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Kort AE, Jones KE. Function of revolute zygapophyses in the lumbar vertebrae of early placental mammals. Anat Rec (Hoboken) 2024; 307:1918-1929. [PMID: 37712919 DOI: 10.1002/ar.25323] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
The unique morphology of mammalian lumbar vertebrae allows the spine to flex and extend in the sagittal plane during locomotion. This movement increases stride length and allows mammals to efficiently breathe while running with an asymmetric gait. In extant mammals, the amount of flexion that occurs varies across different locomotor styles, with dorsostable runners relying more on movement of long limbs to run and dorsomobile runners incorporating more flexion of the back. Although long limbs and a stabilized lumbar region are commonly associated with each other in extant mammals, many "archaic" placental mammals with short limbs had lumbar vertebrae with revolute zygapophyses. These articulations with an interlocking S-shape are found only in artiodactyls among extant mammals and have been hypothesized to stabilize against flexion of the back. This would suggest that archaic placental mammals may not have incorporated dorsoventral flexion into locomotion to the same extent as extant mammals with similar proportions. We tested the relative mobility of fossil lumbar vertebrae from two early placental mammals, the creodonts Patriofelis and Limnocyon, to see how these vertebrae may have functioned. We compared range of motion (ROM) between the original vertebrae, with revolute morphology and digitally altered vertebrae with a flat morphology. We found that the revolute morphology had relatively little effect on dorsoventral flexion and instead that it likely prevented disarticulation due to shear forces on the spine. These results show that flexion of the spine has been an important part of mammalian locomotion for at least 50 million years.
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Affiliation(s)
- Anne E Kort
- Department of Earth and Environmental Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Katrina E Jones
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK
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Hung CY, Wang B, Chang HC, Wu WT, Liu PT, Chang KV, Su DCJ, Mezian K, Ricci V, Özçakar L. Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome. Life (Basel) 2024; 14:499. [PMID: 38672769 PMCID: PMC11051048 DOI: 10.3390/life14040499] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, Taipei 24213, Taiwan;
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | | | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, 12800 Prague, Czech Republic;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Hipp J, Grieco T, Newman P, Patel V, Reitman C. Reference Data for Diagnosis of Spondylolisthesis and Disc Space Narrowing Based on NHANES-II X-rays. Bioengineering (Basel) 2024; 11:360. [PMID: 38671782 PMCID: PMC11048070 DOI: 10.3390/bioengineering11040360] [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: 03/08/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Robust reference data, representing a large and diverse population, are needed to objectively classify measurements of spondylolisthesis and disc space narrowing as normal or abnormal. The reference data should be open access to drive standardization across technology developers. The large collection of radiographs from the 2nd National Health and Nutrition Examination Survey was used to establish reference data. A pipeline of neural networks and coded logic was used to place landmarks on the corners of all vertebrae, and these landmarks were used to calculate multiple disc space metrics. Descriptive statistics for nine SPO and disc metrics were tabulated and used to identify normal discs, and data for only the normal discs were used to arrive at reference data. A spondylolisthesis index was developed that accounts for important variables. These reference data facilitate simplified and standardized reporting of multiple intervertebral disc metrics.
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Affiliation(s)
- John Hipp
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | - Trevor Grieco
- Medical Metrics, Houston, TX 77056, USA; (T.G.); (P.N.)
| | | | - Vikas Patel
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Charles Reitman
- Medical University of South Carolina, Charleston, SC 29425, USA;
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Ding Z, Di D, Wang L, Liu X. Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes. J Neurosurg Spine 2024:1-8. [PMID: 38579351 DOI: 10.3171/2024.1.spine23841] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/24/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors' knowledge of its mechanisms comes from in vitro biomechanical research only; there is a lack of radiographic evidence of the effects of violation on the superior adjacent-segment facet joint, intervertebral disc, and other local radiographic parameters. Furthermore, any differences between unilateral and bilateral violation remain relatively unclear. The authors therefore aimed to explore the effects of nonviolation and unilateral and bilateral violation on radiographic degeneration of the facet joint and intervertebral disc at the fusion and superior adjacent segment. Patient-reported clinical outcomes were compared at the 2-year follow-up. METHODS The authors retrospectively analyzed data from 148 patients with lumbar degenerative diseases who underwent single-segment minimally invasive transforaminal lumbar interbody fusion between 2016 and 2020. FJV and facet joint degeneration were evaluated and graded using Shah's method and Pathria's standard, respectively. Radiographic parameters, including disc height and intervertebral Cobb angle at the fusion and superior adjacent segment, were measured. Clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association scores. RESULTS Preoperative data were comparable among the 3 groups (nonviolation, unilateral violation, and bilateral violation) (p > 0.05). Patient-reported clinical outcomes were followed up for at least 2 years (average duration 28.17 ± 6.17 months). At the last follow-up, facet joint degeneration grades were sequentially increased in the nonviolation, unilateral violation, and bilateral violation groups (p = 0.006). The unilateral (2.45 ± 2.17 mm) and bilateral (2.70 ± 1.94 mm) violation groups had more severe losses of disc height in the superior adjacent segment than did the nonviolation group (1.31 ± 2.01 mm). The VAS low-back pain and Japanese Orthopaedic Association scores in the bilateral (2.57 ± 1.44 and 19.83 ± 2.84, respectively) and unilateral (2.26 ± 0.79 and 20.43 ± 3.85, respectively) violation groups were significantly worse than in the nonviolation group (1.69 ± 1.12 and 21.80 ± 3.36, respectively) (p < 0.05). By contrast, there were no significant between-group differences in disc height, intervertebral Cobb angle in the fusion segment, or VAS leg pain scores (p > 0.05). CONCLUSIONS FJV was associated with postoperative low-back pain and worse functional outcomes. It also aggravated facet joint and intervertebral disc changes in the superior adjacent segment, especially when bilateral violation occurred; this may be part of the mechanisms of adjacent-segment degeneration.
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Affiliation(s)
- Zhiguo Ding
- 1Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong
- 2Department of Orthopedics, Shouguang People's Hospital, Shouguang, Shandong; and
| | - Derun Di
- 1Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong
- 3Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lianlei Wang
- 1Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong
- 3Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xinyu Liu
- 1Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong
- 3Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Kumar N, Akosman I, Mortenson R, Kumar A, Xu G, Lathrop C, Bakhmat K, Amen TB, Hussain I. Gender disparities in postoperative outcomes following elective spine surgery: a systematic review and meta-analysis. J Neurosurg Spine 2024; 40:420-427. [PMID: 38157525 DOI: 10.3171/2023.11.spine23979] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Several studies have described disparities between male and female patients following spine surgery, but no pooled analyses have performed a robust review characterizing differences in postoperative outcomes based on gender. The purpose of this study was to broadly assess the effects of gender on postoperative outcomes following elective spine surgery. METHODS Between November 2022 and March 2023, PubMed, MEDLINE, ERIC, and Embase were queried using artificial intelligence-assisted software for relevant cohort studies. Cohort studies with a minimum sample of 100 patients conducted in the United States since 2010 were eligible. Studies related to trauma, tumors, infections, and spinal cord pathology were excluded. Independent extraction by multiple reviewers was performed using Nested Knowledge software. A fixed- or random-effects model was used if heterogeneity among included studies in a meta-analysis was < 50% or ≥ 50%, respectively. Risk of bias was assessed independently by multiple reviewers using the Newcastle-Ottawa Scale. Pooled effect sizes were calculated for readmission, nonroutine discharge (NRD), length of stay (LOS), extended LOS, reoperation, mortality, all medical complications (individual analyses for cardiovascular, deep venous thrombosis/pulmonary embolism, genitourinary, neurological, respiratory, and systemic infection complications), and wound-related complications. For each outcome, two subanalyses were performed with studies that used either center-based (single- or multi-institution) or high-volume (national or state-wide) databases. RESULTS Across 124 included studies, male patients had an increased incidence of mortality (OR 0.54, p < 0.0001) and all medical complications (OR 0.80, p = 0.0114), specifically cardiovascular (OR 0.68, p < 0.0001) and respiratory (OR 0.76, p = 0.0008) complications. Female patients were more likely to experience a wound-related surgical complication (OR 1.16, p = 0.0183). These findings persisted in the high-volume database subanalyses. Only center-based subanalyses showed that female patients were at greater odds of experiencing an NRD (OR 1.18, p = 0.0476), longer LOS (SMD 0.23, p = 0.0036), and extended LOS (OR 1.28, p < 0.0001). CONCLUSIONS Males are more likely to experience death and medical complications, whereas females were more likely to face wound-related surgical complications. At the institution level, females more often experience NRD and longer hospital stays. These findings may better inform preoperative expectation management and provide more detailed postoperative risk assessments based on the patient's gender.
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Affiliation(s)
- Neerav Kumar
- 1Weill Cornell Medical College, New York, New York
| | | | | | | | - Grace Xu
- 4Princeton University, Princeton, New Jersey
| | - Cooper Lathrop
- 5Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Troy B Amen
- 7Hospital for Special Surgery, New York, New York; and
| | - Ibrahim Hussain
- 8Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
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Kaen A, Quillo-Olvera J, Park MK, Rocha S, Durand F, Martin I, Son SK. Five-step unilateral biportal endoscopic surgery for central lumbar canal stenosis: "Z" technique nuance. Neurosurg Focus Video 2024; 10:V3. [PMID: 38616911 PMCID: PMC11013373 DOI: 10.3171/2024.1.focvid23182] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the "Z" sequence, which aims to reduce surgical time and complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23182.
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Affiliation(s)
- Ariel Kaen
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Javier Quillo-Olvera
- Neurosurgery Unit, Spine Center, Hospital Angeles Centro Sur, Querétaro City, Mexico
| | - Man Kyu Park
- Department of Neurosurgery, Good Gangan Hospital, Busan, Korea; and
| | - Santiago Rocha
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Fernando Durand
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Ignacio Martin
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Sang-Kyu Son
- Department of Neurosurgery, Good Moonhwa Hospital, Busan, Korea
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Wang Y, Wang F, Tong T, Miao D, Li W, Zhu H, Zheng X, Wang L. Sex differences in the accuracy of vertebral bone quality score assessing bone density in patients undergoing lumbar spinal fusion. J Neurosurg Spine 2024; 40:405-411. [PMID: 38157527 DOI: 10.3171/2023.10.spine23721] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides a tool for primary screening of bone density. The validity of this score as a predictor across sexes has not been investigated. This study aimed to explore the effect of sex on the diagnostic efficacy of the VBQ in predicting osteopenia/osteoporosis and whether a sex-specific threshold exists. METHODS In this retrospective cohort study, patients who underwent lumbar fusion at a tertiary care center were reviewed. VBQ was obtained by noncontrast T1-weighted MRI. Patients were stratified according to sex and bone density. Data were analyzed between the groups. Pearson correlation analysis and linear regression were used to analyze the correlation between the VBQ and DEXA T values. Receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC) calculation, was used to evaluate the predictive performance of VBQ for low BMD in both sexes. RESULTS A total of 271 patients (92 male, 179 female patients) were analyzed. The correlation coefficient between VBQ and the lowest T value was -0.40 for male and -0.554 for female patients. In comparing the bone density subgroups, among male patients a significant difference in the VBQ scores was observed only between the normal and osteoporosis subgroups (p = 0.012). VBQ demonstrated statistically significant differences among female patients across all three subgroups (p < 0.001). The ROC analysis revealed that the predictive performance of VBQ in detecting low BMD was more consistent with the gold-standard DEXA results in female than in male patients (AUC 0.647 vs AUC 0.823, p = 0.02). The optimal thresholds were similar in both sexes. CONCLUSIONS Compared with male patients, VBQ has better discrimination between female patients with low BMD and those with normal bone density. Although the correlation between VBQ and bone density is weaker in male than in female patients, the optimal thresholds are similar in both sexes.
