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Manoharan R, Cherry A, Raj A, Srikandarajah N, Xu M, Iorio C, Nielsen CJ, Rampersaud YR, Lewis SJ. Distal Lumbar Lordosis is Associated With Reoperation for Adjacent Segment Disease After Lumbar Fusion for Degenerative Conditions. Global Spine J 2024:21925682241262704. [PMID: 38874188 DOI: 10.1177/21925682241262704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
STUDY DESIGN A single centre retrospective review. OBJECTIVE Recent studies have suggested that distal lordosis (L4-S1, DL) remains constant across all pelvic incidence (PI) subgroups, whilst proximal lordosis (L1-L4, PL) varies. We sought to investigate the impact of post-operative DL on adjacent segment disease (ASD) requiring reoperation in patients undergoing lumbar fusion for degenerative conditions. METHODS Patients undergoing 1-3 level lumbar fusion with the two senior authors between 2007-16 were included. Demographic and radiographic data were recorded. Univariate, multivariate binary logistic regression, and Kaplan Meier survivorship analyses were performed. RESULTS 335 patients were included in the final analysis. Most had single (67%) or two (31%) level fusions. The mean follow-up was 64-month. Fifty-seven patients (17%) underwent reoperation for ASD at an average of 78-month post-operatively (R group). The R group had a significantly lower mean post-operative DL (27.3 vs 31.1 deg, P < .001) and mean PI (55.5 vs 59.2 deg, P < .05). On univariate analysis, patients with a post-operative DL of <35 deg had higher odds of reoperation for ASD than those with a post-operative DL of ≥35 deg (OR 2.7, P = .016). In the multivariate model, post-operative DL, low/average PI, and spondylolisthesis were all significantly associated with reoperation for ASD. CONCLUSION This study provides preliminary support to an association between post-operative distal lumbar lordosis and risk of reoperation for ASD in patients undergoing fusions for degenerative conditions. Further multicentre prospective study is needed to independently confirm this association and identify the impact of restoration of physiological distal lumbar lordosis on long term patient outcomes.
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Affiliation(s)
- Ragavan Manoharan
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ahmed Cherry
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Orthopedic Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aditya Raj
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Nisaharan Srikandarajah
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- The Walton Centre, Liverpool, L9 7LJ" and "Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mark Xu
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carlo Iorio
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Orthopaedic and Spine Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Yoga Raja Rampersaud
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
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Yu R, Xiang Y, Dou H, Li H, Zheng Y, Chen B. Percutaneous Transforaminal Endoscopic Lumbar Foraminotomy in Stable Degenerative Lumbar Isthmic Spondylolisthesis with Radicular Leg Pain: A Retrospective Study. J Pain Res 2024; 17:1953-1965. [PMID: 38828087 PMCID: PMC11143981 DOI: 10.2147/jpr.s454771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Endoscopic surgery is a minimally invasive option for effectively addressing lumbar degenerative diseases. This study aimed to describe the specific technology of percutaneous transforaminal endoscopic lumbar foraminotomy (PTELF) as a therapeutic intervention for managing radicular leg pain (RLP) resulting from stable degenerative lumbar isthmic spondylolisthesis (DLIS) and to present the associated clinical results. Methods From March 2022 and April 2023, 25 patients were diagnosed with single-level stable DLIS with RLP and underwent PTELF. Clinical assessments utilized the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. All endoscopic surgery videos were reviewed to interpret the pathology associated with DLIS. Results The mean age of the cohort was 65.3 ± 11.0 years. The mean preoperative ODI score, VAS score for low back, and VAS score of the leg were 64.1 ± 8.2, 7.0 ± 0.7, and 7.3 ± 0.8, respectively. These scores significantly improved to 16.3 ± 10.4, 2.0 ± 0.6, and 1.7 ± 1.0 at the final follow-up, respectively (P<0.01). The modified MacNab criteria indicated "good" or "excellent" outcomes in 92.0% of cases. Analysis of 23 surgical videos revealed 15 patients with disc herniation, nine with lower vertebral endplate involvement, consistent presence of uneven bone spurs (at the proximal lamina stump and around the foramen), and accumulated scars. Two patients experienced postoperative dysesthesia, and one encountered a recurrence of RLP. Conclusion PTELF emerges as a potentially safe and effective procedure for alleviating RLP in patients with stable DLIS. However, additional evidence and extended follow-up periods are imperative to evaluate the feasibility and potential risks associated with PTELF.
