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Hu H, Wu C, Tan L. Analysis of Factors Associated with Lumbar Degenerative Disease Complicated by Baastrup's Disease. World Neurosurg 2024; 185:e1192-e1198. [PMID: 38499242 DOI: 10.1016/j.wneu.2024.03.050] [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: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To investigate the factors associated with the occurrence of Baastrup's disease (BA) in patients with lumbar degenerative diseases (LDDs). METHODS A retrospective analysis was conducted on 168 patients with LDDs (including lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis) who were treated at our hospital from January 2020 to January 2023, comprising 95 males and 73 females, aged 48-84 years.Patients were divided into two groups based on the presence of Baastrup's disease: those with BA (Group A) and those without BA (Group B).Relevant patient factors were extracted, including age, gender, occupation, smoking history, alcohol consumption history, body mass index, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, endplate Modic changes, degree of intervertebral disc degeneration, and facet joint degeneration (Weishaupt grading).Statistical analysis was performed using, Statistical Package for the Social Sciences 26.0 software to compare the differences in these factors between the two groups, and statistically significant results were included in a multivariate logistic regression analysis. RESULTS Univariate analysis indicated that there were no statistically significant differences between the two groups in terms of gender, smoking history, alcohol consumption history, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, and endplate Modic changes (P>0.05),whereas age, occupation, body mass index, degree of intervertebral disc degeneration, and degree of facet joint degeneration showed statistically significant differences (P < 0.05).Multivariate logistic regression analysis revealed that age, degree of intervertebral disc degeneration, and degree of facet joint degeneration were independent risk factors for the occurrence of BA in patients with LDDs (P < 0.05). CONCLUSIONS BA is relatively common in patients with LDDs, and advanced age, severe intervertebral disc degeneration, and facet joint degeneration are its independent risk factors.
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Affiliation(s)
- Haigang Hu
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China.
| | - Chao Wu
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Lun Tan
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China
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Fibiger G, Glądys K, Fibiger W, Pasternak A, Szura M. Repair of type II paraesophageal hernia with Nissen fundoplication in a patient with von Willebrand disease and spondylolisthesis - a clinical case report. Folia Med (Plovdiv) 2024; 66:287-290. [PMID: 38690827 DOI: 10.3897/folmed.66.e111803] [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: 08/28/2023] [Accepted: 12/11/2023] [Indexed: 05/03/2024] Open
Abstract
Hiatal hernias continue to be fairly common in clinical practice. However, the variety of different symptoms presented by patients may hinder establishing the ultimate diagnosis. Nevertheless, currently, the diagnosis of hiatal hernia can be easily established, based on barium swallow radiography. We would like to present a clinical case report of a patient with complex medical history, including von Willebrand disease, degenerative spinal disease, and chronic sinusitis, who was finally diagnosed with hiatal hernia and treated with a standard laparoscopic Nissen fundoplication. Our case focuses on the significance of comorbidities on patients' symptoms, which sometimes may mislead the therapeutic process.
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Affiliation(s)
| | - Kinga Glądys
- Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Fibiger
- Podhale State Vocational University in Nowy Targ, Nowy Targ, Poland
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Yoshihara T, Morimoto T, Tsukamoto M, Toda Y, Hirata H, Kobayashi T, Takashima S, Mawatari M. Analyzing lumbar vertebral shape and alignment in female patients with degenerative spondylolisthesis: Comparisons with spinal stenosis and risk factor exploration. PLoS One 2024; 19:e0301974. [PMID: 38626167 PMCID: PMC11020370 DOI: 10.1371/journal.pone.0301974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE This study aimed to examine the vertebral body shape characteristics and spondylopelvic alignment in L4 degenerative spondylolisthesis (DS) as well as the risk factors for the development of DS. METHODS This cross-sectional study compared vertebral morphology and sagittal spinopelvic alignment in female patients with lumbar DS and lumbar spinal stenosis (LSS). The degree of lumbar lordosis (LL), pelvic incidence (PI), cross-sectional area (CSA), and vertebral body height ratio (ha/hp) of the lumbar spine were compared using full-length spine radiographs and computed tomography in 60 females with DS and in 60 women with LSS. RESULTS No significant differences in age or body mass index were observed between the two groups; however, the DS and LSS groups significantly differed in PI (mean, 58.9±10.8 vs. 47.2±11.6, P < 0.001), L4 CSA (mean, 1,166.2 m2 vs. 1,242.0 m2, P = 0.002) and ha/hp (mean, 1.134 vs. 1.007, P < 0.001). The L4 ha/hp was significantly higher in the DS group than in the LSS group. Additionally, LL values were negatively correlated with vertebral L5 CSA in the DS group (r = -0.28, P < 0.05). The LSS and DS groups demonstrated positive correlations between LL and L2, L3, and L4 ha/hp (r = 0.331, 0.267, and 0.317; P < 0.01, < 0.05, and < 0.05, respectively) and between LL and L4 and L5 ha/hp (r = 0.333, 0.331; P < 0.01, respectively). Multivariate regression analyses revealed that PI and ha/hp ratio may be independent predictors of DS development. CONCLUSION The DS group had significantly larger LL, PI, and L4 ha/hp and smaller L4 CSA than the LSS group. The lumbar vertebral body shape and sagittal spinopelvic alignment in females might be independent predictors of DS development.
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Affiliation(s)
- Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Satoshi Takashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Federico VP, Forlenza EM, Acuna AJ, Vucicevic RS, Conaway WK, Nie JW, Butler AJ, Gabriel S, Lopez GD, An HS, Colman MW, Phillips FM. Risk of Subsequent Fusion After Isolated Decompression of Lumbar Facet Cysts. J Am Acad Orthop Surg 2024; 32:339-345. [PMID: 38320287 DOI: 10.5435/jaaos-d-23-00765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Lumbar facet cysts represent a potential source of nerve root compression in elderly patients. Isolated decompression without fusion has proven to be a reasonable treatment option in properly indicated patients. However, the risk of lumbar fusion after isolated decompression and facet cyst excision has yet to be elucidated. METHODS The PearlDiver database was reviewed for patients undergoing isolated laminectomy for lumbar facet cyst from January 2015 to December 2018 using Current Procedural Terminology coding. Patients undergoing concomitant fusion or additional decompression, as well as those diagnosed with preexisting spondylolisthesis or without a minimum of 5-year follow-up, were excluded. Rates of subsequent lumbar fusion and potential risk factors for subsequent fusion were identified. Statistical analysis included descriptive statistics, chi square test, and multivariate logistic regression. Results were considered significant at P < 0.05. RESULTS In total, 10,707 patients were ultimately included for analysis. At 5-year follow-up, 727 (6.79%) of patients underwent subsequent lumbar fusion after initial isolated decompression. Of these, 301 (2.81% of total patients, 41.4% of fusion patients) underwent fusion within the first year after decompression. Multivariate analysis identified chronic kidney disease, hypertension, and osteoarthritis as risk factors for requiring subsequent lumbar fusion at 5 years following the index decompression procedure ( P < 0.033; all). CONCLUSION Patients undergoing isolated decompression for lumbar facet cysts undergo subsequent lumbar fusion at a 5-year rate of 6.79%. Risk factors for subsequent decompression include chronic kidney disease, hypertension, and osteoarthritis. This study will assist spine surgeons in appropriately counseling patients on expected postoperative course and potential risks of isolated decompression.
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Affiliation(s)
- Vincent P Federico
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Federico, Forlenza, Acuna, Vucicevic, Conaway, Nie, Butler, Lopez, An, Colman, and Phillips), and the Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA (Gabriel)
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Silva PS, Pereira P. Answer to the Letter to the Editor of Bansal Tungish, et al. concerning "Minimally invasive fusion surgery for patients with degenerative spondylolisthesis and severe lumbar spinal stenosis: a comparative study between MIDLIF and TLIF" by Pedro Santos Silva, et al. (Eur Spine J [2023]; doi:10.1007/s00586-023-07847-6). Eur Spine J 2024; 33:1306-1308. [PMID: 38286910 DOI: 10.1007/s00586-023-08081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Pedro Santos Silva
- Spine Unit, Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal.
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
- Neuroscience Unit, Hospital CUF Porto, Porto, Portugal.
