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Sample records for posterior-lateral lumbar interbody

  1. Lateral Lumbar Interbody Fusion.

    Pawar, Abhijit; Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-12-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  2. Contralateral radiculopathy after transforaminal lumbar interbody fusion

    Hunt, Travis; Shen, Francis H.; Shaffrey, Christopher I.; Arlet, Vincent

    2007-01-01

    Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative spondylolisthesis and degenerative disc disease. Opposite side radiculopathy after the TLIF procedure has been recognized in this institution but has not been addressed in the literature. We present a case of opposite side radiculopathy after the TLIF procedure. We believe that this complication is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased l...

  3. Mini-open anterior lumbar interbody fusion.

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ . PMID:27364424

  4. Surgical Results of Lumbar Interbody Fusion Using Calcium Phosphate Cement

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

    2014-01-01

    Clinical and radiological outcomes of lumbar interbody fusion using artificial fusion cages filled with calcium phosphate cements (CPCs) were retrospectively reviewed. Between 2002 and 2011, 25 patients underwent lumbar interbody fusion at Tokushima University Hospital, and 22 patients were enrolled in this study. Of these, 5 patients received autologous local bone grafts and 17 received CPC. Japan Orthopedic Association (JOA) score was used for clinical outcome assessments. Lumbar radiograph...

  5. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches

    Cole, Chad D; McCall, Todd D.; Meic H. Schmidt; Dailey, Andrew T

    2009-01-01

    The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrod...

  6. CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

    Emiliano Vialle

    2015-12-01

    Full Text Available Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative radiographs were used for measuring lumbar lordosis (LL, segmental lordosis (SL at the level of interbody fusion, and sacral slope (SS. Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001 as well as the SS (33.8o:31.2o, p=0.05. SL did not change significantly (11.4:11.06, p=0.85. There were no significant differences when comparing patients who received crescent shaped cage (n=27 and rectangular cage (n=43. Hypolordotic patients (Roussouly types 1 and 2 had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4. Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

  7. Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients

    Silvestre, Clément; Mac-Thiong, Jean-Marc; Hilmi, Radwan; Roussouly, Pierre

    2012-01-01

    Study Design A retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution. Purpose To report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine. Overview of Literature Different approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation. Methods A total of 179 patients with previous ...

  8. Ureteral injury after posterior lumbar discectomy with interbody screw fixation

    Pillai, Sunil Bhaskara; Hegde, Padmaraj; Venkatesh, Giridhar; Iyyan, Bhalaguru

    2013-01-01

    We report a case of iatrogenic ureteral injury secondary to L5 laminectomy and microdiscectomy with L5–S1 bone graft with posterior lumbar interbodyfusion using presacral cancellous screw fixation, managed by initial ureteral stent placement and subsequent Boari bladder flap repair. A 33-year-old woman underwent L5 laminectomy and microdiscectomy with L5–S1 bone graft with posterior lumbar interbody fusion using presacral cancellous screw fixation. On postoperative day 10, she developed lower...

  9. Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis.

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-11-01

    This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86 years, and the mean BMI was 30.31 kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, and this decreased as the series progressed. The median length of stay was 5 days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (± standard deviation) preoperative visual analogue scale (VAS) of 8.28 ± 1.39 to 1.50 ± 1.05 at 12 months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82 mm to 2.80 mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. PMID:26358199

  10. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

    Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

    2016-09-01

    Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research. PMID:27349468

  11. Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results

    Hackenberg, Lars; Halm, Henry; Bullmann, Viola; Vieth, Volker; Schneider, Marc; Liljenqvist, Ulf

    2005-01-01

    The unilateral transforaminal approach for lumbar interbody fusion as an alternative to the anterior (ALIF) and traditional posterior lumbar interbody fusion (PLIF) combined with pedicle screw instrumentation is gaining in popularity. At present, a prospective study using a standardized tool for outcome measurement after the transforaminal lumber interbody fusion (TLIF) with a follow-up of at least 3 years is not available in the current literature, although there have been reports on specifi...

  12. Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation

    Melgar, Miguel A; Tobler, William D.; Ernst, Robert J; Raley, Thomas J; Anand, Neel; Miller, Larry E; Nasca, Richard J

    2014-01-01

    Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 con...

  13. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion

    Christensen, A; Høy, K; Bünger, C;

    2014-01-01

    Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost......-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. 100 Patients were randomized to TLIF or PLF (51/49) and followed for 2 years. Cost data were acquired from national registers, and outcomes were measured using the Oswestry Disability...

  14. Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion

    Xue, Qingyun; Li, Haisheng; Zou, Xuenong; Bünger, Mathias; Egund, Niels; Lind, Martin; Christensen, Finn Bjarke; Bünger, Cody

    2004-01-01

    This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily ...

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

    Nicandro Figueiredo; Johnny Wesley G. Martins; Alfredo A. Arruda; Alexandre R. Serra; Marco Antônio A. Figueiredo; Rodrigo C. Diniz; Alessandro A. Cavicchioli

    2004-01-01

    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 t...

  16. Analysis of Internet Information on Lateral Lumbar Interbody Fusion.

    Belayneh, Rebekah; Mesfin, Addisu

    2016-07-01

    Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.]. PMID:27111081

  17. Minimally invasive L5-S1 oblique lumbar interbody fusion with anterior plate.

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5-S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction. The video can be found here: https://youtu.be/VMUYWKLAl0g . PMID:27364428

  18. Modified Posterior Lumbar Interbody Fusion for Radiculopathy Following Healed Vertebral Collapse of the Middle-Lower Lumbar Spine

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

    2014-01-01

    Study Design Retrospective study. Objectives Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure. Methods Fourteen patients with at least 2-year follow-up were enrolled in this study. The radiologic ...

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

    Kim, Jin Kwon; Moon, Byung Gwan; Kim, Deok Ryeng; Kim, Joo Seung

    2014-01-01

    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...

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

    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 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

  1. Transdural retrieval of a retropulsed lumbar interbody cage: Technical case report.

    Zaidi, Hasan Aqdas; Shah, Ashish; Kakarla, Udaya Kumar

    2016-01-01

    The purpose of this case report was to describe a novel method to retrieve a herniated lumbar interbody cage. Transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method of spinal fixation and fusion. Unexpected retropulsion of an interbody is a rare event that can result in intractable pain or motor compromise necessitating surgical retrieval of the interbody. Both anterior and posterior approaches to removing migrated cages may be associated with significant surgical morbidity and mortality. A 60-year-old woman underwent an L4-S1 TLIF coupled with pedicle screw fixation at a previous hospital 5 years prior to admission. She noted sudden-onset bilateral lower extremity weakness and right-sided foot drop. Magnetic resonance imaging and radiographs were notable for purely centrally herniated interbody. A posterior, midline transdural approach was used to retrieve the interbody. Situated in between nerve rootlets to the ventral canal, this virgin corridor allowed us to easily visualize and protect neurological structures while safely retrieving the interbody. The patient experienced an immediate improvement in symptoms and was discharged on postoperative day 3. At 12-month follow-up, she had no evidence of cerebrospinal fluid (CSF) leak and had returned to normal activities of daily living. While the risk of CSF leak may be higher with a transdural approach, we maintain that avoiding unnecessary retraction of the nerve roots may outweigh this risk. To our knowledge, this is the first case report of a transdural approach for the retrieval of a retropulsed lumbar interbody cage. PMID:26889290

  2. Set screw fracture with cage dislocation after two-level transforaminal lumbar interbody fusion (TLIF): a case report

    Leute, Philip Johannes Felix; Hammad, Ahmed; Hoffmann, Isabel; Hoppe, Sebastian; Klinger, Hans-Michael; Lakemeier, Stefan

    2015-01-01

    Introduction Transforaminal lumbar interbody fusion is a popular procedure used to achieve spondylodesis in patients with degenerative lumbar spinal diseases. We present a rare case of a patient with a set screw fracture with cage dislocation after an open transforaminal lumbar interbody fusion procedure. To the best of our knowledge, this case is the first of its kind to be reported. Case presentation A 44-year-old Caucasian woman attended a follow-up appointment at our hospital 3 months aft...

  3. MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION IN DEGENERATIVE LUMBAR SPINE DISEASE

    Pankaj

    2015-12-01

    Full Text Available OBJECTIVE To assess the clinical and radiological outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF and to analyze the surgical outcome for degenerative lumbar spine disease. METHODS A multicenter retrospective analysis of 20 patients who underwent a MI-TLIF by image guidance from 1 January 2012 to April 2015. The study included 13 males and 7 females (Mean age 53 year. CT scan of operating area was done to evaluate the pedicle screw, cage placement and fusion at 6 months post operatively. Oswestry Disability Index (ODI scores and Visual Analogue Scale (VAS were recorded pre-operatively and at 6-month followup. RESULTS Eighteen (90% patients had evidence of fusion at 6 months post operatively with a mean improvement of 34 on the ODI score. Mean length of hospital stay was 4 days. The mean operative time was 170min. One patient developed transient nerve root pain in the postoperative period which was managed conservatively and one patient developed superficial wound infection. There was no case of CSF leak. CONCLUSION MI-TLIF is a safe and effective surgical procedure for management of degenerative lumbar spine disease.

  4. Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease.

    Yang Zhang

    Full Text Available There have been few studies comparing the clinical and radiographic outcomes between the Dynesys dynamic stabilization system and posterior lumbar interbody fusion (PLIF. The objective of this study is to compare the clinical and radiographic outcomes of Dynesys and PLIF for lumbar degenerative disease.Of 96 patients with lumbar degenerative disease included in this retrospectively analysis, 46 were treated with the Dynesys system and 50 underwent PLIF from July 2008 to March 2011. Clinical and radiographic outcomes were evaluated. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD.The mean follow-up time in the Dynesys group was 53.6 ± 5.3 months, while that in the PLIF group was 55.2 ± 6.8 months. At the final follow-up, the Oswestry disability index and visual analogue scale score were significantly improved in both groups. The range of motion (ROM of stabilized segments in Dynesys group decreased from 7.1 ± 2.2° to 4.9 ± 2.2° (P < 0.05, while that of in PLIF group decreased from 7.3 ± 2.3° to 0° (P < 0.05. The ROM of the upper segments increased significantly in both groups at the final follow-up, the ROM was higher in the PLIF group. There were significantly more radiographic ASDs in the PLIF group than in the Dynesys group. The incidence of complications was comparable between groups.Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially preserves the ROM of the stabilized segments, limits hypermobility in the upper adjacent segment, and may prevent the occurrence of ASD.

  5. Lumbar interbody expanding cage. A preliminary study on an animal model.

    Manunta, M L; Careddu, G M; Masala, G; Columbano, N; Doria, C; Crissantu, L; Sanna Passino, E

    2008-01-01

    Interbody fusion devices are used in human medicine for treating degenerative diseases of the spine. Currently, there is not a universally accepted assessment tool for determining fusion, and the definitive criteria for diagnosing a successful interbody fusion remain controversial. The aim of this study was to describe microscopic and helical computed tomography (CT) imaging in the assessment of lumbar interbody fusion using cylindrical threaded titanium expanding cage in sheep. One cylindrical threaded expanding titanium cage (Proconcept--SA, Orange, France) was inserted through a transperitoneal approach after radical discectomy and packed with cancellous bone autograft in five adult sheep. The subjects were euthanatized after three, six, 12, 18 and 24 months. CT images revealed lumbar fusion at 12 months post operation, whereas microscopic evaluations indicated the presence of lumbar fusion at 18 months. CT and histological grades were the same in 65% of the cases observed. There were not a significant difference between CT, histological and micro radiographic grades. Helical CT scanning can be considered to be a suitable method for the monitoring of lumbar fusion as it enables observation of the deposition of bony bridging within the cage. PMID:18704248

  6. Radiographic Results of Single Level Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease: Focusing on Changes of Segmental Lordosis in Fusion Segment

    Kim, Sang-Bum; Jeon, Taek-Soo; Heo, Youn-Moo; Lee, Woo-Suk; Yi, Jin-Woong; Kim, Tae-kyun; Hwang, Cheol-Mog

    2009-01-01

    Background To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. Methods Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. Results The segmental lordosi...

  7. Improvement of Segmental Lordosis in Transforaminal Lumbar Interbody Fusion: A Comparison of Two Techniques

    Rice, James W.; Sedney, Cara L.; Daffner, Scott D.; Arner, Justin W.; Emery, Sanford E.; France, John C.

    2015-01-01

    Study Design Retrospective review. Objective The purpose of this study was to determine the radiographic impact of a transforaminal lumbar interbody fusion (TLIF) versus a cantilever TLIF technique on segmental lordosis, segmental coronal alignment, and disk height. Methods A retrospective review was done of all patients undergoing TLIF procedures from 2006 to 2011 by three spine surgeons. Traditional TLIF versus cantilever TLIF results were compared, and radiographic outcomes were assessed. ...

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

    Kim, Moon-Chan; Chung, Hung-Tae; Cho, Jae-Lim; Kim, Dong-jun; Chung, Nam-Su

    2011-01-01

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

  9. Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion.

    Xue, Qingyun; Li, Haisheng; Zou, Xuenong; Bünger, Mathias; Egund, Niels; Lind, Martin; Christensen, Finn Bjarke; Bünger, Cody

    2005-04-01

    This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily for 3 months. The histological fusion rate was 2/5 in alendronate-treated allograft and 3/5 in non-treated allograft. The mean bone volume was 39% and 37.2% in alendronate-treated or non-treated allograft (NS), respectively. No statistical difference was found between the same grafted cage comparing two groups. The histological fusion rate was 7/10 in all autograft cage levels and 5/10 in combined allograft cage levels. No fusion was found at all in empty cage levels. With the numbers available, no statistically significant difference was found in histological fusion between autograft and allograft applications. There was a significant difference of mean bone volume between autograft (49.2%) and empty cage (27.5%) (P<0.01). In conclusion, this study did not demonstrate different healing properties of alendronate-treated and non-treated allograft for anterior lumbar interbody fusion in pigs. PMID:15248057

  10. POSTERIOR LUMBAR INTERBODY FUSION AND INSTRUMENTED POSTEROLATERAL FUSION IN ADULT SPONDYLOLISTHESIS: ASSESSMENT AND CLINICAL OUTCOME

    Rajarajan

    2015-11-01

    Full Text Available OBJECTIVE: Aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF and posterolateral fusion (PLF in adult isthmic spondylosthesis. BACKGROUND: Posterolateral fusion has been considered the best method and widely been used for surgical treatment of adult spondylolisthesis.Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation MATERIALS AND METHODS: Thirty six patients with isthmic spondylolisthesis were operated. One group (20 patients had decompression and posterolateral fusion (PLF with a pedicle screw system; other group (16 patients was treated by decompression, posterior lumbar interbody fusion (PLIF and a Pedicle screw system. In both groups adequate decompression was done RESULTS: Seventy seven percent of the patients had a good result with (PLIF and 68 percent with posterolateral fusion (PLF. However there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. Fusion rate was 93% with (PLIF and 68% with (PLF, but without any significant incidence in the functional outcome. 78% has relief of sciatica and neurogenic claudication. CONCLUSION: Based on these findings we found that for high grade spondylolisthesis which requires reduction or if the disc space is still high posterior lumbar inter body fusion is preferable. For low grade spondylolisthesis or if the disc space is narrow posterolateral fusion is preferable. A successful result of fusion operation depends on adequate decompression which relieves radicular symptoms.

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

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

    2012-01-01

    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...

  12. Outcome of instrumented lumbar fusion for low grade spondylolisthesis; Evaluation of interbody fusion with & without cages

    Fathy, Mostafa; Fahmy, Mohamed; Fakhri, Mazen; Aref, Khaled; Abdin, Khaled; Zidan, Ihab

    2010-01-01

    Object: The aim is to evalute the outcome of posterior lumbar interbody fusion with autologous bone graft versus titanium Cages, BAK system (Bagby – Kuslich, Spine Tech, Inc. Minneapolis, MN) for low grade spondyloisthesis (Grade1,11). Interbody cages have been developed to replace tricortical Interbody grafts in posterior lumbar interbody fusion (PLIF) procedures. The cages provide immediate post operative stability and facilitate bony union with cancellous bone packed in the cage itself. METHOD: We Evaluated 50 consecutive patients in whom surgery was performed between June 2000 to June 2003 in the Main Alexandria University Hospital at EGYPT. Twenty five patients were operated using autologous bone graft and 25 patients using the BAK cages. The neuro–radiologic al work up consisted of; plain X – ray lumbosacral spine including dynamic films preoperative and postoperative follow up; C.T lumbosacral spine and MRI lumbosacral spine. The surgery was performed at L4-5 level in 34 cases and at L5-S1 level in 16 cases. The median follow up was 15 months. RESULTS: Satisfactory fusion was obtained at all levels at a minimum one year follow – up. The fusion rate was 96% (24 patients) for the cage group and 80% (20 patients) for bone graft group however clinical improvement was 64% (16 patients) for those with bone graft group. CONCLUSION: A higher fusion rates and a better clinical outcome have been obtained by Instrumented PLIF with titanium cages that with bone graft. Inderbody fusion cages help to stabilize spainal segment primarily by distracting them as well as by allowing bone ingrowth and fusion. The procedure is safe and effective with 96% fusion rate and 76% overall Satisfactory rate. The use of cages help to distract the space between the vertebral bodies making the correction of the degree of spondylolisthesis easier. Long term follow up revealed better fusion rate and better realignment and less resorption with cages than with bone grafts. PMID

  13. Klinische und radiologische Ergebnisse nach monosegmentaler „posterior lumbar interbody fusion“ (PLIF) mit zwei unterschiedlichen Titancages und dorsaler Stabilisierung bei degenerativer Spondylolisthese

    Abbushi, Alexander

    2010-01-01

    This is a retrospective study of 40 patients, who had a monosegmental lumbar degenerative spondylolisthesis treated by monosegmental posterior lumbar interbody fusion (PLIF) using two different types of titan cages and pedicle screw fixation. The objective was to evaluate the radiographic and clinical results of these patients treated with posterior lumbar interbody fusion and pedicle screw fixation either by using the Prospace Titan Cage of Aesculap or the O.I.C Titan Cage of Stryker. ...

  14. Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

    Sherman, Blake P.; Lindley, Emily M.; Turner, A. Simon; Seim III, Howard B.; Benedict, James; Burger, Evalina L; Patel, Vikas V.

    2010-01-01

    A prospective, randomized study was performed in an ovine model to compare the efficacy of an anorganic bovine-derived hydroxyapatite matrix combined with a synthetic 15 amino acid residue (ABM/P-15) in facilitating lumbar interbody fusion when compared with autogenous bone harvested from the iliac crest. P-15 is a biomimetic to the cell-binding site of Type-I collagen for bone-forming cells. When combined with ABM, it creates the necessary scaffold to initiate cell invasion, binding, and sub...

  15. Excessive distraction of lumbar disc space induces early degeneration of the adjacent segment after posterior lumbar interbody fusion (PLIF)

    Posterior lumbar interbody fusion (PLIF) for lumbar spondylolisthesis usually results in an excellent outcome, but the problem of so-called adjacent segment disease (ASD) remains unresolved. ASD at L3/4 was investigated in 85 patients with LA spondylolisthesis treated by L4/5 PLIF with uniform pedicle screws and interbody cages who had been followed up for more than two years (mean, 38.8±17.1 months). The patients were divided into three groups according to the final outcome: a group without ASD (n=58), a group with radiological ASD (n=14), and a group with clinical ASD (n=13). Eleven patients in the third group were reoperated to treat L3/4 lesions. L4-5 disc height distraction by cage insertion in the three groups was 3.1 mm, 4.4 mm, and 6.2 mm, respectively, and the latter two values were significantly higher than the first value. Excessive distraction of the L4/5 disc space proved to be a significant risk factor for radiological and clinical ASD at L3/4. (author)

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

    Hardenbrook MA; Miller LE; Block JE

    2013-01-01

    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...

  17. Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.

    Sedra, Fady; Lee, Robert; Dominguez, Ignacio; Wilson, Lester

    2016-09-01

    We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised. PMID:27349467

  18. A meta-analysis of unilateral versus bilateral pedicle screw fixation in minimally invasive lumbar interbody fusion.

    Zheng Liu

    Full Text Available 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.

  19. Incidence of graft extrusion following minimally invasive transforaminal lumbar interbody fusion.

    Bakhsheshian, Joshua; Khanna, Ryan; Choy, Winward; Lawton, Cort D; Nixon, Alex T; Wong, Albert P; Koski, Tyler R; Liu, John C; Song, John K; Dahdaleh, Nader S; Smith, Zachary A; Fessler, Richard G

    2016-02-01

    Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been scrutinized for having a complex learning curve. Careful assessment of MI-TLIF complications and critical analyses of prevention may aid a safe adoption of this technique. The current report focuses on the incidence of interbody cage extrusions following MI-TLIF in a series of 513 patients. The authors discuss their experience with graft extrusions and provide methods to minimize this complication. This study retrospectively reviewed 513 prospectively followed patients who underwent MI-TLIF over a 10 year period. The inclusion criteria consisted of all patients who underwent one to three level MI-TLIF, from whom the incidence of cage extrusion was analyzed. Cage extrusion was defined as an interbody graft migrating outside the cephalad and caudal vertebral body posterior margin. Cage extrusions were diagnosed by comparing the intraoperative radiographs to the postoperative radiographs. Patients with >10° coronal curves, significant sagittal malalignment, infection, and preoperative instrumentation failure were excluded. Of 513 patients undergoing MI-TLIF, five patients (0.97%) were diagnosed with cage migrations. The mean follow-up duration was 13.6 ± standard deviation of 8.8 months. Complications included asymptomatic cage migration alone (two patients) neurological decline (two patients) and epidural hematoma (one patient). On average, cage migrations cost a university hospital an additional $US17,217 for revision treatment. While the incidence of cage migrations is low (0.97%), it can lead to postoperative complications that require revision surgery and increased hospital costs. The risk for this significant complication can be minimized with proper technique and patient selection. PMID:26578209

  20. A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine.

    Jalalpour, Kourosh; Neumann, Pavel; Johansson, Christer; Hedlund, Rune

    2015-08-01

    Study Design Randomized controlled trial. Objective Despite a large number of publications of outcomes after spinal fusion surgery, there is still no consensus on the efficacy of the several different fusion methods. The aim of this study was to determine whether transforaminal lumbar interbody fusion (TLIF) results in an improved clinical outcome compared with uninstrumented posterolateral fusion (PLF) in the surgical treatment for chronic low back pain. Methods This study included 135 patients with degenerative disk disease (n = 96) or postdiskectomy syndrome (n = 39). Inclusion criteria were at least 1 year of back pain with or without leg pain in patients aged 20 to 65 with one- or two-level disease. Exclusion criteria were sequestration of disk hernia, psychosocial instability, isthmic spondylolisthesis, drug abuse, and previous spine surgery other than diskectomy. Pain was assessed by visual analog scale (pain index). Functional disability was quantified by the disability rating index and Oswestry Disability Index. The global outcome was assessed by the patient and classified as much better, better, unchanged, or worse. The patients were randomized to conventional uninstrumented PLF (n = 67) or TLIF (n = 68). PLF was performed in a standardized fashion using autograft. TLIF was performed with pedicle titanium screw fixation and a porous tantalum interbody spacer with interbody and posterolateral autograft. The clinical outcome measurements were obtained preoperatively and at 12 and 24 months postoperatively. The 2-year follow-up rate was 98%. Results The two treatment groups improved significantly from preoperatively to 2 years' follow-up. At final follow-up, the results in the TLIF group were significantly superior to those in the PLF group in pain index (2.0 versus 3.9, p = 0.007) and in disability rating index (22 versus 36, p = 0.003). The Oswestry Disability Index was better in the TLIF group (20 versus 28, p = 0

  1. Improvement of Segmental Lordosis in Transforaminal Lumbar Interbody Fusion: A Comparison of Two Techniques.

    Rice, James W; Sedney, Cara L; Daffner, Scott D; Arner, Justin W; Emery, Sanford E; France, John C

    2016-05-01

    Study Design Retrospective review. Objective The purpose of this study was to determine the radiographic impact of a transforaminal lumbar interbody fusion (TLIF) versus a cantilever TLIF technique on segmental lordosis, segmental coronal alignment, and disk height. Methods A retrospective review was done of all patients undergoing TLIF procedures from 2006 to 2011 by three spine surgeons. Traditional TLIF versus cantilever TLIF results were compared, and radiographic outcomes were assessed. Results One hundred one patients were included in the study. Patients undergoing the cantilever TLIF procedure had a significantly greater change in segmental lordosis and disk height compared with those who underwent the traditional procedure (p > 0.0001). Conclusions The cantilever TLIF technique can lead to greater change in segmental lordosis based upon radiographic outcomes. PMID:27099813

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

    Zeilstra DJ

    2013-08-01

    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: Axia

  3. Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion

    Ahn, Dong Ki; Moon, Sang Ho; Kim, Tae Woo; Boo, Kyung Hwan; Hong, Sung Won

    2014-01-01

    Study Design A case controlled study with prospective data collection. Purpose To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF). Overview of Literature DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount. Methods Patients who had a PLIF were allocated into two groups. Group I (70 cases)...

  4. Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

    DONG Zhan

    2014-12-01

    Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10~19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P<0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

  5. Relation between radiological assessment and biomechanical stability of lumbar interbody fusion in a large animal model

    R.J. Kroeze; A.J. van der Veen; B.J. van Royen; R.A. Bank; M.N. Helder; T.H. Smit

    2013-01-01

    Purpose To relate the progress of vertebral segmental stability after interbody fusion surgery with radiological assessment of spinal fusion. Methods Twenty goats received double-level interbody fusion and were followed for a period of 3, 6 and 12 months. After killing, interbody fusion was assessed

  6. Relation between radiological assessment and biomechanical stability of lumbar interbody fusion in a large animal model

    Kroeze, R. J.; van der Veen, A. J.; van Royen, B. J.; Bank, R. A.; Helder, M. N.; Smit, T. H.

    2013-01-01

    To relate the progress of vertebral segmental stability after interbody fusion surgery with radiological assessment of spinal fusion. Twenty goats received double-level interbody fusion and were followed for a period of 3, 6 and 12 months. After killing, interbody fusion was assessed radiographicall

  7. Lifestyle-Related Diseases Affect Surgical Outcomes after Posterior Lumbar Interbody Fusion.

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

    2016-02-01

    Study Design Retrospective study. Objective Hyperlipidemia (HL) and hypertension (HT) lead to systemic atherosclerosis. Not only atherosclerosis but also bone fragility and/or low bone mineral density result from diabetes mellitus (DM) and chronic kidney disease (CKD). The purpose of this study was to examine whether these lifestyle-related diseases affected surgical outcomes after posterior lumbar interbody fusion (PLIF). Methods The subjects comprised 122 consecutive patients who underwent single-level PLIF for degenerative lumbar spinal disorders. The clinical results were assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2 years postoperatively. The fusion status was graded as union in situ, collapsed union, or nonunion at 2 years after surgery. The abdominal aorta calcification (AAC) score was assessed using preoperative lateral radiographs of the lumbar spine. Results HL did not significantly affect the JOA score recovery rate. On the other hand, HT and CKD (stage 3 to 4) had a significant adverse effect on the recovery rate. The recovery rate was also lower in the DM group than in the non-DM group, but the difference was not significant. The AAC score was negatively correlated with the JOA score recovery rate. The fusion status was not significantly affected by HL, HT, DM, or CKD; however, the AAC score was significantly higher in the collapsed union and nonunion group than in the union in situ group. Conclusions At 2 years after PLIF, the presence of HT, CKD, and AAC was associated with significantly worse clinical outcomes, and advanced AAC significantly affected fusion status. PMID:26835195

  8. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  9. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial

    WANG Hong-li; L(U) Fei-zhou; JIANG Jian-yuan; MA Xin; XIA Xin-lei; WANG Li-xun

    2011-01-01

    Background In recent years,a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy,but some dispute remains regarding the advantages over open surgery.This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors,postoperative back muscle function,and 24-month postoperative follow-up results.Methods From September 2006 to June 2008,patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study.Patients were randomized to undergo either minimally invasive surgery (MIS,transforaminal lumbar interbody fusion via MAST Quadrant retractor,41 cases) or open surgery (improved transforaminal lumbar interbody fusion,38 cases).Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group,and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P <0.05 for all).MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P <0.01).Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P <0.01).The Oswestry disability index and visual analog scale scores were better at 3,6,12 and 24 months postoperatively than preoperatively in both groups.Both groups of patients met the imaging convergence criteria at the last follow-up.Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery,which is conducive to early functional recovery.In the short term,MIS is superior to open surgery,but in the long term there is no significant difference between the two procedures.

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

    Cohen Anders

    2011-09-01

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

  11. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    Lian, Xiaofeng; Berlin, Connor; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement. PMID:27529069

  12. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    Xiaofeng Lian

    2016-01-01

    Full Text Available Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF. Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years. We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy can be achieved by combining Airo navigation with navigated guide tubes for screw placement.

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

    Xiangdong Duan

    2009-05-01

    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.

  14. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    Lian, Xiaofeng; Navarro-Ramirez, Rodrigo; Berlin, Connor; Jada, Ajit; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. "Total navigation" (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement. PMID:27529069

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

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

  16. Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

    Hao WU

    2016-04-01

    Full Text Available Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS.  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36. Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T12-S1 vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min, intraoperative blood loss was 320 ml (200-1000 ml and hospital stay was 8.21 d (5-12 d. All patients were followed-up for 12.13 months (5-24 months. Compared with preoperation, VAS (P = 0.000, for all and ODI scores (P = 0.000, for all decreased significantly, SF-36 score increased (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all, sagittal lordosis angle (P = 0.000, for all, coronal and sagittal deviation (P = 0.000, for all decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02%, fusion rate of vertebral bodies

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

    Tien V. Le

    2012-01-01

    Full Text Available 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 radiographs. Mean disc height changes were also measured. Results. The mean follow-up period was 13.3 months. Fifty total levels were fused with a mean of 1.42 levels fused per patient. Mean segmental Cobb angle increased from 11.10° to 13.61° (<0.001 or 22.6%. L2-3 had the greatest proportional increase in segmental lordosis. Mean regional Cobb angle increased from 52.47° to 53.45° (=0.392. Mean disc height increased from 6.50 mm to 10.04 mm (<0.001 or 54.5%. Conclusions. The MIS LIF improves segmental lordosis and disc height in the lumbar spine but not regional lumbar lordosis. Anterior longitudinal ligament sectioning and/or the addition of a more lordotic implant may be necessary in cases where significant increases in regional lumbar lordosis are desired.

  18. Thrombosis of Left Common Iliac Artery Following Anterior Lumbar Interbody Fusion: Case Report and Review of Literatures

    Kim, Jin-Sung; CHOI, KYUNG-CHUL; Jung, Byungjoo; Lee, Sang-Ho

    2009-01-01

    We report on a case of thrombosis of the left common iliac artery following anterior lumbar interbody fusion (ALIF) of L4-5 in a 79-year-old man with no previous medical problems, including peripheral vascular disease. After completing the ALIF procedure, the surgeon could not feel the pulsation of the left dorsalis pedis artery, and the oxygen saturation (SaO2) had fallen below 90% from pulse oxymetry on the left great toe. Thrombectomy was successfully performed after confirming the thrombu...

  19. Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle

    Lee, Jun Gue; Kim, Hyeun Sung

    2015-01-01

    Objective The purpose of this study was to evaluate the clinical outcomes of minimally invasive extraforaminal lumbar interbody fusion (ELIF) for revision surgery. Methods From January 2011 to December 2012, 12 patients who underwent minimally invasive ELIF through the Kambin's triangle for revision surgery were included in this study. All patients underwent the surgical procedure in the following sequence: (1) epidural anesthesia, (2) exposing the Kambin's triangle toward the lateral part of the dura (partial resection of the superior articular process), (3) bilateral cage insertion for reinforcement of stabilization and fusion, and (4) percutaneous transpedicular screwing. Clinical outcomes were assessed using the visual analogue scale (VAS), and Oswestry disability index (ODI). Imaging and clinical findings including surgical techniques, clinical outcomes, and related complications were depicted and analyzed. Results The mean age of the patients (5 men, 7 women) was 60.7±13.4 years, and the mean follow-up period was 27.1±4.9 months. The mean VAS (back and leg) score improved significantly at final follow-up. The mean ODI score decreased as follows: preoperative, 76.78±6.08; 3 months after the surgery, 37.74±6.67; and at final follow-up, 29.91±2.98. Two patients presented with transient nerve root irritation, but there were no cases of incidental dural tear or serious infection. No significant neurological deterioration or major complication was noted in any of the patients. Conclusion Minimally invasive ELIF for revision surgery is an effective surgical option with a low complication rate. PMID:26834815

  20. Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

    Kleiner JB

    2016-05-01

    Full Text Available Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA Study design: Disk material removed (DMR during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF surgery was compared to the corresponding bone graft (BG volumes inserted at the time of fusion. A novel BG delivery tool (BGDT was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD. This study was performed prospectively. Summary of background data: Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods: A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results: DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion: The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk

  1. [Three-dimensional Finite Element Analysis of Biomechanical Effect of Rigid Fixation and Elastic Fixation on Lumbar Interbody Fusion].

    Wei, Jiangbo; Song, Yueming; Liu, Limin; Zhou, Chunguan; Yang, Xi

    2015-04-01

    This study was aimed to compare the mechanical characteristics under different physiological load conditions with three-dimensional finite element model of rigid fixation and elastic fixation in the lumbar. We observed the stress distribution characteristics of a sample of healthy male volunteer modeling under vertical, flexion and extension torque situation. The outcomes showed that there existed 4-6 times pressure on the connecting rod of rigid fixation compared with the elastic fixations under different loads, and the stress peak and area of force on elastic fixation were much higher than that of the rigid fixations. The elastic fixation has more biomechanical advantages than rigid fixation in promoting interbody lumbar fusion after surgery. PMID:26211247

  2. Evaluation of the 96/4 PLDLLA polymer resorbable lumbar interbody cage in a long term animal model.

    Lazennec, Jean Y; Madi, Abdallah; Rousseau, Marc A; Roger, Bernard; Saillant, Gérard

    2006-10-01

    Arthrodesis using interbody cages has demonstrated high fusion rates. However, permanent cages are exposed to stress-shielding, corrosion, and may require explanation when necessary. Polylactic acid (PLA) bioresorbable cages are developed for avoiding these problems, but significant tissue reaction has been reported with 70/30 PLDLLA in some preclinical animal studies. The objective was to evaluate 96/4 PLDLLA cages in a sheep model over 3 years. Sixteen sheeps underwent one level anterior lumbar interbody fusion using 96/4 PLDLLA cages, filled and surrounded with cancellous bone graft from the iliac crest. Six groups of three animals were killed after 3, 6, 9, 12, 24, and 36 months. Harvested lumbar spine had radiographic, MRI, and CT evaluation and histological analysis. Histological results: cage swelling and slight signs of fragmentation associated to fibrocartilaginous tissue apposition at 3 months; bone remodeling around the cage with direct apposition of the mineralization front at 6 months; active cage degradation and complete fusion around the cage at 9 months; cage fragmentation and partial replacement by bone tissue at 12 months; bone bridges in and around the cage at 24 months; full resorption and intervertebral fusion at 36 months. Radiological results: partial arthrodesis at 3 months; definite peripheral arthrodesis at 6 months; similar aspect at 9 months; significant cage resorption at 12 months; definite inner and outer fusion at 24 months; complete cage resorption and calcification at the location of the cage at 36 months confirmed histological observations. Radiographic, CT scan, MRI, and histological data were consistent for showing progressive resorption of 96/4 PLDLLA, interbody fusion, and bone remodeling, with no significant signs of local intolerance reaction. These results are promising and suggest further development of 96/4 PLDLLA cages. PMID:16736199

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

    Hardenbrook MA

    2013-06-01

    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

  4. Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring

    LUO Wei; ZHANG Fan; LIU Tie; DU Xing-li; CHEN An-ming; LI Feng

    2012-01-01

    Background Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery,because they may have advantage over conventional open surgery in approach-related morbidity.This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring.Methods Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion.A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement.The operative duration,blood loss,complications,and fluoroscopic time were recorded.Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index.Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates.Results The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively.A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan.Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring.The average fluoroscopy time in each patient was 31.8 seconds,which equals to 7.9 seconds per pedicle screw.No patients had instrument related neurological complications,infection,implant failure or revision.Successful fusion was found in all patients.Conclusions The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.

