Full Text Available ... lumbar interbody fusion. And the approaches can be done open, as we’re doing today; mini-open; ... picture, the dotted lines outline what would be done with a posterior lumbar interbody fusion. And where ...
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- ...
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 broadcast, spine ...
Full Text Available ... next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate ... lumbar interbody fusion. Surgeons take bone off the spine to make more room for the spinal canal, ...
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 ...
Full Text Available ... pain, or classic sciatica, due to compression of one or more nerves in the spinal canal. Now, ... for sciatica due to a herniated disc. Now, one might as why we’re doing an interbody ...
Full Text Available ... interbody fusion and how we approach doing the discectomy and putting the cage in. What you see ... the disc and enter the disc for a discectomy. Now, once we start to do the discectomy— ...
The potential advantages of a mini-open transforaminal interbody fusion (TLIF) operation are reduced blood loss, shorter length of stay, and less soft-tissue trauma compared to the standard open technique. Prior reports from our group and others have demonstrated successful outcomes using MIS techniques in lumbar fusion surgery. In this 3D video, we demonstrate the key steps of the mini-open technique for a transforaminal lumbar interbody fusion using an expandable tubular retractor and contralateral percutaneous screw fixation for the treatment of a multiple recurrent disc herniation. The video demonstrates patient positioning, surgical opening with development of the Wiltse plane, placement of the tubular retractor, pedicle screw placement through both a percutaneous technique and a mini-open technique, decompression of the neural elements, graft insertion, and wound closure. The video can be found here: http://youtu.be/LYRU9lbBdNg. PMID:23829850
Amin, Beejal Y; Tu, Tsung-Hsi; Mummaneni, Praveen V
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 ...
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’ ...
Full Text Available ... arrow is the direction of the transforaminal interbody fusion and how we approach doing the discectomy and putting the cage in. What you see ... from the front, you can get a better discectomy, but you have to go ... to obtain a fusion. Now, this is another instrument called a chondrotome, ...
Full Text Available ... and do some interaction at the table. 00:13:32 TODD ALBERT, MD: So what is a TLIF? A TLIF is a transforaminal lumber interbody fusion. And here I’ve shown you a cartoon looking at the back of the spine. This is actually one level lower than we’re doing the TLIF ...
Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery. PMID:24002831
Mobbs, Ralph J; Loganathan, Aji; Yeung, Vivian; Rao, Prashanth J
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 ...
Full Text Available ... of your questions as possible. Today we’re performing a lumbar laminectomy for TLIF for spinal stenosis ... going to go through the thought process of performing the operation and then give you a few ...
Full Text Available ... Today we’re performing a lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going ... talk here, in terms of a laminectomy and TLIF for stenosis and scoliosis, which is what this ...
The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrod...
Cole, Chad D.; Mccall, Todd D.; Schmidt, Meic H.; Dailey, Andrew T.
Percutaneous techniques may be helpful to reduce approach-related morbidity of conventional open surgery. The aim of the study was to evaluate the feasibility and safety of mini-open posterior lumbar interbody fusion for instabilities and degenerative disc diseases. From May 2005 until October 2008, 20 patients affected by monosegmental instability and disc herniation underwent mini-open lumbar interbody fusion combined with percutaneous pedicle screw fixation of the lumbar spine. Clinical ou...
Logroscino, C. A.; Proietti, L.; Pola, E.; Scaramuzzo, L.; Tamburrelli, F. C.
This review will outline the history of spinal fusion. It will compare the different approaches currently in use for interbody fusion. A comparison of the techniques, including minimally invasive surgery and graft options will be included. Lumbar interbody fusion is a commonly performed surgical procedure for a variety of spinal disorders, especially degenerative disease. Currently this procedure is performed using anterior, lateral, transforaminal and posterior approaches. Minimally invasive techniques have been increasing in popularity in recent years. A posterior approach is frequently used and has good fusion rates and low complication rates but is limited by the thecal and nerve root retraction. The transforaminal interbody fusion avoids some of these complications and is therefore preferable in some situations, especially revision surgery. An anterior approach avoids the spinal cord and cauda equina all together, but has issues with visceral exposure complications. Lateral lumbar interbody fusion has a risk of lumbar plexus injury with dissection through the psoas muscle. Studies show less intraoperative blood loss for minimally invasive techniques, but there is no long-term data. Iliac crest is the gold standard for bone graft, although adjuncts such as bone morphogenetic proteins are being used more frequently, despite their controversial history. More high-level studies are needed to make generalisations regarding the outcomes of one technique compared with another. PMID:25439753
Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H
The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47–72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-colu...
Guo, Shuguang; Sun, Junying; Tang, Genlin
Full Text Available SciELO South Africa | Language: English Abstract in english AIM: To assess the complications and outcome of patients who underwent transforaminal lumbar interbody fusion (TLIF) with an interbody cage. METHODS: Fifty-two consecutive patients were reviewed retrospectively. Clinical and radiological data were collected and analysed. Thirty-three female and 19 m [...] ale patients underwent the procedure with a mean age of 45.7 years (12-76 years). Eight cases were revision surgery. The primary pathology was a lytic listhesis in 20 patients, degenerative disc disease in 17, adjacent segment disease following a previous fusion in eight, degenerative listhesis in four, a congenital abnormality (L5 hemivertebrae and segmentation failure L2-4) in two, and a neuromuscular scoliosis in one patient. The mean blood loss was 610 ml and mean operative time 170 minutes. Mean stay in ICU or high care was 1 day, and mean hospital stay was 7.8 days. All patients operated since 2005 were evaluated pre- and post-op using the following scoring systems: EQ 5D, Visual Analogue Scale (VAS), Roland Morris scale and Oswestry Disability Index (ODI). RESULTS: There were no intra-operative complications. One patient developed a cauda equina syndrome 48 hours postoperatively when he was mobilised. This resolved completely following evacuation of the haematoma. In one case there was instrumentation failure with a rod screw disarticulation which led to failure of the posterior construct. There were statistically significant improvements in all clinical scores except the EQ 5D. Fusion could be assessed in 47 patients. Anterior interbody fusion was achieved in 95.3% of cases and posterior lateral fusion was achieved in 83.7%. CONCLUSION: Transforaminal lumbar interbody fusion is a safe and effective option to achieve circumferential fusion. It is technically challenging and the surgeon needs to be proficient in the technique to avoid catastrophic complications. Clinical scoring confirmed that our patients did benefit significantly in terms of pain and overall health status.
MJD, Jacobsohn; RN, Dunn.
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
Introduction We hypothesized that an Integrated Lumbar Interbody Fusion Device (PILLAR SA, Orthofix, Lewisville, TX) will function biomechanically similar to a traditional anterior interbody spacer (PILLAR AL, Orthofix, Lewisville, TX) plus posterior instrumentation (FIREBIRD, Orthofix, Lewisville, TX). Purpose of this study was to determine if an Integrated Interbody Fusion Device (PILLAR SA) can stabilize single motion segments as well as an anterior interbody spacer (PILLAR AL) + pedicle screw construct (FIREBIRD). Methods Eight cadaveric lumbar spines (age: 43.9±4.3 years) were used. Each specimen's range of motion was tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) under intact condition, after L4-L5 PILLAR SA with intervertebral screws and after L4-L5 360° fusion (PILLAR AL + Pedicle Screws and rods (FIREBIRD). Each specimen was tested in flexion (8Nm) and extension (6Nm) without preload (0 N) and under 400N of preload, in lateral bending (±6 Nm) and axial rotation (±5 Nm) without preload. Results Integrated fusion using the PILLAR SA device demonstrated statistically significant reductions in range of motion of the L4-L5 motion segment as compared to the intact condition for each test direction. PILLAR SA reduced ROM from 8.9±1.9 to 2.9±1.1° in FE with 400N follower preload (67.4%), 8.0±1.7 to 2.5±1.1° in LB, and 2.2±1.2 to 0.7±0.3° in AR. A comparison between the PILLAR SA integrated fusion device versus 360° fusion construct with spacer and bilateral pedicle screws was statistically significant in FE and LB. The 360° fusion yielded motion of 1.0±0.5° in FE, 1.0±0.8° in LB (p0.05). Conclusions The PILLAR SA resulted in motions of less than 3° in all modes of motion and was not as motion restricting as the traditional 360° using bilateral pedicle screws. The residual segmental motions compare very favorably with published biomechanical studies of other interbody integrated fusion devices. PMID:25694931
Voronov, Leonard I.; Vastardis, Georgios; Zelenakova, Julia; Carandang, Gerard; Havey, Robert M.; Waldorff, Erik I.; Zindrick, Michael R.
Full Text Available SciELO Brazil | Language: English Abstract in portuguese Artrodese lombar intersomática transforaminal (TLIF) é uma técnica relativamente nova de artrodese lombar intersomática via transforaminal posterior, indicada principalmente nos casos de doença discal degenerativa, espondilolistese (grau I e II) e reoperação para hérnia discal, especialmente quando [...] existe indicação para fusão intersomática e descompressão posterior. A maior vantagem do TLIF é que ele permite remoção completa do disco através do forame, descompressão do canal e neuroforame, com mínimo risco de lesão neural, uma vez que o acesso é lateral aos nervos. Em nosso estudo, descrevemos os primeiros 24 casos de TLIF que realizamos, que se mostrou como cirurgia segura e eficiente em nossa série, com alívio da dor em 83,3% dos pacientes, melhora na qualidade de vida em 75% dos casos e satisfação com a cirurgia em 79,1% dos pacientes. Abstract in english Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indica [...] tion for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. In this study, we describe the first 24 cases of TLIF that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.
Nicandro, Figueiredo; Johnny Wesley G., Martins; Alfredo A., Arruda; Alexandre R., Serra; Marco Antônio A., Figueiredo; Rodrigo C., Diniz; Alessandro A., Cavicchioli.
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
Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF. PMID:23743981
Chau, Anthony Minh Tien; Xu, Lileane Liang; Wong, Johnny Ho-Yin; Mobbs, Ralph Jasper
The aim of this study is to evaluate the therapeutic efficacy of patients with lumbar degeneration and instability treated with percutaneous pedicle screw fixation and minimally invasive lumbar interbody fusion. Twenty-one patients were selected in our hospital from November, 2012 to March, 2013. The patients with an average age 55.62 years, including 8 vertebral spondylolisthesis, 4 lumbar intervertebral disc herniation, and 9 lumbar spinal canal stenosis cases. All the patients were managed to take the lumbar MRI and radiographs. The comparison of preoperative and postoperative (3 days, 2 weeks, 3 months) VAS and ODI score were analyzed. The results indicated that VAS scores were 7.14 ± 0.79 before operation, and 5.19 ± 0.81 in 3 days after operation, 4 ± 0.84 after 2 weeks, and 2.67 ± 0.66 after 3 months. The pain was relieved, and the postoperative VAS score was lower than that before treatment (P pedicle screw fixation combined with minimally invasive interbody fusion is a safe, effective, feasible minimally invasive spine operation, with worthy for spreading. PMID:25550904
He, Er-Xing; Cui, Ji-Hao; Yin, Zhi-Xun; Li, Chuang; Tang, Cheng; He, Yi-Qian; Liu, Cheng-Wei
Bone morphogenetic protein (BMP) is commonly used as an ICBG substitute for transforaminal lumbar interbody spine fusion (TLIF). However, multiple recent reports have raised concerns regarding a substantial incidence of perioperative radiculopathy. Also, given the serious complications reported with anterior cervical BMP use, risks related to swelling and edema with TLIF need to be clarified. As TLIF related complications with rhBMP-2 have generally been reported in small series or isolated c...
Owens, Kirk; Glassman, Steven D.; Howard, Jennifer M.; Djurasovic, Mladen; Witten, Jonathan L.; Carreon, Leah Y.
Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiff...
Zhao, Jie; Hou, Tiesheng; Wang, Xinwei; Ma, Shengzhong
Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber–reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4–L5 and L5–S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5–S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability. PMID:24436878
Sardar, Zeeshan; Jarzem, Peter
Few reports have described the combined use of unilateral pedicle screw fixation and interbody fusion for lumbar stenosis. We retrospectively reviewed 79 patients with lumbar stenosis. The rationale and effectiveness of unilateral pedicle screw fixation were studied from biomechanical and clinical perspectives, aiming to reduce stiffness of the implant. All patients were operated with posterior interbody fusion using a diagonal cage in combination with unilateral transpedicular screw fixation and had reached the 3-year follow-up interval after operation. The mean operating time was 115 minutes (range=95-150 min) and the mean estimated blood loss was 150 mL (range=100-200 mL). The mean duration of hospital stay was 10 days (range=7-15 days). Clinical outcomes were assessed prior to surgery and reassessed at intervals using Denis' pain and work scales. Fusion status was determined from X-rays and CT scans. At the final follow-up, the clinical results were satisfactory and patients showed significantly improved scores (pmalpositioned or fractured hardware. Posterior interbody fusion using a diagonal cage with unilateral transpedicular fixation is an effective treatment for decompressive surgery for lumbar stenosis. PMID:21237659
Zhao, Jian; Zhang, Feng; Chen, Xiaoqing; Yao, Yu
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
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 dir...
Ma, Hardenbrook; Le, Miller; Je, Block
Retrospective radiographic analysis.To determine the fusion rate of stand-alone lateral lumbar interbody fusion (LLIF). Biomechanical studies have indicated that LLIF may be more stable than anterior or transforaminal lumbar interbody fusion. Early clinical reports of stand-alone LLIF have shown success in obtaining fusion and indirectly decompressing nerve roots. A consecutive case series of stand-alone LLIF was analyzed with chart and radiographic review. Non-union was determined by symptomatology consistent with non-union and absence of bridging bone on the CT scan. Thirty-nine levels of stand alone LLIF were performed in 23 patients. Eleven patients received 1-level surgery, 7 patients received 2-level surgery, 3 patients received 3-level surgery, and 1 patient received 4-level surgery. Excluding 1 infected case, we analyzed 37 levels of stand alone LLIF in 22 patients. Non-union incidence was 7 levels in 6 patients. Non-union rate was 7/37 (19%) per level and 6/22 (27%) per patient. While our study population was relatively low, a non-union rate of 19% to 27% is concerning for modern spine surgery. Currently in our practice, we occasionally still perform stand-alone LLIF utilizing 22 mm wide grafts in low-demand levels in non-smoking and non-osteoporotic patients. However, in a majority of patients, we provide supplemental fixation: bilateral pedicle screws in most patients and unilateral pedicle screws or spinous process plates in some patients. PMID:25546670
Watkins, Robert; Watkins, Robert; Hanna, Robert
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)
The use of biological technologies for the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. BMP strategies have gained wide support for an inherent potential to improve the ossification process. It has been extensively studied in combination with various techniques for spinal stabilisation from both anterior and posterior approach. We studied the fusion process after implantation of rhBMP-2 in 17 patients with degenerative lumbar spine disease...
Meisel, Hans Jo?rg; Schno?ring, Mark; Hohaus, Christian; Minkus, Yvonne; Beier, Andre; Ganey, Timothy; Mansmann, Ulrich
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
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
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.
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6 months after surgery, and once every 6 months thereafter. The mean follow-up was 26.6 months (range 18-36 months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12 months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease. PMID:24814852
Shen, Xiaolong; Zhang, Hailong; Gu, Xin; Gu, Guangfei; Zhou, Xu; He, Shisheng
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
Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks p...
Oh, Hyeong Seok; Lee, Sang-ho; Hong, Soon-woo
This biomechanical study was performed to test the primary segmental in vitro stabilising effect of a standard and large footprint radiolucent poly-ether-ether-ketone (PEEK) box cage versus a titanium box cage for anterior lumbar interbody fusion. Eighteen L2-L3 and sixteen L4-L5 cadaveric motion segments were divided into three groups and received a titanium cage or a radiolucent PEEK cage with standard or large footprint. All specimens were tested in three testing conditions: intact, stand-...
Spruit, M.; Falk, R. G.; Beckmann, L.; Steffen, T.; Castelein, R. M.
Background: Recurrent lumbar disk herniation (RLDH) is one of the major causes of failure of standard discectomy. The optimal treatment method for RLDH is controversial. In the current study, we aimed to compare the clinical and functional outcomes of treating RLDH with discectomy alone and discectomy associated with posterolateral interbody fusion (PLIF).Material and Methods: There were 41 patients with RLHD after primary discectomy in the current retrospective study. Patients were assigne...
Hossein Nayeb Aghayee; Shirzad Azhari; Farshad Heidarnejad
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
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.
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 (Psoft 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
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)
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.
Study Design/Objective. A single-centre, prospective, non-comparative study of 25 patients to evaluate the performance and safety of the Memory Metal Minimal Access Cage (MAC) in Lumbar Interbody Fusion. Summary of Background Data. Interbody fusion cages in general are designed to withstand high axial loads and in the meantime to allow ingrowth of new bone for bony fusion. In many cages the contact area with the endplate is rather large leaving a relatively small contact area for the bone gra...
Veldhuizen, A. G.; Wapstra, F. H.; Donk, R. D.; Kok, D.
