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Iess G, Levi D, Della Valle R, Bonomo G, Broggi G, Egidi M. Articular arthrodesis with the facet wedge technique for the treatment of unstable lumbar degenerative disease and associated conditions: A retrospective study of 96 patients. World Neurosurg X 2024; 22:100351. [PMID: 38469389 PMCID: PMC10926358 DOI: 10.1016/j.wnsx.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Background Lumbar articular fusion with the facet wedge (FW) technique is gaining increasing interest among surgeons for the treatment of vertebral instability due to its limited invasiveness and ease of use. Studies on cadavers have reported biomechanical properties similar to pedicle screws. Yet, the evidence supporting their use is still limited and moreover focused only on spinal degenerative disease. Methods 96 cases of lumbar articular fusion with the FW techniques performed at 3 different centers between 2014 and 2022 were retrospectively analyzed based on the specific surgical indications: 1) degenerative spondylolisthesis/unstable lumbar stenosis; 2) synovial cysts; 3) adjacent segment disease (ASD). Medical records were reviewed to identify rates of complications and measures of functional outcome (ODI, low back pain VAS and modified Macnab scale) were collected both at baseline and at the follow-up visits. Wilcoxon signed-rank test was adopted to test for significant functional improvements. Results Significative clinical improvements were observed from baseline to follow-up regarding ODI and VAS scores. Overall rate of moderate and severe complications (according to Landriel-Ibañez scale) was 7.9%. Only 3.4% of patients with degenerative disease developed ASD requiring reoperations. Only one case of radicular deficit and one of device mobilization were reported. 2/4 cases of synovial cysts treated with unilateral fusions developed contralateral complications. 9 out of 16 (56.25%) patients who underwent long-term postoperative CT scans presented adequate degree of articular fusion. Conclusion FW technique is easy, safe, and effective. Its low rate of complications justifies its use for cases of mild lumbar instability.
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Affiliation(s)
- Guglielmo Iess
- Department of Neurosurgery, San Carlo Borromeo Hospital, Via Pio II, 3, Milan, Italy
- University of Milan, Via Festa del Perdono, 7, Milan, Italy
- Foundation IRCCS Carlo Besta Neurological Institute, Via Giovanni Celoria, 11, Milan, Italy
| | - Daniel Levi
- Le Betulle Private Hospital, Viale Italia, 36, Appiano Gentile, Italy
- Piccole Figlie Hospital, Via Po, 1, Parma, Italy
- Fondazione I.E.N., Corso Venezia, 18, Milan, Italy
| | - Raul Della Valle
- Department of Neurosurgery, San Carlo Borromeo Hospital, Via Pio II, 3, Milan, Italy
- University of Milan, Via Festa del Perdono, 7, Milan, Italy
| | - Giulio Bonomo
- Foundation IRCCS Carlo Besta Neurological Institute, Via Giovanni Celoria, 11, Milan, Italy
| | - Giovanni Broggi
- Foundation IRCCS Carlo Besta Neurological Institute, Via Giovanni Celoria, 11, Milan, Italy
- Le Betulle Private Hospital, Viale Italia, 36, Appiano Gentile, Italy
- Piccole Figlie Hospital, Via Po, 1, Parma, Italy
- Fondazione I.E.N., Corso Venezia, 18, Milan, Italy
| | - Marcello Egidi
- Department of Neurosurgery, San Carlo Borromeo Hospital, Via Pio II, 3, Milan, Italy
- University of Milan, Via Festa del Perdono, 7, Milan, Italy
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Saremi A, Goyal KK, Benzel EC, Orr RD. Evolution of lumbar degenerative spondylolisthesis with key radiographic features. Spine J 2024:S1529-9430(24)00009-3. [PMID: 38199449 DOI: 10.1016/j.spinee.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Spondylolisthesis is a common finding in middle-aged and older adults with back pain. The pathophysiology of degenerative spondylolisthesis is a subject of controversy regarding not only its etiology but also the mechanisms of its progression. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: dysfunction, instability, and finally, restabilization. There is a paucity of literature on the unification of the radiological hallmarks seen in spondylolisthesis within these phases. The radiographic features include (1) facet morphology/arthropathy, (2) facet effusion, (3) facet vacuum, (4) synovial cyst, (5) interspinous ligament bursitis, and (6) vacuum disc as markers of dysfunction, instability, and/or restabilization. We discuss these features, which can be seen on X-ray, CT, and MRI, with the intention of establishing a timeline upon which they present clinically. Spondylolisthesis is initiated as either degeneration of the intervertebral disc or facet joints. Early degeneration can be seen as facet vacuum without considerable arthropathy. As the vertebral segment becomes increasingly dynamic, fluid accumulates within the facet joint space. Further degeneration will lead to the advancement of facet arthropathy, degenerative disc disease, and posterior ligamentous complex pathology. Facet effusion can eventually be replaced with a vacuum in severe facet osteoarthritis. Intervertebral disc vacuum continues to accumulate with further cleft formation and degeneration. Ultimately, autofusion of the vertebra at the facets and endplates can be observed. With this review, we hope to increase awareness of these radiographical markers and their timeline, thus placing them within the framework of the currently accepted model of degenerative spondylolisthesis, to help guide future research and to help refine management guidelines.
