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Percutaneous posterior-lateral lumbar interbody fusion for degenerative disc disease using a B-Twin expandable spinal spacer.  

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Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were selected to conservative treatment. Under fluoroscopy in the posterior-lateral position, a K-wire was advanced into the intervertebral space and a dilator and working cannula were introduced into the disc space step by step. Discectomy and endplate scratching were performed through the cannula using pituitary forceps and endplate curettage. An ESS was inserted into the intervertebral space by a B-Twin expandable spinal delivery system after some bone graft chips implanted into the disc space. The ongoing study includes intraoperative difficulties, complications, radiologic evidence of fusion and clinical outcome as scored by pre- and postoperative questionnaires pertaining to pain intensity and degree of disability. The 12 procedures of lumbar interbody fusion using stand-alone expandable spinal system through percutaneous approach were successful. Radiologic study demonstrated fusion in a total of 11 cases and only 1 exception after more than 1 year visiting. The values of Visual Analog Scale (VAS) on movement and Oswestry Disability Index (ODI) dropped by more than 80 and 67.4%, respectively. Disk space heights averaging 9.0 mm before procedure were increased to 11.5 mm 1 month (a significant difference compared with preprocedure, P surgery and stabilized at 10.8 mm upon final follow-up (a significant difference compared with preprocedure, P lumbar interbody fusion using expandable spinal system is a valuable micro-invasion method for the DDD patients and can achieve the same outcome as with other methods. PMID:19784677

Xiao, Lizu; Xiong, Donglin; Zhang, Qiang; Jian, Jin; Zheng, Husan; Luo, Yuhui; Dai, Juanli; Zhang, Deren

2010-02-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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LUMBAR LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ANNOUNCER: During the next hour in a real-time Internet ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available LUMBAR LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ANNOUNCER: During the next hour in a real-time Internet ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... lumbar laminectomy transforaminal lumbar interbody fusion. Surgeons take bone off the spine to make more room for ... re taking off the middle part of her bone as well. We’ve done this TLIF approach ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ... Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat lower ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00: ... time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... questions as possible. Today we’re performing a lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on the air ... for degenerative disc disease, though much less commonly; scoliosis, as in ... front, called an anterior lumbar interbody fusion, or ALIF; we can do it ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... we’re trying to recreate when we do spinal surgeries and fusions and interbody fusions, and especially in this patient, ... with the patient that can occur certainly with spinal surgery, and the ability to obtain a solid fusion if a solid fusion is necessary, what we’ ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... and especially in this patient, not only is balance to her spine but appropriate balance. And the presence of an interbody cage, which ... to try to do is try to help balance her out. And how we’re going to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... 08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University ... 01:00:23 ANNOUNCER: This has been a real-time broadcast of a lumbar laminectomy and transforaminal lumbar ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... will demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy transforaminal ... collapse of those disc spaces. Now, axial low back pain, which many patients complain of with back disorders, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... watching audience to know that is one true emergency in lumbar surgery: it’s called cauda equina syndrome, ... the hospital in that time. So there are emergencies, but the answer is patients don’t have ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on the air ... of a laminectomy and TLIF for stenosis and scoliosis, which is what this patient has. So let’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... lumbar spine are operated on for pain and disability, for a patient’s loss of function, not for ... experienced as your largest inconvenience or limitation, in terms of surgical instrumentation or devices for spinal surgery?” ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy transforaminal ... old female who has significant back and leg pain, worse with standing and walking, and it’s been ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... performing a lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on ... in terms of a laminectomy and TLIF for stenosis and scoliosis, which is what this patient has. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... spinous ligament. And we’re pointing out the facet joint, the facet joint and the—and the lamina. And the area ... emergency in lumbar surgery: it’s called cauda equina syndrome, if they lose control of their bowel and ...

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Surgical results of lumbar interbody fusion using calcium phosphate cement.  

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Clinical and radiological outcomes of lumbar interbody fusion using artificial fusion cages filled with calcium phosphate cements (CPCs) were retrospectively reviewed. Between 2002 and 2011, 25 patients underwent lumbar interbody fusion at Tokushima University Hospital, and 22 patients were enrolled in this study. Of these, 5 patients received autologous local bone grafts and 17 received CPC. Japan Orthopedic Association (JOA) score was used for clinical outcome assessments. Lumbar radiography and computed tomography (CT) were performed at 12, 24 months and last follow-up period to assess bony fusion. The mean JOA score of all patients improved from 9.3 before surgery to 21.0 at 24 months after surgery. Fusion had occurred in 5 of 5 patients in the local bone graft group and in 16 of 17 patients in CPC group at 24 months postoperatively. No surgically related complication was occurred in both groups. CPC is a useful and safe graft material for lumbar interbody fusion. PMID:25169138

Hirasawa, Motohiro; Mure, Hideo; Toi, Hiroyuki; Nagahiro, Shinji

2014-09-15

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Clinical and radiological outcomes of axial lumbar interbody fusion.  

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Axial lumbar interbody fusion is a novel percutaneous alternative to common open techniques, such as anterior, posterior, and transforaminal lumbar interbody fusion. This minimally invasive technique uses the presacral space to access the L5-S1 and L4-L5 disk space. The goal of this study was to examine outcomes following axial lumbar interbody fusion. The charts of all patients who underwent axial lumbar interbody fusion surgery at our institution between 2006 and 2008 were reviewed. Clinical outcomes included visual analog scale (VAS) and Oswestry Disability Index (ODI). Radiographs were also evaluated for disk space height, L4-L5 and/or L5-S1 Cobb angle, and fusion. Of the 50 patients (32 women, 18 men; mean age, 49.29 years) treated with axial lumbar interbody fusion, 48 had preoperative VAS scores and 16 had preoperative ODI scores available. Complete radiographic data were available at the preoperative, initial postoperative, and final postoperative time points for 46 patients (92%). At last follow-up (average, 12 months), ODI scores were reduced from 46 to 22, and VAS scores were lowered from 8.1 to 3.6. Of the 49 patients with postoperative radiographs, 47 (96%) went on to a solid fusion. There were no significant differences between pre- and postoperative disk space height and lumbar lordosis angle. The most common complications were superficial infection and pseudoarthrosis. Other complications were rectal injury, hematoma, and irritation of a nerve root by a screw. Overall, we found the axial lumbar interbody fusion procedure in combination with pedicle screw placement to have good clinical and radiological outcomes. PMID:21162514

Patil, Suresh S; Lindley, Emily M; Patel, Vikas V; Burger, Evalina L

2010-12-01

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Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS: Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS: Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%, good in 16 cases (27.6% and fair/poor in 5 cases (8.6% according to the Macnab criteria. No severe complications were found throughout this study.CONCLUSION: Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

Wei Lu, Yan-Hao Li, Xiao-Feng He

2010-03-01

 
 
 
 
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Anterior Lumbar Interbody Fusion: Two-Year Results with a Modular Interbody Device  

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Study Design Retrospective case series. Purpose To present radiographic outcomes following anterior lumbar interbody fusion (ALIF) utilizing a modular interbody device. Overview of Literature Though multiple anterior lumbar interbody techniques have proven successful in promoting bony fusion, postoperative subsidence remains a frequently reported phenomenon. Methods Forty-three consecutive patients underwent ALIF with (n=30) or without (n=11) supplemental instrumentation. Two patients underwent ALIF to treat failed posterior instrumented fusion. The primary outcome measure was presence of fusion as assessed by computed tomography. Secondary outcome measures were lordosis, intervertebral lordotic angle (ILA), disc height, subsidence, Bridwell fusion grade, technical complications and pain score. Interobserver reliability of radiographic outcome measures was calculated. Results Forty-three patients underwent ALIF of 73 motion segments. ILA and disc height increased over baseline, and this persisted through final follow-up (p4 mm occurred in 12% of patients. There were eight surgical complications (19%): one major (reoperation for nonunion/progressive subsidence) and seven minor (five subsidence, two malposition). Conclusions The use of a modular interbody device for ALIF resulted in a high rate of radiographic fusion and a low rate of subsidence. The large endplate and modular design of the device may contribute to a low rate of subsidence as well as maintenance of ILA and lordosis. Previously reported quantitative radiographic outcome measures were found to be more reliable than qualitative or categorical measures. PMID:25346811

Yeoman, Chevas; Chung, Woosik M.; Chappuis, James L; Freedman, Brett

2014-01-01

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Finite element analysis of minimal invasive transforaminal lumbar interbody fusion.  

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The purpose of our study is to develop and validate three-dimensional finite element models of transforaminal lumbar interbody fusion, and explore the most appropriate method of fixation and fusion by comparing biomechanical characteristics of different fixation method. We developed four fusion models: bilateral pedicle screws fixation with a single cage insertion model (A), bilateral pedicle screws fixation with two cages insertion model (B), unilateral pedicle screws fixation with a single cage insertion model (C), and unilateral pedicle screws fixation with two cages insertion model (D); the models were subjected to different forces including anterior bending, posterior extension, left bending, right bending, rotation, and axial compressive. The von Mises stress of the fusion segments on the pedicle screw and cages was recorded. Angular variation and stress of pedicle screw and cage were compared. There were differences of Von Mises peak stress among four models, but were within the range of maximum force. The angular variation in A, B, C, and D decreased significantly compared with normal. There was no significant difference of angular variation between A and B, and C and D. Bilateral pedicle screws fixation had more superior biomechanics than unilateral pedicle screws fixation. In conclusion, the lumbar interbody fusion models were established using varying fixation methods, and the results verified that unilateral pedicle screws fixation with a single cage could meet the stability demand in minimal invasive transforaminal interbody fusion. PMID:24782059

Zhao, Chuncheng; Wang, Xinhu; Chen, Changchun; Kang, Yanzhong

2014-09-01

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Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion  

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Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. The purpose of this study was to assess and co...

Madan, S. S.; Boeree, N. R.

2003-01-01

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Minimally invasive transforaminal lumbar interbody fusion and spondylolisthesis.  

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The purpose of this study was to assess the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) surgery for lumbar spondylolisthesis. A prospective analysis was conducted of 23 consecutive patients with grade I or grade II lumbar spondylolisthesis who underwent a MI-TLIF using image guidance between August 2008 and September 2010. The patient group comprised 13 males and 10 females (mean age 57 years), 22 of whom underwent single level fusion and one patient with a two level fusion. All patients underwent postoperative CT scans to assess pedicle screw and cage placement and fusion at six months. The Oswestry Disability Index (ODI) scores were recorded preoperatively and at the six-month follow-up. We found that 22 of 23 (95.7%) patients showed evidence of fusion at six months with a mean improvement of 26.7 on ODI scores. The mean length of hospital stay was four days. The mean operative time was 172 minutes. Anatomical reduction of the spondylolisthesis was complete in 16 patients and incomplete in seven. Regarding complications, we observed: one of 94 (1.1%) pedicle screws misplaced, which did not require revision postoperatively; one of 23 patients (4.3%) with a pulmonary embolism and one of 23 (4.3%) patients with transient nerve root pain. There were no occurrences of infection and no postoperative cerebrospinal fluid leaks. We conclude that MI-TLIF offers patients a safe and effective surgical option for lumbar spondylolisthesis treatment. Furthermore, it may offer patients additional advantages in terms of postoperative pain and recovery. PMID:22386479

Tsahtsarlis, Antonio; Wood, Martin

2012-06-01

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Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis  

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Objective To analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis. Methods A total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF. Results All of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8±1.1, which improved to 3.2±2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0±14.8, which improved to 34.2±27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic. Conclusion Our results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis. PMID:25371780

Kim, Sung Han; Kang, Moo-Sung; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun

2014-01-01

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Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion  

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We retrospectively evaluated 488 percutaneous pedicle screws in 110 consecutive patients that had undergone minimally invasive transforaminal lumbar interbody fusion (MITLIF) to determine the incidence of pedicle screw misplacement and its relevant risk factors. Screw placements were classified based on postoperative computed tomographic findings as “correct”, “cortical encroachment” or as “frank penetration”. Age, gender, body mass index, bone mineral density, diagnosis, operatio...

Kim, Moon-chan; Chung, Hung-tae; Cho, Jae-lim; Kim, Dong-jun; Chung, Nam-su

2011-01-01

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Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis.  

Science.gov (United States)

Object Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a wellestablished procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. Methods A prospective cohort study was undertaken by a group of neurosurgeons. They prospectively enrolled 80 patients into either bilateral or unilateral pedicle screw instrumentation groups (40 patients/group). Demographic data collected for each group included sex, age, body mass index, tobacco use, and Workers' Compensation/litigation status. Operative data included segments operated on, number of levels involved, estimated blood loss, length of hospital stay, and perioperative complications. Long-term outcomes (hardware malfunction, wound dehiscence, and pseudarthrosis) were recorded. For all patients, preoperative baseline and 6-month postoperative scores for Medical Outcomes 36-Item Short Form Health Survey (SF-36) outcomes were recorded. Results Patient follow-up times ranged from 37 to 63 months (mean 52 months). No patients were lost to follow-up. The patients who underwent unilateral pedicle screw instrumentation (unilateral cohort) were slightly younger than those who underwent bilateral pedicle screw instrumentation (bilateral cohort) (mean age 42 vs 47 years, respectively; p = 0.02). No other significant differences were detected between cohorts with regard to demographic data, mean number of lumbar levels operated on, or distribution of the levels operated on. Estimated blood loss was higher for patients in the bilateral cohort, but length of stay was similar for patients in both cohorts. The incidence of pseudarthrosis was significantly higher among patients in the unilateral cohort (7 patients [17.5%]) than among those in the bilateral cohort (1 patient [2.5%]) (p = 0.02). Wound dehiscence occurred for 1 patient in the unilateral cohort. Reoperation was offered to 8 patients in the unilateral cohort and 1 patient in the bilateral cohort (p = 0.03). The physical component scores of the Medical Outcomes SF-36 outcomes improved significantly for all patients (p < 0.001). Conclusions Transforaminal lumbar interbody fusion with either unilateral or bilateral segmental pedicular instrumentation is an effective treatment for lumbar spondylosis. Because patients with unilateral constructs were 7 times more likely to experience pseudarthrosis and require reoperation, TLIF with bilateral constructs might be the biomechanically superior technique. PMID:25084031

Gologorsky, Yakov; Skovrlj, Branko; Steinberger, Jeremy; Moore, Max; Arginteanu, Marc; Moore, Frank; Steinberger, Alfred

2014-10-01

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Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages  

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The authors conducted a study to determine at what stage after surgery the subsidence occurred, and to assess the relationships of radiographic fusion and the recurrence of symptoms with the development of subsidence. Ninety patients underwent a single-level anterior lumbar interbody fusion (ALIF) using paired stand-alone rectangular cages between November 2000 and June 2002. All patients had regular clinical or imaging follow-up for a minimum of 19 months (range 19–38 months, mean = 27 ...

Choi, Jae Young; Sung, Kyeong Hoon

2006-01-01

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Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion  

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Degenerative lumbar spinal stenosis (DLSS) has become increasingly common and is characterized by multilevel disc herniation and lumbar spondylolisthesis, which are difficult to treat. The current study aimed to evaluate the short-term clinical outcomes and value of the combined use of microendoscopic discectomy (MED) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of multilevel DLSS with spondylolisthesis, and to compare the combination with traditio...

Wu, Han; Yu, Wei-dong; Jiang, Rui; Gao, Zhong-li

2013-01-01

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AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion  

Directory of Open Access Journals (Sweden)

Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF system is a minimally invasive fusion device that accesses the lumbar (L4–S1 intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

Rapp SM

2011-08-01

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Differences in early osteogenesis and bone micro-architecture in anterior lumbar interbody fusion with rhBMP-2, equine bone protein extract, and autograft  

DEFF Research Database (Denmark)

To investigate the microstructural differences and responsible mechanisms in early bone formation in anterior lumbar interbody fusion (ALIF) in the spine using rhBMP-2 (INFUSE), equine bone protein extract (COLLOSS E) or autograft.

Foldager, Casper; Bendtsen, Michael

2009-01-01

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Primary investigation of clinical application of percutaneous posterior lumbar interbody fusion  

International Nuclear Information System (INIS)

Objective: To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods: Clinical data from 32 cases [16 male, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervertebral distability or I degree spondylolisthesis (21 cases), LDH with intervertebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using ?2 test. Results: The average operation time 1 hour and blood loss 0.05). Conclusions: Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability, which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The long-term outcome, complications and fusion rate need further observing. (authors)

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Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion.  

Science.gov (United States)

Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. The purpose of this study was to assess and compare the outcome of instrumented circumferential fusion through a posterior approach [PLIF and posterolateral fusion (PLF)] with instrumented ALIF using the Hartshill horseshoe cage, for comparable degrees of internal disc disruption and clinical disability. It was designed as a prospective study, comparing the outcome of two methods of instrumented interbody fusion for internal disc disruption. Between April 1994 and June 1998, the senior author (N.R.B.) performed 39 instrumented ALIF procedures and 35 instrumented circumferential fusion with PLIF procedures. The second author, an independent assessor (S.M.), performed the entire review. Preoperative radiographic assessment included plain radiographs, magnetic resonance imaging (MRI) and provocative discography in all the patients. The outcome in the two groups was compared in terms of radiological improvement and clinical improvement, measured on the basis of improvement of back pain and work capacity. Preoperatively, patients were asked to fill out a questionnaire giving their demographic details, maximum walking distance and current employment status in order to establish the comparability of the two groups. Patient assessment was with the Oswestry Disability Index, quality of life questionnaire (subjective), pain drawing, visual analogue scale, disability benefit, compensation status, and psychological profile. The results of the study showed a satisfactory outcome (score0.05). On categorising Oswestry Index scores into "excellent", "better", "same", and "worse", we found no difference in outcome between the two groups: 79.5% (n=31) had satisfactory outcome with ALIF and 80% (n=28) had satisfactory outcome with PLIF. The rate of return to work was no different in the two groups. On radiological assessment, we found two nonunions in the circumferential fusion (PLIF) group (94.3% fusion rate) and indirect evidence of no nonunions in the ALIF group. There was no significant difference between the compensation rate and disability benefit rate between the two groups. There were three complications in ALIF group and four in the PLIF (circumferential) group. On the basis of these results, we conclude that it is possible to treat discogenic back pain by anterior interbody fusion with Hartshill horseshoe cage or with circumferential fusion using instrumented PLIF. PMID:14673717

Madan, S S; Boeree, N R

2003-12-01

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A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion  

Science.gov (United States)

Study Design Meta-analysis. Background Bilateral pedicle screw fixation (PS) after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS) lumbar interbody fusion for one-level degenerative lumbar spine disease. Methods MEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2. Results Six studies (5 RCTs and 1 CCT) involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS) for leg pain, VAS for back pain, Oswestry disability index (ODI). Both fixation procedures had similar length of hospital stay (MD?=?0.38, 95% CI?=??0.83 to 1.58; P?=?0.54). In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P?=?0.002) and significantly longer operation time (P?=?0.02) as compared with unilateral PS fixation. Conclusions Unilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease. PMID:25375315

Liu, Zheng; Fei, Qi; Wang, Bingqiang; Lv, Pengfei; Chi, Cheng; Yang, Yong; Zhao, Fan; Lin, Jisheng; Ma, Zhao

2014-01-01

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Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion.  

Science.gov (United States)

Adjacent segment disease (ASD) is a potential long-term risk after lumbar fusion. Its incidence has been evaluated in anterior and posterior lumbar interbody fusions, but few studies have focused on transforaminal lumbar interbody fusion (TLIF). Relative risk of ASD with open or minimally invasive (MI) TLIF is poorly understood. To report our experience with risk for ASD in patients receiving TLIF and test its association with surgical approach, we performed a retrospective cohort study based on medical record review at a single institution. Eligible patients were ?18years old at operation, underwent single-level TLIF during the period 2007-2008, and had at least 6months postoperative follow-up. Patients were categorized by surgical approach (open versus MI). Primary outcome of interest was development of symptomatic ASD, defined by (1) new back and/or leg pain, (2) imaging findings adjacent to original surgical level, and (3) decision to treat. A total of 68 patients (16 open, 52 MI) were included in the analysis. Groups had similar baseline characteristics, except the open group tended to be older (p=0.04). Seven (10%) patients developed ASD. Mean patient age was 62years and three were male. Three underwent open and four underwent MI TLIF. Risk of ASD did not differ significantly by surgical approach. The MI group showed a trend toward decreased risk of ASD compared to the open group, although it was not statistically significant. This suggests MI TLIF may be associated with decreased long-term morbidity compared to the open approach. Large prospective studies are needed to confirm these findings. PMID:24880486

Yee, Timothy J; Terman, Samuel W; La Marca, Frank; Park, Paul

2014-10-01

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Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion.  

Science.gov (United States)

The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF. We performed an extensive Medline and Ovid database search through December 2010 revealing 39 articles. Inclusion criteria necessitated that a one or two level TLIF procedure was performed through a paramedian MIS approach with bilateral posterior pedicle screw instrumentation and without posterolateral bone grafting. CT scan verified fusion rates were mandatory for inclusion. Seven studies (case series and case-controls) met inclusion criteria with a total of 408 patients who underwent MIS TLIF as described above. The mean age was 50.7 years and 56.6% of patients were female. A total of 78.9% of patients underwent single level TLIF. Average radiographic follow-up was 15.6 months. All patients had local autologous interbody bone grafting harvested from the pars interarticularis and facet joint of the approach side. Either polyetheretherketone (PEEK) or allograft interbody cages were used in all patients. Overall fusion rate, confirmed by bridging trabecular interbody bone on CT scan, was 94.7%. This meta-analysis suggests that MIS TLIF performed with interbody bone grafting alone has similar fusion rates to MIS or open TLIF performed with interbody supplemented with posterolateral bone grafting and fusion. PMID:24913928

Bevevino, Adam J; Kang, Daniel G; Lehman, Ronald A; Van Blarcum, Gregory S; Wagner, Scott C; Gwinn, David E

2014-10-01

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Cajas intersomáticas lumbares: ¿medios de fusión o solo espaciadores? / Lumbar interbody cages: fusing means or only spacers?  

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Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish Introducción: La fusión quirúrgica de la columna lumbar es un método muy utilizado para el tratamiento de la inestabilidad segmentaria lumbar dolorosa. En la actualidad, las dos técnicas de fusión instrumentada más utilizadas son la fusión posterolateral con tornillos pedicula-res y la fusión circun [...] ferencial mediante asociación de caja intersomática. Si bien hay evidencia de que la asociación de dispositivos intersomáticos aumenta la tasa de fusión, la mayoría de los estudios no discriminan si esta se produce solo de forma posterolateral o si se asocia una fusión anterior. El objetivo de este trabajo es determinar si existe fusión ósea real a nivel de las cajas intersomáticas o si estas actúan solo como espaciadores. Materiales y métodos: Se analizaron 28 pacientes con patología de la columna lumbar sometidos a artrodesis lumbar circunferencial en un solo nivel entre mayo de 2007 y enero de 2012, mediante tomografía computarizada posquirúrgica para valorar la presencia o no de artrodesis anterior. Se efectuó un estudio de valor terapéutico, descriptivo, de observación (nivel de evidencia IV); mediante evaluación estadística se realizó un análisis de frecuencias para describir la proporción de casos con fusión anterior. Resultados: Se detectó una tasa de fusión del 92,86% y falta de fusión radiológica anterior en el 7,14% de los pacientes. Conclusiones: Hay una alta tasa de fusión anterior a nivel de las cajas intersomáticas; de este modo, se demuestra que dichos dispositivos actúan como medios de fusión y no solo como espaciadores. Abstract in english Background: Surgical fusion of the lumbar spine is a frequently used method for the treatment of painful lumbar segmental instability; currently the two instrumented fusion techniques most commonly used are posterolateral fusion with pedicle screws, and circumferential fusion by association of inter [...] body cages. Although evidence shows that the association of intersomatic devices increases the fusion rate, most studies do not discriminate if this fusion occurs only posterolaterally, or an anterior fusion also occurs. The aim of this study is to determine if there is a true bone fusion at the level of interbody cages or if they act only as spacers. Methods: We analyzed 28 patients with lumbar spine pathology surgically treated with one level circumferential lumbar fusion from May 2007 to January 2012, using post-surgical computed tomography, to assess the presence or absence of anterior arthrodesis. A therapeutic value, descriptive, observational study was conducted (evidence level IV); by statistical evaluation, frequency analysis was performed to describe the proportion of cases with anterior fusion. Results: The fusion rate reached 92.86%; while there was no anterior radiological fusion in 7.14% of patients. Conclusions: There is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.

Diego Nicolás, Flores Kanter; Alberto Javier, Jabif; Pablo Nicolás, Ortiz.

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Axial lumbar interbody fusion: a 6-year single-center experience  

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Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF. Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months. Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001. Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ?30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001. Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0% patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10, total disc replacement of an uninvolved level (n = 3, facet screw fixation (n = 3, facet screw removal (n = 1, and interbody fusion at L4–L5 (n = 1. Eight (6.1% reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: AxiaLIF, interbody, fusion, lumbosacral, minimally invasive, presacral

Zeilstra DJ

2013-08-01

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Modified posterior lumbar interbody fusion for radiculopathy following healed vertebral collapse of the middle-lower lumbar spine.  

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Study Design?Retrospective study. Objectives?Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods?Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic and clinical features of radiculopathy were retrospectively reviewed. As part of our modified PLIF procedure, a bone block was laid on chipped bone to fill the cavity of the fractured end plate and to flatten the cage-bone interface. Results?The morphologic features of spinal deformity in our patients typically consisted of the intradiscal vacuum phenomenon, spondylolisthesis, and a retropulsed intervertebral disk with a vertebral rim in the damaged segment. Cranial end plate fracture resulted in radiculopathy of the traversing nerve roots due to lateral recess stenosis. On the other hand, caudal end plate fracture led to unilateral radiculopathy of the exiting nerve root due to foraminal stenosis. The mean recovery rate based on the Japanese Orthopaedic Association score was 65.0%. Solid fusion was achieved in all but one case. Conclusions?Because of severe deterioration of the anterior column following end plate fracture, the foraminal zone must be decompressed in caudal end plate fractures. The modified PLIF procedure yielded satisfactory clinical outcomes due to anterior reconstruction and full decompression for both foraminal and lateral recess stenoses. PMID:25396106

Yamashita, Tomoya; Sakaura, Hironobu; Miwa, Toshitada; Ohwada, Tetsuo

2014-12-01

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Minimally invasive presacral approach for revision of an Axial Lumbar Interbody Fusion rod due to fall-related lumbosacral instability: a case report  

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Full Text Available Abstract Introduction The purpose of this study was to describe procedural details of a minimally invasive presacral approach for revision of an L5-S1 Axial Lumbar Interbody Fusion rod. Case presentation A 70-year-old Caucasian man presented to our facility with marked thoracolumbar scoliosis, osteoarthritic changes characterized by high-grade osteophytes, and significant intervertebral disc collapse and calcification. Our patient required crutches during ambulation and reported intractable axial and radicular pain. Multi-level reconstruction of L1-4 was accomplished with extreme lateral interbody fusion, although focal lumbosacral symptoms persisted due to disc space collapse at L5-S1. Lumbosacral interbody distraction and stabilization was achieved four weeks later with the Axial Lumbar Interbody Fusion System (TranS1 Inc., Wilmington, NC, USA and rod implantation via an axial presacral approach. Despite symptom resolution following this procedure, our patient suffered a fall six weeks postoperatively with direct sacral impaction resulting in symptom recurrence and loss of L5-S1 distraction. Following seven months of unsuccessful conservative care, a revision of the Axial Lumbar Interbody Fusion rod was performed that utilized the same presacral approach and used a larger diameter implant. Minimal adhesions were encountered upon presacral re-entry. A precise operative trajectory to the base of the previously implanted rod was achieved using fluoroscopic guidance. Surgical removal of the implant was successful with minimal bone resection required. A larger diameter Axial Lumbar Interbody Fusion rod was then implanted and joint distraction was re-established. The radicular symptoms resolved following revision surgery and our patient was ambulating without assistance on post-operative day one. No adverse events were reported. Conclusions The Axial Lumbar Interbody Fusion distraction rod may be revised and replaced with a larger diameter rod using the same presacral approach.

Cohen Anders

2011-09-01

 
 
 
 
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Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion.  

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Degenerative lumbar spinal stenosis (DLSS) has become increasingly common and is characterized by multilevel disc herniation and lumbar spondylolisthesis, which are difficult to treat. The current study aimed to evaluate the short-term clinical outcomes and value of the combined use of microendoscopic discectomy (MED) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of multilevel DLSS with spondylolisthesis, and to compare the combination with traditional posterior lumbar interbody fusion (PLIF). A total of 26 patients with multilevel DLSS and spondylolisthesis underwent combined MED and MI-TLIF surgery using a single cage and pedicle rod-screw system. These cases were compared with 27 patients who underwent traditional PLIF surgery during the same period. Data concerning incision length, surgery time, blood loss, time of bed rest and Oswestry Disability Index (ODI) score prior to and following surgery were analyzed statistically. Statistical significance was reached in terms of incision length, blood loss and the time of bed rest following surgery (P<0.05), but there was no significant difference between the surgery time and ODI scores of the two groups. The combined use of MED and MI-TLIF has the advantages of reduced blood loss, less damage to the paraspinal soft tissue, shorter length of incision, shorter bed rest time, improved outcomes and shorter recovery times and has similar short-term clinical outcomes to traditional PLIF. PMID:23403827

Wu, Han; Yu, Wei-Dong; Jiang, Rui; Gao, Zhong-Li

2013-02-01

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Diagnostic method for lumbar foraminal stenosis based on the clinical results of transforaminal lumbar interbody fusion (TLIF). Utility of the foraminal stenosis score  

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In this study we analyzed 73 cases treated by transforaminal lumbar interbody fusion (TLIF) for lumbar foraminal stenosis or central canal stenosis and foraminal stenosis, and based on the perioperative findings and outcome of treatment, we considered the diagnostic procedure for lumbar foraminal stenosis in the future. In 25 cases (34.2%) cases there was actually no clear perioperative evidence of foraminal stenosis. We compared the preoperative clinical and imaging findings in the group with perioperative findings and the group without perioperative findings performed a multiple logistic regression analysis to identify factors associated with foraminal stenosis. We also calculated the odds ratio for the perioperative findings and proposed a foraminal stenosis scoring system. (author)

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Application of tridimensional intravertebral bone graft combined with AxiaLIF technique in lumbar interbody fusion  

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Full Text Available "nLumbar interbody fusion techniques are becoming more and more minimally invasive. AxiaLIF technique can be used in low back pain caused by degenerative disc disease or minor spondylolisthesis, but there are risks for fusion failure. Intravertebral bone graft is performed in painful osteoporotic or posttraumatic vertebral compression fractures (VCFs. Until now, no attempt has been made to apply intravertebral bone graft with AxiaLIF technique."nSo first, we hypothesize a novel method for tridimensional intravertebral bone graft with a special designed bone grafting instrument and describe it vividly. The special instrument would mainly consist of a hollow tube and a rod, the distal parts of them would be shape into 45o slope, so the direction of grafting would be decided by the slope. By rotating the tube we can deliver cancellous bone granules in one plane, but by retreating the tube we can perform tridimensional intravertebral bone graft. Second, intravertebral bone graft is supposed to be performed combined with AxiaLIF technique in order to create biologic vertebral reconstruction and raise fusion rate. We believe this is the first description of such a method, future clinical studies are needed to validate these hypotheses.

Xiangdong Duan

2009-05-01

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[Mechanical study of potential ceramic implant materials for minimal invasive anterior lumbar interbody fusion].  

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While autologous bone grafts are highly suitable for use in spinal arthrodesis, their use is also associated with problems (traumatization, complications). Ceramic bone substitute materials provide an attractive alternative for lumbar interbody spinal fusion. The aim of the present study was to investigate the mechanical properties of various types of ceramic using a specific fusion method. Ten specimens each of 7 different types of ceramic were tested using a hydraulic testing machine with two different sample holders: polyurethane foam (mechanical properties similar to cancellous bone) and aluminium. The parameters axial compression and axial torque were investigated. With the polyurethane foam holders, none of the ceramic implants failed under compression, while under axial rotation, two types of ceramic failed. With the aluminium holders, 3 ceramics showed no failure up to 25 kN under compression, while under torsion all the ceramics failed. One type of ceramic showed specific fracture properties with a higher load-bearing capacity after failure in comparison with all the other types studied. PMID:10472728

Placzek, R; Kothe, R; Knopf, U; Morlock, M; Rüther, W; Schneider, E

1999-01-01

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Surgical management of minimally invasive anterior lumbar interbody fusion with stand-alone interbody cage for L4-5 degenerative disorders: clinical and radiographic findings.  

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Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3-21 days). The mean blood loss was 63.7 ml (range, 10-456 ml). The mean operation time was 155.5 min (range, 96-280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved significantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option. PMID:24140782

Hironaka, Yasuo; Morimoto, Tetsuya; Motoyama, Yasushi; Park, Young-Su; Nakase, Hiroyuki

2013-01-01

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TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion  

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Full Text Available Mitchell A Hardenbrook,1,2 Larry E Miller,3,4 Jon E Block4 1Advanced Spine Institute of Greater Boston, North Billerica, MA, 2Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, MA, 3Miller Scientific Consulting Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA Abstract: Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system. Keywords: fusion, lateral, lumbar, minimally invasive, transpsoas, VEO

Hardenbrook MA

2013-06-01

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Analysis of spinal lumbar interbody fusion cage subsidence using Taguchi method, finite element analysis, and artificial neural network  

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Subsidence, when implant penetration induces failure of the vertebral body, occurs commonly after spinal reconstruction. Anterior lumbar interbody fusion (ALIF) cages may subside into the vertebral body and lead to kyphotic deformity. No previous studies have utilized an artificial neural network (ANN) for the design of a spinal interbody fusion cage. In this study, the neural network was applied after initiation from a Taguchi L 18 orthogonal design array. Three-dimensional finite element analysis (FEA) was performed to address the resistance to subsidence based on the design changes of the material and cage contact region, including design of the ridges and size of the graft area. The calculated subsidence is derived from the ANN objective function which is defined as the resulting maximum von Mises stress (VMS) on the surface of a simulated bone body after axial compressive loading. The ANN was found to have minimized the bone surface VMS, thereby optimizing the ALIF cage given the design space. Therefore, the Taguchi-FEA-ANN approach can serve as an effective procedure for designing a spinal fusion cage and improving the biomechanical properties.

