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Goyal DK, Tarazona DA, Segar A, Sutton R, Motto MA, Divi SN, Galtta MS, Hilibrand AS, Kaye ID, Kurd MF, Radcliff KE, Rihn JA, Anderson DG, Kepler CK, Hsu V, Woods B, Vaccaro AR, Schroeder GD. Lumbar Pedicle Morphology and Vertebral Dimensions in Isthmic and Degenerative Spondylolisthesis-A Comparative Study. Int J Spine Surg 2021; 15:243-250. [PMID: 33900981 PMCID: PMC8059380 DOI: 10.14444/8009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The pedicle screw is the most common device used to achieve fixation in fusion of spondylolistheses. Safe and accurate placement with this technique relies on a thorough understanding of the bony anatomy. There is a paucity of literature comparing the surgically relevant osseous anatomy in patients with a degenerative spondylolisthesis (DS) and an isthmic spondylolisthesis (IS). The goal of this study was to determine the differences in the osseous anatomy in patients with a DS and those with an IS. METHODS A retrospective comparative cohort study was conducted on patients with a single-level, symptomatic L4-L5 DS or a single-level, symptomatic L5-S1 IS. Magnetic resonance imaging for these patients was reviewed. Morphometries of the pedicle and vertebral body were analyzed by 2 independent observers for the levels from L3 to S1, and radiographic parameters were compared between groups. RESULTS A total of 572 levels in 143 patients were studied, including 103 patients with a DS and 40 with an IS. After accounting for confounders, IS and DS had an independent effect on transverse vertebral body width, pedicle height and width, and sagittal pedicle angle. Patients with an IS had a smaller pedicle height (P < .001) and pedicle width (P = .001) than patients with DS. In addition, the angulation of the pedicles varied on the basis of the diagnosis. CONCLUSIONS The osseous anatomy is significantly different in patients with a DS than with an IS. Patients with an IS have smaller pedicles in the lumbar spine. Also, the L4 and L5 pedicles are more caudally angulated and the S1 pedicle is less medialized. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Understanding the differences in pedicle anatomy is important for the safe placement of pedicle screws.
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Affiliation(s)
- Dhruv K.C. Goyal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A. Tarazona
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anand Segar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael A. Motto
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S. Galtta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kris E. Radcliff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D. Greg Anderson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor Hsu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Gaspar MP, Motto MA, Lewis S, Jacoby SM, Culp RW, Lee Osterman A, Kane PM. Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques. Orthop J Sports Med 2017; 5:2325967117742077. [PMID: 29238734 PMCID: PMC5721972 DOI: 10.1177/2325967117742077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design Cohort study; Level of evidence, 3. Methods A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P < .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P < .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.
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Affiliation(s)
- Michael P Gaspar
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Darden School of Business, University of Virginia, Charlottesville, Virginia, USA
| | - Michael A Motto
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Lewis
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, Southern California Permanente Medical Group, Fontana, California, USA
| | - Sidney M Jacoby
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Randall W Culp
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - A Lee Osterman
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick M Kane
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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