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
PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. METHODS: Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. RESULTS: The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p
HØy, Kristian; Bünger, Cody
Bone morphogenetic protein (BMP) is commonly used as an ICBG substitute for transforaminal lumbar interbody spine fusion (TLIF). However, multiple recent reports have raised concerns regarding a substantial incidence of perioperative radiculopathy. Also, given the serious complications reported with anterior cervical BMP use, risks related to swelling and edema with TLIF need to be clarified. As TLIF related complications with rhBMP-2 have generally been reported in small series or isolated cases, without a clear denominator, actual complication rates are largely unknown. The purpose this study is to characterize perioperative complications and complication rates in a large consecutive series of TLIF procedures with rhBMP-2. We reviewed inpatient and outpatient medical records for a consecutive series of 204 patients [113 females, 91 males, mean age 49.3 (22-79) years] who underwent TLIF using rhBMP-2 between 2003 and 2007. Complications observed within a 3-month perioperative interval were categorized as to etiology and severity. Wound problems were delineated as wound infection, hematoma/seroma or persistent drainage/superficial dehiscence. Neurologic deficits and radiculopathies were analyzed to determine the presence of a clear etiology (screw misplacement) and identify any potential relationship to rhBMP-2 usage. Complications were observed in 47 of 204 patients (21.6%) during the 3-month perioperative period. Major complications occurred in 13 patients (6.4%) and minor complications in 34 patients (16.7%). New or more severe postoperative neurologic complaints were noted in 13 patients (6.4%), 6 of whom required additional surgery. These cases included one malpositioned pedicle screw and one epidural hematoma. In four patients (2.0%), localized seroma/hematoma in the area of the foramen caused neural compression, and required revision. In one additional patient, vertebral osteolysis caused foraminal narrowing and radiculopathy, but resolved without further surgery. Persistent radiculopathy without clear etiology on imaging studies was seen in six patients. Wound related problems were seen in six patients (2.9%), distributed as wound infection (3), hematoma/seroma (1) and persistent drainage/dehiscence (2). Overall, this study demonstrates a modest complication rate for TLIF using rhBMP-2. While perioperative complications which appeared specific to BMP usage were noted, they occurred infrequently. It will be necessary to weigh this incidence of complications against the complication rate associated with ICBG harvest and any differential benefit in obtaining a solid arthrodesis. PMID:20582554
Owens, Kirk; Glassman, Steven D; Howard, Jennifer M; Djurasovic, Mladen; Witten, Jonathan L; Carreon, Leah Y
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
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...
Chen Shih-Hao; Lin Shang-Chih; Tsai Wen-Chi; Wang Chih-Wei; Chao Shih-Heng
Background Ulf Fernström implanted stainless steel ball bearings following discectomy, or for painful disc disease, and termed this procedure disc arthroplasty. Today, spherical interbody spacers are clinically available, but there is a paucity of associated biomechanical testing. The primary objective of the current study was to evaluate the biomechanics of a spherical interbody implant. It was hypothesized that implantation of a spherical interbody implant, with combined subsidence into the vertebral bodies, would result in similar ranges of motion (RoM) and facet contact forces (FCFs) when compared with an intact condition. A secondary objective of this study was to determine the effect of using a polyetheretherketone (PEEK) versus a cobalt chrome (CoCr) implant on vertebral body strains. We hypothesized that the material selection would have a negligible effect on vertebral body strains since both materials have elastic moduli substantially greater than the annulus. Methods A finite element model of L3-L4 was created and validated by use of ROM, disc pressure, and bony strain from previously published data. Virtual implantation of a spherical interbody device was performed with 0, 2, and 4 mm of subsidence. The model was exercised in compression, flexion, extension, axial rotation, and lateral bending. The ROM, vertebral body effective (von Mises) strain, and FCFs were reported. Results Implantation of a PEEK implant resulted in slightly lower strain maxima when compared with a CoCr implant. For both materials, the peak strain experienced by the underlying bone was reduced with increasing subsidence. All levels of subsidence resulted in ROM and FCFs similar to the intact model. Conclusions The results suggest that a simple spherical implant design is able to maintain segmental ROM and provide minimal differences in FCFs. Large areas of von Mises strain maxima were generated in the bone adjacent to the implant regardless of whether the implant was PEEK or CoCr.
Rundell, Steven A.; Isaza, Jorge E.; Kurtz, Steven M.
This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4-L5 in 51 patients, L5-S1 in 19 patients, and L3-L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1 years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH. PMID:25443080
Li, Zhonghai; Tang, Jiaguang; Hou, Shuxun; Ren, Dongfeng; Li, Li; Lu, Xiang; Hou, Tiesheng
Intraspinal metallomas are rare. The authors present a case after implantation of two titanium threaded interbody cages at the L4L5 level, without posterior instrumentation. To their knowledge this is the first case due to intervertebral cages. The lack of additional instrumentation had probably allowed the cages to make contact. Subsequently, friction generated wear debris, which led to the formation of a granuloma, responsible for compression of the dural sac. Intraspinal metallosis should be kept in mind as an infrequent cause of delayed neurological symptoms after spinal surgery with metallic instrumentation. PMID:23409582
Fernández-Baíllo, Nicomedes; Sánchez Marquez, José Miguel; Conde Gallego, Esther; Martín Esteban, Ana
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
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.
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
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
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)or fusion surgery. (author)
Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL. Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis.
Miller Larry E
The posterior lateral line in zebrafish has emerged as an excellent system to study how a sensory organ system develops. Here we review recent studies that illustrate how interactions between multiple signaling pathways coordinate cell fate, morphogenesis and collective migration of cells in the posterior lateral line primordium. These studies also illustrate how the posterior lateral line system is contributing much more broadly to our understanding of mechanisms operating during the growth,...
Chitnis, Ajay B.; Nogare, Damian Dalle; Matsuda, Miho
Background As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). Methods We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. Results Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). Conclusions We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure. PMID:25729524
Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won
Objective The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model. Methods Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3–L4, L4–L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System. Results Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05). Conclusions Bilateral SMAH fixation can achieve immediate stability after L4–5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration. PMID:25474112
Wang, Xi; Xu, Jing; Zhu, Yuexing; Li, Jiukun; Zhou, Si; Tian, Shunliang; Xiang, Yucheng; Liu, Xingmo; Zheng, Ying; Pan, Tao
Full Text Available Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Trial Registration Clinical Trials NCT00810433
Lumbar spinal fusion is advancing with minimally invasive techniques, bone graft alternatives, and new implants. This has resulted in significant reductions of operative time, duration of hospitalization, and higher success in fusion rates. However, costs have increased as many new technologies are expensive. This study was carried out to investigate the clinical outcomes and fusion rates of a low implant load construct of unilateral pedicle screws and a translaminar screw in transforaminal l...
Sethi, Anil; Lee, Sandra; Vaidya, Rahul
Study Design Prospective longitudinal study. Purpose To determine if preoperative psychological status affects outcome in spinal surgery. Overview of Literature Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires. Methods Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive. Results Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery. Conclusions Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery. PMID:22977697
Lakkol, Sandesh; Budithi, Chakra; Bhatia, Chandra; Krishna, Manoj
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
This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups. PMID:25685795
Lee, Ji-Ho; Lee, Dong-Oh; Lee, Jae Hyup; Shim, Hee Jong
Background The purpose of this retrospective study was to evaluate the efficacy of soft stabilization with an artificial intervertebral ligament after microdecompression for the treatment of grade I degenerative spondylolisthesis. Methods From a total of 54 patients with degenerative spondylolisthesis who were treated surgically from May 2000 to April 2003, 36 patients who showed grade I spondylolisthesis without evidence of concomitant disc herniation necessitating discectomy were enrolled in the study. After decompression, the patients had undergone either soft stabilization with an artificial intervertebral ligament (n = 17) or instrumented posterior lumbar interbody fusion (PLIF; n = 19). Results The average follow-up period was 24 months for the PLIF group and 16 months for the soft stabilization group. In the PLIF group, preoperative mean scores of 60% on the Oswestry Disability Index, 8.8 on the visual analog scale (VAS) for low-back pain, and 9.3 on the VAS for leg pain improved to 28%, 4.1, and 2.6, respectively, after surgery. Corresponding scores in the soft stabilization group were 55%, 8.4, and 8.9, improving to 25%, 4.1, and 2.2 after surgery. There were no significant differences between the 2 groups in any of these clinical parameters. Patients’ subjective improvement rates and satisfaction with the surgical procedure were higher in the soft stabilization group, but the differences were not significant. Mean operation time and mean blood loss were significantly lower in the soft stabilization group than in the PLIF group. In the soft stabilization group, there were 3 cases of progression of slippage in patients who had had preoperative slippage of more than 20%; there was 1 dural tear in the PLIF group. Conclusions Patients with grade I degenerative spondylolisthesis who received soft stabilization with an artificial intervertebral ligament after microdecompression had clinical outcomes similar to those of patients who received PLIF. Since soft stabilization can be done in a much less invasive way than fusion, if slippage is 20% or less, soft stabilization with an artificial ligament is a viable alternative to fusion for patients who are elderly or who have significant comorbidities that make a prolonged operation inadvisable. Level of Evidence This study was a retrospective comparative study with a very limited population (level III evidence).
Lee, Sang-Ho; Park, Sun-Hee; Whang, Ji-Hee
Presacral retroperitoneal approach to axial lumbar interbody fusion: a new, minimally invasive technique at L5-S1: Clinical outcomes, complications, and fusion rates in 50 patients at 1-year follow-up
Background The presacral retroperitoneal approach to an axial lumbar interbody fusion (ALIF) is a percutaneous, minimally invasive technique for interbody fusion at L5-S1 that has not been extensively studied, particularly with respect to long-term outcomes. Objective The authors describe clinical and radiographic outcomes at 1-year follow-up for 50 consecutive patients who underwent the presacral ALIF. Methods Our patients included 24 males and 26 females who underwent the presacral ALIF procedure for interbody fusion at L5-S1. Indications included mechanical back pain and radiculopathy. Thirty-seven patients had disc degeneration at L5-S1, 7 had previously undergone a discectomy, and 6 had spondylolisthesis. A 2-level L4-S1 fusion was performed with a transforaminal lumbar interbody fusion at L4-5 in 15 patients. AxiaLIF was performed as a stand-alone procedure in 5 patients and supplemented with pedicle screws in 45 patients. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were evaluated and complications were tracked. Fusion was evaluated by an independent neuro-radiologist. Results At 1-year follow-up, VAS and ODI scores had significantly improved by 49% and 50%, respectively, versus preoperative scores. By high-resolution computer tomography (CT) scans, fusion was achieved in 44 (88%) patients, developing bone occurred in 5 (10%), and 1 (2%) patient had pseudoarthrosis. One patient suffered a major operative complication–a bowel perforation with a pre-sacral abscess that resolved with treatment. Conclusion Our initial 50 patients who underwent presacral ALIF showed clinical improvement and fusion rates comparable with other interbody fusion techniques; its safety was reflected by low complication rates. Its efficacy in future patients will continue to be monitored, and will be reported in a 2-year follow-up study of fusion.
Bohinski, Robert J.; Jain, Viral V.; Tobler, William D.
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
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
Minimally invasive lumbar interbody fusion (MILIF) offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD). Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study. Objective: To observe and document short-term recovery after minimally invasive interbody fusion for DLD. Materials and Methods: In a predefined 4-week analysis from this study, experienced surgeons (?30 MILIF surgeries pre-study) treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients’ short-term post-interventional recovery (primary objective) including back/leg pain (visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), health status (EQ-5D) and Patient satisfaction. Results: At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83%) and TLIF was the preferred approach (94.8%). For one-level (and two-level) procedures, surgery duration was 128 (182) min, fluoroscopy time 115 (154) sec, and blood-loss 164 (233) mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001) reduced back pain (VAS: 2.9 vs 6.2), leg pain (VAS: 2.5 vs 5.9), and disability (ODI: 34.5% vs 45.5%), and a significantly (P < 0.0001) improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9) 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported. Conclusions: For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to first ambulation, early recovery, high patient satisfaction and improved patient-reported outcomes) and low major perioperative morbidity at 4 weeks postoperatively. PMID:25811615
Pereira, Paulo; Buzek, David; Franke, Jörg; Senker, Wolfgang; Kosmala, Arkadiusz; Hubbe, Ulrich; Manson, Neil; Rosenberg, Wout; Assietti, Roberto; Martens, Frederic; Barbanti Brodano, Giovanni; Scheufler, Kai-Michael
A recent accumulation of surgical and radiological literature has helped spine surgeons to better understand the anatomy and establish surgical trajectories to the anterior L4-L5 disc space. However, the preoperative display of anatomic data in individual subjects in the three-dimensional (3-D) mode has rarely been attempted. The objective of this study was to acquire 3-D images of the abdominal great vessels pertinent to the L4-L5 anterior lumbar interbody fusion (ALIF), and to better define the radiological vascular anatomy. The 3-D images of 100 subjects with non-spinal diseases, generated from abdominal computed tomography angiography (CTA), were analyzed retrospectively. The anatomy of the great vessels pertinent to the L4-L5 ALIF procedure was investigated by measuring the level of the abdominal aorta (AA) bifurcation and that of the inferior vena cava (IVC) confluence in relation to the lumbar vertebral body. These two complexes were segmented into upper or lower parts, or disc level. The visibility of the middle sacral artery (MSA) and the left L4 lumbar artery on the 3-D images was also assessed. The AA bifurcation level was above L4 in 4, at L4 in 55, at L4-L5 in 23, and at L5 in 18 subjects. The IVC confluence level was at L4 in 17, at L4-L5 in 14, at L5 in 68 and below L5 in 1 subject. Levels of the bifurcation of the AA/IVC as combined data showed that the AA bifurcation was usually located 1 - 2 segments above the IVC confluence. The MSA and L4 segmental artery were identified in 79 and 83 subjects, respectively. The 3-D images of the abdominal great vessels together with the lumbar spinal column were reliably depicted. Anatomic data obtained from this study are in accordance with those obtained from conventional 2-D studies, and the 3-D images can serve as a versatile tool for preoperative evaluation for the ALIF candidates and can contribute to the reduction of surgical time and perioperative vascular complications. PMID:16015487
Inamasu, J; Kim, D H; Logan, L
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
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
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.
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.
Background: Although rare, minimally invasive spine techniques do have the risk of intraoperative device failure. Kirschner wire (K-wire) fractures during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have not been previously reported. This report focuses on the incidence of k-wire fractures following MI-TLIF and describes techniques to help avoid and treat these fractures when they occur. Methods: Inclusion criteria: (i) patients underwent 1, 2, or 3 level MI-TLIF over a 10-year period and (ii) had a k-wire fracture leading to a retained fragment. Exclusion criteria included: >10° coronal curves, significant sagittal malalignment, infection, and preoperative instrumentation failure. Results: Of 513 patients undergoing MI-TLIF, 6 (1.2%) sustained k-wire fracture (3 males, 3 females, mean age 43 ± 13 years). Complications included k-wire fracture alone (4 patients), cerebrospinal fluid (CSF) leak (1 patient), and both ileus and revision for hardware removal (1 patient). All six patients went home postoperatively. The mean follow-up duration was 27.7 ± 37.4 months. All retained k-wire fragments were located in the vertebral bodies at the tip of the pedicle screws; none breached the anterior cortex of the vertebral bodies. None of the k-wires migrated at final follow-up 7.8 years (93.7 months) postoperatively. Furthermore, no complications were attributed to retained k-wires. Conclusions: K-wire fractures during MI-TLIF are rare (incidence of 1.2%) and retained k-wire segments led to no postoperative complications (e.g. no migration). PMID:25593770
Scheer, Justin K.; Harvey, Michael J.; Dahdaleh, Nader S.; Smith, Zachary A.; Fessler, Richard G.
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
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.
Full Text Available ... ALBERT, MD: Andrew, can you go ahead and test those screws before he puts the rod in? 00:43:54 ANDREW WIGHT, MD: Sure. ... 16 JAMES S. HARROP, MD: Can I get another rod there, Ron? One more time. 00:45:29 TODD ALBERT, MD: Jim, after we test the screws, would you mind—we’ll go ...
Full Text Available ... you walk downhill or when a lady wears high heels or when they arch their back. That ... stenosis, it would certainly come back from the high degree of instability. And we see patients like ...
Full Text Available ... post-assessment survey at the end of the program 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: ...
Full Text Available ... series of special instruments called curettes, which are cups, sharp cups, that we scrape along the sides of the ... it down to feel it and feel the depth. Dr. Harrop, you’re very good at doing ...
Full Text Available ... lordosis from the deformity. Maybe you want to increase one click on that, David, the distractor, so ... would get rapidly worse, leading to a significant increase in back pain and probably, even if she ...
Full Text Available ... use a series of paddle-type dilators to twist open. In this patient, it’s incredibly important to ... see there’s a counter-torque piece while we twist it—and you hear the snap, it only ...
Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... brings the cells from the tissues and the blood to the area of the fusion and creates ...
Full Text Available ... be done open, as we’re doing today; mini-open; laparoscopically; minimally invasively; a standalone procedure in ... do this because, as you saw from the x-ray, she had a lot of collapse on the ...
Full Text Available ... anterior spacers, so technically this is an off-label use. However, it is in an anterior spacer, ... to use it; however, this is an off-label use of the bone morphogenic protein we’re ...
Full Text Available ... pain and disability, for a patient’s loss of function, not for severe weakness. Though we do operate— ... to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re ...
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 ...
Full Text Available ... lot of force on it, whereas in an osteoporotic patient, we often cannot. 00:25:21 JAMES S. ... the bone in the patient think—the patient’s body think that they’re had a spine fracture, ...
Full Text Available ... spinal arthritis. So the spine becomes sloppy, the tissues grow into the spinal canal and compress the ... skin incision and taken down all the soft tissue to bone, here we’re pointing out that’s ...
Full Text Available ... room for the spinal canal, free the nerve roots, and then fuse the surrounding vertebrae across the ... open up her spinal canal, decompress her nerve roots, or open them up, and this is going ...