| | - Paulo Pereira
- Spine Unit, Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Neuroscience Unit, Hospital CUF Porto, Porto, Portugal
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Ohyama S, Aoki Y, Inoue M, Nakajima T, Sato Y, Sato M, Yoh S, Takahashi H, Nakajima A, Eguchi Y, Orita S, Inage K, Shiga Y, Nakagawa K, Ohtori S. Does vacuum phenomenon at non-fused discs affect the postoperative course after transforaminal lumbar interbody fusion in patients showing a positive value of difference in lumbar lordosis? J Orthop Sci 2024; 29:472-479. [PMID: 36697335 DOI: 10.1016/j.jos.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/17/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Preoperative difference in lumbar lordosis (DiLL) was associated with surgical outcomes after single-level transforaminal lumbar interbody fusion (TLIF). Patients with DiLL>0 (DiLL (+)) tended to show worse clinical outcomes and postoperative greater restoration of lumbar lordosis (LL). However, some patients with DiLL (+) showed relatively good outcomes and no postoperative LL restration. This study aimed to elucidate whether the lumbar intervertebral disc vacuum phenomenon (VP) influences clinical course after single-level TLIF in patients with DiLL (+) and DiLL (-). METHODS Patients with lumbar spinal stenosis and degenerative spondylolisthesis treated with single-level TLIF were included. Pre- and postoperative LL were measured, and postoperative LL improvement was calculated. Preoperative DiLL was calculated as preoperative supine LL minus standing LL. Severity of VP at the non-fused discs (SVP (non-FS)) was evaluated using preoperative reconstructed computed tomography imaging. Clinical outcomes were assessed using the Oswestry disability index, visual analogue scale (VAS; low back pain (LBP), lower-extremity pain, numbness, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Patients were stratified by the median preoperative SVP (non-FS) score into severe and mild VP groups in patients with DiLL (+) or DiLL (-), and their surgical outcomes were compared. RESULTS Overall, 89 patients were included. In patients with DiLL (+) (n = 37), patients with severe VP showed worse clinical outcomes, particulary for LBP and DiLL (+) patients with mild VP showed greater LL improvement (6.5° ± 10.0°). In patients with DiLL(-) (n = 52), patients with severe VP showed worse clinical outcomes, particularly for LBP and no differences in preoperative, postoperative, and improvement of LL were observed between two groups. CONCLUSION Patients with DiLL (+) and DiLL (-) showed different clinical courses depending on VP severity at the non-fused discs after single-level TLIF.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan; Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Satoshi Yoh
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
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Chen JA, Mooney MA, Rachlin JR. Landmine Injury Resulting in Comminuted Lumbar Facet Fracture as a Cause of Lumbar Stenosis and Spondylolisthesis. Mil Med 2024; 189:e902-e906. [PMID: 37675860 DOI: 10.1093/milmed/usad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
Lumbar facet fractures are rarely reported and have been linked to sports and spine surgery. We describe the case of a 77-year-old patient who sustained an injury from multiple landmine blasts during the Vietnam War. He had low back pain since that time, which was initially managed conservatively. However, the pain progressed over decades to severe neurogenic claudication that greatly restricted his quality of life. Neuroimaging revealed the presence of bone fragments impinging on the spinal canal at the L5/6 level (transitional anatomy) that resulted from a comminuted fracture of the lumbar facet at the inferior articular process. We performed an L5/6 decompressive laminectomy, with removal of these fragments, and posterior instrumented fusion, with substantial improvement in symptoms. This case illustrates a unique mechanism of lumbar facet fracture and the biomechanic origination, natural history, and optimal treatment of this entity. We expand on the spectrum of lumbosacral injuries associated with the combat blast injury that have only increased in prevalence in recent conflicts.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael A Mooney
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jacob R Rachlin
- Department of Neurosurgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA
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Anzai A, Katayama H, Spir IAZ, Nery MM, Anhesini M, Tiezzi OS, Spir PRN, Otani P, Bernardo WM. Treatment of refractory low back pain due to arthrosis of the lumbar spine with or without spondylolisthesis using anterior lumbar interbody fusion (ALIF). Rev Assoc Med Bras (1992) 2024; 70:e2023D702. [PMID: 38422324 PMCID: PMC10903269 DOI: 10.1590/1806-9282.2023d702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Adriano Anzai
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | - Haroldo Katayama
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | | | - Mary Martins Nery
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | - Mauricio Anhesini
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
| | | | | | - Pericles Otani
- Guidelines Program of the Brazilian Medical Association - São
Paulo (SP), Brazil
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Yu R, Cheng X, Chen B. Percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis: a retrospective study. BMC Musculoskelet Disord 2024; 25:161. [PMID: 38378495 PMCID: PMC10877792 DOI: 10.1186/s12891-024-07267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Percutaneous transforaminal endoscopic decompression (PTED) is an ideal minimally invasive decompression technique for the treatment of lumbar spinal stenosis (LSS) with degenerative lumbar spondylolisthesis (DLS). The posterosuperior region underneath the slipping vertebral body (PRSVB) formed by DLS is an important factor exacerbating LSS in patients. Therefore, the necessity of removing the PRSVB during ventral decompression remains to be discussed. This study aimed to describe the procedure of PTED combined with the removal of the PRSVB and to evaluate the clinical outcomes. METHODS LSS with DLS was diagnosed in 44 consecutive patients at our institution from January 2019 to July 2021, and they underwent PTED combined with the removal of the PRSVB. All patients were followed up for at least 12 months. The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The mean age of the patients was 69.5 ± 7.1 years. The mean preoperative ODI score, VAS score of the low back, and VAS score of the leg were 68.3 ± 10.8, 5.8 ± 1.0, and 7.7 ± 1.1, respectively, which improved to 18.8 ± 5.0, 1.4 ± 0.8, and 1.6 ± 0.7, respectively, at 12 months postoperatively. The proportion of patients presenting "good" and "excellent" ratings according to the modified MacNab criteria was 93.2%. The percent slippage in spondylolisthesis preoperatively (16.0% ± 3.3%) and at the end of follow-up (15.8% ± 3.3%) did not differ significantly (p>0.05). One patient had a dural tear, and one patient had postoperative dysesthesia. CONCLUSIONS Increasing the removal of PRSVB during the PTED process may be a beneficial surgical procedure for alleviating clinical symptoms in patients with LSS and DLS. However, long-term follow-up is needed to study clinical effects.
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Affiliation(s)
- Rongbo Yu
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China
| | - Xiaokang Cheng
- Department of Orthopedic, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, 100730, China
| | - Bin Chen
- Department of Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China.
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Shetty KD, Chen PG, Brara HS, Anand N, Skaggs DL, Calsavara VF, Qureshi NS, Weir R, McKelvey K, Nuckols TK. Variations in surgical practice and short-term outcomes for degenerative lumbar scoliosis and spondylolisthesis: do surgeon training and experience matter? Int J Qual Health Care 2024; 36:mzad109. [PMID: 38156345 PMCID: PMC10849168 DOI: 10.1093/intqhc/mzad109] [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: 07/22/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 12/30/2023] Open
Abstract
For diverse procedures, sizable geographic variation exists in rates and outcomes of surgery, including for degenerative lumbar spine conditions. Little is known about how surgeon training and experience are associated with surgeon-level variations in spine surgery practice and short-term outcomes. This retrospective observational analysis characterized variations in surgical operations for degenerative lumbar scoliosis or spondylolisthesis, two common age-related conditions. The study setting was two large spine surgery centers in one region during 2017-19. Using data (International Classification of Diseases-10th edition and current procedural terminology codes) extracted from electronic health record systems, we characterized surgeon-level variations in practice (use of instrumented fusion - a more extensive procedure that involves device-related risks) and short-term postoperative outcomes (major in-hospital complications and readmissions). Next, we tested for associations between surgeon training (specialty and spine fellowship) and experience (career stage and operative volume) and use of instrumented fusion as well as outcomes. Eighty-nine surgeons performed 2481 eligible operations. For the study diagnoses, spine surgeons exhibited substantial variation in operative volume, use of instrumented fusion, and postoperative outcomes. Among surgeons above the median operative volume, use of instrumented fusion ranged from 0% to >90% for scoliosis and 9% to 100% for spondylolisthesis, while rates of major in-hospital complications ranged from 0% to 25% for scoliosis and from 0% to 14% for spondylolisthesis. For scoliosis, orthopedic surgeons were more likely than neurosurgeons to perform instrumented fusion for scoliosis [49% vs. 33%, odds ratio (OR) = 2.3, 95% confidence interval (95% CI) 1.3-4.2, P-value = .006] as were fellowship-trained surgeons (49% vs. 25%, OR = 3.0, 95% CI 1.6-5.8; P = .001). Fellowship-trained surgeons had lower readmission rates. Surgeons with higher operative volumes used instrumented fusion more often (OR = 1.1, 95% CI 1.0-1.2, P < .05 for both diagnoses) and had lower rates of major in-hospital complications (OR = 0.91, 95% CI 0.85-0.97; P = .006). Surgical practice can vary greatly for degenerative spine conditions, even within the same region and among colleagues at the same institution. Surgical specialty and subspecialty, in addition to recent operative volume, can be linked to variations in spine surgeons' practice patterns and outcomes. These findings reinforce the notion that residency and fellowship training may contribute to variation and present important opportunities to optimize surgical practice over the course of surgeons' careers. Future efforts to reduce unexplained variation in surgical practice could test interventions focused on graduate medical education. Graphical Abstract.
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Affiliation(s)
- Kanaka D Shetty
- RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Peggy G Chen
- RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Harsimran S Brara
- Kaiser Permanente, Los Angeles Medical Center, 4867 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Neel Anand
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - David L Skaggs
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | | | - Nabeel S Qureshi
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Rebecca Weir
- RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Karma McKelvey
- Rocky Vista University, Montana College of Osteopathic Medicine, 4130 Rocky Vista Way, Billings, Montana 59106, USA
| | - Teryl K Nuckols
- RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Schönnagel L, Muellner M, Suwalski P, Guven AE, Camino-Willhuber G, Tani S, Caffard T, Zhu J, Haffer H, Arzani A, Chiapparelli E, Amoroso K, Shue J, Duculan R, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis. Pain 2024; 165:376-382. [PMID: 37856648 DOI: 10.1097/j.pain.0000000000003018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
ABSTRACT Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP ≥ 4 numeric analogue scale (OR = 9.49, 95% confidence interval [CI]: 2.71-40.59, P < 0.001) and postoperative LBP ≥ 4 (OR = 1.72, 95% CI: 0.92-3.21, P = 0.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR = 0.44, 95% CI: 0.22-0.85, P = 0.016; severe AAC: OR = 0.41, 95% CI: 0.2-0.82, P = 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Phillip Suwalski
- Medical Heart Center of Charité CBF-Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, United States
| | - Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Roland Duculan
- Hospital for Special Surgery, New York City, NY, United States
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY, United States
- Weill Cornell Medical College, New York, NY, United States
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, United States
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Camino-Willhuber G, Schönnagel L, Caffard T, Zhu J, Tani S, Chiapparelli E, Arzani A, Shue J, Duculan R, Bendersky M, Zelenty WD, Sokunbi G, Lebl DR, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP, Sama AA. Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis. Clin Spine Surg 2024; 37:E1-E8. [PMID: 37651562 DOI: 10.1097/bsd.0000000000001510] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Retrospective study of prospective collected data. OBJECTIVE To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. METHODS We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. RESULTS A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. CONCLUSION Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | | | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires
- Intraoperative Monitoring, Department of Pediatric Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - William D Zelenty
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Gbolabo Sokunbi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Darren R Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY
- Weill Cornell Medical College, New York, NY
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY
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Rahyussalim AJ, Widyahening IS, Belantara LAS, Canintika AF. Association between spinopelvic alignment and the development of degenerative spondylolisthesis: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2024; 34:713-722. [PMID: 37855936 DOI: 10.1007/s00590-023-03754-0] [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: 07/26/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Spinopelvic parameter may result in the development of degenerative spondylolisthesis. However, previous studies show conflicting results; some found a significant relationship of some of these parameters with degenerative spondylolisthesis, while others did not. Previously, there was no meta-analysis regarding the association between spinopelvic alignment and degenerative spondylolisthesis. This meta-analysis aims to determine the association between spinopelvic alignment and degenerative spondylolisthesis. METHODS Systematic reviews and meta-analyses are based on the selected item reporting method for systematic review and meta-analysis (PRISMA). A literature search was performed using PubMed, EMBASE, ScienceDirect, Cochrane, and Google Scholar. Methodological quality is based on the cross-sectional checklist of the Agency for Healthcare Research and Quality (AHRQ) quality check methodology and the Newcastle-Ottawa scale (NOS) for cohort studies. Statistical analysis was performed using Rev-Man 5.3. Subgroup analyses were performed based on ethnicity and study design to ascertain racial relations and heterogeneity. RESULTS A total of 3236 articles were obtained. Of these, we found that pelvic incidence (mean difference [MD] = 11.94 [1.81-22.08], P = 0.02), pelvic tilt (MD = 4.47 [0.81-8.14]), P = 0.02), and age (MD = 11.94 [1.81-22.08], P = 0.02) were associated with the development of degenerative spondylolisthesis. CONCLUSION This meta-analysis proves that pelvic incidence, pelvic tilt, and age are associated with degenerative spondylolisthesis.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Latsarizul Alfariq Senja Belantara
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
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Shen X, Gao YC, Zhang P, Song P, Jiang ZL, Wang F, Xuan WB, Gao ZX. Is unilateral-approach full-endoscopic lumbar fusion effective for single-level lumbar spondylolisthesis with bilateral symptoms? A preliminary report of 43 CT analysis. Eur Spine J 2024; 33:409-416. [PMID: 37378709 DOI: 10.1007/s00586-023-07667-8] [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: 12/02/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To investigate the clinical results and radiological parameters changes after unilateral-approach endoscopic lumbar interbody fusion (Endo-LIF) for lumbar spondylolisthesis with bilateral symptoms. METHODS 43 single-level lumbar spondylolisthesis patients with bilateral lower limb symptoms were included from June 2020 to May 2022. All patients underwent unilateral-approach Endo-LIF and postoperative computed tomography. Radiological parameters including disk height (DH), degree of upper vertebral slip (DUVS), and foramen intervertebral parameters including bilateral foraminal height (FH), contralateral foraminal areas (FA) were evaluated. The clinical outcomes including low back pain and bilateral leg pain were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. RESULTS All cases were successfully completed surgery and followed for average 15.16 ± 5.2 months. DH (44% ± 11%) and DUVS were significantly improvement postoperatively compared with preoperatively (p < 0.05). Statistically significant increases in bilateral FH (25% ± 11% on the surgical side, 17% ± 8% on the contralateral side) and contralateral FA (26% ± 6%) were observed (p < 0.05). The VAS and the ODI scores were significantly decreased in comparison with the preoperative scores (p < 0.05). CONCLUSION Unilateral-approach with contralateral indirect decompression in Endo-LIF can acquire satisfactory clinical outcomes. Therefore, unilateral-approach Endo-LIF may be a promising option for lumbar spondylolisthesis with bilateral symptoms.