Nassau, Christopher John; Litofsky, N. Scott; Lin, Yuyi

2012-09-01

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Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach  

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We set out to determine whether a minimally invasive approach for one-level instrumented posterior lumbar interbody fusion reduced undesirable changes in the multifidus muscle, compared to a conventional open approach. We also investigated associations between muscle injury during surgery (creatinine kinase levels), clinical outcome and changes in the multifidus at follow-up. We studied 59 patients treated by one team of surgeons at a single institution (minimally invasive approach in 28 and ...

Fan, Shunwu; Hu, Zhijun; Zhao, Fengdong; Zhao, Xing; Huang, Yue; Fang, Xiangqian

2010-01-01

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Posterior interbody spondylodesis with cage in the system of lumbar osteochondrosis treatment  

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Titanic cage in combination with autobone can be used successfully for the different types of interbody spondilodesis additionally to the other known implants. Owing to the holes located in the corpus of titanic cage there is contact between autobone and osseous tissue of the adjacent vertebrae. The favaourable conditions have been created for formation of bone-metallic spondylodesis. The application of titanium cage has reduced traumatic effect of operation and has not required additional us...

Khusniddin Nuraliev

2012-01-01

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Posterior interbody spondylodesis with cage in the system of lumbar osteochondrosis treatment  

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Full Text Available Titanic cage in combination with autobone can be used successfully for the different types of interbody spondilodesis additionally to the other known implants. Owing to the holes located in the corpus of titanic cage there is contact between autobone and osseous tissue of the adjacent vertebrae. The favaourable conditions have been created for formation of bone-metallic spondylodesis. The application of titanium cage has reduced traumatic effect of operation and has not required additional use of autobone tissue from the iliac crest.

Khusniddin Nuraliev

2012-10-01

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Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation. A minimum 3-year follow-up study  

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The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1deg, 39.2deg, and 32.6deg to 32.9deg, 44.5deg, and 36.6deg, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery. (author)

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Fusão intersomática lombar transforaminal: experiência de uma instituição / Transforaminal lumbar interbody fusion: a single-center experience / Fusión intersomática lumbar transforaminal: la experiencia de una institución  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Relatar a experiência inicial de um serviço de referência em cirurgia da coluna em São Paulo, Brasil com a técnica de fusão intersomática lombar transforaminal (TLIF) nas suas mais variadas indicações. MÉTODOS: Avaliamos retrospectivamente os dados gravados em prontuário de 25 pacientes qu [...] e foram submetidos à cirurgia com a técnica de TLIF no ano de 2011. Um paciente foi excluído porque não consideramos que a TLIF foi a principal técnica empregada. As indicações incluíram nove casos de hérnia de disco lombar, sete espondilolisteses, quatro cirurgias de revisão, sendo duas por pseudoartrose e duas por lombalgias e, finalmente, quatro pacientes com estenose espinhal lombar. RESULTADOS: Todos os pacientes referiram melhora da dor e/ou claudicação neurológica em comparação com o estado pré-operatório. Apenas cinco pacientes continuaram usando alguma medicação analgésica. Cinco pacientes apresentaram alguma complicação, mas somente duas delas estão relacionadas diretamente com o procedimento. CONCLUSÕES: Trata-se de uma técnica segura, possível de ser realizada em todos os níveis da coluna lombar e aplicável a grande parte das doenças que acometem essa região da coluna. Abstract in spanish OBJETIVO: Relatar la experiencia de un servicio de referencia en cirugía de la columna en São Paulo, Brasil con la técnica de fusión intersomática lumbar transforaminal (TLIF) en sus más variables indicaciones. MÉTODOS: Valoramos retrospectivamente el historial médico de 25 pacientes que fueron some [...] tidos a la cirugía con la técnica de TLIF en el año de 2011. Un paciente fue excluido porque no consideramos que la TLIF fue la principal técnica empleada. Las indicaciones incluyeron nueve casos de hernia de disco lumbar, siete espondilolistesis, cuatro cirugías de revisión siendo dos por pseudoartrosis y dos por lumbalgias y, finalmente, cuatro pacientes con estenosis espinal. RESULTADOS: Todos los pacientes presentaron mejora del dolor y/o claudicación neurogénicas en comparación con el status preoperatorio. Solamente cinco pacientes continuaron usando alguna medicación analgésica. Cinco pacientes presentaran alguna complicación, pero sólo dos de ellas están relacionadas directamente al procedimiento. CONCLUSIONES: Es una técnica segura, posible de ser realizada en todos los niveles de la columna lumbar y es aplicable a la mayoría de las enfermedades que afectan a esta región de la columna. Abstract in english OBJECTIVE: Describe the early results and experience from a reference center in spine surgery in São Paulo, Brazil with transforaminal lumbar interbody fusion (TLIF) technique in its various indications. METHODS: We retrospectively reviewed the medical records of 25 patients who underwent surgery wi [...] th TLIF technique in 2011. One patient was excluded because we considered that TLIF was not the most important technique used. The indications were 9 lumbar disc herniations, 7 spondylolistheses, 4 revision surgeries of which 2 were for pseudoarthroses and 2 for low back pain, and finally, 4 lumbar spinal stenoses. RESULTS: All the patients reported low back pain and/or neurologic claudication improvement when comparing to preoperative status. Only five patients continued using analgesics. Five patients presented some complication, but only two of them were related to the procedure. CONCLUSIONS: TLIF is a safe technique which can be performed at any lumbar level of the lumbar spine and is applicable to the majority of diseases that affect this region.

Vinicius de Meldau, Benites; Eduardo Augusto, Iunes; Alexandre José dos Reis, Elias; Rodrigo Miziara, Yunes; Franz Jooji, Onishi; Sérgio, Cavalheiro.

2012-12-01

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Fusão intersomática lombar transforaminal: experiência de uma instituição Fusión intersomática lumbar transforaminal: la experiencia de una institución Transforaminal lumbar interbody fusion: a single-center experience  

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Full Text Available OBJETIVO: Relatar a experiência inicial de um serviço de referência em cirurgia da coluna em São Paulo, Brasil com a técnica de fusão intersomática lombar transforaminal (TLIF nas suas mais variadas indicações. MÉTODOS: Avaliamos retrospectivamente os dados gravados em prontuário de 25 pacientes que foram submetidos à cirurgia com a técnica de TLIF no ano de 2011. Um paciente foi excluído porque não consideramos que a TLIF foi a principal técnica empregada. As indicações incluíram nove casos de hérnia de disco lombar, sete espondilolisteses, quatro cirurgias de revisão, sendo duas por pseudoartrose e duas por lombalgias e, finalmente, quatro pacientes com estenose espinhal lombar. RESULTADOS: Todos os pacientes referiram melhora da dor e/ou claudicação neurológica em comparação com o estado pré-operatório. Apenas cinco pacientes continuaram usando alguma medicação analgésica. Cinco pacientes apresentaram alguma complicação, mas somente duas delas estão relacionadas diretamente com o procedimento. CONCLUSÕES: Trata-se de uma técnica segura, possível de ser realizada em todos os níveis da coluna lombar e aplicável a grande parte das doenças que acometem essa região da coluna.OBJETIVO: Relatar la experiencia de un servicio de referencia en cirugía de la columna en São Paulo, Brasil con la técnica de fusión intersomática lumbar transforaminal (TLIF en sus más variables indicaciones. MÉTODOS: Valoramos retrospectivamente el historial médico de 25 pacientes que fueron sometidos a la cirugía con la técnica de TLIF en el año de 2011. Un paciente fue excluido porque no consideramos que la TLIF fue la principal técnica empleada. Las indicaciones incluyeron nueve casos de hernia de disco lumbar, siete espondilolistesis, cuatro cirugías de revisión siendo dos por pseudoartrosis y dos por lumbalgias y, finalmente, cuatro pacientes con estenosis espinal. RESULTADOS: Todos los pacientes presentaron mejora del dolor y/o claudicación neurogénicas en comparación con el status preoperatorio. Solamente cinco pacientes continuaron usando alguna medicación analgésica. Cinco pacientes presentaran alguna complicación, pero sólo dos de ellas están relacionadas directamente al procedimiento. CONCLUSIONES: Es una técnica segura, posible de ser realizada en todos los niveles de la columna lumbar y es aplicable a la mayoría de las enfermedades que afectan a esta región de la columna.OBJECTIVE: Describe the early results and experience from a reference center in spine surgery in São Paulo, Brazil with transforaminal lumbar interbody fusion (TLIF technique in its various indications. METHODS: We retrospectively reviewed the medical records of 25 patients who underwent surgery with TLIF technique in 2011. One patient was excluded because we considered that TLIF was not the most important technique used. The indications were 9 lumbar disc herniations, 7 spondylolistheses, 4 revision surgeries of which 2 were for pseudoarthroses and 2 for low back pain, and finally, 4 lumbar spinal stenoses. RESULTS: All the patients reported low back pain and/or neurologic claudication improvement when comparing to preoperative status. Only five patients continued using analgesics. Five patients presented some complication, but only two of them were related to the procedure. CONCLUSIONS: TLIF is a safe technique which can be performed at any lumbar level of the lumbar spine and is applicable to the majority of diseases that affect this region.

Vinicius de Meldau Benites

2012-12-01

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Clinical and radiographic outcomes with L4–S1 axial lumbar interbody fusion (AxiaLIF and posterior instrumentation: a multicenter study  

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Full Text Available William D Tobler,1 Miguel A Melgar,2 Thomas J Raley,3 Neel Anand,4 Larry E Miller,5 Richard J Nasca6 1Department of Neurosurgery, University of Cincinnati College of Medicine, Mayfield Clinic, and The Christ Hospital, Cincinnati, OH, USA; 2Department of Neurosurgery, Tulane University, New Orleans, LA, USA; 3Advanced Spine and Pain, Arlington, VA, USA; 4Spine Trauma, Minimally Invasive Spine Surgery Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 5Miller Scientific Consulting, Inc, Arden, NC, USA; 6Orthopaedic and Spine Surgery, Wilmington, NC, USA Introduction: Previous studies have confirmed the benefits and limitations of the presacral retroperitoneal approach for L5–S1 interbody fusion. The purpose of this study was to determine the safety and effectiveness of the minimally invasive axial lumbar interbody approach (AxiaLIF for L4–S1 fusion. Methods: In this retrospective series, 52 patients from four clinical sites underwent L4–S1 interbody fusion with the AxiaLIF two-level system with minimum 2-year clinical and radiographic follow-up (range: 24–51 months. Outcomes included back pain severity (on a 10-point scale, the Oswestry Disability Index (ODI, and Odom's criteria. Flexion and extension radiographs, as well as computed tomography scans, were evaluated to determine fusion status. Longitudinal outcomes were assessed with repeated measures analysis of variance. Results: Mean subject age was 52 ± 11 years and the male:female ratio was 1:1. Patients sustained no intraoperative bowel or vascular injury, deep infection, or neurologic complication. Median procedural blood loss was 220 cc and median length of hospital stay was 3 days. At 2-year follow-up, mean back pain had improved 56%, from 7.7 ± 1.6 at baseline to 3.4 ± 2.7 (P < 0.001. Back pain clinical success (ie, ?30% improvement from baseline was achieved in 39 (75% patients at 2 years. Mean ODI scores improved 42%, from 60% ± 16% at baseline to 35% ± 27% at 2 years (P < 0.001. ODI clinical success (ie, ?30% improvement from baseline was achieved in 26 (50% patients. At final follow-up, 45 (87% patients were rated as good or excellent, five as fair, and two as poor by Odom's criteria. Interbody fusion observed on imaging was achieved in 97 (93% of 104 treated interspaces. During follow-up, five patients underwent reoperation on the lumbar spine, including facet screw removal (two, laminectomy (two, and transforaminal lumbar interbody fusion (one. Conclusion: The AxiaLIF two-level device is a safe, effective treatment adjunct for patients with L4–S1 disc pathology resistant to conservative treatments. Keywords: AxiaLIF, axial presacral fusion, interbody, outcomes, two-level fusion

Tobler WD

2013-09-01

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The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis.  

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The "off label" use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom's criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern, including a high rate of postoperative radiculitis. PMID:19475434

Rihn, Jeffrey A; Makda, Junaid; Hong, Joseph; Patel, Ravi; Hilibrand, Alan S; Anderson, David G; Vaccaro, Alexander R; Albert, Todd J

2009-11-01

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Anterior lumbar interbody surgery for spondylosis results from a classically-trained neurosurgeon.  

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Anterior lumbar surgery for degenerative disc disease (DDD) is a relatively novel technique that can prevent damage to posterior osseous, muscular and ligamentous spinal elements. This study reports the outcomes and complications in 286 patients who underwent fusion - with artificial disc implants or combined fusion and artificial disc implants - by a single-operator neurosurgeon, with up to 24 months of follow-up. The visual analogue scale (VAS), Oswestry Disability Index (ODI), Short Form 36 (SF36) and prospective log of adverse events were used to assess the clinical outcome. Radiographic assessments of implant position and bony fusion were analysed. Intraoperative and postoperative complications were also recorded. Irrespective of pre-surgical symptoms (back pain alone or back and leg pain combined), workers' compensation status and type of surgical implant, clinically significant improvements in VAS, ODI and SF36 were primarily observed at 3 and/or 6 month follow-up, and improvements were maintained at 24 months after surgery. A 94% fusion rate was obtained; the overall complication was 9.8% which included 3.5% with vascular complications. The anterior lumbar approach can be used for treating DDD for both back pain and back and leg pain with low complication rates. With appropriate training, single-operator neurosurgeons can safely perform these surgeries. PMID:24786717

Chatha, Gurkirat; Foo, Stacy W L; Lind, Christopher R P; Budgeon, Charley; Bannan, Paul E

2014-09-01

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Bilateral Pedicle Screw Fixation versus Unilateral Pedicle and Contralateral Facet Screws for Minimally Invasive Transforaminal Lumbar Interbody Fusion: Clinical Outcomes and Cost Analysis.  

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Study Design?Retrospective clinical study. Objectives?Recent biomechanical studies have shown no differences in stiffness or range of motion following minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) between unilateral pedicle and contralateral facet screw (UPFS) and bilateral pedicle screw (BPS) constructs. No studies have compared these two constructs based upon clinical outcomes. Methods?Twenty-six consecutive patients who had single-level MIS TLIF were retrospectively reviewed. Outcome measures collected for patients with BPS were compared with those with UPFS. Results?No associations were found between construct and length of stay (p?=?0.5), operative time (p?=?0.2), or Odom's criteria (p?=?0.7); 79% of patients in the UPFS group as compared with 71.5% in the BPS group had good or excellent outcomes. Mean follow-up was 17.7 months for the UPFS group and 20.2 months for the BPS group. There was one complication in each group, including a seroma in the BPS group and a revision operation in the UPFS group. Implant costs for the BPS group were 35% greater than the UPFS group. Conclusions?The present study is the first to demonstrate that patients undergoing MIS TLIF with BPS as compared with UPFS for single-level degenerative lumbar disease had similar clinical outcomes. PMID:24436873

Awad, Basem I; Lubelski, Daniel; Shin, John H; Carmody, Margaret A; Hoh, Daniel J; Mroz, Thomas E; Steinmetz, Michael P

2013-12-01

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Avaliação clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva Evaluación clínica radiológica de la artrodesis lumbar transforaminal abierta versus mínimamente invasiva Clinical and radiological evaluation of open transforaminal lumbar interbody fusion versus minimally invasive  

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Full Text Available OBJETIVO: a proposta deste trabalho é comparar os resultados clínicos e radiológicos dos pacientes submetidos à artrodese transforaminal aberta e minimamente invasiva. MÉTODOS: quarenta e cinco pacientes foram submetidos à artrodese lombar transforaminal pelo Grupo de Cirurgia Espinhal do Hospital Lifecenter/Ortopédico de Belo Horizonte, no período de Dezembro de 2005 a Maio de 2007, sendo 15 no grupo de artrodese aberta e 30 pacientes do grupo de artrodese minimamente invasiva (MIS. As indicações para a artrodese intersomática foram: doença degenerativa do disco, associada ou não a hérnia de disco ou estenose do canal; espondilolistese de baixo grau espondilolítica ou degenerativa; e síndrome pós-laminectomia/discectomia. As variáveis analisadas foram: tempo de cirurgia, tempo de internação hospitalar, necessidade de hemotransfusão, escala analógica visual de dor (VAS lombar e dos membros inferiores, Oswestry, índice de consolidação da artrodese e retorno ao trabalho. RESULTADOS: o seguimento mínimo foi de 24 meses. Havia oito homens e sete mulheres no Grupo Aberto e 17 homens e 13 mulheres no Grupo MIS. O tempo cirúrgico médio foi de 222 minutos e 221 minutos, respectivamente. Houve melhora significativa da VAS e Oswestry no pós-operatório em ambos os grupos. O tempo de internação hospitalar variou de 3,3 dias para o Grupo Aberto e 1,8 dias para o Grupo MIS. O índice de fusão obtido foi de 93,3% em ambos os grupos. Houve necessidade de hemotransfusão em três pacientes no Grupo Aberto (20% e nenhum caso MIS. CONCLUSÕES: a transforaminal lumbar interbody fusion (TLIF minimamente invasiva apresenta resultados similares em longo prazo quando comparado à TLIF aberta, com os benefícios adicionais de menor morbidade pós-operatória, menor período de internação e reabilitação precoce.OBJETIVO: la propuesta de este trabajo es comparar los resultados clínicos y radiológicos de los pacientes sometidos a la artrodesis transforaminal abierta y mínimamente invasiva. MÉTODOS: cuarenta y cinco pacientes fueron sometidos a la artrodesis lumbar transforaminal por el Grupo de Cirugía Espinal del Hospital Lifecenter/Ortopédico de Belo Horizonte, en el periodo de Diciembre de 2005 a Mayo de 2007, siendo 15 en el grupo de artrodesis abierta y 30 pacientes del grupo de artrodesis mínimamente invasiva (MIS. Las indicaciones para la artrodesis intersomática fueron: enfermedad degenerativa de disco, asociada o no a hernia de disco o estenosis del canal; espondilolistesis de bajo grado espondilolítica o degenerativa; y síndrome post-laminectomía/discectomía. Las variables analizadas fueron: tiempo de cirugía, tiempo de internación hospitalar, necesidad de hemotransfusión, escala analógica visual de dolor (VAS lumbar y de los miembros inferiores, Oswestry, índice de consolidación de la artrodesis y regreso al trabajo. RESULTADOS: el seguimiento mínimo fue de 24 meses. Fueron ocho hombres y siete mujeres en el Grupo Abierto y 17 hombres y 13 mujeres en el Grupo MIS. El tiempo quirúrgico promedio fue de 222 minutos y 221 minutos, respectivamente. Hubo mejora significativa del VAS y Oswestry en el postoperatorio en ambos grupos. El tiempo de internación hospitalar varió de 3.3 días para el Grupo Abierto y 1.8 días para el Grupo MIS. El índice de fusión obtenido fue de 93.3% en ambos grupos. Hubo necesidad de hemotransfusión en tres pacientes en el Grupo Abierto (20% y ningún caso MIS. CONCLUSIONES: la TLIF mínimamente invasiva presenta resultados similares a largo plazo cuando comparada con TLIF abierta, con los beneficios adicionales de menor morbilidad postoperatoria, menor periodo de internación y rehabilitación precoz.OBJECTIVE: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. METHODS: forty-five patients underwent transforaminal lumbar interbody fusion by the Department of Spine Surgery of Hospital Lifecenter/Ortopédico, between D

Cristiano Magalhães Menezes

2009-09-01

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Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion : cost-utility evaluation along side an RCT with a 2-year follow-up  

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PURPOSE: Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. METHODS: 100 Patients were randomized to TLIF or PLF (51/49) and followed for 2 years. Cost data were acquired from national registers, and outcomes were measured using the Oswestry Disability Index and SF-6D questionnaires. Conventional cost-effectiveness methodology was employed to estimate net benefit and to illustrate cost-effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped confidence intervals. RESULTS: Results showed no statistically significant difference in either cost or effects although a tendency for the TLIF regimen being more costly on bed days (2,554) and production loss (1,915) was observed. The probability that TLIF would be cost-effective did not exceed 30 % for any threshold of willingness to pay per quality-adjusted life year. Sensitivity analysis was conducted and supported the statistical model for handling of missing data. CONCLUSION: TLIF does not seem to be a relevant alternative to PLF from a socioeconomic, societal point of view.

Christensen, A; HØy, K

2014-01-01

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Avaliação clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva / Clinical and radiological evaluation of open transforaminal lumbar interbody fusion versus minimally invasive / Evaluación clínica radiológica de la artrodesis lumbar transforaminal abierta versus mínimamente invasiva  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: a proposta deste trabalho é comparar os resultados clínicos e radiológicos dos pacientes submetidos à artrodese transforaminal aberta e minimamente invasiva. MÉTODOS: quarenta e cinco pacientes foram submetidos à artrodese lombar transforaminal pelo Grupo de Cirurgia Espinhal do Hospital L [...] ifecenter/Ortopédico de Belo Horizonte, no período de Dezembro de 2005 a Maio de 2007, sendo 15 no grupo de artrodese aberta e 30 pacientes do grupo de artrodese minimamente invasiva (MIS). As indicações para a artrodese intersomática foram: doença degenerativa do disco, associada ou não a hérnia de disco ou estenose do canal; espondilolistese de baixo grau espondilolítica ou degenerativa; e síndrome pós-laminectomia/discectomia. As variáveis analisadas foram: tempo de cirurgia, tempo de internação hospitalar, necessidade de hemotransfusão, escala analógica visual de dor (VAS) lombar e dos membros inferiores, Oswestry, índice de consolidação da artrodese e retorno ao trabalho. RESULTADOS: o seguimento mínimo foi de 24 meses. Havia oito homens e sete mulheres no Grupo Aberto e 17 homens e 13 mulheres no Grupo MIS. O tempo cirúrgico médio foi de 222 minutos e 221 minutos, respectivamente. Houve melhora significativa da VAS e Oswestry no pós-operatório em ambos os grupos. O tempo de internação hospitalar variou de 3,3 dias para o Grupo Aberto e 1,8 dias para o Grupo MIS. O índice de fusão obtido foi de 93,3% em ambos os grupos. Houve necessidade de hemotransfusão em três pacientes no Grupo Aberto (20%) e nenhum caso MIS. CONCLUSÕES: a transforaminal lumbar interbody fusion (TLIF) minimamente invasiva apresenta resultados similares em longo prazo quando comparado à TLIF aberta, com os benefícios adicionais de menor morbidade pós-operatória, menor período de internação e reabilitação precoce. Abstract in spanish OBJETIVO: la propuesta de este trabajo es comparar los resultados clínicos y radiológicos de los pacientes sometidos a la artrodesis transforaminal abierta y mínimamente invasiva. MÉTODOS: cuarenta y cinco pacientes fueron sometidos a la artrodesis lumbar transforaminal por el Grupo de Cirugía Espin [...] al del Hospital Lifecenter/Ortopédico de Belo Horizonte, en el periodo de Diciembre de 2005 a Mayo de 2007, siendo 15 en el grupo de artrodesis abierta y 30 pacientes del grupo de artrodesis mínimamente invasiva (MIS). Las indicaciones para la artrodesis intersomática fueron: enfermedad degenerativa de disco, asociada o no a hernia de disco o estenosis del canal; espondilolistesis de bajo grado espondilolítica o degenerativa; y síndrome post-laminectomía/discectomía. Las variables analizadas fueron: tiempo de cirugía, tiempo de internación hospitalar, necesidad de hemotransfusión, escala analógica visual de dolor (VAS) lumbar y de los miembros inferiores, Oswestry, índice de consolidación de la artrodesis y regreso al trabajo. RESULTADOS: el seguimiento mínimo fue de 24 meses. Fueron ocho hombres y siete mujeres en el Grupo Abierto y 17 hombres y 13 mujeres en el Grupo MIS. El tiempo quirúrgico promedio fue de 222 minutos y 221 minutos, respectivamente. Hubo mejora significativa del VAS y Oswestry en el postoperatorio en ambos grupos. El tiempo de internación hospitalar varió de 3.3 días para el Grupo Abierto y 1.8 días para el Grupo MIS. El índice de fusión obtenido fue de 93.3% en ambos grupos. Hubo necesidad de hemotransfusión en tres pacientes en el Grupo Abierto (20%) y ningún caso MIS. CONCLUSIONES: la TLIF mínimamente invasiva presenta resultados similares a largo plazo cuando comparada con TLIF abierta, con los beneficios adicionales de menor morbilidad postoperatoria, menor periodo de internación y rehabilitación precoz. Abstract in english OBJECTIVE: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. METHODS: forty-five patients underw

Cristiano Magalhães, Menezes; Roberto Sakamoto, Falcon; Marcos Antônio, Ferreira Júnior; Johmeson, Alencar.

2009-09-01

 
 
 
 
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Posterior lumbar interbody fusion for degenerative disc disease using a minimally invasive B-twin expandable spinal spacer: a multicenter study.  

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Acquired degenerative disc disease causes gradual disc space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. Surgical treatment aims to re-expand the intervertebral space and stabilize the involved segment in balanced alignment until fusion is complete. The prevailing methods make use of a twin cage device of predetermined size. Their implantation requires extensive exposure, entailing the sacrifice of posterior stabilizing structures. The procedure also results in significant traction on the dural sac and the cauda equina and is thereby a potential source of neurologic damage. The new expandable spinal spacer (ESS) was designed to mitigate all the shortcomings alluded to above. A prospective multicenter clinical study was conducted of 87 patients with chronic low back pain due to degenerative disc disease, treated by posterior lumbar interbody fusion (PLIF) using a newly designed ESS. The study protocol was approved by the ethics committees of all the participating institutions. The objective was to test the safety and efficacy of the device. Each participant was followed periodically for >1 postoperative year. The ongoing record included intraoperative difficulties and complications, if any, radiologic evidence of fusion and clinical outcome as scored by pre- and postoperative questionnaires pertaining to pain intensity and degree of disability. No dural lacerations or neurologic deficit occurred. There were no mechanical failures of the spacer. Radiologic study demonstrated fusion in all but one patient. Disc space height that averaged 7.53 +/- 2.42 mm before surgery increased to 10.03 +/- 2.00 mm at the time of surgery and stabilized at 9.47 +/- 2.10 mm upon final follow-up. Visual Analog Scale and Oswestry Index decreased by 60% and 58%, respectively. PLIF using the ESS achieves the same ultimate outcome as do other methods currently in use but does not share the handicaps and hazards and is more user-friendly to the surgeon. PMID:14526194

Folman, Yoram; Lee, Sang-Ho; Silvera, Jose Raul; Gepstein, Reuven

2003-10-01

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Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody fusion after decompressive surgery -- a finite element analysis  

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Full Text Available Abstract Background Little is known about the biomechanical effectiveness of transforaminal lumbar interbody fusion (TLIF cages in different positioning and various posterior implants used after decompressive surgery. The use of the various implants will induce the kinematic and mechanical changes in range of motion (ROM and stresses at the surgical and adjacent segments. Unilateral pedicle screw with or without supplementary facet screw fixation in the minimally invasive TLIF procedure has not been ascertained to provide adequate stability without the need to expose on the contralateral side. This study used finite element (FE models to investigate biomechanical differences in ROM and stress on the neighboring structures after TLIF cages insertion in conjunction with posterior fixation. Methods A validated finite-element (FE model of L1-S1 was established to implant three types of cages (TLIF with a single moon-shaped cage in the anterior or middle portion of vertebral bodies, and TLIF with a left diagonally placed ogival-shaped cage from the left L4-5 level after unilateral decompressive surgery. Further, the effects of unilateral versus bilateral pedicle screw fixation (UPSF vs. BPSF in each TLIF cage model was compared to analyze parameters, including stresses and ROM on the neighboring annulus, cage-vertebral interface and pedicle screws. Results All the TLIF cages positioned with BPSF showed similar ROM ( Conclusions TLIF surgery is not favored for asymmetrical positioning of a diagonal cage and UPSF used in contralateral axial rotation or lateral bending. Supplementation of a contralateral facet screw is recommended for the TLIF construct.

Chen Shih-Hao

2012-05-01

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Artrodesis circunferencial: Plif más tornillos translaminofacetarios / Circumferential fusion: Posterior lumbar interbody fusion (plif) and translaminar facet screw fixation / Artrodese circunferencial: Plif mais parafusos translaminares facetários  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Spanish Abstract in portuguese OBJETIVO: Avaliar o resultado clínico e radiológico de 10 pacientes operados devido a doença degenerativa lombar, nos quais se realizou artrodese intersomática com enxerto ósseo tricortical da crista ilíaca e artrodese póstero-lateral instrumentada com parafusos translaminares facetários. MÉTODOS: F [...] oram avaliados 10 pacientes, quatro homens e seis mulheres, operados pelo mesmo cirurgião entre junho de 2006 e dezembro de 2007. RESULTADOS: Atingiu-se queda significante da incapacidade e da dor (segundo a escala de Oswestry e a escala visual analógica), atingindo-se taxa de artrodese de 100% em um ano de acompanhamento. CONCLUSÕES: Os resultados clínicos e radiológicos deste estudo estabelecem que este procedimento é confiável, de baixo custo e de baixa morbidade, com alta taxa de artrodese e bons resultados clínicos. Abstract in spanish OBJETIVO: Evaluar el resultado clínico y radiológico de 10 pacientes operados por patología degenerativa lumbar, en los que se les realizó artrodesis intersomática con injerto óseo tricortical de cresta ilíaca y artrodesis posterolateral instrumentada con tornillos translaminofacetarios. MÉTODOS: Se [...] evaluaron 10 pacientes, 4 hombres y 6 mujeres operados por el mismo cirujano entre junio de 2006 y diciembre de 2007. RESULTADOS: Se obtuvo un significativo descenso de la discapacidad y del dolor (según las escalas de Oswestry y la escala visual analógica), obteniéndose una tasa de fusión del 100% al año de seguimiento. CONCLUSIONES: Los resultados clínicos y radiológicos de este estudio establecen a éste procedimiento como confiable, de bajo costo y baja morbilidad, con una alta tasa de fusión y buenos resultados clínicos. Abstract in english OBJECTIVE: To evaluate the clinical and radiological results of 10 patients operated for degenerative lumbar disease, by performing tricortical bone graft from the iliac crest and instrumented posterior lateral fusion with translaminar facet screw fixation. METHODS: We evaluated 10 patients, four me [...] n and six women, operated by the same surgeon between June 2006 and December 2007. RESULTS: There was a significant reduction of disability and pain (according to the scale of Oswestry and visual analog scale), reaching fusion rate of 100% in one-year follow-up. CONCLUSIONS: The clinical and radiological results of this study establish that this procedure is reliable, has low cost and low morbidity with a high rate of fusion and good clinical results.

Javier Ricardo, Méndez; Nicolás Federico, Maldonado; Enrique Gonzalo, Bovier.

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Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage  

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The objective of our study was to assess the efficacy of Graf ligamentoplasty in comparison with rigid fixation and fusion with the Hartshill horseshoe cage for similar severity of disc degeneration. Although studies have been done on the Graf ligamentoplasty procedure and the Hartshill horseshoe cage, their efficacy has never been compared in any study. This study was done to decide whether retaining mobility and stabilizing the spine is best or stiffening the lumbar segment by fusion is pre...

Madan, Sanjeev; Boeree, Nicholas R.

2003-01-01

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Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma. An experimental study on pigs  

DEFF Research Database (Denmark)

Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (beta-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immediately prior to the surgery, 55 ml blood was collected from each pig for processing PRP. Three-level anterior lumbar interbody fusion was performed with carbon fiber cages and staples on each pig. Autogenous bone graft, beta-TCP, and beta-TCP loaded with PRP were randomly assigned to each level. Pigs were killed at the end of the third month. Fusion was evaluated by radiographs, CT scanning, and histomorphometric analysis. All ten pigs survived the surgery. Platelet concentration increased 4.4-fold after processing. Radiograph examination showed 70% (7/10) fusion rate in the autograft level. All the levels with beta-TCP+PRP showed partial fusion, while beta-TCP alone levels had six partial fusions and four non-fusions ( P=0.08). CT evaluation of fusion rate demonstrated fusion in 50% (5/10) of the autograft levels. Only partial fusion was seen at beta-TCP levels and beta-TCP+PRP levels. Histomorphometric evaluation found no difference between beta-TCP and beta-TCP+PRP levels on new bone volume, remaining beta-TCP particles, and bone marrow and fibrous tissue volume, while the same parameters differ significantly when compared with autogenous bone graft levels. We concluded from our results in pigs that the PRP of the concentration we used did not improve the bone-forming capacity of beta-TCP biomaterial in anterior spine fusion. Both beta-TCP and beta-TCP+PRP had poorer radiological and histological outcomes than that of autograft after 3 months.

Li, Haisheng; Zou, Xuenong

2004-01-01

66

Spontaneous slip reduction of low-grade isthmic spondylolisthesis following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion: technical note and short-term outcome.  