Full Text Available ... happy with the fusion. Sometimes in a small percentage of patients, because it’s put in posteriorly, it ... the fusion—the rate of fusion is much higher when we put the bone graft in the ...
Full Text Available ... It looks like a little bit of a “C” from collapse of those disc spaces. Now, axial ... pain and disability, for a patient’s loss of function, not for severe weakness. Though we do operate— ...
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 ...
Full Text Available ... 00:45:12 ASSISTANT: Right L2. 00:45:16 JAMES S. HARROP, MD: Can I get another rod ... to be embedded starting tomorrow, I believe, November 16. It will be available at www.jeffersonhospital.org/ ...
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 ...
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 ...
Full Text Available ... of the fusion and creates bone. It’s very effective. However, the FDA has approved it for use ... thoughts about spinal surgery: it can be incredibly effective, but it’s also super important that patients who ...
Full Text Available ... correct for a TLIF, the TLIF in this paper, done by Hee and Castro, showed—looking and ... re using is unseating the bone from the top of the transverse process, or what’s called decortication. ...
Full Text Available ... root and then followed it out along its course to make sure it’s not compressed. 00:36: ... end up operating on have had a full course of nonoperative treatment. So the answer is you ...
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 ...
Full Text Available ... pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on ... to two weeks after that visit and begin physical therapy. And usually, I tell patients, after an ...
Full Text Available ... we use what’s called osteotomes, which are bone-cutting instruments, to take down this bone. And we ... sharp instrument—you’re going to see it cutting through the bone and then removing what we ...
Full Text Available ... They’re a critical portion—part of our team as well. Craig Matsumoto, who will help us ... to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re ...
Full Text Available ... as you see on your screen, pulses are present in patients with spinal stenosis and absent in ... marker, that’s where we start to do our work above. And you can see on the lateral ...
Full Text Available ... and squeezing and strangling you— this is the effect on the nerve roots. And here is a ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc ...
Full Text Available ... fusion, or a cage fusion, and it is important to understand a little bit about the biomechanics ... their bowel or bladder, and I guess it’s important for our watching audience to know that is ...
Full Text Available ... long does the patient have to wear a brace? We typically brace patients after this operation for six weeks. We hope to fix her well enough to brace her to restrict her activity a little bit. ...
Full Text Available ... with water. I’m sure everyone in our listening audience has heard—or watching audience has heard— ... MD: Good. I would like everyone in the listening audience to keep their fingers crossed while we ...
Full Text Available ... here is a major operation: it has a blood loss associated with it, it has a large dissection. ... shorter for patients with a TLIF, and the blood loss was less. In addition, having lower complication rates ...
Full Text Available ... what we call the threshold, the amount of voltage that we read in the lower extremity, we ... would take 6 to 7 hours, and there’s negatives associated with that. But it really—to answer ...
Full Text Available ... here you see these special angles—double and triple angle curettes—because we’re going in from ... by 40mm. It’s got a nice, sharp enough point that it will go down. You see it ...
Full Text Available ... the bone from the top of the transverse process, or what’s called decortication. Our goal here is to make the bone in the patient think—the patient’s 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 ...
Full Text Available ... many patients, this allows them to return to normal activities and an improved quality of life. You ... and crush the disc space, collapse it. The normal position of the spine is more with the ...
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 ...
Full Text Available ... L4. And depending on what we call the threshold, the amount of voltage that we read in ... just for the most slight distraction between maybe 3 and 4. You probably want to check those ...
Full Text Available ... see that facet coming off on the next clip after I’ve released it with the osteotome. ... of bleeding that occurs, and in this next clip, you’re going to see us controlling the ...
Full Text Available ... participate in the program by sending questions at any time; just click the MDirectAccess button on the ... viewers that you can submit a question at any time during the broadcast by clicking on the ...
Full Text Available ... down. And if you can just run the “Identification of the Anatomy” video now. Thank you. So ... we’re going to show you is the identification of the anatomy. After we’ve done that ...
Full Text Available ... is to block spinal extension. And there’s other devices like this where they’re put between the ... or limitation, in terms of surgical instrumentation or devices for spinal surgery?” 00:49:42 JAMES S. HARROP, ...
Full Text Available ... Andrew Wight and David Hannala, are assisting as well. I’m in the O.R. as well. I’ve stepped away from the table so ... re going to be putting screws there as well. We’ve already cannulated these pedicles, making holes ...
Full Text Available ... contains all the nerves in a sac of water, the cerebrospinal fluid, and each of those white lines with the ball on it shows where the nerves go out at each level. The circles are the pedicles, where we’re ...
Full Text Available ... some—what you’re doing? 00:22:17 JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ... of where you are here? 00:22:31 JAMES S. HARROP, MD: Here we are. We actually—skipping ...
Full Text Available ... this procedure minimally invasively and see—get the access and see the nerves in the way that we’re going to see them for decompression. There’s a number of different types of cages available for the spine and spacers ...
Full Text Available ... root coming down. You can see how it’s red and swollen. This is the dorsal root ganglion. ... get an electrical impulse through a catch to leads in the patient’s lower extremities at different muscles ...
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 ...
Full Text Available ... You can imagine if someone was grabbing your throat and squeezing and strangling you— this is the ... saw the bleeding when I was doing the cut. There’s a lot of bleeding that occurs, and ...
Full Text Available ... Stop-type procedure can be done as an outpatient in the appropriate patient, and they go home ... re happy to help, both the neurosurgical and orthopedic department works closely together on spinal problems and ...
Full Text Available ... keep going. Where you see, I’m looking right at the disc space and the neural elements from a very wide view. Good, thank you. Now, the next thing you have to do—because there’s many—you saw the bleeding when I was doing the cut. There’s a lot of bleeding that ...
... keep going. Where you see, I’m looking right at the disc space and the neural elements from a very wide view. Good, thank you. Now, the next thing you have to do—because there’s many—you saw the bleeding when I was doing the cut. There’s a lot of bleeding that ...
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 ...
Full Text Available ... they do get some leg pain. It usually responds to steroids, and it’s always self-limited, but ... analogous process to healing of a fracture, where cells will come into the area, blood cells, basic ...
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 ...
Full Text Available ... surrounding vertebrae across the disc space. For many patients, this allows them to return to normal activities ... table continuing to operate. We’ve prepared the patient by exposing them to this point, exposing their ...
Full Text Available ... end up getting—need to get that, a Branigan cage. The other thing to note as you’re ... that’s leftover from what we used in that cage, and we’re going to put it along the side to heal the fusion and, like, weld the spine together. So while ...
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. ...
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 ...
Full Text Available ... pain and develops sciatica is due to a disc herniation or very often is due to a disc herniation. This is something that we’re the most successful with surgery. With the appropriate diagnosis and failure of ... for sciatica due to a herniated disc. Now, one might as why we’re doing ...
Full Text Available ... see them placing the screws as well. 00:42:18 JAMES S. HARROP, MD: And I don’t ... nerve roots underneath in the thecal sac. 00:42:29 TODD ALBERT, MD: Yeah, that’s actually a ...
Full Text Available ... and walking, and it’s been refractory to medical therapies. She has the diagnosis called spinal stenosis, which is a narrowing of the spine, and she has degenerative scoliosis. And degenerative scoliosis is a curvature of the ...
Full Text Available ... and each of those white lines with the ball on it shows where the nerves go out at each level. The circles are the pedicles, where we’re going to put pedicle screws in. And the working zone shows you that ...
Full Text Available ... the plan for the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, and ... looking right at the disc space and the neural elements from a very wide view. Good, thank ...
Full Text Available ... the top of that picture you see the white, which is the canal, is wide open. And ... water, the cerebrospinal fluid, and each of those white lines with the ball on it shows where ...
Full Text Available ... just click the MDirectAccess button on the screen. Physicians may take a post-assessment survey at the ... when walking, and it has to be differentiated. Physicians who look at these patients have to differentiate ...
Full Text Available ... require a fusion because of her scoliosis and instability of her spine. So the plan for the ... certainly come back from the high degree of instability. And we see patients like this and it ...
Full Text Available ... Might want to also add that we did check x-rays before to make sure everything looked ... maybe 3 and 4. You probably want to check those real quick, also, those—So maybe you ...
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 ...
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 ...
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 ...
Full Text Available ... fusion. Surgeons take bone off the spine to make more room for the spinal canal, free the ... you see the spine looks overlapped. And this makes a challenge for placing the screws, which we’ ...
Full Text Available ... exact resection. This was a former patient of mine where we made this video, and we’ve ... 42:31 JAMES S. HARROP, MD: Sorry, that’s probably mine. 00:42:35 TODD ALBERT, MD: But what ...
Full Text Available ... the pedicles, where we’re going to put pedicle screws in. And the working zone shows you that ... Craig Matsumoto, who will help us monitor the pedicle screws. That helps us be safe in terms of ...
Full Text Available ... out to you to answer: “What is the benefit of putting the bone graft in the disc ... grafts as well. But the answer is the benefit is increased fusion rate, and it’s very good ...
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. ...
Full Text Available ... the laminectomy. In addition, we’re using a material called bone morphogenic protein. Now, I 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 ...
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 ...
Full Text Available ... hour with us and maybe learned something about spine surgery. I guess the thing to fin—the final ... it’s also super important that patients who have spine surgery have it for the appropriate indications and the ...
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 ...
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— ...
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, ...
Full Text Available ... patient is dependent 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 if a solid ...
Full Text Available ... actually—skipping around a little bit. What we did it—I’ll take you down to—this ... was completely compressed in the foramen. And we did our—we already did our discectomy here where ...
Full Text Available ... associate professor of neurosurgery. He’s at the table holding the instrument right now, and two of our ... see what the facet looks like we’re holding in the camera. And the cartoon of the ...
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 ...
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 ...
Full Text Available ... the procedure to you. I want to remind all the viewers that you can submit a question ... usually fine sitting and can ride a bike all day. Also very commonly, patients with spinal stenosis ...
Full Text Available ... the patient first. It’s a 67-year-old female who has significant back and leg pain, worse ... when walking, and it has to be differentiated. Physicians who look at these patients have to differentiate ...
Full Text Available ... prepare. It’s a very involved operation with multiple steps, and we’ve been attempting to prepare the ... going to show you some videos of the steps that we’ve taken to the operation, so ...
Full Text Available ... as well. We’ve done this TLIF approach earlier, and we’re going to show you that ... that comes along with distraction. If you remember earlier, I said we want to restore the patient’s ...
Full Text Available ... to resect, and this is one of the advantages of the TLIF: we resect a certain amount ... this case we will not, which is an advantage for the patient. It’s our number one complaint ...
Full Text Available ... have. Most things in spinal surgery, other than spinal cord compression in the neck or in the thoracic ... do here. If we were in the cervical spinal cord, we cannot touch it because we can paralyze ...
Full Text Available ... next clip, you’re going to see us controlling the bleeders. These are called epidural veins, which ... disc out, we need a series of special instruments called curettes, which are cups, sharp cups, that ...
Full Text Available ... processes. What they’re been show to be useful in is mild spinal stenosis. This spinal stenosis, ... back out so he can get a little light in here for a second. You can see ...
Full Text Available ... you can just run the “Identification of the Anatomy” video now. Thank you. So now the next ... to show you is the identification of the anatomy. After we’ve done that skin incision and ...
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— ...
Full Text Available ... as well. Craig Matsumoto, who will help us monitor the pedicle screws. That helps us be safe in terms of if the pedicle screw—to make sure the pedicle screw is in the bone. Jim’s putting the cage in now. It’s almost a two-step process. He’s putting—you can see the angle ...
Full Text Available ... approximately an hour. I want to introduce my co-surgeon, Dr. Harrop, associate professor of neurosurgery. He’s ... do the TLIF and do our laminectomy. In order to save a step, we started our laminectomy ...
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: ...
Full Text Available ... During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital ... this procedure minimally invasively and see—get the access and see the nerves in the way that ...
Full Text Available ... shows where the nerves go out at each level. The circles are the pedicles, where we’re going to put pedicle screws in. And the working zone shows you that is the transforaminal working ...
Full Text Available ... re going to go ahead and spread that open to make it easier. Have you trialed it yet, Jim? 00:23:54 JAMES S. HARROP, MD: We’re actually—we’re going to do that right now. 00:23:56 TODD J. ALBERT, MD: I would start with an 8 trial, Ron, and see if that won’t do ...
Full Text Available ... you look at this between the second and third dot up on the left side of the ... months after surgery, six months after surgery, a year after surgery, and then yearly after that. They’ ...
Full Text Available ... be treated with surgery. But most patients cannot continue to live: they can’t walk, they can’ ... hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...
Full Text Available ... to prop the spine open. So the surgical approach we decide for each patient is dependent on ... or junction degeneration. There is a plethora of approaches available to us: we can do it in ...
Full Text Available ... us controlling the bleeders. These are called epidural veins, which are around—which are around the dura, ... With a little foot pedal, we grab these veins and cauterize them. And when we do so, ...
Full Text Available ... re been show to be useful in is mild spinal stenosis. This spinal stenosis, in at least ... an X-Stop. They’ve been helped in mild to moderate stenosis, and the advantage of these ...
Full Text Available ... MD: Yeah, that’s actually a good picture. Somebody’s head’s in the way now. 00:42:31 JAMES S. ... left. 00:44:08 JAMES S. HARROP, MD: The head turner. 00:44:18 ASSISTANT: L3 on the ...
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 ...
Full Text Available ... strong recommendation. In this case, this is the conservative, not the aggressive, thing to do. The very ... medical education to both patients and the healthcare community. 01:01:05 [END OF BROADCAST
Full Text Available ... well. We’ve already cannulated these pedicles, making holes in them and markers, which you’ll see ... spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. HARROP, MD: Here’s the ...
Full Text Available ... patient is dependent on their diagnosis, but the results, the potential complications which we have to go ... report by Dr. Lowe in 2002 showing good results with a TLIF, and this is just to ...
Full Text Available ... the pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first ... heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s pushing ...
Full Text Available ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ... the surgery: our spine fellows and all the media crew that was here. They did a great ...
Full Text Available ... really a surgical diagnosis. Most Americans, 80 to 90%, will suffer episodes of low back pain in ... And generally, patients can do great. 80% to 90% of patients do great throughout their lives, but ...
Full Text Available ... we’ll be using her loc—what’s called local bone and bone morphogenic protein. I was also ... bone—Ron’s going to mix some of the local bone with—make fajitas, Ron? And you’ve ...
Full Text Available ... model showing you the “NR” is the nerve roots. And again, you can see where the nerve goes out under the pedicle, “P.” The “G” is the ganglion; that’s the nerve center where nerves come in and go out to your legs and give power to your legs. The blue square you see on the left is the area, ...
Full Text Available ... hour, but we’ve been trying to prepare. It’s a very involved operation with multiple steps, and ... has. So let’s talk about the patient first. It’s a 67-year-old female who has significant ...
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 ...
Full Text Available ... the spine looks overlapped. And this makes a challenge for placing the screws, which we’ve already ... to neutralize it, and this will make a challenge to both open it up and to be ...
Full Text Available ... we go off air. This is just some data, and important, when people say, “Why do you ... 54 TODD ALBERT, MD: Yeah, that makes a big difference for that exiting nerve root. And you’ ...
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 ...
We report a case of thrombotic occlusion of the left common iliac artery during an L5-S1 anterior interbody fusion exposed via a retroperitoneal approach. The loss of distal blood flow was detected by loss of cortical and peripheral somatosensory evoked potentials on the left lower extremity. Restoration of the blood flow resulted in gradual return of evoked potentials of the involved extremity. The neurophysiological and pulse oximetry monitoring of the lower extremities are extremely sensitive for an early detection of thrombotic occlusions and vascular complications. PMID:19694209
Haghighi, S S; Zhang, R; Raiszadeh, R; Chammas, J; Bench, G; Raiszadeh, K; Terramanis, T T
Autogenous iliac crest has long served as the gold standard for anterior lumbar arthrodesis although added morbidity results from the bone graft harvest. Therefore, femoral ring allograft, or cages, have been used to decrease the morbidity of iliac crest bone harvesting. More recently, an experimental study in the animal showed that harvesting local bone from the anterior vertebral body and replacing the void by a radio-opaque ?-tricalcium phosphate plug was a valid concept. However, such a ...
Arlet, Vincent; Jiang, Liang; Steffen, Thomas; Ouellet, Jean; Reindl, Rudy; Aebi, Max
Abstract Background Development of the posterior lateral line (PLL) system in zebrafish involves cell migration, proliferation and differentiation of mechanosensory cells. The PLL forms when cranial placodal cells delaminate and become a coherent, migratory primordium that traverses the length of the fish to form this sensory system. As it migrates, the primordium deposits groups of cells called neuromasts, the specialized organs that contain the mechanosensory hair cells. Therefore the primo...
Villablanca Eduardo J; Elkahloun Abdel; Behra Martine; Liang Jin; Gallardo Viviana E; Russo Vincenzo; Allende Miguel L; Burgess Shawn M
Collective migration of adherent cohorts of cells is a common and crucial phemomenon during embryonic development and adult tissue homeostasis. The zebrafish posterior lateral line primordium has emerged as a powerful in vivo model to study collective migration due to its relative simplicity and accessibility. While it has become clear that chemokine signaling is the primary guidance system responsible for directing the primordium along its migratory path it is not clear what mechanisms downs...