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Affiliation(s)
- Xu Shen
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yu-Cheng Gao
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Pei Zhang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Peng Song
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zan-Li Jiang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Feng Wang
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Wen-Bin Xuan
- School of Medicine, Southeast University, Nanjing, 210009, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Zeng-Xin Gao
- School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
- Department of Orthopedics, Nanjing Lishui People's Hospital, Zhongda Lishui Brach, Nanjing, 210009, China.
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Shukla GG, Matur AV, Tao X, Adogwa O. Response to Letter to the Editor Regarding: Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2024; 49:E18. [PMID: 37779319 DOI: 10.1097/brs.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Austevoll IM, Hellum C, Försth P. Letter to the Editor Regarding the Paper of Shukla and Colleagues on Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis. Spine (Phila Pa 1976) 2024; 49:E17. [PMID: 37589286 DOI: 10.1097/brs.0000000000004800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Ivar Magne Austevoll
- Orthopedic Department, Haukeland University Hospital, Kysthospitalet in Hagevik, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Sweden
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Cho J, Kang KN, Lee MS, Kim YU. Surgical versus nonsurgical management of lumbar degenerative spondylolisthesis based on spinal canal cross-sectional area. Medicine (Baltimore) 2024; 103:e36874. [PMID: 38215145 PMCID: PMC10783222 DOI: 10.1097/md.0000000000036874] [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: 03/12/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
Disability and pain associated with lumbar degenerative spondylolisthesis (LDS) result in a significant burden on both the healthcare costs and patients' quality of life. Currently, there exists controversy regarding employment of either nonsurgical management (NSM) or surgical management (SM) in a clinical setting. Spinal canal cross-sectional area (SCA) has been an important morphological parameter for the analysis of LDS. However, there is lack of research about the comparative value of NSM and SM according to SCA. Moreover, previous research have not yet evaluated the clinical most suitable cutoff values of SCA. The objective of this research was to evaluate the effective of NSM and SM for LDS using SCA as an objective morphological parameter. The axial T2 magnetic resonance imaging images were obtained from each patient. We collected SCA samples from 149 patients with LDS. 72 patients underwent SM and the rest did NSM. We measured SCA at the L4/5 LDS on magnetic resonance imaging using a picture archiving and communications system. We measured SCA at the intervertebral disk posterior border, turning down to reach the facet joint side on the opposite edge at the L4/5 level. The average SCA value was 114.34 ± 48.11 mm2 in the NSM group and 69.88 ± 27.87 mm2 in the SM group. Therefore, the SM group had considerably lower SCA (P < .001). In view of the effectiveness of SCA as a prediction factor of surgical option, Receiver Operating Characteristic curve analysis show the optimal cutoff value for SCA as 83.21 mm2, with 70.8% sensitivity, 71.4% specificity, and an area under the curve of 0.80 (95% CI, 0.73-0.87). The narrower the SCA, the higher the probability of SM. Thus, it is proposed that to evaluate surgical decision making, the pain physician should carefully inspect the SCA.
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Affiliation(s)
- Jaeho Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Min Sang Lee
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
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Coskun Benlidayi I, Tirasci E. The effect of lumbosacral transitional vertebra on lumbar spine degeneration and spondylolisthesis among patients with low back pain. Pain Pract 2024; 24:52-61. [PMID: 37497739 DOI: 10.1111/papr.13280] [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: 01/11/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
AIM To examine the impact of lumbosacral transitional vertebra (LSTV) on lumbar spine degeneration, disc protrusion, and spondylolisthesis among patients with low back pain. METHODS The records of the patients who had undergone anterioposterior lumbar radiographs and lumbar magnetic resonance imaging (MRI) for low back pain between November 2014 and September 2021 were extracted retrospectively and assessed for eligibility. Of the remaining patients, those with LSTV were assigned as "case group." Age- and sex-matched patients without LSTV were assigned as "control group." On digitalized lumbar MRIs, Modic degeneration (type I-III) and Pfirrman's disc degeneration (grade I-V) immediately cephalad to the transitional level were evaluated; intervertebral disc height (mm), disc protrusion (mm), and percentage of vertebral slippage (%) were measured. RESULTS Of the 501 patients with low back pain, 128 ineligible patients were excluded; 113 patients with LSTV and 117 age- and sex-matched controls were included in the study. LSTV group revealed decreased intervertebral disc height, increased vertebral endplate degeneration, and slippage, as well as increased disc degeneration and protrusion when compared with controls (p < 0.001). Patients with type III LSTV had greater disc protrusion and higher percentage of slippage compared to those with type I LSTV (p = 0.008 and p = 0.009, respectively). Vertebral endplate degeneration, disc height, and disc degeneration did not differ across categories of LSTV type. CONCLUSION Lumbosacral transitional vertebra malformation is related to decreased intervertebral disc height, increased disc degeneration, vertebral endplate degeneration, disc protrusion, and slippage above the level of transition. Patients with type III LSTV revealed the highest percentage of slippage and disc protrusion.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Emre Tirasci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
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Guo W, Li T, Feng C, Yu Y, Hu Y, Fan X. Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up. J Orthop Surg Res 2023; 18:943. [PMID: 38066527 PMCID: PMC10709901 DOI: 10.1186/s13018-023-04401-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). METHODS The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. RESULTS The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05). CONCLUSIONS Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.
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Affiliation(s)
- Wenlong Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Tong Li
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Chaoqun Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yang Yu
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Youpeng Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xiaohong Fan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
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Kim DC, Laskay N, Alcala C, Schwender J. Minimally Invasive Decompression With Noninstrumented Facet Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Stenosis Associated With Grade 1 Lumbar Degenerative Spondylolisthesis. Clin Spine Surg 2023; 36:E416-E422. [PMID: 37348064 DOI: 10.1097/bsd.0000000000001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN Retrospective matched cohort study. SUMMARY OF BACKGROUND DATA With a growing interest in minimally invasive spine surgery (MIS), the question of which technique is the most advantageous for patients with low-grade degenerative lumbar spondylolisthesis (DLS) still remains unclear. OBJECTIVE To compare patient-reported outcomes, perioperative morbidity, and rates of reoperation between MIS decompression with either unilateral noninstrumented facet fusion (MIS-F) or with transforaminal interbody fusion (MIS-T) for grade 1 DLS. METHODS Twenty patients who underwent MIS-T and 20 patients with MIS-F were matched based on age, sex, and preoperative ODI, VAS back, and VAS leg. All patients had DLS with at least 4 millimeters of translation on standing radiographs. Exclusion criteria included prior level surgery, multilevel instability, disk impinging on the exiting nerve root, spondylolisthesis from significant facet arthropathy, or foraminal compromise from disk collapse. ODI, VAS back, VAS leg, and patient satisfaction measured by the North American Spine Society questionnaire were tracked at 3, 6, 12, and 24 months postoperatively. Minimum clinically important differences and substantial clinical benefits were calculated. RESULTS MIS-F and MIS-T resulted in decreased ODI at 3, 6, and 12 months following the index procedure. Sixty percent of MIS-F and 83% of MIS-T patients reached minimum clinically important difference at 1 year postoperatively; however, using the threshold of 30% ODI reduction from baseline, 67% of MIS-F and 83% MIS-T ( P = 0.25) achieved this goal. Forty-three percent of MIS-F and 59% of MIS-T patients met substantial clinical benefits. Satisfaction at 1 year, measured by a score of 1 or 2 on the North American Spine Society questionnaire, was 64% for MIS-F and 83% for MIS-T. CONCLUSIONS MIS-F and MIS-T are effective treatment options for spinal stenosis associated with low-grade DLS. Both techniques result in comparable patient-reported outcomes and satisfaction up to 2 years and have similar long-term reoperation rates. More evidence is required to delineate optimal selection characteristics for MIS-F versus MIS-T.
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Affiliation(s)
| | - Nicholas Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
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21
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de Dios E, Laesser M, Björkman-Burtscher IM, Lindhagen L, MacDowall A. MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy. BMC Med Imaging 2023; 23:180. [PMID: 37946139 PMCID: PMC10634168 DOI: 10.1186/s12880-023-01151-x] [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: 02/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy. METHODS T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC). RESULTS The SEm was 0.5 mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6 mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5 mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6 mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC = 0.80 [95% CI 0.70-0.87] and ICC = 0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively). CONCLUSIONS This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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Affiliation(s)
- Eddie de Dios
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden.
| | - Mats Laesser
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Aimar E, Iess G, Labiad I, Mezza F, Bona A, Ciuffi A, Grassia F, Isidori A, Zekaj E, Bonomo G. Degenerative L4-L5 spondylolisthesis and stenosis surgery: does over-level flavectomy technique influence clinical outcomes and rates of cranial adjacent segment disease? Acta Neurochir (Wien) 2023; 165:3107-3117. [PMID: 37632571 DOI: 10.1007/s00701-023-05761-w] [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: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar fusion associated with total laminectomy at the same level with those undergoing partial laminectomy. No study has examined the role of selective over-level flavectomy (OLF; i.e., L3-L4). METHODS A total of 299 patients undergoing posterolateral arthrodesis (PLA) for L4-L5 degenerative spondylolisthesis were retrospectively analyzed with a 5-year follow-up. 148 patients underwent PLA + L4-L5 flavectomy + L4 partial laminectomy (control group), while 151 underwent PLA + L4-L5 flavectomy + total L4 laminectomy + L3-L4 flavectomy (OLF group). Rates of reoperations due to CASD were examined utilizing Cox proportional hazard models, while clinical improvement at follow-up (measured in ODI) was analyzed using generalized linear models (GLMs). Adjustments for potential confounders were made (grade of lumbar lordosis, age, sex, BMI, intervertebral disc degeneration, and presurgical cranial spinal stenosis). RESULTS At 5 years from the operation, 16 patients (10.8%) in the control group had undergone revision surgery for CASD compared to 5 patients (3.3%) in the OLF group (p = 0.013). Survival analysis and GLM demonstrated that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcome. There were no differences in the rate of discal degeneration or the onset of Meyerding's grade I degenerative spondylolisthesis at the adjacent segment. BMI was the only other significant predictor of ODI improvement and of the incidence of CASD. CONCLUSIONS In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
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Affiliation(s)
- Enrico Aimar
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy.
