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

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Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were sel...

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

2009-01-01

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

Science.gov (United States)

Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were selected to conservative treatment. Under fluoroscopy in the posterior-lateral position, a K-wire was advanced into the intervertebral space and a dilator and working cannula were introduced into the disc space step by step. Discectomy and endplate scratching were performed through the cannula using pituitary forceps and endplate curettage. An ESS was inserted into the intervertebral space by a B-Twin expandable spinal delivery system after some bone graft chips implanted into the disc space. The ongoing study includes intraoperative difficulties, complications, radiologic evidence of fusion and clinical outcome as scored by pre- and postoperative questionnaires pertaining to pain intensity and degree of disability. The 12 procedures of lumbar interbody fusion using stand-alone expandable spinal system through percutaneous approach were successful. Radiologic study demonstrated fusion in a total of 11 cases and only 1 exception after more than 1 year visiting. The values of Visual Analog Scale (VAS) on movement and Oswestry Disability Index (ODI) dropped by more than 80 and 67.4%, respectively. Disk space heights averaging 9.0 mm before procedure were increased to 11.5 mm 1 month (a significant difference compared with preprocedure, P < 0.01) after surgery and stabilized at 10.8 mm upon final follow-up (a significant difference compared with preprocedure, P < 0.01). The results demonstrated that the percutaneous approach for posterior-lateral lumbar interbody fusion using expandable spinal system is a valuable micro-invasion method for the DDD patients and can achieve the same outcome as with other methods. PMID:19784677

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

2010-02-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... called a lumbar laminectomy transforaminal lumbar interbody fusion. Surgeons take bone off the spine to make more ... an hour. I want to introduce my co-surgeon, Dr. Harrop, associate professor of neurosurgery. He’s at ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... to us: we can do it in the front, opening a patient in the front, called an anterior lumbar interbody fusion, or ALIF; ... laparoscopically; minimally invasively; a standalone procedure in the front; or partially front-and-back; or completely front- ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Science.gov (United States)

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... will demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy ... a 67-year-old female who has significant back and leg pain, worse with standing and walking, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

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

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Comparison of Transforaminal Lumbar Interbody Fusion with Direct Lumbar Interbody Fusion: Clinical and Radiological Results  

Science.gov (United States)

Objective The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes. Methods A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed. Results DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (pDLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05). Conclusion Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach.

Lee, Young Seok; Park, Seung Won; Chung, Chan

2014-01-01

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Posterior Lumbar Interbody Fusion via a Unilateral Approach  

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This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two...

Shin, Hyun Chul; Yi, Seong; Kim, Keung Nyun; Kim, Sang Hyun; Yoon, Do Heum

2006-01-01

 
 
 
 
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Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge  

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This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques....

Lawton, Cort D.; Smith, Zachary A.; Ali Habib; Fessler, Richard G.

2012-01-01

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Comparison of the different surgical approaches for lumbar interbody fusion.  

Science.gov (United States)

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

2014-11-22

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Transforaminal lumbar interbody fusion (TLIF): Assessment of clinical and radiological outcome  

Scientific Electronic Library Online (English)

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.

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Postoperative spondylitis after posterior lumbar interbody fusion using cages  

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The recommended surgical options for postoperative wound infections after instrumented spine surgery include a wide debridement and irrigation with antibiotics. In most cases, implant removal is not recommended for a solid fusion. However, there are few reports on the treatment choices for persistent postoperative wound infections following a posterior lumbar interbody fusion (PLIF) using cages. This paper reviewed ten patients referred to our department, who underwent revision surgery for a ...

Ha, Kee-yong; Kim, Young-hoon

2004-01-01

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Do autologous growth factors enhance transforaminal lumbar interbody fusion?  

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Pseudarthrosis remains a significant problem in spinal fusion. The objective of our study was to investigate the effects of autologous growth factors (AGF) in instrumented transforaminal lumbar interbody spinal fusion (TLIF). A prospective review was carried out of 23 patients who underwent TLIF with application of AGF, with a minimum 2-year follow-up. Comparison with our historical cohort (without AGF application) was performed. Mean age at surgery was 44.3 years in the AGF treatment group. ...

Hee, Hwan T.; Majd, Mohammad E.; Holt, Richard T.; Myers, Leann

2003-01-01

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A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion  

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Aim?To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion.

Mccarthy, M. J. H.; Ng, L.; Vermeersch, G.; Chan, D.

2012-01-01

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The use of allograft (and avoidance of autograft) in anterior lumbar interbody fusion: a critical analysis  

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The aim of this report is to analyze the validity of allograft in anterior lumbar interbody fusion. Forty-three patients underwent anterior lumbar interbody fusion using allograft in the period between 1995 and 1998. All suffered from crippling chronic low back pain with or without sciatica. Discogenic disease was verified in 40 cases by discography. All patients were investigated preoperatively with magnetic resonance imaging (MRI). The surgical technique is described. Follow-up radiographs ...

Sarwat, A.; O Brien, J.; Renton, P.; Sutcliffe, J.

2001-01-01

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Posterior lumbar interbody fusion via a unilateral approach.  

Science.gov (United States)

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain. PMID:16807980

Shin, Hyun Chul; Yi, Seong; Kim, Keung Nyun; Kim, Sang Hyun; Yoon, Do Heum

2006-06-30

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TLIF: transforaminal lumbar interbody fusion TLIF: artrodese intersomática lombar transforaminal  

Directory of Open Access Journals (Sweden)

Full Text Available 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 indication 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.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.

Nicandro Figueiredo

2004-09-01

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TLIF: transforaminal lumbar interbody fusion / TLIF: artrodese intersomática lombar transforaminal  

Scientific Electronic Library Online (English)

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.

2004-09-01

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Surgical outcome of posterior lumbar interbody fusion with pedicle screw fixation for lumbar spondylolisthesis  

International Nuclear Information System (INIS)

Problems of lumbar spondylolisthesis treatment are many surgical tactics, elderly patient, osteoporosis, complications and recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Three hundred and fifty cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2 years), 25.4 (post op. 2-5 years), 25.0 (post op. 5-10 years) and 22.4 (post op. 10-15 yep. 5-10 years) and 22.4 (post op. 10-15 years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. No root injury, and systemic complication except 4 cases of cerebrospinal fluid (CSF) leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10 tears after surgery in this study. Rigid fixation (PLIF+PS) technique for lumbar spondylolisthesis provide good surgical result for over 15 years. Minimum invasive surgery is popular but this technique achieved good satisfaction for patient and prevent malpractice. (author)

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Anterior Lumbar Interbody Fusion for the Treatment of Postoperative Spondylodiscitis  

Science.gov (United States)

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

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

2014-01-01

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The Multiple Benefits of Minimally Invasive Spinal Surgery: Results Comparing Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Fusion  

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Minimally invasive transforaminal lumbar interbody fusion (TLIF) offers equivalent postoperative fusion rates compared to posterior lumbar fusion (PLF) and minimizes the amount of iatrogenic injury to the spinal muscles. The objective of this study was to examine the difference in pain perception, stress, mood disturbance, quality of life, and immunological indices throughout the perioperative course among patients undergoing TLIF and PLF. A prospective, nonrandomized descriptive design was u...

Starkweather, Angela R.; Witek-janusek, Linda; Nockels, Russ P.; Peterson, Jonna; Mathews, Herb L.

2008-01-01

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Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality  

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In this prospective study, our aim was to compare the clinical outcome of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in spondylolisthesis. A total of 138 patients with spondylolisthesis were randomly assigned to two groups: those operated on with pedicle screw fixation and posterior lumbar interbody fusion by autografting (PLIF), and those operated on with pedicle screw fixation and posterolateral fusion by autografting (PLF). The patients were followed-up for fo...

Cheng, Lei; Nie, Lin; Zhang, Li

2008-01-01

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Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion.  

Science.gov (United States)

A variety of implant-related short and long-term complications after lumbar fusion surgery are recognized. Mid to long-term complications due to cage migration and/or cage subsidence are less frequently reported. Here, we report a patient with a complete cage migration into the superior adjacent vertebral body almost 20years after the initial posterior lumbar interbody fusion procedure. In this patient, the cage migration/subsidence was clinically silent, but a selective decompression for adjacent segment degenerative lumbar spinal stenosis was performed. We discuss the risk factors for cage migration/subsidence in view of the current literature. PMID:25455736

Corniola, Marco V; Jägersberg, Max; Stienen, Martin N; Gautschi, Oliver P

2015-03-01

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

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

Choi, Jae Young; Sung, Kyeong Hoon

2005-01-01

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Biomechanical evaluation of three surgical scenarios of posterior lumbar interbody fusion by finite element analysis  

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Abstract Background For the treatment of low back pain, the following three scenarios of posterior lumbar interbody fusion (PLIF) were usually used, i.e., PLIF procedure with autogenous iliac bone (PAIB model), PLIF with cages made of PEEK (PCP model) or titanium (Ti) (PCT model) materiel. But the benefits or adverse effects among the three surgical scenarios were still not fully understood. Method Finite element analysis (FEA), as an efficient tool for the anal...

Xiao Zhitao; Wang Liya; Gong He; Zhu Dong

2012-01-01

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Vertebral osteolytic defect due to cellulose particles derived from gauze fibers after posterior lumbar interbody fusion.  

Science.gov (United States)

Vertebral cystic lesions may be observed in pseudarthroses after lumbar fusion surgery. The authors report a rare case of pseudarthrosis after spinal fusion, accompanied by an expanding vertebral osteolytic defect induced by cellulose particles. A male patient originally presented at the age of 69 years with leg and low-back pain caused by a lumbar isthmic spondylolisthesis. He underwent a posterior lumbar interbody fusion, and his neurological symptoms and pain resolved within a year but recurred 14 months after surgery. Radiological imaging demonstrated a cystic lesion on the inferior endplate of L-5 and the superior endplate of S-1, which rapidly enlarged into a vertebral osteolytic defect. The patient underwent revision surgery, and his low-back pain resolved. A histopathological examination demonstrated foreign body-type multinucleated giant cells, containing 10-?m particles, in the sample collected just below the defect. Micro-Fourier transform infrared spectroscopy revealed that the foreign particles were cellulosic, presumably originating from cotton gauze fibers that had contaminated the interbody cages used during the initial surgery. Vertebral osteolytic defects that occur after interbody fusion are generally presumed to be the result of infection. This case suggests that some instances of vertebral osteolytic defects may be aseptically induced by foreign particles. Hence, this possibility should be carefully considered in such cases, to help prevent contamination of the morselized bone used for autologous grafts by foreign materials, such as gauze fibers. PMID:25259557

Takenaka, Shota; Mukai, Yoshihiro; Hosono, Noboru; Tateishi, Kosuke; Fuji, Takeshi

2014-12-01

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Postoperative Flat Back: Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters  

Science.gov (United States)

Objective Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (plordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). Conclusion Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back. PMID:25371781

Kim, Jin Kwon; Kim, Deok Ryeng; Kim, Joo Seung

2014-01-01

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The Effect of the Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion on Segmental and Regional Lumbar Lordosis  

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Background. The minimally invasive lateral interbody fusion (MIS LIF) in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. Methods. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative rad...

Le, Tien V.; Vivas, Andrew C.; Dakwar, Elias; Baaj, Ali A.; Uribe, Juan S.

2012-01-01

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

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

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

2012-01-01

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

Directory of Open Access Journals (Sweden)

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

Rapp SM

2011-08-01

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

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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&n...

Dj, Zeilstra; Le, Miller; Je, Block

2013-01-01

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

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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

2013-01-01

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Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion  

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The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

2013-01-01

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Comparing miniopen and minimally invasive transforaminal interbody fusion in single-level lumbar degeneration.  

Science.gov (United States)

Degenerative diseases of the lumbar spine, which are common among elderly people, cause back pain and radicular symptoms and lead to a poor quality of life. Lumbar spinal fusion is a standardized and widely accepted surgical procedure used for treating degenerative lumbar diseases; however, the classical posterior approach used in this procedure is recognized to cause vascular and neurologic damage of the lumbar muscles. Various studies have suggested that using the minimally invasive transforaminal interbody fusion (TLIF) technique provides long-term clinical outcomes comparable to those of open TLIF approaches in selected patients. In this study, we compared the perioperative and short-term advantages of miniopen, MI, and open TLIF. Compared with open TLIF, MI-TLIF and miniopen TLIF were associated with less blood loss, shorter hospital stays, and longer operative times; however, following the use of these procedures, no difference in quality of life was measured at 6 months or 1 year. Whether miniopen TLIF or MI-TLIF can replace traditional TLIF as the surgery of choice for treating degenerative lumbar deformity remains unclear, and additional studies are required for validating the safety and efficiency of these procedures. PMID:25629037

Lo, Wei-Lun; Lin, Chien-Min; Yeh, Yi-Shian; Su, Yu-Kai; Tseng, Yuan-Yun; Yang, Shun-Tai; Lin, Jai-Wei

2015-01-01

47

Comparing Miniopen and Minimally Invasive Transforaminal Interbody Fusion in Single-Level Lumbar Degeneration  

Science.gov (United States)

Degenerative diseases of the lumbar spine, which are common among elderly people, cause back pain and radicular symptoms and lead to a poor quality of life. Lumbar spinal fusion is a standardized and widely accepted surgical procedure used for treating degenerative lumbar diseases; however, the classical posterior approach used in this procedure is recognized to cause vascular and neurologic damage of the lumbar muscles. Various studies have suggested that using the minimally invasive transforaminal interbody fusion (TLIF) technique provides long-term clinical outcomes comparable to those of open TLIF approaches in selected patients. In this study, we compared the perioperative and short-term advantages of miniopen, MI, and open TLIF. Compared with open TLIF, MI-TLIF and miniopen TLIF were associated with less blood loss, shorter hospital stays, and longer operative times; however, following the use of these procedures, no difference in quality of life was measured at 6 months or 1 year. Whether miniopen TLIF or MI-TLIF can replace traditional TLIF as the surgery of choice for treating degenerative lumbar deformity remains unclear, and additional studies are required for validating the safety and efficiency of these procedures. PMID:25629037

Lo, Wei-Lun; Lin, Chien-Min; Yeh, Yi-Shian; Tseng, Yuan-Yun; Yang, Shun-Tai

2015-01-01

48

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

DEFF Research Database (Denmark)

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

Foldager, Casper; Bendtsen, Michael

2009-01-01

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Primary investigation of clinical application of percutaneous posterior lumbar interbody fusion  

International Nuclear Information System (INIS)

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

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Good Functional Outcome and Adjacent Segment Disc Quality 10 Years after Single-Level Anterior Lumbar Interbody Fusion with Posterior Fixation  

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We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated rad...

Horsting, Philip P.; Pavlov, Paul W.; Jacobs, Wilco C. H.; Obradov-rajic, Marina; Kleuver, Marinus

2012-01-01

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Evaluation of an injectable calcium phosphate cement as an autograft substitute for transpedicular lumbar interbody fusion: a controlled, prospective study in the sheep model  

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Anteroposterior procedures for lumbar interbody fusion usually combine posterior instrumentation with anterior techniques that achieve primary stability for compressive loading: tricortical strut-graft, anterior plating systems, or cages. In comparison to transpedicular lumbar interbody fusion (TLIF), these methods bear the burden of the additional anterior approach. TLIF with autograft, in contrast, does not prove to be clinically sufficient because of its lack of primary compressive stabili...

Blattert, T.; Delling, G.; Weckbach, A.

2002-01-01

52

Posterior lumbar interbody fusion using rhBMP-2  

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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

2008-01-01

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

Science.gov (United States)

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

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

2014-01-01

54

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

Science.gov (United States)

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

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

2014-10-01

55

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

Scientific Electronic Library Online (English)

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.

2013-06-01

56

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

Directory of Open Access Journals (Sweden)

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

Zeilstra DJ

2013-08-01

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The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion  

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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.

2005-01-01

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The Ligamentotactic Effect on a Herniated Disc at the Level Adjacent to the Anterior Lumbar Interbody Fusion : Report of Two Cases  

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The authors report two cases of spontaneous regression of disc herniation at the level adjacent to the anterior lumbar interbody fusion (ALIF) level. This phenomenon may be due to the increased tension on the posterior longitudinal ligament (PLL) by appropriate restoration of the disc height and lumbar lordosis, which is a mechanism similar to ligamentotaxis applied to the thoracolumbar burst fracture.

Min, Jun-hong; Jang, Jee-soo; Kim, Seok-kang; Maeng, Dae Hyeon; Lee, Sang-ho

2009-01-01

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Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5.  

