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Kanno H, Handa K, Murotani M, Ozawa H. A Novel Intraoperative CT Navigation System for Spinal Fusion Surgery in Lumbar Degenerative Disease: Accuracy and Safety of Pedicle Screw Placement. J Clin Med 2024; 13:2105. [PMID: 38610870 PMCID: PMC11012415 DOI: 10.3390/jcm13072105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In recent years, intraoperative computed tomography (CT) navigation has become widely used for the insertion of pedicle screws in spinal fusion surgery. However, conventional intraoperative CT navigation may be impaired by infrared interference between the infrared camera and surgical instruments, which can lead to the misplacement of pedicle screws. Recently, a novel intraoperative CT navigation system, NextAR, has been developed. It uses a small infrared camera mounted on surgical instruments within the surgical field. NextAR navigation can minimize the problem of infrared interference and be expected to improve the accuracy of pedicle screw placement. Methods: This study investigated the accuracy of pedicle screw insertion under NextAR navigation in spinal fusion surgery for lumbar degenerative diseases. The accuracy of pedicle screw placement was evaluated in 15 consecutive patients using a CT grading scale. Results: Screw perforation occurred in only 1 of the total 70 screws (1.4%). Specifically, there was one grade 1 perforation within 2 mm, but no perforations larger than 2 mm. There were no reoperations or neurological complications due to screw misplacement. Conclusions: NextAR navigation can provide high accuracy for pedicle screw insertion and help ensure safe spinal fusion surgery for lumbar degenerative diseases.
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Affiliation(s)
- Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
| | - Kyoichi Handa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
| | - Motoki Murotani
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
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Nunley PD, Eastlack RK, Miller LE, Poelstra KA, Cox JB, Shedden PM, Stone M. Metal-Free Cortico-Pedicular Device for Supplemental Fixation in Lumbar Interbody Fusion. World Neurosurg 2023; 174:4-10. [PMID: 36871655 DOI: 10.1016/j.wneu.2023.02.119] [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: 02/15/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Pedicle screw fixation is a commonly utilized adjunct for lumbar interbody fusion, yet risks include screw malposition, pullout, loosening, neurovascular injury, and stress transfers leading to adjacent segment degeneration. This report describes the preclinical and initial clinical results of a minimally invasive, metal-free cortico-pedicular fixation device used for supplemental posterior fixation in lumbar interbody fusion. METHODS Safety of arcuate tunnel creation was evaluated in cadaveric lumbar (L1-S1) specimens. A finite element analysis study evaluated clinical stability of the device to pedicular screw-rod fixation at L4-L5. Preliminary clinical results were assessed by analysis of Manufacturer and User Facility Device Experience database complications, and 6-month outcomes in 13 patients treated with the device. RESULTS Among 35 curved drill holes in 5 lumbar specimens, no breaches of the anterior cortex were identified. The mean minimum distance from the anterior surface of the hole to the spinal canal ranged from 5.1 mm at L1-L2 to 9.8 mm at L5-S1. In the finite element analysis study, the polyetheretherketone strap provided comparable clinical stability and reduced anterior stress shielding compared to the conventional screw-rod construct. The Manufacturer and User Facility Device Experience database identified 1 device fracture with no clinical sequelae among 227 procedures. Initial clinical experience showed a 53% decrease in pain severity (P = 0.009), a 50% decrease in Oswestry Disability Index (P < 0.001), and no device-related complications. CONCLUSIONS Cortico-pedicular fixation is a safe and reproducible procedure that may address limitations of pedicle screw fixation. Longer term clinical data in large clinical studies are recommended to confirm these promising early results.
