-02207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Background Intervertebral fusion is the most common surgery to treat lumbar degenerative disease (LDD). And the graft material used in the operation is derived from the iliac crest to promote fusion. However, autografts possess the fatal disadvantage of lack of source. Therefore, economical and practical bone substitutes are urgently needed to be developed. Sinusoidal electromagnetic fields (EMF) combined with tissue engineering techniques may be an appropriate way to promote intervertebral fusion. Methods In this research, porous scaffolds made of polycaprolactone (PCL) and nano-hydroxyapatite (nHA) were used as cell carriers. Then, the scaffolds loaded with bone marrow mesenchymal stem cells (BMSCs) were treated with sinusoidal electromagnetic field and the osteogenic capability of BMSCs was tested later. In addition, an intervertebral disc of the tail vertebra of the rat was removed to construct a spinal intervertebral fusion model with a cell-scaffold implanted. The intervertebral fusion was observed and analyzed by X-ray, micro-CT, and histological methods. Results BMSCs stimulated by EMF possess splendid osteogenic capability under an osteogenic medium (OM) in vitro. And the conditioned medium of BMSCs treated with EMF can further promote osteogenic differentiation of the primitive BMSCs. Mechanistically, EMF regulates BMSCs via BMP/Smad and mitogen-activated protein kinase (MAPK)-associated p38 signaling pathways. In vivo experiments revealed that the scaffold loaded with BMSCs stimulated by EMF accelerated intervertebral fusion successfully. Conclusion In summary, EMF accelerated intervertebral fusion by improving the osteogenic capacity of BMSCs seeded on scaffolds and might boost the paracrine function of BMSCs to promote osteogenic differentiation of the homing BMSCs at the injured site. EMF combined with tissue engineering techniques may become a new clinical treatment for LDD.
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Affiliation(s)
- Weigang Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Chunwei Huang
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tian Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jiachen Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Wenbin Liu
- Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Jiyuan Yan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Gaohong Sheng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Ruizhuo Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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26
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Lee CH, Kim HJ, Lee MK, Kim HS, Choi SS. Comparison of efficacies of unipedicular kyphoplasty and bipedicular kyphoplasty for treatment of single-level osteoporotic vertebral compression fractures: A STROBE-compliant retrospective study. Medicine (Baltimore) 2020; 99:e22046. [PMID: 32957325 PMCID: PMC7505346 DOI: 10.1097/md.0000000000022046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Kyphoplasty (KP) is an effective method for treating osteoporotic vertebral compression fractures (OVCFs). Although the bipedicular approach is considered the main treatment approach, the unipedicular approach has also been shown to be effective. This study aimed to retrospectively compare the radiological and clinical outcomes of unipedicular and bipedicular KP in the treatment of single-level OVCFs.In total, 96 patients with single-level OVCF who received KP were divided into 2 groups: the unipedicular group, in which 28 patients underwent KP via the unipedicular approach, and the bipedicular group, in which 68 patients underwent KP via the bipedicular approach. Clinical results, radiological findings, and complications were compared between the groups. The clinical results were evaluated for up to 1 year after surgery using a numerical rating scale score. The radiological findings were compared in terms of recovery of the lowest vertebral body height at the same location on radiographs taken both 1 day and 1 year after surgery. The degrees of recovery of the kyphotic angle (KA) were simultaneously compared. The surgical time, amount of cement used, and any postoperative complications were also compared.Both groups showed significant improvements in all clinical and radiological parameters until 1 year after surgery. The unipedicular group required significantly lower amounts of cement than the bipedicular group (unipedicular: 4.4 ± 0.8 mL, bipedicular: 5.6 ± 1.0 mL, P = .00), but there were no significant differences in the clinical and radiological results for up to 1 year after surgery. There were no significant differences in leakage of intradiscal cement, appearance of adjacent vertebral compression fractures within 1 year of surgery, and surgical time.Unipedicular and bipedicular KP significantly reduced the pain experienced by patients with single-level OVCF, restored vertebral height, and corrected the KA, which remained stable for at least 1 year after treatment. Unipedicular KP required lower amounts of cement than bipedicular KP and was as effective as bipedicular KP in terms of radiological and clinical outcomes. The results of this study have level three evidence and grade B recommendation.