  5. Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation.

    Chen, Kevin S; Park, Paul

    2016-07-01

    This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires. The video can be found here: https://youtu.be/2u6H4Pc_8To . PMID:27364422

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

    Pollock, Raymond; Lakkol, Sandesh; Budithi, Chakra; Bhatia, Chandra; Krishna, Manoj

    2012-01-01

    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 ...

  7. Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes

    Choi, Won-Suh; Kim, Jin-Sung; Ryu, Kyeong-Sik; Hur, Jung-Woo; Seong, Ji-Hoon

    2016-01-01

    Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF) at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH), disc angle (DA), disc slope angle, segmental lordotic angle (SLA), lumbar lordotic angle (LLA), and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS), Oswestry disability index (ODI), and patient satisfaction rate (PSR) were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21) at 12 months' follow-up. The most common cage position was anteromedial (15/21). The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21). Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable. PMID:27433472

  8. Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

    Cao Peng; Chen Zhe; Zheng Yuehuan; Wang Yuren; Jiang Leisheng; Yang Yaoqi; Zhuang Chengyu

    2014-01-01

    Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion (iPLIF) in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes (LDH-MC).Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale (VAS) as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association (JOA) score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

  9. Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better?

    Q R Abdul

    2011-01-01

    Full Text Available Study design: A prospective clinical study of posterior lumbar interbody fusion in grade I and II degenerative spondylolisthesis was conducted between Mar 2007 and Aug 2008. Purpose: The objective was to assess the clinicoradiological profile of structural v/s nonstructural graft on intervertebral disc height and its consequences on the low back pain (LBP assessed by Visual analog score (VAS score and oswestry disability index (ODI . This study involved 28 patients. Inclusion criteria: Age of 30-70 years, symptomatic patient with disturbed Activities of daily living (ADL, single-level L4/L5 or L5/S1 grade I or grade II degenerative spondylolisthesis. Exclusion criteria: Patients with osteoporosis, recent spondylodiscitis, subchondral sclerosis, visual and cognitive impairment and all other types of spondylolisthesis. All the patients underwent short-segment posterior fixation using CD2 or M8 instrumentation, laminectomy discectomy, reduction and distraction of the involved vertebral space. In 53.5% (n = 15 of the patients, snugly fitted local bone chips were used while in 46.4% (n = 13 of the patients, cage was used. Among the cage group, titanium cage was used in nine (32.1% and PEEK cages were used in four (14.2% patients. In one patient, a unilateral PEEK cage was used. The mean follow-up period was 24 months. Among the 28 patients, 67.8% (n = 19 were females and 32.14% (n = 9 were males. 68.24% (n = 18 had L4/L5 and 35.71% (n = 10 had L5/S1 spondylolisthesis. 39.28% (n = 11 were of grade I and 60.71% (n = 17 were of grade II spondylolisthesis. Conclusions: There was a statistically significant correlation (P < 0.012 and P < 0.027 between the change in disc height achieved and the improvement in VAS score in both the graft group and the cage group. The increment in disc height and VAS score was significantly better in the cage group (2 mm ± SD vis-a-vis 7.2 [88%] than the graft group (1.2 mm ± SD vis-a-vis 5 [62 %].

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

    Miller Larry E

    2011-09-01

    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

  11. Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team.

    Mobbs, Ralph J; Phan, Kevin; Daly, Daniel; Rao, Prashanth J; Lennox, Andrew

    2016-03-01

    Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss. PMID:26933616

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

    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)

  13. Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct.

    Chen, Benjamin; Akpolat, Yusuf T; Williams, Paul; Bergey, Darren; Cheng, Wayne K

    2016-06-01

    In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation time, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and survivorship without the need for revision surgery. Telephone follow-ups were conducted to ascertain survivorship, clinical outcomes (VAS, ODI) and patient satisfaction. Operation time was longer in the hybrid group (p=0.021). The hybrid group showed a significant improvement in VAS and ODI with 52.2% and 50.0% improvement versus 28.3% and 25.5% in the ALIF group (pdisability scores. PMID:26896904

  14. The Outcomes of Surgical Treatment of Recurrent Lumbar Disk Herniation with Discectomy Alone and Discectomy with Posterolateral Interbody Fusion

    Hossein Nayeb Aghayee

    2014-04-01

    Full Text Available Background: Recurrent lumbar disk herniation (RLDH is one of the major causes of failure of standard discectomy. The optimal treatment method for RLDH is controversial. In the current study, we aimed to compare the clinical and functional outcomes of treating RLDH with discectomy alone and discectomy associated with posterolateral interbody fusion (PLIF.Material and Methods: There were 41 patients with RLHD after primary discectomy in the current retrospective study. Patients were assigned to 2 groups based on the surgical method: discectomy alone (17 patients and discectomy with PLIF (21 patients. At the final visit the following variables were measured and compared between groups: the back and radicular pain intensity using visual analogue scale (VAS, functional outcome using oswestry low back pain disability scale (ODI, return to previous work and complication. Patients were followed for 13.9±2.8 and 15±3 months in discectomy alone and discectomy with PLIF groups, retrospectively.Results: Complete fusion was achieved in 24 patients of PLIF group. The back pain intensity was the same; however the radicular pain intensity was significantly lower in PLIF group (1.5±0.9 V.s 2.3±1; p=0.017. Also, the mean of ODI scale was the same. 82.3% of patients in discectomy group and 87.5% of patients in PLIF group returned to previous work and the difference was not significant. One patient in discectomy group and 2 patients in PLIF group developed temporary neurological deficit which disappeared after 3 months.Conclusions: Although both discectomy alone and discectomy with PLIF were associated with favorable mid-term results in treating patients with RLDH, however, the authors recommend using discectomy with PLIF for lower radicular pain.

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

    Lakkol, Sandesh; Budithi, Chakra; Bhatia, Chandra; Krishna, Manoj

    2012-01-01

    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

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

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

    2013-01-01

    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...

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

    Tobler WD

    2013-09-01

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

  18. Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis

    Choovongkomol, Kongtush; Piyapromdee, Urawit; Leownorasate, Manoon

    2016-01-01

    Study Design Retrospective study. Purpose To compare the neurological outcome of transforaminal debridement and interbody fusion with transpedicular decompression for treatment of thoracic and lumbar spinal tuberculosis. Overview of Literature Few articles have addressed the impact of neurological recovery in patients with tuberculosis who were treated by two different operative methods via the posterior-only approach. Methods Clinical and radiographic results of one-stage posterior instrumented spinal fusion for treatment of tuberculous spondylodiscitis with neurological deficits were reviewed and analyzed from 2009 to 2013. The extensive (E) group consisted of patients who received transforaminal debridement and interbody fusion, whereas transpedicular decompression was performed on limited (L) group. Rapid recovery was improvement of at least one Frankel grade within 6 weeks after operation. Otherwise, it was slow recovery. Results All 39 patients had improved neurological signs. The median follow-up period was 24 months. Proportionately younger patients (under 65 years of age) received extensive surgery (15 of 18, 83.3% vs. 11 of 21, 52.4%; p=0.04). The mean operative time and blood loss in the group E were higher than in the group L (both pdecompression.

  19. Hospital charges associated with "never events": comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty.

    Daniels, Alan H; Kawaguchi, Satoshi; Contag, Alec G; Rastegar, Farbod; Waagmeester, Garrett; Anderson, Paul A; Arthur, Melanie; Hart, Robert A

    2016-08-01

    OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that "never events" are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than

  20. 单侧椎间融合内固定治疗腰椎间盘突出症的手术效果%Surgical Effect of Unilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation

    李开雄; 邵玉凯; 郑晓刚; 郭金元; 肖卫; 欧艳春

    2016-01-01

    目的 分析椎间盘突出症椎间融合后单侧内固定的手术效果 .方法 随机选取2007年8月—2014年12月收治的腰椎间盘突出症患者68例,均给予椎间植骨融合术治疗,随机分为单侧内固定治疗的观察组(34例)和双侧内固定治疗的对照组(34例),观察与对比两组患者手术治疗情况. 结果 与对照组比较,观察组患者的手术时间、术中出血量 、术后引流量均低于对照组,差异有统计学意义(P<0.05);术后二组患者的椎间隙曲度、融合率以及JOA评分、MACMAB疗效评定的差异均无统计学意义. 结论 研究表明,单侧椎间融合内固定治疗手术创伤小,可取得与双侧手术相当的近远期疗效.%Objective To analyze the surgical effect of unilateral pedicle screw fixation and lumbar interbody fusion in the treatment of lumbar disc herniation. Methods 68 patients with lumbar disc herniation admitted from August 2007 to De-cember 2014 were randomly divided into the observation group and the control group with 34 cases in each. The observation group were treated by the unilateral pedicle screw fixation and lumbar interbody fusion, while the control group were treated by bilateral pedicle screw fixation and lumbar interbody fusion. And the surgical treatment effect of the two groups was ob-served and compared. Results Compared to the control group, the observation group had shorter operative time, less intra-operative blood loss and less postoperative drainage, the differences were statistically significant (P<0.05). The differences in intervertebral curvature, fusion rate, JOA score and result of MACMAB between the groups after surgery were not statistical-ly significant. Conclusion The study shows that for the treatment of lumbar disc herniation, unilateral pedicle screw fixation and lumbar interbody fusion have smaller trauma, but can obtain the same short-term and long-term effects as bilateral pedicle screw fixation and lumbar interbody fusion.

  1. Novel pedicle screw and plate system provides superior stability in unilateral fixation for minimally invasive transforaminal lumbar interbody fusion: an in vitro biomechanical study.

    Jie Li

    Full Text Available This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body.Seven fresh calf lumbar spines (L3-L6 were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB. After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR; unilateral pedicle screw and plate (UP; UR and transfacet pedicle screw (TFS; UP and TFS; UP and UR.All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR. The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs.The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF.

  2. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages.

    Deng, Qian-Xing; Ou, Yun-Sheng; Zhu, Yong; Zhao, Zeng-Hui; Liu, Bo; Huang, Qiu; Du, Xing; Jiang, Dian-Ming

    2016-06-01

    This study reports the clinical effects of nano-hydroxyapatite/polyamide66 cages (n-HA/PA66 cages) and compares the clinical outcomes between n-HA/PA66 and polyetheretherketone cages (PEEK cages) for application in transforaminal lumbar interbody fusion (TLIF). A retrospective and case-control study involving 124 patients using n-HA/PA66 cages and 142 patients using PEEK cages was conducted. All patients underwent TLIF and had an average of 2-years of follow-up. The Oswestry Disability Index and Visual Analog Scale were selected to assess the pain of low back and leg, as well as neurological status. The intervertebral space height and segmental angle were also measured to estimate the radiological changes. At the 1-year and final follow-ups, the fusion and subsidence rates were evaluated. There was no significant difference between the two groups regarding clinical and radiological results. At the final follow-up, the bony fusion rate was 92.45 and 91.57 % for the n-HA/PA66 and PEEK groups, respectively, and the subsidence rate was 7.55 and 8.99 %, respectively. The study indicated that both n-HA/PA66 and PEEK cages could promote effective clinical and radiographic outcomes when used to treat degenerative lumbar diseases. The high fusion and low subsidence rates revealed that n-HA/PA66 cages could be an alternative ideal choice as the same to PEEK cages for lumbar reconstruction after TLIF. PMID:27091044

  3. Complications and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of one- or two-level degenerative disc diseases of the lumbar spine in patients older than 65 years

    WU Wen-jian; LIANG Yu; ZHANG Xin-kai; CAO Peng; ZHENG Tao

    2012-01-01

    Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been successfully used to treat degenerative diseases of the lumbar spine.There are few reports comparing the complications and clinical outcomes in older patients who have undergone one- or two-level MIS-TLIF with those of younger patients.The aim of this study was to investigate the clinical outcomes of MIS-TLIF in the treatment of degenerative disc disease of lumbar spine of the patients older than 65 years,with an emphasis on perioperative complications compared to the younger patients.Methods One hundred and fifty-one consecutive cases of one- or two-level degenerative disc disease of lumbar spine treated with MIS-TLIF were reviewed for the radiological and clinical outcomes.They were divided into elderly group (age ≥65 years old) and younger group (age <65 years old),and were followed for at least 6 months.Radiographs were obtained before and after surgery,3 months postoperatively,and at the final follow-up to determine the presence of fusion,hardware-related problems.The clinical outcomes were evaluated using the Oswestry Disability Index (ODI)before and after surgery,and at the final follow-up.The visual analogue scale (VAS) score of back and leg pain were evaluated as well.The intra-operative data and peri-operative complications were recorded.Results The mean age of these patients at operation was (57.7±14.2) years (range 26-82 years).Of 151 patients,62were 65 years or older.The elderly patients had more comorbidities and more porportion of lumbar canal stenosis.The overall fusion rate was 88.4% at the final follow-up,with no significant difference between younger and elderly patients.The ODI,the VAS of back pain and radicular pain of both young and elderly group were significantly improved aftersurgery and at the final follow-up,without significant difference between two groups.There were 16 complications with an incidence of 10.6%,including 7 major complications

  4. Comparison of the effect of posterior lumbar interbody fusion with pedicle screw fixation and interspinous fixation on the stiffness of adjacent segments

    LI Chun-de; SUN Hao-lin; LU Hong-zhang

    2013-01-01

    Background Adjacent segment degeneration could seriously affect the long-term prognosis of lumbar fusion.Dynamicfixation such as the interspinous fixation,which is characterized by retaining the motion function of the spinal segment,has obtained satisfactory short-term effects in the clinical setting.But there are few reports about the biomechanicalexperiments on whether dynamic fixation could prevent adjacent segment degeneration.Methods The surgical segments of all 23 patients were L4/5.Thirteen patients with disc herniation of L4/5 underwentWallis implantation surgery,and 10 patients with spinal stenosis of L4/5 underwent posterior lumbar interbody fusion(PLIF).L3-S1 segmental stiffness and displacement were measured by a spine stiffness gauge (SSG) device duringsurgery when the vertebral plate was exposed or during spinal decompression or internal fixation.Five fresh,frozencadavers were used in the self control experiment,which was carried out in four steps:exposure of the vertebral plate,decompression of the spinal canal,implantation of a Wallis fixing device,and PLIF of L4/5 after removing the Wallis fixingdevice.Then,L3-S1 segment stiffness was measured by an SSG device.Results The experiments showed that the average stiffness of the L4/5 segment was (37.1±8.9) N/mm after exposure of the vertebral plate,while after spinal decompression,the average stiffness fell to (26.2±7.1) N/mm,decreasing by 25.8% (P <0.05).For the adjacent segments L3/4 and L5/S1,their stiffness showed no significant difference between the L4/5 segment decompression and the exposure of the vertebral plate (P >0.05).After Wallis implantation of L4/5,the stiffness of the cephalic adjacent segment L3/4 was (45.8±10.7) N/mm,which was 20.5% more than that after the exposure of the vertebral plate (P <0.05); after L4/5 PLIF surgery,the stiffness of L3/4 was (35.3±10.7) N/mm and was decreased by 12.4% more than that after the exposure of the vertebral plate (P <0.05).The

  5. Minimally invasive transforaminal lumbosacral interbody fusion.

    Chang, Peng-Yuan; Wang, Michael Y

    2016-07-01

    In minimally invasive spinal fusion surgery, transforaminal lumbar (sacral) interbody fusion (TLIF) is one of the most common procedures that provides both anterior and posterior column support without retraction or violation to the neural structure. Direct and indirect decompression can be done through this single approach. Preoperative plain radiographs and MR scan should be carefully evaluated. This video demonstrates a standard approach for how to perform a minimally invasive transforaminal lumbosacral interbody fusion. The video can be found here: https://youtu.be/bhEeafKJ370 . PMID:27364426

  6. Clinical study on lumbar spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion%微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究

    王建; 黄博; 周跃; 张正丰; 李长青; 任先军; 初同伟; 王卫东; 郑文杰; 潘勇

    2011-01-01

    目的 回顾性分析和比较微创经椎间孔腰椎间融合术(MIS-TLIF)和开放经椎间孔腰椎间融合术(OTLIF)治疗腰椎滑脱症的临床结果.方法 自2006年6月至2010年5月,371例Ⅰ°或Ⅱ°腰椎滑脱症患者接受TLIF和腰椎弓根螺钉固定治疗并获得随访,男性134例,女性237例;年龄37~85岁,平均50.4岁.采用可扩张通道下单节段TLIF和经皮椎弓根螺钉内固定治疗患者172例(MIS-TLIF组),传统开放TLIF和椎弓根螺钉内固定方法治疗患者199例(OTLIF组).分析两组手术时间、术中术后出血、放射线暴露时间和并发症等方面的差异.采用视觉模拟评分( VAS)和Oswestry功能障碍指数(ODI)评分评估临床结果,行腰椎动力位X线片和薄层CT扫描重建检查评价椎间融合情况.结果 371例患者均获得随访,随访时间12~ 58个月,平均32.7个月.术前两组性别、年龄、滑脱类型和融合节段差异无统计学意义.术中出血MIS-TLIF组平均为(310±75)ml,OTLIF组(623±156)ml,MIS-TLIF组显著优于OTLIF组(t=2.836,P<0.01).术后出血MIS-TLIF组平均为(38±13)ml,OTLIF组(184±72)ml,MIS-TLIF组显著优于OTLIF组(=3.274,P<0.01).与OTLIF组放射暴露时间(20±10)s比较,MIS-TLIF组放射暴露时间(51±19)s更长(t=2.738,P<0.01).两组在手术时间、腰痛VAS评分、ODI评分和并发症发生方面差异均无统计学意义.结论 针对Ⅱ°以下腰椎滑脱症,MIS-TLIF安全有效,相对而言,与开放固定比较具有出血少及组织损伤轻优点.%Objectives To retrospectively analyze the treatment of lumbar spondylolisthesis using minimally invasive and open transforaminal lumbar interbody fusion (TLIF),and compare the clinical results of two techniques.Methods From June 2006 to May 2010,371 patients with lumbar spondylolisthesis grade 1 and 2 were treated with TLIF,pedicle screw fixation and followed up.The mean age was 50.4 years (range,37-85 years).There were 172 patients who underwent minimally

  7. 经椎间孔椎体间融合术治疗复发性腰椎椎间盘突出症的疗效分析%Transforaminal lumbar interbody fusion for treatment of recurrent lumbar disc herniation: an analysis of therapeutic Effect

    张剑刚; 丁文元; 申勇; 徐佳欣; 安志辉; 杨少坤

    2011-01-01

    Objective To assess the therapeutic effect of transforaminal lumbar interbody fusion ( TLIF ) in treatment of recurrent lumbar disc herniation. Methods From February 2008 to June 2010, 27 patients ( average age 52. 4, ranging 28 ~ 64 years old ) with recurrent lumbar disc herniation, who had been treated by TLIF, were collected in the present study. Japanese Orthopaedic Association ( JOA )score system and Nakai standards were used to evaluate the clinical results. Suk criterion was used to evaluate bone graft fusion. Results All the patients were followed up for 8-36 months ( a mean of 23 months ). According to JOA score system, excellent outcomes were obtained in 20 cases and good in 7, with the average improvement rate being 88. 5%. According to Nakai standard, excellent outcomes were obtained in 18 cases, good in 6 cases, and fair in 3 cases, with the excellent and good rate being 88. 9%. Bone grafts in all patients were fused according to Suk criterion. Conclusion TLIF is an effective procedure for treatment of recurrent lumbar disc herniation; it can obtain satisfactory clinical results.%目的 探讨经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗复发性腰椎椎间盘突出症(recurrent lumbar disc herniation,RLDH)的疗效.方法 2008年2月~2010年6月应用TLIF技术再手术治疗的RLDH患者27例,年龄为28~64岁,平均52.4岁.采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分系统、Nakai标准评价治疗效果,Suk方法评价植骨融合情况.结果 患者均获得随访,随访时间为8~36个月(平均23个月).术后根据JOA评分,优20例,良7例,平均改善率88.5%;根据Nakai评分标准,优18例,良6例,可3例,优良率88.9%;根据Suk标准患者椎间植骨均获得骨性融合.结论 TLIF是治疗RLDH的有效术式,可以获得满意临床效果.

  8. Comparison of clinical efficacy of minimally invasive versus open transforaminal lumbar interbody fusion with unilat-eral pedicle screw fixation for lumbar disc herniation%单侧微创与开放经椎间孔腰椎椎体间融合内固定治疗腰椎椎间盘突出症的临床疗效比较

    井贵龙; 袁峰; 郭开今; 孙玛骥

    2014-01-01

    Objective To compare the clinical effect of minimally invasive versus open transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for lumbar disc herniation.Methods The data of 54 patients with lumbar disc herniation who were a-dopted from October 2009 to October 2012 were retrospectively analyzed.There were 32 males and 22 females, and the mean age was 42. 7 years (rang, 32-60 years).The level of surgery was L4/L5 in 34 patients,L5/S1 in 20 patients.All patients were divided into 2 groups according to the surgical methods, including 30 patients undergoing open transforaminal lumbar interbody fusion (OTLIF) and 24 patients undergoing minimally invasive transforaminal lumbar interbody fusion(MiTLIF).The operation time, intraoperative and postoperative blood loss, length of hospital-stay, intraoperative and postoperative complications were recorded .Intervertebral fusion rates 1 year after the operation were observed by radiographic data.Japanese Orthopaedic Association (JOA) scores were used for assessment.Results All patients were followed up for a mean period of 21.4 months (range, 12-36 months).In the MiTLIF group, the intraoperative andpostoperative blood loss was (40.2±15.6) mL, the length of hospital-stay was (6.2 ±2.4) d.Two weeks after the operation, the JOAscore was 18.7±1.9.In the OTLIF group, the intraoperative and postoperative blood loss was (203.6 ±52.8) mL, the length of hospital-stay was (10.8±4.2) d.Two weeks after the operation, the JOA score was 15.1 ±1.4.The difference between the 2 groups werestatistically significant (P 0.05). Conclusion The MiTLIF has the advantages of less blood loss, shorter hospitalization time and rapid postoperative recovery in thetreatment of lumbar disc herniation with unilateral pedicle screw fixation.%目的:比较微创经椎间孔融合内固定与传统开放经椎间孔融合内固定术治疗腰椎椎间盘突出症的临床疗效。方法2009年10月~2012年10月,对54例腰

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

    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

    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.

  10. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain

    Ara J Deukmedjian

    2015-01-01

    Full Text Available Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD. Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. Materials and Methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS, patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS. Results: The average resolution of preoperative back pain per patient was 84% (n = 205 while the average resolution of preoperative leg pain was 90% (n = 190 while a mean follow-up period of 528 days (1.5 years. Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001, a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4. Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11 and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4. Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3; surgical site infection (n = 7; repair of cerebrospinal fluid leak (n = 1, and one patient death at home 3 days after discharge. Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

  11. 单侧椎弓根螺钉固定经椎间孔腰椎体间融合治疗腰椎间盘突出症疗效分析%The effect analysis of transforamen lumbar interbody fusion in treatment of lumbar intervertebral disk herniation with unilateral pedicle screw fixation

    李光富; 刘文斌; 罗政; 周焱涛

    2015-01-01

    Objective To explore the effect of transforamen lumbar interbody fusion in treatment of lumbar intervertebral disk herniation with unilateral pedicle screw fixation. Methods Retrospectivly studied the clinical data of 36 patients with lumbar intervertebral disk herniation who were treated through transforamen lumbar interbody fusion with unilateral pedicle screw from January 2011 to October 2012. There were 22 male and 14 female patients, aged form 44 to 68 years old with mean age of 56. The lesion positions included 8 patients in L3/4, 17 patients in L4/5, and 11 patients in L5/S1. The data of operation time, intraoperative bleeding volume, and postoperative drainage volume were collected. Therapeutic effect were evaluated by visual analogue score (VAS), lumbar vertebral score of Japanese Orthopedic Association (JOA) score, and Oswestry dysfunction index (ODI). Results Operation time was 65-100 min with mean time of 85 min. Intraoperative bleeding volume was 100-250 ml with mean volume of 135 ml. Postoperative drainage volume was 100-200 ml with mean volume of 150 ml. Followed up for 12-36 months with mean time of 20 months. No loosening, breakage of screws or displacement of interbody fusion cages were found in the follow up period. The rate of anastomosis was 100%(36/36). The VAS was (7.9 ± 1.2) scores before operation and (1.1±0.3) scores at the end of follow up period, there was significant difference( P<0.05). The JOA score was (10.2±2.6) scores before operation and (23.2±4.3) scores at the end of follow up period, there was significant difference (P<0.05). The ODI was (43.3±6.2) scores before operation and (15.2±4.3) scores at the end of follow up period, there was significant difference ( P<0.05). Conclusion The effect of transforamen lumbar interbody fusion with unilateral pedicle screw fixation is proper for the patients who are suffering from lumbar intervertebral disk herniation, which has advantages of less invasion, less bleeding, better

  12. Extreme lateral transforaminal lumbar interbody fusion (E-TLIF) designed via digital technology%数字化设计微创极外侧经椎间孔腰椎椎体间融合术

    杨明杰; 李立钧; 祝建光; 潘杰; 谭军

    2011-01-01

    目的 通过数字技术设计一种新的手术方式——微创极外侧经椎间孔腰椎椎体间融合术(extreme lateral transforaminal lumbar interbody fusion,E-TLIF),并探讨其治疗退变性腰椎疾患的可行性.方法 通过对志愿者(男,26岁,健康,体重67 kg,身高172 cm)腰椎行CT扫描及Mimics三维重建,研究椎间孔区域骨性结构和神经根走行,探讨腰椎椎间孔区域的解剖学特点.在Mimics软件中模拟E-TLIF手术操作,切除上关节突而保留下关节突,并植入椎弓根螺钉和椎体间融合器.最后通过尸体模拟手术证实E-TLIF的可行性.结果 正中线旁开9 cm的纵行手术切口,45°斜向椎体的手术通道可以充分暴露病椎的椎间孔区域.通过E-TLIF手术途径可充分地显露目标椎间盘和神经根以及后方的上、下关节突和关节囊,操作简便直观.E-TLIF手术可以实现单纯切除上关节突,而保留下关节突,通过扩大的椎间孔牵开神经根后可以显露并切除椎间盘,并能完成椎间融合器的植入.结论 (1)通过Mimics可以精确地进行手术设计,模拟手术操作.成本低,可操作性强,对真实手术有较好的指导作用.(2)E-TLIF手术仅切除上关节突而保留了下关节突,在达到与传统手术同样的减压、固定、融合效果的同时,更完整保留了脊柱后方的张力带结构,加强术后即刻稳定性,并促进患者更快恢复,是一种创伤更小、安全、有效的腰椎椎体间融合术式.%Objective To design a new operation approach:extreme lateral transforaminal lumbar interbody fusion (E-TLIF) via digital technology and to discuss its feasibility in treatment of degenerative lumbar diseases.Methods CT scan image data of lumbar vertebra were obtained from volunteer (a healthy male of 26 years old,67 kg in weight and 172 cm in height).Mimics was used to read and reconstruct the data into 3D images.We observe the anatomical bone structures of intervertebral foramen and nerve

  13. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.

    Qian-Shi Zhang

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

  14. 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

    Cristiano Magalhães Menezes

    2009-09-01

    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

  15. Combination therapy of transforaminal lumbar interbody fusion and Wiltse pedicle screw fixation approach in the treatment of the lumbar disc protrusion%经椎间孔椎间融合术联合Wiltse入路椎弓根固定治疗腰椎间盘突出症

    隋海涛; 冯涛; 李亮; 于学忠

    2013-01-01

    [Objective] To compare the clinical effects of transforaminal lumbar interbody fusion with Wiltse pedicle screw fixation approach combined (TLIF,group A) and posterior lumbar interbody fusion (PLIF,group B).[Methods] From March 2008 to September 2012,186 patients on treatment for lumbar disc were divided into two groups:there were 104 patients in group A,48 males and 56 females,aged between 43 to 65,55 on average and 82 patients in group B,39 males and 43 females,aged between 45 to 67,57 on average.The bleeding volume,average time of operation,the rate of complications,fusion rate,the intervertebral space and the improvements in symptoms were compared and statistical analyzed.Visual analogue pain score (VAS) of low back pain and leg pain as well as the Oswestry disability index (ODI) were used in preoperative assessment and postoperative follow-up for symptoms evaluation.[Results] There were no statistical differences in the age,sex,intervertebral space,VAS score and ODI score before operation.The follow-up times without statistical difference were 26 months on average in group A and 23 months in group B.No significant differences were found between the two groups in last VAS scores of leg pain,ODI scores,fusion rate and intervertebral space (P > O.05).But group A had significant (P < 0.01) advantages of the bleeding volume,average time of operation,the rate of complications and the last VAS scores of low back pain.Significant improvements (P < 0.01) of intervertebral space,VAS scores and ODI scores after operation were ensured in both groups by the last follow-ups.[Conclusion] The efficacy of TLIF and PLIF are both satisfactory,but TLIF is better for less trauma,fewer complications and lower residual low back pain rate after operation.%[目的]比较经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF,A组)联合Wiltse入路椎弓根固定与传统经后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF,B组)治疗腰

  16. 椎间打压植骨联合棘突椎板复合体回植内固定治疗退变性腰椎不稳症%LUMBAR INTERBODY FUSION IMPACTED BONE GRAFTS COMBINED WITH REGRAFTING IN SITU WITH SPINOUS PROCESS AND VERTEBRAL PLATE COMPLEX AND PEDICLE SCREW FIXATION FOR LUMBAR DEGENERATIVE INSTABILITY

    张超远; 孟祥翔; 秦晓彬; 付玉娟; 付鹏军

    2012-01-01

    Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instability. Methods Between January 1998 and October 2010, 48 patients with lumbar degenerative instability were treated by posterior decompression, lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation. There were 26 males and 22 females, aged 52-76 years (mean, 62.4 years). The disease duration was 7 months to 25 years (mean, 6.5 years). One segmental instability was located at L3,4 in 1 case, at L4,5 in 10 cases, and at L5, S1 in 11 cases; multi-segmental instability was located at L3,4, L4,5, and L5, S1 in 5 cases, at L2,3 and L3,4 in 2 cases, at L3,4 and L4,5 in 10 cases, and at L4,5 and L5, S1 in 9 cases. Of 48 patients, 32 complicated by lumbar disc herniation, 46 by lumbar spinal stenosis, and 16 by degenerative scoliosis. The clinical results were evaluated by the Japanese Orthopaedic Association (JOA) score, recovery rate, disc height, and lumbar lordosis angles. Results The incisions obtained healing by first intention after operation. No nerve injury, rod or screw breakage, and infection occurred during and after operation. All 48 patients were followed up 1 to 6 years. The fusion time was 12-18 weeks (mean, 16.2 weeks). Vertebra slipping or degenerative scoliosis was corrected, and spinal column series became normal. At preoperation, 6 months after operation, and last follow-up, the disc heights were (5.2 ± 2.3), (11.9 ± 2.0), and (11.6 + 2.1) mm, respectively; the JOA scores were 3.2 + 2.1, 12.8 ± 1.6, and 13.6 + 1.2, respectively; and the lumbar lordosis angles were (-20.5 ± 10.5), (30.5 ± 8.5), and (31.2 + 5.6)°, respectively. The JOA scores, disc heights, and lumbar lordosis angles were significantly improved at 6 months after

  17. Extreme Lateral Interbody Fusion Procedure

    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 ...

  18. 单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症%Treatment of lumbar instability with transforaminal lumbar interbody fusion (with single cage) combined with uni-lateral pedicle screw fixation

    华永均; 王人彦; 郭志辉; 朱利民; 陆建阳

    2014-01-01

    Objective:To explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability. Methods:The clinical data of 50 patients with lumbar in-stability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain ,and unilateral primarily or unilateral lower limb ra-diation pain,X ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods,they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group,8 males and 12 females,aged from 26 to 66 years old,2 cases with isthmic spondylolisthesis of degreeⅠ,8 cases with degenerative spondylolisthesis,10 cases with lumbar disc herniation;fusion location with L3,4 was in 1 case,L4,5 was in 12 cases,L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group,14 males and 16 females,aged from 41 to 62 years old,4 cases with isthmic spondylolisthesis of degree Ⅰ,14 cases with degenerative spondylolisthesis,12 cases with lumbar disc herniation;fusion location with L3,4 was in 3 cases,L4,5 was in 15 case,L5S1 was in 12 cases. Operation time,intraoperative blood loss,postoperative drainage,complications were analyzed and intervertebral height,lordosis angle changes,fusion rate and clinical effect were compared between two groups. Results:All incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically,no infection,endo-rachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was

  19. The VariLift® Interbody Fusion System: expandable, standalone interbody fusion

    Emstad E

    2015-05-01

    Full Text Available Erik Emstad,1 Diana Cardenas del Monaco,1 Louis C Fielding,2 Jon E Block2 1Wenzel Spine, Inc., Austin, TX, 2The Jon Block Group, San Francisco, CA, USA Abstract: Intervertebral fusion cages have been in clinical use since the 1990s. Cages offer the benefits of bone graft containment, restored intervertebral and foraminal height, and a more repeatable, stable procedure compared to interbody fusion with graft material alone. Due to concerns regarding postoperative stability, loss of lordosis, and subsidence or migration of the implant, interbody cages are commonly used with supplemental fixation such as pedicle screw systems or anterior plates. While providing additional stability, supplemental fixation techniques increase operative time, exposure, cost, and morbidity. The VariLift® Interbody Fusion System (VariLift® system has been developed as a standalone solution to provide the benefits of intervertebral fusion cages without the requirement of supplemental fixation. The VariLift® system, FDA-cleared for standalone use in both the cervical and lumbar spine, is implanted in a minimal profile and then expanded in situ to provide segmental stability, restored lordosis, and a large graft chamber. Preclinical testing and analyses have found that the VariLift® System is durable, and reduces stresses that may contribute to subsidence and migration of other standalone interbody cages. Fifteen years of clinical development with the VariLift® system have demonstrated positive clinical outcomes, continued patient maintenance of segmental stability and lordosis, and no evidence of implant migration. The purpose of this report is to describe the VariLift® system, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The VariLift® System represents an improved surgical option for a stable interbody fusion without

  20. Endoscopic foraminotomy for recurrent lumbar radiculopathy after TLIF: Technical report

    Telfeian, Albert E.

    2015-01-01

    Background: Transforaminal lumbar interbody fusion (TLIF) is a well-accepted fusion technique that uses unilateral facet removal as an oblique corridor for inserting an interbody spacer. This manuscript focused on five cases of endoscopic foraminotomy for patients presenting with recurrent radiculopathy after TLIF procedures. Methods: After Institutional Review Board approval, charts from five patients with lumbar radiculopathy and instrumented TLIF procedures who underwent subsequent end...

