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Sample records for circumferential lumbar fusion

  1. OUTCOME OF POSTEROLATERAL FUSION VERSUS CIRCUMFERENTIAL FUSION WITH CAGE FOR LUMBAR STENOSIS AND LOW DEGREE LUMBAR SPONDYLOLISTHESIS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis. Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups. Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion. The two groups were compared for clinical and radiological outcomes. Results All patients were followed up for 12 to 72 months. In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24). Two cases suffered from residual symptoms. Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%. No infection or neurological complication occurred in this group. In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90. 5% ( 19/21 ). One case suffered from residual symptoms. Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%. Four cases of infection or neurological complication occurred in this group. Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during followup. But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion. Only when patients suffer from severe preoperative disc

  2. ISSLS prize winner: cost-effectiveness of two forms of circumferential lumbar fusion

    DEFF Research Database (Denmark)

    Freeman, Brian J C; Steele, Nicholas A; Sach, Tracey H;

    2007-01-01

    STUDY DESIGN: Economic evaluation alongside a prospective, randomized controlled trial from a secondary care National Health Service (NHS) perspective. OBJECTIVE: To determine the cost-effectiveness of titanium cages (TC) compared with femoral ring allografts (FRA) in circumferential lumbar spina...

  3. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion

    DEFF Research Database (Denmark)

    Videbaek, Tina S; Christensen, Finn B; Soegaard, Rikke;

    2006-01-01

    -36 instrument, and the Low Back Pain Rating Scale. All measures assessed the endpoint outcomes at 5 to 9 years after surgery. RESULTS: The available response rate was 93%. The circumferential group showed a significantly better improvement (P ...STUDY DESIGN: Prospective randomized clinical study with a 5- to 9-year follow-up period. OBJECTIVE: The aim of the present study was to analyze the long-term outcome with respect to functional disability, pain, and general health of patients treated by means of circumferential lumbar fusion...... fusion (titanium Cotrel-Dubousset) or circumferential lumbar fusion (instrumented posterolateral fusion with anterior intervertebral support by a Brantigan cage). The primary outcome measure was the Dallas Pain Questionnaire (DPQ). The secondary outcome measures were the Oswestry Disability Index, the SF...

  4. Meta-analysis of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease%腰椎后外侧融合与360°融合的系统评价

    Institute of Scientific and Technical Information of China (English)

    崔璀; 朱悦; 韩秀鑫

    2009-01-01

    目的 对腰椎后外侧融合与360°融合治疗腰椎疾病的疗效进行系统对比评价.方法 计算机检索MEDLINE(1966.1-2007.12,Ovid检索平台)、EMBASE(1984.1-2007.12)、Cochrance Central Register of Controlled Trial(4th Quarter 2007)、中国生物医学文献数据库(1986.1-2007.12)等,手工检索Spine、European SPine Jurnal、The Journat of Bone and Joint Surgery、、、等相关期刊,检索两种融合术式的相关病例研究结果、综述等相关内容,并评价纳入研究的方法学质量,采用RevMan 5.0,5.0软件对总体疗效、融合率、二次手术率、并发症发生率、平均手术时间、手术出血量进行荟萃分析.结果 有4个临床随机对照试验(RCT)符合纳入标准,共437例患者.在融合率[OR 0.47,95%CI(0.24,0.94)]、并发症发生率[OR 0.53,95%CI(0.32,0.87)]、术中出血量[加权均数差值(WMD)=-349.95,95%CI(-561.64,-138.26)]方面,360°融合组要高于后外侧融合组,差异具有统计学意义(P=0.030、0.010、0.001);在二次手术率[OR 2.28,95%CI(1.30,3.98)]方面,后外侧融合组要高于360°融合组,差异具有统计学意义(P=0.004);在总体疗效[OR 1.04,95%CI(0.64,1.68)]和手术时间[WMD=-90.24,95%CI(-190.20,9.71)]上,两组差异无统计学意义(P=0.870、0.080).结论 360°融合组相比于后外侧融合组,能显著提高融合率,降低二次手术率,但并发症、术中出血量也显著高于后者.本研究结果尚需要多中心大样本RCT进一步证实.%Objective To evaluate the efficacy of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease. Methods Searched MEDLINE(January, 1966 to December, 2007), EMBASE (January, 1984 to December, 2007), Coehrance Central Register of Controlled Trial (4th Quarter 2007), The China Biological Medicine Database (1984 to December, 2007), and hand searched several related journals, such as Spine, European Spine Journal, The Journal of Bone and Joint Surgery, Chinese

  5. Lateral Lumbar Interbody Fusion.

    Science.gov (United States)

    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

  6. 不同后路环状融合术治疗老年人腰椎不稳症的临床疗效%The therapeutic effect of different posterior circumferential fusion on lumbar instability in aged patients

    Institute of Scientific and Technical Information of China (English)

    陈柏龄; 黎艺强; 刘少喻; 李佛保; 梁春祥

    2011-01-01

    目的 评价传统后路环状融合术和简化后路环状融合术治疗老年人腰椎不稳症的临床疗效。 方法 2005年开始使用椎弓根钉系统辅助后路环状融合术治疗60岁及以上单节段腰椎不稳症80例,58例进行2年以上随访,其中28例采用了横突间植骨的传统后路环状融合术(PLIF+PLF,A组),30例采用不进行横突间植骨的简化后路环状融合术(PLIF+FF,B组)。术前和术后1、3、6、12、24个月应用X线评价腰椎状态及植骨融合情况,并应用视觉疼痛评分(VAS)和()swestry功能障碍指数(ODI)评价患者腰腿疼痛程度及生活功能情况。 结果 A组手术时间(185.3±56.6)min,术中出血量(376.3±92.9)ml;B组手术时间(146.4±46.3)min,术中出血量(234.3±64.5)ml,两组比较手术时间和出血量差异均有统计学意义(t= 12.37和37.49,均P<0.01)。A组28例中27例获骨性融合,融合率96.4%,B组30例中28例获骨性融合,融合率93.3%,两组骨融合率差异无统计学意义(x2=0.004,P>0.05)。两组患者术后腰、腿痛VAS评分及ODI均较术前明显改善。术后1个月和3个月,B组腰痛VAS评分比A组显著降低(t=3.178和2.158,P<0.05),其余3个时间点两组之间腰痛VAS差异无统计学意义(均P>0.05)。术后5个时间点A、B两组间腿痛VAS评分及ODI值均无统计学差别(均P>0.05)。 结论对于具有手术指征的老年腰椎不稳症患者,采用不进行横突间植骨融合的简化后路环状融合术与传统的后路环状融合术相比,可获得相似的融合率和满意的临床疗效,且创伤显著减少,是值得推荐的一种手术方式。%Objective To compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. Methods The elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80

  7. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.

    Science.gov (United States)

    Skovrlj, Branko; Guzman, Javier Z; Caridi, John; Cho, Samuel K

    2016-02-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach. PMID:26835214

  8. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

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

    2007-01-01

    consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2...... posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life...

  9. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion

    DEFF Research Database (Denmark)

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

    2014-01-01

    -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...

  10. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    Directory of Open Access Journals (Sweden)

    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.

  11. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    OpenAIRE

    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...

  12. Percutaneous fusion of lumbar facet with bone allograft

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

  14. Adjacent Segment Pathology after Lumbar Spinal Fusion.

    Science.gov (United States)

    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

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

    OpenAIRE

    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 ...

  16. Transforaminal lumbar interbody fusion versus posterolateral fusion in degenerative lumbar spondylosis

    Science.gov (United States)

    Zhang, Bin-Fei; Ge, Chao-Yuan; Zheng, Bo-Long; Hao, Ding-Jun

    2016-01-01

    Abstract Objective: The aim of the study was to evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) versus posterolateral fusion (PLF) in degenerative lumbar spondylosis. Methods: A systematic literature review was performed to obtain randomized controlled trials (RCTs) and observational studies (OSs) of TLIF and PLF for degenerative lumbar spondylosis. Trials performed before November 2015 were retrieved from the Medline, EMBASE, Cochrane library, and Chinese databases. Data extraction and quality evaluation of the trials were performed independently by 2 investigators. A meta-analysis was performed using STATA version 12.0. Results: Two RCTs and 5 OSs of 630 patients were included. Of these subjects, 325 were in the TLIF and 305 were in the PLF group. Results showed that TLIF did not increase the fusion rate based on RCTs (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.95–1.18; P = 0.321), but increased it based on OSs (RR = 1.14; 95% CI: 1.07–1.23; P = 0.000) and overall (RR = 1.11; 95% CI: 1.05–1.18; P = 0.001) as compared with PLF. TLIF was able to improve the clinical outcomes based on 1 RCT (RR = 1.33; 95% CI: 1.11–1.59, P = 0.002) and overall (RR = 1.19; 95% CI: 1.07–1.33; P = 0.001), but not based on OSs (RR = 1.11; 95% CI: 0.97–1.27; P = 0.129) as compared with PLF. There were no differences between TLIF and PLF in terms of visual analogue scale, Oswestry Disability Index, reoperation, complications, duration of surgical procedure, blood loss, and hospitalization. Conclusions: In conclusion, evidence is not sufficient to support that TLIF provides higher fusion rate than PLF, and this poor evidence indicates that TLIF might improve only clinical outcomes. Higher quality, multicenter RCTs are needed to better define the role of TLIF and PLF. PMID:27749558

  17. The Effect of Early Initiation of Rehabilitation after Lumbar Spinal Fusion

    DEFF Research Database (Denmark)

    Oestergaard, Lisa Gregersen; Nielsen, Claus Vinther; Bünger, Cody E;

    2012-01-01

    examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.Methods: Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate...

  18. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

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    Coe, Jeffrey D; Zucherman, James F; Kucharzyk, Donald W; Poelstra, Kornelis A; Miller, Larry E; Kunwar, Sandeep

    2016-01-01

    The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. PMID:27729817

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

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    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.

  20. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Bünger, Cody E; Christiansen, Terkel;

    2007-01-01

    STUDY DESIGN: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. OBJECTIVE: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective. SUMMARY...... no significant difference between posterolateral and circumferential fusion reporting cost-effectiveness from a 2-year viewpoint. METHODS: A total of 146 patients were randomized to posterolateral or circumferential fusion and followed 4 to 8 years after surgery. The mean age of the cohort was 46 years (range...... of the labor market due to sickness. The EQ-5D instrument was applied for the measurement of health-related quality of life and costs (2004 U.S. dollars) were measured in a full-scale societal perspective. Productivity costs were valued by the Friction Cost method, and both costs and effects were discounted...

  1. ANALYSIS OF INTERBODY VERSUS POSTEROLATERAL FUSION FOR LUMBAR SPONDYLOSIS

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    Rodrigo Góes Medéa de Mendonça

    2015-12-01

    Full Text Available Objective : To evaluate and compare radiographic and clinical evaluation of patients undergoing interbody fusion versus posterolateral fusion of the lumbar spine. Methods : Retrospective study of patients diagnosed with lumbar spondylosis that were surgically treated in the period from 2012 to 2014. The results were observed by clinical evaluation by the Visual Analogue Scale (VAS for low back and leg pain. We evaluated functional results and quality of life through the application of the Oswestry Disability Index (ODI and the Short Form-36 (SF-36 questionnaires, respectively. The pre and postoperative condition were compared in Group 1 (interbody fusion and Group 2 (posterolateral fusion, in addition to evaluation of fusion by means of post-operative radiograph. Results : A total of 30 patients of 36 were eligible, 12 in Group 1 and 18 in Group 2. The mean follow-up was 10.1 months. Statistical analysis showed similar scores for back and leg pain VAS, SF-36 function scores and Oswestry between groups with interbody and posterolateral fusion, and compared within these groups regarding the pre- and postoperative condition, and found no statistical significance. The successful fusion was similar in both groups, with 11 of 12 patients in Group 1 showing bone fusion and 17 of 18 in Group 2 showing arthrodesis. Conclusion : No clinical or radiographic differences between patients who underwent posterolateral or interbody fusion were observed. Both methods showed improvement in functional outcome and pain reduction.

  2. Early Versus Late Initiation of Rehabilitation After Lumbar Spinal Fusion

    DEFF Research Database (Denmark)

    Oestergaard, Lisa G; Christensen, Finn B; Nielsen, Claus V;

    2013-01-01

    , and costs. METHODS: A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group...

  3. Comparison of the different surgical approaches for lumbar interbody fusion.

    Science.gov (United States)

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

    2015-02-01

    This review will outline the history of spinal fusion. It will compare the different approaches currently in use for interbody fusion. A comparison of the techniques, including minimally invasive surgery and graft options will be included. Lumbar interbody fusion is a commonly performed surgical procedure for a variety of spinal disorders, especially degenerative disease. Currently this procedure is performed using anterior, lateral, transforaminal and posterior approaches. Minimally invasive techniques have been increasing in popularity in recent years. A posterior approach is frequently used and has good fusion rates and low complication rates but is limited by the thecal and nerve root retraction. The transforaminal interbody fusion avoids some of these complications and is therefore preferable in some situations, especially revision surgery. An anterior approach avoids the spinal cord and cauda equina all together, but has issues with visceral exposure complications. Lateral lumbar interbody fusion has a risk of lumbar plexus injury with dissection through the psoas muscle. Studies show less intraoperative blood loss for minimally invasive techniques, but there is no long-term data. Iliac crest is the gold standard for bone graft, although adjuncts such as bone morphogenetic proteins are being used more frequently, despite their controversial history. More high-level studies are needed to make generalisations regarding the outcomes of one technique compared with another.

  4. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

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    Kulkarni, Arvind G; Bohra, Hussain; Dhruv, Abhilash; Sarraf, Abhishek; Bassi, Anupreet; Patil, Vishwanath M

    2016-01-01

    Background: The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF. Materials and Methods: All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17). Results: 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P blood loss (open 358.8 ml, MI 111.81 ml, P group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P group than in O-TLIF group, indicating lesser tissue trauma. Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are

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

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    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.

  6. Use of autologous growth factors in lumbar spinal fusion.

    Science.gov (United States)

    Lowery, G L; Kulkarni, S; Pennisi, A E

    1999-08-01

    The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a

  7. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

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    Coe JD

    2016-09-01

    Full Text Available Jeffrey D Coe,1 James F Zucherman,2 Donald W Kucharzyk,3 Kornelis A Poelstra,4 Larry E Miller,5 Sandeep Kunwar,6 1Silicon Valley Spine Institute, Campbell, 2San Francisco Orthopaedic Surgeons, San Francisco, CA, 3Orthopaedic Pediatric and Spine, Crown Point, IN, 4Department of Surgery, Sacred Heart Hospital on the Emerald Coast, Miramar Beach, FL, 5Miller Scientific Consulting, Inc., Asheville, NC, 6Bell Neuroscience Institute, Washington Hospital Healthcare System, Fremont, CA, USA Abstract: The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. Keywords: degenerative disc disease, expandable, low back pain, Luna

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

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    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.

  9. Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease.

    Science.gov (United States)

    Xu, Bao-Shan; Liu, Yue; Xu, Hai-Wei; Yang, Qiang; Ma, Xin-Long; Hu, Yong-Cheng

    2016-05-01

    The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion.

  10. Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease.

    Science.gov (United States)

    Xu, Bao-Shan; Liu, Yue; Xu, Hai-Wei; Yang, Qiang; Ma, Xin-Long; Hu, Yong-Cheng

    2016-05-01

    The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. PMID:27384734

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  13. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion.

    Science.gov (United States)

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

    2014-07-01

    Interbody fusion techniques have been promoted as an adjunct to lumbar fusion procedures in an effort to enhance fusion rates and potentially improve clinical outcome. The medical evidence continues to suggest that interbody techniques are associated with higher fusion rates compared with posterolateral lumbar fusion (PLF) in patients with degenerative spondylolisthesis who demonstrate preoperative instability. There is no conclusive evidence demonstrating improved clinical or radiographic outcomes based on the different interbody fusion techniques. The addition of a PLF when posterior or anterior interbody lumbar fusion is performed remains an option, although due to increased cost and complications, it is not recommended. No substantial clinical benefit has been demonstrated when a PLF is included with an interbody fusion. For lumbar degenerative disc disease without instability, there is moderate evidence that the standalone anterior lumbar interbody fusion (ALIF) has better clinical outcomes than the ALIF plus instrumented, open PLF. With regard to type of interbody spacer used, frozen allograft is associated with lower pseudarthrosis rates compared with freeze-dried allograft; however, this was not associated with a difference in clinical outcome.

  14. Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients

    OpenAIRE

    Lee, Jung-Hyun; Chun, Hyoung-Joon; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung

    2012-01-01

    Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complic...

  15. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion

    OpenAIRE

    Liang, Jinqian; Dong, Yulei; Zhao, Hong

    2014-01-01

    Background Although measures to reduce and treat degenerative changes after fusion are discussed, these are still controversial. Methods A retrospective study was conducted on a consecutive series of 3,799 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 1999 and January 2009. A total of 28 patients with symptomatic adjacent segment degeneration surgery were identified. Another group of 56 matched patients with degenerative lumbar disease without ...

  16. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

    OpenAIRE

    Kumar, Malhar; Baklanov, Andrei; Chopin, Daniel

    2001-01-01

    Adjacent segment degeneration following lumbar spine fusion remains a widely acknowledged problem, but there is insufficient knowledge regarding the factors that contribute to its occurrence. The aim of this study is to analyse the relationship between abnormal sagittal plane configuration of the lumbar spine and the development of adjacent segment degeneration. Eighty-three consecutive patients who underwent lumbar fusion for degenerative disc disease were reviewed retrospectively. Patients ...

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

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    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.

  18. Durotomy is associated with pseudoarthrosis following lumbar fusion.

    Science.gov (United States)

    Bydon, Mohamad; De la Garza-Ramos, Rafael; Abt, Nicholas B; Macki, Mohamed; Sciubba, Daniel M; Wolinsky, Jean-Paul; Bydon, Ali; Gokaslan, Ziya L; Witham, Timothy F

    2015-03-01

    Pseudoarthrosis is a known complication following lumbar fusion, and although several risk factors have been established, the association of durotomy and pseudoarthrosis has not been studied to our knowledge. A retrospective review was performed to identify all adult patients who underwent lumbar posterolateral fusion (without interbody fusion) for degenerative spine disease over a 20 year period at a single institution. Patients were divided into durotomy and no durotomy cohorts. Patients were included if they had at least 1 year of follow-up. The main outcome variable was development of pseudoarthrosis. A total of 327 patients were identified, of whom 17 (5.19%) had a durotomy. Pseudoarthrosis rates were significantly higher in the durotomy group (35.29%) when compared to the no durotomy group (13.87%), with the difference being statistically significant (p=0.016). Univariate analysis revealed that durotomy (p=0.003) and the number of levels fused (p=0.015) were the only two significant risk factors for pseudoarthrosis. After controlling for the number of levels fused, the adjusted relative risk (RR) revealed that patients with a durotomy were 2.23 times more likely to develop pseudoarthrosis (RR 2.23; 95% confidence interval 1.05-4.75) when compared to patients without durotomy. The findings in the present study suggest an association between durotomy and pseudoarthrosis development. Patients with a durotomy were 2.2 times more likely to develop pseudoarthrosis compared to patients without a durotomy. Future and larger studies are required to corroborate our findings.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.].

  2. Complication avoidance and management in anterior lumbar interbody fusion.

    Science.gov (United States)

    Than, Khoi D; Wang, Anthony C; Rahman, Shayan U; Wilson, Thomas J; Valdivia, Juan M; Park, Paul; La Marca, Frank

    2011-10-01

    The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.

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

    OpenAIRE

    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 ...

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

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

    2014-07-01

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

  6. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome following lumbar fusion.

    Science.gov (United States)

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

    2014-07-01

    Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

  7. INTRASITE VANCOMYCIN POWDER AS A PROPHYLACTIC ADJUVANT IN LUMBAR FUSION

    Directory of Open Access Journals (Sweden)

    Jorge Álvaro González Ross

    2016-03-01

    Full Text Available ABSTRACT Objective: To identify whether the use of prophylactic intrasite vancomycin as an adjuvant is a protective factor against deep tissue infection of the surgical site. Methods: Retrospective, descriptive, case-control study evaluating 210 patients, of whom 70 received intrasite vancomycin (case group and 140 were controls. It was made a follow up for at least one year, reviewing the physical and electronic records. Data were tabulated in spreadsheets (Excel including all variables and the statistical analysis was made with Epi InfoTM 7 to calculate the odds ratio. Results: Seven cases of deep infection occurred in the control group and none was found in the case group (odds ratio [95% confidence interval]: 0.1262 [0.007-2.24], P = 0.1585. Among the predisposing factors, diabetes and surgical time were the most relevant. Conclusions: Intrasite use of vancomycin has a protective effect against deep infection in patients undergoing lumbar fusion surgery without presenting considerable side effects.

  8. Repeated adjacent-segment degeneration after posterior lumbar interbody fusion.

    Science.gov (United States)

    Okuda, Shinya; Oda, Takenori; Yamasaki, Ryoji; Maeno, Takafumi; Iwasaki, Motoki

    2014-05-01

    One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4-5. At the second operation, L3-4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2-3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

  9. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.

    Science.gov (United States)

    Mobbs, Ralph J; Phan, Kevin; Malham, Greg; Seex, Kevin; Rao, Prashanth J

    2015-12-01

    Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines

  10. Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.

    Science.gov (United States)

    Zhao, Jie; Hou, Tiesheng; Wang, Xinwei; Ma, Shengzhong

    2003-04-01

    Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24

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

    OpenAIRE

    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...

  12. [Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

    Science.gov (United States)

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

    Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR. PMID:27026564

  13. The Quality and Readability of Information Available on the Internet Regarding Lumbar Fusion.

    Science.gov (United States)

    Zhang, Dafang; Schumacher, Charles; Harris, Mitchel B; Bono, Christopher M

    2016-03-01

    Study Design An Internet-based evaluation of Web sites regarding lumbar fusion. Objective The Internet has become a major resource for patients; however, the quality and readability of Internet information regarding lumbar fusion is unclear. The objective of this study is to evaluate the quality and readability of Internet information regarding lumbar fusion and to determine whether these measures changed with Web site modality, complexity of the search term, or Health on the Net Code of Conduct certification. Methods Using five search engines and three different search terms of varying complexity ("low back fusion," "lumbar fusion," and "lumbar arthrodesis"), we identified and reviewed 153 unique Web site hits for information quality and readability. Web sites were specifically analyzed by search term and Web site modality. Information quality was evaluated on a 5-point scale. Information readability was assessed using the Flesch-Kincaid score for reading grade level. Results The average quality score was low. The average reading grade level was nearly six grade levels above that recommended by National Work Group on Literacy and Health. The quality and readability of Internet information was significantly dependent on Web site modality. The use of more complex search terms yielded information of higher reading grade level but not higher quality. Conclusions Higher-quality information about lumbar fusion conveyed using language that is more readable by the general public is needed on the Internet. It is important for health care providers to be aware of the information accessible to patients, as it likely influences their decision making regarding care. PMID:26933614

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

    Science.gov (United States)

    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

  15. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis.

    Science.gov (United States)

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

    2014-07-01

    Patients presenting with stenosis associated with a spondylolisthesis will often describe signs and symptoms consistent with neurogenic claudication, radiculopathy, and/or low-back pain. The primary objective of surgery, when deemed appropriate, is to decompress the neural elements. As a result of the decompression, the inherent instability associated with the spondylolisthesis may progress and lead to further misalignment that results in pain or recurrence of neurological complaints. Under these circumstances, lumbar fusion is considered appropriate to stabilize the spine and prevent delayed deterioration. Since publication of the original guidelines there have been a significant number of studies published that continue to support the utility of lumbar fusion for patients presenting with stenosis and spondylolisthesis. Several recently published trials, including the Spine Patient Outcomes Research Trial, are among the largest prospective randomized investigations of this issue. Despite limitations of study design or execution, these trials have consistently demonstrated superior outcomes when patients undergo surgery, with the majority undergoing some type of lumbar fusion procedure. There is insufficient evidence, however, to recommend a standard approach to achieve a solid arthrodesis. When formulating the most appropriate surgical strategy, it is recommended that an individualized approach be adopted, one that takes into consideration the patient's unique anatomical constraints and desires, as well as surgeon's experience.

  16. 下腰椎前方三维CT血管造影重建及其意义%3D-CT angiography of anterior vessels and their circumferential structure at lower lumbar vertebraes

    Institute of Scientific and Technical Information of China (English)

    康忠山; 王文军; 曹琼钦; 朱一平; 晏怡果

    2009-01-01

    目的:观察下腰椎前方血管走行特点,为下腰椎前路椎间融合术,特别是腹腔镜下微创手术提供解剖学依据.方法:对60例(男女各30例)患下腰椎疾病需行前路手术治疗的患者行下腰椎三维CT血管造影(3D-CTA),观察下腰椎前方血管在椎体前的走行,测量与腰椎前方血管位置相关的解剖学参数.结果:三维CT重建图像发现腹主动脉分叉点变异较多,髂总静脉汇合点相对恒定;腹主动脉分叉点到L5椎体下缘的距离男性平均39.1mm,女性平均37.4mm;髂总静脉汇合点到L5椎体下缘的距离男性平均27.1mm,女性平均25.9mm;L5/S1椎间隙手术窗大小男性平均36.7mm,女性平均34.6mm;腹主动脉分叉角男性平均56.3°,女性平均58.9°;髂总静脉汇合角男性平均63.1°,女性平均65.7°;右髂总动脉与左髂总静脉夹角男性平均53.6°,女性平均57.3°.结论:下腰椎前方血管解剖位置具有多变性,以腹主动脉分叉点为甚,术前行腰椎3D-CTA检查能明确血管解剖,为手术尤其是腹腔镜下微创手术提供安全保障.%Objective:To morphoiogize the vascular configuration anteriorly to lower lumbar vertebraes and their circumferential structure,and to provide the anatomic data for anterior lumbar spine inter-body fusion es-pecially for minimal invasive surgery under laparescopy.Method:60 cases(30 cases for each sex) neccessitat-ing ALIF underwent three dimensional computed tomographic angiography(3D-CTA) anteriorly to lower lumbar vertebraes,the orientation and distribution of vessels anteriorly to lower lumbar vertebraes were depicted and the anatomic parameters with respect to vessels and their circumferential were recorded either.Result:The bi-furcation level of the ventral aorta varied significantly under 3D-CTA imaging while the confluence level of the common iliac vein was constant.The distance from the bifurcation of ventral aorta to the top of L5/S1 disc averaged 39.1mm in male and 37.4mm in

  17. Evaluation of Posterolateral Lumbar Fusion in Sheep Using Mineral Scaffolds Seeded with Cultured Bone Marrow Cells

    OpenAIRE

    Cuenca-López, María D.; Andrades, José A.; Santiago Gómez; Plácido Zamora-Navas; Enrique Guerado; Nuria Rubio; Jerónimo Blanco; José Becerra

    2014-01-01

    The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft) for posterolateral lumbar fusion (PLF) in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM) mesenchymal stem cells (MSCs) have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts...

  18. Older literature review of increased risk of adjacent segment degeneration with instrumented lumbar fusions

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusions: Too many studies assume that TLIF, PLIF, and even PLF instrumented fusions are the "gold standard of care" for dealing with degenerative disease of the lumbar spine without documented instability. It is time to correct that assumption, and reassess the older literature along with the new to confirm that decompression alone and noninstrumented fusion avoid significant morbidity and even potentially mortality attributed to unnecessary instrumentation.

  19. Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery

    OpenAIRE

    Robinson, Yohan; Michaëlsson, Karl; Sandén, Bengt

    2013-01-01

    Background and purpose Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE). Methods All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed t...

  20. Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn B; Lauerberg, Ida;

    2006-01-01

    Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patie...... service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program.......Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient......-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral...

  1. A comparison of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for lumbar degenerative diseases

    Institute of Scientific and Technical Information of China (English)

    Yang Xiaoming; Wang Hong; Zhao Quanlai; Xu Hongguang; Liu Ping; Jin Yuelong

    2014-01-01

    Background Bilateral transpedicular screw fixation in conjunction with interbody fusion is widely used to treat lumbar degenerative diseases; however,there are some disadvantages of using this fixation system.This study comparatively analyzes the results of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion (TLIF) for one-level lumbar degenerative diseases.Methods Sixty-six cases with one-level lumbar degenerative diseases were studied.The patients were divided according to surgical approach into a unilateral group (Group A) and a bilateral group (Group B).The patients were evaluated for pain by visual analog scale (VAS) and Oswestry Disability Index (ODI).Operating time,blood loss,duration of hospitalization,and complication rate were also evaluated.Patients were examined at 1,3,6,and 12 months postoperatively and every year thereafter.Results Group A patients' average preoperative VAS and ODI scores were 7.03 ± 0.98 and (64.22±6.38)%,respectively,significantly decreased to 2.91 ± 0.88 and (14.42±2.08)%,respectively,at the last follow-up (P =0.000).In Group B,the average preoperative VAS and ODI scores were 6.79±0.86 and (63.22±4.70)%,respectively,significantly decreased to 3.12±0.96 and (14.62±2.08)%,respectively,at the last follow-up (P=0.000).No significant difference in the duration of hospitalization was found between groups.Operating time and blood loss of (125.9±13.0) minutes and (211.4±28.3) ml,respectively,in Group A were significantly less than (165.2±15.3) minutes and (258.6±18.3) ml,respectively,in Group B (P=-0.000).All patients achieved good bone union and had no pseudarthrosis at the last follow-up.Conclusions There are no clinical differences between unilateral and bilateral pedicle screw fixation combined with TLIF for one-level lumbar degenerative diseases.Unilateral fixation reduces operating time,bleeding,and cost of hospitalization.

  2. Fusion Rates of Instrumented Lumbar Spinal Arthrodesis according to Surgical Approach: A Systematic Review of Randomized Trials

    OpenAIRE

    Lee, Choon Sung; Hwang, Chang Ju; Lee, Dong-Ho; Kim, Yung-Tae; Lee, Hee Sang

    2011-01-01

    Background Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques. Methods Relevant randomized trials comparing the fusion rates of different surgical approach...

  3. Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

    Institute of Scientific and Technical Information of China (English)

    TANG Kai; MA Jian; MA Fu-sheng; JlA Yu-he; ZHANG Shu

    2006-01-01

    @@ Catheter ablation for the treatment of atrial fibrillation (AF) has been a focal target of electrophysiological study in recent years. Up to date,circumferential pulmonary vein ablation (CPVA)guided by three-dimensional (3-D) electroanatomic mapping (Carto, USA) has been one of the most favourable procedures for the treatment of AF.

  4. Decisive factor in increase of loading at adjacent segments after lumbar fusion: operative technique, pedicle screws, or fusion itself: biomechanical analysis using finite element

    Science.gov (United States)

    Park, Joon-Hee; Kim, Ho-Joong; Kang, Kyoung-Tak; Kim, Ka-yeon; Chun, Heoung-Jae; Moon, Seong-Hwan; Lee, Hwan-Mo

    2010-03-01

    The aim of this study is to investigate the change in biomechanical milieu following removal of pedicle screws or removal of spinous process with posterior ligament complex in instrumented single level lumbar arthrodesis. We developed and validated a finite element model (FEM) of the intact lumbar spine (L2-4). Four scenarios of L3-4 lumbar fusion were simulated: posterolateral fusion (PLF) at L3-4 using pedicle screw system with preservation of PLC (Pp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system with preservation of PLC (Pp WoP), L3-4 using pedicle screw system without preservation PLC (Sp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system without preservation of PLC (Sp WoP). For these models, we investigated the range of motion and maximal Von mises stress of disc in all segments under various moments. All fusion models demonstrated increase in range of motion at adjacent segments compared to the intact model.For the four fusion models, the WiP model s P had the largest increase in range of motion at each adjacent segment. This study demonstrated that removal of pedicle screw system and preservation of PLC after complete lumbar spinal fusion could reduce the stress of adjacent segments synergistically and might have beneficial effects in preventing ASD.

  5. Evaluation of Posterolateral Lumbar Fusion in Sheep Using Mineral Scaffolds Seeded with Cultured Bone Marrow Cells

    Directory of Open Access Journals (Sweden)

    María D. Cuenca-López

    2014-12-01

    Full Text Available The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft for posterolateral lumbar fusion (PLF in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM mesenchymal stem cells (MSCs have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts in posterolateral lumbar fusion in sheep. In our study, four experimental spinal fusions in two animal groups were compared in sheep: autograft and allograft (reference group, hydroxyapatite scaffold, and hydroxyapatite scaffold seeded with cultured and osteoinduced bone marrow MSCs (hybrid construct. During the last three days of culture, dexamethasone (dex and beta-glycerophosphate (β-GP were added to potentiate osteoinduction. The two experimental situations of each group were tested in the same spinal segment (L4–L5. Spinal fusion and bone formation were studied by clinical observation, X-ray, computed tomography (CT, histology, and histomorphometry. Lumbar fusion rates assessed by CT scan and histology were higher for autograft and allograft (70% than for mineral scaffold alone (22% and hybrid constructs (35%. The quantity of new bone formation was also higher for the reference group, quite similar in both (autograft and allograft. Although the hybrid scaffold group had a better fusion rate than the non-hybrid scaffold group, the histological analysis revealed no significant differences between them in terms of quantity of bone formation. The histology results suggested that mineral scaffolds were partly resorbed in an early phase, and included in callus tissues. Far from the callus area the hydroxyapatite alone did not generate bone around it, but the hybrid scaffold did. In nude mice, labeled cells were induced to differentiate in vivo and monitored

  6. Evaluation of posterolateral lumbar fusion in sheep using mineral scaffolds seeded with cultured bone marrow cells.

    Science.gov (United States)

    Cuenca-López, María D; Andrades, José A; Gómez, Santiago; Zamora-Navas, Plácido; Guerado, Enrique; Rubio, Nuria; Blanco, Jerónimo; Becerra, José

    2014-12-16

    The objective of this study is to investigate the efficacy of hybrid constructs in comparison to bone grafts (autograft and allograft) for posterolateral lumbar fusion (PLF) in sheep, instrumented with transpedicular screws and bars. Hybrid constructs using cultured bone marrow (BM) mesenchymal stem cells (MSCs) have shown promising results in several bone healing models. In particular, hybrid constructs made by calcium phosphate-enriched cells have had similar fusion rates to bone autografts in posterolateral lumbar fusion in sheep. In our study, four experimental spinal fusions in two animal groups were compared in sheep: autograft and allograft (reference group), hydroxyapatite scaffold, and hydroxyapatite scaffold seeded with cultured and osteoinduced bone marrow MSCs (hybrid construct). During the last three days of culture, dexamethasone (dex) and beta-glycerophosphate (β-GP) were added to potentiate osteoinduction. The two experimental situations of each group were tested in the same spinal segment (L4-L5). Spinal fusion and bone formation were studied by clinical observation, X-ray, computed tomography (CT), histology, and histomorphometry. Lumbar fusion rates assessed by CT scan and histology were higher for autograft and allograft (70%) than for mineral scaffold alone (22%) and hybrid constructs (35%). The quantity of new bone formation was also higher for the reference group, quite similar in both (autograft and allograft). Although the hybrid scaffold group had a better fusion rate than the non-hybrid scaffold group, the histological analysis revealed no significant differences between them in terms of quantity of bone formation. The histology results suggested that mineral scaffolds were partly resorbed in an early phase, and included in callus tissues. Far from the callus area the hydroxyapatite alone did not generate bone around it, but the hybrid scaffold did. In nude mice, labeled cells were induced to differentiate in vivo and monitored by

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

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn B

    2006-01-01

    clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied...... fact that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative.......The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in...

  8. A review: Reduced reoperation rate for multilevel lumbar laminectomies with noninstrumented versus instrumented fusions

    Directory of Open Access Journals (Sweden)

    Nancy Ellen Epstein

    2016-01-01

    Conclusions: Many studies document no benefit for adding instrumentation to laminectomies performed for degenerative disease, including spondylolisthesis. Reoperation rates for laminectomy alone/laminectomy with noninstrumented fusions vary from 1.3% to 5.6% whereas reoperation rates for ASD after instrumented PLIF was 80% at 5 postoperative years. This review should prompt spinal surgeons to reexamine when, why, and whether instrumentation is really necessary, particularly for treating degenerative lumbar disease.

  9. Application and development of transforaminal lumbar interbody fusion%经椎间孔腰椎椎体间融合术的应用与发展

    Institute of Scientific and Technical Information of China (English)

    李华; 王辉; 丁文元

    2015-01-01

    Lumbar fusion has become a major surgical method in the treatment of lumbar degenerative diseases. Transforaminal lumbar interbody fusion ( TLIF ) has a series of advantages such as less damage to lumbar structure, less nerve injuries and less postoperative complications. With the constant increase of lumbar degenerative diseases, TLIF has been rapidly developed in recent years. With the development of surgery, minimally invasive technique has been used in TLIF. Minimally invasive-TLIF ( MI-TLIF ) has become one of the research hotspots in spinal surgery. The development process, technical features, biomechanical advantages, internal ifxation methods and fusion materials of TLIF and MI-TLIF are reviewed in this paper.

  10. 3-D MRI/CT fusion imaging of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Yamanaka, Yuki; Kamogawa, Junji; Misaki, Hiroshi; Kamada, Kazuo; Okuda, Shunsuke; Morino, Tadao; Ogata, Tadanori; Yamamoto, Haruyasu [Ehime University, Department of Bone and Joint Surgery, Toon-shi, Ehime (Japan); Katagi, Ryosuke; Kodama, Kazuaki [Katagi Neurological Surgery, Imabari-shi, Ehime (Japan)

    2010-03-15

    The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise. We combined 3-dimensional (3-D) computed tomography (CT) imaging of bone with 3-D magnetic resonance imaging (MRI) of neural architecture (cauda equina and nerve roots) for two patients using VirtualPlace software. Although the pathological condition of nerve roots could not be assessed using MRI, myelography or CT myelography, 3-D MRI/CT fusion imaging enabled unambiguous, 3-D confirmation of the pathological state and courses of nerve roots, both inside and outside the foraminal arch, as well as thickening of the ligamentum flavum and the locations, forms and numbers of dorsal root ganglia. Positional relationships between intervertebral discs or bony spurs and nerve roots could also be depicted. Use of 3-D MRI/CT fusion imaging for the lumbar vertebral region successfully revealed the relationship between bone construction (bones, intervertebral joints, and intervertebral disks) and neural architecture (cauda equina and nerve roots) on a single film, three-dimensionally and in color. Such images may be useful in elucidating complex neurological conditions such as degenerative lumbar scoliosis(DLS), as well as in diagnosis and the planning of minimally invasive surgery. (orig.)

  11. Posterior interbody fusion using a diagonal cage with unilateral transpedicular screw fixation for lumbar stenosis.

    Science.gov (United States)

    Zhao, Jian; Zhang, Feng; Chen, Xiaoqing; Yao, Yu

    2011-03-01

    Few reports have described the combined use of unilateral pedicle screw fixation and interbody fusion for lumbar stenosis. We retrospectively reviewed 79 patients with lumbar stenosis. The rationale and effectiveness of unilateral pedicle screw fixation were studied from biomechanical and clinical perspectives, aiming to reduce stiffness of the implant. All patients were operated with posterior interbody fusion using a diagonal cage in combination with unilateral transpedicular screw fixation and had reached the 3-year follow-up interval after operation. The mean operating time was 115 minutes (range=95-150 min) and the mean estimated blood loss was 150 mL (range=100-200 mL). The mean duration of hospital stay was 10 days (range=7-15 days). Clinical outcomes were assessed prior to surgery and reassessed at intervals using Denis' pain and work scales. Fusion status was determined from X-rays and CT scans. At the final follow-up, the clinical results were satisfactory and patients showed significantly improved scores (pdiagonal cage with unilateral transpedicular fixation is an effective treatment for decompressive surgery for lumbar stenosis.

  12. Instrumented posterior lumbar interbody fusion (PLIF) with interbody fusion device (Cage) in degenerative disc disease (DDD): 3 years outcome.

    Science.gov (United States)

    Ahsan, M K; Hossain, M A; Sakeb, N; Khan, S I; Zaman, N

    2013-10-01

    This prospective interventional study carried out at Bangabandhu Sheikh Mujib Medical University and a private hospital in Dhaka, Bangladesh during the period from October 2003 to September 2011. Surgical treatment of degenerative disc disease (DDD) should aim to re-expand the interbody space and stabilize until fusion is complete. The present study conducted to find out the efficacy of using interbody fusion device (Cage) to achieve interbody space re-expansion and fusion in surgical management of DDD. We have performed the interventional study on 53 patients, 42 female and 11 male, with age between 40 to 67 years. All the patients were followed up for 36 to 60 months (average 48 months). Forty seven patients were with spondylolisthesis and 06 with desiccated disc. All subjects were evaluated with regard to immediate and long term complications, radiological fusion and interbody space re-expansion and maintenance. The clinical outcome (pain and disability) was scored by standard pre and postoperative questionnaires. Intrusion, extrusion and migration of the interbody fusion cage were also assessed. Forty seven patients were considered to have satisfactory outcome in at least 36 months follow up. Pseudoarthrosis developed in 04 cases and 06 patients developed complications. In this series posterior lumbar interbody fusion (PLIF) with interbody cage and instrumentation in DDD showed significant fusion rate and maintenance of interbody space. Satisfactory outcome observed in 88.68% cases.

  13. Systematic review of the effect of fusion added to discectomy compared with discectomy alone for lumbar disk prolapse surgery

    Directory of Open Access Journals (Sweden)

    Botelho RV

    2011-12-01

    Full Text Available Ricardo Vieira Botelho1,2, Thiago Lusvarghi Cardoso2, Wanderley Marques Bernardo3,41Neurosurgical Service, Hospital do Servidor Público do Estado de São Paulo; 2Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID; 3Faculdade de Medicina, Universidade Lusíadas (UNILUS, Santos; 4Hospital das Clinicas da Universidade de São Paulo, São Paulo, BrazilIntroduction: Lumbar disk herniation is the pathologic condition most commonly responsible for radicular pain, and the condition for which lumbar surgery is performed most frequently. Fusion in the lumbar spine, which is associated with surgical treatment of disk prolapse, has been discussed since the beginning of the contemporary era of lumbar spine surgery. It is questionable whether or not fusion would address the potential effects in the evolutive degenerative process in the years following the surgery. A systematic review of controlled studies was conducted to clarify the effect of fusion.Methods: An evidenced-based practice systematic method called the PICO was used to search the best evidence in MEDLINE using PubMed tools.Results: Only retrospective comparative studies were found, and they revealed superior long-term results in outcomes such as satisfactory rates, recurrence of disk herniation, and chronic low back rates for a fusion group of patients.Discussion: Several papers have concluded that there is conflictive evidence of the role for fusion in surgery for lumbar herniated disks. For the first time, this conflictive evidence has been clarified by means of systematic review and meta-analysis.Conclusion: There were substantial statistical heterogeneous results favoring spinal fusion in surgery for lumbar disk herniation, producing conflictive evidence to support fusion as an option.Keywords: intervertebral disk displacement, lumbar vertebrae, surgical procedures, discectomy, spinal fusion, treatment outcome

  14. Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions

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    Nancy E Epstein

    2015-01-01

    Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

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

    Science.gov (United States)

    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

  16. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion.

    Science.gov (United States)

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

    2014-07-01

    The utilization of orthotic devices for lumbar degenerative disease has been justified from both a prognostic and therapeutic perspective. As a prognostic tool, bracing is applied prior to surgery to determine if immobilization of the spine leads to symptomatic relief and thus justify the performance of a fusion. Since bracing does not eliminate motion, the validity of this assumption is questionable. Only one low-level study has investigated the predictive value of bracing prior to surgery. No correlation between response to bracing and fusion outcome was observed; therefore a trial of preoperative bracing is not recommended. Based on low-level evidence, the use of bracing is not recommended for the prevention of low-back pain in a general working population, since the incidence of low-back pain and impact on productivity were not reduced. However, in laborers with a history of back pain, a positive impact on lost workdays was observed when bracing was applied. Bracing is recommended as an option for treatment of subacute low-back pain, as several higher-level studies have demonstrated an improvement in pain scores and function. The use of bracing following instrumented posterolateral fusion, however, is not recommended, since equivalent outcomes have been demonstrated with or without the application of a brace.

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

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    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

  18. Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease:a retrospective study

    Institute of Scientific and Technical Information of China (English)

    LIU Hai-ying; ZHOU Jian; WANG Bo; WANG Hui-min; JIN Zhao-hui; ZHU Zhen-qi; MIAO Ke-nan

    2012-01-01

    Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration.There are few reports on Topping-off surgery and its rationality and indications remains highly controversial.Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery.Methods The 25 cases that underwent L5-S1 posterior lumbar interbody fusion(PLIF)+L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group.The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group.Both groups matched in gender,age,body mass index and Pfirrmann grading(4 to 6).The patients were evaluated with visual analogue scale(VAS)and Japanese orthopaedic association(JOA)scores before surgery and in the last follow-up.Modic changes of endplates were recorded.Results The follow-up averaged 24.8 and 23.7 months.No symptomatic or radiological adjacent segment degeneration was observed.There was no significant difference in intraoperative blood loss or postoperative drainage.VAS and lumbar JOA scores improved significantly in both groups(t=12.1 and 13.5,P<0.05).Neither anterior nor posterior disc height was significantly changed.Segmental lordosis of L4-L5 and total lordosis were all increased significantly(Topping-off group:t=-2.30 and-2.24,P<0.05;PLIF group:t=-2.76 and-1.83,P<0.01).In the hyperextension and hyperflexion view,Topping-off group's range of motion(ROM)and olisthesis in the L4-L5 segment did not significantly change in flexion,but decreased in extension.In PLIF group,ROM(t=-7.82 and-4.90,P<0.01)and olisthesis(t=-15.67and-18.58,P<0.01)both significantly increased in extension and flexion.Conclusions Compared with single segment PLIF surgery,Topping-off surgery can achieve similar

  19. Endoscopic decompression combined with interspinous process implant fusion for lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    LIU Gang; ZHAO Jian-ning; Akira Dezawa

    2008-01-01

    Objective: To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods: This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 21306. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association (JOA) score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results: There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions: The median approach endoscopic decom-pression is an ideal method for bilateral radicuiopathy result-ing from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exUent. Preservation of adjacent level disease can be assessed only in long-term follow-up.

  20. Disc height and anteroposterior translation in fused and adjacent segments after lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Frobin, Wolfgang

    2003-09-01

    Full Text Available In a series of 46 patients the effects of spinal fusion upon intervertebral height and sagittal alignment in operated and non-operated segments were retrospectively evaluated on digitized radiographs. Data was compared with age- and gender-normalized standard values. The objective was to evaluate the influence of different types of spine fusions primarily upon adjacent segments, particularly in terms of degeneration and sagittal profile of the lumbar spine. Incidence of adjacent segment degeneration (ASD is still highly controversial. However, not every degeneration adjacent to spinal fusion must be caused by the fusion and responsibility of the fusion for ASD may vary with its range and type. Distortion Corrected Roentgen Analysis (DCRA was utilized. DCRA is a proven valid, reliable, observer-independent, and accurate tool for assessment of these parameters over time and in comparison with "normal" cohorts. With this method the exact posture of the patients needs not to be known.There was little evidence for serious fusion-related ASD within an average of 40 months follow-up. No difference could be detected for rigid vs. non-rigid fusion and instrumented vs. non-instrumented techniques. Temporary postoperative distraction effects could be detected in operated and non-operated segments. Absolute preoperative values for intervertebral height and vertebral slip were age-related. Retrospectively, the choice of segments for fusion was clearly based upon radiological criteria. Thus we conclude that radiological parameters have an obvious clinical relevance for decision-making and need to be quantified. Within the limitations of this pilot study, true fusion related ASD seems to be infrequent.

  1. Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation

    Science.gov (United States)

    Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

    2016-01-01

    BACKGROUND: Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. PURPOSE: The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. METHODS: We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. RESULTS: Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they “awaited the result of surgery”, and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. CONCLUSION: The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of

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

    OpenAIRE

    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...

  3. The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11-13 year follow-up

    DEFF Research Database (Denmark)

    Andersen, Thomas; Videbaek, Tina S; Hansen, Ebbe S;

    2008-01-01

    INTRODUCTION: Few studies have investigated the long-term effect of posterolateral lumbar spinal fusion on functional outcome. AIM: To investigate the long-term result after posterolateral lumbar spinal fusion with and without pedicle screw instrumentation. METHODS: Questionnaire survey of 129 pa...