Aman, Andy; Piotrowski, Tatjana
The development of functional neural circuits requires that connections between neurons be established in a precise manner. The mechanisms by which complex nervous systems perform this daunting task remain largely unknown. In the posterior lateral line of larval zebrafish, each afferent neuron forms synaptic contacts with hair cells of a common hair-bundle polarity. We investigated whether afferent neurons distinguish hair-cell polarities by analyzing differences in the synaptic signaling bet...
Nagiel, Aaron; Patel, Suchit H.; Andor-ardo?, Daniel; Hudspeth, A. J.
Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis / Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto
Full Text Available SciELO Brazil | Language: English Abstract in portuguese O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espon [...] dilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida. Abstract in english The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted t [...] o surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.
Fernando Luiz Rolemberg, Dantas; Mirto Nelso, Prandini; Mauro A.T., Ferreira.
Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto
Full Text Available The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF. Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF, and 47.6 for Group II (PLIF. The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.
Fernando Luiz Rolemberg Dantas
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
Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period. PMID:24848500
Fischer, Uwe M; Davies, Mark G; Sayed, Hosam El
Full Text Available ... disruptive procedure for spine surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform the ... as XLIF. A better term would be extreme lateral interbody fusion. This is a procedure that has ...
Biphasic calcium phosphate (BCP) has been investigated extensively as a bone substitute nowadays. However, the bone formation capacity of BCP is limited owing to lack of osteoinduction. Silk fibroin (SF) has a structure similar to type I collagen, and could be developed to a microsphere for the sustained-release of rhBMP-2. In our previous report, bioactivity of BCP could be enhanced by rhBMP-2/SF microsphere (containing 0.5 µg rhBMP-2) in vitro. However, the bone regeneration performance of the composite in vivo was not investigated. Thus, the purpose of this study was to evaluate the efficacy of BCP/rhBMP-2/SF in a sheep lumbar fusion model. A BCP and rhBMP-2/SF microsphere was developed, and then was integrated into a BCP/rhBMP-2/SF composite. BCP, BCP/rhBMP-2 and BCP/rhBMP-2/SF were implanted randomly into the disc spaces of 30 sheep at the levels of L1/2, L3/4 and L5/6. After sacrificed, the fusion segments were evaluated by manual palpation, CT scan, biomechanical testing and histology at 3 and 6 months, respectively. The composite demonstrated a burst-release of rhBMP-2 (39.1 ± 2.8 %) on the initial 4 days and a sustained-release (accumulative 81.3 ± 4.9 %) for more than 28 days. The fusion rates, semi-quantitative CT scores, fusion stiffness in bending in all directions and histologic scores of BCP/rhBMP-2/SF were significantly greater than BCP and BCP/rhBMP-2 at each time point, respectively (P < 0.05). These findings indicate that the SF microspheres containing a very low dose of rhBMP-2 improve fusion in sheep using BCP constructs. PMID:25690620
Chen, Liang; Liu, Hai-Long; Gu, Yong; Feng, Yu; Yang, Hui-Lin
Canonical Wnt signaling plays crucial roles during development and disease. How Wnt signaling is modulated in different in vivo contexts is currently not well understood. Here, we investigate the modulation of Wnt signaling in the posterior lateral line primordium (pLLP), a cohort of ~100 cells that collectively migrate along the trunk of the zebrafish embryo. The pLLP comprises proliferative progenitor cells and organized epithelial cells that will form the mechanosensory organs of the posterior lateral line. Wnt signaling is active in the leading progenitor zone of the pLLP and restricted from the trailing zone through expression of the secreted Wnt inhibitors dkk1b and dkk2. We have identified a zebrafish strain, krm1(nl10), which carries a mutation in the kremen1 gene, a non-obligate co-receptor for the Dkk family of proteins. Previous studies have shown that Kremen1 inhibits Wnt signaling by facilitating internalization of the Kremen1-Dkk-Lrp5/6 complex. Surprisingly, we found that disruption of Kremen1 in the pLLP exhibited molecular and cellular phenotypes associated with a decrease rather than overactivation of Wnt signaling. Transplantation of wild-type cells into the mutant primordia failed to rescue the krm1(nl10) phenotype, thus revealing that the effects of Kremen1 loss are non-cell-autonomous. Finally, ectopic expression of Dkk1b-mTangerine protein revealed larger spread of the fusion protein in the mutant primordia compared with the wild type. Based on our data, we propose a novel mechanism in which Kremen1 modulates Wnt activity by restricting the range of secreted Dkk proteins during collective cell migration in the pLLP. PMID:25038040
McGraw, Hillary F; Culbertson, Maya D; Nechiporuk, Alex V
Purpose/Objective: The ability to treat the brain to greater doses is limited by normal brain tissue tolerance. With the use of 3-dimensional treatment planning dose escalation will result in increased target dose while sparing normal tissue. Treatment of the supratentorial region of the brain presents several unique difficulties due to the changing contour of the calvarium, which are especially noticeable with treatment to the posterior lateral quadrant. The use of a single wedge beam is sub-optimal and a more appropriate solution would employ a two tier wedge arrangement to better conform the isodoses around the target volume. In the past it has only been possible to use a single wedge during treatment with a single port, however, the dynamic wedge presents the opportunity to employ a two tier wedge system by simultaneously using conventional and dynamic wedging. Methods and Materials: An anthropomorphic phantom with a lesion located in the posterior lateral aspect of the brain where the external surface slopes at a maximum was configured. CT generated contours outlined the external surface, normal anatomy, gross tumor, and target volumes. We used the beam's-eye-view projection from the 3D planning system to derive the conformal beams. A standard opposed lateral and posterior oblique wedge pair beam arrangements, were compared to a three field technique (PA, lateral, and vertex) which used both a single wedge arrangement and a two-tier wedge plan. Treatment plans we a two-tier wedge plan. Treatment plans were evaluated by calculating isodose distribution, DVH, TCP, and NTCP. Each beam arrangement was used to treat our phantom with film placed in between the phantom layers at the tumor levels to confirm the accuracy of the 3-D system calculations. Results: The three field, two-tier wedge technique isodose distribution was significantly superior when compared to the standard 2-D plans, and a moderate improvement over the three field, single wedge technique in terms of conforming dose to the tumor and percentage of normal brain tissue spared, when 60.0 Gy covers 100% of the target volume. The percentage of normal brain receiving greater than 45.0 Gy was; 31% for the opposed laterals; 32% for the posterior wedge pair, 19% for the three field, single tier wedge; and 15% for the three field two tier wedge plan. The film dosimetry confirmed the isodose distributions for all beam arrangements to within 5%. Conclusions: Treatment of a posterior or posterior-lateral supratentorial brain lesion present a unique problem in terms of radiation therapy treatment planning due to the rapidly changing contours of the calvarium, resulting in diverging concave anatomical surfaces contained within a single beam port. The use of a multiple field, two tier wedge beam arrangement offers the unique ability to tightly conform the dose in areas of rapidly changing external surfaces while sparing normal tissues
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 (PLL), comprises the neuromasts on the body and tail and has its ganglion just posterior to the otic vesicle. The peripheral location of the PLL system makes it accessible and easily visualized by imaging methods. 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. Positively charged lipophilic carbocyanine dyes, such as DiI, have traditionally been used to label neurons, as described here. This method is especially useful for the analysis of PLL innervation because injection of the dye into a neuromast leads to specific labeling of the afferent neurons. The method can also be used to follow the flow of PLL information to higher central nervous system levels by first labeling the central projection of chosen afferent neurons and then making a second injection of DiI within the synaptic field to label the second-order neurons that extend dendrites to this field. PMID:24298035
Schuster, Kevin; Ghysen, Alain
Full Text Available Abstract Background Development of the posterior lateral line (PLL system in zebrafish involves cell migration, proliferation and differentiation of mechanosensory cells. The PLL forms when cranial placodal cells delaminate and become a coherent, migratory primordium that traverses the length of the fish to form this sensory system. As it migrates, the primordium deposits groups of cells called neuromasts, the specialized organs that contain the mechanosensory hair cells. Therefore the primordium provides both a model for studying collective directional cell migration and the differentiation of sensory cells from multipotent progenitor cells. Results Through the combined use of transgenic fish, Fluorescence Activated Cell Sorting and microarray analysis we identified a repertoire of key genes expressed in the migrating primordium and in differentiated neuromasts. We validated the specific expression in the primordium of a subset of the identified sequences by quantitative RT-PCR, and by in situ hybridization. We also show that interfering with the function of two genes, f11r and cd9b, defects in primordium migration are induced. Finally, pathway construction revealed functional relationships among the genes enriched in the migrating cell population. Conclusions Our results demonstrate that this is a robust approach to globally analyze tissue-specific expression and we predict that many of the genes identified in this study will show critical functions in developmental events involving collective cell migration and possibly in pathological situations such as tumor metastasis.
Villablanca Eduardo J
Full Text Available Abstract Background Mechanosensory information gathered by hair cells of the fish lateral-line system is collected by sensory neurons and sent to the ipsilateral hindbrain. The information is then conveyed to other brain structures through a second-order projection. In the adult, part of the second-order projection extends to the contralateral hindbrain, while another part connects to a midbrain structure, the torus semicircularis. Results In this paper we examine the second-order projection from the posterior lateral-line system in late embryonic/early larval zebrafish. At four days after fertilization the synaptic field of the sensory neurons can be accurately targeted, allowing a very reproducible labeling of second-order neurons. We show that second-order projections are highly stereotyped, that they vary according to rhombomeric identity, and that they are almost completely lateralized. We also show that the projections extend not only to the contralateral hindbrain and torus semicircularis but to many other brain centers as well, including gaze- and posture-controlling nuclei in the midbrain, and presumptive thalamic nuclei. Conclusion We propose that the extensive connectivity observed in early brain development reveals a basic scaffold common to most vertebrates, from which different subsets are later reinforced in various vertebrate groups. The large repertoire of projection targets provides a promising system to study the genetic encoding of this differential projection capacity.
Collective migration of cells in the zebrafish posterior lateral line primordium (PLLp) along a path defined by Cxcl12a expression depends on Cxcr4b receptors in leading cells and on Cxcr7b in trailing cells. Cxcr7b-mediated degradation of Cxcl12a by trailing cells generates a local gradient of Cxcl12a that guides PLLp migration. Agent-based computer models were built to explore how a polarized response to Cxcl12a, mediated by Cxcr4b in leading cells and prevented by Cxcr7b in trailing cells, determines unidirectional migration of the PLLp. These chemokine signaling-based models effectively recapitulate many behaviors of the PLLp and provide potential explanations for the characteristic behaviors that emerge when the PLLp is severed by laser to generate leading and trailing fragments. As predicted by our models, the bilateral stretching of the leading fragment is lost when chemokine signaling is blocked in the PLLp. However, movement of the trailing fragment toward the leading cells, which was also thought to be chemokine dependent, persists. This suggested that a chemokine-independent mechanism, not accounted for in our models, is responsible for this behavior. Further investigation of trailing cell behavior shows that their movement toward leading cells depends on FGF signaling and it can be re-oriented by exogenous FGF sources. Together, our observations reveal the simple yet elegant manner in which leading and trailing cells coordinate migration; while leading cells steer PLLp migration by following chemokine cues, cells further back play follow-the-leader as they migrate toward FGFs produced by leading cells. PMID:25063456
Dalle Nogare, Damian; Somers, Katherine; Rao, Swetha; Matsuda, Miho; Reichman-Fried, Michal; Raz, Erez; Chitnis, Ajay B
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 usin...
Rhiew, Richard B.; Sunil Manjila; Lozen, Andrew M.; David Hong; et al.
The proper wiring of the vertebrate brain represents an extraordinary developmental challenge, requiring billions of neurons to select their appropriate synaptic targets. In view of this complexity, simple vertebrate systems provide necessary models for understanding how synaptic specificity arises. The posterior lateral-line organ of larval zebrafish consists of polarized hair cells organized in discrete clusters known as neuromasts. Here we show that each afferent neuron of the posterior la...
Nagiel, Aaron; Andor-ardo?, Daniel; Hudspeth, A. J.
The posterior lateral line primordium (PLLp) migrates caudally and periodically deposits neuromasts. Coupled, but mutually inhibitory, Wnt-FGF signaling systems regulate proto-neuromast formation in the PLLp: FGF ligands expressed in response to Wnt signaling activate FGF receptors and initiate proto-neuromast formation. FGF receptor signaling, in turn, inhibits Wnt signaling. However, mechanisms that determine periodic neuromast formation and deposition in the PLLp remain poorly understood. ...
Matsuda, Miho; Nogare, Damian Dalle; Somers, Katherine; Martin, Kathleen; Wang, Chongmin; Chitnis, Ajay B.
The primordium that generates the embryonic posterior lateral line of zebrafish migrates from the head to the tip of the tail along a trail of SDF1-producing cells. This migration critically depends on the presence of the SDF1 receptor CXCR4 in the leading region of the primordium and on the presence of a second SDF1 receptor, CXCR7, in the trailing region of the primordium. Here we show that inactivation of the estrogen receptor ESR1 results in ectopic expression of cxcr4b throughout the pri...
Gamba, Laurent; Cubedo, Nicolas; Ghysen, Alain; Lutfalla, Georges; Dambly-chaudie?re, Christine
Injuries of the meniscus roots are increasingly recognized as a serious knee joint pathology. An avulsion fracture of the meniscus root is a rare variant of this injury pattern. In this article, a case of a traumatic simultaneous avulsion fracture of both the posterior medial and posterior lateral meniscus root associated with a tear of the anterior cruciate ligament is presented. Both avulsion fractures were treated by indirect arthroscopic transtibial pullout fixation of the bony fragment. Based on the findings of our literature review, root avulsion fractures seem to be more common in young male patients after an acute trauma to the knee joint. PMID:24337588
Feucht, Matthias J; Salzmann, Gian M; Pestka, Jan M; Südkamp, Norbert P; Niemeyer, Philipp
Collective cell migration is critical for normal development, tissue repair and cancer metastasis. Migration of the posterior lateral line primordium (pLLP) generates the zebrafish sensory organs (neuromasts, NMs). This migration is promoted by the leader cells at the leading edge of the pLLP, which express the G protein-coupled chemokine receptor Cxcr4b and respond to the chemokine Cxcl12a. However, the mechanism by which Cxc112a/Cxcr4b signaling regulates pLLP migration remains unclear. Her...
Xu, Hui; Ye, Ding; Behra, Martine; Burgess, Shawn; Chen, Songhai; Lin, Fang
The posterior lateral line primordium (pLLp) migrates caudally, depositing neuromasts to establish the posterior lateral line system in zebrafish. A Wnt-dependent FGF signaling center at the leading end of the pLLp initiates the formation of `proneuromasts' by facilitating the reorganization of cells into epithelial rosettes and by initiating atoh1a expression. Expression of atoh1a gives proneuromast cells the potential to become sensory hair cells, and lateral inhibition mediated by Delta-No...
Matsuda, Miho; Chitnis, Ajay B.
Full Text Available XLIF PROCEDURE: MINIMALLY DISRUPTIVE PROCEDURE FOR SPINE SURGERY TAMPA GENERAL HOSPITAL TAMPA, FL May 14, 2008 00: ... live minimally-disruptive procedure for spine surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will ...
Stand-alone cage for posterior lumbar interbody fusion in the treatment of high-degree degenerative disc disease: design of a new device for an “old” technique. A prospective study on a series of 116 patients
Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age. The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis. In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing interest in minimally invasive surgery and the unsatisfactory results reported in the literature (mainly due to t...
Costa, Francesco; Sassi, Marco; Ortolina, Alessandro; Cardia, Andrea; Assietti, Roberto; Zerbi, Alberto; Lorenzetti, Martin; Galbusera, Fabio; Fornari, Maurizio
Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto
The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first...
Fernando Luiz Rolemberg Dantas; Mirto Nelso Prandini; Ferreira, Mauro A. T.
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
Full Text Available Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF and transforaminal lumbar interbody fusion (TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure.The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency.