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Affiliation(s)
- Yunsheng Wang
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Feng Wang
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Tong Tong
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Dechao Miao
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Wenshuai Li
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Houze Zhu
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Xiao Zheng
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Linfeng Wang
- 1Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei; and
- 2Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
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Heo DH. Biportal endoscopic transforaminal lumbar interbody fusion using a large cage for degenerative spondylolisthesis with stenosis. Neurosurg Focus Video 2024; 10:V15. [PMID: 38616903 PMCID: PMC11013353 DOI: 10.3171/2024.1.focvid23231] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
Recently, biportal endoscopic transforaminal lumbar interbody fusion (TLIF) has been used to treat lumbar degenerative diseases, such as lumbar instability and spondylolisthesis. Biportal endoscopic TLIF may have the advantages of endoscopic spine approaches and minimally invasive lumbar fusion surgeries. In this biportal endoscopic TLIF, large cages similar to oblique lumbar interbody fusion (OLIF) cages have been used. Biportal endoscopic TLIF using a large cage can be successfully performed in the lower lumbar area. The author presents the surgical technique of biportal endoscopic TLIF using a large cage. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23231.
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Affiliation(s)
- Dong Hwa Heo
- Department of Neurosurgery, Endoscopic Spine Surgery Center, Chungdam Harrison Spinartus Hospital, Seoul, South Korea
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Ekşi MŞ, Özcan-Ekşi EE, Orhun Ö, Huet SE, Turgut VU, Pamir MN. Association between facet joint orientation/tropism and lumbar intervertebral disc degeneration. Br J Neurosurg 2024; 38:293-300. [PMID: 33356603 DOI: 10.1080/02688697.2020.1864289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Background: The aim of this study was to understand how facet joint orientation (FJO) and facet joint tropism (FJT) affected severe intervertebral disc degeneration (IVDD) process at lower lumbar levels in patients with LBP.Methods: This study is a cross-sectional analysis of a retrospective database. Patients were evaluated in terms of IVDD, FJO, and FJT at all lumbar levels on magnetic resonance imaging.Results: In this study (n: 123) facet joints were aligned more coronal in men than in women at upper lumbar levels. Men had less FJT compared to women, significantly at L2-L3 and L3-L4 levels. Severe IVDD at L4-L5 was associated with more coronal aligned L1-L2 (29.0 ± 2.5° vs. 23.3 ± 2.3°, p = 0.006) and misaligned L5-S1 (8.3 ± 1.9° vs. 4.5 ± 1.7°, p = 0.008). Besides, severe IVDD at L3-L4 was associated with more coronal aligned L4-L5 (49.1 ± 3.2° vs. 41.4 ± 2.8°, p = 0.014).Conclusion: There is a close association between FJO/FJT with lumbar IVDD. Facet joint orientation and FJT do not affect the disc at only the corresponding level; the lumbar spine should be evaluated as a whole.
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Affiliation(s)
- Murat Şakir Ekşi
- Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, İstanbul, Turkey
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Sibel Emilie Huet
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Veli Umut Turgut
- Antalya Atatürk State Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - M Necmettin Pamir
- Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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Liu C, Liu Q, Zheng J, Niu N, Shi J, Yang Z. Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study. Front Surg 2024; 11:1365498. [PMID: 38596166 PMCID: PMC11003786 DOI: 10.3389/fsurg.2024.1365498] [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: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Objective This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance. Methods A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated. Results The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up. Conclusion Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.
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Affiliation(s)
- Changhao Liu
- Department of Orthopedics, Zhangye People’s Hospital Affiliated to Hexi University, Zhangye, Gansu, China
| | - Qiang Liu
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianping Zheng
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ningkui Niu
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zongqiang Yang
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Agustini D, Heimann MK, Co M, Walter BA, Purmessur D, Moore SA. Modic changes in the lumbar vertebral column of chondrodystrophic and non-chondrodystrophic dogs with intervertebral disc disease. Front Vet Sci 2024; 11:1359016. [PMID: 38566749 PMCID: PMC10985344 DOI: 10.3389/fvets.2024.1359016] [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: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Modic changes (MC) are signs of vertebral pathology visible on magnetic resonance (MR) images that have been associated with low back pain (LBP) and disc degeneration in people. Multiple breeds of dogs also develop MCs and coincident back pain. However, the association between breed, MC, and spinal pathologies has yet to be fully elucidated. This study aimed to identify the prevalence of MC that occur spontaneously in the lumbar vertebral column of dogs diagnosed with intervertebral disc disease (IVDD) and examine their association with demographic criteria and the disc width index (DWI). Methods Medical records and lumbar vertebral column MR images were examined from 104 dogs (831 intervertebral disc spaces and adjacent vertebrae), which were divided into three groups: chondrodystrophic dogs (CD; n =54) and non-chondrodystrophic dogs (NCD; n =30) with IVDD as the primary diagnosis, and control dogs (n =20) with other spinal diseases as their primary diagnosis. Results Increasing age and a diagnosis of IVDD were significantly associated with MC in dogs (p < 0.001 and p = 0.0062, respectively). In CD dogs with IVDD, Type 2 MC were most prevalent, whereas, in NCD dogs, Type 3 MC were the most prevalent type. Type 2 MC were distributed nearly equally across the lumbar vertebral column, while Type 3 MC were primarily detected at the level of L7-S1. Discussion This study demonstrated that MC developed spontaneously in dogs, are common in dogs diagnosed with IVDD, and the type observed varies by breed. Further research is needed to understand the pathogenesis of MC; however, the increased presence of Type 2 MC in CD dogs, similar to what is found in people with disc degeneration, suggests that CD dogs could serve as models for MC in people.
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Affiliation(s)
- Dyah Agustini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Mary K Heimann
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Megan Co
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Benjamin A Walter
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Devina Purmessur
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH, United States
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
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12
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Klinge PM, Leary OP, Allen PA, Svokos K, Sullivan P, Brinker T, Gokaslan ZL. Clinical criteria for filum terminale resection in occult tethered cord syndrome. J Neurosurg Spine 2024:1-9. [PMID: 38489815 DOI: 10.3171/2024.1.spine231191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Tethered cord syndrome (TCS) comprises three symptom categories: back/leg pain, bowel/bladder, and neurological complaints. MRI typically reveals a low-lying conus medullaris, filum terminale (FT) pathology, or lumbosacral abnormalities. FT resection is established in TCS but not in radiologically occult TCS (OTCS). This study aims to identify patients with OTCS who are likely to benefit from FT resection. METHODS The authors recruited 149 patients with OTCS (31 pediatric, 118 adult) treated with FT resection-including only cases with progressive TCS, negative spine MRI, and no concurrent neurological/urological conditions. A comprehensive questionnaire collected patient self-reported symptoms and clinical findings at the preoperative and at 3- and 12-month follow-up examinations. Based on questionnaire data, the authors extracted a 15-item symptoms and findings scale to represent the three TCS symptom categories, assigning 1 point for each item present. RESULTS OTCS presents without radicular/segmental sensorimotor findings, but with leg/back pain and conus dysfunction, in addition to leg fatigue and spasticity; the latter indicating an upper motoneuron pathology. The 15-item scale showed clinical improvement in 89% of patients at the 3-month follow-up and 68% at the 12-month follow-up. Multivariate analysis of the scale revealed that it accurately predicts outcome of FT resection in 82% of cases. Patients with a preoperative score exceeding 6 points are most likely to benefit from surgery. CONCLUSIONS By applying the study's inclusion criteria and incorporating the novel 15-item scale, surgeons can effectively select candidates for FT resection in patients with OTCS. The observed outcomes in these selected patients are comparable to those achieved in degenerative spine surgery.
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Affiliation(s)
- Petra M Klinge
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Owen P Leary
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Philip A Allen
- 2Department of Psychology, University of Akron, Ohio; and
| | - Konstantina Svokos
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Patricia Sullivan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Thomas Brinker
- 3Department of Neurosurgery, Medical School Hannover, Germany
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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13
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Fujimoto M, Miyazaki T, Yamamoto A, Ikezawa M, Tanioka S, Nishikawa H, Mizuno M, Suzuki H. A novel approach to evaluation of lumbar bone density using Hounsfield units in volume of interest on computed tomography imaging. J Neurosurg Spine 2024:1-9. [PMID: 38457796 DOI: 10.3171/2024.1.spine231137] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/08/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The purpose of this retrospective study was to evaluate the relationship between bone mineral density (BMD), as assessed with dual-energy x-ray absorptiometry (DEXA), and Hounsfield units (HU) measured in volumes of interest (VOIs) and regions of interest (ROIs) on lumbar spine CT. METHODS A retrospective analysis was performed on data of lumbar vertebrae obtained from patients who underwent both DEXA and lumbar spine CT scan within a 6-month period. Vertebrae with a history of compression fracture, infectious spondylitis, cement reinforcement, or lumbar surgery were excluded. HU measurements were performed in the VOI and ROI (midaxial, midcoronal, and midsagittal sections) with CT, whereas BMD was assessed with DEXA. Statistical analyses, including correlation assessments and receiver operating characteristic (ROC) curve analyses, were performed. RESULTS This analysis included 712 lumbar vertebrae, with a median patient age of 72.0 years. BMD values and HU measurements in the VOI increased sequentially from L1 to L4, whereas HU values in the ROI did not show a consistent pattern. HU values in the VOI consistently showed a stronger correlation with BMD than those in the ROI. ROC analysis revealed patient-level cutoff values for the diagnosis of osteoporosis at different lumbar vertebral levels with high sensitivity and specificity, as well as an excellent area under the curve. CONCLUSIONS This is the first study to introduce a novel approach using the HU value in the VOI to assess bone health at the lumbar spine. There is a strong correlation between the HU value in the VOI and BMD, and the HU value in the VOI can be used to predict osteoporosis.
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Affiliation(s)
| | - Takahiro Miyazaki
- 2Department of Neurosurgery, Suzuka Kaisei Hospital, Kou-cho, Suzuka, Mie, Japan
| | - Atsushi Yamamoto
- 3Department of Neurosurgery, Mie Prefectural General Medical Center, Hinaga, Yokkaichi, Mie, Japan
| | - Munenari Ikezawa
- 4Department of Neurosurgery, Mie Chuo Medical Center, Hisai-myojin-cho, Tsu, Mie, Japan; and
| | - Satoru Tanioka
- 5Charité Lab for Artificial Intelligence in Medicine, Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | | | - Masaki Mizuno
- 2Department of Neurosurgery, Suzuka Kaisei Hospital, Kou-cho, Suzuka, Mie, Japan
- 6Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Edobashi, Tsu, Mie, Japan
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Humphreys SC, Hodges SD, Sielatycki JA, Sivaganesan A, Block JE. Are We Finally Ready for Total Joint Replacement of the Spine? An Extension of Charnley's Vision. Int J Spine Surg 2024; 18:24-31. [PMID: 38071570 DOI: 10.14444/8538] [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] [Indexed: 03/06/2024] Open
Abstract
Professor Sir John Charnley has been rightfully hailed as a visionary innovator for conceiving, designing, and validating the Operation of the Century-the total hip arthroplasty. His groundbreaking achievement forever changed the orthopedic management of chronically painful and dysfunctional arthritic joints. However, the well-accepted surgical approach of completely removing the diseased joint and replacing it with a durable and anatomically based implant never translated to the treatment of the degenerated spine. Instead, decompression coupled with fusion evolved into the workhorse intervention. In this commentary, the authors explore the reasons why arthrodesis has remained the mainstay over arthroplasty in the field of spine surgery as well as discuss the potential shift in the paradigm when it comes to treating degenerative lumbar disease.