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Affiliation(s)
| | - Robert K Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, San Diego, CA, United States
| | | | - Kornelis A Poelstra
- The Robotic Spine Institute of Las Vegas at Nevada Spine Clinic, Las Vegas, NV, United States
| | - J Bridger Cox
- Neuroscience Specialists, Oklahoma City, OK, United States
| | - Peter M Shedden
- Greater Houston Neurosurgery Center, The Woodlands, TX, United States
| | - Marcus Stone
- Spine Institute of Louisiana, Shreveport, LA, United States
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Tartara F, Garbossa D, Armocida D, Di Perna G, Ajello M, Marengo N, Bozzaro M, Petrone S, Giorgi PD, Schirò GR, Legrenzi S, Boeris D, Piazzolla A, Passarelli AC, Longo A, Ducati A, Penner F, Tancioni F, Bona A, Paternò G, Tassorelli C, De Icco R, Lamaida GA, Gallazzi E, Pilloni G, Colombo EV, Gaetani P, Aimar E, Zoia C, Stefini R, Rusconi A, Querenghi AM, Brembilla C, Bernucci C, Fanti A, Frati A, Manelli A, Muzii V, Sedia M, Romano A, Baram A, Figini S, Ballante E, Gioia G, Locatelli M, Pluderi M, Morselli C, Bassani R, Costa F, Cofano F. 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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Affiliation(s)
- Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Diego Garbossa
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
| | - Daniele Armocida
- Sapienza University of Rome, Policlinico Umberto I of Rome, Rome, Italy
| | - Giuseppe Di Perna
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
| | - Marco Ajello
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
| | - Nicola Marengo
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | | | - Pietro Domenico Giorgi
- Orthopedics and Traumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Rosario Schirò
- Orthopedics and Traumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Legrenzi
- Orthopedics and Traumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Davide Boeris
- Neurosurgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Piazzolla
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Anna Claudia Passarelli
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | | | | | - Federica Penner
- Spine Surgery Unit, Humanitas Cellini Hospital, Turin, Italy
| | | | - Alberto Bona
- Neurosurgery, Istituto Clinico Città Studi, Milan, Italy
| | | | | | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Giovanni Andrea Lamaida
- Scoliosis and Vertebral Orthopedics and Traumatology Unit, ASST Gaetano Pini - CTO, Milan, Italy
| | - Enrico Gallazzi
- Scoliosis and Vertebral Orthopedics and Traumatology Unit, ASST Gaetano Pini - CTO, Milan, Italy
| | - Giulia Pilloni
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
| | | | - Paolo Gaetani
- Vertebral Surgery Unit, Città di Pavia Clinic, Pavia, Italy
| | - Enrico Aimar
- Vertebral Surgery Unit, Città di Pavia Clinic, Pavia, Italy
| | - Cesare Zoia
- Neurosurgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | | | | | | | - Andrea Fanti
- Neurosurgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Frati
- Sapienza University of Rome, Policlinico Umberto I of Rome, Rome, Italy
| | | | - Vitaliano Muzii
- Neurosurgery, Policlinico Santa Maria Alle Scotte, University of Siena, Italy
| | - Mattia Sedia
- Spine Neurosurgery, Salus Hospital, Reggio Emilia, Italy
| | - Alberto Romano
- Neurosurgery, Humanitas Istituto Clinico Catanese, Catania, Italy
| | - Ali Baram
- Department of Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvia Figini
- Statistics, Department of Political and Social Sciences, University of Pavia, Italy
| | - Elena Ballante
- Statistics, Department of Political and Social Sciences, University of Pavia, Italy
| | - Giuseppe Gioia
- Vertebral Surgery Unit, Piccole Figlie Hospital, Parma, Italy
| | - Marco Locatelli
- Neurosurgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | - Mauro Pluderi
- Neurosurgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | - Carlotta Morselli
- II Spine Unit Milan, Italy, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Roberto Bassani
- II Spine Unit Milan, Italy, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Francesco Costa
- Spine Surgery Unit - NCH4 - Department of Neurosurgery - Fondazione IRCCS Istituto Nazionale Neurologico “C. Besta”, Milan, Italy
| | - Fabio Cofano
- Neurosurgery, Department of Neuroscience, A.O.U. Città Della Salute e Della Scienza, University of Turin, Italy
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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Deviating from the Recommended Torque on Set Screws Can Reduce the Stability and Fatigue Life of Pedicle Screw Fixation Devices. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060808. [PMID: 35744071 PMCID: PMC9228452 DOI: 10.3390/medicina58060808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Using an appropriate torque to tighten set screws ensures the long-term stability of spinal posterior fixation devices. However, the recommended torque often varies between different devices and some devices do not state a recommended torque level. The purpose of this study is to evaluate the effect of set screw torque on the overall construct stability and fatigue life. Materials and Methods: Two commercial pedicle screw systems with different designs for the contact interface between the set screw and rod (Group A: plane contact, Group B: line contact) were assembled using torque wrenches provided with the devices to insert the set screws and tighten to the device specifications. The axial gipping capacity and dynamic mechanical stability of each bilateral construct were assessed in accordance with ASTM F1798 and ASTM F1717. Results: Increasing or decreasing the torque on the set screw by 1 Nm from the recommended level did not have a significant effect on the axial gripping capacity or fatigue strength of Group A (p > 0.05). For Group B, over-tightening the set screw by 1 Nm did cause a significant reduction in the fatigue strength. Conclusions: Excessive torque can damage the rod surface and cause premature failure. When insertion using a manual driver is preferred, a plane contact interface between the set screw and rod can reduce damage to the rod surface when the set screw is over-torqued.