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy.
- Università degli Studi di Milano, Lumbardy, Milan, Italy.
| | - Ikrame Labiad
- Università degli Studi di Milano, Lumbardy, Milan, Italy
| | - Federica Mezza
- Department of Economics, Bocconi University, Lumbardy, Milan, Italy
| | - Alberto Bona
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Andrea Ciuffi
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Fabio Grassia
- Department of Neurosurgery, Anschutz medical campus, Aurora, CO, USA
| | - Alessandra Isidori
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Edvin Zekaj
- Department of Neurosurgery, IRCCS Istituto Ortopedico Galeazzi, Lumbardy, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Lumbardy, Milan, Italy
- Università degli Studi di Milano, Lumbardy, Milan, Italy
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Thornley P, Urquhart JC, Glennie A, Rampersaud R, Fisher C, Abraham E, Charest-Morin R, Dea N, Kwon BK, Manson N, Hall H, Paquette S, Street J, Siddiqi F, Rasoulinejad P, Bailey CS. Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery. Spine J 2023; 23:1512-1521. [PMID: 37307882 DOI: 10.1016/j.spinee.2023.06.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature. However, little is known about the radiographic parameters most associated with improved functional outcomes among patients undergoing surgery for DLS. PURPOSE To identify the effect of postoperative sagittal spinal alignment on functional outcome after DLS surgery. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Two-hundred forty-three patients in the Canadian Spine Outcomes and Research Network (CSORN) prospective DLS study database. OUTCOME MEASURES Baseline and 1-year postoperative leg and back pain on the 10-point Numeric Rating Scale and baseline and 1-year postoperative disability on the Oswestry Disability Index (ODI). METHODS All enrolled study patients had a DLS diagnosis and underwent decompression in isolation or with posterolateral or interbody fusion. Global and regional radiographic alignment parameters were measured at baseline and 1-year postoperatively including sagittal vertical axis (SVA), pelvic incidence and lumbar lordosis (LL). Both univariate and multiple linear regression was used to assess for the association between radiographic parameters and patient-reported functional outcomes with adjustment for possible confounding baseline patient factors. RESULTS Two-hundred forty-three patients were available for analysis. Among participants, the mean age was 66 with 63% (153/243) female with the primary surgical indication of neurogenic claudication in 197/243 (81%) of patients. Worse pelvic incidence-LL mismatch was correlated with more severe disability [ODI, 0.134, p<.05), worse leg pain (0.143, p<.05) and worse back pain (0.189, p<.001) 1-year postoperatively. These associations were maintained after adjusting for age, BMI, gender, and preoperative presence of depression (ODI, R2 0.179, β, 0.25, 95% CI 0.08, 0.42, p=.004; back pain R2 0.152 (β, 0.05, 95% CI 0.022, 0.07, p<.001; leg pain score R2 0.059, β, 0.04, 95% CI 0.008, 0.07, p=.014). Likewise, reduction of LL was associated with worse disability (ODI, R2 0.168, β, 0.04, 95% CI -0.39, -0.02, p=.027) and worse back pain (R2 0.135, β, -0.04, 95% CI -0.06, -0.01, p=.007). Worsened SVA correlated with worse patient reported functional outcomes (ODI, R2 0.236, β, 0.12, 95% CI 0.05, 0.20, p=.001). Similarly, an increase (worsening) in SVA resulted in a worse NRS back pain (R2 0.136, β, 0.01, 95% CI .001, 0.02, p=.029) and worse NRS leg pain (R2 0.065, β, 0.02, 95% CI 0.002, 0.02, p=.018) scores regardless of surgery type. CONCLUSIONS Preoperative emphasis on regional and global spinal alignment parameters should be considered in order to optimize functional outcome in lumbar degenerative spondylolisthesis treatment.
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Affiliation(s)
- Patrick Thornley
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, 1-319, 800 Commissioners Rd, East, London, Ontario N6A 5W9, Canada
| | - Jennifer C Urquhart
- Lawson Health Research Institute, 750 Baseline Road Eat Suite 300, London, Ontario N6C 2R5, Canada
| | - Andrew Glennie
- Department of Orthopedics and Neurosurgery, Dalhousie University, 1796 Summer Street - Room 4558, Halifax, Nova Scotia B3H 3A7, Canada
| | - Raja Rampersaud
- University of Toronto, University Health Network, Arthritis Program, Krembil Research Institute, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Charles Fisher
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Edward Abraham
- Canada East Spine Centre, 555 Somerset Street - Suite 200, Saint John, New Brunswick E2K 4X2, Canada
| | - Raphaele Charest-Morin
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Nicolas Dea
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Brian K Kwon
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Neil Manson
- Canada East Spine Centre, 555 Somerset Street - Suite 200, Saint John, New Brunswick E2K 4X2, Canada
| | - Hamilton Hall
- Division of Orthopedic Surgery, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Scott Paquette
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - John Street
- University of British Columbia, Vancouver General Hospital, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Fawaz Siddiqi
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, 1-319, 800 Commissioners Rd, East, London, Ontario N6A 5W9, Canada
| | - Parham Rasoulinejad
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, 1-319, 800 Commissioners Rd, East, London, Ontario N6A 5W9, Canada
| | - Christopher S Bailey
- London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, 1-319, 800 Commissioners Rd, East, London, Ontario N6A 5W9, Canada.
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Romano A, Butera G, Moltoni G, Acqui M, Miscusi M, Rossi-Espagnet MC, Trasimeni G, Raco A, Bozzao A. Epidural bleeding secondary to a synovial cyst rupture: a case report and review of literature. Br J Neurosurg 2023; 37:1263-1265. [PMID: 33241949 DOI: 10.1080/02688697.2020.1849547] [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: 07/19/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Hemorrhage into a juxtafacet cyst is rare and cyst rupture with hemorrhagic extension into the epidural space is even less commonly seen. We describe the case of a patient with a hemorrhagic synovial cyst with rupture associated to abundant bleeding in the epidural space. A 61-year-old man had a 5-month history of worsening low back pain radiating into the right leg with associated weakness and numbness. A magnetic resonance imaging scan showed the presence of a mild anterior spondylolisthesis of L5 on S1 with increased synovial fluid into both facet joints. A suspected synovial cyst of the right facet joint at level L5-S1, with signal characteristics consistent with hemorrhage was seen. Caudally, epidural blood was evident from S1 to S2 that involved spinal canal and right S1 and S2 foramens. These findings were confirmed at surgery.
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Affiliation(s)
- Andrea Romano
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Butera
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Moltoni
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Michele Acqui
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Massimo Miscusi
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guido Trasimeni
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonino Raco
- NESMOS, Department of Neurosurgery, S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy
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Wang C, Zhang L, Chen Y, Xu D, Wu X, Ma X. A rare discal cyst with concurrent double-level isthmic lumbar spondylolisthesis: a case report and literature review. Br J Neurosurg 2023; 37:1311-1314. [PMID: 33349066 DOI: 10.1080/02688697.2020.1864294] [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: 05/19/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
We presented a 47-year old male diagnosed as a discal cyst with concurrent isthmic lumbar spondylolisthesis, which was not reported in the literature previously. A cystectomy with two-segmental transforaminal lumbar interbody fusion and instruments was performed. The association between concurrent discal cyst and isthmic spondylolisthesis may be illuminated by excessive strain and focal degeneration of the disc. Preoperative discography is probably unnecessary when surgical resection and histopathology are indicated for the patient.
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Affiliation(s)
- Chao Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Department of Medical Research Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunqing Chen
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Derong Xu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolin Wu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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Loubeyre J, Ferrero E, Jmal MM, Guigui P, Khalifé M. Surgical treatment of degenerative lumbar spondylolisthesis: Effect of TLIF and slip reduction on sagittal alignment. Orthop Traumatol Surg Res 2023; 109:103541. [PMID: 36608900 DOI: 10.1016/j.otsr.2022.103541] [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: 04/27/2022] [Revised: 08/08/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The surgical treatment of lumbar degenerative spondylolisthesis (LDS) remains controversial. The aim of this study was to determine the effect of adding transforaminal lumbar interbody fusion (TLIF) to posterolateral fusion (PLF) on the local lordosis, sagittal alignment and potential complications. The second aim was to evaluate the effect of slip reduction on the same parameters. HYPOTHESIS The initial hypothesis was that TLIF provides better correction of the local lordosis and that reducing the slip improves the global sagittal balance. METHODS In this retrospective, single-center study, patients who had been operated on for LSD at one or two levels by laminectomy and PLF, with or without a TLIF cage, were included. Data collected consisted of age, sex, number of levels fused and whether or not a TLIF cage was used. Fusion was defined as the absence of indirect nonunion signs on radiographs at 2 years postoperative. The occurrence and time frame of any complications and the need for reoperation were documented. Lateral radiographs of the entire spine were analyzed preoperatively, in the early postoperative period (3 to 6 months) and at a minimum follow-up of 2 years. The following parameters were measured: pelvic parameters, C7 sagittal tilt (C7ST), spinosacral angle (SSA), maximum lumbar lordosis (LL), lordosis at slipped level (LS), slip percentage. The analysis compared patients treated by PLF and TLIF and determined the impact of slip reduction. RESULTS One hundred and three patients were included in the study (71% women). The mean follow-up was 38 months. The mean age was 69 years. Seventy-seven patients (75%) underwent PLF. Comparing the preoperative and early postoperative data identified 5.4% better spondylolisthesis reduction in the TLIF group than the PLF group (-8.9±9.5% vs -3.5±7.6%; p=0.04) that was not maintained at the final follow-up. The fusion rate was comparable between groups: 94% in APL and 89% in TLIF (p=0.7). The overall complication rate was 46% in the TLIF group versus 33% in the PLF group (p=0.35). A comparison based on whether or not the slip was reduced found significant improvement in the reduction group of the SSA by more than 6° (6.8°±6° vs 0.5°±7.4°; p=0.04). The fusion rate was 91% in the reduced group and 95% in the non-reduced group (p=0.81); the complication rate was 44% versus 28% in the non-reduced group (p=0.10). CONCLUSION This study shows that slip reduction helps to improve the sagittal alignment by increasing the SSA when treating LDS. Posterolateral fusion and TLIF produce comparable radiographic outcomes at 2 years postoperative in the segmental lordosis, slip reduction, global sagittal alignment and fusion rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jeanne Loubeyre
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Cité, Paris, France
| | - Emmanuelle Ferrero
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Cité, Paris, France
| | - Mohamed Mokhtar Jmal
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Cité, Paris, France
| | - Pierre Guigui
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Cité, Paris, France
| | - Marc Khalifé
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Cité, Paris, France.