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Affiliation(s)
- Rongbo Yu
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
| | - Yiliu Xiang
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
| | - Haoduan Dou
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
| | - Hewen Li
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
| | - Yuyang Zheng
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
| | - Bin Chen
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei, 067000, People’s Republic of China
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Wang D, Wang W, Han D, Muthu S, Cabrera JP, Hamouda W, Ambrosio L, Cheung JPY, Le HV, Vadalà G, Buser Z, Wang JC, Cho S, Yoon ST, Lu S, Chen X, Diwan AD. Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1748-1761. [PMID: 38043128 DOI: 10.1007/s00586-023-08041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). METHODS The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. RESULTS Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. CONCLUSION While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Waeel Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt
- Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia.
- St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia.
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Diebo BG, Balmaceno-Criss M, Lafage R, McDonald CL, Alsoof D, Halayqeh S, DiSilvestro KJ, Kuris EO, Lafage V, Daniels AH. Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning. J Bone Joint Surg Am 2024; 106:445-457. [PMID: 38271548 PMCID: PMC10906213 DOI: 10.2106/jbjs.23.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Christopher L. McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sereen Halayqeh
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kevin J. DiSilvestro
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eren O. Kuris
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Nagamoto Y, Okuda S, Matsumoto T, Takahashi Y, Furuya M, Iwasaki M. Mid-Term Results of Single-Level Posterior Lumbar Interbody Fusion in Patients with Pelvic Incidence Minus Lumbar Lordosis Mismatch. World Neurosurg 2024; 183:e796-e800. [PMID: 38218438 DOI: 10.1016/j.wneu.2024.01.031] [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: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Recent literature suggests that sagittal imbalance is a risk factor for adjacent segment disease following fusion surgery. This study explored the influence of pelvic incidence minus lumbar lordosis (PI-LL) mismatch on the mid-term results and reoperation rate after single-level posterior lumbar interbody fusion (PLIF). METHODS The participants of this study included 253 patients (80 men and 173 women; mean age 68.2 years) who underwent L4-5 single-segment PLIF. Preoperative PI-LL mismatch was defined as a PI-LL of 30° or greater. The patients were divided into 2 groups according to the presence or absence of PI-LL mismatch (PI-LL mismatch group; group M, Control group; group C), and the clinical outcomes and radiographic parameters were compared. RESULTS Of the 253 cases, 25 were classified in group M and 228 in group C. The Japanese Orthopaedic Association score at 5 years postoperatively was 23.0 ± 3.6 in group M and 23.5 ± 5.1 in group C, and the recovery rate was 66.2 ± 32.6% in group M and 64.6 ± 21.4% in group C and there was no significant difference in the recovery rate between the 2 groups. All radiographic parameters except sacral slope were significantly worse in group M. One patient (4.3%) in Group M and 18 patients (7.8%) in Group C required revision surgery at 2.4 years (range 0.0-5.0) and there was no significant difference in the revision rate between the 2 groups. CONCLUSIONS The mid-term results of L4-5 single-level PLIF were compared with and without PI-LL mismatch, with the threshold defined as 30°; however, there were no significant differences in both the Japanese Orthopaedic Association recovery and reoperation rates between the 2 groups.