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Pérez-Bovet J, Buxó M, Rimbau Muñoz J. Clinical Practice in Spine Surgery: An International Survey. J Neurol Surg A Cent Eur Neurosurg 2021; 83:451-460. [PMID: 34897620 DOI: 10.1055/s-0041-1739223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. METHODS An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. RESULTS The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. CONCLUSION We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.
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Affiliation(s)
- Jordi Pérez-Bovet
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Maria Buxó
- Department of Statistics, Girona Biomedical Research Institute, Salt, Girona, Spain
| | - Jordi Rimbau Muñoz
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain.,Department of Neurosurgery, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Ankrah NK, Eli IM, Magge SN, Whitmore RG, Yew AY. Age, body mass index, and osteoporosis are more predictive than imaging for adjacent-segment reoperation after lumbar fusion. Surg Neurol Int 2021; 12:453. [PMID: 34621568 PMCID: PMC8492407 DOI: 10.25259/sni_667_2021] [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: 07/03/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Adjacent-segment disease (ASD) is a well-described long-term complication after lumbar fusion. There is a lack of consensus about the risk factors for development of ASD, but identifying them could improve surgical outcomes. Our goal was to analyze the effect of patient characteristics and radiographic parameters on the development of symptomatic ASD requiring revision surgery after posterior lumbar fusion. Methods: In this retrospective cohort study, we identified patients who underwent lumbar fusion surgery and revision surgery from May 2012 to November 2018 using an institutional lumbar fusion registry. Patients having both pre- and post-operative upright radiographs were included in the study. Revision surgeries for which the index operation was performed at an outside hospital were excluded from analysis. Univariate analysis was conducted on candidate variables, and variables with P< 0.2 were selected for multivariate logistic regression. Results: Of the 106 patients identified, 21 required reoperation (29 months average follow-up). Age >65 years (OR 4.14, 95% CI 1.46–11.76, P= 0.008), body mass index (BMI) >34 (OR 1.13, 95% CI 1.04–1.23, P = 0.004), and osteoporosis (OR 14, 95% CI 1.38–142.42, P = 0.03) were independent predictors of reoperation in the multivariate analysis. Increased facet diastasis at fusion levels (OR 0.60, 95% CI 0.42–0.85, P = 0.004) was associated with reduced reoperation rates. Change in segmental LL at the index operation level, rostral and caudal facet diastasis, vacuum discs, and T2 hyperintensity in the facets were not predictors of reoperation. Conclusion: Age >65, BMI >34, and osteoporosis were independent predictors of adjacent-segment reoperation after lumbar spinal fusion.