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Affiliation(s)
- Chung Hun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Hyun Joong Kim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Mi Kyoung Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Hyo Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
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27
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Liu FY, Gu ZF, Zhao ZQ, Ren L, Wang LM, Yu JH, Hou SB, Ding WY, Sun XZ. Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: A retrospective study of 42 patients. Medicine (Baltimore) 2020; 99:e22204. [PMID: 32925797 PMCID: PMC7489674 DOI: 10.1097/md.0000000000022204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many surgical procedures have been developed for the treatment of post-traumatic thoracolumbar kyphosis. But there is a significant controversy over the ideal management. The aim of this study was to illustrate the technique of modified grade 4 osteotomy for the treatment of post-traumatic thoracolumbar kyphosis and to evaluate clinical and radiographic results of patients treated with this technique.From May 2013 to May 2018, 42 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of modified grade 4 osteotomy, and their medical records were retrospectively collected. Preoperative and postoperative sagittal Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) were recorded. The average follow-up period was 29.7 ± 14.2 months.The operation time was 185.5 ± 26.8 minutes, the intraoperative blood loss was 545.2 ± 150.1 mL. The Cobb angles decreased from 38.5 ± 3.8 degree preoperatively to 4.2 ± 2.6 degree 2 weeks after surgery (P < .001). The VAS reduced from 6.5 ± 1.1 preoperatively to 1.5 ± 0.9 at final follow-up (P < .001), and the ODI reduced from 59.5 ± 15.7 preoperatively to 15.9 ± 5.8 at final follow-up (P < .001). Kyphotic deformity was successfully corrected and bony fusion was achieved in all patients. Neurologic function of 7 cases was improved to various degrees.Modified grade 4 osteotomy, upper disc, and upper one-third to half of pedicle are resected, is an effective treatment option for post-traumatic thoracolumbar kyphosis. However, the long-term clinical effect still needs further studies.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Zhen-Fang Gu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Zheng-Qi Zhao
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Liang Ren
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Li-Min Wang
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Jin-He Yu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Shu-Bing Hou
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhuang
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28
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Zileli M, Fornari M, Costa F. Lumbar Spinal Stenosis Recommendations of World Federation of Neurosurgical Societies Spine Committee. World Neurosurg X 2020; 7:100080. [PMID: 32613193 PMCID: PMC7322793 DOI: 10.1016/j.wnsx.2020.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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29
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Zhu G, Hao Y, Yu L, Peng C, Zhu J, Zhang P. [Comparison of the effectiveness of oblique lumbar interbody fusion and posterior lumbar interbody fusion for treatment of Cage dislodgement after lumbar surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:761-768. [PMID: 32538569 DOI: 10.7507/1002-1892.201911020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the clinical and radiological effectiveness of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of Cage dislodgement after lumbar surgery. Methods The clinical data of 40 patients who underwent revision surgery due to Cage dislodgement after lumbar surgery betweem April 2013 and March 2017 were retrospectively analyzed. Among them, 18 patients underwent OLIF (OLIF group) and 22 patients underwent PLIF (PLIF group) for revision. There was no significant difference between the two groups in age, gender, body mass index, intervals between primary surgery and revision surgery, number of primary fused levels, disc spaces of Cage dislodgement, and visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), the segmental lordosis (SL) and disc height (DH) of the disc space of Cage dislodgement, and the lumbar lordosis (LL) before revision ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and complications of the two groups were recorded and compared. The VAS scores of low back pain and leg pain were evaluated at 3 days, 3, 6, and 12 months after operation, and the ODI scores were evaluated at 3, 6, and 12 months after operation. The SL and DH of the disc space of Cage dislodgement and LL were measured at 12 months after operation and compared with those before operation. CT examination was performed at 12 months after operation, and the fusion of the disc space implanted with new Cage was judged by Bridwell grading standard. Results The intraoperative blood loss in the OLIF group was significantly less than that in the PLIF group ( t=-12.425, P=0.000); there was no significant difference between the two groups in the operation time and hospital stay ( P>0.05). Both groups were followed up 12-30 months, with an average of 18 months. In the OLIF group, 2 patients (11.1%) had thigh numbness and 1 patient (5.6%) had hip flexor weakness after operation; 2 patients (9.1%) in the PLIF group had intraoperative dural sac tear. The other patients' incisions healed by first intention without early postoperative complications. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.519, P=0.642). The VAS scores of low back pain and leg pain, and the ODI score of the two groups at each time point after operation were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups at each time point after operation ( P>0.05). At 12 months after operation, SL, LL, and DH in the two groups were significantly increased when compared with preoperative ones ( P<0.05); SL and DH in the OLIF group were significantly improved when compared with those in the PLIF group ( P<0.05), and there was no significant difference in LL between the two groups ( P>0.05). CT examination at 12 months after operation showed that all the operated disc spaces achieved bony fusion. According to the Bridwell grading standard, 12 cases were grade Ⅰ and 6 cases were grade Ⅱ in the OLIF group, and 13 cases were grade Ⅰ and 9 cases were grade Ⅱ in the PLIF group; there was no significant difference between the two groups ( Z=-0.486, P=0.627). During follow-up, neither re-displacement or sinking of Cage, nor loosening or fracture of internal fixation occurred. Conclusion OLIF and PLIF can achieve similar effectiveness in the treatment of Cage dislodgement after lumbar surgery. OLIF can further reduce intraoperative blood loss and restore the SL and DH of the disc space of Cage dislodgement better.