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Affiliation(s)
- Arvin Saremi
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kush K Goyal
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Uri O, Alfandari L, Folman Y, Keren A, Smith W, Paz I, Behrbalk E. Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques. J Orthop Surg Res 2023; 18:974. [PMID: 38111077 PMCID: PMC10726635 DOI: 10.1186/s13018-023-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.
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Affiliation(s)
- Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel.
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Amit Keren
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - William Smith
- Department of Neurosurgery, University Medical Center, Las Vegas, NV, USA
| | - Inbar Paz
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
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Mu X, Deng H, Wei X, Wei J, Caggiari G. Do Modic changes contribute to lumbar instability or other way around? A retrospective study based on their types, extents, and affected lumbar segments. BMC Musculoskelet Disord 2023; 24:879. [PMID: 37951876 PMCID: PMC10638783 DOI: 10.1186/s12891-023-07011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Which types of Modic changes (MCs) and whether or how specific factors associated to MCs work on lumbar instability have yet to be well understood. The purpose of this study was to investigate the influences of the types of MCs, the extent of MCs lesion involvement, and different lumbar levels involved by MCs on lumbar instability. METHODS This retrospective study included 263 adult subjects with MCs who underwent lumbar X-ray examinations in the neutral, flexion, and extension positions. All patients who met our inclusion criteria were examined with 1.5 Tesla magnetic resonance units. Two experienced authors with more than three-year clinical experience independently evaluated and measured the subjects' radiographic images. The subgroup analysis was performed to detect the differences in subjects' baseline characteristics and lumbar segmental motions among three types of MCs, the extent of MCs lesion involvement and different lumbar levels involved by MCs. RESULTS There was a statistical difference in body mass index (BMI) between different involvement extent of MCs (p < 0.01), indicating that the subjects with high BMI are more likely to develop severe MCs. The subjects with Modic type 1 change (MC1) had a significant increase in lumbar angular motion than those with Modic type 2 change (MC2) and Modic type 3 change (MC3) (p < 0.01) and compared with MC3, a significant increase in lumbar translation motion was detected in subjects with MC1 and MC2 (p < 0.01). While, angular motion decreased, translation motion increased significantly as the extent of MCs lesion involvement aggravated (p < 0.01). However, there were no statistical differences in lumbar angular and translation motions between different lumbar levels involved by MCs (p > 0.05). CONCLUSIONS Higher BMI might be a risk factor for the development of severe MCs. MC1 and MC2 significantly contribute to lumbar instability. The extents of MCs lesion involvement are strongly associated with lumbar instability. However, different lumbar levels involved by MCs have little effect on lumbar stability.
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Affiliation(s)
- Xiaoping Mu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No.6, Taoyuan Road, Nanning, 530021, China
| | - Hansheng Deng
- Department of Biomedical Sciences, University of Sassari, 07100, Sassari, Italy
- Orthopaedic Department, Sassari University Hospital, 07100, Sassari, Italy
- Shenzhen Children's Hospital of Shantou Medical University, Shenzhen, People's Republic of China
| | - Xiaodong Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No.6, Taoyuan Road, Nanning, 530021, China
| | - Jianxun Wei
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No.6, Taoyuan Road, Nanning, 530021, China.
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Liu G, Liu W, Jin D, Yan P, Yang Z, Liu R. Clinical outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF). Spine J 2023; 23:271-80. [PMID: 36252809 DOI: 10.1016/j.spinee.2022.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND CONTEXT In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has been more and more favored by spinal surgeons because of its advantages of low trauma, rapid recovery, high fusion rate and fewer complications. PURPOSE To compare the clinical effects of ULIF with those of conventional open posterior lumbar interbody fusion (PLIF). STUDY DESIGN Prospective case control study. PATIENT SAMPLE Twenty-seven patients treated by ULIF and thirty-three patients treated by PLIF. OUTCOME MEASURES The preoperative baseline and surgical technique-related outcomes (mean operation time, blood loss during operation, postoperative drainage, and postoperative hospital stay) were compared between the two groups. The clinical status of the two groups before and after surgery were also compared: visual analogue scale (VAS) score of the legs and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI). The clinical laboratory indexes of the two groups before and after the operation were compared: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine phosphokinase (CPK), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), as well as the incidence of complications, such as dural tear, nerve root injury and infection. METHODS Adult patients who underwent L3-S1 single level lumbar interbody fusion were included in the study. They were divided into a PLIF group and a ULIF group according to the type of surgery. This study comprised 60 cases: 27 cases in the ULIF group and thirty-three cases in the PLIF group. RESULTS There was no significant difference in preoperative baseline between the two groups. The ULIF group experienced less blood loss, postoperative drainage and a shorter postoperative hospital stay than the PLIF group; however the ULIF group required a longer operation time than the PLIF group (p<.05). CRP, ESR, CPK, IL-6, and TNF-α levels of the PLIF group were all significantly higher than those of the ULIF group 5 days after surgery (p<.05). The improvements in the VAS scores for back pain, VAS scores for leg pain and JOA score in the ULIF group were all significantly better than those in the PLIF group at 5 days after surgery (p<.05). There was no significant difference in fusion rate at 6 months between the 2 groups (p>.05). CONCLUSIONS This study showed that ULIF and PLIF were both effective surgical techniques for lumbar interbody fusion. However, ULIF caused less bleeding, reduced inflammatory reaction, less tissue damage and faster postoperative recovery compared with PLIF. Both long-term follow-up and larger clinical studies are needed to validate the clinical and radiological results of this surgery.