Science.gov (United States)

The aim of this prospective randomized study was to compare the radiological and clinical outcome after treatment of lumbar spinal stenosis L4L5 with or without spondylolisthesis, with either posterior lumbar interbody fusion (PLIF) (26 patients) or Dynesys posterior stabilization (27 patients). Demographic characteristics were comparable in both groups. Dynesys stabilization resulted in significantly higher preservation of motion at the index level (p Dynesys group. The latter benefits may be of particular importance for elderly patients, or those with significant comorbidities. Complications were comparable in both groups. Dynesys posterior stabilization was effective for treating spinal stenosis L4L5 with or without spondylolisthesis. PMID:22696995

Yu, Shang-Won; Yang, Shih-Chieh; Ma, Ching-Hou; Wu, Chin-Hsien; Yen, Cheng-Yo; Tu, Yuan-Kun

2012-04-01

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Clinical Results of a Single Central Interbody Fusion Cage and Transpedicle Screws Fixation for Recurrent Herniated Lumbar Disc and Low-Grade Spondylolisthesis  

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Background: The posterior lumbar interbody fusion (PLIF) procedure allows restoration ofthe weight-bearing capacity to a more physiological ventral position andmaintenance of disc space height. However, the procedure can be technicallydifficult and may cause complications. It has always been performed bilaterallywith paired cages; a single central cage has not been commonly used.Methods: Twenty-eight patients who met the interbody fusion criteria from March1999 through November 2001 were incl...

Kuo-Feng Huang; Tzu-Yung Chen

2003-01-01

 
 
 
 
61

Usefulness of Contralateral Indirect Decompression through Minimally Invasive Unilateral Transforaminal Lumbar Interbody Fusion  

Science.gov (United States)

Study Design Retrospective study. Purpose This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach. Methods The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively. Results Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p0.05). Conclusions Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss. PMID:25187862

Yoo, Jae-Sung; Lee, Jun-Yeul

2014-01-01

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

Directory of Open Access Journals (Sweden)

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

Xiangdong Duan

2009-05-01

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A Multi-center Clinical Study of Posterior Lumbar Interbody Fusion with the Expandable Stand-alone Cage (Tyche® Cage) for Degenerative Lumbar Spinal Disorders  

Science.gov (United States)

Objective This multi-center clinical study was designed to determine the long-term results of patients who received a one-level posterior lumbar interbody fusion with expandable cage (Tyche® cage) for degenerative spinal diseases during the same period in each hospital. Methods Fifty-seven patients with low back pain who had a one-level posterior lumbar interbody fusion using a newly designed expandable cage were enrolled in this study at five centers from June 2003 to December 2004 and followed up for 24 months. Pain improvement was checked with a Visual Analogue Scale (VAS) and their disability was evaluated with the Oswestry Disability Index. Radiographs were obtained before and after surgery. At the final follow-up, dynamic stability, quality of bone fusion, interveretebral disc height, and lumbar lordosis were assessed. In some cases, a lumbar computed tomography scan was also obtained. Results The mean VAS score of back pain was improved from 6.44 points preoperatively to 0.44 at the final visit and the score of sciatica was reduced from 4.84 to 0.26. Also, the Oswestry Disability Index was improved from 32.62 points preoperatively to 18.25 at the final visit. The fusion rate was 92.5%. Intervertebral disc height, recorded as 9.94±2.69 mm before surgery was increased to 12.23±3.31 mm at postoperative 1 month and was stabilized at 11.43±2.23 mm on final visit. The segmental angle of lordosis was changed significantly from 3.54±3.70° before surgery to 6.37±3.97° by 24 months postoperative, and total lumbar lordosis was 20.37±11.30° preoperatively and 24.71±11.70° at 24 months postoperative. Conclusion There have been no special complications regarding the expandable cage during the follow-up period and the results of this study demonstrates a high fusion rate and clinical success. PMID:19096552

Kim, Jin Wook; Yoon, Seung Hwan; Oh, Seong Hoon; Roh, Sung Woo; Rim, Dae Cheol; Kim, Tae Sung

2007-01-01

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Quality-of-Life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients  

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Long-term prospective outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) is not well studied. This article is a prospective clinical study to examine short-/long-term outcomes of 304 patients undergoing MITLIF. There were statistically significant clinical outcomes after MITLIF surgery, including spinal fusion and decreased postoperative complications.

Perez-cruet, Mick J.; Hussain, Namath S.; White, G. Zachary; Begun, Evan M.; Collins, Robert A.; Fahim, Daniel K.; Hiremath, Girish K.; Adbi, Fadumo M.; Yacob, Sammy A.

2014-01-01

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Clinical and Radiological Outcomes of a New Cage for Direct Lateral Lumbar Interbody Fusion  

Science.gov (United States)

Objective In Korea, direct lateral interbody fusion (DLIF) was started since 2011, using standard cage (6° lordotic angle, 18mm width). Recently, a new wider cage with higher lordotic angle (12°, 22mm) was introduced. The aim of our study is to compare the clinical and radiologic outcomes of the two cage types. Methods We selected patients underwent DLIF, 125 cases used standard cages (standard group) and 38 cases used new cages (wide group). We followed them up for more than 6 months, and their radiological and clinical outcomes were analyzed retrospectively. For radiologic outcomes, lumbar lordotic angle (LLA), segmental lordoic angle (SLA), disc angle (DA), foraminal height change (FH), subsidence and intraoperative endplate destruction (iED) were checked. Clinical outcomes were compared using visual analog scale (VAS) score, Oswestry disability index (ODI) score and complications. Results LLA and SLA showed no significant changes postoperatively in both groups. DA showed significant increase after surgery in the wide group (p<0.05), but not in the standard group. Subsidence was significantly lower in the wide group (p<0.05). There was no difference in clinical outcomes between the two groups. Additional posterior decompression was done more frequently in the wide group. Postoperative change of foraminal height was significantly lower in the wide group (p<0.05). The iED was observed more frequently in the wide group (p<0.05) especially at the anterior edge of cage. Conclusion The new type of cage seems to result in more DA and less subsidence. But indirect foraminal decompression seems to be less effective than standard cage. Intraoperative endplate destruction occurs more frequently due to a steeper lordotic angle of the new cage. PMID:25346760

Kim, Shin Jae; Lee, Young Seok; Kim, Young Baeg; Hung, Vo Tan

2014-01-01

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Porous biodegradable lumbar interbody fusion cage design and fabrication using integrated global-local topology optimization with laser sintering.  

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Biodegradable cages have received increasing attention for their use in spinal procedures involving interbody fusion to resolve complications associated with the use of nondegradable cages, such as stress shielding and long-term foreign body reaction. However, the relatively weak initial material strength compared to permanent materials and subsequent reduction due to degradation may be problematic. To design a porous biodegradable interbody fusion cage for a preclinical large animal study that can withstand physiological loads while possessing sufficient interconnected porosity for bony bridging and fusion, we developed a multiscale topology optimization technique. Topology optimization at the macroscopic scale provides optimal structural layout that ensures mechanical strength, while optimally designed microstructures, which replace the macroscopic material layout, ensure maximum permeability. Optimally designed cages were fabricated using solid, freeform fabrication of poly(?-caprolactone) mixed with hydroxyapatite. Compression tests revealed that the yield strength of optimized fusion cages was two times that of typical human lumbar spine loads. Computational analysis further confirmed the mechanical integrity within the human lumbar spine, although the pore structure locally underwent higher stress than yield stress. This optimization technique may be utilized to balance the complex requirements of load-bearing, stress shielding, and interconnected porosity when using biodegradable materials for fusion cages. PMID:23897113

Kang, Heesuk; Hollister, Scott J; La Marca, Frank; Park, Paul; Lin, Chia-Ying

2013-10-01

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

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

Hardenbrook MA

2013-06-01

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Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system.  

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Lumbar nerve root anomalies are uncommon phenomena that must be recognized to avoid neural injury during surgery. The authors describe 2 cases of nerve root anomalies encountered during mini-open transforaminal lumbar interbody fusion (TLIF) surgery. One anomaly was a confluent variant not previously classified; the authors suggest that this variant be reflected in an amendment to the Neidre and Macnab classification system. They also propose strategies for identifying these anomalies and avoiding injury to anomalous nerve roots during TLIF surgery. Case 1 involved a 68-year-old woman with a 2-year history of neurogenic claudication. An MR image demonstrated L4-5 stenosis and spondylolisthesis and an L-4 nerve root that appeared unusually low in the neural foramen. During a mini-open TLIF procedure, a nerve root anomaly was seen. Six months after surgery this patient was free of neurogenic claudication. Case 2 involved a 60-year-old woman with a 1-year history of left L-4 radicular pain. Both MR and CT images demonstrated severe left L-4 foraminal stenosis and focal scoliosis. Before surgery, a nerve root anomaly was not detected, but during a unilateral mini-open TLIF procedure, a confluent nerve root was identified. Two years after surgery, this patient was free of radicular pain. PMID:23905960

Burke, Shane M; Safain, Mina G; Kryzanski, James; Riesenburger, Ron I

2013-08-01

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

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

Khusniddin Nuraliev

2012-01-01

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Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy.  

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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 4.1years. 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

2015-02-01

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

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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, post...

Sm, Rapp; Le, Miller; Je, Block

2011-01-01

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

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

Khusniddin Nuraliev

2012-10-01

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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  

Scientific Electronic Library Online (English)

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

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

2012-12-01

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

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

Vinicius de Meldau Benites

2012-12-01

75

Transforaminal lumbar interbody fusion rates in patients using a novel titanium implant and demineralized cancellous allograft bone sponge  

Science.gov (United States)

Background Transforaminal lumbar interbody fusion (TLIF) with grafting and implant options like iliac crest bone graft (ICBG), recombinant bone morphogenetic protein (rhBMP), and polyetheretherketone (PEEK) cages have been reported to achieve extremely high fusion rates. Unfortunately, these options have also been frequently cited in the literature as causing postoperative morbidity and complications at a high cost. Knowing this, we sought to investigate TLIF using an acid-etched, roughened titanium cage that upregulates osteogenesis to see if similar fusion rates to those cited for ICBG, rhBMP, and PEEK cages could be safely achieved with minimal morbidity and complications. Materials and methods A radiographic fusion study of 82 patients who underwent TLIF using an acid-etched, roughened titanium cage with demineralized cancellous bone graft was conducted. Fusion was assessed and graded by an independent radiologist using computed tomography scan with sagittal and coronal reconstructions. Results Fusion rates at 6 months were 41 of 44 (93.2%) and at 12 months were 37 of 38 (97.4%). There were no radiographic device-related complications. Conclusions TLIF with an acid-etched, roughened titanium cage filled with a decalcified bone graft achieved similar fusion rates to historical controls using ICBG, rhBMP, and PEEK. PMID:25580378

Girasole, Gerard; Muro, Gerard; Mintz, Abraham; Chertoff, Jason

2014-01-01

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

International Nuclear Information System (INIS)

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)

77

Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series  

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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

2011-09-01

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The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF  

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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

Birkenmaier Christof

2010-09-01

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Hybrid computer-guided and minimally open surgery: anterior lumbar interbody fusion and translaminar screw fixation  

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Less invasiveness is the way forward for spinal surgery. Minimal disruption of tissue, preservation of muscle function, and restoration of normal spinal alignment are still the goals of most surgical procedures. An anterior lumbar fusion technique using a less invasive procedure with the addition of translaminar screws is described. The autograft is harvested from the vertebral body, thus avoiding the morbidity associated with an iliac crest bone graft. The operative steps for the procedure a...

Kumar, N.; Wild, A.; Webb, J. K.; Aebi, M.

2000-01-01

80

Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw  

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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

2008-01-01

 
 
 
 
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[Use of artifiial bone in lateral interbody fusion of the lumbar spine: a prospective radiographic study].  

Science.gov (United States)

PURPOSE OF THE STUDY The aim of the study was to evaluate the extent of fusion using synthetic ?-tricalcium phosphate as a bone substitute in extreme lateral interbody fusion (XLIF). MATERIAL AnD METHODS In this prospective study, patients undergoing XLIF with an Oracle cage filed with the artifiial bone ChronOs Strip (Synthes, USA) were evaluated. The group consisted of 61 patients, 33 women and 28 men, with an average age of 50.9 years (range, 21 to 73 years). A total of 64 segments were operated on. Stand-alone interbody fusion was performed in 14 segments, lateral plate fiation in 19, transpedicular (TP) fiation before XLIF was carried out in 14 and TP fiation after XLIF in 17 segments. At one-year follow-up, dynamic X-rays to exclude instability, and CT images were obtained in order to evaluate the extent of bone fusion outside the implant (complete fusion, partial fusion, no fusion) and inside it (% of the bone fusion surface area). In addition, bone mineral density following fusion mass bone quality (expressed in Hounsfild units [HU]) was assessed inside the implant at the site of ChronOs Strip placement, using a region of interest (ROI) analysis. For the evaluation of fusion bone quality inside the implant on CT scans with HU qualifiation, the authors propose the following scale: 1. no fusion (0-99 HU) 2. Uncertain fusion (100-190 HU) 3. Probable fusion (200-299 HU) 4. Reliable fusion (300 and more HU) All results were statistically evaluated in relation to the gender, age, treated segment, surgical diagnosis, method of fiation, implant height and intervertebral space reduction at one-year follow-up. RESULTS Fusion outside the implant was complete in 18 segments (28%) and partial in 27 (42%); in 19 segments (30%) it was not detected. The bone fusion surface area inside the implant was 54.5% (0-100%) on the average. It was related to age and implant height; the surface area increased with increasing age and with increasing implant height. Solid bone fusion inside the implant, as assessed on CT images using HU, was reliable in 36 segments (56%), probable in 11 (17%), uncertain in 10 (16%) and was not detected in seven segments (11%). A signifiant relationship was found between the quality of bone fusion and the type of fiation. Of the segments treated by stand-alone XLIF, 29% showed no fusion while the segments managed by lateral plate fiation had 32% of them with probable fusion. Correlations were also found with the height of an implant (the higher the implant, the more reliable its fusion), with age (the higher age, the higher bone density) and with the spinal level (the lower level, the lower bone density). In 45 (70%) segments, bone mineral density inside the implant was higher than the density of surrounding spongious bone. The average density inside the implant was 333.7 HU (14-1075) and that of the surrounding bone was 244.6 HU (66-500). The intervertebral space was reduced by an average of 1.1 mm (0-6.2). All treated segments were found stable on dynamic X-rays. PMID:25651294

Hrabálek, L; ?echáková, E; Bu?val, S; Adamus, M; Langová, K; Vaverka, M

2014-01-01

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Effect of Psychological Status on Outcome of Posterior Lumbar Interbody Fusion Surgery  

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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

2012-01-01

83

Compressive strength of interbody cages in the lumbar spine: the effect of cage shape, posterior instrumentation and bone density  

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One goal of interbody fusion is to increase the height of the degenerated disc space. Interbody cages in particular have been promoted with the claim that they can maintain the disc space better than other methods. There are many factors that can affect the disc height maintenance, including graft or cage design, the quality of the surrounding bone and the presence of supplementary posterior fixation. The present study is an in vitro biomechanical investigation of the compressive behaviour of...

Jost, B.; Cripton, P. A.; Lund, T.; Oxland, T. R.; Lippuner, K.; Jaeger, P.; Nolte, L. -p

1998-01-01

84

Porous Biodegradable Lumbar Interbody Fusion Cage Design and Fabrication Using Integrated Global-Local Topology Optimization With Laser Sintering  

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Biodegradable cages have received increasing attention for their use in spinal procedures involving interbody fusion to resolve complications associated with the use of nondegradable cages, such as stress shielding and long-term foreign body reaction. However, the relatively weak initial material strength compared to permanent materials and subsequent reduction due to degradation may be problematic. To design a porous biodegradable interbody fusion cage for a preclinical lar...

Kang, Heesuk; Hollister, Scott J.; La Marca, Frank; Park, Paul; Lin, Chia-ying

2013-01-01

85

Clinical Results of a Single Central Interbody Fusion Cage and Transpedicle Screws Fixation for Recurrent Herniated Lumbar Disc and Low-Grade Spondylolisthesis  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The posterior lumbar interbody fusion (PLIF procedure allows restoration ofthe weight-bearing capacity to a more physiological ventral position andmaintenance of disc space height. However, the procedure can be technicallydifficult and may cause complications. It has always been performed bilaterallywith paired cages; a single central cage has not been commonly used.Methods: Twenty-eight patients who met the interbody fusion criteria from March1999 through November 2001 were included in the study. Surgery was performedfrom the posterior with a single central cage supplemented withtranspedicle screws. The follow-up period ranged from 8 to 39 months with amean of 14.4 months. Clinical outcomes were assessed. Dynamic radiographyfor fusion mass was interpreted by an independent radiologist.Results: Overall, 92.86% of the patients were satisfied with their conditions aftersurgery. Radiography study showed the rate of bony fusion being 82.14%.Fibrous union was noted in five patients. No migration of the cage wasobserved. One patient experienced laceration of the dura without clinicalsequelae. One patient had transient paresthesia and recovered within 2weeks. One patient had transient bladder atony and recovered within 3 days.Overall, the complications were negligible and none of the patients sustaineda motor deficit and permanent complication.Conclusions: The PLIF procedure using a single, central cage combined with bilateralpedicle screws fixation obtained satisfactory outcome within a short-term orlong-term follow-up period. Since the implant-related complications haveseldom been observed, it may be used as an alternative option for recurrentlumbar disc herniation or low grade spondylolisthesis with apparent degenerativedisc disease.