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Affiliation(s)
- Guangduo Zhu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Yingjie Hao
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Lei Yu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Cheng Peng
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Jian Zhu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Panke Zhang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
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Wang Z, Liu L, Xu XH, Cao MD, Lu H, Zhang KB. The OLIF working corridor based on magnetic resonance imaging: a retrospective research. J Orthop Surg Res 2020; 15:141. [PMID: 32293492 PMCID: PMC7158069 DOI: 10.1186/s13018-020-01654-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To provide an anatomical basis for the development of oblique lumbar interbody fusion (OLIF) in Chinese patients. METHODS Between November 2018 and June 2019, 300 patients' lumbar MRI data were reviewed. According to the Moro system and zone method described by us, the axial view was vertically divided into 6 zones (A, I II, III, IV, P) and was horizontally divided into 4 zones (R, a, b, c, L). The locations of left psoas muscle and the major artery at L2/3, L3/4, and L4/5 levels were evaluated by the grid system. The aortic bifurcation segments will also be evaluated at the level of the vertebral body or the disc. RESULTS At the L2/3 level, left psoas muscle and the major artery in zone Ib were found in 28.0% of subjects, in zone IIb in 20.3%, and in zone Ic in 20.0%; at the L3/4 level, in zone Ab in 20.7% of subjects, in zone Ac in 26.0%, and in zone Ic in 11.0%; and at the L4/5 level, areas in zone Ab in 31.0% of subjects, in zone Ac in 26.0%, and in zone Ib in 11.7%. The aortic bifurcation segments were mainly at the L4 level. The zone of the left psoas muscle at all levels, the zone of the major artery at L4/5 level, and the zone of the aortic bifurcation segments had significant correlation with gender difference (P < 0.05). CONCLUSION The left-sided OLIF at L2-L5 disc levels can be a feasible type of surgery for lumbar interbody fusion in the majority of Chinese patients. Before the operation, in order to screen out the appropriate surgical approach, routine lumbar magnetic resonance imaging is recommended to analyze the patient's local anatomical features.
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Affiliation(s)
- Zhe Wang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Lei Liu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang-He Xu
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ming-de Cao
- Department of Orthopaedics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hai Lu
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Kui-Bo Zhang
- Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
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Accuracy of K-Wireless Insertion of Percutaneous Pedicle Screws Using Computer-Assisted Spinal Navigation: A Systematic Review and Single-Center Experience. World Neurosurg 2020; 138:e267-e274. [PMID: 32105880 DOI: 10.1016/j.wneu.2020.02.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study sought to 1) describe the use K-wireless pedicle screw insertion among adults (age ≥18 years) undergoing a minimally invasive fusion and 2) perform a systematic review (SR) of all studies that describe a navigated, K-wireless technique with 3-dimensional fluoroscopy. METHODS Patients undergoing a minimally invasive fusion requiring pedicle screw fixation for any indication were prospectively enrolled in the observational component of this study. An assessment of pedicle breach was performed independently and in duplicate based on a modification of the Belmont grading scale. Articles for the SR were identified from a structured search of Medline from inception to May 8, 2019, without restriction of language. RESULTS A total of 82 pedicle screws were placed in 20 patients who underwent surgery between January and June 2014. There was no significant difference in mean operative time between the cases included in this study and a matched cohort of 20 patients undergoing surgery with 2-dimensional fluoroscopy and K-wire-assisted pedicle screw placement (95 ± 13 vs. 87 ± 20 minutes, respectively; P > 0.05). There were 2 major pedicle breaches (Belmont grade 3) in a single patient, yielding a major breach rate of 2.44%. A total of 6 papers that described the placement of 700 pedicle screws in 160 patients between May 2011 and March 2017 were included in the SR. The overall breach rate was 7.00% (n = 37). CONCLUSIONS Percutaneous pedicle screws can be placed accurately and safely using 3-dimensional navigation without the use of K-wires and may confer benefits to patients and clinicians by reducing K-wire-associated complications and radiation exposure.