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Affiliation(s)
| | - Scott D Hodges
- Center for Sports Medicine and Orthopedics, Chattanooga, TN, USA
| | - J Alex Sielatycki
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | | | - Jon E Block
- Independent Consultant, San Francisco, CA, USA
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15
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Ton A, Hang N, Liu W, Liu R, Hsieh PC, Wang JC, Hah RJ, Alluri RK. Top 25 Most-Cited Articles on Robotic-Assisted Lumbar Spine Surgery. Int J Spine Surg 2024; 18:37-46. [PMID: 38123971 DOI: 10.14444/8565] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Robot-guided lumbar spine surgery has evolved rapidly with evidence to support its utility and feasibility compared with conventional freehand and fluoroscopy-based techniques. The objective of this study was to assess trends among the top 25 most-cited articles pertaining to robotic-guided lumbar spine surgery. METHODS An "advanced document search" using Boolean search operator terms was performed on 16 November 2022 through the Web of Science and SCOPUS citation databases to determine the top 25 most-referenced articles on robotic lumbar spine surgery. The articles were compiled into a directory and hierarchically organized based on the total number of citations. RESULTS Cumulatively, the "Top 25" list for robot-assisted navigation in lumbar spine surgery received 2240 citations, averaging 97.39 citations annually. The number of citations ranged from 221 to 40 for the 25 most-cited articles. The most-cited study, by Kantelhardt et al, received 221 citations, averaging 18 citations per year. CONCLUSIONS As utilization of robot-guided modalities in lumbar spine surgery increases, this review highlights the most impactful studies to support its efficacy and implementation. Practical considerations such as cost-effectiveness, however, need to be better defined through further longitudinal studies that evaluate patient-reported outcomes and cost-utility. CLINICAL RELEVANCE Through an overview of the top 25 most-cited articles, the present review highlights the rising prominence and technical efficacy of robotic-guided systems within lumbar spine surgery, with consideration to pragmatic limitations and need for additional data to facilitate cost-effective applications. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Nicole Hang
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - William Liu
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Ryan Liu
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Raymond J Hah
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA
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16
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McDermott M, Rogers M, Prior R, Michna R, Guiroy A, Asghar J, Patel A. Single-Position Prone Lateral Lumbar Interbody Fusion Technique Guide: Surgical Tips and Tricks. Int J Spine Surg 2024; 18:110-116. [PMID: 38365737 DOI: 10.14444/8573] [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] [Indexed: 02/18/2024] Open
Abstract
Lateral lumbar interbody fusion (LLIF) is a popular technique as it allows for the placement of a large interbody implant through a retroperitoneal, transpsoas working corridor. Historically, the interbody is placed with the patient in lateral decubitus and then repositioned to prone for the posterior instrumentation. While this has been an effective and successful technique, removing the interoperative flip would improve the efficiency of these cases. This has led to modified LLIF approaches including single-position prone LLIF (pLLIF). This modification has shown to be an efficient and powerful technique; however, learning to navigate the LLIF approach in the prone position has its own challenges. The purpose of this article is to provide a detailed description of our pLLIF technique while simultaneously introducing surgical tips to overcome the challenges of the approach and optimize the implantation of the interbody device.
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Affiliation(s)
| | - Michael Rogers
- Spine Surgery, Duly Health and Care, Naperville, IL, USA
| | - Robert Prior
- Franciscan Health Olympia Fields, Olympia Fields, IL, USA
| | - Rebecca Michna
- Spine Surgery, Duly Health and Care, Naperville, IL, USA
| | | | | | - Ashish Patel
- Spine Surgery, Duly Health and Care, Naperville, IL, USA
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17
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Leyendecker J, Benedict B, Gumbs C, Eysel P, Bredow J, Telfeian A, Derman P, Kashlan O, Amin A, Konakondla S, Hofstetter CP, Ogunlade J. Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes. J Neurosurg Spine 2024; 40:359-364. [PMID: 38064701 DOI: 10.3171/2023.10.spine23936] [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] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18-30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (-3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (-4.4 ± 3.2 vs -2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: -11.4 ± 11.4 vs -9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: -4.3 ± 3.9 vs -3.5 ± 3.8, p = 0.28). CONCLUSIONS The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.
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Affiliation(s)
- Jannik Leyendecker
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Braeden Benedict
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Peer Eysel
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Jan Bredow
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- 5Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | - Albert Telfeian
- 6Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Osama Kashlan
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
| | - Anubhav Amin
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Sanjay Konakondla
- 9Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania
| | | | - John Ogunlade
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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Lv X, Huang R, Zeng Z, Zhang D, Li B, Lin Y, Zhang Z, Wang Q, Nuertai Y, Huang Z, Wang Z, Yang C, Yan H, Peng X, Zhao Q, Li W, Jiang X, Hu X, Gao L. Postoperative quality of life in patients with ankylosing spondylitis and thoraco lumbar kyphosis: risk factors and personalized sagittal reconstruction strategy. J Neurosurg Spine 2024; 40:365-374. [PMID: 38064699 DOI: 10.3171/2023.9.spine23675] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the factors affecting postoperative quality of life in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK), and establish a personalized sagittal reconstruction strategy. METHODS Patients with AS and TLK who underwent pedicle subtraction osteotomy (PSO) from February 2009 to May 2019 were retrospectively included. Quality of life and spinal sagittal radiographic parameters were collected before surgery and at the last follow-up. Patients were divided into two groups based on the attainment of minimal clinically important difference (MCID) on the Bath Ankylosing Spondylitis Functional Index and Oswestry Disability Index. Comparisons of radiographic parameters and clinical outcomes were conducted between and within groups. Regression analysis was used to identify the risk factors within the missing MCID cohort. Sagittal reconstruction equations were established using the pelvic incidence (PI) and thoracic inlet angle (TIA) in the reached MCID cohort. RESULTS The study comprised 82 participants. Significant improvements were observed in most radiographic parameters and all quality-of-life indicators during the final follow-up compared with the preoperative measures (p < 0.05). Factors including cervical lordosis (CL) ≥ 18° (OR 9.75, 95% CI 2.26-58.01, p = 0.005), chin-brow vertical angle (CBVA) ≥ 25° (OR 14.7, 95% CI 3.29-91.21, p = 0.001), and pelvic tilt (PT) ≥ 33° (OR 21.77, 95% CI 5.92-103.44, p < 0.001) independently correlated with a failure to attain MCID (p < 0.05). Sagittal realignment targets were constructed as follows: sacral slope (SS) = 0.84 PI - 17.4° (R2 = 0.81, p < 0.001), thoracic kyphosis (TK) = 0.51 PI + 10.8° (R2 = 0.46, p = 0.002), neck tilt (NT) = 0.52 TIA - 5.8° (R2 = 0.49, p < 0.001), and T1 slope (T1S) = 0.48 TIA + 5.8° (R2 = 0.45, p = 0.002). CONCLUSIONS PSO proved efficacious in treating AS complicated by TLK, yielding favorable outcomes. CBVA ≥ 25°, CL ≥ 18°, and PT ≥ 33° were the primary factors affecting postoperative quality of life in patients with AS. The personalized sagittal reconstruction strategy in this study focused on the subjective sensations and daily needs of patients with AS, which were delineated by the equations SS = 0.84 PI - 17.4°, TK = 0.51 PI + 10.8°, NT = 0.52 TIA - 5.8°, and T1S = 0.48 TIA + 5.8°.
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Affiliation(s)
- Xin Lv
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Renyuan Huang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Ziliang Zeng
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Di Zhang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Bo Li
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Yuhong Lin
- 2Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhilei Zhang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Qiwei Wang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Yelidana Nuertai
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Zhihao Huang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Zheyu Wang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Canchun Yang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Haolin Yan
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xiaoshuai Peng
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Qiancheng Zhao
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Wenpeng Li
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xu Jiang
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Xumin Hu
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
| | - Liangbin Gao
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and
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Grayson VS, Couldwell MW, Shekhawat D, Chaiyamoon A, Cardona JJ, Keshavarzi S, Iwanaga J, Dumont AS, Tubbs RS. L5 spondylolysis: Anatomical study comparing healed and unhealed lesions. Clin Anat 2024; 37:178-184. [PMID: 37466154 DOI: 10.1002/ca.24094] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
The anatomy and pathogenesis of spondylolysis has been widely studied; however, the microanatomy of spondylolysis of the lumbar vertebra has not been well described. Therefore, we aim to better elucidate this anatomy. Twenty dry bone specimens of healed and unhealed spondylolysis of the L5 vertebra were collected from human skeletal remains. Twelve L5 vertebrae were examples of unhealed spondylolysis and eight specimens exhibited a healed (i.e., bony fusion of the lesion) spondylolysis lesion. The specimens underwent macro and microanatomical analysis followed by CT and microCT imaging. Finally, selected healed and unhealed lesions were submitted for histological analysis using Mason Trichrome staining. The pars interarticularis of two L5 vertebrae without signs of healed/unhealed spondylolysis were evaluated histologically as controls. Of the 12 unhealed L5 pars defects, three were unilateral on left side. Of the eight healed pars defects, all were unilateral and seven of these were on left sides. One unilateral pars defect also had spina bifida occulta. Both on imaging and histological analysis, healed pars defects were only so superficially and not at deeper levels. Histologically, unhealed edges were made up of dense cortical bone while healed edges were made up primarily of trabecular bone. Based on our anatomical findings, the so-called healed spondylolysis lesions, although externally fused, are not thoroughly fused internally. Moreover, the anterior and posterior edges of the unhealed spondylosysis lesions are irregular and show signs of long-term disarticulation. Taken together, these data suggest that such 'healed' lesions might not be as stable as the normal L5 pars interarticularis.
