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Kuroshima K, Miyazaki S, Hiranaka Y, Ryu M, Inoue S, Yurube T, Kakutani K, Tadokoro K. Rate and Duration of Bone Union for Conservative Treatment in Pediatric Lumbar Spondylolysis. Spine (Phila Pa 1976) 2024; 49:1085-1091. [PMID: 37807612 DOI: 10.1097/brs.0000000000004849] [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] [Received: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To report the detailed bone fusion rates and duration of treatment in unilateral and bilateral cases of pediatric lumbar spondylolysis (LS). SUMMARY OF BACKGROUND DATA Early diagnosis and optimal conservative management for LS are crucial for achieving bony healing without surgery. However, existing research on the conservative treatment of pediatric LS, particularly regarding bone union rates and treatment duration for each stage of bilateral spondylolysis, is limited. METHODS We retrospectively analyzed 590 pediatric patients (522 boys and 68 girls) under 18 years of age diagnosed with LS and treated conservatively from 2015 to 2021. The diagnosis was based on computed tomography scans and magnetic resonance imaging findings, with stages classified as very early, early, progressive, or terminal. Patient background, sports history, level and stage of spondylolysis, presence of spina bifida occulta, bone union rate, duration of conservative treatment, and recurrence rate were retrospectively analyzed. RESULTS The overall bone union rate was 81.9%, with a mean conservative treatment duration of 53.7 days. Unilateral LS cases showed decreased bone union rates with stage advancement (very early; 98.2%, early; 96.0%, progressive; 64.3%). Bilateral LS cases with progressive or terminal stage demonstrated low bone union rates (very early/very early; 100%, early/very early; 94.1%, progressive/very early; 66.7%, early/early; 82.9%, progressive/early; 32.3%, progressive/progressive; 23.7%, very early/terminal; 0%, early/terminal; 50.0%, progressive/terminal; 11.1%). The duration of conservative treatment extended as the stage of the main and contralateral lesions progressed, ranging from 39.1 days (very early/none) to 105 days (progressive/terminal). The recurrence rate after bone fusion was 16.6%, with no differences based on lesion stage. CONCLUSIONS In this series of 590 patients, conservative treatment yielded high bone union rates for pediatric LS. However, union rates decreased with stage advancement, especially in bilateral cases. These findings provide valuable insights for prognosticating natural history and outcome regarding LS treatment, bone union, and return to activity.
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Affiliation(s)
- Kohei Kuroshima
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Miyazaki
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
| | - Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ko Tadokoro
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan
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Oh J, Jo D, Park K, Kang P, Shin Y. Experimental Rat Model of Bony Defects in the Facet Joint Maintained with Bone Wax for the Study of Spinal Pain. J Pain Res 2022; 15:171-180. [PMID: 35125888 PMCID: PMC8807867 DOI: 10.2147/jpr.s344810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Studies using experimental rat models for low back pain due to facet-joint defects are scarce. This study used a novel experimental rat model to determine whether bony defects induced by facetectomy could be maintained by bone wax, thus mimicking spondylolysis, and to analyze the effect of the facetectomy on rat behavior. Patients and Methods Twelve 10-week-old male Wistar rats weighing 300–350 g were divided into group A (n = 6) that underwent unilateral facetectomy of the right L5-6 facet joint and group B (n = 6) that additionally applied water-soluble bone wax at the facetectomy site. The difference in the left and right stride length, detected by the footprint test, and change in the left and right facet joint area were compared before and 4 weeks after the experiment. Results Even though the difference between the left and right stride lengths of groups A and B was not statistically significant, in contrast to group A, group B showed a shorter stride length on the right side (p = 0.22 and 0.46, in group A and group B, respectively). The right facet joint area, where the facetectomy was performed, was significantly smaller in group B 4 weeks after surgery, but not in group A (p = 0.50 and < 0.01, in group A and group B, respectively). Conclusion Based on the results, we concluded that the bony defects, induced by facetectomy at the L5-6 facet joint, were maintained with bone wax. This study will provide an experimental model for bony defects in the facet joint.