  4. Effect of intraoperative navigation on operative time in 1-level lumbar fusion surgery.

    Science.gov (United States)

    Khanna, Arjun R; Yanamadala, Vijay; Coumans, Jean-Valery

    2016-10-01

    The use of intraoperative image guided navigation (NAV) in spine surgery is increasing. NAV is purported to improve the accuracy of pedicle screw placement but has been criticized for potentially increasing surgical cost, a component of which may be prolongation of total operative time due to time required for setup and intra-operative imaging and registration. In this study, we examine the effect of the introduction of O-Arm conical CT spinal navigation on surgical duration. We retrospectively analyzed consecutive freehand (FH) (n=63) and NAV (n=70) 1-level lumbar transpedicular instrumentation cases at a single institution by a single surgeon. We recorded setup and procedure time for each case. NAV was associated with significantly shorter total operative time for 1-level lumbar fusions compared to FH (4:30+/-0:42 hours vs. 4:53+/-0:39hours, p=0.0013). This shortening of total operative time was realized despite a trend toward slightly longer setup times with NAV. We also found a significant decrease in operative length over time in NAV but not FH cases, indicative of a "learning curve" associated with NAV. The use of NAV in 1-level lumbar transpedicular instrumentation surgery is associated with significantly shorter total operative time compared to the FH technique, and its efficiency improves over time. These data should factor into cost-effectiveness analyses of the use of NAV for these cases. PMID:27364319

  5. Postoperative lumbar spinal stenosis after intertransverse fusion with granules of hydroxyapatite: a case report

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    Inoue Gen

    2012-11-01

    Full Text Available Abstract In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA, bone union was not completed and the patient felt the recurrence of his symptoms within two years. We performed re-decompression with fusion, and in hematoxylin and eosin staining of HA granulation harvested during revision surgery, fibrous tissue with hyaline degeneration surrounded the cavity where the HA had existed. Multinuclear giant cells and lymphocytes infiltrated some parts of the marginal layer of the cavity, and no obvious bony bridge had regenerated from autologous bone. No tartrate-resistant acid phosphate (TRAP -positive osteoclasts could be seen in the new bone, suggesting that the activity of osteoclasts in the new bone decreased during the seven years after the primary surgery. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3483360258050263

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

    Science.gov (United States)

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

    2010-12-01

    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 subsequent osteogenesis. In this study, six adult ewes underwent anterior-lateral interbody fusion at L3/L4 and L4/L5 using PEEK interbody rings filled with autogenous bone at one level and ABM/P-15 at the other level and no additional instrumentation. Clinical CT scans were obtained at 3 and 6 months; micro-CT scans and histomorphometry analyses were performed after euthanization at 6 months. Clinical CT scan analysis showed that all autograft and ABM/P-15 treated levels had radiographically fused outside of the rings at the 3-month study time point. Although the clinical CT scans of the autograft treatment group showed significantly better fusion within the PEEK rings than ABM/P-15 at 3 months, micro-CT scans, clinical CT scans, and histomorphometric analyses showed there were no statistical differences between the two treatment groups at 6 months. Thus, ABM/P-15 was as successful as autogenous bone graft in producing lumbar spinal fusion in an ovine model, and it should be further evaluated in clinical studies.

  7. Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SUN Zhi-jian; LI Wen-jing; ZHAO Yu; QIU Gui-xing

    2013-01-01

    Background Transforaminal lumbar interbody fusion (TLIF) through a minimally invasive approach (mTLIF) was introduced to reduce soft tissue injury and speed recovery.Studies with small numbers of patients have been carried out,comparing mTLIF with traditional open TLIF (oTLIF),but inconsistent outcomes were reported.Methods We conducted a meta-analysis to evaluate the effectiveness of mTLIF and oTLIF in the treatment of degenerative lumbar disease.We searched PubMed,Embase and Cochrane Database of Systematic Reviews in March 2013 for studies directly comparing mTLIF and oTLIF.Patient characteristics,interventions,surgical-related messages,early recovery parameters,long-term clinical outcomes,and complications were extracted and relevant results were pooled.Results Twelve cohort studies with a total of 830 patients were identified.No significant difference regarding average operating time was observed when comparing mTLIF group with oTLIF group (-0.35 minute,95% confidence interval (C/):-20.82 to 20.13 minutes).Intraoperative blood loss (-232.91 ml,95% CI:-322.48 to-143.33 ml) and postoperative drainage (-111.24.ml,95% CI:-177.43 to-45.05 ml) were significantly lower in the mTLIF group.A shorter hospital stay by about two days was observed in patients who underwent mTLIF (-2.11 days,95% CI:-2.76 to-1.45 days).With regard to long-term clinical outcomes,no significant difference in visual analog scale score (-0.25,95% CI:-0.63 to 0.13) was observed; however,there was a slight improvement in Oswestry Disability Index (-1.42,95% CI:-2.79 to-0.04) during a minimum of 1-year follow-up between the two groups.The incidence of complications did not differ significantly between the procedures (RR=1.06,95% CI:0.7 to 1.59).Reoperation was more common in patients in mTLIF group than in oTLIF group (5% vs.2.9%),but this difference was not significant (RR=1.62,95% CI:0.75 to 3.51).Conclusion Current evidence suggests that,compared with traditional open surgery

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

    Science.gov (United States)

    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

  9. Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis

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    Farzad Omidi-Kashani

    2016-02-01

    Full Text Available Background: Lumbar degenerative spondylolisthesis (LDS is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. Methods: This before-after study was carried out on 45 patients (37 female and 8 male with LDS operated from August 2008 to January 2011. The patients’ pain and disability were assessed by visual analogue scale (VAS and Oswestry disability index (ODI questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement.

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

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    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.

  11. Results of instrumented posterolateral fusion in treatment of lumbar spondylolisthesis with and without segmental kyphosis: A retrospective investigation

    Directory of Open Access Journals (Sweden)

    Szu-Yuan Chen

    2015-06-01

    Full Text Available Background: Treatment by posterolateral fusion (PLF with pedicle-screw instrumentation can be unsuccessful in one-segment and low-grade lumbar spondylolisthesis. Segmental kyphosis, either rigid or dynamic, was hypothesized to be one of the factors interfering with the fusion results. Methods: From 2004 to 2005, 239 patients with single-segment and low-grade spondylolisthesis were recruited and divided into two groups: Group 1 consisting of 129 patients without segmental kyphosis and group 2 consisting of 110 patients with segmental kyphosis. All patients underwent instrumented PLF at the same medical institute, and the average follow-up period was 31 ± 19 months. We obtained plain radiographs of the lumbosacral spine with the anteroposterior view, the lateral view, and the dynamic flexion-extension views before the operation and during the follow-ups. The results of PLF in the two groups were then compared. Results: There was no significant difference in the demographic data of the two groups, except for gender distribution. The osseous fusion rates were 90.7% in group 1 and 68.2% in group 2 (p < 0.001. Conclusion: Instrumented PLF resulted in significantly higher osseous fusion rate in patients without segmental kyphosis than in the patients with segmental kyphosis. For the patients with sagittal imbalance, such as rigid or dynamic kyphosis, pedicle-screw fixation cannot ensure successful PLF. Interbody fusion by the posterior lumbar interbody fusion or transforaminal lumbar interbody fusion technique might help overcome this problem.

  12. Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis☆

    Science.gov (United States)

    Mizusaki, Danilo; Gotfryd, Alberto Ofenhejm

    2016-01-01

    Objective To evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic, in patients with adolescent idiopathic scoliosis of Lenke type 1. Methods Forty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line) and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser) were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery. Results The mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B. Conclusions In Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and led to trunk balance. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve. PMID:26962505

  13. Risk Factors for Postoperative Infections Following Single Level Lumbar Fusion Surgery.

    Science.gov (United States)

    Lim, Seokchun; Edelstein, Adam I; Patel, Alpesh A; Kim, Bobby D; Kim, John Y S

    2014-09-29

    Study Design. Retrospective multivariate analysis of a prospectively collected, multi-center database.Objective. To identify patient characteristics and perioperative risk factors associated with postoperative infectious complications following single level lumbar fusion (SLLF) surgery.Summary of Background Data. Postoperative infection is a known complication following lumbar fusion. Risk factors for infectious complications following lumbar fusion have not been investigated using select set of SLLF procedures.Methods. Patients who underwent SLLF between 2006 and 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression analyses were performed to identify pre- and intra-operative risk factors associated with postoperative infection.Results. 3,353 patients were analyzed in this study. Overall, 173 (5.2%) patients experienced a postoperative infection, including 86 (2.6%) surgical site infections (SSI) and 111 (3.3%) non-SSI infectious complications (pneumonia, UTI, sepsis/septic shock). Twenty four (0.7%) patients experienced both SSI and non-SSI infectious complications. Postoperative SSI were associated with obesity (OR 1.628, 95% CI 1.042-2.544), American Society of Anesthesiologist (ASA) class>2 (OR 2.078, 95% CI 1.309-3.299), and operative time >6 hrs (OR 2.573, 95% CI 1.310-5.056). Risk factors for non-SSI infectious complications included age (60-69 yrs, OR 3.279, 95% CI 1.541-6.980;≥70 yrs, OR 3.348, 95% CI 1.519-7.378), female gender (OR 1.791, 95% CI 1.183-2.711), creatinine>1.5mg/dL (OR 2.400, 95% CI 1.138-5.062), ASA >2 (OR 1.835, 95% CI 1.177-2.860), and operative time >6hrs (OR 3.563, 95% CI 2.082-6.097).Conclusions. Across a wide study population, we identified that obesity, advanced ASA classification, and longer operative time were predictive of postoperative SSI. We also demonstrated that increased age, female gender, serum creatinine>1.5mg/dL, and

  14. Degenerative Change in the Adjacent Segments to the Fusion Site after Posterolateral Lumbar Fusion with Pedicle Screw Instrumentation : A Minimum 4-Year Follow-up

    OpenAIRE

    Hayashi, Tetsuo; Arizono, Takeshi; Fujimoto, Toshihiro; Morooka, Takaaki; Shida, Junichi; Tokito, Takeshi; Fukumoto, Shinichi; Masuda, Sachio

    2008-01-01

    Background. Controversy remains regarding the subsequent degeneration of adjacent segments, and little reliable information could be found in the literature regarding long-term clinical results and adjacent segment degeneration. The objective of this study is to investigate the degenerative change of adjacent segments to the fusion site and clinical outcome after posterolateral lumbar fusion with pedicle screw instrumentation and identify the risk factors in degenerative change at adjacent se...

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

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    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

  16. Pain Intensity and Patients’ Acceptance of Surgical Complication Risks With Lumbar Fusion

    Science.gov (United States)

    Bono, Christopher M.; Harris, Mitchel B.; Warholic, Natalie; Katz, Jeffrey N.; Carreras, Edward; White, Andrew; Schmitz, Miguel; Wood, Kirkham B.; Losina, Elena

    2014-01-01

    Study Design Cross-sectional study with prospective recruitment Objective To determine the relationship of pain intensity (back and leg) on patients’ acceptance of surgical complication risks when deciding whether or not to undergo lumbar spinal fusion. Background To formulate informed decisions regarding lumbar fusion surgery, preoperative discussions should include a review of the risk of complications balanced with the likelihood of symptom relief. Pain intensity has the potential to influence a patient’s decision to consent to lumbar fusion. We hypothesized that pain intensity is associated with a patient’s acceptance of surgical complication risks. Methods Patients being seen for the first time by a spine surgeon for treatment of a non-traumatic or non-neoplastic spinal disorder completed a structured questionnaire. It posed 24 scenarios, each presenting a combination of risks of 3 complications (nerve damage, wound infection, nonunion) and probabilities of symptom relief. For each scenario, the patient indicated whether he/she would/would not consent to a fusion for low back pain (LBP). The sum of the scenarios in which the patient responded that he or she would elect surgery was calculated to represent acceptance of surgical complication risks. A variety of other data were also recorded, including age, gender, education level, race, history of non-spinal surgery, duration of pain, and history of spinal injections. Data were analyzed using bivariate analyses and multivariate regression analyses. Results The mean number of scenarios accepted by 118 enrolled subjects was 10.2 (median 8, standard deviation 8.5, range 0 to 24, or 42.5% of scenarios). In general, subjects were more likely to accept scenarios with lower risks and higher efficacy. Spearman’s rank correlation estimates demonstrated a moderate association between the LBP intensity and acceptance of surgical complication risks (r=0.37, p=0.0001) while leg pain intensity had a weak but positive

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

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    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    Xin-Lei Xia; Hong-Li Wang; Fei-Zhou Lyu; Li-Xun Wang; Xiao-Sheng Ma; Jian-Yuan Jiang

    2015-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Anterior Lumbar Intervertebrai Fusion with Artificial Bone in Place of Autologous Bone

    Institute of Scientific and Technical Information of China (English)

    徐卫国; 陈安民; 冯旭; 印卫锋

    2003-01-01

    The feasibility of anterior lumbar intervertebral fusion with artificial bone in place of au-togenous bone was investigated. Porous hydroxyapatite(HA)/ZrO2 ceramics loading bone morpho-genetic protein (BMP) were implanted after removal of lumbar vertebral disc in rabbits. The adja-cent intervertebral discs were also removed by the same way and autogenous illic bone was implan-ted. SEM observation and biomechanical test were carried out. Compound bone had a bit lower os-teoinductive activity than autogenous bone by SEM(Osteoindutive activity of artificial bone in 12weeks was the same as that of autogenous bone in 9 weeks). Biomechanical test revealed that com-pound bone had lower anti-pull strength than autogenous bone (P<0. 001), but there was no sig-nificant difference in anti-pull strength between compound bone at 12th week and autogenous boneat 9th week (P>0.05). It was concluded that compound bone could be applied for anterior spinalfusion, especially for those patients who can't use autogenous bone.

  4. Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

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    Tarnanen Sami

    2012-07-01

    Full Text Available Abstract Background Lumbar spine fusion (LSF effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3 months postoperatively, at the end of the exercise intervention period (15 months postoperatively, and after a 1-year follow-up. Discussion The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF. Trial registration ClinicalTrials.gov Identifier NCT00834015

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

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    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.

  6. In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

    Science.gov (United States)

    Hennessy, Winnie; Wagner, Elizabeth; Dumas, Bonnie P; Handley, Patricia

    2015-12-01

    The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range? PMID:26293197

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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

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

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    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.

  10. Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats.

    Science.gov (United States)

    Zhou, Zhuang; Tian, Fa-Ming; Gou, Yu; Wang, Peng; Zhang, Heng; Song, Hui-Ping; Shen, Yong; Zhang, Ying-Ze; Zhang, Liu

    2016-04-01

    Osteoporosis, which is prevalent in postmenopausal or aged populations, is thought to be a contributing factor to adjacent segment disc degeneration (ASDD), and the incidence and extent of ASDD may be augmented by osteopenia. Parathyroid hormone (PTH) (1-34) has already been shown to be beneficial in osteoporosis, lumbar fusion and matrix homeostasis of intervertebral discs. However, whether PTH(1-34) has a reversing or retarding effect on ASDD in osteopenia has not been confirmed. In the present study, we evaluated the effects of intermittent PTH(1-34) on ASDD in an ovariectomized (OVX) rat model. One hundred 3-month-old female Sprague-Dawley rats underwent L4 -L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after OVX surgery. Control groups were established accordingly. PTH(1-34) was intermittently administered immediately after PLF surgery and lasted for 8 weeks using the following groups (n = 20) (V = vehicle): Sham+V, OVX+V, Sham+PLF+V, OVX+PLF+V, OVX+PLF+PTH. The fused segments showed clear evidence of eliminated motion on the fusion-segment based on manual palpation. Greater new bone formation in histology was observed in PTH-treated animals compared to the control group. The extent of ASDD was significantly increased by ovariotomy. Intermittent PTH(1-34) significantly alleviated ASDD by preserving disc height, microvessel density, relative area of vascular buds, endplate thickness and the relative area of endplate calcification. Moreover, protein expression results showed that PTH(1-34) not only inhibited matrix degradation by decreasing MMP-13, ADAMTS-4 and Col-I, but also promote matrix synthesis by increasing Col-II and Aggrecan. In conclusion, PTH(1-34), which effectively improves lumbar fusion and alleviates ASDD in ovariectomized rats, may be a potential candidate to ameliorate the prognosis of lumbar fusion in osteopenia.

  11. Comparative cost effectiveness of Coflex® interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Schmier JK

    2014-03-01

    Full Text Available Jordana Kate Schmier,1 Marci Halevi,2 Greg Maislin,3 Kevin Ong4 1Health Sciences, Exponent Inc., Alexandria, VA, USA; 2Paradigm LLC, New York, NY, USA; 3Biomedical Statistical Consulting, Wynnewood, PA, USA; 4Biomedical Engineering, Exponent Inc., Philadelphia, PA, USA Introduction: Symptomatic chronic low back and leg pain resulting from lumbar spinal stenosis is expensive to treat and manage. A randomized, controlled, multicenter US Food and Drug Administration Investigational Device Exemption clinical trial assessed treatment-related patient outcomes comparing the Coflex® Interlaminar Stabilization Device, an interlaminar stabilization implant inserted following decompressive surgical laminotomy in the lumbar spine, to instrumented posterolateral fusion among patients with moderate to severe spinal stenosis. This study uses patient-reported outcomes and clinical events from the trial along with costs and expected resource utilization to determine cost effectiveness. Methods: A decision-analytic model compared outcomes over 5 years. Clinical input parameters were derived from the trial. Oswestry Disability Index scores were converted to utilities. Treatment patterns over 5 years were estimated based on claims analyses and expert opinion. A third-party payer perspective was used; costs (in $US 2013 and outcomes were discounted at 3% annually. Sensitivity analyses examined the influence of key parameters. Analyses were conducted using Medicare payment rates and typical commercial reimbursements. Results: Five-year costs were lower for patients implanted with Coflex compared to those undergoing fusion. Average Medicare payments over 5 years were estimated at $15,182 for Coflex compared to $26,863 for the fusion control, a difference of $11,681. Mean quality-adjusted life years were higher for Coflex patients compared to controls (3.02 vs 2.97. Results indicate that patients implanted with the Coflex device derive more utility, on average, than

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion.

    Science.gov (United States)

    Joseph, Jacob R; Smith, Brandon W; Patel, Rakesh D; Park, Paul

    2016-09-01

    OBJECTIVE Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF. METHODS An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post-cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters. RESULTS The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1-4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures. PMID:27104283

  15. Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation.

    Science.gov (United States)

    Lu, Kang; Liliang, Po-Chou; Wang, Hao-Kuang; Liang, Cheng-Loong; Chen, Jui-Sheng; Chen, Tai-Been; Wang, Kuo-Wei; Chen, Han-Jung

    2015-08-01

    OBJECT Multilevel long-segment lumbar fusion poses a high risk for future development of adjacent-segment degeneration (ASD). Creating a dynamic transition zone with an interspinous process device (IPD) proximal to the fusion has recently been applied as a method to reduce the occurrence of ASD. The authors report their experience with the Device for Intervertebral Assisted Motion (DIAM) implanted proximal to multilevel posterior lumbar interbody fusion (PLIF) in reducing the development of proximal ASD. METHODS This retrospective study reviewed 91 cases involving patients who underwent 2-level (L4-S1), 3-level (L3-S1), or 4-level (L2-S1) PLIF. In Group A (42 cases), the patients received PLIF only, while in Group B (49 cases), an interspinous process device, a DIAM implant, was put at the adjacent level proximal to the PLIF construct. Bone resection at the uppermost segment of the PLIF was equally limited in the 2 groups, with preservation of the upper portion of the spinous process/lamina and the attached supraspinous ligament. Outcome measures included a visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI) for functional impairment. Anteroposterior and lateral flexion/extension radiographs were used to evaluate the fusion status, presence and patterns of ASD, and mobility of the DIAM-implanted segment. RESULTS Solid interbody fusion without implant failure was observed in all cases. Radiographic ASD occurred in 20 (48%) of Group A cases and 3 (6%) of Group B cases (p Group A and 3 in Group B were symptomatic; of these patients, 3 in Group A and 1 in Group B underwent a second surgery for severe symptomatic ASD. At 24 months after surgery, Group A patients fared worse than Group B, showing higher mean VAS and ODI scores due to symptoms related to ASD. At the final follow-up evaluations, as reoperations had been performed to treat symptomatic ASD in some patients, significant differences no longer existed between the 2

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

    Institute of Scientific and Technical Information of China (English)

    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.

  17. 腰椎融合及植入物内固定后滑脱腰椎的椎体稳定性%Stability of lumbar vertebrae with lumbar spondylolisthesis after lumbar fusion and implant internal fixation

    Institute of Scientific and Technical Information of China (English)

    朱瑜琪; 王金荣

    2013-01-01

      背景:腰椎滑脱症的治疗目的是重建脊柱序列和椎体稳定性,解除神经压迫,达到永久腰椎融合的作用。目的:探讨腰椎滑脱症患者腰椎融合及植入物内固定后椎体稳定性的恢复。  方法:腰椎滑脱症最常采用Wiltse分型将其分为发育不良性、峡部裂性、退变性、创伤性以及病理性,将腰椎侧位X射线片的上位椎体相对于下位椎体的滑移程度分为5级,根据腰椎滑脱症患者的分型和分级以及患者具体情况选择适宜的治疗方式。  结果与结论:坚强融合内固定,植入物与椎体间是刚性连接,常用来稳定脊柱、矫正畸形,骨融合率较高,减少了假关节形成。动态融合内固定是用弹性材质或微动装置分散坚强内固定负荷传导,减少应力遮挡效应及邻近节段的应力集中。动态非融合内固定能改变脊柱运动节段的负荷传递方式,阻止脊柱运动,预防邻近节段退变,使失稳的腰椎达到其正常状态的活动特性,实现动态重建腰椎序列。峡部关节缺损部位直接修复植骨,适用于青壮年有症状不伴有退行性椎间盘疾病的滑脱患者。腰椎滑脱症选择哪种材料植骨和植骨部位以及哪种入路方法融合和植入物内固定可以得到理想的融合内固定效果一直是学者们争论的焦点,目前尚未达成统一。%BACKGROUND:The purpose of the treatment of lumbar spondylolisthesis is to reconstruct the spine sequence and vertebral stability, relieve nerve compression, and achieve permanent lumbar fusion. OBJECTIVE:To explore the restore of vertebral stability of the lumbar spondylolisthesis patients after lumbar fusion and implant internal fixation. METHODS:The lumbar spondylolisthesis was often divided into dysplastic, isthmic, degenerative, traumatic and pathological with Wiltse classification. The slip degree of upper vertebra relative to lower vertebra on the

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

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Experimental lumbar spine fusion with novel tantalum-coated carbon fiber implant.

    Science.gov (United States)

    Li, Haisheng; Zou, Xuenong; Woo, Charlotte; Ding, Ming; Lind, Martin; Bünger, Cody

    2007-04-01

    Implants of carbon fiber composite have been widely used in orthopedic and spinal surgeries. However, studies using carbon fiber-reinforced cages demonstrate frequent appearance of fibrous layer interposed between the implant and the surrounding bone. The aim of the present study was to test the possibility of coating a biocompatible metal layer on top of the carbon fiber material, to improve its biological performance. Tantalum was chosen because of its bone compatibility, based on our previous studies. A novel spinal fusion cage was fabricated by applying a thin tantalum coating on the surface of carbon-carbon composite material through chemical vapor deposition. Mechanical and biological performance was tested in vitro and in vivo. Compress strength was found to be 4.9 kN (SD, 0.2). Fatigue test with 500,000 cycles was passed. In vitro radiological evaluation demonstrated good compatibility with X-ray and CT scan examinations. In vivo test employed eight pigs weighing 50 kg each. Instrumented lumbar spine fusion of L3/4 and L4/5 with these cages was performed on each pig. After 3 months, excellent bone integration property was demonstrated by direct contact of the cage with the host bone and newly formed bone. No inflammatory cells were found around the implant. Cages packed with two different graft materials (autograft and COLLOSS) achieved the same new bone formation. The present study proved that coating tantalum on top of the carbon-based implant is feasible, and good bone integration could be achieved. PMID:16924610

  20. Experimental lumbar spine fusion with novel tantalum-coated carbon fiber implant.

    Science.gov (United States)

    Li, Haisheng; Zou, Xuenong; Woo, Charlotte; Ding, Ming; Lind, Martin; Bünger, Cody

    2007-04-01

    Implants of carbon fiber composite have been widely used in orthopedic and spinal surgeries. However, studies using carbon fiber-reinforced cages demonstrate frequent appearance of fibrous layer interposed between the implant and the surrounding bone. The aim of the present study was to test the possibility of coating a biocompatible metal layer on top of the carbon fiber material, to improve its biological performance. Tantalum was chosen because of its bone compatibility, based on our previous studies. A novel spinal fusion cage was fabricated by applying a thin tantalum coating on the surface of carbon-carbon composite material through chemical vapor deposition. Mechanical and biological performance was tested in vitro and in vivo. Compress strength was found to be 4.9 kN (SD, 0.2). Fatigue test with 500,000 cycles was passed. In vitro radiological evaluation demonstrated good compatibility with X-ray and CT scan examinations. In vivo test employed eight pigs weighing 50 kg each. Instrumented lumbar spine fusion of L3/4 and L4/5 with these cages was performed on each pig. After 3 months, excellent bone integration property was demonstrated by direct contact of the cage with the host bone and newly formed bone. No inflammatory cells were found around the implant. Cages packed with two different graft materials (autograft and COLLOSS) achieved the same new bone formation. The present study proved that coating tantalum on top of the carbon-based implant is feasible, and good bone integration could be achieved.

  1. Effect of Elastic Modulus on Biomechanical Properties of Lumbar Interbody Fusion Cage

    Institute of Scientific and Technical Information of China (English)

    Yue Zhu; Fusheng Li; Shujun Li; Yulin Hao; Rui Yang

    2009-01-01

    This work focuses on the influence of elastic modulus on biomechanical properties of lumbar interbody fusion cages by selecting two titanium alloys with different elastic modulus.They were made by a new β type alloy with chemical composition of Ti-24Nb-4Zr-7.6Sn having low Young's modulus ~50 GPa and by a conventional biomedical alloy Ti-6Al-4V having Young's modulus ~110 GPa.The results showed that the designed cages with low modulus (LMC) and high modulus (HMC) can keep identical compression load ~9.8 kN and endure fatigue cycles higher than 5× 106 without functional or mechanical failure under 2.0 kN axial compression.The anti-subsidence ability of both group cages were examined by axial compression of thoracic spine specimens (T9~T10) dissected freshly from the calf with averaged age of 6 months.The results showed that the LMC has better anti-subsidence ability than the HMC (p<0.05).The above results suggest that the cage with low elastic modulus has great potential for clinical applications.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Reduction in radiation (fluoroscopy while maintaining safe placement of pedicle screws during lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Christopher D. Chaput

    2013-01-01

    Full Text Available OBJECTIVE: The purpose of this study is to report the results using PediGuard (electrical conductivity device to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. METHOD: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard were analyzed. RESULTS: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000, with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15, average decrease of 2.3 (30% per screw in the PediGuard group vs. 7.5 (range, 2 to 17 in the standard group (p< .001. CONCLUSION: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.

  6. Clinical comparative study of 360° lumbar fusion versus posterolateral fusion for lumbar degenerative disease%360°腰椎融合与后外侧融合治疗腰椎退行性疾病的疗效比较

    Institute of Scientific and Technical Information of China (English)

    孟增东; 雷云坤; 胡彪; 赵毅; 赵晓芳; 刘伟

    2012-01-01

    [Objective] To compare the clinical results of 360° lumbar fusion and posterolateral fusion for lumbar degenerative disease. [Methods] This study was based on forty -five lumbar degenerative disease patients who underwent 360° lumbar fusion or the posterolateral fusion since 2008. Twenty - one patients were divided into 360° lumbar fusion group and twenty - four into posterolateral fusion group. The efficacy of the two fusion methods was evaluated on functional recovery, spinal fusion rate, complication rate, and the maintenance of the lumbar lordosis. [ Results ] Conditions of patients in both groups significantly improved in low - back pain, quality of life, spinal fusion rate and maintenance of the lumbar lordosis. The 360° lumbar fusion patients had better improvement [Conclusion] Compared with posterolateral fusion, 360° lumbar fusion patients can achieve better maintenance of the lumbar lordosis, a higher fusion rate, fewer complications, and better functional recovery.%[目的]分析360°腰椎融合与后外侧融合在治疗腰椎退行性疾病中的疗效.[方法]将2008年后在本科进行手术治疗的45例腰椎退行性疾病患者按融合方法不同分为360°腰椎融合组及后外侧融合组,回顾分析并比较两种融合方法在患者功能恢复、脊椎融合率、并发症的发生率及腰椎生理前凸保持方面的不同,评价两种融合方法的疗效差异.[结果]与术前相比,两组患者在生活质量及腰腿痛方面均有明显的改善,360°腰椎融合组患者改善更为明显.与后外侧融合组患者相比,360°腰椎融合组患者的腰椎生理前凸得到更好的保持,同时,腰椎融合率更高.[结论] 360°腰椎融合与后外侧融合相比,能更好的保持腰椎生理前凸,获得更高的融合率,减少并发症的发生,同时能使患者得到更好的功能恢复.

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

    Science.gov (United States)

    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

  8. Proximal Vertebral Body Fracture after 4-Level Fusion Using L1 as the Upper Instrumented Vertebra for Lumbar Degenerative Disease: Report of 2 Cases with Literature Review

    Directory of Open Access Journals (Sweden)

    Yasuhara,Takao

    2013-06-01

    Full Text Available Some cases with lumbar degenerative diseases require multi-level fusion surgeries. At our institute, 27 and 4 procedures of 3- and 4-level fusion were performed out of a total 672 posterior lumbar interfusions (PLIFs on patients with lumbar degenerative disease from 2005 to 2010. We present 2 osteoporotic patients who developed proximal vertebral body fracture after 4-level fusion. Both cases presented with gait disability for leg pain by degenerative lumbar scoliosis and canal stenosis at the levels of L1/2-4/5. After 4-level fusion using L1 as the upper instrumented vertebra, proximal vertebral body fractures were found along with the right pedicle fractures of L1 in both cases. One of these patients, aged 82 years, was treated as an outpatient using a hard corset for 24 months, but the fractures were exacerbated over time. In the other patient, posterolateral fusion was extended from Th10 to L5. Both patients can walk alone and have been thoroughly followed up. In both cases, the fracture of the right L1 pedicle might be related to the subsequent fractures and fusion failure. In consideration of multi-level fusion, L1 should be avoided as an upper instrumented vertebra to prevent junctional kyphosis, especially in cases with osteoporosis and flat back posture.

  9. The concave versus convex approach for minimally invasive lateral lumbar interbody fusion for thoracolumbar degenerative scoliosis.

    Science.gov (United States)

    Scheer, Justin K; Khanna, Ryan; Lopez, Alejandro J; Fessler, Richard G; Koski, Tyler R; Smith, Zachary A; Dahdaleh, Nader S

    2015-10-01

    We retrospectively reviewed patient charts to compare the approach-related (convex versus concave) neurological complications and magnitude of correction in patients undergoing lateral lumbar interbody fusion (LLIF). It is yet to be quantitatively determined if correction of adult degenerative scoliosis from either side of the curve apex using a LLIF results in a reduction in complications and/or improved corrective ability. The inclusion criteria for this study were patients who underwent a LLIF for adult degenerative thoracolumbar scoliosis and had the LLIF prior to any other supplemental procedures. Patients were grouped based on the approach toward the curve apex concavity (CAVE) or the convexity (VEX). Standard coronal and sagittal radiographic measurements were made. Neurological complications and reoperation indications were also recorded. We included 32 patients for review (CAVE: 17; VEX: 15) with a mean age of 65.5 years±a standard deviation of 10.2, and mean follow-up of 17.0 months±15.7. There were eight postoperative neurological complications in eight patients (25.0%), and seven reoperations for six patients (18.8%; CAVE: 4/17 [23.5%]; VEX: 2/15 [13.3%]). The CAVE group had 6/17 neurological complications (35.3%; four ipsilateral and two contralateral to approach side) and VEX had 2/15 (13.3%; one ipsilateral and one bilateral to approach side; p>0.05). All patients significantly improved in the mean regional and segmental Cobb angles (p0.05). There were no significant differences between the groups for any of the radiographic parameters measured (p>0.05). Approaching the curve apex from either the concave or convex side resulted in significant improvements. The concave approach was associated with more postoperative neurological complications.

  10. Uso de morfina intratecal en artrodesis lumbar Uso da morfina intratecal na artrodese lombar Intrathecal morphine in lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Ronald Schulz Ibaceta

    2009-12-01

    Full Text Available OBJETIVO: determinar la eficacia y la seguridad del uso de morfina intratecal, en bajas dosis, en pacientes sometidos a cirugía de instrumentación y artrodesis lumbar. MÉTODOS: estudio prospectivo, randomizado, ciego y controlado. Fueron utilizados dos grupos de pacientes: Grupo Estudio, que recibió morfina intratecal al final de su cirugía, y Grupo Control que sólo recibió el protocolo de analgesia estándar. RESULTADOS: se encontraron diferencias significativas en la escala visual análoga (EVA entre los dos grupos a las 12 horas postoperatorias. La EVA en reposo promedio del Grupo Estudio fue de 2,15 cm y el del Grupo Control, 5 cm (p=0,013. En actividad, el Grupo Estudio presentó una EVA promedio de 4,36 cm, y el Grupo Control 6,9 cm (p=0,029. No se encontraron diferencias en relación a las complicaciones entre los dos grupos. CONCLUSIÓN: el uso de morfina intratecal, en bajas dosis, es seguro y efectivo en el control del dolor en las primeras 12 horas postoperatorias en cirugía de artrodesis lumbar.OBJETIVO: determinar a eficácia e a seguridade do uso da morfina intratecal, em baixas doses, em pacientes submetidos à cirurgia de instrumentação e artrodese lombar. MÉTODOS: estudo prospectivo, randomizado, cego e controlado. Foram utilizados dois grupos de pacientes: Grupo Estudo, que recebeu morfina intratecal no final da cirurgia e o Grupo Controle, que recebeu somente o protocolo de analgesia padrão. RESULTADOS: foram encontradas diferenças significativas na escala visual analógica (EVA entre os dois grupos às 12 horas pós-operatórias. A EVA em repouso, em média, do Grupo Estudo foi de 2,15 cm e do Grupo Controle, 5 cm (p=0,013. Durante atividade, o Grupo Estudo apresentou uma EVA de aproximadamente 4,36 cm e no Grupo Controle, 6,9 cm (p=0,029. Não foram encontradas diferenças com relação às complicações entre os dois grupos. CONCLUSÃO: o uso de morfina intratecal, em baixas doses, foi seguro e efetivo no

  11. Clinical results of posterolateral fusion for degenerative lumbar spinal diseases. A follow-up study of more than 10 years

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    Kuroki, Hiroshi; Tajima, Naoya; Kubo, Shinichiro [Miyazaki Medical Coll., Kiyotake (Japan)

    2002-07-01

    The objective of this retrospective study was to evaluate the long-term clinical outcomes and the effects on unfused motion segments of posterolateral fusion. This study involved 35 cases (37 intervertebral levels) of posterolateral fusion performed to treat degenerative lumbar spinal diseases. There were 20 male and 15 female patients ranging in age from 30 to 67 years, with a mean age of 49 years. The postoperative period ranged from 10 years to 17 years and 8 months, with a mean period of 13 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for assessment of treatment for low back pain. The effects on unfused motion segments were investigated with radiographic and magnetic resonance (MR) imaging. Postoperative satisfactory improvement (mean recovery rate, 66.9%) reached a plateau at 1 year and was maintained at final follow-up. Radiographically, the union rate was 86.5%. There were few cases of induced instability of unfused motion segments. On MR imaging, increased signal intensity in both T{sub 1}- and T{sub 2}-weighted images was seen in the paravertebral muscles in 15 of 20 cases (75.0%). Posterolateral fusion is a useful technique for the treatment of degenerative lumbar spinal diseases. Clinical outcomes were stable throughout follow-up. Instability of unfused motion segments rarely occurred. (author)

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

    Science.gov (United States)

    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

  13. What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

    Science.gov (United States)

    Staats, Peter S.; Nampiaparampil, Devi E.; Hirsch, Joshua A.

    2015-01-01

    Background Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. Methods A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. Results Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. Conclusions The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments. PMID:25852828

  14. Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up.

    Science.gov (United States)

    Arnold, Paul M; Robbins, Stephen; Paullus, Wayne; Faust, Stephen; Holt, Richard; McGuire, Robert

    2009-07-01

    The clinical benefits and complications of posterior lumbar interbody fusion (PLIF) have been studied over the past 60 years. In recent years, spine surgeons have had the option of treating low back pain caused by degenerative disc disease using PLIF with machined allograft spacers and posterior pedicle fixation. The purpose of this clinical series was to assess the clinical benefits of using a machined PLIF allograft spacer and posterior pedicle fixation to treat degenerative disc disease, both in terms of fusion rates and patient outcomes, and to compare these results with those in previous studies using autograft and metal interbody fusion devices. Results were also compared with results from studies using transverse process fusion. This prospective, nonrandomized clinical series was conducted at 10 US medical centers. Eighty-nine (55 male, 34 female) patients underwent PLIF with a presized, machined allograft spacer and posterior pedicle fixation between January 2000 and April 2003. Their outcomes were compared with outcomes in previous series described in the literature. All patients had experienced at least 6 months of low back pain that had been unresponsive to nonsurgical treatment. Physical examinations were performed before surgery, after surgery, and at 4 follow-up visits (6 weeks, 6 months, 12 months, 24 months). At each interval, we obtained radiographs and patient outcome measures, including SF-36 Bodily Pain Score, visual analog scale pain rating, and Oswestry Disability Index. The primary outcome was fusion results at 12 and 24 months; the secondary outcomes were pain, disability, function/quality of life, and satisfaction. One-level PLIFs were performed in 65 patients, and 2-level PLIFs in 24 patients. Flexion-extension radiographs at 12 and 24 months revealed a 98% fusion rate. Of the 72 patients who reached the 12-month follow-up, 86% reported decreased pain and disability as measured with the Oswestry Disability Index. Decreased pain as measured

  15. Lumbar spondylolisthesis treated with lnterbody fusion cage and posteriotaterior lumbar bone graft%椎间融合器联合后外侧植骨融合治疗腰椎滑脱症

    Institute of Scientific and Technical Information of China (English)

    黄永栋; 蒋卫平; 韦冰丹; 杨晓明; 甘坤宁; 周竖平; 刘剑伟; 黄家志

    2012-01-01

    Objective To evaluate the Affiliated to clinical outcome of lumbar spondylolisthesis using hiterbody fusion cage and posteriolalerion lumbar bone graft. Methods From January 2007 to January 2011,32 cases of lumbar spondylolisthesis were treated with lnterbody fusion cages and posteriolaterion lumbar bone graft. Results ['oilowed—up for 12 to 38 months.averaged 3.6 months, the fusion rate was 100%. According lo evaluation standard of ZOU De-wei;19 cases achieved excellent outcomes.good 10 and 3 fair,the clinical satisfaction rate of 90,62%, Conclusions The lnterbody fusion cages and posteriolaterion lumbar bone graft is a effective method for keeping spinal stability and restoring inlerverlebral height and improving the bony fusion rale.%目的 探讨椎间融合器联合后外侧植骨融合治疗腰椎滑脱的术后效果.方法 2007-01-2011-01 采用椎间植骨联合后外侧植骨融合治疗腰椎滑脱患者32 例.结果 随访12~38 月,平均16 个月,根据Suk 方法判定术后骨融合情况,骨融合率为100%.根据邹德威等临床功能评价标准评分:优19 例,良10 例,可3 例,优良率90.62%.结论 椎间融合器联合后外侧植骨融合术治疗腰椎滑脱是一种较理想的手术方法,能维持脊柱稳定性,恢复椎间隙高度和提高植骨融合率.

  16. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology.

    Science.gov (United States)

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

    2014-07-01

    Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with degenerative disease of the lumbar spine. In 2005, the first version of the "Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine" was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.

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

    NARCIS (Netherlands)

    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

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

    NARCIS (Netherlands)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  20. Within Patient Radiological Comparative Analysis of the Performance of Two Bone Graft Extenders Utilized in Posterolateral Lumbar Fusion: A Retrospective Case Series

    OpenAIRE

    Stewart, Geoffrey; Gage, Gary B.; Neidert, Gary; Adkisson, Huston Davis

    2016-01-01

    Two bone graft extenders differing in chemical composition were implanted contralaterally in 27 consecutive patients undergoing instrumented posterolateral lumbar fusion as standard-of-care. Bone marrow aspirate and autogenous bone graft were equally combined either with β-tricalcium phosphate (β-TCP) or a hybrid biomaterial [containing hyaluronic acid (HyA) but lacking a calcium salt] and implanted between the transverse processes. Fusion status on each side of the vertebrae was retrospectiv...

  1. Comparison of standard fusion with a "topping off" system in lumbar spine surgery: a protocol for a randomized controlled trial

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    Kaulhausen Thomas

    2011-10-01

    Full Text Available Abstract Background Fusion of lumbar spine segments is a well-established therapy for many pathologies. The procedure changes the biomechanics of the spine. Initial clinical benefits may be outweighed by ensuing damage to the adjacent segments. Various surgical devices and techniques have been developed to prevent this deterioration. "Topping off" systems combine rigid fusion with a flexible pedicle screw system to prevent adjacent segment disease (ASD. To date, there is no convincing evidence that these devices provide any patient benefits. Methods/Design The study is designed as a randomized, therapy-controlled trial in a clinical care setting at a university hospital. Patients presenting to the outpatient clinic with degenerative disc disease or spondylolisthesis will be assessed against study inclusion and exclusion criteria. After randomization, the control group will undergo conventional fusion. The intervention group will undergo fusion with a supplemental flexible pedicle screw system to protect the adjacent segment ("topping off". Follow-up examination will take place immediately after treatment during hospital stay, after 6 weeks, and then after 6, 12, 24 and 36 months. Subsequently, ongoing assessments will be performed annually. Outcome measurements will include quality of life and pain assessments using questionnaires (SF-36™, ODI, COMI. In addition, clinical and radiologic ASD, work-related disability, and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration, postoperative complications, adverse events, and serious adverse events will be documented and monitored throughout the study. Cost-effectiveness analysis will also be provided. Discussion New hybrid systems might improve the outcome of lumbar spine fusion. To date, there is no convincing published data on effectiveness or safety of these

  2. 改良TLIF治疗腰椎退变性疾病%Modified transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    荣树; 马兆钦

    2011-01-01

    目的 探讨改良TLIF治疗腰椎退变性疾病的疗效.方法 用改良TLIF手术治疗L~S退变性疾病患者24例,共融合40个节段,其中单节段8例,双节段16例.男14例,女lO例;年龄56~78岁,平均64.6岁.退变性滑脱伴椎管狭窄6例,峡不连性滑脱4例,退变性腰椎管狭窄症10例,巨大椎间盘脱出合并椎间失稳4例.术中根据病情需要,采用椎管扩大减压后切除整个下关节突,切除上关节突上部的内侧半,部分开放椎间孔后壁,椎间隙自体微粒骨打压植骨,Cage斜向中线40.方向植入椎间隙,辅以椎弓根螺钉固定完成改良TLIF.结果 术中无并发症发生,24例均获得随访,时间12~20个月,平均17.4个月.所有患者于术后1年随访时均达椎体间融合,无螺钉断裂和Cage移位、沉陷.10例腰椎滑脱者滑脱完全复位并维持良好.根据JOA评分法,本组术前(13.8±4.1)分,末次随访时(24.9±3.0)分,临床改善程度达优16例,良6例,可2例,平均改善率79.5%.结论 改良TLIF扩大了手术适应证,贯彻了TLIF技术的设计思想和微创理念,使操作更加简单、安全,用于下腰椎退变性疾患的治疗效果满意.%Objective To analyze the clinical effects Of modified transforaminal lumbar interbody fusion (TLIF)for the treatment of lumbar degenerative disease. Mothods 24 patients with lumbar degenerative disease (L3-S1) were treated by modified TLIF. There were 14 males and 10 females with an average age of 64.6years(56~78years). A total of 40 levels were fused, including 8 cases of single level and 16 cases of double levels. The results of preoperative diagnosis were lumbar degenerative spondylolisthesis with stenosis (6cases), isthmic spondylolisthesis (4cases), degenerative lumbar stenosis (10cases), huge herniated disc with segmental instability (4cases). During the modified TLIF procedure, total inferior facet process and inner half summit of superior facet process of TLIF side were resected to make the

  3. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery

    Science.gov (United States)

    Balaji, V.; Kaila, R.; Wilson, L.

    2016-01-01

    Objectives We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. Methods The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion. Results A total of six studies (three prospective and three retrospective) reporting on the use of BMP2 met the inclusion criteria (203 patients). Of these, four provided a comparison of BMP2 and bone graft whereas the other two solely investigated the use of BMP2. The primary outcome was seen in 92.3% (108/117) of patients following surgery with BMP2. Although none of the studies showed superiority of BMP2 to bone graft for fusion, its use was associated with a statistically quicker time to achieving fusion. BMP2 did not appear to increase the risk of complication. Conclusion The use of BMP2 is both safe and effective within the revision setting, ideally in cases where bone graft is unavailable or undesirable. Further research is required to define its optimum role. Cite this article: Mr P. Bodalia. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016;5:145–152. DOI: 10.1302/2046-3758.54.2000418. PMID:27121215

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Khoshab A.H.

    2014-05-01

    Full Text Available A prospective multicentral observational study of minimally invasive fusion to treat degenerative lumbar disorders, and to report outcomes of one or two level minimally invasive posterior lumbar interbody fusion (MLIF for degenerative lumbar disorders in a multi-center 1-year prospective study. We prospectively studied a group of 32 patients, mostly female 24 ( 75% female , and 8 males ( 25%. They underwent minimally invasive transforaminal lumbar interbody fusion (mTLIF, 21 of them monosegmental and 11 bisegmental. Patients demographics, intraoperative data and complications were recorded. Time to first ambulation, time to study-defined recovery, surgical duration, blood loss, fluoroscopy time and adverse events were recorded. Visual analogue scale (VAS of back and legs pain, Oswestry disability index (ODI and health-related questionnaire (EQ-5D were assessed preoperatively and at defined time points through 12 months postoperatively. Mean surgical duration, blood loss and intraoperative fluoroscopy time were 125 vs.175 minutes, 150 vs. 170 ml, and 105 vs. 145 seconds in one- and twolevel segments, respectively. Mean preoperative VAS back (6.5 and VAS leg (7.9 scores dropped significantly (p<0.0001 to 3.5 (2.6 and 2.1 (2.0 at discharge (6 weeks. At the end, this is the largest prospective multi-center observational study of MLIF to date, following routine local standard of practice and, MLIF demonstrated favourable clinical results with early and sustained improvement in patient reported outcomes and low major perioperative morbidity.

  6. 经椎间孔行椎体间融合术治疗腰椎退行性疾病的临床分析%Clinical Analysis of Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease

    Institute of Scientific and Technical Information of China (English)

    吴永忠

    2015-01-01

    Objective:To explore the clinical curative effect of transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease.Method:The clinical data of 60 patients with lumbar degenerative disease who were treated by transforaminal lumbar interbody fusion in our hospital from January 2011 to May 2013 were retrospectively analyzed. And 65 patients with posterolateral lumbar fusion at the same time were compared and analyzed.Result:(1)The ODI dysfunction index and the VAS scores of waist and leg pain of patients in the two groups postoperative were significantly lower than those of preoperative(P<0.01),and the VAS scores of waist and leg pain of patients in the TLIF group postoperative were significantly lower than those of patients in the PLF group(P<0.05).(2)The postoperative osseous fusion rate of patients in the TLIF group was 100%,which was obviously higher than 86.15% of patients in the PLF group,the difference was statistically significant(P<0.05).(3)The lumbar lordosis angle and relative height of intervertebral disc in the two groups postoperative were significantly improved compared with preoperative,and the lumbar lordosis angle and relative intervertebral disc height in the TLIF group were increased obviously compared with the PLF group,the differences were statistically significant(P<0.05).Conclusion:The transforaminal lumbar interbody fusion and posterolateral lumbar fusion have preferable clinical curative effects for patients with lumbar degenerative diseases, but the extent of the waist and leg pain relief,convergence rate and intervertebral height adjustment of patients by the transforaminal lumbar interbody fusion are superior than those of patients by posterolateral lumbar fusion,so will the transforaminal lumbar interbody fusion can be regarded as a optimizing operation scheme for lumbar degenerative disease.%目的:探讨经椎间孔行椎体间融合术对腰椎退行性疾病的临床疗效。方法:对本院2011年1

  7. Minimally invasive versusopen transforaminal lumbar interbody fusion for lumbar degenerative disease:a meta-analysis%微小切口与经椎间孔腰椎融合治疗腰椎退行性病的Meta分析

    Institute of Scientific and Technical Information of China (English)

    冉兵; 严磊; 赵晓蕾; 谢远龙; 蔡林

    2014-01-01

    背景:大量研究已证实微小切口与开放经椎间孔腰椎椎间融合治疗单节段和多节段腰椎退行性疾病均有较好的疗效,但两种治疗方法的优劣目前尚无定论。  目的:系统评价微小切口与开放经椎间孔腰椎椎间融合治疗腰椎退行性疾病的疗效及安全性。  方法:计算机检索 The Cochrane Library(2014年第2期)、PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data,检索时限为到2014年2月;收集采用微小切口与开放经椎间孔腰椎椎间融合治疗腰椎退行性疾病的随机或非随机同期对照试验。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。  结果与结论:纳入1个随机对照试验,18个非随机对照试验,共1400例患者。Meta分析结果显示,与传统开放经椎间孔腰椎椎间融合相比,微小切口经椎间孔腰椎椎间融合具有椎旁肌损伤小,出血量少,住院时间短,早期疗效好,腰痛远期缓解率高等优点;但是微小切口经椎间孔腰椎椎间融合在改善远期运动功能,远期腿痛缓解率,减少并发症方面并不优于开放经椎间孔腰椎椎间融合治疗;且手术时间更长。因此,在严格掌握适应证的前提下,采用微小切口经椎间孔腰椎椎间融合能较好解决腰椎退行性疾病患者的病痛。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的随机对照试验进一步验证。临床应根据患者的具体情况,综合评估病情,选择最佳治疗方案。%BACKGROUND:A large number of studies have confirmed that minimaly invasive and open transforaminal lumbar interbody fusion approaches for single-segment and multi-segment lumbar degenerative diseases were effective, but their advantages and disadvantages remain inconclusive. OBJECTIVE:To systematicaly evaluate the effectiveness

  8. 微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术治疗腰椎退变性疾病的疗效及并发症比较%A comparative study on the curative effect and complications of minimally invasive transforaminal lumbar interbody fusion and tradi-tional posterior lumbar interbody fusion in treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    冯建宏; 辛欣

    2016-01-01

    Objective To compare the curative effect and complications of minimally invasive transforaminal lumbar interbody fusion and traditional posterior lumbar fusion in treatment of patients with lumbar degenerative disease. Methods The clinical data of 158 patients with lum-bar degenerative disease,including 83 cases by using traditional posterior lumbar interbody fusion as control group,and remaining 75 cases by u-sing minimally invasive transforaminal lumbar interbody fusion in observation group were retrospectively analyzed. The situations of therapeutic effect and complications in patients of these two groups had been compared. Results The amount of intraoperative blood loss and postoperative drainage in patients of observation group were better than those of patients in control group( P 0. 05). Conclusion The rates of efficay of minimally invasive transforaminal lumbar interbody fusion and tradi-tional posterior lumbar interbody fusion in treatment of patients with lumbar degenerative disease are similar,but the former has higher safety with less invasive,less blood loss,less drainage and less complications.%目的:比较微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术治疗腰椎退变性疾病的临床效果和并发症情况。方法回顾性分析158例腰椎退变性疾病患者的临床资料,其中83例行传统后路腰椎椎体间融合术设为对照组,余75例行微创经椎间孔腰椎椎体间融合术设为观察组;比较两组患者的治疗效果和并发症情况。结果观察组的术中出血量、术后引流量少于对照组( P 0.05)。结论微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术治疗腰椎退变性疾病的疗效类似,但前者手术损伤更小,出血量与引流量更少,神经损伤发生率更低,具有较高安全性。

  9. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic outcome and function.