Hey Hwee Weng
The posterior lateral line primordium (PLLp) migrates caudally and periodically deposits neuromasts. Coupled, but mutually inhibitory, Wnt-FGF signaling systems regulate proto-neuromast formation in the PLLp: FGF ligands expressed in response to Wnt signaling activate FGF receptors and initiate proto-neuromast formation. FGF receptor signaling, in turn, inhibits Wnt signaling. However, mechanisms that determine periodic neuromast formation and deposition in the PLLp remain poorly understood. Previous studies showed that neuromasts are deposited closer together and the PLLp terminates prematurely in lef1-deficient zebrafish embryos. It was suggested that this results from reduced proliferation in the leading domain of the PLLp and/or premature incorporation of progenitors into proto-neuromasts. We found that rspo3 knockdown reduces proliferation in a manner similar to that seen in lef1 morphants. However, it does not cause closer neuromast deposition or premature termination of the PLLp, suggesting that such changes in lef1-deficient embryos are not linked to changes in proliferation. Instead, we suggest that they are related to the role of Lef1 in regulating the balance of Wnt and FGF functions in the PLLp. Lef1 determines expression of the FGF signaling inhibitor Dusp6 in leading cells and regulates incorporation of cells into neuromasts; reduction of Dusp6 in leading cells in lef1-deficient embryos allows new proto-neuromasts to form closer to the leading edge. This is associated with progressively slower PLLp migration, reduced spacing between deposited neuromasts and premature termination of the PLLp system. PMID:23637337
Matsuda, Miho; Nogare, Damian Dalle; Somers, Katherine; Martin, Kathleen; Wang, Chongmin; Chitnis, Ajay B
Collective cell migration is critical for normal development, tissue repair and cancer metastasis. Migration of the posterior lateral line primordium (pLLP) generates the zebrafish sensory organs (neuromasts, NMs). This migration is promoted by the leader cells at the leading edge of the pLLP, which express the G protein-coupled chemokine receptor Cxcr4b and respond to the chemokine Cxcl12a. However, the mechanism by which Cxc112a/Cxcr4b signaling regulates pLLP migration remains unclear. Here we report that signal transduction by the heterotrimeric G protein subunit G?1 is essential for proper pLLP migration. Although both G?1 and G?4 are expressed in the pLLP and NMs, depletion of G?1 but not G?4 resulted in an arrest of pLLP migration. In embryos deficient for G?1, the pLLP cells migrated in an uncoordinated fashion and were unable to extend protrusions at the leading front, phenocopying those in embryos deficient for Cxcl12a or Cxcr4b. A transplantation assay showed that, like Cxcr4b, G?1 is required only in the leader cells of the pLLP. Analysis of F-actin dynamics in the pLLP revealed that whereas wild-type leader cells display extensive actin polymerization in the direction of pLLP migration, counterparts defective for G?1, Cxcr4b or Cxcl12a do not. Finally, synergy experiments revealed that G?1 and Cxcr4b interact genetically in regulating pLLP migration. Collectively, our data indicate that G?1 controls migration of the pLLP, likely by acting downstream of the Cxcl12a/Cxcr4b signaling. This study also provides compelling evidence for functional specificity among G? isoforms in vivo. PMID:24201188
Xu, Hui; Ye, Ding; Behra, Martine; Burgess, Shawn; Chen, Songhai; Lin, Fang
Lymphocoele is a rare and little known complication with only a handful of reports available. We report two cases of lymphocoele after anterior lumbar surgery that have occurred in two different centres and discuss diagnosis and management options. The first case is that of a 53-year-old male patient undergoing two level anterior lumbar interbody fusion (ALIF) for disabling back pain due to disc degeneration in the context of an old spondylodiscitis. He developed a large fluid mass postoperat...
Schizas, Constantin; Foko’o, Noe?l; Matter, Maurice; Romy, Sebastien; Munting, Everard
Serious vascular injury is a rare, but potentially devastating complication during anterior lumbar spinal surgery. The authors describe the first reported case where vascular injury was detected by multimodality neurophysiological monitoring during an L3–S1 anterior lumbar interbody fusion. The case demonstrates the need for multi-modality monitoring and the combined use of somatosensory-evoked potentials and motor-evoked potentials.
Nair, M. Nathan; Ramakrishna, Rohan; Slimp, Jeff; Kinney, Gregory; Chesnut, Randall M.
The lateral line system of amphibians and fish comprises a large number of individual mechanosensory organs, the neuromasts, and their sensory neurons. The pattern of neuromasts varies markedly between species, yet the embryonic pattern is highly conserved from the relatively basal zebrafish, Danio rerio, to more derived species. Here we examine in more detail the development of the posterior lateral line (PLL) in embryos and early larvae of one of the most derived fish species, the blue-fin ...
Ghysen, Alain; Schuster, Kevin; Coves, Denis; La Gandara, Fernando; Papandroulakis, Nikos; Ortega, Aurelio
Full Text Available ... minimizing the soft tissue damage, faster recovery, better results. And that's where we're working. As you ... severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all of the ...
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 ...
Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ?2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures. PMID:25694908
McAfee, Paul C.; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan
Morgan Lorio, MD, FACS, Chair, ISASS Task Force on Coding & Reimbursement In 2011, CPT code 22551 was revised to combine or bundle CPT codes 63075 and 22554 when both procedures were performed at the same site/same surgical session. The add on code +22552 is used to report each additional interspace. 2014 heralded a downward pressure on this now prime target code (for non-coverage?) 22551 through an egregious insurer attempt to redefine cervical arthrodesis, effectively removing spine surgeon choice and altering best practice without clinical evidence. Currently, spine surgeons are equally split on the use of allograft versus cages for cervical arthrodesis. Structural allograft, CPT code 20931, is reported once per same surgical session, regardless of the number of allografts used. CPT code 22851 which is designated solely for cage use, has a higher reimbursement than structural allograft, and may be reported for each inner space. Hence, the rationale behind why some payers wrongly consider "spine cages NOT medically necessary for cervical fusion." A timely consensus paper summarizing spine surgeon purview on the logical progressive evolution of cervical interbody fusion for ISASS/IASP membership was strategically identified as an advocacy focus by the ISASS Task Force. ISASS appreciates the authors' charge with gratitude. This article has both teeth and transparent clinical real-world merit. PMID:25694945
Singh, Kern; Qureshi, Sheeraz
Background Minimally invasive surgery (MIS) is dependent on intraoperative fluoroscopic imaging for visualization, which significantly increases exposure to radiation. Navigation-assisted fluoroscopy (NAV) can potentially decrease radiation exposure and improve the operating room environment by reducing the need for real-time fluoroscopy. The direct lateral interbody fusion (DLIF) procedure is a technique for MIS intervertebral lumbar and thoracic interbody fusions. This study assesses the use of navigation for the DLIF procedure in comparison to standard fluoroscopy (FLUORO), as well as the accuracy of the NAV MIS DLIF procedure. Methods Three fresh whole-body cadavers underwent multiple DLIF procedures at the T10-L5 levels via either NAV or FLUORO. Radiation exposure and surgical times were recorded and compared between groups. An additional cadaver was used to evaluate the accuracy of the NAV system for the DLIF procedure by measuring the deviation error as the surgeon worked further from the anterior superior iliac spine tracker. Results Approach, discectomy, and total fluoroscopy times for FLUORO were longer than NAV (P < .05). In contrast, the setup time was longer in NAV (P = .005). Cage insertion and total operating times were similar for both. Radiation exposure to the surgeon for NAV was significantly less than FLUORO (P < .05). Accuracy of the NAV system was within 1 mm for L2-5. Conclusion Navigation for the DLIF procedure is feasible. Accuracy for this procedure over the most common levels (L2-5) is likely sufficient for safe clinical application. Although initial setup times were longer with NAV, simultaneous anteroposterior and lateral imaging with the NAV system resulted in overall surgery times similar to FLUORO. Navigation minimizes fluoroscopic radiation exposure. Clinical significance Navigation for the DLIF procedure is accurate and decreases radiation exposure without increasing the overall surgical time.
Webb, Jonathan E.; Regev, Gilad J.; Garfin, Steven R.; Kim, Choll W.
Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patient [...] s who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery.
Tianyong, Hou; Qiang, Zhou; Fei, Dai; Fei, Luo; Qingyi, He; Jinsong, Zhang; Jianzhong, Xu.
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
Single level axial lumbar interbody fusion (AxiaLIF) using a transsacral rod through a paracoccygeal approach has been developed with promising early clinical results and biomechanical stability. Recently, the transsacral rod has been extended to perform a two-level fusion at both L4–L5 and L5–S1 levels (AxiaLIF II). No biomechanical studies have been conducted on multilevel fusion using the AxiaLIF technique. In this study, the biomechanics of L4–S1 motion segments instrumented with th...
Erkan, Serkan; Wu, Chunhui; Mehbod, Amir A.; Hsu, Brian; Pahl, Douglas W.; Transfeldt, Ensor E.
... spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... DM, Roditi G. Intravascular contrast media for radiology, CT, and MRI. ... tomography. In: Adam A, Dixon AK, eds. Grainger & Allison's ...
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
Full Text Available A prospective multicentral observational study of minimally invasive fusion to treat degenerative lumbar disorders, and to report outcomes of one or two level minimally invasive posterior lumbar interbody fusion (MLIF for degenerative lumbar disorders in a multi-center 1-year prospective study. We prospectively studied a group of 32 patients, mostly female 24 ( 75% female , and 8 males ( 25%. They underwent minimally invasive transforaminal lumbar interbody fusion (mTLIF, 21 of them monosegmental and 11 bisegmental. Patients demographics, intraoperative data and complications were recorded. Time to first ambulation, time to study-defined recovery, surgical duration, blood loss, fluoroscopy time and adverse events were recorded. Visual analogue scale (VAS of back and legs pain, Oswestry disability index (ODI and health-related questionnaire (EQ-5D were assessed preoperatively and at defined time points through 12 months postoperatively. Mean surgical duration, blood loss and intraoperative fluoroscopy time were 125 vs.175 minutes, 150 vs. 170 ml, and 105 vs. 145 seconds in one- and twolevel segments, respectively. Mean preoperative VAS back (6.5 and VAS leg (7.9 scores dropped significantly (p<0.0001 to 3.5 (2.6 and 2.1 (2.0 at discharge (6 weeks. At the end, this is the largest prospective multi-center observational study of MLIF to date, following routine local standard of practice and, MLIF demonstrated favourable clinical results with early and sustained improvement in patient reported outcomes and low major perioperative morbidity.
Minimally Invasive Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’re joining us at ... a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46- ...
Full Text Available Minimally Invasive Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’re joining us at ... a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46- ...
Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. PMID:25838956
Crawford, Brooke; Lenarz, Christopher; Watson, J Tracy; Alander, Dirk
Many studies have concluded that stand alone cages provide limited stabilization to the spine, and this primary stabilization decreases postoperatively due to various factors. A supplemental fixation may, therefore, be needed to improve the stability. Extensive biomechanical analysis was performed in the present study to further evaluate the stabilization achieved by a laterally inserted cage and the role of an anterior lateral supplemental fixation. Eight human cadaver functional spinal unit...
Le Huec, J.; Liu, M.; Skalli, W.; Josse, L.
Open Discectomy Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall ... area and into one or both legs. Open discectomy uses surgery to remove part of the damaged ...
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.
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
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
Full Text Available Background: Lumbar backache is a very common problem nowadays. Sacralisation of lumbar vertebrae is one of the cause for that. During routine osteology teaching a sacrum with incomplete attached lumbar 5 vertebrae is seen. Observation: Incompletely fused L 5 vertebrae with sacrum is seen. The bodies of the vertebrae are fused but the transverse process of left side is completely fused with the ala of sacrum.But on the right side is incompletely fused. Conclusion: The person is usually asymptomatic or may present with symptoms which include spinal or radicular pain, disc degeneration, L4/L5 disc prolapse, lumbar scoliosis and lumbar extradural defects. In transitional lumbosacral segmentation, it was observed that the lumbosacral intervertebral disc is significantly narrowed. The incidence of disc herniation is found to be higher and can occur even at young ages. There was also relationship established between transitional vertebrae and the degree of slippage in spondylolytic spondylolisthesis. In addition, this anomaly has known implications in the field of disc surgery.
The direct lateral interbody fusion (DLIF), a minimally invasive lateral approach for placement of an interbody fusion device, does not require nerve root retraction or any contact with the great vessels and can lead to short operative times with little blood loss. Due to anatomical restrictions, this procedure has not been used at the lumbosacral (L5-S1) junction. Lumbosacral transitional vertebrae (LSTV), a structural anomaly of the lumbosacral spine associated with low back pain, can result in a level being wrongly identified pre-operatively due to misnumbering of the vertebral levels. To our knowledge, use of the DLIF graft in this patient is the first report of an interbody fusion graft being placed at the disc space between the LSTV and S1 via the transpsoas route. We present a review of the literature regarding the LSTV variation as well as the lateral placement of interbody fusion grafts at the lumbosacral junction. PMID:22551586
Shirzadi, Ali; Birch, Kurtis; Drazin, Doniel; Liu, John C; Acosta, Frank
Full Text Available We evaluated the reliability of static and dynamic lumbar muscle endurance measurements on a BackUP lumbar extension dynamometer. Sixteen healthy participants (8 male; 8 female volunteered for this investigation. Fifty percent of each participant's body weight was calculated to determine the weight load utilized for the static (holding time and dynamic (repetitions lumbar extension endurance tests. Four separate tests (2 static, 2 dynamic were conducted with at least a 24-hour rest period between tests. Test-retest intraclass correlations were shown to be high (static lumbar endurance, ICC = 0.92 (p < 0.0005; dynamic lumbar endurance, ICC = 0.93 (p < 0.0005 for both of the performed tests. Our results demonstrated that static and dynamic lumbar endurance can be assessed reliably on a BackUP lumbar extension dynamometer.
Staci M. Hager
There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudat...
Jin, Dadi; Qu, Dongbin; Chen, Jianting; Zhang, Hao
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.
Bone morphogenetic protein (BMP)-2 induces bone and cartilage tissue formation. Large amounts of BMP-2 are difficult to purify or to produce in vitro using eukaryotic cells. The goal of the present study was to assess the clinical use of Escherichia coli-derived recombinant human BMP-2 (ErhBMP-2) on bone fusion after cervical and lumbar spine surgery in a goat model, compared with the standard autogenous iliac bone grafting. Thirty-six goats were randomized to 3 groups: (A) autogenous iliac bone grafting, (B) cervical interbody fusion cage containing ß-tricalcium phosphate (ß-TCP), or (C) cervical interbody fusion cage containing ß-TCP+ErhBMP-2 (2.5 mg). Cervical bone repair was evaluated using radiographs and computed tomography scans at 0, 3, and 6 months. Histological analyses were performed on cervical samples. Two goats died from infection. The differences in intervertebral height among the groups were not significant 3 months postoperatively but became significant after 6 months between groups A vs B and C (P=.04); there was no difference between groups B and C at 6 months. Adding ErhBMP-2 significantly increased cervical fusion at 6 months (P=.04). Histological examinations showed that ß-TCP+ErhBMP-2 increased new bone area, material degradation rate, and depth of tissue penetration and decreased residual material area, all in a time-dependent manner. Escherichia coli-derived rhBMP-2 combined with an enhanced fusion cage containing ß-TCP induced bone formation in a goat model. Furthermore, its ability to promote bone fusion was similar to autogenous iliac bone grafting. PMID:24679197
Wang, Hongli; Zhang, Fan; Lv, Feizhou; Jiang, Jianyuan; Liu, Dayong; Xia, Xinlei
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
Full Text Available Lumbar spinal stenosis is diagnosed by the clinical picture of radiculopathy and / or spinal claudication caused by narrowing of the spinal canal. Anatomical and radiological features correlate poorly with the clinical features, and are of little prognostic value. The natural history is very benign [...] with fluctuating levels and types of symptoms. Indications for surgery must be individualized, but decompression is effective in the short and medium term. Fusion is only indicated in the case of instability.
The evaluation of patients with suspected lumbar radiculopathy is one of the most common reasons patients are referred for electrodiagnostic testing. The utility of this study depends on the expertise of the physician who plans, performs, and completes the study. This article reviews the strengths and weaknesses of electrodiagnosis to make this diagnosis, as well as the clinical reasoning of appropriate study planning. The current use of electrodiagnostic testing to determine prognosis and treatment outcomes is also discussed. PMID:23177032
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
Background The lateral transpsoas approach to interbody fusion is a less disruptive but direct-visualization approach for anterior/anterolateral fusion of the thoracolumbar spine. Several reports have detailed the technique, the safety of the approach, and the short term clinical benefits. However, no published studies to date have reported the long term clinical and radiographic success of the procedure. Materials and methods The current study is a retrospective chart review of prospectively collected clinical and radiographic outcomes in 62 patients having undergone the Anterolateral transpsoas procedure at a single institution for anterior column stabilization as treatment for degenerative conditions, including degenerative disk disease, spondylolisthesis, scoliosis, and stenosis. Only patients who were a minimum of 2 years postoperative were included in this evaluation. Clinical outcomes measured included visual analog pain scales (VAS) and Oswestry disability index (ODI). Radiographic outcomes included identification of successful arthrodesis. Results Sixty-two patients were treated with lateral interbody fusion between 2003 and December 2006. Twenty-six patients (42%) were single-level, 13 (21%) 2-level, and 23 (37%) 3- or more levels. Forty-five (73%) included supplemental posterior pedicle fixation, 4 (6%) lateral fixation, and 13 (21%) were stand-alone. Pain scores (VAS) decreased significantly from preoperative to 2 years follow-up by 37% (P treatment option for anterior/anterolateral lumbar fusions.
Ozgur, Burak M.; Agarwal, Vijay; Nail, Erin; Pimenta, Luiz
Chemonucleolysis is an advantageous alternative to surgical treatment of lumbar disc herniation. To achieve the best results the indications must be strictly observed and the procedure itself must be technically perfect. In these circumstances a rapid, non-invasive and less expensive treatment of lumbar disc herniation is possible. (orig.)
Since November 88, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. A short-term follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. (orig./GDG)
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.
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.)
A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of ?-tricalcium phosphate (?-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing ?-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the ...
Dai, Li-yang; Jiang, Lei-sheng
Since 1983 iohexol has been routinely used for myelography in our hospital and 1 650 myelographies have been performed. The first 331 patients with lumbar myelography were included in a follow-up study. Headache was observed in 26 per cent, nausea in 12 per cent and vertigo in 6 per cent of the patients, a frequency very similar to that observed in an earlier study of side effects following spinal puncture. Severe reactions were not seen. Three patients had radicular symptoms and 3 patients had minor mental symptoms possibly caused by the contrast medium. It is concluded that most side effects are related to the spinal puncture and that iohexol probably can be used with safety in out-patients. (orig.)
Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)
Objective: To ameliorate the percutaneous lumbar discectomy (APLD) for improving the effectiveness and amplifying the indicative range of PLD. Methods: To ameliorate percutaneous punctured route based on classic PLD and discectomy of extracting pulp out of the herniated disc with special pulpforceps. The statistical analysis of the therapeutic results on 750 disc protrusions of 655 cases undergone APLD following up from 6 to 54 months retrospectively. Results: The effective ratios were excellent in 40.2%, good for 46.6% and bad of 13.3%. No occurrance of intervertebral inflammation and paradiscal hematoma, there were only 1 case complicated with injuried cauda equina, and 4 cases with broken appliance within disc. Conclusions: APLD is effective and safe, not only indicative for inclusion disc herniation, but also for noninclusion herniation. (authors)
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.
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 presenceand 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.)
The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245
Bonaldi, G; Brembilla, C; Cianfoni, A
Intradural hydatidosis is a very uncommon form of vertebrospinal hydatidosis. We report a intradural lumbar localization, presenting the magnetic resonance imaging findings. We emphasize MRI for diagnosis and follow-up in search for residual or recurrent lesions. PMID:10209711
Kabbaj-El Kouhen, N; Dafiri, R; el Ouahabi, A; el Khamlichi, A; Imani, F
Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia
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.
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
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.)
Compared to posterior lumber interbody fusion (PLIF), the transforaminal lumber interbody fusion (TLIF) procedure has a latent disadvantage in terms of bone grafting because of being a unilateral approach. We calculated the rate of graft bone filling in TLIF cases by postoperative CT and evaluated the clinical results. The rate of filling in the TLIF cases was not significantly less than in the PLIF cases. The results also showed no significant difference between TLIF and PLIF. An adequate amount of bone were grafted into the intervertebral space even by the unilateral TLIF approach, however the procedure is not easy. An incidental dural tear occurred in 1 case each treated by TLIF and PLIF. The exposure of the dural tube increases the risk of epidural bleeding and neural tissue injury. We recommend TLIF for discopathy, foraminal stenosis, and repeat surgery to avoid latent risk. (author)
This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidenc...
Swank, M. L.; Lowery, G. L.; Bhat, A. L.; Mcdonough, R. F.
Few histological studies on bone substitutes in human cervical spine are available and the biological processes of bone substitutes are not well documented. The authors studied four failure cases of cervical interbody fusion: two cases with hydroxyapatite (HA), one case with ?-tricalcium phosphate ceramic (?-TCP) and one case with xenograft (bovine bone). Clinical data showed that all the patients experienced neck pain with or without numbness of upper extremity due to fusion failure. Succe...
Xie, Youzhuan; Chopin, Daniel; Hardouin, Pierre; Lu, Jianxi
Background: Use of autogenous bone grafting taken from anterior iliac crest for anteriorcervical interbody fusion has been the “gold-standard” for decades.Substitutes for autogenous bone graft continue to be sought to avoid potentialdonor site morbidity. A titanium-alloy square-shaped hollow cage wasapplied to facilitate the process of fusion as a bone graft substitute, thenassessed in this retrospective clinical study.Methods: From July 2000 to July 2001, sixty-three discs from fifty-fou...
Chi-Chien Niu; Lih-Huei Chen; Po-Liang Lai; Tsai-Sheng Fu; Wen-Jer Chen
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 opera...
Gercek, Erol; Arlet, Vincent; Delisle, Josee; Marchesi, Dante
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.)
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
Background The increase in total disc replacement procedures performed over the last 5 years has increased the occurrence of patients presenting with postoperative iatrogenic deformity requiring revision surgery. Proposed salvage treatments include device retrieval followed by anterior lumbar interbody fusion or posterior fusion. We propose a novel approach for the correction of disc tilt after total disc replacement using a posterior dynamic stabilization system. Methods Pedicle screws can be inserted either in an open manner or percutaneously by standard techniques under fluoroscopy. The collapsed side is expanded, and the convex side is compressed. Universal spacers are placed bilaterally, with the spacer on the collapsed side being taller by 6 mm. Cords are threaded through the spacers and pulled into place with the tensioning instrument. Extra tension is applied to the convex side, and the wound is closed by standard techniques. Results Three patients presenting with tilted total disc replacement devices underwent corrective surgery with posterior dynamic stabilization. Radiographs confirmed correction of deformity in all cases. Conclusions/Level of Evidence This technical note presents a novel indication for posterior dynamic stabilization and describes its surgical application to the correction of disc tilt after total disc replacement. This is level V evidence.
Cheng, Wayne K.; Palmer, Daniel Kyle; Jadhav, Vikram
The authors describe a new minimally invasive technique for posterior supplementation using percutaneous translaminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation. PMID:17633496
Kang, Ho Yeong; Lee, Sang-Ho; Jeon, Sang Hyeop; Shin, Song-Woo
The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1-4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications. PMID:15744815
Kuh, Sung-Uk; Kim, Young-Soo; Cho, Young-Eun; Yoon, Young-Sul; Jin, Byung-Ho; Kim, Keun-Su; Chin, Dong-Kyu
Full Text Available Presentamos un caso excepcional de estenosis de canal lumbar con síndrome de cola de caballo por un hematoma crónico espontáneo en el espacio epidural L2-L3. Se trata de un varón de 53 años que, sin ninguna clase de antecedente patológico relacionado con el problema actual (traumatismos, punciones l [...] umbares, toma de antiagregantes o anticoagulantes), presenta una colección hemática epidural que va comprimiendo progresivamente la cola de caballo. Las pruebas de imagen mostraron una colección polilobulada, bien delimitada, que se interpretó como quiste sinovial. Tras la cirugía (laminectomía descompresiva y evacuación) se confirmó el diagnóstico con estudio histológico. Tras la operación se recuperó por completo la función neurológica. Abstract in english We report an exceptional case of cauda equina syndrome, caused by a chronic epidural hematoma of the lumbar spine, (L2-L3). A 53 year old man without history of trauma, lumbar punctures or antiagregant medication, suffered from progressive back pain and minor motor deficit in the legs. The etiology, [...] MRI, intraoperative findings and microscopical study are presented and discussed. After surgery there was a complete resolution of the clinical picture.
J.M., Belinchón; J., Campos; J., Merino; J.M., Gallego; C., Barcia.
Whether posterior osteophytes in the cervical spine resorb after anterior interbody fusion is controversial. Previous studies have only used plain films. In order to study remodelling, a retrospective study of 53 patients using high-definition CT was performed. There was no evidence of remodelling or resorption of osteophytes and persistent osteophytes continued to deform the spinal cord for up to 12 years after fusion. The importance of this in relation to cervical spinal surgery is that every effort should be made to remove posterior osteophytes during anterior interbody fusion. PMID:8459928
Stevens, J M; Clifton, A G; Whitear, P
Background: The spinal nerve roots exit through the intervertebral foramina and the proportion between the size of the foramen and the relative space occupied by the root determines the chance of root compression in the intervertebral foramen. Not much data exists regarding the variations in the dimensions of the intervertebral foramen in Indian subjects. Methods: Twenty one sets of lumbar vertebrae dissected out from the cadavers in the Department of Anatomy, was used for the study. The v...
Devi Rema; Rajagopalan N
Background: In this study we analyzed and presented our experience of performing transforaminalpercutaneous endoscopic lumbar discectomy (TPELD).Methods: A retrospective study of 142 TPELD was conducted on 134 consecutivepatients from 2001 through 2005. The inclusion criteria for patients werethose who had leg pain with or without low back pain and magnetic resonanceimaging (MRI) that revealed soft contained or noncontained but contiguouslumbar disc herniation (LDH). All patients failed at le...
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
Full Text Available Background : Lumbar disc herniation often causes sciatica. Many different techniques have been advocated with the aim of least possible damage to other structures while dealing with prolapsed disc surgically in the properly selected and indicated cases. Methods : Twenty six patients with clinical symptoms and signs of prolapsed lumbar intervertebral disc having radiological correlation by MRI study were subjected to disc excision by interlaminar fenestration method. Results : The assessment at follow-up showed excellent results in 17 patients, good in 6 patients, fair in 2 patients and poor in 1 patient. The mean preoperative and postoperative Visual Analogue Scores were 9.34 ±0.84 and 2.19 ±0.84 on scale of 0-10 respectively. These were statistically significant (p value< 0.001, paired t test. No significant complications were recorded. Conclusion : Procedures of interlaminar fenestration and open disc excision under direct vision offers sufficient adequate exposure for lumbar disc excision with a smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results in the centers where recent laser and endoscopy facilities are not available.
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
Lumbar nerve root avulsion is a rarely seen clinical entity that may complicate major trauma. The majority of previously reported cases have associated pelvic or lumbar vertebral fractures. Two cases of traumatic pseudo-meningoceles at the lumbar level with associated avulsions of the lumbar nerve roots are presented. Both patients were involved in high velocity motor vehicle accidents. Case 1 had associated pelvic fractures but no spinal fractures and, interestingly, case 2 had no fractures of the spine or pelvis. The value of MRI in making the diagnosis is demonstrated. Copyright (2001) Blackwell Science Pty Ltd
Full Text Available Abstract Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH data set were prepared and used in the study. Three-dimensional (3D computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP. All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical operations by its relative position to the lumbar plexus. 3D reconstructions of the lumbar plexus based on VCH data provide a virtual morphological basis for anterior lumbar surgery.
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.
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
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.
Purpose The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. Procedures This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR.
Connective tissue nevi represents a kind of hamartoma, and coalescence of the lesions in a cerebriform mode in the lumbar region without Proteus syndrome is rarely seen. Here, we report a 26-year-old woman presenting with nodules and plaques in her left lumbar region of 26 years in duration. Histopathological examination and Masson-trichrome stain showed increased dermal collagen bundles in a haphazard array. The diagnosis of connective tissue nevi was made. This is the first case report on cerebriform connective tissue nevi without Proteus syndrome in the lumbar region. PMID:25512235
Chen, Jinbo; Chen, Liuqing; Duan, Yiqun; Li, Dongsheng; Dong, Bilin
Different ways to minimize the gonadal dose in lumbar spine radiography have been studied. Two hundred and fifty lumbar spine radiographs were reviewed to assess the clinical need for lateral L5/S1 projection. Modern film/screen combinations and gonadal shielding of externally scattered radiation play a major role in the reduction of the genetic dose. The number of exposures should be minimized. Our results show that two projections, anteroposterior (AP) and lateral, appear to be sufficient in routine radiography of the lumbar spine. (orig.)
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
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 decompre...
Y?lmaz, Tevfik; Turan, Yahya; Gu?ls?en, I?smail; Dalbayrak, Sedat
Full Text Available ... 05/2014) Spine Injuries and Disorders Extreme Lateral Interbody Fusion Procedure (Tampa General Hospital, Tampa, FL, 5/14/2008) Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson University Hospital, Philadelphia, PA, 11/ ...
Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)
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)
Full Text Available Background: The spinal nerve roots exit through the intervertebral foramina and the proportion between the size of the foramen and the relative space occupied by the root determines the chance of root compression in the intervertebral foramen. Not much data exists regarding the variations in the dimensions of the intervertebral foramen in Indian subjects. Methods: Twenty one sets of lumbar vertebrae dissected out from the cadavers in the Department of Anatomy, was used for the study. The vertical and transverse diameters of the intervertebral foramina were measured. The vertebral foramen index was then calculated by taking the ratio between the vertical diameter and the transverse diameter. Result: It was seen that the vertical diameter was more than the transverse diameter at all levels except at the L5-S1 foramen where it was the other way round. Even though there was a difference in the foramen size between the right and the left sides, it was not statistically significant. There was decrease in the transverse diameter from L 1 (mean 9.89 mm to L 3 levels (mean 9.78 mm and thereafter an increase at L 4 (mean 11.15 mm. The vertical diameter showed an increase from L 1 (mean 14.83 mm to L 2 levels (mean15.52mm and thereafter a decrease from L 3 (mean 15.29 mm to L 5 (mean 12.48 mm which was not statistically significant. The antero-posterior dimension of the superior notch was less than that of the inferior notch at all levels. The vertebral foramen index showed a gradual increase from L 1 (mean 1.47 to L 3 (1.58 and thereafter a decrease at L 5 level (0.94. Conclusion: The foramen dimensions are critical in determining the foraminal constrictions of the lumbar spine. The transverse and vertical dimensions do not have a bearing on each other, as indicated by the vertebral foramen index.
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.
It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciat...
Foad Elahi; Patrick Hitchon; Reddy, Chandan G.
Full Text Available The article presents modeling of human lumbar vertebra and it‘sdeformation analysis using finite elements method. The problemof tissue degradation is raised. Using the computer aided modelingwith SolidWorks software the models of lumbar vertebra(L1 and vertebra system L1-L4 were created. The article containssocial and medical problem analysis, description of modelingmethods and the results of deformation test for one vertebramodel and for model of 4 vertebras (L1-L4.
Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogeo venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.
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 f...
Akeda Koji; Inaba Tadashi; Kasai Yuichi; Uchida Atsumasa
Pigmented villonodular synovitis (PVNS) very rarely develops in the lumbar spine. We have found no more than 14 cases in the literature, only three of which were studied by magnetic resonance imaging (MRI). We present a case of PVNS is a lumbar facet joint. The results of imaging studies (including CT myelography and MRI) are described and discussed, and a review of the literature is provided. (Author) 9 refs
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 m...
Uysal, Hilmi; Bademkiran, Fikret; Albayrak, Nural; Esmer, Ali F?rat; Keles?, Nigar; Si?ndel, Muzaffer; Tekdemi?r, I?brahim; Kizilay, Ferah; Erteki?n, Cumhur
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, ...
Ranjan Alok; Lath Rahul
The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated pre- and postoperatively. To our knowledge, this is the first reported series of such patients ...
Sucu, Hasan Kamil; Gelal, Faz?l
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. PMID:25210343
Y?lmaz, Tevfik; Turan, Yahya; Gül?en, Ismail; Dalbayrak, Sedat
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
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.
A study was made of the clinical and radiological characteristics and the results of microsurgical discectomy without interbody fusion, of 26 young adults, who presented with cervical myelopathy due to nuclear herniations. Neck trauma was not a significant aetiological factor. The disease produced moderate to very severe functional disability in most patients (73%), in a relatively short period (mean symptom duration 6.3 months). Radiological assessment revealed the presence of canal stenosis...
Selladurai, B. M.
Several choices are available for cervical interbody fusion after anterior cervical discectomy. A recent option is dense cancellous allograft (CS) which is characterized by an open-matrix structure that may promote vascularization and cellular penetration during early osseous integration. However, the biomechanical stability of CS should be comparable to that of the tricortical iliac autograft (AG) and fibular allograft (FA) to be an acceptable alternative to these materials. The purpose of t...
Ryu, Stephen I.; Lim, Jesse T.; Kim, Sung-min; Paterno, Josemaria; Willenberg, Rafer; Kim, Daniel H.
With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362–368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique w...
Yao, Nuzhao; Wang, Cheng; Wang, Wenjun; Wang, Lushan
Background - Aim: The distraction and stabilization provided by anterior cervical discectomy and fusion contribute to neural decompression and optimize osteogenesis. A new titanium cervical implant with specific properties was applied through an anterior approach in ten pigs. Implant behavior regarding in situ position and related osteogenesis were evaluated. Methods: In this controlled animal study, the progress of fusion and osteogenesis was evaluated after one level cervical interbody fusi...
Tsitsopoulos, Pd; Tsonidis, Cha; Tsitsopoulos, Pph; Mintelis, Ai; Psalla, Da; Desiris, Ak
Full Text Available Background: Use of autogenous bone grafting taken from anterior iliac crest for anteriorcervical interbody fusion has been the “gold-standard” for decades.Substitutes for autogenous bone graft continue to be sought to avoid potentialdonor site morbidity. A titanium-alloy square-shaped hollow cage wasapplied to facilitate the process of fusion as a bone graft substitute, thenassessed in this retrospective clinical study.Methods: From July 2000 to July 2001, sixty-three discs from fifty-four patients wereselected to receive this cage for one or two segments of the cervical spine foranterior cervical interbody fusion. The Japanese Orthopedic Association(JOA score and Odom's criteria were used to measure the clinical outcome.Postoperative radiographs were analyzed for graft dislodgement, loss of anteriorand posterior disc heights, maintenance of lordosis correction, and statusof fusion between the cage and endplates to assess their suitability as a graftingsubstitute.Results: Eighty-seven percent of patients exhibited satisfactory clinical outcome.Successful fusion was obtained in ninety point five percent of operated discs.Partial cage dislodgement was observed in four point eight percent of discsand caused no adverse symptoms. The mean collapse of the anterior and posteriordisc heights were 1.73 mm and 0.91 mm, respectively. Moreover, themean loss of lordosis correction was 2.75°.Conclusions: Based on this primary clinical experience, the trapezoid-design, titaniumalloycage provided adequate mechanical support and stability in the discspace and an excellent fusion result without significant subsidence of discheight or any other complications.