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Affiliation(s)
- Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
| | - Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | | | - Masayuki Furuya
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
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Bayatli E, Dogan I, Özgüral O, Kuzukiran YC, Demiryurek S, Mete EB, Ozalp Ates FS, Zaimoğlu M, Eroglu U, Kahilogulları G, Ugur HC, Attar A, Caglar YS. Does the Extent of Rod Bending and Actual Lumbar Lordosis Mismatch Affect Quality of Life? World Neurosurg 2024; 182:e57-e61. [PMID: 37979686 DOI: 10.1016/j.wneu.2023.11.032] [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: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND To evaluate any mismatch between rod bending and actual lordosis during posterior lumbar instrumentation and its effects on the quality of life (QOL) of patients. METHODS Patient records for posterior lumbar fusion in 2018-2023 were retrospectively reviewed. The radiologic parameters consisted of pelvic incidence, sacral slope, L1S1 lumbar lordosis, lumbosacral angle, the distance between the posterior wall of the vertebra and the rod, lordosis of the rod. The postoperative QOL of patients was assessed using Oswestry Disability Index. The patients were grouped postoperative into Group-1 (minimal/moderate disability) and Group-2 (severe disability/crippled/bed bound). RESULTS Total of 133 patients were included; 99 women, 34 men. The difference was significant for patients with diabetes to be presented in the more disabled Group-2. The distance between the posterior vertebral wall and the rod was found to be short in Group-2. Preoperative and postoperative sagittal lumbar Cobb angles were significantly higher in Group-2. The changing degree of pain was found to score high in Group-2. The postoperative visual analog scale was high in Group-2. The difference between the preoperative and postoperative lumbar sagittal Cobb and rod Cobb-angles was found to be high in Group-2. CONCLUSIONS The results of our study confirm the importance of considering the preoperative actual lumbar lordosis during bending and maintaining it as much as possible. To our knowledge, this is the first study that evaluated the effect of rod bending on quality of life (QOL) and supports that this might be affected in case of any mismatches.
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Affiliation(s)
- Eyüp Bayatli
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey.
| | - Onur Özgüral
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Yusuf Cem Kuzukiran
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Sevde Demiryurek
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Funda Seher Ozalp Ates
- Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Murat Zaimoğlu
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Gökmen Kahilogulları
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Hasan Caglar Ugur
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Ayhan Attar
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
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Diniz SE, Cordeiro F, Ribau A, Vale J, Rodrigues-Pinto R. Postoperative impact of rod bending in the lumbar spine fusion surgery with polyaxial screws - Validation of a study. J Orthop 2022; 33:112-116. [PMID: 35958980 PMCID: PMC9357705 DOI: 10.1016/j.jor.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction In 2019, Moufid and Gille published a study in which they proposed certain radiological parameters that may justify the mismatch between the lordosis of the lumbar segment and the lordosis of the rod bar using polyaxial screws. The aim of this study is to reproduce the measurements performed by Moufid and Gille and try to validate their findings. Material and methods A retrospective study was performed including patients submitted to L3-L5 posterior fusion with or without interbody devices using polyaxial screws and titanium rods, for degenerative disease. Radiological parameters were analysed:the distance between the posterior wall and the rod for each vertebra(the standard deviation of the three distances was called Alpha); the angle between the screw and the rod for each screw(mean of the three was called Theta); the angle between screws and superior endplate for each instrumented vertebra(mean of the three was called Lambda). The difference between post-operative segmental lordosis and the lordosis of the rod was called DiffL. Results A total of 58 cases were included. The most frequent fusion surgery was posterolateral fusion(77.6%). The mean value of lumbar lordosis, fused segmental lordosis, pelvic incidence, Alpha, Theta, Lambda and DiffL were 48.7 ± 12.7°, 28.4 ± 9.2°, 60.7 ± 11.9°, 3.4 ± 1.6 mm, 90.5 ± 1.8°, 3.9 ± 1.8° e 9.9 ± 9.5° respectively. The mean value of rod lordosis was 20.5 ± 8.1°. DiffL varied between 0.1° (practically no mismatch) and 30.5° of mismatch. DiffL didn't correlate with gender, fusion type, age, PI and Alpha, Theta or Lambda. There was a significant positive correlation between lumbar lordosis and DiffL(ρ = 0.28; p = 0.03). No correlation was found between the radiological parameters for the cut-off point proposed by Moufid and Gille(Alpha 4.7 mm, Theta 86°, Lambda 2.8°) and the DiffL value. Conclusion No significant factors were identified in this study to aid in achieving an ideal match between rod and segmental spine lordosis, therefore not validating the study by Moufid and Gille.