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Affiliation(s)
- Nii-Kwanchie Ankrah
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Ilyas M Eli
- Department of Neurosurgery, University of Utah, Clinical Neurosciences Center, Salt Lake City, Utah, United States
| | - Subu N Magge
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Robert G Whitmore
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Andrew Y Yew
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
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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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Ng JY, Mohiuddin U, Azizudin AM. Clinical practice guidelines for the treatment and management of low back pain: A systematic review of quantity and quality. Musculoskelet Sci Pract 2021; 51:102295. [PMID: 33444892 DOI: 10.1016/j.msksp.2020.102295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low back pain (LBP) is highly prevalent in the general population and is responsible for increased health-care costs, pain, impairment of activity, and if chronic, is associated with a range of comorbidities. OBJECTIVES The purpose of this review was to identify the quantity and assess the quality of evidence-based clinical practice guidelines (CPGs) for the treatment and/or management of LBP in adults. METHODS MEDLINE, EMBASE, CINAHL, and the Guidelines International Network were systematically searched from 2008 to 2018 to identify LBP CPGs. Eligible CPGs were assessed in duplicate using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument across 6 domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. RESULTS Of 181 unique search results, 22 CPGs for the treatment and/or management of LBP were eligible. Scaled domain percentages from highest to lowest were: scope and purpose (90.0%), clarity of presentation (84.0%), stakeholder involvement (54.0%), rigour of development (51.2%), editorial independence (39.6%) and applicability (28.5%). Quality varied within and across CPGs. CONCLUSIONS CPGs varied in quality, with most scoring the highest in the scope and purpose and clarity of presentation domains. CPGs achieved variable and lower scores in the stakeholder involvement, rigour of development, applicability, and editorial independence domains. CPGs with higher AGREE II scores can serve as suitable evidence-based resources for clinicians involved in LBP care; CPGs with lower scores could be improved in future updates using the AGREE II instrument, among other guideline development resources, as a guide.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Uzair Mohiuddin
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Ashlee M Azizudin
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Ng JY, Mohiuddin U. Quality of complementary and alternative medicine recommendations in low back pain guidelines: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1833-1844. [DOI: 10.1007/s00586-020-06393-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/23/2020] [Accepted: 03/22/2020] [Indexed: 11/24/2022]
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10
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Schröder ML, de Wispelaere MP, Staartjes VE. Predictors of loss of follow-up in a prospective registry: which patients drop out 12 months after lumbar spine surgery? Spine J 2019; 19:1672-1679. [PMID: 31125698 DOI: 10.1016/j.spinee.2019.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Long-term patient-reported outcomes (PROMs) are essential in clinical practice and research. Prospective trials and registries often struggle with high rates of loss of follow-up (LOFU), which may bias their findings. Little is known on risk factors for PROM nonresponse, especially for digitally mailed questionnaires. PURPOSE To elucidate which patients are at high risk for LOFU by identifying associated predictors. STUDY DESIGN Analysis of a prospective registry. PATIENT SAMPLE Patients that underwent surgery for degenerative lumbar disease were included. OUTCOME MEASURES Rate of PROM follow-up response at 12 months postoperatively. METHODS Preoperatively and at 12 months postoperatively, patients were asked to complete a range of PROM questionnaires using a web-based tool. All patients who successfully completed their baseline questionnaire were included. Patients were not actively reminded upon nonresponse. Univariate and independent predictors of LOFU at 12 months were identified. RESULTS We included 1,456 patients, of which 861 (59%) were lost to follow-up at 12 months. Univariately, lower age, American Society of Anesthesiologists (ASA) class 1, smoking, lack of prior surgery, higher pain scores and functional disability, and lower quality-of-life were associated with LOFU (all p<.05). Only lower age (OR: 0.98, p=.001), smoking (OR: 1.46, p=.019), lack of prior surgery (OR: 0.59, p=.019), and spondylolisthesis (OR: 0.47, p=.024) independently predicted LOFU. CONCLUSIONS In a prospective registry of lumbar spine surgery patients based on web-based outcome capturing, younger age, active smoking status, lack of prior surgery, and nonspondylolisthesis surgery were independent predictors of loss of follow-up. In the future, it may become possible to preoperatively identify patients at high-risk for study dropout. As the implementation of prospective registries and the use of automated follow-up methods are on the rise, it is crucial to ensure efficiency and reduce bias of the methods on which all clinical research is based on.