    Science.gov (United States)

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

    2014-07-01

    In an effort to diminish pain or progressive instability, due to either the pathological process or as a result of surgical decompression, one of the primary goals of a fusion procedure is to achieve a solid arthrodesis. Assuming that pain and disability result from lost mechanical integrity of the spine, the objective of a fusion across an unstable segment is to eliminate pathological motion and improve clinical outcome. However, conclusive evidence of this correlation, between successful fusion and clinical outcome, remains elusive, and thus the necessity of documenting successful arthrodesis through radiographic analysis remains debatable. Although a definitive cause and effect relationship has not been demonstrated, there is moderate evidence that demonstrates a positive association between radiographic presence of fusion and improved clinical outcome. Due to this growing body of literature, it is recommended that strategies intended to enhance the potential for radiographic fusion are considered when performing a lumbar arthrodesis for degenerative spine disease.

  10. Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study.

    Directory of Open Access Journals (Sweden)

    Haruki Funao

    Full Text Available Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001. The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure

  11. Comparison of the clinical effect between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of degenerative spondylolithesis and instability%后路腰椎椎体间融合与经椎间孔腰椎椎体间融合治疗退行性腰椎滑脱与不稳疗效比较

    Institute of Scientific and Technical Information of China (English)

    罗远明; 徐跃根; 卢厚微; 杨东方

    2012-01-01

    Objective To compare the therapeutic effect of posterior lumbar interbody fusion ( PLIF ) and transforami-nal lumbar interbody fusion ( TLIF ) with pedicle screw fixation on treatment in lumbar degenerative disease. Methods 86 patients were underwent PLIF( PLIF group ) and 76 cases were underwent TLIF( TLIF group ) with one cage and pedicle fixation in 162 patients with lumbar degenerative disease. Operating time and blood loss were quantified, average slip and reduction rate in spondylolithesis, average intervertebral and foramen height were evaluated in preop-eration and postoperation. Pain recorded according to visual analogue scale( VAS ) , functional disability according to oswestry disablity index ( ODI ), and bone graft fusion rate according to Brantigan and Steffee criteria. Results Compared to PLIF group, it took shorter operating time and less blood loss in TLIF group, there was no statistical significance in spondylolithesis, reduction rate, intervertebral and foramen height, VAS, ODI, bone graft fusion rate between the two groups( P >0. 05 ), but there was fewer complications in TLIF group( P 0.05).结论 PLIF与TLIF均为手术治疗退行性脊柱滑脱与不稳的有效方法,而TLIF手术时间短、失血量少,并发症少.

  12. 改良的腰椎后路植骨融合术治疗腰椎退行性疾病的疗效%Modified Posterior Lumbar Interbody Fusion for Lumbar Degenerative Diseases

    Institute of Scientific and Technical Information of China (English)

    高松; 马勇; 张斌; 刘远

    2014-01-01

    目的:探讨改良的腰椎后路椎间植骨融合术治疗腰椎退行性疾病的临床疗效。方法对76例腰椎退行性疾病患者均采用改良的腰椎后路椎间植骨融合术治疗,并采用视觉模拟评分(VAS)法、日本骨科协会评估治疗分数(JOA)评分法对76例患者术前、术后随访3个月时进行VAS、JOA评分。术后随访1年,行X线检查,同时观察植骨融合率的情况。结果76例患者术后随访3个月VAS得分明显低于术前、JOA得分明显高于术前(P<0.05)。术后随访1年,X线检查示76例患者植骨块无明显移位,无断钉、断棒和松动;植骨融合率为97.4%(74/76)。结论改良的腰椎后路椎间植骨融合术是治疗腰椎退行性疾病的一种有效方法。%Objective To explore the clinical efficacy of modified posterior lumbar interbody fusion (PLIF) in the treatment of lumbar degenerative diseases. Methods Seventy-six patients with lumbar degenerative diseases were treated with the modified PLIF. The clinical outcomes were evaluated by visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores before and 3 months after operation. The rate of fusion was measured by X-ray 1 year after operation. Results VAS scores decreased and JOA scores increased after operation (P<0.05). No obvious bone graft displacement, screw breakage, rod breakage and screw loosening were found in all patients after 1 year of follow-up. The bone graft fusion rate was 97.4%(74/76).Conclusion The modified posterior lumbar interbody fusion is effective for lumbar degenerative diseases.

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

    Science.gov (United States)

    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

  14. Biomechanical analysis of a newly developed shape memory alloy hook in a transforaminal lumbar interbody fusion (TLIF in vitro model.

    Directory of Open Access Journals (Sweden)

    Xi Wang

    Full Text Available The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH in a cadaveric transforaminal lumbar interbody fusion (TLIF model.Six human cadaveric spines (L1-S2 were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH; bilateral SMAH (BSMAH; unilateral pedicle screws and rods (UPS; and bilateral pedicle screws and rods (BPS. The L3-L4, L4-L5, and L5-S1 range of motion (ROM were recorded by a Motion Analysis System.Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p0.05. Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05.Bilateral SMAH fixation can achieve immediate stability after L4-5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration.

  15. [Anesthetic management of posterior lumbar spinal fusion in a patient suspected of having acute exacerbation of chronic interstitial pneumonia].

    Science.gov (United States)

    Sakai, Mayuko; Takenami, Tamie; Otsuka, Tomohisa; Hayashi, Norito; Yoshino, Kazuhisa; Matsumoto, Shigehiro; Okamoto, Hirotsugu

    2014-02-01

    A patient complicated with interstitial pneumonia required emergency posterior lumbar spinal fusion. The blood gas analysis showed relatively benign values (PaO2 81 torr, PaCO2 44 torr, under room air), but the honeycombing lungs were noted in the bilateral lung fields on CT, and the KL-6 level was high (1,000 U x ml(-1)), for which the acute exacerbation of interstitial pneumonia was suspected. Sivelestat sodium administration was initiated during the surgery and continued postoperatively. During surgery, setting the FIO2 at 0.34, the P/F ratio and intra-airway pressure could be maintained at 500 and 25 mmHg, respectively. To reduce postoperative respiratory complication, anesthesia was maintained with desflurane, which is dissipated easily, and 0.5% ropivacaine 15 ml was subcutaneously injected to the surgical field at the time of wound closure to reduce the total doses of intraoperative fentanyl and postoperative analgesics. After the completion of surgery, the endotracheal tube was removed with head elevated position, and the patient was transported back to the ward. No acute exacerbation occurred thereafter, and the patient was discharged 67 days after surgery. The prediction of acute exacerbation of interstitial pneumonia is difficult. Moreover, there is no established preventive method, although the mortality is high. Therefore, physicians should be thoroughly informed about the currently available evidence, including developmental factors. PMID:24601111

  16. 后路腰椎椎体间融合术治疗腰椎滑脱的临床疗效%Posterior lumbar interbody fusion for treament of lumbar spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    陈德龙; 陈小强; 叶永松

    2014-01-01

    Objective To evaluate the effectiveness of posterior lumbar interbody fusion for the treatment of lumbar spondylolis-thesis and provide reference for clinical therapeutics .Methods A tatal of 40 cases of adult lumbar spondylolisthesis patients trea-ted by posterior lumbar interbody fusion were reviewed .All cases were followed up at least 3 years.Comparative analysis about Oswestry disability index (ODI), visual analogue scale (VAS) score and the Japanese Orthopaedic Association (JOA) score chan-ges before and after treatment of 1 and 3 years were performed.Results The height of intervertebral disc height and foraminal gap had a significant differences (P0.05) between after treatment 1 years and after 3 years.ODI, low back pain VAS score, leg pain VAS score and JOA score had a significant differences (P0.05) between after treatment 1 years and after 3 years.Conclusion Posterior lumbar interbody fusion can recon-struct the stability of the lumbar spine.Clinical symptoms improvement can be achieved after surgry.This surgry is ideal for the treatment of spondylolisthesis.The mid-and long-term follow-up results are satisfactory.%目的:探讨后路腰椎椎体间融合术( posterior lumbar interbody fusion , PLIF)治疗腰椎滑脱的中期疗效,对腰椎滑脱症的临床治疗提供指导意见。方法回顾性分析采用PLIF治疗的腰椎滑脱40例,所有病例随访观察>3年,对手术前后影像学资料、Oswestry功能障碍指数( Oswestry disability index , ODI )、视觉模拟量表( visual analog scale , VAS)评分及日本骨科学会( Japanese Orthopaedic Association ,JOA)腰背痛手术治疗评分标准的评分变化情况进行比较分析。结果椎间隙高度、椎间孔高度术后1年、3年与术前比较差异均有统计学意义( P<0.05);术后1年与术后3年测量值比较差异不具有统计学意义(P>0.05)。 ODI、腰痛VAS评分、腿痛VAS评分及JOA评分术前和术后1

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

    OpenAIRE

    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 ...

  18. Effect of hyperbaric oxygen on mesenchymal stem cells for lumbar fusion in vivo

    Directory of Open Access Journals (Sweden)

    Lin Song-Shu

    2010-03-01

    Full Text Available Abstract Background Hyperbaric oxygen (HBO therapy has been proved in improving bone healing, but its effects on mesenchymal stem cells (MSCs in vivo is not clear. The aims of this study are to clarify whether the HBO therapy has the same enhancing effect on MSCs with regard to bone formation and maturation and to ascertain whether the transplanted MSCs survive in the grafted area and contribute to new bone formation. Methods Twenty-three adult rabbits underwent posterolateral fusion at L4-L5 level. The animals were divided into three groups according to the material implanted and subsequent treatment: (1 Alginate carrier (n = 6; (2 Alginate-MSCs composite (n = 11; and (3 Alginate-MSCs composite with HBO therapy (n = 6. After 12 weeks, spine fusion was examined using radiographic examination, manual testing, and histological examination. Using a PKH fluorescence labeling system, whether the transplanted MSCs survived and contributed to new bone formation in the grafted area after HBO therapy was also examined. Results The bilateral fusion areas in each animal were evaluated independently. By radiographic examination and manual palpation, union for the Alginate, Alginate-MSCs, and Alginate-MSCs-HBO groups was 0 of 12, 10 of 22, and 6 of 12 respectively. The difference between the Alginate-MSCs and Alginate-MSCs-HBO groups was not significant (P = 0.7997. The fluorescence microscopy histological analysis indicated that the transplanted PKH67-labeled MSCs survived and partly contributed to new bone formation in the grafted area. Conclusions This study demonstrated that the preconditioned MSCs could survive and yield bone formation in the grafted area. HBO therapy did not enhance the osteogenic ability of MSCs and improve the success of spine fusion in the rabbit model. Although there was no significant effect of HBO therapy on MSCs for spine fusion, the study encourages us to research a more basic approach for determining the optimal oxygen tension

  19. MIS-TLIF与PLIF治疗单节段退行性腰椎疾病的疗效比较%Curative effect of minimally invasive surgery transforaminal lumbar interbody fusion and posterior lumbar interbody fusion on single segment degenerative lumbar diseases

    Institute of Scientific and Technical Information of China (English)

    周亮; 刘郑生; 肖嵩华; 毛克亚; 刘建恒; 史腾; 苏祥正

    2013-01-01

    目的:探讨扩张通道管系统(X-tube)辅助微创经椎间孔路腰椎椎体间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)治疗退行性腰椎疾患的疗效。方法回顾性分析2010年10月-2011年9月我科采用X-Tube辅助MIS-TLIF治疗的单节段退行性腰椎病变患者52例,统计术前1 d、术后3 d、5 d、3个月、6个月、1年腰背痛和下肢痛视觉模拟评分(visual analogue scores,VAS),术前1 d、术后3个月、6个月、1年Oswestry功能障碍指数(Oswestry disability index,ODI),术后1年Nakai疗效评级和Bridwell脊柱融合评级,并与同期行传统开放后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)的38例患者进行比较。结果两组一般资料比较,差异均无统计学意义(P>0.05);术后3 d、5 d、3个月,微创组腰背痛VAS评分低于开放组(P<0.05,其中术后3 d、5 d,P<0.01);其余时间两组间腰背痛和下肢痛VAS评分、ODI评分无统计学差异(P>0.05);两组术后1年Nalai疗效评级和Bridwell脊柱融合评级差异无统计学意义(P>0.05)。结论在治疗退行性腰椎疾病时,MIS-TLIF术式可获得与传统开放PLIF术式相当的治疗效果,且术后短期内腰背痛程度较低。%Objective To study the curative effect of X-tube system-assisted minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) on degenerative lumbar diseases.Methods Clinical data about 52 patients with single segment degenerative lumbar disease who underwent MIS-TLIF from October 2010 to September 2011 in our hospital were retrospectively analyzed. Their visual analogue score (VAS) of back and leg pain 3 and 5 days, 3 and 6 months, and 1 year after MIS-TLIF, their Oswestry disability index (ODI) 1 day, 3 and 6 months, and 1 year after MIS-TLIF, their Nakai curative effect and Bridwell spinal fusion classification were compared with those of 38 controls after

  20. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients?

  1. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

    Directory of Open Access Journals (Sweden)

    Torsten Kluba

    2010-04-01

    Full Text Available This prospective study aimed to compare the efficacy of epidural (EDA versus intravenous (PCA application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal post-operative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

  2. Comparison of three calcium phosphate bone graft substitutes from biomechanical, histological, and crystallographic perspectives using a rat posterolateral lumbar fusion model

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Ming-Hsien [Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan (China); Department of Orthopedics, Show-Chwan Memorial Hospital, Changhua 50544, Taiwan (China); Department of Orthopedic Surgery, Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan (China); Lee, Pei-Yuan [Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan (China); Department of Orthopedics, Show-Chwan Memorial Hospital, Changhua 50544, Taiwan (China); Chen, Wen-Cheng, E-mail: wincheng0925@yahoo.com.tw [Department of Fiber and Composite Materials, College of Engineering, Feng Chia University, Taichung 40724, Taiwan (China); Hu, Jin-Jia, E-mail: jjhu@mail.ncku.edu.tw [Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan (China); Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan (China)

    2014-12-01

    This study evaluated the effectiveness of three calcium phosphate bone graft substitutes with different chemical compositions on spinal fusion using a rat posterolateral lumbar fusion model. Specifically, two recently developed non-dispersive tetracalcium phosphate/dicalcium phosphate anhydrous-based calcium phosphate cements (CPCs), namely a CPC consisting of equimolar amounts of the two compounds (nd-CPC) and a CPC consisting of a two-fold greater amount of dicalcium phosphate anhydrous (DCP-rich CPC), were compared with a commercial calcium phosphate bone graft (c-CPG) consisting of hydroxyapatite (60%) and β-tricalcium phosphate (40%). Single-level posterolateral lumbar fusion was performed at the L4–L5 vertebrae in fifteen adult rats (n = 5 for each group). Spinal fusion was evaluated with radiographs, manual palpation, mechanical testing, micro-CT, and histology 8 weeks post-surgery. In particular, the crystallographic phases in the three substitutes were identified before and 8 weeks after their implantation. Manual palpation revealed stable constructs in nearly all of the spine specimens. The stiffness and bending load of fused spines in the two CPC groups were comparable to those in the c-CPG group. The radiographs specifically revealed implant resorption and bone remodeling in the DCP-rich CPC group. Analysis of 3D micro-CT images revealed that the bone volume ratio in the DCP-rich CPC group was significantly greater than those in the nd-CPC and c-CPG groups. Histology showed that the DCP-rich CPC group exhibited the highest degree of bone regeneration and osseointegration. Notably, DCP-rich CPC led to a pronounced phase transformation, generating the greatest amount of poorly crystalline apatite among the three groups, which together with adequate resorption may explain the aforementioned positive findings. We therefore conclude that of the bone graft substitutes considered, DCP-rich CPC has the greatest potential to be used in spinal fusion

  3. Efficacy of minimal invasive posterior transfominal lumbar interbodv fusion and traditional Open tmnsfomminal lumbar interbodv fu-sion in the treatment of Single leve lumbar degenerative disease%微创通道经椎间孔椎间融合术与传统术式治疗单节段腰椎退行性疾病的疗效比较

    Institute of Scientific and Technical Information of China (English)

    舒冬平; 李绍刚; 邓汉华; 彭勇骏; 马兵

    2016-01-01

    目的:探讨微创通道经椎间孔椎间融合术(MIS - TLIF)治疗单节段腰椎退行性疾病的疗效,并与传统开放经椎间孔椎体间融合术(TLIF)比较。方法收治的52例腰椎退行性疾病患者,随机分为对照组和观察组,每组26例,分别采用 TLIF 治疗和 MIS - TLIF 治疗。比较两组手术情况,术前、术后视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)、日本骨科协会评分(JOA)评分变化及椎间植骨融合率。结果观察组手术术中和术后出血量及住院时间显著低于对照组( P <0.05);术后3个月观察组腰疼和腿痛 VAS 评分显著低于治疗前和对照组( P <0.05);术后3个月ODI 较治疗前均显著降低( P <0.05),JOA 评分较治疗前均显著提高( P <0.05),且改善程度显著优于对照组( P<0.05);观察组术后1年椎骨性融合率达到91.43%,显著高于对照组( P <0.05)。结论微创通道经椎间孔椎间融合术治疗单节段腰椎退行性疾病在获得与传统开放经椎间孔椎体间融合术相同的疗效下,植骨融合率更高,出血量、引流量更少,术后恢复更快,综合疗效优于传统方法。%Objective To explore the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS - TLIF)treatment of single segment lumbar degenerative disease and compare with the traditional open transforaminal lumbar interbody fusion(TLIF). Methods 52 cases of lumbar degenerative disease were selected and randomly divided into the control groups and the observation groups,26 cases in each group and were treated with TLIF and MIS - TLIF treatment. The operation index and the VAS,ODI,JOA score and interbody fusion rate before and af-ter treatment of two groups were compared. Results The intraoperative and postoperative bleeding and hospitalization time in the observation groups were significantly lower than that of the control groups( P < 0

  4. 微创经椎间孔腰椎间融合术治疗腰椎退变性疾病%Clinical outcome of minimally invasive transforaminal lumbar interbody fusion in the treat-ment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    高爱国; 赵鹏; 张钦; 程力

    2016-01-01

    目的:探讨微创经椎间孔腰椎间融合术( MIS-TLIF)治疗腰椎退变性疾病的可行性和早期疗效。方法采用MIS-TLIF治疗30例腰椎退变性疾病患者,其中Ⅰ~Ⅱ度退行性或峡部裂型腰椎滑脱症12例,退行性腰椎管狭窄伴节段性不稳8例,腰椎间盘突出症10例。均为单节段融合。结果手术时间127~209(168±41) min;术中出血量23~361(192±169) ml;术中X线照射时间72~136(104±32) s;术后首次下床活动时间1.4~3.8(2.6±1.2) d。疼痛VAS评分术前(7.20±1.02)分,末次随访(1.71±0.66)分,差异有统计学意义(P<0.01)。末次随访椎间融合率为100%。未发生并发症。 X线片显示cage无移位、松动、下沉,椎弓根钉无松动、折断。结论 MIS-TLIF对腰椎的解剖结构破坏小,对椎旁肌肉的剥离少,患者术后恢复快,是一种有效、安全、损伤较小的手术方法,可用于腰椎不稳、局限节段椎间盘病变、≤Ⅱ度以下腰椎滑脱的患者;但手术时间较长,医患X线暴露较多。%Objective To investigate the feasibility and early curative effect of minimally invasive transforaminal lum-bar interbody fusion ( MIS-TLIF) in the treatment of low lumbar degenerative disease. Methods A total of 30 pa-tients underwent MIS-TLIF for low lumbar degenerative disease. They contained 12 cases ofⅠ~Ⅱdegree spondylo-listhesis,8 cases of degenerative lumbar spinal stenosis with segmental instability and 10 cases of protrusion of lumbar intervertebral disc. All the patients underwent one-level fusion by the same surgeon. Results The surgical time, in-traoperative blood loss volume, X-ray exposed time and the first leaving bed time after surgery were 127~209(168 ± 41) min, 23~361(192 ± 169) ml, 72~136(104 ± 32) s,1. 4~3. 8(2. 6 ± 1. 2) d. VAS of the preoperative and the last follow-up were (7. 20 ± 1. 02)points and (1. 71 ± 0. 66)points,the difference had statistical significance(P<0. 01

  5. Wiltse入路微创TLIF治疗腰椎间盘突出疗效观察%Observation of lumbar disc herniation treated with minimally invasive transforaminal lumbar interbody fusion (TLIF) through Wiltse approach

    Institute of Scientific and Technical Information of China (English)

    贾红伟; 马文海; 胡艳军; 任志强; 李艳军; 吴超; 韩哲

    2014-01-01

    Objective To evaluate the efficacy of transforaminal lumbar interbody fusion combining contralateral percutaneous pedicle screw for degenerative lumbar disc herniation by Wiltse approach. Methods We studied 40 patients affected by lumbar disc herniation underwent transforaminal lumbar interbody fusion combining contralateral percutaneous pedicle screw ifxation by Wiltse approach in our hospital from June 2009 until December 2012 retrospectively. Clinical and radiographic evaluation were carried out preoperatively and following surgery. Clinical outcome was assessed using the Visual Analog Scale scores (VAS) and The Japanese Orthopaedic Association (JOA) scores. Results The average follow-up time was fourteen months, the average blood loss was three hundreds twenty-six milliliter, the difference of postoperative VAS score and JOA score comparing with preoperative was statistically significant(P<0.01). All screws showed very good position by photos. Bone fusion was considered as solid in forty patients at postoperative 12 months (100%). Conclusion Transforaminal lumbar interbody fusion using percutaneous pedicle screw ifxation by Wiltse approach is a valid and safe treatment of degenerative lumbar disc herniation.%目的:评估Wiltse 入路(后旁正中入路)经椎间孔椎间融合结合对侧经皮椎弓根螺钉治疗退变性腰间盘突出的有效性。方法回顾性研究2009年6月至2012年12月应用Wiltse 入路经椎间孔椎间融合结合对侧经皮椎弓根螺钉固定治疗的40例腰椎间盘突出患者,术前术后进行临床及影像学评估,临床结果应用疼痛模拟视觉评分(VAS)、日本骨科协会(JOA)评分进行评估。结果患者平均随访14个月,平均失血326 mL,术后VAS评分、JOA评分较术前比较差异具有统计学意义(P<0.01),影像学显示所有椎弓根螺钉位置良好,术后12个月40例患者获得良好的融合(100%)。结论Wiltse入路经椎间

  6. Minimally invasive transforaminal lumbar interbody fusion or posterior lumbar interbody fusion in treatment of lumbar degenerative disorder disease%椎间盘镜辅助X-Tube下椎体间融合术治疗退变性腰椎间盘疾病

    Institute of Scientific and Technical Information of China (English)

    马维虎; 刘观燚; 徐荣明; 孙韶华; 赵刘军; 胡勇; 蒋伟宇; 顾永杰

    2011-01-01

    目的 探讨椎间盘镜辅助X-Tube下腰椎后路椎体间融合术(posterior lumbar interbody fusion,PLIF)和经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性椎间盘疾病的临床疗效.方法 2007年11月至2008年4月,采用椎间盘镜辅助X-Tube下TLIF和PLIF 治疗退变性椎间盘疾病32例:PLIF 13例,TLIF 19例.单节段腰椎间盘突出症伴相应节段腰椎不稳定21例,腰椎滑脱症11例(Ⅰ度6例,Ⅱ度5例).病变节段:L3-4 2例,L4-5 18例,L5S1 12例.年龄38~72岁,平均51.2岁;男19例,女13例.术后进行定期随访和影像学检查,并进行Oswestry功能障碍指数评定以评价术后康复情况.结果 手术时间90~180 min,平均120 min;手术出血量100~400 ml,平均190ml.切口均为甲级愈合,未见切口及椎管、椎间隙感染、内固定失败等并发症发生.所以患者均获随访,随访时间13~41个月,平均21个月.Oswestry功能障碍指数由术前40.1%±4.1%下降到术后3个月的9.5%±3.7%.疗效评价:优19例,良10例,可3例;优良率为90.6%.骨融合均取得成功.结论 椎间盘镜辅助X-Tube下TLIF和PLIF治疗退变性椎间盘疾病具有切口小,创伤小,术后恢复快等优点.%Objective To evaluate the clinical effects of transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion(PLIF) using microendoscopic discectomy under X-Tube system in treatment of lumbar degenerative disc diseases.Methods From December 2007 to April 2008,32 patients with low back disorders were treated by microendoscopic discectomy TLIF or PLIF under X-Tube system,including 19 cases in TLIF and 13 in PLIF.Etiologies including lumbar disc herniation combined with segmental instability in 21 cases,and spondylolisthesis in 11 cases.All patients were under regular postoperative follow-up and radiological examination.The clinical functional outcomes were evaluated according to Oswestry disability questionnaire.Results The

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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

  8. 腰椎Active-L人工椎间盘置换术与腰椎融合术的临床比较研究%Clinical outcomes of total lumbar disc replacement with Active-L versus lumbar fusion

    Institute of Scientific and Technical Information of China (English)

    陈小龙; 海涌; 张强; 鲁世保; 刘玉增; 周立金

    2012-01-01

    Background: Lumbar fusion has been recognised as the "gold standard" to treat degenerative disc disease, but some liter-atures have reported that lumbar fusion can accelerate the adjacent segment degeneration. For retaining physiological and motion characteristics of the spinal functional unit, artificial intervertebral disc replacement has been proposed.Objective; The purpose of the present study is to compare the efficacy and safety between lumbar disc replacement with Active-L artificial disc and posterior lumbar interbody fusion for single-level degenerative disease.Methods: From January 2009 to April 2010, 62 patients with degenerative diseases of lumbar dics were treated by total lumbar disc replacement with the Active-L artificial disc (investigational group) or lumbar fusion (control group). In the investigational group, there were 10 males and 10 females with a mean age of 47.7 years (range 36 -58). Of them, 16 patients were diagnosed as lumbar intervertebral disc protrusion, 4 patients had low back pain and one had posterior operation history; 2 patients were treated at L3-4, 13 at L4-5 and 5 at L5-S1. In the control group, there were 22 males and 20 females with a mean age of 48. 5 years ( range 40 - 60). Of them, 32 patients were diagnosed as lumbar intervertebral disc protrusion, 7 had low back pain and 3 had posterior operation history; 4 patients were treated at 13-4, 26 at L4-5 and 12 at LS-S1. Visual analog scale (VAS) and Oswestry disability index (ODI) were used to assess back pain and functional improvement. X-ray was used to measure the angle of lumbar lordosis and range of motion.Results: Overall clinical success was achieved in all patients. The average follow-up duration was 19.3 months (range 12-27) in investigational group and 19. 8 months (range 12-27) in control group. Patients in the investigational group had statistically lower pain and ODI scores (P <0.05) , compared with the control group. No severe complication occurred in the two

  9. Comparison of three calcium phosphate bone graft substitutes from biomechanical, histological, and crystallographic perspectives using a rat posterolateral lumbar fusion model.

    Science.gov (United States)

    Hu, Ming-Hsien; Lee, Pei-Yuan; Chen, Wen-Cheng; Hu, Jin-Jia

    2014-12-01

    This study evaluated the effectiveness of three calcium phosphate bone graft substitutes with different chemical compositions on spinal fusion using a rat posterolateral lumbar fusion model. Specifically, two recently developed non-dispersive tetracalcium phosphate/dicalcium phosphate anhydrous-based calcium phosphate cements (CPCs), namely a CPC consisting of equimolar amounts of the two compounds (nd-CPC) and a CPC consisting of a two-fold greater amount of dicalcium phosphate anhydrous (DCP-rich CPC), were compared with a commercial calcium phosphate bone graft (c-CPG) consisting of hydroxyapatite (60%) and β-tricalcium phosphate (40%). Single-level posterolateral lumbar fusion was performed at the L4-L5 vertebrae in fifteen adult rats (n=5 for each group). Spinal fusion was evaluated with radiographs, manual palpation, mechanical testing, micro-CT, and histology 8 weeks post-surgery. In particular, the crystallographic phases in the three substitutes were identified before and 8 weeks after their implantation. Manual palpation revealed stable constructs in nearly all of the spine specimens. The stiffness and bending load of fused spines in the two CPC groups were comparable to those in the c-CPG group. The radiographs specifically revealed implant resorption and bone remodeling in the DCP-rich CPC group. Analysis of 3D micro-CT images revealed that the bone volume ratio in the DCP-rich CPC group was significantly greater than those in the nd-CPC and c-CPG groups. Histology showed that the DCP-rich CPC group exhibited the highest degree of bone regeneration and osseointegration. Notably, DCP-rich CPC led to a pronounced phase transformation, generating the greatest amount of poorly crystalline apatite among the three groups, which together with adequate resorption may explain the aforementioned positive findings. We therefore conclude that of the bone graft substitutes considered, DCP-rich CPC has the greatest potential to be used in spinal fusion.

  10. Comparison of three calcium phosphate bone graft substitutes from biomechanical, histological, and crystallographic perspectives using a rat posterolateral lumbar fusion model.

    Science.gov (United States)

    Hu, Ming-Hsien; Lee, Pei-Yuan; Chen, Wen-Cheng; Hu, Jin-Jia

    2014-12-01

    This study evaluated the effectiveness of three calcium phosphate bone graft substitutes with different chemical compositions on spinal fusion using a rat posterolateral lumbar fusion model. Specifically, two recently developed non-dispersive tetracalcium phosphate/dicalcium phosphate anhydrous-based calcium phosphate cements (CPCs), namely a CPC consisting of equimolar amounts of the two compounds (nd-CPC) and a CPC consisting of a two-fold greater amount of dicalcium phosphate anhydrous (DCP-rich CPC), were compared with a commercial calcium phosphate bone graft (c-CPG) consisting of hydroxyapatite (60%) and β-tricalcium phosphate (40%). Single-level posterolateral lumbar fusion was performed at the L4-L5 vertebrae in fifteen adult rats (n=5 for each group). Spinal fusion was evaluated with radiographs, manual palpation, mechanical testing, micro-CT, and histology 8 weeks post-surgery. In particular, the crystallographic phases in the three substitutes were identified before and 8 weeks after their implantation. Manual palpation revealed stable constructs in nearly all of the spine specimens. The stiffness and bending load of fused spines in the two CPC groups were comparable to those in the c-CPG group. The radiographs specifically revealed implant resorption and bone remodeling in the DCP-rich CPC group. Analysis of 3D micro-CT images revealed that the bone volume ratio in the DCP-rich CPC group was significantly greater than those in the nd-CPC and c-CPG groups. Histology showed that the DCP-rich CPC group exhibited the highest degree of bone regeneration and osseointegration. Notably, DCP-rich CPC led to a pronounced phase transformation, generating the greatest amount of poorly crystalline apatite among the three groups, which together with adequate resorption may explain the aforementioned positive findings. We therefore conclude that of the bone graft substitutes considered, DCP-rich CPC has the greatest potential to be used in spinal fusion. PMID

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

    Science.gov (United States)

    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

  12. 微创经椎间孔腰椎椎体间融合术的研究进展%Research progress of minimally invasive transforaminal lumbar interbody fusion

    Institute of Scientific and Technical Information of China (English)

    潘杰; 钱列; 谭军

    2009-01-01

    腰椎融合是目前治疗腰椎退变性疾病、腰椎不稳及椎间盘源性等疾病的主要手段.经椎间孔腰椎间融合术(transforaminal lumbar interbody fusion,TLIF)是近年发展起来的新型的腰椎融合术,而随着微创脊柱外科(minimally invasive spinal surgery,MISS)的进步,微创TLIF技术也得到了快速的发展,相对传统开放TLIF又有了更进一步的优势.作者就微创TLIF的适应证与禁忌证,手术方式,发展与优势及微创手术辅助器械等方面的研究现状作一综述.%Lumbar fusion is currently the major treatment of lumbar degenerative disease, spinal instability and discogenic disease etc. Transforaminal lumbar interbody fusion (TLIF) is a novel lumbar fusion technique in recent years, and with the progress of minimally invasive spinal surgery, minimally invasive TLIF (mini-TLIF) technique has also got access to rapid development, which has more advantages compared with traditional open TLIF. The authors review the indications and contraindications, surgical method, development and advantages and minimally invasive surgical assistant instruments of mini -TLIF.

  13. Evaluation of an injectable silk fibroin enhanced calcium phosphate cement loaded with human recombinant bone morphogenetic protein-2 in ovine lumbar interbody fusion.

    Science.gov (United States)

    Gu, Yong; Chen, Liang; Yang, Hui-Lin; Luo, Zong-Ping; Tang, Tian-Si

    2011-05-01

    The objective of this study was to investigate the efficacy of an injectable calcium phosphate cement/silk fibroin/human recombinant bone morphogenetic protein-2 composite (CPC/SF/rhBMP-2) in an ovine interbody fusion model. Twenty-four mature sheep underwent anterior lumbar interbody fusion at the levels of L1/2, L3/4, and L5/6 with random implantation of CPC/SF, CPC/rhBMP-2, CPC/SF/rhBMP-2, or autogenous iliac bone. After the sheep were sacrificed, the fusion segments were evaluated by manual palpation, CT scan, undestructive biomechanical testing, undecalcified histology, and histomorphology. The fusion rates of CPC/SF/rhBMP-2 were 55.56% and 77.78% at 6 and 12 months, respectively. The fusion was superior to all the biomaterial grafts in stiffness, and reached the same stiffness as the autograft at 12 months. The new bone formation was less than autograft at 6 months, but similar with that at 12 months. However, the ceramic residue volume of CPC/SF/rhBMP-2 was significantly decreased compared with CPC/SF and CPC/rhBMP-2 at both times. The results indicated that CPC/SF/rhBMP-2 composite had excellent osteoconduction and osteoinduction, and balanced degradation and osteogenesis.

  14. Within patient radiological comparative analysis of the performance of two bone graft extenders utilized in posterolateral lumbar fusion: a retrospective case series

    Directory of Open Access Journals (Sweden)

    Geoffrey eStewart

    2016-01-01

    Full Text Available Two bone graft extenders differing in chemical composition were implanted contralaterally in 27 consecutive patients undergoing instrumented posterolateral lumbar fusion as standard of care. Bone marrow aspirate and autogenous bone graft were equally combined either with β-tricalcium phosphate (β-TCP or a hybrid biomaterial (containing hyaluronic acid but lacking a calcium salt and implanted between the transverse processes. Fusion status on each side of the vertebrae was retrospectively graded (1-5 scale on AP planar X-ray at multiple visits as available, through approximately month 12. Additionally, consolidation or resorption since prior visit for each treatment was recorded. Sides receiving β-TCP extender showed marked resorption prior to bone consolidation during the first 6 months. By contrast, sides receiving the hybrid biomaterial containing integrated hyaluronic acid showed rapid bone consolidation by week 6-8, with maintenance of initial bone volume through month 12. Fusion grade was superior for the hybrid biomaterial, differing significantly from β-TCP at day 109 and beyond. Fusion success at >month 12 was 92.9% vs 67.9% for the hybrid biomaterial and β-TCP-treated sides, respectively. The hybrid biomaterial extender demonstrated a shortened time to fusion compared to the calcium-based graft. Mode of action has been demonstrated in the literature to differ between these compositions. Therefore, choice of synthetic biomaterial composition may significantly influence mode of action of cellular events regulating appositional bone growth.

  15. 后路腰椎间融合治疗腰椎管狭窄症患者腰痛的疗效分析%Therapeutic effect of posterior lumbar interbody fusion for treatment of back pain in patients with lumbar stenosis

    Institute of Scientific and Technical Information of China (English)

    王波; 刘海鹰; 王会民; 缪克难; 金朝晖

    2009-01-01

    [Objective] To analyze the causes of back pain in lumbar spinal stenosis and to investigate the therapeutic effect of posterior lumbar interbody fusion (PLIF) for lumbar stenosis with severe back pain. [Methods] The preoperative clinical data on patients with lumbar stenosis and severe back pain were compared with those of patients with typical neurological claudication. The follow - up results of lumbar stenosis with severe low back pain treated by PLIF were analyzed. [ Results] The average age and the rates of segmental instability, degenerative scoliosis, loss of lumbar lordosis in patients with lumbar stenosis and severe back pain were higher than those with lumbar stenosis and typical claudication. After PLIF surgery, the back pain was much relieved, the JOA score was improved , the severity of degenerative scoliosis was reduced, and the lumbar lordosis was restored. Bony fusion was achieved in all operated intervertebral spaces. [Conclusion] PLIF could eliminate various causes due to back pain of lumbar stenosis. PLIF is one of reasonable treatment options for lumbar stenosis with severe low back pain.%[目的]分析腰椎管狭窄症患者腰痛的原因,探讨后路腰椎间融合术对腰椎管狭窄症腰痛的治疗效果.[方法]比较腰痛明显的腰椎管狭窄症患者和典型间歇性跛行症状的腰椎管狭窄症患者的年龄、术前腰椎失稳、生理前凸消失和退变性侧弯的发生率;分析后路腰椎间融合 (posterior lumbar interbody fusion, PLIF) 治疗腰椎管狭窄症患者下腰痛的随访结果.[结果]腰痛明显组的腰椎管狭窄症患者的平均年龄、腰椎节段性失稳率、腰椎前凸消失和退变性侧弯的比率高于间歇性跛行组的腰椎管狭窄症患者.PLIF术后腰痛症状明显减轻,JOA评分改善,退变性侧弯程度减轻,腰椎前凸恢复,椎间均达到骨性融合.[结论]PLIF可消除腰椎管狭窄症的多种腰痛病因,是治疗腰椎管狭窄症下腰痛的较好术式选择.

  16. Unilateral instrumented transforaminal lumbar interbody fusion in low lumbar degenerative diseases%单侧椎弓根固定经椎间孔椎体间融合术治疗下腰椎退行性疾病

    Institute of Scientific and Technical Information of China (English)

    贾其余; 俞宇; 王林; 郭万根; 胡联英; 程晓东

    2014-01-01

    目的:评价单侧椎弓根固定经椎间孔腰椎椎体间融合术( TLIF)治疗下腰椎退行性疾病的疗效。方法采用单侧TLIF术治疗41例下腰椎退行性疾病患者,均为单节段手术。观察手术时间、术中出血量及并发症情况。采用腰痛和腿痛视觉模拟评分( VAS)与Oswestry功能障碍指数( ODI)评价临床效果,并通过影像学检查对椎体间融合情况进行评价。结果41例均获随访,时间24~59(38±6)个月。手术时间80~180(125±10)min,术中出血量100~550(310±30)ml。手术切口均一期愈合。腰痛VAS分值由术前的(6.5±2.1)分下降至末次随访时的(2.3±0.9)分(P<0.01),腿痛VAS分值由术前的(7.6±2.3)分下降至末次随访时的(1.2±0.8)分(P<0.01),ODI由术前的54.2±10.9下降至末次随访时的13.8±2.1(P<0.01)。末次随访融合率为95%,未发现继发性脊柱侧弯、螺钉松动、断裂及Cage移位等情况。结论单侧TLIF术可有选择地治疗下腰椎退行性疾病,其疗效确切,并具有创伤小、手术时间短、出血少、并发症少等优点。%Objective To investigate the effect of unilateral instrumented transforaminal lumbar interbody fusion ( TLIF) in the treatment of low lumbar degenerative diseases. Methods 41 patients with low lumbar degenerative diseases in single segment were treated with unilateral pedicle screw fixation TLIF. Operative time, intraoperative blood loss and complications were observed. The visual analogue scale ( VAS ) and the Oswestry disability index ( ODI) were used to evaluate clinical effect, and radiographic parameters were used to evaluate the fusion rates. Re-sults All cases were followed up for 24~59(38 ±6)months. The operative time was 80~180(125 ±10)min, the intraoperative blood loss was 100~550(310 ± 30) ml. All incisions healed by first intention. The lumbar pain VAS scores dropped from 6. 5 ± 2. 1 preoperatively to 2. 3 ± 0. 9 at final followed-up (P <0. 01), the limb pain VAS

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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. 微创经椎间孔腰椎椎体间融合术研究进展%Research Progress of Minimally Invasive Transforaminal Lumbar Interbody Fusion

    Institute of Scientific and Technical Information of China (English)

    张锋

    2013-01-01

    Lumbar fusion is currently the major treatment of lumbar degenerative disease( spondylosis, spinal instability and discogenic disease etc. ). Transforaminal lumbar interbody fusion ( TLIF )has become increasingly popular in recent years. Compared with PLIF,TLIF requires less neural manipulation and retraction, thus reduces interference to the nerve root and dural sac. With the fast development of minimally invasive spine surgery,minimally invasive TLIF has been widely applied in clinical. Here is to make a review of the indicationsand contraindications,surgical method,advantages and disadvantages of minimally invasive TLIF.%腰椎退变性疾病(腰椎滑脱、退变性腰椎失稳、椎间盘源性疾病等)常须行腰椎椎间融合术,近年来经椎间孔入路的腰椎间融合术(TLIF)得到了充分的发展,与传统的后路腰椎间融合手术相比,TLIF对神经根及硬模囊的干扰较少,从而减少了相关并发症的发生.随着微创脊柱外科的进步,微创TLIF也越来越广泛地应用于临床.该文对微创经椎间孔腰椎椎体间融合术的适应证与禁忌证、手术方式、优势与不足、问题与展望等方面的研究现状予以综述.

  19. Lumbar interbody fusion vs dynamic stabilization system for degenerative lumbar disease%腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床评价

    Institute of Scientific and Technical Information of China (English)

    马辉; 李忠海; 朱晓东; 白玉树; 王传峰; 吴大江; 陈誉; 李明

    2011-01-01

    目的 通过比较分析腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床疗效和术后并发症,探讨腰椎退行性疾病治疗方法的合理选择.方法 2009年1月~2010年12月,选择32例腰椎退行性疾病(L4/L5)患者,按配对设计分为对照组和治疗组,对照组16例患者均行椎弓根螺钉固定并单枚融合器置入;治疗组16例患者行常规椎板切除减压、髓核摘除和Isobar动态固定.比较观察2组病例的治疗效果、手术时间、出血量、手术并发症等.治疗效果评价采用Oswestry功能障碍指数(Oswestry disability index,ODI)及疼痛视觉模拟量表(visual analogue scale,VAS)评分,手术邻近节段(L3/L4和L5/S1)及腰椎(L2~S1)的活动度(range of motion,ROM)采用过伸过屈动力侧位X线片检查进行评价.结果 所有患者均获6~24个月的随访,平均15.8个月.与术前相比,2组患者术后症状均有明显改善,术后ODI及VAS评分与术前相比差异有统计学意义(P0.05);2组均未出现内固定相关并发症;2组术后邻近节段(L3/L4和L5/S1)的ROM与术前相比差异无统计学意义(P>0.05).腰椎(L2~S1)的ROM,融合组较术前显著下降,差异有统计学意义(P0.05).结论 腰椎椎间融合术与Isobar动态固定术治疗单节段腰椎退变性疾病均可取得满意的短期临床疗效,但理论上动态固定技术内固定失败的风险高于椎间融合术,故采用动态固定技术治疗腰椎退变性疾病应慎重.%Objective To assess the clinical effectiveness and postoperative complications of lumbar interbody fusion and dynamic stabilization system( the Isobar system ) for degenerative lumbar disease, in an attempt to explore an optimal surgical procedure. Methods From January 2009 to December 2010, 32 degenerative disease ( L4/L5 ) cases were randomly and equally assigned to an experimental group of decompression and dynamic stabilization with Isobar system ( n = 16 ) and a control group of

  20. Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography

    DEFF Research Database (Denmark)

    Laoutliev, Borislav; Havsteen, Inger; Bech, Birthe Højlund;

    2012-01-01

    Persistent lower back pain after instrumental posterolateral desis may arise from incomplete fusion. We investigate the impact of experience on interobserver agreement in fusion estimation.......Persistent lower back pain after instrumental posterolateral desis may arise from incomplete fusion. We investigate the impact of experience on interobserver agreement in fusion estimation....

  1. Coflex与传统手术方法治疗腰椎退行性疾病疗效的Meta分析%Coflex versus posterior lumbar interbody fusion in the treatment of lumbar spine degenerative diseases: a Meta analysis

    Institute of Scientific and Technical Information of China (English)

    赵海恩; 郭明君; 梅玉峰; 于洋; 王育才; 马保安; 姬振伟; 范清宇

    2012-01-01

    [Objective] To analyze the efficacy and safety of Coflex versus posterior lumbar interbody fusion in the treatment of lumbar spine degenerative diseases such as LSS. [ Methods ] A systematic computer - based search of Medline, EM-BASE, Cochrance Central, and manual search of related journals were performed for collecting controlled trials. RevMan 5. 1 software was used for meta analysis. [Results] Twelve studies involving a total of 684 patients were included. The meta - analysis indicated that statistically significance were noted between two procedures for the operation time, length of hospital stay, blood loss and range of motion of lumbar. While no differences were noted for the low back VAS, ODI and JO A. [Conclusion] Both procedures were effective and safe in pain relief and functional recovery for lumbar spine degenerative diseases. Coflex could also shorten the operation time and length of hospital stay, decrease the blood loss. It showed that Coflex had biomechanical superiority in a short follow - up period.%[目的]系统评价Coflex与传统融合固定两种手术方法治疗腰椎退行性病变的有效性和安全性.[方法]计算机检索数据库,手工检索骨科相关杂志,纳入关于Coflex与传统治疗腰椎退行性病变的研究并进行Meta分析.[结果]纳入12篇研究共684病例,Meta分析结果显示:Coflex与传统手术方法相比较,前者在手术时间和住院时间上短于后者,失血量少于后者,手术节段的ROM大于后者,差异具有统计学意义.后背VAS和JOA差异无统计学意义.[结论]在达到相同治疗效果的情况下,Coflex可以明显减少手术时间、术中出血量和住院时间,而且可以保持手术节段腰椎存在一定活动度,避免了邻近节段的退变,术后短期内随访显示了其生物力学上优越性.

  2. 微创与开放后路腰椎间融合修复单节段腰椎退变性疾病:椎间融合率比较%Minimally invasiveversus open posterior lumbar interbody fusion for single-segment degenerative lumbar disease:the rate of interbody fusion

    Institute of Scientific and Technical Information of China (English)

    过锡敏

    2015-01-01

    BACKGROUND:With the aging population, the incidence of lumbar degenerative disease was apparently increased, but how to treatment of degenerative lumbar disease remains controversial. OBJECTIVE:To compare clinical and radiographic results of minimaly invasive posterior lumbar interbody fusion and open posterior lumbar interbody fusion for single-segment degenerative lumbar disease. METHODS: We retrospectively analyzed the clinical data of 97 patients with single-segment degenerative lumbar disease, who were treated in the Huishan District People’s Hospital of Wuxi City from July 2006 to July 2012. These patients were divided into minimal group (minimaly invasive posterior lumbar interbody fusion;n=51) and open group (open posterior lumbar interbody fusion;n=46). These data were compared between the two groups, including operative time, blood loss (intraoperative blood volume+postoperative drainage volume), total blood transfusion, postoperative back pain (visual analogue scale), length of hospital stay, bed time, perioperative complications, clinical function (Oswestry disability index), and radiographic results. RESULTS AND CONCLUSION:Al of 97 patients were folowed up. The duration of folow-up was 28-78 months and 27-76 months in minimal group and open group, respectively. There was no significant difference between the minimal group and open group in term of folowed-up time (P=0.981). Operative time, blood loss, total blood transfusion, bed time, length of hospital stay and visual analogue scale score during final folow-up were significantly lower in the minimal group than in the open group (P 0.05). These results indicate that for the single-segment degenerative lumbar disease, the use of minimaly invasive posterior lumbar interbody fusion or open posterior lumbar interbody fusion can obtain satisfactory clinical function, but the minimaly invasive posterior lumbar interbody fusion has the advantages of a less trauma, shorter length of hospital stay and bed

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  6. The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis

    International Nuclear Information System (INIS)

    To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences. Material and methods: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations. Results and conclusion: There were significantly more degenerative disc changes (p<0.0001), disc height reduction (p=0.0010) and end-plate changes (p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis

  7. The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis

    Energy Technology Data Exchange (ETDEWEB)

    Danielsson, A.J.; Nachemson, A.L. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Orthopaedics; Cederlund, C.G.; Ekholm, S. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Diagnostic Radiology

    2001-03-01

    To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences. Material and methods: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations. Results and conclusion: There were significantly more degenerative disc changes (p<0.0001), disc height reduction (p=0.0010) and end-plate changes (p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.

  8. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may...... stabilizing lumbar surgery with metallic implants. The SPECT/CT findings were compared with observations from subsequent surgical reexploration. RESULTS: In 6 of 9 patients, the SPECT/CT fully or partially detected the vertebral level of loose pedicle screws. Of 9 cases, 2 were considered inconclusive...