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Affiliation(s)
- Sara Elisa Diniz
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Cordeiro
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Ana Ribau
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - João Vale
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto – Hospital de Santo António, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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Zhang D, Zeng T, Chen K, Jin S. Applications of the Crenel Lateral Interbody Fusion Procedure in Treatment for Adjacent Segments Degeneration of the Lumbar Spine. Orthop Surg 2022; 14:2150-2158. [PMID: 35929663 PMCID: PMC9483051 DOI: 10.1111/os.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To observe the clinical and radiological effect of crenel lateral interbody fusion (CLIF) procedure in the management of lumbar spine adjacent segment degenerative (ASD). METHODS Thirty-seven patients with lumbar spine ASD who underwent the CLIF procedure between June 2018 and December 2019 were included in the study. There were 13 males and 24 females, with a mean age of 64.30 ± 5.92 years. The VAS score of the back (VAS_Back) and legs (VAS_Leg), Oswestry Disability Index (ODI) score, the height of the intervertebral space (HIS), the height of the intervertebral foramen (HIF), the cross-sectional area (CSA) of the vertebral canal, segmental lordosis (SL), and lumbar lordosis (LL) were recorded before the operation, 2 weeks after the operation, 3 months after the operation, and at the last follow-up respectively. Clinical and radiological outcomes before and after the surgery were compared, and correlation and regression analyses were performed. RESULTS There were no vascular and nerve-related complications during the operation. The average follow-up time was 16.63 ± 4.24 months. The median of both VAS_Back and VAS_Leg was 7 before surgery and 1 at the last follow-up. Meanwhile, the average preoperative ODI score, HIS, HIF, CSA of the vertebral canal, LL, and SL was (67.48 ± 7.17) %, (4.80 ± 0.73) mm, (12.95 ± 2.07) mm, (59.52 ± 9.22) mm2 , (37.22 ± 5.92)° and (4.78 ± 1.99)°, respectively. At the final follow-up, ODI score, HIS, HIF, CSA of the vertebral canal, LL, and SL was (7.07 ± 2.66) %, (9.44 ± 0.61) mm, (17.30 ± 1.90) mm, (70.49 ± 8.95) mm2 , (44.67 ± 6.38)° and (13.44 ± 3.27)°, respectively. In the VAS_Back, VAS_Leg, ODI score, LL, SL, HIS, HIF, and CSA of the vertebral canal, the difference between preoperative and 2 weeks after the operation, 3 months after the operation, and the last follow-up were statistically significant (P < 0.05). However, the difference was not statistically significant between each time point after the operation in the CSA of the vertebral canal, LL, and SL (P > 0.05). Nonetheless, the difference was statistically significant in ODI between each time point after the operation (P < 0.05). VAS_Leg was associated with HIS, HIF, and CSA of the vertebral canal, while LL and SL were risk factors for low back pain. CONCLUSION Crenel lateral interbody fusion is an effective procedure in the management of lumbar ASD. Not only was the postoperative swift recovery due to minimal invasion, but also adequate LL and SL were achievable.
