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991.

Purpose

To review the evidence on safety of anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders with an emphasis on the association between neuromonitoring and complications.

Methods

We performed a systematic literature search in the Cochrane (CENTRAL), MEDLINE, EMBASE and the FDA Medical Devices databases. We abstracted information on study design, sample size, population, procedure, number and location of involved levels, follow-up time and complications, as well as information on conflict of interest and source of funding. In addition, for ELIF we collected information on the use of neuromonitoring during the procedure.

Results

34 publications were included in the review: 24 ELIF (all case series), 9 ALIF (8 randomized controlled trials and 1 case series) and one retrospective cohort that directly compared ELIF with ALIF. 18 out of 24 ELIF studies reported using neuromonitoring. The overall complication rate for ELIF was lower compared to ALIF without FDA reports (16.61 vs. 26.47 %, respectively). However, the rate of neurologic complications in ELIF was almost twice as high compared to ALIF without FDA reports (8.92 and 4.96 %, respectively). The rate of overall complications in ELIF studies that were reported using neuromonitoring was lower compared to the studies that did not report using neuromonitoring (16.34 vs. 21.74 %, respectively).

Conclusion

Although the overall complications rate for ELIF was lower compared to ALIF, ELIF is associated with a greater risk of neurological complications compared to ALIF even when used with neuromonitoring.
  相似文献   
992.

Purpose

The present study investigated the percentage of low back pain (LBP) patients who have depressive symptoms and neuropathic pain and analyzed the effects of these on the quality of life (QOL) in these patients.

Methods

Of the 650 new patients with LBP that visited the hospital between June 2012 and December 2013, 309 patients who completed questionnaires to assess LBP and QOL were included in the study. The questionnaire included demographic items, the self-rated depression scale (SDS)-Zung, the Japanese version of the PainDETECT questionnaire (PDQ-J), numerical pain rating scale (NRS), and QOL assessments. The patients were divided into two groups according to their SDS-Zung scores: a nondepressed group with SDS scores <40 and a depressed group with SDS-Zung scores ≥50.

Results

One hundred twenty-five patients (40.5 %) were classified as nondepressed and 63 (20.4 %) as depressed. The mean PDQ-J score was higher in depressed patients than in nondepressed patients. The frequency of neuropathic pain was greater in depressed patients, with neuropathic pain observed in 17 of the 63 (27 %) depressed LBP patients and 11 of the 125 (9 %) nondepressed LBP patients. The SDS-Zung and PDQ-J scores of LBP patients were correlated significantly (r = 0.261, p < 0.001). Depressed patients had higher pain NRS scores and lower QOL scores compared with nondepressed patients.

Conclusions

Both the depressed patients and those with neuropathic LBP had a higher level of pain, greater pain-related disability, and poorer QOL compared with nondepressed patients. This is the first study to use the SDS-Zung and PDQ-J screening questionnaires to estimate the presence of neuropathic pain associated with depressive symptoms in LBP patients and to evaluate the impact of these on QOL.
  相似文献   
993.

Purpose

The goal of this study was to compare the accuracy and cranial facet joint violation rates between percutaneous pedicle screw placements using conventional fluoroscopy and intraoperative 3-D CT (O-arm) computer navigation.

Methods

We reviewed 194 pedicle screw of 28 consecutive patients who underwent minimally invasive lumbar or thoracic spinal stabilization. The accuracy of screw placement was evaluated according to two criteria published by Neo et al. and Upendra et al. Facet joint violation was evaluated according to the classification described by Babu et al.

Results

Upon Neo grading, CFT group had 19.4 % (14/72) pedicle breach rate and CT-IGN group had a 5.7 % (7/122) pedicle breach rate (p < 0.005). The same sets of screws were also assessed using the outcome-based classification established by Upendra. There were no screw caused neurovascular injuries (type 3 = 0) in both groups. The results showed that 87.5 % (63/72) screws had acceptable placements (type I) and 12.5 % (9/72) had unacceptable placements (type II) in CFT group. In contrast, 94.3 % (115/122) screw had acceptable placements (type I) and only 5.7 % (7/122) had unacceptable placements (type II) in CT-IGN group. Additionally, CFT group had a significantly higher facet joint violation rate of 30.5 % (11/36) than CT-IGN group that had a 3.8 % (3/79) violation rate (p < 0.005).

Conclusion

This study indicated the use of intraoperative CT imaging (O-arm) navigation in PPS placement have very beneficial implications for MIS.
  相似文献   
994.