  9. Treatment of lumbar degenerative disease with modified transforaminal lumbar interbody fusion%改良经椎间孔椎体间融合术治疗腰椎退变性疾病

    Institute of Scientific and Technical Information of China (English)

    刘阳; 杨群; 唐开; 马凯; 姜长明; 吴春明; 王宏

    2011-01-01

    目的 探讨改良经椎间孔椎体间融合术治疗腰椎退变性疾病的临床疗效.方法 2007年6月至2009年5月对62例腰椎退变性疾病患者行改良经单侧椎间孔椎体间植骨融合,相应节段椎弓根钉内固定术.其中腰椎间盘突出合并腰椎不稳28例,腰椎间盘突出合并椎管狭窄27例,退变性滑脱7例.累及单节段48例,累及双节段14例.通过观察融合情况,记录术前、术后3个月和末次随访时的视觉模拟评分(VAS)和日本矫形外科学会(JOA)评分判定治疗效果.结果 62例患者均获得随访,随访时间15~30(22.77±3.82)个月.无神经损伤、脑脊液漏、感染及椎弓根钉断裂等并发症.术后1年椎体间融合率为96.8%.依据JOA评分,优34例,良24例,可4例,差0例,优良率为93.5%(58/62).术后VAS和JOA评分与术前比较差异有统计学意义(P<0.05),术后3个月VAS和JOA评分与末次随访时比较差异无统计学意义(P>0.05).结论 改良经椎间孔椎体间融合术在充分减压同时能减少进入椎管带来的并发症,临床疗效好,是治疗腰椎退变性疾病的有效术式.%Objective To investigate the chnical effect of modified transforaminal lumbar interbody fusion (TLIF) on the treatment of lumbar degenerative disease. Methods Sixty-two patients with lumbar degenerative disease were treated by the modified TLIF from June 2007 to May 2009. The preoperative diagnosis was lumbar intervertebral disc herniation with spinal instability (28 cases), lumbar intervertebral disc herniation with lumbar stenosis (27 cases ), degenerative spondylohsthesis (7 cases ). Forty-eight cases were single-level and 14 cases were two-level. The patients were evaluated by observing the fusion rate and comparing the visual analog score( VAS ) and Japanese orthopaedics association (JOA) score of preoperation with those of postoperation. Results All the patients were followed up from 15 to 30 (22.77 ± 3.82)months,no nerve injury,leakage of

  10. 加压与不加压固定融合器对腰椎融合的影响%Effects of compression and non-compression fusion cage on lumbar fusion

    Institute of Scientific and Technical Information of China (English)

    顾勇; 汪凌骏; 陈亮

    2016-01-01

    BACKGROUND:The posterior lumbar interbody fusion is one of the effective methods for the treatment of lumbar and sacral spine diseases. Most surgeons fix the cage by compressing the disc space in order to keep stability and prevent dislodgement. However, some surgeons think that the non-compression technique does favor for increasing of the disc and foraminal height and thus improving the clinical outcomes, and does not increase the risk of fusion shift. OBJECTIVE:To compare the effects in fixing the cage by the compression and non-compression techniques on posterior lumbar interbody fusion. METHODS:Data of 64 patients with single-segment lumbar degeneration undergoing posterior lumbar interbody fusion between August 2009 and June 2014 were retrospectively analyzed. Fusion device was fixed according to compression of intervertebral space. These patients were divided into compression group (n=30) and non-compression group (n=34). RESULTS AND CONCLUSION:(1) Curative effects:Lumbar and leg pain visual analogue score, Oswestry disability index, SF-36 score and the height of intervertebral space, intervertebral foramen height and lumbar lordosis were significantly improved postoperatively in each group compared with preoperatively (P0.05). (3) Correlation analysis:The increase of the intervertebral space and the height of the intervertebral foramen were not significantly correlated with the improvement of the clinical curative effect (P>0.05). (4) Test results demonstrated that outcomes of the compression technique to fix the cage are equivalent to the non-compression in posterior lumbar interbody fusion. Non-compression is advantageous to increase the intervertebral space and the height of the intervertebral foramen. Both of them are conducive to the recovery of lumbar lordosis, but are not correlated with the increase in clinical curative effect.%背景:腰椎后路椎体间融合是腰骶椎退变性疾病常规有效的治疗方法之一。目前,大部分学

  11. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may be u...

  12. Relationship of lumbar interbody fusion with anterior column structure and biomechanics%椎间植骨融合效果与腰椎前柱组织结构及生物力学的关系

    Institute of Scientific and Technical Information of China (English)

    谢鸿儒; 王欢

    2011-01-01

    BACKGROUND: Lumbar spine fusion is one of the most common operations for low back pain in spinal surgeons, but the clinicalspine fusion rate is still low-level. How to availably promote spine fusion, raise fusion rate and clinical effect, and decreasecomplications is a problem for the spinal surgeon to work out.OBJECTIVE: To summarize the relation between lumbar interbody fusion and anterior column, and to analyze the influence ofstructural and biomechanical changes on fusion rate.METHODS: A computer online retrieval of CBM/CNKI/Medline for articles and reviews about lumbar interbody fusion published1995-2009 was performed.RESULTS AND CONCLUSION: The stability and integrality of the anterior column have notable effects on interbody fusion. Inanterior lumbar interbody fusion and the fixations of anterior column fracture, we would better protect the structure and bloodsupply of the anterior column, and resume the integrality and stability of the anterior column to maintain the biomechanicsenvironment of the lumbar, aiming to achieve the better fusion effect.%背景:腰椎融合后,椎间植骨融合率低,是临床上亟待解决的问题.目的:阐述椎间植骨融合效果与腰椎前柱的关系,分析其组织结构及生物力学发生改变后对椎体间植骨融合效果的影响.方法:电子检索CBM/CNKI(2000/2010)和计算机Medline数据库(1995/2010)收录的腰椎椎间植骨融合的相关综述和论文报告,找出并分析其中与前柱结构及生物力学相关的研究进展.结果与结论:腰椎前柱的完整性及生物力学的稳定性对椎间植骨融合的效果有显著的影响.在腰椎前路间盘切除及腰椎前柱爆裂骨折撑开内固定中,应该着重保护好椎体前柱结构及血运,尽量恢复腰椎前柱结构的完整性及稳定性,维持腰椎正常的生物力学环境,以期达到理想的椎间融合效果.

  13. 融合修复双节段腰椎滑脱:椎间高度与骨盆倾斜角及骶骨倾斜角的随访%Fusion for treating double-segment lumbar spondylisthesis:follow-up evaluation of lumbar height, pelvic tilt angle and sacral slope angle

    Institute of Scientific and Technical Information of China (English)

    杨思振; 马进峰; 王德春

    2015-01-01

      方法:双节段腰椎滑脱患者20例,均采用腰椎后路椎间融合治疗,即后路腰椎管减压、神经根松解、椎体间植骨融合、椎弓根螺钉系统复位固定治疗。固定前1 d、固定后1周,固定后3,6个月及固定后1年并以后每隔一年均行腰腿痛目测类比评分,使用Oswestry功能障碍指数问卷调查表评价临床功能恢复情况,并通过影像学检查观察滑脱恢复情况、椎间高度、骨盆倾斜角、骶骨倾斜角和植骨融合情况,综合评价临床疗效。结果与结论:患者20例均获随访,随访时间6个月至3年,目测类比评分及Oswestry功能障碍指数得分固定后及末次随访较固定前降低(P OBJECTIVE:To investigate the clinical efficacy of posterior lumbar interbody fusion with pedicle screws in treatment of double-segment lumbar spondylolisthesis. METHODS:Twenty patients with double-segment lumbar spondylolisthesis were treated with posterior lumbar interbody fusion with pedicle screws, including posterior lumbar-spinal canal decompression, nerve root release, interbody graft fusion, pedicle screws reduction and fixation. Clinical functional recovery was assessed by Oswestry disability index and visual analog scale. Radiographic data including lumbar slippery percentage, lumbar slippery angle, lumbar height, pelvic tilt angle and sacral slope angle were measured. Al data was col ected 1 day before surgery, 1 day, 3 months, 6 months and 1 year after surgery, and every year constantly. RESULTS AND CONCLUSION:Al 20 patients were fol owed up for 6 months to 3 years. Oswestry disability index and visual analog scale were lower after surgery and at the final fol ow-up, when compared with before surgery (P<0.05). Lumbar disc height was significantly increased after surgery and at the final fol ow-up, than those of pre-operation (P<0.05). Lumbar slippery percentage, pelvic tilt angle and sacral slope angle were improved significantly after

  14. Different bone graft fusion materials applied in lumbar interbody fusion%不同植骨融合材料在腰椎椎体间脊柱融合中的应用

    Institute of Scientific and Technical Information of China (English)

    覃建朴; 王翀; 张朋云; 曹广如; 蔡玉强; 廖文波

    2016-01-01

    背景:脊柱融合治疗时选择合适的替代移植骨具有重要的意义,能够解决自体骨移植及其他移植材料带来的弊端。目的:观察不同植骨融合材料性能,探讨不同植骨融合材料在犬腰椎椎体间脊柱融合中的应用效果。方法:选取45只中华田园犬建立腰椎椎体间脊柱融合模型,建模后随机分3组,分别植入自体髂骨、重组人骨形态发生蛋白2复合材料和同种异体髂骨,分析不同植骨融合材料在犬腰椎椎体间脊柱融合中的效果。结果与结论:①融合率:重组人骨形态发生蛋白2复合材料组犬融合率显著高于其他组(P <0.05);②Oswestry 功能障碍指数:重组人骨形态发生蛋白2复合材料组术后 Oswestry 功能障碍指数显著低于其他2组(P <0.05);②组织学形态:苏木精-伊红染色显示,术后12周,与其他2组相比,重组人骨形态发生蛋白2犬完全骨性融合,且形成了连续骨小梁,植入骨与犬上下椎体完全粘连;④结果提示:重组人骨形态发生蛋白2复合材料更能够促更好地促进脊柱愈合,效果优于自体和同种异体骨移植。%BACKGROUND: The choice of suitable bone graft substitute is vital for spinal fusion treatment, which can solve some limitations caused by autogenous bone graft and other materials. OBJECTIVE: To investigate properties of different bone graft fusion materials, and to explore their application in dog spinal fusion of lumbar vertebral body. METHODS: Forty-five Chinese rural dogs were enrol ed to prepare lumbar interbody fusion models, and then were randomized into three groups transplanted with autogenous ilium, recombinant human bone morphogenetic protein-2 composite or al ograft ilium, respectively. Afterwards, effects of different materials in the lumbar interbody fusion were analyzed. RESULTS AND CONCLUSION: The fusion rate of the composite group was significantly higher than those of the other

  15. 后路内窥镜下髓核摘除术联合椎间融合固定治疗腰椎退变失稳性椎间盘突出症%Posterior endoscopic discectomy combined with lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability

    Institute of Scientific and Technical Information of China (English)

    焦峰; 张强; 纪玉清; 丛伟; 韩磊祥

    2012-01-01

    Objective To discuss the clinical efficacy of posterior endoscopic discectomy combined with expandable spinal spacer (B-Twin) lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability. Methods 22 patients with lumbar intervertebral disc protrusion and degenerative lumbar spinal instability in our hospital from November 2007 to November 2009 were selected. All the patients were treated with posterior endoscopic discectomy combine with B-Twin lumbar interbody fusion. JOA score was used to evaluation before operation, one week after operation and the last follow-up, recovery rate was calculated. Conditions of interbody fusion and disc height height change were observed by X-line and CT during reexamination. Results All 22 patients were smoothly finished operation. The operation time was 70-110 min, average of 83 min; amount of bleeding was 200-400 mL, average of 280 mL. All the patients were followed up for 16-40 months, average of 34.3 months. Average JOA score of before operation was 14.8 scores, which of the last time follow-up was 27.6 scores,the improvement rate was 75%-100%. The reexamination of X-line and CT showed that the height of intervertebral lost rate was 18% (4/22) and the lumbar interbody fusion rate is 86% (19/22). There was no complication, such as infection, hematoma, nerve injury, B-twin falling off. Conclusion Application of posterior endoscopic discectomy combined with B-Twin lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability has little trauma and bleeding, and the recent follow-up results are satisfactory.%目的 探讨后路内窥镜下髓核摘除术联合可膨胀脊柱融合器(B-Twin)椎间融合治疗腰椎退变失稳性椎间盘突出症的疗效.方法 选择2007年11月~2009年11月我院收治的退行性腰椎间盘突出症合并腰椎失稳患者22例,均采用后路内窥镜下髓核摘除

  16. 非融合技术在老年退变性腰椎疾病中的应用%Non-fusion motion preservation stabilization techniques for degenerative lumbar diseases in the elderly

    Institute of Scientific and Technical Information of China (English)

    伍骥; 文偃伍; 黄蓉蓉

    2012-01-01

    腰椎非融合外科技术因不固定脊柱节段,也许较融合术具有更多的优势.本文讨论了对于适合的老年患者,腰椎非融合术的主要类型、进展、适应证及禁忌证、存在的优势与不足.并对非融合技术在老年退变性腰椎疾病中的应用前景进行了展望.我们认为,各主要非融合技术在延缓治疗节段椎间盘退变的速度、保留该节段的运动功能、预防相邻节段的退变、减轻临床症状及改善生活质量等方面都显示出较融合术所具有的更多优势和更少的负面影响.%The non-fusion dynamic stabilization techniques maintain the motion of the lumbar vertebrae without fusion spinal segments, so it may have more advantages than fusion surgery. In this review, we discussed the main types, advance, indications and contraindications, advantages and disadvantages of the lumbar non-fusion surgical treatment for the eligible elderly patients. We believed that major non-fusion techniques had more advantages and less disadvantages in delaying the process of disc degeneration of the targeted segment, preserving the motion of segment, preventing degeneration of adjacent segments, alleviating clinical symptoms, and improving quality of life. There would be great prospect of the lumbar non-fusion surgery in the treatment of degenerative lumbar diseases.

  17. 潜行减压单侧改良TLIF手术治疗腰椎退行性疾患%Preliminary efficacy of decompressive unilateral improved transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative diseases

    Institute of Scientific and Technical Information of China (English)

    张居适; 胡松峰; 李志龙

    2014-01-01

    目的:观察椎管潜行减压单侧改良经椎间孔腰椎间融合术(transforaminal lumbar interbody fusion,TLIF)手术治疗腰椎退行性疾病的临床疗效。方法:自2009年8月至2011年12月,采用椎管潜行减压单侧改良TLIF手术治疗腰椎退行性疾病患者28例,其中男16例,女12例;年龄46~71岁,平均61岁;病程6个月~6年。腰椎管狭窄症20例,腰椎间盘突出症8例。潜行减压范围:单节段24例,双节段4例。左侧15例,右侧13例。采用JOA下腰痛评分系统(29分)评价手术前后临床症状、体征及括约肌功能;并采用视觉模拟评分(VAS)评估手术前后腰腿痛情况。结果:28例患者获随访,时间6~28个月,平均14个月。术后JOA、VAS评分(17.9±2.2、2.8±0.7)与术前(8.5±1.7、8.6±1.2)比较有明显改善(P<0.05)。28例患者椎间均达到骨性融合。结论:采用椎管潜行减压单侧改良TLIF手术治疗单侧根性症状的腰椎管狭窄症、腰椎间盘突出症,具有创伤小、疗效确切的优点;能明显节省医疗费用,值得临床研究推广。%Objective:To observe preliminary efficacy of decompressive unilateral improved transforaminal lumbar inter-body fusion(TLIF) for the treatment of lumbar degenerative diseases. Methods:From August 2009 to December 2011,28 pa-tients with lumbar degenerative diseases were treated by decompressive unilateral improved TLIF ,including 16 males and 12 females with an average of 61 (aged 46 to 71) years old,the courses of disease ranged from 6 months to 6 years. Among them , 20 cases suffered from lumbar spinal stenosis ,8 cases were lumbar disc herniation. Decompressive range included single seg-ment in 24 cases,and double segments in 4 cases;15 cases were performed operation on the left side,13 cases on the right side. JOA lower back pain scoring system (29 points) were applied for evaluate preoperative and postoperative

  18. Dynamic stabilization for L4-5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up.

    Science.gov (United States)

    Kuo, Chao-Hung; Chang, Peng-Yuan; Wu, Jau-Ching; Chang, Hsuan-Kan; Fay, Li-Yu; Tu, Tsung-Hsi; Cheng, Henrich; Huang, Wen-Cheng

    2016-01-01

    OBJECTIVE In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4-5. METHODS This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4-5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery. RESULTS A total of 86 patients with L4-5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term. Thus, the comparable results between the 2 groups in this study require longer follow

  19. Lumbar interbody fusion with porous biphasic calcium phosphate enhanced by recombinant bone morphogenetic protein-2/silk fibroin sustained-released microsphere: an experimental study on sheep model.

    Science.gov (United States)

    Chen, Liang; Liu, Hai-Long; Gu, Yong; Feng, Yu; Yang, Hui-Lin

    2015-03-01

    Biphasic calcium phosphate (BCP) has been investigated extensively as a bone substitute nowadays. However, the bone formation capacity of BCP is limited owing to lack of osteoinduction. Silk fibroin (SF) has a structure similar to type I collagen, and could be developed to a microsphere for the sustained-release of rhBMP-2. In our previous report, bioactivity of BCP could be enhanced by rhBMP-2/SF microsphere (containing 0.5 µg rhBMP-2) in vitro. However, the bone regeneration performance of the composite in vivo was not investigated. Thus, the purpose of this study was to evaluate the efficacy of BCP/rhBMP-2/SF in a sheep lumbar fusion model. A BCP and rhBMP-2/SF microsphere was developed, and then was integrated into a BCP/rhBMP-2/SF composite. BCP, BCP/rhBMP-2 and BCP/rhBMP-2/SF were implanted randomly into the disc spaces of 30 sheep at the levels of L1/2, L3/4 and L5/6. After sacrificed, the fusion segments were evaluated by manual palpation, CT scan, biomechanical testing and histology at 3 and 6 months, respectively. The composite demonstrated a burst-release of rhBMP-2 (39.1 ± 2.8 %) on the initial 4 days and a sustained-release (accumulative 81.3 ± 4.9 %) for more than 28 days. The fusion rates, semi-quantitative CT scores, fusion stiffness in bending in all directions and histologic scores of BCP/rhBMP-2/SF were significantly greater than BCP and BCP/rhBMP-2 at each time point, respectively (P sheep using BCP constructs.

  20. 退变性腰椎侧凸长节段固定融合的手术治疗%Long segmental fusion for degenerative lumbar scoliosis

    Institute of Scientific and Technical Information of China (English)

    海涌; 孟祥龙; 鲁世宝; 苏庆军; 关立; 臧磊; 刘玉增

    2013-01-01

    目的探讨选择性减压长节段固定融合治疗退变性腰椎侧凸(DLS)的手术疗效。方法回顾性分析2004年1月至2007年6月首都医科大学附属北京朝阳医院采用选择性减压、长节段固定融合手术治疗的19例DLS患者的临床资料。记录手术减压固定节段、失血量等相关情况,比较术前和末次随访时患者侧凸角度、腰椎前凸角度、视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分的差异。结果手术减压1~4个节段,固定融合5~9个节段,椎间融合15例患者,共24个节段。术前和末次随访时患者Cobb角、腰椎前凸角度、冠状面失平衡、矢状面失平衡、VAS评分、ODI评分比较,差异有统计学意义(P<0.05)。术后至少1年手术满意度调查结果显示,12例患者表示愿意再次接受手术治疗。术后9例出现并发症,其中硬脊膜漏2例,无其他严重并发症和死亡病例,无一例发生内固定失败。结论对于伴有脊柱冠状面和矢状面失平衡的DLS患者,有限减压和长节段固定融合可获得良好疗效。%Objective To analyze the surgical effect of selective decompression and long segmental fusion for degenerative lumbar scoliosis (DLS). Methods Nineteen DLS patients without prior spinal diseases were performed selective decompression and long segmental fusion from January 2004 to June 2007 in Chaoyang Hospital affiliated to Capital Medical University. Surgical segments as well as estimate blood loss were recorded, the differences of Cobb angles,lumbar lordotic angles, visual analogue scale (VAS) score and Oswestry disability index (ODI) between preoperation and the last follow-up were compared. Results Decompression involved 1-4 segments, fusion levels ranged from 5-9 vertebral bodies, and interbody fusion was performed in 15 patients and 24 levels were fused. The differences of Cobb angles, lumbar lordotic angles,coronal/sagittal imbalance

  1. 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

    Institute of Scientific and Technical Information of China (English)

    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

  2. 微创经椎间孔腰椎椎间融合术治疗老年腰椎退变性疾病%Minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in elder-ly

    Institute of Scientific and Technical Information of China (English)

    陈云生; 陈荣春; 郭朝阳; 游辉; 钟红发; 张树芳

    2013-01-01

    Objectives: To evaluate outcomes of posterior transforaminal lumbar interbody fusion (MI-TLIF) under Pipeline expandable access system for lumbar degenerative diseases in elderly. Methods: From Febru-ary 2010 to June 2012, 46 elderly patients with lumbar degenerative diseases who underwent TLIF by using two different approaches were retrospectively analyzed. All patients were classified into observation group(MI-TLIF group) and control group(conventional open TLIF, CO-TLIF) according to the operative methods. There were 24 cases in observation group including 15 males and 9 females, aged from 60 to 79 years (average, 66.3 years), and the course of diseases ranging from 6 to 60 months(average, 18.5 months); 22 cases in con-trol group including 10 males and 12 females, aged from 62 to 75 years(average, 67.0 years), and course of diseases ranging from 8 to 64 months(average, 22.6 months). The blood loss, operation time, amount of blood transfusion and postoperative complications were compared. The clinical outcomes of both groups were evalu-ated by using the VAS(at postoperative 1 week, 3 months and the final follow-up) and ODI(at postoperative 3 months and the final follow-up), respectively. The bony fusion of both groups were assessed by the Suk stan-dard at the final follow-up. Results: There were significant differences on blood loss, amount of blood trans-fusion and postoperative complications (P0.05). All patients were followed up for an average of 18 months(range, 13 to 26 months). The VAS and ODI of both groups at each time point postoperatively experienced improvement compared with the preoperation (P0.05). Conclusions: MI-TLIF has similar surgical outcome with CO-TLIF for lumbar degenerative diseases in elderly, but the former has less blood loss and complications than the latter.%目的:探讨Pipeline可扩张通道辅助下行后路经椎间孔腰椎椎间融合术(minimally invasive transforam-inal lumbar interbody fusion,MI-TLIF)治疗老年腰

  3. Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis.

    Science.gov (United States)

    Lee, Chang-Hyun; Jahng, Tae-Ahn; Hyun, Seung-Jae; Kim, Chi Heon; Park, Sung-Bae; Kim, Ki-Jeong; Chung, Chun Kee; Kim, Hyun-Jib; Lee, Soo-Eon

    2016-01-01

    OBJECTIVE The Dynesys, a pedicle-based dynamic stabilization (PDS) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of PDS over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of patients who underwent PDS using the Dynesys system with those who underwent posterior lumbar interbody fusion (PLIF). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of patients who underwent PDS or PLIF for the treatment of degenerative lumbar spinal disease were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the Oswestry Disability Index (ODI) and back and leg pain visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate weighted mean differences (WMDs), 95% confidence intervals, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 participants [Dynesys, 250; PLIF, 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76-32.70 minutes), blood loss (81.87 ml, 95% CI 45.11-118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23-2.41 days). Both the Dynesys and PLIF groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI -3.48 to 3.72; back pain VAS score: WMD -0.15; 95% CI -0.56 to 0.26; leg pain VAS score: WMD -0.07; 95% CI -0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI -0.33 to 2.59). Although the

  4. Clinical efficacy of modified posterior lumbar interbody fusion on degenerative lumbar dis-ease%改良后路椎间植骨融合术治疗腰椎退行性疾病

    Institute of Scientific and Technical Information of China (English)

    谭小云; 蒲涛; 刘计鲁; 赵丽; 刘伟; 许轩铭

    2015-01-01

    目的:探讨改良后路椎间植骨融合术(PLIF)治疗腰椎退行性疾病的临床效果。方法将186例腰椎退行性病变伴腰腿痛的患者分成两组,分别使用改良 PLIF 和传统 PLIF 治疗。记录所有患者术前、术后 VAS 评分和 JOA 评分。结果两组术后住院时间差异无统计学意义(P >0.05),而手术时间及术中出血量改良 PLIF组均优于传统 PLIF 组(P <0.05)。患者均获随访,时间6~36个月。JOA 评分:两组术后3个月和末次随访与术前比较差异均有统计学意义(P <0.05),术后3个月与末次随访比较差异均无统计学意义(P >0.05)。末次随访时两组 JOA 评分、VAS 评分比较差异均无统计学意义(P >0.05)。结论改良 PLIF 治疗腰椎退行性疾病可以获得与传统 PLIF 相同的临床效果,且具有手术时间短、术中出血少及组织损伤轻等优点。%Objective To explore the clinical outcomes of modified posterior lumbar interbody fusion (PLIF)in the treatment of degenerative lumbar disease.Methods 186 patients with degenerative lumbar disease were divided into 2 groups and treated with traditional PLIF and modified PLIF respectively.Visual analogue scale (VAS)scores and Japanese Orthopaedic Association (JOA)scores were recorded before and after the treatment.Results The postop-erative hospital stay was not different (P >0.05 ),but there were significant differences between the 2 groups in terms of operation time and blood loss (P 0.05).Neither was the JOA score (P >0.05).Conclusions Functional outcome of modified PLIF is similar to traditional PLIF technique in the treatment of degenerative lumbar disease.But it has shorter operation time,and less blood loss and tissue damage.

  5. 异体骨垫在腰椎结核椎间融合术中的临床应用%Clinical application of allogeneic bone pad in intervertebral fusion of lumbar spine tuberculosis

    Institute of Scientific and Technical Information of China (English)

    范相成; 关玉成; 贾勇; 邵向明

    2012-01-01

    [目的]评价异体骨垫在腰椎结核椎间融合中的临床应用效果.[方法]2005年6月~2009年11月,采用异体骨垫对腰椎单节段结核病灶清除后进行植骨融合41例.[结果]所有病例全部治愈,未发生结核复发,椎间融合率100%.[结论]采用异体骨垫对腰椎单节段结核病灶清除后进行植骨融合,方法简单,效果可靠,值得临床应用.%[Objective] To clinically evaluate the application effect of allogeneic bone pad in interveitebral fusion of lumbar spine tuberculosis. [Methods] Forty -one cases of bone graft fusion were performed with allogeneic bone pad after clearance of tuberculose focus at single lumbar segment from June 2005 to November 2009. [ Results] All patients were cured without recurrence of tuberculosis and the ratio of interveitebral fusion were 100%. [Conclusion] For its reliability and simplicity, bone graft fusion with allogeneic bone pad is worthy of clinical application after clearance of tuberculose focus at single lumbar segment

  6. Removal of lumbar disc with cage bone graft fusion and internal fixation for the treatment of lumbar disc herniation%腰椎间盘摘除加cage植骨融合内固定治疗腰椎间盘突出症

    Institute of Scientific and Technical Information of China (English)

    张亚; 冯虎; 李健华; 刁天月; 蒋学军; 杨挺

    2016-01-01

    目的:探讨腰椎间盘摘除加cage植骨融合内固定治疗腰椎间盘突出症的临床疗效。方法对32例腰椎间盘突出症患者行腰椎间盘摘除加cage植骨融合内固定术,采用Oswestry功能障碍指数( ODI)和疼痛视觉模拟评分( VAS)对手术疗效进行评估。结果患者均获得随访,时间12~36(18±6.5)个月。患者术后疼痛均明显缓解,功能改善,术后ODI与VAS评分均较术前明显降低,差异有统计学意义( P<0.05)。术后融合节段均骨性愈合。随访期间内cage位置正常,内固定物无断裂及滑脱。结论腰椎间盘摘除加cage植骨融合内固定术能增加脊柱的稳定性及脊柱融合率,缓解患者症状及改善功能,临床疗效满意。%Objective To investigate the clinical effect of removal of lumbar disc with cage bone graft fusion and in-ternal fixation for the treatment of lumbar disc herniation. Methods 32 patients with lumbar disc herniation who un-derwent removal of lumbar disc with cage bone graft fusion and internal fixation systems. Oswestry disability index ( ODI) and visual analogue scale ( VAS) were used to evaluate the surgical effect. Results All patients were fol-lowed up for 12 ~36 ( 18 ± 6. 5 ) months. The postoperative pain was significantly relieved and function was im-proved, postoperative ODI and VAS decreased significantly comparing with that of the preoperation (P<0. 05). All fusion segments achieved solid fusion, all these implants were in good places without displacement or internal fixation failure. Conclusions Removal of lumbar disc with cage bone graft fusion and internal fixation for the treatment of lumbar disc herniation can increase the stability of the spine and the rate of fusion, significantly relieve symptoms and improve patients′function, which can obtain a satisfactory clinical effect.

  7. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion.

    Science.gov (United States)

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Yang, Sidong; Wang, Yanhong; Wang, Qian; Zhang, Feng; Ding, Wenyuan

    2016-08-01

    The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis.In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics-preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables-the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope.PJK was developed in 17 of 98 patients (17.3%) until to the final follow-up and were enrolled as the PJK group, and 81 patients without PJK at final follow-up were enrolled as the non-PJK group. There was no statistically significant difference between the 2 groups in age at operation (P = 0.900). The patient's sex was excluded in statistical analysis because of the predominance of female patients. There were statistically significant difference between the 2 groups in BMI ([25.5 ± 1.7] kg/m in the PJK group and [23.6 ± 1.9] kg/m in the non-PJK group, P 25 kg/m, osteoporosis, and UIV at thoracolumbar junction were independently associated with PJK.In conclusion, osteoporosis, obesity, and UIV at thoracolumbar junction are risk factors for the development and progression of PJK in DLS patients following long instrumented posterior spinal fusion. Antiosteoporosis treatment extends the fusion level above the thoracolumbar

  8. 核心稳定性训练与植入物内固定腰椎融合修复退变性腰椎滑脱:腰椎功能评价%Core stabilization exercises, implant fixation and lumbar fusion for degenerative lumbar spondylolisthesis:lumbar function evaluation

    Institute of Scientific and Technical Information of China (English)

    罗盛飞; 张德俭

    2015-01-01

    背景:腰椎退变性疾病是脊柱外科中的常见病、多发病,并且随着年龄的增加,发病率升高。目的:通过对腰椎退变性疾病不同分期植入物内固定腰椎融合治疗及功能训练后脊柱稳定性分析,为提高临床治疗效果改善患者生活质量提供指导。方法:①采用前瞻性随机对照设计,将52例Ⅰ度、Ⅱ度退变性腰椎滑脱患者随机分为训练组和对照组,每组26例。对照组给予传统训练,训练组给予核心稳定性训练,疗程24周。分别在治疗后6,12,24周进行数字疼痛评分和Oswestry功能障碍指数疗效评定。②通过数据库文献检索方法评估腰椎融合及植入物内固定修复退变性腰椎滑脱后的脊柱稳定性。结果与结论:①治疗24周后,训练组的数字疼痛评分和Oswestry功能障碍指数均明显低于对照组(P <0.05或P <0.01)。核心稳定性训练对腰椎滑脱患者疼痛的缓解和恢复机体活动能力有显著效果。核心稳定性训练对退变性腰椎滑脱所致的慢性腰痛及功能改善优于传统的功能训练。②椎弓根固定并后外侧融合与后侧椎体间融合都可有效治疗Ⅱ度以内腰椎滑脱,后侧椎体间融合能更好的维持滑脱矫形及结构的稳定,后外侧融合后期易出现矫正丢失及内固定失败等问题,但临床疗效不受明显影响。%BACKGROUND:Lumbar degenerative disease is a common and frequently occurring disease in spinal surgery. With increasing age, the incidence rate is increased. OBJECTIVE: To elevate clinical outcomes and improve the quality of life of patients by analyzing spinal stability after lumbar implant fixation fusion and functional training in treatment of lumbar degenerative disease. METHODS: (1) We used a prospective randomized controled design. The 52 patients with I° or II° degenerative lumbar spondylolisthesis were randomly divided into two groups, with 26 cases in each group

  9. The early clinical observation about Dynesys and lumbar interbody fusion in treatment of lumbar degenerative diseases%非融合技术与腰椎融合术治疗腰椎退变性疾病的早期疗效观察

    Institute of Scientific and Technical Information of China (English)

    王孟; 李坤; 王飞; 张元豫

    2012-01-01

    Objective To investigate the difference of early clinical efficacy between Dynesys and lumbar interbody fusion in treatment of lumbar degenerative diseases. Methods Clinical data of 36 patients under two methods treatment of lumbar degenerative diseases with 18 examples in each were retrospectively analyzed. Patients were observed blood loss, VAS, ODI index, the rate for short-term excellent or good relief of symptoms and ROM. Results Two groups of VAS and ODI index had been significantly improved; Dynesys group maintained adjacent segment ROM to its original condition, while instrumented segment ROM decreased; In lumbar interbody fusion group, adjacent segment ROM increased, and instrumented segments fused. Conclusions Dynesys and the lumbar interbody fusion can all take the ideal early curative effect. Dynesys preserve partial ROM ,and prevent accelerated degeneration, which is a desirable method of treatment.%目的 探讨Dynesys和腰椎融合治疗腰椎退行性疾病早期临床疗效.方法 采用两种方法治疗36例腰椎退行性疾病患者,Dynesys组18例,腰椎融合组18例.观察两组手术时间、术中出血量、VAS评分、ODI指数、手术效果优良率及椎间活动度(ROM).结果 两组术后VAS及ODI都得到明显改善;Dynesys组邻近节段ROM维持在原来状态,手术节段ROM减小;腰椎融合组邻近节段ROM增大,手术节段融合.结论 Dynesys与腰椎融合术均可取的理想的早期疗效,Dynesys保持了部分椎间活动度,有利于防止退变加速.

  10. 退变性腰椎管狭窄症的腰后路减压椎间植骨融合术治疗观察%The Treatment Observation of Degenerative Lumbar Spinal Stenosisby Posterior Lumbar Decompression and Interbody Fusion

    Institute of Scientific and Technical Information of China (English)

    赖征文; 李敏; 李平安; 刘云彬

    2011-01-01

    Objective:Observed the treatment effect of degenerative lumbar spinal stenosis by posterior lumbar decompression and interbody fusion.Methods:42 patients admitted to our hospital with degenerative lumbar spinal stenosis were divided into two groups,the control group were taken a simple decompression,the treatment group were taken by lumbar posterior decompression and interbody fusion surgery,compared the efficacy and prognosis of two groups.Results:The treatment group,the three time periods JOA scores are significantly better than the control group,P>0.05.Conclusion:The lumbar posterior decompression and interbody fusion can improve the symptoms,the effect last stability,is a good treatment option.%目的:观察腰后路减压椎间植骨融合术对于退变性腰椎管狭窄症的治疗效果.方法:将本院收治的42例退变性腰椎管狭窄症患者分为两组,对照组采取单纯减压术,治疗组采取经腰后路减压椎间植骨融合术,对比两组的近期疗效及预后情况.结果:治疗组在三个时间段的JOA评分均明显优于对照组,P>0.05.结论:经腰后路减压椎间植骨融合术可有效改善患者的症状,效果持久稳定,是一种良好的治疗选择.

  11. MASTERS-D Study: A Prospective, Multicenter, Pragmatic, Observational, Data-Monitored Trial of Minimally Invasive Fusion to Treat Degenerative Lumbar Disorders, One-Year Follow-Up

    Science.gov (United States)

    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

  12. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  13. Open versus minimally invasive transforaminal lumbar interbody fusion for single segment degenerative lumbar disease:A Meta-analysis%开放与微创经椎间孔椎体间融合治疗单节段退行性腰椎疾病的Meta分析★

    Institute of Scientific and Technical Information of China (English)

    王银; 陈根元; 胡龙; 萧文耀; 王建民

    2013-01-01

      背景:微创经椎间孔椎体间融合技术采用微小切口经可扩张通道进行,与开放经椎间孔椎体间融合技术相比,微创技术视野小,操作更为精细,对周围组织的损伤较小,有利于恢复。  目的:对微创经椎间孔椎体间融合技术与开放经椎间孔椎体间融合技术治疗单节段退行性腰椎疾病的疗效及临床价值进行评价。  方法:检索2005至2012年间 Cochrane library、PubMed、Embase、SCI、中国生物医学文献数据库、中国知网和万方数据库,手工检索相关文献的参考文献及4种中文主要骨科杂志,纳入以单节段退行性腰椎疾病为研究对象,比较微创与开放经椎间孔椎体间融合技术治疗的随机对照试验,前瞻性队列研究及回顾性队列研究,严格评价纳入研究的方法学质量并提取资料,用 Cochrane 协作网提供的Revman5.1进行 Meta 分析。  结果与结论:经过筛选纳入7个研究(856例患者)。7个研究圴选用手术时间作为观察指标,结果显示微创手术的手术操作时间与开放手术比较差异无显著性意义(P=0.11);6个研究选用术中出血量作为观察指标,结果显示微创手术的术中出血量明显少于开放手术(P OBJECTIVE: To evaluate the surgical outcome and clinicaI value between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of single segment degenerative lumbar disease. METHODS: The Cochrane library, PubMed database, Embase database, SCI database, CNKI database, Wanfang database and Chinese Biomedical database were searched for control ed trials, prospective cohort study and retrospective cohort study on the comparison between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of degenerative lumbar disease. Furthermore, we also manual y searched the relevant references and four Chinese orthopedic journals. Methodology quality of the

  14. A lumbar disc surgery predictive score card.

    Science.gov (United States)

    Finneson, B E

    1978-06-01

    A lumbar disc surgery predictive score card or questionnaire has been developed to assess potential candidates for excision of a herniated lumbar disc who have not previously undergone lumbar spine surgery. It is not designed to encompass patients who are being considered for other types of lumbar spine surgery, such as decompressive laminectomy or fusion. In an effort to make the "score card" usable by almost all physicians who are involved in lumbar disc surgery, only studies which have broad acceptance and are generally employed are included. Studies which have less widespread use such as electromyogram, discogram, venogram, special psychologic studies (MMPI, pain drawings) have been purposely excluded.

  15. A prospective, multi-center clinical and radiographic outcomes evaluation of ChronOS strip for lumbar spine fusion.

    Science.gov (United States)

    Kanter, Adam S; Gandhoke, Gurpreet S; Welch, William C; Arnold, Paul M; Cheng, Joseph S; Okonkwo, David O

    2016-03-01

    This prospective clinical study evaluated the use of a composite bone void filler (ChronOS Strip, DePuy Synthes, West Chester, PA, USA), combined with bone marrow aspirate plus local autologous bone, in a series of patients undergoing instrumented posterolateral spinal fusion with interbody support. Seventy-six patients were enrolled and treated per protocol at 13 clinical sites. At 24 months, 55/76 patients (72%) were evaluated, with 49/76 (65%) having sufficient data to determine the primary endpoint. The primary endpoint, posterolateral fusion success, was achieved in 48/54 (88.9%) patients at 12 months and in 45/49 (91.8%) patients at 24 months. At all follow-up time points, statistically significant improvements were observed when compared to baseline in back and leg pain and functional status as measured by visual analog scale, Oswestry Disability Index and 12-Item Short Form health surveys. This prospective multi-center series provides evidence that the composite bone void filler, when applied posterolaterally with instrumentation, bone marrow aspirate and/or local autologous bone and concomitant interbody support, can be used to achieve a successful posterolateral fusion, resulting in improvements in clinical outcomes in patients with degenerative disc disease.

  16. Fusion

    CERN Document Server

    Mahaffey, James A

    2012-01-01

    As energy problems of the world grow, work toward fusion power continues at a greater pace than ever before. The topic of fusion is one that is often met with the most recognition and interest in the nuclear power arena. Written in clear and jargon-free prose, Fusion explores the big bang of creation to the blackout death of worn-out stars. A brief history of fusion research, beginning with the first tentative theories in the early 20th century, is also discussed, as well as the race for fusion power. This brand-new, full-color resource examines the various programs currently being funded or p

  17. 钉棒置入与椎间融合修复极外侧型腰椎间盘突出症:远期腰椎稳定性随访%Extreme lateral lumbar disc herniation after pedicle screw fixation and interbody fusion cage:lumbar stability at long-tem follow-up

    Institute of Scientific and Technical Information of China (English)

    史瑞明; 李国胜; 张义峰; 黄震源; 孙利; 王存

    2014-01-01

    BACKGROUND:Extreme lateral lumbar disc herniation is a rare type of lumbar disc herniation, there are a variety of treatment methods, but the therapeutic efficacy and recurrence rate are controversial. OBJECTIVE:To investigate the availability of lumbar pedicle screw fixation combined with interbody fusion cage for treating extreme lateral lumbar disc herniation. METHODWe retrospectively analyzed 19 patients with extreme lateral lumbar disc herniation after treatment with lumbar pedicle screw fixation combining with interbody fusion cage from March 2006 to January 2009. The outcomes were evaluated depending on VAS scoring standard and Macnab scoring standard, lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after lumbar pedicle screw fixation combined with interbody fusion cage depending on literature search. RESULTS AND CONCLUSION:Al the 19 patients were fol owed up for 13 months to 3 years, the leg and lumbar pain of al the patients were relieved to varying degrees. Preoperative VAS score was 7.3±1.28 points and postoperative VAS score was 2.1±0.8 points, showing significant difference between two groups (P  目的:探讨应用腰椎椎弓根钉棒内固定联合椎间融合器置入椎间融合修复极外侧型腰椎间盘突出症的临床效果。  方法:回顾性分析2006年3月至2009年1月行腰椎椎弓根钉棒系统联合椎间融合器置入椎间融合治疗的19例极外侧型腰椎间盘突出症患者的临床资料,根据目测类比评分标准及Macnab评价标准进行疗效判定,观察治疗后腰椎稳定性,通过数据库文献检索方法评估腰椎椎弓根钉棒内固定联合椎间融合器置入椎间融合修复极外侧型腰椎间盘突出症的效果。  结果与结论:19例患者均得到随访,随访时间13个月-3年。所有患者治疗后即有下肢及腰部疼痛不同程度的缓解,治

  18. 非融合技术在腰椎退行性疾病中的临床应用%Clinical Application of Non-Fusion Technology in the Lumbar Degenerative Disease

    Institute of Scientific and Technical Information of China (English)

    李新炜

    2011-01-01

    腰椎融合手术一段时间以来是治疗腰椎退行性疾病的有效方法.近年来,由于融合手术术后并发症的发生,使得非融合手术应运而生并得到发展.通过研究国内外非融合手术的随访文献发现非融合技术在保持病变节段一定的活动度、减缓邻近节段的退行性变、限制异常活动等方面有独特的优势.因此,非融合技术可以作为一种行之有效的手术方式来治疗腰椎退行性疾病.%Fusion surgery has been an effective way for the treatment of lumbar degenerative diseases for a long time. Due to the complications after surgery seen in recent years,the non-fusion technology has appeared and developed. According to studies of the recent follow-up literatures,it's learned that the non-fusion technology has some advantages such as retaining some residual motion, delaying degeneration of adjacent segment,and limiting abnormal activity etc.. Therefore,the non-fusion technology can be applied as an effective way of treating lumbar degenerative disease.

  19. Effect comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of degenerative lumbar disease%微创和开放经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的效果比较

    Institute of Scientific and Technical Information of China (English)

    陈文明; 黄华伟; 黄勇全

    2014-01-01

    Objective To compare the clinical effect of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of degenerative lumbar disease. Methods 32 patients with degenerative lumbar disease in our hospital were selected as research subjects and randomly allocated to the research group and the control group,and there were 16 patients in each group.The control group received conventional open surgery,and the research group re-ceived minimally invasive transforaminal lumbar interbody fusion.Treatment effect between the two groups were com-pared. Results The total effective rate in the research group (93.75%) was obviously higher than that in the control group (68.75%) (P<0.05). Conclusion Minimally invasive transforaminal lumbar interbody fusion treating degenerative lumbar disease helps not only improve total curative effects,but also reduce postoperative complications,which is worthy of clinical promotion.%目的:比较微创和开放经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的临床效果。方法选取本院收治的32例腰椎退变性疾病患者为研究对象,随机分为研究组与对照组,各16例,对照组给予传统开放手术治疗,研究组给予微创经椎间孔腰椎椎间融合术治疗,比较两组的治疗效果。结果研究组的总有效率为93.75%,明显高于对照组的68.75%(P<0.05)。结论采用微创经椎间孔腰椎椎间融合术治疗腰椎退变性疾病不仅可以提高整体治疗效果,还可以减少术后并发症的出现,值得临床推广。

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Dynesys与后路椎间融合治疗腰椎管狭窄症的临床效果比较研究%Dynesys and posterior lumbar interbody fusion for lumbar spinal stenosis in the comparative study of clinical effect

    Institute of Scientific and Technical Information of China (English)

    高洪亮

    2015-01-01

    Objective: To investigate the Dynesys and posterior lumbar interbody fusion in the treatment of lumbar spinal stenosis in.Methods:a total of August 2012 to 2014 years 5 months in our hospital from lumbar spinal stenosis were 85 cases, and were randomly divided into group A (n = 42) and group B (n = 43). The A group was treated by posterior lumbar interbody fusion, and the B group was treated by pedicle Dynesys operation, and the treatment effect was compared between the two groups. Results: there was no significant difference in the length of the incision in the A group and the B group (P>0.05). ODI score and VAS score were significantly lower in A group and B group (P0.05) and the VAS score at the end of groups (ODI).Conclusion: in lumbar spinal canal stenosis treatment in, posterior lumbar interbody fusion surgery and transpedicular Dynesys surgical treatment effect is similar, but the latter has a shorter operation time, less trauma and bleeding quantity low characteristic, can effectively stabilize the spine, and is worthy to be popularized.%目的:探讨Dynesys与后路椎间融合在腰椎管狭窄症中的治疗效果.方法:选取2012年8月到2014年5月我院收治的腰椎管狭窄症者85例,并随机分为A组(n=42)和B组(n=43).A组都采用后路椎间融合手术,B组均采用经椎弓根Dynesys手术治疗,对比两组的治疗效果.结果:A组、B组切口长度相比,差异无统计学意义(P>0.05).A组、B组末次随访ODI评分、VAS评分显著比手术前降低(P0.05).结论:在腰椎管狭窄症治疗中,后路椎间融合手术和经椎弓根Dynesys手术治疗效果相近,但后者具有手术时间短、创伤小和出血量低等特点,可有效地稳定脊柱,值得推广.

