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1.
Fumitake Tezuka Toshinori Sakai Mitsunobu Abe Kazuta Yamashita Yoichiro Takata Kosaku Higashino Takashi Chikawa Akihiro Nagamachi Koichi Sairyo 《The spine journal》2017,17(12):1875-1880
Background Context
Percutaneous endoscopic discectomy is a minimally invasive procedure for the surgical treatment of lumbar disc herniation (LDH). It can be performed under local anesthesia and requires a skin incision of only 8?mm, with minimal disruption of the spinal structures including ligaments and muscles. However, performing percutaneous endoscopic discectomy with a transforaminal approach (TF-PED) for the lower lumbar spine is associated with some anatomical problems, such as interference from the iliac crest. This study sought to assess the operability of TF-PED for the lower lumbar spine.Purpose
The purpose of this study was to assess a three-dimensional relationship between the trajectory of TF-PED and the iliac crest, and the operability of TF-PED at the lower lumbar disc levels (L4–L5 and L5–S1) using CT images.Study Design
This is a retrospective study using 323 multiplanar abdominal computed tomography (CT) scans.Patient Sample
We retrospectively reviewed contrast-enhanced multiplanar abdominal CT scans of 323 consecutive patients (203 male and 120 female) in our hospital from April 2009 to March 2013. The mean age was 66.5 (range 15–89) years old.Outcome Measures
The operability of the TF-PED was the outcome measure.Materials and Methods
We defined the tangent line in the iliac crest and the superior articular process of the caudal spine as the trajectory line of TF-PED, and evaluated the maximum inclination angle of the trajectory of the TF-PED (α angle) at the L4–L5 and the L5–S1 disc levels. Assuming the use of an oblique viewing endoscope at 25°, we defined α angle≥65° as the operability of TF-PED.Results
(1) Relationship between iliac crest and disc level: The trajectory of the TF-PED interfered with the iliac crest at L4–L5 in 40.2% (right) and 54.5% (left) of the subjects, and at L5–S1 in 99.7% and 100% of the subjects. (2) The maximum inclination angle of the trajectory of TF-PED: the α angles were 84.3° and 82.3° at the L4–L5, and 56.8° and 55.2° at L5–S1. (3) Laterality of the α angle: At both disc levels, the mean age of the subjects with a laterality of ≥10° was significantly higher than that of subjects with a laterality of <10°. (4) Operability of TF-PED: At L4–L5, TF-PED could be performed in 94.4% and 90.4% of the subjects. In contrast, at L5–S1 the procedure could be performed in 24.1% and 19.2% of the subjects (male: 15.8% and 10.8%, female: 38.3% and 33.3%).Conclusions
From the results of this study, the trajectory of TF-PED can be limited by the surrounding anatomical structures. The maximum inclination angle indicated that treatment for the central type of LDH at the L5–S1 disc level was considered more difficult than that at the L4–L5 disc level because of the iliac crest. In the clinical setting, such anatomical particularities can be overcome by using a more perpendicular approach (hand-down technique) with the possible addition of a foraminoplasty. Moreover, we found that we must consider the laterality of the trajectory of TF-PED in terms of the patients' age or sex. 相似文献2.
Jeong-Hyuk Ju Sung-Jun Kim Kyung-Hyun Kim Dal-Sung Ryu Jeong-Yoon Park Dong-Kyu Chin Keun-Su Kim Yong-Eun Cho Sung-Uk Kuh 《The spine journal》2018,18(5):747-754
Background Context
Dural laceration frequently occurs during surgery in patients with ossification of the ligamentum flavum (OLF), mainly because of dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and the dura mater. However, the radiological predictive factors of DA in OLF have rarely been reported.Purpose
The objective of this study was to determine the preoperative radiological signs for predicting intraoperative DA in OLF by using preoperative magnetic resonance imaging (MRI) and computed tomography (CT).Study Design
This is a retrospective study.Patient Sample
This study included 182 patients who underwent decompressive laminectomy and OLF removal from 2005 to 2014.Outcome Measure
Demographic data, preoperative neurologic status, surgical procedure and results, and intraoperative and postoperative complications were analyzed. Clinical outcome was assessed with the Japanese Orthopaedic Association score.Materials and Methods
Depending on the morphologic appearance of OLF in preoperative radiographs, we aimed to investigate the prevalence of intraoperative DA and DO. We used the following factors of representative classifications: (1) surface appearance, (2) “double-layer” or “tram-track” sign, (3) cross-sectional area of the stenosed level, (4) Sato classification as axial classification, (5) Kuh classification as sagittal classification, and (6) high–signal-intensity change on T2-weighted MRI.Results
Intraoperative evidence of DA was observed in 52 patients (29%), and DO was observed in 23 patients (13%). Twenty-seven patients (15%) had dural laceration during surgery. Statistically, DA was closely associated with the non-uniform type of surface appearance (odds ratio 5.396, p=.001) and with the presence of either a double-layer sign or a tram-track sign (odds ratio 11.525, p<.001). In the preoperative CT and MRI, 21 out of 23 patients with DO showed a “double-layer sign” or a “tram-track sign.”Conclusions
This study identified two predictive factors of DA in OLF, which were the non-uniform surface appearance and the presence of a double-layer sign or a tram-track sign. The presence of DO in OLF was closely associated with a double-layer sign or a tram-track sign in the preoperative radiological images. 相似文献3.