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Li C, Liu W, Luo W, Zhang H, Zhao J, Gu R. Lumbar Facet Joint Effusion on Magnetic Resonance Imaging: Do Different Joint Effusion Images Have Different Clinical Values? World Neurosurg 2022; 167:e406-e412. [PMID: 35964904 DOI: 10.1016/j.wneu.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of the study was to explore the significance of the distribution of lumbar facet joint effusion (unilateral or bilateral) and the amount of joint effusion in the process of lumbar degeneration. METHODS A total of 142 patients with L4-5 lumbar facet joint effusion in our hospital from December 2020 to December 2021 were analyzed retrospectively, including 69 cases of unilateral facet joint effusion and 73 cases of bilateral facet joint effusion. The correlation between joint effusion width, effusion area and lumbar stability, facet joint degeneration grade, lumbar intervertebral disc degeneration index, and lumbosacral angle (LSA) was analyzed. To study the significance of the distribution of joint effusion, the patients were divided into unilateral and bilateral effusion groups. RESULTS The size of the LSA in the bilateral effusion group was significantly larger than that in the unilateral effusion group (t = 3.6634, P < 0.05). There was a significant difference in the proportion of stability between both groups (P < 0.05). The width of the joint effusion was positively correlated with lumbar stability and the LSA. When the width of the joint effusion was 2 mm, the probability of lumbar instability was 58.1%. The area of joint effusion was positively correlated with lumbar stability and the LSA. When the area of effusion was 0.2 cm2, the probability of lumbar instability was 58.9%. CONCLUSIONS A bilateral effusion signal is more likely to indicate lumbar instability than a unilateral effusion signal. The distribution width and area of effusion were positively correlated with lumbar stability and LSA.
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Affiliation(s)
- Chaoyuan Li
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Wanguo Liu
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Wenqi Luo
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Hongchao Zhang
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Jianhui Zhao
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China
| | - Rui Gu
- Department of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, People's Republic of China.
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Lin F, Zhou X, Zhang B, Shan B, Niu Y, Sun Y. Utility of Flexion-Extension Radiographs with Brackets and Magnetic Resonance Facet Fluid for the Assessment of Lumbar Instability in Degenerative Lumbar Spondylolisthesis. World Neurosurg 2022; 167:e940-e947. [PMID: 36055619 DOI: 10.1016/j.wneu.2022.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To propose a new standardized technique for evaluating lumbar stability in degenerative lumbar spondylolisthesis using lumbar lateral flexion-extension radiographs with brackets and magnetic resonance facet fluid. METHODS A retrospective analysis of 57 patients diagnosed with lumbar (L4-5) spondylolisthesis was performed. We analyzed lateral flexion-extension radiographs obtained with a bracket (LFEB) and without a bracket (LFE). Sagittal translation, segmental angulation, posterior opening, lumbar instability, and changes in lumbar lordosis were compared using functional radiographs. The mean width and maximum width of the facet fluid, mean facet joint length, and facet fluid index (FFI) of the 2 groups were compared using sagittal translation. RESULTS The average value of sagittal translation was 1.68 ± 0.96 mm in LFE and 3.07 ± 1.29 mm in LFEB, and the difference was significant (P < 0.05). Segmental angulation, posterior opening, and changes in lumbar lordosis were significantly greater in LFEB than in LFE. The instability detection rate was 14.0% in LFE and 35.1% in LFEB. The FFI, maximum width, and mean width were significantly increased in the unstable lumbar spondylolisthesis group compared with the stable group in LFEB. The FFI and maximum width of the facet fluid were significantly increased in the unstable lumbar spondylolisthesis group compared with the stable group in LFE. CONCLUSIONS Lumbar lateral flexion-extension radiographs with brackets can standardize the operation process and provide sufficient hyperflexion and hyperextension images. The width of the facet fluid and FFI are significant factors in the evaluation of lumbar stability in patients with lumbar spondylolisthesis.