  2. Clinical Research Status of Adjacent Segment Degeneration After Lumbar Spinal Fusion%腰椎融合术后邻近节段退变的临床研究现状

    Institute of Scientific and Technical Information of China (English)

    张波; 李伟; 苟林; 李亮; 张兵; 吴辉; 林宏

    2015-01-01

    ObjectiveClinical research status of adjacent segment degeneration after lumbar fusion analysis.Methods The clinical data of adjacent segment degeneration collected in our hospital in recent years appeared after lumbar fusion, research status of adjacent segment degeneration after lumbar fusion and comprehensive analysis. Results The concept of adjacent segment degeneration included imaging of adjacent segment degeneration of adjacent segment degeneration and clinical symptoms, the incidence of a minimum of 8% of the former, up to 95%, the lowest incidence of clinical symptoms for 5.2% adjacent segment degeneration, a maximum of 18.5%. For adjacent segment degeneration prevention measures include: to reduce intraoperative fusion segments, application of non fusiontechnology, sagittal balance etc. ConclusionAfter lumbar fusion is prone to adjacent segment degeneration, the patients with application of non fusion technology can signiifcantly reduce the incidence of adjacent segment degeneration.%目的:分析腰椎融合术后邻近节段退变的临床研究现状。方法收集我院近年来出现的腰椎融合术后邻近节段退变的临床资料,综合分析腰椎融合术后邻近节段退变的研究现状。结果邻近节段退变的概念包括影像学邻近节段退变和临床症状邻近节段退变,前者的发生率最低为8%,最高可达到95%,临床症状邻近节段退变的发生率最低为5.2%,最高为18.5%。对于邻近节段退变的预防措施主要有:术中减少融合节段、应用非融合技术、维持矢状面平衡等等。结论腰椎融合术后很容易发生邻近节段退变,通过对患者应用非融合技术可显著减少邻近节段退变的发生。

  3. Quadrant 单侧固定椎间融合治疗不稳定型腰椎间盘突出症%Unilateral Pedicle Screw Fixation and Interbody Fusion for the Treatment of Lumbar Disc Hernia-tion with Lumbar Spinal Instability under Mast Quadrant System

    Institute of Scientific and Technical Information of China (English)

    李青; 姚海燕; 梁道臣; 赵成毅; 张爱明; 梅治; 陈应超; 张非

    2014-01-01

    Objective To explore the clinical outcome of the minimally invasive surgical approach by mast Quadrant sys-tem in the treatment of lumbar disc herniation with lumbar spinal instability. Methods For 31 patients with single level lum-bar disc herniation with lumbar spinal instability which diagnosed by magnetic resonance imaging and dynamic X-rays. This group included 20 males and 11 females. All patients were managed by unilateral pedicle screw fixation and interbody fusion under Mast Quadrant system. We evaluate the therapeutic effect according to Japanese Orthopaedic Association(JOA)and Os-westry disability index(ODI)before and after surgery. X-rays was used to evaluate the height variation and fusion of interverte-bral space. Results All patients were followed up for 14 to 36 months,with a mean period of 20. 4 months. The symptoms of lumbar and lower extremity were relieved completely. There was no decrease of intervertebral height. Radiographic interbody fu-sion rate was 100% . According to JOA scoring,the score increased from(7. 6 ± 2. 5)before operation to(25. 7 ± 1. 4)in the last follow-up,improvement rate of treatment was 84. 46% ,the score of ODI decreased from(55. 5 ± 5. 2)to(10. 9 ± 3. 0)in the last follow up after surgery. Conclusion The minimally invasive surgical treatment of unilateral pedicle screw fixation and interbody fusion assisted mast Quadrant system for lumbar disc herniation with lumbar spinal instability is reliable and provides satisfactory lumbar fusion and clinical results.%目的:探讨在 MastQuadrantTM 可扩张管通道系统下单侧固定加 Cage 治疗腰椎间盘突出症伴腰椎不稳的临床疗效。方法对31例腰椎间盘突出症伴腰椎不稳患者,采用 Quadrant 微创下单侧固定加 Cage 椎间融合术治疗,其中男20例,女11例;年龄34~76岁。术前、术后采用日本骨科学会(Japanese orthopaedic association,JOA)腰背痛评分及 Oswestry 功能障碍指数(oswestry disability

  4. Transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation for upper lumbar disc hernia-tion%经椎间孔行腰椎间融合联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症疗效分析

    Institute of Scientific and Technical Information of China (English)

    谭健; 李平元; 欧军; 苏小桃; 卢政好

    2014-01-01

    Objective To investigate the clinical effect of transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation for upper lumbar disc herniation. Methods Retrospectively analysed the clinical data of 16 patients with upper lumbar disc herniation from Jun 2009 to Feb 2013 in our hospital, who were treated with transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation;using the visual analogue scale assessed the pain degree of patients at admission and after operation; assessed the clinical efficacy at last follow-up according to the modified MacNab criteria and observed intervertebral fusion. Results 16 patients were followed up 12 to 52 months (average 24.2 months) after surgery. All the patients had no nerve damage and leakage of cerebrospinal fluid complications. VAS score at different postopera-tive periods had significant difference compared with the VAS score before operation (P<0.01). According to the modified Mac-Nab criteria,the excellent and good rate was 93.75%. X-ray examination showed that there were no internal fixation failure and lumbar interbody non-fusion at the last follow-up. Conclusion Transforaminal lumbar interbody fusion combined with uni-lateral pedicle screw fixation has satisfied effect in the treatment of upper lumbar disc herniation,and has the advantages of small trauma,less complications,low cost.%目的:探讨经椎间孔行腰椎间融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症的临床疗效。方法回顾性分析2009年6月~2013年2月本院16例高位腰椎间盘突出症患者临床资料,均采用TLIF联合单侧椎弓根螺钉固定术治疗;采用腰腿痛视觉模拟评分测评入院时和TLIF联合单侧椎弓根螺钉固定术后(术后1周、1个月、3个月及末次随访)患者疼痛情况,末次随访采用改良MacNab标准评定临床疗效,并了解椎间融合

  5. Dynesys动态稳定系统置入内固定与后路腰椎间融合修复腰椎退行性病的比较%Dynesys dynamic stabilization system versus posterior lumbar interbody fusion in treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    彭超; 何智勇; 母建松; 兰海; 李开南

    2014-01-01

    背景:后路腰椎椎体间融合是腰椎退行性疾病经典的治疗方法,目前大量研究表明,融合固定后的相邻节段会发生退变。近年来越来越多的学者关注脊柱的非融合固定技术发展。  目的:比较Dynesys动态稳定系统置入内固定和后路腰椎椎体间融合治疗腰椎退行性疾病的临床疗效。  方法:对2009年7月至2010年7月收治的56例退行性腰椎间盘疾病患者的临床资料进行回顾性对比分析,其中采用Dynesys动态稳定系统置入内固定治疗28例,采用后路腰椎椎体间融合治疗28例。比较两组患者的手术时间、出血量、治疗后住院时间,应用目测类比评分进行疼痛评估,以Oswestry功能评分评价临床疗效。  结果与结论:56例患者均获随访,随访时间18-24个月。两组患者治疗后12个月随访时的Oswestry功能评分、目测类比评分均较治疗前有明显改善(P OBJECTIVE:To compare clinical effects of Dynesys dynamic stabilization system fixation and posterior lumbar interbody fusion in treatment of lumbar degenerative disease. METHODS:From July 2009 to July 2011, clinical data of 56 patients with lumbar degenerative disease were retrospectively analyzed. There were 28 cases of Dynesys dynamic stabilization system fixation, and 28 cases of posterior lumbar interbody fusion. Operation time, bleeding volume, and postoperative hospitalization time were compared in both groups. Visual analog scale was used to assess pain. Oswestry disability index was utilized to evaluate clinical effects. RESULTS AND CONCLUSION:A total of 56 patients were fol owed up for 18-24 months. Visual analog scale and Oswestry disability index scores were significantly improved at 12 months after treatment in both groups (P<0.01). Significant differences in operation time, bleeding volume, and postoperative hospitalization time were detected between both groups (P<0.01). Dynesys dynamic

  6. Efficacy of a Human Amniotic Tissue-derived Allograft, NuCel, in Patients Undergoing Posteriolateral Lumbar Fusions for Degenerative Disc Disease

    Science.gov (United States)

    2016-10-13

    Lumbar Degenerative Disc Disease; Spinal Stenosis; Spondylolisthesis; Spondylosis; Intervertebral Disk Displacement; Intervertebral Disk Degeneration; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Spondylolysis

  7. 腰椎后路单Cage单侧椎体间融合术在腰椎退变性疾病中的应用%Posterior lumbar interbody fusion using a unilateral single cage in the degenerative lumbar spine

    Institute of Scientific and Technical Information of China (English)

    顾宇彤; 姚振均; 陈统一; 董健; 姜晓幸; 张键; 费琴明; 阎作勤

    2011-01-01

    目的 对单Cage单侧PLIF治疗腰椎退变性疾病的临床疗效及放射影像学结果进行回顾性分析.方法 2005年10月至2008年3月间,使用填有移植骨的单Cage单侧PLIF技术为55例腰椎退变性疾病患者施行手术,术中将腰椎后路减压所取下的骨块咬碎后填于Cage前方,术后平均随访39.2个月.使用VAS法对患者的术前、术后1年及末次随访进行临床评估,用ODI法对术前及末次随访的功能进行评估,在末次随访中使用Prolo评分法,放射影像学可通过椎间高度、Cage周围的骨桥、射线透亮区及过伸过屈侧位片上椎间不稳的表现来评估. 结果VAS评分、ODI指数、Prolo评分均表明该术式的临床疗效非常令人满意,放射影像学评估显示术后6月时55例中有96.4%(53例)获牢固融合,末次随访时所有病例均获得完全融合.结论 单Cage单侧PLIF治疗腰椎退变性疾病,能维持合适的椎间高度,有可靠的脊柱稳定性、良好的骨连接和较高的骨融合率,可获得令人满意的临床疗效和放射影像学结果.%Objective We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) using a unilateral single cage and a local morselized bone graft. Methods Fifty five patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 39.2 months. The clinical outcomes were evaluated with the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the final follow-up, the Oswestry Disability Index and the Prolo scale at the final follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instability and the disc height.Results For the clinical evaluation, the VAS pain index, the Oswestry Disability Index and the Prolo scale showed excellent outcomes. For the radiological

  8. 短节段与长节段固定融合在退变性腰椎侧凸合并腰椎管狭窄症治疗的效果观察%Short fusion and long fusion for degenerative lumbar scoliosis with lumbar stenosis

    Institute of Scientific and Technical Information of China (English)

    刘胄; 赵庆华; 吴兴洲; 宋锐; 袁根; 田纪伟

    2012-01-01

    Objective To explore the indications,surgical techniques and prognostic factors of short fusion versus long fusion for elder patients with degenerative lumbar scoliosis.Methods Thirty-eight patients undergoing different kinds of surgical procedures for lumbar spinal scoliosis between June 2005 and October 2010 were recruited for this retrospective study.The mean patient age at surgery was 64.2 years (range:61 -75).The short fusion group included 13 patients and the long fusion group 25 patients.Results There were a variety of treatment methods of degenerative scoliosis based on the symptomatology and radiological measurements of scoliosis and stenosis.Thirty-eight patients were followed up for an average of 37 months.The number of fused levels was 2.8 ±0.7 segments in the short fusion group versus 5.1 ± 1.4 in the long fusion group.The average preoperative Cobb angle was 18.6°(range:12 -27)in the short fusion group versus 33.5°(range:3 -42)in the long fusion group.The correction of Cobb angle averaged 40% in the short fusion group versus 67% in the long fusion group.Clinical symptoms and functional tolerance for daily activities improved postoperatively.Radiographic evaluations showed reduced deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument-related failures or reoperations.Conclusions Long segment fusion is superior to its short segment counterpart in correcting scoliotic curvature and coronal imbalance and improving rotational subluxation of apical vertebra.Careful perioperative preparation is essential in the treatment of elder patients with lumbar spinal scoliosis.%目的 探讨短节段与长节段固定融合术式在65岁以上老年人腰椎退变性侧凸症手术治疗中的可靠性、适应证选择及手术后的效果.方法 回顾性分析自2005年6月至2010年10月经手术治疗的38例腰椎退变性侧弯的矫正效果、并发症和随访结果.其病程6~120个月,平均45.2

  9. Retrospective analysis of transforaminal lumbar interbody fusion for the treatment of acute and chronic lumbar intervertebral disc injury%经椎间孔椎间融合固定治疗急慢性腰椎间盘损伤回顾性分析

    Institute of Scientific and Technical Information of China (English)

    孙俊; 汪颖峰; 罗俊杰

    2011-01-01

    Objective To summary the effect of treatment of lumbar intervertebral disc in acute and chronic injury by transforaminal lumbar interbody fusion ( transforaminal lumbar interhody fusion , TLIF). Methods From in July 2007 to October 2010 , application of bilateral partial laminectomy decompression underwent TLIF fixation , treatment of lumbar intervertehral disc in 10 cases of acute and chronic injury in a total of 12 segments of 6 males and 4 females , aged 38-72 years , mean age 51 years.Lumbar degenerative changes associated with nerve root canal stenosis in 1 case, 3 cases of chronic lumbar spondylolisthesis , acute traumatic spondylolisthesis with bilateral nerve root injury in 2 , lumbar disc hemiation with lumbar instability in 4 cases. Results All patients with no neurological complications were followed up for 10 (6 to 48 months ) months . according to Denis pain ratings ,JOA score , mean postoperative improvement rate of 90%. Conclusion TLIF method can obtain the full relief under the premise of the immediate stability of the spine bone graft done at the same time , fusion rate and few complications, for lumbar intervertebral disc with acute and chronic injury , the effects are short-term clinical affirm.%目的 总结经椎间孔椎间融合术(TLIF)治疗腰椎间盘急慢性损伤的疗效.方法 2007年7月-2010年10月应用双侧椎板部分切除减压后行TLIF融合固定,治疗腰椎间盘急慢性损伤10例共12个节段,男6例,女4例,年龄38~72岁,平均年龄51岁.腰椎退行性变伴神经根管狭窄1例,慢性腰椎滑脱3例,急性外伤性腰椎滑脱伴双侧神经根损伤2例,腰椎间盘突出合并腰椎失稳4例.结果 全部患者均未出现神经系统并发症,平均随访10(6~48个月)个月,根据Denis疼痛分级、JOA评分法,术后平均改善率90%.结论 TLIF方法 可在充分减压的前提下获得脊柱的即刻稳定同时完成植骨,融合率高,并发症少,用于腰椎间盘急、慢性损伤中、短期随访临床效果肯定.

  10. [Lumbar hernia].

    Science.gov (United States)

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year.

  11. 长节段与短节段固定融合治疗退变性腰椎侧凸的比较%Short fusion versus long fusion for degenerative lumbar scoliosis

    Institute of Scientific and Technical Information of China (English)

    王飞; 单建林; 天林; 李放

    2013-01-01

    固定融合,其明显延长了手术时间,增加术中出血量及手术并发症。因此,对存在中度及以上下腰痛,侧凸Cobb′s角≥30°的患者,手术耐受力较好时应选择行长节段固定融合,否则应选择短节段固定融合。%Objective To explore the selecton of short fusion versus long fusion for degenerative lumbar scoliosis.Methods 37 patients undergoing decompression and fusion with pedicle screw instrumentation were evaluated.The long fusion group included 21 patients and the short fusion group included 16 patients.The low back pain,the lower limbs pain and activity function were evaluated by VAS and ODI scores .The Cobb′s angles were measured to assess the lumbar scoliosis and kyphosis .The clinical and radiographic outcomes ,including surgery time , blooding and surgery complications were compared between two groups .Results The mean follow-up was 3.2 years (2-6)for all patients.The blooding and surgery time of long fusion group was significantly more than that of short fusion group(P<0.01);Before surgery,the average Cobb angle was 18.5°±3.7°in the short fusion group and 27.3°±6.2°in the long fusion group.At the last follow up was 9.7°±3.9°and 8.7°±5.6°,respectively.The recovery rate of long fusion group was better than that of short fusion group ( P<0.01 ) .The lumbar lordosis angles of the preoperative was 21.3°±11.3°and 18.8°±10.7°,and improved to 31.5°±12.1°and 32.6°±11.5°at the last follow-up.The correction rate of two groups had no significant difference ( P=0.35 ) .Coronal imbalance improved significantly in the long fusion group more than in the short fusion group ( P <0.05 ) .However , there was no difference in the correction of lumbar lordosis and sagittal imbalance between the two groups .The ODI score of the preoperative was 64.3 ±21.4 and 72.3 ±15.4 ,at the last follow up was 47.6 ±26.6 and 49.8 ±17.1 .The improve rate of two groups had no difference ( P=0.19 ) .The VAS

  12. Comparison of clinical outcome of two transforaminal lumbar interbody fusions for single-level degenerative lumbar disease%两种经椎间孔椎体间融合治疗单节段腰椎退行性疾病的疗效比较

    Institute of Scientific and Technical Information of China (English)

    刘新宇; 原所茂; 田永昊; 郑燕平; 王连雷; 李建民

    2015-01-01

    Objective To compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (M-TLIF) and Wiltse-approach TLIF (W-TLIF) in treating single-level degenerative lumbar disease.Methods A retrospective review was performed on the 57 patients with single-level degenerative lumbar disorder managed via M-TLIF (n =27) and W-TLIF (n =30) from December 2009 to December 2010.In M-TLIF group degeneration at the L4-5 disc were noted in 11 cases and at the L5-S1 disc in 16 cases.And 19 cases were diagnosed with lumbar isthmus spondylolisthesis (17 with Grade Ⅰ spondylolisthesis and 2 with Grade Ⅱ spondylolisthesis),4 lumbar spinal stenosis and instability,2 lumbar disc herniation combined with huge posterior osteophytes,1 recurrent lumbar disc herniation after lumbar fenestration,and 1 recurrent lumbar spinal stenosis after decompression.In W-TLIF group degeneration at L4~5 disc were noted in 12 cases and at the L5-S1 disc in 18 cases.There were 19 cases diagnosed with lumbar isthmus spondylolisthesis (18 with Grade Ⅰ spondylolisthesis and 1 with Grade Ⅱ spondylolisthesis),3 with lumbar disc herniation,and 8 with lumbar spinal stenosis.Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) were used to measure low back and leg pain.Modified Brantigan score was used to assess lumbar interbody fusion.Results Operative time was not significantly different between the two groups (P > 0.05).Incision length and mean blood loss were (5.1 ± 0.7) cm and (90.1 ± 10.5) ml in M-TLIF group,but were (6.9 ± 1.0)cm and (155.3 ±21.2)ml in W-TLIF group (P<0.05).At postoperative 1 and 3 days VAS in M-TLIF group was (2.1 ± 0.5) points and (1.0 ± 0.1) points respectively,but in W-TLIF group was (3.6 ± 0.1) points and (2.4 ± 1.0) points respectively (P < 0.05).Intraoperative X-ray fluoroscopy frequencies were (46 ± 9) times in M-TLIF group and (7 ± 2) times in W-TLIF group (P < 0.05).Mean period of follow-up was 26.7 months

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

    Institute of Scientific and Technical Information of China (English)

    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

  14. 腰椎融合后邻近节段影像学评估方法的应用随访%Follow-up application of imaging evaluation on adjacent lumbar segment after instrumented posterior spinal fusion

    Institute of Scientific and Technical Information of China (English)

    吴超; 魏剑; 王清; 谭伦; 黄迅; 唐玉湖

    2011-01-01

    背景:目前多数研究只分析了脊柱融合治疗紧邻融合区域头尾侧节段的术后改变,未对其他紧邻内固定的未作融合节段进行对照研究.目的:探讨腰椎邻近节段的测量方法,对腰椎后外侧融合后邻近节段的改变进行长期随访影像学评估.方法:选取尸体骨架6具,以不同投照方式和标本位置行腰椎侧位数字化标准X射线片共计42次(每具标本投照7次).随访57例腰椎后外侧融合患者,随访时间1.5~4年,拍摄融合前及末次随访时的数字化标准X射线片,所有资料用失真代偿X射线分析法测量椎体间矢状角度、椎间盘高度、椎体间前后移位.结果与结论:失真代偿X射线分析法测量邻近节段矢状曲度、椎间盘高度、椎体间前后移位时,不同投照方式比较差异均无显著性意义(P > 0.05).固定节段尾侧椎体间未发现显著的影像学改变,固定节段头侧的多个椎体间矢状角度、椎间盘高度均有明显的改变.提示腰椎后外侧融合后影像学的改变提示固定节段头侧多个椎间盘加速退变.%BACKGROUND: Now, most studies related to adjacent segment degeneration only analyze the changes of motion segmentsabove and below the fusion. There were no controlled studies on adjacent segments to all the other unfused segments afterinstrumented posterior fusion.OBJECTIVE: To study measurement of adjacent lumbar segments and evaluate long-term radiographic changes in all adjacentlumbar segments after instrumented posterolateral lumbar fusion.METHODS: Totally 42 digitized radiographs of lateral lumbar spine from 6 corpse skeletons were obtain through differentprojections and specimen postures (every specimen with 7 projection). Fifty-seven patients with posterolateral lumbar fusion werefollowed-up from 1.5 to 4 years. Digitized radiographs of them we re photographed before fusion surgery and final follow-up.Distortion-compensated roentgen analysis (DCRA) method was used to

  15. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2015-01-01

    Full Text Available Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p=0.009 and lower intraoperative blood loss: 108 mL (versus 93 mL; NS. Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS. There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

  16. 椎间撑开解剖复位对于退变性腰椎滑脱症价值的前瞻性比较研究%Prospective comparison research of intervertebral disc space distraction and anatomical reduction of instrumented posterior lumbar interbody fusion for lumbar degenerative spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    刘好源; 黄哲元; 陈峰嵘; 黄建明; 简国坚; 龚灏; 徐天睿; 王博文; 王俊; 叶志扬

    2015-01-01

    目的:通过前瞻性研究评价椎间撑开解剖复位对于退变性腰椎滑脱症价值.方法:2006年1月~2009年12月,对56例退变性腰椎滑脱症(II度以上)患者均施行经后路椎体间融合术(posteriorlumbarinterbodyfusion,PLIF),但随机选择是否在术中进行解剖复位的操作,复位组30例,对照组26例,随访时比较两组病例的影像学、JOA功能障碍评分及并发症.结果:56例均获得13~46个月(平均32月)随访.复位组的影像学结果及最终融合率均优于对照组(P<0.01).末次随访时,两组患者都有较高的JOA功能障碍评分,复位组略优于对照组(P<0.01).复位组和对照组的并发症发生率分别为10%和23.1%.结论:经后路椎体间融合术治疗退变性腰椎滑脱症术中进行解剖复位可以获得更为理想的影像学结果、植骨融合及生活质量.%Objective:To prospectively evaluate the special roles of anatomical reduction of instrumented posterior lumbar interbody fusion for lumbar degenerative spondylolisthesis.Methods:From January 2006 to December 2009, fifty-six lumbar degenerative spondylolisthesis cases were treated by instrumented posterior lumbar interbody fusion, all surgical cases were randomly divided into reduction group and matched group according to whether anatomical reduction. The definitive reduction of the spondylolisthesis using pedicle screw instrumentation was followed by primary reduction using intervertebral disc space distraction and interbody fusion with insert cages and local morselized bone after decompressive laminectomy. Main outcome measurements included imaging, JOA dysfunction score and complication.Results:Fifty-six patients were followed up for 13 to 46 (average, 32) months, the Imaging results and solid bony fusion rate of reduction group were better than matched group (P<0.01). Both groups had preferable JOA dysfunction score. Reduction group was slightly better than matched group (P<0.01). The complication rates for

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

    NARCIS (Netherlands)

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

    2009-01-01

    STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE.: To assess fusion, clinical outcome, and complications. SUMMARY OF BACKGROUND DATA: Resorbable poly-L- lactide-co-D,L-lactide (PLDLLA) cages intended to aid spinal interbody fusion have been introduced into clinical practice within th

  18. Remodeling of heat-treated cortical bone allografts for posterior lumbar interbody fusion: serial 10-year follow-up.

    Science.gov (United States)

    Muramatsu, Koichi; Hachiya, Yudo; Izawa, Hiroyuki; Yamada, Harumoto

    2012-12-01

    We have selected heat-treated bone allografts as the graft material since the Tokai Bone Bank, the first regional bone bank in Japan, was established in 1992. In this study, we examined changes in bone mineral density (BMD), and morphology observed by magnetic resonance imaging (MRI), and histological findings of bone grafts in cases followed up for 7-10 years after bone grafting to grasp the remodeling of heat-treated cortical bone allografts for posterior lumber interbody fusion (PLIF). BMD of bone grafts was reduced by half at 10 years after grafting. MRI revealed that bone grafts were indistinguishable initially in only 22.2% of cases, whereas after a lengthy period of 10 years distinguishable in many cases. Histologically, new bone formation at the graft-host interface was observed earlier, at 1 year after grafting, than that at the periphery of canals in the specimens. The laminated structure of the cortical bone eroded over time, and fragmented bone trabeculae were observed in the specimens at 8 years or longer after grafting, though necrotic bone still remained in some sites.

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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

  20. MAST QUADRANT 可扩张管下单侧椎弓根钉置入与椎体间融合治疗腰椎退变性疾病%Recent clinical observation in treatment of lumbar degenerative diseases with posterior lumbar interbody fusion cage and pedicle screw fixation under MAST QUADRANT expansive pipe

    Institute of Scientific and Technical Information of China (English)

    孙郁雨; 崔志明; 保国锋; 李卫东; 徐冠华; 王玲玲; 崔颖; 储惊蛰

    2011-01-01

    背景:腰椎后路椎体间融合治疗腰椎退变性疾病,能够恢复椎间隙高度、维持腰椎生理前凸、提供腰椎的即刻稳定性及取得较高的椎间骨性融合率.目的:验证运用MAST QUADRANT 可扩张管通道微创系统行单侧椎弓根钉置入并椎体间融合治疗腰椎退变性疾病的适应证及有效性.方法:在3.0 cm的微创切口内放置MAST QUADRANT可扩张管,应用单侧椎弓根钉内固定加椎体间融合治疗腰椎退变性疾病患者32例.结果与结论:患者置入内固过程中未发生硬膜囊撕裂、神经根和大血管等副损伤.随访3个月以上.置入3个月后JOA评分明显高于置入前(P < 0.01),目测类比评分显著低于置入前(P < 0.01).X射线片显示椎间隙骨密度均逐渐增加,未发现椎间融合器移位、假关节、内固定松脱或折断等并发症,亦无炎症、过敏等不良反应.%BACKGROUND: Posterior lumbar interbody fusion for lumbar degenerative disease can restore disc height, maintain the lumbar lordosis, provide immediate stability for the lumbar spine and achieve a higher rate of interbody bonefusion. OBJECTIVE: To explore the indications, surgical techniques and early curative effects in treatment of lumbar degenerative diseases with posterior lumbar interbody fusion cage and pediclescrew fixation under MAST QUADRANT expansive pipe. METHODS: Thirty-two cases suffering from lumbar degenerative diseases were treated by posterior lumbar interbody fusion cage and unilateral pedicle screw fixation with MAST QUADRANT expansive pipe which was placed in 3.0 cm minimally invaswe incision.RESULTS AND CONCLUSION: Therewere no epidural capsuletear, injury of nerve root and great vessel after reatment. Postoperative follow up continued over 3 months. Compared with preoperation. JO As core difference had statistical significance at 3 months after operation (P < 0.01). VAS score difference also had statistical significance at 3 months after operation (P< 001

  1. Observation of Clinical Curative Effect of Transmultifidus Lumbar Interbody Fusion in the Treat-ment of Lumbar Degenerative Diseases%经多裂肌间隙椎间融合术治疗腰椎退行性疾病观察

    Institute of Scientific and Technical Information of China (English)

    赵建; 刘少; 林波; 刘丽平

    2014-01-01

    Objective To investigate and analyze the clinical curative effect of transmultifidus lumbar interbody fusion in the treatment of lumbar degenerative diseases. Methods 62 patients with lumbar degenerative diseases who came to our hos-pital from April,2011 to July,2012 were randomly divided into the control group and the experimental group according to the random number method. There were 31 cases in each group. The control group accepted transforaminal lumbar interbody fusion while the experimental group accepted transmultifidus lumbar interbody fusion. The clinical curative effect of the two groups was compared. Results Blood loss and postoperative drainage volume of the experimental group was significantly less than that of the control group(P0. 05). The VAS score in the 3rd day and 2 weeks after the operation,the ODI index in 1st month and 6th month of the experimental group was statistically better than that of the control group(P0. 05). Conclusion Transmultifidus lumbar interbody fusion has a significant effect in treating lumbar degenerative diseases. The approach has less damage during the operation and improves the efficacy of surgery and patients'quality of life. So it is worth promoting.%目的:探讨分析经多裂肌间隙入路椎体间融合治疗腰椎退行性疾病的临床疗效。方法选取我院自2011年4月至2012年7月收治的62例腰椎退行性疾病患者,将所有患者按随机数法分为实验组和对照组,各31例。对照组接受经椎间孔椎体间融合术,实验组接受经多裂肌间隙椎间融合术,对比分析两组患者的临床疗效。结果实验组术中出血量及术后引流量均明显少于对照组( P0.05),实验组术后3 d,术后2周的VAS评分及术后1个月与术后半年的ODI评分明显优于对照组( P0.05);实验组与对照组手术前及术后1年滑脱角、椎间隙高度及Taillard指数的比较差异无统计学意义( P>0.05)。结论经多裂肌间隙入路

  2. SU-E-T-82: Comparison of Several Lumbar Intervertebral Fusion Titanium Cages with Respect to Their Backscattering Properties

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    Failing, T; Chofor, N; Poppinga, D; Schoenfeld, A; Poppe, B [Pius Hospital and Carl von Ossietzky University, Oldenburg, Germany, Oldenburg, Niedersachsen (Germany); Willborn, K [Pius Hospital Oldenburg, Germany, Oldenburg, Niedersachsen (Germany)

    2014-06-01

    Purpose: Investigating the backscatter dose factor with regards to structure and geometry of the surface material. Methods: The titanium cages used for this study representing both prototypes and well established products are made of a laser-sintered titanium alloy (AditusV GmbH, Berlin, Germany). A set of four radiochromic EBT3 films was used in a stacked geometry to measure the range and the magnitude of the expected surface dose enhancement due to the in comparison to water increased secondary electron release from the material. The measurement geometry and the small thickness of radiochromic EBT3 film allowed the dose measurement at distances of 0.1 mm, 0.9 mm, 1.7 mm and 2.5 mm from the probe surfaces. Water reference measurements were taken under equal conditions, in order to allow the calculation of the relative dose enhancement at the surface of a probe. Measurements were performed within a water phantom. An Epson Expression 10000 XL flatbed scanner was used for digitization. Results: Sintered titanium showed a dose enhancement factor of 1.22 at the surface of the material. The factor can be reduced to less than 1.10 by utilizing mesh structures. In both cases, the dose enhancement factor decreased to less than 1.03 at a distance of 1.7mm indicating the low energy of scattered electrons. Conclusion: Backscattering of titanium cages should be considered in treatment planning, especially when the cages are located close to organs at risk. While mesh structures were introduced to improve bone fusion with the implant structure, the potentially harmful surface dose enhancement is significantly reduced.

  3. 微创经椎间孔椎间融合术治疗35例腰椎退行性疾病的疗效分析%Analysis of the Efficacy of Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of 35 Cases of Lumbar Degenerative Disease

    Institute of Scientific and Technical Information of China (English)

    杨林; 廖绪强; 赵新建; 吴锐辉; 曾志超; 李世渊

    2014-01-01

    Objective To explore minimally invasive transforaminal lumbar interbody fusion (MiTLIF) treatment of 35 cases of lumbar degenerative disease effect. Methods 70 cases of lumbar degenerative disease patients according to surgical indications and patient willingness divided into study group and the control group, 35 cases in each group. Study Groups MiTLIF treatment, the control group received conventional transforaminal lumbar fusion between (TLIF) treatment. Results The study group blood loss, intraoperative blood transfusion, postoperative drainage was significantly lower than the control group (P0.05). Study group VAS scores, time in bed than the control group (P0.05). Conclusion MiTLIF treatment of lumbar degenerative disease a significant effect, can effectively reduce surgical blood loss, intraoperative blood transfusion and postoperative drainage, improve postoperative pain conditions, reducing time in bed, safe, reliable, and suitable for clinical application.%目的:探讨微创经椎间孔椎间融合术(MiTLIF)治疗35例腰椎退行性疾病的疗效。方法将70例腰椎退行性疾病患者根据手术指征及患者意愿分为研究组与对照组,每组各35例。研究组采取MiTLIF治疗,对照组采取常规椎间孔腰椎间融合术(TLIF)治疗。结果研究组手术出血量、术中输血量、术后引流量明显低于对照组(P<0.05);两组手术时间对比,差异无统计学意义(P>0.05)。研究组术后VAS评分、卧床时间均优于对照组(P<0.05);JOA评分差异无统计学意义(P>0.05)。结论 MiTLIF治疗腰椎退行性疾病疗效显著,可以有效降低手术出血量、术中输血量及术后引流量,改善术后疼痛情况,减少卧床时间,安全可靠,适于临床推广与应用。

  4. 后路椎间融合加椎弓根螺钉固定术治疗退行性腰椎间盘病变%Posterior lumbar interbody fusion combined with pedicle screw fixation in treatment of degenerative diseases of lumbar intervertebral disc

    Institute of Scientific and Technical Information of China (English)

    黄占柱; 仇小华; 张如意

    2011-01-01

    Objective To investigate the clinical effect of treating the patients suffering from degenerative diseases of lumbar intervertebral disc with posterior lumbar interbody fusion (PLIF) combined with pedicle screw fixation.Methods This study was based on 100 cases suffering from degenerative diseases of lumbar intervertebral disc who underwent PLIF combined with pedicle screw fixation.All the patients were followed by 1 - 2 years.The shape and the function of spinal column were both estimated before and after the operation,and they were also estimated during the following of the patients after the operation.The datas in the formal 3 stages were multiply compared.Results Between the preoperative and postoperative datas,there were statistically significant differences in the JOA scores and the angle of scoliosis and kyphosis (P < 0.05 ).And so do the preoperative datas and the datas during the following (P <0.05).But no similar result was detected between the postoperative data and the data during the following (P > 0.05).Conclusions Posterior lumbar interbody fusion (PLIF) combined with pedicle screw fixation has a significant effect in treating degenerative diseases of lumbar intervertebral disc,deserving further study and clinical popularization.%目的 探讨后路椎间融合加椎弓根螺钉固定术治疗退行性腰椎间盘病变的临床疗效.方法 对100例退行性腰椎间盘病变患者采取后路椎间融合加椎弓根螺钉固定术,术后予1~2年随访,并比较术前、术后及随访时脊柱形态、功能恢复情况(JOA评分).结果 术后与术前患者脊柱后凸、侧凸角度和JOA评分比较差异均有统计学意义(P均<0.05),随访时与术前比较差异也有统计学意义(P<0.05),随访时与术后比较差异无统计学意义(P>0.05).结论 后路椎体间融合术治疗退行性腰椎间盘病变效果显著,有进一步研究和推广价值.

  5. Systematic review for the treatment of degenerative diseases with the lumbar posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF)%腰椎后路椎体间融合术与后外侧融合术治疗腰椎退行性疾病的系统评价

    Institute of Scientific and Technical Information of China (English)

    崔兆辉; 滕元君; 夏亚一; 汪静; 姜金; 陈少龙

    2013-01-01

    [Objective] To systematically evaluate the effects of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) for lumbar degenerative disease.[Methods] An electronic search for the eligible randomized controlled trials (RCTs) was conducted in the databases of PubMed,Embase,CNKI,and the Chinese Biomedical Literature Database (CBM).Two researchers independently completed literature selection and data collection,the assessment of methodological quality was conducted in accordance with the Cochrane Handbook 5.1.Meta-analysis was performed using the RevMan 5.1 software.[Results] Six studies involving 487 patients were included.The results of meta-analysis showed that the PLIF had a higher rate of fusion [OR =3.90,95% CI (2.05,7.40),P <0.001] with less ODI score in postoperative 1 year [WMD =-3.86,95%CI (-7.59,-0.13),P=0.04],and both had statistical differences (P<0.05).However,both groups were similar in operation time [WMD =15.85,95% CI (-16.25,47.96),P =0.33],blood loss [WMD =-90.57,95%CI (-292.50,111.36),P=0.38],the rates of complications [OR =0.99,95%CI (0.22,4.47),P=0.99] and secondary surgery [OR =0.87,95% CI (0.52,1.45),P =0.25].[Conclusion] Compared with PLF,the PLIF has a significantly higher rate of fusion with less ODI score in postoperative l year,and there Is no significant difference in operation time,blood loss,the rates of complications and secondary surgery.%[目的]系统评价腰椎后路椎体间融合术(posterior lumbar interbody fusion)对比后外侧融合术(posterolateral fusion)治疗腰椎退行性疾病的术后疗效.[方法]计算机检索PubMed、EMBASE、CNKI、CBM等数据库、学术会议资料和学位论文等.全面收集有关两种方法治疗腰椎退行性疾病的文献.制定文献纳入及排除标准,由2名研究者分别独立筛选文献,按照Cochrane Handbook 5.1进行严格的质量评估,并用Revman 5.2软件进行Meta分析.[结果]经过筛选,共有6篇

  6. Combined therapy of integration and non-fusion fixation to lumbar degenerative disease%融合联合非融合固定治疗腰椎退行性病

    Institute of Scientific and Technical Information of China (English)

    孙义忠; 刘宝平; 何强; 范先东; 李铁军; 王锋宝

    2012-01-01

    Objective To investigate the clinical efficacy of the combined therapy of integration and non-fusion fixation to lumbar degenerative disease. Methods Forty-two patients who received integration and non-fusion fixation for the treatment of lumbar disc herniation and another 30 patients who received spondylolisthesis merge adjacent segments intcrvcrtebral herniation between May 2006 to December 2011 were in included in the study. After surgery, patients had an average follow-up of 19 (6-50) months. Visual analogue scales (VAS) and Oswestry disability index (ODI) were employed to assess postoperative efficacy. Results No postoperative infection, nerve root injury, cerebrospinal fluid leakage and other complications occurred. VAS and ODI evaluation results showed that postoperative changes in VAS and ODI scores were statistically significant (P<0. 01) . Conclusion Integration and non-fusion fixation for the treatment of lumbar degenerative disease has marked decompression effect with reliable fixation. It can effectively mitigate the adjacent inter-vcrtebral disc degeneration. Thus it is an effective method in the treatment of lumbar degenerative disease.%目的 探讨融合联合非融合固定联合治疗腰椎退行性病的临床疗效.方法 选取我院2006年5月~2011年12月作者采用融合联合非融合固定治疗腰椎间盘突出症患者42例及腰椎滑脱合并椎间盘突出症30例.术后患者获得平均19(6~50)个月的随访,采用视觉模拟评分法(VAS)及腰椎功能障碍指数(ODI)评定患者手术后的治疗疗效.结果 本组患者术后均无感染、神经根损伤、脑脊液漏等并发症发生.VAS及ODI评定结果显示患者术后VAS及ODI分值改善优于术前,手术前后比较差异有统计学意义(P<0.01).结论 融合联合非融合固定治疗腰椎退行性病减压效果明显、固定可靠,有效减缓了相邻椎间盘退变,是治疗腰椎退行性病的一种有效方法.

  7. Clinical curative effect of modified posterior lumbar interbody fusion%改良腰椎后路椎体间植骨融合术的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    王静成; 蒋朝勇; 杨建东

    2012-01-01

    Objective To evaluate the clinical outcome o[ modified posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicel screw system for several lumbar degenerative disease. Methods From January 2008 to June 2009, 52 patients with lumbar spine of degenerative disease were divided into modified PLIF group ( n = 30) and TLIF group (n =22). The clinical outcome and fusion rate in these two groups were compared. Results All patients had primary healing incision. There was no significant difference in clinical curative effect and postoperative complications between the two groups (P > 0. 05 ) . Conclusion Modified PLIF can reduce the postoperative complications, improve the excellent rate and success rate, reduce the postoperative overhaul rate. It's a safe, reliable and feasible method.%目的 对比研究改良腰椎后路椎体间植骨融合术(PLIF)与经椎间孔入路腰椎椎间植骨融合术(TLIF)治疗腰椎退行性疾病的临床疗效.方法 选择本院2008年1 月-2009年6月收治的52例腰椎退行性疾病患者,随机分为改良PLIF组30例及TLIF组22例,对比2组患者术前、术后第1周,术后第6、12个月腰、腿视觉模拟评分(VAS)及日本骨科学会(JOA)评分,以及术后并发症情况.结果 52例患者切口均一期愈合.2组患者临床疗效及术后并发症发生率无显著差异(P>0.05).结论 改良PLIF减少了术后并发症,提高了手术优良率和手术成功率,且降低了术后翻修率,是一种安全、可靠和可行的方法.

  8. 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?

    Directory of Open Access Journals (Sweden)

    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 %].

  9. 双侧小切口肌间隙入路腰椎椎体间融合治疗下腰椎退行性疾病%Using small incision of dual side and paraspinal approach lumbar interbody fusion for the treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    方志祥; 李坚; 闫亮; 许海波; 赵建峰

    2012-01-01

    Objective To study the clinical results of lumbar interbody fusion through small incision of dual side and paraspinal approach in the treatment of lumbar degenerative disease. Methods 32 patients who had lumbar degenerative disease underwent single level decompression and lumbar interbody fusion through small incision of dual side paraspinal approach. The operative time, operative blood loss and improvement of clinical symptoms were assessed, visual analogue scores ( VAS ) was used to evaluate the effect of the operation. Results Operation time was 90 ~ f 50 ( 110 ±21 )min, blood loss in the operation was 150~380( 282 ±37 )ml. Incisions were primary healed. All patients were followed up for 7-14 months, the VAS score of two weeks after the operation and the last followed up had statistically significant difference from the scores of the preoperation ( P < 0. 05 ). All cases had bone union and no screws were loosed or broken in the last followe-up, the rate of bone fusion was 100% . Conclusions The lumbar interbody fusion through the small incision of dual side paraspinal approach is an effective method in the treatment of lumbar degenerative disease, which can reduce the blood loss and injury of the soft tissue, accelerate the rehabilitation simultaneously.%目的 评价双侧小切口肌间隙入路腰椎椎体间融合治疗下腰椎退行性疾病的疗效.方法 采用双侧小切口肌间隙入路腰椎椎体间融合结合椎弓根螺钉内固定治疗32例下腰椎退行性疾病患者,观察手术时间、术中出血量及术后症状缓解情况.术前、术后采用视觉模拟疼痛评分(VAS)评价疗效.结果 手术时间90~150(110±21)min,术中出血量150~380(282±37)ml.患者伤口均一期愈合.32例均获随防,时间7~14个月.术后2周及末次随访VAS评分,与术前比较差异均有统计学意义(P<0.05).末次随访椎体间均骨性融合,融合率为100%.未发生螺钉松动、断钉等情况.结论双侧小切口肌

  10. Analysis of the curative effects of 3 methods of bone fusion for degenerative lumbar spondylolisthesis%三种植骨融合术治疗退变性腰椎滑脱症的疗效分析

    Institute of Scientific and Technical Information of China (English)

    谢松林; 顾开宏; 秦树连

    2012-01-01

    Objective To compare the therapeutic effects of trans foramina! Lumbar interbody fusion I'TLIF). Posterior lumbar interbody fusion (PLIF) and posterolateral lumbar fusion I'PLP) for degenerative lumbar spondylolisihesis. Methods From January 2003 to January 2010, the follow-up data of 120 patients of lumbar spondyloiisthesis were retrospectively analysed. All patients were divided into 3 groups: group A (TLIF, 35 cases), group B (PLIF, 40 cases) and group O (PLF, 45 cases) based on fusion method. Nakai scale, bone fusion rate, maintenance of disc height and intcrvcrtcbral foramen area of different fusion methods were compared and analysed. Results Comparing the 3 groups of A, B and C, the excellence rates respectively were 88.57%, 87.50% and 88.89% without significant differences (P>0.05). The fusion rates respectively were 91.43%, 92.50% and 68.89% with significant differences (P0.05). Maintenance of disc height andinterveitebral foramen area were compared in all the 3 groups, significant differences existed comparing A. B with C (P0.05). Conclusions All 3 methods can be used to treat degenerative lumbar spondyloiisthesis. The fusion rates of TL1F and PL1F arc better than PLF. TL1F and PLIF have significant advantages in the correction of spondyloiisthesis, fusion rate, maintenance of disc height, enlargement of intervertebral foramen area and so on. TL1F and PLIF should be given priority to in the treatment of degenerative lumbar spondylolisthesis..%目的 比较腰椎经椎间孔椎间植骨融合术(TLIF)、腰椎后路椎间植骨融合术(PLIF)及腰椎后外侧融合术(PLF)治疗退变性腰椎滑脱症的临床疗效差异.方法 回顾性分析2003年1月至2010年1月收治且获得随访的120例腰椎滑脱患者,根据植骨方式不同分为A组(TLIF组,35例)、B组(PLIF组,40例)及C组(PLF组,45例),比较3种植骨融合术的Nakai评分、融合率、椎间隙高度、椎间孔面积等情况.结果 A、B及C3组Nakai

  11. Biomechanical changes of lumbar segment after fusion analyzed with three-dimensional nonlinear finite element%以三维非线性有限元法分析融合腰椎的生物力学变化

    Institute of Scientific and Technical Information of China (English)

    张延辉; 姜宏春; 李静; 张宝弟

    2013-01-01

    . OBJECTIVE:To find a simple, convenient and accurate method to construct the model of lumber fusion and to analyze the biomechanics of lumbar motion segment after lumbar fusion. METHODS:Lamel ar CT and Matlab (Matrix Laboratory) scientific computing software combining Ansys finite element software was used to construct the models of lumber fusion. Then the models were loaded to analyze the biomechanical change of the fusion model. RESULTS AND CONCLUSION:The established models were loaded with axial, bending and stretching loads, and the biomechanical analysis showed that interbody fusion had the best stability among al the fusion models. Combined with joint fusion, the axial displacements of interbody, rear side and rear fusion models were decreased by 5%, 1%and 4%than that of simple interbody fusion, posterolateral fusion and posterior fusion models. Under the stretch-buckling load conditions, the rotation angles were reduced by 23%, 11%and 45%. Stress concentration to the fusion parts showed fusion block could increase the load displacement. The technology of lamel ar CT, Matlab software and Ansys finite element software can accelerate the construction of lumber fusion model and make the model more accurate. Facet joint fusion combined with interbody fusion, posterolateral fusion and posterior fusion can get better lumbar stability, and this increased stability is more significant in the rear fusion. Stress distribution of posterior fusion is more reasonable.

  12. Applied anatomy of presacral approach for axial lumbar interbody fusion%轴向腰椎椎间融合术入路的应用解剖

    Institute of Scientific and Technical Information of China (English)

    李向明; 张玉松; 侯致典; 吴涛; 丁自海

    2011-01-01

    Objective The aim of this study was to evaluate the safety of the presacral approach for axial lumbar interbody fusion.Methods (1) The pelvic region of 12 adult cadavers was dissected and analyzed.All specimens were divided in the median sagittal plane.The main goal of these dissection was to understand the fascial structures of the presacral space and measure some data correlated with the rectosacral fascia and pelvic splanchnic nerves.(2) The blunt guide pin was inserted using the technique described by Marotta into 24 pelvic-halves, the distance from the trocar to important structures in the presacral space was measured.Results (1) The fascial structures of the presacral space was multilaminar, it could be divided into five levels.(2) The rectosacral fascia was found in 11 out of 12 specimens (91.7%),it originated from the parietal presacral fascia at the level of S2 in 16.7% ,S3 in 41.7% and S4 in 33.3%.The presacral space was divided into superior and inferior portions by the rectosacral fascia.(3) Pelvic splanchnic nerves confined the dissection of the lower rectum, its length which could be used as a measure of the'sagittal safe zone' for presacral space was (22.9±3.2)mm.(4) In this study, the shortest distance from the guide pin to pelvic splanchnic nerves was (7.8 ±l.9)mm, the vertical distance to the S3/4 junction was (15.0 ±3.6)mm.Conclusion It is risky to perform the presacral approach for axial lumbar interbody fusion because of the presence of the rectosacral fascia, presacral venous plexus and the vascular variations.%目的 探讨经骶前间隙轴向腰椎椎间融合术入路的安全性.方法 (1) 12具(24侧)防腐固定成人骨盆段标本,解剖骶前间隙,观察骶前的筋膜层次,骶直肠筋膜,盆内脏神经等,测量骶直肠筋膜和盆内脏神经的相关解剖数据.(2)参照Marotta方法,模拟手术置入导针,测量导针在骶前间隙中的相关解剖学数据.结果 (1)骶前的筋膜可分为5层;(2)

  13. Clinical efficacy of posterior decompression and fusion and internal fixation for treatment of degenerative lumbar spi-nal stenosis with lumbar segmental instability%后路减压融合内固定术治疗退变性腰椎椎管狭窄合并节段性腰椎不稳的临床疗效

    Institute of Scientific and Technical Information of China (English)

    李新福; 刘勇

    2014-01-01

    目的:观察后路腰椎椎管减压、椎弓根螺钉内固定并椎体间植骨融合术,治疗退变性腰椎椎管狭窄合并节段性腰椎不稳定患者的临床疗效。方法2006年1月~2011年12月收治的82例退变性腰椎椎管狭窄合并节段性腰椎不稳的患者,行后路减压融合内固定术治疗。采用Oswestry功能障碍指数(Oswestry disability index, ODI),疼痛视觉模拟量表(visual analogue scale, VAS)和日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估临床疗效。同时行影像学检查,测量椎间隙高度,用Bridwell方法评价腰椎融合情况。结果平均随访48个月,术后腰痛VAS评分、腿痛VAS评分、JOA评分、ODI、椎间隙高度均较术前明显改善,差异有统计学意义(P<0.01)。末次随访时,根据Bridwell腰椎融合评价标准,Ⅰ级和Ⅱ级为80例(97.5%)。末次随访时,X线片、MRI检查发现4例螺钉松动断裂但已骨性融合(4%),2例植骨未融合,椎间隙高度降低(2%)。疗效评定优24例,良46例,可8例,差5例,优良率为85.4%。结论减压融合固定治疗退变性腰椎椎管狭窄症合并节段性腰椎不稳远期疗效肯定,但应把恢复该节段的稳定作为重点。%Objective To observe the Clinical efficacy of posterior decompression and fusion and internal fixation for treat -ment of degenerative lumbar spinal stenosis with lumbar segmental instability .Methods From 2006 January to 2011 Decem-ber, 82 cases of degenerative lumbar spinal stenosis with lumbar segmental instability were treated with posterior decompres -sion, fusion and internal fixation.Oswestry disability index (ODI), visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA ) scores were used to evaluate the clinical efficacy .Intervertebral height were observed on roentgenographs , and Bridwell method were used to evaluate lumbar fusion .Results The average

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

    OpenAIRE

    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 ...