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Affiliation(s)
- Di Zhang
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Tong Zeng
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Keng Chen
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Song Jin
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Qu Z, Deng B, Gao X, Pan B, Sun W, Feng H. The association between Roussouly sagittal alignment type and risk for adjacent segment degeneration following short-segment lumbar interbody fusion: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:653. [PMID: 35804342 PMCID: PMC9264674 DOI: 10.1186/s12891-022-05617-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background To date, the influence of Roussouly type on development of adjacent segment degeneration (ASD) after lumber fusion is still not fully explored, and the current study is aimed to evaluate the effect of Roussouly type on development of radiological ASD after single-level lumber fusion, and to compare the Roussouly types and spinopelvic parameters among those with different degenerative patterns of ASDs on sagittal plane. Methods A retrospective review of 288 patients underwent L4/5 or L5/S1 single-level posterior interbody fusions between January 2016 and December 2018 with a minimum 2-year follow up was performed. Radiological ASDs were identified and divided into 3 groups according to different degenerative patterns of the cephalad adjacent level on sagittal plane, including the types of retrolisthesis (Group A), anterolisthesis (Group B), and axial disc space narrowing (Group C). Roussouly types and radiological measurements were compared among three groups and potential risk factors for ASD were evaluated. Results Radiological ASD was found in 59 (20.5%) cases, in which patients with Roussouly type-2 was the most common. While, on subgroup analysis among three ASD groups, Roussouly type-1 occupied the highest proportion in Group A, differ in Group B and Group C, both with Type-2 as the most common. Moreover, Group A had significantly lower pelvic tilt (PT), larger sacral slope (SS), and larger segmental angle (SA) than Group B and Group C, which showed a more anteverted pelvic in Group A. Multivariate regression analysis noted Roussouly type, preoperative PT, and ∆PI-LL as the independent risk factors for radiological ASD. Conclusion Roussouly type was significantly associated with the development of radiological ASD; however, the Roussouly types and spinal pelvic parameters were varied among different sagittal degenerative patterns of ASD, which was important in restoring optimal lumbar sagittal alignments in initial surgery.
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Affiliation(s)
- Zhe Qu
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Bin Deng
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Xiao Gao
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Bin Pan
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Wei Sun
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China.,Xuzhou Medical University, Xuzhou, China
| | - Hu Feng
- Department of Spine Surgery, the Affiliated Hospital of Xuzhou Medical University, Huaihai West Road 99, Xuzhou, 221006, China. .,Xuzhou Medical University, Xuzhou, China.
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10
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Park BJ, Gold CJ, Woodroffe RW, Yamaguchi S. What is the most accurate substitute for an invisible T1 slope in cervical radiographs? A comparative study of a novel method with previously reported substitutes. J Neurosurg Spine 2022; 36:815-821. [PMID: 34826812 DOI: 10.3171/2021.8.spine21901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The ability to utilize the T1 slope is often limited by poor visibility on cervical radiographs. The C7 slope has been proposed as a reliable substitute but may have similar limitations of visibility. Herein, the authors propose a novel method that takes advantage of the superior visibility on CT to accurately substitute for the radiographic T1 slope and compare the accuracy of this method with previously reported substitutes. METHODS Lateral neutral standing cervical radiographs and cervical CT scans were examined. When the T1 slope was clearly visible on radiographs, the C3-7 slopes and T1 slope were measured. In CT method 1, a direct method, the T1 slope was measured from the upper endplate of T1 to the bottom edge of the CT image, assuming the edge was parallel to the horizontal plane. In CT method 2, an overlaying method, the T1 slope was calculated by superimposing the C7 slope angle measured on a radiograph onto the CT scan and measuring the angle formed by the upper endplate of T1 and the superimposed horizontal line of the C7 slope. A Pearson correlation with linear regression modeling was performed for potential substitutes for the actual T1 slope. RESULTS Among 160 patients with available noninstrumented lateral neutral cervical radiographs, the T1 slope was visible in only 54 patients (33.8%). A total of 52 patients met the inclusion criteria for final analysis. The Pearson correlation coefficients between the T1 slope and the C3-7 slopes, CT method 1, and CT method 2 were 0.243 (p = 0.083), 0.292 (p = 0.035), 0.609 (p < 0.001), 0.806 (p < 0.001), 0.898 (p < 0.001), 0.426 (p = 0.002), and 0.942 (p < 0.001), respectively. Linear regression modeling showed R2 = 0.807 for the correlation between C7 slope and T1 slope and R2 = 0.888 for the correlation between T1 slope with the CT method 2 and actual T1 slope. CONCLUSIONS The C7 slope can be a reliable predictor of the T1 slope and is more accurate than more rostral cervical slopes. However, this study disclosed that the novel CT method 2, an overlaying method, was the most reliable estimate of true T1 slope with a greater positive correlation than C7 slope. When CT studies are available in patients with an invisible T1 slope on cervical radiographs, CT method 2 should be used as a substitute for the T1 slope.