Background Context
Percutaneous endoscopic lumbar discectomy (PELD) is one of minimally invasive techniques to treat patients with low back and radiating pain resulting from lumbosacral disc herniation (LDH).Purpose
The purpose of this study is to evaluate the clinical efficacy of PELD to treat patients with low back and radicular pain due to LDH and to investigate which clinical and radiological variables have the ability to predict clinical outcome after PELD.Study design/setting
This is a retrospective study design carried out at a spine hospital.Patient sample
The sample comprised 75 patients who had undergone PELD for treatment of low back and radiating leg pain resulting from LDH and who could be followed up for at least 12 months.Outcomes measures
Clinical outcomes were assessed using numeric rating scale for back and radiating leg pain (NRS back and leg), Oswestry Disability Index (ODI), and modified MacNab criteria at 1 month (short-term follow-up) and at least 12 months (long-term follow-up) after PELD.Methods
The patients were divided into successful and unsuccessful outcome groups according to improvement of NRS back, NRS leg, and ODI (%) at long-term follow-up period. We compared the various clinical and radiological variables between the two groups to identify which variables could be the prognostic factors of clinical outcomes of PELD. This analysis was performed in terms of whole population, the subgroup of dominant back pain, and the subgroup of dominant leg pain, respectively.Results
Significant improvements were observed in NRS back, NRS leg, ODI (%), and modified MacNab criteria at short-term and long-term follow-up after PELD. Positive straight leg raising (SLR) was significantly related to successful outcome as to NRS leg and ODI (%), and longer pain duration also showed significant relationship with unsuccessful outcomes as to NRS leg in whole population. Positive SLR had significant relationship with successful NRS leg as well as successful ODI (%) in the subgroup of dominant leg pain.Conclusions
PELD was an effective treatment in patients with back and leg pain due to LDH. Positive SLR had the predictive ability to successful reduction of radiating leg pain and successful functional improvement. Longer pain duration was also related to unsuccessful reduction of radiating leg pain. 相似文献4.
Stephen G. George Nathan H. Lebwohl Giulio Pasquotti Seth K. Williams 《The spine journal》2018,18(9):1570-1577
Background Context
All currently described percutaneous iliac screw placement methods are entirely dependent on fluoroscopy.Purpose
The purpose of this study was to determine the safety and the accuracy of percutaneous and open iliac screw placement using a primarily tactile technique with adjunctive anteroposterior (AP) fluoroscopy.Study Design/Context
All patients who underwent open and percutaneous iliac screw placement over a 5-year period were identified. Charts were reviewed to assess for any instances of neurologic or vascular injury associated with iliac screw placement. Screw accuracy was judged with postoperative computed tomography (CT) scans.Patient Sample
A total of 133 patients were identified who underwent open or percutaneous iliac screw placement. Computed tomography scans were available for 57 patients, and all of these patients were included in the study, with a total of 115 iliac screws.Outcome Measures
Radiographic measurements were performed, consisting of the distance of the iliac screw to the sciatic notch on postoperative radiographs and CT scans. Computed tomography scans were used to determine iliac screw accuracy.Methods
Charts were reviewed to assess for any neurologic or vascular injuries related to screw placement. The distance of the iliac screw to the sciatic notch was measured and compared on AP radiography and CT scans. Computed tomography scans were assessed for any screw violation of the iliac cortex or the sciatic notch. The accuracy of open iliac screw placement was compared with minimally invasive percutaneous placement.Results
There were no neurologic or vascular injuries related to screw placement in the 133 patients. Computed tomography scans were available for 115 iliac screws, with 3 cortical breaches, all by less than 2?mm. All 112 other screws were accurately intraosseous. There was a strong correlation between the iliac screw to the sciatic notch distance when measured by CT scan compared with AP radiography (r=0.9), thus validating the accuracy of AP fluoroscopy in guiding iliac screw placement with respect to the sciatic notch. Iliac screw accuracy was equal with the open and percutaneous insertion techniques.Conclusions
The described surgical technique represents a safe and reliable surgical option for iliac screw placement. Intraoperative AP fluoroscopy accurately reflects the distance of the iliac screw to the sciatic notch. Percutaneous iliac screws placed with this technique are as accurate as open iliac screws. 相似文献5.