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Affiliation(s)
- Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Daehyun Jo
- Jodaehyun Pain Center, Jeonju, Republic of Korea
| | - Kicheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Posoon Kang
- Department of Anesthesiology and Pain Medicine, Konynang University Hospital, Daejeon, Republic of Korea
| | - Youngsup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Correspondence: Youngsup Shin, Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, 282, Munhwa-ro, Junggu, Daejon, 35015, Republic of Korea, Tel +82-42-280-7840, Fax +82-42-280-7968, Email
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Comparing Surgical Treatments for Spondylolysis: Review on Current Research. Clin Spine Surg 2021; 34:276-285. [PMID: 33298798 DOI: 10.1097/bsd.0000000000001115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To compare the various surgical methods of repairing spondylolysis defects in regard to improving pain, restoration of function, radiographic improvement, and complication rate. SUMMARY OF BACKGROUND DATA Spondylolysis is a defect in the pars interarticularis of the vertebral arch, typically in the lumbar vertebra. Treatment can be nonoperative and/or surgical. There are various types of surgical repair including spinal compression, fusion, and direct pars repair. METHODS A comprehensive review of the English literature was performed utilizing Medline, Embase, and Web of Science. Inclusion criteria included papers or abstracts that evaluated the surgical techniques. Exclusion criteria included non-English-language papers or abstracts with inadequate information about outcomes. RESULTS Postoperative pain levels and patient function were consistently improved, regardless of surgical technique chosen. Positive clinical outcomes after surgery were seen more often in patients under age 20 and those who underwent minimally invasive repairs. Positive radiographic improvements were reported broadly, although some reported higher rates of nonunion with spinal compression. Complication rates were low throughout and minimally invasive techniques reported decreased blood loss and shorter hospital stays. CONCLUSIONS Present surgical options appear largely comparable in terms of their ability to provide meaningful treatment for spondylolysis where conservative treatments have failed or otherwise remain unattempted.
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Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother 2021; 11:19. [PMID: 34372944 PMCID: PMC8351422 DOI: 10.1186/s40945-021-00113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures. PURPOSE AND IMPORTANCE TO PRACTICE The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations. CLINICAL IMPLICATIONS This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions. FUTURE RESEARCH PRIORITIES Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrew A. Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA 22030 USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
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Koehler S, Held C, Stetter C, Westermaier T. Alloplastic or Autologous? Bone Chips versus PEEK Cage for Lumbar Interbody Fusion in Degenerative Spondylolisthesis. J Neurol Surg A Cent Eur Neurosurg 2021; 82:562-567. [PMID: 33845507 DOI: 10.1055/s-0040-1718770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study was conducted to compare bone-filled intervertebral cages with autologous bone chips for instrumented lumbar interbody fusion in patients with spinal stenosis and degenerative spondylolisthesis. METHODS Surgery consisted of posterior instrumentation and decompression, diskectomy, and intervertebral fusion using a polyetheretherketone (PEEK) cage surrounded and filled with spongious bone chips (group 1, n = 57) or spongious bone chips alone (group 2, n = 37). The choice of method was left to the discretion of the surgeon. Postoperative results were prospectively evaluated using a standardized protocol. Radiological assessment included fusion rates and vertebral height, while clinical assessment included the visual analog scale (VAS) and Oswestry Disability Index (ODI). RESULTS In group 1, a mean of 1.38 ± 0.64 segments were fused. In group 2, a mean of 1.58 ± 0.65 segments were fused. In both groups, the VAS for back pain and leg pain and the ODI improved without significant differences between the two groups. Osseous fusion was documented by computerized tomography in 73% in group 1 and 89% in group 2 after a mean of 18 months. The loss of height was 2.8 ± 4.0% in group 1 and 2.4 ± 5.2% in group 2. CONCLUSION Regardless of whether a PEEK cage filled with spongious bone chips or spongious bone chips alone were used for lumbar interbody fusion, clinical parameters improved significantly after surgery. There were no significant differences in the rate of bony fusion and loss of height between the two groups. The results of this nonrandomized cohort study indicate that the implantation of autologous spongious bone chips harvested during the decompression procedure is a useful and cheap alternative to an intervertebral cage in patients with degenerative pseudospondylolisthesis.