Science.gov (United States)

STUDY DESIGN.: Retrospective clinical data analysis. OBJECTIVE.: To investigate and verify our philosophy of spontaneous slip reduction following circumferential release via bilateral minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) for treatment of low-grade symptomatic isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA.: Symptomatic isthmic spondylolisthesis usually requires surgical intervention, and the most currently controversial focus is on method and degree of reduction; and Mini-TLIF is an attractive surgical procedure for isthmic spondylolisthesis. METHODS.: Between February 2004 and June 2008, 21 patients with low-grade isthmic spondylolisthesis underwent Mini-TLIF in our institute. Total resection of the scar around the pars interarticularis liberated the nerve roots, achieving posterior release as well. The disc was thoroughly resected, and the disc space was gradually distracted and thoroughly released with sequential disc shavers until rupture of anulus conjunct with anterior longitudinal ligament, accomplishing anterior release, so as to insert Cages. Because of circumferential release, the slipped vertebrae would tend to obtain spontaneous reduction, and with pedicle screw fixation, additional reduction would be achieved without any application of posterior translation force. Radiographs, Visual Analogue Scale, and Oswestry Disability Index were documented. All the cases were followed up for 10 to 26 months. RESULTS.: Slip percentage was reduced from 24.2% ± 6.9% to 10.5% ± 4.0%, and foraminal area percentage increased from 89.1% ± 3.0% to 93.6% ± 2.1%. Visual Analogue Scale and Oswestry Disability Index decreased from 7.8 ± 1.5 to 2.1 ± 1.1 and from 53.3 ± 16.2 to 17.0 ± 7.8, respectively. No neurologic complications were encountered. There were no signs of instrumentation failure. The fusion rate approached 100%. CONCLUSION.: Slip reduction is based on circumferential release. The procedure can be well performed via Mini-TLIF, the outcome of which is equally gratifying to that of instrumented slip reduction and traditional midline approach. There is no need to fully reduce the slipped vertebrae. Circumferential release contributes to achieving spontaneous slip reduction partially, which aids sufficiently in the surgical treatment of low-grade isthmic spondylolisthesis. PMID:20714277

Pan, Jie; Li, Lijun; Qian, Lie; Zhou, Wei; Tan, Jun; Zou, Le; Yang, Mingjie

2011-02-15

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Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome  

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The aim of this study was to evaluate the short-term radiological and functional outcome of surgical treatment for symptomatic, low-grade, adult isthmic spondylolisthesis. Twelve patients underwent a monosegmental fusion for symptomatic spondylolisthesis. Posterior reduction with pedicle screw instrumentation was followed by second-stage anterior interbody fusion with a cage. All patients underwent a decompressive laminectomy. At an average of 2.1 (range 1.4–3.0) years following surgery, al...

Spruit, M.; Pavlov, P.; Leitao, J.; Kleuver, M.; Anderson, P.; Den Boer, F.

2002-01-01

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Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis  

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Full Text Available Abstract Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Methods Three trapezoid 8° interbody fusion cage models (dual paralleled cages, a single large cage, or a two-part cage consisting of a trapezoid box and threaded cylinder were created with or without pedicle screws fixation to investigate the relative importance of the screws on the spinal segmental response. The contact stress on the facet joint, slip displacement of the cage on the endplate, and rotational angle of the upper vertebra were measured under different loading conditions. Results Simulation results demonstrated less facet stress and slip displacement with the maximal contact on the cage-bone interface. A stand-alone two-part cage had good slip behavior under compression, flexion, extension, lateral bending and torsion, as compared with the other two interbody cages, even with the additional posterior fixation. However, the two-part cage had the lowest rotational angles under flexion and torsion, but had no differences under extension and lateral bending. Conclusion The biomechanical benefit of a stand-alone two-part fusion cage can be justified. This device provided the stability required for interbody fusion, which supports clinical trials of the cage as an alternative to circumferential fixations.

Hsieh Pang-Hsing

2008-06-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the disc, and then use a series of paddle-type dilators to twist open. In this patient, ... your screen, showing the effect of placing these paddle dilators into the disc space. And here you ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... them for decompression. There’s a number of different types of cages available for the spine and spacers ... front, though we are going to use a type of a spacer put in from the back ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on a ... to two weeks after that visit and begin physical therapy. And usually, I tell patients, after an operation ...

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Full Text Available ... the spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. HARROP, MD: Here’s ... 54 TODD ALBERT, MD: Yeah, that makes a big difference for that exiting nerve root. And you’ ...

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Full Text Available ... them to return to normal activities and an improved quality of life. You may participate in the ... that other rod might be a little too short, but we’ll check it out. Might have ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... foramen, and when we have a scoliosis, which causes compression on the nerve roots, just like we ... going, and that’ll help with her muscle pain. And then we will get them ... do here. If we were in the cervical spinal cord, we cannot touch it because we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... on the screen. Physicians may take a post-assessment survey at the end of the program for CME credit. 00:00:55 TODD J. ... on the screen. Physicians may take a post-assessment survey at the end of the program for CME credit. This Internet broadcast represents the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... year-old female who has significant back and leg pain, worse with standing and walking, and it’s ... of the arteries in their aorta or their legs. And patients with neurogenic claudication, or spinal stenosis, ...

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Full Text Available ... for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01:01:05 [END OF BROADCAST

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... or the nerves. And this is called a bipolar cautery that we use. With a little foot ... disc, and then use a series of paddle-type dilators to twist open. In this patient, it’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the screen. Physicians may take a post-assessment survey at the end of the program for CME ... we go off air. This is just some data, and important, when people say, “Why do you ...

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Full Text Available ... have been able to show you all the parts of the operation. That’s a 6mm by 40mm— ... This is called the final tightener. It’s two parts to it. You can see there’s a counter- ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... talk about patients with degenerative scoliosis is our goal is not to correct her deformity, as it ... we try to correct the deformity significantly. The goal here is because we have to do the ...

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Full Text Available ... to return to normal activities and an improved quality of life. You may participate in the program ... this, their bone—even though this patient’s bone quality isn’t terrific, the bone gets very, very ...

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Full Text Available ... this procedure. You see on your screen a report by Dr. Lowe in 2002 showing good results ... hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

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Full Text Available ... we’ve got some very good questions. These sound like perhaps patient questions that I think would ... Jim’s microphone. That squeak is titanium; that’s the sound titanium makes when you’re tightening it against ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... we’re doing this laminectomy over two to three spinal levels, we’ll save the bone from ... therapy and get back to normal almost within three months. 00:39:30 JAMES S. HARROP, MD: Todd, ...

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Full Text Available ... nerve goes out under the pedicle, “P.” The “G” is the ganglion; that’s the nerve center where ... by 40mm. It’s got a nice, sharp enough point that it will go down. You see it ...

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Full Text Available ... 09 TODD ALBERT, MD: Okay. So the L4 nerve root goes right medial to that. And after we put the screws in, we’re going to do something called triggered EMG, where we’re going to put a little probe down on the screw and put an electrical current through it. Craig’s going to then ramp ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... that area. It’s a great milieu for fusion healing. And another patient asked, “Can I be treated ... lower complication rates and lower arthrosis, or non-healing rates for the TLIF. So both of them— ...

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Full Text Available ... MD: No, because I’m trying to be political for the first time in my life. 00: ... hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... forgot to introduce was Ron Forcina, our scrub nurse who’s helping. He’s critical. Without him we couldn’ ... there’s an issue that we need to take care of, but usually six weeks after surgery, three ...

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Full Text Available ... 08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson ... and 4. You probably want to check those real quick, also, those—So maybe you want to ...

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Full Text Available ... the pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first ... around the nerves. That sac is filled with water. I’m sure everyone in our listening audience ...

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Full Text Available ... So the plan for the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, ... largest inconvenience or limitation, in terms of surgical instrumentation or devices for spinal surgery?” 00:49:42 ...

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Full Text Available ... popped up on the right lower area—the carbon fiber cage, similar to what we’re going ... operation done through tubes would take 6 to 7 hours, and there’s negatives associated with that. But ...

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Full Text Available ... bone graft along the back as well, which we’ll show you as Dr. Harrop starts to put the ... all our screws are okay, so now what we’re going to show is our—the rod being placed into the ...

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Full Text Available ... ll see what we—how we made a skin incision. And this is called the fascia you ... down along the spinous processes. And that’s the skin incision. And then we use an instrument called ...

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Full Text Available ... During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring ...

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Full Text Available ... of the spine. You can see on the right side, if you look at the canal—I don’t know if you can see my computer or not—I’m showing you the area of significant stenosis. We then can look at another picture. You can see that ... you’re looking at the right side where there’s the pinching. And on the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... get an electrical impulse through a catch to leads in the patient’s lower extremities at different muscles enervated by L4. And depending on what we call the threshold, the amount of voltage that we read in the lower ...

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Full Text Available ... to go to the table. Jim, are you ready to show some—what you’re doing? 00: ... 36 TODD J. ALBERT, MD: So are you ready to put the cage in, Jim? 00:23: ... J. ALBERT, MD: Do you have the Branigans ready? Do you have an 8 Branigan? I think ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... patient. So actual low back pain is usually caused with no sciatica, or nerve compression; disc degeneration ... ll see what we—how we made a skin incision. And this is called the fascia you ...

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Full Text Available ... please don’t hesitate to call 1-800-JEFF-NOW. We’re happy to help, both the ... Thomas Jefferson University Hospital physician, call 1-800-JEFF-NOW or click the “Make an appointment” button ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... where the nerve goes out under the pedicle, “P.” The “G” is the ganglion; that’s the nerve ... of the transforaminal working zone. And below, the “P,” is the pedicle. That’s our marker, that’s where ...

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Full Text Available ... that our most—one of our most important critical member I forgot to introduce was Ron Forcina, our scrub nurse who’s helping. He’s critical. Without him we couldn’t do the operation. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... of spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, and it has ... so we’ve gone for other materials and means for avoiding fusion. In this patient, since we’ ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... Stop is under the broad category of spinal bumpers, and spinal bumpers are meant, as I explained to you, that ... circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... has degenerative scoliosis. And degenerative scoliosis is a curvature of the spine based on degeneration of the ... problem is degenerative scoliosis, and that is a curvature of the spine due to asymmetric narrowing of ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... TODD ALBERT, MD: Jim, when you get those caps on—are you on the left side now, ... drop that rod in and you get the caps in 3 and 4, let’s do a minimal ... this procedure. You see on your screen a report by Dr. Lowe in 2002 showing good results ...

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Full Text Available ... and go out to your legs and give power to your legs. The blue square you see ... that our most—one of our most important critical member I forgot to introduce was Ron Forcina, ...

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Full Text Available ... patients after this operation for six weeks. We hope to fix her well enough to brace her ... allowing us to bring it to you. I hope you’ve enjoyed spending this hour with us ...

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Full Text Available ... the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will ... submit a question at any time during the broadcast by clicking on the MDirectAccess button on your ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... back to normal almost within three months. 00:39:30 JAMES S. HARROP, MD: Todd, we’re going ... ahead with putting the screws in now. 00:39:32 TODD ALBERT, MD: Okay, it’s a perfect ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... precursor molecule to making bone. It derives the cells, it brings the cells from the tissues and the blood to the ... analogous process to healing of a fracture, where cells will come into the area, blood cells, basic ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. Todd Albert, professor and vicechairman of orthopedics at Thomas Jefferson University. I’m at the operating room at Thomas Jefferson University ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the spine to make more room for the spinal canal, free the nerve roots, and then fuse the ... right. And we want to open up her spinal canal, decompress her nerve roots, or open them up, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the screen. Physicians may take a post-assessment survey at the end of the program for CME ... the screen. Physicians may take a post-assessment survey at the end of the program for CME ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... their spine, which is somewhat involved: taking the muscles off their spine and preparing some sites where ... get going, and that’ll help with her muscle pain. And then we will get them doing ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... at the operating room at Thomas Jefferson University right now. We’ve been operating for approximately an ... neurosurgery. He’s at the table holding the instrument right now, and two of our spine fellows, Andrew ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... spinal surgery. It’s a molecule made from recombinant DNA that is a precursor molecule to making bone. ... TLIF. So both of them—both of the groups did have some issues with persistent radiculopathy. I’ ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... been refractory to medical therapies. She has the diagnosis called spinal stenosis, which is a narrowing of ... form a fusion. First let’s talk about the diagnosis a little bit. I’ve already alluded to ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the fusion—the rate of fusion is much higher when we put the bone graft in the ... hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... flexing the spine makes them better. Now, the other component of this patient’s problem is degenerative scoliosis, ... in from one side to reach to the other side. And this will be a cartoon that ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... going to then ramp up the current and read if they get what’s called an electrical breech, ... the threshold, the amount of voltage that we read in the lower extremity, we will know that ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... MD: No, because I’m trying to be political for the first time in my life. 00: ... MD: I want to thank the Jefferson media marketing group that’s put this— helped us put this ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... on their diagnosis, but the results, the potential complications which we have to go over with the patient that can occur certainly with spinal surgery, and the ability to obtain a solid fusion ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... better. Now, the other component of this patient’s problem is degenerative scoliosis, and that is a curvature ... not—we are not good at fixing this problem with surgery; we do sometimes operate for back ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... It usually responds to steroids, and it’s always self-limited, but it can be painful for the ... there’s an issue that we need to take care of, but usually six weeks after surgery, three ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... from collapse of those disc spaces. Now, axial low back pain, which many patients complain of with ... Americans, 80 to 90%, will suffer episodes of low back pain in their lifetime. It is not— ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the vessels. But vascular claudication in patients with hardening of the arteries can have very similar symptoms. ... and absent in those with vascular stenosis, or hardening of the arteries in their aorta or their ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... nerves in a sac of water, the cerebrospinal fluid, and each of those white lines with the ... heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s pushing ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... for you and a slide talk here, in terms of a laminectomy and TLIF for stenosis and scoliosis, which is what this patient has. So let’s talk about the patient first. It’s a 67-year-old female who has ...

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Full Text Available ... 00:00:55 TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. Todd Albert, professor and ... their lifetime. It is not—we are not good at fixing this problem with surgery; we do ...

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Full Text Available ... allows them to return to normal activities and an improved quality of life. You may participate in ... right now. We’ve been operating for approximately an hour. I want to introduce my co-surgeon, ...

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Full Text Available ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put this webcast together. I want to thank our patron, who will remain anonymous, for ... our spine fellows and all the media crew that was here. They did a great ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... through a slight distraction. Now, there is a negative that comes along with distraction. If you remember ... would take 6 to 7 hours, and there’s negatives associated with that. But it really—to answer ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... stenosis and scoliosis, which is what this patient has. So let’s talk about the patient first. It’s a 67-year-old female who has significant back and leg pain, worse with standing ...

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Full Text Available ... I’m going to go through the thought process of performing the operation and then give you ... cage in now. It’s almost a two-step process. He’s putting—you can see the angle of ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... then fuse the surrounding vertebrae across the disc space. For many patients, this allows them to return ... also put a cage in the inner vertebral space. So as you look at your screen, I’ ...

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Full Text Available ... important to understand a little bit about the biomechanics of this spine. I won’t bore you ... incision video, please. You’ll see that video running. Are we running that video? Thank you. Good. ...

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Full Text Available ... 22:17 JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ALBERT, MD: Okay, good. So what ... demonstrate the space for the nerve. 00:28:19 JAMES S. HARROP, MD: You can see now the ...

 
 
 
 
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Full Text Available ... the table holding the instrument right now, and two of our spine fellows, Andrew Wight and David ... you. You can see the dots. The bottom two dots are L5, the middle two dots are ...

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Full Text Available ... stops. Similarly, a patient is worse in spinal extension, which occurs when you walk downhill or when ... and their symptoms get much worse with spinal extension. So the idea of the X-Stop is ...

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Full Text Available ... out And here you see these special angles—double and triple angle curettes—because we’re going ... root coming down. You can see how it’s red and swollen. This is the dorsal root ganglion. ...

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Full Text Available ... the pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first ... button on the screen. Physicians may take a post-assessment survey at the end of the program ...

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Full Text Available ... the spine, and she has degenerative scoliosis. And degenerative scoliosis is a curvature of the spine based on degeneration of the disc space. Here ... the other component of this patient’s problem is degenerative scoliosis, and that is a ... the spine due to asymmetric narrowing of the disc. And ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... xrays on her on the PowerPoint. 00:32:48 JAMES S. HARROP, MD: Once again, with—this lady ... go to the overhead camera, please? 00:35:48 JAMES S. HARROP, MD: Kind of hard a little ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... when they arch their back. That doesn’t help for vascular claudication, and it is worse when ... but it is rare. The things we can help much better are sciatica, or nerve pinching, much ...

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Full Text Available ... recommended to have this procedure. Is this the latest and best procedure or is there something new ... problem—this is the best and I guess latest procedure. Some might argue that they could do ...

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Full Text Available ... this procedure minimally invasively and see—get the access and see the nerves in the way that ... removed that entire facet, and that gives me access to the transforaminal area. And there’s—you see ...

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Full Text Available ... the screw and they’re ramping up the electricity. Okay, we’re good? 00:44:38 ASSISTANT: ... cells will come into the area, blood cells, basic blood cells, and they will be bone-forming ...

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Full Text Available ... Jim, is there anything else you want to point out before we have to sign off here? 00:57:57 JAMES S. HARROP, MD: No, just once again we’re going to check all the nerves, and they look great. 00: ...

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Full Text Available ... successful with surgery. With the appropriate diagnosis and failure of nonoperative treatment 95 to 97% of patients ... this procedure. You see on your screen a report by Dr. Lowe in 2002 showing good results ...

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Full Text Available ... audience can hear it through Jim’s microphone. That squeak is titanium; that’s the sound titanium makes when you’re tightening it against distraction. This is called the final ...

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Full Text Available ... of the program for CME credit. 00:00:55 TODD J. ALBERT, MD: Hello. Good afternoon, I’ ... close and take any other questions. 00:45:55 JAMES S. HARROP, MD: Can I get a coca, ...

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Full Text Available ... you’ll see there’s going to be a final tightening that’s going to happen. You can hear ... tightening it against distraction. This is called the final tightener. It’s two parts to it. You can ...

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Full Text Available ... the TLIF: we resect a certain amount of bone on one side of the spine. If pathology is only on one side of the spine, many times we can perform that resection as outlined here through what’s ... osteotomes, which are bone-cutting instruments, to take down this bone. And ...

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Full Text Available ... the next week to two weeks after that visit and begin physical therapy. And usually, I tell ... 41:53 JAMES S. HARROP, MD: Might want to also add that we did check x-rays before ...

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Full Text Available ... spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, and it has to ... precursor molecule to making bone. It derives the cells, it brings the cells from the tissues and ...

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Full Text Available ... MD: I want to thank the Jefferson media marketing group that’s put this— helped us put this ... post-assessment survey at the end of the program for CME credit. This Internet broadcast represents the ...

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Full Text Available ... successful with surgery. With the appropriate diagnosis and failure of nonoperative treatment 95 to 97% of patients ... deformity, but the bone graft, the fusion—the rate of fusion is much higher when we put ...

 
 
 
 
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Full Text Available ... should spend a moment speaking about bone morphogenic protein. It is a molecule. It’s been a great advance in spinal surgery. It’s a molecule made from recombinant DNA that is a precursor molecule to making ...

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Full Text Available ... come for her follow-up, she’ll have x-rays. She’ll get the brace—start weaning out of the brace over the next week to two weeks after that visit and begin physical therapy. And usually, I tell patients, after an operation ...

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Full Text Available ... deformity, but the bone graft, the fusion—the rate of fusion is much higher when we put ... the answer is the benefit is increased fusion rate, and it’s very good in that area. It’s ...

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Full Text Available ... the nerves in a sac of water, the cerebrospinal fluid, and each of those white lines with the ... has heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s pushing ...

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Full Text Available ... incision video, please. You’ll see that video running. Are we running that video? Thank you. Good. And then you’ ... in the middle of the foramen. It’s completely free, looks very relaxed. 00:28:31 TODD J. ...

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Full Text Available ... this bone. And we have a series of special instruments, straight and angled, to take down—to ... the disc out, we need a series of special instruments called curettes, which are cups, sharp cups, ...

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Full Text Available ... put in posteriorly, it can create an inflammatory reaction where they do get some leg pain. It ... getting worse. I get the questions all the time from patients, “Why do you have to do ...

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Full Text Available ... to prepare. It’s a very involved operation with multiple steps, and we’ve been attempting to prepare ... again, with—this lady has a deformity in multiple planes, and what we’re going to try ...

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Full Text Available ... probe down on the screw and put an electrical current through it. Craig’s going to then ramp ... and read if they get what’s called an electrical breech, or at what point they get an ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... patient. So actual low back pain is usually caused with no sciatica, or nerve compression; disc degeneration ... another; we do do it for degenerative disc disease, though much less commonly; ... what we—how we made a skin incision. And this is called the fascia you ...

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Full Text Available ... then fuse the surrounding vertebrae across the disc space. For many patients, this allows them to return to normal activities and an improved quality of life. You may participate in the program by sending questions at any time; just click the MDirectAccess button on the screen. ...

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Full Text Available ... To make an appointment with a Thomas Jefferson University Hospital physician, call 1-800-JEFF-NOW or click the “Make an appointment” button on the screen. Physicians may take a post-assessment survey at the end of the program ...

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Full Text Available ... it’s put in posteriorly, it can create an inflammatory reaction where they do get some leg pain. ... well. But the answer is the benefit is increased fusion rate, and it’s very good in that ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... sponge and bone marrow, or sometimes bone morphogenic protein, which is not really approved for use in ... we’re using a material called bone morphogenic protein. Now, I should spend a moment speaking about ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... out to you to answer: “What is the benefit of putting the bone graft in the disc space?” The advantage of putting the bone graft and the spacer in the disc spaces, too. The spacer is to prop open the disc space and keep it neutralized to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... button on the screen. Physicians may take a post-assessment survey at the end of the program ... button on the screen. Physicians may take a post-assessment survey at the end of the program ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you remember that cartoon I showed at the beginning of the talk, that helps us prop open ... spinal procedures. There—as I said at the beginning of the talk, there’s minimally invasive, maximally invasive, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... body think that they’re had a spine fracture, they’re had a bone fracture, because the process of bone fusion is the exact analogous process to healing of a fracture, where cells will come into the area, blood ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to normal activities and an improved quality of life. You may participate in the program by sending questions at any time; just click the MDirectAccess button on the screen. Physicians may take a post-assessment survey at the end of the program for CME credit. 00:00: ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... spinous ligament. And we’re pointing out the facet joint, the facet joint and the—and the lamina. And the ... the pars so that we remove the inferior facet. So there you see some of the things ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the operation for you. I’m going to go through the thought process of performing the operation ... look at your screen, I’m going to go through some pictures for you and a slide ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... two of our spine fellows, Andrew Wight and David Hannala, are assisting as well. I’m in ... you want to increase one click on that, David, the distractor, so he can put an anterior. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... types of cages available for the spine and spacers when we take out the disc space to ... are threaded and go in with distraction plugs; spacers are placed more frequently from the front, though ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... of the m-plates to get the disc material out And here you see these special angles— ... instruments and get about 75% of the disc material out, which is plenty to obtain a fusion. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... questions at any time; just click the MDirectAccess button on the screen. Physicians may take a post- ... during the broadcast by clicking on the MDirectAccess button on your computer screen. We’ll try to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... nerve that exits in that area that’s been compressed, and worse when the patient is walking. Now, ... freely move around, whereas before it was completely compressed in the foramen. And we did our—we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... comparing 53 patients with anterior-posterior fusions to 11 patients done with a TLIF, they showed shorter ... MD: We’re going to decorticate. 00:53:11 TODD ALBERT, MD: Okay, great. Why don’t ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... fine sitting and can ride a bike all day. Also very commonly, patients with spinal stenosis say, “ ... appropriate patient, and they go home the same day, much like a discectomy is done in the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to normal almost within three months. 00:39:30 JAMES S. HARROP, MD: Todd, we’re going to ... good at doing those pedicle holes. 00:40:30 JAMES S. HARROP, MD: You know, it’s a lot ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... a catch to leads in the patient’s lower extremities at different muscles enervated by L4. And depending ... of voltage that we read in the lower extremity, we will know that the screw is okay ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... of what’s called the dura, or the spinal elements. And the dural tube contains all the nerves ... right at the disc space and the neural elements from a very wide view. Good, thank you. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the operating room at Thomas Jefferson University right now. We’ve been operating for approximately an hour. ... He’s at the table holding the instrument right now, and two of our spine fellows, Andrew Wight ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... had a spine fracture, they’re had a bone fracture, because the process of bone fusion is the exact analogous process to healing of a fracture, where cells will come into the area, blood cells, basic blood cells, and they will be bone-forming cells. But we are going to help ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... have you experienced as your largest inconvenience or limitation, in terms of surgical instrumentation or devices for ... that because there’s never been—there’s been no limitation, we’re not limited in what we have? ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... cannulated these pedicles, making holes in them and markers, which you’ll see on the field. We ... below, the “P,” is the pedicle. That’s our marker, that’s where we start to do our work ...

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Full Text Available ... the way, though. Can you—is it wide open now? 00:50:52 ASSISTANT: Yeah, it feels good. 00:50:54 TODD ALBERT, MD: Yeah, that makes a big difference for that exiting nerve root. And you’ ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... I removed that entire facet, and that gives me access to the transforaminal area. And there’s—you ... JAMES S. HARROP, MD: Do you have a—let me have that spreader, the 10 spreader. 00:24: ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... co-surgeon, Dr. Harrop, associate professor of neurosurgery. He’s at the table holding the instrument right now, ... was Ron Forcina, our scrub nurse who’s helping. He’s critical. Without him we couldn’t do the ...

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Full Text Available ... here. This is the remainder of the L5 lamina, the L5 pedicle here, and the L5 nerve root coming around the pedicle. This is her ... look at this between the second and third dot up on the left side of the ... open up the area where that nerve exits. So Dr. Harrop will help take away ...

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Full Text Available ... patient has. So let’s talk about the patient first. It’s a 67-year-old female who has ... up the disc space and form a fusion. First let’s talk about the diagnosis a little bit. ...

 
 
 
 
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Full Text Available ... Here on your screen you will see her x-rays. You can see that her spine is not straight. The dots on the x-ray on your left—it’s called an anterior/posterior x-ray. This x-ray is if you’re ...

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Full Text Available ... to normal activities and an improved quality of life. You may participate in the program by sending ... be political for the first time in my life. 00:49:56 TODD ALBERT, MD: Okay, it’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... under the pedicle, “P.” The “G” is the ganglion; that’s the nerve center where nerves come in ... red and swollen. This is the dorsal root ganglion. Here is the collapse of the disc—disc ...

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Time-sequential changes of differentially expressed miRNAs during the process of anterior lumbar interbody fusion using equine bone protein extract, rhBMP-2 and autograft  

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The precise mechanism of bone regeneration in different bone graft substitutes has been well studied in recent researches. However, miRNAs regulation of the bone formation has been always mysterious. We developed the anterior lumbar interbody fusion (ALIF) model in pigs using equine bone protein extract (BPE), recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), and autograft as bone graft substitute, respectively. The miRNA and gene expression profiles of different bone graft materials were examined using microarray technology and data analysis, including self-organizing maps, KEGG pathway and Biological process GO analyses. We then jointly analyzed miRNA and mRNA profiles of the bone fusion tissue at different time points respectively. Results showed that miRNAs, including let-7, miR-129, miR-21, miR-133, miR-140, miR-146, miR-184, and miR-224, were involved in the regulation of the immune and inflammation response, which provided suitable inflammatory microenvironment for bone formation. At late stage, several miRNAs directly regulate SMAD4, Estrogen receptor 1 and 5-hydroxytryptamine (serotonin) receptor 2C for bone formation. It can be concluded that miRNAs play important roles in balancing the inflammation and bone formation.

Chen, Da-Fu; Zhou, Zhi-Yu; Dai, Xue-Jun; Gao, Man-Man; Huang, Bao-Ding; Liang, Tang-Zhao; Shi, Rui; Zou, Li-Jin; Li, Hai-Sheng; Bünger, Cody; Tian, Wei; Zou, Xue-Nong

2014-03-01

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The Significance of Removing Ruptured Intervertebral Discs for Interbody Fusion in Treating Thoracic or Lumbar Type B and C Spinal Injuries through a One-Stage Posterior Approach  

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Objectives To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. Methods This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2–15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively. Results Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p0.05 Fisher's exact test). Conclusion Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure. PMID:24827733

Zhang, Qian-Shi; Lu, Guo-Hua; Wang, Xiao-Bin; Li, Jing

2014-01-01

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... for spine surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform the procedure. Dr. ... A better term would be extreme lateral interbody fusion. This is a procedure that has been performed ...

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Essential requirement for zebrafish anosmin-1a in the migration of the posterior lateral line primordium.  

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Kallmann syndrome (KS) is a human genetic disease that impairs both cell migration and axon elongation. The KAL-1 gene underlying the X-linked form of KS, encodes an extracellular matrix protein, anosmin-1, which mediates cell adhesion and axon growth and guidance in vitro. We investigated the requirement for kal1a and kal1b, the two orthologues of the KAL-1 gene in zebrafish, in the journey of the posterior lateral line primordium (PLLP). First, we established that while the accumulation of ...

Yanicostas, Constantin; Ernest, Sylvain; Dayraud, Cyrielle; Petit, Christine; Soussi-yanicostas, Nadia

2008-01-01

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Instrumented Minimally Invasive spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF); Minimum 5-years Follow-up With Clinical and Radiologic Outcomes.  

Science.gov (United States)

STUDY DESIGN:: A retrospective study. OBJECTIVE:: To determine the clinical and radiological outcomes of the long-term results of instrumented MIS-TLIF in unstable, single level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disc disease, and recurrent disc herniation. SUMMARY OF BACKGROUND DATA:: MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. METHODS:: Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005, were retrospectively reviewed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), patient satisfaction rate (PSR), and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiological follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, CT and MRI were used in all patients in last follow-up period. RESULTS:: The mean VAS scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7 respectively in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0 respectively in the IS group (n=25) (P<0.001). The mean ODI scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). PSR was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS, and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. CONCLUSIONS:: The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single-level spine are favorable. PMID:23027364

Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

2012-09-28

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Labeling hair cells and afferent neurons in the posterior lateral-line system of zebrafish.  

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The lateral line is a mechanosensory system that comprises a set of discrete sense organs called neuromasts, which are arranged in reproducible patterns on the surface of fish and amphibians. The posterior component of the system, the posterior lateral line, comprises the neuromasts on the body and tail. Each neuromast has a core of mechanosensory hair cells, each of which is depolarized by water motion in one direction and hyperpolarized by motion in the other direction, thereby enabling fish to extract information from the movements of water around their body. Neuromasts are innervated by a few afferent neurons (usually two, but sometimes more), which have their cell bodies clustered in cranial ganglia and project their central axons to the hindbrain, where they extend longitudinally along all rhombomeres. Hair cells are readily labeled by small cationic styryl pyridinium dyes such as DiASP. Afferent fibers are also progressively labeled with this dye, presumably by trans-synaptic uptake. Adjusting the dye concentration and incubation time can lead to the labeling of the entire afferent system, thereby providing a fast and easy method for visualizing the central projection in the hindbrain of live fish. The simplicity of the method makes it potentially useful for screens based on forward or reverse genetic approaches. Here we present protocols for labeling hair cells in live zebrafish and for labeling afferent neurons in zebrafish embryos. PMID:24298034

Schuster, Kevin; Ghysen, Alain

2013-12-01

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... lateral interbody fusion. This is a procedure that has been performed for quite a few years, and ... to the arm. Dr. Nichols. And the tube has numbers that is telling me how deep is ...

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... all of the above. So again, he's still working on the discectomy. As soon as Dr. Uribe is ready to place the cage, we'll go back to him ... fusion, interbody is this little device that we place to allow for fusion. Simple ... and there is Dr. Uribe working in the final stages, and again, we've ...

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Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion  

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A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Yoshimine, Toshiki

2014-01-01

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Postoperative Changes in Paraspinal Muscle Volume: Comparison between Paramedian Interfascial and Midline Approaches for Lumbar Fusion  

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In this study, we compared the paramedian interfascial approach (PIA) and the traditional midline approach (MA) for lumbar fusion to determine which approach resulted in the least amount of postoperative back muscle atrophy. We performed unilateral transforaminal posterior lumbar interbody fusion via MA on the symptomatic side and pedicle screw fixation via PIA on the other side in the same patient. We evaluated the damage to the paraspinal muscle after MA and PIA by measuring the preoperativ...

Hyun, Seung Jae; Kim, Young Baeg; Kim, Yang Soo; Park, Seung Won; Nam, Taek Kyun; Hong, Hyun Jong; Kwon, Jeong Taik

2007-01-01

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Antibody to the HNK-1 glycoepitope affects fasciculation and axonal pathfinding in the developing posterior lateral line nerve of embryonic zebrafish.  

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The HNK-1 glycoepitope, carried by many cell recognition molecules, is present in the developing posterior lateral line nerve and on other primary axons of zebrafish. To elucidate the function of HNK-1 in vivo, the antibody 412 to HNK-1 was injected into zebrafish embryos at 16 h post fertilization (hpf). The injected antibody bound specifically to axons carrying HNK-1. This treatment selectively affected the growth of either one or both posterior lateral line nerves in 39% of the experimental cases (13 of 33 animals), which was significantly more (Pposterior lateral line was not affected in its caudal migration and in depositing differentiating neuromasts along the trunk, showing that injections did not retard development and that initial formation of lateral line organs is probably independent of contact with nerve fibers. We suggest that the HNK-1 glycoepitope is an important modulator of embryonic nerve growth. PMID:11677051

Becker, T; Becker, C G; Schachner, M; Bernhardt, R R

2001-11-01

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... severe facet disease. These are all stages of arthritis. And it will happen to anybody. It will ... suffering from severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all ...