  1. Comparison of clinical efficacies of single segment transforaminal lumbar interbody fusion with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis: a prospective randomized controlled study%椎间融合器植入与单纯自体颗粒骨植骨治疗退变性腰椎管狭窄症的比较

    刘培盛; 刘小臻; 乔雪静; 都文楠; 罗大伟; 郑修军

    2014-01-01

    Objective To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis.Methods A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups.A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients.Operative duration,blood loss,length of stay and cost of hospitalization of two groups were recorded.They were followed up at 1 week,12,24 months post-operation.Oswestry disability index (ODI),visual analogue scale (VAS) fusion rates,intervertebral space and foramen height restoration,lumbar lordosis and postoperative complications were compared between two groups.Results No significant inter-group difference existed in operative duration,blood loss or length of stay.However,the average hospitalization cost in group A were 18% higher than that of group B (P < 0.05).Both groups achieved excellent clinical outcomes within 2 years.ODI,VAS score improvement rates and postoperative complication rates were not statistically different.Lumbar fusion rate was 86.7% in group A versus 85.7% in group B after 2 years.And there was no significant difference (P > 0.05).The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B.Both groups had similar improvements of lumbar lordosis.Conclusion For degenerative lumbar spinal stenosis,usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft.However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective.Two grafting methods yield similar overall clinical outcomes.%目的 比较单节段经椎间孔腰椎椎间融合术(TLIF)手术中椎间融合器植入或单纯自体颗粒骨植骨两种融合方式治疗退变性腰椎管

  2. 后路减压经椎间孔椎间融合术治疗钙化型高位腰椎间盘突出症的临床研究%Study of Transforaminal Lumbar Interbody Fusion in Patients with Calcified Upper Lumbar Intervertebral Disc Herniation

    易泽洪; 肖波; 杨国奇; 刘光勇; 刘建伟; 蔡杰勇; 黄亮; 马俊; 权正学

    2014-01-01

    目的:探讨后路减压经椎间孔椎间融合术( transforminal lumbar interbody fusion,TLIP)治疗钙化型高位腰椎间盘突出症的临床疗效。方法2008年1月至2011年12月采用全椎板切除TLIP技术治疗的钙化型高位腰椎间盘突出症患者19例。男10例,女9例;年龄23~58岁,平均41.2岁。其中L1/24例,L2/38例,L3/47例。合并T12/L1突出1例,其余均为单间隙椎间盘突出。术前、末次随访时进行疼痛视觉模拟评分( VAS)、Oswestry功能障碍指数( ODI)评分,根据Otani方法评定疗效。结果所有病例获得随访,随访时间3~24个月,平均12个月。术中3例硬脊膜损伤,术后脑脊液漏,经加压包扎处理后痊愈,1例出现对侧神经牵拉症状,经对症处理后缓解。1例术后症状无恢复。术前VAS评分与ODI评分分别为(8.1±1.4)分、(57.79±1.90)%,末次随访 VAS 评分与 ODI 评分分别为(2.2±1.0)分、(20.53±0.3)%。均较术前有统计学差异(P0. 05). According to Otani’s criteria,the results were excellent in 9 ca-ses,good in 6 cases,improved in 3 cases,fair in 1 case,and poor in 1 case with an excellent and good rate of 78. 9%. Conclusion Posterior decompression TLIP is effective in the treatment of patients with calcified upper lumbar intervertebral disc herniation.

  3. L4、5侧路单枚cage椎间融合术式的生物力学及临床研究%Biomechanical and Clinical Study of L4.5 Lateral Lumbar Interbody Fusion Using Single Anatomical Threaded Cage

    郑忠; 翁绳健; 吴立忠; 李炜明; 陈国龄

    2011-01-01

    Objective To evaluate the relative stability of L4.5 lateral lumbar interbodyfusion using single anatomical threaded cage.Methods Twelve calf spine models and dimensional element models of lateral and posterior approach were established.Pure moment and forces were applied to the top of spinal eolumn. The motion range of all the specimens was measured during the experiment. The improvement rate of lumbar pain in 33 patients who took operation from Dec. 2003 to Dec. 2006 was evaluated. Results The stability in lateral group was superior to posterior group. The effective rate of operation was 100%. The improvement rate of lumbar pain was 93.94%.The patients's satisfactory rate was 100%.Conclusion Interbody fusion of L4.5 through lateral approach using single anatomical threaded cage without internal fixation is a mini-invasive operation process. It can provide instant posterior biomechanical stiffness. It is an effective operation process of interbody fusion in lumbar.%目的 评价L4、5侧路单枚椎间融合器融合术式的稳定性及力学合理性.方法 建立L4、5侧路与后路单枚椎间融合器融合术式的三维有限元模型及小牛脊柱模型,测定二者的位移变化.临床随访2003年12月~2006年12月行侧路单枚椎间融合器融合术式33例,评价腰痛改善率.结果 实验显示侧路模型的稳定性优于后路模型.临床研究显示手术有效率100%,腰痛改善率93.94%,患者满意率100%.结论 侧路植入单枚椎间融合器融合术式是一种微创的术式,不使用椎弓根固定系统而又能够提供足够的术后即刻生物力学刚度,是一种合理有效的腰椎椎间融合术式.

  4. 单侧椎弓根螺钉内固定联合单枚融合器治疗极外侧腰椎间盘突出症%Unilateral pedicle screw fixation combined with single cage interbody fusion for far lateral lumbar disc herniation

    王佳; 周耀; 李伟; 杨方

    2013-01-01

    Objective To evaluate the surgical results of treating far lateral lumbar disc herniations by lumbar inter-body fusion with unilateral pedicle screw fixation and single cage. Methods 26 cases of far lateral lumbar disc herniations were received the treatment of lumbar interbody fusion with unilateral pedicle screw fixation and single cage via a posterior approach. X-ray or CT examinations were taken in the regular follow-up to observe the fusion rates and complications, and the outcome of the surgery was assessed by Japanese Orthopaedic Association ( JOA ) low back pain scores. Results There were no wound infection or nerve complications after operation. All patients were followed up for 18 ~27 months. The fusion rate was 96. 2%( 25/26 ). The average JOA scores of preoperation and final followed-up were 12. 43 2. 16 and 24. 53 2. 97 respectively, which showed significant difference ( P <0. 05 ) between the two observations. The mean improvement rate was 81. 6% , and 19 cases got excellent results,5 good and 2 fair. The excellent and good rate was 92. 3%( 24/26 ). Conclusions Lumbar interbody fusion with unilateral pedicle screw fixation combined with single cage can provide simple procedure, little trauma, reliable fixation, high fusion rate, and satisfactory clinical results.%目的 评估单侧椎弓根螺钉内固定联合单枚融合器治疗极外侧腰椎间盘突出症的疗效.方法 对26例极外侧腰椎间盘突出症患者经腰椎后路行单侧椎弓根螺钉内固定联合单枚cage的融合手术.术后定期复查X线片或CT片,观察融合率及并发症情况;采用JOA腰腿痛评分法评估疗效.结果 术后均无伤口感染、神经损伤.患者均获随访,时间18~27个月.临床融合率96.2%(25/26).JOA评分:术前为12.43分±2.16分,末次随访时为24.53分±2.97分,差异有统计学意义(P<0.05),平均改善率为81.6%.疗效评定:优19例,良5例,中2例,优良率92.3%(24/26).结论 单侧椎弓根螺钉内固定联合单

  5. 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

    Vinicius de Meldau Benites

    2012-12-01

    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.

  6. Clinical effects of minimally invasive transforaminal lumbar interbody fusion for obese ;patients with lumbar disc herniation in peri operation period%微创经椎间孔腰椎椎间融合术治疗腰椎间盘突出肥胖患者围手术期疗效评价

    张权; 毛克亚; 王博; 顾挺帅; 熊森; 张雅宾; 韩振川; 王义国; 肖波

    2015-01-01

    of minimally invasive transforaminal lumbar interbody fusion (MIS‐TLIF) for the obese patients with lumbar disc herniation in peri operation period .Methods The retrospective analysis of 56 obese patients with lumbar disc herniation from January 2013 to June 2014 ,body mass index (BMI) of all patients was higher than 30 kg/m2 .There were 32 cases in MIS‐TLIF group and 24 cases in open transforaminal lumbar interbody fusion (Open‐TLIF) group . The average operation time ,intraoperative blood loss ,length of incision ,ambulation time ,hospitalization time ,blood indexes ,complication rate were compared between two groups . Japanese Orthopedic Association (JOA) score ,visual analogue scale (VAS) ,and Oswestry Dability Index (ODI) were assessed .Results The average operation time ,intraoperative blood loss ,length of incision ,ambulation time , hospitalization time ,complication rate were 200 .00 ± 43 .05 min ,420 .56 ± 86 .42 mL ,8 .00 ± 4 .01 cm ,100 .80 ± 53 .04 h ,9 .30 ± 3 .40 d and 8 .33% in Open‐TLIF group ,respectively .They were 120 .00 ± 28 .26 min ,110 .83 ± 50 .51 mL ,5 .00 ± 2 .52 d ,24 .37 ± 8 .50 h ,2 .50 ± 0 .18 cm and 6 .25% in MIS‐TLIF group ,respectively .There were significant differences between two groups (P 0 .05) .WBC , ESR and CRP in MIS‐TLIF group were significantly lower than those in Open‐TLIF group at 3 , 5 days postoperatively (P<0 .05) .JOA scores ,VAS scores and ODI in MIS‐TLIF group were better than those in Open‐TLIF group at 5 days postoperatively (P<0 .05) .The complication rate in MIS‐TLIF group was significantly lower than that in Open‐TLIF group (P<0 .05) .Conclusion MIS‐TLIF for the obese patients with lumbar disc herniation could have the advantages of less bleeding ,fewer complication rate ,shorter hospitalization time and quick recovery . It is the future trend of treatment for the obese patients with lumbar disc herniation .

  7. Multimodal connectivity mapping of the human left anterior and posterior lateral prefrontal cortex.

    Reid, Andrew T; Bzdok, Danilo; Langner, Robert; Fox, Peter T; Laird, Angela R; Amunts, Katrin; Eickhoff, Simon B; Eickhoff, Claudia R

    2016-06-01

    Working memory is essential for many of our distinctly human abilities, including reasoning, problem solving, and planning. Research spanning many decades has helped to refine our understanding of this high-level function as comprising several hierarchically organized components, some which maintain information in the conscious mind, and others which manipulate and reorganize this information in useful ways. In the neocortex, these processes are likely implemented by a distributed frontoparietal network, with more posterior regions serving to maintain volatile information, and more anterior regions subserving the manipulation of this information. Recent meta-analytic findings have identified the anterior lateral prefrontal cortex, in particular, as being generally engaged by working memory tasks, while the posterior lateral prefrontal cortex was more strongly associated with the cognitive load required by these tasks. These findings suggest specific roles for these regions in the cognitive control processes underlying working memory. To further characterize these regions, we applied three distinct seed-based methods for determining cortical connectivity. Specifically, we employed meta-analytic connectivity mapping across task-based fMRI experiments, resting-state BOLD correlations, and VBM-based structural covariance. We found a frontoparietal pattern of convergence which strongly resembled the working memory networks identified in previous research. A contrast between anterior and posterior parts of the lateral prefrontal cortex revealed distinct connectivity patterns consistent with the idea of a hierarchical organization of frontoparietal networks. Moreover, we found a distributed network that was anticorrelated with the anterior seed region, which included most of the default mode network and a subcomponent related to social and emotional processing. These findings fit well with the internal attention model of working memory, in which representation of

  8. The relationship between discography pressure and outcome of anterior lumbar interbody fusion for discogenic low back pain%椎间盘造影压力与椎间盘源性腰痛手术疗效的关系

    张继东; 夏群; 胡永成; 苗军; 徐宝山

    2009-01-01

    目的 探讨椎间蕊造影压力与腰椎间盘源件疼痛手术疗效的关系.方法 2004年4月至2006年6月,65例慢性腰痛患者经压力控制性椎间盘造影确诊为椎间盘源性腰痛.其中22例经保守治疗无效者接受前路腰椎椎间融合术,年龄25~67岁,平均43.6岁.L4-5例,L5S112例,L4-5和L5S1双间隙2例.记录椎间盘造影诱发疼痛时的压力,将患者分为椎间盘造影压力≤300 kPa(低压组)10例,300~500 kPa(高压组)12例.椎间cage融合术22例24个椎间盘.术后3~7 d下地活动.腰围固定3个月.根据术前、术后VAS评分和ODI评分比较高压组和低压组手术疗效.结果 所有患者随访6~26个月,平均18个月.手术时间70~120 min,平均90 min;出血量100~400 ml,平均220 ml.低压组与高压组术前VAS评分和ODI评分、椎间隙高度、手术时间、出血量差异无统计学意义.术后腰及下肢痛症状明显缓解,均恢复正常生活或工作.椎间隙高度从术前平均9.5 mm增加至13.5 mm.术后6个月低压组VAS、ODI改善率分别为82.4%、90.1%,高压组为71.7%、80.6%.随访时未发现肠梗阻、逆行射精和假体位置移动.结论 压力控制性椎间盘造影能够提高椎间盘源性腰痛的诊断准确性,低压力椎间盘造影阳性者手术疗效更好.%Objective To explore the relationship between discography pressure and outcome of an-terior lumbar interbody fusion (ALIF) for discogenic low back pain. Methods From April 2004 to June 2006, 65 patients with chronic low back pain were identified as diseogenic origin by pressure controlled discography, 22 cases of which received ALIF after failed conservative treatment for at least 6 months. The surgically treated patients aged 43.6 on the average (range, 25-67). The treated discs located: 8 in L4-5, 12 in L5S1, 2 in both L4-5 and L5S1. 22 cases received ALIF in 24 levels via retroperitoneal approach. The pressure as soon as accordant initially induced pain was recorded during

  9. 选择性椎间融合与椎弓根螺钉置入修复退变性腰椎侧凸:脊柱稳定性评价%Selective interbody fusion combined with pedicle screw fixation for degenerative lumbar scoliosis:spinal stability

    尹承慧; 符臣学; 叶永平; 徐皓

    2015-01-01

    fusion should be conducted. This can achieve nerve decompression, spinal stability, and is relatively minimaly invasive. OBJECTIVE:To explore the efficacy of selective interbody fusion, limited neural decompression combined with pedicle screw system fixation for degenerative lumbar scoliosis. METHODS:Clinical characteristics of 53 patients with degenerative lumbar scoliosis were retrospectively analyzed, and the indication and contraindication were investigated. Selective interbody fusion, and limited neural decompression combined with pedicle screw system fixation were performed in the patients. Treatment effect and complication were analyzed. During folow-up, Suk standard was utilized to judge bone graft fusion. Before treatment and during final folow-up, lower back pain score system recommended by the Japanese Orthopaedic Association was used for assessment, and the excelent and good rate of curative effects was calculated. Cobb’s angle on the sagittal and coronal positions was compared and analyzed before and after treatment. RESULTS AND CONCLUSION:The patients were folowed up for 12 to 36 months. According to low back pain score of Japanese Orthopaedic Association Scores, the excelent and good rate of curative effect was 89% during the last folow-up. According to Suk standard, the fusion rate of vertebra was 94%. The last X-ray films revealed that Cobb’s angle was averagely (4.3±2.3)° (0°-13.5°) on the coronal plane after treatment, and the correction rate of scoliosis was 56%. The Cobb’s angle was averagely (45.1±12.5)° (10.4°-65.3°) after treatment, and the correction rate of lordosis was 36%. Complications after repair consisted of cerebrospinal fluid leakage in two cases, nerve injury in two cases, instrumental failure in one case, and pulmonary infection in one case, and symptomatic deep venous thrombosis in three cases. These findings suggest that selective interbody fusion, and limited neural decompression combined with pedicle screw system

  10. Clinical effect of minimally invasive transforaminal lumbar interbody fusion combined with unilateral pedicle fixation on elderly lumbar degenerative diseases%微创经椎间孔椎间融合术并单侧椎弓根固定治疗老年人腰椎退变性疾病的临床疗效观察

    张建乔; 曾忠友; 叶招明; 宋永兴; 韩建福; 籍剑飞

    2015-01-01

    Objective To analyze the clinical effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in combination with unilateral pedicle fixation on lumbar degenerative diseases in the elderly.Methods From June 2011 and June 2013,51 elderly patients with lumbar degenerative diseases who underwent MI-TLIF in combination with unilateral pedicle fixation,including 39 males and 12 females,aged from 60 to 72 years (average 65 years old),were included in this study.All the 51 cases had mono segmental lesion,including 11 cases with the lesion in L3.4,22 cases with the lesion in L4.5,and 18 cases with the lesion in L5-S1.The operation time,blood loss,postoperative drainage and complications were recorded.Postoperative outpatient follow-ups were conducted once every 2-3 months for all cases,and JOA scoring criteria (29 points) of lower back pain were adopted to evaluate the clinical effects.Thin-layer helical CT scanning reconstruction was applied to evaluate the fusion rate of bone grafting.X-ray film of lumbar vertebra AP & LAT was employed to evaluate the intervertebral space height,the internal fixation and the position of cage.Results The operation time ranged between 50-90 min with a mean value of 65 min; blood loss ranged between 80-180 ml (average 110 ml); and postoperative drainage volume ranged between 20-70 ml (average 40 ml).Healing phase I was achieved in 49 cases,while post-operative local cutaneous necrosis around the incision site occurred in 2 case and the wound healed well after wound dressing.Dural laceration without nerve root injury occurred in 2 cases.The follow up in 51 patients ranged between 18 24 months (average 20 months).In terms of JOA scoring,the preoperative score was (9.7± 1.6),the post operative score was (21.4 ± 1.4) 7 d after operation and the score was (25.4 ± 1.2) in the final follow up.During the final follow-up,35 cases were evaluated as excellent,11 cases as good and 5 cases as moderate,the excellent and good rate was

  11. 腰椎融合术对脊柱-骨盆矢状面平衡及疗效的临床观察%Clinical observation and efficacy on lumbar interbody fusion for spine pelvic sagittal balance

    罗江洪; 李伟; 陆庭盛

    2015-01-01

    Objective To analyze the clinical therapeutic effect of lumbar fusion in the treatment of lumbar degenerative diseases in the spine pelvic sagittal balance. Methods From June 2009 to June 2012,the clinical data of 92 cases with lumbar degenerative diseases ac-cepted lumbar spinal fusion operation in our hospital was collected. The contrast lumbar lordosis ( LL) ,lumbar sagittal vertical axis ( SVA) , pelvic incidence angle ( PI) ,sacral inclination angle ( SS) ,pelvic tilt angle ( PT) and other numerical parameters,using the Oswestry disabil-ity index ( ODI) ,visual analogue scale ( VAS) and the Japan Society of Department of orthopedics ( JOA) score were followed up two years after operation,and the postoperative effect was evaluated. Results The spinal pelvic parameters SVA,LL,SS and PT after surgery were changed obviously,and the difference was statistically significant(P<0. 05). The postoperative follow-up of VAS,ODI and JOA score were better than that of preoperation,the difference was significant(P<0. 05). Conclusion Lumbar fusion operation can restore lumbar lordosis, to maintain the spine pelvic sagittal balance and improve the effect of operation,and have positive significance to improve the postoperative symptoms.%目的:探讨腰椎退变性疾病采用腰椎融合术治疗对脊柱-骨盆矢状面平衡及临床疗效分析。方法收集2009年6月至2012年6月我院骨科接受腰椎内固定融合手术的92例腰椎退行性疾病患者的临床资料,术后2年内随访患者,对比腰椎前凸角( LL)、腰椎矢状垂直轴( SVA)、骨盆入射角( PI)、骶骨倾斜角( SS)、骨盆倾斜角( PT)等参数数值,采用Oswestry功能障碍指数( ODI)、视觉模拟评分法( VAS)及日本骨科学会( JOA)评分,评估术后疗效。结果脊柱骨盆参数SVA、LL、SS及PT手术后均较术前有明显改变,且差异有统计学意义(P<0.05),术后随访VAS、ODI及JOA 评分,均较术前有明显改善,治疗

  12. Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

    Skovrlj, Branko; Belton, Patrick; Zarzour, Hekmat; Qureshi, Sheeraz A.

    2015-01-01

    AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).

  13. Stability and interbody fusion of augmented pedicle screws with bone cement for lumbar spondylolisthesis accompanied with osteoporosis%骨水泥螺钉强化固定伴骨质疏松腰椎滑脱症的稳定性及椎间融合

    姚珍松; 丁金勇; 唐永超; 陈康; 江晓兵; 梁德; 晋大祥; 庄洪; 张顺聪; 杨志东

    2016-01-01

    polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. Al complications were recorded. RESULTS AND CONCLUSION: Al cases were fol owed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final fol ow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final fol ow-up. Al patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.

  14. Rationale of Revision Lumbar Spine Surgery

    Elgafy, Hossein; Vaccaro, Alexander R; Chapman, Jens R.; Dvorak, Marcel F.

    2012-01-01

    Revision lumbar spine surgeries are technically challenging with inconstant outcome results. This article discusses the preoperative, intraoperative, as well as postoperative management in these difficult patients. Successful intervention requires a detailed history and physical examination and carefully chosen diagnostic tests. Preoperative planning is paramount in these cases. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion ...

  15. 新型后路腰椎椎间融合器的研制和动物实验研究%The design and animal study of a new posterior lumbar interbody fusion cage

    洪鑫; 吴小涛; 茅祖斌; 庄苏阳; 陈辉

    2005-01-01

    目的研制一种新型镍钛形状记忆合金腰椎椎体间融合器,通过动物实验了解其生物力学和组织学性能.方法本研究分为三个步骤.第一步将12个绵羊腰椎功能单位随机分成四组,每组3个,分别为对照组、髂骨植骨组(IG组)、interfix-lumbar cage组(cage组)和镍钛融合器组(NT组),进行生物力学测试,并检测镍钛融合器的力学性能;第二步将15只成年绵羊随机分为对照组、Interfix-lumbar cage组(cage组)和镍钛融合器组(NT组),每组5只,术后定期摄X线片了解椎间隙高度变化及融合进程;第三步将上述动物在术后6个月处死进行组织学观察以了解融合情况.所有数据采用统计学分析软件处理.结果对照组和髂骨植骨组与cage组和NT组在腰椎强度和轴向刚度方面相比,差异均有统计学意义(P<0.05).镍钛融合器的最大破坏载荷可达11 200 N,安全系数达到1.2以上.cage组和NT组手术6个月时手术节段高度分别丧失16%和16.5%,但仍高于正常椎间隙高度(P<0.05).光镜下可见新生骨小梁与宿主骨小梁发生连接.结论镍钛融合器的力学性能良好,可以作为腰椎椎间融合装置应用于临床.

  16. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    Koshi Ninomiya; Koichi Iwatsuki; Yu-ichiro Ohnishi; Toshika Ohkawa; Toshiki Yoshimine

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to...

  17. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    Koshi Ninomiya

    2014-01-01

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

  18. Extreme Lateral Interbody Fusion Procedure

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

  19. Extreme Lateral Interbody Fusion Procedure

    Full Text Available ... down to the psoas muscle that is a large muscle that helps stabilize the spine. From there, ... the lumbar spine with the nerve. That's the large muscle that we call the psoas. This muscle ...

  20. Extreme Lateral Interbody Fusion Procedure

    Full Text Available ... done for many years, and it's considered a lumber -- it's considered a standard lumbar spine fusion. The ... spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all of the above. So ...

  1. Extreme Lateral Interbody Fusion Procedure

    Full Text Available ... with an open procedure, what we call a standard open procedure, it is always a potential for ... and it's considered a lumber -- it's considered a standard lumbar spine fusion. The difference is the approach, ...

  2. Extreme Lateral Interbody Fusion Procedure

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

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

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

    2014-05-01

    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

  4. MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

    Javier Quillo-Olvera

    2015-12-01

    Full Text Available Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

  5. Clear Zone Formation around Screws in the Early Postoperative Stages after Posterior Lumbar Fusion Using the Cortical Bone Trajectory Technique

    Ninomiya, Koshi; Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

    2015-01-01

    Study Design Retrospective study. Purpose To evaluate the initial fixation using the cortical bone trajectory (CBT) technique for posterior lumbar fusion through assessment of the clear zones around the screws and the risk factors involved. Overview of Literature Postoperative radiolucent zones (clear zones) are an indicator of poor conventional pedicle screw fixation. Methods Between January 2013 and April 2014, 19 patients (8 men and 11 women) underwent posterior lumbar interbody fusion or ...

  6. Biomechanange ical chof lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction: report of 23 cases

    Zhou Yue; Luo Gang; Chu Tongwei; Wang Jian; Li Changqing; Zheng Wenjie; Zhang Zhengfeng; Hao Yong; Zhang Chao

    2008-01-01

    Objective: To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion (TLIF) and unilateral pedicle screw fixation by X-Tube system. Methods: Five human lumbar cadaveric functional spine units(FSU) were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion (posterior lumbar interbody fusion) and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic faceteetomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results: There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 (65.2%), good in 6 (26.1%) and fair in 2 (8.7%). The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion: The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy

  7. Single-level transforaminal interbody fusion for traumatic lumbosacral fracture-dislocation: a case report.

    Herrera, Anthony J; Berry, Chirag A; Rao, Raj D

    2013-02-01

    L5S1 fracture-dislocations are rare three-column injuries. The infrequency of this injury has led to a lack of a universally accepted treatment strategy. Transforaminal lumbar interbody fusion (TLIF) has been shown to be an effective approach for interbody fusion in degenerative indications, but has not been previously reported in the operative management of traumatic lumbosacral dislocation. The authors report a case of traumatic L5S1 fracture-dislocation in a 30-year-old male, presenting with a right-sided L5 neurologic deficit, following a street sweeper accident. Imaging revealed an L5S1 fracture-dislocation with fracture of the S1 body. Open reduction with TLIF and L5S1 posterolateral instrumented fusion was carried out within 24 hours of injury. Excellent reduction was obtained, and maintained at long-term follow-up, with complete resolution of pain and neurologic deficit. In this patient, L5S1 fracture-dislocation was treated successfully, with an excellent outcome, with a single level TLIF and instrumented posterolateral fusion at L5S1. PMID:23547528

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

    Adam M. Caputo

    2012-01-01

    Full Text Available 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 average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Validated clinical outcome scores were obtained on patients preoperatively and at most recent follow-up. Complications were recorded. Results. The study group demonstrated improvement in multiple clinical outcome scores. Oswestry Disability Index scores improved from 24.8 to 19.0 (P < 0.001. Short Form-12 scores improved, although the change was not significant. Visual analog scores for back pain decreased from 6.8 to 4.6 (P < 0.001 while scores for leg pain decreased from 5.4 to 2.8 (P < 0.001. A total of six minor complications (20% were recorded, and two patients (6.7% required additional surgery. Conclusions. Based on the significant improvement in validated clinical outcome scores, XLIF is effective in the treatment of adult degenerative scoliosis.

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

    Chung Sung-Soo

    2011-04-01

    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

  10. Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

    Putzier, Michael; Strube, Patrick; Funk, Julia F.; GROSS, Christian; Mönig, Hans-Joachim; Perka, Carsten; Pruss, Axel

    2009-01-01

    The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients with degenerative spinal disease were treated with a monosegmental spondylodesis (ventrally, 1 PEEK-cage; dorsally, a scre...

  11. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease (Review)

    Jacobs, W.; Willems, P.C.P.H.; Limbeek, J. van; Bartels, R.H.M.A.; Pavlov, P.; Anderson, P.G.; Oner, C.

    2011-01-01

    BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. OBJECTIVES: To determine which technique of anterior interbody fusion

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

    Xiao-Bin Wang

    2014-01-01

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

  13. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

    Jackson, Keith L; Hire, Justin M; Jacobs, Jeremy M; Key, Charles C; DeVine, John G

    2015-06-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO. PMID:26097664

  14. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL

    Cédric Barrey; Gilles Perrin; Sabina Champain

    2013-01-01

    Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction,...

  15. Minimally Invasive Lumbar Discectomy

    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. ...

  16. Iatrogenic neurologic deficit after lumbar spine surgery: A review.

    Ghobrial, George M; Williams, Kim A; Arnold, Paul; Fehlings, Michael; Harrop, James S

    2015-12-01

    731 (4.1%) had a new onset neurologic injury after anterior lumber interbody fusion or lateral lumber interbody fusion. Thirty-seven out of 2052 (1.9%) patients had a neurologic injury after posterior decompression and fusion. Screw malposition was responsible for 11 deficits. Spinal surgery for lumbar degenerative disease carries a low but definite rate of neurologic deficits. Despite the introduction of neuromonitoring, these complications still occur. Interpretation of neurologic injury rates for lumbar surgery is limited by the few prospective and cohort-matched controlled studies. Likewise, most injuries were associated with the placement of instrumentation despite the type of approach. PMID:26386902

  17. Operative Management of Lumbar Degenerative Disc Disease.

    Lee, Yu Chao; Zotti, Mario Giuseppe Tedesco; Osti, Orso Lorenzo

    2016-08-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  18. Operative Management of Lumbar Degenerative Disc Disease

    Lee, Yu Chao; Osti, Orso Lorenzo

    2016-01-01

    Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term. PMID:27559465

  19. Lumbar Osteotomy.

    Wood, Kirkham B

    2016-04-01

    When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation? PMID:27015064

  20. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    Tianyong Hou

    2015-02-01

    Full Text Available OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery.

  1. The finite element modeling and analysis of human lumbar segment herniation

    HUANG Ju-ying

    2012-08-01

    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.

  2. Lumbar paraganglioma.

    Dillard-Cannon, Erika; Atsina, Kofi-Buaku; Ghobrial, George; Gnass, Esteban; Curtis, Mark T; Heller, Joshua

    2016-08-01

    Spinal paragangliomas (SP) are benign and overall rare extra-adrenal neuroendocrine tumors often diagnosed during workup for lower back pain. Complete surgical resection achieves both symptomatic relief and cure. We present a 32-year-old man with a longstanding history of lumbago and bilateral lower extremity pain found to have a lumbar paraganglioma at the level of the L3 vertebrae. The clinical, histopathological, and radiological characteristics are described, including the rare finding of superficial siderosis on MRI of the brain. A laminectomy with microscopic dissection of the intradural mass achieved complete debulking without evidence of residual tumor. Excellent prognosis can be achieved with complete surgical resection of SP without the need for adjuvant therapy. Therefore, care should be taken to distinguish these spinal tumors from those that appear similar but are more aggressive. As such, the radiological finding of superficial siderosis should raise the suspicion for SP when a vascular intradural extramedullary spinal tumor is observed. PMID:27032749

  3. Minimally Invasive Lumbar Discectomy

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

  4. Lumbar spine CT scan

    ... an x-ray of the spinal cord and spinal nerve roots (myelography) or an x-ray of the disk (discography). ... spine Bone problems Fracture Lumbar disk herniation Lumbar spinal stenosis Spondylolisthesis

  5. Minimally Invasive Lumbar Discectomy

    Full Text Available ... Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common procedure. Many patients ... have been around for a while, but the learning curve is quite steep. It takes some specialized ...

  6. Herniated Lumbar Disc

    Herniated Lumbar Disc What is a herniated disc? Nonsurgical treatment Medication and pain management Surgery What can I expect after ... at and just below the waist. A herniated lumbar disc can press on the nerves in the spine ...

  7. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    Jacobs, Wilco; Willems, Paul C.; van Limbeek, Jacques; Bartels, Ronald; Pavlov, Paul; Anderson, Patricia G.; Oner, Cumhur

    2011-01-01

    Background The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. Objectives To determine which technique of anterior interbody fusion g

  8. Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods

    Jacques Benezech

    2016-01-01

    Full Text Available Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov’Spine, France composed of rods made from PEEK-OPTIMA® polymer (Invibio Biomaterial Solutions, UK without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%, quality of life was improved (ODI = 16%, and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones.

  9. Congenital Lumbar Hernia

    Sanjay Sharma; Gagan Bali; Satish Parihar; Neeraj Koul

    2008-01-01

    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

  10. Congenital Lumbar Hernia

    Sanjay Sharma

    2008-01-01

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

  11. Early experience with endoscopic revision of lumbar spinal fusions.

    McGrath, Lynn B; Madhavan, Karthik; Chieng, Lee Onn; Wang, Michael Y; Hofstetter, Christoph P

    2016-02-01

    Approximately half a million spinal fusion procedures are performed annually in the US. It is estimated that up to one-third of arthrodesis constructs require revision surgeries. In this study the authors present endoscopic treatment strategies targeting 3 types of complications following arthrodesis surgery: 1) adjacent-level foraminal stenosis; 2) foraminal stenosis at an arthrodesis segment; and 3) stenosis caused by a displaced interbody cage. A retrospective chart review of 11 patients with a mean age of 68 ± 15 years was performed (continuous variables are shown as the mean ± SEM). All patients had a history of lumbar arthrodesis surgery and suffered from unilateral radiculopathy. Endoscopic revision surgeries were done as outpatient procedures, and there were no intraoperative or perioperative complications. The cohort included 3 patients with foraminal stenosis at the level of previous arthrodesis. They presented with unilateral radicular leg pain (visual analog scale [VAS] score: 7.3 ± 2.1) and were severely disabled, as evidenced by an Oswestry Disability Index (ODI) of 46 ± 4.9. Transforaminal endoscopic foraminotomies were performed, and at a mean follow-up time of 9.0 ± 2.5 months VAS was reduced by an average of 6.3. The cohort also includes 7 patients suffering unilateral radiculopathy due to adjacent-level foraminal stenosis. Preoperative VAS for leg pain of the symptomatic side was 6.0 ± 1.6, VAS for back pain was 5.2 ± 1.7, and ODI was 40 ± 6.33. Endoscopic decompression led to reduction of the ipsilateral leg VAS score by an average of 5, resulting in leg pain of 1 ± 0.5 at an average of 8 months of follow-up. The severity of back pain remained stable (VAS 4.2 ± 1.4). Two of these patients required revision surgery for recurrent symptoms. Finally, this study includes 1 patient who presented with weakness and pain due to retropulsion of an L5/S1 interbody spacer. The patient underwent an endoscopic interlaminar approach with partial

  12. Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness

    Chedid, Mokbel K; Tundo, Kelly M; Block, Jon E; Muir, Jeffrey M

    2015-01-01

    Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hya...

  13. Minimally invasive transforaminal lumbar interbody fusion Results of 23 consecutive cases

    Amit Jhala

    2014-01-01

    Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.

  14. Minimally invasive transforaminal lumbar interbody fusion—indications and clinical experience

    Akshay Hari

    2016-01-01

    Conclusions: Our clinical experience along with a review of the medical literature indicates that TLIF can be effectively and safely performed in a minimally invasive fashion for a wide variety of indications.

  15. Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

    Nunley, Pierce; Sandhu, Faheem; Frank, Kelly; Stone, Marcus

    2016-01-01

    Introduction. The lateral lumbar interbody fusion (LLIF) surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system. Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA). There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year. Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253) of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%). Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient. PMID:27294140

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

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

    2007-11-01

    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

  17. Hydroxyapatite Ceramics in Multilevel Cervical Interbody Fusion – Is There a Role?

    Vukić, Miroslav; Walters, Beverly C; Radić, Ankica; Jurjević, Ivana; Marasanov, Sergej M.; Rožanković, Marjan; Jednačak, Hrvoje

    2011-01-01

    The aim of this study is to evaluate the efficacy of hydroxyapatite grafts in multilevel cervical interbody fusion during the one year follow-up. A total of 86 patients with degenerative cervical disc disease underwent all together 224 cervical interbody fusion procedures in which either Smith-Robinson or Cloward type hydroxyapatite grafts were used. The surgeries included radiculopathy in 38 cases, myelopathy in 20 cases and myeloradicuopathy in 28 patients. In 65 out of 86 patients, fusion ...

  18. The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

    William D. Harrison

    2013-01-01

    Full Text Available Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

  19. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up.

    Wang, Michael Y; Grossman, Jay

    2016-02-01

    OBJECTIVE One of the principal goals of minimally invasive surgery has been to speed postoperative recovery. In this case series, the authors used an endoscopic technique for interbody fusion combined with percutaneous screw fixation to obviate the need for general anesthesia. METHODS The first 10 consecutive patients treated with a minimum of 1 year's follow-up were included in this series. The patients were all treated using endoscopic access through Kambin's triangle to allow for neural decompression, discectomy, endplate preparation, and interbody fusion. This was followed by percutaneous pedicle screw and connecting rod placement using liposomal bupivacaine for long-acting analgesia. No narcotics or regional anesthetics were used during surgery. RESULTS All patients underwent the procedure successfully without conversion to open surgery. The patients' average age was 62.2 ± 9.0 years (range 52-78 years). All patients had severe disc height collapse, and 60% had a Grade I spondylolisthesis. The mean operative time was 113.5 ± 6.3 minutes (range 105-120 minutes), and blood loss was 65 ± 38 ml (range 30-190 ml). The mean length of hospital stay was 1.4 ± 1.3 nights. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that the Oswestry Disability Index improved from 42 ± 11.8 to 13.3 ± 15.1; the 36-Item Short Form Health Survey (SF-36) Physical Component Summary improved from 47.6 ± 3.8 to 49.7 ± 5.4; the SF-36 Mental Component Summary decreased from 47 ± 3.9 to 46.7 ± 3.4; and the EQ-5D improved from 10.7 ± 9.5 to 14.2 ± 1.6. There were no cases of nonunion identified radiographically on follow-up imaging. CONCLUSIONS Endoscopic fusion under conscious sedation may represent a feasible alternative to traditional lumbar spine fusion in select patients. Larger clinical series are necessary to validate that clinical improvements are sustained and that arthrodesis rates are

  20. Lumbar stenosis: clinical case

    Pedro Sá

    2014-08-01

    Full Text Available Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

  1. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis

    Kee-yong Ha

    2013-01-01

    Full Text Available Background: Degenerative lumbar scoliosis surgery can lead to development of adjacent segment degeneration (ASD after lumbar or thoracolumbar fusion. Its incidence, risk factors, morbidity and correlation between radiological and clinical symptoms of ASD have no consensus. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and certain imperative parameters. Materials and Methods: 98 patients who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative lumbar scoliosis with a minimum 5 year followup were included in the study. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and imperative patient parameters like age at operation, sex, body mass index (BMI, medical comorbidities and bone mineral density (BMD. The radiological parameters taken into consideration were Cobb′s angle, angle type, lumbar lordosis, pelvic incidence, intercristal line, preoperative existence of an ASD on plain radiograph and magnetic resonance imaging (MRI and surgical parameters were number of the fusion level, decompression level, floating OP (interlumbar fusion excluding L5-S1 level and posterolateral lumbar interbody fusion (PLIF. Clinical outcomes were assessed with the Visual Analogue Score (VAS and Oswestry Disability Index (ODI. Results: ASD was present in 44 (44.9% patients at an average period of 48.0 months (range 6-98 months. Factors related to occurrence of ASD were preoperative existence of disc degeneration (as revealed by MRI and age at operation ( P = 0.0001, 0.0364. There were no statistically significant differences between radiological adjacent segment degeneration and clinical results (VAS, P = 0.446; ODI, P = 0.531. Conclusions: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI were at a higher risk of developing ASD.