Kuo-Feng Huang

2003-03-01

86

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  

Directory of Open Access Journals (Sweden)

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

Cristiano Magalhães Menezes

2009-09-01

87

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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. Throu...

Hey Hwee Weng; Hee Hwan

2010-01-01

88

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

Scientific Electronic Library Online (English)

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

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

89

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

Scientific Electronic Library Online (English)

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

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

2009-09-01

90

Clinical and Radiological Comparison of Posterolateral Fusion and Posterior Interbody Fusion Techniques for Multilevel Lumbar Spinal Stabilization In Manual Workers  

Science.gov (United States)

Study Design Eighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively. Purpose We aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine. Overview of Literature Previous studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques. Methods After standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months. Results Patients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154). Conclusions PLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients. PMID:25346809

Çakar, Albert; Hüseyino?lu, Nergiz; Hüseyino?lu, Urfettin; Çelik, Recep

2014-01-01

91

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

DEFF Research Database (Denmark)

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

Li, Haisheng; Zou, Xuenong

2004-01-01

92

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

Directory of Open Access Journals (Sweden)

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

Hsieh Pang-Hsing

2008-06-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... they walk a lot at home and do kind of try to stay as active as possible. That’s why we fixed her, so she can get up and get going, and that’ll help with her muscle pain. And then we will get them doing ...

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

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Full Text Available ... spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, and it has to ... a patient’s loss of function, not for severe weakness. Though we do operate—there are times we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... compression; disc degeneration only. And again, it’s less successful with surgery, as opposed to what we call ... This is something that we’re the most successful with surgery. With the appropriate diagnosis and failure ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... actual low back pain is usually caused with no sciatica, or nerve compression; disc degeneration only. And ... answering that because there’s never been—there’s been no limitation, we’re not limited in what we ...

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... TLIF. So both of them—both of the groups did have some issues with persistent radiculopathy. I’ ... I want to thank the Jefferson media marketing group that’s put this— helped us put this webcast ...

 
 
 
 
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Full Text Available ... put in posteriorly, it can create an inflammatory reaction where they do get some leg pain. It ... deformity, but the bone graft, the fusion—the rate of fusion is much higher when we put ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... for a laminectomy procedure; any thoughts on the efficacy of X-Stop? Okay. This is—X-Stop ... correct her deformity, as it is in an adolescent patient with scoliosis where we try to correct ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... with the bone, and we’ve been very happy with the fusion. Sometimes in a small percentage ... to call 1-800-JEFF-NOW. We’re happy to help, both the neurosurgical and orthopedic department ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to it. You can see there’s a counter-torque piece while we twist it—and you hear ... means it’s tight enough. It has a tightening torque to know that it’s tightened enough. Well, here’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to your surgeon and say, What are the alternatives? Are there any other ways this can be ... to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... different today is that we’re doing a full laminectomy. Because this patient has severe stenosis, we’ ... we end up operating on have had a full course of nonoperative treatment. So the answer is ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... lower part right below the spreader where the metal instrument is, the big hole. 00:25:29 ... basic blood cells, and they will be bone-forming cells. But we are going to help them ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to your surgeon and say, What are the alternatives? Are there any other ways this can be ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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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 ...

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Full Text Available ... another; we do do it for degenerative disc disease, though much less commonly; scoliosis, as in this ... bipolar cautery that we use. With a little foot pedal, we grab these veins and cauterize them. ...

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... of with back disorders, is not really a surgical diagnosis. Most Americans, 80 to 90%, will suffer episodes ... helps to prop the spine open. So the surgical approach we decide for each patient is dependent on their diagnosis, but the results, the potential complications which we ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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

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Full Text Available ... are not good at fixing this problem with surgery; we do sometimes operate for back pain, but ... degeneration only. And again, it’s less successful with surgery, as opposed to what we call radicular leg ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the spine makes them better. Now, the other component of this patient’s problem is degenerative scoliosis, and ... right side of her spine was as collapses 2 mm. And the effect of spreading that out, ...

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

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Full Text Available ... Without him we couldn’t do the operation. He’s the only one who knows the names of the instruments. So ... from the deformity. Maybe you want to increase one click on that, David, the distractor, so he can put an anterior. Can you give a ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... down on the screw and put an electrical current through it. Craig’s going to then ramp up ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Full Text Available ... received another question: “What have you experienced as your largest inconvenience or limitation, in terms of surgical instrumentation or devices for spinal surgery?” 00:49:42 JAMES S. HARROP, ...

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Full Text Available ... vascular claudication in patients with hardening of the arteries can have very similar symptoms. And so as ... those with vascular stenosis, or hardening of the arteries in their aorta or their legs. And patients ...

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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. 01:01:05 [END OF BROADCAST

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Full Text Available ... picture you see the white, which is the canal, is wide open. And at these levels, L3-4 and 4- 5, it’s very collapsed. ... she has progressive stenosis at each of these levels. So we are left with ... open up her spinal canal, decompress her nerve roots, or open them up, ...

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Full Text Available ... isn’t terrific, the bone gets very, very hard and sclerotic, whereby we actually can put a ... 00:35:48 JAMES S. HARROP, MD: Kind of hard a little bit to see because I actually ...

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Full Text Available ... to put pedicle screws in. And the working zone shows you that is the transforaminal working zone, where we’re going to distract and put ... is the area, again, of the transforaminal working zone. And below, the “P,” is the pedicle. That’s ...

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

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

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Full Text Available ... the biomechanics of this spine. I won’t bore you too much with it, but this cartoon ... because when we do a TLIF without a wide laminectomy, we have to resect, and this is ...

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Full Text Available ... prepared the patient by exposing them to this point, exposing their spine, which is somewhat involved: taking ... by 40mm. It’s got a nice, sharp enough point that it will go down. You see it ...

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Full Text Available ... or spinal stenosis, feel better with sitting and bending over, where vascular claudication will only get better ... better when I’m at the grocery store bending over a shopping cart,” so flexing the spine ...

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Full Text Available ... bone on one side of the spine. If pathology is only on one side of the spine, ... your diagnosis is. We think for this particular pathology and problem that—which is not a simple ...

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Full Text Available ... muscles off their spine and preparing some sites where we’re going to put screws in, which ... Again, you’re looking at the right side where there’s the pinching. And on the right side ...

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Full Text Available ... talk about the patient first. It’s a 67-year-old female who has significant back and leg pain, worse with standing and walking, and it’s been refractory to medical therapies. She has the diagnosis called spinal stenosis, ...

 
 
 
 
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Full Text Available ... cages and spaces in that cages often are threaded and go in with distraction plugs; spacers are ... it. Now they’re going to measure the rod and cut it and contour it. And Jim, ...

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

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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 ...

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

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Full Text Available ... for—emergently if patients lose their bowel or bladder, and I guess it’s important for our watching ... if they lose control of their bowel and bladder from severe compression of the nerves. It’s rare, ...

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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, ...

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Full Text Available ... L3, 4, and 5. You do not see perfect squares at the bottom because of her scoliosis ... 38 TODD J. ALBERT, MD: Well, that’s the perfect timing. And you can see what the effect— ...

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

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Full Text Available ... circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, ... bender. 00:43:45 ASSISTANT: How do these heights look to you? 00:43:48 JAMES S. HARROP, ...

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Full Text Available ... plan for the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, and then ... that we’re going to see them for decompression. There’s a number of different types of cages ...

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Full Text Available ... when you walk downhill or when a lady wears high heels or when they arch their back. ... question—how long does the patient have to wear a brace? We typically brace patients after this ...

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Full Text Available ... spinal surgery, and the ability to obtain a solid fusion if a solid fusion is necessary, what we’re after, and ... re happy to see any patient with these type of problems who’s ... in between the retrieval bodies are our disc spaces— we talked about those. ...

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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 ...

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Full Text Available ... a ground to make a full circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, MD: I need a rod bender. 00:43:45 ASSISTANT: How do these heights look to ...

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Full Text Available ... patients like this and it becomes much, much harder and more difficult and dangerous operation to revise ... can get it done, but sometimes it’s much harder than others. So if you noticed, they’re ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... out to you to answer: “What is the benefit of putting the bone graft in the disc ... grafts as well. But the answer is the benefit is increased fusion rate, and it’s very good ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... space. For many patients, this allows them to return to normal activities and an improved quality of ... and probably, even if she had a honeymoon period where she got resolution of the nerve pain ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

 
 
 
 
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Full Text Available ... program for CME credit. 00:00:55 TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. ... JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ALBERT, MD: Okay, good. So what you see— ...

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Full Text Available ... You can imagine if someone was grabbing your throat and squeezing and strangling you— this is the ... material out And here you see these special angles—double and triple angle curettes—because we’re ...

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

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Full Text Available ... legs and give power to your legs. The blue square you see on the left is the ... back out so he can get a little light in here for a second. You can see ... MD: You can’t really see it. The light’s not great. But we did get it—we ...

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Full Text Available ... and just do this TLIF?” Well, if the indication is correct for a TLIF, the TLIF in ... put in the patient. This is for another indication. This is one of my other patients that ...

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Full Text Available ... popped up on the right lower area—the carbon fiber cage, similar to what we’re going ... 22:17 JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ALBERT, MD: Okay, good. So what ...

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Full Text Available ... the spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. HARROP, MD: Here’s ... we go off air. This is just some data, and important, when people say, “Why do you ...

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Full Text Available ... MD: Okay, so he’s going to put that joy—that’s called the joystick that we probe the ... don’t pop off, just loosen it lightly, David. That’s going to be—that’s going to make ...

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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 ...

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Full Text Available ... about the patient first. It’s a 67-year-old female who has significant back and leg pain, ... latest and best procedure or is there something new on the horizon? I have to say, to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... depending on what we distract. Is that an 8 to 10 spreader, Jim? 00:24:27 JAMES S. HARROP, MD: This is an 8 to 10 spreader. I’m just trying to give us a little bit more room here. As you can see, she really wants to collapse ... ready? Do you have an 8 Branigan? I think an 8 Branigan. Jim, they’ ...

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

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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 ...

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

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Full Text Available ... what we call the threshold, the amount of voltage that we read in the lower extremity, we ... your spine and we have to keep an eye on the other levels. And generally, patients can ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Full Text Available ... what we call the threshold, the amount of voltage that we read in the lower extremity, we ... directly at the transverse processes so that the high-speed burr that they’re using is unseating ...

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Full Text Available ... You may participate in the program by sending questions at any time; just click the MDirectAccess button ... all the viewers that you can submit a question at any time during the broadcast by clicking ...

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Full Text Available ... your spine and we have to keep an eye on the other levels. And generally, patients can do great. 80% to 90% of patients do great throughout their lives, but it’s best that—and very important— that they keep, in terms of good spine health, that they keep in superb condition and keep ...

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Full Text Available ... shorter for patients with a TLIF, and the blood loss was less. In addition, having lower complication rates and lower arthrosis, or non-healing rates for the TLIF. So both of them—both of the groups did have some issues with persistent radiculopathy. I’ ...

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

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Full Text Available ... you look at the canal—I don’t know if you can see my computer or not— ... 25:21 JAMES S. HARROP, MD: I don’t know if you can see. Actually we can see ... do the operation. He’s the only one who knows the names of the instruments. So Ron’s preparing ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat lower back ... the disc space. Here on your screen you will see her x-rays. You can see that ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... space. Here on your screen you will see her x-rays. You can see that her spine is not straight. The dots on the ... if you’re looking at the patient from her back. She is standing with her back to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... more room for the spinal canal, free the nerve roots, and then fuse the surrounding vertebrae across ... a patient who cannot walk well because her nerves are pinched. Every time she stands and walks, ...

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Full Text Available ... 26:49 TODD J. ALBERT, MD: And our monitoring p—we have monitoring people in the room. They’re a critical ... have had no problems during the surgery. Our monitoring has been good, so we know her nerves ...

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

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Full Text Available ... this patient; a pseudoarthrosis is a nonhealed fusion; failed laminectomies; and degeneration above a fusion, or junction ... body think that they’re had a spine fracture, they’re had a bone fracture, because the ...

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 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 ...

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Full Text Available ... stenosis, it would certainly come back from the high degree of instability. And we see patients like ... directly at the transverse processes so that the high-speed burr that they’re using is unseating ...

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

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

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Full Text Available ... these work. If you use just a straight instrument, you can’t get as much disc out of the disc space. And so here you’ll see the disc— ... see all the way down into the disc space. 00:25:25 TODD J. ALBERT, MD: ... spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. ...

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Full Text Available ... distraction. This is called the final tightener. It’s two parts to it. You can see there’s a counter-torque piece while we twist it—and you hear the snap, it only has to snap once because that ...

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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, ...

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

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Full Text Available ... re happy to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re happy to see any patient with these type of problems who’s been recommended ...

 
 
 
 
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Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc ...

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Full Text Available ... ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University ... in the program by sending questions at any time; just click the MDirectAccess button on the screen. ...

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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’ ...

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

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Full Text Available ... above that is severely collapsed, and she has severe stenosis. If you look toward the top of ... doing a full laminectomy. Because this patient has severe stenosis, we’re taking off the middle part ...

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

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

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

Science.gov (United States)

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

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

2014-03-01

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Miniopen Oblique Lateral L5-S1 Interbody Fusion: A Report of 2 Cases  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Extreme lateral interbody fusion (XLIF) has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF), but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF) of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage a...

Keijiro Kanno; Seiji Ohtori; Sumihisa Orita; Kazuyo Yamauchi; Yawara Eguchi; Yasuchika Aoki; Junichi Nakamura; Masayuki Miyagi; Miyako Suzuki; Gou Kubota; Kazuhide Inage; Takeshi Sainoh; Jun Sato; Yasuhiro Shiga; Koki Abe

2014-01-01

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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  

Scientific Electronic Library Online (English)

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.

2007-09-01

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Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases.  

Science.gov (United States)

Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. All operations were done with the patient in the sitting position. Central venous pressure monitoring was used only infrequently. There was a 96% incidence of relief of significant arm pain and/or paresthesia and a 98% incidence of resolution of preoperatively present motor deficit. Eight hundred twenty-eight procedures (98%) were preceded by Pantopaque cervical myelography. There was a 71.5% incidence of correlation between preoperative clinical findings (both sensory and motor) and operative findings. In 13% of the cases, two spaces were thought by the operating surgeon to be equally involved by the spondylotic process. Most (91.5%) of the patients describe themselves as either "good or excellent" postoperatively. There was no significant difference postoperatively regarding results or recurrence between patients with suspected soft or hard disc protrusions and those with strictly spondylotic radiculopathy. Nor was there any statistical difference in results among the three patient population groups ("private" vs. compensation vs. liability). The mean length of time to return to work or other "normal" activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%. PMID:6316196

Henderson, C M; Hennessy, R G; Shuey, H M; Shackelford, E G

1983-11-01

212

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

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

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

2008-01-01

213

Extreme Lateral Interbody Fusion Procedure  

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

214

Posterior lumbar interbody fusion using nonresorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices: a prospective, randomized study to assess fusion and clinical outcome  

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STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE.: To assess fusion, clinical outcome, and complications. SUMMARY OF BACKGROUND DATA: Resorbable poly-L- lactide-co-D,L-lactide (PLDLLA) cages intended to aid spinal interbody fusion have been introduced into clinical practice within the last decade. Although early case series show promising results with respect to fusion rate, worries persist with regards to efficacy and potential risks of early failure of these implants. Despit...

Jiya, T. U.; Smit, T. H.; Deddens, J.; Mullender, M. G.

2009-01-01

215

Interobserver agreement using computed tomography to assess radiographic fusion criteria with a unique titanium interbody device.  