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Affiliation(s)
| | | | - Devendra Shekhawat
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Arada Chaiyamoon
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sassan Keshavarzi
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
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Ogunsola O, Linzey JR, Zaki MM, Chang V, Schultz LR, Springer K, Abdulhak M, Khalil JG, Schwalb JM, Aleem I, Nerenz DR, Perez-Cruet M, Easton R, Soo TM, Tong D, Park P. Risk factors of emergency department visits following elective cervical and lumbar surgical procedures: a multi-institution analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine 2024:1-7. [PMID: 38427993 DOI: 10.3171/2024.1.spine23842] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Emergency department visits 90 days after elective spinal surgery are relatively common, with rates ranging from 9% to 29%. Emergency visits are very costly, so their reduction is of importance. This study's objective was to evaluate the reasons for emergency department visits and determine potentially modifiable risk factors. METHODS This study retrospectively reviewed data queried from the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry from July 2020 to November 2021. MSSIC is a multicenter (28-hospital) registry of patients undergoing cervical and lumbar degenerative spinal surgery. Adult patients treated for elective cervical and/or lumbar spine surgery for degenerative pathology (spondylosis, intervertebral disc disease, low-grade spondylolisthesis) were included. Emergency department visits within 90 days of surgery (outcome measure) were analyzed utilizing univariate and multivariate regression analyses. RESULTS Of 16,224 patients, 2024 (12.5%) presented to the emergency department during the study period, most commonly for pain related to spinal surgery (31.5%), abdominal problems (15.8%), and pain unrelated to the spinal surgery (12.8%). On multivariate analysis, age (per 5-year increase) (relative risk [RR] 0.94, 95% CI 0.92-0.95), college education (RR 0.82, 95% CI 0.69-0.96), private insurance (RR 0.79, 95% CI 0.70-0.89), and preoperative ambulation status (RR 0.88, 95% CI 0.79-0.97) were associated with decreased emergency visits. Conversely, Black race (RR 1.30, 95% CI 1.13-1.51), current diabetes (RR 1.13, 95% CI 1.01-1.26), history of deep venous thromboembolism (RR 1.28, 95% CI 1.16-1.43), history of depression (RR 1.13, 95% CI 1.03-1.25), history of anxiety (RR 1.32, 95% CI 1.19-1.46), history of osteoporosis (RR 1.21, 95% CI 1.09-1.34), history of chronic obstructive pulmonary disease (RR 1.19, 95% CI 1.06-1.34), American Society of Anesthesiologists class > II (RR 1.18, 95% CI 1.08-1.29), and length of stay > 3 days (RR 1.29, 95% CI 1.16-1.44) were associated with increased emergency visits. CONCLUSIONS The most common reasons for emergency department visits were surgical pain, abdominal dysfunction, and pain unrelated to index spinal surgery. Increased focus on postoperative pain management and bowel regimen can potentially reduce emergency visits. The risks of diabetes, history of osteoporosis, depression, and anxiety are areas for additional preoperative screening.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ilyas Aleem
- 4Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Richard Easton
- 5Department of Orthopedics, William Beaumont Hospital, Troy, Michigan
| | - Teck M Soo
- 6Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan; and
| | - Doris Tong
- 6Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan; and
| | - Paul Park
- 7University of Tennessee & Semmes Murphey Clinic, Memphis, Tennessee
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Gould SL, Davico G, Liebsch C, Wilke HJ, Cristofolini L, Viceconti M. Variability of intervertebral joint stiffness between specimens and spine levels. Front Bioeng Biotechnol 2024; 12:1372088. [PMID: 38486868 PMCID: PMC10937554 DOI: 10.3389/fbioe.2024.1372088] [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: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction: Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the passive mechanical properties of the intervertebral joint is crucial. The intervertebral joint stiffness, in particular, is typically derived from the literature, and the differences between individuals and spine levels are often disregarded. Methods: This study tested if an optimisation method of personalising the intervertebral joint stiffnesses was able to capture expected stiffness variation between specimens and between spine levels and if the variation between spine levels could be accurately captured using a generic scaling ratio. Multibody models of six T12 to sacrum spine specimens were created from computed tomography data. For each specimen, two models were created: one with uniform stiffnesses across spine levels, and one accounting for level dependency. Three loading conditions were simulated. The initial stiffness values were optimised to minimize the kinematic error. Results: There was a range of optimised stiffnesses across the specimens and the models with level dependent stiffnesses were less accurate than the models without. Using an optimised stiffness substantially reduced prediction errors. Discussion: The optimisation captured the expected variation between specimens, and the prediction errors demonstrated the importance of accounting for level dependency. The inaccuracy of the predicted kinematics for the level-dependent models indicated that a generic scaling ratio is not a suitable method to account for the level dependency. The variation in the optimised stiffnesses for the different loading conditions indicates personalised stiffnesses should also be considered load-specific.
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Affiliation(s)
- Samuele L. Gould
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Davico
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Luca Cristofolini
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Biomechanics Group, Department of Industrial Engineering, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [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] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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McNassor R, Yang J, Shost MD, Benzil DL. Comparison of sleep improvement in patients undergoing lumbar spine decompression. J Neurosurg Spine 2024:1-5. [PMID: 38306641 DOI: 10.3171/2023.11.spine23704] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Degenerative spine conditions affect many people each year. These conditions have been shown to negatively impact pain, function, and patient quality of life (QOL), which often require surgical intervention. It is understood that sleep plays an important role in all of these factors. However, the relationship between sleep disruption and lumbar surgery is not well understood. The objective of this study was to use a large database to understand the relationship between sleep quality and lumbar spine surgery outcomes. METHODS The surgical database of the authors' institute was used to identify all patients undergoing lumbar spine surgery for degenerative spine disease from January 1, 2012, through December 31, 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were collected, and only patients with both pre- and postoperative scores were included. Additional measures related to disability, pain, and depression were also obtained. Chart review was performed to collect patient demographics, health risk factors, and information related to sleep disturbances such as sleep medication usage and prior sleep condition diagnosis. RESULTS The study had 674 patients who met the criteria. At 3, 6, and 12 months postoperatively, there was a significant decrease in sleep disruption scores (i.e., sleep improvement), although these decreases were not greater than the minimal clinically important difference (MCID). When stratified based on preoperative sleep quality, patients with poor preoperative scores (PROMIS sleep disruption > 63.04) showed a significant decrease in sleep disruption by 8.17 at 3 months, 7.99 at 6 months, and 7.21 at 12 months. All of these decreases were greater than the sleep disruption MCID of 6.5. Multivariate analysis showed high preoperative sleep disruption and improvement in PROMIS physical health were most associated with decreased postoperative sleep disruption at all postoperative time points. CONCLUSIONS In patients with degenerative spine conditions, lumbar spine surgery offers improvement in sleep disruption for all patients. Those with poor preoperative sleep quality are more likely to see clinical improvement in their sleep disruption.
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Affiliation(s)
- Ryan McNassor
- 1Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio; and
- 2Beaumont Orthopedic Institute, Beaumont Health, Royal Oak, Michigan
| | - Jennifer Yang
- 1Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio; and
| | - Michael D Shost
- 1Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio; and
| | - Deborah L Benzil
- 1Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio; and
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24
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Sevin IE, Dağ OD, Kahraman A, Sucu HK. A case of rare lumbar intradural tumor: paraganglioma. J Surg Case Rep 2024; 2024:rjae054. [PMID: 38362492 PMCID: PMC10867302 DOI: 10.1093/jscr/rjae054] [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: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Lumbar paragangliomas are rare neuroendocrine neoplasms arising from specialized neural crest cells in the cauda equina/filum terminale region. They are difficult to diagnose radiologically and can be difficult to treat surgically if they secrete catecholamines. A 38-year-old woman presented with three and a half years of increasing lower back and sacrum discomfort. Her neurological examination was normal. The MRI revealed an L4 intradural lesion that was compressing the cauda equina. A total tumor resection was conducted. The paraganglioma was diagnosed by the pathology report. Paragangliomas should be considered in the differential diagnosis of intradural masses of the lumbar spine.
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Affiliation(s)
- Ismail Ertan Sevin
- Department of Neurosurgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, 35360 Izmir, Turkey
| | - Onur Davut Dağ
- Department of Neurosurgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, 35360 Izmir, Turkey
| | - Aslı Kahraman
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, 35360 Izmir, Turkey
| | - Hasan Kamil Sucu
- Department of Neurosurgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, 35360 Izmir, Turkey
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25
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Tani Y, Naka N, Ono N, Kawashima K, Paku M, Ishihara M, Adachi T, Taniguchi S, Ando M, Saito T. Lumbar lordosis restoration by minimally invasive short-segment fusion with anterior column realignment for adult spinal deformity: minimum 2-year follow-up. J Neurosurg Spine 2024; 40:152-161. [PMID: 37976518 DOI: 10.3171/2023.9.spine23829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The efficacy of anterior column realignment (ACR) remains relatively unclear, possibly because some safety concerns have limited its adoption and extensive evaluation. The authors aimed to study whether a minimally invasive surgery (MIS) triad consisting of ACR, lateral lumbar interbody fusion, and percutaneous pedicle screw fixation in a select group of adult spinal deformity (ASD) patients helps shorten fusion length without compromising clinical and radiographic outcomes over a minimum 2-year follow-up period. METHODS A series of 61 ASD patients (mean age 72.8 years) with pelvic incidence (PI) - lumbar lordosis (LL) (PI-LL) mismatch > 10° underwent the short-segment MIS triad (mean fusion length 3.0 levels) as a single-stage operation with a mean operative time and estimated blood loss of 157 minutes and 127 mL, respectively. Exclusion criteria were 1) thoracic scoliosis as the main deformity, 2) thoracolumbar junction kyphosis > 25°, 3) ankylosed facet joints, and 4) previous spinal fusion surgery. Seven patients, who needed fusion to be extended to S1, underwent mini-open transforaminal lumbar interbody fusion at L5-S1. RESULTS The segmental disc angle at the ACR level more than quintupled, averaging from 2.9° preoperatively to 18.9° at the latest follow-up (p < 0.0001). LL, in turn, nearly doubled from 17.0° to 32.8° (p < 0.0001) and PI-LL decreased by nearly half from 28.8° to 13.2° (p < 0.0001). At the same time, other spinopelvic deformity parameters as well as Oswestry Disability Index (ODI) scores significantly improved. Patients were divided into two groups at the latest postoperative evaluation: 36 patients whose PI-LL improved to < 10° and 25 patients who maintained a PI-LL mismatch > 10°. Binary logistic regression revealed preoperative PI-LL mismatch as the only factor that significantly influenced this dichotomous separation postoperatively. Receiver operating characteristic curve analysis identified the critical preoperative mismatch of 26.4° with 68% sensitivity and 84% specificity. Despite this different radiographic consequence, the two groups had an equally successful clinical outcome with no significant difference in ODI scores. CONCLUSIONS As long as the ASD characteristics are consistent with the authors' exclusion criteria, the short-segment MIS triad served as an excellent surgical option in the patients with preoperative PI-LL mismatch < 26.4°, but the technique also worked well even in those with a mismatch > 26.4°, although ideal spinopelvic alignment targets were not necessarily achieved in these patients.
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26
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Siyaji ZK, Nguyen AQ, Federico VP, Zbeidi S, Zavras AG, Baker JD, Basques BA, Sayari AJ, Phillips FM. Comparison of clinical outcomes in patients undergoing one- and two-level minimally invasive lumbar microdiscectomy. J Neurosurg Spine 2024; 40:169-174. [PMID: 37922555 DOI: 10.3171/2023.8.spine21761] [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] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Herniated nucleus pulposus (HNP) is one of the most common lumbar spine conditions treated surgically, often through a minimally invasive surgery (MIS) microdiscectomy approach. This technique attempts to reduce damage to the paraspinal muscular-ligamentous envelope. However, there are currently limited data regarding comparative outcomes using patient-reported outcome measures (PROMs) for one- and two-level MIS discectomies. The aim of this study was to quantify comparative clinical outcomes in patients undergoing one-level and two-level MIS lumbar microdiscectomy for HNP using PROMs. METHODS The authors performed a retrospective review of patients undergoing MIS lumbar microdiscectomy between 2004 and 2019 for the primary diagnosis of HNP at a single academic institution. All patients had a minimum 1-year follow-up. Patient demographics and comorbidities were collected to establish baselines between cohorts. PROMs and minimal clinically important differences (MCIDs) were used to examine the patient's perception of operative success. Bivariate and multivariate linear/logistic regression analyses were used to compare one- and two-level discectomies. The bivariate analysis included the t-test and chi-square test, which were used to assess continuous and categorical variables, respectively. Statistical significance was established at p < 0.05. RESULTS A total of 293 patients underwent one-level (n = 250) or two-level (n = 43) MIS discectomies. The mean follow-ups for the one- and two-level cohorts were 50.4 (SD 35.5) months and 61.6 (SD 39.8) months, respectively. Fewer female patients underwent two-level discectomies, and BMI and operative duration were higher in the two-level group (p < 0.001). Recurrent herniation requiring reoperation was recorded at rates of 6.80% and 11.6% in the one- and two-level groups, respectively (p = 0.270). Pre- and postoperative PROMs were largely similar between the cohorts; however, patients undergoing one-level discectomy had greater improvement in leg pain, and a significantly greater proportion of these patients achieved MCID for the leg pain visual analog scale score (p < 0.001). CONCLUSIONS At the 1-year clinical follow-up, patients who underwent two-level discectomy had significantly less improvement in leg pain scores with lower achievement of MCID for leg pain improvement than patients undergoing one-level procedures. At the 1-year follow-up, there were no other significant differences in PROMs between the two cohorts. Given these findings, patients should be counseled regarding the anticipated outcomes to better manage expectations. Further studies are warranted to examine the long-term clinical outcomes associated with single- and multilevel MIS discectomy.