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Affiliation(s)
- Fanguo Lin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bingchen Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanping Niu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongming Sun
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Wang JC, Cao Z, Li ZZ, Zhao HL, Hou SX. Full-Endoscopic Lumbar Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion with a Tubular Retractor System: A Retrospective Controlled Study. World Neurosurg 2022; 165:e457-68. [PMID: 35752422 DOI: 10.1016/j.wneu.2022.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to compare the safety and clinical efficacy of full-endoscopic lumbar interbody fusion (FE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS A total of 70 patients with single-level lumbar degenerative diseases underwent FE-LIF or MIS-TLIF with a tubular retractor system from August 2018 to August 2020. Postoperatively, the efficacy and safety were compared using several clinical and radiological indices. RESULTS A total of 32 patients underwent FE-LIF and 38 received MIS-TLIF with a tubular retractor system, and all patients had no apparent complications. The FE-LIF group had higher radiation exposure, longer operation time, and less bleeding than the MIS-TLIF group (P < 0.05). Postoperative lumbar magnetic resonance imaging showed that the nerve decompression was sufficient. The pain in the lower back and legs was significantly relieved, and the Oswestry Disability Index (ODI) score was greatly improved after surgery (P < 0.01) in both the groups. The sensory and motor functions of nerve roots were remarkably recovered in both the groups at the 1-year follow-up (P < 0.05), and there was no significant difference in MacNab scores between the 2 groups. As per Mannion's fusion classification, the interbody fusion rate was significantly better in the FE-LIF group than in the MIS-TLIF group. CONCLUSIONS FE-LIF, which is safe, effective, and minimally invasive, exhibits the same clinical efficacy as MIS-TLIF but with longer operation time and increased radiation exposure.
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Abstract
BACKGROUND Low back pain is a significant spinal disorder that affects much of the population at some point during their lives. OBJECTIVE While proper diagnosis is key, diagnosing the underlying cause of low back pain may often be unclear. METHOD In this review article, we discuss lumbar instability as an etiology of low back pain and its treatment by prolotherapy. RESULTS Spinal ligaments may be an underlying culprit in the development of lumbar instability with resultant low back pain and associated disorders. CONCLUSION In these cases, adequate treatment consisting of non-biologic prolotherapy or cellular prolotherapy, including platelet rich plasma (PRP), can be beneficial in restoring spinal stability and resolving chronic low back pain.
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Affiliation(s)
- Ross A. Hauser
- Caring Medical Florida, Fort Myers, FL, USA,Corresponding author: Ross Hauser, Caring Medical Florida, 9738 Commerce Center Court, Fort Myers, FL 33908, USA. E-mail:
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Seyedhoseinpoor T, Dadgoo M, Taghipour M, Ebrahimi Takamjani I, Sanjari MA, Kazemnejad A, Ebrahimi H, Hasson S. Combining clinical exams can better predict lumbar spine radiographic instability. Musculoskelet Sci Pract 2022; 58:102504. [PMID: 35063746 DOI: 10.1016/j.msksp.2022.102504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Several clinical tests have been proposed to diagnose lumbar instability, but their accuracy is still in question. The primary purpose of this study was to evaluate the diagnostic accuracy of the clinical lumbar instability tests. The secondary goal was to design a model to detect lumbar instability. DESIGN A prospective diagnostic cross-sectional study. METHOD A sample of 202 patients with chronic low back pain were participated in the study. Five lumbar instability tests including Aberrant movement, Passive lumbar extension, Prone segmental instability, H and I and pheasant tests were compared to flexion/extension radiography as the gold standard for diagnosing lumbar instability using two by two tables. Multiple Logistic Regression analysis was applied to develop a model using demographic information as well as the patients' pain intensity, disability level, lumbar lordosis and the clinical tests. RESULTS Among the five examined tests, Prone segmental instability, H and I and pheasant tests showed very small likelihood ratios and diagnostic odd's ratio. The largest values were for H and I test with the positive likelihood ratio of 1.28 (95% CI: 0.72 to 2.29) and diagnostic odd's ratio of 1.37 (95% CI: 0.66 to 2.83); the diagnostic accuracy measures were smaller for the other studied clinical tests. The model was developed using weight (t = 1.15, p = 0.03) and lumbar lordosis (t = 3.04, p = 0.00) (which showed a significant relationship with lumbar instability) and prone segmental instability test. The final model has the positive likelihood ratio of 2.07 (95% CI: 1.41 to 3.05) and diagnostic odd's ratio of 3.77 (95% CI: 2.03 to 7.01). CONCLUSION Each individual test had very small to no power in discriminating patients with lumbar instability. The developed model just slightly improved the accuracy of radiological instability detection.
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Affiliation(s)
- Tahere Seyedhoseinpoor
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Taghipour
- Mobility Impairment Research Center, Health Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hadi Ebrahimi
- Department of Neurosurgery, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
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Xie P, Feng F, Chen Z, He L, Yang B, Chen R, Wu W, Liu B, Dong J, Shu T, Zhang L, Chen CM, Rong L. Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:546. [PMID: 32799839 PMCID: PMC7429717 DOI: 10.1186/s12891-020-03566-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Received: 02/09/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). Methods This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. Results The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. Conclusion The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.
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Affiliation(s)
- Peigen Xie
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Feng Feng
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Zihao Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Lei He
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bu Yang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Ruiqiang Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Wenbin Wu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bin Liu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Jianwen Dong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Tao Shu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Liangming Zhang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Chien-Min Chen
- Minimally Invasive Spine Center, Changhua Christian Hospital, No.135, Nansiao St., Changhua city, Changhua county, Taiwan.
| | - Limin Rong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China.