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11
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Revision Surgery for Adjacent Segment Degeneration After Fusion for Lumbar Spondylolisthesis: Is there a Correlation with Roussouly Type? Spine (Phila Pa 1976) 2022; 47:E10-E15. [PMID: 32991517 DOI: 10.1097/brs.0000000000003708] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to investigate whether there is an association between revision surgery rates for adjacent segment degeneration (ASD) and Roussouly type after L4-5 transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. SUMMARY OF BACKGROUND DATA Revision surgery for ASD is known to occur after spinal fusion; however, it is unclear whether rates of ASD are associated with certain Roussouly types. METHODS Patients who underwent L4-5 TLIF for spondylolisthesis at the University of California San Francisco from January 2006 to December 2016 with minimum 2-year follow-up were retrospectively analyzed by Roussouly type. Revision surgery for ASD was noted and correlated by Roussouly type. Spinopelvic parameters were also measured for correlation. A value of P < 0.05 was significant. RESULTS There were 174 patients who met inclusion criteria, (59 males and 115 females). The average age was 62.3 (25-80) years. A total of 132 patients had grade I spondylolisthesis, and 42 had grade II. Mean follow-up was 45.2 months (24-497). A total of 22 patients (12.6%) underwent revision surgery for ASD after L4-5 TLIF. When classified by Roussouly type, revision surgery rates for ASD were: 1, 14.3%; 2, 22.6%; 3, 4.9%; and 4, 15.6% (P = 0.013). Type 3 spines with normal PI-LL (8.85° ± 6.83°) had the lowest revision surgery rate (4.9%), and type 2 spines with PI-LL mismatch (11.06° ± 8.81°) had the highest revision surgery rate (22.6%), a four-fold difference (P = 0.013). The PI-LL mismatch did not change significantly in each type postoperatively (P > 0.05). CONCLUSION We found that there may be a correlation between Roussouly type and revision surgery for ASD after L4-5 TLIF for spondylolisthesis, with type 2 spines having the highest rate. Spinopelvic parameters may also correlate with revision surgery for ASD after L4-5 TLIF.Level of Evidence: 4.
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Harada GK, Khan JM, Vetter C, Basques BA, Sayari AJ, Hayani Z, Tchalukov K, Louie PK, Colman M, An HS. Does the Number of Levels Fused Affect Spinopelvic Parameters and Clinical Outcomes Following Posterolateral Lumbar Fusion for Low-Grade Spondylolisthesis? Global Spine J 2021; 11:116-121. [PMID: 32875855 PMCID: PMC7734270 DOI: 10.1177/2192568220901527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis. METHODS This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale [VAS]-back, VAS-leg, Oswestry Disability Index [ODI]), and postoperative complications were compared. RESULTS Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions. CONCLUSIONS Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.