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Affiliation(s)
- Zakariah K Siyaji
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 2Regenerative Pain & Spine, Chicago, Illinois
| | - Austin Q Nguyen
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 3Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Vincent P Federico
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Athan G Zavras
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - James D Baker
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 5Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas; and
| | - Bryce A Basques
- 6Department of Orthopaedics, Division of Spine Surgery, Brown University, Providence, Rhode Island
| | - Arash J Sayari
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Frank M Phillips
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
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Lee JK, Kim DH, Hyun SJ, Yang SH, Kim KJ. Radiographic outcomes following surgical correction for lumbar degenerative kyphosis: the impact of supine pelvic tilt. J Neurosurg Spine 2024; 40:132-142. [PMID: 38000072 DOI: 10.3171/2023.9.spine23155] [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] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Lumbar degenerative kyphosis (LDK), a flexible deformity, is a common form of sagittal imbalance in Asian countries. Assessing a patient's spine prior to surgery by using positional radiographs is becoming more crucial in determining surgical planning to achieve favorable clinical and radiographic outcomes, especially in patients with flexible deformities. This study aims to identify radiographic characteristics of supine pelvic tilt (sPT) and its relation to mechanical failure (MF) following LDK correction. METHODS A single-center, single-surgeon retrospective analysis was performed in patients who underwent LDK correction with sacropelvic fixation between January 2014 and May 2019. Patients were grouped into pelvic match and mismatch groups according to the difference between postoperative pelvic tilt (PT) and sPT. Demographic, surgical, and radiographic parameters were compared. Chronological change of PT was assessed by comparing preoperative, supine, immediate postoperative, and final PT. RESULTS Baseline demographics and sagittal alignments were similar between PT match (n = 25) and mismatch (n = 42) groups (p > 0.05). There was a significant difference in the rate of MF between PT match and mismatch groups (4% vs 31%, p = 0.021). Multivariable analysis demonstrated that after including control variables, PT mismatch was independently associated with the likelihood of MF development (OR 33.42, p = 0.04). CONCLUSIONS sPT reflects postoperative PT changes; therefore, supine imaging may represent a tool that could be used for preoperative decision-making in patients with LDK or possibly those with flexible adult spinal deformity. PT mismatch > 10° or < 0° is a significant risk factor for MF following correction of LDK. Measurement of sPT would aid surgeons in optimal preoperative planning and in minimizing catastrophic MF following deformity correction surgery.
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Affiliation(s)
- Jae-Koo Lee
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Do-Hyoung Kim
- 2Department of Neurosurgery, Spine Center, Yonsei Okay Hospital, Uijeongbu-si, Gyeonggi-do; and
| | - Seung-Jae Hyun
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Seung Heon Yang
- 3Department of Neurosurgery, Spine Center, Seoul Barun Hospital, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
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Moon MH, Shin MH, Yoo SC, Choi DY, Kim JT. Lordosis distribution index for predicting mechanical complications after long-level fusion surgery: comparison of Global Alignment and Proportion score and Roussouly classification. J Neurosurg Spine 2024:1-9. [PMID: 38277663 DOI: 10.3171/2023.11.spine23725] [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: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Both the Global Alignment and Proportion (GAP) score and Roussouly classification account for the lordosis distribution index (LDI), but the LDI of the GAP score (G-LDI) is typically set to 50%-80%, while the LDI of the Roussouly classification (R-LDI) varies depending on the degree of pelvic incidence (PI). The objective of this study was to validate the ability of the G-LDI to predict mechanical complications and compare it with the predictive probability of R-LDI in patients with long-level fusion surgery. METHODS A total of 171 patients were divided into two groups: 93 in the nonmechanical complication group (non-MC group) and 78 in the mechanical complication group (MC group). The mean age of the participants was 66.79 ± 8.56 years (range 34-83 years), and the mean follow-up period was 45.49 ± 16.20 months (range 24-62 months). The inclusion criteria for the study were patients who underwent > 4 levels of fusion and had > 2 years of follow-up. The predictive models for mechanical complications using the G-LDI and R-LDI were analyzed using binomial logistic regression and receiver operating characteristic analyses. RESULTS There was a significant correlation between R-LDI and PI (r = -0.561, p < 0.001), while there was no correlation between G-LDI and PI (r = 0.132, p = 0.495). In reference to G-LDI, most patients in the non-MC group were classified as having alignment (72, 77.4%), while the MC group had an inhomogeneous composition (aligned: 34, 43.6%; hyperlordosis: 37, 47.4%). The agreement between the G-LDI and R-LDI was moderate (κ = 0.536, p < 0.001) to fair (κ = 0.383, p = 0.011) for patients with average or large PI, but poor (κ = -0.255, p = 0.245) for those with small PI. The areas under the curve for the G-LDI and R-LDI were 0.674 (95% CI, 0.592-0.757) and 0.745 (95% CI, 0.671-0.820), respectively. CONCLUSIONS The R-LDI, which uses a PI-based proportional parameter, enables individual quantification of LL for all PI sizes and has been shown to have a higher accuracy in classifying cases and a stronger correlation with the risk of mechanical complications compared with G-LDI.
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Maloy GC, Halperin SJ, Ratnasamy PP, Grauer JN. Characterizing Gabapentinoid Use Among Patients With Isolated Low Back Pain. Global Spine J 2024:21925682231224390. [PMID: 38270402 DOI: 10.1177/21925682231224390] [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] [Indexed: 01/26/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Gabapentinoids have been increasingly studied as a non-narcotic option for neuropathic and postoperative pain. However, there is evidence suggesting that off-label use of these medications for the treatment of isolated LBP is not effective. The purpose of the current study was to evaluate prescription patterns for gabapentinoids among patients with isolated low back pain. METHODS Adult patients with LBP were abstracted from the 2019 M91Ortho PearlDiver dataset using International Classification of Diseases (ICD-10) code M54.5. Patients were excluded if they had a diagnosis of neurologic symptoms, history of spinal surgery, spinal fracture, or conditions for which gabapentinoids are FDA approved. Gabapentinoid and narcotic prescriptions within one year of LBP diagnosis were identified. Patient characteristics and prescriber specialty were extracted from the dataset and predictors of gabapentinoid prescriptions were determined using univariate and multivariate analyses. RESULTS Among the 1,158,875 isolated LBP patients, gabapentinoids were prescribed for 11%, narcotics for 8%, and both for 3%. The most common prescriber specialties included: primary care physicians (45%), nurse practitioners (15%), and pain management physicians (5%). Independent predictors of gabapentinoid prescriptions included: female sex, region of the country, and insurance type (P-values <.001). CONCLUSIONS Of nearly 1.2 million patients with isolated LBP, 14.2% were prescribed gabapentinoids within one year of their LBP diagnosis. Patient characteristics predictive of receiving gabapentinoids were predominantly non-clinical factors.
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Affiliation(s)
- Gwyneth C Maloy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Scott J Halperin
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Philip P Ratnasamy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Zhang T, Gao G, Gao F, Guo N, Wang Y. Percutaneous microchannel unilateral approach bilateral micro decompression for adjacent segmental degeneration after lumbar fusion at 10 years: a case report and review of literature. Front Surg 2024; 11:1284967. [PMID: 38327546 PMCID: PMC10847338 DOI: 10.3389/fsurg.2024.1284967] [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: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Adjacent segmental degeneration after lumbar fusion is one of the common long-term complications after lumbar fusion. With the continuous development of adjacent segmental degeneration, patients who fail conservative treatment often need reoperation to relieve symptoms. In recent years, the technique of bilateral microdecompression through unilateral approach under microchannel has been widely used in the treatment of lumbar degenerative diseases. However, the efficacy of this procedure for adjacent-segment degeneration after lumbar fusion has not been established. Here, we report a case of bilateral microscopic decompression via a unilateral approach through a microchannel in a patient with adjacent segmental degeneration after lumbar fusion. Case report A 70-year-old male patient was admitted to hospital because of lumbago accompanied by left lower extremity pain, numbness and weakness for 2 years, which aggravated for 2 months. Ten years ago, he underwent PLIF for lumbar spinal stenosis, and recovered well after the operation. According to imaging data and physical examination, the diagnosis was adjacent segmental degeneration after lumbar fusion. Bilateral microdecompression was performed through a unilateral approach under a microchannel. Good clinical outcomes was observed through 1-year postoperative follow-up. Conclusions This report reports the successful treatment of a patient with ASD 10 years after lumbar fusion. Bilateral microdecompression via a unilateral approach under a microchannel is a safe and effective method for the treatment of ASD after lumbar fusion with good surgical outcomes.
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Affiliation(s)
- Tingxin Zhang
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Gang Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Feng Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
| | - Nana Guo
- Critical Care Medicine, Ordos Central Hospital, Ordos, China
| | - Yongjiang Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, China
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Hsu C, Krabak B, Cunningham B, Borg-Stein J. Swimming Anatomy and Lower Back Injuries in Competitive Swimmers: A Narrative Review. Sports Health 2024:19417381231225213. [PMID: 38262981 DOI: 10.1177/19417381231225213] [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] [Indexed: 01/25/2024] Open
Abstract
CONTEXT Competitive swimmers are at high risk of overuse musculoskeletal injuries due to their high training volumes. Spine injuries are the second most common musculoskeletal injury in swimmers and are often a result of the combination of improper technique, high loads on the spine in strokes that require hyperextension, and repetitive overuse leading to fatigue of the supporting trunk muscles. The purpose of this review is to summarize the current evidence regarding swimming biomechanics, stroke techniques, and common injuries in the lumbar spine to promote a discussion on the prevention and rehabilitation of lower back injuries in competitive swimmers. EVIDENCE ACQUISITION From a PUBMED/MEDLINE search, 16 articles were identified for inclusion using the search terms "swimming," "low back" or "lumbar," and "injury" or "injuries." STUDY DESIGN Narrative review. LEVEL OF EVIDENCE Levels 4 and 5. RESULTS The trunk muscles are integral to swimming stroke biomechanics. In freestyle and backstroke, the body roll generated by the paraspinal and abdominal muscles is integral to efficient stroke mechanics by allowing synergistic movements of the upper and lower extremities. In butterfly and breaststroke, the undulating wave like motion of the dolphin kick requires dynamic engagement of the core to generate repetitive flexion and extension of the spine and is a common mechanism for hyperextension injuries. The most common lower back injuries in swimming were determined to be lumbar strain, spondylolysis and spondylolisthesis, facet joint pain, and disc disease. Most overuse swimming injuries can be treated conservatively with physical therapy and training adjustments. CONCLUSION Managing swimmers with low back pain requires a basic knowledge of swimming technique and a focus on prevention-based care. Since most swimming injuries are secondary to overuse, it is important for providers to understand the mechanisms underlying the swimming injury, including an understanding of the biomechanics involved in swimming and the role of spine involvement in the 4 strokes that assist in stabilization and force generation in the water. Knowledge of the biomechanics involved in swimming and the significant demands placed on the spinal musculoskeletal system will aid the clinician in the diagnosis and management of injuries and assist in the development of a proper rehabilitation program aimed at correction of any abnormal swimming mechanics, treatment of pain, and future injury prevention. STRENGTH OF RECOMMENDATIONS B. Recommendation based on limited quality or inconsistent patient-oriented evidence.