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Liu J, Ding W, Yang D, Wu H, Hao L, Hu Z, Fan S, Zhao F. Modic Changes (MCs) Associated with Endplate Sclerosis Can Prevent Cage Subsidence in Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone. World Neurosurg 2020; 138:e160-e168. [PMID: 32081816 DOI: 10.1016/j.wneu.2020.02.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the association between Modic changes (MCs) and endplate sclerosis; and to investigate the effect of MCs and endplate sclerosis on cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. METHODS We included 78 inpatients who underwent OLIF stand-alone from August 2015 to August 2017. All patients underwent computed tomography (CT) and magnetic resonance imaging. The presence and the types of MCs were assessed. Endplate sclerosis was evaluated from sagittally reconstructed CT images. Cage subsidence was evaluated at the 1-, 3-, 6-, and 12-month follow-up. RESULTS Of 78 patients, 92 discs underwent OLIF without posterior instrumentation; 32 of 92 (34.8%) had MCs. Type I, II, and III MCs were seen in 10 (10.9%), 19 (20.7%), and 3 (3.2%) endplates, respectively. Among 32 endplates with MCs, 10 (31.3%) showed evidence of sclerosis on CT images, including 2 of 10 endplates (20%) with type I MCs, 5 of 19 (26.3%) with type II, and 3 of 3 (100%) with type III. Among 60 endplates without MCs, 5 (8.3%) showed evidence of sclerosis. Cage subsidence rate in the no-MCs group was higher than that in the MCs group (P <0.01). We found only 1 case of cage subsidence in the MCs group (n = 32), which was classified as MCs type I, whereas 6 cases of cage subsidence were observed in the no-MCs group (n = 60). Hounsfield unit ratios for sclerotic and no-sclerotic endplates were 2.2 ± 0.3 and 1.1 ± 0.1, respectively. No subsidence of cage was found in the sclerotic endplates group (n = 15), whereas 7 cases of cage subsidence were found in the no-sclerotic group (n = 77). CONCLUSION MCs associated with endplate sclerosis can prevent cage subsidence in OLIF stand-alone.
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Affiliation(s)
- Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dalong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Lu Hao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhijun Hu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China.
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Laratta JL, Shillingford JN, Pugely AJ, Gupta K, Gum JL, Djurasovic M, Crawford CH. Accuracy of cortical bone trajectory screw placement in midline lumbar fusion (MIDLF) with intraoperative cone beam navigation. JOURNAL OF SPINE SURGERY 2019; 5:443-450. [PMID: 32042994 DOI: 10.21037/jss.2019.09.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cortical bone trajectory (CBT) screws have been recently described as a method of lumbosacral fixation. These screws are typically inserted under fluoroscopic guidance with a medial-to-lateral trajectory in the axial plane and a caudal-to-cephalad trajectory in the sagittal plane. In an effort to reduce surgeon radiation exposure and improve accuracy, CBT screws may be inserted under navigation with intraoperative cone beam computed tomography (CT). However, the accuracy of CBT screw placement under intraoperative navigation has yet to be assessed in the literature. The purpose of the study was to evaluate the accuracy of CBT screw placement using intraoperative cone beam CT navigation. Methods One hundred and thirty-four consecutive patients who underwent CBT fixation with 618 screws under intraoperative navigation were analyzed from May 2016 through May 2018. Screws were placed by one of three senior spine surgeons using the Medtronic O-Arm Stealth Navigation. Screw position and accuracy were assessed on intraoperative and postoperative CT scans using 2D and 3D reconstructions with VitreaCore software. Results The majority of surgeries were primary cases (73.1%). The mean age at the time of surgery was 61.5±10.0 years and the majority of patients were female (61.2%). Most patients underwent surgery for a diagnosis of degenerative spondylolisthesis (47.8%) followed by mechanical collapse with foraminal stenosis (22.4%). Ten violations of the vertebral cortex were noted with an average breach distance of 1.0±0.7 mm. Three breaches were lateral (0.5%) and seven were medial (1.1%). The overall navigated screw accuracy rate was 98.3%. The accuracy to within 1 mm of error was 99.2%. There were no intra-operative neurologic, vascular, or visceral complications related to the placement of the CBT screws. Conclusions CBT screw fixation under an intraoperative cone beam CT navigated insertion technique is safe and reliable. Despite five breaches greater than 1mm, there were no complications related to the placement of the CBT screws in this series.
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Affiliation(s)
- Joseph L Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Jamal N Shillingford
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | | | - Karishma Gupta
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Mladen Djurasovic
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
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Relationship Between Alterations of Spinal/Pelvic Sagittal Parameters and Clinical Outcomes After Oblique Lumbar Interbody Fusion. World Neurosurg 2019; 133:e156-e164. [PMID: 31476474 DOI: 10.1016/j.wneu.2019.08.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF). METHODS Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed. RESULTS ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery. CONCLUSIONS OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions.