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Affiliation(s)
- Marc L Schröder
- Department of Neurosurgery, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE, Naarden, The Netherlands
| | - Marlies P de Wispelaere
- Department of Clinical Informatics, Bergman Clinics, Gooimeer 11, 1411 GE, Naarden, The Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE, Naarden, The Netherlands; Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
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Reid PC, Morr S, Kaiser MG. State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease. J Neurosurg Spine 2019; 31:1-14. [PMID: 31261133 DOI: 10.3171/2019.4.spine18915] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/26/2022]
Abstract
Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent-and costlier-issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.
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12
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Zhang J, Pan A, Zhou L, Yu J, Zhang X. Comparison of unilateral pedicle screw fixation and interbody fusion with PEEK cage vs. standalone expandable fusion cage for the treatment of unilateral lumbar disc herniation. Arch Med Sci 2018; 14:1432-1438. [PMID: 30393499 PMCID: PMC6209698 DOI: 10.5114/aoms.2018.74890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/17/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study was conducted to compare the clinical effects of unilateral pedicle screw fixation and interbody fusion with PEEK cage (UPSFC) and standalone expandable fusion cage (SAEFC) on unilateral lumbar disc herniation. MATERIAL AND METHODS From September 2011 to July 2014, a respective investigation was performed on 130 lumbar disc herniation patients treated with SAEFC or UPSFC. The hospital stay, operating time, blood loss, Japanese orthopaedic association scores (JOA), and visual analogue score (VAS) in the two groups were compared using Student's t-test. RESULTS The average of follow-up time was 25.6 ±6.4 and 25.2 ±5.8 months, respectively. No significant difference in the postoperative hospitalizsation, intraoperative blood loss, operative time, and postoperative fusion rate was detected between the two groups. VAS score in the UPSFC group was significantly lower than in the SAEFC group at 6 and 12 months after operation (p = 0.014, p = 0.004). X-ray images indicated that the subsidence rate was 8.1% (5/62) in the SAEFC group, while no subsidence was detected in UPSFC group 12 month after operation. CONCLUSIONS Both SAEFC and UPSFC are effective techniques. UPSFC may be a better choice for patients with lumbar disc herniation and unilateral limb symptoms of nerve root in view of the advantages of better low back pain relief and low subsidence rate.
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Affiliation(s)
- Jinlei Zhang
- Department of Orthopaedics, Zhoukou City Central Hospital, The Affiliated Hospital of Xinxiang Medical College, Zhoukou Shi, China
| | - Aixing Pan
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Orthopaedics, Zhoukou City Central Hospital, The Affiliated Hospital of Xinxiang Medical College, Zhoukou Shi, China
| | - Jingyi Yu
- Department of Orthopaedics, Zhoukou City Central Hospital, The Affiliated Hospital of Xinxiang Medical College, Zhoukou Shi, China
| | - Xiao Zhang
- Department of Orthopaedics, Zhoukou City Central Hospital, The Affiliated Hospital of Xinxiang Medical College, Zhoukou Shi, China
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Hendrickson NR, Kelly MP, Ghogawala Z, Pugely AJ. Operative Management of Degenerative Spondylolisthesis. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.17.00181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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14
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Coutinho PO. Revisiting the Role of Uninstrumented Posterior Lumbar Interbody Fusion. World Neurosurg 2018; 115:503-505. [PMID: 29758370 DOI: 10.1016/j.wneu.2018.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
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Barzilai O. Current Role of Uninstrumented Lumbar Fusion. World Neurosurg 2018; 115:509-511. [PMID: 29783011 DOI: 10.1016/j.wneu.2018.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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16
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Prolo LM, Oklund SA, Zawadzki N, Desai M, Prolo DJ. Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes? World Neurosurg 2018; 115:490-502. [PMID: 29631080 DOI: 10.1016/j.wneu.2018.03.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the 1980s, numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These operations often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of PLIF with allogeneic bone (allo-PLIF). METHODS Between 1981 and 2006, 321 patients aged 12-80 years underwent 339 1-level or 2-level allo-PLIFs for degenerative instability and were followed for 1-28 years. Fusion status was determined by radiographs and as available, by computed tomography scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. RESULTS Of the 321 patients, 308 were followed postoperatively (average 6.7 years) and 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, P = 0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores after initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (P = 0.001). A positive association between a patient characteristic and outcome was observed only with age 65 years and greater, whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to the low back, or industrial injuries. The total complication rate was 7%. CONCLUSIONS With 3 decades of follow-up, we found that successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone.