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... the patient on a lateral decubitus position, that means right side is down, and he's using the ... patient is suffering from severe lumbar spondylosis. That means damage to the disc space, damage to the ...

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... fusion without disturbing the rest of the lumbar anatomy. Again, I mean, as you saw, it was ... minimal, and it's just extremely happy with this surgical intervention, as everything is moving the way that ...

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Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... there, we just get access to the disk space and perform the fusion. And that's all done ... are placed to allow exposure to the disc space. This patient is suffering from severe lumbar spondylosis. ...

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A novel approach to the lumbar sympathetic chain: lateral access.  

Science.gov (United States)

Plantar hyperhydrosis is a disabling condition of excessive, symmetric, focal sweating of the feet with social, psychological, and medical implications. Treatment options include topical agents, iontophoresis, botulinum toxin injection, and surgical disruption of the lumbar sympathetic chain. Surgical corridors include transperitoneal and retroperitoneal approaches. We report our technique with a novel minimally invasive lateral retroperitoneal approach commonly used for lateral interbody fusions. The lateral approach for sectioning of the sympathetic chain in the treatment of hyperhydrosis appears safe. The approach may be advantageous for the patient and surgeons familiar with lateral interbody fusion. Further studies may elucidate the long term efficacy and safety of the lateral approach. The video can be found here: http://youtu.be/Q82SGpmAXng. PMID:23829842

Rodgers, Shaun D; Engler, John A; Perin, Noel L

2013-07-01

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Traumatic lumbar hernia: can't afford to miss.  

Science.gov (United States)

We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation. PMID:24424984

Saboo, Sachin S; Khurana, Bharti; Desai, Naman; Juan, Yu-Hsiang; Landman, Wendy; Sodickson, Aaron; Gates, Jonathan

2014-06-01

 
 
 
 
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Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis.  

Science.gov (United States)

Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels. PMID:23906522

Caputo, Adam M; Michael, Keith W; Chapman, Todd M; Jennings, Jason M; Hubbard, Elizabeth W; Isaacs, Robert E; Brown, Christopher R

2013-11-01

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Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation  

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Background: Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury. Materials and Methods: A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly. Results: Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup. Conclusion: Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

Wang, Xiao-Bin; Yang, Ming; Li, Jing; Xiong, Guang-Zhong; Lu, Chang; Lu, Guo-Hua

2014-01-01

223

Tricortical cervical inter-body screw fixation.  

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Full Text Available A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.

Goel A

1997-01-01

224

Forelimb amputation-induced reorganization in the ventral posterior lateral nucleus (VPL) provides a substrate for large-scale cortical reorganization in rat forepaw barrel subfield (FBS).  

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In this study, we examined the role of the ventral posterior lateral nucleus (VPL) as a possible substrate for large-scale cortical reorganization in the forepaw barrel subfield (FBS) of primary somatosensory cortex (SI) that follows forelimb amputation. Previously, we reported that, 6 weeks after forelimb amputation in young adult rats, new input from the shoulder becomes expressed throughout the FBS that quite likely has a subcortical origin. Subsequent examination of the cuneate nucleus (CN) 1 to 30 weeks following forelimb amputation showed that CN played an insignificant role in cortical reorganization and led to the present investigation of VPL. As a first step, we used electrophysiological recordings in forelimb intact adult rats (n=8) to map the body representation in VPL with particular emphasis on the forepaw and shoulder representations and showed that VPL was somatotopically organized. We next used stimulation and recording techniques in forelimb intact rats (n=5) and examined the pattern of projection (a) from the forelimb and shoulder to SI, (b) from the forepaw and shoulder to VPL, and (c) from sites in the forepaw and shoulder representation in VPL to forelimb and shoulder sites in SI. The results showed that the projections were narrowly focused and homotopic. Electrophysiological recordings were then used to map the former forepaw representation in forelimb amputated young adult rats (n=5) at 7 to 24 weeks after amputation. At each time period, new input from the shoulder was observed in the deafferented forepaw region in VPL. To determine whether the new shoulder input in the deafferented forepaw VPL projected to a new shoulder site in the deafferented FBS, we examined the thalamocortical pathway in 2 forelimb-amputated rats. Stimulation of a new shoulder site in deafferented FBS antidromically-activated a cell in the former forepaw territory in VPL; however, similar stimulation from a site in the original shoulder representation, outside the deafferented region, in SI did not activate cells in the former forepaw VPL. These results suggest that the new shoulder input in deafferented FBS is relayed from cells in the former forepaw region in VPL. In the last step, we used anatomical tracing and stimulation and recording techniques in forelimb intact rats (n=9) to examine the cuneothalamic pathway from shoulder and forepaw receptive field zones in CN to determine whether projections from the shoulder zone might provide a possible source of shoulder input to forepaw VPL. Injection of biotinylated dextran amine (BDA) into physiologically identified shoulder responsive sites in CN densely labeled axon terminals in the shoulder representation in VPL, but also gave off small collateral branches into forepaw VPL. In addition, microstimulation delivered to forepaw VPL antidromically-activated cells in shoulder receptive field sites in CN. These results suggest that forepaw VPL also receives input from shoulder receptive sites in CN that are latent or subthreshold in forelimb intact rats. However, we speculate that following amputation these latent shoulder inputs become expressed, possibly as a down-regulation of GABA inhibition from the reticular nucleus (RTN). These results, taken together, suggest that VPL provides a substrate for large-scale cortical reorganization that follows forelimb amputation. PMID:25058605

Li, Cheng X; Chappell, Tyson D; Ramshur, John T; Waters, Robert S

2014-10-01

225

Applying hierarchical task analysis to improving the patient positioning for direct lateral interbody fusion in spinal surgery.  

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The present study brings together for the first time the techniques of hierarchical task analysis (HTA), human error identification (HEI), and business process management (BPM) to select practices that can eliminate or reduce potential errors in a surgical setting. We applied the above approaches to the improvement of the patient positioning process for lumbar spine surgery referred to as 'direct lateral interbody fusion' (DLIF). Observations were conducted to gain knowledge on current DLIF positioning practices, and an HTA was constructed. Potential errors associated with the practices specific to DLIF patient positioning were identified. Based on literature review and expert views alternative practices are proposed aimed at improving the DLIF patient positioning process. To our knowledge, this is the first attempt to use BPM in association with HEI/HTA for the purpose of improving the performance and safety of a surgical process - with promising results. PMID:24332824

Al-Hakim, Latif; Maiping, Tanaphon; Sevdalis, Nick

2014-07-01

226

The finite element modeling and analysis of human lumbar segment herniation  

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Full Text Available Objective To study the biomechanical character of intervertebral disc in different loadings of axial compression, flexion, lateral bending, extension, rotation to develop the finite element (FE of human lumbar L3-5 segment. Methods According to CT radiological data of a healthy adult, the vertebra and intervertebral disc of lumbar L3-5 segment were respectively reconstructed by Mimics 10.0 software and Geomagic 10.0 software. The FE model of L3-5 segment was reconstructed, and intact disc and herniated lumbar disc were created by adding the lumbar attaching ligaments into the simulating model and changing the corresponding material properties after the disc was extruded in Ansys software. The biomechanical characteristics of two models were simulated under the five loadings of axial compression, flexion, lateral bending, extension and rotation by FE method. Results After the L3, 4 lumbar disc was extruded, the stress distribution on the disc and the ability of load transfer were changed. The stress was concentrated in the posterior lateral of annulus fibrous. Conclusion After the disc was extruded, the load-bearing capacity decreased.

HUANG Ju-ying

2012-08-01

227

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... is joining now. He’s the chief of neurological surgery here at Medical Baptist and the medical director ... to be doing in a few minutes. Lumbar surgery, particularly from the micro-lumbar discectomy style, it ...

228

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common procedure. Many patients ... muscles and get them functioning back into normal style. So I do not routinely send patients to ...

229

Ipsilateral pedicle screw placement with contralateral percutaneous facet screws: Early results with an alternative in lumbar arthrodesis  

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Full Text Available Richard B Rhiew, Sunil Manjila, Andrew M Lozen, David Hong, Murali Guthikonda, S S RengacharyDepartment of Neurosurgery, Wayne State University, Detroit, MI, USAAbstract: Transforaminal lumbar interbody fusion (TLIF is a widely used method of surgical treatment for a variety of lumbar spinal disorders. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody graft to provide additional stability. In this technical note, we describe our fusion construct using ipsilateral pedicle screw placement on the side of TLIF and contralateral facet screw placement. We performed this construct at six levels in four patients. Suggested advantages include: low morbidity, small incision and lower cost. Outcomes parameters included radiographic evidence of solid union at four months and improvement in Oswestry Disability Index. A mean improvement from a preoperative score of 73 to 26 after surgery was observed at one-year follow-up. There were no instrument-related complications. In conclusion, this hybrid screw system minimizes contralateral dissection and is an attractive alternative to standard bilateral pedicle screw fixation.Keywords: TLIF, facet screw, pedicle screw, lumbar spine fusion

Richard B Rhiew

2009-03-01

230

Congenital Lumbar Hernia  

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Full Text Available Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can becongenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month oldmale baby

Sanjay Sharma

2008-01-01

231

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... a herniated disc and you 10 have intermittent lumbar radiculopathy pain shooting down your leg, what are some ... Now let’s talk a little bit about other surgeries. I mean this minimally invasive approach doesn’t only work for just lumbar discs. As we mentioned before, it can even ...

232

Structural and mechanical evaluations of a topology optimized titanium interbody fusion cage fabricated by selective laser melting process.  

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A topology optimized lumbar interbody fusion cage was made of Ti-Al6-V4 alloy by the rapid prototyping process of selective laser melting (SLM) to reproduce designed microstructure features. Radiographic characterizations and the mechanical properties were investigated to determine how the structural characteristics of the fabricated cage were reproduced from design characteristics using micro-computed tomography scanning. The mechanical modulus of the designed cage was also measured to compare with tantalum, a widely used porous metal. The designed microstructures can be clearly seen in the micrographs of the micro-CT and scanning electron microscopy examinations, showing the SLM process can reproduce intricate microscopic features from the original designs. No imaging artifacts from micro-CT were found. The average compressive modulus of the tested caged was 2.97+/-0.90 GPa, which is comparable with the reported porous tantalum modulus of 3 GPa and falls between that of cortical bone (15 GPa) and trabecular bone (0.1-0.5 GPa). The new porous Ti-6Al-4V optimal-structure cage fabricated by SLM process gave consistent mechanical properties without artifactual distortion in the imaging modalities and thus it can be a promising alternative as a porous implant for spine fusion. PMID:17415762

Lin, Chia-Ying; Wirtz, Tobias; LaMarca, Frank; Hollister, Scott J

2007-11-01

233

Ildr1b is essential for semicircular canal development, migration of the posterior lateral line primordium and hearing ability in zebrafish: implications for a role in the recessive hearing impairment DFNB42.  

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Immunoglobulin-like domain containing receptor 1 (ILDR1) is a poorly characterized gene that was first identified in lymphoma cells. Recently, ILDR1 has been found to be responsible for autosomal recessive hearing impairment DFNB42. Patients with ILDR1 mutations cause bilateral non-progressive moderate-to-profound sensorineural hearing impairment. However, the etiology and mechanism of ILDR1-related hearing loss remains to be elucidated. In order to uncover the pathology of DFNB42 deafness, we used the morpholino injection technique to establish an ildr1b-morphant zebrafish model. Ildr1b-morphant zebrafish displayed defective hearing and imbalanced swimming, and developmental delays were seen in the semicircular canals of the inner ear. The gene expression profile and real-time PCR revealed down-regulation of atp1b2b (encoding Na(+)/K(+) transporting, beta 2b polypeptide) in ildr1b-morphant zebrafish. We found that injection of atp1b2b mRNA into ildr1b-knockdown zebrafish could rescue the phenotype of developmental delay of the semicircular canals. Moreover, ildr1b-morphant zebrafish had reduced numbers of lateral line neuromasts due to the disruption of lateral line primordium migration. In situ hybridization showed the involvement of attenuated FGF signaling and the chemokine receptor 4b (cxcr4b) and chemokine receptor 7b (cxcr7b) in posterior lateral line primordium of ildr1b-morphant zebrafish. We concluded that Ildr1b is crucial for the development of the inner ear and the lateral line system. This study provides the first evidence for the mechanism of Ildr1b on hearing in vivo and sheds light on the pathology of DFNB42. PMID:24990150

Sang, Qing; Zhang, Junyu; Feng, Ruizhi; Wang, Xu; Li, Qiaoli; Zhao, Xinzhi; Xing, Qinghe; Chen, Weiyu; Du, Jiulin; Sun, Shan; Chai, Renjie; Liu, Dong; Jin, Li; He, Lin; Li, Huawei; Wang, Lei

2014-12-01

234

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’ ... much more rapid recovery returning to their routine lives much quicker than the way we used to ...

235

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... main differences between this minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? ... know, with this particular operation, I mean in terms of recovery time, what are we looking at ...

236

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... that are done for herniated discs, for bony spurs when they compress a nerve or the spinal ... disc herniation or whether it is a bony spur, or whether it’s a degenerative process that lumbar ...

237

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... micro-lumbar discectomy style, it is a very common procedure. Many patients throughout the country and the ... at L-5, S-1, which is the most common disc herniation, and it creates severe pain not ...

238

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... Invasive Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today ... patient is going to be coming into the OR very soon, so we’re going to take ...

239

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46-year- ... is Dr. Sergio Gonzalez-Arias, who is joining now. He’s the chief of neurological surgery here at ...

240

Results of lumbar disk surgery in a city compensation population.  

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This is a retrospective analysis of 118 patients who underwent 132 operations in a city compensation setting for the treatment of lumbar disk disease from January 1976 to December 1987. Each of these patients had a work-related injury. There was a minimum 2-year follow up with an average follow up of 6.9 years. No patients were lost to follow up. The purpose was to determine what percentage of patients treated in a work-related setting could be expected to return to a sustained, pre-injury employment state following a carefully executed lumbar spine surgical procedure. Satisfactory surgical results were considered achieved only by those patients who returned to full-duty work status. Only 31 of the 118 patients (26%) returned to full duty and were considered satisfactory. Regarding the number of surgical procedures, 31 of 132 operations (23%) were successful. Sixteen reoperations in 13 patients all resulted in failure. Only 16 of the 64 patients (25%) treated with laminectomy and diskectomy alone had a satisfactory result. When a two-level, posterior lateral spinal fusion was added the success rate was increased to 44%, with 12 of 27 patients returning to work. Six patients with spinal stenosis underwent decompression laminectomy and entry level foraminotomies, and all had unsatisfactory results. Five patients with isthmic spondylisthesis underwent a Gill procedure and fusion. Only one of these patients (25%) returned to work. For a 2-year period chymopapain injection was given to 14 patients. Only two returned to work, with a 14% success rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7603919

Bosacco, S J; Berman, A T; Bosacco, D N; Levenberg, R J

1995-04-01

 
 
 
 
241

Evaluation of unilateral cage-instrumented fixation for lumbar spine  

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Full Text Available Abstract Background To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF affects the three-dimensional flexibility in degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. Methods Twelve motion segments in sheep lumbar spine specimens were tested for flexion, extension, axial rotation, and lateral bending by nondestructive flexibility test method using a nonconstrained testing apparatus. The specimens were divided into two equal groups. Group 1 received unilateral procedures while group 2 received bilateral procedures. Laminectomy, facectomy, discectomy, cage insertion and transpedicle screw insertion were performed sequentially after testing the intact status. Changes in range of motion (ROM and neutral zone (NZ were compared between unilateral and bilateral cage-instrumented PLIF. Results Both ROM and NZ, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF, transpedicle screw insertion procedure did not revealed a significant difference between flexion-extension, lateral bending and axial rotation direction except the ROM in the axial rotation. The bilateral group's ROM (-1.7 ± 0. 8 of axial rotation was decreased significantly after transpedicle screw insertion procedure in comparison with the unilateral group (-0.2 ± 0.1. In the unilateral cage-instrumented PLIF group, the transpedicle screw insertion procedure did not demonstrate a significant difference between right and left side in the lateral bending and axial rotation direction. Conclusions Based on the results of this study, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF have similar stability after transpedicle screw fixation in the sheep spine model. The unilateral approach can substantially reduce exposure requirements. It also offers the biomechanics advantage of construction using anterior column support combined with pedicle screws just as the bilateral cage-instrumented group. The unpleasant effect of couple motion resulting from inherent asymmetry was absent in the unilateral group.

Chen Hung-Yi

2010-11-01

242

Comparison of degree of postoperative muscle damage between MIS-TLIF- and PLIF treatment for single-level degenerative lumbar disease  

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Full Text Available Objective?To compare the postoperative muscle damage after either posterior lumbar interbody fusion (PLIF or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF with the aid of X-Tube system in patients with singlelevel degenerative lumbar spinal disease. Methods?The clinical data of 52 patients (males 28, females 24, aged 54.3±7.8 years with single-level degenerative lumbar spinal disease undergoing MIS-TLIF assisted by the X-Tube system from Oct 2010 to Sep 2011 was analyzed retrospectively. The operative time, intraoperative blood loss, postoperative drainage volume, postoperative bedtime, and serum creatine kinase (CK level 1 day before surgery and 1, 3 and 5 days after surgery were recorded and compared with those of 38 patients (males 20, females 18, aged 51.6±8.6 years with the same disease undergoing conventional open PLIF during the corresponding period. The back pain visual analogue score (VAS, Oswestry disability index (ODI score and imaging examination were performed before operation, after operation and during follow-up duration for each patient. Results?There was no significant difference in the gender, age, clinical diagnosis, lesion location, preoperative CK level, VAS and ODI scores between the two groups (P>0.05. The operative time was longer in MIS-TLIF group than in PLIF group (P0.05. Radiological followup observation revealed good fusion 6 months after operation in all the patients. Conclusion?The X-Tube-assisted MIS-TLIF has several advantages over conventional open PLIF, such as less intraoperative blood loss, milder muscle damage, and lighter back pain. DOI: 10.11855/j.issn.0577-7402.2013.12.04

Liang ZHOU

2014-01-01

243

Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization.  

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The aim of the current study was to evaluate changes in lumbar kinematics after lumbar monosegmental instrumented surgery with rigid fusion and dynamic non-fusion stabilization. A total of 77 lumbar spinal stenosis patients with L4 degenerative spondylolisthesis underwent L4-5 monosegmental posterior instrumented surgery. Of these, 36 patients were treated with rigid fusion (transforaminal lumbar interbody fusion) and 41 with dynamic stabilization [segmental spinal correction system (SSCS)]. Lumbar kinematics was evaluated with functional radiographs preoperatively and at final follow-up postoperatively. We defined the contribution of each segmental mobility to the total lumbar mobility as the percent segmental mobility [(sagittal angular motion of each segment in degrees)/(total sagittal angular motion in degrees) × 100]. Magnetic resonance imaging was performed on all patients preoperatively and at final follow-up postoperatively. The discs were classified into five grades based on the previously reported system. We defined the progress of disc degeneration as (grade at final follow-up) - (grade at preoperatively). No significant kinematical differences were shown at any of the lumbar segments preoperatively; however, significant differences were observed at the L2-3, L4-5, and L5-S1 segments postoperatively between the groups. At final follow-up, all of the lumbar segments with rigid fusion demonstrated significantly greater disc degeneration than those with dynamic stabilization. Our results suggest that the SSCS preserved 14% of the kinematical operations at the instrumented segment. The SSCS may prevent excessive effects on adjacent segmental kinematics and may prevent the incidence of adjacent segment disorder. PMID:21301893

Morishita, Yuichiro; Ohta, Hideki; Naito, Masatoshi; Matsumoto, Yoshiyuki; Huang, George; Tatsumi, Masato; Takemitsu, Yoshiharu; Kida, Hirotaka

2011-09-01

244

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: bone graft extenders and substitutes as an adjunct for lumbar fusion.  

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In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs. PMID:24980593

Kaiser, Michael G; Groff, Michael W; Watters, William C; Ghogawala, Zoher; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Sharan, Alok; Wang, Jeffrey C; Dhall, Sanjay S; Resnick, Daniel K

2014-07-01

245

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... because you’re increasing the pressure in the spinal canal with prolonged sitting. Come on out, Danny, let’s ... or whether it’s a degenerative process that lumbar spinal stenosis, which is a very common problem that presents as we age, in which our canal becomes compressed like a napkin ring. And what ...

246

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... at Miami’s Baptist Hospital. You’re going to be a seeing a procedure called a “minimally invasive ... to see exactly what we’re going to be doing in a few minutes. Lumbar surgery, particularly ...

247

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... techniques just means that we are approaching the spine with the least amount of tissue damage that we can, that we need to be able to release the pressure whether it’s a disc herniation or whether it is a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a ...

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Full Text Available ... Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson University ... Presbyterian, New York, NY, 12/05/2007) Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson University ...

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Full Text Available ... Hospital, Coral Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ... Hartford Hospital, Hartford, CT, 6/21/2007) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ...

250

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis.  

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There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7 degrees before surgery to 6.8 degrees after surgery in the L5 group, and from 22.8 degrees to 7.7 degrees in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration. PMID:19165507

Cho, Kyu-Jung; Suk, Se-Il; Park, Seung-Rim; Kim, Jin-Hyok; Choi, Sung-Wook; Yoon, Young-Hyun; Won, Man-Hee

2009-04-01

251

Benign lumbar arachnoiditis  

International Nuclear Information System (INIS)

Gadolinium was used as a contrast agent in ten patients to see whether it would benefit the evaluation of benign lumbar arachnoiditis. The results of myelography, postmyelography CT, and noncontrast MR imaging, especially long TR axial images, were concordant. After the administration of gadolinium, enhancement of the clumped nerve roots ranged from nil to mild. Mild arachnoiditis produced minimal enhancement that was often difficult to detect. In severe arachnoiditis, mild enhancement of clumped and tethered nerve roots was visualized. In general, the amount of enhancement was less that that seen in leptomeningeal tumor spread. In conclusion, lumbar arachnoiditis by itself is best evaluated with noncontrast long TR MR imaging. However, benign arachnoiditis can show some mild enhancement with Gd-DTPA, depending on the severity of the disease

252

IMAGENOLOGIA DEL DOLOR LUMBAR  

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Full Text Available EL dolor lumbar es un síntoma de consulta frecuente, con ribetes de problema de Salud Pública. El imagenólogo tiene un papel crucial tanto en el diagnóstico como en el tratamiento de este problema. La comprensión de la clínica, la fisiopatología, la patología y las distintas alternativas terapéuticas permitirá un estudio imagenológico dirigido que aportará información complementaria y orientará hacia tratamientos más adecuados. La categorización de los distintos cuadros clínicos y técnicas orientadas a la búsqueda de patología especifica permitirá hacer aproximaciones etiologicas de los diversos cuadros que pueden dar origen al dolor lumbar.The low back pain is a common cause of consultation and may be considered a public health problem. The imaging physician has an important role in the diagnoses and treatment. The understanding of the clinical aspects, physiology, pathology and different options of treatment will permit a tailored imaging examination. This will result in useful clinical information and the correct treatment for the patients.

Cristian Matus Y

2003-01-01

253

Traumatic lumbar hernia  

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BACKGROUND: Trauma has various presentations ranging from common injuries that are easily managed to uncommon presentations such as traumatic hernia that may be missed. METHODS: Despite being operated for fracture of the femur after a road traffic accident, a 50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months after the accident. In this period, the patient underwent incision and drainage thrice for swelling in the right flank which was diagnosed as an infected hematoma by a doctor. RESULTS: The patient underwent surgery for repair of traumatic lumbar hernia by combined fascia lata graft and mesh hernioplasty. She remains well on follow-up. CONCLUSION: This case underscores the need for awareness of this entity for correct diagnosis and appropriate management that are the key to avoiding complications.

Jayant, Mayank; Kaushik, Robin

2012-01-01

254

Lumbar facet syndromes.  

Science.gov (United States)

Low back pain is a common presenting complaint to sports medicine providers. The lumbar spine is a complex anatomic structure with multiple potential pain generators. Epidemiologic studies have shown that the intervertebral disc is the most common pain generator in all patients with low back pain. The facet joints may account for 15%-40% of low back pain. It can be challenging at times to establish a firm diagnosis of facet pain. Facet pain can have different presentations, and pain emanating from other lumbopelvic structures can present similarly as facet joint pain. This article reviews the anatomy and biomechanics of the lumbar facet joints, presenting symptoms and physical examination findings seen with facet pain. We also will discuss diagnostic and treatment paradigms that are helpful to the clinician treating low back pain in athletes. PMID:20071922

Beresford, Zach M; Kendall, Richard W; Willick, Stuart E

2010-01-01

255

Chordoma Of Lumbar Spine  

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Full Text Available Chordoma, lesion derived from the notochord, represents about 4% of the primary malignant bone tumours. Males are affected more commonly than females and it is very rare in children;the peak incidence is in the sixth decade of life.The sacrococcygeal region accounts for 50% of cases and the spheno-occipital region or the base of the skull for 37% of cases.The remainder of the cases reported occur in the descending order of frequency in the cervical,thoracic and the lumbar spine.It is found to be rarely involving the lumbar spine(about 2%.We present a case of chordoma involving L4 and L5 vertebral body and disc.The role of epithelial cell marker study has proved a well adjunct to the histopathological diagnosis of chordoma.

Nirmala M.J.*, H.A. Parshwanath and A.M.Patil

2010-10-01

256

LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING  

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Full Text Available Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K., full golf swings were monitored without a corset (WOC, with a soft corset (SC, and with a hard corset (HC, with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38° or HC (28° than under WOC (44° conditions (p < 0.05. The maximum angular velocity after impact was significantly smaller under HC (94°/sec than under SC (177°/sec and WOC (191° /sec conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC

Koji Hashimoto

2013-03-01

257

Evaluation of spinal interbody fusion using magnetic resonance imaging  

International Nuclear Information System (INIS)

Twenty patients underwent spinal interbody fusion via an anterior approach in this study. Beginning immediately after surgery, serial T1-weighted and T2-weighted MR images, as well as post-contrast MRI, were performed. Signal intensity changes were examined in the bone graft, the border between the graft and the adjacent vertebrae, and in the adjacent vertebrae, and were classified into 5 patterns (P1-P5) on each image. Unclassifiable patterns were also defined. On T1-weighted images, the graft exhibited high intensity immediately after surgery. The intensity subsequently decreased with time. On T2-weighted images, the graft was isointense for a period of time after surgery, and then exhibited high intensity. The grafts eventually became isointense on both T1-weighted and T2-weighted images by the time of bony union as determined from plain radiographs. On postcontrast images, an enhancement effect was noted from the upper and lower edges of the graft. This effect gradually increased until the entire graft became enhanced. In the adjacent vertebrae, transient changes were found in the early postoperative period. Postcontrast images revealed contrast enhancement. In cases with a favorable course, there was a tendency to gradually change from P1 to P5 with time. Unfavorable courses were characterized by a mosaic appearance of the graft on the T1-weighted image, widening of the border in the direction of the graft, and continuous changes in the adjacent vertebrae on each image (pattern PU). (K.H.)

258

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.  

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The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period. PMID:23768025

Gragnaniello, Cristian; Seex, Kevin A; Eisermann, Lukas G; Claydon, Matthew H; Malham, Gregory M

2013-08-01

259

Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005.  

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The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied the eligibility criteria. A list of criteria for methodological quality assessment was established by merging the criteria recommended by leading health economists with the criteria recommended by the Cochrane Back Review Group. The two reviewers independently scored the selected literature and the disagreement was resolved by means of consensus following discussion. Key data were extracted and the level of evidence concluded. Seven studies were eligible; these studies reflected the diversified choices of economic methodology, study populations (diagnosis), outcome measures and comparators. At the conclusion of quality assessment, the methodological quality of three studies was judged credible. Two studies investigated posteolateral fusion (PLF) +/- instrumentation in different populations: one investigated non-specific low back pain and one investigated degenerative stenosis + spondylolisthesis. Both studies reflected that cost-effectiveness of instrumentation in PLF is not convincing. The third study concerned the question of circumferential vs anterior lumbar interbody fusion and found a non-significant difference between the techniques. In conclusion, the literature is limited and, in view of the fact that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative. PMID:16369828

Soegaard, Rikke; Christensen, Finn B

2006-08-01

260

Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up.  

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This randomized controlled health economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Social and healthcare perspectives after 2 years are reported. In all, 152 patients were randomized to either TDR (n = 80) or lumbar FUS (n = 72). Cost to society (total mean cost/patient, Swedish kronor = SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for lumbar FUS SEK 685,919 (422,903) (ns). The difference was not significant: SEK 86,359 (-45,605 to 214,332). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (1,202 to 43,055). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over 2 years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost-effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the "non-difference" in treatment outcome, which is why cost/QALY was not meaningful to define. Using cost-effectiveness probabilistic analysis, the net benefit (with CI) was found to be SEK 91,359 (-73,643 to 249,114) (ns). We used the currency of 2006 where 1 EURO = 9.26 SEK and 1 USD = 7.38 SEK. It was not possible to state whether TDR or FUS is more cost-effective after 2 years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time. PMID:21053028

Fritzell, Peter; Berg, Svante; Borgström, Fredrik; Tullberg, Tycho; Tropp, Hans

2011-07-01

 
 
 
 
261

Lumbar spinal stenosis  

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Lumbar spinal stenosis is a condition of polyetiologic origin. It is defined as narrowing of the spinal canal, the nerve root canals or the intervertebral canals. For clinical, diagnostic and therapeutic reasons it may be divided into two main types: central and lateral stenosis with obstruction of the lateral recesses. Plain radiographs may be suggestive in central or generalized narrowing only. Diagnosis is confirmed by additional investigations, i.e. myelography and CT. Lumbar myelography allows definitive diagnosis of central spinal stenosis. However, validity regarding visualization of the lateral recesses is limited and a decision on the nature of the obstruction, bony or soft tissue, cannot be made. In contrast, CT does support information on the bony outline of the lateral recess as related to the facet and soft tissue structures in particular. Treatment of choice should be conservative-supportive if clinical symptoms permit. Surgery is indicated when there is intolerable pain, progressive muscle weakness or sphincter dysfunction. Surgery seeks to attain complete decompression of neural elements, if instability is present or imminent spinal fusion has to be considered. Shape, size and configuration of the spinal canal have to be determined prior to any surgical approach. CT fulfills these requirements most admirably. (orig.)

262

Lumbar spinal stenosis  

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Lumbar spinal stenosis is a condition of polyetiologic origin. It is defined as narrowing of the spinal canal, the nerve root canals or the intervertebral canals. For clinical, diagnostic and therapeutic reasons it may be divided into two main types: central and lateral stenosis with obstruction of the lateral recesses. Plain radiographs may be suggestive in central or generalized narrowing only. Diagnosis is confirmed by additional investigations, i.e. myelography and CT. Lumbar myelography allows definitive diagnosis of central spinal stenosis. However, validity regarding visualization of the lateral recesses is limited and a decision on the nature of the obstruction, bony or soft tissue, cannot be made. In contrast, CT does support information on the bony outline of the lateral recess as related to the facet and soft tissue structures in particular. Treatment of choice should be conservative-supportive if clinical symptoms permit. Surgery is indicated when there is intolerable pain, progressive muscle weakness or sphincter dysfunction. Surgery seeks to attain complete decompression of neural elements, if instability is present or imminent spinal fusion has to be considered. Shape, size and configuration of the spinal canal have to be determined prior to any surgical approach. CT fulfills these requirements most admirably.

Galanski, M.; Weidner, A.; Vogelsang, H.

1982-12-01

263

The imaging of lumbar spondylolisthesis  

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Lumbar spondylolisthesis is a common finding on plain radiographs. The condition has a variety of causes which can be differentiated on the basis of imaging findings. As the treatment is dependent upon the type of spondylolisthesis, it is important for the radiologist to be aware of these features. We present a pictorial review of the imaging features of lumbar spondylolisthesis and explain the differentiating points between different groups of this disorder. The relative merits of the different imaging techniques in assessing lumbar spondylolisthesis are discussed

264

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography  

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A prospective, controlled study was performed to compare side effect incidences after lumbar iohexol myelography (n=97) and diagnostic lumbar puncture (n=85). No significant side effect incidence differences (iohexol vs. controls) were found regarding number of patients with any side effect (63 vs. 73%), headache (44 vs. 54%), nausea, dizziness, visual, auditory, or psychic symptoms. Early-onset headache occurred significantly more often in the iohexol group (16 vs 5%), while postural headache occurred most frequently after lumbar puncture (25 vs. 41%). These results suggest that apart from the slight early-onset headache, most side effets after lumbar iohexol myelography are related to the puncture per se, not to the contrast agent. (orig.)