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Affiliation(s)
- Stefan Koehler
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.,Neurosurgical Practice Prof. Krone, Neurochirurgische Praxis Prof. Krone, Würzburg, Germany
| | - Christopher Held
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Christian Stetter
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.,Department of Neurosurgery, Helios Amper-Klinikum Dachau, Krankenhausstr, Germany
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Perceptions of low back pain in elite gymnastics: A multi-disciplinary qualitative focus group study. Phys Ther Sport 2020; 44:33-40. [PMID: 32375075 DOI: 10.1016/j.ptsp.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore the multidisciplinary team experience of Low Back Pain (LBP) in elite gymnastics. DESIGN A qualitative focus group. SETTING British Gymnastics. PARTICIPANTS Ten coaching, sports science and medicine multidisciplinary team members working with British gymnasts. MAIN OUTCOME MEASURES A topic guide informed by literature/expert opinion enabled discussion that was recorded/transcribed verbatim. Initial inductive analytic process developed theoretical insights. Manual coding using constant comparative methods categorised meaningful themes and sub-themes. RESULTS Two key aspects were identified. Emerging themes for LBP presentation included: early identification LBP and influence of multidisciplinary team members on outcomes; factors influencing LBP reporting e.g. coach-athlete relationship; frequent presentations of LBP and accepted norms; athlete history and physical examination e.g. training load. Emerging themes for causation of LBP included: intrinsic risk factors e.g. growth and maturation; extrinsic risk factors e.g. equipment. CONCLUSIONS Individual responses of a gymnast to experiencing LBP were important across all themes. Some LBP was perceived as normal. The coach-athlete relationship and support team are crucial decision-makers around training load and adaptation. Early detection will help minimise time loss from training/performance to expedite healing.
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One Center’s Experience with Hybrid Technique for Lumbar Spine Instrumentated Surgeries: Evaluation of Different Instrumentation Systems and Their Management. World Neurosurg 2018; 120:153-158. [DOI: 10.1016/j.wneu.2018.08.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022]
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Linhares D, Cacho Rodrigues P, Ribeiro da Silva M, Matos R, Veludo V, Pinto R, Neves N. Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:1743-1749. [DOI: 10.1007/s00586-018-5833-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
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Ricciardi L, Sturiale CL, Pucci R, Reale G, Stifano V, Izzo A, Perna A, Proietti L, Forcato S, Rivera Perla KM, El Boustany S, Olivi A, Polli FM. Patient-Oriented Aesthetic Outcome After Lumbar Spine Surgery: A 1-Year Follow-Up Prospective Observational Study Comparing Minimally Invasive and Standard Open Procedures. World Neurosurg 2018; 122:e1041-e1046. [PMID: 30415051 DOI: 10.1016/j.wneu.2018.10.208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite recent treatment developments, back pain and related disabilities still represent a challenge for practitioners. Among the available surgical techniques, many different features and outcomes have been investigated; however, aesthetic result was missing among them. The present investigation was designed to prospectively compare patient-oriented aesthetic results after minimally invasive surgery (MIS) and standard open surgery (SOS) for the lumbar spine. METHODS This was a prospective observational study with 1-year follow-up. Patients who underwent SOS were assigned to group 1 and MIS to group 2. Patient-oriented aesthetic result evaluation was collected using a dedicated visual aesthetic analogue scale. The Vancouver Scar Scale was used to exclude objective underlying influencing factors. The Oswestry Disability Index and a 10-point itemized visual analogue scale for back pain were administered to assess the clinical and functional status. Follow-up data were collected before discharge at 1, 6, and 12 months. Statistical analysis was conducted, and P < 0.05 was considered as significant. RESULTS We enrolled 74 patients, 44 in group 1 and 30 in group 2. The 2 groups were homogeneous for demographic and clinical data. No clinical or functional differences were measured at the end of follow-up. Visual aesthetic analogue scale reported greater mean values in group 1 at every follow-up time. CONCLUSIONS Patients seem to prefer the aesthetic result from a single midline incision after SOS compared with MIS. The use of specific techniques could be considered if there is scientific evidence reporting greater aesthetic outcome, having similar clinical and functional ones.