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Affiliation(s)
- Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sally A Oklund
- Western Transplantation Services, San Jose, California, USA
| | - Nadine Zawadzki
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donald J Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Western Transplantation Services, San Jose, California, USA.
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Ducis K, Florman JE, Rughani AI. Appraisal of the Quality of Neurosurgery Clinical Practice Guidelines. World Neurosurg 2016; 90:322-339. [PMID: 26947727 DOI: 10.1016/j.wneu.2016.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The rate of neurosurgery guidelines publications was compared over time with all other specialties. Neurosurgical guidelines and quality of supporting evidence were then analyzed and compared by subspecialty. METHODS The authors first performed a PubMed search for "Neurosurgery" and "Guidelines." This was then compared against searches performed for each specialty of the American Board of Medical Specialties. The second analysis was an inventory of all neurosurgery guidelines published by the Agency for Healthcare Research and Quality Guidelines clearinghouse. All Class I evidence and Level 1 recommendations were compared for different subspecialty topics. RESULTS When examined from 1970-2010, the rate of increase in publication of neurosurgery guidelines was about one third of all specialties combined (P < 0.0001). However, when only looking at the past 5 years the publication rate of neurosurgery guidelines has converged upon that for all specialties. The second analysis identified 49 published guidelines for assessment. There were 2733 studies cited as supporting evidence, with only 243 of these papers considered the highest class of evidence (8.9%). These papers were used to generate 697 recommendations, of which 170 (24.4%) were considered "Level 1" recommendations. CONCLUSION Although initially lagging, the publication of neurosurgical guidelines has recently increased at a rate comparable with that of other specialties. However, the quality of the evidence cited consists of a relatively low number of high-quality studies from which guidelines are created. Wider implications of this must be considered when defining and measuring quality of clinical performance in neurosurgery.
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Affiliation(s)
- Katrina Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
| | - Jeffrey E Florman
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Anand I Rughani
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA; Center for Excellence in Neuroscience, University of New England, Biddeford, Maine, USA
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Wang H, Chen W, Jiang J, Lu F, Ma X, Xia X. Analysis of the correlative factors in the selection of interbody fusion cage height in transforaminal lumbar interbody fusion. BMC Musculoskelet Disord 2016; 17:9. [PMID: 26754610 PMCID: PMC4709994 DOI: 10.1186/s12891-016-0866-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022] Open
Abstract
Background Selecting an interbody cage with appropriate height is one of the key steps in lumbar interbody fusion, and has an important impact on clinical efficacy. How to choose the appropriate height of the cage becomes one of the core problems of lumbar interbody fusion for spine surgeons. However, studies about objective selection criteria on interbody cage height was rare. Methods One hundred fifty-seven patients with single segment lumbar degenerative diseases treated by TLIF surgery from January 2011 to July 2013 were retrospectively analyzed. Parameters analyzed included: gender, age, body height, clinical diagnosis, pathological segment location and the intervertebral height of pathological segment, pathological segment activity, the intervertebral height of the adjacent segments. And further to analyze the correlation between these parameters and interbody cage height. By measuring the intervertebral height of pathological segment and normal segment to calculate the regression equation of interbody cage height. Results The average interbody cage height of male patients (12.38 ± 1.43) mm was significantly higher than female (11.62 ± 1.45) mm (p < 0.001). The L4-5 segment interbody cage height (12.11 ± 1.38) mm was significantly greater than the L5-S1 (11.25 ± 1.32) mm (p = 0.04). Body height, the intervertebral height of pathological segment, and the middle intervertebral heigh of upper adjacent