  2. Minimally Invasive Lumbar Discectomy

    Full Text Available ... invasive microscopic lumbar discectomy.” Now this is a patient who a 46-year-old woman who had ... style, it is a very common procedure. Many patients throughout the country and the world have herniated ...

  3. Minimally Invasive Lumbar Discectomy

    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 ...

  4. Minimally Invasive Lumbar Discectomy

    Full Text Available ... to make an appropriate diagnosis. And that, by far, is the best option that there is for ... a diagnostic test, and an MRI is by far the gold standard for evaluation of the lumbar ...

  5. Minimally Invasive Lumbar Discectomy

    Full Text Available ... minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? 2 Well, the minimally ... think it’s important to stress here that the effectiveness of this procedure is about the same as ...

  6. Herniated lumbar disc

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

    2011-01-01

    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.

  7. Minimally Invasive Lumbar Discectomy

    Full Text Available ... on the type of job that the work environment, they can go to work right after I ... MRI is by far the gold standard for evaluation of the lumbar spine. Okay. If they can’ ...

  8. Minimally Invasive Lumbar Discectomy

    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 ...

  9. Minimally Invasive Lumbar Discectomy

    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- ...

  10. Minimally Invasive Lumbar Discectomy

    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. ...

  11. Is the transsacral axial interbody fusion a candidate surgical approach for fusing both L5/S1 and L4/5?

    LIU Bi-feng; ZHANG Li-guo; LIU Yan-bin; YAN Ning; ZHANG Hai-long; GU Xin; DING Yue; GUO Cheng-bin; HE Shi-sheng

    2011-01-01

    Background Previous clinical and basic research of axial lumbar interbody fusion (AxiaLIF) all focused on the L5/S1.However,there is no data on the feasibility of this approach for the fusion of both L4/5 and L5/S1.This study aimed to explore whether transsacral axial interbody fusion is a candidate for the fusion of both L4/5 and L5/S1.Methods The subjects (n=40) underwent lumbosacral magnetic resonance imaging (MRI).The median sagittal MRI images were analyzed and five measurement markers were defined as follows:the center of the L4/5 disc (A),the center of the L5/S1 disc (B),the anterior margin of the S1/2 space (C),the sacrococcygeal junction (D),and the coccygeal tip (E).The measurement markers were connected each other to produce nine lines (AB,AC,AD,AE,BC,BD,BE,CD and CE) as the reference lines for surgical approaches.The distance between each reference line and the anterior and posterior margins of the L4,L5 and S1 vertebral bodies were measured to determine the safety of the respective approaches.Results Twenty subjects were capable of finding one reference line to fuse both L4/5 and L5/S1 via transsacral axial interbody fusion approach.The surgical approach reference line was AE or CE line.In the other 20 subjects,it was failed to find a reference line which met the safety criteria for fusing both L4/5 and L5/S1.Conclusions About half of subjects were capable of finding a suitable AxiaLIF reference line to fuse both L4/5 and L5/S1.In some subjects,it was difficult to find a suitable AxiaLIF reference line to fuse both L4/5 and L5/S1.

  12. LUMBAR DISC HERNIATION

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

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physi...

  13. Spontaneously disappearing lumbar disc protrusion

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

    2008-01-01

    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.

  14. [Enlargement in managment of lumbar spinal stenosis].

    Steib, J P; Averous, C; Brinckert, D; Lang, G

    1996-05-01

    instability and to restore the normal static anatomy; thus bone resection is not necessary. At the present time all the lumbar stenoses with reduction in flexion are instrumented with spinal reduction and arthrodesis without opening the canal. The laminoarthrectomy and the enlargement are done when there is a fixed arthrosis which is rare in our practice and found in an older population. The follow-up shows a loss of reduction in some cases after reduction-instrumentation-arthrodesis and poses the question of an interbody fusion. We don't open the canal only for fusion (PLIF) if this is not necessary for the treatment of the stenosis. We think that, in such a situation, the future is ALIF with endoscopical approach. The problem is to determine which disc demanding this anterior fusion, is able to regenerate or not. PMID:24193678

  15. Spinal shortening and monosegmental posterior spondylodesis in the management of dorsal and lumbar unstable injuries

    Tarek A Aly

    2011-01-01

    Full Text Available Introduction: Patients with spinal injuries have been treated in the past by laminectomy in an attempt to decompress the spinal cord. The results have shown insignificant improvement or even a worsening of neurologic function and decreased stability without effectively removing the anterior bone and disc fragments compressing the spinal cord. The primary indication for anterior decompression and grafting is narrowing of the spinal canal with neurologic deficits that cannot be resolved by any other approach. One must think of subsequent surgical intervention for increased stability and compressive posterior fusion with short-armed internal fixators. Aim: To analyze the results and efficacy of spinal shortening combined with interbody fusion technique for the management of dorsal and lumbar unstable injuries. Materials and Methods: Twenty-three patients with traumatic fractures and or fracture-dislocation of dorsolumbar spine with neurologic deficit are presented. All had radiologic evidence of spinal cord or cauda equina compression, with either paraplegia or paraparesis. Patients underwent recapping laminoplasty in the thoracic or lumbar spine for decompression of spinal cord. The T-saw was used for division of the posterior elements. After decompression of the cord and removal of the extruded bone fragments and disc material, the excised laminae were replaced exactly in situ to their original anatomic position. Then application of a compression force via monosegmental transpedicular fixation was done, allowing vertebral end-plate compression and interbody fusion. Results: Lateral Cobb angle (T10-L2 was reduced from 26 to 4 degrees after surgery. The shortened vertebral body united and no or minimal loss of correction was seen. The preoperative vertebral kyphosis averaged +17 degrees and was corrected to +7 degrees at follow-up with the sagittal index improving from 0.59 to 0.86. The segmental local kyphosis was reduced from +15 degrees to −3

  16. Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of 18F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after 18F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) 18F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following 18F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, 18F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category

  17. Pseudarthrosis after lumbar spinal fusion: the role of {sup 18}F-fluoride PET/CT

    Peters, Marloes; Willems, Paul; Jutten, Liesbeth; Arts, Chris; Rhijn, Lodewijk van [Maastricht University Medical Center, Department of Orthopedic Surgery, Postbox 5800, Maastricht (Netherlands); Weijers, Rene; Wierts, Roel; Urbach, Christian; Brans, Boudewijn [Maastricht University Medical Center, Radiology /Nuclear Medicine, Maastricht (Netherlands)

    2015-11-15

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of {sup 18}F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after {sup 18}F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) {sup 18}F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following {sup 18}F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, {sup 18}F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest

  18. Minimally Invasive Lumbar Discectomy

    Full Text Available ... called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46-year-old ... L-5, S-1. So that’s why she’s having this procedure. The man who is doing the procedure ...

  19. Minimally Invasive Lumbar Discectomy

    Full Text Available ... We perform micro-lumbar surgical procedures in the cervical spine routinely. These are procedures that are done for herniated discs, for bony spurs when they compress a nerve or the spinal cord, creating significant compression. And so also those patients we usually like ...

  20. Minimally Invasive Lumbar Discectomy

    Full Text Available ... Miami’s Baptist Hospital. You’re going to be a seeing a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46-year-old woman who ...

  1. Analytical comparison study of the clinical and radiological outcome of spine fixation using posterolateral, posterior lumber interbody and transforaminal lumber interbody spinal fixation techniques to treat lumber spine degenerative disc disease

    Al Barbarawi, Moh’d M; Audat, Ziad M; Mohammed Z. Allouh

    2015-01-01

    Background Degenerative disc disease is a common cause of chronic and disabling back pain that requires surgical intervention, posterolateral and posterior instrumental fixation (PLF), posterior lumber interbody fusion (PLIF) and transforaminal lumber interbody fusion (TLIF) are the techniques used to deal with such a problem. Objective To compare the clinical and radiological outcome of the variable surgical techniques used to deal with Lumber degenerative disc disease and to recommend the t...

  2. Clinical efficacy of three different minimally invasive procedures for far lateral lumbar disc herniation

    LIU Tao; ZHOU Yue; WANG Jian; CHU Tong-wei; LI Chang-qing; ZHANG Zheng-feng; ZHANG Chad; ZHENG Wen-jie

    2012-01-01

    Background Far lateral lumbar disc hemiation (FLLDH) accounts for 2.6% to 11.7% of all lumbar herniated discs.Numerous surgical approaches have been described for treating this condition.The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH.Methoda From June 2000 to March 2006,52 patients with FLLDH were treated with minimally invasive procedures.All patients were assessed by anteroposterior and lateral roentgenography and computed tomography (CT).Some patients underwent myelography,discography,and magnetic resonance imaging.Procedures performed included Yeung Endoscopy Spine System (YESS) (n=25),METRx MicroDiscectomy System (n=13),and X-tube (n=14).Patients were followed up for a mean of 13.5 months.Clinical outcomes were assessed using a visual analog scale (VAS) and Nakai criteria.Results All 3 procedures significantly improved radiating leg symptoms (P <0.005).After surgery,84.0%,84.6%,and 92.8% of patients in the YESS,METRx,and X-tube groups had excellent or good outcomes.There were no statistically significant differences of VAS scores between the groups.The YESS procedure was associated with the shortest operation time,simplest anesthesia,and least trauma compared with the other 2 procedures,especially for type Ⅰherniations.The METRx procedure was the most suitable for type Ⅱ herniations and posterior endoscopic facetectomy.Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability (type Ⅲ).Conclusion Minimally invasive strategies and options should be determined with reference to the type of FLLDH.

  3. Hemorrhagic Lumbar Synovial Cyst

    Park, Hyun Seok; Sim, Hong Bo; Kwon, Soon Chan; Park, Jun Bum

    2012-01-01

    Synovial cysts of the lumbar spine are an uncommon cause of back and radicular pain. These cysts most frequently present as back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms secondary to spinal canal compromise. Although less common, they can also present with acute spinal cord or root compression symptoms. We report of a case in which hemorrhaging into a right L2-3 facet synovial cyst caused an acute onset of back pain and radiculopathy, requiring surgical...

  4. Laparoscopic lumbar spine surgery

    O’Dowd, J. K.

    2000-01-01

    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 l...

  5. Lumbar hernia: a diagnostic dilemma

    Ahmed, Syed Tausif; Ranjan, Rajeeva; Saha, Subhendu Bikas; Singh, Balbodh

    2014-01-01

    Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis an...

  6. Lumbar corsets can decrease lumbar motion in golf swing.

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

    2013-01-01

    Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity) in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt) were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38°) or HC (28°) than under WOC (44°) conditions (p golf swing can effectively decrease lumbar extension and rotation angles and angular velocity.Wearing lumbar corsets increased the rotational motion of the hip joint while reducing the rotation of the lumbar spine. PMID:24149729

  7. Chemonucleolysis of lumbar disc herniation

    Chemonucleolysis is an advantageous alternative to surgical treatment of lumbar disc herniation. To achieve the best results the indications must be strictly observed and the procedure itself must be technically perfect. In these circumstances a rapid, non-invasive and less expensive treatment of lumbar disc herniation is possible. (orig.)

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

    Webb John K

    2002-10-01

    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.

  9. Lumbar percutaneous discectomy

    Since November 88, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. A short-term follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. (orig./GDG)

  10. Rate of graft bone filling by transforaminal lumber interbody fusion (TLIF) with mesh cages

    Compared to posterior lumber interbody fusion (PLIF), the transforaminal lumber interbody fusion (TLIF) procedure has a latent disadvantage in terms of bone grafting because of being a unilateral approach. We calculated the rate of graft bone filling in TLIF cases by postoperative CT and evaluated the clinical results. The rate of filling in the TLIF cases was not significantly less than in the PLIF cases. The results also showed no significant difference between TLIF and PLIF. An adequate amount of bone were grafted into the intervertebral space even by the unilateral TLIF approach, however the procedure is not easy. An incidental dural tear occurred in 1 case each treated by TLIF and PLIF. The exposure of the dural tube increases the risk of epidural bleeding and neural tissue injury. We recommend TLIF for discopathy, foraminal stenosis, and repeat surgery to avoid latent risk. (author)

  11. Anterior cervical allograft arthrodesis and instrumentation: Multilevel interbody grafting or strut graft reconstruction

    Swank, M. L.; Lowery, G. L.; Bhat, A. L.; McDonough, R. F.

    1997-01-01

    This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidenc...

  12. Using Provocative Discography and Computed Tomography to Select Patients with Refractory Discogenic Low Back Pain for Lumbar Fusion Surgery.

    Xi, Mengqiao Alan; Tong, Henry C; Fahim, Daniel K; Perez-Cruet, Mick

    2016-01-01

    Background Context Controversy remains over the use of provocative discography in conjunction with computed tomography (CT) to locate symptomatic intervertebral discs in patients with chronic, low back pain (LBP). The current study explores the relationship between discogenic pain and disc morphology using discography and CT, respectively, and investigates the efficacy of this combined method in identifying surgical candidates for lumbar fusion by evaluating outcomes. Methods 43 consecutive patients between 2006 and 2013 who presented with refractory low back pain and underwent discography and CT were enrolled in the study. For this study, "refractory LBP" was defined as pain symptoms that persisted or worsened after 6 months of non-operative treatments. Concordant pain was defined as discography-provoked LBP of similar character and location with an intensity of ≥ 8/10. Fusion candidates demonstrated positive-level discography and concordant annular tears on CT at no more than two contiguous levels, and at least one negative control disc with intact annulus. Surgical outcomes were statistically analyzed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) for back-related pain and disability preoperatively, and 2 weeks, 3, 6, 12, and 24 months postoperatively. Results Annular tears were found in 87 discs. Concordant pain was reported by 9 (20.9%) patients at L3-L4, 21 (50.0%) at L4-L5, and 34 (82.9%) at L5-S1; pain occurred significantly more often in discs with annular tears than those without (pfusion at L3-L4 (n=1(6%)), L4-L5 (n=6 (33%)), L5-S1 (n=5 (28%)), and two-level L4-S1 (n=6 (33%)) via a minimally invasive transforaminal lumbar interbody fusion (MITLIF) approach with the aim to replace the nucleus pulposus with bone graft material. Median follow-up time was 18 months (range: 12-78 months). VAS, ODI, and SF-36 scores demonstrated significant improvements at 10 out of 12 postoperative time points compared with

  13. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications

  14. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

    Bonaldi, G., E-mail: bbonaldi@yahoo.com [Neuroradiology Department, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Brembilla, C. [Department of neurosurgery, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Cianfoni, A. [Neuroradiology of Neurocenter of Italian Switzerland, Lugano, CH (Switzerland)

    2015-05-15

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.

  15. LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

    Koji Hashimoto

    2013-03-01

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

  16. The Shamrock lumbar plexus block

    Sauter, Axel R; Ullensvang, Kyrre; Niemi, Geir;

    2015-01-01

    BACKGROUND: The Shamrock technique is a new method for ultrasound-guided lumbar plexus blockade. Data on the optimal local anaesthetic dose are not available. OBJECTIVE: The objective of this study is to estimate the effective dose of ropivacaine 0.5% for a Shamrock lumbar plexus block. DESIGN: A...... prospective dose-finding study using Dixon's up-and-down sequential method. SETTING: University Hospital Orthopaedic Anaesthesia Unit. INTERVENTION: Shamrock lumbar plexus block performance and block assessment were scheduled preoperatively. Ropivacaine 0.5% was titrated with the Dixon and Massey up......-and-down method using a stepwise change of 5 ml in each consecutive patient. Combined blocks of the femoral, the lateral femoral cutaneous and the obturator nerve were prerequisite for a successful lumbar plexus block. PATIENTS: Thirty patients scheduled for lower limb orthopaedic surgery completed the study...

  17. Reproduction of the lumbar lordosis

    Andreasen, Marianne Løgtholt; Langhoff, Lotte; Jensen, Tue Secher; Albert, Hanne B

    2007-01-01

    OBJECTIVE: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra- and interexaminer reliability of measurements of...... the lumbar lordosis on radiographs and MRI. METHODS: This was an observational study, which included an intra- and interexaminer reliability study. The lumbar lordosis was measured digitally on radiographs taken from 22 patients in an upright standing position, and 22 MRI scans of the same patients...... lying supine with straightened lower extremities. These measurements were compared statistically. Intra- and interexaminer reliability was calculated applying the Bland and Altman method. RESULTS: The lumbar lordosis in the standing position was reproduced in the straightened supine position with a...

  18. Biomechanical study of percutaneous lumbar diskectomy

    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

  19. Lumbar spondylolysis: a review

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

    2011-06-15

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

  20. Lumbar spondylolysis: a review

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

  1. Lumbar peritoneal shunt

    Yadav Yad

    2010-01-01

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

  2. Radicular interdural lumbar disc herniation

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

    2009-01-01

    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...

  3. A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine.

    Street, John T; Andrew Glennie, R; Dea, Nicolas; DiPaola, Christian; Wang, Zhi; Boyd, Michael; Paquette, Scott J; Kwon, Brian K; Dvorak, Marcel F; Fisher, Charles G

    2016-09-01

    OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23-0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and

  4. Feasibility evaluation of applying the first stage posterior lateral approach lesion clearance bone grafting operation for elderly patients with thoracic spinal tuberculosis%老年胸椎结核患者应用一期后外侧入路病灶清除植骨融合术的可行性评价

    钟鸿波

    2016-01-01

    目的:评价探讨老年胸椎结核患者应用一期后外侧入路病灶清除植骨融合术的可行性和临床疗效。方法回顾性分析我院2014年5月至2015年5月收治的40例老年胸椎结核患者的临床资料,按照不同的手术方法将患者分为观察组和对照组各20例患者,观察组患者使用一期后外侧入路病灶清除植骨融合术,对照组患者使用一期前路病灶清除植骨融合术,治疗结束后观察对比两组患者的治疗效果。结果观察组的术后复发率5%显著低于对照组的45%,P<0.05,差异具有统计学意义,观察组的手术时间、术中出血量、住院时间等治疗指标均优于对照组 P <0.05。结论将一期后外侧入路病灶清除植骨融合术应用于老年胸椎结核患者的治疗中,可明显缩短患者的住院时间,减小手术过程中造成的创伤,具有优良的疗效,有效改善患者预后提高患者的生活治疗,值得在临床工作中推广使用。%Objective to evaluate feasibility and clinical effect of applying the first stage posterior lateral approach lesion clearance bone grafting operation for elderly patients with thoracic spinal tuberculosis. Method review and analyze clinical data of 40 cases elderly patients with thoracic spinal tuberculosis in our hospital from May 2014 to May 2015.According to different surgical methods divide them into observation and control group, 20 cases in each. Observation group were treated with the first stage posterior lateral approach lesion clearance bone grafting operation, and control group with the first stage anterior lateral approach lesion clearance bone grafting operation, compare and observe two groups with therapeutic effect after treatment. Result postoperative recurrence rate of observation group was 5%, significantly lower than 45% of control group, P < 0.05, difference showed statistical significance. And operation time, blood loss, hospitalization time and

  5. NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

    Ville Leinonen

    2004-03-01

    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

  6. Preoperative education for lumbar surgery for radiculopathy

    Louw, A; Q Louw; L. Crous

    2009-01-01

    To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptive...

  7. Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

    Luis Marchi; Nitamar Abdala; Leonardo Oliveira; Rodrigo Amaral; Etevaldo Coutinho; Luiz Pimenta

    2012-01-01

    The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6 ± 10 y/o; 73.1% female; 27.4 ± 3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were perf...

  8. [Ultrasound-assisted neuraxial anesthesia in a patient with previous lumbar laminectomy and fusion: a case report].

    Geng, J; Li, M

    2016-02-18

    A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine. PMID:27538165

  9. Segmentalliverincarcerationthrougha recurrent incisional lumbar hernia

    Nikolaos S. Salemis; Konstantinos Nisotakis; Stavros Gourgiotis; Efstathios Tsohataridis

    2007-01-01

    BACKGROUND: Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after lfank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD: Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS: The patient underwent an open repair of the com-plicated hernia. An expanded polytetralfouoroethylene (e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS: Although lumbar hernia rarely results in incarceration or strangulation, early repair is necessary because of the risks of complications and the increasing dififculty in repairment as it enlarges. Surgical repair is often dififcult and challenging.

  10. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease

    Jacobs, W.; Willems, P.C.P.H.; Kruyt, M.; Limbeek, J. van; Anderson, P.G.; Pavlov, P.; Bartels, R.H.M.A.; Oner, C.

    2011-01-01

    STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine which technique of anterior cervical interbody fusion (ACIF) gives the best outcome in patients with cervical degenerative disc disease. SUMMARY OF BACKGROUND DATA: The number of surgical techniques for decomp

  11. Intervertebral disk-like biphasic scaffold—demineralized bone matrix cylinder and poly(polycaprolactone triol malate)—for interbody spine fusion

    Li Jin; Yuqing Wan; Shimer, Adam L.; Shen, Francis H.; Li, Xudong J

    2012-01-01

    Interbody fusion is an established procedure to preserve disk height and anterior fusion, but fusion with autografts, allografts, and metallic cages has its endogenous shortcomings. The objective of this study is to investigate whether a biphasic scaffold model, the native demineralized bone matrix cylinder in conjunction with degradable biomaterial poly(polycaprolactone triol malate), can be employed as a biological graft for interbody fusion. The poly(polycaprolactone triol malate) was synt...

  12. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review.

    Goldstein, Christina L; Macwan, Kevin; Sundararajan, Kala; Rampersaud, Y Raja

    2016-03-01

    OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias. PMID:26565767

  13. Design and fabrication of 3D-printed anatomically shaped lumbar cage for intervertebral disc (IVD) degeneration treatment.

    Serra, T; Capelli, C; Toumpaniari, R; Orriss, I R; Leong, J J H; Dalgarno, K; Kalaskar, D M

    2016-01-01

    Spinal fusion is the gold standard surgical procedure for degenerative spinal conditions when conservative therapies have been unsuccessful in rehabilitation of patients. Novel strategies are required to improve biocompatibility and osseointegration of traditionally used materials for lumbar cages. Furthermore, new design and technologies are needed to bridge the gap due to the shortage of optimal implant sizes to fill the intervertebral disc defect. Within this context, additive manufacturing technology presents an excellent opportunity to fabricate ergonomic shape medical implants. The goal of this study is to design and manufacture a 3D-printed lumbar cage for lumbar interbody fusion. Optimisations of the proposed implant design and its printing parameters were achieved via in silico analysis. The final construct was characterised via scanning electron microscopy, contact angle, x-ray micro computed tomography (μCT), atomic force microscopy, and compressive test. Preliminary in vitro cell culture tests such as morphological assessment and metabolic activities were performed to access biocompatibility of 3D-printed constructs. Results of in silico analysis provided a useful platform to test preliminary cage design and to find an optimal value of filling density for 3D printing process. Surface characterisation confirmed a uniform coating of nHAp with nanoscale topography. Mechanical evaluation showed mechanical properties of final cage design similar to that of trabecular bone. Preliminary cell culture results showed promising results in terms of cell growth and activity confirming biocompatibility of constructs. Thus for the first time, design optimisation based on computational and experimental analysis combined with the 3D-printing technique for intervertebral fusion cage has been reported in a single study. 3D-printing is a promising technique for medical applications and this study paves the way for future development of customised implants in spinal

  14. Lumbar epidural varices: An unusual cause of lumbar claudication

    Meenakshisundaram Subbiah

    2016-01-01

    Full Text Available Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP. However as the magnetic resonance imaging (MRI in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings.

  15. Introduction and evaluation of an anterior interbody fusion model on rabbits%一种兔腰椎间融合模型的建立及效果评价

    汤嘉军; 杨宇超; 陈国荣; 张忠民

    2015-01-01

    目的:利用兔腰椎骨性结构测量数据建立一种稳定的腰椎椎体间植骨融合模型,为组织工程学研究提供标准化的模型参考。方法选用健康新西兰大白兔(2~2.5 kg)44只,随机分为A、B、C、D四组,A组(n=10)用于解剖进行腰椎椎体测量,B组(n=12)行L4/5椎体间椎骨融合术加内固定;C组(n=12只)行L4/5椎体间植骨融合术未进行内固定,D组(n=10)行单纯显露加横突破坏。B、C、D 3组造模后4周行X线检查,术后12周取标本进行大体观察、Micro-CT、生物力学及组织学切片检查。结果 B组仅出现1例因固定螺钉进入椎管导致脊髓损伤造成双下肢瘫痪。手触法检测B组融合率为100%(12/12),C组融合率为75%(9/12),D组标本未见椎间盘损伤及间隙破坏。影像学B组植入骨块位置明显优于C组,融合评分明显高于C组(P<0.05)。组织学提示B、C两组椎体间融合部位均可见新生软骨,C组中可见植骨块脱出后形成软组织空腔。生物力学显示B组最大载荷显著高于C组(P<0.05)。结论在兔腰椎解剖基础上进行兔腰椎间植骨融合模型制作是安全、可靠的。内固定装置可以为椎间植骨块提供稳定的融合空间,防止植骨块脱离融合位置,有助于提高该模型的融合效率。%Objective In order to provide a standardized model for tissue engineering research,we took measurement of lumbar bodies on rabbits to establish a stable interbody fusion model. Methods Forty-four healthy adult New Zealand white rabbits (2~2.5 kg) were randomly divided into an anatomical analysis group (group A, n=10), an interbody fusion with fixation group (group B, n=12), an interbody fusion with no fixation group(group C, n=12) and a blank control group (group D, n=10). Animals in group B、C、D underwent x-ray examination at 4 weeks after operation. At 12 weeks all rabbits were euthanasized, the fusion segments were

  16. The early-to-mid treatment efficacy of applying ROI interbody fusion cage in cervical spondylotic myelopathy%双嵌式颈椎融合器治疗脊髓型颈椎病早中期效果

    李战友; 潘兵; 阮立奇; 张志敬

    2015-01-01

    Objective:To observe the clinical effect and radiological outcomes of ROI interbody fusion cage in cervical spondylotic myelopathy. Methods:21 patients were treated with lumbar disc excision and cervical vertebra fusion with ROI cage trans anterior approach. Clinical effect was evaluated by Japanese Orthopaedic Association (JOA) score for cervical function.Each patient underwent cervical anteroposterior and lateral radiographs,CT scanning before operation,at 3 days,3 months,and 6 months after operation to assess fusion effect. Intervertebral height was measured. The time of operation,in-traoperative blood loss and complication relative to opration were recorded. Results:As time goes on,the score of JOA was increased gradually after operation,and patients were all cured after 6 months. The fusion rate was 100%. No complication was found. Conclusion:Favorable early and midterm outcomes may be yielded in patients with cervical spondylotic myelopathy treated by anterior cervical discectomy and fusion with ROI interbody fusion cage.%目的:评估双嵌式颈椎融合器(ROI-C)治疗脊髓型颈椎病的临床疗效及影像学效果. 方法:2012年5月-2013年6月我科应用颈椎压力固定器对21名患者行颈椎前路减压椎间盘切除椎体融合术.应用JOA功能评分评价临床疗效,并于术前,术后3d、术后3个月、术后6个月行常规X线正侧位片检查,评估椎体间融合情况及椎间高度,并记录每例病例手术时间、出血量及手术相关并发症情况. 结果:JOA评分随时间顺序逐渐升高,6个月内所有病例椎间全部融合,椎间高度在术后3 d即显著恢复,3个月内下降,术后6个月趋于稳定.在随访期间,未发生手术相关并发症.结论:应用双嵌式颈椎融合器治疗脊髓型颈椎病可在早中期达到较好的临床疗效.

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

    Marc Röllinghoff

    2010-01-01

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

  18. Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals

    Mehta, Roma Satish; Dabadghav, Rachana; Rairikar, Savita; Shayam, Ashok; Sancheti, Parag

    2016-01-01

    Study Design Observational study. Purpose To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. Overview of Literature IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Methods Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. Results For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=–0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=–0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). Conclusions The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain. PMID:27340529

  19. Physiotherapeutic rehabilitation and lumbar fusion surgery

    Abbott, Allan

    2010-01-01

    Over the last two decades, the economic costs and rates of lumbar fusion surgery for chronic low back pain has risen dramatically in western industrialized countries. Data from the Swedish National Spine Register suggest that 25% of patients experience unimproved pain and up to 40% are not satisfied with the outcome of lumbar fusion surgery. Thus, there is a definite need to optimize the selection and management of patients to improve lumbar fusion outcomes. Aim: To inve...

  20. Case report and review of lumbar hernia

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

    2014-01-01

    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/polyg...

  1. Laparoscopic total extraperitoneal repair of lumbar hernia

    Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee; Yang, Dae Hyun

    2011-01-01

    Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mes...

  2. Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia

    Nam, Soon Young; Kee, Se Kook; Kim, Jae Oh

    2011-01-01

    Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hern...

  3. The design of a cervical vertebra titanium plate-interbody fusion cage

    2006-01-01

    Objective: To study the biomechanical feature of a newly designed cervical vertebra internal fixation device and its clinical applications Methods: Some functional spinal units were fixed respectively with titanium plate, fusion cage and new device designed by ourselves, then a controlled biomechanical study including flexion, extension, torsion and lateral bending was performed and the results were analyzed. Results: As to the mechanical performance, fusion cage showed poor performance in extension test and so did the titanium plate in the distortion test. However, the new device showed good performance in every test. Conclusion: Both simple titanium plate fixation and simple fusion cage fixation have biomechanical defaults, but they are complementary. The titanium plate-interbody fusion cage avoids the defaults and has specific advantages.

  4. Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

    Ding Zi-hai

    2011-04-01

    Full Text Available Abstract Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH data set were prepared and used in the study. Three-dimensional (3D computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP. All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical

  5. Traumatic lumbar spinal subdural hematoma

    William E. Gordon

    2014-12-01

    Our case illustrates rapid resolution of a posttraumatic spinal SDH after treatment with oral corticosteroids. Recognition of blood products on MRI is vital to diagnosis and expedient treatment. There is agreement that prompt laminectomy with evacuation of SDH should be performed before permanent damage to the spinal cord occurs. Including our patient, 4 of 11 reported cases of thoracic or lumbar SDH resolved with conservative treatment.

  6. Traumatic lumbar spinal subdural hematoma

    Gordon, William E.; Brent Y. Kimball; Arthur, Adam S

    2014-01-01

    Spinal subdural hematoma (SDH) is a rare and potentially life-threatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic SDH is even more uncommon than other forms of SDH with only 10 reported cases in the literature. Following a punch to the head and loss of consciousness, a 35-year-old man reported headaches, right-sided tinnitus, and dull ache behi...

  7. Arteriovenous fistula following lumbar laminectomy

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

  8. Corticosteroids in Lumbar Disc Surgery

    Lundin, Anders

    2005-01-01

    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...

  9. Lumbar Intraspinal Extradural Ganglion Cysts

    Cho, Sung Min; Rhee, Woo Tack; Choi, Soo Jung; Eom, Dae Woon

    2009-01-01

    The lumbar intraspinal epidural ganglion cyst has been a rare cause of the low back pain or leg pain. Ganglion cysts and synovial cysts compose the juxtafacet cysts. Extensive studies have been performed about the synovial cysts, however, very little has been known about the ganglion cyst. Current report is about two ganglion cysts associated with implicative findings in young male patients. We discuss about the underlying pathology of the ganglion cyst based on intraoperative evidences, asso...

  10. Preliminary outcome of intervertebral fusion under Quadrant minimally invasive system for treatment of recurrent intervertebral lumbar disc herniation%微创Quadrant通道下椎间融合术治疗复发性腰椎间盘突出症的初步疗效

    陈嘉裕; 刘展亮; 张惠城

    2014-01-01

    目的:评价腰椎后路微创Quadrant 通道下椎间融合术治疗复发性腰椎间盘突出症的初步临床疗效。方法2010年1月~2012年12月,我科收治25例复发性腰椎间盘突出症患者,采用后路原切口双侧肌间隙入路(Wiltse入路),经微创Quadrant 通道下行椎间融合术。应用Oswestry功能障碍指数(ODI)及疼痛视觉类比评分(VAS)对患者再次手术前、手术后进行临床疗效评价,腰椎薄层CT扫描及三维重建评估椎体间融合。结果25例患者均获得随访,随访的时间为12~36个月,平均19.2个月。术前VAS平均评分为8.26±1.4分,术后末次随访VAS平均评分为2.47±0.65分,与术前比较差异有统计学意义(P<0.05)。ODI评分术前平均40.32±3.14分,术后末次随访平均为6.67±2.54分,与术前比较差异有统计学意义(P<0.05)。末次随访椎体间植骨均融合,无椎弓根螺钉断裂和融合器移位。结论微创Quadrant通道下椎间融合术治疗复发性腰椎间盘突出症安全有效。%Objective To evaluate preliminary clinical efficacy of minimally invasive posterior lumbar spine interbody fusion under Quadrant system for recurrent lumbar disc herniation. Methods From January 2010 to December 2012,.a total of 25 cases with recurrent lumbar disc herniation were implemented surgery. The patients underwent interbody fusion via bilateral paramedian approach under Quadrant invasive system. ODI and VAS score were used to evaluate the pre-and post-revision operation outcome. Lumbar CT scan and three-dimensional reconstruction were used to assess the lumbar interbody fusion. Results Twenty five patients were followed up for 12-36 months (mean, 19.2 months). The VAS score at preoperation was 8.26±1.4, and 2.47±0.65 at last follow-up after operation, which showed statistical significance (P<0.05). ODI score preoperative and the last follow-up after operation were 40

  11. Lumbar discoidectomy by minimal incision

    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

  12. Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

    Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

    2016-02-01

    Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting

  13. Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

    Marchi, Luis; Abdala, Nitamar; Oliveira, Leonardo; Amaral, Rodrigo; Coutinho, Etevaldo; Pimenta, Luiz

    2012-01-01

    The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6 ± 10 y/o; 73.1% female; 27.4 ± 3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.). The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P < 0.001) and was maintained through 24 months (7.1%, P < 0.001). Segmental lordosis (P < 0.001) and disc height (P < 0.001) were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17%) and 7/52 cases (13%) spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis. PMID:22545019

  14. Remote cerebellar hemorrhage after lumbar spinal surgery

    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

    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.

  15. Spontaneous hemorrhage into a lumbar synovial cyst

    Cicuendez, Marta; Jose F Alen; Ana RAMOS; Lobato, Ramiro D.; Lagares, Alfonso

    2010-01-01

    Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature.

  16. Genetic association studies in lumbar disc degeneration

    Eskola, Pasi J; Lemmelä, Susanna; Kjær, Per;

    2012-01-01

    Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI) in humans....

  17. Primary lumbar hernia: A rarely encountered hernia

    Sharada Sundaramurthy

    2016-01-01

    Conclusion: A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.