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Liu CW, Wang LL, Xu YK, Chen CM, Wang JC, Tsai WT, Lin SC. Traditional and cortical trajectory screws of static and dynamic lumbar fixation- a finite element study. BMC Musculoskelet Disord 2020; 21:463. [PMID: 32664920 DOI: 10.1186/s12891-020-03437-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) were shown to provide equivalent pull-out strengths of a screw. CBT utilizing a laterally-directed trajectory engaging only cortical bone in the pedicle is widely used in minimal invasive spine posterior fusion surgery. It has been demonstrated that CBT exerts a lower likelihood of violating the facet joint, and superior pull-out strength than the TT screws, especially in osteoporotic vertebral body. No design yet to apply this trajectory to dynamic fixation. To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization. METHODS A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison. RESULTS The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking. CONCLUSIONS Modeling the effects of TT and CBT fixation in a full lumbosacral model suggest that dynamic TT provide slightly superior stability compared with dynamic CBT especially in bending and rotation. In dynamic CBT design, large diameter screws might avoid issues with loosening and cracking.
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Manfrè L, De Vivo AE, Al Qatami H, Ventura F, Zobel B, Midiri M, Chandra RV, Carter NS, Hirsch J. Percutaneous CT-guided lumbar trans-facet pedicle screw fixation in lumbar microinstability syndrome: feasibility of a novel approach. Neuroradiology 2020; 62:1133-40. [PMID: 32367350 DOI: 10.1007/s00234-020-02438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Prospective experimental uncontrolled trial. BACKGROUND Lumbar microinstability (MI) is a common cause of lower back pain (LBP) and is related to intervertebral disc degeneration that leads to inability to adequately absorb applied loads. The term "microinstability" has recently been introduced to denote a specific syndrome of biomechanical dysfunction with minimal anatomical change. Trans-facet fixation (TFF) is a minimally invasive technique that involves the placement of screws across the facet joint and into the pedicle, to attain improved stability in the spine. PURPOSE In this study, we aimed to evaluate the effectiveness, in terms of pain and disability reduction, of a stand-alone TFF in treatment of patients with chronic low back pain (LBP) due to MI. Moreover, as a secondary endpoint, the purpose was to assess the feasibility and safety of a novel percutaneous CT-guided technique. METHODS We performed percutaneous CT-guided TFF in 84 consecutive patients presenting with chronic LBP attributable to MI at a single lumbar level without spondylolysis. Pre- and post-procedure pain and disability levels were measured using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). RESULTS At 2 years, TFF resulted in significant reductions in both VAS and ODI scores. CT-guided procedures were tolerated well by all patients under light sedation with a mean procedural time of 45 min, and there were no reported immediate or delayed procedural complications. CONCLUSION TFF seems to be a powerful technique for lumbar spine stabilization in patients with chronic mechanical LBP related to lumbar MI. CT-guided technique is fast, precise, and safe and can be performed in simple analgo-sedation.
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Casagrande J, Agosti E, Veiceschi P. How I do it: step-by-step BacJac™ posterior interspinous spacer placement. Acta Neurochir (Wien) 2020; 162:937-941. [PMID: 32006187 DOI: 10.1007/s00701-020-04240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND BacJac™ is a posterior interspinous spacer for selected cases of degenerative lumbar spine diseases. It blocks the metameric vertebral segment in terminal extension, restoring foraminal heights. METHODS The authors provide a detailed step-by-step description of the surgical technique, shedding light on surgical tips and pitfalls of this procedure. An accurate pre-operative patient selection is analyzed, defining meticulously surgical indications. A high-quality video of the surgical procedure is provided. CONCLUSION BacJac™ interspinous device allows a safe, mini-invasive, and effective treatment of selected cases of degenerative lumbar spine disease.
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Affiliation(s)
- J Casagrande
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Agosti
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - P Veiceschi
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Sharif S, Shaikh Y, Bajamal AH, Costa F, Zileli M. Fusion Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100077. [PMID: 32613190 PMCID: PMC7322802 DOI: 10.1016/j.wnsx.2020.100077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
Lumbar spine stenosis represents a complex degenerative pathology that has been a subject of significant dispute when it comes to fusion. A review of the literature from 2008 to 2019 was performed on the role of fusion in the treatment of lumbar spinal stenosis using PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Using the key words "lumbar spinal stenosis," "lumbar fusion," "lumbar decompression," and "lumbar pedicle screw fixation," the search revealed 490 papers. Of these, only Level 1 or Level 2 evidence papers were selected, leading to only 3 randomized controlled trials (RCTs) that were analyzed. None of the good-quality studies (RCTs) performed so far have proven any clinical benefit of adding fusion to degenerative lumbar spine decompression. The effect of spinal instability on the outcome following decompression remains controversial. At present, no unanimous criteria exist among the RCTs to identify what constitutes true instability. Fusion for instability or stenosis alone remains controversial, and the results are unconvincing. At this point, the issue expands to not only lumbar degenerative diseases but spinal fractures and lumbar isthmic spondylolisthesis. We thereby present the consensus of the World Federation of Neurosurgical Societies Spine Committee, which formulated the indications for lumbar spine fusion in degenerative lumbar stenosis.