Introduction

Several types of stem cells have been successfully demonstrated to exist in the human degenerated intervertebral disc (IVD), which is composed of annulus fibrosus (AF), nucleus pulposus (NP) and cartilage endplate (CEP). However, the differences in the biological characteristics among these and bone marrow derived mesenchymal stem cells (BM-MSCs) remain unclear.

Materials and methods

To investigate this issue, cells were harvested from human AF, NP, CEP, and bone marrow, respectively; passage 2 cells were selected using the agarose suspension culture system to obtain stem cell clones. Following expansion in vitro, stem cells from different anatomical regions were compared regarding the morphology, proliferation ability, immunophenotypic expression, and multi-lineage differentiation capacity. In addition, stem cell-alginate bead compositions were constructed for the comparison of DNA and sGAG content.

Results

There were subtle differences regarding cell morphology, but no significant differences in proliferation ability among the four types of stem cells. For the immunophenotypic analysis, all stem cells basically fulfilled the criteria for mesenchymal stem cells (MSCs), which have been published by the International Society for Cellular Therapy (ISCT), with a significant difference in CD105 expression. A comparison of the osteogenic capacities indicated: cartilage endplate-derived stem cells (CESCs) > annulus fibrosus-derived stem cells (AFSCs) > BM-MSCs > nucleus pulposus-derived stem cells (NPSCs). The chondrogenesis difference was similar to osteogenesis. For adipogenesis: BM-MSCs >NPSCs >CESCs >AFSCs. In the stem cell/alginate composition, the CESCs consistently showed the superior chondrogenic potential among all those cell types.

Conclusions

Our data indicated that all the four types of stem cells shared some similar biological properties (regarding shape, proliferation ability and immunophenotypic expression). CESCs, which had the strongest osteogenic and chondrogenic potentials, may serve as excellent seed cells for NP/cartilage or bone tissue engineering.
  相似文献   
995.

Purpose

To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.

Methods

An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.

Results

Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = ?151.01 (?288.22, ?13.80), P = 0.03], shorter length of hospital stay [WMD = ?69.33 (?110.39, ?28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].

Conclusions

Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.
  相似文献   
996.

Purpose

C5 palsy is a well-known complication of cervical spine decompression surgery. The complication develops in both posterior and anterior approaches. We aimed to review reports regarding postoperative C5 palsy in hopes for better prevention and treatment of this morbidity.

Method

We systematically reviewed and evaluated the abstracts and full texts of the identified papers in the literature. We reviewed and analyzed papers published between January 1970 and February 2015 regarding C5 palsy as a complication of cervical surgical procedures. We made statistical comparisons as much as possible.

Results

We did not find any statistical significance between the pathologies (p = 0.088) and between the surgical routes (p = 0.486). There was statistical significance between the types of procedures (p < 0.05). Posterior laminectomy had low incidence of C5 palsy when compared to laminectomy and fusion (p = 0.029) and laminoplasty (p = 0.37). There was no statistically significant difference between anterior cervical decompression and fusion and other procedures (p > 0.05).

Conclusion

Some studies conclude that anterior procedure is more safe. Of all anterior procedures, the multilevel ACDF had the lowest incidence of C5 palsy. The hybrid technique can be chosen for more than two-vertebra corpectomy. In term of posterior procedures, laminectomy is safer. To prevent C5 palsy, electromyography can be used as a sensitive predictor and selective foraminotomy can be performed.
  相似文献   
997.

Purpose

LDD is an important cause of low back pain. Many people believe there is an adverse influence of type 2 diabetes (T2D) on lumbar intervertebral disc degeneration (LDD). We examined a population sample for epidemiological evidence of association.

Methods

Twin volunteers from the TwinsUK cohort having spine magnetic resonance (MR) scans coded for LDD and information about T2D were investigated in two ways. First, as a population sample and second as a cotwin case control study in twin pairs discordant for T2D. Other risk factors for LDD considered were age, body-mass index (BMI), smoking, and alcohol.

Results

In 956 twin volunteers T2D had a prevalence of 6.6 %. LDD score was higher in T2D twins (14.9 vs 13.1 p = 0.04) but was not an independent risk factor if the influence of age and BMI were included in the model. Discordant twin analysis (n = 33 pairs) showed no significant difference in LDD between twins having T2D and their unaffected cotwins.