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Haider G, Varshneya K, Rodrigues A, Marianayagam N, Stienen MN, Veeravagu A. Progression to fusion after lumbar laminectomy for degenerative lumbar spondylolisthesis: Rate and risk-factors. A national database study. Clin Neurol Neurosurg 2023; 233:107919. [PMID: 37536253 DOI: 10.1016/j.clineuro.2023.107919] [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: 07/03/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Lumbar laminectomy is often utilized in the treatment of degenerative lumbar spondylolisthesis. Risk factors that contribute to reoperation rates, in particular to progression to fusion, are poorly understood. We aimed to identify rate and risk factors of lumbar fusion surgery following lumbar laminectomy for the treatment of degenerative lumbar spinal spondylolisthesis. METHODS Our sample was obtained from the national MarketScan Commercial Claims and Encounters Database. We reviewed patients undergoing lumbar laminectomy for stable degenerative lumbar spondylolisthesis (Grade-1) at one or two levels between January 2007 and December 2016. RESULTS A total of 33,681 patients were included. By 2 years after the index operation, 2.48 % of patients had required lumbar fusion surgery. Female sex was associated with lower odds (OR 0.8, 95 %CI 0.7-0.9) of reoperation for fusion. Diabetes (OR 1.2, 95 %CI 1.1-1.4), rheumatoid arthritis (OR 1.5, 95 %CI 1.2-1.7) and clinical presentation with LBP (OR 2.1, 95 %CI 1.6-2.9), lower extremity weakness (OR 1.4, 95 %CI 1.1-1.5), as well as occurrence of a postoperative neurological complications (OR 2.0, 95 %CI 1.1-3.4) increased the odds ratio for requiring fusion surgery within two years after lumbar laminectomy. CONCLUSION In this large cross-sectional sample of a national claims database consisting of lumbar laminectomy patients for the treatment of spondylolisthesis, approximately 2.5 % required subsequent lumbar fusion. Several modifiable risk factors for fusion progression were identified, which may guide clinicians in shared decision-making and to help identify patients with elevated post-operative risk providing potential leverage point for prevention.
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Affiliation(s)
- Ghani Haider
- Department of Neurosurgery, Stanford University, Stanford, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Kunal Varshneya
- School of Medicine, Stanford University, Stanford, 291 Campus Drive, Stanford, CA 94305, USA
| | - Adrian Rodrigues
- School of Medicine, Stanford University, Stanford, 291 Campus Drive, Stanford, CA 94305, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Stanford University, Stanford, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Martin N Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, Rorschacher Str. 95, CH-9007 St.Gallen, Switzerland
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University, Stanford, 300 Pasteur Drive, Stanford, CA 94305, USA
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Li R, Liu Y, Zhu Y, Lu M, Jiang W. Clinical and radiographic outcomes of oblique lumbar interbody fusion with anterolateral screw and rod instrumentation in osteopenia patients: a retrospective study. BMC Musculoskelet Disord 2023; 24:760. [PMID: 37749502 PMCID: PMC10521488 DOI: 10.1186/s12891-023-06873-1] [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: 09/29/2022] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The purpose of this paper is to evaluate the clinical and radiographic outcomes of oblique lumbar interbody fusion (OLIF) to perform in L4/5 degenerative lumbar spondylolisthesis (DLS) patients who diagnosed with osteopenia. METHODS From December 2018 to 2021 March, 94 patients were diagnosed with degenerative spondylolisthesis underwent OLIF and divided into two groups with different bone mineral density. Anterolateral screw and rod instrumentation was applied in two groups. The primary outcomes were VAS, JOA and ODI. The secondary outcomes included disc height (DH), cross-sectional height of the intervertebral foramina (CSH), cross-sectional area of the dural sac (CSA), lumbar lordorsis (LL), pelvic titlt (PT), pelvic incidence (PI) and sacrum slop (SS). RESULTS All patients finished at least 1 years follow-up with 21.05 ± 4.42 months in the group A and 21.09 ± 4.28 months in the group B. The clinical symptoms were evaluated by VAS, JOA and ODI and 94 patients showed good outcomes at final follow-up (P < 0.05), with significant increases in DH, CSH and CSA. In group A, DH increased from 8.54 ± 2.48 to 11.11 ± 2.63 mm, while increased from 8.60 ± 2.29 to 11.23 ± 1.88 were recorded in group B. No statistical difference was found in DH between the two groups (P > 0.05). The cage subsidence was 1.14 ± 0.83 mm in group A and 0.87 ± 1.05 mm in group B (P > 0.05). There was no significant difference in the adjusted parameters of spino-pelvic between two groups (P > 0.05). CONCLUSION Oblique lumbar interbody fusion with anterolateral screw and rod instrumentation is feasible to be performed in osteopenia patients who diagnosed with degenerative spondylolisthesis.
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Affiliation(s)
- Renjie Li
- Department of Orthopedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, 215123, China
| | - Yijie Liu
- Department of Orthopedic Surgery, The first affiliated hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Yi Zhu
- Department of Orthopedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, 215123, China
| | - Minhua Lu
- Department of Orthopedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, 215123, China
| | - Weimin Jiang
- Department of Orthopedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, 215123, China.
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Andresen AK, Wickstrøm LA, Holm RB, Carreon LY, Andersen MØ. Instrumented Versus Uninstrumented Posterolateral Fusion for Lumbar Spondylolisthesis: A Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:1309-1317. [PMID: 37347830 DOI: 10.2106/jbjs.22.00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND In Scandinavia, spinal fusion is frequently performed without instrumentation, as use of instrumentation in the elderly can be complicated by poor bone quality and the risk of screw pull-out. However, uninstrumented fusion carries the risk of nonunion. We performed a randomized controlled trial in an attempt to determine if use of instrumentation leads to better outcomes and fusion rates when spinal fusion is performed for degenerative spondylolisthesis in the elderly. METHODS This was a randomized, single-center, open-label trial of patients with symptomatic single-level degenerative spondylolisthesis who were assigned 1:1 to decompression and fusion with or without instrumentation after at least 12 weeks of nonoperative treatment had failed. The primary outcome was the change in the Oswestry Disability Index (ODI), and secondary outcomes included fusion rates within 1 year, reoperation rates within 2 years, and changes in the EuroQol-5 Dimension-3 Level (EQ-5D) score. RESULTS Fifty-four subjects were randomized to each of the 2 groups, which had similar preoperative demographic and surgical characteristics. We found similar improvements in the ODI (p = 0.791), back pain, leg pain, and quality of life between groups at 1 and 2 years of follow-up. Solid fusion on computed tomography (CT) scans was noted in 94% of the patients in the instrumented group and 31% in the uninstrumented group (p < 0.001). One patient (2%) in the instrumented group and 7 (13%) in the uninstrumented group (p = 0.031) had a reoperation within 2 years after the index surgery. CONCLUSIONS We found no difference in patient-reported outcomes when we compared instrumented with uninstrumented fusion in patients with degenerative spondylolisthesis. The uninstrumented group had a significantly higher rate of nonunion and reoperations at 2 years. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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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, Denmark
- Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Line A Wickstrøm
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Randi B Holm
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Leah Y Carreon
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østerheden Andersen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
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Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review. Medicina (Kaunas) 2023; 59:1430. [PMID: 37629720 PMCID: PMC10456558 DOI: 10.3390/medicina59081430] [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: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.
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Affiliation(s)
- Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Bartłomiej Kulesza
- Department of Medical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Natalia Gołębiowska
- Department of Neurosurgery and Spine Surgery, Regional Hospital in Kielce, 25-736 Kielce, Poland
| | - Bartłomiej Tyzo
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Krzysztof Kura
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland
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van Grafhorst JMP, Dijkerman ML, Peul WC, Vleggeert-Lankamp CLA. Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression. Acta Neurochir (Wien) 2023; 165:2145-2151. [PMID: 37410183 PMCID: PMC10409655 DOI: 10.1007/s00701-023-05667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment. METHODS Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as 'satisfied' or 'unsatisfied' after initial and secondary surgery. The follow-up was 6 to 12 years. RESULTS Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation. CONCLUSION Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.
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Affiliation(s)
| | - Manon L Dijkerman
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Carmen L A Vleggeert-Lankamp
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem/Hoofddorp, Netherlands
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Kaiser R, Kantorová L, Langaufová A, Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 2023; 94:657-666. [PMID: 36849239 PMCID: PMC10359551 DOI: 10.1136/jnnp-2022-330158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER CRD42022308267.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Lucia Kantorová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Simona Slezáková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Dagmar Tučková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Zdeněk Klézl
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Pavel Barsa
- Department of Neurosurgery, Regional Hospital Liberec, Liberec, Czech Republic
| | - Jan Cienciala
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Richard Hajdúk
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Lumír Hrabálek
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Kučera
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Martin Prýmek
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Repko
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
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Toyoda H, Terai H, Yamada K, Kato M, Suzuki A, Takahashi S, Tamai K, Yabu A, Iwamae M, Sawada Y, Nakamura H. A decision tree analysis to predict clinical outcome of minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis. Spine J 2023; 23:973-981. [PMID: 36739978 DOI: 10.1016/j.spinee.2023.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/25/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Implementing machine learning techniques, such as decision trees, known as prediction models that use logical construction diagrams, are rarely used to predict clinical outcomes. PURPOSE To develop a clinical prediction rule to predict clinical outcomes in patients who undergo minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis using a decision tree model. STUDY DESIGN/SETTING A retrospective analysis of prospectively collected data. PATIENT SAMPLE This study included 331 patients who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥2 years at 1 institution. OUTCOME MEASURES Self-report measures: The Japanese Orthopedic Association (JOA) scores and low back pain (LBP)/leg pain/leg numbness visual analog scale (VAS) scores. Physiologic measures: Standing sagittal spinopelvic alignment, computed tomography, and magnetic resonance imaging results. METHODS Low achievement in clinical outcomes were defined as the postoperative JOA score at the 2-year follow-up <25 points. Univariate and multiple logistic regression analysis and chi-square automatic interaction detection (CHAID) were used for analysis. RESULTS The CHAID model for JOA score <25 points showed spontaneous numbness/pain as the first decision node. For the presence of spontaneous numbness/pain, sagittal vertical axis ≥70 mm was selected as the second decision node. Then lateral wedging, ≥6° and pelvic incidence minus lumbar lordosis (PI-LL) ≥30° followed as the third decision node. For the absence of spontaneous numbness/pain, sex and lateral olisthesis, ≥3mm and American Society of Anesthesiologists physical status classification system score were selected as the second and third decision nodes. The sensitivity, specificity, and the positive predictive value of this CHAID model was 65.1, 69.8, and 64.7% respectively. CONCLUSIONS The CHAID model incorporating basic information and functional and radiologic factors is useful for predicting surgical outcomes.