segment were highly positively correlated to the interbody cage height. The range of interbody cage height used in transforaminal lumbar interbody fusion for Chinese patients with lumbar degenerative diseases was: L3-4 (11.28 ± 3.29) mm ~ (12.76 ± 2.40) mm, L4-5 (11.62 ± 2.89) mm ~ (13.18 ± 1.91) mm, L5-S1 (10.52 ± 2.22) mm ~ (11.90 ± 2.80) mm. The regression equation of interbody cage height was: interbody cage height = 11.123-0.563 * (gender) + 0.149 * (the middle intervertebral height of pathological segment). Conclusions The selection of interbody cage height was influenced by sex, body height, pathological segment location, the intervertebral height of pathological segment and other factors. The interbody cage height for the lower lumbar spine mostly selected 11,12,13 mm, L3-4, L4-5 segment highly selective in general should not be less than 10 mm, and L5-S1 segments height was relatively small, usually not more than 13 mm. The interbody cage height might be selected based on the regression equation of interbody cage height. But, the regression equation maybe need to be verified in a prospective study.
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Affiliation(s)
- Hongli Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Wenjie Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Feizhou Lu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Xinlei Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Nguyen HS, Shabani S, Patel M, Maiman D. Posterolateral lumbar fusion: Relationship between computed tomography Hounsfield units and symptomatic pseudoarthrosis. Surg Neurol Int 2015; 6:S611-4. [PMID: 26693390 PMCID: PMC4671137 DOI: 10.4103/2152-7806.170443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background: Assessment of bone quality can guide spinal surgery. However, surgeons infrequently evaluate bone quality in a quantitative manner. Recent literature suggests a role for computed tomography (CT) Hounsfield units (HUs) as a marker for bone quality. Limited data exist regarding its utility with respect to posterolateral lumbar fusion (PLF). Methods: From fall 2010 to winter 2012, 10 patients underwent revision surgery for symptomatic pseudoarthrosis (defined as intractable pain associated with either radiographic evidence of nonunion or intraoperative evidence of nonunion) after a prior L4–S1 PLF. These patients were age-matched (±5 years) to 10 patients who underwent L4–S1 PLF with no clinical signs of pseudoarthrosis at 1-year follow-up. Available CT imaging (with or without instrumentation) was evaluated from L1 to L5 for the averaged HU. Data were pooled among L1–L3 values and between L4 and L5 values. Results: Within the pseudoarthrosis group, the pooled L1–L3 HU value was similar to the pooled L4–L5 HU value (168.39 ± 22.84 HU vs. 166.98 ± 23.20 HU respectively, P = 0.89). The same pattern was observed for the control group (190.24 ± 37.13 HU vs. 201.89 ± 36.59 HU respectively, P = 0.44). On the other hand, the pooled L1–L3 and L4–L5 HU values were larger for the control group compared to the pseudoarthrosis group, with the pooled L4–L5 HU demonstrating statistical significance, P = 0.01. Conclusion: Currently, CT imaging is typically not obtained prior to lumbar fusion. Results demonstrated that CT HU values were significantly larger for patients who did not exhibit symptomatic pseudoarthrosis at 1-year follow-up compared to those who required revision surgery. As such, CT HU values may serve as a predictor for bony fusion to guide surgical management of patients under consideration for PLF.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohit Patel
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dennis Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Deukmedjian AJ, Cianciabella AJ, Cutright J, Deukmedjian A. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:183-9. [PMID: 26692696 PMCID: PMC4660495 DOI: 10.4103/0974-8237.167869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. MATERIALS AND METHODS Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS). RESULTS The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge. CONCLUSION Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.
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Affiliation(s)
- Ara J Deukmedjian
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
| | | | - Jason Cutright
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
| | - Arias Deukmedjian
- Deuk Spine Foundation, Department of Neurosurgery, Melbourne, Florida, Australia
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