Conclusions

Twins having T2D did manifest higher LDD scores but the effect was abrogated once BMI was included in multivariable analysis, showing it is not an independent risk factor for LDD. The population study had 80 % power at 0.1 significance level to detect a difference of 1.8 in LDD score (range of 0–60), so if there is an effect of T2D on LDD, it is likely to be small.
  相似文献   
998.
The aim of the present study was to analyze the clinical and radiographic outcomes and Kaplan–Meier survivorship of patients who underwent revision surgeries of the acetabular cup that had sustained aseptic loosening. We reviewed 101 consecutive patients (120 hips; 10 men 11 hips; 91 women 109 hips; age at surgery 66 years; range 45–85) who underwent acetabular component revision surgery, at a follow-up period of 15.6 years (range 10–32). To evaluate the state of the acetabulum, acetabular bony defects were classified according to the AAOS classification based on intraoperative findings: type I (segmental deficiencies n = 24 hips), type II (cavity deficiency n = 48), type III (combined deficiency n = 46), and type IV (pelvic discontinuity n = 2). The Harris hip score improved from 42.5 ± 10.8 (mean ± SD) before surgery to 74.9 ± 14.6 points at follow-up. The survival rates of the acetabular revision surgery with cemented, cementless, and cemented cups plus reinforcement devices were 74, 66, and 82 %, respectively. The difference in the survival rate between the cemented and cementless group was marginal (p = 0.048 Gehan–Breslow–Wilcoxon, p = 0.061 log-rank), probably due to the early-stage failure cases in the cementless group. The cementless and reinforcement groups included nine early-stage failure cases. To prevent early-stage failure, we recommend the cementless cups for types I and II acetabular bone defects with adequate contact between host bone and acetabular component, and the cemented cup with or without reinforcement devices, together with restoration of bone stock by impaction or structured bone grafting, for cases lacking such contact.  相似文献   
999.

Background

Various megaprostheses are currently available for reconstruction of the proximal femur after tumor resection. This study evaluates the survival and complications of a modular megaprosthesis for reconstruction of the proximal femur.

Materials and methods

We studied the medical files of 109 tumor patients (age range 16–86 years) who underwent proximal femoral reconstruction with the MRP® megaprosthesis from 2002 to 2011. There were 70 patients with metastases, 34 patients with bone sarcomas, and five patients with hematological malignancies; 82 were primary and 27 were revision reconstructions. Mean follow-up was 2.5 years; 31 patients had a minimum five-year follow-up. We evaluated the survival and function of the patients, and the survival and complications of the megaprostheses.

Results

Survival was significantly higher for the patients with bone sarcomas compared to those with metastases and hematological malignancies. Mean MSTS functional score was similar between patients with bone sarcomas and those with hematological malignancies and metastases, and between patients with primary and those with revision reconstructions. Overall survival of the MRP® megaprostheses was 74 % at 5 and 9 years. Fourteen (13.6 %) major complications occurred at a mean period of 1.4 years (range 3 months to 4.5 years); these included infection (5.8 %), dislocation (3.9 %), local recurrence (2.9 %), and acetabular fracture (1 %).

Conclusion

MRP® megaprostheses are a valuable reconstruction option after tumor resection of the proximal femur.
  相似文献   
1000.

Introduction

Nonunions after operative fixation of the femur, although infrequent, remain a challenge for orthopedic surgeons. The aim of this study was to assess the effectiveness of double locking plate fixation in the treatment for femoral shaft nonunions.

Materials and methods

From 2009 to 2013, 21 patients with femoral nonunions (mean age 46.9 years, range 25–81) were treated and evaluated utilizing double locking plate fixation. Patients were followed for at least 6 months postoperatively or until they achieved complete union to investigate bone healing and functional outcomes in femoral shaft nonunions treated with double locking plate and autogenous cancellous bone graft.

Results

The main outcomes evaluated were the presence of bony union, time to achieve union, and SF-36 score. All 21 femoral nonunions healed (100 % union rate). The average time to bony union was 5.3 months (range, 4–7). The mean follow-up duration time was 24.8 months (range, 6–60). Average scores of the physical function and bodily pain components of the SF-36 were 96 (range, 90–99) and 94.2 (range, 92–99), respectively. No significant complications were noted postoperatively.

Conclusion

Because of the high union rates and lack of significant complications in our series, double locking plate fixation can serve as an effective method of addressing femoral shaft nonunions. No significant complications were found postoperatively.
  相似文献   
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