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Affiliation(s)
- Connie Hsu
- Harvard Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Brian Krabak
- University of Washington, Department of Physical Medicine and Rehabilitation, Sports Medicine Department, Seattle, Washington
- USA Swimming, Colorado Springs, Colorado
| | - Brian Cunningham
- USA Swimming, Colorado Springs, Colorado
- Advocate Health Care, Glenview, Illinois
| | - Joanne Borg-Stein
- Harvard Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Brigham Sports Medicine Department, Boston, Massachusetts
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Bouchard A, Mun J, Vazquez F, Tang A, Delsole E, Strom R, Chen T. Radiographic Robustness of Lumbar Interbody Fusion Techniques. Global Spine J 2024:21925682241226659. [PMID: 38197369 DOI: 10.1177/21925682241226659] [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] [Indexed: 01/11/2024] Open
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES Lumbar interbody fusion (LIF) can be achieved with various techniques. Evidence supporting the long-term clinical advantages of one technique over another are inconclusive. The purpose of this study was to (1) determine the changes in sagittal parameters in the preoperative, intraoperative, and post-operative phase, (2) evaluate the radiographic maintenance of these parameters over time, and (3) compare the demographics and patient reported outcomes of patients undergoing various LIF techniques. METHODS We performed a retrospective chart review of patients with degenerative spine disease undergoing single level anterior (ALIF), lateral (LLIF), posterior (PLIF), or transforaminal (TLIF) lumbar interbody fusion. Data collected included patient demographics and diagnosis at time of surgery. Upright lumbar radiographs taken pre-operatively, intra-operatively, and post-operatively were measured for lumbar lordosis (LL), segmental lordosis (SL), posterior disc height (PDH), and foraminal height (FH). RESULTS 194 patients in a single center were included. PDH and FH increased intra-operatively following ALIF (P < .0001), PLIF (P < .0001), LLIF (P < .0001), and TLIF (P < .0001). SL also increased intra-operatively for ALIF (P = .002) and LLIF (P = .0007). Compared to intra-operative radiographs, PDH and FH decreased at latest post-operative phase for ALIF (P < .03), LLIF (P < .003), TLIF (P < .001), and PLIF (P < .005). SL decreased for ALIF (P = .0008), and TLIF (P = .02). LL did not change postoperatively across techniques. Patient reported outcomes improved post-surgically and disability index decreased, but neither differed between techniques. CONCLUSION LIF, regardless of technique, was shown to provide significant radiographic changes in PDH and FH. Techniques utilizing larger intervertebral cage sizes (ALIF/LLIF) improved SL. Single level LIF did not affect overall LL. No single technique displayed superior radiographic robustness over time.
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Affiliation(s)
- Alice Bouchard
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Jeffrey Mun
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Frank Vazquez
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Alex Tang
- Northeast Orthopaedic Surgery Residency, Geisinger, Wilkes-Barren, PA, USA
| | - Edward Delsole
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Russell Strom
- Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA
| | - Tan Chen
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
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Chen C, Jia J, Wang P. The saturation effect of body mass index on total lumbar bone mineral density for adults: The NHANES 2011-2020. Medicine (Baltimore) 2024; 103:e36838. [PMID: 38181230 PMCID: PMC10766303 DOI: 10.1097/md.0000000000036838] [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: 10/08/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
To explore the association between body mass index (BMI) and total lumbar bone mineral density (BMD) in adults. This study included 9927 participants from 2011 to 2020 National Health and Nutrition Examination Survey (NHANES). The date on BMI, total lumbar BMD and other covariates were collected. Multivariate linear regression analyses were performed to evaluate the association between BMI and total lumbar BMD. Smoothing curve fitting and saturation effects analysis models were used to analyze the nonlinear relationships and saturation values. Multivariate linear regression analyses revealed that BMI was positively linked to total lumbar BMD in non-adjusted models (β = 0.003, 95% CI: 0.003-0.003, P < .00001). After adjusting for gender and race (β = 0.003, 95% CI: 0.003-0.004, P < .00001) and all covariates (β = 0.004, 95% CI: 0.003-0.004, P < .00001), the association still existed. Smoothing curve fitting showed that there was nonlinear correlation between BMI and total lumbar BMD with saturation effect. The BMI saturation value was 21.2 kg/m2 in the total lumbar BMD based on saturation effects analysis models. There was nonlinear positive correlation between BMI and total lumbar BMD with saturation effect. For adults, keeping the BMI at a reasonable value (21.2 kg/m2) would obtain an optimal balance between BMI and total lumbar BMD.
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Affiliation(s)
- Cong Chen
- Department of Orthopedics, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, P. R. China
| | - Jun Jia
- Department of Orthopedics, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, P. R. China
| | - Peng Wang
- Department of Orthopedics, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, P. R. China
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Jain S, Cloud GW, Gordon AM, Lam AW, Vakharia RM, Saleh A, Razi AE. Cannabis Use Disorder Is Associated With Longer In-Hospital Lengths of Stay, Higher Rates of Medical Complications, and Costs of Care Following Primary 1- to 2-Level Lumbar Fusion. Global Spine J 2024; 14:67-73. [PMID: 35395920 PMCID: PMC10676152 DOI: 10.1177/21925682221093965] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES The purpose of this study is to assess whether cannabis use disorder (CUD) patients undergoing primary 1- to 2-level lumbar fusion (1-2LF) for the treatment of degenerative lumbar spine disorders have higher rates of: (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) healthcare expenditures. MATERIALS AND METHODS A retrospective case-control study of the MSpine dataset of the PearlDiver claims from January 2007 to March 2018 was performed. Patients with CUD undergoing 1-2LF were queried and matched to a comparison group in a 1:5 ratio by age, sex, and various medical comorbidities yielding 22, 815 patients within the study (CUD = 3805; control = 19 010). Outcomes analyzed included LOS, 90-day medical complications, and costs. A P-value less than .004 was considered significant. RESULTS This study found CUD patients undergoing primary 1-2LF experience longer in-hospital LOS (4- vs. 3-days, P < .0001). Additionally, CUD patients were found to have significantly higher frequency and odds-ratios (OR) (31.88 vs. 18.01% OR: 1.41, P < .0001) of adverse events within ninety days following their procedure. CUD patients also had significantly higher day of surgery ($18,946.79 vs. $15,691.02, P < .0001) and 90 days healthcare expenditures ($21,469.01 vs. $19,556.71, P < .0001). CONCLUSION Patients with CUD can prepare for increased LOS, complications, and costs following primary 1-2LF. The study can be used to educate these patients of the potential outcomes following their procedure.
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Affiliation(s)
- Shreya Jain
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Geoffrey W. Cloud
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Adam M. Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron W. Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Lalwala M, Koya B, Devane K, Gayzik FS, Weaver AA. Modular incorporation of deformable spine and 3D neck musculature into a simplified human body finite element model. Comput Methods Biomech Biomed Engin 2024; 27:45-55. [PMID: 36657616 PMCID: PMC10354211 DOI: 10.1080/10255842.2023.2168537] [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] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
Spinal injuries are a concern for automotive applications, requiring large parametric studies to understand spinal injury mechanisms under complex loading conditions. Finite element computational human body models (e.g. Global Human Body Models Consortium (GHBMC) models) can be used to identify spinal injury mechanisms. However, the existing GHBMC detailed models (with high computational time) or GHBMC simplified models (lacking vertebral fracture prediction capabilities) are not ideal for studying spinal injury mechanisms in large parametric studies. To overcome these limitations, a modular 50th percentile male simplified occupant model combining advantages of both the simplified and detailed models, M50-OS + DeformSpine, was developed by incorporating the deformable spine and 3D neck musculature from the detailed GHBMC model M50-O (v6.0) into the simplified GHBMC model M50-OS (v2.3). This new modular model was validated against post-mortem human subject test data in four rigid hub impactor tests and two frontal impact sled tests. The M50-OS + DeformSpine model showed good agreement with experimental test data with an average CORrelation and Analysis (CORA) score of 0.82 for the hub impact tests and 0.75 for the sled impact tests. CORA scores were statistically similar overall between the M50-OS + DeformSpine (0.79 ± 0.11), M50-OS (0.79 ± 0.11), and M50-O (0.82 ± 0.11) models (p > 0.05). This new model is computationally 6 times faster than the detailed M50-O model, with added spinal injury prediction capabilities over the simplified M50-OS model.
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Affiliation(s)
- Mitesh Lalwala
- Department of Biomedical Engineering, Wake Forest University School of Medicine, NC, USA
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, NC, USA
| | - Bharath Koya
- Department of Biomedical Engineering, Wake Forest University School of Medicine, NC, USA
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, NC, USA
| | - Karan Devane
- Department of Biomedical Engineering, Wake Forest University School of Medicine, NC, USA
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, NC, USA
| | - F. Scott Gayzik
- Department of Biomedical Engineering, Wake Forest University School of Medicine, NC, USA
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, NC, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, NC, USA
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, NC, USA
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Andresen AK, Carreon LY, Overgaard S, Jacobsen MK, Andersen MØ. Safety and Reoperation Rates in Non-instrumented Lumbar Fusion Surgery: Secondary Report From a Randomized Controlled Trial of ABM/P-15 vs Allograft With Minimum 5 years Follow-Up. Global Spine J 2024; 14:33-40. [PMID: 35481422 PMCID: PMC10676187 DOI: 10.1177/21925682221090924] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Randomized controlled trial with minimum of 5-years follow-up. OBJECTIVE The purpose of this study is to evaluate the peri- and postoperative complications rates, ectopic bone migration, and reoperation rates, and secondly evaluate the 5-year patient reported outcomes (PROs), in patients treated with decompression and non-instrumented posterolateral fusion with ABM/P-15 or allograft. METHODS Patients with degenerative spondylolisthesis were enrolled in a Randomized Clinical Trial and randomized 1:1 to either ABM/P-15 or allograft bone. Patient Reported Outcomes were collected at 5-year follow-up, and patients were invited to a clinical follow-up including a computed tomography scan (CT) to evaluate signs of osteolysis, ectopic bone formation, and bone migration. RESULTS Of 101 subjects enrolled in the primary study, 83 patients were available for the 5-year follow-up. We found a statistically significant difference in back pain and Oswestry Disability Index between groups. Fifty-eight patients agreed to participate in the CT study. Sixty percentage in the ABM/P-15 group vs 30% in the allograft group was classified as fused (P = .037). There were no differences in complications, reoperation-, or infection rates between the 2 groups. We found 2 patients with migration of graft material. Both patients were asymptomatic at minimum 5-year follow-up. CONCLUSION Our study indicated that complication rates are no higher in patients treated with ABM/P-15 than allograft. We found significantly higher fusion rates in the AMB/P-15 group than in the allograft group, and patients in the ABM/P-15 group reported less back pain and lower disability score at 5-year follow-up.
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Affiliation(s)
- Andreas K. Andresen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Leah Y. Carreon
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Søren Overgaard
- Bispebjerg, Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Michael K. Jacobsen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Mikkel Ø. Andersen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
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Liu F, Liu F, Wang H. Half of the adolescent idiopathic scoliosis patients may have lumbar adjacent segment degeneration following spinal fusion: A systemic review and meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241248711. [PMID: 38647667 DOI: 10.1177/10225536241248711] [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] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This study aims to assess the impact of surgical approaches and other factors on the incidence of Adjacent Segment Degeneration (ASD) following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS). METHODS We conducted a comprehensive search of four electronic databases from their inception until March 30, 2023. Two independent reviewers screened titles, abstracts, and full texts and evaluated the methodological quality of the studies. A random-effects model was used to calculate the incidence of ASD. RESULTS Our analysis included 14 studies involving 651 individuals. The overall incidence of ASD was 47% (95%CI: 0.37, 0.56). Subgroup analyses revealed that the prevalence of ASD increased with postoperative time (53% (95%CI: 0.31, 0.75) versus 48% (95%CI: 0.36, 0.60) versus 39% (95%CI: 0.22, 0.56)). For the number of fused segments, a group with more than 10 segments had a higher prevalence (49% (95%CI: 0.38, 0.60) versus 44% (95%CI: 0.21, 0.69)). In terms of regions, East Asia had the highest prevalence, followed by Occident and West Asia (52% (95%CI: 0.41, 0.62) versus 43% (95%CI: 0.20, 0.68) versus 37% (95%CI: 0.17, 0.59)). However, the surgical approach, male ratio, and the position of the lowest instrumented vertebra (LIV) did not show significant differences between groups. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: t = 1.62, p-value = .1274). CONCLUSION This meta-analysis found that nearly half of AIS patients following spinal fusion surgery experienced ASD. Long-term follow-up, regular screening, and timely interventions are essential to reduce the prevalence of ASD.