  18. Lumbar Epidural Varix Mimicking Disc Herniation.

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  19. Lumbar Epidural Varix Mimicking Disc Herniation

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  20. Hernia discal lumbar: Tratamiento conservador

    López-Sastre Núñez, Antonio; Candau Pérez, Ernesto

    1999-01-01

    Existe una gran demanda de patología lumbar crónica y aguda que debe de tratarse conjuntamente entre el especialista en Rehabilitación y el Cirujano de columna vertebral. En este trabajo se detallan las posibilidades del tratamiento conservador antes de optar por la cirugía. Se realiza una revisión bibliográfica de los resultados conservadores del tratamiento de la lumbociática de origen discal comparando aquellos estudios publicados con validez estadística. Se detallan las modernas pautas de...

  1. 单侧椎弓根钉固定结合椎间融合治疗腰椎间盘突出症30例临床回顾报道%Unilateral Pedicle Screw Fixation Combined With Lumbar Disc Herniation in 30 Cases of Lumbar Disc Herniation

    李加立

    2015-01-01

    Objective Discussion with unilateral pedicle screw ifxation and clinical efifcacy of the treatment of lumbar disc herniation of intervertebral fusion, and to evaluate its clinical value. Methods 30 cases of lumbar disc herniation underwent unilateral pedicle screw fixation combined with interbody fusion for treatment from March 2012~March 2013 in our hospital, surgery in 6 months, 12 months, 18 month, 24 month follow-up, follow-up observations of bone fusion, clinical symptoms as well as occurrence of complications. Results Clinical symptoms of all patients have received varying degrees of ease, clinical after 6 months, 12 months, 18 months, 24 months recovery rates were 76.7%, 83.3%, 90%and 86.7%. Perioperative complication rate was 23.3%, after treatment, symptoms were controlled and improved. Conclusion Clinical unilateral pedicle screw ifxation combined with interbody fusion for lumbar disc herniation is remarkable, worth promoting.%目的:探讨研究单侧椎弓根钉固定结合椎间融合治疗腰椎间盘突出症临床疗效,并评价其临床应用价值。方法给予2012年3月~2013年3月于我院就诊的30例腰椎间盘突出症患者行单侧椎弓根钉固定结合椎间融合术进行治疗,术后于6个月、12个月、18个月、24个月随访,随访观察记录骨融合情况、临床症状缓解情况以及并发症发生情况。结果所有病患的临床症状均得到了不同程度的缓解,临床术后6个月、12个月、18个月、24个月恢复率分别为76.7%、83.3%、90%、86.7%。围手术期并发症发生率为23.3%,经过治疗后症状均得到控制及改善。结论临床采用单侧椎弓根钉固定结合椎间融合术治疗腰椎间盘突出症疗效显著。

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

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

    2014-01-01

    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 he...

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

    Tevfik Yilmaz; Yahya Turan; Ismail Gulsen; Sedat Dalbayrak

    2014-01-01

    Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompre...

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

    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)

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

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

    2014-01-01

    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

  6. Spontaneous resolution of lumbar vertebral eosinophilic granuloma.

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

    2004-02-01

    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

  7. Septic arthritis of a lumbar facet joint

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

  8. Design concepts in lumbar total disc arthroplasty

    Galbusera, Fabio; Bellini, Chiara M.; Zweig, Thomas; Ferguson, Stephen; Raimondi, Manuela T.; Lamartina, Claudio; Brayda-bruno, Marco; Fornari, Maurizio

    2008-01-01

    The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc prostheses. Both theoretical and experimental studies were analyzed, by a PUBMED search (performed in February 2007, revise...

  9. Imaging of lumbar spinal surgery complications

    Malhotra, Ajay; Kalra, Vivek B; Wu, Xiao; Grant, Ryan; Bronen, Richard A; Abbed, Khalid M.

    2015-01-01

    Abstract Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery. Their use in patients with metallic implants is somewhat limited by ar...

  10. Posteroanterior versus anteroposterior lumbar spine radiology

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

  11. Posteroanterior versus anteroposterior lumbar spine radiology

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

    1990-03-01

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

  12. Bleichner’s hernia – lumbar hernia

    Petersen, Katherine; Snikeris, Jaclyn; Hall, Timothy S.

    2013-01-01

    Summary Background: We present a case of a lumbar hernia and a review of the literature of this rare hernia type. Case Report: The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. Conclusions: Lumbar hernias are rare cases, but should be pursued in diagnosis and treated aggressively because of the high rate of incar...

  13. Lumbar lordosis in osteoporosis and in osteoarthritis

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

    2008-01-01

    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...

  14. Lumbar Disk Herniation Surgery: Outcome and Predictors

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-01-01

    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 proc...

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

    Chen Hsiang-Ho

    2007-03-01

    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

  16. Preoperative education for lumbar surgery for radiculopathy

    A. Louw

    2009-02-01

    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  17. Automatic Lumbar Spondylolisthesis Measurement in CT Images.

    Liao, Shu; Zhan, Yiqiang; Dong, Zhongxing; Yan, Ruyi; Gong, Liyan; Zhou, Xiang Sean; Salganicoff, Marcos; Fei, Jun

    2016-07-01

    Lumbar spondylolisthesis is one of the most common spinal diseases. It is caused by the anterior shift of a lumbar vertebrae relative to subjacent vertebrae. In current clinical practices, staging of spondylolisthesis is often conducted in a qualitative way. Although meyerding grading opens the door to stage spondylolisthesis in a more quantitative way, it relies on the manual measurement, which is time consuming and irreproducible. Thus, an automatic measurement algorithm becomes desirable for spondylolisthesis diagnosis and staging. However, there are two challenges. 1) Accurate detection of the most anterior and posterior points on the superior and inferior surfaces of each lumbar vertebrae. Due to the small size of the vertebrae, slight errors of detection may lead to significant measurement errors, hence, wrong disease stages. 2) Automatic localize and label each lumbar vertebrae is required to provide the semantic meaning of the measurement. It is difficult since different lumbar vertebraes have high similarity of both shape and image appearance. To resolve these challenges, a new auto measurement framework is proposed with two major contributions: First, a learning based spine labeling method that integrates both the image appearance and spine geometry information is designed to detect lumbar vertebrae. Second, a hierarchical method using both the population information from atlases and domain-specific information in the target image is proposed for most anterior and posterior points positioning. Validated on 258 CT spondylolisthesis patients, our method shows very similar results to manual measurements by radiologists and significantly increases the measurement efficiency. PMID:26849859

  18. Therapeutic efficacy of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting for tuberculosis of lumbar vertebra

    Jia-ming LIU

    2015-11-01

    Full Text Available Objective To evaluate the efficacy and safety of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting in the treatment of tuberculosis of mono-segmental lumbar vertebra. Methods From January 2010 to April 2013, 21 patients (9 males and 12 females with an average age of 49.1 years with mono-segmental tuberculosis of lumbar vertebra underwent surgery in our hospital were included. Eight patients had neurological deficit. The focus of tuberculosis was located on one side of the vertebral body, and all the patients had obvious signs of bone destruction on CT and MRI. All the patients were given anti-tuberculosis chemotherapy for 2-3 weeks before surgery. The local bone chips and autologous iliac cancellous bone were used as the intervertebral bone graft. Postoperative plain radiographs and CT were obtained to evaluate the fusion rate and degree of lumbar lordosis. The visual analogue scale score (VAS, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP before and after operation, and at final follow-up date were recorded. Results All the patients were followed up for 25.3±4.2 months. The mean operation time was 157±39 minutes, and the average blood loss was 470±143ml. The fusion rate of the interbody bone graft was 95.2%, with an average fusion period of 6.1±2.5 months. The neurological function was improved by 100%, and no severe complication or neurological injury occured. The preoperative and postoperative lordosis angles of the lumbar spine were 21.4°±5.7° and 33.6°±3.1°, respectively, and it was 31.3°±2.7° at the final follow up. The preoperative and postoperative VAS scores were 7.8±2.6 and 2.4±1.7 respectively, and it was 0.9±0.7 at the final follow up. The ESR and CRP were significantly decreased 3 months after surgery, and they became normal at 6 months. Conclusion Pedicle screw-rod internal fixation after one-stage posterior

  19. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

    Surendra Mohan Tuli

    2011-01-01

    Conclusion: Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

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

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

    2014-09-15

    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.)

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

    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.)

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

    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

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

    Tevfik Yilmaz

    2014-01-01

    Full Text Available 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.

  4. Magnetic resonance imaging analysis of surgical trans-sacral axial L5/S1 interbody fusion

    YAN Ning; HE Shi-sheng; ZHANG Hai-long; GU Guang-fei; LIU Bi-feng; LIU Yan-bin; ZHANG Li-guo; GU Xin; DING Yue; GUO Cheng-bin

    2011-01-01

    Background Trans-sacral axial L5/S1 interbody fusion (AxiaLIF), a novel surgical procedure, recently adopted in clinical practice, has excellent clinical outcomes. However, there is inadequate data on the feasibility of the approach in all adult patients and the optimal surgical approach is currently unclear; therefore, further studies are required. In order to enhance the surgical approach for AxiaLIF, prospective anatomical imaging optimization is necessary. The objective of this study was to investigate the ability of magnetic resonance imaging (MRI) to achieve an optimal procedural setting.Methods The subjects (n=40) underwent lumbosacral MRI examination. The median sagittal MRI images were analyzed and four measurement markers were defined as follows: the center of the L5/S1 disc (A), the anterior margin of the S1/2 disc space (B), the sacrococcygeal junction (C), and the coccygeal tip (D). The measurement markers were connected to each other to produce five lines (AB, AC, AD, BC, and BD), as reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L5 and S1 vertebral bodies was measured to determine the safety of the respective approaches.Results In all patients, Lines AB and AC satisfied the imaging safety criteria. Line AB would result in a significant deviation from the median and was determined to be unsuitable for AxiaLIF. Line AD satisfied the imaging safety criteria in 39 patients. However, the anal proximity of the puncture point proved to be limiting. For lines BC and BD, the imaging safety criteria were satisfied in 70% and 45% of patients, respectively.Conclusions The AxiaLIF procedure is a safe technique for insertion of fusion implants in all subjects. Line AC is a favorable reference line for surgical approach and safe for all subjects, while line BC is not suitable for all subjects.

  5. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  6. Irreductable Nonstrangulated Lumbar Hernia Mimicking Lipoma: A Case Report

    Söğütlü, Gökhan; Bilen, Bilge Türk; Cinpolat, Özgür; Işık, Burak; Yılmaz, Mehmet; Kılınç, Hıdır

    2006-01-01

    We submit a 45 year old woman presenting irreduction of sigmoid colon within a lumbar hernia. There was no large bowel obstruction or strangulation so; this entity was misdiagnosed as lipoma. Key words: Lumbar hernia, Sigmoid colon, Strangulation, Lipoma

  7. Isthmic lumbar spondylolisthesis with sciatica

    Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: Normal nerve (n=8), II: Compressed nerve (n=16); III: Disappearance of fat, nerve not possible to identify (n=9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information. (orig.)

  8. MR-guided lumbar sympathicolysis

    Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)

    2002-06-01

    The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

  9. MR-guided lumbar sympathicolysis

    The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

  10. Traumatic lumbar visceral herniation in a young woman ☆

    Woolbert, Ashley; Calasanz, Emily R.; Nazim, Muhammad

    2013-01-01

    INTRODUCTION Lumbar herniation is uncommon, with traumatic etiology being rare. Traumatic lumbar hernias are usually caused by seatbelt injury in motor vehicle accidents. It is exceedingly uncommon to see lumbar hernias in an unrestrained passenger of a motor vehicle accident. PRESENTATION OF CASE We present a case of a traumatic inferior lumbar hernia in a young woman who was an unrestrained driver of a vehicle involved in a high-speed collision, with multiple rollover and ejection. CT scans...

  11. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    Lee, Su-Keon; Lee, Seung-Hwan; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

    2016-01-01

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

  12. A musculoskeletal model for the lumbar spine.

    Christophy, Miguel; Faruk Senan, Nur Adila; Lotz, Jeffrey C; O'Reilly, Oliver M

    2012-01-01

    A new musculoskeletal model for the lumbar spine is described in this paper. This model features a rigid pelvis and sacrum, the five lumbar vertebrae, and a rigid torso consisting of a lumped thoracic spine and ribcage. The motion of the individual lumbar vertebrae was defined as a fraction of the net lumbar movement about the three rotational degrees of freedom: flexion-extension lateral bending, and axial rotation. Additionally, the eight main muscle groups of the lumbar spine were incorporated using 238 muscle fascicles with prescriptions for the parameters in the Hill-type muscle models obtained with the help of an extensive literature survey. The features of the model include the abilities to predict joint reactions, muscle forces, and muscle activation patterns. To illustrate the capabilities of the model and validate its physiological similarity, the model's predictions for the moment arms of the muscles are shown for a range of flexion-extension motions of the lower back. The model uses the OpenSim platform and is freely available on https://www.simtk.org/home/lumbarspine to other spinal researchers interested in analyzing the kinematics of the spine. The model can also be integrated with existing OpenSim models to build more comprehensive models of the human body. PMID:21318374

  13. Minimally invasive procedures on the lumbar spine.

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

    2015-01-16

    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

  14. Tractography of lumbar nerve roots: initial results

    Balbi, Vincent; Budzik, Jean-Francois; Thuc, Vianney le; Cotten, Anne [Hopital Roger Salengro, Service de Radiologie et d' Imagerie musculo-squelettique, Lille Cedex (France); Duhamel, Alain [Universite de Lille 2, UDSL, Lille (France); Bera-Louville, Anne [Service de Rhumatologie, Hopital Roger Salengro, Lille (France)

    2011-06-15

    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.)

  15. Lumbar hernia associated with chronic obstructive pulmonary disease (COPD)

    Xu, Tao; Zhang, Shuwei; Wang, Huaying; YU, WANJUN

    2013-01-01

    Lumbar hernias are very rare posterolateral abdominal wall hernias, and they are spontaneous in most adult patients. Here we report two cases of spontaneous lumbar hernias associated with chronic obstructive pulmonary disease (COPD). Some factors such as chronic cough, poor nutritional status and old age in patients with COPD would contribute to lumbar hernia.

  16. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

    Huan-Chieh Chen; Chih-Hsun Lee; Li Wei; Tai-Ngar Lui; Tien-Jen Lin

    2015-01-01

    Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herni...

  17. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain

    Cho, Igsoo; Jeon, Chunbae; Lee, Sangyong; Lee, Daehee; Hwangbo, Gak

    2015-01-01

    [Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respect...

  18. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  19. Costs and effects in lumbar spinal fusion

    Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel;

    2007-01-01

    Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient......) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means......-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar...

  20. [Lumbar disc herniation and andrological diseases].

    Jin, Bao-fang

    2015-10-01

    Lumbar disc herniation is a common male disease. In the past, More academic attention was directed to its relationship with lumbago and leg pain than to its association with andrological diseases. Studies show that central lumber intervertebral disc herniation may cause cauda equina injury and result in premature ejaculation, erectile dysfunction, chronic pelvic pain syndrome, priapism, and emission. This article presents an overview on the correlation between central lumbar intervertebral disc herniation and andrological diseases, focusing on the aspects of etiology, pathology, and clinical progress, hoping to invite more attention from andrological and osteological clinicians. PMID:26665671

  1. Microdiscectomy for a Paracentral Lumbar Herniated Disk.

    Millhouse, Paul W; Schroeder, Gregory D; Kurd, Mark F; Kepler, Christopher K; Vaccaro, Alexander R; Savage, Jason W

    2016-02-01

    Lumbar disk herniations occur frequently and are often associated with leg pain, weakness, and paresthesias. Fortunately, the natural outcomes of radiculopathy due to a disk herniation are generally favorable, and the vast majority of patients improve with nonoperative care. Surgical intervention is reserved for patients who have significant pain that is refractory to at least 6 weeks of conservative care, patients who have a severe or progressive motor deficit, or patients who have any symptoms of bowel or bladder dysfunction. This paper reviews the preoperative and postoperative considerations, as well as the surgical technique, for a microdiscectomy for a lumbar intervertebral disk herniation. PMID:26710186

  2. Return to Play After Lumbar Spine Surgery.

    Cook, Ralph W; Hsu, Wellington K

    2016-10-01

    Surgical management of lumbar spine conditions can produce excellent outcomes in athletes. Microdiscectomy for lumbar disc herniation has favorable outcomes; most athletes return to play at preoperative performance levels. Direct pars repair is successful in younger athletes, with high rates of return to play for a variety of fixation techniques. Fusion in athletes with scoliosis is a negative predictor. There are few evidence-based return to play criteria. Athletes should demonstrate full resolution of symptoms and flexibility, endurance, and strength before returning to play. Deciding when to return an athlete to sport depends on particular injury sustained, sport, and individual factors. PMID:27543402

  3. Adjacent Instability after Instrumented Lumbar Fusion.

    Wen-Jer Chen

    2003-11-01

    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.

  4. Percutaneous fusion of lumbar facet with bone allograft

    Félix Dolorit Verdecia

    2015-03-01

    Full Text Available OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone allograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.

  5. [Relationship between lumbosacral multifidus muscle and lumbar disc herniation].

    Chen, Wei-ye; Wang, Kuan; Yuan, Wei-an; Zhan, Hong-sheng

    2016-06-01

    As a common disease in clinical, the treatment of lumbar disc herniation (LDH) focused on local intervertebral disc, such as surgery and other interventional therapy treatment, but postoperative complications and recurrence rate has been a difficult problem in the field of profession. With the development of spine biomechanics and anatomy, researches on lumbar herniation also increased. Researchers discovered that the incidence and prognosis of LDH were inseparable with local muscle and soft tissue. As the deep paraspinal muscles, multifidus muscle plays an important role to make lumbar stability. Its abnormal function could reduce the stable of lumbar spine, and the chronic lumbar disease could also lead to multifidus muscle atrophy. PMID:27534095

  6. Decompression alone versus decompression with instrumented fusion for young patients with single-level lumbar disc herniation:a short-term prospective comparative study

    Sun Zhuoran; Li Weishi; Chen Zhongqiang; Guo Zhaoqing; Qi Qiang; Zeng Yan; Sun Chuiguo

    2014-01-01

    Background For young patients,the surgical method for lumbar disc herniation remains controversial.The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation.Methods In this prospective comparative study between April 2010 and August 2011,a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation.The patients were divided into two groups:decompression alone and decompression with instrumented fusion.An independent examiner clinically evaluated the patients at preoperation and at 1,3,6,and 12 months after surgery.The patients filled out the instruments for back and leg pain using a Visual Analog Scale (VAS),Oswestry Low Back Pain Disability Questionnaire (ODI),and Japanese Orthopaedic Association (JOA) scores.The differences between the two groups were analyzed.Results The mean age of all the patients at the time of surgery was 33.7 years.Of the 80 patients,38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion.Increasing complexity of surgery was associated with a longer surgery time,greater blood loss,and a longer hospital stay after surgery.Both methods of surgery independently improved outcomes compared with baseline status based on VAS,ODI,and JOA scores (P <0.05),and no significant differences were found between the two groups at most of the measuring points in time,although patients with decompression alone had a higher JOA score (P=0.016) and higher JOA recovery rate (P=0.010) at the 3-month follow-up.Conclusions The short-term results of our study showed that both methods of surgery obtained effective clinical outcomes,but decompression alone had some advantages (shorter surgery time,less blood loss,shorter hospital stay,and lower cost) compared with decompression with instrumented fusion.Young patients with decompression alone could achieve great physical function earlier.

  7. Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases.

    Thakar, Sumit; Sivaraju, Laxminadh; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Hegde, Alangar S

    2016-05-01

    OBJECTIVE The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements. METHODS The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy). RESULTS Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039). CONCLUSIONS Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy

  8. Lumbar microdiscectomy and lumbar decompression improve functional outcomes and depression scores

    Tharin, Suzanne; Mayer, Eric; Krishnaney, Ajit

    2012-01-01

    Study design:  Retrospective review. Introduction:  Lumbar radiculopathy and claudicant leg pain are common degenerative spinal conditions often treated by elective microdiscectomy or decompression. Published outcome data for these procedures have focused on improvement in pain scores, and not on grounded functional outcome or depression scores.1,2,3 Moreover, depression is considered by many surgeons to be a red flag for poor outcome for surgical treatment. We asked what effect lumbar microd...

  9. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report.

    Zoe Quintero Delgado

    2005-11-01

    Full Text Available Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

  10. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report.

    Zoe Quintero Delgado; Guillermo Cortiza Orbe; Yusimy Izaguirre Martínez

    2005-01-01

    Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

  11. FJ脊柱内固定系统并椎体及横突间植骨治疗腰椎滑脱症%Treatment of lumbar spondylolisthesis with FJ spinal system and posterior lumbar interbody fusion and posterolateral fusion

    黄建华; 熊传芝; 戴维享; 徐荣华

    2007-01-01

    目的 总结采用后路椎管减压,椎体及横突间植骨和FJ脊柱内固定系统治疗腰椎滑脱症的临床疗效.方法 采用FJ系列滑脱系统对滑脱椎体进行提拉复位、固定、后路椎管减压、椎体及横突间植骨融合治疗腰椎滑脱症46例.结果 患者均获随访,时间12~36个月.28例Ⅰ度和16例Ⅱ度患者滑脱完全复位,1例Ⅱ度和1例Ⅲ度滑脱复位达90%,未见螺钉松动或断裂,无植骨块脱出,植骨均达骨性愈合.根据Amundsen评定标准:优41例,良4例,可1例.结论 应用FJ滑脱系统结合椎体及横突间植骨具有操作简便,复位效果好,植骨融合率高及固定可靠的优点,临床疗效满意.

  12. Benign fibrous histiocytoma of the lumbar vertebrae

    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

    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.)

  13. Degenerative Pathways of Lumbar Motion Segments

    Jensen, Rikke K.; Kjaer, Per; Jensen, Tue S.;

    2016-01-01

    from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into...

  14. Magnetic Resonance Imaging (MRI): Lumbar Spine

    ... performed to assess the anatomy of the lumbar spine, to help plan surgery on the spine, or to monitor changes in the spine after ... For example, it can find areas of the spine where the spinal canal (which ... narrowed and might require surgery. It can assess the disks to see whether ...

  15. Surgical treatment of lumbar stenosis in achondroplasia

    Thomeer, RTWM; Van Dijk, JMC

    2002-01-01

    Object. The authors conducted a study to evaluate the results of a unique surgical procedure for treating primary lumbar stenosis in patients with achondroplasia, based on its distorted anatomical dimensions. Methods. A consecutive single-center series of 36 achondroplastic dwarfs with symptomatic l

  16. Partial Facetectomy for Lumbar Foraminal Stenosis

    Kevin Kang

    2014-01-01

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

  17. Acute Sciatic Neuritis following Lumbar Laminectomy

    Foad Elahi

    2014-01-01

    Full Text Available It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient’s newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy.

  18. Iliac Arteriovenous Fistula Complicating Lumbar Laminectomy

    Chiariello, Luigi; Marino, Benedetto; Nigri, Antonio; Macrina, Francesco; Ruvolo, Giovanni; SINATRA, RICCARDO

    1983-01-01

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

  19. A hundred years of lumbar puncture.

    Dugacki, V

    1992-01-01

    In the years 1991 and 1992 the 100th anniversary of the announcement of the lumbar puncture method (1891) and 150th anniversary of the birth of its inventor Heinrich Irenaeus Quincke (1842) are celebrated. In the article a short review is given of the development of this method. PMID:1463808

  20. A case of inferior lumbar hernia

    Vidhyasagar M. Sharma; Sushil D. Akruwala; Shashank Desai; Dave, Rajendra I.

    2013-01-01

    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

  1. A case of inferior lumbar hernia

    Vidhyasagar M. Sharma

    2013-02-01

    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

  2. Physiological pattern of lumbar disc height

    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 adjoining discs and not on a deviation from a craniocaudal sequence pattern. (orig.)

  3. Surgical treatment of dysphagia after anterior cervical interbody fusion%前路颈椎融合术后吞咽困难的外科治疗

    Fogel GR; McDonnell MF

    2005-01-01

    BACKGROUND CONTEXT: Dysphagia is a frequent complication after anterior cervical interbody fusion (ACIF). Although dysphagia usually improves over 6 months, it remains a significant and persistent problem for some patients. The etiology is poorly understood but has been reported to be associated with vocal cord paralysis, dislodgement of instrumentation and unidentified causes, such as hematoma, adhesion formation and denervation of the pharyngeal plexus. A surgical treatment of dysphagia after ACIF has not been reported.

  4. General practitioners' willingness to request plain lumbar spine radiographic examinations

    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 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

  5. Ergonomic lumbar risk analysis of construction workers by NIOSH method

    Cinara Caetano Pereira; Déborah Figueiró Debiase; Joni Márcio de Farias; Kristian Madeira; Willians Cassiano Longen

    2015-01-01

    Work in construction has tasks directly connected with manual transport. One of the body segments suffering greater demand in works with these characteristics is the lumbar spine segment. The aim of this study was to analyze the level of risk of lumbar construction workers in the shipment of materials. The sample was composed of 74 construction workers. Were used as a research tool: the NIOSH method for lumbar risk verification expressed by weight limit recommended (WPR) and the lifting Index...

  6. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

    Jackson, Keith L.; Hire, Justin M; Jacobs, Jeremy M.; Key, Charles C.; DeVine, John G.

    2015-01-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly re...

  7. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    Mostofi, Keyvan

    2015-01-01

    Study Design Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. Purpose The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). Overview of Literature Several studies have shown promising results following this surgery. Methods We reviewed the files of 104 patients ...

  8. Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases

    Mehmet ŞENOĞLU; Kasım Zafer YÜKSEL; Mürvet YÜKSEL

    2006-01-01

    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...

  9. Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

    Koakutsu, Tomoaki; Morozumi, Naoki; Koizumi, Yutaka; Ishii, Yushin

    2011-01-01

    Study design Case-series study. Objective To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis. Background Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports. Methods Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 ye...

  10. Myeloperoxidase Activities in Polymorphonuclear Leukocytes in Lumbar Disc Disease

    Mehmet ŞENOĞLU; Ergul Belge KURUTAŞ; İdris ALTUN; Yalçın ATLI; Vedat NACİTARHAN

    2009-01-01

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

  11. Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study

    Schick, U; Döhnert, J.; Richter, A.; König, A.; Vitzthum, H

    2001-01-01

    This study investigated electromyographic (EMG) activity as a marker of nerve root irritation during two different surgical procedures for lumbar disc herniation. Mechanically elicited EMG activity was recorded during the dynamic stages of surgery in muscle groups innervated by lumbar nerve roots. Confirmation of surgical activity was correlated with the activity of the electromyogram. Fifteen patients with lumbar disc herniations were treated via an endoscopic medial approach, and 15 patient...

  12. Angiogenesis in the degeneration of the lumbar intervertebral disc

    David, Gh; Ciurea, AV; Iencean, SM; Mohan, A.

    2010-01-01

    The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth ...

  13. Complications in lumbar spine surgery: A retrospective analysis

    Luca Proietti; Laura Scaramuzzo; Giuseppe R Schiro; Sergio Sessa; Carlo A Logroscino

    2013-01-01

    Background: Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate. Materials and Metho...

  14. Symptomatic Pneumocephalus after Lumbar Disc Surgery: a Case Report

    Zahir Kizilay; Ali Yilmaz; Ozgur Ismailoglu

    2015-01-01

    Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient...

  15. Traumatic Intradural Lumbar Disc Herniation without Bone Injury

    Lee, Hyun-Woo; Kwon, Young-Min

    2013-01-01

    Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did no...

  16. Lumbar hernia misdiagnosed as a subcutaneous lipoma: a case report

    Amelio Gianfranco; Mingolla Giuseppe

    2009-01-01

    Abstract Introduction Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Case presentation We report the case of a 40-year-old Caucasian woman with a superior lumbar hernia (Grynfeltt hernia) initially misdiagnosed as a recurrent lipoma. The correct diagnosis was made intra-operatively and the hernia was repaired using synthetic mesh. The patient was free of recurrence at 4 months after the operation. Conclusion A lumbar or flank mass should alway...

  17. Grynfelt lumbar hernias. Presentation of a congenital case.

    Cleopatra Cabrera Cuellar; Nilda B. Cortizo Martínez; Alina L. Díaz Dueñaz; Sergio Elías Molina Lamothe

    2006-01-01

    Lumbar hernias are uncommon and are reported rarely, they are informed only few more than 300 in literature and of them only 10 cases are congenital. The hernias that are produced through the superior lumbar space or Grynfelt-Lesshalf´s hernia, are due to the fact that they are more constant and larger they are usually more frequent than the Petit triangle. We are reporting a Newborn infant with the diagnosis of bilateral lumbar hernias and malformation of the vertebral column.

  18. Lumbar Incisional Hernia Repair After Iliac Crest Bone Graft

    Do, Michael V.; Richardson, William S.

    2012-01-01

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

  19. Midsagittal Anatomy of Lumbar Lordosis in Adult Egyptians: MRI Study

    Hegazy, Abdelmonem A.; Hegazy, Raafat A.

    2014-01-01

    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. Th...

  20. Evaluation of a Modified POSSUM Scoring System for Predicting the Morbidity in Patients Undergoing Lumbar Surgery

    Ying, Li; Bo, Bai; Huo-yan, Wu; Hong, Zhuang

    2013-01-01

    For most spine surgeons, operative intervention is common for the treatment of lumbar disc herniation, lumbar stenosis, lumbar fracture or lumbar spondylolisthesis. However, with the increase in lumbar surgery, the complication rate increases accordingly. Whereas the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system has been widely used to predict morbidity in various surgical fields, the application of this system in lumbar surg...

  1. Indental gynecological findings on lumbar spine MRI

    Female genital organs are partly visible on lumbar spine MRI. Uterus and/or ovaries were partly visualized in 100 out of 227 women. The examinations were performed at a 1,5 T system. In a group of 100 patients,the abnormalities of these organs were found in 38 cases.The following diagnoses were suggested:leiomyoma in 23 cases, adenomyosis in 3, deep endometrial endometriosis in 1,endometrial carcinoma in 4, Nabothian cyst in 8, simple ovarian cyst in 1, endometrial cyst in 1, dermoid cyst in 1, ovarian cancer in 1, fluid in Douglas ' pouch in 2. Lumbar spine MRI should be interpreted using unmagnified images, including the localizer series, because of frequent incidental gynecological findings in unaware women. (author)

  2. Primary lumbar extradural hemangiosarcoma in a dog.

    Paek, Matthew; Glass, Eric; Kent, Marc; Clifford, Craig A; De Lahunta, Alexander

    2015-01-01

    A 9 yr old castrated male golden retriever weighing 36 kg was presented for evaluation of progressive left pelvic limb paresis and fecal and urinary incontinence. MRI demonstrated an extradural, ovoid mass compressing the lumbar spinal cord. Surgical excision of the mass was performed. Histologically, the mass was consistent with hemangiosarcoma with no involvement of the adjacent vertebrae. The dog underwent a doxorubicin-based chemotherapy protocol with the addition of oral cyclophosphamide. After completion of chemotherapy, the dog was evaluated q 4 mo for restaging. Clinicopathological evidence of primary tumor recurrence or metastatic disease was not detected for 15 mo after initial diagnosis and treatment. To the authors' knowledge, this is the first report of a primary extradural hemangiosarcoma in the lumbar vertebral column in a dog. The clinical presentation, diagnosis, treatment, and outcome are also discussed. PMID:25955146

  3. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Hae-Yeon Lee

    2003-12-01

    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.

  4. [Idiopathic Lumbar Hernia: A Case Report].

    Tsujino, Takuya; Inamoto, Teruo; Matsunaga, Tomohisa; Uchimoto, Taizo; Saito, Kenkichi; Takai, Tomoaki; Minami, Koichiro; Takahara, Kiyoshi; Nomi, Hayahito; Azuma, Haruhito

    2015-11-01

    A 68-year-old woman, complained of an indolent lump about 60 × 70 mm in size in the left lower back. We conducted a computed tomography scan, which exhibited a hernia of Gerota'sfascia-commonly called superior lumbar hernia. In the right lateral position, the hernia contents were observed to attenuate, hence only closure of the hernial orifice was conducted by using Kugel patch, without removal of the hernia sack. Six months after the surgery, she has had no relapse of the hernia. Superior lumbar hernia, which occurs in an anatomically brittle region in the lower back, is a rare and potentially serious disease. The urologic surgeon should bear in mind this rarely seen entity. PMID:26699890

  5. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Sharma A

    2005-01-01

    Full Text Available Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.

  6. Clinical trial of iohexol in lumbar myelography

    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.)

  7. Endoscopic posterior decompression of lumbar canal stenosis

    Yad Ram Yadav; Nishtha Yadav; Vijay Parihar; Yatin Kher; Shailendra Ratre

    2013-01-01

    Lumbar canal stenosis (LCS) is quite common. Surgery is indicated when patient fails to improve after conservative treatment. Endoscopic technique can be used in LCS and lateral recess stenosis. It can be performed in degenerative canal stenosis or with disc bulges. Bilateral severe bony canal stenosis and unstable spine are the contraindications. This procedure should be avoided in patients with a history of trauma. Detailed history and thorough physical examination should be performed to fi...

  8. Pyogenic Spondylodiscitis after Percutaneous Endoscopic Lumbar Discectomy

    Choi, Kyeong-Bo; Lee, Choon-Dae; Lee, Sang-Ho

    2010-01-01

    We reviewed 9 cases of pyogenic spondylodiscitis following percutaneous endoscopic lumbar discectomy (PELD). Microbiologic cultures revealed 6 causative organisms. Five patients were managed conservatively and four were treated surgically. The mean follow-up period was 20.6 months and the average length of hospitalization was 24 days. Radiological evidence of spinal fusion was noted and infection was resolved in all patients. Although PELD is a safe and effective procedure, the possibility of...

  9. Lumbar disc cyst with contralateral radiculopathy

    Kishore Tourani; Belman Murali; Akshay Sahoo; Dandu Ravi Varma; Narayan Prasad

    2012-01-01

    Disc cysts are uncommon intraspinal cystic lesions located in the ventrolateral epidural space. They communicate with the nucleus pulposus of the intervertebral disc and cause symptoms by radicular compression. We report a unique case of lumbar disc cyst that was associated with disc herniation and contralateral radiculopathy. A 22 year old male presented with one month history of back-ache radiating to the left leg. Magnetic Resonance Imaging (MRI) showed L3-L4 disc herniation with annular t...

  10. Outpatient Treatment of Lumbar Disc Sciatica

    Swezey, Robert L.; Crittenden, James O.; Swezey, Annette M.

    1986-01-01

    Of 47 patients with lumbar disc disease and sciatic radiculopathy (L-5 or S-1), 39 were successfully managed at home and as outpatients in an ambulatory care facility designed for the treatment of arthritis and back pain. When these patients were evaluated one to three years following discharge, they maintained their maximum level of activity and functional improvement noted at discharge. The average total cost per patient including physician's fees, x-rays, laboratory and therapy was approxi...

  11. Adolescent lumbar disc herniation: a case report

    King, Laurie; Mior, Silvano A.; Devonshire-Zielonka, Kim

    1996-01-01

    Lumbar spine disc herniations in children are a relatively rare condition reported to occur in less than 3% of those presenting with low back pain. Unlike the adult, the etiology and clinical picture often provides few clues to making the diagnosis. Although conservative management is the treatment of choice, surgical intervention may be required in some cases. The role of spinal manipulation in these cases may be of limited value. A case report is presented that illustrates the difficulty in...

  12. Lumbar Incisional Hernias: Diagnostic and Management Dilemma

    Salameh, Jihad R.; Salloum, Ellis J.

    2004-01-01

    Introduction: Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), posttraumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions. Case Report: We present 2 patients who had undergone flank incisions and subsequently developed significant bulging of that area. ...

  13. Iatrogenic fistula after lumbar disc surgery

    Reekers, J. A.; Hoorn, F. van; Spijkerboer, A. M.

    2011-01-01

    Background: A 54-year-old patient presented with dyspnea, palpitation, a swollen, dysfunctional edematous left leg and discomfort. Medical history revealed chronic, a-specific leftsided thoracic pain, corticosteroid use because of Morbus Sjogren and a recent surgical lumbar hernia repair.Retrospectively, follow-up conventional imaging showed a progressive right-sided cardiac enlargement, left pleural effusion and a prominent superior mediastinum.