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Farah K, Leroy HA, Karnoub MA, Obled L, Fuentes S, Assaker R. Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study. 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 2019; 29:306-313. [PMID: 31410621 DOI: 10.1007/s00586-019-06107-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). METHODS Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2-L3 to L5-S1 disc spaces were identified. At each level, left psoas surface (in cm2), access corridor (in mm) and vessel movement were calculated in the three positions. Paired t test was used for comparison. RESULTS The mean surface of the left psoas ranged from 7.83 to 17.19 cm2 in the three positions (p > 0.05). From L2-3 to L4-5, in RLD, when the left hip shifted from extension to flexion, nor the access corridor nor vessel movements were significantly different. When the volunteers shifted from supine to RLD position with hip in extension, arteries moved 3.66-5.61 mm to the right (p < 0.05 at L2-3, L3-4 and L5-S1), while the venous structures moved 0.92-4.96 mm (p < 0.05 at L2-3) to the right. When the position shifted from supine to RLD with hip in flexion, the arterial structures moved 0.47-4.88 mm (p < 0.05 at L2-3 and L3-4) to the right, while the venous structures moved - 0.94 to 4.13 mm (p < 0.05 at L2-3 and L3-4) to the right. CONCLUSION Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kaissar Farah
- Department of Neurosurgery, Lille University Hospital, Lille, France. .,Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France.
| | | | | | - Louis Obled
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Stephane Fuentes
- Department of Neurosurgery and Spine Unit, La Timone University Hospital, Marseille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Hu JN, Yang XF, Li CM, Li XX, Ding YZ. Comparison of cortical bone trajectory versus pedicle screw techniques in lumbar fusion surgery: A meta-analysis. Medicine (Baltimore) 2019; 98:e16751. [PMID: 31415372 PMCID: PMC6831251 DOI: 10.1097/md.0000000000016751] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Biomechanical studies have demonstrated that cortical bone trajectory (CBT) screw can provide a 30% increase in uniaxial yield pullout load than pedicle screw (PS). In addition, the insertion torque of CBT screw is 1.71 times higher than that of PS. A meta-analysis was conducted to evaluate clinical results between CBT screw technique and PS technique in lumbar fusion surgery. METHODS An extensive search of literature was performed in PubMed, Embase, the Cochrane library. The following outcomes were extracted: visual analog scale (VAS), Oswestry disabilities index (ODI), Japanese Orthopaedic Association (JOA) score, complications, fusion rates, hospital stay, incision length, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 12 studies were included in the final analysis. The results indicated that CBT group with less blood loss [P < .01], less hospital stay [P < .01], and less incision length [P < .01] than PS group. There were no significant differences between 2 groups in other clinical parameters and outcomes. CONCLUSION CBT technique provided similar clinical outcomes and fusion rates compared to PS technique in lumbar fusion surgery. However, CBT technique provided additional benefits of less blood loss, less hospital stay, and less incision length.
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Wen BT, Chen ZQ, Sun CG, Jin KJ, Zhong J, Liu X, Tan L, Yang P, le G, Luo M. Three-dimensional navigation (O-arm) versus fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette: A retrospective comparative study. Medicine (Baltimore) 2019; 98:e15647. [PMID: 31096488 PMCID: PMC6531158 DOI: 10.1097/md.0000000000015647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/27/2022] Open
Abstract
Three-dimensional intraoperative navigation (O-arm) has been used for many years in spinal surgeries and has significantly improved its precision and safety. This retrospective study compared the efficacy and safety of spinal cord decompression surgeries performed with O-arm navigation and fluoroscopy. The clinical data of 56 patients with thoracic spinal stenosis treated from March 2015 to April 2017 were retrospectively analyzed. Spinal decompression was performed with O-arm navigation and ultrasonic bone curette in 29 patients, and with ultrasonic bone curette and fluoroscopy in 27 patients. Patients were followed-up at postoperative 1 month, 3 months, and the last clinic visit. The neurologic functions were assessed using the Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire. The accuracy of screw placement was examined using three-dimensional computed tomography (CT) on postoperative day 5. There was no significant difference in the incidences of intraoperative dural tear, nerve root injury, and spinal cord injury between the two groups. The two groups showed no significant difference in postoperative JOA scores (P > .05). The O-arm navigation group had significantly higher screw placement accuracy than the fluoroscopy group (P < .05). O-arm navigation is superior to fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette in terms of screw placement accuracy. However, the two surgical modes have similar rates of intraoperative complications and postoperative neurologic functions.