265

Lumbar peritoneal shunt  

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Full Text Available A lumbar peritoneal (LP shunt is a technique of cerebrospinal fluid (CSF diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension, normal pressure hydrocephalus, spinal and cranial CSF leaks, pseudomeningoceles, slit ventricle syndrome, growing skull fractures which are difficult to treat by conventional methods (when dural defect extends deep in the cranial base or across venous sinuses and in recurrent cases after conventional surgery, raised intracranial pressure following chronic meningitis, persistent bulging of craniotomy site after operations for intracranial tumors or head trauma, syringomyelia and failed endoscopic third ventriculostomy with a patent stoma. In spite of the large number of indications of this shunt and being reasonably good, safe, and effective, very few reports about the LP shunt exist in the literature. This procedure did not get its due importance due to some initial negative reports. This review article is based on search on Google and PubMed. This article is aimed to review indications, complications, results, and comparison of the LP shunt with the commonly practiced ventriculoperitoneal (VP shunt. Shunt blocks, infections, CSF leaks, overdrainage and acquired Chiari malformation (ACM are some of the complications of the LP shunt. Early diagnosis of overdrainage complications and ACM as well as timely appropriate treatment especially by programmable shunts could decrease morbidity. Majority of recent reports suggest that a LP shunt is a better alternative to the VP shunt in communicating hydrocephalus. It has an advantage over the VP shunt of being completely extracranial and can be used under conditions other than hydrocephalus when the ventricles are normal sized or chinked. More publications are required to establish its usefulness in the treatment of wide variety of indications.

Yadav Yad

2010-01-01

266

Lumbar peritoneal shunt.  

Science.gov (United States)

A lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension, normal pressure hydrocephalus, spinal and cranial CSF leaks, pseudomeningoceles, slit ventricle syndrome, growing skull fractures which are difficult to treat by conventional methods (when dural defect extends deep in the cranial base or across venous sinuses and in recurrent cases after conventional surgery), raised intracranial pressure following chronic meningitis, persistent bulging of craniotomy site after operations for intracranial tumors or head trauma, syringomyelia and failed endoscopic third ventriculostomy with a patent stoma. In spite of the large number of indications of this shunt and being reasonably good, safe, and effective, very few reports about the LP shunt exist in the literature. This procedure did not get its due importance due to some initial negative reports. This review article is based on search on Google and PubMed. This article is aimed to review indications, complications, results, and comparison of the LP shunt with the commonly practiced ventriculoperitoneal (VP) shunt. Shunt blocks, infections, CSF leaks, overdrainage and acquired Chiari malformation (ACM) are some of the complications of the LP shunt. Early diagnosis of overdrainage complications and ACM as well as timely appropriate treatment especially by programmable shunts could decrease morbidity. Majority of recent reports suggest that a LP shunt is a better alternative to the VP shunt in communicating hydrocephalus. It has an advantage over the VP shunt of being completely extracranial and can be used under conditions other than hydrocephalus when the ventricles are normal sized or chinked. More publications are required to establish its usefulness in the treatment of wide variety of indications. PMID:20508332

Yadav, Yad R; Parihar, Vijay; Sinha, Mallika

2010-01-01

267

Lumbar spondylolysis: a review  

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Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its epidemiology, pathogenesis, and general treatment guidelines, as well as a detailed review and discussion of the imaging principles for the diagnosis and follow-up of this condition. (orig.)

Leone, Antonio; Magarelli, Nicola; Bonomo, Lorenzo [Dept. of Bioimaging and Radiological Sciences, Catholic Univ., Rome (Italy); Cianfoni, Alessandro [Dept. of Radiology and Radiological Sciences, Medical Univ. of South Carolina, Charleston (United States); Cerase, Alfonso [General Hospital, Unit Neuroimaging and Neurointervention (NINT), Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena (Italy)

2011-06-15

268

Pars Stress Fracture (Lumbar Spondylolysis)  

Science.gov (United States)

... Neck and Back) > Pars Stress Fracture Pars Stress Fracture Page Content Pars stress fractures occur in young athletes involved in repetitive bending ... an episode of low back pain Pars stress fracture, also called lumbar spondylolysis, is one of the ...

269

Biomechanical evaluation of immediate stability with rectangular versus cylindrical interbody cages in stabilization of the lumbar spine  

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Full Text Available Abstract Background Recent cadaver studies show stability against axial rotation with a cylindrical cage is marginally superior to a rectangular cage. The purpose of this biomechanical study in cadaver spine was to evaluate the stability of a new rectangular titanium cage design, which has teeth similar to the threads of cylindrical cages to engage the endplates. Methods Ten motion segments (five L2-3, five L4-5 were tested. From each cadaver spine, one motion segment was fixed with a pair of cylindrical cages (BAK, Sulzer Medica and the other with paired rectangular cages (Rotafix, Corin Spinal. Each specimen was tested in an unconstrained state, after cage introduction and after additional posterior translaminar screw fixation. The range of motion (ROM in flexion-extension, lateral bending, and rotation was tested in a materials testing machine, with +/- 5 Nm cyclical load over 10 sec per cycle; data from the third cycle was captured for analysis. Results ROM in all directions was significantly reduced (p Conclusions There was no significant difference in immediate stability in any direction between the threaded cylindrical cage and the new design of the rectangular cage with endplate teeth.

Webb John K

2002-10-01

270

Lumbar spinal stenosis  

International Nuclear Information System (INIS)

Spinal stenosis, which has attracted increasing attention in recent years, represents an important group of clinical and radiologic entities. Recognition and ultimate surgical management of the many abnormalities found in this group require precise preoperative delineation of the morbid anatomy. Conventional axial tomography provided the first accurate picture of the sagittal dimension, but it was limited by poor contrast resolution. Computerized tomography and ultrasound have finally provided the means for accurate measurement of midsagittal diameter and surface area. It is now possible to provide a preoperative assessment of bony and soft-tissue canal compression and to guide surgical decompression by objective anatomic measurements. True spinal stenosis of the lumbar vertebral canal is a form of compression produced by the walls of the vertebral canal. It involves the whole of the vertebral canal by exerting compression at two of its opposite surfaces. There are two types of stenosis: (1) transport stenosis, wherein the clinical manifestations are due to impeded flow of fluid, which is dependent on the available cross-sectional area of the canal surface of the stenotic structure, and (2) compressive stenosis, which includes abnormal compression of opposing surfaces only. According to these definitions, indentation on the spinal canal by disc protrusion or localized tumor is not considered true spinal stenoses. In this chapter the authors discuss only those conditions that produce true canal stenosis

271

Manejo del síndrome doloroso lumbar Management of lumbar syndrome  

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Full Text Available Se realizó una revisión bibliográfica del síndrome doloroso lumbar y se seleccionaron los artículos relacionados con este síndrome publicados desde 1991 hasta 2009. Se hizo hincapié en la búsqueda de guías para el manejo del dolor lumbar en la práctica clínica, y sus criterios fueron revisados por el equipo de especialistas en Ortopedia y Traumatología del Servicio de columna vertebral del Hospital Ortopédico Docente "Fructuoso Rodríguez" y adaptados a las condiciones del Sistema Nacional de Salud cubano.A bibliographic review on painful syndrome was made selecting the articles published from 1991 to 2009 related to this syndrome. Authors emphasize in the search of guides for management of lumbar pain in the clinical practice, whose criteria were analyzed by the team Orthopedics and Traumatology team of the spinal column service from the "Fructuoso Rodríguez" Hospital and adjusted to conditions of the Cuban Health System.

Rafael Rivas Hernández

2010-03-01

272

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS  

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Full Text Available Impaired motor and sensory functions have been associated with low back pain (LBP. This includes disturbances in a wide range of sensorimotor control e.g. sensory dysfunctions, impaired postural responses and psychomotor control. However, the physiological mechanisms, clinical relevance and characteristics of these findings in different spinal pathologies require further clarification. The purposes of this study were to investigate postural control, lumbar muscle function, movement perception and associations between these findings in healthy volunteers (n=35, patients with lumbar disc herniation (n=20 and lumbar spinal stenosis (LSS, n=26. Paraspinal muscle responses for sudden upper limb loading and muscle activation during flexion-extension movement and the lumbar endurance test were measured by surface electromyography (EMG. Postural stability was measured on a force platform during two- and one-footed standing. Lumbar movement perception was assessed in a motorised trunk rotation unit in the seated position. In addition, measurements of motor-(MEP and somatosensory evoked potentials (SEP and needle EMG examination of lumbar multifidus muscles were performed in the LSS patients. Clinical and questionnaire data were also recorded. A short latency paraspinal muscle response (~50 ms for sudden upper limb loading was observed. The latency of the response was shortened by expectation (p=0.017. The response latency for unexpected loading was similar in healthy persons and disc herniation patients but the latency was not shortened by expectation in the patients (p = 0.014. Also impaired postural control (p < 0.05 and lumbar movement perception (p = 0.012 were observed in disc herniation patients. The impaired lumbar movement perception (p=0.054 and anticipatory muscle activation (p = 0.043 tended to be restored after successful surgery but postural control had still not recovered after 3 months of follow-up. The majority of LSS patients were unable to sense a rotational movement in the lumbar area and thus had clearly impaired lumbar movement perception (p = 0.006. Abnormal MEPs had only inconsistent and SEPs showed no associations with impaired movement perception and postural stability in LSS. Abnormal needle EMG findings and flexion-extension activation of paraspinal muscles were frequently observed in LSS patients. Lumbar paraspinal muscle endurance was better than in previously evaluated healthy subjects and chronic LBP patients (p < 0.001. The results demonstrated clearly impaired lumbar sensory and motor function in sciatica and LSS patients. The pure reflex activation of paraspinal muscles was not affected in sciatica but a difference was found in the premotoneuronal response control. The impaired proprioceptive functions and premotoneuronal response control seem to recover at least partially but the maintenance of postural stability is a complex activity which does not seem to recover automatically in operated sciatica patients at least in three months follow-up. Paraspinal muscle denervation and dysfunction were clearly detectable in LSS but lumbar paraspinal muscle endurance was unexpectedly good.

Ville Leinonen

2004-03-01

273

Percutaneous endoscopic decompression for lumbar spinal stenosis.  

Science.gov (United States)

Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery. PMID:25033889

Ahn, Yong

2014-11-01

274

Lumbar artery hemorrhage associated with lumbar fractures: Arteriographic diagnosis and therapy  

International Nuclear Information System (INIS)

Nine patients who sustained massive lumbar arterial hemorrhage associated with lumbar spinal fractures are described. Pelvic fracture hemorrhage was present in five patients. Spasm and extravasation, a subtle finding on aortography, were usually obvious on lumbar arteriography, often originating from multiple lumbar vessels. Gelfoam embolization controlled bleeding in seven patients. One patient died of exsanguination during embolization; another, not embolized, required 7 units of blood transfusion. Two died of cerebral injury and pulmonary embolism. The authors conclude that lumbar arteriography should be considered during angiography for pelvic fracture when there are lumbar fractures, and life-threatening lumbar artery hemorrhage can be controlled by Gelfoam embolization

275

LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING  

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Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), wi...

Koji Hashimoto; Kei Miyamoto; Takashi Yanagawa; Ryo Hattori; Takaaki Aoki; Toshio Matsuoka; Takatoshi Ohno; Katsuji Shimizu

2013-01-01

276

Knodt rod distraction lumbar fusion.  

Science.gov (United States)

Ninety-nine cases of Knodt rod fusions have been followed for an average of 18 months postoperatively. These patients were all severely incapacitated with pain for an average of 5.3 years prior to surgery. They all had a thorough preoperative work-up including myelogram, EMG and extensive conservative care. The procedure performed was an extensive bilateral laminectomy of the L5 vertebra with foramenotomy and a posterior lateral intertransverse fusion with the use of Knodt rods between the L4-5 and S1 levels. There was an overall average improvement after surgery in 70.35% of the cases. When the consideration of psychological problems and industrial cases were eliminated, the overall improvement was 80.38%. There were no major complications except that in five patients the Knodt rods were removed from between one week and one year postoperatively. Knodt rod fusions have results reported in the literature of frequent complications and very poor success rates. They can be a very good adjunct to the spine surgeon's armamentarium. In patients with long-range back pain who plan to return to heavy labor, the Knodt rods can give a surprisingly high rate of success. PMID:6635794

White, A H; Wynne, G; Taylor, L W

1983-01-01

277

Functional lumbar myelography with iohexol  

International Nuclear Information System (INIS)

The results of 25 functional lumbar myelographies with iohexol are reported. The image quality was good or excellent in all. The side effects were mostly mild and showed that the same frequency as reported in lumbar and thoracic myelographies with metrizamide. A slight increase in the frequency of side effects was found in 13 patients with spinal repuncture 6 or 24 hours after the myelography. Vacuolized monocytes in ultracentrifuged CSF following repuncture was found in 5 patients. No EEG changes or serious complications were found. Iohexol is considered safe in intrathecal use. (Auth.)

278

Degenerative lumbar spinal stenosis and lumbar spine configuration.  

Science.gov (United States)

As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis. PMID:20652366

Abbas, J; Hamoud, K; May, H; Hay, O; Medlej, B; Masharawi, Y; Peled, N; Hershkovitz, I

2010-11-01

279

Lumbar myelography with omnipaque (iohexol)  

International Nuclear Information System (INIS)

Lumbar myelography with iohexol (Omnipaque) was performed in 103 consecutive adult patients with low back pain or sciatica. The patients were observed for 48 h with registration of possible adverse reactions. Mild or moderate transient side effects were recorded in 24 patients. No serious adverse reactions were noted, and EEG recorded in 25 patients showed no changes. (orig.)

280

MR myelography for lumbar disease  

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The usefulness of MR myelography for lumbar diseases was assessed. The subjects were 92 patients (48 males and 44 females) who had undergone MR myelography since April 1998. The MR myelography studies were performed under the following conditions: turbo spin echo, TR=9000 ms, TE=600 ms, 320 mm FOV, 35 mm slice thickness, and 512 matrix, clear images of the nerve roots were obtained as a result. Three cases (lumbar disk herniation, stenosis of the lumbar spinal canal, and low back pain) are for the most part described. The MR myelograms were inferior to the X-ray myelograms in bone imaging and functional imaging, but MR myelography is non-invasive, there is no risk of infection or iodine allergy, and it can be performed on an out patient basis. MR myelography of the lumbar portion of the spine became more useful after image processing. In the future MR myelography is expected to be performed not only as a preliminary study, but as a substitute for X-ray myelography. (K.H.)

Ohno, Takuya; Takigawa, Souichirou; Aihara, Masanori; Nagai, Takashi; Hasegawa, Makoto [Showa Univ., Tokyo (Japan). Toyosu Hospital; Fujimaki, Etsuo

2000-02-01

 
 
 
 
281

Construct Rigidity after Fatigue Loading in Pedicle Subtraction Osteotomy with or without Adjacent Interbody Structural Cages.  

Science.gov (United States)

Introduction?Studies document rod fracture in pedicle subtraction osteotomy (PSO) settings where disk spaces were preserved above or adjacent to the PSO. This study compares the multidirectional bending rigidity and fatigue life of PSO segments with or without interbody support. Methods?Twelve specimens received bilateral T12-S1 posterior fixation and L3 PSO. Six received extreme lateral interbody fusion (XLIF) cages in addition to PSO at L2-L3 and L3-L4; six had PSO only. Flexion-extension, lateral bending, and axial rotation (AR) tests were conducted up to 7.5 Newton-meters (Nm) for groups: (1) posterior fixation, (2) L3 PSO, (3) addition of cages (six specimens). Relative motion across the osteotomy (L2-L4) and entire fixation site (T12-S1) was measured. All specimens were then fatigue tested for 35K cycles. Results?Regardingmultiaxial bending, there was a significant 25.7% reduction in AR range of motion across L2-L4 following addition of cages. Regarding fatigue bending, dynamic stiffness, though not significant (p?=?0.095), was 22.2% greater in the PSO?+?XLIF group than in the PSO-only group. Conclusions?Results suggest that placement of interbody cages in PSO settings has a potential stabilizing effect, which is modestly evident in the acute setting. Inserting cages in a second-stage surgery remains a viable option and may benefit patients in terms of recovery but additional clinical studies are necessary to confirm this. PMID:24353970

Deviren, Vedat; Tang, Jessica A; Scheer, Justin K; Buckley, Jenni M; Pekmezci, Murat; McClellan, R Trigg; Ames, Christopher P

2012-12-01

282

Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine  

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Full Text Available In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD. This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI and a Visual Analogue Scale (VAS. Surgery performed was dorsolateral fusion (46.9% or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%. Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively. Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54% showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20% complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%. Of these, indications were adjacent segment disease (16 cases, pedicle screw loosening (7 cases, and infection (one case. At follow-up of 29.4 months, patients with radiographic ASD had worse ODI scores than patients without (54.7 vs. 36.6; P less than 0.001. Multilevel fusion for degenerative disease still has a high rate of complications, up to 50%. The problem of adjacent segment disease after fusion surgery has not yet been solved. This study underscores the need for strict indication guidelines to perform lumbar spine fusion of more than two levels.

Karl Stefan Delank

2010-03-01

283

PEEK Versus Ti Interbody Fusion Devices: Resultant Fusion, Bone Apposition, Initial and 26 Week Biomechanics.  

Science.gov (United States)

STUDY DESIGN:: Comparative evaluation of in vitro and in vivo biomechanics, resulting fusion and histomorphometric aspects of Polyetheretherketone (PEEK) versus Titanium (Ti) interbody fusion devices in an animal model with similar volumes of bone graft. OBJECTIVE:: Identify differences in the characteristics of fusion and biomechanics immediately following implantation (time zero) and at 26 weeks with each interbody implant. SUMMARY OF BACKGROUND DATA:: PEEK has been well accepted in spinal surgery, it provides a closer match to the mechanical properties of bone than metallic implants such as titanium. This is thought to reduce graft stress shielding and subsidence of interbody fusion devices. There remains controversy as to the overall influence of this as a factor influencing resultant fusion and initial stability. While material modulus is one factor of importance, other design factors are likely to play a large role determining overall performance of an interbody implant. METHODS:: A Ti and PEEK device of similar size with a central void to accommodate graft material were compared. The PEEK device had a ridged surface on the caudal and cephalad surfaces, while Ti device allowed axial compliance and had bone ingrowth endplates and polished internal surfaces. A two level ALIF was performed in 9 sheep and fusion, biomechanics, and bone apposition were evaluated at 26 weeks. Time zero in vitro biomechanical tests were performed to establish initial stability immediately following implantation. RESULTS:: No differences were detected in the biomechanical measures of each of the devices in in vitro time zero tests. All levels were fused by 26 weeks with considerably lower Range of Motion (ROM) when compared to in vitro tests. ROM in all modes of bending was reduced by over 70% when compared to intact values for Axial Rotation (Ti-74%, PEEK-71%), Lateral Bending (Ti-90%, PEEK-88%) and Flexion/Extension (Ti-92%, PEEK-91%). Mechanical properties of fusions formed with each implant did not differ, however bone apposition was variable with polished internal Ti surfaces being lower than PEEK and treated Ti endplates showing the greatest levels. Graft material displayed axial trabecular alignment with both implants. CONCLUSIONS:: Although material properties and surface characteristics resulted in differing amounts of biological integration from the host, both implants were capable of producing excellent fusion results using similar volumes of bone graft. PMID:22801456

Pelletier, Matthew; Cordaro, Nicholas; Lau, Abe; Walsh, William R

2012-07-13

284

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome.  

Science.gov (United States)

A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion. PMID:24980580

Ghogawala, Zoher; Whitmore, Robert G; Watters, William C; Sharan, Alok; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Groff, Michael W; Wang, Jeffrey C; Resnick, Daniel K; Dhall, Sanjay S; Kaiser, Michael G

2014-07-01

285

DOLOR LUMBAR RELACIONADO AL EMBARAZO  

Directory of Open Access Journals (Sweden)

Full Text Available El dolor lumbar ha sido considerado la complicación más frecuente del embarazo, a pesar de ello, su etiopatogenia aún es controvertida. La prevalencia en nuestro medio es desconocida, y el tratamiento se basa para muchos médicos solo en el reposo, medida que no tiene sustento en la literatura. En esta revisión, nos centramos en la historia clínica, terminología, mecanismos fisiológicos teóricamente implicados, factores de riesgo, prevalencia y proponemos un enfoque de tratamiento del dolor lumbar asociado al embarazoThe low back pain has been considered the most frequent complication of pregnancy, despite this fact, etiology and pathophysiology is unclear at present time. The prevalence in our country is unknown, and the treatment is based on in rest-periods for the most physicians, instead literature rationality. In our research, based in the literature, we focus in the history, terminology, theoretical physiological mechanism, risk factors, prevalence and we propose pathways for treatment of pregnancy-related low back pain

Milan Munjin L

2007-01-01

286

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

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...2010-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section 572.19 Transportation... § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the part of the torso...

2010-10-01

287

49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.  

Science.gov (United States)

...2010-10-01 false Lumbar spine, abdomen, and pelvis. 572.9 Section 572.9 Transportation... § 572.9 Lumbar spine, abdomen, and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the assemblies designated...

2010-10-01

288

Arteriovenous fistula following lumbar laminectomy  

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A case of iatrogenic aortocaval fistula is presented. The fistula arose from lumbar disc surgery. Its presence was immediately suspected on ultrasound and computed tomogram, and was promptly confirmed by angiography. Ultrasound and computed tomogram also precisely define the anatomy between the aorta or its branches and the IVC or its tributaries. Sudden deterioration of the patient's condition necessitated surgical correction of the fistula before the elected date. The successful corrective operation is described.

Hwang, Jung Won; Park, Hae Won; Chang, Un Ha [Koryo General Hospital, Seoul (Korea, Republic of)

1988-06-15

289

Arteriovenous fistula following lumbar laminectomy  

International Nuclear Information System (INIS)

A case of iatrogenic aortocaval fistula is presented. The fistula arose from lumbar disc surgery. Its presence was immediately suspected on ultrasound and computed tomogram, and was promptly confirmed by angiography. Ultrasound and computed tomogram also precisely define the anatomy between the aorta or its branches and the IVC or its tributaries. Sudden deterioration of the patient's condition necessitated surgical correction of the fistula before the elected date. The successful corrective operation is described

290

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS  

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Impaired motor and sensory functions have been associated with low back pain (LBP). This includes disturbances in a wide range of sensorimotor control e.g. sensory dysfunctions, impaired postural responses and psychomotor control. However, the physiological mechanisms, clinical relevance and characteristics of these findings in different spinal pathologies require further clarification. The purposes of this study were to investigate postural control, lumbar muscle function, movement percep...

Ville Leinonen

2004-01-01

291

Lumbar discoidectomy by minimal incision  

International Nuclear Information System (INIS)

The objective is to review the experience with the presented technique. Background: Lumbar disc herniation is the most frequent cause of low back pain, becoming a disabling condition. There are multiple surgical procedures to treat lumbar disc herniation; however, review of the literature found similar outcomes within open and percutaneous techniques. Materials and methods: Seventy patients with lumbar disc herniation were operated within 1990 and 2003, 38 years-old of mean age, 6 years 3 months of mean follow-up. Results were evaluated by Spain type, severity of herniation, and presence of neurological deficit, preoperative treatment, and complications and assessment of outcomes according to Ebeling's Scale. Results: 91% of disc herniation were by a physical mechanism. 57% were protruded disc herniation; most common paint type was lumbo-radicular (83%). Disturbances Motor improved in 100% and 69% of sensitive. There were no infections. According to Ebeling's Scale, 94,3% of patients had excellent outcomes, 4.3% well and 1.4% had regular outcomes. Recommendations: The minimally invasive technique is safe and has low incidence of complications, this promotes early clinical recovery and reintegration to daily and laboral activities. Costs are less with this technique than the microsurgical technique because of this does not require of high-technology equipment

292

Osteomielitis vertebral lumbar / Ostéomyélite vertébrale lombaire / Lumbar vertebral osteomyelitis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se mostró la terapéutica médica y quirúrgica ante un caso con osteomielitis vertebral secundaria a discectomía, mediante el estudio observacional descriptivo en un paciente de 50 años de edad, afecto de hernia discal del 5to. espacio lumbar, a quien se le había practicado discectomía abierta; que in [...] gresó a los 15 días con un cuadro doloroso lumbar e hipertermia de 39 °C.Se hizo una revisión actualizada del tema de osteomielitis vertebral y se expuso la terapéutica quirúrgica y antimicrobiana realizada al paciente. Luego de desbridamientos quirúrgicos seriados demandantes y secuenciales, así como de irrigación continua, se observó la resolución del cuadro infeccioso y del cuadro radicular que presentaba el paciente. En consulta externa se reflejó la negatividad de las investigaciones analíticas de infección a los 4 meses de evolución. Se concluyó que es importante ante los signos clínicos de infección (dolor, fiebre), realizar una tomografía axial computarizada en un paciente con discectomía abierta, para ver la repercusión ósea y operar lo antes posible. La modalidad de desbridamiento secuencial y demandante con una irrigación continua de solución salina fisiológica 0,9 % con antibiótico sensible al microorganismo, da resultados satisfactorios. Abstract in english Surgical and medical therapy was shown in a case of vertebral osteomyelitis secondary to disectomy by means of a descriptive observational study conducted in a 50 years old patient affected by herniation of the fifth lumbar disk that had undergone open disectomy; who was admitted 15 days after this [...] with a painful lumbar manifestation and hyperthermia of 39 °C. An updated review of the topic of vertebral osteomyelitis was made and the surgical and antimicrobial therapy followed in the patient was shown. After demanding sequential serial surgical debridements with continuous irrigation, the resolution of the infectious and radicular manifestation that the patient presented was observed. The negative impacts of the analytical investigations of infection were presented in the outpatient consultation after four months of evolution. It was concluded that, in the presence of clinical signs of infection such as pain and fever, it is important to indicate a CT-scan to a patient who had undergone open disectomy to observe the osseous percussion and operate on as soon as possible. The modality of demanding sequential serial surgical debridement with continuous irrigation with 0.9 % physiological saline solution and a sensitive antibiotic to the microorganism gives satisfactory results.

Hiralio, Collazo Álvarez; Javier, Pacheco López; Lander, García de Rojas; Juan Pablo, Yandún Quiroz.

293

Osteomielitis vertebral lumbar / Ostéomyélite vertébrale lombaire / Lumbar vertebral osteomyelitis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se mostró la terapéutica médica y quirúrgica ante un caso con osteomielitis vertebral secundaria a discectomía, mediante el estudio observacional descriptivo en un paciente de 50 años de edad, afecto de hernia discal del 5to. espacio lumbar, a quien se le había practicado discectomía abierta; que in [...] gresó a los 15 días con un cuadro doloroso lumbar e hipertermia de 39 °C.Se hizo una revisión actualizada del tema de osteomielitis vertebral y se expuso la terapéutica quirúrgica y antimicrobiana realizada al paciente. Luego de desbridamientos quirúrgicos seriados demandantes y secuenciales, así como de irrigación continua, se observó la resolución del cuadro infeccioso y del cuadro radicular que presentaba el paciente. En consulta externa se reflejó la negatividad de las investigaciones analíticas de infección a los 4 meses de evolución. Se concluyó que es importante ante los signos clínicos de infección (dolor, fiebre), realizar una tomografía axial computarizada en un paciente con discectomía abierta, para ver la repercusión ósea y operar lo antes posible. La modalidad de desbridamiento secuencial y demandante con una irrigación continua de solución salina fisiológica 0,9 % con antibiótico sensible al microorganismo, da resultados satisfactorios. Abstract in english Surgical and medical therapy was shown in a case of vertebral osteomyelitis secondary to disectomy by means of a descriptive observational study conducted in a 50 years old patient affected by herniation of the fifth lumbar disk that had undergone open disectomy; who was admitted 15 days after this [...] with a painful lumbar manifestation and hyperthermia of 39 °C. An updated review of the topic of vertebral osteomyelitis was made and the surgical and antimicrobial therapy followed in the patient was shown. After demanding sequential serial surgical debridements with continuous irrigation, the resolution of the infectious and radicular manifestation that the patient presented was observed. The negative impacts of the analytical investigations of infection were presented in the outpatient consultation after four months of evolution. It was concluded that, in the presence of clinical signs of infection such as pain and fever, it is important to indicate a CT-scan to a patient who had undergone open disectomy to observe the osseous percussion and operate on as soon as possible. The modality of demanding sequential serial surgical debridement with continuous irrigation with 0.9 % physiological saline solution and a sensitive antibiotic to the microorganism gives satisfactory results.

Hiralio, Collazo Álvarez; Javier, Pacheco López; Lander, García de Rojas; Juan Pablo, Yandún Quiroz.

2013-06-01

294

Minimally invasive lumbar decompression for the treatment of spinal stenosis of the lumbar spine.  

Science.gov (United States)

SUMMARY Lumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs. PMID:24645862

Deer, Timothy

2012-09-01

295

Homeopatía y dolor lumbar / Homeopathy and lumbar pain  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish El dolor lumbar es una causa frecuente que afecta a los pacientes que acuden a consulta, siendo uno de los más incapacitantes. Prevalece en la población adulta, con mayor incidencia en los mayores de 30 años, pudiendo evolucionar por crisis, o ser constante y resultar temporal, permanente o recidiva [...] nte. En su tratamiento se emplean medicamentos alopáticos, modalidades físicas y diferentes técnicas de medicina natural y tradicional con el objetivo de aliviar el dolor, recuperar o mantener la función, así como evitar su recurrencia. Teniendo en cuenta el desarrollo en los últimos tiempos de la homeopatía, se decidió realizar una revisión bibliográfica con el objetivo de identificar los principales medicamentos homeopáticos susceptibles de ser utilizados en esta entidad según criterios actuales. Abstract in english The lumbar pain is a frequent symptom affecting patients assisting the consultation, and it is one of the most incapacitating. It prevails among the adult population, with a higher incidence in those aged more than 30 years. It may lead to crisis, or may be constant and temporal, permanent or recidi [...] vist. Treating it we use allopathic medicines, physical modalities and different traditional and natural medicine techniques with the objective of alleviating pain, recover or maintain the function, and also avoiding its recurrence. Considering the current development of the homeopathy, we decided to make a bibliographic review to identify the main homeopathic medicines that could be used in this entity according to the current criteria.

Eva María, Castro Morillo; Osmany, Ramos Marrero; Maritza Catalina, Lozano Tarifa; Johann, Perdomo Delgado; Evelyn Annie, González Plá.

2011-02-01

296

Homeopatía y dolor lumbar / Homeopathy and lumbar pain  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish El dolor lumbar es una causa frecuente que afecta a los pacientes que acuden a consulta, siendo uno de los más incapacitantes. Prevalece en la población adulta, con mayor incidencia en los mayores de 30 años, pudiendo evolucionar por crisis, o ser constante y resultar temporal, permanente o recidiva [...] nte. En su tratamiento se emplean medicamentos alopáticos, modalidades físicas y diferentes técnicas de medicina natural y tradicional con el objetivo de aliviar el dolor, recuperar o mantener la función, así como evitar su recurrencia. Teniendo en cuenta el desarrollo en los últimos tiempos de la homeopatía, se decidió realizar una revisión bibliográfica con el objetivo de identificar los principales medicamentos homeopáticos susceptibles de ser utilizados en esta entidad según criterios actuales. Abstract in english The lumbar pain is a frequent symptom affecting patients assisting the consultation, and it is one of the most incapacitating. It prevails among the adult population, with a higher incidence in those aged more than 30 years. It may lead to crisis, or may be constant and temporal, permanent or recidi [...] vist. Treating it we use allopathic medicines, physical modalities and different traditional and natural medicine techniques with the objective of alleviating pain, recover or maintain the function, and also avoiding its recurrence. Considering the current development of the homeopathy, we decided to make a bibliographic review to identify the main homeopathic medicines that could be used in this entity according to the current criteria.

Eva María, Castro Morillo; Osmany, Ramos Marrero; Maritza Catalina, Lozano Tarifa; Johann, Perdomo Delgado; Evelyn Annie, González Plá.

297

Homeopatía y dolor lumbar Homeopathy and lumbar pain  

Directory of Open Access Journals (Sweden)

Full Text Available El dolor lumbar es una causa frecuente que afecta a los pacientes que acuden a consulta, siendo uno de los más incapacitantes. Prevalece en la población adulta, con mayor incidencia en los mayores de 30 años, pudiendo evolucionar por crisis, o ser constante y resultar temporal, permanente o recidivante. En su tratamiento se emplean medicamentos alopáticos, modalidades físicas y diferentes técnicas de medicina natural y tradicional con el objetivo de aliviar el dolor, recuperar o mantener la función, así como evitar su recurrencia. Teniendo en cuenta el desarrollo en los últimos tiempos de la homeopatía, se decidió realizar una revisión bibliográfica con el objetivo de identificar los principales medicamentos homeopáticos susceptibles de ser utilizados en esta entidad según criterios actuales.The lumbar pain is a frequent symptom affecting patients assisting the consultation, and it is one of the most incapacitating. It prevails among the adult population, with a higher incidence in those aged more than 30 years. It may lead to crisis, or may be constant and temporal, permanent or recidivist. Treating it we use allopathic medicines, physical modalities and different traditional and natural medicine techniques with the objective of alleviating pain, recover or maintain the function, and also avoiding its recurrence. Considering the current development of the homeopathy, we decided to make a bibliographic review to identify the main homeopathic medicines that could be used in this entity according to the current criteria.

Eva María Castro Morillo

2011-02-01

298

Foramen Vertebral Lumbar Inconstante en Bos taurus / Inconstant Lumbar Vertebral Foramen in Bos taurus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish En Anatomía Veterinaria la investigación de los forámenes de la columna vertebral es necesaria para expandir nuestro conocimiento de osteología sistemática, y para el estudio de la vascularización de la columna vertebral y de la médula espinal. El objetivo de este trabajo es informar acerca de la pr [...] esencia y características de forámenes inconstantes hallados en las vértebras lumbares bovinas. Quince de 100 (15 %) vértebras lumbares presentaban forámenes. Todos los forámenes estaban localizados en el cuerpo de la vértebra lumbar sobre su cara lateral derecha. Cuatro de estas vértebras eran la lumbar 2 y tres de ellas la lumbar 5 Abstract in english In Veterinary Anatomy the research of the foramina of the vertebral column is necessary for to expand our knowledge of systematic osteology, and for study of the vascularization of the vertebral column and spinal cord. The objective of this work is to inform about presence and characteristics of inc [...] onstant foramina found in bovine lumbar vertebrae. Fifteen of 100 (15 %) of lumbar vertebrae presented foramina. All foramina were found at the body of lumbar vertebrae on their right lateral face. Four of these vertebrae were lumbar 2 and three of them lumbar 5

Martin, Lima; William, Pérez.