  14. Primary lumbar hernia: A rarely encountered hernia

    Sharada Sundaramurthy; H.B. Suresh; Anirudh, A.V.; Anthony Prakash Rozario

    2016-01-01

    Introduction: Lumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option. Presentation of case: A 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. H...

  15. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Sharma A.; Panse R; Khullar R; Soni V; Baijal M; Chowbey P

    2005-01-01

    Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Lap...

  16. Acupuncture Treatment for Lumbar Disc Herniation

    Karovski, Martin; Zhu, Jihe; Arsovska, Blagica; Kozovska, Kristina

    2016-01-01

    BACKGROUND: Herniated disc is a disease that comes with aging, which always comes to prolapse and irritation of the surrounding nerves and the conventional medicine offer non-painful and invasive treatments such as epidural injection, lumbar microscopic discectomy open or laparoscopic surgery of the spine. Acupuncture for centuries is been used as a successful treatment for many diseases and the development of the medicine and better knowledge of the pathological conditions of the organism, n...

  17. Lumbar myelography in 79 dogs, using different puncture sites

    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

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

    Jeong-ho Kim

    2010-06-01

    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.

  19. Skin to posterior lumbar epidural space distance

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

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

    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.)

  1. Complication and treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy%经皮内窥镜治疗腰椎间盘突出症的并发症及其处理

    温冰涛; 孙建华; 张西峰; 王岩; 肖嵩华; 刘郑生; 刘保卫; 张永刚; 宋将; 种衍学

    2011-01-01

    669 cases.double lumbar intervertebral disc herniation were 19; three lumbar intervertebral disc herniation were 1.Central type in 66,side central type in 365,lateral type in 242,extreme lateral type in 10,sequestered type in 6.These cases with complications in operation and postoperation were studied retrospectively.Results There were nucleus pulposus omissions in 5 patients and 2 patients underwent open resection of nucleus pulposus during operation immediately and the second operation was needed in 3 cases,1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection of nucleus pulposus.Two patients had nerve root injury,but all completely recovered in 3-6 months after operation.Spinal dura mater disruption was in 2 patients,recovered after suturing of skin wound.All 689 patients were followed up for 6-96 months,mean follow-up time was 33 months.Postoperative spondylodiscitis was in 7 patients,recovery after expectant treatment in 1,pereutaneous puncture irrigation and drainage for continued use of local antibiotics in 4,posterior infective lumbar discectomy in 2.Postoperative relapse was in 6 patients,operated secondly by PELD in 4 and by TLIF in 2,recovery after the second operation.Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 19 patients,the symptom was improved by analgesic drug,neurotrophy drug and physiotherapy.The effect of single segment PELD was not good in 10 patients with spinal stenosis,who underwent multiple segment TLIF later.Conclusions The complications during operation usually are nucleus pulposus omissions,nerve root injury,spinal dura mater disruption.Accordingly the complications after operation include spondylodiscitis,recurrence,nerve root induced hyperalgesia or burning-like nerve root pain.Strict indication,aseptic technique,skilled operation and proper rehabilitation exercise are effective ways to reduce complications.

  2. Chemonucleolysis of lumbar disc herniation. [Localization of lesion by CT

    Braun, J.P.; Tournade, A.

    1989-04-01

    Chemonucleolysis is an advantageous alternative to surgical treatment of lumbar disc herniation. To achieve the best results the indications must be strictly observed and the procedure itself must be technically perfect. In these circumstances a rapid, non-invasive and less expensive treatment of lumbar disc herniation is possible.

  3. Computed tomography in the diagnosis of the lumbar disc herniation

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

    1984-06-01

    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.

  4. Lumbar hernia - a case report and review of the literature

    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)

  5. Complex radiodiagnosis of the lumbar spine spinal canal stenosis

    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

  6. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    Sandén Bengt; Robinson Yohan

    2009-01-01

    Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging reco...

  7. Chemoembolization for Hepatocellular Carcinoma Supplied by a Lumbar Artery

    Kim, Han Myun, E-mail: seoul49@naver.com [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital (Korea, Republic of); Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Woo, Sungmin, E-mail: j-crew7@hotmail.com [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of); Son, Kyu Ri, E-mail: kyurad@gmail.com [Korea University College of Medicine, Department of Radiology, Korea University Medical Center (Korea, Republic of); Cho, Seong Whi, E-mail: chosw@kangwon.ac.kr [Kangwon National University College of Medicine, Department of Radiology, Kangwon National University Hospital (Korea, Republic of); Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of)

    2015-02-15

    PurposeTo describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery.MethodsBetween April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms.ResultsPatients had received 1–27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20).ConclusionWhen HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.

  8. Percutaneous treatment of lumbar disc herniation

    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

    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.

  9. [Ischemic optic neuropathy after lumbar spine surgery].

    Bermejo-Alvarez, M A; Carpintero, M; García-Carro, G; Acebal, G; Fervienza, P; Cosío, F

    2007-12-01

    Ischemic optic neuropathy is the most common cause of visual complications after non-ophthalmic surgery. The incidence has varied in different case series, but prone-position spine surgery appears to be involved in most of the reports. We present the case of a 47-year-old woman who developed near total blindness in the left eye following lumbar spine fusion surgery involving the loss of 900 mL of blood. An ophthalmic examination including inspection of the ocular fundus, fluorescein angiography, and visual evoked potentials returned a diagnosis of retrolaminar optic neuropathy. Outcome was poor. PMID:18200998

  10. Dolor lumbar agudo: mecanismos, enfoque y tratamiento

    2009-01-01

    El dolor lumbar agudo tiene un gran impacto socioeconómico a nivel mundial, esto lo constituye en un problema de salud pública. En nuestro país su ocurrencia es muy similar a la de otras latitudes. A lo largo de la historia se ha considerado como un “precio” que debemos pagar los mamíferos bipedestres de importante longevidad. Comparte sus mecanismos fisiopatológicos con los otros tipos de dolor agudo. Sin embargo, en la gran mayoría de los casos, implica un reto determinar su origen patológi...

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

    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/cm2 in the femoral neck, while for controls the corresponding figures were 0.989g/cm2 and 0.765g/cm2. 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

  12. TLIF Treatment of 23 Cases of Extreme Lateral Lumbar Disc Herniation%TLIF治疗极外侧腰椎间盘突出症23例体会

    卢斌

    2012-01-01

      目的探讨经椎间孔入路的腰椎间盘摘除椎间融合技术(TLIF)治疗极外侧腰椎间盘突出症的疗效及优缺点.方法自2006年以来应用TLIF技术治疗极外侧腰椎间盘突出23例,年龄33~67岁,其中男18例,女5例;L3~46例,L4~514例,L5S13例;单间隙突出4例,双间隙突出10例,多间隙突出9例;均应用单枚肾形Cage进行操作.结果采用中华骨科学会脊柱组腰背痛手术评定标准,优15,良6,可2例.优良率达91.3%.结论 TLIF治疗极外侧型腰椎间盘突出症,术野清晰,直视下操作不易损伤神经根,创伤小,对腰椎稳定性影响较小,是一种有效的治疗方法.%  Objective To investigate the clinical effect, advantages and disadvantages of extreme lateral 1umbar disc herniation with tranforaminal lumbar interbody fusion. Methods Application TLIF technique in the treatment of far lateral lumbar disc herniation 23 cases since 2006, age 33 to 67 years, including 18 males and 5 females;L3~4 6 cases, L4~5 14 page cases, L5S1 3 cases;single gap highlights the four cases, prominent double-gap10 cases, multi-gap highlight the nine cases;application of single pieces of kidney-shaped Cage operate. Results Chinese Academy of Orthopaedic Surgeons spine group back pain surgery assessment standards, excellent in 15, good in 6, 2 cases. 91.3%. Conclusion TLIF treatment of far lateral lumbar disc herniation, the operative field clear, the operation is not easy to damage the nerve root under direct vision, less invasive, less impact on the stability of lumbar spine is an effective treatment method.

  13. Sacral Insufficiency Fractures Mimicking Lumbar Spine Pathology.

    Sudhir, G; K L, Kalra; Acharya, Shankar; Chahal, Rupinder

    2016-06-01

    Sacral insufficiency fractures (SIFs) are a common cause of back pain in the elderly. SIFs mimic the symptoms of lumbar spine pathology and so are commonly missed or underdiagnosed. Here we present four cases of missed SIFs that were subsequently identified and treated. One patient was treated as mechanical lower back ache, another patient underwent root block and two patients underwent surgery for lumbar canal stenosis. None experienced relief of their symptoms after these procedures. Retrospective analysis of X-ray and magnetic resonance imaging data revealed SIFs that were confirmed by computed tomography scans. All four patients were treated for underlying osteoporosis. Two patients who underwent surgery were treated conservatively and other two were treated by sacroplasty involving injection of cement into the fracture. Sacroplasty produced immediate pain relief and early mobilization compared to the conservative group. SIFs should always be considered in the differential diagnosis of an elderly patient presenting with low back symptoms. Sacroplasty can be considered for immediate pain relief and rapid mobilization. PMID:27340538

  14. Conjoined nerve root of the lumbar spine

    There have been a number of reports on lumbosacral nerve root anomalies. Among the most common of these anomalies is the conjoined nerve root. However, it is difficult to diagnose this condition preoperatively. We review the records of 142 patients who underwent microendoscopic discectomy (MED) for herniation of the lumbar disc. All patients had undergone magnetic resonance imaging (MRI) of the lumbar spine before surgery. For most patients, only sagittal and axial images were obtained; coronal images were obtained in only a minority of the patients. Postoperative coronal images were obtained in patients with conjoined nerve roots. A diagnosis of conjoined nerve roots was made intraoperatively in 4 patients; this diagnosis had not been possible preoperatively. After surgery, new coronal images were obtained for the 4 patients with conjoined nerve roots; however, there was no evidence of the condition on the new images. The surgical procedure employed was endoscopic decompression and herniotomy. The results were favorable, even though pediculotomy was not performed. It is difficult to diagnose nerve root anomalies preoperatively. However, the possibility of nerve root anomalies should always be considered during surgery to ensure a safe procedure, without intraoperative occurrence of nerve root injury. (author)

  15. Collateral Adverse Outcomes After Lumbar Spine Surgery.

    Daniels, Alan H; Gundle, Kenneth; Hart, Robert A

    2016-01-01

    Collateral adverse outcomes are the expected or unavoidable results of a procedure that is performed in a standard manner and typically experienced by the patient. Collateral adverse outcomes do not result from errors, nor are they rare. Collateral adverse outcomes occur as the direct result of a surgical procedure and must be accepted as a trade-off to attain the intended benefits of the surgical procedure. As such, collateral adverse outcomes do not fit into the traditional definition of a complication or adverse event. Examples of collateral adverse outcomes after lumbar spine arthrodesis include lumbar stiffness, postoperative psychological stress, postoperative pain, peri-incisional numbness, paraspinal muscle denervation, and adjacent-level degeneration. Ideally, a comparison of interventions for the treatment of a clinical condition should include information on both the negative consequences (expected and unexpected) and potential benefits of the treatment options. The objective evaluation and reporting of collateral adverse outcomes will provide surgeons with a more complete picture of invasive interventions and, thus, the improved ability to assess alternative treatment options. PMID:27049197

  16. Computed Tomography of the lumbar facet joints

    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

    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.

  17. General versus epidural anesthesia for lumbar microdiscectomy.

    Ulutas, Murat; Secer, Mehmet; Taskapilioglu, Ozgur; Karadas, Soner; Akyilmaz, Ahmet Aykut; Baydilek, Yunus; Kocamer, Betul; Ozboz, Ayse; Boyaci, Suat

    2015-08-01

    This study was a retrospective analysis of 850 lumbar microdiscectomy (LMD) under epidural anesthesia (EA; n=573) or general anesthesia (GA; n=277) performed by the same surgeon and paid by invoice to the Social Security Institution of the Turkish Republic between April 2003 and May 2013. Although GA is the most frequently used method of anesthesia during LMD, the choice of regional anesthetia (epidural, spinal or a combination of these) differs between surgeons and anesthetists. Studies have reported that EA in surgery for lumbar disc herniation may be more reliable than GA, as it enables the surgeon to communicate with the patient during surgery, but few studies have compared the costs of these two anesthetic methods in LMD. We found that EA patient costs were significantly lower than GA patient costs (p0.05). The anesthetic method used during LMD affected the complication rate, cost and efficiency of operating room use. We suggest that EA is an anesthetic method that can contribute to health care cost savings and enable LMD to be completed with less nerve root manipulation and more comfort, efficacy, reliability and cost efficiency without affecting the success rate of the surgical procedure. PMID:26067543

  18. Preliminary evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease in Chinese patients

    JIA Yu-hua; SUN Peng-fei

    2012-01-01

    Background There has been some controversy related to the use of the Wallis system,rather than disc fusion in the treatment of patients with degenerative spine disease.Furthermore,there are no reports concerning the application of this dynamic stabilization system in Chinese patients,who have a slightly different lifestyle with Western patients.The aim of this study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases in Chinese patients.Methods The clinical outcomes of 20 patients with lumbar degenerative disease treated by posterior decompression with the Wallis posterior dynamic lumbar stabilization implant were studied.All of the patients completed the visual analogue scale and the Chinese version of the Oswestry Disability Index.The following radiologic parameters were measured in all patients:global lordotic angles and segmental lordotic angles (stabilized segments,above and below adjacent segments).The range of motion was then calculated.Results Nineteen patients (95%) were available for follow-up.The mean follow-up period was (27.25±5.16) months (range 16-35 months).The visual analogue scale decreased from 8.55±1.21 to 2.20±1.70 (P <0.001),and the mean score on the Chinese version of the Oswestry Disability Index was improved from 79.58%±15.93% to 22.17%±17.24% (P <0.001).No significant changes were seen in the range of motion at the stabilized segments (P=0.502) and adjacent segments (above,P=0.453; below,P=0.062).The good to excellent result was 94.4% at the latest follow-up.No complications related to the use of the Wallis posterior dynamic lumbar stabilization occurred.Conclusions It was found to be both easy and safe to use the Wallis posterior dynamic lumbar stabilization implant in the treatment of degenerative lumbar disease,and the early therapeutic effectiveness is good.The Wallis system provides an alternative method for the treatment of lumbar degenerative

  19. ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

    Jefferson Coelho de Léo; Álvaro Coelho de Léo; Igor Machado Cardoso; Charbel Jacob Júnior; José Lucas Batista Júnior

    2015-01-01

    Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the ...

  20. Imaging Characterization Lumbar Disk Hernia in Operated patients.

    Enrique Hernández Padrón

    2009-07-01

    Full Text Available Background: The details of lumbar disk hernia are specifically described in imaging studies, which leads to very specific diagnosis contributing to its appropriate treatment. Objective: To characterize through imaging studies the lumbar disk hernia in operated patients. Methods: Descriptive observational, correlational, retrospective study of a series of cases, carried out in the University Hospital “Dr. Gustavo Aldereguía Lima” of Cienfuegos, from 2000 to 2005, including all the patients who required imaging studies for a suspect of lumbar disk hernia, who received surgical treatment in that institution. The available imaging means were used: spine simple radiography in lumbar area, myelography and computerized axial tomography. Results: Males were more affected by lumbar disk hernia. The most common sings observed through spine simple radiography in lumbar area were: decrease of the intervertebral space and arthrosic changes in the vertebral bodies. Myelography was performed in six patients and three of them were positive. The most common kind of hernia according with their localization was the lateral, and according with the amount of herniated material, the protruded hernia. The most affected spaces were: L5- S1 and L4-L5. The patients of the third and fourth decade of life were the most affected, with a prevalence of the protruded hernia in the L5-S1 y L4 -L5 spaces. Conclusions: The imaging studies contributed to a correct characterization of lumbar disk hernia.

  1. Adverse Event Recording and Reporting in Clinical Trials Comparing Lumbar Disk Replacement with Lumbar Fusion: A Systematic Review.

    Hiratzka, Jayme; Rastegar, Farbod; Contag, Alec G; Norvell, Daniel C; Anderson, Paul A; Hart, Robert A

    2015-12-01

    Study Design Systematic review. Objectives (1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive information when making treatment decisions. Methods A systematic search of PubMed, the Cochrane collaboration database, and the National Guideline Clearinghouse through May 2015 was conducted. Randomized controlled trials with at least 2 years of follow-up comparing lumbar artificial disk replacement with lumbar fusion were included. Patients were required to have axial or mechanical low back pain of ≥3 months' duration due to degenerative joint disease defined as degenerative disk disease, facet joint disease, or spondylosis. Outcomes included the quality of AE acquisition methodology and results reporting, and AEs were defined as those secondary to the procedure and reoperations. Individual and pooled relative risks and their 95% confidence intervals comparing lumbar TDR with fusion were calculated. Results RCTs demonstrated a generally poor description of methods for assessing AEs. There was a consistent lack of clear definition or grading for these events. Furthermore, there was a high degree of variation in reporting of surgery-related AEs. Most studies lacked adequate reporting of the timing of AEs, and there were no clear distinctions between acute or chronic AEs. Meta-analysis of the pooled data demonstrated a twofold increased risk of AEs in patients having lumbar fusion compared with patients having lumbar TDR at 2-year follow-up, and this relative risk was maintained at 5 years. Furthermore, the pooled data demonstrated a 1.7 times greater relative risk of

  2. MRI manifestations of lumbar active inflammation in ankylosing spondylitis

    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, 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)

  3. MEDICINAL INJECTION FOR TREATMENT OF 54 CASES OF LUMBAR STRAIN

    WANG Zhan-hui

    2006-01-01

    @@ Lumbar strain refers to the long-term accumulated mild injuries due to improper posture and overload in soft tissues, such as in lumbar sacral muscle, ligament and fascia. It happens generally at young age, is the common disorder in clinic and leads to quite inconvenience and pain in the life of patient. The author adopted medicinal injection with procaine and Vit. B1 on Tingyaoxue (挺腰穴) to treat 54 cases of lumbar strain and has achieved the remarkable effects. The report is presented as follows.

  4. Discal Cyst of the Lumbar Spine: A Case Report

    Kim, Seong-Hwan; Ahn, Soon-Seob; Choi, Gi-Hwan; Kim, Dae-Hyun

    2012-01-01

    Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent inter...

  5. The lumbar interspinous bursae and Baastrup's syndrome. An autopsy study.

    Bywaters, E G; Evans, S

    1982-01-01

    This study describes the prevalence, distribution, pathology and pathogenesis of lumbar interspinous bursitis (described as a clinical syndrome by Baastrup in 1933). It is based on an anatomic study of 152 lumbar spines derived from routine and random postmortem material, together with selected specimens from autopsies on patients with various rheumatic diseases. From a statistical study of 50 randomly chosen spines, bursae are found when the interspinous distance is small compared with the total height of the lumbar spine ('bursal index'): nearly all bursal spaces show some sign of inflammation and a few show severe bony erosion. Crystal deposits therein are also described. PMID:7178764

  6. Modelo de elementos finitos de la columna lumbar

    Ezquerro Juanco, F.; Simón Mata, A.; Mellado Arjona, E.; Villanueva Pareja, F.

    1999-01-01

    En este trabajo se describe un modelo de Elementos Finitos de la columna lumbar humana. El objetivo buscado es la utilización del mismo como herramienta de investigación aplicada a la cirugía ortopédica de columna lumbar. Para conseguir este objetivo se ha elaborado un modelo no lineal y paramétrico de la columna lumbar completa, el cual puede modificarse con facilidad tanto en su geometría como en sus características mecánicas de modo que puedan reflejarse tanto distintas alte...

  7. Microendoscopic discectomy for treatment of lumbar disc herniation

    ARJUN Sinkemani; WU Xiao-tao

    2015-01-01

    A lumbar microendoscopic discectomy ( MED ) is a minimally invasive surgical technique performed through a tubular device which is designed for the pain relieve caused by herniated discs pressing the nerve roots . In 1997, a new minimally invasive surgical approach for the management of symptomatic lumbar disc herniation , MED was introduced .This technique uses a tubular retractor system and a microendoscope for visualization rather than the operating microscope .However , recent literature suggests that MED is an effective microendoscopic system which has a fine long-term outcome in treating lumbar disc herniation .This article describes the operative tech-niques and outcomes reported in the literature for MED .

  8. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    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

    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

  9. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    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

  10. Grynfelt lumbar hernias. Presentation of a congenital case.

    Cleopatra Cabrera Cuellar

    2006-04-01

    Full Text Available Lumbar hernias are uncommon and are reported rarely, they are informed only few more than 300 in literature and of them only 10 cases are congenital. The hernias that are produced through the superior lumbar space or Grynfelt-Lesshalf´s hernia, are due to the fact that they are more constant and larger they are usually more frequent than the Petit triangle. We are reporting a Newborn infant with the diagnosis of bilateral lumbar hernias and malformation of the vertebral column.

  11. Clinicoradiological Images of a Rare Type of Lumbar Hernia.

    Agarwal, Arjun; Mukherjee, Sujoy; Garg, Cheena

    2015-12-01

    A surgeon will rarely see a case of lumbar hernia in his lifetime. They are usually divided into superior and inferior types, but in cases of huge hernias where anatomical delineation is not possible, they are called as diffuse. Further classification into primary and secondary types (on the basis of etiology) and congenital and acquired types is done. Evisceration in a lumbar hernia can be present due to secondary causes but never spontaneously. This is therefore probably the first reported case of a primary eviscerated diffuse lumbar hernia. PMID:26884669

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

    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.)

  13. Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations

    Alexandre Fogaça Cristante

    2016-05-01

    Full Text Available OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes. Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138. The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.

  14. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients

    Jeong, Ui-Cheol; Sim, Jae-Heon; Kim, Cheol-Yong; Hwang-Bo, Gak; Nam, Chan-Woo

    2015-01-01

    [Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and ...

  15. Kinematic Evaluation of Association between Disc Bulge Migration, Lumbar Segmental Mobility, and Disc Degeneration in the Lumbar Spine Using Positional Magnetic Resonance Imaging

    Hu, Jonathan K.; Morishita, Yuichiro; Montgomery, Scott R.; Hymanson, Henry; Taghavi, Cyrus E.; Do, Duc; Wang, Jeff C.

    2011-01-01

    Degenerative disc disease and disc bulge in the lumbar spine are common sources of lower back pain. Little is known regarding disc bulge migration and lumbar segmental mobility as the lumbar spine moves from flexion to extension. In this study, 329 symptomatic (low back pain with or without neurological symptoms) patients with an average age of 43.5 years with varying degrees of disc degeneration were examined to characterize the kinematics of the lumbar intervertebral discs through flexion, ...

  16. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  17. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  18. Upright positional MRI of the lumbar spine

    Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples

  19. Adjacent Segment Pathology after Lumbar Spinal Fusion.

    Lee, Jae Chul; Choi, Sung-Woo

    2015-10-01

    One of the major clinical issues encountered after lumbar spinal fusion is the development of adjacent segment pathology (ASP) caused by increased mechanical stress at adjacent segments, and resulting in various radiographic changes and clinical symptoms. This condition may require surgical intervention. The incidence of ASP varies with both the definition and methodology adopted in individual studies; various risk factors for this condition have been identified, although a significant controversy still exists regarding their significance. Motion-preserving devices have been developed, and some studies have shown their efficacy of preventing ASP. Surgeons should be aware of the risk factors of ASP when planning a surgery, and accordingly counsel their patients preoperatively. PMID:26435804

  20. Lumbar disc cyst with contralateral radiculopathy

    Kishore Tourani

    2012-08-01

    Full Text Available Disc cysts are uncommon intraspinal cystic lesions located in the ventrolateral epidural space. They communicate with the nucleus pulposus of the intervertebral disc and cause symptoms by radicular compression. We report a unique case of lumbar disc cyst that was associated with disc herniation and contralateral radiculopathy. A 22 year old male presented with one month history of back-ache radiating to the left leg. Magnetic Resonance Imaging (MRI showed L3-L4 disc herniation with annular tear and cystic lesion in the extradural space anterior to the thecal sac on right side, which increased in size over a period of 3 weeks. L3 laminectomy and bilateral discectomy and cyst excision was done with partial improvement of patients symptoms.

  1. Upright positional MRI of the lumbar spine

    Alyas, F.; Connell, D. [London Upright MRI Centre, London (United Kingdom); Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [London Upright MRI Centre, London (United Kingdom); Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom)], E-mail: asif.saifuddin@rnoh.nhs.uk

    2008-09-15

    Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples.

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

    Nam, Ji Eun; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Park, Mi Suk [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional delayed contrast enhanced MR imaging in the assessment of postoperative herniated lumbar disc. Forty-one postoperative herniated lumbar disc (HLD) lesions of 32 patients with back pain were examined with MR imaging (1.5T, Vision, Siemens, Germany). Five-phase dynamic 2D FLASH sagittal images (TR/TE = 118.1msec/4.1msec) were obtained every 19 seconds with a 4 minutes delayed image after contrast injection. As seen on delayed images, the discs were assessed as recurred, fibrosis, or no change. On dynamic images, the pattern of enhancement was evaluated as follows : Type 1 (no change in peripheral disc enhancement between the early and late phases) ; or Type 2 (minimal internal extension of marginal smooth enhancement during the late phase) ; or Type 3 (marked internal extension of peripheral irregular enhancement). Dynamic and delayed imaging were compared, and early epidural space enhancement with rapid wash-out was also evaluated. Of 41 postoperative HLDs, 39 lesions showed peripheral contrast enhancement. Evaluation depended on delayed imaging, and was as follows : recurred HLD (n=27) ; fibrosis (n=5) ; no change in postoperative disc (n=7). On dynamic contrast-enhanced imaging, enhancement patterns were Type 1 (n=29), Type 2 (n=7), and Type 3 (n=3). In 29 Type 1 lesions, there were no significant differences in image findings between dynamic and delayed images. However, in ten lesions (type 2 : n=7, type 3 : n=3), findings additional to those revealed by delayed images were demonstrated by dynamic contrast-enhanced MR imaging. Nine of the ten Type 2 and 3 lesions were diagnosed as recurred HLD. On dynamic images, five lesions showed early epidural space enhancement. Dynamic contrast-enhanced lumbar spine MR imaging provided additional findings such as increased peripheral disc enhancement, and epidural space enhancement, which cannot be detected on

  3. Minimally invasive lumbar decompression-the surgical learning curve.

    Kim, Choll W

    2016-08-01

    Commentary On: Ahn J, Iqbal A, Manning BT, Leblang S, Bohl DD, Mayo BC, et al. Minimally invasive lumbar decompression-the surgical learning curve. Spine J 2016:16:909-16. (in this issue). PMID:27545398

  4. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans;

    2007-01-01

    registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS...

  5. Lumbar hernia misdiagnosed as a subcutaneous lipoma: a case report

    Amelio Gianfranco

    2009-12-01

    Full Text Available Abstract Introduction Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Case presentation We report the case of a 40-year-old Caucasian woman with a superior lumbar hernia (Grynfeltt hernia initially misdiagnosed as a recurrent lipoma. The correct diagnosis was made intra-operatively and the hernia was repaired using synthetic mesh. The patient was free of recurrence at 4 months after the operation. Conclusion A lumbar or flank mass should always raise suspicion of a lumbar hernia. Ultrasound and computed tomography may confirm the diagnosis. Adequate surgical treatment should be planned on the basis of etiology and hernia size. Both open and laparoscopic techniques can be used with good results.

  6. Lumbar stabilization: core concepts and current literature, Part 1.

    Barr, Karen P; Griggs, Miriam; Cadby, Todd

    2005-06-01

    The factors that affect lumbar stability have been an area of extensive research. The clinical application of this research in the form of lumbar stabilization exercise programs has become a common treatment of low back pain and is also increasingly used by athletes to improve performance and by the general public for health and the prevention of injury. This article includes a review of the key concepts behind lumbar stabilization. The literature regarding how those with low back pain differ in their ability to stabilize the spine from those without low back pain is discussed, and an overview of current research that assesses the benefits of a lumbar stabilization program to treat low back pain is provided. PMID:15905663

  7. Imaging evaluation strategy of spinal interbody fusion%对脊柱椎间融合的影像学评价策略

    高志强; 李洋; 罗飞

    2015-01-01

    背景:椎间融合是脊柱外科常用的修复方式,融合失败会导致多种并发症。对融合的正确判断非常重要。目前临床常使用影像学方法对融合情况进行判断。在评价融合时,X射线片、CT、MRI等检查手段拥有各自特殊的方法、特点,从而导致了其在敏感性、特异性等方面存在诸多差异。  目的:综述影像学检查手段在脊柱椎间融合评价中的研究进展。  方法:以英文关键词“lambar fusion,cervical fusion,interbody fusion,evaluation method”为检索词,在PubMed 数据库中进行检索。筛选出对椎间融合方法进行详细描述的文献进行综述,包含影像学手段的多种评价方法的对比研究。  结果与结论:依据纳入标准及排除标准,共入选40篇文献进行综述。X射线片和CT是使用最为广泛的判定手段,CT的判断结果更加可靠。MRI、骨扫描等其他影像学检查无法准确、直接的对脊柱融合情况进行评价。综合判断症状、体征和各种影像资料是更为合理的脊柱椎间融合评价策略。%BACKGROUND:Interbody fusion is widely used in spine surgeries. Failed fusion may cause many complications, so it is very important to evaluate fusion before surgery. Imaging methods are commonly used to evaluate fusion, including X ray, CT and MRI. Above methods have their own specific methods and characteristics, which cause their differences in sensibility and specificity. OBJECTIVE:To review the research progress of imaging methods in interbody fusion. METHODS:The English key words were“lambar fusion, cervical fusion, interbody fusion, evaluation method”in the PubMed database. The literatures with detailed description of interbody fusion were selected for further review, including comparative study on a variety of evaluation methods of imaging means. RESULTS AND CONCLUSION:According to the inclusion criteria and exclusion criteria, a total of 40

  8. Functional connectivity separates switching operations in the posterior lateral frontal cortex

    Stelzel, C.; Basten, U.; Fiebach, C.J.

    2011-01-01

    Task representations consist of different aspects such as the representations of the relevant stimuli, the abstract rules to be applied, and the actions to be performed. To be flexible in our daily lives, we frequently need to switch between some or all aspects of a task. In the present study, we ex

  9. Lumbar spinal canal size of sciatica patients

    Hurme, M.; Alaranta, H.; Aalto, T.; Knuts, L.R.; Vanharanta, H.; Troup, J.D.G. (Turku City Hospital (Finland). Dept. of Surgery; Social Insurance Institution, Turku (Finland). Rehabilitation Research Centre; Helsinki Univ. (Finland). Dept. of Physical Medicine and Rehabilitation; Liverpool Univ. (UK). Dept. of Orthopaedic and Accident Surgery)

    Seven measures at the three lowest lumbar interspaces were recorded from conventional radiographs of the lumbar spines of 160 consecutive patients with low back pain and sciatica admitted for myelography and possible surgery. Eighty-eight patients were operated upon for disc herniation, and of the conservatively-treated 72 patients, 18 had a pathologic and 54 a normal myelogram. The results were evaluated after one year using the occupational handicap scales of WHO. Correlations of radiographic measures to stature were moderate and to age small. After adjusting for stature and age, only the male interpedicular distances and the antero-posterior diameter of intervertebral foramen at L3 were greater than those of females. The males with a pathologic myelogram had smaller posterior disc height at L3 and a smaller interarticular distance at L3 and L4 than those with normal myelogram, likewise the midsagittal diameter at L3 and L4 in females. In all patients other measures besides posterior disc height were smaller than those for low back pain patients (p<0.001) or for cadavers (p<0.001). The only correlation between measures and clinical manifestations was between pedicular length at L3 and limited straight leg raising. Where the disc material had been extruded into the spinal canal, the interpedicular distance was significantly wider. Only anterior disc height at L3 revealed differences between good and poor outcome one year after surgery, as did the interarticular distance at S1 in patients with normal myelogram after conservative treatment. (orig.).

  10. Chronic inflammatory demyelinating polyneuropathy mimicking a lumbar spinal stenosis syndrome.

    Ginsberg, L; Platts, A. D.; Thomas, P K

    1995-01-01

    A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) established by biopsy developed cauda equina symptoms due to swelling of the nerve roots in the lumbar spinal canal. Magnetic resonance imaging of the lumbar spine showed profoundly thickened nerve roots from the level of the conus medullaris, filling the caudal thecal sac. Immunosuppressant treatment produced partial clinical and radiological resolution. This case shows that spinal compressive syndromes may occur in acqu...

  11. Presentation of a Rare Case of Bilateral Lumbar Synovial Cysts

    Konstantinos Violaris; Maria Karakyriou

    2012-01-01

    Purpose: To report a quite rare case of bilateral symptomatic synovial cysts of the lumbar spine. Surgical resection is usually the cure for this condition. Methods: A 65 year old female patient came to our department, complaining for severe lumbar and sciatic pain. MRI and CT were used to diagnose bilateral synovial cysts. Because of the intensity of symptoms, she was subjected to surgery. Laminectomy and cyst resection were performed. Results: The patient showed complete resolution of pain ...

  12. A comparative morphometric study of the hominid lumbar spine.

    Martelli, S. A.

    2005-01-01

    This thesis investigates the size/shape variation in the lumbar spine of extant and fossil hominoids. As a novelty, 3D coordinate data sets were obtained from the last five consecutive presacral vertebrae for comparative analyses. Size/shape variation of single vertebrae and patterns of metameric size/shape variation along the lumbar spine are investigated. Large samples of populations of Homo sapiens, Gorilla gorilla, Pan troglodytes, and Pongo pygmaeus are investigated. The fossil sample in...

  13. The effect of breast shielding during lumbar spine radiography:

    Žontar, Dejan; Škrk, Damijan; Mekiš, Nejc

    2013-01-01

    Background The aim of the study was to determine the influence of lead shielding on the dose to female breasts in conventional x-ray lumbar spine imaging. The correlation between the body mass index and the dose received by the breast was also investigated. Materials and methods Breast surface dose was measured by thermoluminescent dosimeters (TLD). In the first phase measurements of breast dose with and without shielding from lumbar spine imaging in two projections were conducted on an anthr...

  14. Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

    Salih Kalay

    2011-09-01

    Full Text Available Cerebral edema resulting in elevated intracranial pressure is a well-known complication of galactosemia. Lumbar puncture was performed for the diagnosis of clinically suspected bacterial meningitis. Herniation of cerebral tissue through the foramen magnum is not a common problem in neonatal intensive care units because of the open fontanelle in infants. We present the case of a 3-week-old infant with galactosemia who presented with signs of cerebellar herniation after lumbar puncture.

  15. Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

    Salih Kalay; Osman Öztekin; Gönül Tezel; Hakan Demirtaş; Mustafa Akçakuş; Nihal Oygür

    2011-01-01

    Cerebral edema resulting in elevated intracranial pressure is a well-known complication of galactosemia. Lumbar puncture was performed for the diagnosis of clinically suspected bacterial meningitis. Herniation of cerebral tissue through the foramen magnum is not a common problem in neonatal intensive care units because of the open fontanelle in infants. We present the case of a 3-week-old infant with galactosemia who presented with signs of cerebellar herniation after lumbar puncture.

  16. Accuracy of physical examination for chronic lumbar radiculopathy

    Iversen, Trond; Solberg, Tore; Romner, Bertil; Wilsgaard, Tom; Nygaard, Øystein Petter; Waterloo, Knut; Brox, Jens Ivar; Ingebrigtsen, Tor

    2013-01-01

    Background: Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Methods: A total of 116 patients referred with symptoms of lumbar r...

  17. Bias in the physical examination of patients with lumbar radiculopathy

    Katz Jeffrey N; Hunter David J; Suri Pradeep; Li Ling; Rainville James

    2010-01-01

    Abstract Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI) on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent...

  18. Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

    Shin Ahn; Young Sang Ko; Kyung Soo Lim

    2013-01-01

    Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-o...

  19. Arterio-venous fistula following a lumbar disc surgery

    Thanyani V Mulaudzi; Sikhosana, Mbokeleng H

    2011-01-01

    Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tr...