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Affiliation(s)
- Fuze Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Fuhui Liu
- School of Clinical Medical, Weifang Medical University, Weifang, China
| | - Hai Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Manabe H, Morimoto M, Sugiura K, Takeuchi M, Tezuka F, Yamashita K, Sakai T, Sairyo K. Morphological Evaluation of Lumbar Facet Joints in Professional Baseball Players. Orthop J Sports Med 2024; 12:23259671231219194. [PMID: 38188616 PMCID: PMC10768590 DOI: 10.1177/23259671231219194] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/11/2023] [Indexed: 01/09/2024] Open
Abstract
Background Many professional baseball players experience low back pain, a major cause of which is lumbar facet joint arthropathy. Purpose To evaluate the relationship between the dominant hand side and facet joint morphology in baseball movement. Study Design Cross-sectional study; Level of evidence, 3. Methods Participants were 25 Japanese professional baseball players (11 pitchers and 14 fielders) with low back pain and lower limb symptoms. Player age, hand dominance, and length of professional playing experience were recorded, and the lateral diameter of all lumbar facet joints was determined from the axial computed tomography scans. We defined the facet joints ipsilateral and contralateral to the dominant hand as dominant and nondominant, respectively. The nondominant-to-dominant (N/D) ratio of the lateral diameter was calculated, and differences between the pitchers and fielders were analyzed using the unpaired t test. Results The average player age and length of professional playing experience were 26.9 years (range, 19-37 years) and 7.2 years (range, 1-15 years), respectively. The right hand was dominant in 9 pitchers and 5 fielders, while the left hand was dominant in 2 pitchers and 9 fielders. In pitchers, the average lateral facet joint diameter on the nondominant side was significantly larger than on the dominant side at all vertebral levels except L1 to L2 (P < .05 for all). The N/D ratio for each facet joint was 1.06 (L1-L2), 1.11 (L2-L3), 1.10 (L3-L4), 1.12 (L4-L5), and 1.12 (L5-S1). In fielders, the average lateral facet joint diameter on the dominant side was significantly larger than on the nondominant side at L3 to L4 (P < .05), with N/D ratios of 0.98 (L1-L2), 0.96 (L2-L3), 0.94 (L3-L4), 0.97 (L4-L5), and 0.98 (L5-S1). The N/D ratio was significantly larger in pitchers than in fielders at all levels (P < .05 for all). Conclusion The facet joints of professional baseball players were enlarged asymmetrically, with different tendencies observed between pitchers and fielders. Although pitching and batting are movements that transmit the rotation from the lower limbs to the upper limbs, the effects of rotation and lateral flexion were associated significantly with facet joint hypertrophy.
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Affiliation(s)
- Hiroaki Manabe
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Findlay MC, Hamrick FA, Kim RB, Twitchell S, Mahan MA. Hospital cost differences between open and endoscopic lumbar spine decompression surgery. J Neurosurg Spine 2024; 40:77-83. [PMID: 37856388 DOI: 10.3171/2023.8.spine23439] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE In recent years, fully endoscopic decompression surgery for degenerative spine disease has become increasingly popular in the US. Although an endoscopic approach has demonstrated some benefits compared with open procedures in randomized controlled trials, the cost of advanced technologies remains contested. The authors evaluated the differences in costs and cost drivers between open and endoscopic decompression surgical procedures performed at a single institution. METHODS Using associated Current Procedural Terminology codes, the authors identified all open and endoscopic decompression lumbar surgical procedures performed from January 1, 2016, through December 31, 2022. Preoperative comorbidities, surgical characteristics, and postoperative outcomes were captured. The costs of index surgery-related readmission for revision, washout, or other complications were included in the index surgery expenses. Associated in-hospital costs were collected; these were reported in comparative percentages with open surgical procedures as the baseline because of an institutional agreement. Univariate and multivariate analyses were performed. RESULTS The retrospective search identified 633 open surgical procedures and 195 endoscopic surgical procedures for inclusion. The two patient cohorts were similar, with clinically nonrelevant but statistically significant differences in mean age (open 55.7 years vs endoscopic 59.4 years, p = 0.01) and mean American Society of Anesthesiologists physical status class (open 2.3 vs endoscopic 2.4, p = 0.03). Postoperatively, patients who underwent open surgical procedures had significantly longer mean hospital stays (open 1.4 days vs endoscopic 0.7, p < 0.01) and more perioperative complications (open 7.9% of patients vs endoscopic 3.1%, p = 0.02), and they required washout surgical procedures in some cases (open 1.3% vs endoscopic 0%, p = 0.12). The largest cost difference between open and endoscopic surgical procedures was the significantly greater cost of disposable supplies for endoscopic cases (10.1% vs 31.7% of the total cost of open procedures, p < 0.01), and open surgical procedures were generally less costly in total (100.0% vs 115.1%, p < 0.01). In multivariate linear regression, endoscopic surgery was independently associated with greater total costs (standardized beta 15.9%, p < 0.01), although length of hospital stay (standardized beta 34.0%) and readmissions (standardized beta 30.0%, p < 0.01) had larger effects on cost. CONCLUSIONS The endoscopic approach was associated with greater total in-hospital costs compared with open procedures. The findings of further cost evaluations, including those of patient-reported outcomes, social cost, and capital costs per procedure type, need to be included in operational and clinical decisions.
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Affiliation(s)
| | - Forrest A Hamrick
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert B Kim
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Spencer Twitchell
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mark A Mahan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Jeong G, Park H, Lee SJ, Park DH, Paeng SH, Lee E. [Imaging of Sequestered Lumbar Discs]. J Korean Soc Radiol 2024; 85:3-23. [PMID: 38362393 PMCID: PMC10864158 DOI: 10.3348/jksr.2023.0154] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Intervertebral disc herniation is frequently encountered in radiological practice. Sequestered disc herniation occurs when the disc material undergoes degeneration and completely loses continuity with the parent nucleus pulposus. Sequestered discs can reside within and outside the spinal canal, exerting a mass effect on adjacent structures, compressing nerve pathways, and eliciting a range of clinical symptoms. In particular, sequestered discs within the dura cannot be identified without durotomy. Therefore, precise preoperative localization is crucial for surgical planning. On MRI, the signal intensity of the sequestered disc may vary due to independent degeneration processes. Additionally, most sequestered disc fragments show varying degrees of peripheral enhancement depending on the degree of angiogenesis and granulation around the isolated tissue. In this article, we review various imaging findings and the location of the sequestered disc to provide patients with an accurate diagnosis and appropriate treatment direction.
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Wator J, Battis A, Vellucci C, Beaudette SM. The acute effects of kinesio-taping on movement kinematics and muscle co-activation in rowing athletes. J Back Musculoskelet Rehabil 2023:BMR230216. [PMID: 38250754 DOI: 10.3233/bmr-230216] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue. OBJECTIVE To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries. METHODS Participants (n= 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee. RESULTS Responding participants (n= 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion. CONCLUSION KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements.
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Kang SH, Lynch L, Wolf E, Mirka GA. Quantifying the effectiveness of a passive trunk-support exosuit at reducing erector spinae muscle fatigue during a quasi-static posture maintenance task. Ergonomics 2023:1-10. [PMID: 38108329 DOI: 10.1080/00140139.2023.2295214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task.
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Affiliation(s)
- Sang Hyeon Kang
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Laura Lynch
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Emma Wolf
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Gary A Mirka
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
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Nguyen K, Razzouk J, Brandt Z, Carlson P, Vyhmeister E, Bouterse A, Wycliffe N, Cheng W, Danisa O. Anatomic Assessment of L1-S1 Neuroforaminal Dimensions Using Computed Tomography in 1,000 Patients: A Follow-Up Study. Global Spine J 2023:21925682231220043. [PMID: 38061394 DOI: 10.1177/21925682231220043] [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] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES While the radiographic criteria for diagnosing central lumbar stenosis are well described, criteria for diagnosing neuroforaminal stenosis (NFS) are unclear. Prior research has utilized magnetic resonance imaging (MRI) to characterize neuroforaminal dimensions (NFDs). However, this approach has inherent limitations that can adversely impact measurement accuracy. Existing literature on the use of computed tomography (CT) to investigate normal NFDs is limited. The purpose of the present study was to describe normal lumbar NFDs that would aid in the establishment of objective quantitative criteria for the diagnosis of NFS. METHODS This study evaluated CT imaging of 494 female and 506 male subjects between 18 and 35 years of age to determine normal NFDs, specifically the sagittal anteroposterior width, craniocaudal height, and area. Statistical analyses were performed to assess differences in NFDs according to variables including sex, height, weight, body mass index, and ethnicity. RESULTS Without differentiating between sides or disc levels, mean NFDs were 8.71 mm for sagittal anteroposterior width, 17.73 mm for craniocaudal height, and 133.26 mm2 for area (n = 10,000 measurements each). Male subjects had larger NFDs than females at multiple levels. Asian and Caucasian subjects had larger NFDs than Hispanic and African American subjects at multiple levels. There were no associations between NFDs and anthropometric factors. CONCLUSIONS The present study describes normal lumbar NFDs in young, healthy patients. NFDs were influenced by sex and ethnicity but not by anthropometric factors.
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Affiliation(s)
- Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Zachary Brandt
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Patricia Carlson
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Ethan Vyhmeister
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Alex Bouterse
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University, Loma Linda, CA, United States
| | - Wayne Cheng
- Jerry L Pettis Memorial Veterans Hospital, Loma Linda, CA, United States
| | - Olumide Danisa
- Department of Orthopedics, Loma Linda University, Loma Linda, CA, United States
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Atherton M, Safdar A, Motiei-Langroudi R. Does the Number of Interbody Devices Affect the Fusion Outcome in Short-Segment Posterior Lumbar Fusion? Cureus 2023; 15:e50113. [PMID: 38186530 PMCID: PMC10771103 DOI: 10.7759/cureus.50113] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Interbody devices (IBDs) have been shown to improve outcomes when used in posterior lumbar fusion (PLF) surgery; however,the exact extent of their clinical benefit remains a current topic of interest. Our primary objective in this study was to identify whether the use of an IBD at every level of fusion construct would affect fusion outcomes such as adjacent segment pathology (ASP) and pseudarthrosis after one- to three-level PLF surgery. METHODS This was a single-institution retrospective study. We studied the association of factors such as smoking status, BMI, gender, age, and number of IBDs on the development of ASP and pseudarthrosis. To study the effect of independent variables on ASP and pseudoarthrosis, univariate and multivariate regression analyses were used. RESULTS The study included 2,061 patients with a history of posterior lumbar fusion who were identified and reviewed. Among these, 363 patients met our inclusion criteria; 247 patients had a minimum follow-up of six months and were finally included in the study. The median follow-up was 30 months. Among the 247 patients, 105 (42.5%) and 24 (9.7%) experienced ASP and pseudarthrosis, respectively. Gender and use of IBD significantly affected the presence of pseudarthrosis (with a higher rate in males and those without any IBDs). Gender, age, BMI, and use of IBDs did not affect ASP. Moreover, using an IBD at each fused level reduced the pseudarthrosis rate significantly compared to when IBDs were not used at all levels (7.3% vs. 27.6%, p <0.001), while there was no significant difference in the rate of ASP (43.6% vs. 34.5%, p = 0.35). CONCLUSIONS In patients undergoing one- to three-level PLF surgery, the use of an IBD at all levels of the fusion construct significantly reduces the rate of pseudarthrosis. There was no significant correlation between the rates of ASP. Studies with a larger sample size and a longer follow-up time are suggested to validate our results for pseudoarthrosis and ASP. Our results suggest the use of an IBD per fusion level in short-segment PLF surgeries.