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Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Yousuf Shaikh
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Research Hospital, Milan, Italy
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Bornova, Izmir, Turkey
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16
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Sun ZM, Jiang C, Xu JJ, Chen ZX, Guo Q, Lin Y, Wu YS. Vacuum Facet Phenomenon in Computed Tomography Imaging: A Sign of Instability in Degenerative Spondylolisthesis? World Neurosurg 2019; 129:e393-e400. [PMID: 31150862 DOI: 10.1016/j.wneu.2019.05.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the relationship between vacuum facet phenomena and lumbar instability in patients with degenerative spondylolisthesis (DS) in L4-L5. METHODS Patients with L4-L5 DS who had both lumbosacral flexion-extension radiographs and computed tomography (CT) scans available for review from January 2016 to December 2017 were eligible for the present study. The dynamic motion index (DMI) of each patient was used to represent the percentage of slippage of L-L4 on the L5 vertebral disks on the flexion radiographs minus the percentage on the extension radiographs. The facet vacuum index refers to the average width of the facet vacuum on the left and right sides. RESULTS A total of 67 patients with L4-L5 DS were included in the present study. Of the 67 patients, 35 had a vacuum facet phenomenon on their CT scan and 32 patients did not. The incidence of lumbar instability in the patients with a vacuum facet phenomenon was significantly greater than that in the patients without a vacuum facet phenomenon (P = 0.015). The mean DMI for the patients with a vacuum facet phenomenon was significantly greater than that for the patients without a vacuum facet phenomenon (P < 0.001). A positive linear correlation was found between the facet vacuum index and DMI for patients with a vacuum facet phenomenon (Pearson correlation coefficient, 0.597; P < 0.001). CONCLUSIONS A linear correlation was found between the degree of segmental motion and the width of the vacuum facet phenomenon in patients with DS at L4-L5. Our study has shown that vacuum facet phenomena detected on the CT images of patients with DS are highly predictive of segmental instability.
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Affiliation(s)
- Ze-Ming Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chao Jiang
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jia-Jing Xu
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Ze-Xin Chen
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qiang Guo
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China; Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yan Lin
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Yao-Sen Wu
- Department of Orthopaedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.
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Meng FZ, Gao Q, Wang XL, He Y. [Case control study of interbody fusion with simple decompression bone block in treating degenerative lumbar instability and spinal stenosis]. Zhongguo Gu Shang 2018; 30:400-405. [PMID: 29417769 DOI: 10.3969/j.issn.1003-0034.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the value of the self-decompression bone block in interbody fusion. METHODS From April 2014 to May 2015, 42 patients with degenerative lumbar instability and spinal stenosis were treated by posterior vertebral lamina decompression and pedicle nail-rod fixation and unilateral modified transforaminal lumbar interbody fusion, including 18 males and 24 females. The treatment group had 24 cases with autologous pure decompression bone block as single interbody fusion material and the control group had 18 cases with cage and autologous bone as interbody fusion material. Clinical data, bone healing time, interbody fusion rate, intervertebral height and curative effect were analyzed in two groups. RESULTS All the patients were followed up for 12 to 24 months with an average of 16 months. There was no significant difference in age, sex ratio, degree of lumbar instability, or follow-up time between two groups(P>0.05); and there was no significant difference in curative effect, intervertebral height loss, or interbody fusion rate between two groups(P>0.05). CONCLUSIONS Using self-decompression bone block fusion can get high fusion rate, maintain good intervertebral height, obtain satisfactory curative effect. Its design was scientific and reasonable with less complication, which provide an effective, economic, and practical method for degenerative lumbar instability and spinal stenosis.
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Affiliation(s)
- Fan-Zhi Meng
- The Second Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Linyi City, Linyi 276002, Shandong, China;
| | - Qin Gao
- The Second Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Linyi City, Linyi 276002, Shandong, China
| | - Xing-Long Wang
- The Second Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Linyi City, Linyi 276002, Shandong, China
| | - Yong He
- The Second Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Linyi City, Linyi 276002, Shandong, China
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Barzilai O. Current Role of Uninstrumented Lumbar Fusion. World Neurosurg 2018; 115:509-511. [PMID: 29783011 DOI: 10.1016/j.wneu.2018.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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19
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Akhavan-Sigari R, Rohde V, Prasad SK, Vahedi P. Uninstrumented Posterior Lumbar Interbody Fusion-Evidence Based or Matter of Habit? Perspective Statement. World Neurosurg 2018; 115:506-508. [PMID: 29775767 DOI: 10.1016/j.wneu.2018.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Srinivas K Prasad
- Department of Neurological Surgery, Division of Spine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Payman Vahedi
- Department of Neurological Surgery, Division of Spine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Bohl MA, Almefty KK, Preul MC, Turner JD, Kakarla UK, Reece EM, Chang SW. Vascularized Spinous Process Graft Rotated on a Paraspinous Muscle Pedicle for Lumbar Fusion: Technique Description and Early Clinical Experience. World Neurosurg 2018; 115:186-192. [PMID: 29673822 DOI: 10.1016/j.wneu.2018.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Vascularized bone grafts (VBGs) are described as having superior osteogenicity, osteoconductivity, and osteoinductivity compared with other graft types and have been used in high-risk patients to augment arthrodesis. Pedicled VBGs are rotated on an intact vascular pedicle and therefore maintain all the benefits of VBGs but avoid many of the challenges and additional morbidity of free-tissue transfer. This study describes a novel surgical technique for rotating vascularized spinous process into the posterolateral space for augmenting arthrodesis in patients undergoing posterolateral fusion (PLF). METHODS A technique is described for rotating the spinous process into the posterolateral space on an intact vascular pedicle of paraspinal muscle. Early clinical and radiographic outcomes are reported for 4 patients who have undergone this procedure. RESULTS Four patients were treated with a single or 2-level PLF combined with posterior, anterior, or lateral interbody fusion and vascularized spinous process graft. Three-month postoperative computed tomography scans demonstrated a dislodged graft in 1 patient and successful arthrodesis in 3 patients. Additional operative time taken for graft harvest and implantation ranged from 22 minutes for the first patient to 6 minutes for the fourth patient. CONCLUSIONS Rotation of vascularized spinous process graft for augmentation of posterolateral arthrodesis in the lumbar spine is a potentially safe, effective surgical technique that results in successful arthrodesis in as little as 3 months but requires further study. This technique is expected to add little additional time or morbidity to the traditional lumbar PLF because it requires no separate incision or additional bone removal.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Edward M Reece