Evan D. Sheha Dennis S. Meredith Grant D. Shifflett Benjamin T. Bjerke Sravisht Iyer Jennifer Shue Joseph Nguyen Russel C. Huang 《The spine journal》2018,18(6):986-992
Background Context
Postoperative pain at the site of bone graft harvest for posterior spine fusion is reported to occur in 6%–39% of cases. However, the area around the posterior, superior iliac spine is a frequent site of referred pain for many structures. Therefore, many postoperative spine patients may have pain in the vicinity of the posterior iliac crest that may not in fact be caused by bone graft harvesting. The literature may then overestimate the true incidence of postoperative iliac crest pain.Purpose
We performed a prospective study testing the hypothesis that patients will not report significantly higher visual analog scores over the graft harvest site when compared with the contralateral, non-harvested side.Study design/Setting
This is a prospective, randomized cohort study.Patient Sample
Patients aged 18–75 years undergoing elective spinal fusion of one to two levels between L4 and S1 for spinal stenosis and spondylolisthesis were randomized to left-sided or right-sided iliac crest bone graft (ICBG) donor sites and blinded to the side of harvest.Outcome Measures
Primary outcome was a 10-point visual analog scale (VAS) for pain over the left and right posterior superior iliac spine.Methods
Bone graft was harvested via spinal access incisions without making a separate skin incision over the crest. Each patient's non-harvested side served as an internal control. Data points were recorded by patients on their study visit sheets preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively.Results
Forty patients were enrolled in the study (23 females) with an average follow-up of 8.1 months (1.5–12 months). Mean age was 51.7 years (23–77 years). Left- and right-side ICBG harvesting was performed equally between the 40 patients. The average volume of graft harvested from the left was 35.3?mL (15–70?mL) and 36.1?mL (15–60?mL) from the right. There was no statistical difference between preoperative VAS score on the harvested side compared with the non-harvested side (p=.415). Postoperatively, there were consistently higher VAS scores on the operative side; however, these differences were not statistically significant at 6 weeks (p=.111), 3 months (p=.440), 6 months (p=.887), or 12 months (p=.240). Both groups did, however, show statistically significant improvements in VAS scores over time within the operative and nonoperative sides (p<.05). Graft volume had no effect on the VAS scores (p=.382).Conclusions
The current literature does not adequately illuminate the incidence of postoperative pain at the site of harvest and the relative magnitude of this pain in comparison with the patient's residual low back pain. This is the first study to blind the patient to the laterality of bone graft harvesting. Our randomized investigation showed that although pain on the surgical side was slightly higher, it was neither clinically nor statistically different from the nonsurgical side. Our conclusion supports surgeons' use of autologous bone graft, which offers a cost-effective, efficacious spinal fusion supplement. 相似文献6.
Jae Hwan Cho Youn-Suk Joo Cheongsu Lim Chang Ju Hwang Dong-Ho Lee Choon Sung Lee 《The spine journal》2017,17(12):1794-1802
Background Context
Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance.Purpose
To reveal the effect of one- or two-level PLIF on global sagittal balance.Design/Setting
A retrospective case-control study.Patients Sample
This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis.Outcome Measures
Clinical and radiological parameters were measured pre- and postoperatively.Methods
All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7–S1 sagittal vertical axis (SVA): Group N: SVA≤5?cm vs Group I: SVA>5?cm; they were also divided according to postoperative changes in C7–S1 SVA. Clinical and radiological outcomes were compared between the groups.Results
All clinical outcomes and radiological parameters improved postoperatively. C7–S1 SVA improved (?1.6?cm) after L3–L5 fusion, but it was compromised (+3.6?cm) after L4–S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7–S1 SVA decreased from 9.5?cm to 3.8?cm (p<.001) in Group I. Furthermore, all sagittal parameters improved in Group I. On comparing the postoperative changes in C7–S1 SVA, we found that the decreasing trend in the postoperative C7–S1 SVA was related to a larger preoperative C7–S1 SVA (p=.030) and a more proximal level fusion (L3–L5 vs L4–S1, p=.033).Conclusions
Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3–L4, L4–L5, or L3–L5 PLIF. However, no such restoration was observed after L5–S1 or L4–S1 PLIF. Thus, we could anticipate sagittal balance restoration after performing PLIF at L3–L4 or L4–L5 level. However, caution is required when planning for L5–S1 fusion if preoperative sagittal imbalance is present. 相似文献7.