  15. Influence of posterior lumbar interbody fusion to adjacent segment degeneration%后路腰椎椎间融合术对邻近节段退变的影响

    Institute of Scientific and Technical Information of China (English)

    管俊杰; 石志才

    2011-01-01

    Objective Lumbar interbody fusion induces the change of lumbar normal biomechanical environment. The adjacent segments have the character of stress concentration. This study aimed to observe the lurnhar adjacent segment degeneration(ASD) after posterior lumbar interbody fusion(PLIF). Methods From 2002 to 2006, 60 patients (38 males and 22 females, aged 25-77 years old, with a mean value of 46 years old) with symptomatic degenerative diseases underwent PLIF The incidence of ASD, position and radiographic characteristics were studied. The relation between “floating fusion” and ASD were compared, and the relation of fusion range and ASD was also studied. Results All patients were followed up for 2.0-6.5 years ( mean 4.5 years). Eleven patients ( 18.3% ) were found to have radiographic characteristics of ASD. Nine of them had ASD at cranial segments, the other 2 at caudal segnents. The difference between using “floating fusion” or not in the risk of ASD was not statistically significant. The dffference between single-level fusion and double-level fusion was not statisticaly significant, either. Conclusion After PLIF, stress concentration of adjacent segments was abnormal ,which increases the incidence of ASD. The cranial segment has a higher degeneration risk than the caudal segment.%目的 腰椎融合术改变了腰椎的生物力学环境,使邻近节段应力集中,本研究就后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)对邻近节段退变(adjacent segment degeneration,ASD)的影响进行探讨.方法 2002~2006年,采用PLIF治疗腰椎退行性疾病患者60例,其中男38例,女22例;年龄为25~77岁,平均46岁.观察其术后ASD的发生率、发生部位及影像学特点,对是否"悬浮固定"及内固定融合范围引发ASD的风险进行对比.结果 所有患者随访2.0~6.5年,平均4.5年.影像学有退变表现者11例(18.3%),其中9例发生在内固定头侧邻近节段,2例发生在尾侧邻近节段.是

  16. 显微内镜辅助经皮微创椎间孔入路腰椎椎体间融合术治疗腰椎退行性疾病%Minimally invasive percutaneous transpedicular screw fixation combined with microendoscopy-assisted transforaminal lumbar interbody fusion for lumbar degenerative diseases

    Institute of Scientific and Technical Information of China (English)

    戎利民; 杨阳; 刘斌; 谢沛根; 冯丰; 杨补; 刘小明; 陈瑞强; 何磊; 李宁

    2012-01-01

    背景:传统开放椎间孔入路腰椎椎体问融合术(transforaminal lumbar interbody fusion,TLIF)由于剥离肌肉广泛及长时间牵拉,可导致部分患者持续性腰背痛.随着脊柱微创技术的发展,采用微创手段实施TLIF技术取得了良好的临床效果,但小切口经扩张通道系统的微创TLIF仍不可避免存在肌肉剥离,需探索更加微创的手术方式.目的:探讨显微内镜辅助经皮微刨TLIF治疗腰椎退行性疾病的近期疗效及安全性.方法:2010年9月至2011年7月,72例腰椎退行性疾病患者接受了单节段TLIF手术,腰椎失稳症36例,腰椎管狭窄症25例,复发型腰椎间盘突出症11例.采用VIPER经皮椎弓根螺钉系统结合椎间盘镜下TLIF手术32例(微创组),传统开放TLIF手术40例(开放组),对两组患者近期临床疗效、并发症、术中射线暴露指标等进行比较.结果:所有患者均获随访,随访时间6~15个月,平均9个月.两组手术时间无明显统计学差异(P>0.05),微创组术中出血量、伤口引流量、住院天数、术后应用镇痛药剂量均明显低于开放组(P<0.01);微创组术中射线暴露时间及剂量高于开放组(P<0.01);微创组术后疼痛(VAS评分)及ODI功能指数较开放组明显降低(P<0.01).微创组出现术中减压错误1例,置钉位置错误1例,导针穿透椎体前壁1例,硬膜撕裂1例;开放组出现术中硬膜撕裂3例,术后伤口浅表感染1例.两组患者均未出现神经损伤并发症.结论:显微内镜辅助经皮微创TLIF较传统开放手术具有创伤小、出血少、恢复快、住院时间短等优点,具有良好的近期疗效,是治疗腰椎失稳症值得推荐的微创手术方式.%Background: TLIF (transforaminal lumbar interbody fusion) as traditional open surgery induce persistent low back pain because of wildly separating muscle and long time traction. With recent advances in minimal invasive spine surgery technological development

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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

  18. Adjacent segment degeneration after posterior lumbar fusion: a five-year follow-up%腰椎后路固定融合术后邻近节段退变的中期随访研究

    Institute of Scientific and Technical Information of China (English)

    陈文钧; 许耀; 许桦; 马晓生; 姜建元

    2011-01-01

    Objective To observe the degenerative changes of the discs adjacent to fixed lumber segment in patients undergoing posterior lumbar fusion 5 years ago by radiologic records, and to investigate the impact of these changes and their causes. Methods A total of 33 patients who underwent L4/L5 or L4/L5/S1 posterior lumbar fusion during 1999 to 2003 were enrolled to investigate the degenerative changes of the discs adjacent to fixed lumber segment ( L3/L4 or L4/S5) through their X-ray film and/or MRI. Intervertebral disc heights were measured before and after surgery. The patients were divided into 2 groups based on the fusion segment. Clinical status was evaluated by the recovery rate of the Japanese Orthopedic Association (JOA) score. Results Degeneration of the discs adjacent to fixed lumber segment was observed in 54.5% of subjects (18/ 33). However, no significant correlation was seen between postoperative disc narrowing and JOA score. Conclusion Degeneration of the discs adjacent to fixed lumber segment is quite common in the patients after posterior lumbar fusion. But there is no evidence that the degeneration has a correlation with clinical outcome of posterior lumbar fusion.%目的 随访观察腰椎后路融合内固定术后>5年邻近节段椎间盘退行性变的程度,讨论其影响程度和因素.方法 随访1999~2003年行腰椎后路融合术(L4/L5/S1、L5/S1)的患者33例,通过X线检查及部分病例的MRI检查,观察腰椎固定融合术后上方邻近节段(L3/L4、L4/S5)椎间盘退行性变的发生率和程度.结果 腰椎固定融合术后邻近节段椎间盘退行性变的发生率为54.5% (18/33),但邻近节段椎间隙高度降低和日本骨科学会(Japanese Orthopae-dic Association,JOA)评分之间没有明显关联.结论 腰椎融合术后邻近节段椎间盘发生退行性变的比例较高,但退变和临床疗效间并没有明显联系.

  19. Cox regression analysis of risk factors of adjacent segment deterioration after lumbar fusion%腰椎融合术后邻近节段退化危险因素的Cox回归分析

    Institute of Scientific and Technical Information of China (English)

    陈景泉; 李念虎; 徐展望

    2015-01-01

    Objective:To investigate the risk factors and the relative degree of postoperative occurrence of adjacent segment de-terioration (ASDet) after lumbar fusion. To reduce the occurrence of ASDet,improve the clinical efficacy of surgical treatment of lumbar fusion. Methods:136 cases who had been performed lumbar fusion were selected. All cases underwent MRI for eva-luating intervertebral disc degeneration. Cox proportional hazards regression model was used to analyze the correlation and the relative risk degree from the occurrence of ASDet and 9 related factors which included age,sex,osteoporosis,intervertebral disc degeneration,laminectomy,range of lumbar fusion,intervertebral disc space distraction,internal fixation,lumbosacral fusion. Result:Multivariate Cox regression analysis showed that intervertebral disc degeneration (RR=4.272,P=0.000) and intervertebral disc space distraction (RR=2.022,P=0.024) were significant correlated with the occurrence of ASDet. Conclusion:To choose operation reas-onably for the patients with intervertebral disc degeneration and not to distract the intervertebral disc space overmuch could re-duce the occurrence of ASDet.%目的:探讨腰椎融合术后邻近节段退化(adjacent segment deterioration,ASDet)的危险因素及相对风险度,以求降低患者术后发生ASDet的风险。方法:选择山东中医药大学附属医院2010年9月至2014年7月行腰椎融合手术患者136例。应用MRI评估患者术前椎间盘退变情况,应用Cox比例风险回归模型分析腰椎融合术后ASDet的发生与年龄、性别、骨质疏松、术前邻近节段椎间盘退变、椎板减压术、融合节段数、椎间隙撑开、使用内固定、腰骶椎融合等9个因素的相关性和风险性。结果:术前椎间盘退变(RR=4.272,P<0.01)和椎间隙撑开(RR=2.022,P=0.024)与术后ASDet的发生呈显著相关。结论:术前椎间盘退变及术中行椎间隙撑开可增加术后发生ASDet的风险。

  20. 腰椎退行性变的经皮椎弓根螺钉固定结合微创腰椎间融合术治疗%Percutaneous pedicle screw ifxation combined with minimally invasive lumbar interbody fusion in the treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    何二兴; 郭倞; 崔基浩; 郭志勇; 尹知训; 李创; 唐程; 何贻骞; 刘成伟

    2015-01-01

    Objective To investigate the safety and effectiveness of percutaneous pedicle screw fixation combined with minimally invasive lumbar interbody fusion in the treatment of lumbar degenerative disease.Methods From November 2012 to August 2014, a total of 127 patients with lumbar degeneration and instability were recruited. There were 86 males and 41 females, with the mean age of 58.4 years ( range: 18-79 years ). There were 16 cases of spondylolisthesis, 35 cases of lumbar disc herniation, and 76 cases of lumbar stenosis. According to different pathological characteristics, percutaneous pedicle screw ifxation combined with minimally invasive posterior lumbar interbody fusion ( mini-plif ) (44 cases), minimally invasive transforaminal lumbar interbody fusion ( mini-tlif ) ( 49 cases ) or extended decompression and fusion ( 34 cases ) were performed respectively for treatment. The postoperative followed-up was at least 3 months. Before surgery, all patients received anteroposterior, lateral and lfexion-extension X-ray examination of the lumbar spine, as well as lumbar MRI. The average insertion time and X-ray exposure times for each pedicle screw, average blood loss and postoperative drainage volume for each decompression level were analyzed. Hospital stay, pedicle screw position and complications were also recorded. Pre- and postoperative 3-days, 2-weeks, 3-months visual analogue scale ( VAS ) and Oswestry disability index ( ODI ) scores were compared. Results The average insertion time for each pedicle screw was ( 12.6±6.3 ) min. The average X-ray exposure times for each pedicle screw was ( 4.2±2.3 ) times. The mean blood loss for each decompression level was ( 67.9±16.7 ) ml,and the postoperative drainage volume was ( 52.6±13.8 ) ml. The average hospital stay was ( 9.0±2.4 ) days. The VAS and ODI scores were found to be signiifcantly improved after surgery in 3 groups (P<0.05 ). A total of 635 screws were inserted. The position of pedicle screws was good in 546

  1. Recent therapeutic effects of minimally invasive transforaminal lumbar interbody fusion for single segmental lumbar ;degenerative disease%微创小切口经椎间孔腰椎椎间融合治疗单节段腰椎退变疾病的近期疗效

    Institute of Scientific and Technical Information of China (English)

    岳晨; 李国庆; 张群; 辛欣

    2014-01-01

    Objective To observe the recent therapeutic effects of small incision minimally invasive transforaminal lumbar interbody fusion ( TLIF) on single segmental lumbar degenerative disease .Methods 120 patients with single segmen-tal lumbar degenerative disease were randomly divided into 2 groups, 60 cases in the control group took traditional open trans-foraminal lumbar inter-body fusion treatment , observation group of 60 cases received minimally invasive transforaminal lumbar inter-body fusion treatment , compared 2 groups of patients ’ JOA score and evaluated the life quality of patients with lumbar spine.Results Observation group patients ’ operation time is longer than that of the control group [(149.3 ±23.2) min vs. (128.4 ±24.7) min, P <0.05],but its operation blood loss , length of incision and the average days of hospitalization were significantly lower than that of control group ( P <0.05);2 months after treatment, the observation group patients quality of life score was significantly higher than that in control group [(75.4 ±8.2)points vs.(59.5 ±7.7)points, P <0.05],JOA scores of the 2 groups were all improved ( P <0.05),and the lumbar JOA in observation group after treatment was also higher than that of the control group [(26.6 ±2.8)points vs.(18.5 ±2.4)points, P <0.05].Conclusion Effect of minimally in-vasive small incision transforaminal lumbar interbody fusion for the treatment of single segment lumbar degenerative diseases is good, worthy of clinical choice .%目的:观察微创小切口经椎间孔腰椎椎间融合( TLIF)治疗单节段腰椎退变疾病的近期疗效。方法将收治并确诊的120例单节段腰椎退变疾病患者随机分为2组,对照组60例采取传统开放椎间孔腰椎椎间融合治疗,观察组60例采取微创小切口经椎间孔腰椎椎间融合治疗,比较2组患者在手术住院方面的差异,同时评价患者生活质量、腰椎JOA评分。结果观察组患者

  2. The Finite Element Analysis of Postoperative Adjacent Segmental Lumbar Fusion Intervertebral Disc Stress%腰椎融合术后临近节段椎间盘应力的有限元分析

    Institute of Scientific and Technical Information of China (English)

    潘志强; 叶立民; 王求永; 黄剑波; 傅冬梅

    2014-01-01

    Objective:To analysis model under different loads and stress changes by posterior lumbar discectomy through the establishment of normal, L4-5 and L4-S1 fusion and internal fixation model.Method: Analyzed 98 image nodes from 1 volunteers what were divided unit to establish the normal lumbar motion segment (L1-S1) finite element model and L4-5, L4-S1 segment of posterior lumbar interbody fusion and internal fixation model, the three models with five direction load, calculation of adjacent segment disc shall be stress variation, and the results were statistically analyzed.Result: The research showed that the upper two segments adjacent segment than the single disc fusion segment average effective stress in flexion, extension , lateral flexion , rotation load difference was statistically significant(P0.05), whether it was single or double segment L4-5 segment L4-S1 was fixed , the neighboring L3~4 disc effective stress in flexion, extension , vertical compression , lateral flexion, rotation were greater than unfused fixed, the difference was statistically significant(P0.05)。不管是单节段L4~5还是双节段L4~S1固定后,邻近L3~4椎间盘有效应力在前屈、后伸、垂直压缩、侧屈、旋转时均大于未融合固定,差异有统计学意义(P<0.05),各加载方式两两比较,加载平均应力由大到小依次为旋转、侧屈、后伸、前屈和垂直压缩,且两两之间比较差异有统计学意义(P<0.05)。结论:腰椎后路椎间融合术后,节段融合固定的应力要明显大于非融合固定临近椎间盘的应力,而且更容易加快邻近椎间盘的退变,双节段腰椎融合内固定比单节段在大部分活动状态下更易加快邻近椎间盘退变,尤其是旋转活动。

  3. Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis

    Directory of Open Access Journals (Sweden)

    Luciano Miller Reis Rodrigues

    2011-01-01

    Full Text Available OBJETIVO: Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar MÉTODO: 38 pacientes operados de estenose de canal lombar e submetidos à artrodese avaliados por meio de questionários (escala visual analógica - VAS e questionário de incapacidade Rolland Morris. Foram solicitadas radiografias para avaliação da fusão lombar. RESULTADOS: Foi observada uma efetiva melhora entre o momento pré-operatório e após um ano em relação ao VAS, tanto no grupo que obteve fusão óssea como no grupo com pseudartrose. Em relação ao questionário Rolland Morris houve uma tendência de melhora no grupo com fusão óssea e uma significante melhora no grupo com pseudoartrose. CONCLUSÃO: Não houve diferença entre os grupos (fusão óssea e pseudoartrose em relação à dor e incapacidade. Nível de Evidência: Nível II, estudo prospectivo longitudinal.OBJECTIVE: Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis METHODS: 38 patients operated on for lumbar spinal stenosis and submitted to arthrodesis were evaluated by the Visual Analogue Scale (VAS and Roland Morris Disability Questionnaire. Radiographs were requested to evaluate spinal fusion. RESULTS: An effective improvement was observed between the preoperative period and one year after the operation, in relation to VAS, both in the group that received a bone fusion and in the group with pseudarthrosis. With regard to the Roland Morris questionnaire, there was a tendency towards an improvement in the bone fusion group and a significant improvement in the pseudarthrosis group. CONCLUSION: There was no difference between the groups (bone fusion and pseudarthrosis in relation to pain and disability. . Level of Evidence: Level II, longitudinal prospective study.

  4. Intertransverse lumbar interbody fusion: A biomechanical in vitro study%腰椎横突间入路椎体间融合术的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    汤俊君; 王新伟; 袁文; 董军; 顾韬

    2008-01-01

    目的 观察腰椎横突间入路椎体间融合术(ILIF)及附加椎弓根钉固定后的生物力学稳定性.方法 采用小牛脊柱运动节段标本12具,依序进行不同处理后分为以下7组:(1)正常对照组(IS);(2)左侧小关节切除+椎间融合器植入组(TLIF);(3)TLIF附加同侧椎弓根钉固定组;(4)TLIF附加双侧椎弓根钉固定组;(5)左侧横突间入路椎间融合器植入组(ILIF);(6)ILIF附加同侧椎弓根钉固定组;(7)ILIF附加双侧椎弓根钉固定组.分别测试各组在轴向压缩、前屈、后伸、左右侧屈时的载荷-应变、载荷-位移变化以及轴向刚度和双向扭转稳定性等生物力学指标,并进行统计学比较.结果 所有生物力学指标中ILIF组稳定性均大于TLIF组(P0.05). 结论 ILIF手术生物力学稳定性优于TLIF手术;ILIF附加同侧椎弓根钉固定与附加双侧椎弓根钉固定生物力学稳定性相当,使用ILIF术式附加侧同椎弓根螺钉固定,可提供较好的即刻稳定性.%Objective To assess the relative stability and kinematics of the lumbar segmental stiffness among intertransverse lumbar interbody fusion (ILIF) with or without transpedicular screw rod fixation and transforaminar lumbar interbody fusion (TLIF) with or without transpedicular screw rod fixation.Methods Twelve fresh frozen bovine lumbar functional spinal units (FSU) were prepared for biomechanical test.According to the different treatments,the specimens were divided into 7 groups: (1) intact specimens (IS);(2) specimens were treated by left unilateral facetectomy and had homolateral anatomical threaded cages inserted (TLIF);(3) TLIF with homolateral pedicle screw fixation (TLIF+HPSF);(4) TLIF with bilateral pedicle screw fixation (TLIF+BPSF);(5) specimens had anatomical threaded cages inserted on the left by intertransverse process approach (ILIF);(6) ILIF with homolateral pedicle screw fixation (ILIF+HPSF);(7) ILIF with bilateral pedicle screw fixation (ILIF+BPSF).Data were

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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

  6. SHORT-TERM EFFECTIVENESS OF INTERLAMINAR LUMBAR INSTRUMENTED FUSION THROUGH A SMALL INCISION FOR LUMBAR SPINAL STENOSIS%小切口椎板间插装融合技术治疗腰椎管狭窄症的近期疗效

    Institute of Scientific and Technical Information of China (English)

    王少飞; 晁建虎; 卫建民; Fernando G.Diaz

    2012-01-01

    Objective To evaluate the short-term effectiveness of local laminectomy and interlaminar lumbar instrumented fusion (ILIF) through a small incision for lumbar spinal stenosis. Methods Between November 2009 and January 2011, 16 patients with lumbar spinal stenosis were treated by local laminectomy and ILIF through a small incision. There were 7 males and 9 females with an average age of 52.8 years (range, 49-67 years). Sixteen patients had lumbar degenerative stenosis with an average disease duration of 4 years and 7 months (range, 2 years-9 years and 4 months). Four cases complicated by lateral recessus stenosis, 3 by lumbar disc herniation. Involved segments included L3,4 in 2 cases, L4,5 in 4 cases, L5, S1 in 4 cases, L3,4 and L4,5 (double segments) in 2 cases, L4,5 and L5, S1 (double segments) in 4 cases. The effectiveness was evaluated with the pre- and post-operative Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI). The cross-sectional areas of spinal canal were measured by CT scanning and were compared between pre- and post-operation. Results The average operative time was 47 minutes (range, 35-80 minutes); the average blood loss was 145 mL (range, 120-350 mL); and the average hospitalization days were 7.8 days (range, 4-15 days). Cerebrospinal fluid leakage occurred in 1 case, and healing of incisions by first intention was achieved in the others. The patients were followed up 12-22 months (mean, 14.8 months). CT scanning showed interspinous fusion in 14 cases and possible fusion in 2 cases after operation, with an average fusion time of 4.6 months (range, 3-10 months). The postoperative VAS score, ODI, and cross-sectional area were significantly improved when compared with preoperative values (P < 0.05). Conclusion The ILIF can promote fusion between spinous processes, provide spine stabilization, and protect the spinal cord. The procedure has small incision, simple method of fixation and fusion.%目的 探讨经小切口局部椎板

  7. Posterior Isobar non-fusion internal fixation system in repair of lumbar disc herniation:more advantages in restoring range of motion of lumbar spine%后路Isobar非融合内固定系统修复腰椎间盘突出症:恢复腰椎活动度更具优势

    Institute of Scientific and Technical Information of China (English)

    刘彦斌; 付强

    2015-01-01

    背景:对于腰椎间盘突出症患者采取后路内固定治疗,可以常规选择后路椎间融合钉棒系统内固定的方式,近年来Isobar非融合内固定系统作为一种半坚强内固定腰椎后路动态钉棒固定系统开始逐渐应用在临床,成为患者的治疗选择方式之一。目的:临床对比观察研究分析采取后路Isobar非融合内固定系统和传统椎间融合钉棒系统内固定治疗腰椎间盘突出症的临床疗效。方法:对2011年9月至2012年9月收治解放军第二军医大学附属长海医院骨科进行手术治疗的腰椎间盘突出症患者40例,分为Isobar组和坚强内固定组,各20例,分别采用后路Isobar非融合内固定系统和传统椎间融合钉棒系统内固定进行治疗。结果与结论:两组患者均顺利完成手术,并完成至少2年以上随访,无脱落。与内固定前相比,两组患者内固定后腰腿痛目测类比评分、Oswestry功能障碍指数功能指数均显著改善;且与坚强内固定组相比,Isobar组患者治疗后腰椎活动度较大,而两组患者腰腿痛目测类比评分和Oswestry功能障碍指数接近。说明采用后路Isobar非融合内固定治疗能够获得传统治疗相同的治疗效果,且在腰椎活动度方面更具有优势。%BACKGROUND:The patients with lumbar intervertebral disc protrusion can be treated with internal fixation of posterior surgery way. We can choose the conventional posterior intervertebral fusion nail stick system internal fixation. Isobar non-fusion internal fixation system was used in recent years. As a kind of a strong internal fixation of lumbar posterior dynamic screw rod fixation system, it has been gradual y applied in clinic, and has been one of patient’s treatment options. OBJECTIVE:To compare and analyze the clinical efficacy of Isobar non-fusion internal fixation system and traditional intervertebral fusion nail rod system internal fixation operation

  8. 短节段固定融合治疗退变性腰椎侧凸合并腰椎管狭窄症的临床分析%A clinical analysis of short-segment fixation and fusion for degenerative lumbar scoliosis combined with lumbar stenosis

    Institute of Scientific and Technical Information of China (English)

    强喆; 宋跃明; 刘立岷; 杨曦; 胡星新; 陵廷贤

    2015-01-01

    目的:探讨短节段固定融合术治疗退变性腰椎侧凸( degenerative lumbar scoliosis,DLS )合并腰椎管狭窄症的手术策略及临床疗效。方法回顾性研究2010年5月至2013年8月,我院收治的26例DLS合并腰椎管狭窄症患者,男11例,女15例;年龄52~78(平均64.1)岁。术前全脊柱X线片示腰椎Cobb’s角11°~26°(平均16.4°),腰椎前凸角12°~46°(平均27.3°),以Oswestry功能障碍指数( oswestry disability index,ODI )评估患者疼痛和功能情况。手术方式为选择性减压、短节段固定融合。比较术前和术后随访的躯干平衡矫正及ODI改善等情况。结果随访12~39(平均20)个月,术前Cobb’s角平均(16.4±3.8)°,术后随访Cobb’s角平均(6.9±2.2)°,矫正率为58%;腰椎前凸角由术前平均(27.3±7.9)°矫正至末次随访平均(33.5±5.9)°;冠状面失平衡术前平均(11.2±4.5) mm,术后平均(5.2±2.3) mm;矢状面失平衡术前平均(11.7±6.0) mm,术后平均(6.0±2.3) mm;末次随访与术前相比ODI明显下降,改善率为83.1%,其中19例优,6例良,1例可。术后所有指标与术前相比,差异有统计学意义( P<0.05)。术后早期并发症发生率为26.9%,所有患者未发现钉棒松动或断裂等情况。结论对于Cobb’s角<30°且躯干失平衡较小的患者,行选择性减压、短节段固定融合术可获得良好的疗效。%Objective To explore the surgical strategies and clinical results of short-segment fixation and fusion for degenerative lumbar scoliosis combined with lumbar stenosis. Methods Twenty-six patients with degenerative lumbar scoliosis combined with lumbar stenosis who underwent short-segment ifxation and fusion from May 2010 to August 2013 were recruited for this retrospective study. There were 11 males and 15 females, whose mean age was 64.1 years old ( range:52-78 years ). The preoperative X-ray of the total spine showed the mean Cobb’s angle was

  9. 49 CFR 178.345-7 - Circumferential reinforcements.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Circumferential reinforcements. 178.345-7 Section... reinforcements. (a) A cargo tank with a shell thickness of less than 3/8 inch must be circumferentially... tank heads. (1) Circumferential reinforcement must be located so that the thickness and...

  10. 单侧椎弓根螺钉内固定椎间融合治疗腰椎退行性病变临床研究%Unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    徐海栋; 陈勇; 许斌; 赵建宁

    2011-01-01

    Objective This study aimed to investigate the clinical outcome of unilateral pedicle screw (Ups) fixation and transforaminal lumbar interbody fusion (TLJF) in the treatment of lumbar degenerative disease. Methods Forty-two patients with lumbar degenerative disease were assigned to two groups on a voluntary basis to receive Ups + TLJF ( n = 24 ) and bilateral pedicle screw fixation combined with fusion between vertebra (n = 18). Pre-and post-operative back pains were compared using the visual analog scale (VAS) system, the clinical outcomes assessed by the Kim method, and the fusion status evaluated by the Schulte method. Results The clinical symptoms of all the patients were improved post-operatively, with no complications. The Ups + TL1F group showed higher VAS and Kim scores than the bilateral fixation group, but no significant differences were observed in the bone graft fusion between the two groups. The patients were followed up for6 to 18 (mean 12.8) months. Conclusion Ups + TLJF, characterized by minimal invasiveness, is a reliable and effective option for the management of lumbar degenerative disease. However, its indications should be well considered.%目的 评估单侧椎弓根螺钉内固定(unilateral pedicle screw fixation,Ups)结合经椎间孔椎间融合(transforaminallumbar interbody fusio,TLIE)治疗腰椎退行性疾病的临床疗效. 方法 2009年12月至2010年12月,共收治不同类型腰椎退行性疾病患者42例,按照自愿的原则,采用Ups结合TLIF治疗24例和双侧椎弓根螺钉内固定术结合椎间融合术治疗18例.应用视觉模拟评分系统(Visual Analog Scale,VAS)评估患者术前、术后疼痛情况,应用Kim方法评价临床效果,应用Schulte方法观察植骨融合情况. 结果 所有患者术后临床症状较术前明显改善、临床疗效良好,无并发症的发生.VAS评分、Kim评分单侧固定优于双侧固定,Schulte方法观察植骨融合2组无显著差异.随访时间6~18个月,平均12

  11. Circumferential cracking of steam generator tubes

    Energy Technology Data Exchange (ETDEWEB)

    Karwoski, K.J.

    1997-04-01

    On April 28, 1995, the U.S. Nuclear Regulatory Commission (NRC) issued Generic Letter (GL) 95-03, {open_quote}Circumferential Cracking of Steam Generator Tubes.{close_quote} GL 95-03 was issued to obtain information needed to verify licensee compliance with existing regulatory requirements regarding the integrity of steam generator tubes in domestic pressurized-water reactors (PWRs). This report briefly describes the design and function of domestic steam generators and summarizes the staff`s assessment of the responses to GL 95-03. The report concludes with several observations related to steam generator operating experience. This report is intended to be representative of significant operating experience pertaining to circumferential cracking of steam generator tubes from April 1995 through December 1996. Operating experience prior to April 1995 is discussed throughout the report, as necessary, for completeness.

  12. Circumferential TIG welding of zircaloy flow tubes

    International Nuclear Information System (INIS)

    Reactivity control mechanism consists of 10 mtr. long zircaloy flow tubes (inner and outer) with components welded to hold the absorber elements. These components were welded by the plug welding process and supplied to Madras Atomic Power Station (MAPS) and Narora Atomic Power Station (NAPS). In view of the in-service problem faced in Rajasthan Atomic Power Station (RAPS), the spot welds were modified to circumferential TIG welding with additional reinforcement. Development work was taken up for additional reinforcement with screws and circumferential TIG welding of these assemblies. The additional reinforcement with screws and spot welds were critically examined and the job was taken up and successfully completed at Narora site for Narora Atomic Power Projects (NAPP-II). Several trials were conducted for circumferential TIG welding of zircaloy. Since zircaloy is highly reactive in nature, good shielding with inert gas should be ensured to avoid weld contamination due to oxygen and nitrogen. The strength, microstructural and radiographical requirements were examined with different parameters of welding such as weld current, feed, inert gas flow and weld configuration. The strength and other requirements were achieved meeting stringent specifications and assemblies for KAPP-I were successfully completed and despatched. (author). 7 figs

  13. PRESENT CLINICAL RESEARCH SITUATION OF ADJACENT SEGMENT DEGENERATION AFTER LUMBAR SPINAL FUSION%腰椎融合术后邻近节段退变的临床研究现状

    Institute of Scientific and Technical Information of China (English)

    双峰; 侯树勋

    2013-01-01

    Objective To review the present clinical research situation of adjacent segment degeneration (ASD) after lumbar spinal fusion. Methods The recent literature concerning ASD in the concept, the incidence, the risk factors, and prevention was reviewed. Results The concept of ASD includes radiographic ASD and clinical ASD. The incidences of radiographic ASD and clinical ASD were 8%-100% and 5.2%-18.5%, respectively. The risk factors for ASD include both patient and surgical factors. Patient factors include age, gender, preoperative condition, and so on. Surgical factors include the length of the fusion, mode of fusion, internal fixator, sagittal balance, excessive distraction of disc space, and so on. It can prevent ASD to reduce the length of the fusion, to keep sagittal balance, and to use the non-fusion technology. Conclusion Many researches have proved that the incidence of ASD is increased after lumbar spinal fusion, and it can be reduced by the non-fusion technology. Non-fusion technology has obtained good short-term results. But the long-term results should be further observed because there are some complications.%目的 对腰椎融合术后出现邻近节段退变(adjacent segment degeneration,ASD)的临床研究现状进行综述. 方法 查阅近年关于腰椎融合术后出现ASD的概念、发生率、相关影响因素和预防等方面的文献,并进行综述. 结果 ASD的概念包括影像学ASD和临床症状ASD,腰椎融合术后影像学ASD发生率可达8%~100%,临床症状ASD发生率为5.2%~18.5%.ASD的发生与个体因素(年龄、性别、术前情况等)和手术因素(融合节段长短、融合术式、内固定使用、矢状面平衡、椎间隙过度撑开等)相关.术中减少融合节段、维持矢状面平衡以及非融合技术的应用可预防ASD的发生. 结论 腰椎融合术后ASD发生率增高.非融合技术的应用降低了ASD的发生率,取得了较好的近期临床效果,但也存在一些并发症,

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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

  15. 旁正中入路单侧固定椎间融合治疗腰椎退行性疾病%Unilateral Fixation and Intervertebral Fusion by Paramedian Approach to Treat Lumbar Degenerative Diseases

    Institute of Scientific and Technical Information of China (English)

    王晓斌

    2015-01-01

    Objective To analyze the clinical effects of lumbar degenerative diseases treated with unilateral fixation and transforaminal lumbar interbody fusion (TLIF) by paramedian approach. Methods 60 patients who suffered from lumbar degenerative diseases admitted to our hospital were selected. All patients were treated with unilateral pedicle screw internal fixation combined with TLIF. The intraoperative blood loss, operation time and length of incision were observed. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the back pain, leg pain, and functional recovery before surgery, 3 months after surgery and at last follow-up. Results All the operations were successful, with the length of incision of (4.3 ± 0.4) cm (3.5~5.2 cm), intraoperative blood loss of (169 ± 73) mL (120 ~340 mL), and operation time of (104 ± 13) min (80 ~130 min). No serious complication was found after surgery, and the VAS scores of back pain and leg pain, and ODI after surgery were significantly lower than those before surgery (P<0.05). Conclusions The therapy of unilateral fixation and transforaminal lumbar interbody fusion (TLIF) by paramedian approach for lumbar degenerative diseases has the advantages of less trauma, less bleeding and faster postoperative recovery, which can help to alleviate back pain, and improve quality of life. Surgical indications must be considered comprehensively to ensure the best clinical outcomes.%目的 探讨旁正中入路单侧固定经椎间孔椎间融合 (TLIF) 治疗腰椎退行性疾病的临床效果. 方法 选取我院2012年1月至2015年1月收治的60例腰椎退行性疾病患者, 均采用旁正中入路单侧椎弓根螺钉内固定TLIF治疗, 观察术中出血量、手术时间、 切口长度等, 采用疼痛VAS评分、 功能障碍指数 (ODI) 于术前、 术后3个月及末次随访对患者腰痛、 腿痛、 功能恢复进行评估. 结果 60例患者均顺利完成手术, 手术切口长度3

  16. Correlation of posterior lumbar interbody fusion procedures with spinal and pelvic balance%后正中入路腰椎间融合与脊柱骨盆平衡相关性研究

    Institute of Scientific and Technical Information of China (English)

    汪勇刚; 徐林军; 胡伟; 许永涛

    2016-01-01

    Objective To investigate the effect of posterior lumbar interbody fusion (PLIF) procedures on the sagittal balance of spine and pelvis in treatment of lumbar degenerative diseases. Methods Forty cases of lumbar disc herniation, lumbar spondylolisthesis or lumbar spinal stenosis admitted to our department from February 2011 to June 2012 and treated with PLIF procedures were retrospectively analyzed. The parameters of spinal the pelvic balance (SS, PT, PI, and LL) were measured before and after surgery, one year and two years af⁃ter surgery, respectively. Meanwhile, JOA scores were recorded to assess the improvement of symptoms and signs of low back pain. All the data were analyzed by SPSS 17.0 software package for the significance test. The P value was set at 0.05. Results There was significant difference in LL, SS and PT before and after operation (P<0.05). The lumbar lordosis and sacral slope was increased respectively from 38.6° ± 5.2° , 28.2° ± 6.7° to 46.8°±7.3°, 33.4°±5.3°, and the pelvic incidence was decreased from 21.6°±7.8° to 18.2±9.4°, but there was no significant difference between different postoperative periods. As compared with the preoperation, the JOA scores in 35 patients at the final follow⁃up were increased from (12.5 ± 1.8) to (21.6 ± 3.2) (P<0.05). Conclu⁃sion PLIF procedure can relieve symptoms and improve quality of life of patients. PLIF procedure can effec⁃tively improve lumbar lordosis, and the recovery to lumbar normal lordosis has a positive effect on the mainte⁃nance of sagittal balance of spine and pelvis.%目的:探讨采用经后正中入路腰椎间融合(posterior lumber interbody fusion, PLIF)治疗腰椎退变性疾病时对脊柱骨盆矢状面平衡的影响。方法回顾性分析2011年2月至2012年6月我院通过PLIF治疗腰椎间盘突出症、腰椎滑脱、腰椎管狭窄症的患者40例,以常用的脊柱骨盆平衡参数中的骨盆入射角(pelvic incidence, PI

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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

  18. Adjacent level disease following lumbar spine surgery: A review

    Directory of Open Access Journals (Sweden)

    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.

  19. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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. ...

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  2. 经椎间孔椎间融合后腰椎即刻稳定性的生物力学实验%Initial lumbar stability following transforaminal interbody fusion: Biomechanical test

    Institute of Scientific and Technical Information of China (English)

    陈兵乾; 张烽; 董士奎; 居建文; 王素春; 王以进

    2008-01-01

    背景:经椎间孔椎间融合适用于腰椎任何节段,并且保留了侧椎板和关节突关节的完整,较传统的椎间融合具有一定的优势,但有关其生物力学性能的研究很少.目的:应用生物力学应力方法观察经椎间孔椎间融合术后及附加单侧和双侧椎弓根螺钉后腰椎即刻稳定性的变化.设计、时间及地点:生物力学测试,于2005-08/2006-04在南通大学和上海大学生物力学研究所完成.材料:新鲜1月龄小牛腰椎标本20具.方法:20具小牛标奉模拟临床手术,分别依次建市经椎间孔椎间融合单纯椎间融合模型、经椎间孔椎间融合附加单侧椎弓根螺钉模型、经椎间孔椎间融合附加双侧椎弓根螺钉模型,每组5个标本,在脊柱三维运动测试机上进行生物力学测试.主要观察指标:记录应变、位移、应力、扭角等力学量.结果:行单纯经椎间孔椎间融合后,虽然在平均应变和应力上变化不大,但刚度和扭转强度明显减小了,说明虽然椎间融合器的植入能提供即刻的稳定性.分别附加单侧椎弓根螺钉和双侧椎弓根螺钉固定后,其稳定性明显比单纯融合组加强了,甚至超过正常组,附加双侧内固定组的稳定性明显优于单侧内固定组.虽然附加单侧椎弓根螺钉同定后的腰椎稳定性逊于附加双侧椎弓根螺钉固定组,但是其即刻稳定性也大大地加强了,甚至超过了正常标本,说明附加单侧内固定同样也能提供腰椎术后足够的初始稳定性.结论:单纯经椎间孔椎间融合后,腰椎的初始稳定性是不够的,附加单侧和双侧椎弓根螺钉固定都能明显的增加腰椎的初始稳定性.%BACKGROUND:Transforaminal lumbar interbody fusion(TLIF)can be applied in any lumbar segment,and retain integrity of lateral vertebral plate and zygapophysiai joints.However,few studies have been conducted about the biomechanical performance.OBJECTIVE:To explore the stability of lumbar

  3. Clinical Analysis on the Impact of Lumbar Fixation and Intervertebral Fusion to the Adjacent Segment Degeneration%腰椎融合内固定术融合节段对相邻节段退变影响的临床分析

    Institute of Scientific and Technical Information of China (English)

    郭朝阳; 李明恒; 陈荣春

    2014-01-01

    Objective:To investigate the relationship between postoperative degeneration of adjacent segment and fusion segment number of lumbar vertebra.Method:A retrospective analysis of 69 patients were made,who underwent pedicle screws fixation and posterior lumbar intervertebral fusion for lumbar degenerative disease form June 2002 to May 2008. According to the number of lumbar fusion segments,those patients were divided into three groups. The group A was single segment fusion(24 cases);the group B was double segments fusion(26 cases)and the group C was multi-segments fusion( ≥ 3 segments,19 cases). The intervertebral height,displacement of slippage of the adjacent segment,lumbar lordosis angle and lumbosacral joint angle was measured on the X-ray preoperative and postoperative at the last follow-up. The incidence rate of adjacent segment degeneration was assessed by imaging evaluation criteria,and the relationship between adjacent segment degeneration and the number of fusion segment was analyzed.Result:The average follow-up period was 31.6 months(18-72 months).All patients had no neurological deterioration. At the last follow-up,there were 2 patients in the group A(8.3%),4 patients in the group B(15.4%)and 4 patients in group C(21.1%)occurred adjacent segment degeneration. There was no significant difference between group A and group B at the incidence of the adjacent segment degeneration(P>0.05). Compared with the group A and B,the group C had significant differences at the incidence of the adjacent segment degeneration(P0.05);C组相邻节段退变发生率与其他两组比较差异有统计学意义(P<0.05)。结论:腰椎后路融合内固定术会增加相邻节段退变,融合固定节段越多,相邻节段退变发生率越高。

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

    OpenAIRE

    Jacques Benezech; Bruno Garlenq; Gilles Larroque

    2016-01-01

    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,...

  5. Posterior lumbar inter-body fusion (PLIF) using autogenous bone and cage with pedicle screw instrumentation versus PLIF using cage with pedicle screw instrumentation in adult spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    Dou Yusheng; Hao Dingjun; Wen Shiming

    2005-01-01

    Objective: To compare the clinical outcomes of PLIF using autogenous bone and cage with pedicle screw fixation (group 2) and simple cage fusion with pedicle screw fixation (group 1) in adult spondylolisthesis.Methods: 27 patients with minimum follow-up of 24 months, treated by inter-body fusion with pedicle screw fixation were prospectively studied. Disc space height, degree of slippage and fusion rate had been compared before and after operation between the two groups. Results: After minimum 24 month's follow-up, there was no significant difference between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain,radiating pain, fusion rate, or complication (P>0.05). however, there was a significant difference between the two groups in terms of disc space height and percentage of slippage (P<0.05). Conclusion: PLIF using autogenous bone and cage with pedicle screw fixation more beneifical to improve fusion rate and prevent long-term instabilities than simple cage fusion with pedicle screw fixation in adult spondylolisthesis.

  6. Application of Pulsed Lavage in lumbar posterior single-segment fusion surgery%高压脉冲冲洗在腰椎后路手术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    文天用; 阳普山; 季伟; 张超; 何勍

    2014-01-01

    Objective To investigate the clinical efficacy of Pulsed Lavage in lumbar posterior single-segment fu-sion surgery. Methods Eighty patients diagnosed with single-segment lumbar disc herniation or lumbar spinal stenosis and needed a surgery treatment were assigned to receive surgical flush with either pulsed lavage (observation group, n=40) or artificial dumping rinse(the control group, n=40).The surgical flush time, the nature and volume of fluid drainage, the In-flammatory factors(TNF-α, IL-1、6) of the fluid drainage in the 2th day, the Erythrocyte Sedimentation Rata(ESR) and the C-reactive protein(CRP)in the 5th day were compared between the two groups. Results The observation group had short-er surgical flush time, less volume of fluid drainage and inflammatory factor(TNF-α, IL-1, 6)expression(P 0.05). Conclusion These results suggested that pulsed lavage device is effective in lumbar posterior single-segment fusion surgery, and can decrease the concentrations of inflammatory factors in fluid drainage, and should be recommended in patients who are affordable.%目的:探讨脉冲高速冲洗方法对于后路脊柱手术的临床效果。方法选择我科2012年8月至2013年7月因腰椎间盘突出或椎管狭窄而行单节段椎间融合后路内固定治疗患者80例,术中应用高压脉冲冲洗者40例(实验组),应用常规倾倒冲洗者40例(对照组),观察对比两组患者术后伤口引流总量、术后第二天伤口引流液内炎性因子(TNF-α,IL-1,IL-6)表达情况及术后第5天血沉及C反应蛋白变化,并进行统计学分析。结果术后伤口引流总量方面,高压脉冲冲洗组为(389.37±109.89)ml,明显高于常规倾倒冲洗组[(275.77±102.00)ml]。术后早期患者伤口引流液TNF-α,IL-1,IL-6分别为(15.06±3.04)ng/L、(13.83±4.13)ng/L、(12.20±3.41)ng/L,显著低于对照组[(25.40±8.45)ng/L、(22.60±4.49)ng/L、(24.58±7.69)ng/L],

  7. A systemic review of adjacent segment deterioration after lumbar fusion%腰椎融合术后邻近节段退化的系统回顾分析

    Institute of Scientific and Technical Information of China (English)

    沈凯; 李锋; 谭祖健

    2012-01-01

    目的 探讨腰椎融合术导致融合邻近节段退化(ASDet)发生的概率、发病机制及危险因素.方法 通过计算机检索和人工检索,对近30年来国内外发表的关于腰椎融合术导致邻近节段退化的文献进行系统回顾.结果 共搜索到301篇相关文献,筛选出30篇符合人选标准的文献.本研究发现ASDet发病率波动在6.3%~100%,邻近节段退变(ASDeg)发病率波动范围8%~100%,邻近节段疾病(ASDis)发病率波动范围6.3%~27.4%.ASDeg平均发病率高于ASDis,P=6.751×10-7(P<0.05).多种影响因素参与ASDet的发生.结论 ASDet、ASDeg 、ASDis发病率差异较大.目前ASDet发生的机制仍不明,绝大多数学者认为与手术引起的邻近节段生物力学机制改变有关.年龄大于60岁、使用内固定器械、损伤上方小关节、改变腰椎前凸和骶倾角、破坏腰椎后方组织结构、已绝经妇女是邻近节段退化性疾病发生的危险因素.然而长节段融合是否导致ASDet的发病率增高还有待进一步研究.%Objective To investigate the incidence, pathogenesis and risk factor of adjacent segment deterioration(ASDet) after lumbar fusion. Methods Our systemic review was based on the literatures of adjacent segment deterioration after lumbar fusion published around the world during the past three decades, through computer retrieval and manual retrieval. Results Out of 301 literatures, a sample of 30 literatures were chosen according to the criteria. The incidence of adjacent segment deterioration (ASDet) ranged from 6.3%~100%, and that of adjacent segment degeneration (ASDeg) ranged from 8%~100%, and that of adjacent segment disease (ASDis) ranged from 6.3%~27.4%. The average incidence of ASDeg was higher than that of ASDis, P =6.751xl0'(P <0.05). The ASDet was related with several factors. Conclusion The incidence of ASDet.ASDeg and ASDis are so different. By now, the pathogenesis of adjacent segment deterioration is

  8. 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

    Institute of Scientific and Technical Information of China (English)

    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

  9. Posterior lumbar interbody fusion using B-Twin expandable spinal spacer with microendoscopic discectomy for lumbar disc herniation accompanying degenerative instability%椎间盘镜下B-Twin椎间融合治疗腰椎间盘突出症伴腰椎不稳

    Institute of Scientific and Technical Information of China (English)

    王博; 杨群; 张德强; 王宏; 吴春明; 马凯; 唐开; 刘阳

    2011-01-01

    Objective To explore the clinical outcomes of posterior lumbar interbody fusion using BTwin expandable spinal spacer with microendoscopic discectomy (MED) for lumbar disc herniation accompanying degenerative instability.Methods From March 2006 to May 2010,87 patients with lumbar disc heniation (only one level) accompanying degenerative instability were managed with posterior lumbar interbody fusion using B-Twin with MED,includeing 49 males and 38 females with an average of 47.6 years (range,37-65).Objective level located in L3,4 in 2 cases,L4,5 in 43,and L5S1 in 41.The patients were treated with single BTwin (Single group,n=51) and double B-Twin (Double group,n=36).Clinical outcomes were evaluated with surgical time,blood loss,visual analogue scale (VAS) scores,Oswestry disability questionnaire (ODI),and the pre- and post-operative disk space heights.Results The patients were followed up for an average of 35.8months (range,12-46).All the patients felt the low back pain and radiation pain disappeared or relieved apparently.The mean preoperative ODI and VAS scores decreased from 78%±3% to 18%±3%,and (8.70±11.3)to (0.65±10.48) at the final follow-up respectively.Disc space increased from a pre-operative height of (8.76±1.3) mm to a post-operative of (11.8±0.6) mm.ODI,VAS and the disk space heights in all patient showed statistical significance,which revealed no statistical significance between the two groups.However,the operation time,blood loss were statistical difference between the two groups.All the patients achieved solid union or probable union at a mean time of 5.6 months (range,3.9-8.6).Conclusion Posterior lumbar interbody fusion using B-Twin with MED can obtain satisfactory outcomes in the treatment of lumbar disc herniation accompanying degenerative instability.Single B-Twin can get similar clinical outcomes,but shorter surgical time,less blood loss,and less medical costs.%目的 探讨椎间盘镜下减压、B-Twin融合器植骨融合术治

  10. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    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, ...

  11. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    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. ...

  12. Spontaneous resolution of lumbar vertebral eosinophilic granuloma.

    Science.gov (United States)

    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

  13. 腰椎融合术后相邻节段退变的相关因素分析%Correlative factors for adjacent segment degeneration after lumbar spinal fusion

    Institute of Scientific and Technical Information of China (English)

    黄觅; 于淼; 刘晓光; 姜亮; 韦峰; 吴奉良; 刘忠军

    2014-01-01

    Objectives: To explore risk factors associating with adjacent segmental degenerations after lumbar fusion surgery. Methods: A retrospective analysis was performed on 109 cases of lumbar stenosis undergoing lumbar posterior decompression, pedicle screw fixation and fusion in orthopedic department of Peking Univer-sity Third Hospital from January 2009 to January 2011. These cases included 39 males and 70 females with ages ranging from 24 to 79 years(average, 54 years). All of them were followed up by a 2- to 4-year(aver-age, 3.4 years) outpatient questionnaire. Measurement included peroperative angles of fusion segment (FA), proximal and distal adjacent angles of fusion segments(PA, DA), lumbar lordosis(LL), sacral slope(SS), pelvic incidence(PI) in pre-operation, and slip distance(SD) between fusion and non-fusion segments. Adjacent seg-ment rdiograpfic degeneration was defined as adjacent segmental slip of 3mm or more on standing X-ray at post-operative 24 months. All patients were categorized into degenerative group(group A) and non-degenerative group(group B). Gender, age, bone mineral density, number of fusion segments were also recorded. The com-parative results between two groups were analyzed by t-test and χ2 -test. Risk factors of adjacent segment radiographic degeneration were analyzed by using Logistic regression. Results: There were 18 cases(16.5%) in group A and 91 cases(83.5%) in group B developing ASD, and all ASD occurred at proximal adjacent seg-ments. Preoperative results were as follows: LL for group A and B was 29.8°±12.5° and 32.4°±11.2°; SS for group A and B was 31.5°±12.1° and 37.4°±13.4°; FA for group A and B was 18.3°±9.0° and 14.8°±10.5°;PA for group A and B was 6.8° ±3.2° and 7.2° ±5.2° , which all showed significant differences between two groups(P0.05). Logistic regression analysis showed significant correlation with PI and incidence of ASD(P0.05). Conclusions: Of the risk factors inducing ASD, low PI may be one

  14. 腰椎融合联合Coflex动态固定手术治疗腰椎退行性疾病%Spinal fusion combined with dynamic interspinous fixation with Coflex system for lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    李忠海; 王诗媛; 唐昊; 马辉; 张秋林; 侯铁胜

    2011-01-01

    目的:总结腰椎后路椎间融合术联合Coflex动态固定术治疗腰椎退行性疾病的临床疗效.方法:对2008年3月至2010年3月应用腰椎后路椎间融合术联合Coflex动态固定治疗的18例腰椎退行性疾病患者(均为双节段)的临床资料进行回顾性总结分析.男11例,女7例;年龄41~62岁,平均50.2岁.分析内容包括:ODI指数、腰痛和下肢痛的VAS评分,并通过腰椎动力位X线观察活动度(ROM)、椎间隙高度(DHI)的变化情况.结果:所有患者获得随访,时间6~30个月,平均12个月.在末次随访时.腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善(P<0.001).腰痛VAS评分术前(7.20±0.90)分.末次随访(1.50±0.90)分;下肢痛VAS评分术前(5.20±0.90)分,末次随访(1.10±0.80)分.ODI指数术前(52.50±5.90)%,未次随访(15.90±5.80)%.Coflex置入节段的DHI术前0.23±O.05,术后0.35±0.06,末次随访0.33±0.04,椎间隙高度未见明显丢失.Coflex置入节段的ROM术前(8.90±1.80)°,术后降至(8.30±1.90)°,末次随访(8.10±1.80)°.与术前差异无统计学意义(P=0.19).Conex置入节段活动度未见明显改变.L2-S1 ROM术前为(20.20±5.60)°,术后(14.40±5.70)°,末次随访(15.50±5.20)°.与术前比较有统计学差异(P=0.01).结论:腰椎后路椎间融合术联合Coflex动态固定治疗双节段腰椎退变性疾病能取得满意的中短期临床疗效,但没有充分证据证明这项技术优于多节段融合术.手术适应证的合理选择十分重要.%Objective:To summarize the effect of the implantation of Coflex interspious stabilization device combined with spinal fusion for the treatment of lumbar degenerative disease.Methods: From March 2008 to March 2010, 1 8 patients with two levels lumbar degenerative disease were treated with spinal fusion and dynamic interspinous fixation with Coflex system. There were 11 males and 7 females. The average age was 50.2 years (range 41 to 62 years). The VAS and the Oswestry

  15. Lumbar pedicle cortical bone trajectory screw

    Institute of Scientific and Technical Information of China (English)

    Song Tengfei; Wellington K Hsu; Ye Tianwen

    2014-01-01

    Objective The purpose of this study was to demonstrate the lumbar pedicle cortical bone trajectory (CBT) screw fixation technique,a new fixation technique for lumbar surgery.Data sources The data analyzed in this review are mainly from articles reported in PubMed published from 1994 to 2014.Study selection Original articles and critical reviews relevant to CBT technique and lumbar pedicle fixation were selected.Results CBT technique was firstly introduced as a new fixation method for lumbar pedicle surgery in 2009.The concepts,morphometric study,biomechanical characteristics and clinical applications of CBT technique were reviewed.The insertional point of CBT screw is located at the lateral point of the pars interarticularis,and its trajectory follows a caudocephalad path sagittally and a laterally directed path in the transverse plane.CBT technique can be used for posterior fixation during lumbar fusion procedures.This technique is a minimally invasive surgery,which affords better biomechanical stability,fixation strength and surgical safety.Therefore,CBT technique has the greatest benefit in lumbar pedicle surgery for patients with osteoporosis and obesity.Conclusion CBT technique is a better alternative option of lumbar pedicle fixation,especially for patients with osteoporosis and obesity.