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Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Yuta Sawada
- Department of Orthopaedic Surgery, Metropolitan University, Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Shukla GG, Chilakapati SS, Matur AV, Palmisciano P, Conteh F, Onyewadume L, Duah H, Griffith A, Tao X, Vorster P, Gupta S, Cheng J, Motley B, Adogwa O. Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2023; 48:874-884. [PMID: 37026781 DOI: 10.1097/brs.0000000000004673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/17/2023] [Indexed: 04/08/2023]
Abstract
STUDY DESIGN Systematic review and Meta-analysis. OBJECTIVE To compare outcomes and complications profile of laminectomy alone versus laminectomy and fusion for the treatment of degenerative lumbar spondylolisthesis (DLS). SUMMARY OF BACKGROUND DATA Degenerative lumbar spondylolisthesis is a common cause of back pain and functional impairment. DLS is associated with high monetary (up to $100 billion annually in the US) and nonmonetary societal and personal costs. While nonoperative management remains the first-line treatment for DLS, decompressive laminectomy with or without fusion is indicated for the treatment-resistant disease. METHODS We systematically searched PubMed and EMBASE for RCTs and cohort studies from inception through April 14, 2022. Data were pooled using random-effects meta-analysis. The risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. We generated odds ratio and standard mean difference estimates for select parameters. RESULTS A total of 23 manuscripts were included (n=90,996 patients). Complication rates were higher in patients undergoing laminectomy and fusion compared with laminectomy alone (OR: 1.55, P <0.001). Rates of reoperation were similar between both groups (OR: 0.67, P =0.10). Laminectomy with fusion was associated with a longer duration of surgery (Standard Mean Difference: 2.60, P =0.04) and a longer hospital stay (2.16, P =0.01). Compared with laminectomy alone, the extent of functional improvement in pain and disability was superior in the laminectomy and fusion cohort. Laminectomy with fusion had a greater mean change in ODI (-0.38, P <0.01) compared with laminectomy alone. Laminectomy with fusion was associated with a greater mean change in NRS leg score (-0.11, P =0.04) and NRS back score (-0.45, P <0.01). CONCLUSION Compared with laminectomy alone, laminectomy with fusion is associated with greater postoperative improvement in pain and disability, albeit with a longer duration of surgery and hospital stay.
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Affiliation(s)
- Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Fatu Conteh
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louisa Onyewadume
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry Duah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Azante Griffith
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Salmons HI, Pinter ZW, Streufert B, Sebastian AS, Nassr A. Performing 2-Stage Circumferential Fusion in an Adolescent With High-Grade Spondylolisthesis: A Surgical Technique. Clin Spine Surg 2023; 36:163-168. [PMID: 36150712 DOI: 10.1097/bsd.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
The surgical approach to high-grade spondylolisthesis at the lumbosacral junction remains controversial. Appropriate surgical techniques can be challenging with the potential for high complication rates, particularly with reduction. Multiple techniques have been described including posterior only reduction and instrumentation, posterior only instrumentation with in situ arthrodesis, and anterior-posterior reduction and instrumentation. Regardless of technique, the operative goals are to provide sufficient stability and biological support to promote bony fusion, maintain global balance, and decompress the neural elements while avoiding neurological complications. During instrumentation of a high-grade spondylolisthesis at the lumbosacral junction, it can be difficult to obtain access to the L5-S1 disc space for interbody insertion. We present a novel technique for improving access to the L5-S1 disc space through an osteotomy of the anterior-inferior aspect of the L5 vertebral body as part of a 2-stage circumferential fusion in the treatment of high-grade spondylolisthesis in an adolescent.
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36
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Su C, Liu X, Shao Y, Wang W, Yang G, Sun J, Cui X. Specific foraminal changes originate from degenerative spondylolisthesis on computed tomographic images. Eur Spine J 2023; 32:1077-1086. [PMID: 36732420 DOI: 10.1007/s00586-023-07557-z] [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: 09/15/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Operative treatment for degenerative spondylolisthesis (DS) is accompanied by the high incidence of nerve injury. Foraminal structures, especially the hypertrophied facet joints, have significant impacts on the adjacent nerve. This study aims to identify the specific foraminal changes relating to DS and nerve injury. METHODS The CT images of 70 patients with DS and 50 patients without lumbar disease were collected. The length and height of the foraminal structure were measured horizontally and vertically on sagittally reconstructed images. Horizontal stenosis, meaning to pending compression to nerve root after complete reduction, was evaluated on the image located to the middle of the foramen. Chi-square test or T-test were carried out using SPSS 26.0. RESULTS The hyperplasia of the superior articular process (SAP) and articular capsule (Ac) incidence rates in DS group was significantly more common than that of the control group (9.2 vs 0.0%, 42.9 vs 2.0%). The height and width of the SAP and Ac in vertical and horizontal directions were significantly greater than those in the control group (4.95 mm vs - 0.47 mm, P < 0.0001; 3.28 vs 0.02 mm, P < 0.0001; 5.27 vs3.44 mm, P < 0.0001; 2.60 vs 0.37 mm, P < 0.0001). In the DS group, hyperplasia of the SAP and Ac accounted for 9 and 43% respectively, 85 and 45% of which were accompanied by horizontal stenosis of the intervertebral foramen. CONCLUSION DS is usually characterized of excessive hyperplasia of the SAP and Ac, both of which are possible elements of nerve root injury after complete reduction in operation and should be focused on during surgery.
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Affiliation(s)
- Cheng Su
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
| | - Xiaoyang Liu
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Yuandong Shao
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Binzhou People's Hospital, Binzhou, 256600, Shandong, China
| | - Wenchao Wang
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Guihe Yang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China
- Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China.
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Chen X, Wang L, Zhang Y, Sun Q, Yuan S, Tian Y, Liu X. Sacroiliac joint degeneration in degenerative lumbar spondylolisthesis and related risk factors: a retrospective study. Eur Spine J 2023; 32:1375-1382. [PMID: 36826600 DOI: 10.1007/s00586-023-07558-y] [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: 09/17/2022] [Revised: 11/25/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE This study was performed to evaluate the degree of radiological sacroiliac joint (SIJ) degeneration in patients with degenerative lumbar spondylolisthesis (DLS). The related risk factors for SIJ degeneration were also investigated. METHODS We retrospectively analyzed the lumbar and pelvic computed tomography (CT) scans of 303 patients with DLS admitted from January 2018 to December 2021. One hundred and fifty-six age-, gender-, and body mass index-matched patients without lumbar anomality who underwent lower abdominal or pelvic computed tomography scans were included in the control group. Sagittal parameters were measured on full-length lateral radiographs. Two protocols (Backlund's grade and Eno's classification) were used to assess SIJ degeneration. Univariate analysis and bivariate and multivariate regression analysis were performed to identify the factors affecting SIJ degeneration in patients with DLS. RESULTS According to Backlund's grade and Eno's classification, SIJ degeneration was more severe in the DLS group than in the control group (P < 0.001). Multi-segment degenerative changes (P = 0.032), two-level DLS (P = 0.033), a history of hysterectomy (P < 0.001), lower extremity pain (P = 0.016), and pelvic pain (P = 0.013) were associated with more significant SIJ degeneration as assessed by Backlund's grade. The results of Pearson's correlation analysis showed positive correlation between the sagittal vertical axis and SIJ degeneration (r = 0.232, P = 0.009). The multivariate linear regression analysis showed that a history of hysterectomy was significantly correlated with SIJ degeneration in patients with DLS (r = 1.951, P = 0.008). CONCLUSIONS SIJ degeneration was more severe in patients with than without DLS. We should take SIJ degeneration into consideration when diagnosing and treating DLS especially those who had undergone previous hysterectomy or showed sagittal malalignment.
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Affiliation(s)
- Xing Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Yuchen Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Qingyu Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, 107 Wenhua Road, Jinan, 250012, Shandong, People's Republic of China.
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Li X, Xu J, Rudd S, Li Z, Ding W, Yang S. Spinal Shortening Surgery for Lumbosacral Nerve Bowstring Disease: A Surgical Technique. J Vis Exp 2023. [PMID: 36847404 DOI: 10.3791/64802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Lumbosacral nerve bowstring disease (LNBD) is a syndrome of neurological symptoms caused by differences in the development speed of lumbosacral bone tissue and nerve tissue, which result in a longitudinal stretch of the slow-growing nerve tissue. LNBD is usually caused by congenital factors and accompanied by other lumbosacral diseases, such as lumbar spinal stenosis, lumbar spondylolisthesis, and iatrogenic factors. The main symptoms of LNBD are lower extremity neurological symptoms and fecal dysfunction. The conservative treatment of LNBD includes rest, functional exercise, and drug therapy, but it usually fails to achieve satisfactory clinical results. Few studies have reported on the surgical treatment of LNBD. In this study, we used posterior lumbar interbody fusion (PLIF) to shorten the spine (0.6-0.8mm/segment). This reduced the axial tension of the lumbosacral nerves and relieved the patient's neurological symptoms. We report on the case of a 45 year old male patient whose main symptoms were left lower extremity pain, decreased muscle strength, and hypoesthesia. The above symptoms were significantly relieved 6 months after surgery.