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Affiliation(s)
- Bing-Tao Wen
- Department of Orthopedics, Peking University International Hospital
| | - Zhong-Qiang Chen
- Department of Orthopedics, Peking University International Hospital
| | - Chui-Guo Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing
| | - Kai-Ji Jin
- Department of Orthopedics, Peking University International Hospital
| | - Jun Zhong
- Department of Orthopedics, Peking University International Hospital
| | - Xin Liu
- Department of Orthopedics, Peking University International Hospital
| | - Lei Tan
- Department of Orthopedics, Peking University International Hospital
| | - Peng Yang
- Department of Orthopedics, Peking University International Hospital
| | - Geri le
- Department of Orthopedics, Peking University International Hospital
| | - Man Luo
- Department of Orthopedics, Guangxi International Zhuang Medicine Hospital, Nanning, Guangxi, China
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Lin S, Cui L, Chen G, Huang J, Yang Y, Zou K, Lai Y, Wang X, Zou L, Wu T, Cheng JCY, Li G, Wei B, Lee WYW. PLGA/β-TCP composite scaffold incorporating salvianolic acid B promotes bone fusion by angiogenesis and osteogenesis in a rat spinal fusion model. Biomaterials 2019; 196:109-121. [DOI: 10.1016/j.biomaterials.2018.04.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 12/19/2022]
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Three-Dimensional Patient-Specific Guides for Intraoperative Navigation for Cortical Screw Trajectory Pedicle Fixation. World Neurosurg 2019; 122:674-679. [DOI: 10.1016/j.wneu.2018.11.159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 12/12/2022]
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Sadrameli SS, Jafrani R, Staub BN, Radaideh M, Holman PJ. Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws. Int J Spine Surg 2018; 12:650-658. [PMID: 30619667 PMCID: PMC6314338 DOI: 10.14444/5081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Standard fluoroscopic navigation and stereotactic computed tomography-guided lumbar pedicle screw instrumentation traditionally relied on the placement of Kirshner wires (K-wires) to ensure accurate screw placement. The use of K-wires, however, is associated with a risk of morbidity due to potential ventral displacement into the retroperitoneum. We report our experience using a computer image-guided, wireless method for pedicle screw placement. We hypothesize that minimally invasive, wireless pedicle screw placement is as accurate and safe as the traditional technique using K-wires while decreasing operative time and avoiding potential complications associated with K-wires. METHODS We conducted a retrospective review of 42 consecutive patients who underwent a stereotactic-guided, wireless lumbar pedicle screw placement. All screws were placed to provide fixation to a variety of interbody fusion constructs including anterior lumbar interbody fusion, lateral interbody fusion, and transforaminal lumbar interbody fusion. The procedures were performed using the O-arm intraoperative imaging system with StealthStation navigation (Medtronic, Memphis, TN) and Medtronic navigated instrumentation. After placing a percutaneous navigation frame into the posterior superior iliac spine or onto an adjacent spinous process, an intraoperative O-arm image was obtained to allow subsequent StealthStation navigation. Para-median incisions were selected to allow precise percutaneous access to the target pedicles. The pedicles were cannulated using either a stereotactic drill or a novel awl-tipped tap along with a low-speed/high-torque power driver. The initial trajectory into the pedicle was recorded on the Medtronic StealthStation prior to removal of the drill or awl-tap, creating a "virtual" K-wire rather than inserting an actual K-wire to allow subsequent tapping and screw insertion. Accurate screw placement is achieved by following the virtual path as an exact computer-aided design model of the screw traversing the pedicle is projected onto the display and by using audible and tactile feedback. A second O-arm scan was obtained to confirm accuracy of screw placement. RESULTS A total of 20 women and 22 men (average age = 56 years) underwent a total of 182 pedicle screw placements using the stereotactic, wireless technique. The total breach rate was 9.9%, with a clinically significant breach rate of 0% (defined as >2 mm medial breach or >4 mm lateral breach) and a clinical complication rate of 0%. CONCLUSIONS Wireless, percutaneous placement of lumbar pedicle screws using computed tomography-guided stereotactic navigation is a safe, reproducible technique with very high accuracy rates.
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Affiliation(s)
- Saeed S Sadrameli
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Ryan Jafrani
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Blake N Staub
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Majdi Radaideh
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Paul J Holman
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
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Ricciardi L, Sturiale CL, Pucci R, Reale G, Stifano V, Izzo A, Perna A, Proietti L, Forcato S, Rivera Perla KM, El Boustany S, Olivi A, Polli FM. Patient-Oriented Aesthetic Outcome After Lumbar Spine Surgery: A 1-Year Follow-Up Prospective Observational Study Comparing Minimally Invasive and Standard Open Procedures. World Neurosurg 2018; 122:e1041-e1046. [PMID: 30415051 DOI: 10.1016/j.wneu.2018.10.208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite recent treatment developments, back pain and related disabilities still represent a challenge for practitioners. Among the available surgical techniques, many different features and outcomes have been investigated; however, aesthetic result was missing among them. The present investigation was designed to prospectively compare patient-oriented aesthetic results after minimally invasive surgery (MIS) and standard open surgery (SOS) for the lumbar spine. METHODS This was a prospective observational study with 1-year follow-up. Patients who underwent SOS were assigned to group 1 and MIS to group 2. Patient-oriented aesthetic result evaluation was collected using a dedicated visual aesthetic analogue scale. The Vancouver Scar Scale was used to exclude objective underlying influencing factors. The Oswestry Disability Index and a 10-point itemized visual analogue scale for back pain were administered to assess the clinical and functional status. Follow-up data were collected before discharge at 1, 6, and 12 months. Statistical analysis was conducted, and P < 0.05 was considered as significant. RESULTS We enrolled 74 patients, 44 in group 1 and 30 in group 2. The 2 groups were homogeneous for demographic and clinical data. No clinical or functional differences were measured at the end of follow-up. Visual aesthetic analogue scale reported greater mean values in group 1 at every follow-up time. CONCLUSIONS Patients seem to prefer the aesthetic result from a single midline incision after SOS compared with MIS. The use of specific techniques could be considered if there is scientific evidence reporting greater aesthetic outcome, having similar clinical and functional ones.