Background Context
The oblique lateral interbody fusion (OLIF) procedure is aimed at mitigating some of the challenges seen with traditional anterior lumbar interbody fusion (ALIF) and transpsoas lateral lumbar interbody fusion (LLIF), and allows for interbody fusion at L1–S1.Purpose
The study aimed to describe the OLIF technique and assess the complication and fusion rates.Study Design
This is a retrospective cohort study.Patient Sample
The sample is composed of 137 patients who underwent OLIF procedure.Outcome Measures
The outcome measures were adverse events within 6 months of surgery: infection, symptomatic pseudarthrosis, hardware failure, vascular injury, perioperative blood transfusion, ureteral injury, bowel injury, renal injury, prolonged postoperative ileus (more than 3 days), incisional hernia, pseudohernia, reoperation, neurologic deficits (weakness, numbness, paresthesia), hip flexion pain, retrograde ejaculation, sympathectomy affecting lower extremities, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, and cerebrovascular accident. The outcome measures also include fusion and subsidence rates based on computed tomography (CT) done at 6 months postoperatively.Methods
Retrospective chart review of 150 consecutive patients was performed to examine the complications associated with OLIF at L1–L5 (OLIF25), OLIF at L5–S1 (OLIF51), and OLIF at L1–L5 combined with OLIF at L5–S1 (OLIF25+OLIF51). Only patients who had at least 6 months of postoperative follow-up, including CT scan at 6 months after surgery, were included. Independent radiology review of CT data was performed to assess fusion and subsidence rates at 6 months.Results
A total of 137 patients underwent fusion at 340 levels. An overall complication rate of 11.7% was seen. The most common complications were subsidence (4.4%), postoperative ileus (2.9%), and vascular injury (2.9%). Ileus and vascular injuries were only seen in cases including OLIF51. No patient suffered neurologic injury. No cases of ureteral injury, sympathectomy affecting the lower extremities, or visceral injury were seen. Successful fusion was seen at 97.9% of surgical levels.Conclusions
Oblique lateral interbody fusion is a safe procedure at L1–L5 as well as L5–S1. The complication profile appears acceptable when compared with LLIF and ALIF. The oblique trajectory mitigates psoas muscle and lumbosacral plexus-related complications seen with the lateral transpsoas approach. Furthermore, there is a high fusion rate based on CT data at 6 months. 相似文献8.
Vincent J. Alentado Stephanie Caldwell Heath P. Gould Michael P. Steinmetz Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(2):236-243
Background Context
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.Purpose
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study Design
This is a retrospective review of patients who underwent instrumented lumbar fusion.Patient Sample
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome Measures
Outcome measures included preoperative and postoperative EQ-5D Index scores.Materials and Methods
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.Results
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.Conclusions
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively. 相似文献9.
Kylie Shaw James Chen William Sheppard Mohanad Alazzeh Howard Park D.Y. Park A. Nick Shamie 《The spine journal》2018,18(12):2181-2186
Background context
Lumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes.Purpose
This study aims to further previous investigations in elucidating the predictive nature of body mass distribution with peri- and postoperative complications in lumbar surgery.Study Design/Setting
This is a retrospective study conducted at a single institution.Patient Sample
Two hundred eighty-five patients who underwent lumbar laminectomy, laminotomy, or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures between 2013 and 2016.Outcome Measures
Magnetic resonance imaging (MRI) results and electronic medical records were reviewed for measurements and relevant complications.Methods
Previously known risk factors were identified and MRI measurements of subcutaneous adipose depth (SAD) relative to spinous process height (SPH) were measured at the surgical site to generate the subcutaneous lumbar spine (SLS) index. This measurement was then analyzed in association with recorded surgical complications.Results
The SLS index was found to be a significant risk factor for total complications (0.292, p=.041), perioperative complications (0.202, p=.015), and need for revision surgery (0.285, p<.001). The SAD alone proved to be negatively associated with perioperative complications (?0.075, p=.034) and need for revision surgery (?0.104, p=.001), with no predictive association seen for total or postoperative complications. Linear regression revealed an SLS index of 3.43 as a threshold value associated with a higher risk of total complications, 5.8 for perioperative complications, and 3.81 for the need for revision surgeries.Conclusion
Body mass distribution of the surgical site as indicated by SAD to SPH (SLS index) is significantly associated with increasing risk of postoperative and perioperative complications as well as increased likelihood for necessary revision surgery. This relationship was shown to be a more accurate indication of perioperative risk than previous standards of body mass index and SAD alone, and may allow spine surgeons to assess surgical risk when considering lumbar spine surgery using simple calculations from standard preoperative MRI results. 相似文献10.