- Departments of Neurosurgery and Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Prolo LM, Oklund SA, Zawadzki N, Desai M, Prolo DJ. Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes? World Neurosurg 2018; 115:490-502. [PMID: 29631080 DOI: 10.1016/j.wneu.2018.03.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the 1980s, numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These operations often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of PLIF with allogeneic bone (allo-PLIF). METHODS Between 1981 and 2006, 321 patients aged 12-80 years underwent 339 1-level or 2-level allo-PLIFs for degenerative instability and were followed for 1-28 years. Fusion status was determined by radiographs and as available, by computed tomography scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. RESULTS Of the 321 patients, 308 were followed postoperatively (average 6.7 years) and 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, P = 0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores after initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (P = 0.001). A positive association between a patient characteristic and outcome was observed only with age 65 years and greater, whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to the low back, or industrial injuries. The total complication rate was 7%. CONCLUSIONS With 3 decades of follow-up, we found that successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone.
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Affiliation(s)
- Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sally A Oklund
- Western Transplantation Services, San Jose, California, USA
| | - Nadine Zawadzki
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donald J Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Western Transplantation Services, San Jose, California, USA.
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Balasubramanian VA, Douraiswami B, Subramani S. Outcome of transforaminal lumbar interbody fusion in spondylolisthesis-A clinico-radiological correlation. J Orthop 2018; 15:359-62. [PMID: 29881153 DOI: 10.1016/j.jor.2018.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Lumbar spondylolisthesis is a common cause of morbidity in middle aged individuals. Spinal fusion with instrumentation has become the gold standard for lumbar segmental instability. Studies which correlate the improvement in radiology postoperatively with functional outcome show contrasting reports. This study is aimed at finding the correlation between clinical and radiological outcomes after surgery with transforaminal lumbar interbody fusion. Methods A retrospective study in 35 patients who underwent transforaminal lumbar interbody fusion in a period of 1 year was done. Preoperative pain (VAS Score), functional ability (ODI), radiological parameters (slip angle, slip grade, disc height, foraminal height, lumbar lordosis) were compared with postoperative recordings at the last followup. Functional improvement (Macnab's criteria) and fusion (Lee's fusion criteria) were assessed. Statistical analysis was done with student's paired t-test and Pearson's correlation coefficient. Results VAS score, ODI improved from 8 to 2 and 70 to 15 respectively. Slip angle improved from 23°to 5° on an average. 80% patients showed fusion and 85% showed good clinical outcome at 1 year followup. Analyzing with Pearson correlation coefficient showed no significant relation between pain scores and radiological parameters. But there was statistically significant relation between radiological fusion and the final clinical outcome. Conclusion TLIF produces spinal fusion in most individuals. Strong spinal fusion is essential for good clinical outcome in spondylolisthesis patients who undergo TLIF. Reduction in slip is not necessary for all patients with listhesis.
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Ferrari S, Manni T, Bonetti F, Villafañe JH, Vanti C. A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice. Chiropr Man Therap 2015; 23:14. [PMID: 25866618 PMCID: PMC4392873 DOI: 10.1186/s12998-015-0058-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/22/2015] [Indexed: 01/15/2023] Open
Abstract
Background Several clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice. Methods We searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales. Results Six papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97). The diagnostic accuracy of AMP depends on each singular test. The PIT and the PST demonstrated by fair to moderate sensitivity and specificity [PIT sensitivity = 0.71 (95% CI: 0.51 - 0.83), PIT specificity = 0.57 (95% CI: 039 - 0.78); PST sensitivity = 0.50 (95% CI: 0.41 - 0.76), PST specificity = 0.48 (95% CI: 0.22 - 0.58)]. The PLE showed a good reliability (k = 0.76), but this result comes from a single study. The inter-rater reliability of the PIT ranged by slight (k = 0.10 and 0.04), to good (k = 0.87). The inter-rater reliability of the AMP ranged by slight (k = −0.07) to moderate (k = 0.64), whereas the inter-rater reliability of the PST was fair (k = 0.27). Conclusions The data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients. Electronic supplementary material The online version of this article (doi:10.1186/s12998-015-0058-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvano Ferrari
- Master of Manual Therapy and Musculoskeletal Rehabilitation, Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | | | | | - Carla Vanti
- Master of Manual Therapy and Musculoskeletal Rehabilitation, Department of Molecular Medicine, University of Padova, Padova, Italy
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Lee SW, Kim SY. Effects of hip exercises for chronic low-back pain patients with lumbar instability. J Phys Ther Sci 2015; 27:345-8. [PMID: 25729164 PMCID: PMC4339134 DOI: 10.1589/jpts.27.345] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare hip range of motion between a lumbar
stability group and a lumbar instability group, and to evaluate the effectiveness of hip
exercises for low-back pain patients with lumbar instability. [Subjects] Seventy-eight
patients with chronic low-back pain were the subjects. [Methods] The patients were divided
into two groups: a lumbar stability group (n=45) and a lumbar instability group (n=33).