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Affiliation(s)
- Xiangyu Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Jiaxin Xu
- Department of Spine Surgery, The Third Hospital of Hebei Medical University;
| | - Samuel Rudd
- School of Chemical Engineering, The University of Queensland
| | - Zhaohui Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
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Agarwal N, Aabedi AA, Chan AK, Letchuman V, Shabani S, Bisson EF, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Haid RW, Chou D, Mummaneni PV. Leveraging machine learning to ascertain the implications of preoperative body mass index on surgical outcomes for 282 patients with preoperative obesity and lumbar spondylolisthesis in the Quality Outcomes Database. J Neurosurg Spine 2023; 38:182-191. [PMID: 36208428 DOI: 10.3171/2022.8.spine22365] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior studies have revealed that a body mass index (BMI) ≥ 30 is associated with worse outcomes following surgical intervention in grade 1 lumbar spondylolisthesis. Using a machine learning approach, this study aimed to leverage the prospective Quality Outcomes Database (QOD) to identify a BMI threshold for patients undergoing surgical intervention for grade 1 lumbar spondylolisthesis and thus reliably identify optimal surgical candidates among obese patients. METHODS Patients with grade 1 lumbar spondylolisthesis and preoperative BMI ≥ 30 from the prospectively collected QOD lumbar spondylolisthesis module were included in this study. A 12-month composite outcome was generated by performing principal components analysis and k-means clustering on four validated measures of surgical outcomes in patients with spondylolisthesis. Random forests were generated to determine the most important preoperative patient characteristics in predicting the composite outcome. Recursive partitioning was used to extract a BMI threshold associated with optimal outcomes. RESULTS The average BMI was 35.7, with 282 (46.4%) of the 608 patients from the QOD data set having a BMI ≥ 30. Principal components analysis revealed that the first principal component accounted for 99.2% of the variance in the four outcome measures. Two clusters were identified corresponding to patients with suboptimal outcomes (severe back pain, increased disability, impaired quality of life, and low satisfaction) and to those with optimal outcomes. Recursive partitioning established a BMI threshold of 37.5 after pruning via cross-validation. CONCLUSIONS In this multicenter study, the authors found that a BMI ≤ 37.5 was associated with improved patient outcomes following surgical intervention. These findings may help augment predictive analytics to deliver precision medicine and improve prehabilitation strategies.
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Affiliation(s)
- Nitin Agarwal
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Alexander A Aabedi
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Vijay Letchuman
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Saman Shabani
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 5Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
| | - Christopher I Shaffrey
- Departments of6Neurosurgery and
- 7Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 8Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 9Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 10Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Y Wang
- 13Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L Asher
- 10Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Michael S Virk
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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Cheng L, Qiu C, Liu XY, Sang XG. Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries: A case report and literature review. Chin J Traumatol 2023; 26:33-40. [PMID: 35868949 PMCID: PMC9912182 DOI: 10.1016/j.cjtee.2022.06.006] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/28/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
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Affiliation(s)
- Lin Cheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China; Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xin-Yu Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xi-Guang Sang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China.
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Rossi A, Parenti G. Cervical spondylolisthesis in mucopolysaccharidosis type II. Neurol Sci 2023; 44:409-410. [PMID: 36006554 PMCID: PMC9816237 DOI: 10.1007/s10072-022-06357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Alessandro Rossi
- Department of Translational Medicine, Section of Pediatrics, University of Naples "Federico II", Naples, Italy.
| | - Giancarlo Parenti
- Department of Translational Medicine, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
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Mohanty S, Barchick S, Kadiyala M, Lad M, Rouhi AD, Vadali C, Albayar A, Ozturk AK, Khalsa A, Saifi C, Casper DS. Should patients with lumbar stenosis and grade I spondylolisthesis be treated differently based on spinopelvic alignment? A retrospective, two-year, propensity matched, comparison of patient-reported outcome measures and clinical outcomes from multiple sites within a single health system. Spine J 2023; 23:92-104. [PMID: 36064091 DOI: 10.1016/j.spinee.2022.08.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis is one of the most common pathologies addressed by surgeons. Recently, data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. However, given not all degenerative spondylolistheses are clinically comparable, the best treatment option may depend on multiple parameters. Specifically, the impact of spinopelvic alignment on patient reported and clinical outcomes following fusion versus decompression for grade I spondylolisthesis has yet to be explored. PURPOSE This study assessed two-year clinical outcomes and one-year patient reported outcomes following laminectomy with concomitant fusion versus laminectomy alone for management of grade I degenerative spondylolisthesis and stenosis. The present study is the first to examine the effect of spinopelvic alignment on patient-reported and clinical outcomes following decompression alone versus decompression with fusion. STUDY DESIGN/SETTING Retrospective sub-group analysis of observational, prospectively collected cohort study. PATIENT SAMPLE 679 patients treated with laminectomy with fusion or laminectomy alone for grade I degenerative spondylolisthesis and comorbid spinal stenosis performed by orthopaedic and neurosurgeons at three medical centers affiliated with a single, tertiary care center. OUTCOME MEASURES The primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and post-operatively at 4-6 and 10-12 months postoperatively. Secondary outcomes included operative parameters (estimated blood loss and operative time), and two-year clinical outcomes including reoperations, duration of postoperative physical therapy, and discharge disposition. METHODS Radiographs/MRIs assessed stenosis, spondylolisthesis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt; from this data, two cohorts were created based on pelvic incidence minus lumbar lordosis (PILL), denoted as "high" and "low" mismatch. Patients underwent either decompression or decompression with fusion; propensity score matching (PSM) and coarsened exact matching (CEM) were used to create matched cohorts of "cases" (fusion) and "controls" (decompression). Binary comparisons used McNemar test; continuous outcomes used Wilcoxon rank-sum test. Between-group comparisons of changes in PROMIS GPH and GMH scores were analyzed using mixed-effects models; analyses were conducted separately for patients with high and low pelvic incidence-lumbar lordosis (PILL) mismatch. RESULTS 49.9% of patients (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. In the high PLL mismatch cohort at 10-12 months postoperatively, fusion-treated patients reported improved PROs, including GMH (26.61 vs. 20.75, p<0.0001) and GPH (23.61 vs. 18.13, p<0.0001). They also required fewer months of outpatient physical therapy (1.61 vs. 3.65, p<0.0001) and had lower 2-year reoperation rates (12.63% vs. 17.89%, p=0.0442) compared to decompression-only patients. In contrast, in the low PLL mismatch cohort, fusion-treated patients demonstrated worse endpoint PROs (GMH: 18.67 vs. 21.52, p<0.0001; GPH: 16.08 vs. 20.74, p<0.0001). They were also more likely to require skilled nursing/rehabilitation centers (6.86% vs. 0.98%, p=0.0412) and extended outpatient physical therapy (2.47 vs. 1.34 months, p<0.0001) and had higher 2-year reoperation rates (25.49% vs. 14.71%,p=0.0152). CONCLUSIONS Lumbar laminectomy with fusion was superior to laminectomy in health-related quality of life and reoperation rate at two years postoperatively only for patients with sagittal malalignment, represented by high PILL mismatch. In contrast, the addition of fusion for patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony (low PILL mismatch) resulted in worse quality of life outcomes and reoperation rates.
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Affiliation(s)
- Sarthak Mohanty
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen Barchick
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Manasa Kadiyala
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Meeki Lad
- New Jersey Medical School; Rutgers University; 185 W S Orange Ave, Newark, NJ, 07103, USA
| | - Armaun D Rouhi
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Chetan Vadali
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Ahmed Albayar
- University of Pennsylvania Department of Neurosurgery; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Ali K Ozturk
- University of Pennsylvania Department of Neurosurgery; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Amrit Khalsa
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA
| | - Comron Saifi
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine; 6445 Main St. 2500, Houston, TX, 77030, USA
| | - David S Casper
- University of Pennsylvania, Department of Orthopaedics; 3737 Market St, Philadelphia, PA, 19104, USA.
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Duarte MP, Joncas J, Parent S, Labelle H, Barchi S, Mac-Thiong JM. Is quality of life after surgery for adolescent idiopathic scoliosis affected by the presence of a concomitant low-grade isthmic spondylolisthesis non-surgically treated? A retrospective cohort study. Eur Spine J 2022; 31:3042-3049. [PMID: 35994113 DOI: 10.1007/s00586-022-07281-0] [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: 12/30/2021] [Revised: 04/12/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The HRQoL after surgery for adolescent idiopathic scoliosis (AIS) is not affected by the presence of concomitant isthmic spondylolisthesis non-surgically treated. Improvement in QoL after surgery was similar for AIS patients with and without concomitant spondylolisthesis. The purpose is to compare preoperative and postoperative Health-Related Quality of Life (HRQoL) scores in operated AIS patients with and without concomitant isthmic spondylolisthesis. METHODS A retrospective study of a prospective cohort of 464 individuals undergoing AIS surgery between 2008 and 2018 was performed. All patients undergoing surgery for AIS with a minimum 2-year follow-up were included. We excluded patients with prior or concomitant surgery for spondylolisthesis. HRQoL scores were measured using the SRS-22 questionnaire. Comparisons were performed between AIS patients with versus without concomitant spondylolisthesis treated non-surgically. RESULTS AIS surgery was performed for 36 patients (15.2 ± 2.5 y.o) with concomitant isthmic spondylolisthesis, and 428 patients (15.5 ± 2.4 y.o) without concomitant spondylolisthesis. The two groups were similar in terms of age, sex, preoperative and postoperative Cobb angles. Preoperative and postoperative HRQoL scores were similar between the two groups. HRQoL improved significantly for all domains in both groups, except for pain in patients with spondylolisthesis. There was no need for surgical treatment of the spondylolisthesis and no slip progression during the follow-up duration after AIS surgery. CONCLUSION Patients undergoing surgical treatment of AIS with non-surgical management of a concomitant isthmic grade I spondylolisthesis can expect improvement in HRQoL scores, similar to that observed in patients without concomitant spondylolisthesis.
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Affiliation(s)
- Matias Pereira Duarte
- Université de Montréal, Montréal, QC, H3T 1C5, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
| | | | - Stefan Parent
- Université de Montréal, Montréal, QC, H3T 1C5, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
| | - Hubert Labelle
- Université de Montréal, Montréal, QC, H3T 1C5, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
| | | | - Jean-Marc Mac-Thiong
- Université de Montréal, Montréal, QC, H3T 1C5, Canada.
- CHU Sainte-Justine, Montréal, QC, Canada.
