Analysis of the relationship between the facet fluid sign and lumbar spine motion of degenerative spondylolytic segment using Kinematic MRI

PurposeTo investigate the relationship between the facet fluid sign (FFS) and kinematics of affected lumbar segment in patients with low-grade, single-level lumbar degenerative spondylolisthesis using kinematic magnetic resonance imaging (kMRI).Materials and methods Ninety-two patients diagnosed with low-grade (Grade 1 or 2), single level lumbar degenerative spondylolisthesis L3 to S1. Angular and translational motion, whole lumbar motion, slip percentage, and facet angle were measured. Disc degeneration and degrees of osteoarthritis were graded, facet effusion was evaluated and classified as Positive or Negative FFS (PosFFS or NegFFS).Results There were significant differences in the facet degeneration, translational motion, percentage of total angular motion, and flexion-extension slip difference between the PosFFS and NegFFS group. 28.3% of the patients in PosFFS group had anterolisthesis in flexion, but not extension.There was a significant difference in the incidence of FFS between the dynamic and static spondylolisthesis (75% vs 35%, p < 0.001). If FFS was present on kMRI, a positive predictive value for dynamic spondylolisthesis was 75.6%. with the sensitivity and specificity of 0.75 and 0.65 for posFFS to diagnose dynamic DS. The likelihood ratio for dynamic slips in the presence of FFS was 2.1, and the likelihood ratio for static slips in the presence of FFS was 1.1.Conclusion Facet fluid sign was present in weight-bearing neutral position, and the presence of FFS in kMRI increased the probability of having dynamic spondylolisthesis.     

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

Background

To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position.

Methods

Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°).

Results

Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033).

Conclusions

Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients.     

Spondylolisthesis accompanying bilateral pedicle stress fracture at two vertebrae

There has been no report of bilateral pedicle stress fractures involving two vertebrae. The authors describe a unique case of spondylolisthesis accompanying a bilateral pedicle stress fracture involving two vertebrae. De novo development of spondylolisthesis at the L5-S1 vertebrae accompanying a bilateral pedicle stress fracture at L4 and L5 was observed in a 70-year-old woman. The patient's medical history was unremarkable and she did not have any predisposing factors except severe osteoporosis. Interbody fusion with bone cement augmented screw fixation was performed. Surgical treatment resulted in good pain management and improved functional recovery.     

钛钢螺纹椎体融合器治疗腰椎滑税症13例疗效观察

目的：通过对13例腰椎滑税患者使用TFC治疗的临床分析,探讨其在腰椎滑税中的治疗作用。方法：13例患者采用后路椎管减压TFC植入。结果：所有病人原有症状均改善。本组随访12－24个月,平均14．5个月,优良率84．6％,融合率100％。结论：TFC能对腰椎滑脱患者治疗起到稳定脊柱,坚固骨融合,神经减压作用及易于护理和早期重返工作岗位。     

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature

BACKGROUNDDeep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.CASE SUMMARYWe here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure.CONCLUSIONIn conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.     

椎弓根钉加椎间融合治疗腰椎滑脱并发症分析

目的分析椎管减压,椎弓根钉器械复位内固定加椎间植骨融合术治疗腰椎滑脱患者术后并发症,探讨其发生的原因及防治措施、方法随访1996～2002年收治的63例椎管减压,椎弓根钉器械复位内固定并椎间植骨融合治疗腰椎滑脱病人3～6年后并发症．结果63例患者中,术后并发症主要有：腰痛及下肢痛4例,占6．34％,下肢痛伴麻木3例,占4．76％,假关节形成2例,占3．33％,断钉2例,占3．33%。结论椎弓根钉复位内固定加椎间植骨融合治疗腰椎滑脱具有较好的临床效果,但术后出现下腰痛、假关节形成和下肢神经痛及断钉是其主要并发症,应引起高度重视。     

经皮椎弓根钉内固定治疗高龄患者腰椎退变性滑脱所致腰痛的临床研究

目的观察经皮椎弓根钉治疗高龄老人腰椎退变性滑脱所致腰痛的临床疗效。方法201O年4月～2013年8月28例腰椎退变性滑脱所致腰痛的高龄老人,采用经皮椎弓根钉内固定实施治疗,对比术前、术后1周、术后6个月视觉模拟评分（VAS）和功能障碍指数（ODI）,记录手术时间及术中出血量,评价临床疗效。结果本组28例患者,术前视觉模拟评分（VAS）为（7．61±1．22）分,功能障碍指数（OO!）为（53．12±3．32）分：采用经皮椎弓根钉内固定治疗,术后1周内均带护腰支具下地活动,下地后术前腰痛症状消失或明显缓解,术后2周伤口甲级愈合并拆线。术后1周VAS为（2．30±0．98）分,0DI为（7．64±1．23）分;平均手术时间130分钟,平均出血量110ml。所有患者均获得随访,随访时间6个月,随访时VAS为（2．12±1．33）分,ODI为（8．46±2．20）分。结论经皮椎弓根钉内固定治疗高龄老人腰椎退变性滑脱所致腰痛疗效确切。     