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Affiliation(s)
- Luca Ricciardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Resi Pucci
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Gabriele Reale
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Vito Stifano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Forcato
- Unità operativa di neurochirurgia, Pia Fondazione Panico, Ospedale di Tricase (LE), Italy
| | | | | | - Alessandro Olivi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
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Efficacy and outcome predictors of fluoroscopy-guided facet joint injection for spondylolysis. Skeletal Radiol 2018; 47:1137-1144. [PMID: 29396693 DOI: 10.1007/s00256-018-2897-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of fluoroscopy-guided facet joint injection for symptomatic spondylolysis and to analyze the outcome predictors. MATERIALS AND METHODS This study included 108 patients who underwent fluoroscopy-guided facet joint steroid injection for symptomatic spondylolysis with follow-up medical records from January 2013 to December 2016. Among them, 47 patients underwent concomitant epidural steroid injection. Response to injection was assessed at the initial follow-up. The symptom-free interval was analyzed using the Kaplan-Meier method. Outcome predictors were statistically analyzed using independent t test and Chi-square test. RESULTS The facet joint injection was effective in 52 of 108 (48.1%) patients at initial follow-up. Recurrence was reported in 21 of these 52 (40.4%) patients. For the 52 patients in whom facet joint injection was effective, the median symptom-free interval was 298 days (95% confidence interval, 29-567 days). No significant difference was found in the response between the group with facet joint injection only (n = 61) and the group with facet joint injection and additional ESI (n = 47). Additionally, no significant outcome predictors were detected. CONCLUSIONS Fluoroscopy-guided facet joint injection may potentially be an effective therapy for providing prolonged pain relief and avoiding unnecessary surgery for symptomatic spondylolysis without significant outcome predictors.
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Sencan S, Ozcan-Eksi EE, Cil H, Tay B, Berven S, Burch S, Deviren V, Demir-Deviren S. The effect of transforaminal epidural steroid injections in patients with spondylolisthesis. J Back Musculoskelet Rehabil 2018; 30:841-846. [PMID: 28372316 DOI: 10.3233/bmr-160543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transforaminal epidural steroid injection (TFE) is a widely accepted non-surgical treatment for pain in patients with spondylolisthesis. However, the effectiveness of TFE has not been compared in patients with degenerative (DS) and isthmic spondylolisthesis (IS). OBJECTIVE To compare the effectiveness of bilateral TFEs in DS and IS. METHODS Patients who underwent bilateral TFEs for spondylolisthesis at University of California San Francisco Orthopaedic Institute from 2009 to 2014 were evaluated retrospectively. RESULTS DS patients (120 female, 51 male) were significantly older and had higher comorbidity than those with IS (18 female, 14 male). They had better pain relief after TFE than patients with IS (72.11 ± 27.46% vs 54.39 ± 34.31%; p = 0.009). The number of TFEs, the mean duration of pain relief after TFE, follow-up periods, translation and facet joint widening were similar in DS and IS groups (p > 0.05). DS group had higher successful treatment rate (66.1% vs 46.9%, p = 0.009) and longer duration of pain relief (181.29 ± 241.37 vs 140.07 ± 183.62 days, p = 0.065) compared to IS group. CONCLUSIONS Bilateral TFEs at the level of spondylolisthesis effectively decreased pain in patients. TFEs provided better pain relief for longer duration in patients with DS than for those with IS.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Marmara University, Pain Management, Istanbul, Turkey
| | - Emel E Ozcan-Eksi