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Affiliation(s)
| | - Aleeza Safdar
- Neurosurgery, University of Kentucky, Lexington, USA
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Shtaya A, Thomas M, Sampson MM, Giannoulis K, Nader-Sepahi A. Resolving solitary osteolytic lumbar tuberculosis in young adult. Br J Neurosurg 2023; 37:1872-1875. [PMID: 34251952 DOI: 10.1080/02688697.2021.1950632] [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] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Lumbar vertebral tuberculosis presenting with a focal solitary osteolytic lesion is rare in spinal tuberculosis (TB) and the English literature describing this entity is scant. The differential diagnosis includes primary and secondary malignancies. In this report, we describe a case of 35-year-old woman who presented with low back pain and was found to have a focal L4 vertebral lytic lesion on MRI and CT. Whole body CT was carried out as a potential malignancy staging procedure and demonstrated lung lesions suggestive of TB. Her neurological and general examination were entirely normal. Her blood test was positive for QuantiFERON Gold. She was managed conservatively with anti-TB medications and serial imaging which showed evidence of resolution of the osteolytic lesion. Although it is unusual for TB to present as an isolated osteolytic vertebral body lesion, the possibility should always be considered in the differential diagnosis, along with neoplastic processes. Conservative medical management, in the absence of neurological deficits and deformity, is the main stay of management with a very good outlook.
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Affiliation(s)
- Anan Shtaya
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew Thomas
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Madeline M Sampson
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kyriakos Giannoulis
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ali Nader-Sepahi
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Weston EB, Hassett AL, Khan SN, Weaver TE, Marras WS. Cognitive dissonance increases spine loading in the neck and low back. Ergonomics 2023; 66:2133-2147. [PMID: 36861457 DOI: 10.1080/00140139.2023.2186323] [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] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Cognitive dissonance refers to a state where two psychologically inconsistent thoughts, behaviours, or attitudes are held at the same time. The objective of this study was to explore the potential role of cognitive dissonance in biomechanical loading in the low back and neck. Seventeen participants underwent a laboratory experiment involving a precision lowering task. To establish a cognitive dissonance state (CDS), study participants were provided negative feedback on their performance running counter to a pre-established expectation that their performance was excellent. Dependent measures of interest were spinal loads in the cervical and lumbar spines, calculated via two electromyography-driven models. The CDS was associated with increases to peak spinal loads in the neck (11.1%, p < .05) and low back (2.2%, p < .05). A greater CDS magnitude was also associated with a greater spinal loading increase. Therefore, cognitive dissonance may represent a risk factor for low back/neck pain that has not been previously identified.Practitioner summary: Upon establishing a cognitive dissonance state in a group of participants, spinal loading in the cervical and lumbar spines were increased proportional to the magnitude of the cognitive dissonance reported. Therefore, cognitive dissonance may represent a risk factor for low back and neck pain that has not been previously identified.
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Affiliation(s)
- Eric B Weston
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Safdar N Khan
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Orthopedics, The Ohio State University, Columbus, OH, USA
| | - Tristan E Weaver
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
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McCormick ZL, Conger A, Kendall R, Wagner G, Henrie AM, Littell M, Sperry BP, Petersen R, Cooper AN, Teramoto M, Burnham TR. A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes. Pain Med 2023; 24:1318-1331. [PMID: 37578437 PMCID: PMC10690866 DOI: 10.1093/pm/pnad107] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. OBJECTIVE Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements. DESIGN Prospective randomized comparative trial. METHODS Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models. RESULTS Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48-85), 55% (95% CI 34-74), and 45% (95% CI 26-66) of participants met the NPRS responder definition, compared to 25% (95%CI 9-53), 25% (95% CI 9-53), and 17% (95% CI 5-45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05). CONCLUSIONS C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains. TRIAL REGISTRATION DETAILS ClinicalTrials.gov (NCT03614793); August 3, 2018.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Richard Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Graham Wagner
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - A Michael Henrie
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Madelaine Littell
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Beau P Sperry
- University of California Los Angeles School of Medicine, Los Angeles, CA 90095, United States
| | - Russel Petersen
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Amanda N Cooper
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
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Passfall L, Imbo B, Lafage V, Lafage R, Smith JS, Line B, Schoenfeld AJ, Protopsaltis T, Daniels AH, Kebaish KM, Gum JL, Koller H, Hamilton DK, Hostin R, Gupta M, Anand N, Ames CP, Hart R, Burton D, Schwab FJ, Shaffrey CI, Klineberg EO, Kim HJ, Bess S, Passias PG. The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoraco lumbar adult spinal deformity. J Neurosurg Spine 2023; 39:742-750. [PMID: 37503903 DOI: 10.3171/2023.5.spine22752] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/09/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The objective of this study was to identify the effect of baseline cervical deformity (CD) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in patients with adult spinal deformity (ASD). METHODS This study was a retrospective analysis of a prospectively collected, multicenter database comprising ASD patients enrolled at 13 participating centers from 2009 to 2018. Included were ASD patients aged > 18 years with concurrent CD (C2-7 kyphosis < -15°, T1S minus cervical lordosis > 35°, C2-7 sagittal vertical axis > 4 cm, chin-brow vertical angle > 25°, McGregor's slope > 20°, or C2-T1 kyphosis > 15° across any three vertebrae) who underwent surgery. Patients were grouped according to four deformity classification schemes: Ames and Passias CD modifiers, sagittal morphotypes as described by Kim et al., and the head versus trunk balance system proposed by Mizutani et al. Mean comparison tests and multivariable binary logistic regression analyses were performed to assess the impact of these deformity classifications on PJK and PJF rates up to 3 years following surgery. RESULTS A total of 712 patients with concurrent ASD and CD met the inclusion criteria (mean age 61.7 years, 71% female, mean BMI 28.2 kg/m2, and mean Charlson Comorbidity Index 1.90) and underwent surgery (mean number of levels fused 10.1, mean estimated blood loss 1542 mL, and mean operative time 365 minutes; 70% underwent osteotomy). By approach, 59% of the patients underwent a posterior-only approach and 41% underwent a combined approach. Overall, 277 patients (39.1%) had PJK by 1 year postoperatively, and an additional 189 patients (26.7%) developed PJK by 3 years postoperatively. Overall, 65 patients (9.2%) had PJF by 3 years postoperatively. Patients classified as having a cervicothoracic deformity morphotype had higher rates of early PJK than flat neck deformity and cervicothoracic deformity patients (p = 0.020). Compared with the head-balanced patients, trunk-balanced patients had higher rates of PJK and PJF (both p < 0.05). Examining Ames modifier severity showed that patients with moderate and severe deformity by the horizontal gaze modifier had higher rates of PJK (p < 0.001). CONCLUSIONS In patients with concurrent cervical and thoracolumbar deformities undergoing isolated thoracolumbar correction, the use of CD classifications allows for preoperative assessment of the potential for PJK and PJF that may aid in determining the correction of extending fusion levels.
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Affiliation(s)
- Lara Passfall
- 1Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York
| | - Bailey Imbo
- 1Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York
| | - Virginie Lafage
- 2Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Renaud Lafage
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- 4Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Breton Line
- 5Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Andrew J Schoenfeld
- 6Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, Massachusetts
| | | | - Alan H Daniels
- 8Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Khaled M Kebaish
- 9Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Jeffrey L Gum
- 10Norton Leatherman Spine Center, Louisville, Kentucky
| | - Heiko Koller
- 11Department of Neurosurgery, Technical University of Munich (TUM), Klinikum Rechts Der Isar, Munich, Germany
- 21Department for Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - D Kojo Hamilton
- 12Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard Hostin
- 13Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas
| | - Munish Gupta
- 14Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Neel Anand
- 15Department of Orthopedic Surgery, Cedars-Sinai Health Center, Los Angeles, California
| | - Christopher P Ames
- 16Department of Neurological Surgery, University of California, San Francisco, California
| | - Robert Hart
- 17Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Douglas Burton
- 18Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Frank J Schwab
- 2Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Christopher I Shaffrey
- 19Division of Spine Surgery, Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Eric O Klineberg
- 20Department of Orthopaedic Surgery, University of California, Davis, California; and
| | - Han Jo Kim
- 3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- 5Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Peter G Passias
- 1Division of Spine Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, New York
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Akar E, Öğrenci A, Koban O, Yilmaz M, Dalbayrak S. Three region spinal decompression in the same session: a case report. Br J Neurosurg 2023; 37:1898-1900. [PMID: 33629635 DOI: 10.1080/02688697.2021.1887449] [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] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND IMPORTANCE Multiregional spinal stenosis [tandem spinal stenosis (TSS)] is not rare but operating on multiple regions at the same sitting is. Decompression of cervical and lumbar spine in the same session has a frequency of 5-25% all TSS cases, the most frequent one is TSS. Decompression in three different regions is so rare that there is only one case in the literature. We report the second. CLINICAL PRESENTATION A 72-year-old man with pain in legs and arms, neurogenic claudication, progressive loss of balance, radiculopathy and myelopathy in lower and upper extremities whose cervical-thoracic and lumbar spinal stenosis were treated with decompressive surgery in the same session. Total time of surgery for three regions was 330 min. No complications were observed. The patient was mobilized on day 1 postoperative and was discharged from the hospital on day 3. By month 3, motor function had improved almost completely, and pyramidal findings have decreased. CONCLUSION Multiregional spinal stenosis of three spinal regions at the same time is a rare case and these cases, surgery of three regions can be carried out in the same session respectively.
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Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Okan University, Istanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Okan University, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Neurosurgery, Neurospinal Academia, Istanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Okan University, Istanbul, Turkey
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Bayram Y, Pınar E. Assessment of the Quality and Reliability of YouTube as an Information Source for Transforaminal Interbody Fusion. Cureus 2023; 15:e50210. [PMID: 38192971 PMCID: PMC10772853 DOI: 10.7759/cureus.50210] [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] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND This study aims to assess the quality and reliability of the information for patients from YouTube videos on transforaminal interbody fusion (TLIF). MATERIAL AND METHODS One hundred videos were listed by inputting "TLIF," "TLIF surgery," and "transforaminal interbody fusion" in the YouTube search engine. The top 50 most popular videos based on video power index (VPI), view ratio, and exclusion criteria were selected for review. One orthopedic consultant surgeon and one neurosurgeon consultant analyzed the videos together. The modified DISCERN score, the Global Quality Score (GQS), the Journal of the American Medical Association (JAMA) score, and a novel interbody fusion score were used to evaluate videos. Data of video length, view count, number of likes and dislikes, like ratio (like x 100/(like+dislike)), video source, and comment rate were collected. RESULTS The quality of the videos could have been better according to all scoring systems, regardless of the video source. The scores of the videos published by patients and commercials were significantly lower than those of physicians and allied professionals (p <0.05). VPI and view ratios were similar in all sources. Conclusion: The study demonstrates that YouTube videos providing information related to TLIF surgery are available and accessed by the public. The results of this study would suggest that YouTube is not currently an appropriate source of information on TLIF surgery for patients. Most of the YouTube videos about TLIF surgery contain information about the surgical technique and have limited information about the post-operative condition of the patients.
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Affiliation(s)
- Yusuf Bayram
- Orthopedics and Traumatology, Hisar Intercontinental Hospital, Istanbul, TUR
| | - Ertuğrul Pınar
- Neurological Surgery, Special Pendik Yuzyil Hospital, Istanbul, TUR
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