  20. Lumbar intervertebral disc degeneration and related factors in Korean firefighters

    Jang, Tae-Won; Ahn, Yeon-Soon; Byun, Junsu; Lee, Jong-In; Kim, Kun-Hyung; KIM, YOUNGKI; Song, Han-Soo; Lee, Chul-Gab; Kwon, Young-Jun; Yoon, Jin-Ha; Jeong, Kyoungsook

    2016-01-01

    Objectives The job of firefighting can cause lumbar burden and low back pain. This study aimed to identify the association between age and lumbar intervertebral disc degeneration and whether the association differs between field and administrative (non-field) firefighters. Methods Subjects were selected using a stratified random sampling method. Firefighters were stratified by geographic area, gender, age and type of job. First, 25 fire stations were randomly sampled considering regional dist...

  1. Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages o...

  2. Kidney herniation through lumbar triangle following open pyeloplasty

    Qais Al Hooti; Abdulsalam Taher Ahmed Saleh; Ali Bin Mahfooz; Mohammed Aslam; Maher Moazin

    2014-01-01

    Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild ...

  3. Imaging Characterization Lumbar Disk Hernia in Operated patients.

    Enrique Hernández Padrón; Félix Dueñas Ros

    2009-01-01

    Background: The details of lumbar disk hernia are specifically described in imaging studies, which leads to very specific diagnosis contributing to its appropriate treatment. Objective: To characterize through imaging studies the lumbar disk hernia in operated patients. Methods: Descriptive observational, correlational, retrospective study of a series of cases, carried out in the University Hospital “Dr. Gustavo Aldereguía Lima” of Cienfuegos, from 2000 to 2005, including all the patients who...

  4. Lumbar herniation following extended autologous latissimus dorsi breast reconstruction

    Fraser, Sheila Margaret; Fatayer, Hiba; Achuthan, Rajgopal

    2013-01-01

    Background Reconstructive breast surgery is now recognized to be an important part of the treatment for breast cancer. Surgical reconstruction options consist of implants, autologous tissue transfer or a combination of the two. The latissimus dorsi flap is a pedicled musculocutaneous flap and is an established method of autologous breast reconstruction. Lumbar hernias are an unusual type of hernia, the majority occurring after surgery or trauma in this area. The reported incidence of a lumbar...

  5. Kidney herniation through lumbar triangle following open pyeloplasty

    Qais Al Hooti

    2014-01-01

    Full Text Available Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild pain.

  6. Laparoscopic surgery for treatment of incisional lumbar hernia

    M. Tobias-Machado; Freddy J. Rincon; Marco T. Lasmar; Zambon, Joao P; Roberto V. Juliano; Eric R. Wroclawski

    2005-01-01

    OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following rele...

  7. Neutral lumbar spine sitting posture in pain-free subjects

    O'Sullivan, Kieran; O'Dea, Patrick; Dankaerts, Wim; O'Sullivan, Peter; Clifford, Amanda; O'Sullivan, Leonard

    2010-01-01

    Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP o...

  8. Ruling out Piriformis Syndrome before Diagnosing Lumbar Radiculopathy

    Chi-Chien Niu

    2009-04-01

    Full Text Available Background: Piriformis syndrome (PS, a rare cause of sciatica, is usually diagnosed onlyafter excluding all other possibilities. But this principle is being challengedbecause of the number of patients with PS who have had ineffective lumbardecompressive surgery after positive findings on image study.Methods: From 2001 to 2004, twelve patients with piriformis syndrome diagnosed byphysical examination were retrospectively enrolled in this study. Indicatorsof piriformis syndrome include a positive Freiberg sign and local tendernessover the piriformis tendon. All patients received local injection of triamcinoloneacetonide and lidocaine into the piriformis tendon. The course ofdiagnosis and treatment was reviewed retrospectively from patient recordsand patient recollections.Results: Of seven (58.3% patients who had positive findings on computed tomography(CT or magnetic resonance imaging (MRI studies of the lumbar spine,four had previously undergone unsuccessful lumbar surgeries but wereresponsive to local injection and three received the injection first. Two ofthose three required no lumbar discectomy thereafter. However, one patientsubsequently underwent lumbar decompression surgery because of failedresponse to the local injection. Three patients had negative CT or MRI findings,and two received no CT or MRI study. According to our diagnosticflowchart for PS, further lumbar surgery was unnecessary for eleven of thetwelve patients at follow-up.Conclusions: According to experience in this series, a Freiberg test and local injectionshould be performed first to rule out PS in patients with unilateral sciatica. Ifsymptoms are relieved by local injection and further physical therapy for PS,unnecessary lumbar surgery can be avoided.

  9. Ossification of the posterior longitudinal ligament of the lumbar spine

    The ossification on the cervical posterior longitudinal ligament (OPLL) is widely known and studied in Japan where a roentgenological incidence of 2.6% adults affected has been found. Data concerning the ossification of the lumbar posterior longitudinal ligament are few and occasional. An epidemiological survey on lumbar OPLL was performed by the authors in Matsumoto, Japan, on a total of 972 subjects, 554 of whom over the age of 35, by means of X-ray of the lumbar spine. Ossification of the lumbar posterior longitudinal ligament was detected in 23 subjects (2.9%), with no significant difference between males (3.0%) and females (2.8). Lumbar OPLL was absent in the 238 subjects aged less than 34; it was most prevalent after the age of 45 (5.1% in males and 4.5% in females). The ossification developed in two ways: continuous ossified layer extending over several vertebrae; circumscribed ossification of the ligament corresponding to the level of the invertebral disk (retrodiscal type). The results of this epidemiological survey showed a roentgenological incidence of lumbar OPLL of the same magnitude than that of cervical OPLL

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

    Endres Stefan

    2011-11-01

    Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients

  11. Postural Cueing to Increase Lumbar Lordosis Increases Lumbar Multifidus Activation During Trunk Stabilization Exercises: Electromyographic Assessment Using Intramuscular Electrodes.

    Beneck, George J; Story, John W; Donald, Shelby

    2016-04-01

    Study Design Controlled laboratory study, repeated-measures design. Background Diminished multifidus activation and cross-sectional area are frequent findings in persons with low back pain. Increasing lumbar lordosis has been shown to increase activation of the multifidus with a minimal increase in activation of the long global extensors during unsupported sitting. Objectives To examine the influence of postural cueing to increase lumbar lordosis on lumbar extensor activation during trunk stabilization exercises. Methods Thirteen asymptomatic participants (9 male, 4 female) were instructed to perform 6 trunk stabilization exercises using a neutral position and increasing lumbar lordosis. Electrical activity of the deep multifidus and longissimus thoracis was recorded using fine-wire intramuscular electrodes. The mean root-mean-square of the electromyography (EMG) signal obtained during each exercise was normalized to a maximum voluntary isometric contraction (MVIC). A 2-way, repeated-measures analysis of variance (posture by exercise) was performed for each muscle. Results When averaged across the 6 exercises, postural cueing to increase lumbar lordosis resulted in greater multifidus EMG activity compared to performing the exercises in a neutral posture (35.3% ± 15.1% versus 29.5% ± 11.2% MVIC). No significant increase in longissimus thoracis EMG activity was observed when exercising with cueing to increase lumbar lordosis. Conclusion This study suggests that postural cueing to increase lumbar lordosis during trunk stabilization exercises may better promote multifidus activation than traditional stabilization exercises alone. Future studies are needed to determine whether increasing lumbar lordosis improves multifidus activation in persons with low back pain. J Orthop Sports Phys Ther 2016;46(4):293-299. Epub 8 Mar 2016. doi:10.2519/jospt.2016.6174. PMID:26954268

  12. Biomechanical effect of altered lumbar lordosis on intervertebral lumbar joints during the golf swing: a simulation study.

    Bae, Tae Soo; Cho, Woong; Kim, Kwon Hee; Chae, Soo Won

    2014-11-01

    Although the lumbar spine region is the most common site of injury in golfers, little research has been done on intervertebral loads in relation to the anatomical-morphological differences in the region. This study aimed to examine the biomechanical effects of anatomical-morphological differences in the lumbar lordosis on the lumbar spinal joints during a golf swing. The golf swing motions of ten professional golfers were analyzed. Using a subject-specific 3D musculoskeletal system model, inverse dynamic analyses were performed to compare the intervertebral load, the load on the lumbar spine, and the load in each swing phase. In the intervertebral load, the value was the highest at the L5-S1 and gradually decreased toward the T12. In each lumbar spine model, the load value was the greatest on the kypholordosis (KPL) followed by normal lordosis (NRL), hypolordosis (HPL), and excessive lordosis (EXL) before the impact phase. However, results after the follow-through (FT) phase were shown in reverse order. Finally, the load in each swing phase was greatest during the FT phase in all the lumbar spine models. The findings can be utilized in the training and rehabilitation of golfers to help reduce the risk of injury by considering individual anatomical-morphological characteristics. PMID:25162173

  13. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report. Hernia lumbar congénita asociada a síndrome lumbocostovertebral. Reporte de un caso.

    Yusimy Izaguirre Martínez; Guillermo Cortiza Orbe; Zoe Quintero Delgado

    2005-01-01

    Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

    Se reporta el caso de una paciente de color de piel blanca, ...

  14. Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

    DING Wen-yuan; YANG Da-long; CAO Lai-zhen; SUN Ya-peng; ZHANG Wei; XU Jia-xin; ZHANG Ying-ze; SHEN Yong

    2011-01-01

    Background Degenerative lumbar scoliosis is common in older patients.Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis.A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed.The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.Methods From January 2001 to August 2010,96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls.Cobb angle,height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides,the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group.The height of L2/L3,L3/L4,L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group.The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups.The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results In scoliosis group,the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001 ).The vertebral body height on the convex side was greater than the height on the concave side (P=0.016).There was a significant difference between the scoliosis group and the control group (P=0.003),and between T-value and the rate of osteoporosis between the two groups (both P <0.001).Results were verified using multiple linear regression analysis.Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and

  15. Management of lumbar zygapophysial (facet) joint pain

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Falco, Frank JE; Boswell, Mark V

    2016-01-01

    AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain. METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V

  16. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

    Manchikanti L

    2012-08-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati,1 Ramsin Benyamin3,41Pain Management Center of Paducah, Paducah, KY; 2University of Louisville, Louisville, KY; 3Millennium Pain Center, Bloomington, IL; 4University of Illinois, Urbana-Champaign, IL, USAAbstract: Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures, the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management

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

    C. López Carballo; S. Vázquez del Valle; M. Garrido García; J. Pico Veloso; R. Valle Yáñez; M. J. Bermúdez López; F. J. Pardo-Sobrino López

    2013-01-01

    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 alternativa, que ...

  18. Magnetic resonance imaging of normal lumbar intervertebral discs

    Objective was to study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed. (author)

  19. Bias in the physical examination of patients with lumbar radiculopathy

    Katz Jeffrey N

    2010-11-01

    Full Text Available Abstract Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent group' with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'. The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ≤ 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1 provocative testing, 2 motor strength testing, 3 pinprick sensory testing, and 4 deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05. Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered

  20. REHABILITATION OF LUMBAR HYPERLORDOSIS THROUGH SWIMMING-SPECIFIC EXERCISES

    Petrea Renato-Gabriel

    2014-12-01

    Full Text Available The purpose of this paper is to show the importance and utility of swimming within rehabilitation and therapeutic programs for posture deficiencies, in our context for the rehabilitation of lumbar hyperlordosis. We consider that, by using exercises specific to swimming and means specific to acquiring swimming procedures, we will reduce the range of lumbar hyperlordosis. More precisely, we believe that, through exercises specific to swimming, we will reduce the range of lumbar hyperlordosis by at least 15 mm. Our study comprise three subjects (young girls, who suffer from lumbar hyperlordosis. For establishing the diagnostic, the following examinations and tests took place: anamnesis; somatoscopy; somatometry; muscular testing; specific tests (Schõber, “finger-floor”. The therapeutic program applied included the following: exercises for learning and consolidating the swimming procedures of crawl, backstroke, breaststroke and butterfly. The rehabilitation program lasted five months and a half; we had two sessions per week, each session of 35-40 minutes; water temperature ranged between 29 and 31 degrees Celsius. Initial testing showed that the lordosis amplitude was 70 mm for subject A.B., 60 mm for subject R.A. and 55 mm for subject S.A. At the end of research the results of the lordosis amplitude were 52 mm for subject A.B., 45 mm for subject R.A. and 40 mm for subject S.A. The conclusion of this study underlines that the early and correct intervention through individualized rehabilitation programs for lumbar hyperlordosis leads to a decrease in the lumbar curvature, down to physiological values. In addition, the means used for acquiring and consolidating swimming procedures can constitute important means in the rehabilitation process for lumbar hyperlordosis.

  1. The Clinical Characteristics and Treatment of Far Lateral Lumbar Disc Herniation%极外侧型腰椎间盘突出症的临床特征及治疗

    孟增东; 胡彪; 雷云坤; 李俊昌; 刘思波; 陈一沧

    2011-01-01

    Objective To study the clinical characteristics of far lateral lumbar disc herniation (FLLDH) and the appropriate operation way. Methods Thirteen patients with far lateral disc herniation were divided into two types by the place of herniated disc, that was foraminal disc herniation and extraforaminal disc herniation. The patients with foraminal disc herniation were treated with posterior lumbar interbody fusion (PLIF) while the patients with extraforaminal disc herniation were treated with intertransverse approach discectomy (IAD). Results All cases were observed for 6 to 24 months (average 18 months). Clinical outcomes were assessed by Macanab and Visual Analogue Score ( VAS). The postoperative overall excellent and good rate wre 92.31%. The average preoperative leg pain VAS score was 8 points, 1.4 points after surgery, low back pain VAS score was 1.6 points before surgery, 1 points after surgery. Conclusions The patients with far lateral lumbar disc herniation should be treated with different operations according to its types, choosing a appropriate operative way is a key to get satisfactory result.%目的 探讨极外侧型腰椎间盘突出症的临床特征和术式选择.方法 13例极外侧型腰椎间盘突出症患者中,椎间孔内型8例,椎间孔外型5例.分别采用单侧后路椎板减压、切除关节突关节、摘除椎间盘,并进行后路椎间植骨融合内固定手术和横突间入路单纯摘除椎间盘手术.结果 13例患者均获得随访,平均随访18个月.疗效按照Macanab分级和VAS评定:本组优8例,良4例,可1例,差0例,总优良率92.31%.术前腿痛平均VAS评分为8分,术后为1.4分,术前腰痛VAS评分为1.6分,术后为1分.结论 对椎间孔内型采用单侧后路椎板减压、髓核摘除间植骨融合内固定术;对椎间孔外型,采用横突间入路单纯摘除椎间盘术疗效满意.

  2. Reoperation factors and treatment strategies for posterior lumbar intervertebral disc herniation%腰椎椎间盘突出症再手术因素及治疗策略

    吴伟平; 刘宝戈; 江建明

    2011-01-01

    Objective To discuss the reoperation factors, surgical treatment strategies, and the treatment outcomes of patients with posterior lumbar intervertebral disc herniation. Methods A total of 73 patients with posterior lumbar intervertebral disc herniation who underwent reoperation during January 2007 to June 2010 after primary lumbar discectomy with or without instrument fixation were retrospectively studied. Reoperation was performed by discectomy with unilateral laminactomy in 14 cases, hemilaminactomy decompression in 11 cases, discectomy with total laminactomy in 6 cases, posterior lumbar interbody fusion ( PLIF ) in 40 cases, and revision surgery with failed instrument in 2 cases. Results After a follow-up of 21 months ( ranging 6-44 months ), complications were found in 14 cases; the Oswestry disability index ( ODI )and visual analog scale ( VAS ) scores were both significantly improved after operation ( P<0.05 ). ODI was decreased from ( 63. 26 ±5. 36 )% before operation to ( 19. 68 ± 8. 42 ) % 3 months after operation. VAS score was decreased from 7. 26 ± 2.06 before operation to 3. 68 ± 1. 22 3 months after operation. Conclusion The major reoperation factors for posterior lumbar intervertebral disc surgery include intraoperative segment malpositioning, residual nucleus pulposus, sequestered intervertebral disc, adjacent segment degeneration, inadequate decompression, lumbar instability and instrumentation failure. Satisfactory effectiveness of reoperation can be obtained by proper operation time and surgery strategies.%目的 探讨腰椎椎间盘突出症再手术的因素,以及手术治疗的方法和疗效.方法 回顾分析2007年1月~2010年6月收治的腰椎椎间盘突出症再手术病例共计73例,再手术方式为单侧椎板开窗椎间盘切除术14例,半椎板切除减压椎间盘切除术11例,全椎板切除减压椎间盘切除术6例,后路腰椎椎间盘切除联合椎体间植骨融合术40例,内固定翻修2例.结果

  3. Endoscopic posterior decompression of lumbar canal stenosis

    Yad Ram Yadav

    2013-01-01

    Full Text Available Lumbar canal stenosis (LCS is quite common. Surgery is indicated when patient fails to improve after conservative treatment. Endoscopic technique can be used in LCS and lateral recess stenosis. It can be performed in degenerative canal stenosis or with disc bulges. Bilateral severe bony canal stenosis and unstable spine are the contraindications. This procedure should be avoided in patients with a history of trauma. Detailed history and thorough physical examination should be performed to find out exact level of pathology responsible for symptoms. Patient′s symptoms must correlate with radiological findings. Magnetic resonance imaging is the investigation of choice because of its superior visualization of soft-tissue. Computed tomography scan does give a more accurate and detailed picture of the bony anatomy. Although the operative time and the complication rate could be more in the initial learning curve, the results of endoscopic decompression are comparable with conventional open procedures with the additional benefit of decreased complications and lower morbidity, when sufficient experience is gained. Complications in endoscopic surgery for LCS could be dural tears, hematomas and root and facet injury. This procedure is also associated with limitations such as steep learning curve and the contra lateral decompression may not be as good as ipsilateral side. Some of the limitations of this technique can be overcome by attending live operative workshop, practice on models and hands on cadaveric dissection. Conversion to an open procedure may be required when there is disorientation, management of dural tear and for control of bleeding.

  4. Lumbar puncture refusal in febrile convulsion.

    Ling, S G; Boey, C C

    2000-10-01

    A descriptive study was carried out on patients admitted for febrile convulsion over a two-year period to determine rate of lumbar puncture (LP) refusal, factors associated with LP refusal and outcome of such patients. From 77 patients indicated and requested for LP, 19 (25%) patients refused the procedure. Refusal of LP was significantly more common among the Malay ethnic group (p = 0.01) but not significantly associated with age,gender or whether the patient was admitted for a first or recurrent febrile convulsion. Half of the patients who refused LP had to be started empirically on antibiotics for meningitis. Patients who refused LP were also 8.5 times more likely to discharge themselves "at own risk" (AOR), compared to other patients with febrile convulsion (p = 0.004). In conclusion, LP refusal is a common problem in the local setting and is a hindrance to the proper management of patients with fever and seizure. Appropriate measures must be carried out to educate the public, particularly those from the Malay ethnic group on the safety and usefulness of the procedure. Reasons for patients discharging AOR following LP refusal also need to be addressed and problems rectified. PMID:11281439

  5. Fractures of the thoraco-lumbar spine.

    Lifeso, R M; Arabie, K M; Kadhi, S K

    1985-08-01

    A personal prospective study of 98 consecutive patients presenting with neurological impairment and fractures or dislocations between the 9th thoracic and 2nd lumbar vertebrae bodies. Fifty-three patients underwent Harrington instrumentation, and 45 patients were treated recumbently. Neurological improvement was much better following Harrington rods in the complete paraplegia group but there was no difference in neurological recovery between the two groups in those with incomplete paraplegia. Forty-two patients who had been stabilised with Harrington rods underwent post-operative myelography or tomography to assess the adequacy of spinal decompression. The best results were in patients with adequate neural canal decompression. In 21 cases decompression had not been adequate, usually due to a stereotyped pattern in which the postero-superior aspect of the fractured body remained in the neural canal. All 21 underwent anterior decompression at an average of five months post injury. All the incomplete anterior decompression at an average of five months post injury. All the incomplete paraplegics (nine patients) regained the ability to walk, three of the 12 complete paraplegics improved and regained the ability to walk with bilateral ankle-foot orthoses. Neurological improvement was dependent upon the adequacy of spinal cord decompression and not upon Harrington rods. per se. Harrington rods alone were not adequate to decompress the spinal canal in 50 per cent of cases. The best results after anterior decompression occurred where neural compression was caused by a minimally displaced wedge fracture distal to T12. PMID:4047711

  6. 3-D MRI for lumbar degenerative diseases

    Three-dimensional (3-D) magnetic resonance (MR) images obtained from 10 patients with lumbar degenerative diseases were retrospectively reviewed to determine how far 3-D MR imaging is capable of demonstrating nerve roots. In 8 of the 10 patients, the area up to the dorsal root ganglion was visualized on 3-D MR images. Thus, it is capable of detecting a wide area of nerve roots, thereby allowing the determination of running of nerve root, and size and location of dorsal root ganglion. In delineating the area from the dural canal to root cyst, 3-D MR imaging was equal to conventional myelography. The former was superior to the latter in detecting the positional relation between the degenerative intervertebral disc and the nerve root, and herniation-compressed root cyst. In 3 of 9 patients who presented with root symptoms, disturbed nerve roots were of high signal on 3-D MR images. This may suggest that it has the potential for selectively detecting root nerves associated with clinical manifestations. (N.K.)

  7. Congenital lumbar hernia associated to lumbar costovertebral syndrome. A case report. Hernia lumbar congénita asociada a síndrome lumbocostovertebral. Reporte de un caso.

    Yusimy Izaguirre Martínez

    2005-12-01

    Full Text Available Reported the case of a born patient of color of white skin, 6 years old, of pregnancy and normal childbirth that it was valued in the Service of Surgery of the Pediatric Hospital ¨Paquito González Cueto¨ because it presented increase of volume in both lumbar regions, without another associate sintomatology. Congenital bilateral lumbar hernia associated to syndrome lumbocostovertebral, strange affection in the pediatric age.

    Se reporta el caso de una paciente de color de piel blanca, de 6 años de edad, nacida de embarazo y parto normal que fue valorada en el Servicio de Cirugía del Hospital Pediátrico ¨Paquito González Cueto¨ debido a que presentaba aumento de volumen en ambas regiones lumbares, sin otra sintomatología asociada. Se diagnostica hernia lumbar bilateral congénita asociada a síndrome lumbocostovertebral, afección rara en la edad pediátrica.

  8. Para-muscular and trans-muscular approaches to the lumbar inter-vertebral foramen: an anatomical comparison Acessos paramuscular e transmuscular ao forame intervertebral lombar: comparação anatômica

    Arthur Werner Poetscher

    2005-03-01

    Full Text Available Foraminal and extra-foraminal disc herniations comprise up to 11.7% of all lumbar disc herniations. Facetectomy, which had been the classic approach, is now recognized as cause of pain and instability after surgery. Otherwise, posterior lateral approaches through a trans-muscular or a para-muscular technique offer no significant damage to key structures for spinal stability. The surgical anatomy of these approaches has already been described, but they were not compared. In order to quantify the angle of vision towards the intervertebral foramen offered by each technique, 12 fresh cadavers were dissected and studied regarding these approaches. The angle presented by trans-muscular approach was wider in all studied lumbar levels. Surgery through the trans-muscular approach is performed with a better working angle, requiring a smaller resection of surrounding tissues. Therefore, minor surgical trauma can be expected. Our measurements support previously published data that point the trans-muscular approach as the best surgical option.As hérnias de disco lombares apresentam-se como foraminais ou extra-foraminais em até 11,7% dos casos. Seu tratamento cirúrgico através de facetectomias pode causar dor e instabilidade, o que não ocorre com a utilização de acessos cirúrgicos posteriores laterais ao canal central, quer seja por via transmuscular ou paramuscular. Nosso objetivo foi comparar o ângulo de trabalho relativo ao forame intervertebral permitido por cada via e avaliar possíveis implicações cirúrgicas. Dissecções e medidas realizadas em doze cadáveres frescos demonstraram que este ângulo é maior na via transmuscular em todos os níveis lombares estudados. Dado que um ângulo mais favorável permite uma ressecção menor das estruturas envolvidas para que se estabeleça o campo de trabalho, a cirurgia por meio da via transmuscular permitirá, então, um trauma cirúrgico menor. Nossos resultados corroboram publicações pr

  9. Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

    Saleem, Shafaq; Aslam, Hafiz Muhammad; Rehmani, Muhammad Asim Khan; Raees, Aisha; Alvi, Arsalan Ahmad; Ashraf, Junaid

    2013-01-01

    Study Design Cross sectional and observational. Purpose To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. Overview of Literature Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration ...

  10. THE EFFECT OF POSTERIOR ELEMENT RESECTION ON THE STRESS DISTRIBUTION IN THE LUMBAR SPINE

    戴力扬; 成培来; 屠开元; 徐印坎; 张文明

    1995-01-01

    A three-dimenslonal finite element model of the lumbar motion segment was used to predict the stress distribution in lumbar spine with posterior element resection. It was shown that the stress level in all parts of the lumbar spine was elevated although the stress distribution remalned unchanged. The authors concluded that the posterior element resectlcal in lumbar surgery should he avoided as much as possible.

  11. Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Xu, Kai; Chen, Chun; Shan-dong HUANG; Zhang, Ying; Qing-shui YIN

    2011-01-01

    Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and ...

  12. LUMBAR LORDOSIS IN ASYMPTOMATICS SUBJECTS AND PATIENTS WITH CHRONIC LOW BACK PAIN

    Mousavi, S.J.; MOHAMMAD REZA NOURBAKHSH

    2003-01-01

    Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP) has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar l...

  13. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    Altinkaya, Naime [Baskent University Medical School, Department of Radiology, Adana (Turkey); Cekinmez, Melih [Baskent University Medical School Adana, Department of Neurosurgery, Adana (Turkey)

    2016-01-15

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  14. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  15. Effect of total lumbar disc replacement on the treatment of discogenic low lumbar pain: preliminary outcomes

    LI Zhi-yu; HAN Xiao; MA Sai; TIAN Wei

    2013-01-01

    Background Lumbar pedicle screw fixation and fusion are major procedures for treating discogenic low back pain (DLBP).However,due to its advantages of preserving the segmental motion and biomechanical simulation,artificial total lumbar disc replacement (TDR) is increasingly popular.Methods From 2007 to 2010,68 DLBP patients were enrolled.TDR were performed on 34 patients and the other 34 controls underwent the traditional fixation procedure.Qualitative and quantitative evaluations were followed including the changes in range of motion (ROM) and interpedicle height (IPH) at the posterior intervertebral body of operated level,in 6 and 12 months,and 3 years,postoperatively.Results Qualitative results showed satisfying improvement in the two groups after 6 and 12 months,respectively,and the inter-group differences were significant (P >0.05).The results of ROM and IPH have shown significant differences between the TDR and spinal fusion groups (P <0.05).Conclusion With similar clinical improvements as the traditional spinal fusion method,TDR offered significantly better ROM and intervertebral foramen height.

  16. Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

    Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery

  17. Mechanical contribution to lumbar stress injuries in female gymnasts.

    Hall, S J

    1986-12-01

    Because female gymnasts as a group display higher than average incidences of stress-related pathologies of the lumbar spine, it was of interest to evaluate mechanical factors which are potential contributors. Lumbar hyperextension and impact forces were quantified for performances of five commonly executed gymnastics skills by four competitive collegiate women gymnasts. The skills performed were the front walkover, the back walkover, and the front handspring, the back handspring, and the handspring vault. Wielke's (1983) radius method was used to quantify lumbar curvatures from film data during normal relaxed standing postures and during subject performances of the five selected skills. A force platform was used to monitor vertical and lateral ground reaction forces at the terminations of the respective skill performances. Of the skills examined, the handspring vault produced the highest vertical and lateral impact forces, and the back handspring and back walkover required the greatest amounts of lumbar hyperextension. During the front and back walkovers and during the back handspring, maximum lumbar hyperextension occurred very close to the time that impact force was sustained by either the hands or the feet. PMID:3784872

  18. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

    戴力扬; 徐印坎

    1998-01-01

    ObjectS. To investigate the biomechanical aspects of etiology, pathology, clinical manifestation, diagnosis and surgical treatment of the lumbar spinal stenosis. Methods. A series of biomechanical methods, such as three-dimensional finite element models, threedimensional kinematic measurement, cadeveric evaluation, and imaging assessment was applied to correlate lumbar biomechanics and lumber spinal stenosls. Surgery of lumber spinal stenosis has been improved. Results.The stresses significantly concentrate on the posterolateral part of the annulus fibrcsms of disc, the posterior surface of vertebral body, the pedlcle, the interarticularis and the beet joints. This trend is intensified by disc degeneration and lumber backward extension. Posterior elcxnent resection has a definite effect upon the biomechanical behavior of lumbar vertebrae. The improved operations proved satisfactory. Conclusion. Stress concentration in the lumber vertebrae is of importance to the etiology of degenerative lumbar spinal stenosls, and disc degeneratkm is the initial key of this process. Than these will be aggravatnd by backward extension. Functloval radiography and myelography are of assistance to the diagnosis of the lumhar spinal stenosls. For the surgcal treatment of the lumber spinal stenosis, destruction of the posterior element should be avoid as far as possible based upon the thorough decmnpression. Maintaining the lumbar spine in flexion by fusion after decorapression has been proved a useftd method. When developmental spinal stenoals is combined with disc herniation, discectoray through laminotomy is recommend for decompression.

  19. Microsurgical approach to lumbar synovial cysts. Technical notes.

    Cipri, S; Cafarelli, F; Ielo, A; Gambardella, G

    2004-03-01

    Intraspinal extradural synovial cysts are quite common in the lumbar spine. With respect to clinical presentation and surgical treatment, juxta-facet cysts (ganglion and synovial cysts) share identical characteristics and results. Nowadays, current treatment strategies of intraspinal juxta-facet cysts continue to inspire controversy regarding appropriate surgical approaches, and include many technical options. The purpose of this report is to illustrate the advantage of minimally invasive approaches in 3 cases of lumbar synovial cysts. We performed a small flavectomy in the 1st case, a transarticular partial facectomy, followed by etherologous bone graft fusion in the 2nd case, and a flavectomy and partial facectomy in the 3rd case. In our cases, a microsurgical approach to lumbar synovial cysts yielded to complete excision of the lesions and excellent pain relief, with early mobilization and hospital discharge of the patients. In our opinion, minimally invasive approaches and microsurgical excision of lumbar juxta-facet cysts are advantageous over conventional lumbar laminectomy because they reduce later development of segmental instability at the operative level, and therefore a less invasive strategy for intraspinal synovial cysts removal should be recommended. PMID:15257263

  20. Lumbar Stenosis: A Recent Update by Review of Literature.

    Lee, Seung Yeop; Kim, Tae-Hwan; Oh, Jae Keun; Lee, Seung Jin; Park, Moon Soo

    2015-10-01

    Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome. PMID:26435805

  1. Midline lumbar ganglion/synovial cyst mimicking an epidural tumor: case report and review of pathogenesis.

    Azzam, C J

    1988-08-01

    A case of a midline lumbar extradural ganglion/synovial cyst causing lumbar canal stenosis and mimicking an epidural tumor is presented. The lesion was demonstrated by a magnetic resonance imaging study, and relief of symptoms was achieved with decompressive laminectomy and total removal of the mass. The pathogenesis of lumbar ganglion/synovial cyst is reviewed. PMID:2972941

  2. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

    Mukhergee G. S

    2016-06-01

    Full Text Available BACKGROUND Spinal stenosis is one of the most common conditions in the elderly. It is defined as a narrowing of the spinal canal. The term stenosis is derived from the Greek word for narrow, which is “Stenos”. The first description of this condition is attributed to Antoine portal in 1803. Verbiest is credited with coining the term spinal stenosis and the associated narrowing of the spinal canal as its potential cause. [1-10] Kirkaldy–Willis subsequently described the degenerative cascade in the lumbar spine as the cause for the altered anatomy and pathophysiology in spinal stenosis. [11-15] If compression does not occur, the canal should be described as narrow but not stenotic. Some studies defined lumbar spinal stenosis as a “narrowing of the osteoligamentous vertebral canal and/or the intervertebral foramina causing compression of the thecal sac and/or the caudal nerve roots; at a single vertebral level, narrowing may affect the whole canal or part of it” (Postacchini 1983. This definition distinguished between disc herniation and stenosis. [16] . The most common type of spinal stenosis is caused by degenerative arthritis of the spine. Hypertrophy and ossification of the posterior longitudinal ligament which usually are confined to the cervical spine, and diffuse idiopathic skeletal hyperostosis (DISH syndrome also may result in an acquired form of spinal stenosis. Congenital forms caused by disorders such as achondroplasia and dysplastic spondylolisthesis are much less common. Congenital spinal stenosis usually is central and is evident or imaging studies. Idiopathic congenital narrowing usually involves the anteroposterior dimension of the canal secondary to short pedicles; the patient otherwise is normal. In contrast, in achondroplasia, the canal is narrowed in the anteroposterior plane owing to shortened pedicles and in lateral dimension because of diminished interpedicular distance. Acquired forms of spinal stenosis usually are

  3. Lumbar motion changes in chronic low back pain patients

    Mieritz, Rune M; Hartvigsen, Jan; Boyle, Eleanor;

    2014-01-01

    /SETTING: Secondary analysis of a subset of participants from a randomized clinical trial. PATIENT SAMPLE: 199 study participants with low back pain of more than six weeks' duration who had spinal motion measures obtained before and after the period of intervention. OUTCOME MEASURES: Lumbar region spinal kinematics...... sampled using a six-degree-of-freedom instrumented spatial linkage system. METHODS: Trained therapists collected regional lumbar spinal motion data at baseline and at 12 weeks follow up. The lumbar region spinal motion data were analyzed as a total cohort and relative to treatment modality (high...... half, the motion parameters included in the analysis. The spinal manipulation group changed to a smoother motion pattern (reduced jerk index) while the exercise groups did not. CONCLUSION: This study provides evidence that spinal motion changes can occur in chronic low back pain patients over a 12-week...

  4. Manual therapy treatment of lumbar radiculopathy: A single case report

    J.A. Riley

    2011-01-01

    Patients  with  lumbar  radiculopathy  are  often  managed with  manual therapy.  The  aim  of  this  single  case  study  was  to  describe  the outcome of manual therapy treatment of a patient with lumbar radiculopathy.  A 47-year-old female presented with acute, severe left buttock and postero-lateral thigh pain.  Symptom provocation occurred during lumbar flexion, coughing, sneezing, driving and prolonged sitting. her left straight leg raise neurodynamic test was limited and reproduced he...

  5. Spinal CT scan, 2. Lumbar and sacral spines

    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  6. [Endovascular repair of iliocaval arteriovenous fistula complicating lumbar disc surgery].

    Ben Jemaa, H; Maalej, A; Lazzez, K; Jemal, H; Karray, S; Ben Mahfoudh, K

    2016-05-01

    Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful. PMID:26920402

  7. Treatment of lumbar disc herniation: Evidence-based practice

    Andrew J Schoenfeld

    2010-07-01

    Full Text Available Andrew J Schoenfeld1, Bradley K Weiner21Department of Orthopedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Weill Cornell Medical College and The Methodist Hospital, Houston, TX, USAClinical question: What is the best treatment for lumbar disc herniations? Results: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function.Implementation: While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.Keywords: lumbar disc, herniation, back pain, spine

  8. Clinical study of CT discography for the lumbar disc herniation

    Sakamoto, Tadashi (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1990-08-01

    The purpose of this clinical study was to introduce technique for correct positioning of the needle into the center of the disc for discography by means of CT analysis and also to clarify usefulness of CT discography for diagnosis of the lumbar disc herniation. We have taken CT analysis in order to determine correct place and the angle of inserting the needle. This measurement provides easy needle insertion. Unless the needle tip places center of disc, discogram false positive or negative will occur as a result. The materials of this study are 222 discs of 105 cases with the lumbar disc herniation. Comparative study of the findings among myelography, discography and CT discography was investigated. The results indicated that CT discography demonstrates the most clear findings and is useful in the diagnosis of lumbar disc herniation, especially in obtaining detailed observation of herniated discs. (author).

  9. Sensitivity of lumbar spine loading to anatomical parameters

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John;

    2016-01-01

    models for four different postures. The in uence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine were studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force...... were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most in uential. The results indicated that measuring these parameters from X-rays would be most important to morph an existing musculoskeletal...... lumbar spine model for a subject-specic approach with respect to bone geometry. Furthermore, degeneration processes could lead to computational problems and it is advised that stiffness properties of discs and ligaments should be individualized....