Jong Joo Lee Dong Ah Shin Seong Yi Keung Nyun Kim Do Heum Yoon Hyun Chul Shin Yoon Ha 《The spine journal》2018,18(10):1779-1786
Background Context
Despite the fact that ossification of posterior longitudinal ligament (OPLL) is a three-dimensional disease, conventional studies have focused mainly on a two-dimensional measurement, and it is difficult to accurately determine the volume of OPLL growth and analyze the factors affecting OPLL growth after posterior decompression (laminoplasty or laminectomy and fusion).Purpose
The present study aimed to investigate the factors affecting OPLL volume growth using a three-dimensional measurement.Study Design/Setting
This was a retrospective case study.Patient Sample
Eighty-three patients with cervical OPLL who were diagnosed as having multilevel cervical OPLL of more than three levels on cervical computed tomography (CT) scans were retrospectively reviewed from June 1, 1998, to December 31, 2015.Outcome Measures
The OPLL volume from the C1 vertebrae to the C7 vertebrae was measured on preoperative and the most recent follow-up CT scans.Methods
Eighty-three patients were retrospectively examined for age, gender, body mass index, hypertension, diabetes, type of OPLL, surgical method, preoperative cervical curvature, and preoperative and postoperative cervical range of motion. Preoperative cervical CT and the most recent follow-up cervical CT scans were converted to Digital Imaging and Communications in Medicine data, and the OPLL volume was three-dimensionally measured using the Mimics program (Materialise, Leuven, Belgium). The OPLL volume growth was analyzed using univariate and multivariate analyses.Results
The average follow-up period was 32.36 (±23.39) months. Patients' mean age was 54.92 (±8.21) years. In univariate analysis, younger age (p=.037) and laminoplasty (p=.012) were significantly associated with a higher mean annual growth rate of OPLL (%/y). In multivariate analysis, only laminoplasty (p=.027) was significantly associated with a higher mean annual growth rate of OPLL (%/y). The mean annual growth rate of OPLL was about seven times faster with laminoplasty (8.00±13.06%/y) than with laminectomy and fusion (1.16±9.23%/y).Conclusions
Posterior instrumented fusion has the effect of reducing OPLL growth rate compared with motion-preserving laminoplasty. Patients' age and the surgical method need to be considered in surgically managing the multilevel OPLL. 相似文献11.
Background Context
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.Purpose
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).Study Design
A randomized controlled trial was performed.Patient Sample
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.Outcome Measures
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.Methods
The LA group (Group L, n=50) received 10?mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10?mL 0.25% bupivacaine+40?mg methylprednisolone at L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.Results
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.Conclusions
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid. 相似文献12.
13.
Shota Ikegami Jun Takahashi Hiromichi Misawa Takahiro Tsutsumimoto Mutsuki Yui Shugo Kuraishi Toshimasa Futatsugi Masashi Uehara Hiroki Oba Hiroyuki Kato 《The spine journal》2018,18(5):755-761
Background Context
There is little information on the relationship between magnetic resonance imaging (MRI) T2-weighted high signal change (T2HSC) in the spinal cord and surgical outcome for cervical myelopathy. We therefore examined whether T2HSC regression at 1 year postoperatively reflected a 5-year prognosis after adjustment using propensity scores for potential confounding variables, which have been a disadvantage of earlier observational studies.Purpose
The objective of this study was to clarify the usefulness of MRI signal changes for the prediction of midterm surgical outcome in patients with cervical myelopathy.Study Design/Setting
This is a retrospective cohort study.Patient Sample
We recruited 137 patients with cervical myelopathy who had undergone surgery between 2007 and 2012 at a median age of 69 years (range: 39–87 years).Outcome Measures
The outcome measures were the recovery rates of the Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) scores for complaints at several body regions.Materials and Methods
The subjects were divided according to the spinal MRI results at 1 year post surgery into the MRI regression group (Reg+ group, 37 cases) with fading of T2HSC, or the non-regression group (Reg? group, 100 cases) with either no change or an enlargement of T2HSC. The recovery rates of JOA scores from 1 to 5 years postoperatively along with the 5-year postoperative VAS scores were compared between the groups using t test. Outcome scores were adjusted for age, sex, diagnosis, symptom duration, and preoperative JOA score by the inverse probability weighting method using propensity scores.Results
The mean recovery rates in the Reg? group were 35.1%, 34.6%, 27.6%, 28.0%, and 30.1% from 1 to 5 years post surgery, respectively, whereas those in the Reg+ group were 52.0%, 52.0%, 51.1%, 49.0%, and 50.1%, respectively. The recovery rates in the Reg+ group were significantly higher at all observation points. At 5 years postoperatively, the VAS score for pain or numbnessin the arms or hands of the patients in the Reg+ group (24.7?mm) was significantly milder than that of the patients in the Reg? group (42.2?mm).Conclusions
Spinal T2HSC improvement at 1 year postoperatively may predict a favorable recovery until up to 5 years after surgery. 相似文献14.