Science.gov (United States)

The accuracy of using computed tomography (CT) to assess interbody fusion in patients with titanium implants has been questioned in the past. Radiologists have reported difficulty assessing fusion bone quality because of metal artifact and small graft windows. A new titanium interbody implant with a large footprint and a wide graft aperture has been developed. We conducted a study to determine the interobserver reliability of using CT to assess radiographic fusion variables with the new titanium interbody device. Patients underwent anterior lumbar interbody fusion with the same titanium interbody implant. Reconstructed CT images were obtained randomly at 6, 9, or 12 months. Two independent radiologists reviewed the scans. Interobserver reliability was calculated using the ? statistic. Fifty-six spinal fusion levels (33 patients) were analyzed. The radiologists agreed on 345 of the 392 fusion data points reviewed (? = .88). Agreement for solid fusion formation was 0.77. This interbody device demonstrated minimal artifact and minimal subsidence, and trabecular bone was easily identified throughout the implant in the vast majority of cases reviewed. High interobserver agreement was noted across all radiographic variables assessed. PMID:25658078

Slosar, Paul J; Kaiser, Jay; Marrero, Luis; Sacco, Damon

2015-02-01

216

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

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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.

2009-01-01

217

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... them. So now I can have a mapping where the nerves are. Now back to you, Dr. ... is what we call a cage. And that's where the term comes from: extreme lateral interbody fusion. ...

218

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform the procedure. Dr. Uribe is the assistant ... University of South Florida College of Medicine. He will be joined by Dr. Fernando Vale, vice chief ...

219

Estrogen receptor ESR1 controls cell migration by repressing chemokine receptor CXCR4 in the zebrafish posterior lateral line system  

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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

2010-01-01

220

Simultaneous combined anterior and posterior lumbar fusion with femoral cortical allograft  

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The radiographic fusion rates, graft behaviour and clinical outcome of 41 patient with simultaneous combined anterior lumbar interbody fusion and posterior arthrodesis with translaminar screws were reviewed independently. In all patients a femoral cortical allograft (FCA) ring filled with autologous iliac crest cancellous bone was used anteriorly to replace the disc and achieve interbody fusion. The follow-up averaged 30.6 months, with a minimum follow-up of 24 months. All patients had disabl...

Liljenqvist, U.; O’brien, J. P.; Renton, P.

1998-01-01

 
 
 
 
221

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

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Objective?To compare the postoperative muscle damage after either posterior lumbar interbody fusion (PLIF) or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with the aid of X-Tube system in patients with singlelevel degenerative lumbar spinal disease. Methods?The clinical data of 52 patients (males 28, females 24, aged 54.3±7.8 years) with single-level degenerative lumbar spinal disease undergoing MIS-TLIF assisted by the X-Tube system from Oct 2010 to Sep 2011 was ...

Zhou, Liang; Liu, Zheng-sheng; Mao, Ke-ya; Liu, Jian-heng; Xiao, Bo; Xu, Jiao; Wang, Yi-guo

2014-01-01

222

Clinical Outcomes of Extreme Lateral Interbody Fusion in the Treatment of Adult Degenerative Scoliosis  

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Introduction. The use of extreme lateral interbody fusion (XLIF) and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF. Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an avera...

Caputo, Adam M.; Michael, Keith W.; Chapman, Todd M.; Massey, Gene M.; Howes, Cameron R.; Isaacs, Robert E.; Brown, Christopher R.

2012-01-01

223

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

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The aim of the current study was to evaluate changes in lumbar kinematics after lumbar monosegmental instrumented surgery with rigid fusion and dynamic non-fusion stabilization. A total of 77 lumbar spinal stenosis patients with L4 degenerative spondylolisthesis underwent L4–5 monosegmental posterior instrumented surgery. Of these, 36 patients were treated with rigid fusion (transforaminal lumbar interbody fusion) and 41 with dynamic stabilization [segmental spinal correction system (SSCS)]...

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

2011-01-01

224

Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF  

Directory of Open Access Journals (Sweden)

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

2010-01-01

225

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... in order to map the nerves on the lumbar plexus. And with the NeuroVision monitoring on the ... and it's used for patients with severe intractable lumbar spondylosis. Anybody that suffers from spine disease from ...

226

Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion  

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Adjacent segment degeneration (ASD) is discussed to impair long-term outcome after lumbar interbody fusion. Nevertheless the amount and origin of degeneration and its clinical relevance remain unclear. Only little data is published studying quantitative disc height reduction (DHR) as indicator for ASD in long-term follow-up. Forty patients (23 men, 17 women) (group 1: degenerative disc disease, n = 27; group 2: lytic spondylolisthesis, n = 13) underwent lumbar 360° instrumentation and fu...

Schulte, Tobias L.; Leistra, Freek; Bullmann, Viola; Osada, Nani; Vieth, Volker; Marquardt, Bjo?rn; Lerner, Thomas; Liljenqvist, Ulf; Hackenberg, Lars

2007-01-01

227

Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration.  

Science.gov (United States)

The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Although these materials have desirable biocompatibility and mechanical properties, they require further modification to support osseointegration. Reports of extensive research on this topic are available in biomaterial-centric published reports; however, there are few clinical studies concerning surface modification of interbody spinal implants. The current article focuses on surface modifications aimed at fostering osseointegration from a clinician's point of view. Surface modification of Ti by creating rougher surfaces, modifying its surface topography (macro and nano), physical and chemical treatment and creating a porous material with high interconnectivity can improve its osseointegrative potential and bioactivity. Coating the surface with osteoconductive materials like hydroxyapatite (HA) can improve osseointegration. Because PEEK spacers are relatively inert, creating a composite by adding Ti or osteoconductive materials like HA can improve osseointegration. In addition, PEEK may be coated with Ti, effectively bio-activating the coating. PMID:24890288

Rao, Prashanth J; Pelletier, Matthew H; Walsh, William R; Mobbs, Ralph J

2014-05-01

228

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... and allow for a fusion without disrupting the rest of the soft tissue. You can see Dr. ... allows bone-to-bone fusion without disturbing the rest of the lumbar anatomy. Again, I mean, as ...

229

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... kind of operation? Well, yes. This is not experimental. This has been done for many years, and it's considered a lumber -- it's considered a standard lumbar spine fusion. The ...

230

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... The minimally invasive XLIF procedure takes a unique approach with a side entry. This allows the surgeon ... that can be corrected with this minimal access approach to the lumbar spine. So that's the way ...

231

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... what this offers is more alternative to a patient that is suffering from severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all of the ...

232

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... going to stimulate in order to map the nerves on the lumbar plexus. And with the NeuroVision ... tell me how far I am from the nerves. Generally, numbers 20 or more -- 20 or more ...

233

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... on the lumbar plexus. And with the NeuroVision monitoring on the screen, we are obtaining the numbers ... are changing. Now we can see on the monitoring, you have 9, so it's telling me that ...

234

Conservative management of psoas haematoma following complex lumbar surgery.  

Science.gov (United States)

We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period. PMID:24600073

Lakkol, Sandesh; Sarda, Praveen; Karpe, Prasad; Krishna, Manoj

2014-01-01

235

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... the disc -- and we are inside the disc space. So we are going to place our cage there. So now I'm going ... this little lumbar spine, this represents the disc space, which is going to be removed. That's what Dr. Juan Uribe was doing. And then we basically place this cage that is replacing the disc. This ...

236

Extreme Lateral Interbody Fusion Procedure  

Medline Plus

Full Text Available ... from behind, so what this offers is more alternative to a patient that is suffering from severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all of the above. So again, he's still working on the discectomy. As soon as Dr. Uribe ...

237

Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.  

Science.gov (United States)

The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies. PMID:25415482

Staub, Blake N; Holman, Paul J

2015-02-01

238

Protecting the genitofemoral nerve during direct/extreme lateral interbody fusion (DLIF/XLIF) procedures.  

Science.gov (United States)

A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe "burning" in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3-L4 and L4-L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 microsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1-L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain. PMID:21313792

Jahangiri, Faisal R; Sherman, Jonathan H; Holmberg, Andrea; Louis, Robert; Elias, Jeff; Vega-Bermudez, Francisco

2010-12-01

239

The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion for degenerative spondylolisthesis can yield high levels of patient satisfaction and restore spinal balance Methods A retrospective study of clinical outcomes and a radiological review was performed on 18 patients with one or two level degenerative spondylolisthesis. Patients were divided into two groups: the patients without improvement in pelvic tilt, postoperatively (Group A; n = 10 and the patients with improvement in pelvic tilt postoperatively (Group B; n = 8. Pre- and postoperative clinical outcome surveys were administered to determine Visual Analogue Pain Scores (VAS and Oswestry disability index (ODI. In addition, we evaluated full spine radiographic films for pelvic tilt (PT, sacral slope (SS, pelvic incidence (PI, thoracic kyphosis (TK, lumbar lordosis (LL, sacrofemoral distance (SFD, and sacro C7 plumb line distance (SC7D Results All 18 patients underwent surgery principally for the relief of radicular leg pain and back pain. In groups A and B, mean preoperative VAS were 6.85 and 6.81, respectively, and these improved to 3.20 and 1.63 at last follow-up. Mean preoperative ODI were 43.2 and 50.4, respectively, and these improved to 23.6 and 18.9 at last follow-up. In spinopelvic parameters, no significant difference was found between preoperative and follow up variables except PT in Group A. However, significant difference was found between the preoperative and follows up values of PT, SS, TK, LL, and SFD/SC7D in Group B. Between parameters of group A and B, there is borderline significance on preoperative PT, preoperative LL and last follow up SS. Correlation analysis revealed the VAS improvements in Group A were significantly related to postoperative lumbar lordosis (Pearson's coefficient = -0.829; p = 0.003. Similarly, ODI improvements were also associated with postoperative lumbar lordosis (Pearson's coefficient = -0.700; p = 0.024. However, in Group B, VAS and ODI improvements were not found to be related to postoperative lumbar lordosis and to spinopelvic parameters. Conclusion In the current series, patients improving PT after fusion were found to achieve good clinical outcomes in degenerative spondylolisthesis. Overall, our findings show that it is important to quantify sagittal spinopelvic parameters and promote sagittal balance when performing lumbar fusion for degenerative spondylolisthesis.

Chung Sung-Soo

2011-04-01

240

Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review  

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Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. T...

Su, I-chang; Chen, Chang-mu

2007-01-01

 
 
 
 
241

Control of cell migration in the development of the posterior lateral line: antagonistic interactions between the chemokine receptors CXCR4 and CXCR7/RDC1  

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Full Text Available Abstract Background The formation of the posterior lateral line of teleosts depends on the migration of a primordium that originates near the otic vesicle and moves to the tip of the tail. Groups of cells at the trailing edge of the primordium slow down at regular intervals and eventually settle to differentiate as sense organs. The migration of the primordium is driven by the chemokine SDF1 and by its receptor CXCR4, encoded respectively by the genes sdf1a and cxcr4b. cxcr4b is expressed in the migrating cells and is down-regulated in the trailing cells of the primordium. sdf1a is expressed along the path of migration. There is no evidence for a gradient of sdf1a expression, however, and the origin of the directionality of migration is not known. Results Here we document the expression of a second chemokine receptor gene, cxcr7, in the migrating primordium. We show that cxcr7 is highly expressed in the trailing cells of the primordium but not at all in the leading cells, a pattern that is complementary to that of cxcr4b. Even though cxcr7 is not expressed in the cells that lead primordium migration, its inactivation results in impaired migration. The phenotypes of cxcr4b, cxcr7 double morphant embryos suggest, however, that CXCR7 does not contribute to the migratory capabilities of primordium cells. We also show that, in the absence of cxcr4b, expression of cxcr7 becomes ubiquitous in the stalled primordium. Conclusion Our observations suggest that CXCR7 is required to provide directionality to the migration. We propose that directionality is imposed on the primordium as soon as it comes in contact with the stripe of SDF1, and is maintained throughout migration by a negative interaction between the two receptors.

Ghysen Alain

2007-03-01

242

Characteristics of Back Muscle Strength in Patients with Scheduled for Lumbar Fusion Surgery due to Symptomatic Lumbar Degenerative Diseases  

Science.gov (United States)

Study Design Cross sectional study. Purpose To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. Overview of Literature Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. Methods Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0°, 12°, 24°, 36°, 48°, 60°, and 72°) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age (0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). Conclusions In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients. PMID:25346820

Park, Won Hah; Lee, Chong Suh; Kang, Kyung Chung

2014-01-01

243

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... a few minutes. Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common ... used for cervical spine problems? Yeah. We perform micro-lumbar surgical procedures in the cervical spine routinely. ...

244

Tricortical cervical inter-body screw fixation.  

Directory of Open Access Journals (Sweden)

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

Goel A

1997-01-01

245

Disc herniation in the thoracolumbar junction treated by minimally invasive transforaminal interbody fusion surgery.  

Science.gov (United States)

Minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) has demonstrated efficacy in the treatment of lumbar degenerative diseases. Use of this procedure for thoracolumbar junction disc herniation remains challenging. Reports concerning MIS-TLIF at the thoracolumbar junction are rare. Thus, we performed a retrospective analysis of the clinical outcomes of 10 patients with thoracolumbar junction disc herniation treated by MIS-TLIF between December 2007 and October 2010. The purpose of this study was to investigate the efficacy and safety of MIS-TLIF for disc herniation in the thoracolumbar junction. Clinical and radiological data were collected and analyzed. Fusion levels included T12-L1 (two patients), L1-L2 (four patients) and L2-L3 (four patients). Clinical outcome was assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). The average follow-up period was 39.2 months, with a minimum of 24 months. The mean ± standard error of the mean of the operative time, intraoperative blood loss, and x-ray exposure were 128 ± 36 minutes, 204 ± 35 mL, and 43 ± 12 seconds, respectively. The VAS for back and leg pain decreased significantly postoperatively from 6.4 ± 2.7 to 1.5 ± 0.6 (pthoracolumbar junction. Occurrence of non-union is relatively high compared to previous findings. PMID:24225365

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Huang, Bo

2014-03-01

246

A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results  

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The literature reports on the safety and efficacy of titanium cages (TCs) with additional posterior fixation for anterior lumbar interbody fusion. However, these papers are limited to prospective cohort studies. The introduction of TCs for spinal fusion has resulted in increased costs, without evidence of superiority over the established practice. There are currently no prospective controlled trials comparing TCs to femoral ring allografts (FRAs) for circumferential fusion in the literature. ...

Mckenna, Patrick J.; Freeman, Brian J. C.; Mulholland, Robert C.; Grevitt, Michael P.; Webb, John K.; Mehdian, S. H.

2005-01-01

247

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

Science.gov (United States)

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

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

2014-07-01

248

The finite element modeling and analysis of human lumbar segment herniation  

Directory of Open Access Journals (Sweden)

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

HUANG Ju-ying

2012-08-01

249

Minimally Invasive Lumbar Discectomy  

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

250

Congenital Lumbar Hernia  

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

Sanjay Sharma; Gagan Bali; Satish Parihar; Neeraj Koul

2008-01-01

251

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

Directory of Open Access Journals (Sweden)

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

Richard B Rhiew

2009-03-01

252

Minimal Access Spinal Technologies (Mast Fusion Procedures For The Treatment Of The Degenerative Lumbar Spine (A Part Of Multicentral Prospective Study  

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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.

Khoshab A.H.

2014-05-01

253

Adjacent Segment Instability and Degeneration After Posterior Lumbar Stabilisation  

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Full Text Available Objective: In our study, we aimed to research the changes of adjacent segment degeneration in posterior lumbar spinal fusion patients.Material and Method: In this study, lumbar spondylolysthesis operation applied 36 patients were investigated. Posterior stahilisation and fusion were applied to the first group of 26 patients hy using transpedicular screw and to the second group of 10 patients hy using interbody cage. Patients' JOA scales, adjacents segment disc heihts, osteophyte formations, lomher lordosis angles, and lysthesis degrees were evaluated before and after operation.Results: In hoth groups, as bej'ore and and after operation, the clinical healing was detected statistically significant according to JOA scale measurement. Postoperative lomher lordosis angles were increased, upper and lower disc spaces heights nex to the fused segments were decreased, new instability nex to the segment has not heen found and thus these results were not statistically significant.Conclusion: We observed significant clinical improvement in posterior lumhar spinal fusion applied patients in early postoperative period and ur?significant degeneration in adjacent segments.

Engin Ozar

2006-01-01

254

The influence of obesity on intra- and postoperative complications in Posterior Lumbar Interbody Fusion (PLIF)  

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In conclusion, that the patient's weight expressed as body mass index, favors the risk for the occurrence of intra-or postoperative complications. In addition, the risk of complications increases if the patients are risk factors that include the pre-an unfavorable position for a surgery and postoperative treatment. Also introduces a BMI> 25 to a poorer outcome in terms of subsequent treatment. Compared to the patient population with a BMI <25 had three times as many patients in a rehabilitati...