Descompressão intradiscal lombar percutânea para tratamento de dor discogênica / Percutaneous lumbar disc decompression for treatment of discogenic pain / Descompresión percutánea de disco lumbar para tratar el dolor discogénico
Full Text Available SciELO Brazil | Languages: English, Portuguese Abstract in portuguese OBJETIVO: Relatar a segurança e os desfechos clínicos de procedimentos de descompressão intradiscal percutânea em pacientes com dor discogênica nos quais houve falha do tratamento conservador. Procedimentos cirúrgicos minimamente invasivos são uma tendência de tratamento. METODOS: Estudo retrospecti [...] vo com descrição dos desfechos clínicos de pacientes tratados com NucleoplastyTM e DeKompressorTM, com seguimento de 5 anos. RESULTADOS: Trinta e quatro (n = 34) pacientes foram submetidos a descompressão intradiscal com seguimento mínimo de 5 anos, 21 obtiveram resolução do quadro álgico, 8 foram submetidos a artrodese intersomática lombar, um foi submetido a discectomia cirúrgica e 4 apresentam dor lombar residual. Não ocorreram eventos adversos. CONCLUSÃO: Foi demonstrada a mesma segurança obtida em outros trabalhos que também avaliaram o uso da zona triangular de segurança para procedimentos percutâneos. O índice de sucesso com o procedimento percutâneo assemelha-se a outros estudos mais recentes publicados em uma metanálise. A realização de estudos comparativos, prospectivos e controlados será útil para definir melhor a efetividade dos procedimentos percutâneos. Abstract in spanish OBJETIVO: Informe de la seguridad y los resultados clínicos de los procedimientos de descompresión intradiscal percutánea en pacientes con dolor de origen discal que fracasó el tratamiento conservador. Tratamientos quirúrgicos mínimamente invasivos son una tendencia está OK. METODOS: Estudio retrosp [...] ectivo que describe los resultados clínicos de los pacientes tratados con NucleoplastyTM y DeKompressorTM, con un seguimiento de 5 años. RESULTADOS: Treinta y cuatro (n = 34) pacientes fueron sometidos a descompresión intradiscal y evaluados por período de 5 años, 21 tuvieron la resolución del dolor, 8 se sometieron a artrodesis lumbar intersomática, un paciente fue sometido a una discectomía quirúrgica y 4 tienen dolor lumbar residual. No hubo eventos adversos. CONCLUSIÓN: Se ha demostrado el mismo grado de seguridad alcanzado en otros estudios que también evaluaron el uso de la zona triangular de seguridad para procedimientos percutáneos. La tasa de éxito con el procedimiento percutáneo es similar a otros estudios publicados en un reciente meta-análisis. Los estudios comparativos, prospectivos y controlados serán útiles para definir mejor la eficacia de los procedimientos percutaneous. Abstract in english OBJECTIVE: Report safety and clinical outcomes of percutaneous intradiscal decompression procedures in patients with discogenic pain that failed conservative treatment. Minimally invasive surgical treatments are a trend. METHODS: A retrospective study describing the clinical outcomes of patients tre [...] ated with NucleoplastyTM and DeKompressorTM, with follow up of 5 years. RESULTS: Thirty-four (n=34) patients underwent intradiscal decompression with a follow-up period of 5 years, 21 had resolution of pain, eight underwent lumbar interbody arthrodesis, one underwent surgical discectomy and 4 had residual back pain. There were no adverse events. CONCLUSION: It was demonstrated the same safety obtained in other studies that also evaluated the use of triangular safety zone for percutaneous procedures. The success rate with the percutaneous procedure is similar to other studies published in a recent meta-analysis. The comparative studies, prospective and controlled will be useful to better define the effectiveness of percutaneous procedures.
Jonas Lenzi de, Araujo; Pedro Grein, Del Santoro; Henrique, Motizuki; Xavier, Soler i Graells; Ed Marcelo, Zaninelli; Marcel Luiz, Benato.
Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: Normal nerve (n=8), II: Compressed nerve (n=16); III: Disappearance of fat, nerve not possible to identify (n=9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information. (orig.)
Full Text Available Background: In this study we analyzed and presented our experience of performing transforaminalpercutaneous endoscopic lumbar discectomy (TPELD.Methods: A retrospective study of 142 TPELD was conducted on 134 consecutivepatients from 2001 through 2005. The inclusion criteria for patients werethose who had leg pain with or without low back pain and magnetic resonanceimaging (MRI that revealed soft contained or noncontained but contiguouslumbar disc herniation (LDH. All patients failed at least 6 weeks ofconservative treatment or could not tolerate it.Results: The patients had an average age of 38 years. The mean follow-up period was8 months. The outcomes were evaluated using the modified MacNab criteria.The percentage of successful outcomes (excellent or good was 89%. Amongthe remainder of the patients, six (4.5% had open surgery later. Moreover,eight patients (6% sustained temporary dysesthesia over the proximal lowerlimb of the operated side. No major neurovascular injuries or deathsoccurred.Conclusions: In experienced hands, TPELD is minimally invasive, safe and effective fortreating soft contained or noncontained but contiguous LDH.
Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs.
Goethem, J.W.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Kelft, E. van de [Department of Neurosurgery, University of Antwerp, Edegem (Belgium); Biltjes, I.G.G.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hasselt, B.A.A.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hauwe, L. van den [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Parizel, P.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Schepper, A.M.A. de [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium)
Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs
The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)
Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)
The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)
Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159
Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y
Full Text Available 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 niño 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.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 puncture, 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
...2010-10-01 2010-10-01 false Lumbar spine and pelvis. 572.115 Section 572...Percentile Male § 572.115 Lumbar spine and pelvis. The specifications and test procedure for the lumbar spine and pelvis are identical to those for...
...2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected to continuously...paragraph (b) of this section, the lumbar spine assembly shall flex by an amount that...
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.
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.)
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.)
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
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
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. PMID:25361862
Crowell, Michael S; Alitz, Curtis
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
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.
Teplick, J.G.; Haskin, M.E.
The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs
Lumbar stenosis patients typically present with neurogenic claudication or radiculopathy. Studies have shown the benefit of surgical management of lumbar stenosis for patients who fail medical management. Surgical management traditionally involved an open laminectomy and foramenotomies. The emergence of minimally invasive spinal surgery has allowed for comparable clinical outcomes to open laminectomies, with the potential additional benefits of decreased blood loss, shorter hospital stay, decreased postoperative narcotic requirement, decreased rate of infection, and the potential benefit of decreasing the risk of postoperative instability. A shorter length of stay and faster return to work after minimally invasive lumbar decompression may result in the minimally invasive approach being more cost effective than an open approach. A literature review was performed to evaluate the clinical outcomes and cost effectiveness associated with minimally invasive decompression of lumbar stenosis. PMID:25370820
Johans, S J; Amin, B Y; Mummaneni, P V
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 presencia y características de forámenes inconstantes hallados en las vértebras lumbares bovinas. Quince de 100 (15 %) vértebras lumbares presentaban forámenes. Todos los forámenes estab...
Martin Lima; William Pérez
Objectives: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. Design: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. Setting: Finland. Subjects: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). Results: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. Conclusions: General practitioners commonly use plain lumbaral practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination
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.)
It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient's newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy. PMID:25024708
Elahi, Foad; Hitchon, Patrick; Reddy, Chandan G
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.)
... performed to assess the anatomy of the lumbar spine, to help plan surgery on the spine, or to monitor changes in the spine after ... For example, it can find areas of the spine where the spinal canal (which ... narrowed and might require surgery. It can assess the disks to see whether ...
Full Text Available In this article we report a case of inferior lumbar hernia. The patient underwent preperitoneal meshplasty. The patient is well on follow up with no recurrence. The relevant literature has been reviewed and management discussed in brief. [Int J Res Med Sci 2013; 1(1.000: 33-35
Vidhyasagar M. Sharma
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)
Background Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. Methods This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (?), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. Results Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, ?, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. Conclusion The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. Level of Evidence Prospective cohort study with good follow-up (level 1b).
Aydin, Ahmet Levent; Oktenoglu, Tunc; Cosar, Murat; Ataker, Yaprak; Kaner, Tuncay; Ozer, Ali Fahir
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)
Objective: To evaluate the effect of the percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation. Methods: 75 cases of lumbar disc herniation with significant clinical signs were confirmed by CT scan. The technique of the percutaneous lumbar puncture led the needle to approach nerve root and injected medicine diffusing into extraduramater, and then relieved the symptom of sciatica. Results: The rate of success of percutaneous lumbar puncture guided by CT reached to 100%. After two weeks of follow-up, the symptom of pain was obviously improved and disappeared in 63.3% cases. There were 23.0% cases needed a second procedure, and no change was obsesved in 9.3% cases. Conclusions: The percutaneous lumbar puncture guided by CT to treat sciatica resulted from lumbar disc herniation is one of the safe, reliable, effective new methods with no complication. The long term effectiveness is still in need of investigation. (authors)
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.
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.
Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical / Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease
Full Text Available El objetivo de este estudio fue comparar los resultados de la artrodesis cervical mediante fusión intersomática con hueso autólogo y/o espaciador intersomático en discopatía cervical. Material y métodos: Estudio comparativo transversal en 49 pacientes tratados quirúrgicamente con artrodesis anterior [...] , en el período Enero 2011 a Diciembre 2011; revisión del expediente clínico. Resultados: Incluimos 49 pacientes de los cuales 20 (40.8%) fueron hombres y 29 (59.2%) mujeres; el diagnóstico en todos fue patología discal (hernia cervical) con uno o dos niveles de afectación; el tiempo quirúrgico promedio fue 69.12, mínimo 53 - máximo 110, ± 19.61 minutos para artrodesis cervical con injerto y promedio 61.18, mínimo 50 - máximo 96.00, ± 11.38 minutos para artrodesis cervical con espaciador intersomático (p = 0.00 t de Student); las características sociodemográficas, clínicas y complicaciones se muestran. Los pacientes operados con ambas técnicas tuvieron una adecuada integración radiológica, p = 0.015 consideramos estadísticamente significativa una p ? a 0.05, ?². Conclusiones: La integración ósea es buena tanto con la aplicación de caja intersomática como con la aplicación de injerto autólogo de cresta iliaca, en pacientes con patología discal cervical. Abstract in english The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. Material and methods: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior [...] arthrodesis between January and December 2011, whose clinical records were reviewed. Results: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 ± 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 ± 11.38 minutes for cervical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p ? a 0.05 as significant, ?2. Conclusions: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.
JJ, Salvatori-Rubí; AJ, Montiel-Jarquín; RG, Barragán-Hervella; OS, García-Díaz; A, Pacheco-Espinosa; MA, Sánchez-Durán; MI, Domínguez-Cid; MS, Romero-Figueroa; M, García-Carrasco.
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)
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...
Wd, Tobler; Ma, Melgar; Tj, Raley; An,; N; Le, Miller; Rj, Nasca
This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis.Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial.There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up.The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes. PMID:25860219
Cheng, Zhaohui; Wang, Jian; Zheng, Qixin; Wu, Yongchao; Guo, Xiaodong
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)
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.
Lumbar disc herniation is one of the most common damage of musculoskeletal system. The incidence of pain of lumbosacral spine is estimated approximately on 60-90% in general population, whereas the incidence of disc herniation in patients experiencing low back pain is about 91%. Despite the high incidence and uncomplicated pathogenesis of disc disease there is a problem with the nomenclature. In the vast majority of cases, the naming confusion stems from ignorance of the etiology of low back pain. Different terminologies: morphological, topographical, Radiological and Clinical are used interchangeably. In addition, diagnosis is presented in a variety of languages: Polish, English and Latin. Moreover, the medical and traditional language are used alternately. The authors found in Polish literature more, than 20 terms to describe lumbar disc herniation. All of these terms in the meaning of the authors are used to determine one pathology--mechanical damage to the intervertebral disc and moving the disc material beyond the anatomical area. PMID:25338336
Rad?o, Pawe?; Smetkowski, Andrzej; Tesiorowski, Maciej
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.)
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.)
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)
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.)
We reviewed 9 cases of pyogenic spondylodiscitis following percutaneous endoscopic lumbar discectomy (PELD). Microbiologic cultures revealed 6 causative organisms. Five patients were managed conservatively and four were treated surgically. The mean follow-up period was 20.6 months and the average length of hospitalization was 24 days. Radiological evidence of spinal fusion was noted and infection was resolved in all patients. Although PELD is a safe and effective procedure, the possibility of...
Choi, Kyeong-bo; Lee, Choon-dae; Lee, Sang-ho
918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author)
A questionnaire was used to assess the outcome of automated percutaneous lumbar discectomy (APLD), to correlate patients’ data and to identify criteria for pain relief and patient satisfaction. Two hundred and thirty eight patients were operated on by APLD between 1988 and 1990. The questionnaire returned by 182 patients (76.4%) was suitable for evaluation. The mean follow-up was 2.5 years. Overall, 60% reported pain relief and 52% were satisfied with APLD. Conventio...
Bernd, L.; Schiltenwolf, M.; Mau, H.; Schindele, S.
The role of posterior correction and fusion in thoracolumbar and lumbar scoliosis as well as pedicle screw instrumentation in scoliosis surgery are matters of debate. Our hypothesis was that in lumbar and thoracolumbar scoliosis, segmental pedicle screw instrumentation is safe and enables a good frontal and sagittal plane correction with a fusion length comparable to anterior instrumentation. In a prospective clinical trial, 12 consecutive patients with idiopathic thoracolumbar or lumbar scol...
Halm, H.; Niemeyer, T.; Link, T.; Liljenqvist, U.
The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time. PMID:24785474
Sparrey, Carolyn J; Bailey, Jeannie F; Safaee, Michael; Clark, Aaron J; Lafage, Virginie; Schwab, Frank; Smith, Justin S; Ames, Christopher P
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.
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)
Spinal fusion surgery for alleviation of intractable lower back pain in humans is currently a primary therapeutic technique, with failure rates averaging between 5 to 35%. Implanted and external source-based electrical stimulation devices have been investigated in an attempt to increase osteogenesis at the fusion site in an attempt to reduce spinal fusion failure rates. The purpose of our study was to evaluate the efficacy of two co-processor systems and an additional system with an SIS generation field at 15.8 mA (rms) using biomechanical, dual-energy X-ray absorptiometry (DXA), and histomorphometric analyses, in rabbits following dorsolateral (= posteriolateral [in humans]) spinal fusion. Fifty-six male New Zealand White underwent bilateral lumbar spinal fusion by performing decortication of the transverse processes of lumbar vertebrae four and five with placement of autogenic cancellous bone graft harvested from the ilial wings. Four study groups were designated based on the type of IES device used for stimulation or as a control. Eight weeks after surgery all subjects were sacrificed and the quality and strength of the fusion masses were compared using radiographic, biomechanical, histomorphometry, and qualitative histological evaluation. While some variation existed within and between groups, Group 2 showed a significant improvement in all parameters measured as compared to the control group (P < 0.05). The use of adjunct non-invasive surface IES for improving bony fusion rates for patients undergoing lumbar spinal fusion is supported by this study. PMID:16810348
Nawrocki, Michael A; Martinez, Steven A; Hughes, Joanne; Lincoln, James D; Shih, Mei-Shu; Zheng, Hellen; Carroll, William J
The aim of the study is to determine if leg pain can be caused by contralateral lumbar disk herniation and if intervention from only the herniation side would suffice in these patients. Five patients who had lumbar disk herniations with predominantly contralateral symptoms were operated from the side of disk herniation without exploring or decompressing the symptomatic side. Patients were evaluated pre- and postoperatively. To our knowledge, this is the first reported series of such patients who were operated only from the herniation side. The possible mechanisms of how contralateral symptoms predominate in these patients are also discussed. In all patients, the shape of disk herniations on imaging studies were quite similar: a broad-based posterior central-paracentral herniated disk with the apex deviated away from the side of the symptoms. The symptoms and signs resolved in the immediate postoperative period. Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient. It is probable that traction rather than direct compression is responsible from the emergence of contralateral symptoms. PMID:16231173
Sucu, Hasan Kamil; Gelal, Fazil
Objective: To evaluate the influence of lumbar disc herniation type on the curative effect of percutaneous lumbar disc ectomy (PLD). Methods: 158 patients were classified into two groups including contained and discontained herniation according to clinical symptoms and diagnostic images. They were treated by means of the same technique in nonvascular intervention. Their curative effects were compared with each other in this study. Results: The curative and total effective rates were 81.1% and 98.5% respectively in contained group, 7.7% and 38.5% in discontained group without serious complications. The duration of follow up ranged from 3 months to 73 months. Conclusions: PLD is a effective procedure for lumbar disc herniation, which is relatively simple and safe with rapid recovery and without serious complications. It should be confirmed in simple contained herniation only
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)
To assess the significance of computed tomography (CT) in the elucidation of morphology of the lumbar spinal canal (LSC), the antero-posterior (AP) and transverse (T) diameter, and T area of the soft and bony LSC, and dural canal (DC) were measured by CT in 15 patients with lumbar canal stenosis, 45 patient with spondylosis, and 33 control subjects. The AP diameter failed to indicate the degree of stenosis because it was independent of morphology of the LSC. The T area of the LSC did not always help to determine the degree of DC compression, but showed some degree of stenosis. The T area of the DC was useful in determining the degree of stenosis and morphology of the stenosed site. With the use of the T area of the DC, the upper margin of articular segment was found to be most stenosed in patients with lumbar canal stenosis. (Namekawa, K.)
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
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 ve...
Michaelis Martina; Luttmann Alwin; Linhardt Oliver; Hofmann Friedrich; Haerting Johannes; Grifka Joachim; Elsner Gine; Ditchen Dirk; Ellegast Rolf; Jäger Matthias; Bergmann Annekatrin; Seidler Andreas; Petereit-Haack Gabriela; Schumann Barbara; Bolm-Audorff Ulrich
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.)
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
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.
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.
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
Objective: To investigate the clinical effectiveness of percutaneous lumbar diskectomy (PLD) combined with intradiscal electrothermal therapy (IDET) for the treatment of lumbar disc herniation. Methods: The clinical data of 87 patients with lumbar disc herniation were retrospectively analyzed. Of 87 cases, single PLD was performed in 39 and PLD followed by IDET in 48. The therapeutic results were measured and analyzed, and the complications were recorded. Results: All patients were followed up for 12-36 months. Relief in pain after the procedure was seen in both groups, but the patients in PLD+IDET group showed more improvement than the patients in PLD group. The clinical effective rate for PLD+IDET group and PLD group was 87.50% and 76.92% respectively, with no significant difference between two groups (P>0.01). No serious complications occurred. Conclusion: Both PLD+IDET and PLD are very effective in treating lumbar disc herniation. IDET is very helpful in relieving low back pain, although it can hardly improve patient's daily activities. (authors)
Full Text Available 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.