Background Context
Arthrodesis of the lumbosacral junction continues to be a challenge in pediatric and adult spinal deformity surgery.Purpose
To evaluate the biomechanical rigidity of two types of lumbosacral fixation. Our hypothesis was that the use of S2 alar-iliac (S2AI) fixation will result in statistically similar biomechanical fixation as compared with use of an iliac screw with a 95% confidence interval.Study Setting
Controlled biomechanical laboratoryMethods
Ten human cadaveric lumbosacral specimens were separated into two test groups: (1) S2AI (n=5) and (2) iliac screw (n=5). S2AI and iliac screws were placed according to current clinical practice techniques. Specimens were mounted in an unconstrained dual leg stance configuration for testing in flexion, extension, lateral bending, and axial rotation. These loads were induced by moving the offset loading arm 10?mm in the respective direction from the point of neutral motion with displacement control up to a 10 N-m moment, except axial rotation which used a 4 N-m moment. Optical tracking was used to monitor motion of the vertebra, pelvis, and fixation instrumentation during testing. Specimens were tested in intact and instrumented states. The stiffness values between S2AI and iliac screw configurations were compared.Disclosure
The present study received external research support (>$50,000 –<$75,000) from Stryker Spine (Allendale, NJ, USA).Results
There was a consistent trend of increased construct stiffness for all S2AI samples compared with the iliac screw group. However, none of the groups tested reached statistical significance for a 95% confidence interval.Conclusions
S2AI screws are just as stable as iliac screws with biomechanical testing in flexion, extension, rotation, lateral bending, and axial rotation. Given the similarities of biomechanical testing to human movements, these findings support S2AI screws as a viable option for lumbosacral fixation. 相似文献15.
Genki Okita Tetsuro Ohba Tomohiro Takamura Shigeto Ebata Ryo Ueda Hiroshi Onishi Hirotaka Haro Masaaki Hori 《The spine journal》2018,18(2):268-275
Background Context
Surgical outcome and the severity of cervical spondylotic myelopathy (CSM) are unpredictable and cannot be estimated by conventional anatomical magnetic resonance imaging (MRI). The utility of diffusion tensor imaging (DTI) to quantify the severity of CSM and to assess postoperative neurologic recovery has been investigated. However, whether conventional DTI should be applied in a clinical setting remains controversial. Neurite orientation dispersion and density imaging (NODDI) is a recently introduced model-based diffusion-weighted MRI technique that quantifies specific microstructural features related directly to neuronal morphology. However, there are as yet few clinical applications of NODDI reported. Indeed, there are no reports to indicate NODDI is useful for diagnosing CSM.Study Design
This is a retrospective cohort study using consecutive patients.Purpose
The objective of this study was to evaluate the utility of NODDI and conventional DTI for detecting changes in the spinal cord microstructure. In particular, this study aimed to quantify the preoperative severity of CSM and to assess postoperative neurologic recovery from this myelopathy.Patient Sample
We included 27 consecutive patients with a nontraumatic cervical lesion from CSM who underwent laminoplasty at a single institution between April 2012 and April 2015. The patients underwent MRI before and approximately 2 weeks after surgery.Outcome Measures
In addition to conventional DTI metrics, we evaluated the intracellular volume fraction (ICVF) and the orientation dispersion index (ODI), which are metrics derived from NODDI. The 10-second grip and release test and the Japanese Orthopaedic Association scoring system were used before and 1 year after surgery to assess neurologic outcome.Materials and Methods
Neurite orientation dispersion and density imaging and conventional DTI values were measured at the C2–C3 intervertebral level (control value) and at the most compressed levels (C3–C7 intervertebral levels) were measured. The changes in these values pre- and postoperative were demonstrated. Correlations between NODDI and conventional DTI values and clinical outcome were determined.Results
Preoperative fractional anisotropy was significantly correlated with the severity of neural damage, but not with postoperative neurologic recovery. No significant correlation could be found between the preoperative ICVF, the ODI, the apparent diffusion coefficient, and the severity of the preoperative neurologic dysfunction. Preoperative ICVF was most strongly correlated with the severity of neurologic dysfunction and postoperative neurologic recovery.Conclusions
Conventional DTI may be applied clinically to assess the severity of myelopathy. Neurite orientation dispersion and density imaging may be more valuable than conventional DTI to predict outcome following surgery in patients with CSM. 相似文献16.