2007-12-01

299

Estenosis espinal lumbar degenerativa / Degenerative spinal lumbar stenosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Fundamento: el aumento progresivo de la esperanza de vida viene acompañado de una mayor incidencia de las enfermedades degenerativas del raquis como la estenosis espinal. Objetivo: actualizar y sistematizar los conocimientos sobre la estenosis espinal degenerativa del canal espinal lumbar. Método: s [...] e realizó una revisión de la literatura de los último cinco años. Se insistió en la clasificación, patogenia, diagnóstico y tratamiento. Desarrollo: la estenosis espinal degenerativa del canal lumbar es un desorden multifactorial caracterizado por un estrechamiento del canal vertebral, del receso lateral o de los agujeros de conjunción secundaria a hipertrofia degenerativa y progresiva de cualquiera de las estructuras óseas, cartilaginosas o ligamentosas que culmina en una compresión neurológica y vascular. La claudicación neurogéna es de los síntomas más característicos. El diagnóstico se basa en las mediciones realizadas en las imágenes de tomografía axial computarizada y en la resonancia nuclear magnética. Las opciones terapéuticas incluyen el tratamiento conservador y el quirúrgico, con las técnicas descompresivas convencionales y las de mínima invasión, preferidas en la actualidad. Conclusiones: la estenosis espinal degenerativa es una enfermedad multifactorial. El diagnóstico se fundamenta en la sospecha clínica confirmada en los estudios imagenológicos. Para la elección del tratamiento deben tenerse en cuenta factores relacionados con el paciente, con las características de la estenosis y con la disponibilidad de la tecnología. El objetivo de la cirugía se encaminará a descomprimir las estructuras neurovasculares y respetar la estabilidad del raquis para disminuir la morbilidad posoperatoria. Abstract in english Background: the progressive increase of life expectancy came along with a greater incidence of degenerative diseases of the rachis like spinal stenosis. Objective: to systematize and bring the knowledge about degenerative spinal stenosis of the spinal lumbar channel up to date. Method: a review of t [...] he literature from the last five years was made, making emphasis in the classification, pathogeny, diagnosis, and treatment. Development: degenerative spinal stenosis of the lumbar channel is a multifactorial disorder characterized by a narrowing of the vertebral channel, of the lateral recess, or of the secondary intervertebral foramina, conditions commonly observed in degenerative and progressive hypertrophy of any of the cartilaginous, ligamentous, or osseous structures that ends in a neurologic or vascular squeeze. Neurogenic claudication is one of the most characteristic symptoms. The diagnosis is based on measuring made through the images in the computerized axial tomography and in the nuclear magnetic resonance. The therapeutic options include the conservative treatment and the surgical treatment, with conventional decompressing techniques and the techniques of minimal invasion that are the most used nowadays. Conclusions: degenerative spinal stenosis is a multifactorial disease. The diagnosis is based on the clinical suspicion confirmed through imagenology studies. Some factors related to the patient, to the characteristics of the stenosis, and to the availability of the technology should be taken into consideration for choosing the treatment. The objective of the surgery will be aimed at decompressing the neurovascular structures and keeping the stability of the rachis in order to reduce the postoperative morbidity.

Erick Héctor, Hernández González; Antonio, Puente Álvarez; Gretel, Mosquera Betancourt.

300

Estenosis espinal lumbar degenerativa / Degenerative spinal lumbar stenosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Fundamento: el aumento progresivo de la esperanza de vida viene acompañado de una mayor incidencia de las enfermedades degenerativas del raquis como la estenosis espinal. Objetivo: actualizar y sistematizar los conocimientos sobre la estenosis espinal degenerativa del canal espinal lumbar. Método: s [...] e realizó una revisión de la literatura de los último cinco años. Se insistió en la clasificación, patogenia, diagnóstico y tratamiento. Desarrollo: la estenosis espinal degenerativa del canal lumbar es un desorden multifactorial caracterizado por un estrechamiento del canal vertebral, del receso lateral o de los agujeros de conjunción secundaria a hipertrofia degenerativa y progresiva de cualquiera de las estructuras óseas, cartilaginosas o ligamentosas que culmina en una compresión neurológica y vascular. La claudicación neurogéna es de los síntomas más característicos. El diagnóstico se basa en las mediciones realizadas en las imágenes de tomografía axial computarizada y en la resonancia nuclear magnética. Las opciones terapéuticas incluyen el tratamiento conservador y el quirúrgico, con las técnicas descompresivas convencionales y las de mínima invasión, preferidas en la actualidad. Conclusiones: la estenosis espinal degenerativa es una enfermedad multifactorial. El diagnóstico se fundamenta en la sospecha clínica confirmada en los estudios imagenológicos. Para la elección del tratamiento deben tenerse en cuenta factores relacionados con el paciente, con las características de la estenosis y con la disponibilidad de la tecnología. El objetivo de la cirugía se encaminará a descomprimir las estructuras neurovasculares y respetar la estabilidad del raquis para disminuir la morbilidad posoperatoria. Abstract in english Background: the progressive increase of life expectancy came along with a greater incidence of degenerative diseases of the rachis like spinal stenosis. Objective: to systematize and bring the knowledge about degenerative spinal stenosis of the spinal lumbar channel up to date. Method: a review of t [...] he literature from the last five years was made, making emphasis in the classification, pathogeny, diagnosis, and treatment. Development: degenerative spinal stenosis of the lumbar channel is a multifactorial disorder characterized by a narrowing of the vertebral channel, of the lateral recess, or of the secondary intervertebral foramina, conditions commonly observed in degenerative and progressive hypertrophy of any of the cartilaginous, ligamentous, or osseous structures that ends in a neurologic or vascular squeeze. Neurogenic claudication is one of the most characteristic symptoms. The diagnosis is based on measuring made through the images in the computerized axial tomography and in the nuclear magnetic resonance. The therapeutic options include the conservative treatment and the surgical treatment, with conventional decompressing techniques and the techniques of minimal invasion that are the most used nowadays. Conclusions: degenerative spinal stenosis is a multifactorial disease. The diagnosis is based on the clinical suspicion confirmed through imagenology studies. Some factors related to the patient, to the characteristics of the stenosis, and to the availability of the technology should be taken into consideration for choosing the treatment. The objective of the surgery will be aimed at decompressing the neurovascular structures and keeping the stability of the rachis in order to reduce the postoperative morbidity.

Erick Héctor, Hernández González; Antonio, Puente Álvarez; Gretel, Mosquera Betancourt.

2013-08-01

 
 
 
 
301

Axial loaded MRI of the lumbar spine  

Energy Technology Data Exchange (ETDEWEB)

Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

Saifuddin, A. E-mail: asaifuddin@aol.com; Blease, S.; MacSweeney, E

2003-09-01

302

Effect of Laminectomy on Stability of Lumbar Spine Effect of Laminectomy on Stability of Lumbar Spine  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The paper aims at the presentation of the lumbar spine finite element model used in a study of segmental kinematics including the tissue loading. Lumbar spine FE-model consisting of the three lumbar vertebras, two disc (including annulus and nucleus) and vast variety of ligaments. The primary model objective is its verification by experimental test data obtained from cadaver spine segments. A confirmed model was used for a study of various range of laminectomy effect. On this model we simulat...

Petr Tichy; Zdenek Horak; Jana Sindelarova

2009-01-01

303

Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis: anterior interbody fusion versus expansive laminoplasty  

International Nuclear Information System (INIS)

Background: there have been many reports about newly developed degenerative changes in the adjacent segments after anterior interbody fusion. It is a controversial issue whether the adjacent-segment disease in patients treated by anterior interbody fusion is the result of progressive cervical spondylosis at the adjacent levels or is caused by the arthrodesis. The aim of this study is to clarify the difference in postoperative effect an the adjacent segments between anterior interbody fusion and expansive laminoplasty. Method: this study included 14 patients who underwent pre- and postoperative MR images at 6 and 12 months. Seven patients underwent cervical interbody fusion and the other 7 patients underwent expansive laminoplasty. Disc degeneration was evaluated semi-quantitatively by calculating the degenerative index (DI) that is a ratio of the intensity in the disc to that in the upper cervical cord. Findings: in the anterior interbody fusion group, the adjacent disc intensities decreased within 12 months (F = 20.42; P < 0.01). The pre-operative mean DI was 0.59 ± 0.16. The post-operative mean DIs were 0.56 ± 0.16 at 6 months and 0.47 ± 0.16 at 12 months. In the expansive laminoplasty group, the signal intensities of both the adjacent discs and the discs within the range of laminoplasty had no serial changes during the same period (F = 2.67; P = 0.09 and F = 0.15; P = 0.87 respectively). Interpretation. Anterior interbody fusion had a significant influence on the adjacent discs even as soon as 12 months after surgery, but laminoplasty had no influence on them during the same period. (author)

304

Migrating lumbar facet joint cysts  

Energy Technology Data Exchange (ETDEWEB)

The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints. (orig.)

Palmieri, Francesco; Cassar-Pullicino, Victor N.; Lalam, Radhesh K.; Tins, Bernhard J.; Tyrrell, Prudencia N.M.; McCall, Iain W. [Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Department of Radiology, Oswestry (United Kingdom)

2006-04-15

305

Migrating lumbar facet joint cysts  

International Nuclear Information System (INIS)

The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints. (orig.)

306

Constitutional stenosis of the lumbar spinal canal  

Energy Technology Data Exchange (ETDEWEB)

The radiographic findings of lumbar spinal stenosis are presented with special reference to the constitutional form and the cheirolumbar dysostotic form as well as the pathologic changes associated with diffuse developmental anomalies of the skeleton.

Wackenheim, A.; Vallier, D.; Babin, E.

1980-10-01

307

Septic arthritis of a lumbar facet joint  

International Nuclear Information System (INIS)

Septic arthritis of the posterior lumbar joints is extremely rare. The clinical picture of the unusual site of infection can easily lead to confusion with spondylo-discitis which is more common. We report a case of a 50-year-old women with Staphylococcus aureus septic arthritis of the left L5-S1 lumbar facet joint. CT scan was helpful to establish the diagnosis and to guide the percutaneous needle biopsy. (authors)

308

Posteroanterior versus anteroposterior lumbar spine radiology.  

Science.gov (United States)

The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae. PMID:2338520

Tsuno, M M; Shu, G J

1990-01-01

309

Posteroanterior versus anteroposterior lumbar spine radiology  

International Nuclear Information System (INIS)

The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae

310

Posteroanterior versus anteroposterior lumbar spine radiology  

Energy Technology Data Exchange (ETDEWEB)

The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae.

Tsuno, M.M.; Shu, G.J. (Cleveland Chiropractic College, Los Angeles, CA (USA))

1990-03-01

311

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Science.gov (United States)

... false Lumbar spine, abdomen, and pelvis assembly and test procedure. 572...572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis assembly. The lumbar spine,...

2010-10-01

312

Case report 516: Lumbar vertebral chordoma causing sclerosis of affected vertebra (3rd lumbar vertebra)  

International Nuclear Information System (INIS)

A case is described of a 61-year-old man with chordoma involving a lumbar vertebra, causing sclerosis of the vertebra without vertebral collapse or a soft tissue mass - a hitherto unreported appearance. CT studies yielded no additional information and the diagnosis was made following needle biopsy of the lumbar vertebra. (orig.)

313

Lumbar facet syndrome - Lumbar facet joint injection and low back pain  

International Nuclear Information System (INIS)

The authors conducted a retrospective study lo evaluate the effectiveness of injection therapy in the lumbar zygapophysial joints with anesthetics and steroids in patients with persisting low back pain and lumbar facer syndrome. Thirty-seven patients with low back pain who reported immediate relief of their pain after controlled blocks into the facet joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were evaluated. Outcome was evaluated using the visual analog pain scales. All outcome measures were repeated at eight days and six weeks alter controlled injection. At six-week follow-up examination 83,7% of thirty-seven patients experienced a good response to controlled blocks of the lumbar zygaphyseal (facet) joints. Good result is the pain relief of 50% or more. Fifteen patients experienced a good response with pain relief of eight points or more in the VAS

314

Chordoma of the lumbar spine: a case report / Cordoma de la columna lumbar: caso clínico  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: English Abstract in spanish Los cordomas son tumores poco frecuentes que pueden presentarse en cualquier parte de la columna vertebral y en el clivus. Sólo un mínimo porcentaje de estos tumores afectan el área lumbar. En este escrito presentamos un caso de cordoma lumbar y discutimos su presentación clínica, radiológica y las [...] opciones de tratamiento. Abstract in english Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of th [...] is chordoma arising from the lumbar vertebra.

H., Tuna; V., Aydin; M., Bozkurt; A., Attar.

2005-04-01

315

Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly  

Science.gov (United States)

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

Y?lmaz, Tevfik; Turan, Yahya; Gulsen, Ismail; Dalbayrak, Sedat

2014-01-01

316

Role of femoral ring allograft in anterior interbody fusion of the spine.  

Directory of Open Access Journals (Sweden)

Full Text Available A review was carried out on 59 patients (10 males and 49 females who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75. The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1-2 in 12, L2-3 in 17, L3-4 in 22, L4-5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12. The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months there was no significant change in allograft angles (average = 1.6 degrees . Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated and 3% were in grade II (partially incorporated. Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly. One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates - graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.

Chotivichit A

2001-12-01

317

Headache and Meningismus Following Lumbar Puncture  

Directory of Open Access Journals (Sweden)

Full Text Available Post-lumbar puncture headache is the most common complication of lumbar puncture. This condition is thought to be the result of persistent cerebrospinal fluid leakage at the puncture site, leading to low cerebrospinal fluid pressure and traction on the meninges and intracranial veins. Associated symptoms may include nausea, vomiting, auditory and vestibular symptoms. Meningeal irritation signs are unexpected as clinical findings unless serious medical conditions such as subarachnoid hemorrhage or meningitis occur. We are present a case of headache and meningismus following by lumbar puncture. A 17-year-old female presented to the emergency department suffering from headache, nausea and vomiting, starting one day after a lumbar puncture procedure. The characteristics of the headache were different and more severe than the previous form. Her vital signs and physical and detailed neurological examination were normal, except meningismus findings such as neck stiffness and Brudzinksy’s sign. Since the meningismus findings were unexpected, lumbar puncture was performed again to diagnose meningitis and subarachnoid hemorrhage. Cerebrospinal fluid pressure, protein, glucose, microscopic examination, blood and cerebrospinal fluid cultures were normal. Finally, magnetic resonance imaging of the brain revealed no pathological meningeal enhancement. In patients harboring uncontrollable factors, variables such as needle size, bevel orientation and the avoidance of traumatic lumbar puncture should be taken into consideration more seriously than ever. Furthermore, since, meningeal irritation signs such as neck stiffness and Brudzinksy’s and Kernig’s signs are not the expected clinical findings of post-lumbar puncture headache, serious medical conditions such as subarachnoid hemorrhage and meningeal infections should be investigated in the emergency setting.

F?rat Bekta?

2012-06-01

318

An optimization study of the screw orientation on the interfacial strength of the anterior lumbar plate system using neurogenetic algorithms and experimental validation.  

Science.gov (United States)

Anterior lumbar plate (ALP) systems have been widely used as an effective interbody fusion device for treating spinal cord compression. However, clinical complications, such as implant loosening and breakage, still occur. Past studies have investigated the effects of the screw orientation on the interfacial strength, but these studies were inconsistent. The purpose of this study was to identify an ALP system with excellent interfacial strength by varying the screw orientation. Three-dimensional finite element models of L4-L5 segments with an ALP system were first constructed. A neurogenetic algorithm, which combines artificial neural networks and genetic algorithms, was subsequently developed to discover the optimum plate design. Finally, biomechanical tests were conducted to validate the results of the finite element models and the engineering algorithm. The results indicated that the interfacial strength of the optimum plate design obtained using the neurogenetic algorithm was excellent compared with the other designs and that all of the locking screws should be inserted divergently. Both the numerical and experimental outcomes can provide clinical suggestions to surgeons and help them to understand the interfacial strength of ALP systems in terms of the screw orientation. PMID:25162521

Lee, Chian-Her; Hsu, Ching-Chi; Huy, Dinh Cong

2014-11-01

319

Biomechanical effects of polyaxial pedicle screw fixation on the lumbosacral segments with an anterior interbody cage support  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Lumbosacral fusion is a relatively common procedure that is used in the management of an unstable spine. The anterior interbody cage has been involved to enhance the stability of a pedicle screw construct used at the lumbosacral junction. Biomechanical differences between polyaxial and monoaxial pedicle screws linked with various rod contours were investigated to analyze the respective effects on overall construct stiffness, cage strain, rod strain, and contact ratios at the vertebra-cage junction. Methods A synthetic model composed of two ultrahigh molecular weight polyethylene blocks was used with four titanium pedicle screws (two in each block and two rods fixation to build the spinal construct along with an anterior interbody cage support. For each pair of the construct fixed with polyaxial or monoaxial screws, the linked rods were set at four configurations to simulate 0°, 7°, 14°, and 21° lordosis on the sagittal plane, and a compressive load of 300 N was applied. Strain gauges were attached to the posterior surface of the cage and to the central area of the left connecting rod. Also, the contact area between the block and the cage was measured using prescale Fuji super low pressure film for compression, flexion, lateral bending and torsion tests. Results Our main findings in the experiments with an anterior interbody cage support are as follows: 1 large segmental lordosis can decrease the stiffness of monoaxial pedicle screws constructs; 2 polyaxial screws rather than monoaxial screws combined with the cage fixation provide higher compression and flexion stiffness in 21° segmental lordosis; 3 polyaxial screws enhance the contact surface of the cage in 21° segmental lordosis. Conclusion Polyaxial screws system used in conjunction with anterior cage support yields higher contact ratio, compression and flexion stiffness of spinal constructs than monoaxial screws system does in the same model when the spinal segment is set at large lordotic angles. Polyaxial pedicle screw fixation performs nearly equal percentages of vertebra-cage contact among all constructs with different sagittal alignments, therefore enhances the stabilization effect of interbody cages in the lumbosacral area.

Chen Hsiang-Ho

2007-03-01

320

Dolor lumbar agudo: mecanismos, enfoque y tratamiento  

Directory of Open Access Journals (Sweden)

Full Text Available El dolor lumbar agudo tiene un gran impacto socioeconómico a nivel mundial, esto lo constituye en un problema de salud pública. En nuestro país su ocurrencia es muy similar a la de otras latitudes. A lo largo de la historia se ha considerado como un “precio” que debemos pagar los mamíferos bipedestres de importante longevidad. Comparte sus mecanismos fisiopatológicos con los otros tipos de dolor agudo. Sin embargo, en la gran mayoría de los casos, implica un reto determinar su origen patológico estructural exacto. El adecuado enfoque del paciente con lumbalgia aguda, garantiza su adecuado tratamiento. Su diagnóstico requiere de una evaluación clínica exhaustiva, con el fin de clasificarlo en uno de estos tres grupos: dolor lumbar potencialmente asociado a radiculopatía (irradiado, dolor lumbar potencialmente asociado a condición específica (específico o dolor lumbar no específico (simple. Los estudios imagenológicos deben limitarse a los pacientes que tienen signos de alarma, aquellos que no se encuentran en el grupo de lumbalgia inespecífica. La evidencia actual sugiere que el tratamiento farmacológico con Antiinflamatorios no Esteroideos (AINEs y Acetaminofen debe ser el de primera línea en dolor lumbar agudo. Su pronóstico es benigno en la mayoría de los casos.

Marco Tulio Mahecha Toro

2009-10-01

 
 
 
 
321

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate.  

Science.gov (United States)

Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250?N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. PMID:22002745

Ordway, Nathaniel R; Rim, Byeong Cheol; Tan, Rong; Hickman, Rebecca; Fayyazi, Amir H

2012-04-01

322

49 CFR 572.115 - Lumbar spine and pelvis.  

Science.gov (United States)

...2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572.115 Transportation...Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for the SID...

2010-10-01

323

Interlaminar decompression in lumbar canal stenosis.  

Directory of Open Access Journals (Sweden)

Full Text Available Opinion is still divided over a standard surgical procedure to decompress lumbar canal stenosis. Both, laminectomy with or without facetectomy and foraminotomy and interlaminar fenestration have been advocated. In the present communication interlaminar decompression in lumbar canal stenosis has been discussed. Sixteen consecutive patients (7 males and 9 females with clinical, neurological and radiological features of lumbar canal stenosis were treated by interlaminar (fenestration decompression. The age of onset of symptoms ranged between 22-57 years. Adjoining lamina around interlaminar space of involved segment along with ligamentum flavum and part of facet joint (undercutting facetectomy, extending laterally (foraminotomy were removed at single or multiple levels. Follow-up response (93.7% over a period of two and half years showed the results as good in 73.3% and fair in 26.7% of cases, with uniformly uneventful post-operative period.

Patond K

1999-10-01

324

Functional oblique views of the lumbar spine  

International Nuclear Information System (INIS)

The first part of the paper deals with measurements of 152 radiographs. It was found that the conventional views of the lumbar spine in two planes can demonstrate only 49.1% of the articular joints. Oblique views in two planes increase the accuracy to 88.7%. In view of the relatively high accuracy of the oblique views, these were used as the basis for a new functional method for examining the intervertebral joints. For this examination, oblique views of the lumbar spine are taken in the lordotic and kyphotic positions. The position of the patient during the examination is described in detail. In the second part of the paper, the results of measurements of 80 functional examinations are evaluated. Average values for the mobility of individual elements of the lumbar spine have been derived. Finally, the practical value of the new technique is demonstrated. Its special place for subluxations and spondylolyses is stressed. (orig.)

325

Side effects after lumbar iohexol myelography  

International Nuclear Information System (INIS)

Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography. (orig.)

326

Magnetic resonance imaging of the lumbar spine  

International Nuclear Information System (INIS)

The author discusses how MRI has become an invaluable diagnostic adjunct to CT in the study of the lumbar spine. MRI provides improved resolution of soft tissue structures, which leads to more accurate diagnosis of degenerative disc disease and lateral nerve root entrapment as well as spinal neoplasm, infection, and hematoma. MRI is the procedure of choice in the study of complicated spine pathology in postoperative patients. CT currently remains the procedure of choice in the study of degenerative disease of the lumbar spine in the nonoperated patient because of its superb bone and soft tissue imaging and its inexpensiveness when compared to MRI. MRI imaging can be expect to improve with software modifications and new imaging techniques. MRI will play an increasingly prominent role in lumbar spine imaging

327

Congenital block vertebrae in lumbar spine  

Directory of Open Access Journals (Sweden)

Full Text Available A 34-year-old female visited our rheumatology clinic with the complaint of non-inflammatory back pain that usually occurred on bending down and radiated to bilateral lower limbs. A diagnosis of compressive neuropathy was suspected and an initially performed digital X-ray of lumbar spine revealed a rare congenital anomaly termed as ‘Congenital block vertebrae’ in the lumbar spine (Fig 1.Block vertebrae, a congenital anomaly, occurs due to improper segmentation of vertebral column during fetal development. Improper segmentation leads to fusion of adjacent vertebrae through their inter-vertebral disc. The most common site of this deformity is cervical spine and the lumbar vertebral involvement is rare. The disco-vertebral articulation is always involved and depending on the degree of involvement, the presenting complaints could be either neurological due to the compression of nerve roots or scoliosis due to the vertebral deformity.

Ankur Nandan Varshney

2013-05-01

328

Computed tomography of the postoperative lumbar spine  

International Nuclear Information System (INIS)

In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period

329

 

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Full Text Available ... Doctors Hospital, Coral Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ... Tumors (Hartford Hospital, Hartford, CT, 6/21/2007) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ...

330

Management of Lumbar Artery Injury Related to Pedicle Screw Insertion  

Directory of Open Access Journals (Sweden)

Full Text Available We report on 2 patients who experienced injury to one of their lumbar arteries related to pedicle screw misplacement. In this report, the lumbar pedicle screw holes were made laterally with resultant injury to the lumbar artery. During surgery, arterial bleeding was controlled with pressure and gauze; however, the patients experienced vital shock after surgery. Vital shock ensued and they were rescued by catheter embolization. If patients receiving lumbar instrumentation surgery experience severe anemia or vital shock postoperatively, the surgeon should assume lumbar artery injury as a differential diagnosis.

Sugimoto,Yoshihisa

2013-04-01

331

AVULSION TRAUMÁTICA RADICULAR LUMBAR: CASO CLÍNICO DE INTERÉS TRAUMATIC LUMBAR NERVE ROOT AVULSION  

Digital Repository Infrastructure Vision for European Research (DRIVER)

La avulsión traumática de una raíz lumbo-sacra es una lesión poco frecuente que se presenta en asociación con fracturas lumbares y pélvicas o luxaciones de cadera. Se describe un caso clínico de avulsión traumática de la raíz lumbar L1 derecha, en un paciente de 63 años, víctima de un accidente de alta energía, quien no presentó lesiones asociadas. La resonancia magnética mostró un pseudomeningocele traumático de Ll y el estudio con gadolinio intratecal permitió confirmar el...

Miguel Ángel Lecaros L; Francisco Ilabaca G; Patricio Melero D; Ratko Yurac B; Bartolomé Marré P; Víctor Amagada V; Alejandro Urzúa B; Milan Munjin L

2008-01-01

332

MRI of transforaminal lumbar interbody fusion: imaging appearance with and without the use of human recombinant bone morphogenetic protein-2 (rhBMP-2)  

International Nuclear Information System (INIS)

To describe the vertebral endplate and intervertebral disc space MRI appearance following TLIF, with and without the use of rhBMP-2, and to determine if the appearance is concerning for discitis/osteomyelitis. After institutional review board approval, 116 TLIF assessments performed on 75 patients with rhBMP-2 were retrospectively and independently reviewed by five radiologists and compared to 73 TLIF assessments performed on 45 patients without rhBMP-2. MRIs were evaluated for endplate signal, disc space enhancement, disc space fluid, and abnormal paraspinal soft tissue. Endplate edema-like signal was reported when T1-weighted hypointensity, T2-weighted hyperintensity, and endplate enhancement were present. Subjective concern for discitis/osteomyelitis on MRI was graded on a five-point scale. Generalized estimating equation binomial regression model analysis was performed with findings correlated with rhBMP-2 use, TLIF level, graft type, and days between TLIF and MRI. The rhBMP-2 group demonstrated endplate edema-like signal (OR 5.66; 95 % CI [1.58, 20.24], p = 0.008) and disc space enhancement (OR 2.40; 95 % CI [1.20, 4.80], p = 0.013) more often after adjusting for the TLIF level, graft type, and the number of days following TLIF. Both groups had a similar temporal distribution for endplate edema-like signal but disc space enhancement peaked earlier in the rhBMP-2 group. Disc space fluid was only present in the rhBMP-2 group. Neither group demonstrated abnormal paraspinal soft tissue and discitis/osteomyelitis was not considered likely in any patient. Endplate edema-like signal and disc space enhancement were significantly more frequent and disc space enhancement developed more rapidly following TLIF when rhBMP-2 was utilized. The concern for discitis/osteomyelitis was similar and minimal in both groups. (orig.)

333

MRI of transforaminal lumbar interbody fusion: imaging appearance with and without the use of human recombinant bone morphogenetic protein-2 (rhBMP-2)  

Energy Technology Data Exchange (ETDEWEB)

To describe the vertebral endplate and intervertebral disc space MRI appearance following TLIF, with and without the use of rhBMP-2, and to determine if the appearance is concerning for discitis/osteomyelitis. After institutional review board approval, 116 TLIF assessments performed on 75 patients with rhBMP-2 were retrospectively and independently reviewed by five radiologists and compared to 73 TLIF assessments performed on 45 patients without rhBMP-2. MRIs were evaluated for endplate signal, disc space enhancement, disc space fluid, and abnormal paraspinal soft tissue. Endplate edema-like signal was reported when T1-weighted hypointensity, T2-weighted hyperintensity, and endplate enhancement were present. Subjective concern for discitis/osteomyelitis on MRI was graded on a five-point scale. Generalized estimating equation binomial regression model analysis was performed with findings correlated with rhBMP-2 use, TLIF level, graft type, and days between TLIF and MRI. The rhBMP-2 group demonstrated endplate edema-like signal (OR 5.66; 95 % CI [1.58, 20.24], p = 0.008) and disc space enhancement (OR 2.40; 95 % CI [1.20, 4.80], p = 0.013) more often after adjusting for the TLIF level, graft type, and the number of days following TLIF. Both groups had a similar temporal distribution for endplate edema-like signal but disc space enhancement peaked earlier in the rhBMP-2 group. Disc space fluid was only present in the rhBMP-2 group. Neither group demonstrated abnormal paraspinal soft tissue and discitis/osteomyelitis was not considered likely in any patient. Endplate edema-like signal and disc space enhancement were significantly more frequent and disc space enhancement developed more rapidly following TLIF when rhBMP-2 was utilized. The concern for discitis/osteomyelitis was similar and minimal in both groups. (orig.)

Fox, Michael G.; Goldberg, Judd M.; Gaskin, Cree M.; Barr, Michelle S.; Alford, Bennett [University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Patrie, James T. [University of Virginia, Department of Public Health Sciences, Charlottesville, VA (United States); Shen, Francis H. [University of Virginia, Department of Orthopedic Surgery, Charlottesville, VA (United States)

2014-09-15

334

Lumbar Morphometry: A Study of Lumbar Vertebrae from a Pakistani Population Using Computed Tomography Scans  

Science.gov (United States)

Study Design A cross-sectional study. Purpose To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations. Overview of Literature Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population. Methods An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various dimensions were analyzed. Results Generally, the size of the vertebrae, vertebral canals and recesses were found to be greater in male patients. The difference was statistically significant for transverse and anteroposterior diameters of the vertebral bodies and sagittal diameter of pedicles on the left side (p<0.05). Comparison of populations revealed statistically significant differences in pedicle dimensions between Pakistani population and others. Conclusions This study provides anatomical knowledge of the lumbar region in a sample population of Pakistan. There were significant differences in various dimensions of lumbar vertebrae between female and male patients. This would prove to be critical for performing a safe operation. PMID:25187858

Alam, Muhammad M; Waqas, Muhammad; Shallwani, Hussain

2014-01-01

335

Effect of Laminectomy on Stability of Lumbar Spine Effect of Laminectomy on Stability of Lumbar Spine  

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Full Text Available The paper aims at the presentation of the lumbar spine finite element model used in a study of segmental kinematics including the tissue loading. Lumbar spine FE-model consisting of the three lumbar vertebras, two disc (including annulus and nucleus and vast variety of ligaments. The primary model objective is its verification by experimental test data obtained from cadaver spine segments. A confirmed model was used for a study of various range of laminectomy effect. On this model we simulate a various loading states witch can spine segment arrive at under physiologic conditions (compression, flexion, extension and lateral bending. FE-model could predict the laminectomy impact on the operation approach. The paper aims at the presentation of the lumbar spine finite element model used in a study of segmental kinematics including the tissue loading. Lumbar spine FE-model consisting of the three lumbar vertebras, two disc (including annulus and nucleus and vast variety of ligaments. The primary model objective is its verification by experimental test data obtained from cadaver spine segments. A confirmed model was used for a study of various range of laminectomy effect. On this model we simulate a various loading states witch can spine segment arrive at under physiologic conditions (compression, flexion, extension and lateral bending. FE-model could predict the laminectomy impact on the operation approach.

Petr Tichy

2009-12-01

336

Computer tomography assisted stereotactic percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

Authors presents experiences and results of prospective study of 54 patients operated by technique of computer tomography assisted stereotactic percutaneous lumbar discectomy. New stereotactic instrumentation for percutaneous discectomy is introduced, which was designed by authors. There were no significant per-operative complications in the study group and a good postoperative clinical outcome was achieved. (authors)

337

Iliac Arteriovenous Fistula Complicating Lumbar Laminectomy  

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An iliac arteriovenous fistula may rarely complicate lumbar laminectomy, particularly at the L4-L5 level. We present such a complication in a 45-year-old man who presented in our institution with a postlaminectomy iliac arteriovenous fistula and severe congestive heart failure. Repair of the fistulous orifice and tubular reconstruction of the iliac artery were successfully performed.

Chiariello, Luigi; Marino, Benedetto; Nigri, Antonio; Macrina, Francesco; Ruvolo, Giovanni; Sinatra, Riccardo

1983-01-01

338

Benign fibrous histiocytoma of the lumbar vertebrae  

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Benign fibrous histiocytoma is an extremely rare spinal tumor with ten reported cases in the literature. Benign fibrous histiocytoma constitutes a diagnostic challenge because it shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions involving the spine. We present a case of benign fibrous histiocytoma of the lumbar spine and discuss its differential diagnosis and management. (orig.)

Demiralp, Bahtiyar; Oguz, Erbil; Sehirlioglu, Ali [Gulhane Military Medical Academy, Department of Orthopedics and Traumatology, Ankara (Turkey); Kose, Ozkan [Diyarbakir Education and Research Hospital, Department of Orthopedics and Traumatology, Diyarbakir (Turkey); Ataslar Serhat Evleri, Diclekent Bulvari, Diyarbakir (Turkey); Sanal, Tuba [Gulhane Military Medical Academy, Department of Radiology, Ankara (Turkey); Ozcan, Ayhan [Gulhane Military Medical Academy, Department of Pathology, Ankara (Turkey)

2009-02-15

339

Functional examinations of the lumbar vertebral column  

International Nuclear Information System (INIS)

The article presents functional examination of the lumbar vertebral column via BV-TV-screening by means of fluorography in the terminal position. The methods of measurement are described. Examples are shown demonstrating a) different movements with different pathological findings and b) their importance in clinical therapy. (orig.)