Vascular complications from percutaneous nephrostomy/nephrolithotripsy (PCN/PCNL) mostly involve the kidneys. Lumbar artery pseudoaneurysms from PCN and PCNL are a rare occurrence. We report a case of lumbar artery pseudoaneurysm following PCNL. This was treated successfully by transcatheter embolization.
Tummala, Venkat; Nanavati, Kunal I.; Yrizarry, Joes M.; Scagnelli, Thomas
Lumbar puncture may lead to neurological complications. These include intracranial hypotension, cervical epidural haematomas, and cranial and lumbar subdural haematomas. MRI is the modality of choice to diagnose these complications. This report documents MRI findings of such complications in a child treated for leukaemia. (orig.)
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
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.
Gabrielsen, T.O.; Gebarski, S.S.; Knake, J.E.; Latack, J.T.; Yang, P.J.; Hoff, J.T.
Magnetic resonance (MR) imaging has been performed in consecutive 114 patients with a chief complaint of lumbar pain. A retrospective review of MR images of a total of 570 lumbar vertebrae from these patients were done to examine lumbar disc degeneration. According to the MR intensity of nucleus pulposus on T2-wighted sagittal images, lumbar disc degeneration was graded on a scale of 0-4: 0=uniform hyperintensity; 1=slight hypointensity; 2=centrally band-like hypointensity with marginal hyperintensity; 3=irregular hypointensity in both the central and marginal sites; 4=uniform hypointensity. Lumbar disc degeneration was observed in 76%; and it was rapidly increased in frequency in the 30 or older age groups. Of 570 vertebrae, 51 (8.9%) had narrowing of intervertebral cavity. For these vertebrae, a mean score of lumbar disc degeneration was 3.1. Lumbar disc herniation was seen in 93 vertebrae, with a mean score of lumbar disc degeneration being 3.07. Changes in vertebral body marrow were seen in 14 vertebrae (2.5%), in which a mean score of intervertebral disc degeneration was 3.71. (N.K.)
Chemonucleolysis is an advantageous alternative to surgical treatment of lumbar disc herniation. To achieve the best results the indications must be strictly observed and the procedure itself must be technically perfect. In these circumstances a rapid, non-invasive and less expensive treatment of lumbar disc herniation is possible.
Braun, J.P.; Tournade, A.
Thoracic and lumbar spine conditions cause primarily mechanical back pain, although the clinician has to ensure that the symptoms are not from another etiology. We present the case of a patient with thoracic and lumbar non mechanical pain, resistant to treatment, diagnosed with a herniation of the intervertebral disc through the vertebral end-plate. We also performed a literature review. PMID:21794532
Esteban Navarro, Pedro Luis; García Casas, Oscar; Girvent Montllor, Francesc
Vascular injuries which occur during lumbar disk surgery, although rare, can give rise to potentially fatal complications which may be overlooked due to a broad range of clinical manifestations, and which surgeons and radiologists should be aware of. We report a recently encountered case of pseudoaneurysm of the abdominal aorta after lumbar disc surgery, and review the associated literature.
Kim, Dong Hun; Yoon, Sang Won; Kim, Kyung Seuk; Kim, Woo Hyuk [Armed Forces Kwang Ju Hospital, Kwangju (Korea, Republic of)
Vascular injuries which occur during lumbar disk surgery, although rare, can give rise to potentially fatal complications which may be overlooked due to a broad range of clinical manifestations, and which surgeons and radiologists should be aware of. We report a recently encountered case of pseudoaneurysm of the abdominal aorta after lumbar disc surgery, and review the associated literature
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
Diagnostic value of plain CT was assessed on 42 patients clinically suspected to have lumbar disc herniation with sacral or lumbar root pains. CT of the lumbar region visualized the site and size of prolapse of the disc and the positional relationship between the prolapsed disc and the compressed nerve root. CT is one of the useful examination methods for lumbar disc herniation, but its large exposure dose calls for selection of indications on the basis of clinical findings. Since it can be conducted on patients with lumbar disc herniation at the outpatient clinic, patients with iodine hypersensitivity or those with difficult postural change because of strong pains can also be studied. (Chiba, N.)
Full Text Available Spontaneous disc regression is described in lumbar, thoracic, cervical regions and also in various clinical situations. Although, spontaneous regression of lumbar disc herniation is a well defined clinical situation, the exact mechanism has not been adequately clarified yet. Currently , there are some suggested hypotheses. In this study, two cases with the complaint of lumbar radiculopathy and spontaneous regression of the disc herniation during their follow-up period, relevant with their clinical improvement and along with the radiological documentation of their situation, are presented. Possibility of the spontaneous regression of the lumbar discs and amelioration in some neurological symptoms with conservative therapy should be taken into account while giving a decision for operation on a patient with lumbar disc herniation.
Opacification of collateral pathways other than the central channels is very rare in lumbar epidural venography. Two cases of opacification of the inferior mesenteric vein following extravasation of contrast medium at the tip of the lateral sacral vein catheter are reported. One case is presented in which filling of normal parametrial venous plexuses and the left ovarian vein occurred as a consequence of incompetent or absent valves in the internal iliac vein. The literature containing comparable collateral flow patterns in disease is reviewed. The significance of the phlebographic features in our cases is discussed. (orig.)
Opacification of collateral pathways other than the central channels is very rare in lumbar epidural venography. Two cases of opacification of the inferior mesenteric vein following extravasation of contrast medium at the tip of the lateral sacral vein catheter are reported. One case is presented in which filling of normal parametrial venous plexuses and the left ovarian vein occurred as a consequence of incompetent or absent valves in the internal iliac vein. The literature containing comparable collateral flow patterns in disease is reviewed. The significance of the phlebographic features in our cases is discussed.
Thijssen, H.O.M.; Ike, B.W.; Chevrot, A.; Bijlsma, R.
918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.
Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)
Full Text Available Background/Objective: Lumbar spinal stenosis is the common cause of low back pain. MRI is the best modality for diagnosis of spinal canal stenosis. The aim of this study is to evaluate lumbar spinal canal diameters and relationship with gender, age, stature, weight and job."nPatients and Methods: One-hundred men and 100 women in the age range of 25 to 40 years from East Azarbayjan who were referred to Sheikholrais MRI Center were selected. The diameters of the spinal canal were measured on the midsagittal and axial section on T2 weighted images by 0.3 T MRI Unite. The results of measurements were analyzed by SPSS software. "nResults: The results showed that the least anteroposterior diameter was at the third lumbar vertebra but the narrowest transverse diameter was at the first lumbar vertebra. The mean anteroposterior diameter of the lumbar spinal canal decreased from the first to the third lumbar vertebra, followed by an increase from the third to the fifth. From the first to the fifth lumbar vertebra, there was an increase in the mean transverse diameters. The mean transverse diameter in the middle part of the vertebra is longer than the lower part. A frank relation was seen between the gender of physical workers with lumbar spinal canal stenosis, although there was no relation between age, stature, and weight with lumbar spinal canal stenosis."nConclusion: Considering the high incidence of lumbar canal stenosis and the relationship with heavy manual work, it is recommended that a plain radiography is taken before choosing heavy manual work and exercises. People whose canal is relatively narrow should be refused from heavy manual work and exercises.
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. PMID:19422710
Seidler, Andreas; Bergmann, Annekatrin; Jäger, Matthias; Ellegast, Rolf; Ditchen, Dirk; Elsner, Gine; Grifka, Joachim; Haerting, Johannes; Hofmann, Friedrich; Linhardt, Oliver; Luttmann, Alwin; Michaelis, Martina; Petereit-Haack, Gabriela; Schumann, Barbara; Bolm-Audorff, Ulrich
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.
Full text: Lumbar vertebral bone mineral density (BMD) using dual X-ray absorptiometry (DXA) has generally been calculated from a region of interest which includes the entire vertebral body. Although this region excludes part of the transverse processes, it does include the outer cortical shell of the vertebra. Recent software has been devised to calculate BMD in a central vertebral region of interest which excludes the outer cortical envelope. Theoretically this area may be more sensitive to detecting osteoporosis which affects trabecular bone to a greater extent than cortical bone. Apart from the sensitivity of BMD estimation, the reproducibility of any measurement is important owing to the slow rate of change of bone mass. We have evaluated the reproducibility of this new vertebral region of interest in 23 women who had duplicate lumbar spine DXA scans performed on the same day. The patients were repositioned between each measurement. Central vertebral analysis was performed for L2-L4 and the reproducibility of area, bone mineral content (BMC) and BMD calculated as the coefficient of variation; these values were compared with those from conventional analysis. Thus we have shown that the reproducibility of the central BMD is comparable to the conventional analysis which is essential if this technique is to provide any additional clinical data. The reasons for the decrease in reproducibility of the area and hence BMC requires further investigation further investigation
There have been a number of reports on lumbosacral nerve root anomalies. Among the most common of these anomalies is the conjoined nerve root. However, it is difficult to diagnose this condition preoperatively. We review the records of 142 patients who underwent microendoscopic discectomy (MED) for herniation of the lumbar disc. All patients had undergone magnetic resonance imaging (MRI) of the lumbar spine before surgery. For most patients, only sagittal and axial images were obtained; coronal images were obtained in only a minority of the patients. Postoperative coronal images were obtained in patients with conjoined nerve roots. A diagnosis of conjoined nerve roots was made intraoperatively in 4 patients; this diagnosis had not been possible preoperatively. After surgery, new coronal images were obtained for the 4 patients with conjoined nerve roots; however, there was no evidence of the condition on the new images. The surgical procedure employed was endoscopic decompression and herniotomy. The results were favorable, even though pediculotomy was not performed. It is difficult to diagnose nerve root anomalies preoperatively. However, the possibility of nerve root anomalies should always be considered during surgery to ensure a safe procedure, without intraoperative occurrence of nerve root injury. (author)
Full Text Available Introduction: It is a well recognized fact that a significant proportion of patients operated on for lumbar disc herniation exhibit a poor outcome, regardless of the apparent technical success of the operative procedure itself. Aim: to identify a set of widely available variables that accurately predict short-term outcome after discectomy and to develop a predictive model based upon those variables. Patients and methods: Basic demographic, clinical and radiological variables were evaluated in a group of 70 patient operated on for disc herniation. Outcome was assessed using VAS and RM scales 6 months postoperatively and correlated to aforementioned variables. Results: Preoperative pain intensity and duration, age and type of disc herniation were all shown to be statistically significant predictors of short-term outcome, unlike sex, type of radiological investigation and preoperative tension sign testing results. Multivariate regression analysis including only variables previously identified as good outcome predictors revealed that the pain intensity exhibited the strongest correlation with outcome, followed by pain duration, type of disc herniation and age. Even though MR scan was more sensitive in detecting disc extrusion than CT (sensitivity of 100% versus 65%, respectively, the presence of preoperative MR scan did not influence the outcome. Conclusion: The study identified a set of widely available and easily attainable variables as fair predictors of short-term outcome after lumbar discectomy. Subsequent logistic regression resulted in a predictive model whose accuracy is to be determined in another prospective study.
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.
A 68-year-old diabetic man, who had been on dialysis for 3 years, suffered a five week history of severe back pain that was unresponsive to bed rest, analgesics, and bracing. The vertebral cleft formed by an injury gradually increased in size on sequential plain films. Hence, he underwent calcium phosphate cement-assisted percutaneous transpedicular balloon kyphoplasty to treat a painful interbody vacuum cleft. Immediate pain relief and firm bone union were obtained.
Ishiguro, Shigeo; Tsujii, Masaya; Sudo, Akihiro
The objective of this study is to study the anatomy of lumbar plexus on human fetuses and to establish its morphometric characteristics and differences compared with adults. Twenty lumbar plexus of 10 human fetal cadavers in different gestational ages and genders were dissected. Lumbar spinal nerves, ganglions, and peripheral nerves were exposed. Normal anatomical structure and variations of lumbar plexus were investigated and morphometric analyses were performed. The diameters of lumbar spinal nerves increased from L1 to L4. The thickest nerve forming the plexus was femoral nerve, the thinnest was ilioinguinal nerve, the longest nerve through posterior abdominal wall was iliohypogastric nerve, and the shortest nerve was femoral nerve. Each plexus had a single furcal nerve and this arose from L4 nerve in all fetuses. No prefix or postfix plexus variation was observed. In two plexuses, L1 nerve was in the form of a single branch. Also, in two plexuses, genitofemoral nerve arose only from L2 nerve. Accessory obturator nerve was observed in four plexuses. According to these findings, the morphological pattern of the lumbar plexus in the fetus was found to be very similar to the lumbar plexus in adults. PMID:22696243
Yasar, Soner; Kaya, Serdar; Temiz, Ca?lar; Tehli, Ozkan; Kural, Cahit; Izci, Yusuf
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.
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El fenómeno de flexión-relajación, disminución brusca y espontánea de la actividad del músculo erector spinae durante la flexión, es la respuesta específica de este músculo en personas sanas. Se ha estudiado la intensidad de contracción del ES durante ejercicios en el banco romano con el objeto de graduar la intensidad del entrenamiento de la musculatura lumbar, pero se desconoce si el patrón de activación varía respecto al observado en postura erecta. Se registraron simultáneamente la EMG de superficie del músculo erector spinae derecho y el movimiento angular del raquis dorsolumbar durante ciclos de flexo-extensión del tronco en el banco romano y en postura erecta (n=20, M: 21.4 años, 64.5Kg y 168.4cm y se compararon los patrones de activación del músculo en ambas posturas, observando que fueron diferentes. El fenómeno de flexión relajación del músculo erector spinae apareció durante la flexión desde postura erecta pero no en el banco romano; la máxima amplitud de flexión fue significativamente menor (p ? 0.05 y la actividad decayó progresiva y simultáneamente con el incremento de flexión en el banco romano. “Evitar rangos máximos de movimiento” como norma durante la práctica de ejercicios del tronco puede proporcionar cierta protección al raquis.
PALABRAS CLAVE: Erector spinae, fenómeno de flexión-relajación, banco romano, fortalecimiento lumbar, movimiento lumbar.
The flexion-relaxation-phenomenon is the specific response of the erector spinae muscles, in free-pain subjects, during forward bending from upright standing. The contraction intensity of the erector spinae has been studied during trunk exercises on the roman chair, which has brought about significant information in order to graduate lumbar training intensity. To our knowledge, no study determined the pattern of erector spinae activity in the course of movement at the roman-chair exercises. The EMG of the right erector spinae and the angular displacement of the dorso-lumbar spine were symultaneously recorded during the time-course of flexion-extension exercises at upright standing and roman chair (n=20, M: 21.4 years, 64.5Kg and 168.4cm, the muscles activation were compared between the two exercises and different patterns were observed. The flexion-relaxation–phenomenon was observed during flexion form upright standing but not during exercises at the roman chair, the maximum amplitude of flexion was significantly less (p ? 0.05 and progresive decrease in ES activity occurred when the trunk flexed by maximum. Avoiding maximum range of flexion during trunk exercises is recommended since, as a rule during lumbar training, it may prevent from spine injury.
KEY WORDS: Erector spinae, flexion-relaxation phenomenon, roman-chair exercises, lumbar-strengthening-exercises, lumbar motion.
M. A. Sarti
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
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 result [...] ados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor. Abstract in english 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 als [...] o describe different aspects such as: age, sex, causes and segmentary pain topography.
J. E., Martínez-Suárez; L., Camblor; S., Salva; W. A. de, Jongh.
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.)
Osteochondromas are common, benign tumors in the long bones, but osteochondromas are rare in the vertebrae. Most vertebral osteochondromas arise from the cervical or upper thoracic spine. However, lumbar osteochondromas have rarely been reported. In this report, a rare case of a lumbar osteochondroma arising from the spondylolytic L3 lamina in a 57-year-old woman is presented. She also had a ruptured disc and lumbar canal stenosis at L4-5-S1. The osteochondroma was completely removed and a po...
Choi, Byung Kwan; Han, In Ho; Cho, Won Ho; Cha, Seung Heon
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)
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 < 0.001), and walking time (P < 0.001). Conclusion. The criterion validity and responsiveness of the FLS-25 were confirmed. The use of FLS-25 in clinical and investigational settings is warranted to monitor patients and evaluate therapeutic efficacy. Level of Evidence: 3 PMID:25365718
Wakita, Takafumi; Otani, Koji; Onishi, Yoshihiro; Fukuhara, Shunichi; Kikuchi, Shin-ichi; Konno, Shin-ichi
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.
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
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.
Full Text Available 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 discs, 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.
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)
Full Text Available Disc cysts are uncommon intraspinal cystic lesions located in the ventrolateral epidural space. They communicate with the nucleus pulposus of the intervertebral disc and cause symptoms by radicular compression. We report a unique case of lumbar disc cyst that was associated with disc herniation and contralateral radiculopathy. A 22 year old male presented with one month history of back-ache radiating to the left leg. Magnetic Resonance Imaging (MRI showed L3-L4 disc herniation with annular tear and cystic lesion in the extradural space anterior to the thecal sac on right side, which increased in size over a period of 3 weeks. L3 laminectomy and bilateral discectomy and cyst excision was done with partial