  16. 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

    Directory of Open Access Journals (Sweden)

    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.

  17. 后路固定椎间碎骨植骨与髂骨块植骨融合术治疗退行性腰椎不稳的临床研究%Clinical study of posterior internal fixation and iliac crest or granular bone grafting lumbar interbody fusion for the treatment of the degenerative lumbar instability

    Institute of Scientific and Technical Information of China (English)

    林斌; 林秋燕; 邵泽豹

    2012-01-01

    [Objective] To compare the clinical outcome of posterior pedicle screw fixation and iliac crest or granular bone grafting lumbar interbody fusion for the treatment of degenerative lumbar instability. [ Methods] There were 75 patients with degenerative lumbar disease. They were 41 males and 34 females, aged from 27 to 68 years with an average of 55. 6 years. Clinical manifestation; there were 72 cases with lower back pain and 47 cases with intermittent claudication. All of 75 cases had leg pain, including 37 cases of unilateral kg pain, 23 cases of bilateral leg pain and 15 cases of alternative leg pair.. Fifty - seven cases were positive with straight leg raising test, 66 cases had sensory disturbance, 58 cases had movement disorders, and 45 cases had abnormal achilles tendon reflex and knee jerk reflex, and 45 cases had injuries of cauda equina. There were 32 cases with degeneration of L4、5 , 26 cases with degeneration of L5S1 , 6 cases with degeneration of L3、4, and 11 cases with degeneration more than 2 segments. They were divided into two groups randomly: iliac bone group and granular bone group. The iliac bone group were treated with decompression, internal fixation for degenerative lumbar instability with pedicle screw and interbody fusion with iliac crest grafting. The granular bone group were treated with decompression, internal fixation and with granular bone grafting fusion. All of the cases had X -ray in routine and oblique view, CT and MRI preoperatively. The Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI) were evaluated before and 3, 6, 12 months after surgery. And fusion situation was evaluated by reviewing the roentgenographic film. [ Results] ( I ) Significant difference of JOA score and 0D1 were founded in each group before and after surgery. But it was no significant different between two groups. (2) The loss of intervertebral height was significant different between two group before and after surgery. The loss of

  18. Posterior pedicle screw fixation and interbody fusion in the treatment of recurrent lumbar disc herniation:an evaluation of vertebral stability%后路钉棒内固定椎间融合治疗复发性腰椎间盘突出症:椎体稳定性评价

    Institute of Scientific and Technical Information of China (English)

    刘凤松; 王凯; 景成伟; 张亮; 刘宾; 杨亚林

    2014-01-01

    BACKGROUND:Discectomy is an important therapy for lumbar disc herniation, but a smal number of patients undergoing discectomy wil relapse. OBJECTIVE:To investigate the spinal stability fol owing posterior pedicle screw fixation combined with interbody fusion cage for treatment of recurrent lumbar disc herniation. METHODS:Twenty-six patients with recurrent lumbar disc herniation from January 2007 to December 2011 were enrol ed and subjected to posterior pedicle screw fixation combined with interbody fusion cage. Pain relief and lumbar stability were observed postoperatively. We analyzed the spinal stability in recurrent lumbar disc herniation patients after posterior pedicle screw fixation combined with interbody fusion cage depending on literature search. RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 12-36 months. After treatment, al patients effectively al eviated the symptoms of low back pain, and lumbar interbody fusion was good, with a good rate of 96.2%. There was no pedicle screw loosening, broken, non-fusion phenomenon. Posterior decompression and interbody fusion cage combined with posterior pedicle screw fixation for recurrent lumbar disc herniation, characterized as fast symptom relief, strong fixation, exact interbody fusion exact, is an ideal treatment for recurrent lumbar disc herniation.%背景:腰椎间盘突出症治疗的重要方法是椎间盘切除,但有少部分患者会出现复发现象。  目的:探讨后路椎弓根钉棒内固定联合cage植入椎间融合治疗复发性腰椎间盘突出症后的脊柱稳定性。  方法:选择2007年1月至2011年12月复发性腰椎间盘突出症患者26例,应用后路减压cage植入椎间融合加钉棒系统内固定治疗复发性腰椎间盘突出症进行再手术治疗,观察患者治疗后疼痛症状缓解情况以及腰椎稳定性。通过数据库文献检索的方法分析后路钉棒内固定椎间融合治疗复发性腰椎间盘突出症的椎

  19. Posterior Decompression and Fusion in Treatment of 49 Patients with Degenerative Lumbar Scoliosis%后路减压有限固定融合术治疗退变性腰椎侧凸49例分析

    Institute of Scientific and Technical Information of China (English)

    王飞; 单建林; 天林; 李放

    2014-01-01

    Objective To explore the curative effect of posterior decompression and fusion in treatment of degen-erative lumbar scoliosis. Methods Clinical data of 49 patients undergoing posterior approach therapy during January 2005 and October 2011 was retrospectively analyzed. The low back pain, the lower limbs pain and neural function before and after operation were evaluated by Oswestry disability index ( ODI) and Visual analogue scale ( VAS) . Clinical symp-toms, viability improvement and deformity correction of patients were observed. Results The mean follow-up time was 3. 8 years, and the fineness rate was 87. 8%. The scores of ODI and VAS, Cobb's angle and sagittal plane imbalance were improved after the operation compared with those before the operation, and the differences were statistically signifi-cant (P<0. 05). Conclusion Posterior decompression and fusion is an effective surgical method in treatment of degen-erative lumbar scoliosis. Full decompression and the spinal balance, especially the recovery of sagittal plane are the key for satisfactory treatment outcomes.%目的:探讨腰椎退变性侧凸行后路减压固定融合术的临床疗效。方法回顾性分析2005年1月-2011年12月行后路手术治疗49例的临床资料,应用Oswestry功能障碍指数( ODI)和视觉模拟评分( VAS)评价术前、术后腰腿痛和神经功能情况。观察患者临床症状、生活能力改善及畸形矫正情况。结果平均随访3.8年,优良率为87.8%。手术后ODI、VAS、侧凸角、矢状面失衡比术前均有明显改善(P<0.05)。结论腰椎后路融合术治疗退行性腰椎侧凸畸形疗效确实,充分减压及脊柱平衡尤其是矢状面平衡的恢复是获得良好疗效的关键。

  20. Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Raj K. [The George Washington University School of Medicine, Washington, DC (United States); Moncayo, Valeria M.; Pierre-Jerome, Claude; Terk, Michael R. [Emory University School of Medicine, Radiology Department, Musculoskeletal Division, Atlanta, GA (United States); Smitson, Robert D. [Emory University School of Medicine, Atlanta, GA (United States)

    2010-05-15

    A 45-year-old man presented with vertebral collapse at L5 as an initial manifestation of multiple myeloma and underwent spinal fusion surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2). Subsequent computed tomography (CT) scans and X-rays revealed heterotopic ossification of the left psoas muscle, pelvis, and anterior abdominal wall. While the occurrence of heterotopic ossification has previously been reported when rhBMP-2 has been used for spinal fusion surgery, this case demonstrates that it can occur to a much greater degree than previously seen. (orig.)

  1. 三种单纯腰椎椎间融合并双侧椎弓根螺钉内固定后即刻稳定性的比较%Initial stability of lumbar spine following three types of interbody fusion and bilateral pedicle screw fixation

    Institute of Scientific and Technical Information of China (English)

    张烽; 陈兵乾; 居建文; 王素春; 段广超; 王以进

    2008-01-01

    BACKGROUND:Operative approaches of lumbar interbody fusion include anterior (ALIF),posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF).The resected structures and cage implantation sites are different,and the initial stability of lumbar spine is varied.OBJECTIVE:To compare the initial stability of lumbar spine following ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.DESIGN:Comparative observation.MATERIALS:Fifteen samples of fresh calf lumbar spine were used.METHODS:Models ofALIE PLIF and TLIF were simulated.After examination as normal group,the samples were randomly divided into three groups (n=5).Besides anterior,posterior and transforaminal lumbar interbody fusion include anterior,bilateral pedicle screw fixation was performed.MAIN OUTCOME MEASURES:Biomechanical characteristics of the lumbar spine before and after ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.RESULTS:Following three approaches of lumbar interbody fusion,the stability of lumbar spine was significantly reduced,which was enhanced after bilateral pedicle screw fixation (torsion indexes were also increased).In addition,rigidity of the lumbar spine was enhanced.The stability indexes of lumbar spine following TLIF were significantly greater than the other approaches,indicating the initial stability of TLIF was the best.The rigidity,stress,and swain of lumbar spine following PLIF were greater than ALIE but torsion indexes were smaller than ALIE CONCLUSION:The stability of lumbar spine following lumbar interbody fusion was significantly reduced compared with normal sample.But bilateral pedicle screw fixation greatly increases the stability.Among three types of lumbar interbody fusion,the initial stability of lumbar spine following TLIF is the best.%背景:椎间融合术按照手术入路主要有前路椎间融合术、后路椎间融合术和椎间孔入路椎问融合术.3种融合术术中切除的结构不同,融合器置入的部位

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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

  3. Clinical effect analysis of short-segment fixation and fusion for degenerative lumbar scoliosis ;combined with lumbar stenosis%短节段固定融合术治疗退变性腰椎侧凸合并腰椎管狭窄疗效观察

    Institute of Scientific and Technical Information of China (English)

    王磊; 李天旺; 刘建强; 刘晓宗; 王照国; 田艳; 张永兴; 王伟

    2016-01-01

    Objective To investigate the surgical strategies and clinical results of short-segment fixation and fusion for degenerative lumbar scoliosis ( DLS) combined with lumbar stenosis .Methods Sixty-eight cases of DLS with lumbar spinal canal stenosis underwent selective decompression and short segmental fixation and interbody fusion .The Cobb angle, lumbar lordosis, coronal plane trunk shift , and sagittal plane trunk shift in the preoperative and final follow-up were measured .Function were assessed by Oswestry disability index ( ODI) .Results All the patients were followed up for 36~60 months.The Cobb angle was 12°~28°(15.9°±4.6°) preoperatively and was 3.6°~9.8°(5.2°± 3.1°)at final follow-up;lumbar lordosis was 1.2°~3.3°(1.9°±2.9°) preoperatively and was -28.1°~4.6° (-23.6°±3.7°) postoperatively;coronal plane trunk shift was 8.2~13.7 (10.8 ±5.2 ) mm preoperatively and was 2.8~5.6(4.3 ±1.8)mm at final follow-up;sagittal plane trunk shift was 10.2~15.6(12.6 ±3.7)mm preoper-atively and was 3.1~6(4.6 ±2.2)mm at final follow-up;the ODI was 25.2~29.8(27.6 ±2.1)points preoperative-ly and was 2.1~4.2(3.6 ±1.3)points at final follow-up.There were statistically significant differences in the above indexes between the final follow-up and the preoperative comparison ( P<0.05 ) .The early complication incidence rate was 7.3%.At the final follow-up, there was no instrument-related failure.Conclusions The selective decom-pression and short-segment fixation and fusion is an safe and effective technique for DLS combined with spinal stenosis patients with small Cobb angle (<30°) and minor spinal imbalance .%目的:探讨短节段固定融合术治疗退变性腰椎侧凸( DLS)合并腰椎管狭窄的手术策略、影像学及临床疗效。方法选择性减压、短节段固定融合术治疗68例DLS合并腰椎管狭窄患者,比较患者术前及末次随访时的Cobb角、腰椎前凸角、冠状面躯干偏移及

  4. Lumbar paraganglioma.

    Science.gov (United States)

    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

  5. Adjacent segment disc degeneration after lumbar interbody fusion:a systematic review%腰椎融合术后发生邻近节段椎间盘退变的系统评价

    Institute of Scientific and Technical Information of China (English)

    郝俊龙; 陈永刚; 夏亚一; 汪玉良; 王栓科; 汪静; 王翠芳; 耿彬

    2011-01-01

    [ Objective] To assess the efficacy and safety of bone morphogenetic protein for fractures. [ Methods] We searched the Cochrane Central Register of Controlled Trials (CENTRAL) ( Issue 3, 2010) , MEDLINE, EMBASE, CBM,CNKI, VIP, Wanfang database, etc. from their inception to June 2010. Some relevant journals were handsearched as well. Two reviewers independently evaluated the quality of included studies and extracted the data. Meta - analysis was performed by RevMan 5.0 software. [ Results ] Four trials involving 451 patients were included. Meta analysis showed that as for functional training, lumbar fusion increased risk of adjacent segment disc degeneration (ASD) . The incidence of ASD after lumbar laminectomy is higher than non - laminectomy. The existence of ASD preoperative increased risk of postoperative ASD. The incidence of ASD had no relation with internal fixation or the number of fusion segments. [ Conclusion ] Lumbar fusion can increase the incidence of ASD, and is related with laminectomy and the existence of preoperative ASD, but is not related with internal fixation and the number of lumbar fusion segments. However, there is a moderate possibility of selection bias, performance bias and publication bias in this review because of the small number of the included studies, which may weaken the strength of the evidence of our results. More large sample size, high -quality RCTs are needed.%[目的]对腰椎融合术加速邻近节段椎间盘退变进行系统评价.[方法]按照Coehrane协作网制订的检索策略进行检索,计算机检索MEDLINE(1966~2010年8月)、EMBASE(1974~2010年8月)、Cochrane图书馆(2010年第8期)、中国生物医学文献数据库(CBM,1978~2010年8月)、中国期刊全文数据库(CNKI,1994~2010年8月)、中文科技期刊全文数据库(VIP,1989~2010年8月)及万方数据库(1979~2010年8月).手工检索相关的中英文骨科杂志和会议论文.纳入腰椎融合术后发生邻近节段椎间盘

  6. Clinical efficacy and operation strategy of intervertebral foramen intervertebral fusion for degenerative lumbar disease%经椎间孔椎间融合治疗退变性腰椎疾病的临床疗效及手术策略

    Institute of Scientific and Technical Information of China (English)

    王福贵; 娄颜伟; 朱俊昭; 邹扬道; 陈伟

    2015-01-01

    目的::探讨经椎间孔椎间单枚融合器融合、椎弓根钉内固定治疗退变性腰椎疾病的临床疗效。方法:采用经椎间孔椎体内单枚椎间融合器结合椎弓根钉棒系统治疗退变性腰椎疾病21例。通过下腰痛JOA评分和Dswestry功能障碍指数评分,评估其临床效果。结果:本组获随访4~14个月,术后3个月及1年JOA及ODI评分与术前比较差异显著(P﹤0.05)。结论:经椎间孔单枚融合器融合结合单侧或双侧椎弓根钉内固定治疗退变性腰椎疾病是一种创伤小、疗效确切的治疗方法。%Objective:To evaluate the clinical effect of foraminal single fusion cage, pedicle screw fixation for the treatment of lumbar degenerative disease. Methods:21 cases with using transforaminal lumbar vertebral body single fusion cage combined with pedicle in treat-ment of degenerative lumbar disease . The pain score of JOA and Dswestry disability index score evaluated the clinical effect. Results:The patients were followed up for 4~14 months, after 3 months and 1 years of compared with the preoperative JOA and ODI score difference was significant (P < 0. 05). Conclusion:Transforaminal single fusion cage combined with unilateral or bilateral pedicle screw fixation for the treatment of lumbar degenerative disease might be a safe,and effective method.

  7. Clinical evaluation of lumbar CT assisted discography in comparison with human cadaver

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Shigehiko

    1988-04-01

    In order to estimate the clinical value of lumbar CT assisted discography (CTD), results obtained by this method were compared with histological findings of the cross section of the spine in fresh human cadavera. Based on these findings, preoperative CTD of lumbar disc herniation was investigated. In the discs of human cadavera, the contrast medium mainly invaded the fissures of nucleus pulposus and the ruptures of annulus fibrosus and then diffused to the surrounding tissues. These ruptures were classified into two categories: radial and circumferential. This indentification was possible only in CTD and was obscure in the usual discogram. Not all the ruptures could be dyed in a severe degenerative disc, and a rupture which was not communicated with nucleus pulposus was not dyed in a mild degenerative disc. In the preoperative CTD of lumbar disc herniation, the posterior radial ruptures representing the route of herniated nuclei were characteristic and the circumferential ruptures were found complicated.

  8. Clinical characteristics and reoperation of symptomatic adjacent segment degeneration post-operation of lumbar fusion%腰椎融合术后症状性邻近节段退变的临床特点和再手术治疗

    Institute of Scientific and Technical Information of China (English)

    孙浩林; 李淳德; 刘宪义; 邑晓东; 刘洪; 卢海霖; 李宏; 于峥嵘; 赵硕

    2012-01-01

    Objective:To evaluate the clinical characteristics and reoperation of symptomatic adjacent segment degeneration post-operation of lumbar fusion. Methods;In the study, 28 cases of symptomatic adjacent segment degeneration post-operation of lumbar fusion from May 2007 to April 2012 were retrospectively reviewed,with an average age of (64. 3±8. 7) years. The mean period between reoperation and primary fusion surgery was (47. 5 ±30. 8) months. Symptomatic adjacent segment degeneration located in cephalic segments in 12 cases, in caudal segments in 14 cases and in both segments in 2 cases. Of all the 28 patients, 12 suffered from lumbar stenosis, other 13 from lumbar disc herniation and still other 3 from both lumbar stenosis and disc herniation, of whom 11 were together with segment instability. Localization diagnoses of 19 cases were clear and other 9 received diagnostic nerve root block. The cases were divided into two groups by the type of reoperation, of which 8 cases were in adjacent degenerative segment nonfusion group and the other 20 cases in adjacent degenerative segment fusion group. The clinical results were assessed by lumbar pain visual analog score (VAS) and lower limber pain VAS, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score before operation and in the final follow-up. Results; In adjacent degenerative segment nonfusion group, the average operation time was (86. 3±17. 1) min and average blood volume was (125. 0±37. 8 ) mL of reoperation and 1 case with dural injury; and in adjacent degenerative segment fusion group, the average operation time was (201.6± 71. 0) min and average blood volume was (313. 6±18. 9) mL of revision surgery and 4 cases with dural injury. The average follow-up period was 25. 5 months. In the final follow-up,lumbar pain VAS,lower limber pain VAS, lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 2.4± 1. 2, 2. 8±1.4,23. 5±4. 2 and 8. 2±1

  9. Cause analysis and treatment strategy of cage retropulsion after lumbar interbody fusion%腰椎融合器后移的原因分析及处理对策

    Institute of Scientific and Technical Information of China (English)

    王洪立; 姜建元; 吕飞舟; 马晓生; 夏新雷; 王立勋

    2012-01-01

    目的 探讨腰椎融合术后融合器后移的原因及临床处理对策.方法 回顾性分析2005年12月至2011年10月腰椎融合术后融合器后移至椎管的11例患者的完整资料,男7例,女4例;初次手术时年龄36~78岁,平均52.3岁.6例患者在初次手术后0.5~3个月,平均2.1个月椎间融合器发生后移(早期移位),5例患者在初次手术后14~36个月,平均24.8个月发生后移(晚期移位).分析11例患者融合器后移发生原因,根据患者是否伴腰痛及下肢症状而行保守或手术治疗.结果 早期移位发生原因与椎间隙处理不当、髓核残留过多、软骨终板刮除不足、融合器型号选择过小、融合器植入位置不当、固定强度不足等相关.晚期移位发生原因与手术方案选择不当、多节段融合固定、术前椎间节段存在不稳定、高龄、骨质疏松及合并糖尿病等有关.11例患者均获得随访,随访时间6~72个月,平均34个月;3例经保守治疗、8例接受翻修手术治疗均获得临床愈合.随访期间该组病例临床症状无明显加重,影像学随访未发现融合器再次移位、植骨不融合、椎弓根螺钉松动等并发症. 结论 腰椎融合术后融合器后移的发生原因复杂,移位发生时间的不同对移位原因的判断具有一定的临床价值;针对不同的移位原因、临床表现及影像学检查结果选择个性化方案进行治疗.%Objective To investigate causes and treatment strategy of cage retropulsion after lumbar interbody fusion.Methods Data of 11 patients with cage retropulsion after lumbar interbody fusion from December 2005 to October 2011 in our hospital were retrospectively analyzed.There were 7 males and 4 females.Their age ranged from 36 to 78 years (average,52.3 years) at the time of the primary operation.Six cases occurred cage retropulsion 0.5 to 3 months after the primary operation,while 5 cases occurred cage retropulsion 14 to 36 months after the

  10. 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.

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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

  12. Effects of posterior lumbar spinal fusion on the stability of unstable lumbar segment and biomechanical properties of adjacent segments: a finite element study%腰椎后路融合手术对失稳模型节段稳定性及相邻节段力学的影响

    Institute of Scientific and Technical Information of China (English)

    费琦; 赵凡; 杨雍; 李东; 李锦军; 王奇; 林吉生; 严华刚; 王炳强

    2015-01-01

    目的 在腰椎单节段退变手术失稳模型基础上比较两种融合术式对腰椎失稳节段稳定性及相邻节段的力学影响.方法 用有限元方法建立切除腰椎单节段退变L4-5椎间小关节内侧2/3及相应椎板的L3-S1术后失稳模型,在此基础上模拟腰椎后外侧融合术(PLF)和后路腰椎椎间融合术(PLIF),记录手术前后失稳节段(L4-5)在生理载荷下的运动范围(ROM)变化,并记录生理载荷下相邻节段(L3-4、L5-S1)的ROM变化以及垂直载荷下相邻节段椎间盘Von Mises应力变化.结果 两种术式术后失稳节段(L4-5)的稳定性均得到明显恢复.与失稳模型L4-5节段ROM相比,PLF模型前屈、后伸、侧向旋转ROM分别减少了87%、87%和88%;PLIF模型前屈、后伸、侧向旋转ROM分别减少了85%、84%和86%.与失稳模型相比,两种术式均未导致相邻节段(L3-4、L5-S1)的(ROM)增大;相邻节段椎间盘Von Mises应力集中部位由纤维环后部转向前外侧,同时应力较术前失稳模型明显增大,两种术式对相邻节段椎间盘力学影响的差异无统计学意义[(1.056±0.061)mPa比(1.070±0.075)mPa;(1.147±0.055)mPa比(1.162±0.075)mPa,P>0.05].结论 PLF和PLIF均可恢复腰椎椎板减压术后失稳节段的稳定性,两种术式均可增加相邻椎间盘的应力,可能和术后相邻节段椎间盘退变相关.%Objective To explore the effects of posterolateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF) on the stability of postoperative unstable single lumbar segment and the biomechanical alterations of the adjacent segments.Methods A finite element model of L3-S1 segments with a single segmental degeneration at the L4-5 level was established, and the model of L4-5 segmental instability after posterior laminectomy and facetectomy was also established, in which laminar and interior 2/3 area of bilateral facet joints were resected.Physical loads were applied to the models and the changes

  13. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  14. Herniated Lumbar Disc

    Science.gov (United States)

    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 ...

  15. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  16. 腰椎融合术后症状性相邻节段退变原因及再手术治疗%Cause analysis and reoperations of symptomatic adjacent segment degeneration after lumbar fusion surgery

    Institute of Scientific and Technical Information of China (English)

    赵广民; 李放

    2013-01-01

      Objective To analyze the causes and operation results of symptomatic adjacent segment degeneration ( ASD ) after lumbar fusion surgery. Methods 15 patients with ASD after lumbar fusion surgery were treated in our department from January 2011 to May 2012. The interval from primary operation to revision surgery was 6.7 years on average ( range; 6.1-8.3 years ). When the symptoms were relieved after the primary operation, clinical manifestations were back pain, radiating pain of lower limps, numbness and intermittent claudication from 6 to 12 months before the second operation. The imaging findings were disc herniation, spinal stenosis and instability of degenerative segments in the proximal or distal adjacent motion segments. The revision surgery was needed, due to the poor conservative treatment results. Bony fusion in fused segments was confirmed in 10 patients by CT reconstruction. The primary internal fixator was removed, and laminectomy was performed in adjacent segments. Partial disc herniation sides or the whole articular process was taken out, and the disc was resected. Intervertebral body fusion and internal fixation were carried out. Fusion failure in fused segments was found in 4 cases, and the primary internal fixator was reserved. Laminectomy was expanded upwards, and extended implantation was used, with intervertebral body fusion. 1 patient had unconfirmed fusion, and the primary internal fixator was taken out. The Dynesys dynamic pedicle screws were fixed, which were then extended to the proximal adjacent segments. The average operation time was 160 minutes, and the average blood loss during the surgery was 560ml. All patients were followed up for 6-18 months postoperatively. The visual analogue scale ( VAS ) was used to evaluate the relief of back and leg pain, and the oswestry disability index ( ODI ) was used to assess the living ability of the patients after the surgery. Results All patients had successful operations. 1 patient developed

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Freeze-dried fibular allograft in anterior spinal surgery: cervical and lumbar applications.

    OpenAIRE

    Wetzel, F.T.; Hoffman, M. A.; Arcieri, R. R.

    1993-01-01

    Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assi...

  19. Return to Play After Lumbar Spine Surgery.

    Science.gov (United States)

    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

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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

  1. Outcomes of minimally invasive transforaminal lumbar interbody fusion via Quadrant retractor versus conventional posterior open surgery for degenerative lumbar spine disease%微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较

    Institute of Scientific and Technical Information of China (English)

    闫国良; 纪振钢; 高浩然; 李存孝; 史锦华; 李红; 刘海潮; 钱济先

    2013-01-01

    助于早期功能恢复.%Objectives: To compare clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF group) via MAST Quadrant retractor vs conventional posterior open surgery(open group) for degenerative lumbar spine disease. Methods: From March 2008 to June 2010, 80 patients with single-level lumbar degenerative disease and failed with conservative treatment were enrolled in this study. All cases were divided into two groups randomly, with 40 patients in each group. There was no significant difference in age, gender, body weight, clinical diagnosis or the segment between the two groups (P>0.05). Minimally invasive transforaminal lumbar interbody fusion via MAST Quadrant retractor or the conventional posterior open surgery was performed randomly. The operation time, blood loss, postoperative drainage, hospital stay, creatine phos-phokinase(CPK) in serum, MRI-T2 relaxation time, visual analogue scores (VAS) for back and leg pain, Os-westry disability index(ODl), and fusion rate by 24-36 months follow-up(mean time, 29 months) between two groups were compared. Results: The MIS-TLIF group had similar operation time to the open surgery group (141.0±27.3min vs 139.5±33.7min, P>0.05). Intraoperative blood loss, postoperative drainage in MIS-TLIF group was 268.0±122.2ml and 25.6±32.4ml, which was significantly less than 370.0±147.1ml and 277.8± 167.4ml of the open group, respectively (P0.05). The CPK levels were significantly higher at 1, 3, 5 days after surgery(P0.05). Conclusions: Minimally invasive transforaminal lumbar interbody fusion via MAST Quadrant retractor surgery and conventional posterior open surgery both can achieve a good short-term efficiency, but the former surgery had less soft tissue intervention, and conducive to early functional recovery.

  2. Congenital Lumbar Hernia

    Directory of Open Access Journals (Sweden)

    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

  3. Analysis of adjacent segment degeneration with laminectomy above a fused lumbar segment.

    Science.gov (United States)

    Gard, Andrew P; Klopper, Hendrik B; Doran, Stephen E; Hellbusch, Leslie C

    2013-11-01

    Although recent data suggests that lumbar fusion with decompression contributes to some marginal acceleration of adjacent segment degeneration (ASD), few studies have evaluated whether it is safe to perform a laminectomy above a fused segment. This study investigates the hypothesis that laminectomy above a fused lumbar segment does not increase the incidence of ASD, and assesses the benefits and risks of performing a laminectomy above a lumbar fusion. A retrospective review of 171 patients who underwent decompression and instrumented fusion of the lumbar spine was performed to analyze the association between ASD and laminectomy above the fused lumbar segment. Patients were divided into two groups - one group with instrumented fusion alone and the other group with instrumented fusion plus laminectomy above the fused segment. Of the 171 patients, 34 underwent additional decompressive laminectomy above the fused segment. There was a significant increase in ASD incidence as well as progression of ASD grade in both groups. There was no significant increase in ASD in patients with decompressive laminectomy above the fused lumbar segment compared to patients with laminectomy limited to the fused segment. This retrospective review of 171 patients who underwent decompression and instrumented fusion with follow-up radiographs demonstrates that laminectomy decompression above a fused segment does not significantly increase radiographic ASD. There is, however, a significant increase in ASD over time, which was observed throughout the entire cohort likely representing a natural progression of lumbar spondylosis above the fusion segment.

  4. 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

    Institute of Scientific and Technical Information of China (English)

    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 .

  5. PELD 与 TLIF 治疗腰椎间盘突出症并神经根管狭窄疗效比较%Comparison of clinical effects between percutaneous endoscopic lumba r discectomy and transforaminal lumbar int erbody fusion in the treatment of lumbar disc herniation and nerve root canal stenosis

    Institute of Scientific and Technical Information of China (English)

    禤天航; 曹正霖; 关宏刚; 王刚; 肖隆艺; 付忠泉

    2015-01-01

    目的:比较经皮椎间孔镜髓核摘除术( PELD)和经椎间孔入路腰椎体间融合术( TLIF)治疗腰椎间盘突出症并神经根管狭窄的临床疗效。方法根据治疗方法不同将38例腰椎间盘突出症并神经根管狭窄患者分为2组:17例行PELD术治疗者作为PELD组,21例行TLIF术治疗者作为TLIF组,2组均随访12个月。比较2组手术完成情况,术中及术后并发症发生情况,治疗前后VAS评分、ODI评分变化,随访12个月手术疗效。结果 PELD组手术切口小于TLIF组(P<0.05),手术时间、住院时间均短于TLIF组(P均<0.05)。2组并发症发生率比较差异无统计学意义。 PELD组术后1 d VAS评分明显低于TLIF组( P<0.05),2组术后1,6,12个月VAS评分比较差异无统计学意义。2组术后12个月ODI评分及改良Macnab疗效评价优良率比较差异均无统计学意义。结论 PELD与TLIF均是治疗腰椎间盘突出症并神经根管狭窄的有效手段。尽管前者学习曲线更陡峭,但其相对于后者更具微创性,对邻近节段的影响更小。%Objective It is to compare the clinical effects between the percutaneous endoscopic lumbar discectomy (PELD) and transforaminal lumbar interbody fusion(TLIF) in the treatment of lumbar disc herniation and nerve root canal stenosis .Methods 38 patients with lumbar disc herniation and nerve root canal stenosis were divided into two groups according to their treatment method:17 cases treated with PELD as PELD group, and other 21 patients received TLIF as TLIF group, both the two groups were followed up for 12 months.The operation finishing, occurrence of complications during and after sur-gery, the changes of visual analogue scale(VAS) and Oswestry disability index(ODI) before and after the operation were com-pared between the two groups.Results The cut area of PELD group was smaller while operation time and hospitalizaion time were shorter than that of TLIF

  6. Predictive value of intraoperative nerve monitoring for posterior lumbar interbody fusion%不同术中神经监测方法对后路腰椎椎间融合手术的预测作用

    Institute of Scientific and Technical Information of China (English)

    史图龙; 汪萌; 薛静; 彭江; 薛丽娟; 尚咏

    2015-01-01

    目的 比较体感诱发电位(somatosensory evoked potential,SEP)、运动诱发电位(motor evoked potential,MEP)和肌电图(electromyography,EMG)不同组合监测方式对腰椎后路椎板减压椎弓根螺钉固定椎体融合术(posterior lumbar interbody fusion,PLIF)术后结果的预测作用.方法 回顾性研究空军总医院骨科腰椎后路椎管减压融合术临床资料117例,其中66例行SEP+ EMG监测,51例采用MEP+ EMG监测.根据术中监测情况,并与术后结果疗效进行比较,并行统计学分析.结果 MEP+ EMG组手术时间明显少于SEP+ EMG组(P<0.05).SEP+ EMG组患者中,3例出现假阴性,8例为假阳性,1例出现监测信号引出不满意,共3例出现术后症状加重.在MEP+ EMG组中,2例未能引出信号,其中1例术后症状加重.两组监测方法对术后疗效准确性的比较有统计学意义(P<0.05).结论 MEP+ EMG监测反应灵敏,对腰椎融合术的手术结果及疗效有良好的预测作用,且对手术时间的影响更小.

  7. Effect of circumferential wave number on stability of suspension flow

    Directory of Open Access Journals (Sweden)

    Wang Feng-Hui

    2014-01-01

    Full Text Available The linear stability analysis is carried out for the suspension flow of spherical particles between a rotating inner cylinder and a stationary concentric outer cylinder. The mass conservation equation and Navier-Stokes equation are applied to the continuous fluid phase and the particle phase. Results of stability analysis show that the increase of wave number in the circumferential direction attenuates the effect of the axial wave number on the amplification factor. The ratio of particle density to fluid density increasing above 0.1 amplifies the flow instability, while it can be weakened with higher circumferential direction wave number. Effect of the critical Taylor number on the amplification factor is reduced by increasing the circumferential direction wave number. The flow stability is affected by the geometry of flow field (the radius ratio at non-zero circumferential direction wave numbers.

  8. 不同融合节段后路减压椎间融合内固定术对邻近节段稳定性影响的影像学分析%Radiologic stability analysis of adjacent segments after different fusion segments of posterior lumbar interbody fusion

    Institute of Scientific and Technical Information of China (English)

    刘玉增; 海涌; 杨晋才; 关立

    2013-01-01

    Objective To investigate the radiologic stability of adjacent segments after single, double and triple fusion segments of posterior lumbar interbody fusion ( PLIF ). Methods All 45 patients who were treated by PLIF were divided into 3 groups, including group A of single segment, group B of double segments and group C of triple segments, with 15 patients in each group. The effects on the stability of adjacent segments after fusion were retrospectively analyzed. The preoperative and postoperative lumbar lordosis angle and range of motion ( ROM ) of upper adjacent segments were measured. Results The results showed the lumbar ROM was decreased in the latest follow-up when compared with that preoperatively by 10.4° in group A, 11.4° in group B and 16° in group C on average. And the ROM of adjacent segments was increased in the latest follow-up when compared that preoperatively by 2.1° in group A, 1.9° in group B and 8.1° in group C on average. The preoperative ROM of adjacent segments was ( 3.6±2.0 ) °, ( 8.4±5.5 ) ° and ( 5.0±4.5 ) ° in group A, group B and group C, and the postoperative ROM was ( 6.5±1.6 ) °, ( 9.8±9.5 ) ° and ( 13.0±7.6 ) ° respectively. The differences between the preoperative and postoperative ROM in each group were statistically signiifcant ( P<0.01 ), and the differences of the postoperative ROM among all groups were statistically signiifcant ( P<0.01 ). Conclusions With the adding of fusion segments, the ROM of adjacent segments also increases. Based on the preoperative lumbar lordosis angle, a modest recovery of the physiological lordosis angle is achieved during the operation. It is an effective method to maintain the stability of adjacent segments.%目的探讨单节段、双节段和三节段后路椎间融合器置入椎弓根内固定术( posterior lumbar interbody fusion,PLIF )对融合节段邻近节段稳定性的影响。方法回顾性单节段( A组),双节段( B组)和三节段( C组) PLIF,共45例,对融

  9. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  10. 腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病%Clinical application of anterior lumbar interbody fusion assisted with laparoscopic

    Institute of Scientific and Technical Information of China (English)

    王文军; 贺更生; 晏怡果; 姚女兆; 王麓山; 王程; 韩东

    2011-01-01

    目的 探讨腹腔镜辅助腰椎前路椎间融合术治疗腰椎退变性疾病的疗效.方法 2006年1月至2009年6月腰椎退变性疾病患者37例行腹腔镜辅助腰椎前路椎间融合,男22例,女15例;年龄16~55岁,平均43.7岁.全部病例行血管造影三维CT检查、17例行椎间盘造影检查,确定责任椎间盘为L5S121例,L4-5 11例,L3-4 2例,L2-3 2例,L1-2 1例.29例经腹腔人路、8例经腹膜后入路行椎间盘切除及椎间融合器融合,3例以骨盆重建钛板固定.术后3、6、12个月通过X线或CT观察植骨融合情况,3个月时采用中华医学会骨科学分会脊柱学组腰背痛手术评分评价疗效.结果 手术时间60~140 min,平均100 min;术中出血50~300 ml,平均120 ml;住院时间7~12d,平均8d.2例经腹腔入路患者出现麻痹性肠梗阻.全部病例随访6~35个月,平均18.7个月.疗效为优23例、良11例、差3例,优良率91.9%(34/37).23例于术后3个月、12例于术后6个月植骨融合;2例术后6个月时椎间前缘高度丢失1.3mm和1.9 mm,无明显不适症状,术后12个月植骨融合.无内植物松动、脱落等并发症.结论 腹腔镜辅助腰椎前路椎间融合术创伤小、卧床时间短、并发症少.经腹腔入路术后肠梗阻相对多见.在选择手术入路时应考虑术者经验和下腰椎前方大血管的解剖位置.%Objective To evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.Methods From January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years (range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody

  11. 腰椎退变性疾病患者行腰椎融合术后居家康复行为及影响因素的前瞻性纵向研究%Rehabilitation Behaviors and the Influencing Factors of Patients with Lumbar Degeneration undergone Lumbar Spine Fusion Surgery:A Prospective Cohort Study

    Institute of Scientific and Technical Information of China (English)

    耿笑微; 朱薇; 许蕊凤; 孙垂国

    2012-01-01

    Objective To investigate the change characteristics of rehabilitation behaviors and the influential factors of patients with lumbar degeneration disease who underwent lumbar spine fusion surgery within one year. Methods The prospective cohort study and questionnaire survey were employed. The data of the patients 1 month, 3 months, 6 months, and 12 months after the surgery were collected by telephone interview or personal interview. The main contents of follow - up included the performance of major rehabilitation behavior and the self - evaluated influential factors. Results A total 169 patients had been followed up successfully. ( 1 ) 85. 8% ( 145/169 ) and 92. 3% ( 156/169 ) of the patients had been doing " ankle - pump" exercise and " straight leg raising" exercise every day respectively within one month after the treatment; 91. 1% ( 154/169 ) had been practicing exercise to strengthen the low back muscle after the surgery; however only 45. 5% ( 70/154 ) of them kept the practicing for more than 6 months. ( 2 ) During the first 3 months after surgery, the crucial influential factors for the patients were " possible low back pain or leg pain w"hen exercising" , " possible break - up of internal fixation w"hen exercising" and " pain around the operative incision when exercising" , of which for 84 patients was in one - month and for 114 patients in three - month after the surgery. Conclusion The compliances of " ankle - pump" and" straight leg raising" behaviors are good generally. However, the consistency of exercise to strengthen the low back muscle is poor. The main crucial influential factors to the pot - operative rehabilitation behavior are the pain or harmful result possibly induced by the exercise during the first 3 months after the surgery. This implicates that the community intervention is indispensable for patients who underwent the lumbar spine fusion surgery.%目的 了解腰椎退变性疾病患者行腰7椎融合术后1年内居家康复行为的变

  12. Rationale of Revision Lumbar Spine Surgery

    OpenAIRE

    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 ...

  13. Clinical comparative evaluation of hybrid dynamic stabilization with posterior spinal fusion versus single-level fusion in treatment of lumbar degenerative diseases%腰椎融合辅以邻近节段动态固定与腰椎融合治疗腰椎退行性疾病早期疗效的对比观察

    Institute of Scientific and Technical Information of China (English)

    施荣茂; 王浩明; 陈道森; 李瀚卿; 邸宁; 代飞; 罗飞; 许建中; 周强

    2013-01-01

    Objective To evaluate the clinical value of hybrid dynamic stabilization with posterior spinal fusion (a topping-off surgery) in treatment of lumbar degenerative diseases by comparing with that of single-level fusion.Methods Twenty-seven patients with preoperative adjacent segment degeneration were given hybrid dynamic stabilization with posterior spinal fusion (topping-off surgery,TOS group),and 30 patients without preoperative adjacent segment degeneration were given single-level fusion (SLF group).The clinical efficacy was evaluated and compared by visual analogue scale (VAS),Oswestry disability index (ODI),range of motion (ROM) of global lumbar spine,ROM of adjacent segments,intervertebral space ratio (ISR),ROM of index level (the level dynamically stabilized by Isobar),and the incidence of adjacent segment degeneration (ASDeg).Results All the patients were followed up for 12-40 months.VAS and ODI score were significantly improved in both two groups,but the difference between the two groups was not significant.The ROM of global lumbar spine was not significantly different between the two groups at the last follow-up.The ISR of index level was not significantly different before operation and at the last follow-up.The ROM of first cranial adjacent segment increased significantly at the last follow-up in both two groups.No progression of degeneration was observed in the index levels during the follow-up.Adjacent segment instability was observed in 7 patients of the TOS group and 5 patients of the SLF group,the incidence of adjacent segment instability was no significant difference between the two groups.Looseness or breakage of fixation system was observed in two patients of the TOS group.Conclusion Hybrid dynamic stabilization with posterior spinal fusion achieves satisfying clinical efficacy during early follow-up,but the incidence of fixation system failure may be higher than the single-level fusion,suggesting selection of appropriate indications is important

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    OpenAIRE

    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).

  16. The anatomic study and clinical significance of the modified transforaminal lumbar interbody fusion%改良经椎间孔腰椎椎体间融合术的解剖学研究及临床意义

    Institute of Scientific and Technical Information of China (English)

    姜建元; 马昕; 吕飞舟; 王洪立; 陈文钧; 马晓生; 夏新雷

    2009-01-01

    目的 对传统的经椎间孔腰椎椎体间融合术(TLIF)进行改良并探讨其临床意义.方法 在12具新鲜成人尸体上完成传统后路腰椎椎体间融合(PLW)和THF术式,扩大解剖显露周围结构,根据解剖学研究发现提出改良TLIF手术方式,并在12具新鲜尸体上操作、完成该术式,对其可行性及潜在优势进行分析.结果 前期的解剖学研究发现传统PLIF和TLIF手术在行椎间融合时相应神经根张力较高,存在一定的损伤风险,同时发现在一侧上关节突与棘突及棘间韧带等中间结构之间存在一定的可操作区域.提出了将PLIF工作区域外移,TLIF工作区域内移的改良TLIF手术人路,即:采取后正中入路,保留棘突、椎板上缘、棘上、棘间韧带等后结构,剥离双侧椎旁肌,暴露椎板及关节突关节,不暴露横突,切除一侧下关节突及椎板下2/3(暴露上关节突关节面),单侧斜向处理椎间隙而行椎体间融合.在12具新鲜成人尸体上顺利模拟完成了改良TLIF手术,结果显示该术式具有以下优势:(1)不必暴露横突,保留棘突、椎板上缘、棘上、棘间韧带等后结构,仅咬除一侧下关节突及椎板下2/3;(2)中央管及术侧侧隐窝及神经根管可同时有效减压;(3)斜向处理目标椎间隙,后正中结构的保留有效地限制了对硬膜囊及下位神经根的牵拉,术中无需暴露上位神经根,不易损伤上位神经根.结论 改良TLIF手术入路安全可行,理论上可以有效地降低神经根损伤的发生率,对于绝大多数国人腰椎疾患患者可能是一个较理想的选择.%Objective To put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance. Methods Completed the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to

  17. Operative Management of Lumbar Degenerative Disc Disease

    Science.gov (United States)

    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

  18. Operative Management of Lumbar Degenerative Disc Disease.

    Science.gov (United States)

    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

  19. Dynamic stabilization for degenerative spondylolisthesis and lumbar spinal instability.

    Science.gov (United States)

    Ohtonari, Tatsuya; Nishihara, Nobuharu; Suwa, Katsuyasu; Ota, Taisei; Koyama, Tsunemaro

    2014-01-01

    Lumbar interbody fusion is a widely accepted surgical procedure for patients with lumbar degenerative spondylolisthesis and lumbar spinal instability in the active age group. However, in elderly patients, it is often questionable whether it is truly necessary to construct rigid fixation for a short period of time. In recent years, we have been occasionally performing posterior dynamic stabilization in elderly patients with such lumbar disorders. Posterior dynamic stabilization was performed in 12 patients (6 women, 70.9 ± 5.6 years old at the time of operation) with lumbar degenerative spondylolisthesis in whom % slip was less than 20% or instability associated with lumbar disc herniation between March 2011 and March 2013. Movement occurs through the connector linked to the pedicle screw. In practice, 9 pairs of D connector system where the rod moves in the perpendicular direction alone and 8 pairs of Dynamic connector system where the connector linked to the pedicle screw rotates in the sagittal direction were installed. The observation period was 77-479 days, and the mean recovery rate of lumbar Japanese Orthopedic Association (JOA) score was 65.6 ± 20.8%. There was progression of slippage due to slight loosening in a case with lumbar degenerative spondylolisthesis, but this did not lead to exacerbation of the symptoms. Although follow-up was short, there were no symptomatic adjacent vertebral and disc disorders during this period. Posterior dynamic stabilization may diminish the development of adjacent vertebral or disc disorders due to lumbar interbody fusion, especially in elderly patients, and it may be a useful procedure that facilitates decompression and ensures a certain degree of spinal stabilization.

  20. Early clinical results of channel-assisted combined fixation and interbody fusion for treating lumbar vertebra diseases by muscle-splitting approach%通道下肌间隙入路椎间融合术治疗腰椎病变的近期疗效

    Institute of Scientific and Technical Information of China (English)

    曾忠友; 宋永兴; 吴鹏; 严卫锋; 籍剑飞; 张建乔; 毛克亚

    2015-01-01

    Objective To explore the feasibility and effectiveness of channel-assisted spatium intermusculare approach interbody fusion for treating lumbar vertebra diseases.Methods A total of 81 patients with lumbar vertebra diseases were treated from June 2012 to December 2013,including 35 males and 46 females between 29 and 76 years old with an average age of 54.6.There were 36 cases of lumbar disc degeneration,10 cases of recurrence in situ after lumbar disc herniation surgery,6 cases of huge lumbar disc herniation,11 cases of lumbar disc herniation with spinal canal stenosis,5 cases of extreme lateral lumbar disc herniation and 13 cases of lumbar degenerative spondylolisthesis.There were 67 cases of single segment lesion and 14 cases of two segment lesions.Lesion sites contained L1,2 in 1 case,L3,4 in 4 cases,L4,5 in 50 cases,L5S1 in 12 cases,L3,4 and L4,5 in 8 cases,and L4,5 and L5S1 in 6 cases.Results The length of incision was 2.42±0.45 cm in cases of single segment lesion and 4.28±0.38 cm in cases of two segment lesions.The operation time was 96.00±21.53 minutes and intraoperative blood loss was 347.50± 241.62 ml.During the operation,one case suffered from dural laceration,cerebrospinal fluid leakage and ipsilateral nerve root injury.Two cases suffered from pedicle fractures.Eight cases experienced epidermal necrosis of the incision.One case had poor wound healing.Three cases suffered from nerve injury.A total of 76 patients were followed up for 12-30 months,averagely 20.5 months.Intervertebral height of lesion segments was apparently recovered after surgery,and maintained in good condition during the final follow-up.No significant difference in the changes of area and grade of multifidus was detected 12 months after surgery and before surgery.Except 4 cases,the remaining had interbody fusion with a fusion rate of 94.7%.The balance between the coronal plane and sagittal plane of the lumbar spine was evidently improved.Average Japanese Orthopaedic Association

  1. Structural and leakage integrity of tubes affected by circumferential cracking

    Energy Technology Data Exchange (ETDEWEB)

    Hernalsteen, P. [TRACTEBEL, Brussels (Belgium)

    1997-02-01

    In this paper the author deals with the notion that circumferential cracks are generally considered unacceptable. He argues for the need to differentiate two facets of such cracks: the issue of the size and growth rate of a crack; and the issue of the structural strength and leakage potential of the tube in the presence of the crack. In this paper the author tries to show that the second point is not a major concern for such cracks. The paper presents data on the structural strength or burst pressure characteristics of steam generator tubes derived from models and data bases of experimental work. He also presents a leak rate model, and compares the performance of circumferential and axial cracks as far as burst strength and leak rate. The final conclusion is that subject to improvement in NDE capabilities (sizing, detection, growth), that Steam Generator Defect Specific Management can be used to allow circumferentially degraded tubes to remain in service.