Bode, Frank

2010-01-01

255

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... a joke in neurosurgical circles that the blood drawing that you give, actually before you have the ... used for cervical spine problems? Yeah. We perform micro-lumbar surgical procedures in the cervical spine routinely. ...

256

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... touch upon that. You actually can see in 3D. Correct. One of the greatest advances, at least ... the lumbar nerve roots. But without getting some imaging studies, you’re really not going to know ...

257

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... the lumbar nerve roots. But without getting some imaging studies, you’re really not going to know ... to what’s going on, but he really needs imaging study, and that really, today, relies on an ...

258

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... not improve and we have on the MRI study a demonstrable compression of the nerve, which correlates ... lumbar nerve roots. But without getting some imaging studies, you’re really not going to know for ...

259

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very ... a little bit more. I mean with conservative management, people think about taking the non-steroidal anti- ...

260

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... inside the MRI. But MRI is really the gold standard for diagnosing these types of conditions. What ... test, and an MRI is by far the gold standard for evaluation of the lumbar spine. Okay. ...

 
 
 
 
261

Herniated lumbar disc  

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Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1.

Jordon, Jo; Konstantinou, Kika; O Dowd, John

2011-01-01

262

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... this minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? 2 Well, the ... more on top here. Okay. Is there, you know, with this particular operation, I mean in terms ...

263

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

Science.gov (United States)

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

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

2007-11-01

264

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.  

Science.gov (United States)

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

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

2014-12-01

265

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5-S1.  

Science.gov (United States)

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

2012-07-01

266

Interspace distraction and graft subsidence after anterior lumbar fusion with femoral strut allograft.  

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The authors performed a retrospective review of 32 patients who had undergone a single-level anterior lumbar fusion with femoral strut allograft as an isolated procedure. The goal of the study was to use clinical radiographs to measure interspace distraction, graft subsidence, interspace collapse, the nature of allograft incorporation, and to correlate these results with successful arthrodesis. Results were categorized according to plain radiographic appearance and flexion/extension stability. Sixty-six percent of the group exhibited radiographic union with flexion/extension stability. Twenty-two percent exhibited stability on the flexion-extension analysis but less than complete arthrodesis was present. Twelve percent exhibited radiographic non-union and flexion-extension instability. Interspace distraction of 11 mm was obtained initially with a follow-up distraction of 5.5 mm. Graft subsidence was noted posteriorly in 27 patients with an average subsidence of 4 mm. The authors' conclusions were: 1) Interspace distraction can be achieved with anterior lumbar fusion if appropriate interbody grafts are used. 2) Despite a solid arthrodesis rate of only 66%, "functional arthrodesis" was achieved in 88%. In a retrospective review of patients who underwent anterior lumbar fusion with femoral strut allograft, interspace distraction, graft subsidence, and incorporation and arthrodesis status were measured. A solid arthrodesis was achieved in 66% of the patients, and functional arthrodesis in another 22%. Interspace distraction was maintained in 59% of cases. PMID:8303439

Kumar, A; Kozak, J A; Doherty, B J; Dickson, J H

1993-12-01

267

Current strategies for the restoration of adequate lordosis during lumbar fusion.  

Science.gov (United States)

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

Barrey, Cédric; Darnis, Alice

2015-01-18

268

Current strategies for the restoration of adequate lordosis during lumbar fusion  

Science.gov (United States)

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

Barrey, Cédric; Darnis, Alice

2015-01-01

269

Osteoinductive activity of ErhBMP-2 after anterior cervical diskectomy and fusion with a ß-TCP interbody cage in a goat model.  

Science.gov (United States)

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

2014-02-01

270

Spontaneously disappearing lumbar disc protrusion  

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Spontaneous disappearance of a herniated lumbar disc is known to occur. This case study describes a 45-year-old patient whose symptoms of lumbar radiculopathy resolved and follow-up imaging showed complete disappearance of the disc prolapse. This phenomenon strengthens the role of conservative treatment in the management of lumbar disc protrusions.

Ushewokunze, Shungu; Abbas, Naeem; Dardis, Ronan; Killeen, Ian

2008-01-01

271

QUANTIFICATION OF LUMBAR ENDURANCE ON A BACKUP LUMBAR EXTENSION DYNAMOMETER  

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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

2006-12-01

272

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... nerve compression on one of the lumbar nerve roots. But without getting some imaging studies, you’re ... I don’t want to damage the nerve root as I mobilize it. It’s really the disc ...

273

Herniated Lumbar Disc  

Science.gov (United States)

... may be recommended if you have severe leg pain. These are injections of corticosteroid into the epidural space (the area ... back of the pelvis. While occasionally useful for pain control, trigger point injections do not help heal a herniated lumbar disc. ...

274

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... the person that everybody focuses on. But minimally invasive surgery can only be performed if you have a ... Now let’s talk a little bit about other surgeries. I mean this minimally invasive approach doesn’t only work for just lumbar ...

275

Ascending lumbar veins  

International Nuclear Information System (INIS)

The normal anatomy of the ascending lumbar veins and a catheterization technique used to demonstrate these veins at phlebography are reported. The use of this examination when dealing with malignant disease in the abdomen and retroperitoneal region is not warranted, on account of the wide range of anatomic and phlebographic variation. (Auth.)

276

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... the surgery, before I keep talking about the cervical spine, now I’m entering the disc space where the herniation occurred from and removing ... approach doesn’t only work for just lumbar discs. As we mentioned before, it ... and the cervical region. Thoracic is pretty rare because thoracic spine ...

277

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... clue us in that there might be some type of nerve compression on one of the lumbar nerve roots. But without getting ... risk of damaging the spinal cord from this type of operation. You want to tell us why that ... in most patients end up at about the L-1, L-2 space, and beneath that is the ...

278

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

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

Liang ZHOU

2014-01-01

279

QUANTIFICATION OF LUMBAR ENDURANCE ON A BACKUP LUMBAR EXTENSION DYNAMOMETER  

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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...

Hager, Staci M.; Udermann, Brian E.; Reineke, David M.; Gibson, Mark H.; Mayer, John M.; Murray, Steven R.

2006-01-01

280

Benign lumbar arachnoiditis  

International Nuclear Information System (INIS)

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

 
 
 
 
281

Laparoscopic lumbar spine surgery  

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The use of transperitoneal endoscopic approaches to the distal segments of the lumbar spine has recently been described. This has been the catalyst for the development of other minimally invasive anterior ¶approaches to the spine. This review looks at the published results so ¶far, and highlights the principles, techniques and complications. The limitations of laparoscopic approaches have meant that surgeons are moving on to endoscopic extraperitoneal and mini-open approaches, but important...

O’dowd, J. K.

2000-01-01

282

 

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

283

 

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

284

Anterior cervical fusion with interbody cage containing ?-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up  

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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

2008-01-01

285

Lumbar spinal stenosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english 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.

JA, Shipley.

2008-06-01

286

Lumbar spinal stenosis  

International Nuclear Information System (INIS)

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

287

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

Science.gov (United States)

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

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

2011-07-01

288

Lumbar myelography with iohexol  

International Nuclear Information System (INIS)

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.)

289

Ameliorative percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

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)

290

Herniated lumbar intervertebral disk  

International Nuclear Information System (INIS)

From a series of 25 patients with low-back pain and sciatica who subsequently underwent surgical exploration, 24 lumbar herniated disks and one asymmetrically bulging disk were correctly diagnosed with use of a 0.5-T MR imaging unit. The radiologic findings on saggital images included a polypoid protrusion beyond the posterior margin of the vertebral bodies more clearly displayed with T1-weighted than with T-2 weighted sequences and a focal extension into the extradural space on axial views. In most, the signal intensity of HNP was isointense to the disk of origin. The study suggests that MR imaging is currently capable of accurately predicting an HNP. The diagnosis is based primarily on morphologic characteristics rather than signal intensity alterations

291

Lumbar disk herniations  

International Nuclear Information System (INIS)

This paper reports that little is known concerning spontaneous CT changes of lumbar disk herniations occurring after relief of sciatic pain in patients treated conservatively. Twenty-one consecutive patients underwent CT at the time of presentation with sciatic (n = 19) or femoral (n = 2) nerve root pain and again more than 6 months (12.9 months) after relief of the pain. In all 21 patients, a herniated disk (HD) was seen on the initial CT scan. Eleven patients had a large HD, possibly extruded in five cases. All patients were treated conservatively. None underwent intradiskal therapy. Size and location of the HD on the initial and follow-up CT scans were compared blindly

292

Lumbar epidural venography  

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Myelography is widely used for radiological diagnosis of herniated lumbar disc. But the diagnostic accuracy is only about 84% with range of 67 to 100% with many cases of false negative and equivocal cases. In cases of extreme lateral disc herniation and short cul de sac or wide epidural space, even quite a large disc herniation cannot be detected on myelography. But with epidural venography these defects of myelography can easily be overcome. 52 cases of epidural venography were performed in department of Radiology of Capital Armed Forces General Hospital during the 20 months from May 1979 to December 1980. And the findings were compared with those of myelography and operative results. The results are as follows; 1. Of 52 cases, satisfactory opacification was obtained in 48 cases (92.3%). 2. Single vein injection was adequate for satisfactory opacification in 40 cases (76.9%). 3. There were 2 cases of retroperitoneal extravasation of contrast media, but the patient recovered without difficulty. 4. Of 24 cases operated, the venographic finding was confirmed in 21 cases (87.5%) and of the 48 cases adequately opacified, there were only 3 cases of confirmed diagnostic error and so the error rate is only 6.25%. 5. Abnormal findings of myelography were exactly reproduced on epidural venography and many cases with equivocal or normal myelographic findings were accurately diagnosed with epidural venography. 6. In cases of total block, epidural venography was very useful for evaluation of the caudal portion. So lumbar epidural venography is very useful not only as an adjunctive method to myelography, but also as the first diagnostic procedure for herniated disc, for the procedure is simple and the diagnostic accuracy is very high.

Ha, Sung Whan [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

1981-06-15

293

Lumbar epidural venography  

International Nuclear Information System (INIS)

Myelography is widely used for radiological diagnosis of herniated lumbar disc. But the diagnostic accuracy is only about 84% with range of 67 to 100% with many cases of false negative and equivocal cases. In cases of extreme lateral disc herniation and short cul de sac or wide epidural space, even quite a large disc herniation cannot be detected on myelography. But with epidural venography these defects of myelography can easily be overcome. 52 cases of epidural venography were performed in department of Radiology of Capital Armed Forces General Hospital during the 20 months from May 1979 to December 1980. And the findings were compared with those of myelography and operative results. The results are as follows; 1. Of 52 cases, satisfactory opacification was obtained in 48 cases (92.3%). 2. Single vein injection was adequate for satisfactory opacification in 40 cases (76.9%). 3. There were 2 cases of retroperitoneal extravasation of contrast media, but the patient recovered without difficulty. 4. Of 24 cases operated, the venographic finding was confirmed in 21 cases (87.5%) and of the 48 cases adequately opacified, there were only 3 cases of confirmed diagnostic error and so the error rate is only 6.25%. 5. Abnormal findings of myelography were exactly reproduced on epidural venography and many cases with equivocal or normal myelographic findings were accurately diagnosed with epidural venography. 6. In cases of total block, epidural venography was very useful for e epidural venography was very useful for evaluation of the caudal portion. So lumbar epidural venography is very useful not only as an adjunctive method to myelography, but also as the first diagnostic procedure for herniated disc, for the procedure is simple and the diagnostic accuracy is very high

294

Radicular interdural lumbar disc herniation  

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Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between t...

Akhaddar, Ali; Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

2010-01-01

295

Lumbar disc syndrome in Finland.  

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The prevalence of lumbar disc syndrome (herniated disc or typical sciatica) and its consequences in terms of disability, handicap, and need for medical care were studied as part of the Mini-Finland Health Survey. A sample of 8000 persons representative of the Finnish population aged 30 or over was asked to come for examination, and 7217 (90%) participated. A diagnosis of lumbar disc syndrome based on medical history, symptoms, and standardised physical examination was made for 5.1% of the men...

Helio?vaara, M.; Impivaara, O.; Sievers, K.; Melkas, T.; Knekt, P.; Korpi, J.; Aromaa, A.

1987-01-01

296

Biomechanical study of percutaneous lumbar diskectomy  

International Nuclear Information System (INIS)

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

297

Evaluation of spinal interbody fusion using magnetic resonance imaging  

International Nuclear Information System (INIS)

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

298

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

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

Webb John K

2002-10-01

299

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

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Hardenbrook MA, Miller LE, Block JE. Medical Devices: Evidence and Research. 2013;6:91–95. On page 94, the disclosure was listed as "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH reports no conflict of interest in this work." in error. The disclosure should have been "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH receives a royalty for the VEO system, in addition to other pa...

Ma, Hardenbrook; Le, Miller; Je, Block

2013-01-01

300

Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.  

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Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done. PMID:17273839

Su, I-Chang; Chen, Chang-Mu

2007-12-01

 
 
 
 
301

Postdecompression lumbar instability.  

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In the last two decades, the concept of spinal stenosis and its treatment by surgical decompression has been widely accepted. Complications such as olisthy, disc rupture, facet fracture, and intractable back pain began to appear postoperatively, suggesting instability as their cause. A retrospective study of 344 patients treated surgically for lumbar stenosis revealed a 17% reoperation rate for complications resulting from obvious or suspected instability. Sixteen cases of postdecompression olisthy, 14 cases of fresh disc herniation, and 27 cases of intractable back pain required further surgery. Preoperative indicators of potential instability are degenerated discs as evidenced by traction spurs or diminished disc height, olisthy, and scoliosis or asymmetrically narrowed discs. Total facetectomy and pars excision at surgery destabilize the spine and must be added to the preoperative risk factors for instability. Calcified annulus, capsule and ligamentum flavum, or complete disc resorption may offer some protection from postoperative instability. The level of instability may be preselected by the proximity to the intercrestal line. It is recommended that during surgical decompression for spinal stenosis, the posterior elements be spared as much as possible to avoid instability after surgery. Factors suggesting instability noted preoperatively or decompression which produces instability suggest that fusion should be combined with decompression. Spinal fusion is the treatment for postoperative instability. PMID:2962798

Hopp, E; Tsou, P M

1988-02-01

302

Lumbar spinal stenosis  

International Nuclear Information System (INIS)

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

303

Percutaneous endoscopic decompression for lumbar spinal stenosis.  

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

Ahn, Yong

2014-11-01

304

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS  

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

Ville Leinonen

2004-03-01

305

Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques  

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Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusi...

Luiz Pimenta; Thiago Coutinho; Carlos De Castro; Rodrigo Amaral; Leonardo Oliveira; Luis Marchi; Etevaldo Coutinho

2012-01-01

306

[Anterior interbody fusion of cervical spine with case-plate PCB].  

Science.gov (United States)

Two cases with cervical discopathy and radiculopathy are presented. Discectomy and anterior interbody fusion with cage-plate PCB manufactured by French company Scient'x was performed. Authors present the shape of the implant and technical details of implantation. The paper discusses the advantages of the PCB which simplifies and shortens the operation procedure, minimizes the risk of traditional bone graft harvesting and provides immediate stabilization of the operated segment. PMID:11987712

Radek, M; Radek, A; Zapa?owicz, K; Maciejczak, A

2001-01-01

307

Lateral interbody fusion for treatment of discogenic low back pain: minimally invasive surgical techniques.  

Science.gov (United States)

Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total) between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3%) stand-alone levels experienced cage subsidence. Pain (VAS) and disability (ODI) improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months. PMID:22548181

Marchi, Luis; Oliveira, Leonardo; Amaral, Rodrigo; Castro, Carlos; Coutinho, Thiago; Coutinho, Etevaldo; Pimenta, Luiz

2012-01-01

308

Lumbar hernia: anatomical route assessed by computed tomography.  

Science.gov (United States)

Lumbar hernia is classically described as arising from the superior (Grynfeltt's) lumbar triangle or the inferior (Jean-Louis Petit's) lumbar triangle. The present anatomical study based on a computed tomography examination performed in a patient with lumbar hernia, has led to the suggestion that lumbar hernias cross the lumbar wall through a musculoaponeurotic tunnel, whose deep and superficial openings are the superior and inferior lumbar triangles, respectively. PMID:12197011

Guillem, P; Czarnecki, E; Duval, G; Bounoua, F; Fontaine, C

2002-02-01

309

Lumbar discography: an update.  