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Affiliation(s)
- Luca Ricciardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Resi Pucci
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Gabriele Reale
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Vito Stifano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Forcato
- Unità operativa di neurochirurgia, Pia Fondazione Panico, Ospedale di Tricase (LE), Italy
| | | | | | - Alessandro Olivi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
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Hadley MN, Shank CD, Rozzelle CJ, Walters BC. In Reply: Guidelines for the Use of Electrophysiological Monitoring for Surgery of the Human Spinal Column and Spinal Cord. Neurosurgery 2018; 83:E85-E86. [DOI: 10.1093/neuros/nyy232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koenders N, Rushton A, Verra ML, Willems PC, Hoogeboom TJ, Staal JB. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: 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 2018; 28:696-709. [DOI: 10.1007/s00586-018-5680-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 01/29/2023]
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Thayaparan GK, Owbridge MG, Thompson RG, D’Urso PS. Designing patient-specific solutions using biomodelling and 3D-printing for revision lumbar spine surgery. 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 2018; 28:18-24. [DOI: 10.1007/s00586-018-5684-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/24/2018] [Indexed: 11/28/2022]
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Ma C, Gerhard E, Lu D, Yang J. Citrate chemistry and biology for biomaterials design. Biomaterials 2018; 178:383-400. [PMID: 29759730 DOI: 10.1016/j.biomaterials.2018.05.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022]
Abstract
Leveraging the multifunctional nature of citrate in chemistry and inspired by its important role in biological tissues, a class of highly versatile and functional citrate-based materials (CBBs) has been developed via facile and cost-effective polycondensation. CBBs exhibiting tunable mechanical properties and degradation rates, together with excellent biocompatibility and processability, have been successfully applied in vitro and in vivo for applications ranging from soft to hard tissue regeneration, as well as for nanomedicine designs. We summarize in the review, chemistry considerations for CBBs design to tune polymer properties and to introduce functionality with a focus on the most recent advances, biological functions of citrate in native tissues with the new notion of degradation products as cell modulator highlighted, and the applications of CBBs in wound healing, nanomedicine, orthopedic, cardiovascular, nerve and bladder tissue engineering. Given the expansive evidence for citrate's potential in biology and biomaterial science outlined in this review, it is expected that citrate based materials will continue to play an important role in regenerative engineering.
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Affiliation(s)
- Chuying Ma
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, 16801, PA, USA
| | - Ethan Gerhard
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, 16801, PA, USA
| | - Di Lu
- Rehabilitation Engineering Research Laboratory, Biomedicine Engineering Research Centre Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, 16801, PA, USA.
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Twitchell S, Karsy M, Reese J, Guan J, Couldwell WT, Dailey A, Bisson EF. Assessment of cost drivers and cost variation for lumbar interbody fusion procedures using the Value Driven Outcomes database. Neurosurg Focus 2018; 44:E10. [DOI: 10.3171/2018.1.focus17724] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEfforts to examine the value of care—combining both costs and quality—are gaining importance in the current health care climate. This thrust is particularly evident in treating common spinal disease where both incidences and costs are generally high and practice patterns are variable. It is often challenging to obtain direct surgical costs for these analyses, which hinders the understanding of cost drivers and cost variation. Using a novel tool, the authors sought to understand the costs of posterior lumbar arthrodesis with interbody devices.METHODSThe Value Driven Outcomes (VDO) database at the University of Utah was used to evaluate the care of patients who underwent open or minimally invasive surgery (MIS), 1- and 2-level lumbar spine fusion (Current Procedural Terminology code 22263). Patients treated from January 2012 through June 2017 were included.RESULTSA total of 276 patients (mean age 58.9 ± 12.4 years) were identified; 46.7% of patients were men. Most patients (82.2%) underwent 1-level fusion. Thirteen patients (4.7%) had major complications and 11 (4.1%) had minor complications. MIS (β = 0.16, p = 0.002), length of stay (β = 0.47, p = 0.0001), and number of operated levels (β = 0.37, p = 0.0001) predicted costs in a multivariable analysis. Supplies and implants (55%) and facility cost (36%) accounted for most of the expenditure. Other costs included pharmacy (7%), laboratory (1%), and imaging (1%).CONCLUSIONSThese results provide direct cost accounting for lumbar fusion procedures using the VDO database. Efforts to improve the value of lumbar surgery should focus on high cost areas, i.e., facility and supplies/implant.