340

Lumbar myelography with iohexol and metrizamide  

International Nuclear Information System (INIS)

Two non-ionic contrast media, iohexol and metrizamide, were compared in a double-blind clinical trial which included 50 patients who underwent lumbar myelography for disc herniation or spinal stenosis. The frequency of adverse reactions was lower for iohexol which is recommended for extended trials and for examination of other compartments of the subarachnoid space. (orig.)

 
 
 
 
341

Partial facetectomy for lumbar foraminal stenosis.  

Science.gov (United States)

Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Methods. Partial facetectomy was performed by removal of the medial portion of the superior facet in patients with lumbar foraminal stenosis. 47 patients underwent the procedure from 2001 to 2010. Those who demonstrated neurogenic claudication without spinal instability or central canal stenosis and failed conservative management were eligible for the procedure. Functional level was recorded for each patient. These patients were followed for an average of 3.9 years to evaluate outcomes. Results. 27 of 47 patients (57%) reported no back pain and no functional limitations. Eight of 47 patients (17%) reported moderate pain, but had no limitations. Six of 47 patients (13%) continued to experience degenerative symptoms. Five of 47 patients (11%) required additional surgery. Conclusions. Partial facetectomy is an effective means to decompress the lumbar nerve root foramen without causing spinal instability. PMID:25110591

Kang, Kevin; Rodriguez-Olaverri, Juan Carlos; Schwab, Frank; Hashem, Jenifer; Razi, Afshin; Farcy, Jean Pierre

2014-01-01

342

Physiological pattern of lumbar disc height  

International Nuclear Information System (INIS)

Purpose of this study is to present a new method of quantifying objectively the height of all discs in lateral radiographs of the lumbar spine and of analysing the normal craniocaudal sequence pattern of lumbar disc heights. Methods: The new parameter is the ventrally measured disc height corrected for the dependence on the angle of lordosis by normalisation to mean angles observed in the erect posture of healthy persons. To eliminate radiographic magnification, the corrected ventral height is related to the mean depth of the cranially adjoining vertebra. In this manner lumbar disc heights were objectively measured in young, mature and healthy persons (146 males and 65 females). The craniocaudal sequence pattern was analysed by mean values from all persons and by height differences of adjoining discs in each individual lumbar spine. Results: Mean normative values demonstrated an increase in disc height between L1/L2 and L4/L5 and a constant or decreasing disc height between L4/L5 and L5/S1. However, this 'physiological sequence of disc height in the statistical mean' was observed in only 36% of normal males and 55% of normal females. Conclusion: The radiological pattern of the 'physiological sequence of lumbar disc height' leads to a relevant portion of false positive pathological results especially at L4/L5. An increase of disc height from L4/L5 to L5/S1 may be normal. The recognition of decreased disc height should be based on an abrupt change in the heights of adjoon an abrupt change in the heights of adjoining discs and not on a deviation from a craniocaudal sequence pattern. (orig.)

343

Discitis pospunción lumbar en un niño  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish La infección del espacio intervertebral es causada generalmente después de intervenciones quirúrgicas a la columna vertebral y al espacio discal en particular, pero otras múltiples causas se han mencionado y dentro de ellas las punciones lumbares y cateterismos espinales. Se reporta el caso de un ni [...] ño de 8 años de edad que luego de una punción lumbar comenzó a quejarse de lumbalgia, limitación marcada para la marcha y priapismo. La tomografía axial computadorizada realizada de urgencia mostró signos evidentes de discitis con discreta osteomielitis de los cuerpos vertebrales adyacentes. La conducta terapéutica fue conservadora con administración de antimicrobianos de amplio espectro, se obtuvo una respuesta favorable a las 24 h. Tiene 2 años de seguimiento en consulta, se encuentra asintomático y sin signos radiológicos de inestabilidad lumbosacra. Abstract in english The infection of intervertebral space generally occurs after surgeries performed in the vertebral column and the disc space in particular; but many other causes have been mentioned such lumbar punctures and spinal catheterism. This paper presents the case of an 8-years old boy, who, after lumbar pun [...] cture, began complaining of lumbar pain, great difficulties when walking and priapism. Computed tomography showed evident signs of discitis, with discrete osmeolytis in adjacent vertebral bodies. Conservative therapy was applied in the form of administration of wide spectrum antimicrobials to which a positive response was obtained 24 hours later. The boy has been followed-up for two years, and he is asymptomatic, without radiological signs of lumbosacral instability.

Nelson, Fuentes Rodríguez; Armando, Felipe Morán; José A., Prince López.

2004-06-01

344

Discitis pospunción lumbar en un niño  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish La infección del espacio intervertebral es causada generalmente después de intervenciones quirúrgicas a la columna vertebral y al espacio discal en particular, pero otras múltiples causas se han mencionado y dentro de ellas las punciones lumbares y cateterismos espinales. Se reporta el caso de un ni [...] ño de 8 años de edad que luego de una punción lumbar comenzó a quejarse de lumbalgia, limitación marcada para la marcha y priapismo. La tomografía axial computadorizada realizada de urgencia mostró signos evidentes de discitis con discreta osteomielitis de los cuerpos vertebrales adyacentes. La conducta terapéutica fue conservadora con administración de antimicrobianos de amplio espectro, se obtuvo una respuesta favorable a las 24 h. Tiene 2 años de seguimiento en consulta, se encuentra asintomático y sin signos radiológicos de inestabilidad lumbosacra. Abstract in english The infection of intervertebral space generally occurs after surgeries performed in the vertebral column and the disc space in particular; but many other causes have been mentioned such lumbar punctures and spinal catheterism. This paper presents the case of an 8-years old boy, who, after lumbar pun [...] cture, began complaining of lumbar pain, great difficulties when walking and priapism. Computed tomography showed evident signs of discitis, with discrete osmeolytis in adjacent vertebral bodies. Conservative therapy was applied in the form of administration of wide spectrum antimicrobials to which a positive response was obtained 24 hours later. The boy has been followed-up for two years, and he is asymptomatic, without radiological signs of lumbosacral instability.

Nelson, Fuentes Rodríguez; Armando, Felipe Morán; José A., Prince López.

345

Microendoscopic discectomy for prolapsed lumbar intervertebral disc  

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Full Text Available Background: Lumbar disc prolapse is a common problem and the current surgical standard for its treatment is a microsurgical discectomy. Microendoscopic discectomy (MED is a minimally invasive spinal procedure being done successfully for prolapsed intervertebral disc disease. Aims: We report the technique, outcome and complications seen in 107 cases of prolapsed lumbar intervertebral disc who underwent MED. Setting and Design: The study was carried out at the Department of Neurosurgery, at a tertiary hospital in South India and the data was collected prospectively. Materials and Methods: 107 patients with prolapsed lumbar intervertebral disc who were seen at our institution between November 2002 and January 2006 were included in the study. Data was collected prospectively. The METRx system (Medtronic Sofamor Danek, Memphis,TN was used to perform MED. Outcome assessment was done by the modified Macnab criteria. Results: 107 patients (67 males, 40 females underwent MED for prolapsed lumbar intervertebral disc. Follow up ranged from 2 to 40 months with a mean follow up 12.9 months. Seventy six patients had an excellent outcome, 22 patients had a good outcome, 5 patients had a fair outcome and 3 patients had a poor outcome. One patient with a long dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Complications included dural puncture with K-wire (1, dural tear (2, superficial wound infection (1, discitis (1 and recurrent disc prolapse (2. Conclusions: Microendoscopic Discectomy (MED is a safe and effective procedure for the treatment of prolapsed lumbar intervertebral disc.

Ranjan Alok

2006-01-01

346

Proximal Conduction Time Along The Lumbar Plexus  

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Full Text Available Scientific Background: One of the matters in clinical neurophysiology is evaluation of the proximal conduction time along the lumbar plexus. Objectives: Instead of investigating only distal segment of the nerve from the groin as is generally done we aimed to investigate both proximal and distal parts of the nerves originating from the lumbar plexus.Material and Methods: In this paper different proximal conduction methods were studied in 109 healthy adult human subjects by measuring proximal motor conduction time of femoral, obturator and genitofemoral nerve along the lumbar plexus using both by using lumbar magnetic and peripheral electrical stimulation and by using the H-reflex methods in adductor and quadriceps muscle group. The anatomical parts of the study were applied on 20 human adult cadavers, dissecting femoral, obturator genitofemoral nerve and roots proximally.Results: The total distance from ligamentum inguinale to spinal level was 392.4±13.3mm in femoral nerve. The total distance was approximately 382.8±11.1mm in obturator nerve and the total distance was approximately 353.1±12.5 mm in genitofemoral nerve. With the H reflex method, using the distance obtained from the cadaver, femoral and obturator nerve proximal conduction velocity were determined to be 62.5±6.1 m/sec and 53.6±7.4 m/sec, respectively. Using lumbar magnetic stimulation and the peripheral electrical stimulation, proximal conduction velocities in femoral, obturator and genitofemoral nerves were determined to be 59.1±13.3m/sec, 52.7±14.9 and 58.7±0.8 m/sec, respectively.Conclusions: No statistical differences were found between the proximal conduction velocities elicited by both methods. Either approach is preferable to evaluate proximal conduction time.

Hilmi UYSAL

2012-03-01

347

Effects of facet tropism and disk degeneration on far lateral lumbar disk herniation. Comparison with posterolateral lumbar disk herniation  

International Nuclear Information System (INIS)

Differences in facet tropism and disk degeneration were investigated as key factors distinguishing the development of far lateral lumbar disk herniation from that of posterolateral lumbar disk herniation in 46 patients with far lateral lumbar disk herniation individually matched with 46 patients with posterolateral lumbar disk herniation. Preoperative standing body height, body weight, and body mass index were compared. Facet tropism was measured using computed tomography and disk degeneration was evaluated using magnetic resonance imaging. Mean body mass index showed a significant difference between patients with the far lateral and posterolateral lumbar disk herniation (24.9±2.7 vs. 23.7±2.3 kg/m2, p=0.04). However, no significant differences were found in standing body height and body weight, facet tropism, or disk degeneration between two groups. Neither facet tropism nor disk degeneration are involved in distinguishing the development of far lateral lumbar disk herniation from that of posterolateral lumbar disk herniation. (author)

348

Subsidence of stand-alone cervical cages in anterior interbody fusion: warning.  

Science.gov (United States)

Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. We retrospectively reviewed eight patients with cervical radiculopathy operated upon with anterior discectomy and fusion with a stand-alone titanium cervical cage. During surgery, only the cartilage portion of the end plate was removed and the cages were filled with autologous cancellous bone graft from the iliac crest. To assess possible subsidence or migration, three different radiographic measurements in the sagittal plane were taken for each case, postoperatively and at the latest follow-up. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Follow-up time was 12-18 months (average 15 months). Five of the nine fused levels had radiological signs of cage subsidence. No posterior or anterior migration was observed. However, subsidence did not correlate with clinical symptoms in four of the five patients. The remaining patient with signs of subsidence, whose neck pain and neurologic symptoms had regressed in the early postoperative course, suffered recurrence of radiculopathy 6 months after the surgery. Her symptoms were explained by the subsidence of the cage and the subsequent foraminal stenosis observed on the magnetic resonance imaging (MRI) scan. At 15 months' follow-up, her cage was broken. Our preliminary results, so far limited in number, represent a serious warning to the proponents of stand-alone cervical cages PMID:12827473

Gercek, Erol; Arlet, Vincent; Delisle, Josee; Marchesi, Dante

2003-10-01

349

Autologous clavicle bone graft for anterior cervical discectomy and fusion with titanium interbody cage.  

Science.gov (United States)

A variety of donor-site complications have been reported for anterior cervical discectomy and fusion (ACDF) using autologous iliac bone graft. To minimize such morbidities and to obtain optimal bony fusion at the ACDF surgery, a novel technique was used to harvest cancellous bone from the autologous clavicle instead of the popular iliac crest graft. After a routine cervical discectomy of the affected level, a 1.5-cm linear skin incision was made over the clavicle within 2.5 cm of the sternoclavicular joint on the medial one-third portion. This portion is known as an anatomically safe zone, with no subcutaneous distribution of the supraclavicular nerve. Then, cancellous bone was harvested through a small cortical window developed on the clavicle. Care was taken not to injure the subclavian major vessels and the lung below the clavicle. A box-type titanium cage was packed with the harvested cancellous bone and then inserted into the discectomy-treated space for cervical interbody fusion. From 2009 to 2013, 16 patients with cervical radiculopathy and/or myelopathy underwent single-level ACDF with this method. All but 1 patient experienced significant improvement of clinical symptoms after the surgery and showed radiographic evidence of solid bony fusion and spinal stabilization within 6 months. Further, no peri- and postoperative complications at the clavicular donor site were noted. The mean visual analog scale pain score (range 0 [no pain to 10 [maximum pain]) at 1 year after the surgery was 0.1, and 13 of 14 patients with data at 1-year follow-up were highly satisfied with their donor-site cosmetic outcome. The clavicle is a safe, reliable, and technically easy source of autologous bone graft that yields optimal fusion rates and patient satisfaction with ACDF surgery. PMID:25170654

Iwasaki, Koichi; Ikedo, Taichi; Hashikata, Hirokuni; Toda, Hiroki

2014-11-01

350

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement  

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Interbody fusion cages are small hollow implants that are inserted into the intervertebral space to restore physiological disc height and to allow bony fusion. They sometimes cause clinical complications due to instability, subsidence or dislocation. These are basic biomechanical parameters, which influence strongly the quality of a fusion device; however, only few data about these parameters are available. Therefore, the purpose of the present study was to investigate the primary stabilizing...

Wilke, H. -j; Kettler, A.; Claes, L.

2000-01-01

351

CT recognition of lateral lumbar disk herniation  

International Nuclear Information System (INIS)

Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

352

Oriental Medical Treatment of Lumbar Spinal Stenosis  

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Full Text Available Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins, or a combination of two or more of the above factors. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or other neurologic compromise causes distress. In one case, we administrated oriental medical treatment with acupuncture treatment and herb-medicine. Oriental medical treatment showed desirable effect on lumbar spinal stenosis.

Hae-Yeon Lee

2003-12-01

353

Mild procedure for lumbar decompression: a review.  

Science.gov (United States)

Lumbar spinal stenosis (LSS) is characterized by narrowing of the spinal canal with impingement of the spinal cord by surrounding tissues of bones. Current management options for LSS include rest, medications, physical therapy, epidural steroid injections, alternative medicine, and surgical decompression. Because each modality of treatment has its own set of limitations, there is a need for a safe, effective, and cost-saving treatment for LSS. mild is a minimally invasive procedure for treatment of degenerative LSS with ligamentum flavum hypertrophy through percutaneous decompression of the hypertrophic ligamentum flavum. The effect is debulking of tissue that is a contributor to lumbar canal narrowing with minimal trauma to surrounding tissue. This literature review presents a brief review of the pathophysiology, clinical presentation, and current treatment options for LSS and reviews the current literature regarding the efficacy, safety, and cost-effectiveness of the mild procedure. PMID:22726247

Chen, Hamilton; Kelling, Jonathan

2013-02-01

354

Progression of a lumbar disc extrusion.  

Science.gov (United States)

The patient was a 34-year-old woman who was referred to a physical therapist for a chief complaint of progressively worsening right buttock pain with paresthesias of the right posterior thigh and calf. Prior magnetic resonance imaging of the patient's lumbar spine revealed a large left paracentral disc extrusion at L5-S1. Following physical therapist intervention, the patient reported a new onset of left posterior thigh pain, with paresthesias of the dorsolateral aspect of the left foot. Repeat magnetic resonance imaging of the patient's lumbar spine revealed an increase in the size of the disc extrusion at L5-S1. J Orthop Sports Phys Ther 2014;44(11):910. doi:10.2519/jospt.2014.0413. PMID:25361862

Crowell, Michael S; Alitz, Curtis

2014-11-01

355

Clinical trial of iohexol in lumbar myelography  

International Nuclear Information System (INIS)

Iohexol containing 180 mg I/ml was used in 20 patients for lumbar myelography. By using an adequate volume up to a maximum of 15 ml, satisfactory films were obtained in all cases. Minor or moderate adverse effects occurred in 4 patients. There were no changes in vital signs or neurologic examination related to the examinations. No patient had difficulty with concentration, personality changes or seizures. Later encephalographies performed in all patients before and during 24 h after the iohexol injections, showed no seizure or abnormal activity or any significant change. Repeated lumbar puncture was performed in 9 patients 24 h after the injection of iohexol. One of these, a patient with symptoms due to disc prolapse, whose CSF was abnormal before the myelography, had a slightly increased cellular response. There was no significant change in any of the other patients. Iohexol is a very satisfactory contrast medium for myelography and compared favorably with other non-ionic contrast media. (Auth.)

356

Side effects after ambulatory lumbar iohexol myelography  

International Nuclear Information System (INIS)

Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography. (orig.)

357

Etiología, cronificación y tratamiento del dolor lumbar  

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Full Text Available El dolor lumbar es un problema que afecta en torno al 70-80 % de la población general en algún momento de su vida, de los que un 15 % aproximadamente tienen un origen claro, pero el resto, se considera inespecífico o inclasificable, siendo en estos casos donde el tratamiento convencional ha fracasado. En el origen de este dolor lumbar inespecífico se encuentran factores biológicos, psicológicos y sociales y factores como las conductas de dolor y otros procesos de aprendizaje que influyen en su proceso de cronificación. Es el mayor responsable de incapacidad y de absentismo laboral con el consiguiente elevado coste económico y deterioro en la calidad de vida de quienes lo padecen. Los tratamientos clínicos deben unificarse para aumentar su eficacia, evitar los procesos de cronificación y reducir los costes económicos.

M.\\u00AA Isabel Casado Morales

2008-01-01

358

The imaging of lumbar spinal stenosis review  

Energy Technology Data Exchange (ETDEWEB)

Lumbar spinal stenosis (LSS) is a relatively common condition of varied aetiology which results in chronic compression of the cauda equina. It becomes clinically relevant when giving rise to symptoms of neurogenic claudication or leg pain. Lumbar spinal stenosis can be classified based on anatomy or aetiology and the diagnosis in any single case should include a consideration of both the site and the cause. Plain radiography is of limited value. Myelography with erect lateral flexion/extension views will demonstrate the dynamic component of the stenosis which cannot be appreciated on plain computed tomography (CT) or magnetic resonance imaging (MRI). Therefore, in patients with a good history of symptomatic LSS, and a borderline stenosis on MRI, CT myelography is recommended as the definitive pre-operative imaging investigation. Saifuddin, A. (2000)

Saifuddin, A

2000-08-01

359

Recognition of lumbar disk herniation with NMR  

International Nuclear Information System (INIS)

Fifteen nuclear magnetic resonance (NMR) studies of 14 patients with herniated lumbar intervertebral disks were performed on the UCSF NMR imager. Computed tomographic (CT) scans done on a GE CT/T 8800 or comparable scanner were available at the time of NMR scan interpretation. Of the 16 posterior disk ruptures seen at CT, 12 were recognized on NMR. Diminished nucleus pulposus signal intensity was present in all ruptured disks. In one patient, NMR scans before and after chymopapain injection showed retraction of the protruding part of the disk and loss of signal intensity after chemonucleolysis. Postoperative fibrosis demonstrated by CT in one patient and at surgery in another showed intermediate to high signal intensity on NMR, easily distinguishing it from nearby thecal sac and disk. While CT remains the method of choice for evaluation of the patient with suspected lumbar disk rupture, the results of this study suggest that NMR may play a role in evaluating this common clinical problem

360

Laser-guided lumbar medial branch kryorhizotomy.  

Science.gov (United States)

The authors describe a modification of the medial branch kryorhizotomy technique for the treatment of lumbar facet joint syndrome using a fluoroscopy-based laser-guided method. A total of 32 patients suffering from lumbar facet joint syndrome confirmed by positive medial nerve block underwent conventional or laser-guided kryorhizotomy. The procedural time (20.6 +/- 1.0 vs 16.3 +/- 0.9 minutes, p 0.05). No difference in the outcome was observed between the 2 groups of patients (visual analog scale score 3.5 +/- 0.2 vs 3.3 +/- 0.3, p > 0.05). This improved minimally invasive surgical technique offers advantages to conventional fluoroscopy-based kryorhizotomy. PMID:20809727

Andres, Robert H; Graupner, Thilo; Bärlocher, Christian B; Augsburger, Arthur; Fandino, Javier

2010-09-01

 
 
 
 
361

Intradural herniation of lumbar intervertebral discs.  

Science.gov (United States)

A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression. PMID:741242

Hodge, C J; Binet, E F; Kieffer, S A

1978-12-01

362

Major vascular injury during lumbar laminectomy.  

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Major vascular injury during lumbar laminectomy is an extremely rare complication of one of the commonest surgical procedures performed in orthopaedic and neurosurgical units. Its occurrence may be associated with high morbidity and mortality, particularly if it is not diagnosed in the early stages. Early diagnosis and repair is associated with an improved prognosis in the long term. We illustrate these points with a description of two cases, and discuss the anatomical factors predisposing to...

Calder, I.; Ewah, B.

1996-01-01

363

Congenitally absent lumbar pedicle: a reappraisal  

International Nuclear Information System (INIS)

Three patients who had a diagnosis of congenitally absent lumbar pedicle underwent CT examination. Findings showed that each patient had an aberrant hypoplastic pedicle plus a retroisthmic defect in their ipsilateral lamina rather than an absent pedicle. Axial CT was the diagnostic modality of choice; reformated images were of little value. The differential diagnosis to be considered from the findings of plain film radiography includes pediculate thinning, neoplastic disease, neurofibroma, mesodermal dysplasia associated with neurofibromatosis, and vascular anomalies

364

Congenitally absent lumbar pedicle: a reappraisal  

Energy Technology Data Exchange (ETDEWEB)

Three patients who had a diagnosis of congenitally absent lumbar pedicle underwent CT examination. Findings showed that each patient had an aberrant hypoplastic pedicle plus a retroisthmic defect in their ipsilateral lamina rather than an absent pedicle. Axial CT was the diagnostic modality of choice; reformated images were of little value. The differential diagnosis to be considered from the findings of plain film radiography includes pediculate thinning, neoplastic disease, neurofibroma, mesodermal dysplasia associated with neurofibromatosis, and vascular anomalies.

Wortzman, G.; Steinhardt, M.I.

1984-09-01

365

Discographic visualisation of lumbar disc herniations  

International Nuclear Information System (INIS)

The myelographic diagnosis of lumbar disc herniations remains nuclear in about 5% of the cases. When the clinical examination does not allow clear localisation of the segmental level of the lesion and symptomatology is atypical, discography may be the only procedure providing further diagnostic information. Very lateral as well as ventral disc herniations can thus be cleary demonstrated. Knowledge of both typical and atypical findings is, however, required to avoid false negative results. (orig.)

366

Synovial chondromatosis in a lumbar apophyseal joint  

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A 31-year-old woman presented with painful swelling in the right paravertebral region that had been present for 2 years. Radiography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.) With 5 figs., 11 refs.

Burrafato, V.; Campanacci, D.A.; Capanna, R. [Department of Orthopedic Oncology, Centro Traumatologico Ortopedico, Florence (Italy); Franchi, A. [Institute of Pathology, University of Florence, Florence (Italy)

1998-07-01

367

Synovial chondromatosis in a lumbar apophyseal joint  

International Nuclear Information System (INIS)

A 31-year-old woman presented with painful swelling in the right paravertebral region that h[ been present for 2 years. R[iography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.)

368

Lumbar-Pelvic Range and Coordination During Lifting Tasks  

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Spine motion has been described to have two regions, a neutral zone where lumbar rotation can occur with little resistance and an elastic zone where structures such as ligaments, facet joints and intervertebral disks resist rotation. In vivo, the passive musculature can contribute to further limiting the functional neutral range of lumbar motion. Movement out of this functional neutral range could potentially put greater loads on these structures. In this study, the range of lumbar curvature ...

Maduri, A.; Pearson, B. L.; Wilson, S. E.

2008-01-01

369

Lumbar Incisional Hernia Repair After Iliac Crest Bone Graft  

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The iliac crest is a common donor site for autogenous bone grafts. Among the reported complications, lumbar hernias occur infrequently with a reported incidence of 5% to 9%. Surgical repair is advocated secondary to the risk of incarceration or strangulation. Computed tomography is the diagnostic study of choice. Various transabdominal, retroperitoneal, and laparoscopic approaches have been described for the repair of lumbar hernias. We describe a case of successful lumbar incisional hernia r...

Do, Michael V.; Richardson, William S.

2012-01-01

370

Myeloperoxidase Activities in Polymorphonuclear Leukocytes in Lumbar Disc Disease  

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Objectives: The exact pathogenesis of lumbar pain and radiculopathy is often poorly understood. Although nerve root entrapment resulting in mechanical pressure has been the most widely held concept to explain radiculopathy and lumbar pain, much of the recent research work increasingly supports an inflammatory reaction occurring in the lumbar intervertebral disc tissue. In this study, we aimed to show the role of Myeloperoxidase as an inflammatory marker and the correlation of inflammation wit...

S?enog?lu, Mehmet; Kurutas?, Ergul Belge; Altun, I?dris; Atli, Yalc??n; Naci?tarhan, Vedat

2009-01-01

371

X-Ray parameters of lumbar spine  

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Full Text Available Knowledge of anatomic spinal structures, especially its relation-ship to the functions performed, is necessary to form a correct diagnosis. The anatomical structure of the vertebrae varies de-pending on the level of the spinal segment. Normal anatomical parameters, derived from bone structures of the spine, are roughly determined by X-ray method.This paper presents the results of the survey radiography of the lumbar spine in a straight line and lateral projections in 30 individ-uals without pathology spine, aged 21-60 years with frequently observed lumbar spinal stenosis stenosis. Applying X-ray method there were studied shape, height, and the contours of the vertebral bodies and intervertebral disc in the front (interpedicular and sagittal planes; there were measured dimensions of the lumbar canal and foramen holes in the same planes. Using X-ray method can fully identify the bone parameters of vertebral column. How-ever, the informativity of the method depends on knowledge of radiologist about topographic anatomical features of spine.

Otabek Ablyazov

2012-05-01

372

Skin to posterior lumbar epidural space distance  

International Nuclear Information System (INIS)

To measure the clinically relevant skin to posterior lumbar epidural space distance in adult surgical patients and to correlate this distance with the patient physical factors to construct a model for the prediction of this distance using the correlation. The study was carried out in 100 patients divided into three groups, who were scheduled for different surgical procedures. Group-I consisted of female patients scheduled for lower segment caesarian section (L.S.C.S); group-II adult non-pregnant females undergoing elective surgery and group-III adult males undergoing different surgical procedures. Epidural anaesthesia was given, using loss of resistance (LOR) technique, and skin to posterior epidural space was measured. The mean skin to posterior lumbar epidural space distance was found to be 3.8 +- 0.5 cm in group-I, 3.76 +- 0.7 cm in group- II and 4.0 +- 0.5 cm in group-III. Skin to posterior epidural space distance correlates best with weight of the patient. Posterior lumbar skin to epidural space distance has been found to be less than what is normal in rest of the world. These results may be used as a guideline for performing successful epidural blocks in Pakistani population. A reliable model using patient physical factors to predict skin to posterior epidural space distance could not be constructed. (author)

373

Morphometric analysis of lumbar pedicles in degenerative lumbar scoliosis with a cobb angle ?30 degrees  

International Nuclear Information System (INIS)

The purpose of our study was to assess the asymmetry of lumbar pedicle morphology in degenerative lumbar scoliosis by analyzing the images obtained by multiplanar reconstruction computed tomography (MPR-CT). Eleven patients (88 pedicles) with a Cobb angle ?30 deg who underwent preoperative MPR-CT were the subjects of our study. The morphometric parameters of each pedicle inside the curves were measured. Transverse pedicle width and minimum pedicle diameter on the concave side were significantly smaller than on the convex side, and the axial angle on the concave side was significantly larger than on the convex side. These differences were most evident at L4. We speculated that these asymmetrical changes in the lumbar pedicles were attributable to the remodeling caused by axial load imbalance and the limited space available for pedicles on the concave side. Surgeons should keep these differences in mind and pay attention to screw size and direction when inserting pedicle screws on the concave side. (author)

374

Lumbar myelography in 79 dogs, using different puncture sites  

International Nuclear Information System (INIS)

Lumbar myelography was performed in 79 dogs either before spinal surgery or as part of an investigation of neurological disease. In small dogs the site of the puncture was between L1 and L5, avoiding the lumbosacral intumescence, whereas in large dogs the site was between T13 and L2. It was found that a lumbar puncture cranial to the lumbar intumescence was easier and caused no problems. The lumbar puncture was unsuccessful in three obese dogs. In 72 per cent of the cases the myelogram revealed a lesion, and the main cause of a non-diagnostic myelogram was epidural leakage

375

Lumbar and iliac artery aneurysms in Menkes' disease: endovascular cover stent treatment of the lumbar artery aneurysm  

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We report lumbar and iliac artery aneurysms in a 3-month-old boy with Menkes' disease. The iliac artery aneurysm thrombosed spontaneously, documented by follow-up colour Doppler sonography. The lumbar artery aneurysm was successfully treated using a cover stent. There was no filling of the lumbar artery aneurysm and no stenosis of the cover stent during the 9-month follow-up. (orig.)

Adaletli, Ibrahim; Omeroglu, Alp; Kurugoglu, Sebuh; Cantasdemir, Murat; Numan, Furuzan [Istanbul University, Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul (Turkey); Elicevik, Mehmet [Istanbul University, Department of Paediatric Surgery, Cerrahpasa Faculty of Medicine, Istanbul (Turkey)

2005-10-01

376

Tadpole system as new lumbar spinal instrumentation  

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Full Text Available Abstract Background There have been reports of serious complications associated with pedicle screw fixation, including nerve root injuries caused by accidental screw insertion. We have developed a new system of lumbar spinal instrumentation that we call Tadpole system®. The purposes of this report were to show the results of a biomechanical study and the short-term outcome of a clinical study, as well as to determine the usefulness of this system. Methods The Tadpole system® lumbar spinal fusion is a hook-and-rod system according to which the spine is stabilized using 2 sets of 2 spinous processes each that are held in place by 4 hooks tandemly connected to a rod. The biomechanical study was done using 5 human lumbar cadaveric spines, and the range of motion (ROM was examined in a non-treatment model, an injured model, a pedicle screw fixation model and a Tadpole system® model. For the short-term clinical study the Tadpole system® was used in 31 patients, and the factors analyzed were operation time, time required for spinal instrumentation, amount of intraoperative bleeding, postoperative improvement rate of the Japanese Orthopaedic Association (JOA score for lumbar spinal disorders, instrumentation failure, spinous process fracture, spinal fluid leakage, nerve root injury, postoperative infection, and bone fusion 2 years after the operation. Results The ROM in the Tadpole system® model was slightly bigger than that in the pedicle screw fixation model, but smaller than that in the normal control model. These biomechanical data indicated that the Tadpole system® provided fairly good stability. The mean operation time was 79 min, the mean time required for spinal instrumentation was 8 min, and the mean amount of intraoperative bleeding was 340 mL. The mean postoperative improvement rate of JOA score was 70.9 ± 24.8%. Instrumentation failure (dislocation of a hook occurred in one patient, and none of the patients developed spinous process fracture, spinal fluid leakage, nerve root injury, or postoperative infection. Two years after the operation, bone union was confirmed in 29 of the 31 patients (93.5%. Conclusion We conclude that this system is a useful, easy-to-use and safe spinal instrumentation technique for lumbar fusion surgery.

Akeda Koji

2008-09-01

377

Lumbar disk herniation surgery: outcome and predictors.  

Science.gov (United States)

Study Design?A retrospective cohort study. Objectives?To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods?We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results?Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion?Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire-Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power. PMID:25396104

Sedighi, Mahsa; Haghnegahdar, Ali

2014-12-01

378

A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females  

Science.gov (United States)

The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1–L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8°; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9–T10 and L1–L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy. PMID:20033740

Dar, Gali; Peleg, Smadar; Steinberg, Nili; Medlej, Bahaa; May, Hila; Abbas, Janan; Hershkovitz, Israel

2009-01-01

379

The Association of Presacral Nodules with Biomechanics of the Lumbar Region and Lumbar Discopaties in Patients with Low Back Pain  

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Full Text Available Objective: The aim of this study was to investigate the relationship between Copeman’s nodules, which are seen in the presacral region, and demographic features such as: age, gender, body mass index, number of pregnancies, and presence of lumbar disc lesions and biomechanics of the lumbar region.Materials and Methods: This trial included 58 inpatients (49 women, 9 men; mean age SD:40.7±11.7 years, range 21-67 years with low back pain. Standing lateral roentgenograms of lumbo-sacral region, ultrasonography of soft tissues and lumbar magnetic resonance imaging were performed in all patients. Sacral angle, lumbo-sacral angle and lumbar lordotic curve were evaluated using Cobb’s method in lumbo-sacral x-rays. Results: Significant correlations between Copeman’s nodules and body mass index, presence of lumbar discopathy, degrees of lumbar lordotic curve were found. However, age, gender, number of pregnancies, sacral and lumbosacral angle did not correlate with the presence of Copeman’s nodules. Conclusion: Copeman’s nodules may represent the alterations of the biomechanics of lumbo-sacral region and lumbar disc herniation due to weakness of abdominal muscles. Therefore, strengthening of abdominal muscles and correction of lumbar biomechanics in patients with nodules and low back pain are important in the management of lumbar lordosis. Turk J Phys Med Rehab 2010;56:18-20.