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Discogenic pain most commonly affects the low back, buttocks, and hips and is thought to be a byproduct of internal disk degeneration. It is postulated that progressive annular breakdown and tearing results in biomechanical and/or biochemical stimulation of the pain fibers that reside in the outer one third of the annulus. Although multiple imaging modalities, most notably MRI, can show morphologic abnormalities of the spine, discography remains the only test that provides physiologic information regarding what role a given intervertebral disk plays in a patient's symptom complex. The controversy surrounding discography is here to stay until more definitive, well-designed studies are performed. In the meantime, there are certain things that can help the discographer maximize the accuracy of the test: 1. Always try to inject one "normal" disk as a "control level." 2. Be alert for factors that are associated with an increased false-positive rate (abnormal non-anatomic pain maps, a history of chronic pain of spinal or nonspinal origin, abnormal psychometric testing, and prior surgery at the injected disk level). In these cases, special attention should be directed to both the patient's verbal and nonverbal cues during disk injection. 3. Do not give any audible clues as to what level is being injected or when the injection is starting or finishing. In this regard, we find it very helpful to have one of our personnel talk with the patient during this portion of the procedure while closely observing the patient for any nonverbal cues regarding their pain response. This distraction is preferable to a silent room where the patient is intensely focused on what is going on with the injections. We also find that music playing during the procedure helps to relax and often distract the patient as well. 4. If the results are equivocal at a level (i.e., you are unable to determine whether or not the patient's pain response was truly concordant), go on to inject another disk level and then come back to reinject more contrast into the disk in question. As radiologists, we tend to focus on the technical aspects of a procedure and the anatomic/morphologic information it provides. However, it cannot be emphasized enough that when performing lumbar discography, the assessment of the patient's pain response during the injection is the most important component of the procedure, and requires not only technical skills, but an understanding of how best to avoid some of the pitfalls that can lead to inaccurate results. PMID:14976837

Anderson, Mark W

2004-01-01

310

Hematoma epidural lumbar crónico espontáneo / Chronic spontaneous lumbar epidural hematoma  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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.

2005-12-01

311

Lumbar Epidural Varix Mimicking Perineural Cyst  

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Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery...

Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent; Izci, Yusuf

2013-01-01

312

Case report and review of lumbar hernia.  

Science.gov (United States)

Lumbar hernias are uncommon and about 300 cases have been reported till date. They commonly occur due to trauma, surgery and infection. They are increasingly being reported after motor vehicle collision injuries. However, spontaneous lumbar hernias are rare and are reported infrequently. It is treated with different surgical approaches and methods. We report a case of primary spontaneous lumbar hernia which was repaired by transperitonial laparoscopic approach using Vypro (polypropylene/polyglactin) mesh and covered with a peritoneal flap. PMID:25555145

Walgamage, Thilan B; Ramesh, B S; Alsawafi, Yaqoob

2015-01-01

313

Minimal Invasive Decompression for Lumbar Spinal Stenosis  

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Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smal...

Anderson, David G.; Victor Popov

2012-01-01

314

NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS  

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

Ville Leinonen

2004-01-01

315

Corticosteroids in Lumbar Disc Surgery  

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In a prospective randomised double-blind study eighty patients with MRI verified lumbar disc herniation and corresponding clinical findings underwent microscopic disc removal. The patients were peroperatively given systemic and local corticosteroids or placebo, and followed for 2 years. The hospital stay and time to return to full-time work was significantly shorter in the treatment group. Pain measured as worst pain during the last week was also lower in the corticosteroid group. The results...

Lundin, Anders

2005-01-01

316

Lumbar discoidectomy by minimal incision  

International Nuclear Information System (INIS)

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

317

Functional morphology of indrid lumbar vertebrae.  

Science.gov (United States)

Indrids are primarily vertical clingers and leapers but also engage to various extents in climbing, suspensory postures, bimanual movement, bipedal hopping, and quadrupedalism. It has been demonstrated that these behaviors are well reflected in the appendicular anatomy of these primates, while indrid vertebral anatomy has received relatively little attention. In this morphometric study, biomechanically relevant aspects of the lumbar vertebrae of Indri indri, Propithecus diadema, and Propithecus verreauxi were compared to those of Varecia variegata, a large-bodied predominantly pronograde and quadrupedal lemur. Results indicate that, compared to Varecia, the indrids have relatively shorter lumbar vertebral bodies, shorter lumbar regions, more dorsally projecting lumbar spinous processes, and more dorsally positioned lumbar transverse process tips. In addition, indrid lumbar spinous and transverse processes are oriented differently than those of Varecia. Overall, indrid lumbar vertebral morphology converges with that of hominoids, atelines, and possibly lorids, suggesting a lumbar adaptation to upright or "antipronograde" postures that require a reduction in spinal flexibility. The dorsally projecting spinous processes may be related to back muscle extensor power during leaping and/or the maintenance of upright postures. By contrast, the lumbar vertebrae of Varecia resemble those of primates and other mammals that have habitually pronograde postures and emphasize spinal flexibility in the sagittal plane during locomotion. PMID:8572156

Shapiro, L

1995-11-01

318

Osteomielitis vertebral lumbar / Ostéomyélite vertébrale lombaire / Lumbar vertebral osteomyelitis  

Scientific Electronic Library Online (English)

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

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

2013-06-01

319

49 CFR 572.187 - Lumbar spine.  

Science.gov (United States)

...in Figure U2-A in appendix A to this subpart. Torque the lumbar hex nut (p/n 9000057) on to the lumbar...centerline between 37 ms to 57 ms after the time the peak translation-rotation value is reached. [71 FR 75331, Dec. 14,...

2010-10-01

320

Remote cerebellar hemorrhage after lumbar spinal surgery  

Energy Technology Data Exchange (ETDEWEB)

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 pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

Cevik, Belma [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: belmac@baskent-ank.edu.tr; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)

2009-04-15

 
 
 
 
321

Epileptic seizure following lumbar radiculography with Iopamidol  

International Nuclear Information System (INIS)

This is a report of a case of a serious side effect following lumbar radioculography with the water soluble contrast medium Iopamidol. The complication consisted of a generalized seizure after an episode of myoclonic jerking of the legs. This was the first complication in a series of 1070 lumbar and cervical myelograms with this medium. (orig.)

322

Homeopatía y dolor lumbar / Homeopathy and lumbar pain  

Scientific Electronic Library Online (English)

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

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

2011-02-01

323

The provocative lumbar facet joint  

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Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints th...

Binder, David S.; Nampiaparampil, Devi E.

2009-01-01

324

Lumbar spine curvature during office chair sitting.  

Science.gov (United States)

Prolonged sitting is generally accepted as a high risk factor in low back pain and it is frequently suggested that a lordotic posture of the lumbar spine should be maintained during sitting. We asked whether the sagittal curvature of the lumbar spine during sitting is affected by the seat tilt, backrest and the direction of the synchronised mechanism of the back and seat tilt (synchro tilt). Two office chairs were tested by multibody analysis interfacing a human model with a chair model. Results indicate that a synchronised mechanism of an office chair representing a posterior tilt of the seat while the backrest is reclined maintains an evenly distributed lumbar lordosis. The segmental angles are between 3.1 and 3.6 degrees at the lumbar vertebrae 1/2-4/5 (L1/2-L4/5). These lumbar spine segmental angles are not sensitive to the backrest height. In contrast, a synchro tilt concept with a reduction of the seat's posterior tilt while the backrest is reclined causes a strong reduction of the lumbar lordosis in backrest recline with a maximum reduction from 11.7 to 2.8 degrees in L4/5. As a consequence of these results, a synchro tilt concept with a posterior tilt of the seat while the backrest is reclined is preferable from the lumbar spine kinematics point of view. PMID:11259935

Lengsfeld, M; Frank, A; van Deursen, D L; Griss, P

2000-11-01

325

Gonadal dose reduction in lumbar spine radiography  

International Nuclear Information System (INIS)

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.)

326

Cerebriform connective tissue nevus of lumbar.  

Science.gov (United States)

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

2015-02-01

327

The Clinical Analysis on 32 Cases of Herniated Lumbar Disc Patients according to Lumbar CT scan  

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Objective : This study is to evaluate the effectiveness of the oriental medicine treatment on lumbar disc herniation. Subjects and Methods : The clinical analysis was done on 32 cases of patients with lumbar disc herniation diagnosed by lumbar CT scan. Patients who admitted in Cheongju Oriental Medicine Hospital from April 2007 to April 2008 were analyzed according to the distribution of sex, age, the period of disease, condition on admission, the symptom on admission, Admission day, the t...

Jeong-ho Kim; Jeong-hwan Lee; Young-il Kim

2010-01-01

328

Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation  

International Nuclear Information System (INIS)

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)

329

Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.  

Science.gov (United States)

Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy. PMID:24811105

Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

2014-01-01

330

Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion  

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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.

2006-01-01

331

[Management of cervical and lumbar stenosis].  

Science.gov (United States)

Spinal stenosis is most common in elderly patients and is defined as narrowing of the spinal canal and (or) lateral nerve root canals. The underlying processes leading to spinal stenosis are degenerative changes in facet joints and intervertebral discs and buckling of the ligamentum flavum. Spinal stenosis can occur in both the cervical and the lumbar spine. Cervical stenosis mayleat to the development of radiculopathy and (or) myelopathy. The majority of patients respond to nonoperative management. Degenerative lumbar spinal stenosis presents with back and (or) leg paints of valuing severity and duration. Nonoperative treatment associated with lumbar spinal stenosis consists of restituting and avoiding those maneuvers that reproduce pain. Surgical treatment of cervical and lumbar stenosis includes decompressive lamine ctomy, often fusion and instrumentation. PMID:17941576

Nowakowski, Andrzej; Kubaszewski, Lukasz; Kaczmarczyk, Jacek

2007-01-01

332

Lumbar epidural varix mimicking perineural cyst.  

Science.gov (United States)

Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent; Izci, Yusuf

2013-06-01

333

Large volume full columnar lumbar myelography  

Energy Technology Data Exchange (ETDEWEB)

A technique utilizing dilute water-soluble intrathecal contrast medium is described which allows a full columnar upright examination thereby facilitating sensitive simultaneous myelographic evaluation of the lumbar region and thoracolumbar junction.

Jinkins, J.R.

1987-07-01

334

Large volume full columnar lumbar myelography  

International Nuclear Information System (INIS)

A technique utilizing dilute water-soluble intrathecal contrast medium is described which allows a full columnar upright examination thereby facilitating sensitive simultaneous myelographic evaluation of the lumbar region and thoracolumbar junction. (orig.)

335

Spontaneous resolution of lumbar vertebral eosinophilic granuloma.  

Science.gov (United States)

Eosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It's often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans' cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontaneous resolution of vertebral body lesions is very rare. In this case, the patient had one EG in a cervical vertebra and a similar lesion in a lumbar vertebra. This case is important because it featured a symptomatic lesion in the cervical spine accompanied by an asymptomatic lesion in a lumbar vertebra. We treated the cervical lesion by surgical fusion and followed the lumbar lesion up conservatively, with the patient in a corset. After 8 years of follow-up, control MRI showed that the lumbar lesion had spontaneously resolved. PMID:14963750

Bavbek, M; Atalay, B; Altinörs, N; Caner, H

2004-02-01

336

Proximal Conduction Time Along The Lumbar Plexus  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2012-01-01

337

Remote cerebellar hemorrhage after lumbar spinal surgery  

International Nuclear Information System (INIS)

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.

338

Minimally invasive 360° instrumented lumbar fusion  

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A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflat...

Thalgott, J. S.; Chin, A. K.; Ameriks, J. A.; Jordan, F. T.; Giuffre, J. M.; Fritts, K.; Timlin, M.

2000-01-01

339

Lumbar lordosis in osteoporosis and in osteoarthritis  

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The curvature of the lumbar spine and the risk of developing either osteoporosis (OP) or osteoarthritis (OA) are influenced by many common factors. The aim of this study is to determine whether lumbar lordosis is different between patients with either disease and healthy persons. A cross-sectional, blinded, controlled design was implemented. One hundred and twelve postmenopausal women were evaluated for bone mineral density as well as undergoing spinal radiography. Lordosis measurement was pe...

Papadakis, Michael; Papadokostakis, Georgios; Stergiopoulos, Konstantinos; Kampanis, Nikos; Katonis, Pavlos

2008-01-01

340

Pigmented villonodular synovitis in lumbar spine  

International Nuclear Information System (INIS)

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

 
 
 
 
341

Computed tomography of the lumbar epidural veins  

International Nuclear Information System (INIS)

High-resolution computed tomography and epidural venography (CT epidural venograhy) was combined as a means of better demonstrating the morphology of the lumbar epidural veins and their location within the spinal canal. Herniated disks in the lumbar region can be seen without intrathecal enhancement, and selective opacification of the epidural veins shows that they can represent a significant component of the soft-tissue deformity described as a herniated disk

342

Partial Facetectomy for Lumbar Foraminal Stenosis  

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Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Methods. Partial facetectomy...

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

2014-01-01

343

Single level Lumbar Fusion for Degenerative Disc Disease is Associated with Worse outcomes compared to Fusion for Spondylolisthesis in a Workers' Compensation Setting.  

Science.gov (United States)

Study Design. Retrospective cohort studyObjective. Compare lumbar fusion outcomes, return to work (RTW) status in particular, between workers' compensation (WC) subjects undergoing single level posterolateral fusion for either spondylolisthesis or degenerative disc disease (DDD)Summary of Background Data. Lumbar fusion for spondylolisthesis tends to yield more consistent outcomes than fusion for DDD and discogenic low back pain. Within the clinically distinct WC population, relatively few studies exist which evaluate lumbar fusion outcomes.Methods. 869 Ohio WC subjects were identified that underwent single level posterolateral lumbar fusion with or without posterior interbody fusion between 1993-2010 using CPT procedural and ICD-9 diagnostic codes. 269 underwent fusion for spondylolisthesis, and 620 of underwent fusion for DDD.Subjects were considered returned to work within a reasonable timeline if they made a stable RTW within 2 years of fusion and remained working for greater than 6 months of the following year. To determine predictors of RTW status, we performed a multivariate logistic regression analysis. We measured a number of secondary outcomes.Results. Fusion for spondylolisthesis was positively associated with RTW status (p = 0.050; OR 1.42,CI 1.00-2.00). 36.4% of the spondylolisthesis cohort and 24.4% of the DDD cohort returned to work in a reasonable timeline postoperatively.Other negative predictors included: age >50 at fusion (OR 0.66,CI 0.45-0.95), >2 years between injury and index fusion (OR 0.59,CI 0.41-0.84), permanent disability (OR 0.61,CI 0.43-0.86), legal representation (OR 0.67,CI 0.46-0.97), and psychological comorbidity before fusion (OR 0.30,CI 0.14-0.62).Subjects in the DDD cohort were prescribed opioid analgesics for an average of 294 of additional days postoperatively (p<0.001), which equated to 24,759 additional milligrams of morphine equivalents (p<0.001).Conclusions. Our study is supportive of the conclusion that DDD is a questionable indication for spinal fusion. Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar WC patients. PMID:25494321

Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U

2014-12-01

344

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  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: 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.

345

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

International Nuclear Information System (INIS)

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

346

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

Science.gov (United States)

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury. PMID:25210343

Y?lmaz, Tevfik; Turan, Yahya; Gül?en, ?smail; Dalbayrak, Sedat

2014-01-01

347

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

International Nuclear Information System (INIS)

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

348

Headache and Meningismus Following Lumbar Puncture  

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

F?rat Bekta?

2012-06-01

349

Bacterial Sacroiliitis Probably Induced by Lumbar Epidural Analgesia  

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Background: Properly administered, lumbar epidural analgesia provides adequate pain relief during labor and delivery, and is considered to be a safe procedure with limited complications. The prevalence of infection after lumbar epidural analgesia is negligible.

Shimon Edelstein; Yeouda Edoute

2003-01-01

350

Tractography of lumbar nerve roots: initial results  

International Nuclear Information System (INIS)

The aims of this preliminary study were to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and fibre tracking (FT) of the lumbar nerve roots, and to assess potential differences in the DTI parameters of the lumbar nerves between healthy volunteers and patients suffering from disc herniation. Nineteen patients with unilateral sciatica related to posterolateral or foraminal disc herniation and 19 healthy volunteers were enrolled in this study. DTI with tractography of the L5 or S1 nerves was performed. Mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated from tractography images. FA and MD values could be obtained from DTI-FT images in all controls and patients. The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (p=0.0001) and of the nerve roots of volunteers (p=0.0001). MD was significantly higher in compressed nerve roots than in the contralateral nerve root (p=0.0002) and in the nerve roots of volunteers (p=0.04). DTI with tractography of the lumbar nerves is possible. Significant changes in diffusion parameters were found in the compressed lumbar nerves. (orig.)