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Julian Li JX, Mobbs RJ, Phan K. Morphometric MRI Imaging Study of the Corridor for the Oblique Lumbar Interbody Fusion Technique at L1-L5. World Neurosurg 2017; 111:e678-e685. [PMID: 29294391 DOI: 10.1016/j.wneu.2017.12.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior lumbar interbody fusion and lateral lumbar interbody fusion are associated with approach-related disadvantages. Oblique lumbar interbody fusion (OLIF) is the proposed solution, especially for upper lumbar levels. We analyzed the size and regional anatomy of the corridor used in the OLIF technique between levels L1 and L5. METHODS This is a morphometric study of 200 randomly selected magnetic resonance imaging (MRI) studies with features of lumbar degenerative disease. On MRI, the oblique corridor was defined as the smallest distance between the psoas major muscle and aorta or inferior vena cava (or common iliac artery) and measured at the L1/L2, L2/L3, L3/L4, and L4/L5 disc levels on both the left and right on the axial images at the mid-disc level. RESULTS Mean distances of the oblique corridor on the left side were L1/L2 = 18.90 mm, L2/L3 = 15.50 mm; L3/L4 = 12.75 mm, and L4/L5 = 8.92 mm; on the right side, they were L1/L2 = 14.80 mm, L2/L3 = 5.50 mm, L3/L4 = 3.00 mm, and L4/L5 = 1.46 mm. For both sides, the corridor size was not significantly affected by sex, and it increased with age and decreased at the inferior lumbar disc levels. The L1/L2 and L2/L3 levels may be obstructed by the ipsilateral kidney and renal vasculature on both sides and the liver on the right side. CONCLUSIONS A left-sided OLIF approach is viable for both sexes. Oblique access to the L1/L2 and L2/L3 disc levels is feasible regardless of age, whereas the L3/L4 and L4/L5 levels may be more suitable in older patients, especially for male patients. The right-sided approach is less likely to be performed effectively.
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Affiliation(s)
- Jia Xi Julian Li
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia
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Duarte RM, Varanda P, Reis RL, Duarte ARC, Correia-Pinto J. Biomaterials and Bioactive Agents in Spinal Fusion. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:540-551. [DOI: 10.1089/ten.teb.2017.0072] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rui M. Duarte
- School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal
| | - Rui L. Reis
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
| | - Ana Rita C. Duarte
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
| | - Jorge Correia-Pinto
- School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal
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Lu H, Peng L. Efficacy and safety of Mobi-C cervical artificial disc versus anterior discectomy and fusion in patients with symptomatic degenerative disc disease: A meta-analysis. Medicine (Baltimore) 2017; 96:e8504. [PMID: 29245217 PMCID: PMC5728832 DOI: 10.1097/md.0000000000008504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model. RESULTS Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10-0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43-5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11-0.37; P < .001). Mobi-C was found to produce comparable neurological deterioration (OR = 0.77; 95% CI = 0.35-1.72; P = .53), radiographic success (OR = 1.18; 95% CI = 0.39-3.59; P = .77), and overall success (OR = 2.13; 95% CI = 0.80-5.70; P = .13) compared with ACDF treatment. CONCLUSION Among the 4 included RCTs, 3 articles were studying patients with 1 surgical level, and 1 article reported 2 surgical levels. When compared with ACDF surgery in symptomatic degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.
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Affiliation(s)
- Hui Lu
- Department of Orthopaedics, Jiangjin Central Hospital of Chongqing
| | - Lihua Peng
- Department of Orthopaedics, The People's Hospital of Bishan District, Chongqing, P.R. China
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Phan K, Ramachandran V, Tran TM, Shah KP, Fadhil M, Lackey A, Chang N, Wu AM, Mobbs RJ. Systematic review of cortical bone trajectory versus pedicle screw techniques for lumbosacral spine fusion. JOURNAL OF SPINE SURGERY 2017; 3:679-688. [PMID: 29354747 DOI: 10.21037/jss.2017.11.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws. This study aims to review the available evidence to assess the merits of the CBT approach. Six electronic databases were searched for original published studies which compared CBT with traditional PS and their findings reviewed. Nine comparative studies were identified through a comprehensive literature search. Studies were classified as retrospective cohort, prospective cohort or case control studies with medium quality as assessed by the GRADE criteria. The available literature is not cohesive regarding outcomes and complications of CBT versus PT procedures. Most studies found no difference in operative time, but reported less blood loss during CBT. Radiological outcomes show no difference in slippage at one year although CBT is associated with greater bone-density compared to PT. Results for post-operative pain are inconclusive.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | | | - Tommy M Tran
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kevin P Shah
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Fadhil
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alan Lackey
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - Nicholas Chang
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Center, the Second Affiliated Hospital, Hangzhou 310000, China.,Department of Spine Surgery, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
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