They were assessed using the Korean version of the Oswestry Disability Index (KODI) to
determine the level of disability of the patients with low-back pain. A 100 mm visual
analog scale (VAS) was used to assess low-back pain. [Results] The limitation of hip range
of motion of the lumbar instability group was significantly greater than that of the
lumbar stability group. Comparisons among four groups at three weeks and six weeks after
the start of hip exercises revealed that the VAS score of each group had significantly
decreased. Comparisons among four groups at three weeks and at six weeks after the start
of hip exercises revealed that the KODI score of each group had significantly decreased.
[Conclusion] These findings suggest that the performance of hip exercises by chronic
low-back pain patients with lumbar instability is more effective than conventional therapy
at reducing low-back pain and levels of disability.
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Affiliation(s)
- Sang Wk Lee
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
| | - Suhn Yeop Kim
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
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Lee SW, Kim SY. Comparison of chronic low-back pain patients hip range of motion with lumbar instability. J Phys Ther Sci 2015; 27:349-51. [PMID: 25729165 PMCID: PMC4339135 DOI: 10.1589/jpts.27.349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare differences in hip range of motion between a lumbar stability group and a lumbar instability group of patients with chronic low-back pain. [Subjects] Sixty-nine patients with chronic low-back pain were divided into two groups: a lumbar stability group (n=39) and a lumbar instability group (n=30). [Methods] The patients were assessed using a goniometer to evaluate the hip range of motion at pre-test. Data were analyzed using SPSS 18.0 software for Windows. The experimental data were analyzed using one-way ANOVA, repeated one-way ANOVA, and the t-test, and a significance level of 0.05. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. [Conclusion] The chronic low-back pain patients showed greater limitation of hip range of motion than healthy persons, and among them, those who had lumbar instability showed greater limitation than those with lumbar stability.
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Affiliation(s)
- Sang wk Lee
- Graduate School of Physical Therapy, Daejeon University,
Republic of Korea
| | - Suhn Yeop Kim
- Graduate School of Physical Therapy, Daejeon University,
Republic of Korea
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Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011. MATERIALS AND METHODS Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab's criteria) were compared. RESULTS Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF. CONCLUSIONS Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.
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Affiliation(s)
- Najmus Sakeb
- Department of Orthopaedic Surgery, Islami Bank Central Hospital, Anjuman Mufidul Islam Road, Kakrail, Bangladesh,Address for correspondence: Dr. Najmus Sakeb, Room No 605, Islami Bank Central Hospital, 30, Anjuman Mufidul Islam Road, Kakrail, Dhaka - 1000, Bangladesh. E-mail:
| | - Kamrul Ahsan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. N Am J Med Sci 2012; 3:456-61. [PMID: 22363083 PMCID: PMC3271424 DOI: 10.4297/najms.2011.3456] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Lumbar segmental stability is an important biomechanical component that influences symptoms amongst patients with Mechanical low back pain. Aims: To compare the efficacy of segmental stabilization exercises utilizing multifidus and transversus abdominis muscles versus a placebo treatment in patients with lumbar segmental instability. Materials and methods: The study was an observer-blinded randomized placebo-controlled cross-over study of 18 adults (12 men, 6 women), of mean age 22.5 ± 1.09 yrs who scored 7/13 in subjective aspects and 8/14 in objective aspects of Delphi criteria for lumbar segmental instability. The selected subjects were then randomized to receive either placebo-control (prone lying) or experimental (lumbar segmental stabilization) as a first treatment. Each treatment was followed by a wash-out period of 24 hours. Outcomes were measured four times- pre- and post- first intervention, pre- and post- second intervention. The outcome measures used were pain on Visual analogue scale, Pressure pain threshold and Joint play grading scale (0-6 scale) on that level. Results: Two-way analysis of variance and post-hoc analysis using Bonferonni test were used with level of significance set at p<.05 using Statistical package for social sciences version 12.0.1 for Windows. Visual analogue scale changed significantly in both the periods of intervention- in control (P =.016) and experimental (P =.000) periods. However this improvement was more significant in the experimental period. The Joint play grading scale scores improved only in the experimental condition compared to the control condition significantly. The Pressure pain threshold also improved significantly in the experimental condition (P =.000) while the changes in control condition was not statistically significant (P=.816). Conclusion: Segmental stabilization exercise was more effective than placebo intervention in symptomatic lumbar segmental instability.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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