351

Percutaneous lumbar diskectomy using rotating pliers system  

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Objective: To explore the feasibility of using rotating pliers system for treating lumbar disc herniation with concomitant prolapse. Methods: Ex vivo incision experiment was performed on 8 lumbar discs of 2 pigs using rotating pliers. Clinical application included 12 patients of lumbar disc herniation shown by CT or MRI. 40% herniations gave enough pressure on dural sac with concomitant prolapse of different degrees. The symptoms and image finding were concordant. The herniated nucleus pulposus were resected using rotating pliers system, MacNab standard was applied for the clinical evaluation. Results: The ex vivo experiments and clinical application were successful. Clinical application showed CR in 4 patients (33.3%), PR in 5 patients (41.7%) and NR in 3 patients (25.0%). CT demonstrated the herniated disk tissue retraction of different degrees in CR and PR patients, together with decrease in CT attenuation number, ranging from 8-30 HU, 18 ± 5 HU in average but no changes in NR patients. Conclusions: Percutaneous lumbar diskectomy is safe and effective to treat lumbar disc herniation with concomitant prolapse by using rotating pliers systems and thus extending the PLD application

352

Minimally invasive procedures on the lumbar spine  

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Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845

Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A

2015-01-01

353

Enlargement of lumbar spinal canal in lumbar degenerative spondylolisthesis. Evaluation with three-dimensional computed tomography  

International Nuclear Information System (INIS)

A number of clinical studies have demonstrated that enlargement of the lumbar spinal canal is one of the effective surgical procedures for the treatment of the lumbar degenerative spondylolisthesis and provides a good result. In the present study, we have evaluated the long-term outcome of the enlargement of the lumbar canal without fusion in thirty eight patients with lumbar degenerative spondylolisthesis using three-dimensional computed tomography (3D-CT) The improvement rate was excellent in 80% of the patients (mean improvement ratio, 83%) according to the Japanese Orthopedic Association scoring system. We found that the sufficient enlargement of the canal was obtained by the surgery and maintained for a long period of time. The results from 3D-CT suggested that a round shape was maintained in the canal after the surgery because of pressures of the dura mater against to the bony canal. None of patients showed lumbar instability. In conclusion, enlargement of lumbar canal without fusion is useful for the treatment of lumbar degenerative spondylolisthesis, and the enlarged canal has been maintained for a long period of time after the surgery. The results demonstrated the clinical utility of 3D-CT to evaluate the preoperative and postoperative shape of the spine. (author)

354

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

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...mountings so that the pelvic-lumbar adapter is horizontal and...top surface of the pelvic-lumbar adapter. Apply the force...e) of this section, the abdominal force-deflection curve shall...Place the assembled thorax, lumbar spine and pelvic...

2010-10-01

355

Interlaminar decompression in lumbar canal stenosis.  

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

Patond K

1999-10-01

356

Functional oblique views of the lumbar spine  

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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.)

357

Computed tomography of the postoperative lumbar spine  

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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

358

Computed tomography of the postoperative lumbar spine  

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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.

1983-11-01

359

Adjacent Instability after Instrumented Lumbar Fusion.  

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Full Text Available The invention of pedicle screw instrumentation has greatly improved outcomes ofspinal fusion, which has become the treatment of choice for lumbar spondylolisthesis. Asresearchers accumulate experience, both theoretical and clinical advances are continuallybeing reported. A review of the literature and the experience of the authors show that thedevelopment of adjacent instability, as in the breakdown of a neighboring unfixed motionsegment, is a common consequence of an instrumented lumbar spine. This article reviewsthe risk factors and surgical treatment of adjacent instability. The authors believe that properpreoperative planning and complete surgical procedures are imperative to prevent adjacentinstability. For those who need revision surgery, meticulous surgical techniques can achievesatisfactory results.

Wen-Jer Chen

2003-11-01

360

Minimally invasive lumbar decompression for lumbar stenosis: review of clinical outcomes and cost effectiveness.  

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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

2014-11-01

 
 
 
 
361

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

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

Chen Hsiang-Ho

2007-03-01

362

Midsagittal anatomy of lumbar lordosis in adult egyptians: MRI study.  

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Despite the increasing recognition of the functional and clinical importance of lumbar lordosis, little is known about its description, particularly in Egypt. At the same time, magnetic resonance imaging (MRI) has been introduced as a noninvasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar lordosis using midsagittal MRIs. Normal lumbar spine MRIs obtained from 93 individuals (46 males, 47 females; 25-57 years old) were evaluated retrospectively. The lumbar spine curvature and its segments "vertebrae and discs" were described and measured. The lumbar lordosis angle (LLA) was larger in females than in males. Its mean values increased by age. The lumbar height (LH) was longer in males than in females. At the same time, the lumbar breadth (LB) was higher in females than in males. Lumbar index (LI?=?LB/LH?×?100) showed significant gender differences (P lumbar vertebrae. In conclusion, MRI might clearly reveal the anatomy of the lumbar lordosis. Use of LI in association with LLA could be useful in evaluation of lumbar lordosis. PMID:25210630

Hegazy, Abdelmonem A; Hegazy, Raafat A

2014-01-01

363

General practitioners' willingness to request plain lumbar spine radiographic examinations  

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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

364

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

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

Petr Tichy

2009-12-01

365

Computer tomography assisted stereotactic percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

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

366

Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis  

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Context: Both spondylolysis and spondylolisthesis can be diagnosed across the life span of sports-participating individuals. Determining which treatments are effective for these conditions is imperative to the rehabilitation professional. Data Sources: A computer-assisted literature search was completed in MEDLINE, CINAHL, and EMBASE databases (1966-April 2012) utilizing keywords related to nonoperative treatment of spondylolysis and/or spondylolisthesis. Reference lists were also searched to find all relevant articles that fit our inclusion criteria: English language, human, lumbar pain with diagnosed spondylolysis and/or spondylolisthesis, inclusion of at least 1 nonoperative treatment method, and use of a comparative study design. Data Extraction: Data were independently extracted from the selected studies by 2 authors and cross-referenced. Any disagreement on relevant data was discussed and resolved by a third author. Results: Ten studies meeting the criteria were rated for quality using the GRADE scale. Four studies found surgical intervention more successful than nonoperative treatment for treating pain and functional limitation. One study found no difference between surgery and nonoperative treatment with regard to future low back pain. Improvement was found in bracing, bracing and exercises emphasizing lumbar extension, range of motion and strengthening exercises focusing on lumbar flexion, and strengthening specific abdominal and lumbar muscles. Conclusion: No consensus can be reached on the role of nonoperative versus surgical care because of limited investigation and heterogeneity of studies reported. Studies of nonoperative care options suffered from lack of blinding assessors and control groups and decreased patient compliance with exercise programs. PMID:24427393

Garet, Matthew; Reiman, Michael P.; Mathers, Jessie; Sylvain, Jonathan

2013-01-01

367

A case of inferior lumbar hernia  

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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

2013-02-01

368

Benign fibrous histiocytoma of the lumbar vertebrae  

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

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

2009-02-15

369

Functional examinations of the lumbar vertebral column  

International Nuclear Information System (INIS)

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

370

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

International Nuclear Information System (INIS)

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

371

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

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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)

372

Proximal Conduction Time Along The Lumbar Plexus  

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

Hilmi UYSAL

2012-03-01

373

Physiological pattern of lumbar disc height  

International Nuclear Information System (INIS)

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

374

Discitis pospunción lumbar en un niño  

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

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

2004-06-01

375

 

Medline Plus

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

376

Resolución espontánea de hernia de disco lumbar / Spontaneous resolution of a lumbar disc herniation  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish La hernia del disco intervertebral lumbar es una causa frecuente de radiculopatía en miembros inferiores y su tratamiento más efectivo sigue siendo objeto de controversia. Tanto el tratamiento quirúrgico como el conservador consiguen buenos resultados cuando se realiza una correcta selección del pac [...] iente. La desaparición espontánea de hernias de disco intervertebral es un hecho conocido con numerosas referencias en la bibliografía. Los autores presentamos el caso clínico de una paciente con radiculopatía secundaria a una hernia de disco lumbar diagnosticada con resonancia magnética y que se resolvió espontáneamente. Abstract in english Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a [...] well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy.

M., Gelabert-González; R., Serramito-García; E., Aran-Echabe; A., García-Allut.

2007-04-01

377

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

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

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

2014-11-01

378

The imaging of lumbar spinal stenosis review  

International Nuclear Information System (INIS)

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)

379

Side effects after ambulatory lumbar iohexol myelography  

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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.)

380

Side effects after ambulatory lumbar iohexol myelography  

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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.

Sand, T.; Myhr, G.; Stovner, L.J.; Dale, L.G.; Tangerud, A.

1989-03-01

 
 
 
 
381

Hemophilic pseudotumor of the first lumbar vertebra.  

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Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases. PMID:25404776

Nachimuthu, Gurusamy; Arockiaraj, Justin; Krishnan, Venkatesh; Sundararaj, Gabriel David

2014-11-01

382

[Pathological studies on the lumbar facet joints].  

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Relationship between changes of the bony architecture and remodeling in the facet joints of the lumbar spine was studied in cadaveric specimens, using the method of microradiography. The facetal angle was 59 degrees at L1-2, 65 degrees at L2-3, 75 degrees at L3-4 and 92 degrees at L4-5. The subchondral compact bone volume was higher at the anterior part in all cases. The greater compact bone volume was found in the more sagittally facing facets, asymmetrical facets and facets with disc degeneration. Highly mineralized tissues in the trabeculae were observed in the degenerative facets. These tissues consisted of old calcified fibrocartilage, left alone as the result of continued remodeling. The degenerative changes in the lumbar facet joints probably start as calcification of the part where the ligamentum flavum attaches, followed by new bone formation and transformation of the joints. PMID:1761908

Sato, M

1991-11-01

383

Recognition of lumbar disk herniation with NMR  

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

384

Oriental Medical Treatment of Lumbar Spinal Stenosis  

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

Hae-Yeon Lee

2003-12-01

385

Clinical trial of iohexol in lumbar myelography  

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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.)

386

The imaging of lumbar spinal stenosis review  

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

Saifuddin, A

2000-08-01

387

Sagittal spinal alignment in patients with lumbar disc herniation  

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A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and...

Endo, Kenji; Suzuki, Hidekazu; Tanaka, Hidetoshi; Kang, Yupeng; Yamamoto, Kengo

2010-01-01

388

Risk factors for adjacent segment disease after lumbar fusion  

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The incidence of adjacent segment problems after lumbar fusion has been found to vary, and risk factors for these problems have not been precisely verified, especially based on structural changes determined by magnetic resonance imaging. The purpose of this retrospective clinical study was to describe the incidence and clinical features of adjacent segment disease (ASD) after lumbar fusion and to determine its risk factors. We assessed the incidence of ASD in patients who underwent lumbar or ...

Lee, Choon Sung; Hwang, Chang Ju; Lee, Sung-woo; Ahn, Young-joon; Kim, Yung-tae; Lee, Dong-ho; Lee, Mi Young

2009-01-01

389

Postural stability disorders in rural patients with lumbar spinal stenosis  

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Introduction. Hard work in farming may lead to lumbar spinal stenosis, and consequently, to pain. The pain and neurological disorders may lead to disability and postural disorders. Objective. The aim of the presented study was to analyse postural stability and its correlation with functional disability of patients with lumbar spinal stenosis living in rural areas. Materials and methods. The study population consisted of 30 rural patients with lumbar spinal stenosis; mean age: 51.40 (±1...

Aleksandra Truszczy?ska; Olaf Truszczy?ski; Kazimierz R?pa?a; Elzbieta Gmitrzykowska; Adam Tranowski

2014-01-01

390

Midsagittal Anatomy of Lumbar Lordosis in Adult Egyptians: MRI Study  

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Despite the increasing recognition of the functional and clinical importance of lumbar lordosis, little is known about its description, particularly in Egypt. At the same time, magnetic resonance imaging (MRI) has been introduced as a noninvasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar lordosis using midsagittal MRIs. Normal lumbar spine MRIs obtained from 93 individuals (46 males, 47 females; 25–57 years old) were evaluated retrospectively. ...

Hegazy, Abdelmonem A.; Hegazy, Raafat A.

2014-01-01

391

Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases  

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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 cli...

S?enog?lu, Mehmet; Yu?ksel, Kas?m Zafer; Yu?ksel, Mu?rvet

2006-01-01

392

Tadpole system as new lumbar spinal instrumentation  

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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

Akeda Koji; Inaba Tadashi; Kasai Yuichi; Uchida Atsumasa

2008-01-01

393

Percutaneous treatment of lumbar disc herniation  

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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)

394

Oriental Medical Treatment of Lumbar Spinal Stenosis  

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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...

Hae-Yeon Lee; Tae-Hun Lee; Jung-Han Park; Hyun-Seok Cho; Jae-Jun Lee; Dong-Joo Bae; Kyung-Hwan Kong; Tae-Hyun Baik

2003-01-01

395

Remote Cerebellar Hemorrhage after Lumbar Spinal Surgery  

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Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The m...

Nam, Taek Kyun; Park, Seung Won; Min, Byung Kook; Hwang, Sung Nam

2009-01-01

396

Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration.  

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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

2014-05-01

397

Working channel endoscope in lumbar spine surgery.  

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Percutaneous endoscopic lumbar discectomy (PELD) is a well established modality in the treatment of patients with herniated lumbar discs. Since the time of its inception towards the end of 20th century, this technique has undergone significant modifications. With better understanding of the patho-anatomy and development of instrumentation the indications for PELD are on the rise. In the modern era of knowledge exchange there have been considerable variations among different endoscopic surgeons about classical indications and the implications of a particular technique pertaining to those indications. During last 15 years of experience in practicing endoscopic surgery, Choi has published many articles, regarding the techniques of PELD, across many scientific journals. In our practice there has been considerable shift from central debulking to discectomy to selective fragmentectomy. With further advancements the span of this technique is definitely on the rise. Here, we wish to share all the published data along with my current practice trends in more precise manner to help newer endoscopic spine surgeons understand the implications and limitations of a working channel endoscope in lumbar spine pathologies. PMID:24819484

Choi, G; Lee, S H; Deshpande, K; Choi, H

2014-06-01

398

Risk factors for recurrent lumbar disc herniations.  

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The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

Shin, Byung-Joon

2014-04-01

399

The Clinical Analysis on 32 Cases of Herniated Lumbar Disc Patients according to Lumbar CT scan  

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Full Text Available Objective : This study is to evaluate the effectiveness of the oriental medicine treatment on lumbar disc herniation. Subjects and Methods : The clinical analysis was done on 32 cases of patients with lumbar disc herniation diagnosed by lumbar CT scan. Patients who admitted in Cheongju Oriental Medicine Hospital from April 2007 to April 2008 were analyzed according to the distribution of sex, age, the period of disease, condition on admission, the symptom on admission, Admission day, the treatment efficacy at discharge day. Results : 1. The forties was the most, the acutest phase the most, the day of 8-14 days the most. 2. Multiple bulging disc in 37.5% of CT scan was the most common, followed by a single HNP was 28.1%. 3. Almost 81% patients showed effective efficacy under VAS 3 at discharge day. 4. Single bulging and herniated disc were more short admission days than multiple bulging and herniated disc.

Jeong-ho Kim

2010-06-01

400

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

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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)

 
 
 
 
401

Lumbar myelography in 79 dogs, using different puncture sites  

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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

402

The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4–5 Herniated Intervertebral Disc  

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[Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients. PMID:25140094

Yang, Hae-sun; Yoo, Won-gyu

2014-01-01

403

The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4-5 Herniated Intervertebral Disc.  

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[Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4-5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4-5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4-5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4-5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4-5 HIVD patients. PMID:25140094

Yang, Hae-Sun; Yoo, Won-Gyu

2014-07-01

404

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

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

405

Lumbar disk herniation surgery: outcome and predictors.  

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

Sedighi, Mahsa; Haghnegahdar, Ali

2014-12-01

406

Tadpole system as new lumbar spinal instrumentation  

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

Akeda Koji

2008-09-01

407

Successful Bone Union Following Calcium Phosphate Cement-Assisted Percutaneous Transpedicular Balloon Kyphoplasty of a Large Interbody Cleft on Long-term Hemodialysis Patient  

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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

2011-01-01

408

P.L.I.F. : Posterior lumbal interbody fusion method, indication an clinical control between 1995 an 2000 at Benjamin Franklin University Hospital  

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PLIF with inter-body implants prop up the space between the nerve roots. A consequence of the method of operation results in a destabilisation of all three columns of the lumbal spinal column. For this reason PLIF should always be combined with a dorsal instrumentation. Besides an immediate and sufficient stabilisation this allows for a restive state of the often osteochondrotically damaged segment. We have 112 patients who have undergone examinations after a three and a 1...