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Alves A, Langlais T, Odent T, Pham AD, Pouliquen JC, Glorion C. High-grade L5-S1 spondylolisthesis with lumbosacral kyphosis: Long-term results of non-instrumented circumferential arthrodesis in children, adolescents. Orthop Traumatol Surg Res 2022; 108:103093. [PMID: 34601157 DOI: 10.1016/j.otsr.2021.103093] [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: 10/01/2017] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The choice of surgical technique for high-grade spondylolisthesis (HGS) associated with lumbosacral kyphosis remains controversial. Are non-instrumented techniques still relevant, what with the multiplicity and modernity of patient-specific instrumentation? HYPOTHESIS Our hypothesis was that a non-instrumented circumferential arthrodesis performed after a period of gradual reduction of HGS, associated with lumbosacral kyphosis, provided satisfactory long-term functional and radiographic results in children and adolescents while minimizing the risk of complications. MATERIALS AND METHODS Thirty-one L5-S1 HGS associated with a lumbosacral kyphosis operated by non-instrumented circumferential arthrodesis after a period of traction and suspension were included in our study. The first stage of this technique consisted of a gradual reduction using traction followed by immobilization in the corrected position. The second stage involved a posterior, followed by an anterior, surgical procedure and a spica cast immobilization for 4 months. The mean age at surgery was 13.9±2.3 years (6-18) and the mean follow-up was 10.3±4.5 years (2.1-17.8). RESULTS The overall complication rate was 26% (n=8/31): 13% neurologic complications, 10% bone fusion defects and 3% skin complications. The reoperation rate was 13% (n=4/31). The mean ODI (/50) was 3±4.6 (0-22) and the SRS-30 126.7±15 (72-143). The Taillard index decreased by 25% (p<.001) and remained stable throughout the follow-up period (p=.65). The lumbosacral angle was corrected by 13.5% (p=.03) and the correction was maintained throughout the follow-up period (p=.71). At the last follow-up, the lumbosacral angle was significantly correlated with a low ODI score and a high SRS-30 score (p<.05). CONCLUSION Even though this technique achieved a smaller reduction of the lumbosacral angle, it reduced by at least a factor of three the incidence of neurologic complications and resulted in satisfactory functional outcomes when compared to instrumented and intraoperative correction series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexandra Alves
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
| | - Tristan Langlais
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital des enfants Purpan, Université de Toulouse, Place du docteur Baylac, 31000 Toulouse, France
| | - Thierry Odent
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Anne-Dominique Pham
- Département de Biostatistiques et Recherche Clinique, Université Caen-Normandie, avenue de la Côte de Nacre, 14033 Caen cedex 9, France
| | - Jean-Claude Pouliquen
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Christophe Glorion
- Service d'Orthopédie et Traumatologie pédiatrique, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
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Goode AP, Cleveland RJ, George SZ, Schwartz TA, Kraus VB, Renner JB, Gracely RH, DeFrate LE, Hu D, Jordan JM, Golightly YM. Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2022; 74:1659-1666. [PMID: 33973412 PMCID: PMC8578580 DOI: 10.1002/acr.24643] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). METHODS Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. RESULTS Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. CONCLUSION Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
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Affiliation(s)
- Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Richard H. Gracely
- Department of Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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Mathkour M, Shapiro SZ, Scullen T, Werner C, Kilgore MD, Chavarro VS, Denis DR. Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage. Medicina (B Aires) 2022; 58:medicina58091172. [PMID: 36143849 PMCID: PMC9502586 DOI: 10.3390/medicina58091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. Methods: Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). Results: Surgical indications were sagittal plane imbalance caused by L4–L5 degenerative spondylolisthesis (n = 2) and L3–L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2–4) and estimated blood loss was 266 mL (range 200–300). NRS and ODI improved in all patients. All experienced improvements in LL (x¯preop = 33°, x¯postop = 56°), SVA (x¯preop = 180 mm, x¯postop = 61 mm) and PI-LL (x¯preop = 26°, x¯postop = 5°). Conclusion: ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients.
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Affiliation(s)
- Mansour Mathkour
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Stephen Z. Shapiro
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Tyler Scullen
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Cassidy Werner
- Department of Neurosurgery, Northwell Health, Manhasset, NY 11030, USA
| | - Mitchell D. Kilgore
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
| | - Velina S. Chavarro
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
| | - Daniel R. Denis
- Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
- Correspondence: ; Tel.: +1-(310)-606-1403
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Yang W, Pan X, Wang Y, Chen W. Comparative Meta-Analysis of the Effects of OLIF and TLIF in Lumbar Spondylolisthesis Central Nerve Injury. Comput Intell Neurosci 2022; 2022:6861749. [PMID: 35592713 PMCID: PMC9113908 DOI: 10.1155/2022/6861749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
Objective The main objective is to explore the efficacy of oblique anterior lumbar fusion (OLIF) and transforaminal lumbar fusion (TLIF) in the treatment of lumbar spondylolisthesis central nerve injury. Methods The perioperative indexes, pain score (VAS), Oswestry dysfunction index (ODI), vertebral slip degree, slip angle, intervertebral space height, and quality of life score of the two groups were compared by meta-analysis. Results According to the observation indexes, the perioperative indexes of patients in the OLIF group were better than those in the TLIF group, which showed that the effect of OLIF treatment was better than of TLIF. The pain score and ODI score of the two groups can be obtained. The one-week postoperative pain degree and ODI of patients in the OLIF group are lower than those in the TLIF group, indicating that OLIF treatment will reduce the pain of patients to a greater extent and is more conducive to the recovery of patients. There was no significant difference in vertebral slip, slip angle, and intervertebral space height between the OLIF group and TLIF group. After treatment, the quality-of-life scores of patients in the OLIF group were significantly higher than those in the TLIF group. Conclusion The treatment of lumbar fusion through OLIF has irreplaceable perioperative advantages of TLIF, such as less bleeding, shorter operation time, less drainage and shorter hospital stay, less postoperative complications, less surgical wound, indirect decompression, no destruction of lumbar posterior stable structure, and maximum preservation of tissue structure. It has the advantages of reducing the intraoperative dural sac injury and nerve root traction injury and shortening the rehabilitation time of patients. It has the prospect of clinical application and can be popularized.
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Affiliation(s)
- Wanliang Yang
- Qilu Hospital of Shandong University, Jinan 250000, Shandong, China
| | - Xin Pan
- Qilu Hospital of Shandong University, Jinan 250000, Shandong, China
| | - Yibo Wang
- Dingtao District People's Hospital, Jinan 250000, Shandong, China
| | - Wenhao Chen
- Qilu Hospital of Shandong University, Jinan 250000, Shandong, China
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Abstract
IMPORTANCE Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis. OBSERVATIONS The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age. The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI). Nonoperative treatment includes activity modification such as reducing periods of standing or walking, oral medications to diminish pain such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse. Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. For example, in a randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis, decompressive laminectomy improved symptoms more than nonoperative therapy (difference, 7.8 points; 95% CI, 0.8-14.9; minimum clinically important difference, 10-12.8) on the Oswestry Disability Index (score range, 0-100). Among persons with lumbar spinal stenosis and concomitant spondylolisthesis, lumbar fusion increased symptom resolution in 1 trial (difference, 5.7 points; 95% CI, 0.1 to 11.3) on the 36-Item Short Form Health Survey physical dimension score (range, 0-100), but 2 other trials showed either no important differences between the 2 therapies or noninferiority of lumbar decompression alone compared with lumbar decompression plus spinal fusion (MCID, 2-4.9 points). In a noninferiority trial, 71.4% treated with lumbar decompression alone vs 72.9% of those receiving decompression plus fusion achieved a 30% or more reduction in Oswestry Disability Index score, consistent with the prespecified noninferiority hypothesis. Fusion is associated with greater risk of complications such as blood loss, infection, longer hospital stays, and higher costs. Thus, the precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear. CONCLUSIONS AND RELEVANCE Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candidates for decompressive surgery.
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Affiliation(s)
- Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Zoe E Zimmerman
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hanna Mass
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Melvin C Makhni
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Joelson A, Nerelius F, Holy M, Sigmundsson FG. Reoperations After Decompression With or Without Fusion for L3-4 Spinal Stenosis With Degenerative Spondylolisthesis: A Study of 372 Patients in Swespine, the National Swedish Spine Register. Clin Spine Surg 2022; 35:E389-E393. [PMID: 34629386 DOI: 10.1097/bsd.0000000000001255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Register study with prospectively collected data. OBJECTIVE The aim was to investigate reoperation rates at the index level and the adjacent levels after surgery for lumbar L3-4 spinal stenosis with concomitant degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA There are different opinions on how to surgically address lumbar spinal stenosis with DS. The potential benefit of fusion surgery should be weighed against the risks of future reoperations because of adjacent segment degeneration. Data on the reoperation rate at adjacent segments after single level L3-4 fusion surgery are limited. MATERIALS AND METHODS A total of 372 patients, who underwent surgery for lumbar L3-4 spinal stenosis with DS (slip >3 mm) between 2007 and 2012, were followed between 2007 and 2017 to identify reoperations at the index level and adjacent levels. The reoperation rate for decompression and fusion was compared with the reoperation rate for decompression only. Patient-reported outcome measures before and 1 year after surgery were evaluated. RESULTS The reoperation rate at the index level (L3-4) was 3.5% for decompression and fusion and 5.6% for decompression only. At the cranial adjacent level (L2-3), the corresponding numbers were 6.6% and 4.2%, respectively, and the caudal adjacent level (L4-5), the corresponding numbers were 3.1% and 4.9%, respectively. The effect sizes of change were larger for decompression and fusion compared with decompression only. The effect sizes of change were similar for leg pain and back pain. CONCLUSIONS We could not identify any differences in reoperation rates at the cranial or caudal adjacent segment after decompression and fusion compared with decompression only for L3-4 spinal stenosis with DS. The improvement in back pain is similar to the improvement in leg pain after surgery for L3-4 spinal stenosis with DS.
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Affiliation(s)
- Anders Joelson
- Department of Orthopedics, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
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Pazarlis K, Frost A, Försth P. Lumbar Spinal Stenosis with Degenerative Spondylolisthesis Treated with Decompression Alone. A Cohort of 346 Patients at a Large Spine Unit. Clinical Outcome, Complications and Subsequent Surgery. Spine (Phila Pa 1976) 2022; 47:470-475. [PMID: 35213524 DOI: 10.1097/brs.0000000000004291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE To study the clinical outcome, complications and subsequent surgery rate of DA for lumbar spinal stenosis (LSS) with DS. SUMMARY OF BACKGROUND DATA There is still no consensus regarding the treatment approach for LSS with DS. METHODS We performed a retrospectively designed cohort study on prospectively collected data from a single high productive spine surgical center. Results from the Swedish Spine Registry and a local register for complications were used for the analyses. Patients with LSS and DS (>3 mm) who underwent DA during January 2012 to August 2017 were included. Patient reported outcome measures at baseline and 2 years after surgery were analyzed. Complications within 30 days of surgery and all subsequent surgery in the lumbar spine were registered. RESULTS We identified and included 346 patients with completed 2-year follow-up registration. At 2-year follow-up there was a significant improvement in all outcome measures. The global assessment success rate for back and leg pain was 68.3% and 67.6% respectively. Forty-one patients had at least 1 intra- or postoperative complication (11.9%). Nine patients (2.6%), underwent subsequent surgery within 2 years of the primary surgery whereof 2 underwent fusion. During the whole period of data collection, that is, as of June 2020, 28 patients had undergone subsequent surgery (8.1%) whereas 8 of them had had 2 surgeries. Fifteen patients underwent fusion. CONCLUSION DA provides good clinical outcome at 2-year follow-up in patients with LSS and DS with low rate of intra- and postoperative complications and subsequent surgery. Our data supports the evidence that DA is effective and safe for LSS with DS.Level of Evidence: 3.
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Affiliation(s)
- Konstantinos Pazarlis
- Stockholm Spine Center, Upplands Väsby, Sweden
- Department of Surgical Sciences, Division of Orthopaedics, Uppsala University, Uppsala, Sweden
| | | | - Peter Försth
- Department of Surgical Sciences, Division of Orthopaedics, Uppsala University, Uppsala, Sweden
- Spine Surgery Unit, Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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