  10. [Acute rupture of lumbar intervertebral disc caused by violent manipulation].

    Li, J S

    1989-08-01

    Five cases of acute rupture of lumbar intervertebral disc caused by violent manipulation are reported. After protrusion of the lumbar intervertebral disc were treated by violent manipulation, the lumbo-leg pain were severe suddenly. The operations found that the annulus fibrosus had ruptured and the nerve root or cauda equina was constricted by the nucleus pulposus which had entered into the spinal canal. It must be emphasized that their is in danger of more damaging intervertebral disc degenerated by violent manipulation, then the adhesion of the nerve root will occur gradually. We don't suggest to make violent manipulation for the patient with the nerve root injured. We have acquired good results in treating protrusion of lumbar intervertebral disc by combined therapy and they are introduced in this article. PMID:2620603

  11. Rate-dependent fracture characteristics of lumbar vertebral bodies.

    Stemper, Brian D; Yoganandan, Narayan; Baisden, Jamie L; Umale, Sagar; Shah, Alok S; Shender, Barry S; Paskoff, Glenn R

    2015-01-01

    Experimental testing incorporating lumbar columns and isolated components is essential to advance the understanding of injury tolerance and for the development of safety enhancements. This study incorporated a whole column axial acceleration model and an isolated vertebral body model to quantify compression rates during realistic loading and compressive tolerance of vertebrae. Eight lumbar columns and 53 vertebral bodies from 23 PMHS were used. Three-factor ANOVA was used to determine significant differences (pmechanics between vertebral bodies obtained from males and females demonstrated non-significant trends, with female vertebral bodies having lower ultimate force that would be associated with decreased injury tolerance. This was likely a result of smaller vertebrae in that population. Combined with existing literature, results presented in this manuscript contribute to the understanding of lumbar spine tolerance during axial loading events that occur in both military and civilian environments with regard to effects of compression rate and gender. PMID:25154535

  12. Effect of RF internal fixation system combined with Cage on the reduction and functional recovery of lumbar vertebra in patients with lumbar vertebral slippage%RF与Cage联合应用对腰椎滑脱患者椎体复位及腰椎功能恢复的作用

    王瑞; 靳安民; 宋富立; 童斌辉; 张辉

    2004-01-01

    ).INTERVENTIONS: After 45 cases of lumbar vertebral slippage underwent the treatment of RF internal fixation system combined with cage, The Oswestry disability Index was used to evaluate the curative effect; radiograph and laminal CT scanning were used to observe the reduction of lumbar vertebrae and intervertebral fusion postoperatively.RESULTS: The clinical symptom remission rate was 88.8% at 3 months and 95.5% at 6 months postoperatively. The lumbar interbody fusion rate was 92.2% at 6 months, and 95.5% at 12 -24 months postoperatively. Postoperative complication: 1 case of implant sinkage and pseudarthrosis was found.CONCLUSION: The RF internal fixation system combined with cage can make reduction, restore of anatomical structure and fixation function of lumbar vertebrae, improve intervertebral fusion, maintain height of intervertebral space and restore capacity of nerve root, which hereby can relieve pain and improve function of the lumbar vertebrae.

  13. 中国首例可视化人体与正常人腰神经根的椎间行程及其毗邻关系%Intervertebral route of lumbar nerve root in relation to adjacent tissues in the first Chinese visible human and normal human

    游箭; 张绍祥; 邱明国; 李七渝; 陈伟; 陆明

    2005-01-01

    disk herniation recently. Posterior lateral route is often employed. Puncture route was investigated by the application of anatomic methods previously. However, there are relative fewer reports regarding the observation of the route of lumbar nerve root in intervertebral plane and triangle working area from thin section anatomy and CT section anatomy.OBJECTIVE: To clarify the intervertebral route and its adjacent relationship of lumbar nerve root on thin section and CT section to provide a anatomic gist for puncture route in PLDD.DESIGN: An observational study based on corpus and normal individual.SETTING: Department of radiology of a military medical university of Chinese PLA affiliated hospital and the department of anatomy of a military medical university of Chinese PLA.PARTICIPANTS: The collection of the first Chinese visible human was completed in the Department of Anatomy(laboratory of computer medicine) the Faculty of Medicine, Third Military Medical University of Chinese PLA in October 2002. Totally 53 subjects without confirmed vertebral and intervertebral disc diseases and other diseases of the adjacent organs received CT examination and measurement in the Department of Radiology of the Third Military Medical University of Chinese PLA Affiliated Southwest Hospital between january and March 2000.INTERVENTIONS: The intervertebral route of lumbar nerve root in the first Chinese visible human was observed descriptively. The route, morphology, size, adjacent structure, and the distance between puncture line and lumbar nerve in 53 normal individuals were observed and measured by CT.MAIN OUTCOME MEASURES: To describe the intervertebral route of lumbar nerve root in the first CVH and normal individual, to measure the intervertebral length and width of lumbar nerve, and the distance between puncture line and lumbar nerve.RESULTS: The first Chinese visible human lumbar has 48 layers of intervertebral space with a thickness of each layer of 1.0 mm. The route and

  14. Genetic association studies in lumbar disc degeneration: a systematic review.

    Pasi J Eskola

    Full Text Available OBJECTIVE: Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI in humans. METHODS: A systematic literature search was conducted in MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database and The Human Genome Epidemiology Network for information published between 1990-2011 addressing genes and lumbar disc degeneration. Two investigators independently identified studies to determine inclusion, after which they performed data extraction and analysis. The level of cumulative genetic association evidence was analyzed according to The HuGENet Working Group guidelines. RESULTS: Fifty-two studies were included for review. Forty-eight studies reported at least one positive association between a genetic marker and lumbar disc degeneration. The phenotype definition of lumbar disc degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with a weak level of evidence. The level of evidence was moderate for ASPN (D-repeat, COL11A1 (rs1676486, GDF5 (rs143383, SKT (rs16924573, THBS2 (rs9406328 and MMP9 (rs17576. CONCLUSIONS: Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Clear definition of lumbar disc degeneration phenotypes and large population-based cohorts are needed. An international consortium is needed to standardize genetic association studies in relation to disc degeneration.

  15. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  16. Lumbo-Costo-Vertebral Syndrome with Congenital Lumbar Hernia

    Lucky Gupta

    2014-02-01

    Full Text Available Lumbo-costo-vertebral syndrome (LCVS is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

  17. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)

    2006-09-15

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  18. Laparoscopic management of a traumatic lumbar hernia: about a case

    Vandermeulen, Morgan; Detry, Olivier

    2015-01-01

    Traumatic Lumbar hernia (TLH) is a very rare clinical entity with about 100 cases reported worldwide. It is a difficult challenge when encountered and there is no consensus on the best management: early or delayed, open or laparoscopic. We report the clinical case of a 28-year-old man who suffered from a TLH after a 6- meter-high fall. The diagnosis was based on CT imaging showing a defect in the postero-lateral abdominal wall by disinsertion of the lumbar origin of transverse, internal a...

  19. Lumbo-Costo-Vertebral Syndrome with Congenital Lumbar Hernia

    Lucky Gupta; Tariq Ahmed Mala; Rahul Gupta; Shahid Amin Malla

    2014-01-01

    Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side...

  20. Lumbar corpectomy for correction of degenerative scoliosis from osteoradionecrosis reveals a delayed complication of lumbar myxopapillary ependymoma.

    Palejwala, Sheri K; Lawson, Kevin A; Kent, Sean L; Martirosyan, Nikolay L; Dumont, Travis M

    2016-08-01

    Osteoradionecrosis is a known complication following radiation therapy, presenting most commonly in the cervical spine as a delayed consequence of radiation that is often necessary in the management of head and neck cancers. In contrast, osteoradionecrosis has rarely been described in the lumbar spine. Here we describe, to our knowledge, the first reported case of lumbar spine osteoradionecrosis, after adjuvant radiation for a primary spinal cord tumor, leading to progressive degenerative scoliosis which required subsequent operative management. Established guidelines recommend that mature bone can tolerate a dose of up to 6000 cGy without injury. However, once bone has been exposed to radiation over this level progressive soft tissue changes may lead to devascularization, leaving the bone vulnerable to osteonecrosis, specifically when manipulated. Radiation necrosis can be progressive and lead to eventual mechanical instability requiring debridement and surgical fixation. In the setting of the lumbar spine, osseous necrosis can lead to biomechanical instability, deformity, pain, and neurologic deficit. PMID:27056674

  1. Application of percutaneous endoscopic RF/holmium laser lumbar discectomy in the lumbar disc herniation (attach 160 cases reported)

    Objective: To evaluate the efficacy of endoscopic discectomy for the lumbar disc herniation and to determine the prognostic factors affecting surgical outcome. Methods: In the group of 160 cases, posterolateral and trans-interlaminar endoscopic Ho: YAG laser and radio frequency-assisted disc excisions were performed under local anesthesia. Results: In 160 patients with post-surgical follow-up period was 15 months on average (7 ∼ 24 months). Based on the MacNab criteria, there were 117 cases in which result was excellent, in 19 cases good, in 12 cases fair, and in 12 cases poor, and successful rate was 85%. Conclusion: Percutaneous endoscopy lumbar discectomy is effective for recurrent disc herniation in the selected. In applies in particular to the traditional open surgery of lumbar disc herniation in patients with recurrent. (authors)

  2. MRI of the lumbar spine. Technical aspect. T2-weighted fat saturation coronal dynamic MRI of the lumbar spine

    Assess the feasibility of 'dynamic' MRI of the lumbar spine and study the parameters of a single MRI sequence favorable for simultaneous imaging of the meningeal space and the epidural and foraminal venous system. Favor a decline in the number of sacco-radiculograms. Clinical assessment in the following circumstances: discordant clinical and and radiographic findings, difficulty in interpreting single or multiple disc-root conflicts, preoperative work-up in cases of narrow or stenotic lumbar canal. Dynamic MRI of the lumbar spine is possible if the hypothesis that the hyper-lordosis obtained in the supine position creates an anatomic and radiographic situation identical to the hyper-lordosis induced by the upright position is accepted. The 'radiculo-phlebographic' sequence gives images of the root sheaths and the epidural, foraminal and extra-foraminal veins simultaneously, particularly in the coronal plane. (authors)

  3. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY (L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION

    Sahiba Yadav; Megha Arora Nijhawan; Paresh Panda

    2014-01-01

    Background: Various manual therapy techniques are known to treat discogenic pain. Research is limited and controversial in the effectiveness of manual therapy for treatment of lumbar radiculopathy due to lumbar disc disease. In manual therapy, Mulligan has described spinal mobilisation with leg movement technique, for improvement in lumbar lesion resulting in pain and other signs below knee. Purpose of the study: To find out if Mulligan’s Spinal Mobilisation with Leg Movement technique (...

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

    Michaelis Martina; Luttmann Alwin; Linhardt Oliver; Hofmann Friedrich; Haerting Johannes; Grifka Joachim; Elsner Gine; Ditchen Dirk; Ellegast Rolf; Jäger Matthias; Bergmann Annekatrin; Seidler Andreas; Petereit-Haack Gabriela; Schumann Barbara; Bolm-Audorff Ulrich

    2009-01-01

    Abstract Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically ve...

  5. Hallazgos degenerativos de columna lumbar en resonancia magnética de pacientes con dolor lumbar Edgar

    González Rodríguez, Edgar Iván

    2013-01-01

    El resumen es una presentación abreviada y precisa (la NTC 1486 de 2008 recomienda Introducción: Entre los padecimientos que mayor impacto genera en la población económicamente activa en todo el mundo se encuentra el dolor lumbar bajo también conocido como lumbago, lumbalgia o lumbociatalgia. Metodología: Estudio descriptivo retrospectivo de pacientes adultos con dolor lumbar y hallazgos degenerativos en RM. Resultados: La edad promedio fue de 50.8 años. El 86% de los pacientes...

  6. Bioresorbable cage for interbody fusion Progress in research and clinical application%可吸收椎间融合器的理论研究及临床应用

    孙浩林; 李淳德

    2008-01-01

    险带来了相应技术的发展.结论:可吸收椎间融合器的研究和应用仍处于起步阶段,但现有的研究结果已经预示了其进一步研究和临床应用发展前景.%BACKGROUND: The use of interbody cages is rapidly increasing in filed of spinal fusion surgery. The inherent limitations of conventional cages such as cage migration or failure, radiopacity, fusion stress shielding, late-onset inflammation and osteolysis give some impetus for the development of bioresorbable cages. Compared with conventional cages, they show better rigidity and elasticity coefficient, with less interference on the imaging evaluation. OBJECTIVE: To introduce the materials classification and property, animal studies, clinical application, current drawbacks and future directions of bioresorbable fusion cages, and provide objective evidences for the research and clinical application of the cages.RETRIEVAL STRATEGY: The relevant articles published between December 1990 and December 2006 were searched for in Pubmed database by the researchers of this article, with the key words "bioresorbable cages, spine, SCI" in English. A total of 550 articles were selected and reviewed preliminarily by the inclusive standards of: research about materials, animal studies and clinical application of bioresorbable cages. Exclusion criteria: repetitive studies.LITERATURE EVALUATION: The main sources of literatures are researches about materials, animal studies and clinical application of bioresorbable cages. Among the 27 selected articles, 1 is review, while others are clinical or elementary experimental studies. DATA SYNTHESIS: ①Materials: Polylactides becomes the most useful and applied base material for bioresorbable spinal interbody cages; characteristics of bioresorbable materials include crystallinity, average molecular weight, molecular weight distribution (polydispersity), and glass transition temperature. There are also several points to consider in the design of

  7. MASTERS-D Study: A Prospective, Multicenter, Pragmatic, Observational, Data-Monitored Trial of Minimally Invasive Fusion to Treat Degenerative Lumbar Disorders, One-Year Follow-Up

    Manson, Neil; Buzek, David; Kosmala, Arkadiusz; Hubbe, Ulrich; Rosenberg, Wout; Pereira, Paulo; Assietti, Roberto; Martens, Frederic; Lam, Khai; Barbanti Brodano, Giovanni; Durny, Peter; Lidar, Zvi; Scheufler, Kai; Senker, Wolfgang

    2016-01-01

    The objective of the study is to assess effectiveness and safety of minimally invasive lumbar interbody fusion (MILIF) for degenerative lumbar disorders (DLD) in daily surgical practice and follow up with patients for one year after surgery. A prospective, multicenter, pragmatic, monitored, international outcome study in patients with DLD causing back/leg pain was conducted (19 centers). Two hundred fifty-two patients received standard of care available in the centers. Patients were included if they were aged >18 years, required one- or two-level lumbar fusion for DLD, and met the criteria for approved device indications. Primary endpoints: time to first ambulation (TFA) and time to surgery recovery (TSR). Secondary endpoints: patient-reported outcomes (PROs)--back and leg pain (visual analog scale), disability (Oswestry Disability Index (ODI)), health status (EQ-5D), fusion rates, reoperation rates, change in pain medication, rehabilitation, return to work, patient satisfaction, and adverse events (AEs). Experienced surgeons (≥30 surgeries pre-study) treated patients with DLD by one- or two-level MILIF and patients were evaluated for one year (NCT01143324). At one year, 92% (233/252) of patients remained in the study. Primary outcomes: TFA, 1.3 ±0.5 days and TSR, 3.2 ±2.0 days. Secondary outcomes: Most patients (83.3%) received one level MILIF; one (two-level) MILIF mean surgery duration, 128 (182) min; fluoroscopy time, 115 (154) sec; blood loss, 164 (233) mL; at one year statistically significant (P<.0001) and clinically meaningful changes from baseline were reported in all PROs--reduced back pain (2.9 ±2.5 vs. 6.2 ±2.3 at intake), reduced leg pain (2.2 ±2.6 vs. 5.9 ±2.8), and ODI (22.4% ± 18.6 vs. 45.3% ± 15.3), as well as health-related quality of life (EQ-5D index: 0.71 ±0.28 vs. 0.34 ±0.32). More of the professional workers were working at one year than those prior to surgery (70.3% vs. 55.2%). Three AEs and one serious AE were considered

  8. CT of postoperative lumbar disk herniation

    Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47,7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4,7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19,5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply furthere resolutive diagnostic elements, while Myelo-CT sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often

  9. Ergonomic lumbar risk analysis of construction workers by NIOSH method

    Cinara Caetano Pereira

    2015-09-01

    Full Text Available Work in construction has tasks directly connected with manual transport. One of the body segments suffering greater demand in works with these characteristics is the lumbar spine segment. The aim of this study was to analyze the level of risk of lumbar construction workers in the shipment of materials. The sample was composed of 74 construction workers. Were used as a research tool: the NIOSH method for lumbar risk verification expressed by weight limit recommended (WPR and the lifting Index (IL, Visual analogue scale (VAS for the evaluation of pain intensity, the e-1 Corlett.0 for the mapping of the pain and Borg to the subjective perception of the intensity of physical exertion. The present study identified the weight limit (WP of 8.707 for management activity of bags of cement for the load of 8.194 wheelbarrows used. These findings are 6 times under actual weights handled during the activities that revolve around 50 kg with the sacks and averaged 49.72 kg stands with mass. The dimensional settings found in the search are at high risk for ergonomic lumbar region, and measures of reconfiguration of workplaces and operation of auxiliary devices for lifting, transporting and unloading are fundamental, in addition to the need for reflection about the current logistical problems that induce producers to supply the cement sacks with 50 kg.

  10. GRAVITATIONAL THERAPY IN COMPLEX TREATMENT OF LUMBAR OSTEOCHONDROSIS PATIENTS

    I. E. Poverennova; A.K. Povelikhin; G.P. Kotelnikov; E.S. Mikhaylina

    2009-01-01

    A new technique- gravitational therapy- has been used in complex therapy of patients with lumbar osteochondrosis. The substantiation of application of gravitational therapy in case of this pathology is presented. Indications and contraindications to the treatment, technical parameters of procedure are pointed out. Treatment results are considered in comparison with traditional therapy.

  11. Introducing new implants and imaging techniques for lumbar spinal stenosis

    Moojen, Wouter Anton

    2014-01-01

    The main objective of this thesis is to compare bony decompression with implantation of interspinous process devices (IPDs) in patients with intermittent neurogenic claudication (INC) caused by lumbar spinal stenosis (LSS). A national survey among Dutch spine surgeons is presented about the usual ca

  12. A method for quantitative measurement of lumbar intervertebral disc structures

    Tunset, Andreas; Kjær, Per; Samir Chreiteh, Shadi;

    2013-01-01

    There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MR...

  13. A radiological study on lumbar disc herniation in Korean

    Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

  14. Lumbar radiculopathy caused by a tunneling transvertebral Schmorl's node

    We report a rare case of lumbar spinal radiculopathy caused by a tunneling Schmorl's node originating from the superior endplate of the L3 vertebra of a 75-year-old patient and penetrating the spinal canal through the posterior wall of this vertebra. This case highlights recent reports emphasizing the clinical pain syndromes possibly associated with Schmorl's nodes. (orig.)

  15. Accuracy of physical examination for chronic lumbar radiculopathy

    Iversen, Trond; Solberg, Tore K; Romner, Bertil; Wilsgaard, Tom; Nygaard, Øystein; Waterloo, Knut; Brox, Jens I; Ingebrigtsen, Tor

    2013-01-01

    Background Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain. Method...

  16. Surgical treatment in thoraco-lumbar region fractures.

    Jorge Alberto Jerez Labrada

    2008-08-01

    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.

  17. Spontaneous regression of lumbar herniated disc Case presentation

    Chiriac A.

    2015-12-01

    Full Text Available Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  18. Residents’ Lumbar Puncture Skills after Simulation-Based Education

    J Gordon Millichap

    2012-01-01

    Researchers in the Departments of Medicine and Neurology at Northwestern University Feinberg School of Medicine, Chicago, IL evaluated the effect of simulation-based mastery learning (SBML) on internal medicine residents’ lumbar puncture (LP) skills, assessed neurology residents’ acquired LP skills from traditional clinical education, and compared the results of SBML to traditional clinical education.

  19. Adjacent level disease following lumbar spine surgery: A review

    Nancy E Epstein

    2015-01-01

    Conclusions: The incidence of postoperative ASD (up to 30% is greater following either open or MIS instrumented lumbar fusions (e.g., TLIF/PLIF, while decompressions with noninstrumented fusions led to a much smaller 5.6% risk of ASD. Other findings included: MIS instrumented fusions contributed to higher perioperative complication rates, and dynamic stabilization did not protect against ASD.

  20. Lumbar spinal mobility changes among adults with advancing age

    Ismaila Adamu Saidu

    2011-01-01

    Conclusion : Using these data, we developed normative values of spinal mobility for each sex and age group. This study helps the clinicians to understand and correlate the restrictions of lumbar spinal mobility due to age and differentiate the limitations due to disease.

  1. Acupuncture Treatment of 32 Cases of Lumbar Intervertebral Disc Protusion

    CHEN Feng; WANG Si-you

    2003-01-01

    Yaoyangguan ( GV 3 ), Shiqizhui ( Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment.

  2. A generic detailed rigid-body lumbar spine model

    De Zee, Mark; Hansen, Lone; Wong, Christian;

    2007-01-01

    The objective of this work is to present a musculo-skeletal model of the lumbar spine, which can be shared and lends itself to investigation in many locations by different researchers. This has the potential for greater reproducibility and subsequent improvement of its quality from the combined e...

  3. Treatment of Acute Lumbar Sprain by Acupuncture plus Cupping

    WANG Jun-ying; WANG Si-you

    2003-01-01

    Fifty cases of acute lumbar sprain were treated by the combination of acupuncture, cupping and kinesitherapy. Forty-three cases were cured and 7 cases improved, the total effective rate being 100%. This therapy has an exact effect with a short course of treatment.

  4. Laparoscopic surgery for treatment of incisional lumbar hernia

    M. Tobias-Machado

    2005-08-01

    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  5. Lumbar hernia: a rare cause of large bowel obstruction

    Hide, I; Pike, E; Uberoi, R

    1999-01-01

    We describe a 70-year-old woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. This was diagnosed on barium enema and successfully treated surgically.


Keywords: hernia; intestinal obstruction; colon

  6. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    Sandén Bengt

    2009-07-01

    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  7. Kinematics of the lumbar spine : clinical significance of lateral X-rays of the lumbar spine in anteflexion and retroflexion in healthy individuals, in cases of symptomatic herniated lumbar disc diseases and of spondylolisthesis

    M.W. Berfelo

    1989-01-01

    textabstractAbout half of the population of the Netherlands suffers at some stage in their life from low back pain (Haanen, 1984) ; clinical examination of the lumbar spine is a matter of daily routine. X-Rays of the lumbar spine are taken in order to detect morphological changes that may be respons

  8. 椎间盘镜技术微创治疗多节段腰椎间盘突出症%Microendoscopic Discectomy for Minimally Invasive Treatment of Multi-segmental Lumbar Disc Herniation

    张卫红; 王闯建; 张晓博; 朱旭; 吴学建

    2015-01-01

    Objective To evaluate the operation method and clinical efficacy of the minimally invasive treatment of multi-segmen-tal lumbar disc herniation using microendoscopic discectomy. (MED). Methods 52 patients (23 male and 29 female) with age rang-ing from 30~71 years and an average of 53.1 years and with multi-segmental lumbar disc herniation were treated with microendo-scopic discectomy through posterior approach in our hospital between October, 2012 and October 2014. The course of disease ranged from 4 months to 21 years (average, 3.7 years) There were 39 cases of biarticulate intervertebral disk protrusion and 13 cases of triarticular intervertebral disk protrusion. 11 cases with lumbar vertebra mobilization were treated with fully closed-expan-sion type posterior lumbar interbody fusion under endoscope. The clinical efficacy was evaluated according to Macnab criteria. Results After operation, all the patients were followed up for 3~24 months with an average of 11 months. The duration of biarticu-late intervertebral disk protrusion was 50~80 min with an average of 60 min. The duration of those who underwent fully closed-ex-pansion type posterior lumbar interbody fusion increased by 10-30 min with an average of 20min. The amount of bleeding was 50~1 000mL, averaging 300 ml; bleeding of internal vertebral vein was the most common one. Patients can take exercise moderately with waist brace after 3 to 7 days; and the average time of hospitalization was 12 days. Efficacy: 38 cases (73.1%) were remark-able, 10 cases (19.2%) were good, 4 cases (7.7%) were not so well. Postoperative complications: There were 3 cases of dural tear, with no complications such as nerve injury and cage migration. Conclusion Decompression, removal of intervertebral disc and im-plantation of fusion device can be done effectively by microendoscopic discectomy through posterior approach, which is with small trauma and can minimize its infulence on the stability of lumbar spine.%目的:评价椎

  9. Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

    Lumbar total disc replacement (TDR) was developed to treat a painful degenerative lumbar motion segment while avoiding the disadvantages of fusion surgery, such as adjacent segment instabilities. Early clinical results with TDR have shown a significant reduction in low back pain and a significant improvement in disability scores. When compared to fusion, the results with TDR tend to be superior in the short-term follow-up and initial rehabilitation is faster. The radiological assessment is an integral part of the preoperative work-up. Plain X-rays of the lumbar spine should be complemented by flexion - extension views in order to assess residual segmental mobility. Computed tomography is used to exclude osteoarthritis of the zygapophyseal joints, Baastrup's disease (kissing spines) and other sources of low back pain. Magnetic resonance imaging is useful to exclude substantial disc protrusions; it allows for the detection of disc dehydration and bone marrow edema in the case of activated spondylochondrosis. If osteoporosis is suspected, an osteodensitometry of the lumbar spine should be performed. Postoperative plain X-rays should include antero-posterior and lateral views as well as flexion - extension views in the later postoperative course. Measurements should determine the disc space height in the lateral view, the segmental and total lumbar lordosis as well as the segmental mobility in the flexion - extension views. The ideal position of a TDR is exactly central in the ap-view and close to the dorsal border of the vertebral endplates in the lateral view. Malpositioning may cause segmental hyperlordosis and unbalanced loading of the endplates with the risk of implant subsidence and migration. (orig.)

  10. The Lumbar Lordosis in Males and Females, Revisited.

    Ori Hay

    Full Text Available Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females.Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height.Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined.Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis. The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

  11. Diagnostic challenge: bilateral infected lumbar facet cysts - a rare cause of acute lumbar spinal stenosis and back pain

    Yoon S Timothy; Bui Tuan L; Freedman Brett A

    2010-01-01

    Abstract Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5) cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.

  12. Diagnostic challenge: bilateral infected lumbar facet cysts - a rare cause of acute lumbar spinal stenosis and back pain

    Yoon S Timothy

    2010-03-01

    Full Text Available Abstract Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5 cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.

  13. CLINICAL APPLICATION OF "LUMBAR THREE-POINT NEEDLING" IN TREATMENT OF LUMBAR AND BUTTOCK DISEASES

    王黎; 赖新生

    2001-01-01

    "Lumbar three-point needling", meaning puncturing Shenshu (BL 23), Dachangshu (BL 25) and Ciliao(BL 32) at the same time, is a commonly used acupuncture method in the treatment of lumbocrural diseases. Points supplemented according to symptoms. Weizhong(BL 40) is supplemented for lumbar vertebra hypertrophy spondylitis; Weizhong (BL 40) and Kunlun(BL 60) supplemented for acute lumbar muscle sprain; Zhibian (BL 54), Huantiao (GB 30) and Ahshi points supplemented for nervi cluniam superior inflammation, and Sanyinjiao (SP 6) and Mingmen(GV 4) supplemented for impotence. Gauge-28 2 curt long needles are used. The needles are inserted perpendicularly into Shenshu(BL 23), Dachengshu(BL 25) and Ciliao(BL 32) to a depth of about 1.2 --- 1.5 cun. Other supplementary points are needled and stimulated with routine manipulations, generally the reducing method is used for excess syndrome, and the reinforcing method applied to deficiency syndrome. The author, on the basis of many years of clinical practice, considers that "lumbar three-point needling" is fairly effective in treating lumbosacral diseases.

  14. Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing

    Hansen, Bjarke B; Bendix, Tom; Grindsted, Jacob;

    2015-01-01

    STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). SUMMARY OF BACKGROUND DATA: The lumbar lordosis increases with a change of...... position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. METHODS: Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching...... control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. RESULTS: Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75...

  15. Are Modic changes related to outcomes in lumbar disc herniation patients treated with imaging-guided lumbar nerve root blocks?

    Objective: To compare outcomes after imaging-guided transforaminal lumbar nerve root blocks in MRI confirmed symptomatic disc herniation patients with and without Modic changes (MC). Methods: Consecutive adult patients with MRI confirmed symptomatic lumbar disc herniations and an imaging-guided lumbar nerve root block injection who returned an outcomes questionnaire are included. Numerical rating scale (NRS) pain data was collected prior to injection and 20–30 min after injection. NRS and overall improvement were assessed using the patient's global impression of change (PGIC) scale at 1 day, 1 week and 1 month post injection. The proportion of patients with and without MC on MRI as well as Modic I and Modic II was calculated. These groups were compared for clinically relevant ‘improvement’ using the Chi-squared test. Baseline and follow-up NRS scores were compared for the groups using the unpaired t-test. Results: 346 patients are included with MC present in 57%. A higher percentage of patients without MC reported ‘improvement’ and a higher percentage of patients with MC reported ‘worsening’ but this did not reach statistical significance. The numerical scores on the PGIC and NRS scales showed that patients with MC had significantly higher pain and worse overall improvement scores at 1 month (p = 0.048 and p = 0.03) and a significantly lower 1 month NRS change score (p = 0.04). Conclusions: Patients with MRI confirmed symptomatic lumbar disc herniations and MC report significantly lower levels of pain reduction after a lumbar nerve root block compared to patients without MC

  16. Are Modic changes related to outcomes in lumbar disc herniation patients treated with imaging-guided lumbar nerve root blocks?

    Peterson, Cynthia K., E-mail: cynthia.peterson@balgrist.ch [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Pfirrmann, Christian W.A. [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Hodler, Jürg [Department of Radiology, University Hospital, University of Zürich (Switzerland)

    2014-10-15

    Objective: To compare outcomes after imaging-guided transforaminal lumbar nerve root blocks in MRI confirmed symptomatic disc herniation patients with and without Modic changes (MC). Methods: Consecutive adult patients with MRI confirmed symptomatic lumbar disc herniations and an imaging-guided lumbar nerve root block injection who returned an outcomes questionnaire are included. Numerical rating scale (NRS) pain data was collected prior to injection and 20–30 min after injection. NRS and overall improvement were assessed using the patient's global impression of change (PGIC) scale at 1 day, 1 week and 1 month post injection. The proportion of patients with and without MC on MRI as well as Modic I and Modic II was calculated. These groups were compared for clinically relevant ‘improvement’ using the Chi-squared test. Baseline and follow-up NRS scores were compared for the groups using the unpaired t-test. Results: 346 patients are included with MC present in 57%. A higher percentage of patients without MC reported ‘improvement’ and a higher percentage of patients with MC reported ‘worsening’ but this did not reach statistical significance. The numerical scores on the PGIC and NRS scales showed that patients with MC had significantly higher pain and worse overall improvement scores at 1 month (p = 0.048 and p = 0.03) and a significantly lower 1 month NRS change score (p = 0.04). Conclusions: Patients with MRI confirmed symptomatic lumbar disc herniations and MC report significantly lower levels of pain reduction after a lumbar nerve root block compared to patients without MC.

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

    C. López Carballo

    2013-04-01

    Full Text Available 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 alternativa, que no solo proporcionó un aceptable grado de confort, sino que permitió el mantenimiento del sondaje uretral y el lavado vesical continuo. Realizamos una revisión bibliográfica sobre el uso del bloqueo epidural de la neurotransmisión de las aferencias sensitivas vesicales en dolor de origen disfuncional vesical, y analizamos algunas de la teorías publicadas sobre la fisiopatología y génesis de dolor en estos trastornos vesicales, con la intención de interpretar las peculiaridades y complejidad del dolor en el cuadro del caso presentado.We present a clinical case of bladder spasms due to detrusor overactitivity, triggered by continuous vesicoclysis therapy, which was applied in a patient with benign prostatic hypertrophy-related hematuria. Bladder spasms turned out to be refractory to combined antimuscarinic, spasmolytic and systemic opioid therapies. Implantation of a lumbar epidural catheter was chosen for continuous epidural infusion of local anesthetics and opioid drugs as an alternate analgesic therapy, which provided the patient an optimum comfort, but let urethral indwelling catheterization and the maintenance of continuous vesicoclysis therapy as well. We reviewed scientific literature concerning bladder-afferent neurotransmission blockade at epidural level for dysfunctional bladder pain therapy, and discussed several published theories about pain physiopathology and origin in those cases of dysfunctional bladder disturbance, with the

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

    Michaelis Martina

    2009-05-01

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

  19. Efectos del vendaje neuromuscular sobre la flexibilidad del raquis lumbar

    A.M. Labrador-Cerrato

    2015-03-01

    Full Text Available Introducción: El vendaje neuromuscular es una técnica que produce una estimulación muy selectiva sobre la piel a través de la aplicación de unas vendas elásticas especiales con el fin de lograr cambios propioceptivos, aumento o inhibición del tono muscular y mitigación de algias, entre otros. Objetivos: Comprobar si la aplicación del vendaje neuromuscular permite aumentar la flexión del raquis lumbar comparándola con otras técnicas de vendaje placebo (esparadrapo rígido convencional; Omniplaste®-E; observar la concordancia entre la prueba sit-and-reach y el test de Schober en la valoración de la ganancia de flexión lumbar. Material y métodos: Estudio piloto experimental a triple ciego. Se distribuyeron aleatoriamente 45 sujetos sanos de 20-55 años en tres grupos: 1 esparadrapo convencional; 2 Omniplaste®-E; 3 vendaje neuromuscular. En todos los participantes se evaluó la flexión del raquis lumbar mediante la prueba sit-and-reach y el test de Schober antes y después de la intervención siguiendo el mismo protocolo. Resultados: Considerado un intervalo de confianza del 95% y grado de significación estadística p<0,05 en todos los casos, se obtuvo un incremento estadísticamente significativo de la flexión lumbar en todos los grupos según la prueba sit-and-reach, que fue mayor en el grupo del vendaje neuromuscular (1,5 cm de mediana; p=0,011. Según el test de Schober, solamente el vendaje neuromuscular se mostró eficiente (p<0,001, incrementándose el valor basal en un 6,25% (1 cm de mediana. Conclusiones: La aplicación del vendaje neuromuscular sobre la columna lumbar mejora la flexión lumbar respecto a técnicas placebo a partir de los resultados obtenidos mediante el test de Schober, así como una mayor flexión global del tronco que estas técnicas según la prueba sit-and-reach. El test de Schober parece ser más fiable y preciso que la prueba sit-and-reach para estudios de este tipo.

  20. Manual therapy treatment of lumbar radiculopathy: A single case report

    J.A. Riley

    2011-02-01

    Full Text Available Patients  with  lumbar  radiculopathy  are  often  managed with  manual therapy.  The  aim  of  this  single  case  study  was  to  describe  the outcome of manual therapy treatment of a patient with lumbar radiculopathy.  A 47-year-old female presented with acute, severe left buttock and postero-lateral thigh pain.  Symptom provocation occurred during lumbar flexion, coughing, sneezing, driving and prolonged sitting. her left straight leg raise neurodynamic test was limited and reproduced her pain, as did trigger points in the left lumbar and gluteal muscles. clinical neuro-conduction testing revealed weakness of the big and other toe extensors, as well as eversion and plantar flexion of the left ankle, and a diminished left ankle reflex. This indicated possible involvement of both the l5 and S1 nerve roots.   A  manual  therapy  treatment  approach including  lumbar rotation mobilisations (Maitland approach, massage, trigger point pressure release  and  Transversus  Abdominus muscle activation  was  used.   The  patient  was  symptom  free,  had  full pain-free  range  of  all  lumbar  movements,  a full  pain-free  left  straight leg  raise  neurodynamic  test  and  normal  neurological  conduction  six weeks  after  onset, following seven manual therapy treatments.  Although the results of this case report cannot be generalised, it describes the successful outcome of a patient with severe radicular pain and neurological deficits, whose signs and symptoms  had completely resolved following manual therapy treatment.