成人腰椎滑脱症手术治疗进展

腰椎滑脱症是临床上的常见病和多发病,主要症状为下腰部疼痛,可有间歇性跛行及神经根性痛等下肢神经症状,越来越多的患者正饱受其困扰。随着医学技术的不断发展,本病的手术治疗也在不断发展和完善,但其临床表现复杂,目前对其治疗方式的选择尚未达成统一的认识,其手术治疗方式的选择仍在争论和探索。本文对近年手术治疗腰椎滑脱症的相关文献资料进行回顾与总结。     

腰骶移行椎类型与腰椎间盘突出、椎管狭窄及滑脱节段关系的临床研究

目的探讨不同类型的腰骶移行椎与腰椎间盘突出症、腰椎管狭窄症及滑脱节段的关系,为临床诊治提供参考。方法2004～2008年临床资料、影像资料完整腰骶移行椎91例,男46例,女45例;年龄男48．3±12．5（28～85）岁,女48．4±10．6（21～68）岁。按Castellvi分类进行分析。结果91例共发现病变217处。腰椎间盘突出症共51例占56％,其中L3／4,2例占2．2％,均为Ⅱ型移行椎;L4／5,41例占46．2％（Ⅰ型4例,Ⅱ型9例,Ⅲ型25例,Ⅳ型3例）;L5／S1,8例占8．8％,均为Ⅰ型移行椎。腰椎管狭窄症31例占34．1％,其中L3／4,9例占9．8％（Ⅱ型5例,Ⅲ型3例,Ⅳ型1例）;L4／5,11例占12．1％（Ⅰ型1例,Ⅱ型3例,Ⅲ型5例,Ⅳ型2例）;L5／S1,9例占9．8％（Ⅰ型3例,Ⅱ型6例）。腰椎滑脱节段：L4滑脱25例占27．5％（Ⅰ型4例,Ⅱ型9例,Ⅲ型10例,Ⅳ型2例）;L3滑脱3例占3．3％（Ⅱ型1例,Ⅲ型2例）;L2滑脱4例占4．4％（Ⅱ型2例,Ⅲ型2例）;L1滑脱1例;各型均无L5滑脱病例。结论Ⅰ型移行椎L4／5、L5／S1节段均可发生腰椎间盘突出症,Ⅱ型、Ⅲ型、Ⅳ型则只发生在L4／5节段和L3／4节段,L5／S1节段没有突出。Ⅰ型和Ⅱ移行椎以L5／S1节段狭窄及退变多见,L4／5次之;而Ⅲ型和Ⅳ型移行椎时腰椎管狭窄症于L4／5节段最多,L3／4次之,L5／S1节段没有狭窄,所有移行椎病例没有L5滑脱及峡部裂发生,L4滑脱最多,以Ⅱ型、Ⅲ型占主要,其次为L2、L3滑脱。     

Symptoms in relation to the level of spondylolysis

Summary Spondylolysis usually occurs in the fifth lumbar vertebra, which with the rest of the lumbosacral junction may be hypoplastic. About 10% of spondylolysis occurs in the fourth lumbar vertebra which is usually normal radiologically. The present work studies the hitherto unknown prognostic value of the lysis level in relation to symptoms.A comparison was made between 213 patients with lysis at L5 and 42 patients with lysis at L4. The frequency and intensity of low back pain, the need for treatment, change of work, sickleave, and sick pension caused by low-back symptoms were noted during a period of more than 20 years. Pain frequency and intensity and functional impairment were consistently higher in the L4 group. The differences were particularly evident between the two subgroups when there was a marked vertebral slip. It is concluded that the level of spondylolysis is of significance in the occurrence of low-back symptoms.

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Résumé La spondylolyse siège habituellement sur la 5ème vertèbre lombaire qui peut être hypoplasique, de même que l'ensemble de la jonction lombosacrée. Environ 10% des spondylolyses siègent au niveau de la 4ème lombaire qui est en règle radiologiquement normale. Ce travail étudie la valeur pronostique, inconnue jusqu'ici, du niveau de la spondylolyse sur la symptomatologie.On a comparé 232 malades porteurs d'une spondylolyse de L5 et 42 malades dont la lyse siègeait à L4. La fréquence et l'intensité de la lombalgie, la nécessité d'un traitement, le changement de travail, les arrêts pour maladie et les pensions justifiés par les symptômes lombaires ont été notés pendant une période de plus de 20 ans. Les douleurs et le handicap fonctionnel étaient notablement plus importants dans le groupe L4. Les différences étaient encore plus marquées entre les deux sous-groupes lorsqu'il existait un important glissement vertébral. On peut en conclure que le niveau de la spondylolyse est un élément valable de pronostic en ce qui concerne la symptomatologie lombaire.