Masashi Uehara Jun Takahashi Shota Ikegami Hiroyuki Hashidate Shugo Kuraishi Masayuki Shimizu Toshimasa Futatsugi Hiroki Oba Keijiro Mukaiyama Nobuhide Ogihara Hiroki Hirabayashi Hiroyuki Kato 《The spine journal》2017,17(2):190-195
Background Context
Cervical pedicle screw (CPS) insertion is technically demanding and carries a risk of serious neurovascular complications when screws perforate. To avoid such serious risks, we currently perform CPS insertion using a computed tomography (CT)-guided navigation system. However, there remains a low probability of screw perforation during CPS insertion that is affected by factors such as CPS insertion angle and anatomical pedicle transverse angle (PTA).Purpose
This study aimed to understand the perforation tendencies of CPS insertion angles in relation to anatomical PTA.Study Design
This is a retrospective chart review.Patient Sample
The study enrolled 151 consecutive patients (95 men and 56 women, with a mean age of 64.6 years).Outcome Measures
Anatomical PTA and CPS insertion angles were evaluated by axial CT images.Methods
The medical records of 151 consecutive patients who underwent CPS insertion using a CT-based navigation system were reviewed. We examined the relationships between PTA and CPS insertion angle on axial CT images according to vertebral level.Results
The average preoperative PTA at each vertebral level was 32.1° for C2, 41.5° for C3, 41.0° for C4, 39.4° for C5, 34.4° for C6, and 27.3° for C7. Corresponding CT-determined pedicle screw insertion angles were 24.9°, 31.3°, 28.7°, 27.8°, 28.0°, and 26.0°, respectively. The CPS insertion angles at C2–C6 were significantly smaller than those for PTA (p<.01). In evaluations of angle thresholds from C3 to C5 that predicted a higher risk of perforation, the receiver operating characteristic curve analysis determined CPS insertion angles of <24.5° and >36.5° for the identification of lateral and medial perforations, respectively.Conclusion
For CPS insertion into the C3–C5 pedicles using CT, there is an increased likelihood of lateral or medial perforation for insertion angles of <24.5° or >36.5°, respectively. 相似文献17.
Kentaro Yamada Yuichiro Abe Shigenobu Satoh Yasushi Yanagibashi Takahiko Hyakumachi Takeshi Masuda 《The spine journal》2017,17(8):1074-1081
Background Context
No previous studies have reported the radiological features of patients requiring surgery in symptomatic lumbar foraminal stenosis (LFS).Purpose
This study aims to investigate the diagnostic accuracy of a novel technique, foraminal stenotic ratio (FSR), using three-dimensional magnetic resonance imaging for LFS at L5–S by comparing patients requiring surgery, patients with successful conservative treatment, and asymptomatic patients.Study Design
This is a retrospective radiological comparative study.Patient Sample
We assessed the magnetic resonance imaging (MRI) results of 84 patients (168?L5–S foramina) aged ≥40 years without L4–L5 lumbar spinal stenosis. The foramina were divided into three groups following standardized treatment: stenosis requiring surgery (20 foramina), stenosis with successful conservative treatment (26 foramina), and asymptomatic stenotic foramen (122 foramina).Outcome Measures
Foraminal stenotic ratio was defined as the ratio of the length of the stenosis to the length of the foramen on the reconstructed oblique coronal image, referring to perineural fat obliterations in whole oblique sagittal images. We also evaluated the foraminal nerve angle and the minimum nerve diameter on reconstructed images, and the Lee classification on conventional T1 images.Materials and Methods
The differences in each MRI parameter between the groups were investigated. To predict which patients require surgery, receiver operating characteristic (ROC) curves were plotted after calculating the area under the ROC curve.Results
The FSR showed a stepwise increase when comparing asymptomatic, conservative, and surgical groups (mean, 8.6%, 38.5%, 54.9%, respectively). Only FSR was significantly different between the surgical and conservative groups (p=.002), whereas all parameters were significantly different comparing the symptomatic and asymptomatic groups. The ROC curve showed that the area under the curve for FSR was 0.742, and the optimal cutoff value for FSR for predicting a surgical requirement in symptomatic patients was 50% (sensitivity, 75%; specificity, 80.7%).Conclusions
The FSR determined LFS requiring surgery among symptomatic patients, with moderate accuracy. Foramina occupied ≥50% by fat obliteration were likely to fail conservative treatment, with a positive predictive value of 75%. 相似文献18.