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Affiliation(s)
| | | | | | - Bryce A. Basques
- Rush University Medical Center, Chicago, IL, USA,Bryce A. Basques, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA.
| | | | - Zayd Hayani
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
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13
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Shi Z, Wang G, Jin Z, Wu T, Wang H, Sun J, Nicolas YSM, Rupesh KC, Yang K, Liu J. Use of the sagittal Cobb* angle to guide the rod bending in the treatment of thoracolumbar fractures: a retrospective clinical study. J Orthop Surg Res 2020; 15:574. [PMID: 33256851 PMCID: PMC7708173 DOI: 10.1186/s13018-020-02115-5] [Citation(s) in RCA: 6] [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: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pedicle screw fixation is a well-established technique for thoracolumbar fracture. A large number of studies have shown that the bending angle of the connecting rod has a significant correlation with the postoperative spinal stability. However, no studies have confirmed an objective indicator to guide the bending angle of the connecting rod during the operation. Our study aims to define a sagittal Cobb* angle to guide the bending angle of the connecting rod during surgery. Methods The frontal and lateral X-ray films in 150 cases of normal thoracolumbar spine were included to measure the normal spinal sagittal Cobb* angle in each segment. The patients who underwent single segment thoracolumbar fractures and pedicle screw internal fixation surgery were included. The radiological parameters included lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), and sacral slope (SS) were measured. The incidence of adjacent segment degeneration (ASD) 2 years after surgery was measured. Results The average values of normal sagittal Cobb* angle in each segment were − 5.196 ± 3.318° (T12), 2.279 ± 3.324° (L1), 7.222 ± 2.798° (L2), and 12.417 ± 11.962° (L3), respectively. The LL in the three groups was 35.20 ± 9.12°, 46.26 ± 9.68°, and 54.24 ± 15.31°, respectively. Compared with the normal group, there were significant differences in group A and group C, respectively (p < 0.05). The results were similar in the parameters of TL, PT, and SS. The incidences of SVA > 50 mm in group A, group B, and group C were 23.33%, 12.50%, and 19.23%, respectively. The parameter of PI in three groups was 41.36 ± 12.69, 44.53 ± 15.27, and 43.38 ± 9.85°, respectively. The incidences of ASD in group A, group B, and group C 2 years after surgery were 21.67%, 13.75%, and 17.95%, respectively. Conclusions The study confirmed that the sagittal Cobb* angle can be used as a reference angle for bending rods. When the bending angle of the connecting rod is 4 to 8° greater than the corresponding segment sagittal Cobb* angle, the patient’s spinal sagittal stability is the best 2 years after the operation.
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Affiliation(s)
- Zongpo Shi
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Gang Wang
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Zhen Jin
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Tao Wu
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Haoran Wang
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Jinpeng Sun
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Yap San Min Nicolas
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - K C Rupesh
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China
| | - Kaixiang Yang
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China.
| | - Jun Liu
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210000, Jiangsu, China.
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14
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Duan PG, Mummaneni PV, Wang M, Chan AK, Li B, Mayer R, Berven SH, Chou D. Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up. J Neurosurg Spine 2020; 34:83-88. [PMID: 33035999 DOI: 10.3171/2020.6.spine20159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors' aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. METHODS Patients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters. RESULTS A total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24-135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49-0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05). CONCLUSIONS In patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.