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hemra Cil
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Bobby Tay
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Shane Burch
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sibel Demir-Deviren
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Three cases of L4-5 Baastrup's disease due to L5-S1 spondylolytic spondylolisthesis. 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 2017; 26:186-191. [PMID: 28357587 DOI: 10.1007/s00586-017-5014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/29/2017] [Accepted: 02/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Baastrup's disease is characterized by degeneration of spinous processes and interspinous soft tissue, which may cause spinal stenosis. Purpose of this article is to report the possible new cause of Baastrup's disease and result of surgical treatments. METHODS Authors treated three cases of Baastrup's disease on L4-L5 with L5-S1 spondylolytic listhesis. Conservative treatment did not relieve the pain; therefore, surgical treatments were planned according to each specific disease condition. RESULTS In one case, anterior lumbar interbody fusion of L5-S1 was performed, and after surgery, the size of epidural cyst on L4-L5 was decreased. L4-L5 bilateral laminectomy was performed to directly decompress posterior epidural cyst in a case with stable L5-S1 spondylolytic listhesis. In last case, facet joints and spinous process were removed by L5-S1 posterior lumbar interbody fusion (PLIF) surgery. After the surgery, patients' back and leg pain was improved and postoperative MRI revealed successful decompression of the spinal canal. Improvement in back and leg symptoms was noted at 12-month follow-up. CONCLUSIONS Baastrup's disease at the L4-L5 level may have developed from the instability caused by L5-S1 spondylolytic spondylolisthesis. Viable treatment options include the fusion of L5-S1 or a laminectomy at the L4-L5 level.
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Accuracy and efficacy of fluoroscopy-guided pars interarticularis injections on immediate and short-term pain relief. Skeletal Radiol 2016; 45:1329-35. [PMID: 27444614 DOI: 10.1007/s00256-016-2427-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy and short-term efficacy of fluoroscopy-guided steroid/anesthetic injections for symptomatic pars interarticularis (pars) defects. MATERIALS AND METHODS Following IRB approval, all fluoroscopically guided pars injections from a single institution (6/2010 to 3/2016) were retrospectively and independently reviewed by two MSK radiologists. The radiologists evaluated the fluoroscopic images to determine if all of the pars injections associated with each procedure were intra-pars (n = 57 procedures; 106 pars injections), peri-pars (n = 3 procedures; three pars injected), or a combination of intra-pars and peri-pars (n = 6 procedures; 12 pars injected). The patients were asked their pain score (graded on a scale of 0-10) pre-injection, 5-10 min and 1-week post-injection. Age, gender, and fluoroscopic times were recorded. Statistical analysis was performed on the all intra-pars injections only. RESULTS Exact inter-reader agreement was present in 92 % (112/121) of the injections, with 57 of the procedures (106 pars injections) performed on 41 patients (mean age 36; 18 M, 23 F) all intra-pars. The mean pre-injection and 5-10 min post-injection reduction in pain for the all intra-pars injections was -3.0 units (95 % CI: [-3.9, -2.1] units; p < 0.001) with a mean 1-week post-injection (n = 21 procedures; 38 pars) reduction in pain of -0.7 units (95 % CI [-1.5, 0.0]; p = 0.06). The geometric mean fluoroscopic time per pars injected was 42 s. CONCLUSIONS Over 92 % of fluoroscopically guided injections for symptomatic spondylolysis are technically successful with minimum fluoroscopic time, resulting in statistically significant pain reduction immediately post-injection and a trend in pain reduction 1-week post-injection.
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