Öznur Öken

2010-03-01

380

Lumbar hernia - a case report and review of the literature  

International Nuclear Information System (INIS)

The authors present a case of lumbar hernia of inferior right space (Petit's triangle), classified as acquired hernia and diagnosed by clinical history and computed tomography. Lumbar hernia are quite rare. Authors have done a literature review of this disease. (author)

 
 
 
 
381

Iohexol versus metrizamide for lumbar myelography: double-blind trial  

International Nuclear Information System (INIS)

Lumbar myelography was performed in 50 patients; 25 received iohexol and 25 received metrizamide. The two media produced radiographs of equal quality. However, iohexol is stable in solution, while metrizamide is not. Further, markedly less morbidity resulted from iohexol. These features indicate that iohexol may be superior to metrizamide as a contrast agent for lumbar myelography

382

Unilateral lumbar facet joint hypertrophy causing nerve root irritation.  

Science.gov (United States)

We present four cases of massive unilateral lumbar facet joint hypertrophy in an otherwise morphologically normal spine. All presented with a combination of low back pain and symptoms of entrapment of a single lumbar nerve root. The abnormality is best visualised by CT scanning and the results of surgical decompression by partial undercutting facetectomy are favourable. PMID:3190129

Wilde, G P; Szypryt, E P; Mulholland, R C

1988-09-01

383

Lumbar Spinal Stenosis-Specific Symptom Scale  

Science.gov (United States)

Study Design. Cross-sectional study. Objectives. To test the validity and responsiveness of the lumbar spinal stenosis (LSS)–specific symptom scale (FLS-25 [Fukushima LSS Scale 25]). Summary of Background Data. The FLS-25, a self-administered questionnaire designed to comprehensively cover various symptoms of LSS, has been developed to address the need to measure symptoms specific to this disorder. Methods. One hundred sixty-seven patients with confirmed LSS who required conservative therapy were asked to complete a questionnaire including questions regarding walking capacity and the FLS-25. These patients also underwent a lumbar extension test and a walking stress test, which are stress tests designed to objectively evaluate LSS symptoms, to measure standing time, walking distance, and walking time. Relationship between the FLS-25 scores and these external standards was analyzed to evaluate the criterion validity of the FLS-25. The patients underwent the same evaluations after 8 weeks of conservative therapy. The relationship between changes from baseline to week 8 in FLS-25 scores and changes in the 3 external standards was analyzed to evaluate the responsiveness of the FLS-25. Results. The distribution of FLS-25 scores among patients was symmetric, and there were no ceiling or floor effects. FLS-25 scores increased as self-reported walking capacity decreased (P = 0.006). The mean standing time in the lumbar extension test was 165 (SD = 109) seconds, and FLS-25 scores increased as standing time decreased (P = 0.003). In the walking stress test, mean walking distance and mean walking time were 213 (SD = 154) m and 236 (SD = 114) seconds. FLS-25 scores increased as walking distance (P = 0.002) and walking time (P = 0.054) decreased. Changes from baseline to week 8 in FLS-25 scores correlated with changes in the stress test standing time (P = 0.014), walking distance (P evaluate therapeutic efficacy. Level of Evidence: 3

Wakita, Takafumi; Otani, Koji; Onishi, Yoshihiro; Fukuhara, Shunichi; Kikuchi, Shin-ichi; Konno, Shin-ichi

2014-01-01

384

Hernia discal lumbar: algunos aspectos del diagnóstico  

Directory of Open Access Journals (Sweden)

Full Text Available Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades más afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %; 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un año y solo 20 por menos de 6 meses, y en 86 pacientes (63,2 % en el momento del diagnóstico se comprobaron signos de compresión prolongada. La electromiografía ocupó el lugar cimero en cuanto a positividad de los estudios electrofisiológicos, 74,4 %. Se concluye que el diagnóstico de la enfermedad es tardío y condiciona alteraciones electrofisiológicas de compresión prolongada de mal pronóstico para la rehabilitación.A cross-sectional descriptive study of 133 patients diagnosed with lumbar disc herniation L4-L5 and L5-S1 to evaluate some aspects of the diagnosis. More than two thirds were males for an approximate ratio 3:1. The most affected age groups were 30-39 and 40-49 years in both sexes. The most frequent symptom was lumbar pain (64,7 %; 71 patients progressed with the symptoms for over a year, 42 patients kept symptoms from 6 to 12 months and only 20 kept symptoms for less than 6 months. At the time of diagnosis, signs of prolonged compression were conformed in 86 patients (63,2 %. Electromyography held the first place as far as positive electrophysiological studies are concerned (74,4 %. It was concluded that diagnosis of disease was late and determined electrophysiological alterations of prolonged compression that can not be solved with rehabilitation.

Rafael Rivero Torres

2004-06-01

385

CT features and clinical significance of lumbar articular facet syndrome  

International Nuclear Information System (INIS)

Objective: To discuss the CT features and its clinical significance of lumbar articular facet syndrome. Methods: Based on CT findings and clinical data of lumbar articular facet, 51 cases with lumbar articular facet syndrome and 11 normal young adults were analyzed and compared retrospectively. Results: The CT findings of lumbar articular facet syndrome were: (1)hyperostosis and hypertrophy of articular process; (2)the narrowing space of inter-articular facet; (3)vacuum sign in articular facet; (4)coarse and osteosclerosis of articular facet; (5)partial dislocation of articular facet; (6)calcification in peri-articular facet; (7)complications including disc bulge, discprotrusion, vacuum sign in disc, hypertrophy and calcification of ligamentum flavum. Conclusion: CT features of lumbar articular facet syndrome are multifarious, which should be analyzed in all respects. . (authors)

386

Hernia discal lumbar: algunos aspectos del diagnóstico  

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Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades más afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %); 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un añ...

Rafael Rivero Torres; Roger Álvarez Fiallo

2004-01-01

387

A novel computer algorithm allows for volumetric and cross-sectional area analysis of indirect decompression following transpsoas lumbar arthrodesis despite variations in MRI technique.  

Science.gov (United States)

Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry angle. While these images may be sufficient in conjunction with a physical exam to make surgical evaluations, we have found they are often incapable of being used for objective post-operative volumetric comparisons. In order to overcome this, we created a computer program that compensates for these variations in MRI technique. For this study, we examined patients who had undergone outside MRI pre-operatively and were deemed appropriate for a lateral retroperitoneal transpsoas lumbar interbody arthrodesis procedure. Volumetric analysis was performed on sagittal and axial T2-weighted pre- and post-operative MRI. The percentage change of central canal volume and foraminal area was calculated for each level. The authors identified five levels with MRI sufficient for volumetric analysis and eight levels (16 foramina) sufficient for foraminal cross-sectional analysis. Through use of our computer algorithm, average central canal volume and foraminal cross-sectional area was calculated to increase by 32.8% and 67.6% respectively following the procedure. These results are consistent with previous study findings and support the idea that restoration of the anterior column via a lateral approach can result in significant indirect decompression of the neural elements. Additionally, the novel algorithm created and used for this study suggests that it can achieve quick measurement and comparison of MRI studies despite variations in pre- and post-operative technique. PMID:24128766

Gates, Timothy A; Vasudevan, Ram R; Miller, Kai J; Stamatopoulou, Vasiliki; Mindea, Stefan A

2014-03-01

388

Cumulative occupational lumbar load and lumbar disc disease – results of a German multi-center case-control study (EPILIFT  

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Full Text Available Abstract Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg, patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females or symptomatic lumbar disc narrowing (145 males, 206 females were prospectively recruited. Population control subjects (453 males and 448 females were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR and 95% confidence intervals (CI were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males or psychosocial strain at work (in females, respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses. Results We found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease. Conclusion According to our study, cumulative physical workload is related to lumbar disc diseases among men and women.

Michaelis Martina

2009-05-01

389

Lumbar spine degenerative disease : effect on bone mineral density measurements in the lumbar spine and femoral neck  

Energy Technology Data Exchange (ETDEWEB)

To determine the effect of degenerative disease of the lumbar spine on bone mineral density in the lumbar spine and femoral neck. We reviewed radiographs and dual energy x-ray absorptiometry scans of the lumbar spine and hip in 305 Caucasian women with suspected osteoporosis. One hundred and eight-six patient remained after excluding women less than 40 years of age (n=18) and those with hip osteoarthritis, scoliosis, lumbar spine fractures, lumbar spinal instrumentation, hip arthroplasty, metabolic bone disease other than osteoporosis, or medications known to influence bone metabolism (n=101). On the basis of lumbar spine radiographs, those with absent/mild degenerative disease were assigned to the control group and those with moderate/severe degenerative disease to the degenerative group. Spine radiographs were evaluated for degenerative disease by two radiologists working independently; discrepant evaluations were resolved by consensus. Lumbar spine and femoral neck bone mineral density was compared between the two groups. Forty-five (24%) of 186 women were assigned to the degenerative group and 141 (76%) to the control group. IN the degenerative group, mean bone mineral density measured 1.075g/cm? in the spine and 0.788g/cm{sup 2} in the femoral neck, while for controls the corresponding figures were 0.989g/cm{sup 2} and 0.765g/cm{sup 2}. Adjusted for age, weight and height by means of analysis of variance, degenerative disease of the lumbar spine was a significant predictor of increased bone mineral density in the spine (p=0.0001) and femoral neck (p=0.0287). Our results indicate a positive relationship between degenerative disease of the lumbar spine and bone mineral density in the lumbar spine and femoral neck, and suggest that degenerative disease in that region, which leads to an intrinsic increase in bone mineral density in the femoral neck, may be a good negative predictor of osteoporotic hip fractures.

Juhng, Seon Kwan [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of); Koplyay, Peter; Jeffrey Carr, J.; Lenchik, Leon [Wake Forest Univ. School of Medicine, Winston-salem (United States)

2001-04-01

390

[Lumbar spondylodiscitis caused by Salmonella enteritidis].  

Science.gov (United States)

A 19-year-old boy developed paravertebral muscular pain in the lumbar region after an episode of extremely arduous sporting activity, with fever followed by meningism. The cerebrospinal fluid showed a reactive pleocytosis. Initially, no acute inflammatory changes were present on serum and blood analysis, although the erythrocyte sedimentation rate was moderately increased to 25/60 mm. Pyrexia of up to 38.5 degrees C developed 6 days after admission. Because Borrelia IgM and IgG titres were positive, the diagnosis was at first thought to be atypical borreliosis and the patient was treated with antibiotics. However, after a further episode of fever. Salmonella antibody titres, which had initially been normal, rose to 1: 3200 (Salmonella typhi O and H antigens) and 1: 12800 (Salmonella enteritidis, H antigen). At this stage, the erythrocyte sedimentation rate rose to 86/120 mm and the C-reactive protein to 77 mg/dl. The white cell count remained normal throughout. Blood cultures grew Salmonella enteritidis. Abnormalities on bone scintigraphy were confirmed by CT and MRI scans, showing spondylodiscitis of lumbar vertebrae 1 and 2 with limited osteolysis. The lesion resolved completely on 6 week's treatment with ciprofloxacin (200 mg twice a day intravenously) and conservative supportive treatment. Spondylodiscitis is an uncommon complication of salmonellosis and may occur long after the diarrhoea. Cross reactions with Borrelia flagellin antigens may lead to the wrong diagnosis being made. PMID:7924947

Schüler, A; Schaumann, D; Manns, M P; Koch, K M

1994-10-14

391

Foraminal injection for lateral lumbar disc herniation.  

Science.gov (United States)

Between 1986 and 1995, we treated with foraminal injection of local anaesthetic and steroids 30 patients with severe lumbar radiculopathy secondary to foraminal and extraforaminal disc herniation which had not resolved with rest and non-steroidal anti-inflammatory agents. They were assessed prospectively using standardised forms as well as the Low Back Outcome Score, and were reviewed at an average of 3.4 years (1 to 10) after injection by an independent observer (BKW). Relief of symptoms was obtained in 27 immediately after injection. Three subsequently relapsed, requiring operation, and two were lost to long-term follow-up. Thus 22 of the 28 patients available for long-term follow-up had considerable and sustained relief from their symptoms. Before the onset of symptoms 17 were in employment and, after injection, 13 resumed work, all but two in the same job. The average score before injection was 25 out of a possible 75 points. At follow-up, the overall average score was 54, and in those who had obtained relief of symptoms it had improved to a mean of 61. Based on these findings we recommend foraminal injection of local anaesthetic and steroids as the primary treatment for patients with severe radiculopathy secondary to foraminal or extraforaminal herniation of a lumbar disc. PMID:9331040

Weiner, B K; Fraser, R D

1997-09-01

392

MR imaging of lumbar disc disease  

International Nuclear Information System (INIS)

MR examination of 86 lumbar discs of surgically confirmed 42 patients were analysed retrospectively. Eighteen discs were bulging and 68 were herniation. Forty-eight herniations were protrusion type, 17 were extrusion and 3 were free fragment type. L4/5 discs were involved most frequently (35/86) and L5/S1 (27/86), L3/4 (15/86) and L2/3 (8/86) were involved. The signal intensity of adjacent vertebral bodies were hypointense on T1 and T2 weighted images in 18 cases and hypointense on T1 weighted image and hyperintense on T2 weighted image in 13 cases. Thirty-one diseased discs showed hypointensity on both T1 and T2 weighted images. MR imaging showed excellence in the diagnosis of disc rupture. Eight of 10 ruptured discs were confirmed surgically. MR diagnoses of forty-seven (87%) discs of surgically confirmed 54 discs were accord with operation findings. However, CT was superior to the diagnosis of facet joint hypertrophy and ligamentum flavum thickening. We concluded that MR could be a diagnostic imaging of choice in the evaluation of lumbar disc diseases

393

MR imaging assessment of lumbar fusion stability  

International Nuclear Information System (INIS)

Pain after lumbar fusion may result from a pseudoarthrosis. CT, which permits assessment of the anatomic integrity of the fusion, may fail to demonstrate functional segmental instability. The conventional spinal radiographs and the lumbar spinal CT scans were compared with the spinal MR studies of 33 patients who had undergone surgical spinal fusion. The MR studies were performed on a whole-body superconductive 0.35-T Diasonics MTS system (four patients) and a whole body superconductive 1.5-T GE Signa MR imager. Of the patients who had diagnoses of solid fusion, 16 of 19 demonstrated areas of high signal intensity on the more T1-weighted images. The signal intensity of these areas was either isointense or normal on the T2-weighted images. In ten of the 14 patients with segmental instability at the fusion site, subchondral vertebral bands of decreased signal intensity were demonstrated on T1-weighted images which increased on T2-weighted images. MR appears to be useful in patients with symptoms of fusion pseudoarthrosis in whom CT fails to demonstrate anatomic disruption

394

Repair of the spondylolysis in lumbar spine  

International Nuclear Information System (INIS)

The objective is to present the surgical experience in the repair of the spondylolysis in lumbar spine. Background: Spodylolysis is an important cause of low back pain in young adults and is responsible for high grade of incapacity. Classically, patients with surgical indications with Spondylolysis have been treated with vertebral arthrodesis arthrodesis, with the following functional lost of the intervened segment and biomechanical overload of the upper contiguous segment. There are not previous reports about repairing of lysis in national literature and international references in this technique are scarce. Materials and methods: Eight patients within 2002-2004 were operated, a direct repairing of the lyses by in situ, fusion and interfragmental osteosynthesis with AO 3.5 mm titanium cortical screws with autogenous bone grafts was achieved. The casuistic was analyzed depending on clinical presentation, consolidation, mobility and vitality of the disc in imaginology studies. Results: During the follow-up a firm fusion in all cases, mobility and vitality preservation of the L5-S1 intervertebral disc was detected. There was neither infection nor neurological deficit. Recommendations: Repairing of spondylolysis in lumbar column, in young symptomatic patients without or with mild lystesis (grade I) and without associated disc damage, is a safe surgical technique

395

Biomechanical response of the lumbar spine in dynamic compression.  

Science.gov (United States)

The purpose of this study was to investigate the biomechanical properties of the human lumbar spine subjected to dynamic compression. A series of six experiments using the lumbar spines from four human cadavers was performed. The first two tests utilized the entire lumbar spine while the remaining four tests used lumbar functional joints to separate the differences in stability. A high rate material testing machine was used to produce the dynamic compression at a displacement rate of 1 m/s. Custom mounting plates were developed to ensure proper anatomical position of the lumbar spine sections. Both tests with the whole lumbar spines resulted in compression fractures at T12 due to combined axial loads of 5009 N and 5911 N and bending moments of 237 Nm and 165 Nm respectively. These failures occurred as the spine behaved in first order buckling which resulted in concentrated loading and bending of the anterior aspects of the vertebral bodies. All tests with functional units resulted in endplate fractures and recorded substantially higher axial loads between 11,203 N and 13,065 N and substantially lower bending moments between 47 Nm and 88 Nm. The results indicate that the mechanical stability of the lumbar spine is critical component in relation to the tolerable compressive loads. PMID:16817654

Duma, Stefan M; Kemper, Andrew R; McNeely, David M; Brolinson, P Gunnar; Matsuoka, Fumio

2006-01-01

396

Myeloperoxidase Activities in Polymorphonuclear Leukocytes in Lumbar Disc Disease  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: The exact pathogenesis of lumbar pain and radiculopathy is often poorly understood. Although nerve root entrapment resulting in mechanical pressure has been the most widely held concept to explain radiculopathy and lumbar pain, much of the recent research work increasingly supports an inflammatory reaction occurring in the lumbar intervertebral disc tissue. In this study, we aimed to show the role of Myeloperoxidase as an inflammatory marker and the correlation of inflammation with lumbar radiculopathy.Methods: We evaluated 15 patients and 15 healthy controls of a similar age and sex distribution. Myeloperoxidase activities in polymorphonuclear leukocytes were measured spectrophotometrically by the method of O-dianisidine.Results: The mean Myeloperoxidase level was 440 U/mg protein in the patient group and 142 U/mg protein in the control group. The Myeloperoxidase levels of patients in the lumbar radiculopathy group were significantly higher than in the control group (p < 0.001.Conclusion: In this preliminary study, we had found increased Myeloperoxidase level in the lumbar disc patients with radiculopathy. The significantly high level of Myeloperoxidase might indicate a systemic inflammatory response to impingement of the nerve root caused by lumbar disc herniation. This led us to think that Myeloperoxidase might play a role in the activity status of the disease.

Mehmet ?ENO?LU

2009-09-01

397

Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients in the tranexamic acid group and nine in the control group because of postoperative anemia. Complications associated with the administration of tranexamic acid, e.g. renal failure, deep vein thrombosis or pulmonary embolism did not occur. Conclusions This study suggests a less blood loss when administering tranexamic acid in posterior lumbar spine surgery as demonstrated by the higher postoperative hemoglobin concentration and the less blood loss. But given the relatively small volume of blood loss in the patients of this study it is underpowered to show a difference in transfusion rates.

Endres Stefan

2011-11-01

398

Direction of the formation of anterior lumbar vertebral osteophytes  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration. Methods The direction of the formation of 14,250 pairs of anterior lumbar vertebral osteophytes across the adjacent intervertebral discs in 2,850 patients who were all over 60 years old was investigated. Anterior lumbar vertebral osteophytes were distributed into six groups based on the direction of extension of each pair of osteophytes across the intervertebral disc space. Results In L1–L2 and L2–L3, the number of patients classified into groups B (the pair of osteophytes extended in the direction of the adjacent disc and C (almost complete bone bridge formation by a pair of osteophytes across the intervertebral disc space was larger than that classified into group D (the pair of osteophytes extended in a direction away from the adjacent disc. In L3–L4, L4–L5 and L5-S1, the number of patients in group D was greater than that of patients belonging to groups B and C. Conclusion Our study showed that pairs of osteophytes frequently formed in the direction of the adjacent disc in the upper lumbar vertebrae (L1–L2 and L2–L3 and in the direction away from the adjacent disc in middle or lower lumbar vertebrae (L3–L4, L4–L5, and L5-S1.

Akeda Koji

2009-01-01

399

Termocoagulación facetaria lumbar: Experiencia en 252 pacientes Thermocoagulation of lumbar facet joints: Experience in 252 patients  

Directory of Open Access Journals (Sweden)

Full Text Available Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de resultados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor.Two hundred fifty two patients with diagnosis of lumbar facet joint pain underwent the surgical technique of percutaneous thermocoagulation of the facet joint. Our major aim was to relief pain in those patients. We assess the effectiveness of the technique, with 74.7% of surgical success, and we also describe different aspects such as: age, sex, causes and segmentary pain topography.

J. E. Martínez-Suárez

2005-10-01

400

Presentation of a Rare Case of Bilateral Lumbar Synovial Cysts  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose: To report a quite rare case of bilateral symptomatic synovial cysts of the lumbar spine. Surgical resection is usually the cure for this condition. Methods: A 65 year old female patient came to our department, complaining for severe lumbar and sciatic pain. MRI and CT were used to diagnose bilateral synovial cysts. Because of the intensity of symptoms, she was subjected to surgery. Laminectomy and cyst resection were performed. Results: The patient showed complete resolution of pain after the resection of the cysts. Conclusion: Although rare, bilateral synovial cysts may be the cause of severe lumbar pain. In cases of failure of conservative treatment, surgical resection offers good results.

Konstantinos Violaris

2012-04-01

 
 
 
 
401

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report  

International Nuclear Information System (INIS)

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

402

Diagnosis of lumbar disc herniation by computed tomography  

Energy Technology Data Exchange (ETDEWEB)

Plain computed tomography (CT) was performed in 93 patients suspected of having lumbar disc herniation. Its diagnostic value for the responsible height, position and degree of herniation was examined. CT findings for the responsible height and position of lumbar disc herniation coincided completely with laboratory and operative findings (100%), while those for the degree of protrusion coincided with operative findings in a lower rate (84%). In CT diagnosis for lumbar disc herniation, artifacts such as partial volume phenomenon, edge effect, and beam hardening, should be noted.

Hasegawa, Toru; Watanabe, Ryo; Yamano, Keiki; Noguchi, Koji; Namba, Yasuki; Hino, Yohei (Kawasaki Medical School, Kurashiki, Okayama (Japan))

1984-02-01

403

Diagnosis of lumbar disc herniation by computed tomography  

International Nuclear Information System (INIS)

Plain computed tomography (CT) was performed in 93 patients suspected of having lumbar disc herniation. Its diagnostic value for the responsible height, position and degree of herniation was examined. CT findings for the responsible height and position of lumbar disc herniation coincided completely with laboratory and operative findings (100%), while those for the degree of protrusion coincided with operative findings in a lower rate (84%). In CT diagnosis for lumbar disc herniation, artifacts such as partial volume phenomenon, edge effect, and beam hardening, should be noted. (Namekawa, K.)

404

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report  

Energy Technology Data Exchange (ETDEWEB)

Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

2009-12-15

405

Termocoagulación facetaria lumbar: Experiencia en 252 pacientes Thermocoagulation of lumbar facet joints: Experience in 252 patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de resultados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor.Two hundred fifty two patients with di...

Marti?nez-sua?rez, J. E.; Camblor, L.; Salva, S.; Jongh, W. A.

2005-01-01

406

Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

1479-14-01

407

Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

408

Short-term alendronate treatment does not maintain a residual effect on spinal fusion with interbody devices and bone graft after treatment withdrawal : an experimental study on spinal fusion in pigs  

DEFF Research Database (Denmark)

Whether alendronate treatment has a residual effect on bone ingrowth into porous biomaterial in humans or experimental animals after treatment withdrawal is still unknown. The purpose of this study was to investigate bone ingrowth into porous tantalum and carbon fiber interbody implants after discontinuing alendronate treatment in experimental spinal fusion in pigs.

Huang, Baoding; Zou, Xuenong

2013-01-01

409

Hernia discal lumbar: algunos aspectos del diagnóstico  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades m [...] ás afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %); 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un año y solo 20 por menos de 6 meses, y en 86 pacientes (63,2 %) en el momento del diagnóstico se comprobaron signos de compresión prolongada. La electromiografía ocupó el lugar cimero en cuanto a positividad de los estudios electrofisiológicos, 74,4 %. Se concluye que el diagnóstico de la enfermedad es tardío y condiciona alteraciones electrofisiológicas de compresión prolongada de mal pronóstico para la rehabilitación. Abstract in english A cross-sectional descriptive study of 133 patients diagnosed with lumbar disc herniation L4-L5 and L5-S1 to evaluate some aspects of the diagnosis. More than two thirds were males for an approximate ratio 3:1. The most affected age groups were 30-39 and 40-49 years in both sexes. The most frequent [...] symptom was lumbar pain (64,7 %); 71 patients progressed with the symptoms for over a year, 42 patients kept symptoms from 6 to 12 months and only 20 kept symptoms for less than 6 months. At the time of diagnosis, signs of prolonged compression were conformed in 86 patients (63,2 %). Electromyography held the first place as far as positive electrophysiological studies are concerned (74,4 %). It was concluded that diagnosis of disease was late and determined electrophysiological alterations of prolonged compression that can not be solved with rehabilitation.

Rafael, Rivero Torres; Roger, Álvarez Fiallo.

2004-06-01

410

Hernia discal lumbar: algunos aspectos del diagnóstico  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades m [...] ás afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %); 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un año y solo 20 por menos de 6 meses, y en 86 pacientes (63,2 %) en el momento del diagnóstico se comprobaron signos de compresión prolongada. La electromiografía ocupó el lugar cimero en cuanto a positividad de los estudios electrofisiológicos, 74,4 %. Se concluye que el diagnóstico de la enfermedad es tardío y condiciona alteraciones electrofisiológicas de compresión prolongada de mal pronóstico para la rehabilitación. Abstract in english A cross-sectional descriptive study of 133 patients diagnosed with lumbar disc herniation L4-L5 and L5-S1 to evaluate some aspects of the diagnosis. More than two thirds were males for an approximate ratio 3:1. The most affected age groups were 30-39 and 40-49 years in both sexes. The most frequent [...] symptom was lumbar pain (64,7 %); 71 patients progressed with the symptoms for over a year, 42 patients kept symptoms from 6 to 12 months and only 20 kept symptoms for less than 6 months. At the time of diagnosis, signs of prolonged compression were conformed in 86 patients (63,2 %). Electromyography held the first place as far as positive electrophysiological studies are concerned (74,4 %). It was concluded that diagnosis of disease was late and determined electrophysiological alterations of prolonged compression that can not be solved with rehabilitation.

Rafael, Rivero Torres; Roger, Álvarez Fiallo.

411

Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias / Spinal lumbar stenosis: An update  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging di [...] scs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.

Marcelo, Molina; Pablo, Wagner; Mauricio, Campos.

1488-14-01

412

Clinical investigation of lumbar spine MRI in lumbar canal stenosis (LCS)  

Energy Technology Data Exchange (ETDEWEB)

Studies were conducted to know the availability of MRI in the diagnosis of lumbar canal stenosis (LCS). Seventy six patients of advanced age with low back pain were chosen; half of the patients showed neurological manifestations in their lower extremities (LCScases) but the remaining half did not (low back pain (LBP) cases). All patients underwent MRI of the lumbar spine and abnormal imagings were analyzed. The results showed that the following changes could be demonstrated at a high frequency in the cases of LCS as compared with those in LBP; (I) morphological changes classified as either the Trefoil or the Deficit type in the spinal canal cross section, (II) protrusion and degeneration of the intervertebral disk, (III) brightness changes of endplate, and (IV) increasing thickness of the yellow ligament. Individual change did not always correspond to the extent of the neurological manifestation of LCS. However, patients of 92 percent showed the changes of both (II) and (III) in LCS cases. Therefore, lumbar spine MRI provides useful information in the diagnosis of LCS when the changes are considered with clinical signs of patients. (author)

Nobutani, Kazuo [Yamaguchi Univ., Ube (Japan). School of Medicine

2002-10-01

413

Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias / Spinal lumbar stenosis: An update  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging di [...] scs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.

Marcelo, Molina; Pablo, Wagner; Mauricio, Campos.

414

Clinical investigation of lumbar spine MRI in lumbar canal stenosis (LCS)  

International Nuclear Information System (INIS)

Studies were conducted to know the availability of MRI in the diagnosis of lumbar canal stenosis (LCS). Seventy six patients of advanced age with low back pain were chosen; half of the patients showed neurological manifestations in their lower extremities (LCScases) but the remaining half did not (low back pain (LBP) cases). All patients underwent MRI of the lumbar spine and abnormal imagings were analyzed. The results showed that the following changes could be demonstrated at a high frequency in the cases of LCS as compared with those in LBP; (I) morphological changes classified as either the Trefoil or the Deficit type in the spinal canal cross section, (II) protrusion and degeneration of the intervertebral disk, (III) brightness changes of endplate, and (IV) increasing thickness of the yellow ligament. Individual change did not always correspond to the extent of the neurological manifestation of LCS. However, patients of 92 percent showed the changes of both (II) and (III) in LCS cases. Therefore, lumbar spine MRI provides useful information in the diagnosis of LCS when the changes are considered with clinical signs of patients. (author)

415

Computed tomography after lumbar disc surgery  

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Computed tomography (CT) findings following lumbar disc surgery were analyzed in a series of 53 patients one week after surgery and in another series of 43 patients 6 months to 20 years (average 4.3 years) after surgery. In addition to changes caused by the surgical exposition (laminotomy or laminectomy, gas bubbles) a mass lesion was found on the posterior aspect of the disc in all cases. Hypodensity of the disc interspace as well as vacuolization were found in several cases. These changes were less in the patients examined late after surgery but the CT findings were never completely normal. Findings characteristic of recurrent prolapse included disc-like attenuation values within the mass and non-enhancement with contrast medium. Hypodensity of the disc interspace is associated with discitis but as a non-specific finding it is insufficient in itself for diagnosis of discitis.

Ilkko, E.; Laehde, S.; Koivukangas, J.; Jalovaara, P.

416

Computed tomography after lumbar disc surgery  

International Nuclear Information System (INIS)

Computed tomography (CT) findings following lumbar disc surgery were analyzed in a series of 53 patients one week after surgery and in another series of 43 patients 6 months to 20 years (average 4.3 years) after surgery. In addition to changes caused by the surgical exposition (laminotomy or laminectomy, gas bubbles) a mass lesion was found on the posterior aspect of the disc in all cases. Hypodensity of the disc interspace as well as vacuolization were found in several cases. These changes were less in the patients examined late after surgery but the CT findings were never completely normal. Findings characteristic of recurrent prolapse included disc-like attenuation values within the mass and non-enhancement with contrast medium. Hypodensity of the disc interspace is associated with discitis but as a non-specific finding it is insufficient in itself for diagnosis of discitis. (orig.)

417

Iohexol and metrizamide in lumbar myelography  

International Nuclear Information System (INIS)

In routine lumbar myelography carried out in 100 patients iohexol produced side effects in fewer patients, especially meningeal and cerebral, and among these a lower rate of headache, than did metrizamide. The overall frequency of afflicted patients (50% after iohexol and 72% after metrizamide) was high, mainly because of deliberate inclusion of patients with a high risk of side effects in the investigation. The side effects recorded up to six hours after the administration of the contrast medium were less frequent when using iohexol. If severe side effects are present at 24 hours or appear thereafter, as occurred in a few of the present patients after iohexol, surgical treatment or discharge of the patient is in some cases unnecessarily delayed. (orig./MG)

418

Hérnia discal lombar Lumbar disc herniation  

Directory of Open Access Journals (Sweden)

Full Text Available A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas. O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo.Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population, and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks. Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less, where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence in the long term.

Luis Roberto Vialle

2010-01-01

419

Hérnia discal lombar / Lumbar disc herniation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população) e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática [...] pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas). O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo. Abstract in english Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population), and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progress [...] ive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks). Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less), where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence in the long term.

Luis Roberto, Vialle; Emiliano Neves, Vialle; Juan Esteban Suárez, Henao; Gustavo, Giraldo.

420

[Latest treatment of lumbar canal stenosis].  

Science.gov (United States)

Lumbar canal stenosis (LCS) is a degenerative disease involving the lumbar vertebrae, discs, and ligamentum flavum that result in neurological deficit to some extent. The natural history of symptoms of LCS is highly important because they do not necessarily worsen with progressive degeneration. Therefore, a observation therapy is adopted for the treatment of this condition. Although invasive treatment is required for some patients, surgery cannot be performed solely on the basis of radiological findings and careful evaluation of neurological symptoms is necessary. In the event that spinal surgery is required, it is important to minimize degree of invasiveness; various devices and operative approaches and methods have been developed to this end. Our strategy for the surgical treatment of LCS involves microscopic decompression via a posterior approach. In our method, modified bilateral decompression via the splitting of the spinous process using an ultrasonic bone curette (SONOPET), and the results of this approach have been excellent. Our method is less invasive, facilitates the preservation of the paraspinal muscle, and represents a useful approach to posterior spinal elements. Our findings indicate that this method involves less muscle damage as compared to other methods. LCS should be differentiated from conditions other than those involving the spinal canal such as foraminal stenosis and far-out syndrome, piriformis syndrome, and tarsal tunnel syndrome. The incidence of these conditions is higher than appreciated and they present with neurological deficits similar to observed in LCS. Here, we report our criteria of operative indications for surger and the procedures that we developed for the treatment of LCS, based on a review of the available literature. PMID:19526832

Kim, Kyongsong; Isu, Toyohiko

2009-06-01

 
 
 
 
421

Usefulness of dynamic contrast enhanced lumbar spine MR imaging postoperative herniated lumbar disc  

International Nuclear Information System (INIS)

To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional dela