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Affiliation(s)
- Ping-Guo Duan
- 1Departments of Neurological Surgery and
- 3Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | | | | | | | - Bo Li
- 1Departments of Neurological Surgery and
| | - Rory Mayer
- 1Departments of Neurological Surgery and
| | - Sigurd H Berven
- 2Orthopaedic Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Departments of Neurological Surgery and
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Abstract
STUDY DESIGN A prospective cohort. OBJECTIVE The objective of this study was to develop a scoring system for lumbar degenerative spondylolisthesis (LDS) that would guide decision-making. BACKGROUND The management protocol for LDS has been under debate, with no guidelines. Most studies oversimplify LDS as a homogenous entity. MATERIALS AND METHODS A retrospective analysis of 131 patients who underwent surgery for LDS between July 2007 and October 2011 with a minimum follow-up of 3 years was carried out on the basis of clinical, radiologic, and technical factors. A scoring system was conceptualized. Clinical: back pain score-2, age younger than 70 years-1, high-demand activity-1. Radiologic: segmental kyphosis-1.5, segmental dynamic translation-1, disk height >50% of adjacent level-1, facet effusion-1, sagittal facet-orientation-1. Technical: feasibility to decompress without causing instability-1.5. Its reliability was ascertained by a univariate analysis. The benchmark was set at 5.5 according to the Youden Index. This was followed by a prospective study for reliability analysis between November 2011 and January 2017 of 52 patients who underwent stand-alone decompression in LDS with a minimum follow-up of 24 months. Outcomes were evaluated using the Oswestry Disability Index and the Visual Analog Scale. Interobserver variability was determined. None of the patients in the retrospective or prospective group had undergone any lumbar surgery previously. RESULTS The mean Oswestry Disability Index and Visual Analog Scale of both the groups in the retrospective and the stand-alone decompression groups in prospective studies showed significant improvement. The interobserver reliability was high, with a κ value of 0.847. CONCLUSIONS The proposed scoring system helps view LDS as a heterogenous condition and assists in tailoring treatment for individual patients. For a select subgroup of patients with LDS, minimally invasive decompression (unilateral laminotomy and bilateral decompression using a minimally invasive surgery tubular retractor system) without fusion is adequate. LEVEL OF EVIDENCE Level III.
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Li XF, Jin LY, Lv ZD, Su XJ, Wang K, Shen HX, Song XX. Efficacy of percutaneous transforaminal endoscopic decompression treatment for degenerative lumbar spondylolisthesis with spinal stenosis in elderly patients. Exp Ther Med 2019; 19:1417-1424. [PMID: 32010317 DOI: 10.3892/etm.2019.8337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
The efficacy of fusion combined with decompression for the treatment of spinal stenosis with degenerative lumbar spondylolisthesis (DLS) has been debated. Percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia is an ultra-minimally invasive procedure. The present study aimed to evaluate whether PTED is an effective alternative therapy for spinal stenosis associated with DLS in elderly patients. PTED was performed in elderly patients exhibiting lumbar stenosis and low-grade (Meyerding grades I and II) DLS; these patients also exhibited leg-dominant symptoms and had tolerable or absent mechanical back pain. Administration of general anesthesia may be considerably hazardous in patients when combined with comorbid conditions that result from aging. Therefore, the present procedure was performed under local anesthesia. No obvious radiographic lumbar intervertebral instability was identified prior to surgery. Pre- and post-operative visual analogue scale (VAS) score, Oswestry Disability Index (ODI) and walking distance data were collected. The clinical global outcomes following surgery were evaluated using modified MacNab criteria. A total of 18 elderly patients underwent surgery using PTED techniques. The mean follow-up time was 27.7 months (range, 24-33 months) and the mean estimated blood loss was 18.33 ml (range, 10-35 ml). The mean pre-operative ODI, VAS score of the back and VAS score of the leg were 68.2±6.5, 2.8±1.4 and 6.6±1.2, respectively. All average scores improved post-operatively to 31.7±5.2, 1.5±0.6 and 1.7±0.8, respectively, at the latest follow-up. A statistically significant improvement was observed for all scores at 1 month and that the scores remained relatively stable after that. According to modified MacNab criteria, the good-to-excellent rate was 83.3%. Only 1 patient required micro-decompression surgery due to poor rating. The present study indicated that PTED may be an effective alternative therapeutic option for elderly patients with low-grade DLS associated with spinal stenosis. However, PTED techniques continue to evolve and further follow-up studies are required to determine the long-term outcomes of this treatment technique.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200444, P.R. China.,Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Lin-Yu Jin
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhen-Dong Lv
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xin-Jin Su
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Kun Wang
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Hong-Xing Shen
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
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