Chang Ju Hwang Choon Sung Lee Hyojune Kim Dong-Ho Lee Jae Hwan Cho 《The spine journal》2018,18(10):1822-1828
Background Context
Coronal imbalance is a complication of corrective surgeries in adolescent idiopathic scoliosis (AIS). However, few studies about immediate coronal decompensation in Lenke-5C curves have reported its incidence, prognosis, and related factors.Purpose
To evaluate the development of coronal imbalance after selective thoracolumbar-lumbar (TL/L) fusion (SLF) in Lenke-5C AIS, and to reveal related factors.Study Design
Retrospective comparative study.Patient Sample
This study included 50 consecutive patients with Lenke-5C AIS who underwent SLF at a single center.Outcome Measures
Whole-spine anteroposterior and lateral radiographs were used to measure radiological parameters.Methods
Patients were divided into two groups according to the presence or absence of coronal imbalance (distance between C7 plumb line and central sacral vertical line >2?cm) in the early (1 month) postoperative period. Various radiological parameters were statistically compared between groups.Results
Of the patients, 28% (14 of 50) showed coronal imbalance in the early postoperative period; however, most of them (13 of 14) showed spontaneous correction during follow-up. The development of coronal imbalance was related to less flexibility of the TL/L curve (51.3% vs. 52.6%, p=.040), greater T10–L2 kyphosis (11.7° vs. 6.4°, p=.034), and greater distal junctional angle (6.0° vs. 3.7°, p=.025) in preoperative radiographs. Lowermost instrumented vertebra (LIV) tilt was greater in the decompensation [+] group in the early postoperative period (8.8° vs. 4.4°, p=.009). However, this difference disappeared in final follow-up with the decrease of LIV tilt in the decompensation [+] group.Conclusions
Less flexibility of the TL/L curve, greater TL kyphosis, and greater distal junctional angle preoperatively were predictive factors for immediate coronal imbalance in Lenke-5C curves. Although coronal imbalance was frequently detected in the early postoperative period after SLF, it was mostly corrected spontaneously with a decrease of LIV tilt. Thus, SLF for Lenke-5C curves can be a good option regardless of the possible coronal imbalance in the early postoperative period. 相似文献19.
Aaron J. Buckland Subaraman Ramchandran Louis Day Shay Bess Themistocles Protopsaltis Peter G. Passias Bassel G. Diebo Renaud Lafage Virginie Lafage Akhila Sure Thomas J. Errico 《The spine journal》2017,17(11):1601-1610
Background Context
Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied.Purpose
We hypothesized that patients with increasing radiological severity of lumbar stenosis will exhibit worsening sagittal alignment.Study Design
This is a cross-sectional study.Patient Sample
Our sample consists of patients who have DLS.Outcome Measures
Standing pelvic, regional, lower extremity and global sagittal alignment, and health-related quality of life (HRQoL) were the outcome measures.Methods
Patients with DLS were identified from a retrospective clinical database with corresponding full-body stereoradiographs. Exclusion criteria included coronal malalignment, prior spine surgery, spondylolisthesis>Grade 1, non-degenerative spinal pathology, or skeletal immaturity. Central stenosis severity was graded on axial T2-weighted magnetic resonance imaging (MRI) from L1–S1. Foraminal stenosis and supine lordosis was graded on sagittal T1-weighted images. Standing pelvic, regional, lower extremity, and global sagittal alignment were measured using validated software. The HRQoL measures were also analyzed in relation to severity of stenosis.Results
A total of 125 patients were identified with DLS on appropriate imaging. As central stenosis grade increased, patients displayed significantly increasing standing T1 pelvic angle, pelvic tilt, sagittal vertical axis, and pelvic incidence-lumbar lordosis (p<.05). No significant difference wasfound in pelvic incidence, supine lordosis, thoracic kyphosis, or T1 spinopelvic inclination between central stenosis groups. Despite similar supine lordosis between stenosis groups, patients with Grades 2 and 3 stenosis had less standing lordosis, suggesting antalgic posturing. Upper lumbar (L1–L3) stenosis predicted worse alignment than lower lumbar (L4–S1) stenosis.Increasing severity of foraminal stenosis was associated with reduced lumbar lordosis; however, no significant postural difference in lordosis, thoracolumbar, or lower extremity compensatory mechanisms were noted between foraminal stenosis groups. Stenosis grading did not predict worsening HRQoLs in central or foraminal stenosis.Conclusions
Severity of central lumbar stenosis as graded on MRI correlates with severity of sagittal malalignment. These findings support theories of sagittal malalignment as a compensatory mechanism for central lumbar stenosis. 相似文献20.
Jae Hwan Cho Jae Hyup Lee Jin Sup Yeom Bong-Soon Chang Jae Jun Yang Ki Hyoung Koo Chang Ju Hwang Kwang Bok Lee Ho-Joong Kim Choon-Ki Lee Hyoungmin Kim Kyung-Soo Suk Woo Dong Nam Jumi Han 《The spine journal》2017,17(12):1866-1874