Krug, Daniela

2010-01-01

409

Abdominal aortic pseudoaneurysm caused by lumbar discectomy: case report  

International Nuclear Information System (INIS)

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

410

Lumbar hernia - a case report and review of the literature  

International Nuclear Information System (INIS)

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

411

Complex radiodiagnosis of the lumbar spine spinal canal stenosis  

International Nuclear Information System (INIS)

Ultrasound study was done in 67 patients with osteochondrosis of the lumbar spine revealed by x-ray study, magnetic resonance imaging and computed tomography. Ultrasound technique is highly informative in visualizing location, direction, size of the hernia in lumbar osteochondrosis and stenosis of spinal canal

412

Impact of instrumentation in lumbar spinal fusion in elderly patients  

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Background and purpose An increasing number of lumbar fusions are performed using allograft to avoid donor-site pain. In elderly patients, fusion potential is reduced and the patient may need supplementary stability to achieve a solid fusion if allograft is used. We investigated the effect of instrumentation in lumbar spinal fusion performed with fresh frozen allograft in elderly patients.

Andersen, Thomas; Christensen, Finn B.; Niedermann, Bent; Helmig, Peter; Høy, Kristian; Hansen, Ebbe S.; Bu?nger, Cody

2009-01-01

413

Computed tomography in the diagnosis of the lumbar disc herniation  

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In this study, effectiveness of computed tomography (CT) in diagnosing lumbar disc herniation was evaluated. Twenty CT examinations which were interpreted as positive for a herniated disc, and were comfirmed by myelography, were reviewed. In 19 patients, CT demonstrated posterior protrusion of the disc but in one normal disc. Three typical cases were described. This study suggests that CT accurately demonstrates lumbar disc herniation.

Iwakura, Yuichiro (Yatsushiro General Hospital, Kumamoto (Japan)); Hayashi, Yasuo; Suzuki, Mutsuaki; Uemura, Mitsuharu; Fukuda, Kazuyuki; Koito, Hirofumi

1984-06-01

414

Complications of lumbar puncture in a child treated for leukaemia  

International Nuclear Information System (INIS)

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.)

415

Complications of lumbar puncture in a child treated for leukaemia  

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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.)

Staebler, Melanie; Delpierre, Isabelle; Damry, Nash; Christophe, Catherine [Children' s University Hospital Queen Fabiola, Department of Medical Imaging, Brussels (Belgium); Azzi, Nadira [Children' s University Hospital Queen Fabiola, Haematology-Oncology Unit, Brussels (Belgium); Sekhara, Tayeb [Children' s University Hospital Queen Fabiola, Department of Neurology, Brussels (Belgium)

2005-11-01

416

[Biomechanicsl evaluation of a stand-alone interbody fusion cage based on porous TiO2/glass-ceramic on the human cervical spine].  

Science.gov (United States)

Recently, there has been a rapid increase in the use of cervical spine interbody fusion cages, differing in design and biomaterial used, in competition to autologous iliac bone graft and bone cement (PMMA). Limited biomechanical differences in primary stability, as well as advantages and disadvantages of each cage or material have been investigated in studies, using an in vitro human cervical spine model. 20 human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or PMMA after discectomy. Non-destructive biomechanical testing was performed, including flexion/extension and lateral bending using a spine testing apparatus. Three-dimensional segmental range of motion (ROM) was evaluated using an ultrasound measurement system. ROM increased more in flexion/extension and lateral bending after PMMA fusion (26.5%/36.1%), then after implantation of the Ecopore-cage (8.1%/7.8%). In this first biomechanical in vitro examination of a new porous ceramic bone replacement material a) the feasibility and reproducibility of biomechanical cadaveric cervical examination and its applicability was demonstrated, b) the stability of the ceramic cage as a stand alone interbody cage was confirmed in vitro, and c) basic information and knowledge for our intended biomechanical and histological in vivo testing, after implantation of Ecopore in cervical sheep spines, were obtained. PMID:14740523

Korinth, M C; Moersch, S; Ragoss, C; Schopphoff, E

2003-12-01

417

CT features and clinical significance of lumbar articular facet syndrome  

International Nuclear Information System (INIS)

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

418

Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases  

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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.

Mehmet ?ENO?LU

2006-12-01

419

Primary leptomeningeal lymphoma of the lumbar spine.  

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This report describes primary leptomeningeal lymphoma (PLML) of the spine in a 58-year-old female. LML is rare, especially in the immunocompetent, and it is almost always secondary in origin. To our knowledge, there have been very few cases of PLML of the lumbar spine reported in the literature and even fewer reports using recent MR imaging (MRI) technology to aid with diagnosis. MRI is useful in differentiating CNS lesions and may be helpful in the diagnosis of this extremely rare primary lymphoma. PLML is briefly reviewed. PMID:14585565

Carlson, Christian L; Hartman, Robert; Ly, Justin Q; Beall, Douglas P

2003-01-01

420

Percutaneous treatment of lumbar disc herniation  

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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)

1994-12-31

 
 
 
 
421

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

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

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

2001-04-01

422

Reproducibility of central lumbar vertebral BMD  

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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

Chan, F.; Pocock, N.; Griffiths, M.; Majerovic, Y.; Freund, J. [St Vincents Hospital, Sydney, NSW (Australia). Department of Nuclear Medicine

1997-12-01

423

Reproducibility of central lumbar vertebral BMD  

International Nuclear Information System (INIS)

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

424

MR imaging of lumbar disc disease  

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

425

[Lumbar hypermobility: where swimming becomes hydrotherapy].  

Science.gov (United States)

In this paper the authors discuss the clinical problem of lumbar hypermobility. The therapeutical possibilities are resumed briefly. The philosophy of medical training therapy ("Heilgymnastik") is described. More extensive the extra-advantages of hydrotherapy (methodical back-stroke swimming) are searched for in a theoretical deductive way. The authors found that: 1. swimming is a low-impact sport so far as the articulations are concerned, 2. back-stroke is done mainly in a lumbar kyphosis, 3. swimming is also an excellent cardiopulmonary training, 4. when swimming the muscles of the shoulder girdle and pelvic girdle are trained in a nearly isokinetic way (power-endurance), 5. the short transverso-spinal muscles are indirectly trained in their tonic more than phasic stretch reflex (posture function), 6. the muscles of the trunk are trained in a nearly isometric way in the appropriate angles (erect position), 7. the position of the head in the water facilitates the abdominal muscles (tonic neck reflex), 8. the cool temperature of the water generates training-enhancing stress-responses, 9. endurance-training is ideal for the postural function of the lower back muscles (especially the deeper layers near the spine) which are anatomical and physiological suited for this purpose, 10. warming-up and cooling-down procedures prepare the neuromuscular, the cardiovascular and metabolic functions before the workout-session (a cold shower afterwards acts to tonicize the skin and muscles). PMID:2097863

Mergeay, D; De Neve, M

1990-01-01

426

Outcome of symptomatic upper lumbar disc herniation.  

Science.gov (United States)

"Upper" lumbar disc herniations (LDH) are different from the "lower" and possess increased chance of neural compromise and cauda equina syndrome that necessitates operative management despite of contradictory surgical outcome. We underwent the study to assess the clinical and functional outcome of symptomatic upper LDH surgery from July 2003 to June 2012 in BSMMU, Dhaka, Bangladesh. The records of 123 patients (age range, 30-69 years), 56 men and 67 women (mean 52 years) having upper lumbar discectomy were reviewed. The surgical time, intra-operative blood loss, self evaluated back pain and thigh and/or groin pain status [using Visual Analogue Score (VAS)] and the disability status [using Oswestry disability (ODI) questionnaire] was analyzed. Radiological stability (using Posner's criteria), functional outcome [using Japanese Orthopaedic Association (JOA) Score] and overall outcome (using MacNab`s criteria), was calculated. Chi-squared test and z-test using SPSS revealed mean operative time and mean blood loss had no significant (p>0.05) difference. Pain, sensory, motor and reflex status as well as VAS, ODI and all the components of JOA questionnaire had significant (p<0.05) improvement. In spite of intra-operative complications in 20.32% cases, overall satisfactory outcome was achieved in 83.74% cases. The postoperative complications (08.13%) could be managed conservatively. However, carefully decided surgical alternatives resulted in satisfactory clinical and functional outcome in upper LDH surgery. PMID:25481595

Awwal, M A; Ahsan, M K; Sakeb, N

2014-10-01

427

Outcome Prediction in Lumbar Disc Herniation Surgery  

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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.

Harun Brkic

2010-12-01

428

Repair of the spondylolysis in lumbar spine  

International Nuclear Information System (INIS)

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

429

MR imaging assessment of lumbar fusion stability  

International Nuclear Information System (INIS)

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

430

Computed Tomography of the lumbar facet joints  

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The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal gro0008.

Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung [Kang Nam General Hospital, Seoul (Korea, Republic of)

1989-08-15

431

The lumbar spine in backward bending.  

Science.gov (United States)

Cadaveric lumbar motion segments were loaded to simulate backward bending (extension) movements of the lumbar spine. The motion segments' resistance was measured initially, and after the spinous processes and apophyseal joints had been cut through in turn. Compression tests were then performed on the discs while they were wedged in full extension. The results showed that extension is resisted mainly by the disc and spinous processes, and that, in hyperextension, damage usually occurs first in the spinous processes (or the soft tissue squashed between them). However, if the spinous processes are particularly widely spaced, then the apophyseal joints can become damaged first. The protection offered the disc by the neural arch is greater in young people, and after the disc height has been reduced by creep loading. The disc can be damaged in hyperextension if the spine is subjected to high compressive forces at the same time. A sudden application of compressive force can cause an anterior disc prolapse, while a cyclic (fatigue) compressive force can increase the posterior bulging of the lamellas in the posterior annulus. PMID:3206295

Adams, M A; Dolan, P; Hutton, W C

1988-09-01

432

Dynesys fixation for lumbar spine degeneration.  

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The dynamic fixation system Dynesys is utilized in the last 10 years for treatment of degenerative segmental disease of the lumbar spine. Dynesys is a semi-rigid fixation system that allows minimal lengthening and shortening between two segmental pedicle screws as opposed to a rigid metal bar. Thus, the system is regarded to maintain stability and near physiological motion patterns of the lumbar spine. The theoretical advantage of this system is to stabilize the treated segment and to prevent adjacent segment degeneration. The goal of this prospective trial was to evaluate clinical, radiographic, and computed tomography (CT) scan outcomes in 54 consecutive cases. Postoperative complications are discussed in detail. Forty cases were recruited with a mean follow-up of 16 months (range, 12 to 37). Postoperative pain scores (Hannover Activities of Daily Living Questionnaire and VAS for back and leg pain) improved in 29 cases (73%) and was best when dynamic fusion was combined with nerve root decompression. Outcome data were not superior to conventional rigid fusion systems and had a considerable number of complications requiring revision surgery in 27.5% of cases. PMID:17906883

Bothmann, Matthias; Kast, Erich; Boldt, Gerald Jens; Oberle, Joachim

2008-04-01

433

In vivo morphological features of human lumbar discs.  

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Recent biomechanics studies have revealed distinct kinematic behavior of different lumbar segments. The mechanisms behind these segment-specific biomechanical features are unknown. This study investigated the in vivo geometric characteristics of human lumbar intervertebral discs.Magnetic resonance images of the lumbar spine of 41 young Chinese individuals were acquired. Disc geometry in the sagittal plane was measured for each subject, including the dimensions of the discs, nucleus pulposus (NP), and annulus fibrosus (AF). Segmental lordosis was also measured using the Cobb method.In general, the disc length increased from upper to lower lumbar levels, except that the L4/5 and L5/S1 discs had similar lengths. The L4/5 NP had a height of 8.6?±?1.3?mm, which was significantly higher than all other levels (P?lordosis.Although the lengths of the lower lumbar discs were similar, the geometry of the AF and NP showed segment-dependent properties. These data may provide insight into the understanding of segment-specific biomechanics in the lower lumbar spine. The data could also provide baseline knowledge for the development of segment-specific surgical treatments of lumbar diseases. PMID:25526494

Zhong, Weiye; Driscoll, Sean J; Wu, Minfei; Wang, Shaobai; Liu, Zhan; Cha, Thomas D; Wood, Kirkham B; Li, Guoan

2014-12-01

434

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

Science.gov (United States)

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

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

2014-03-01

435

MRI manifestations of lumbar active inflammation in ankylosing spondylitis  

International Nuclear Information System (INIS)

Objective: To study the MRI manifestations of lumbar active inflammation in ankylosing spondylitis (AS), and its relationship with CT grade of sacroiliitis. Methods: 64 cases of AS accepted lumbar MR scan with sagittal STIR/SPIR and T1-weighted fat suppressed sequences after administration of GD-DTPA. MR manifestations of lumbar active inflammation including active spondylitis, spondylodiskitis, arthritis of the facet joints and enthesitis were studied. Spondylitis was especially analyzed by Berlin method. 40 cases accepted CT scan of sacroiliac joints simultaneously, classed by modified New York criteria. Correlation: analysis was made between lumbar involvement and Berlin method. Results: There were 42 cases of active spondylitis, 6 of spondylodiskitis, 37 of arthritis of the facet joints, 32 of enthesitis in all 64 cases. The positive rate of lumbar involvement in AS was 85.9%. Positive rate of Spondylitis was 65.6%. L1/2 was 34.4%, which accounted for the most in all lumbar vertebral units, but there was not statistically significance between L1/2 and other Vertebral Units (P>0.05). The mean score of L5/S1 was 1.23, which was the highest in vertebral units involved, and there was statistically significance between L5/S1 and T12/L1, L1/2, L2/ 3 (P0.05) between lumbar active inflammation and the CT grades of sacroiliitis. Conclusions: Lumbar involvement of AS is common, mostly manifested as spondylitis, common, mostly manifested as spondylitis, arthritis of the facet joints and enthesitis, with spondylodiskitis the least. In spondylitis, L1/2 is the most. There maybe no correlation between lumbar involvement and degree of spondylitis and grade of sacroiliitis. (authors)

436

Direction of the formation of anterior lumbar vertebral osteophytes  

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

Akeda Koji

2009-01-01

437

Lumbar spine radiography for osteoporosis via a staging system - CT densitometry of lumbar vertebrae  

International Nuclear Information System (INIS)

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes. (orig.)

438

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report  

International Nuclear Information System (INIS)

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

439

Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report  

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

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

2009-12-15

440

Vascular Complications in Lumbar Spinal Surgery: Percutaneous Endovascular Treatment  

International Nuclear Information System (INIS)

Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula.We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively

 
 
 
 
441

Vascular complications in lumbar spinal surgery: Percutaneous endovascular treatment  

International Nuclear Information System (INIS)

Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery, in two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula.We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.

442

The cost–utility of lumbar disc herniation surgery  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The cost and utility of surgery for a herniated lumbar disc has not been determined simultaneously in a single cohort. The aim of this study is to perform a cost–utility analysis of surgical and nonsurgical treatment of patients with lumbar disc herniation. Ninety-two individuals in a cohort of 1,146 Swedish subjects underwent lumbar disc herniation surgery during a 2-year study. Each person operated on was individually matched with one treated conservatively. The effects and costs of the t...

Hansson, Elisabeth; Hansson, Tommy

2007-01-01

443

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

Scientific Electronic Library Online (English)

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

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

1479-14-01

444

Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles Continuous lumbar epidural uncontrollable bladder spasms  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con antimuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica altern...

Lo?pez Carballo, C.; Va?zquez Del Valle, S.; Garrido Garci?a, M.; Pico Veloso, J.; Valle Ya?n?ez, R.; Bermu?dez Lo?pez, M. J.; Pardo-sobrino Lo?pez, F. J.

2013-01-01

445

Tratamiento de la radiculopatía lumbar con radiofrecuencia pulsada Treatment of lumbar radiculopathy with pulsed radiofrequency  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objectivos: Valorar la eficacia y los efectos secundarios derivados del tratamiento con radiofrecuencia pulsada en pacientes diagnosticados de radiculopatía lumbar. Material y métodos: Se realiza un estudio observacional prospectivo. Se realizan 20 radiofrecuencias en modo pulsado en 17 pacientes consecutivos con diagnóstico de radiculopatía confirmado mediante electromiografía y clínica congruente desde enero de 2001 hasta enero del 2002. En todos los pacientes antes de efectuar la rad...

Abejo?n, D.; Delgado, C.; Nieto, C.; Fuentes, M. L.; Garci?a Del Valle, S.; Go?mez-arnau, J.; Reig, E.

2004-01-01

446

Lumbar Spinal Stenosis–Specific Symptom Scale  

Science.gov (United States)

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

2014-01-01

447

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

Directory of Open Access Journals (Sweden)

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 for