  2. Circumferential gap propagation in an anisotropic elastic bacterial sacculus

    CERN Document Server

    Taneja, Swadhin; Rutenberg, Andrew D

    2013-01-01

    We have modelled stress concentration around small gaps in anisotropic elastic sheets, corresponding to the peptidoglycan sacculus of bacterial cells, under loading corresponding to the effects of turgor pressure in rod-shaped bacteria. We find that under normal conditions the stress concentration is insufficient to mechanically rupture bacteria, even for gaps up to a micron in length. We then explored the effects of stress-dependent smart-autolysins, as hypothesised by Arthur L Koch [Advances in Microbial Physiology 24, 301 (1983); Research in Microbiology 141, 529 (1990)]. We show that the measured anisotropic elasticity of the PG sacculus can lead to stable circumferential propagation of small gaps in the sacculus. This is consistent with the recent observation of circumferential propagation of PG-associated MreB patches in rod-shaped bacteria. We also find a bistable regime of both circumferential and axial gap propagation, which agrees with behavior reported in cytoskeletal mutants of B. subtilis. We con...

  3. GUIDED CIRCUMFERENTIAL WAVES IN DOUBLE-WALLED CARBON NANOTUBES

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A model of guided circumferential waves propagating in double-walled carbon nanotubes is built by the theory of wave propagation in continuum mechanics, while the van der Waals force between the inner and outer nanotube has been taken into account in the model. The dispersion curves of the guided circumferential wave propagation are studied, and some dispersion characteristics are illustrated by comparing with those of single-walled carbon nanotubes. It is found that in double-walled carbon nanotubes, the guided circumferential waves will propagate in more dispersive ways. More interactions between neighboring wave modes may take place. In particular, it has been found that a couple of wave modes may disappear at a certain frequency and that, while a couple of wave modes disappear, another new couple of wave modes are excited at the same wave number.

  4. The activL® Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain

    OpenAIRE

    Yue, James J.; Garcia, Rolando; Miller, Larry E.

    2016-01-01

    Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR) or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration − the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR receive...

  5. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  6. The histological evaluation of the effect of autologous bone marrow in osteogenous inducement in lumbar intertransverse spinal fusion in rabbits%自体骨髓在兔腰椎横突间融合中诱导成骨的组织学评估

    Institute of Scientific and Technical Information of China (English)

    苏旻罡; 刘志国; 夏铁成; 郝建学; 张建鹏

    2012-01-01

    Objective To investigate the effect of autologous bone marrow augmentation in osteogenous inducement in lumbar intertransverse spinal fusion in rabbits. Methods 24 Chinese white rabbits with skeletal maturation ( 3.0 ~3.5kg) were enrolled in the study. A single - level posterolateral intertransverse process lumbar spine fusion was performed at L5 ~ 6, and corticocancellous bone graft was placed equally in the each side of intertransverse process bed. The 2ml autogenous bone marrow in experimental group was taken out from another iliac crest. The rabbits were killed after 4,8 and 12 weeks,and the spine specimens were excised and analyzed by histological method. Results Intramembranous ossification and endochondral ossification could be observed at different time points both in experimental group and control group. The intramembranous ossification was predominant in experimental group,however,more endochondral ossification was found in control group,with more fibrous tissues showed in sections. Conclusion Autogenous bone marrow is a reliable and effective bone transplantation extender in the animal model of posterolateral intertransverse lumbar spine fusion in rabbits, which can acquire preferable fusion result,with the application of limited autoallergic iliac bone graft.%目的 研究自体骨髓在兔腰椎横突间融合中的诱导成骨作用.方法 骨骼成熟的中国白兔24只,行双侧腰5~6椎体横突间植骨融合.实验组除植入髂骨外,取2 ml自体骨髓植入融合区.不同时期处死动物,脊柱标本应用组织学方法分析.结果 各时期组织学检查显示:实验组和对照组标本切片中均可见到膜内成骨和软骨成骨两种成骨方式,实验组标本中膜内成骨明显占优势,对照组则以软骨成骨为主,此组切片中可见到更多的纤维组织.结论 兔腰椎横突间融合模型中,自体骨髓是一种有效可靠的骨移植添加物,可在应用有限自体髂骨植骨的情况下,获得更好的融合效果.

  7. Factores de riesgo que afectan la fusión en el tratamiento de la inestabilidad en la columna lumbar Fatores de risco que afetam a fusão no tratamento da instabilidade na coluna lombar Risk factors affecting the fusion in the lumbar spine instability treatment

    Directory of Open Access Journals (Sweden)

    José María Jiménez Ávila

    2010-09-01

    the risk factors that affect the vertebral fusion in the lumbar spine instability, in patients attended in our hospital that are related to nutritional aspects. METHODS: A total of 59 patients were reviewed of whom 15 (25.4% were cases (pseudoartrosis, and 44 (74.6% were controls (fusion. The population distribution presented patients, of which 27 (45.8% were female and 32 (54.2%, male. The average age was 51 with a 12 standard deviation, a minimum of 20 and a maximum of 85 years old. Distribution by diagnosis was 29 (49.1% spondylolisthesis, 21 (35.6% fractures, 5 (8.5% herniations, 3 (5.1% infections, and 1 (1.7% tumor. The average weight was 75.9 kg, with 1.60 cm height, BMI of 24.5, a Hb of 15.2, Hto of 35.9, and 3.5 albumin. RESULTS: several risk factors were analyzed between ages higher than 60 years, it showed a 49% more likely to a pseudoartrosis in comparison with the Control Group with a 95% CI=0.12-2.27. More than 90 kg of weight showed 82% more likely to a pseudoartrosis in comparison with the Fusion Group, having as a 95% CI=0.03-0.43, the BMI shows 25% more likely to a pseudoartrosis with a 95% CI=0.18-3.18, hypoalbuminemia less than 3.4 mg/100 mL showed a 78% more likely to the pseudoartrosis (95% CI=0.06-0.75. CONCLUSIONS: the pseudoartrosis is caused by risk factors associated with the nutrient profile, like the obesity itself, the hypoalbuminemia and there is a probability to present 1.5 times more than the values of ordinary people. Thus, it is important that these values are evaluated and fixed before in the pre-surgical with support measures that allows adequate metabolic and, consequently, an optimal outcome, such as fusion. EVIDENCE LEVEL: study case-control with a level III of evidence.

  8. 椎间盘镜下可膨胀性椎间融合器B-Twin椎间融合术治疗退变失稳性腰椎间盘突出症%Using of Microendoscopic Decompression and Interbody Fusion with B-Twin to Treat the Unstable Herniation of Lumbar Disc with Degeneration

    Institute of Scientific and Technical Information of China (English)

    胡安文; 罗光平; 肖业生; 杨长远

    2011-01-01

    Objective To investigate the efficacy of microendoscopic decompression and interbody fusion with B-twin to treat the patients with degenerative lumbar disc herniation with a unstable spine. Methods From June 2005 to June 2008, 32 cases of unstable herniation of the lumbar disc with degeneration received microendoscopic decompression and interbody fusion with expandable spinal spacer of B-Twin. Results Thirty two case VAS pain score decreased from 8.7±0.3 to 2.3±1.7 (t=7.580,P<0.01). The patients were followed up for a mean of 25±3.3 months, According Suk judgement criterion, 1-year fusion rate was 93.8% (30/32), and the 2-year fusion rate was was 96.9%(31/32).No patients showed subsidence of the B-Twin. Conclusion Microendoscopic decompression and interbody fusion with B-Twin is minimal invasive and higher interbody fusion and can obtain a satisfactory outcome.%目的 探讨后路显微椎间盘镜下可膨胀性椎间融合器B-Twin植入椎间融合术治疗腰椎退变失稳性椎间盘突出症的临床疗效.方法 2005年6月~2008年6月,对32例腰椎退变失稳性巨大型椎间盘突出症行后路显微椎间盘镜联合可膨胀性椎间融合器B-Twin植入椎间融合术.结果 术后1周VAS疼痛评分由术前(8.7±0.3)分降至术后(2.3±1.7)分(P<0.01).随访时间平均(25±3.3)个月,植骨融合率采用Suk标准判断:1年融合率为93.8%,2年融合率为96.9%.结论 后路显微椎间盘镜联合可膨胀性椎问融合器B-Twin植入椎间融合术治疗腰椎退变失稳性巨大型椎间盘突出症创伤小、植骨融合率高、临床效果满意.

  9. A Critical Appraisal of Circumferential Resection Margins in Esophageal Carcinoma

    NARCIS (Netherlands)

    Pultrum, Bareld B.; Honing, Judith; Smit, Justin K.; van Dullemen, Hendrik M.; van Dam, Gooitzen M.; Groen, Henk; Hollema, Harry; Plukker, John Th. M.

    2010-01-01

    In esophageal cancer, circumferential resection margins (CRMs) are considered to be of relevant prognostic value, but a reliable definition of tumor-free CRM is still unclear. The aim of this study was to appraise the clinical prognostic value of microscopic CRM involvement and to determine the opti

  10. Ultransonic circumferential waves in empty and water- filled tubes

    Science.gov (United States)

    Li, Xing

    Ultrasonic waves propagating in the circumference of elastic isotropic cylindrical shells are theoretically and experimentally studied. Dispersion relations of different circumferential modes, including the SH-type and Lamb-type families, are obtained by solving the wave equations numerically. Asymptotic solutions are also given for the SH-like modes. Various technologies are applied for generating and detecting the circumferential waves. In particular, a new approach is developed for experimental determination of the dispersion of the circumferential waves in cylindrical shells. With a chirp interdigital transducer (IDT) as a broadband transmitter and receiver made on a stainless steel tube coated with piezoelectric film, both the group and phase velocities of the circumferential waves are obtained over a wide frequency range, which covers the most sensitive region of the lowest flexural mode. Other transduction approaches are also used as complementary tools in the experiments. Experiments are carried out on both empty and fluid- loaded cylindrical shells at different frequencies. With the specially developed experimental configuration, propagation of a new flexural wave type in a water-filled tube is observed. Mode conversions are also observed between the A 0 mode in the shell and the compressional waves in the water. The results show good application potentials in liquid level sensing.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Partial Facetectomy for Lumbar Foraminal Stenosis

    Directory of Open Access Journals (Sweden)

    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.

  13. Access related complications during anterior exposure of the lumbar spine

    OpenAIRE

    Fantini, Gary A; Pawar, Abhijit Y.

    2013-01-01

    The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation (non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimal...

  14. Aspectos medicolegales y bioéticos de la cirugía instrumentada de la columna lumbar degenerativa: Implicaciones en el manejo del dolor crónico Medico-legal and bioethical aspects of fusion surgery in degenerative lumbar spine: Implications in pain management

    Directory of Open Access Journals (Sweden)

    F.J. Robaina Padrón

    2009-10-01

    marketing fraudulento en el campo del dolor está generando multas multimillonarias. Los resultados de este tipo de cirugía en el campo laboral son muy desalentadores. Son muy pocos los operados que recuperan una capacidad mínima para trabajar o refieren un alto nivel de funcionalidad física después de la operación. La investigación en este campo debe tender a la creación de organismos o consorcios nacionales que controlen y financien la investigación, sin intervención directa de la industria sobre el desarrollo de ésta. El incremento del gasto sanitario hace relevante los mecanismos de evaluación de tecnologías sanitarias. Para racionalizar y contabilizar analíticamente la financiación en la sanidad pública de este tipo de patología y técnicas quirúrgicas, se precisa la generación de nuevos grupos relacionados con el diagnóstico, específicos para dolor crónico, concretamente, para la cirugía instrumentada de columna lumbar en la enfermedad degenerativa. Las administraciones sanitarias, central y/o autonómica, son las responsables de estimular la creación de vías y guías clínicas para el manejo de estos pacientes, tanto en la medicina primaria como en la especializada. La acreditación de las unidades multidisciplinarias del dolor por parte de la Administración es una necesidad imperiosa, sobre todo en los hospitales generales donde se realice cirugía de columna instrumentada. La dotación necesaria de personal y tecnología de estas unidades deben ser las adecuadas, y están perfectamente definidas por las correspondientes sociedades científicas nacionales e internacionales.Evidence-based medicine has still not been able to demonstrate the advantages of surgical treatment over medical therapy in patients with chronic degenerative lumbar and sciatic pain. Personal, professional and economic conflicts are involved in this disorder, and are the subject of the present article. The reputation of certain physicians is seen as a desirable asset by

  15. Lumbar stenosis: clinical case

    Directory of Open Access Journals (Sweden)

    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.

  16. The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results.

    Science.gov (United States)

    Wong, Albert P; Smith, Zachary A; Lall, Rohan R; Bresnahan, Lacey E; Fessler, Richard G

    2012-01-01

    Lumbar stenosis is a well-defined pathologic condition with excellent surgical outcomes. Empiric evidence as well as randomized, prospective trials has demonstrated the superior efficacy of surgery compared to medical management for lumbar stenosis. Traditionally, lumbar stenosis is decompressed with open laminectomies. This involves removal of the spinous process, lamina, and the posterior musculoligamentous complex (posterior tension band). This approach provides excellent improvement in symptoms, but is also associated with potential postoperative spinal instability. This may result in subsequent need for spinal fusion. Advances in technology have enabled the application of minimally invasive spine surgery (MISS) as an acceptable alternative to open lumbar decompression. Recent studies have shown similar to improved perioperative outcomes when comparing MISS to open decompression for lumbar stenosis. A literature review of MISS for decompression of lumbar stenosis with tubular retractors was performed to evaluate the outcomes of this modern surgical technique. In addition, a discussion of the advantages and limitations of this technique is provided. PMID:22900163

  17. Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Birkelund, Lasse; Palm, Henrik;

    2012-01-01

    Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the under...

  18. 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

    Institute of Scientific and Technical Information of China (English)

    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

  19. Clinical curative effect observation of discectomy combined with posterolateral fusion for recurrent lumbar disc herni-ation%椎间盘摘除联合后外侧融合术治疗再发性腰椎间盘突出的疗效观察

    Institute of Scientific and Technical Information of China (English)

    栗宇鹏; 冯景茂; 王立强; 周朝波

    2015-01-01

    目的:观察椎间盘摘除联合外侧融合术治疗再发性腰椎间盘突出的临床疗效。方法200例腰椎间盘突出患者根据腰椎有无失稳分为研究组和对照组各100例。对照组患者100例术前无腰椎失稳、退变性滑脱,研究组患者100例合并腰椎失稳、退变性滑脱或椎管狭窄,对照组给予患者椎间盘摘除术治疗,研究组患者给予椎间盘摘除联合外侧融合术治疗,应用JOA、ODI、LBOS、VAS评分表进行评分并记录手术优良率。结果2组患者治疗后JOA、ODI、LBOS、VAS评分均显著优于治疗前(P<0.05),但组间比较差异无统计学意义(P>0.05)。研究组手术优良率为88%高于对照组的85%,但差异无统计学意义(P>0.05)。结论腰椎间盘突出症复发根据病情不同给予针对性治疗,椎间盘摘除联合外侧融合术可改善椎间盘功能,提高手术成功率。%Objective To observe the clinical curative effect of discectomy combined with posterolateral fusion for re -current lumbar disc herniation .Methods 200 patients with recurrent lumbar disc herniation were divided into study group and control group.100 patients who presented lumbar instability and degenerative spondylolisthesis or spinal stenosis were selected as study group .100 patients who did not present lumbar instability ,degenerative spondylolisthesis preoperatively were slected as control group.The study group was treated by discectomy combined with posterolateral fusion treatment ,and the control group was treated by discectomy ,application of JOA,ODI,LBOS,VAS scores were scored and recorded rate of surgical quality .Pa-tients′conditions were assessed by JOA ,ODI,LBOS,VAS score sheet,and surgery excellent rate was recorded .Results After treament,the JOA,ODI,LBOS,VAS score of the two groups were statistically better than before (P0.05).Surgery excellent rate of study group (88.00%) was high than that of control group (85

  20. Herniated lumbar disc

    OpenAIRE

    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.

  1. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  2. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  3. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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- ...

  4. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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. ...

  5. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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’ ...

  6. Ultrasound-assisted neuraxial anesthesia in a patient with previous lumbar laminecto-my and fusion:a case report%超声引导椎管内麻醉用于椎板切除内固定术后1例报道

    Institute of Scientific and Technical Information of China (English)

    耿姣; 李民

    2016-01-01

    SUMMARY A patient with previous L3 -4 posterior lumbar interbody fusion,pedicle screws instrumen-tation 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 her-niorrhaphy.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 ultra-sound 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)lido-caine 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 in-formation for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

  7. 单节段与多节段腰椎融合术后邻近节段退变的临床观察%Clinical observation on the incidence of adjacent segment degeneration after single or multi-level lumbar fusion surgery

    Institute of Scientific and Technical Information of China (English)

    王凌挺; 徐宏光; 王弘

    2014-01-01

    目的:探讨单节段与多节段腰椎融合术后邻近节段退变的临床观察。方法:选取2007年5月~2011年8月在我科诊疗并接受腰椎融合术的61例病例,根据手术方式不同,主要分为单节段组和多节段组。通过测量椎间隙高度JOA评分、Prolo功能评分以及Pfirrmann评分系统,对患者术前、术后以及2年后随访的情况进行评分。结果:两组术后JOA评分、Prolo功能评分明显优于术前,但在末次随访评分中,多节段组明显高于单节段组(P<0.05);末次随访多节段组患者上、下邻近节段的Pfirrmann评分均明显高于单节段组,而椎间隙高度则明显小于单节段组(P<0.05)。结论:腰椎融合术治疗效果显著,多节段融合术后邻近节段较单节段融合术更易发生退变,选择合适的手术方式可提升治疗效果,改善患者生活质量。%Objective:To observe the incidence of adjacent segment degeneration after single or multi-segmental lumbar fusion surgery .Methods:Sixty-one patients undergone lumbar fusion for degenerative disease between May 2007 and August 2011 in our department were allocated to treatment group with single-level arthrodesis or multi-segment fusion on the treatment policy basis .The impacts on the incidence of adjacent segment degeneration were evaluated by comparing the total scores with the two groups concerning the height of intervertebral space measured ,Japanese Orthopaedic Association(JOA) scoring, Prolo functional scale and Pfirrmann score before and after surgery as well as conditions in two years of follow-up.Results:The postoperative scores for JOA and Prolo function were significantly better than those before surgery ,yet the scores by the final follow-up were better in group with multiple segment fusion than those treated with single-level arthrodesis(P<0.05).In addition,final follow-up of patients with multiple segment interventions showed higher scores by

  8. Circumferential buckling instability of a growing cylindrical tube

    KAUST Repository

    Moulton, D.E.

    2011-03-01

    A cylindrical elastic tube under uniform radial external pressure will buckle circumferentially to a non-circular cross-section at a critical pressure. The buckling represents an instability of the inner or outer edge of the tube. This is a common phenomenon in biological tissues, where it is referred to as mucosal folding. Here, we investigate this buckling instability in a growing elastic tube. A change in thickness due to growth can have a dramatic impact on circumferential buckling, both in the critical pressure and the buckling pattern. We consider both single- and bi-layer tubes and multiple boundary conditions. We highlight the competition between geometric effects, i.e. the change in tube dimensions, and mechanical effects, i.e. the effect of residual stress, due to differential growth. This competition can lead to non-intuitive results, such as a tube growing to be thinner and yet buckle at a higher pressure. © 2011 Elsevier Ltd. All rights reserved.

  9. Application of nano-hydroxyapatite/collagen/poly(L-lactide) in posterolateral lumbar spine fusion: safety and effectiveness%纳米晶胶原基骨材料在腰椎后外侧植骨融合中的应用:安全性及效果

    Institute of Scientific and Technical Information of China (English)

    毛立川

    2015-01-01

    背景:腰椎后外侧植骨融合中需要进行植骨,但骨量常不够,需再取患者部分自体髂骨补充.目的:探讨纳米晶胶原基骨材料在腰椎后外侧植骨融合中的应用安全性及效果.方法:回顾性分析四川省眉山骨科医院2013年2月至2014年2月收治的52例腰椎退行性疾病患者的临床资料,均实施腰椎后外侧植骨融合治疗,术中所使用的植骨材料为患者自体骨颗粒混合纳米晶胶原基骨材料.结果与结论:52例患者中,内固定后伤口一期愈合的有 51例,患者局部皮肤均未出现皮温上升以及红肿、疼痛、流液等现象.患者内固定后功能和疼痛症状均得到不同程度的改善,对患者的内固定后植骨融合情况进行分析,可得内固定后3个月完全融合率达13%,内固定后6个月达54%,内固定后12个月达84%,且未出现假关节,随访12个月,所有患者均未出现螺钉松动或者移位等现象,对固定节段相临椎体情况进行检查,均未出现滑脱或者移位等情况.表明在腰椎后外侧植骨融合中应用纳米晶胶原基骨材料可以获得良好的效果,材料具有生物相容性及一定的安全性.%BACKGROUND:Bone grafting is often needed in posterolateral lumbar spinal fusion, but bone mass is often not enough to finish this operation. Part of the autologous iliac bones from patients are needed to take as supplement. OBJECTIVE:To investigate the safety and effectiveness of application of nano-hydroxyapatite/colagen/ poly(L-lactide) for posterolateral lumbar spine fusion. METHODS:The clinical data of 52 patients with lumbar degenerative disease who had received the treatment in Meishan Orthopedics Hospital of Sichuan Province, China during February 2013 to February 2014 were retrospectively analyzed. The patients al received posterolateral lumbar spine fusion with bone grafts made of autologous iliac bone particles and nano-hydroxyapatite/colagen/poly(L-lactide). RESULTS AND CONCLUSION

  10. Lumbar Stenosis: A Recent Update by Review of Literature.

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Hey Hwee Weng

    2010-01-01

    Full Text Available Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF and transforaminal lumbar interbody fusion (TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure.The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of

  12. Analysis of short-term surgical outcome of Cosmic dynamic non-fusion system for lumbar degenerative disease%Cosmic动态非融合系统治疗腰椎退变性疾病的短期疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘伟; 王杰; 蔡凯文

    2013-01-01

    目的 探讨Cosmic动态非融合系统在腰椎退变性疾病治疗中的短期疗效.方法 对22例腰椎退变性疾病在后路减压的同时行Cosmic动态非融合系统内固定术,并评价术后疗效.结果 术后随访8~24个月,平均14.5个月,术后临床疗效优17例、良4例,可l例.VAS疼痛评分术前(6.74±0.59)分,末次随访时(2.13±0.61)分.术前病变脊柱运动节段过伸过屈活动度(ROM) (8.39±2.72)°,末次随访时为(8.17±2.58)°.随访期间未见内固定松动和螺钉断裂现象.结论 采用Cosmic动态非融合内固定系统治疗腰椎退变性疾患具有手术操作简便、安全性高等优点,可减少对脊柱生理结构的破坏,维持节段稳定,减少远期腰椎退变和再次手术的风险,具有很好的临床应用前景.%Objective To analyze the short-term efficacy of the Cosmic dynamic non-fusion system in the treatment of lumbar degenerative disease.Methods The posterior decompression and simultaneously internal fixation with cosmic dynamic nonfusion system were performed in 22 patients with lumbar degenerative disease,and the curative effect was evaluated.Results The postoperative outcomes showed excellent in 17 cases,good in 4 cases and fair in 1 cases after mean follow-up of 2.6 years.VAS scores were decreased from (6.74±0.59) points preoperatively to (2.13±0.61) points at the last follow-up.The preoperative segmental range of motion(ROM) of the operative segments was (8.39±2.72) degrees,and was (8.17±2.58) degrees at the last follow-up.There was no screw loosening or rupture during the follow-up.Conclusion Cosmic dynamic non-fusion system for the treatment of lumbar degenerative disease has many advantages,easy to operate,high safety,etc.,and it can reduce the destruction of the spine,maintain segmental stability,reduce long-term lumbar degeneration and reoperation risk.Cosmic dynamic non-fusion system has a good clinical application prospect.

  13. Thoracic and Lumbar Tuberculosis by One-stage Anterior Debridement and a Fusion Fixation Failure Analysis.%胸、腰椎结核经前路手术病灶清除一期植骨融合内固定失败的原因分析

    Institute of Scientific and Technical Information of China (English)

    吴广森; 才晓军; 李宏伟; 田斌; 靳青

    2011-01-01

    目的 探讨分析胸、腰椎结核经前路手术病灶清除一期植骨融合内固定失败的原因.方法 回顾2006年1月~2011年1月11例胸腰椎结核经前路病灶清除一期植骨融合内固定失败来自笔者医院就诊和复治的患者,其中7例在笔者医院二次手术翻修,并经后路椎弓根系统内固定重建脊柱稳定性.结果 二次胸、腰段脊柱手术翻修和重建的7例患者全部临床康复,随访6个月~2年无结核复发、窦道形成和内固定再次失败等.结论 胸腰椎结核经前路手术病灶清除一期植骨融合内固定有一定失败率(笔者医院统计为3.7%),内固定手术的成功与失败与术者操作技术有明确相关性,此类高难度手术应由经过严格训练的资深医师完成,内固定失败后应及时翻修,二次脊柱稳定性重建选择后路经椎弓根固定具有明显优越性.%Objective Of analysis of thoracic and lumbar tuberculosis by one - stage anterior debridement and a fusion fixation failure. Methods From January 2006 to January 2011,11 cases of thoracic and lumbar tuberculosis by anterior debridement and a fusion with fixation failure to our hospital and retreated patients, including 7 cases of secondary surgery in our hospital renovation and posterior pedicle screw system fixation reconstruction of spinal stability. Results After the second thoracic and lumbar spine surgery renovation and reconstruction of the 7 patients with full clinical recovery, follow - up of 6 months to 2 years, no recurrence of tuberculosis, sinus formation and fixation failed again and so on. Conclusion Thoracic and lumbar tuberculosis by anterior debridement and a fusion with internal fixation have a failure rate (3. 7% , our hospital statistics). There is a clear correlation between success or failure of internal fixation and Surgeon's techniques. Such a difficult surgery should be highly trained senior doctors to complete. The failure of internal fixation should be

  14. Spontaneously disappearing lumbar disc protrusion

    OpenAIRE

    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.

  15. Incarcerated inferior lumbar (Petit's) hernia.

    Science.gov (United States)

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  16. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Science.gov (United States)

    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

  18. Effect comparison of unilateral and bilateral internal fixation combined with nucleus pulposus removal of intervertebral fusion operation treating lumbar disc herniation%单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果比较

    Institute of Scientific and Technical Information of China (English)

    王宁

    2015-01-01

    Objective To compare the effect of unilateral and bilateral internal fixation combined with nucleus pulposus removal of intervertebral fusion operation treating lumbar disc herniation. Methods 49 cases with single gap lumbar disc herniation treated with nucleus pulposus removal of intervertebral fusion operation from January 2010 to December 2012 in our hospital were retrospectively analyzed. Based the fixed way,patients were divided into unilateral fixation group and bilateral fixation group.The surgery time,intraoperative bleeding amount,hospital stay,hospital expense,VAS score of pain,Oswestry disability index (ODI) score,fusion rate and incidence rate of complication between two groups was compared respectively. Results Before operation,there was no statistical difference of VAS,ODI score between two groups (P>0.05),and VAS,ODI score of two groups was significantly reduced respectively at the last follow-up (P0.05).The surgery time in unilateral fixation group was ob-viously shorter than that of bilateral fixation group,intraoperative bleeding amount in unilateral fixation group was obvi-ously less than that of bilateral fixation group,hospital expense in unilateral fixation group was obviously lower than that of bilateral fixation group (P0.05). Conclusion The curative efficacy of unilateral and bilateral internal fixation interverte-bral fusion for single gap lumbar disc herniation is almost the same,but unilateral internal fixation has shorter operation time,less intraoperative bleeding amount and lower hospital expense.%目的:比较单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果。方法回顾性分析本院2010年1月~2012年12月行髓核摘除椎间融合固定术治疗的49例单间隙腰椎间盘突出症患者。依据固定方式将患者分为单侧内固定组和双侧内固定组。比较两组的手术用时、术中出血量、住院时间、住院费用、疼痛VAS评分、Oswestry功能障碍

  19. Lumbar hernia: a diagnostic dilemma.

    Science.gov (United States)

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

    2014-04-15

    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 and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.

  20. Conservative management of psoas haematoma following complex lumbar surgery

    Directory of Open Access Journals (Sweden)

    Sandesh Lakkol

    2014-01-01

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

  1. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  2. Minimally Invasive Lumbar Discectomy

    Medline Plus

    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 ...

  3. 后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响%Effect of the Posterior Ligament Complex on the Adjacent Segment Degeneration after Posterior Lumbar Interbody Fusion

    Institute of Scientific and Technical Information of China (English)

    何方生; 吴兵; 盛文辉; 王春辉; 王自刚; 尚琦松; 韩鹏远; 陈操

    2016-01-01

    目的 探讨后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响.方法 2000年1月至2010年1月在我科实施后路腰椎减压椎间融合内固定治疗L4~5椎间盘突出患者60 例.A组(30 例)行保留后方韧带复合体的腰椎椎间融合术( posterior lumbar interbody fusion,PLIF),B组(30 例)行切除后方韧带复合体的PLIF术.比较两组手术前、后日本骨科协会( Japanese orthopaedic association,JOA)评分及改善率.术前、末次随访时测量腰椎X线片上L3~4椎间盘的高度和椎间隙动态角度、L3~4椎体滑移距离并进行比较.术前及末次随访时对L3~4椎间盘进行Pfir-rmann分级.结果 手术前、后两组患者的JOA评分差异有统计学意义( P0. 05),两组之间改善率差异无统计学意义(P>0. 05).A组9 例患者出现了L3~4节段的邻近节段退变( adjacent segment disease,ASD),B组17 例出现了L3~4节段的ASD.其中A、B两组均有2 例患者为有症状的ASD.术前两组患者X线片上L3~4椎间盘的高度、椎间隙动态角度、L3~4椎体滑移距离相比差异均无统计学意义( P>0. 05),而末次随访时差异有统计学意义( P0. 05). A group had 9 patients with lumbar 3/4 segment of the ASD,B group had 17 cases of lumbar 3~4 segment ASD. Among them,each groups had 2 cases of patients with symptoms of ASD. There were not difference in 3~4 lumbar intervertebral disc height,intervertebral space dy-namic angle ,waist 3 ~ 4 vertebral slip distance . But at the time of last follow - up significant difference could be found( P <0. 05). At the end of the follow-up A group had 6 cases of Pfirrmann grade 1,22 cases of 2,2 cases of grade 3,no 4,5 cases. Bgroup had 4 cases of Pfirrmann grade 1,24 cases of 2,2 cases of grade 3,no 4,5 cases.Conclusion Inlumbarinterbody fusion,posterior ligament complex can decrease the incidence of adjacent segment degeneration.

  4. Estimation of circumferential fiber shortening velocity by echocardiography.

    Science.gov (United States)

    Ruschhaupt, D G; Sodt, P C; Hutcheon, N A; Arcilla, R A

    1983-07-01

    The M-mode and two-dimensional echocardiograms of 40 young patients were analyzed to compare the mean circumferential fiber shortening velocity (Vcf) of the left ventricle calculated separately by two methods. The mean circumferential fiber shortening velocity was derived from the M-mode echocardiogram as minor axis shortening/ejection time and derived from the two-dimensional echocardiogram as actual circumference change/ejection time. With computer assistance, circumference was determined from the short-axis two-dimensional echocardiographic images during end-diastole and end-systole. Good correlations were obtained between the left ventricular diameter derived by M-mode echocardiography and the vertical axis during end-diastole (r = 0.79) and end-systole (r = 0.88) derived by two-dimensional echocardiography. Likewise, high correlations were noted between diameter and circumference in end-diastole (r = 0.89) and end-systole (r = 0.88). However, comparison of Vcf obtained by M-mode echocardiography with that obtained by two-dimensional echocardiography showed only fair correlation (r = 0.68). Moreover, the diameter/circumference ratio determined in end-diastole and end-systole differed significantly (p less than 0.001), possibly owing to the change in geometry of the ventricular sector image during systole. Although Vcf derived by M-mode echocardiography is a useful index of left ventricular performance, it does not truly reflect the circumference change during systole.

  5. Detection of a longitudinal defect in a pipe based on guided circumferential waves techniques

    Institute of Scientific and Technical Information of China (English)

    LI Longtao; HE Cunfu; WU Bin

    2005-01-01

    Based on elasticity theory, the multi-modes and disperse characteristics of guided circumferential waves in a pipe were investigated theoretically and experimentally, the disperse curves of guided circumferential waves were gotten by numerical calculations. The relationships between the angle of beam transducer, frequency and guided circumferential modes were analyzed by our guided wave experiment system. Then single guided circumferential mode was excited in the pipe (O.D 88.8 mm, I.D 80.8 mm). An artificial longitudinal defect (25 × 1 × 0.7 mm)on the surface of the pipe was detected by use of the single guided circumferential wave. The results show that single guided circumferential mode can be excited in the pipe by choosing special frequency and special angle beam transducer, similar to the excitation of Lamb wave in a plate, and it can be used to find the longitudinal defect on a pipe surface.

  6. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

    Directory of Open Access Journals (Sweden)

    Arvind G Kulkarni

    2016-01-01

    Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

  7. Effect of total lumbar disc replacement on the treatment of discogenic low lumbar pain: preliminary outcomes

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Effects of interspinous spacers on lumbar degenerative disease.

    Science.gov (United States)

    Zhou, Dong; Nong, Lu-Ming; DU, Rui; Gao, Gong-Ming; Jiang, Yu-Qing; Xu, Nan-Wei

    2013-03-01

    The present study aimed to evaluate the early effects of interspinous spacers on lumbar degenerative disease. The clinical outcomes of 23 patients with lumbar degenerative disease, treated using interspinous spacer implantation alone or combined with posterior lumbar fusion, were retrospectively studied and assessed with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Pre-operative and post-operative interspinous distance, disc space height, foraminal width and height and segmental lordosis were determined. The early effects and complications associated with the interspinous spacers were recorded. The surgical procedures performed with the in-space treatment were easy and minimally invasive. The VAS scores and ODI were improved post-operatively compared with pre-operatively. Significant changes in the interspinous distance, disc space height, foraminal width and height and segmental lordosis were noted. In-space treatment for degenerative lumbar disease is easy and safe, with good early effects. The in-space system provides an alternative treatment for lumbar degenerative disease.

  9. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

    Institute of Scientific and Technical Information of China (English)

    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.

  10. 微创单侧减压单枚Cage融合治疗退变腰椎间盘突出症的近期疗效%Short-term Effect of Minimally Invasive Unilateral Decompression and Fusion with Single Cage in the Treatment of Degenerative Lumbar Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    周文忠; 陈练; 赵杰

    2014-01-01

    Objective:To observe the short-term effect of minimally invasive laminectomy and fusion with unilateral pedicle screw and single Cage implantation in the treatment of degenerative lumbar disc herniation.Method:32 cases of degenerative lumbar disc herniation treated with minimally invasive unilateral decompression and fusion with single Cage in our department from October 2008 to June 2012 were involved in this research.The cases included 13 males and 19 females,aged from 52 to 75 years old,with an average of 61.8 years.Protruding sections:L4-5 15 cases, L5-S1 9 cases,L4-5 and L3-4 3 cases, L4-5 and L5-S1 5 cases,among these cases,17 cases associated with spondylolisthesis instability,11 cases associated with nerve root canal stenosis.Nakai evaluation criteria was adopted to evaluate the curative effect of minimally invasive unilateral decompression and interbody fusion with single cage,X-ray and CT images were used to observe whether postoperative intervertebral displacement happen,and the location of pedicle screws and interbody.Result:The operative time was 75-140 minutes,an average of 95 minutes.Blood loss was 180-550 ml,an average of 380 ml.Concurrent dural tear happened in 3 cases,and nerve root traction injury in 2 cases.Follow-up time was 18 months to 3 years and 8 months,lumbar sequence returned to normal after an average of 25 months.Fusion was assessed by Nakai standard 18 months postoperatively,excellent in 23 cases,good in 7 cases,ameliorateve in 2 cases,and the good rate was 93.8%.Interbody fusion rate assessed by Suk standard was 100% at final follow-up time,no asymptomatic recurrence nor loose or shifting of pedicle screws and interbody happened.Conclusion:The short-term effect of minimally invasive unilateral decompression and fusion with single cage in the treatment of degenerative lumbar disc herniation is good,which is well in maintaining responsibility intervertebral height and segmental stability.%目的:观察微创单侧椎板减压椎弓

  11. Influence of interbody fusion intervertebral fixation on adjacent joint degeneration in patients with lumbar diseases%椎间植骨融合内固定术对腰椎疾患邻近椎间关节退变的影响

    Institute of Scientific and Technical Information of China (English)

    黄占柱; 仇小华; 张淑兰; 陈为国; 郭颖

    2014-01-01

    Objective To explore the influence of interbody fusion intervertebral fixation on adjacent joint degeneration in patients with lumbar diseases .Methods 56 patients with lumbar diseases who were taken interbody fusion intervertebral fixation were selected as the research subjects ,and the adjacent intervertebral joint degeneration in patients were followed up .Results 56 patients were followed up for 24-72 months,the average time was (41.2 ± 8.3)months.The new clinical symptoms were occurred in 12 cases(21.4%),including 8 cases of low back pain, 3 patients with leg pain,1 case of lumbocrural pain.Radiographic changes occurred in 9 cases(16.1%),9 cases of patients with new clinical symptoms ,including 5 cases of osteophyte formation or exacerbation ,2 cases for adjacent segment instability ( I degree of vertebral spondylolisthesis ) ,1 case of small joint hyperplasia stage spinal stenosis , 1 case of protrusion of intervertebral disc .In 9 patients with imaging performance ,internal fixation of upper adjacent segment degeneration in 7 cases,internal fixation of the adjacent segment degeneration in 2 cases.Conclusion Inter-body fusion intervertebral fixation in the treatment of lumbar diseases ,adjacent joint is prone to degeneration ,so the destruction of adjacent joint operation should be reduced .%目的:探讨椎间植骨融合内固定术对腰椎疾患邻近椎间关节退变的影响。方法以采用椎间植骨融合内固定术治疗的腰椎疾患患者56例作为研究对象,随访患者术后邻近椎间关节的退变情况。结果56例患者均获门诊随访,随访时间24~72个月,平均(41.2±8.3)个月。其中出现新的临床症状有12例(21.4%),其中8例为下腰痛、3例为下肢痛、1例为腰腿痛;出现影像学改变9例(16.1%),9例患者均伴有新的临床症状,其中5例为骨赘形成或加重,2例为邻近节段不稳(椎体I度滑脱),1例为小关节增生

  12. Comparison of the efficacy of discectomy and intervertebral disc fusion in treatment of recurrent lumbar disc herniation%椎间盘摘除术与椎间盘融合术治疗再发性腰椎间盘突出症效果比较

    Institute of Scientific and Technical Information of China (English)

    钟斌; 徐玉生

    2016-01-01

    Objective To compare the efficacy of discectomy and intervertebral disc fusion in the treatment of patients with recurrent lumbar disc herniation.Methods 1 80 patients with lumbar disc herniation were selected and divided into group A(in-tervertebral fusion surgery,90 cases)and group B(discectomy,90 cases)according to their condition.The efficacy and compli-cations of the two groups were compared.Results The total effective rate of group A was 75.56%(68 /90),and that of Group B was 72.22%(65 /90).There was no difference in total effective rate between two groups(P >0.05).The ODI and VAS scores after surgery in two groups were improved,and the differences was not statistically significant between two groups(P >0.05).The incidences of complications were 1 4.44%(1 3 /90)in group A and 1 6.67%(1 5 /90)in group B,and there was no statistical difference between two groups(P >0.05).Conclusion For patients with recurrent lumbar disc herniation,the effica-cy of discectomy and intervertebral disc fusion selected according to the condition was good.%目的:对比分析椎间盘摘除术与椎间盘融合术治疗再发性腰椎间盘突出症的效果。方法选取180例再发性腰椎间盘突出症患者,根据手术方式分为 A 组(椎间盘融合术,90例)和 B 租(椎间盘摘除术,90例)。对比分析两组患者的治疗效果及并发症发生情况。结果A 组总有效率为75.56%(68/90),B 组为72.22%(65/90);两组总有效率差异无统计学意义(P >0.05)。术后两组患者 ODI 及 VAS 评分均较术前明显改善(P <0.05);治疗后 ODI 及 VAS 评分组间差异无统计学意义(P >0.05)。术后 A 组并发症发生率为14.44%(13/90),B 组为16.67%(15/90);两组并发症发生率比较,差异无统计学意义(P >0.05)。结论根据再发性椎间盘突出症患者的病情给予不同的手术方案,均有较好的治疗效果。

  13. Combination of interspinous stabilization system and fusion fixation system to treat degenerative lumbar disorders%棘突间固定系统与融合固定系统联合应用治疗腰椎退变性疾患

    Institute of Scientific and Technical Information of China (English)

    张建伟

    2012-01-01

    [目的]探讨棘突间固定系统与融合固定系统联合应用治疗腰椎退变性疾病的临床疗效.[方法]2007年2月~2009年2月本院收治的90例腰椎退变性疾病患者90例,分为棘突间固定系统与融合固定系统联合应用组和单纯棘突间固定系统应用组,各45例.分别对两组患者术后即时疗效进行评价.术后定期随访(30 ~ 54个月),分别对两组患者不良预后指标进行评估.[结果]两组患者术后即时疗效相比,联合应用组总有效率(93.3%)明显优于单纯应用组(75.6%)(P<0.05).从随访结果分析看,联合应用组不良预后发生率显著低于单纯应用组(P<0.05).[结论]棘突间固定系统与融合固定系统联合应用治疗腰椎退变性疾病较单纯棘突间固定系统应用具有更好的临床治疗效果.%[ Objective] To investigate curative effect of the combination of interspinous stabilization system and fusion fixation system to treat lumbar degenerative disorders. [ Methods] A retrospective analysis was carried out on 90 patients of lumbar degenerative disease from February 2007 to February 2009. In the combination treatment group, 45 patients received a combined therapy of interspinous stabilization system and fusion fixed system. In the control group, 45 patients only received interspinous stabilization system for treatment Patients were followed up for 30 - 54 months. Immediate postoperative efficacy evaluation was performed in both groups, and the prognosis and complication were recorded and analyzed at end of following. [Results] The total immediately effective rate in the combination treatment group was 93. 3% , and significantly higher than that of control group (75. 6% ) (P <0.05) . The incidence rate of complication in the combination treatment group were markedly less than that of control group (P<0. 05) . [Conclusion] The combined use of interspinous stabilization system and fusion fixation system is effective in treatment of

  14. Polyetheretherketone (PEEK) rods: short-term results in lumbar spine degenerative disease.

    Science.gov (United States)

    Colangeli, S; Barbanti Brodàno, G; Gasbarrini, A; Bandiera, S; Mesfin, A; Griffoni, C; Boriani, S

    2015-06-01

    Pedicle screw and rod instrumentation has become the preferred technique for performing stabilization and fusion in the surgical treatment of lumbar spine degenerative disease. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Thus, the use of semirigid rods made of polyetheretherketone (PEEK) has been proposed. Although the PEEK rods biomechanical properties, such as anterior load sharing properties, have been shown, there are few clinical studies evaluating their application in the lumbar spine surgical treatment. This study examined a retrospective cohort of patients who underwent posterior lumbar fusion for degenerative disease using PEEK rods, in order to evaluate the clinical and radiological outcomes and the incidence of complications.

  15. Characterization of mechanical and geometrical properties of a tube with axial and circumferential guided waves.

    Science.gov (United States)

    Yeh, Cheng-Hung; Yang, Che-Hua

    2011-05-01

    Guided waves propagating in cylindrical tubes are frequently applied for the characterization of material or geometrical properties of tubes. In a tube, guided waves can propagate in the axial direction and called axial guided waves, or in the circumferential direction called circumferential guided waves. Dispersion spectra for the axial and circumferential guided waves share some common behaviors and however exhibit some particular behaviors of their own. This study provides an investigation with theoretical modeling, experimental measurements, and a simplex-based inversion procedure to explore the similarity and difference between the axial guided waves and circumferential guided waves, aiming at providing useful information while axial and circumferential guided waves are applied in the area of material characterization. The sensitivity to the radius curvature for the circumferential guided waves dispersion spectra is a major point that makes circumferential guided waves different from axial guided waves. For the purpose of material characterization, both axial and circumferential guided waves are able to extract an elastic moduli and wall-thickness information from the dispersion spectra, however, radius information can only be extracted from the circumferential guided waves spectra. PMID:21211810

  16. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

    Directory of Open Access Journals (Sweden)

    Savni R Satoskar

    2014-01-01

    Full Text Available Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    Jefferson Coelho de Léo

    2015-09-01

    Full Text Available 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 lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5% had low lumbar lordosis; in this group 24 (82.8% had central disc herniation, 4 (13.8% had lateral recess disc herniation and 1 (3.4% had extraforaminal disc herniation (p<0.05. Of the 61 patients, 18 (29.5% had low sacral slope; of this group 15 (83.3% had central disc herniation and 3 (16.7% had disc herniation in lateral recess (p<0.05.Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

  19. Dynamic Stabilization for Challenging Lumbar Degenerative Diseases of the Spine: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Tuncay Kaner

    2013-01-01

    Full Text Available Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies.

  20. Analysis of adjacent segment reoperation after lumbar total disc replacement

    OpenAIRE

    Rainey, Scott; Blumenthal, Scott L.; Zigler, Jack E.; Guyer, Richard D.; Ohnmeiss, Donna D.

    2012-01-01

    Background Fusion has long been used for treating chronic back pain unresponsive to nonoperative care. However, potential development of adjacent segment degeneration resulting in reoperation is a concern. Total disc replacement (TDR) has been proposed as a method for addressing back pain and preventing or reducing adjacent segment degeneration. The purpose of the study was to determine the reoperation rate at the segment adjacent to a level implanted with a lumbar TDR and to analyze the pre-...

  1. Facet joint changes after application of lumbar nonfusion dynamic stabilization.

    Science.gov (United States)

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

    2016-01-01

    OBJECTIVE The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery. METHODS Patients who underwent monosegmental surgery at L4-5 with nonfusion dynamic stabilization using the Dynesys system (Dynesys group) or transforaminal lumbar interbody fusion with pedicle screw fixation (fusion group) were retrospectively compared. Facet joint degeneration was evaluated at each segment using the CT grading system. RESULTS The Dynesys group included 15 patients, while the fusion group included 22 patients. The preoperative facet joint degeneration CT grades were not different between the 2 groups. Compared with the preoperative CT grades, 1 side of the facet joints at L3-4 and L4-5 had significantly more degeneration in the Dynesys group. In the fusion group, significant facet joint degeneration developed on both sides at L2-3, L3-4, and L5-S1. The subjective back and leg pain scores were not different between the 2 groups during follow-up, but functional outcome based on the Oswestry Disability Index improved less in the fusion group than in the Dynesys group. CONCLUSIONS Nonfusion dynamic stabilization using the Dynesys system had a greater preventative effect on facet joint degeneration in comparison with that obtained using fusion surgery. The Dynesys system, however, resulted in facet joint degeneration at the instrumented segments and above. An improved physiological nonfusion dynamic stabilization system for lumbar spinal surgery should be developed.

  2. Single-stage Posterior Spondylectomy,Circumferential Decompression and Reconstruction Using Mesh Cage for Spinal Tumors

    Institute of Scientific and Technical Information of China (English)

    Yong Zhu; Hong Zhao; Giu-xing Qiu; Jian-guo Zhang; Ye Tian; Shu-gang Li; Suo-mao Yuan

    2009-01-01

    Objective To explore the feasibility and clinical results of circumferential decompression and threecolumn reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment.Methods Totally,24 patients with spinal tumor underwent tumor resection and spinal reconstruction through single-stage posterior transpedicular approach.Preoperatively,according to the Frankel classification,12 patients were grade E,9 grade D,and 3 grade C.Anterior column was reconstructed with non-expandable titanium cages.Posterior segmental instrumentation was used to maintain the stability of spine in all cases.Anterior and posterolateral fusion was performed with autograft and allogenic bone.The following data were followed up in these patients:deformity angle,local recurrence,neurological function,and spinal bony fusion.Results The average operating time and blood loss was 5.6 hours and 3 400 ml respectively.No intraoperative and postoperative complications were observed in this group.Postoperatively,21 patients were Frankel grade E,2 grade D,and 1 grade C.Four patients reported significant functional restoration and twenty patients reported complete resolution of pain.At follow-up(range,6-42 months),implant failure or recurrent neurological symptoms was not found.Conclusions The tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor.It can fully decompress the neurological structures,correct the kyphosis,and achieve early weight-bearing.This technique can improve life quality for the patients with spinal tumor.

  3. Evolução clínica e funcional dos pacientes com infecção após artrodese de coluna lombar Evolución clínica y funcional de los pacientes con infección post-artrodesis de columna lumbar Clinical and functional outcome of patients with deep wound infection after spinal lumbar fusion

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2009-06-01

    any patient. The patients were evaluated radiologically, clinically and functionally during the follow-up. Paired analyses were performed by means of Wilcoxon test. RESULTS: the incidence of infection was 3.1% (15/485. The most prevalent etiological agent was Staphylococcus aureus. All surgical procedures obtained consolidation. In a mean follow-up of 47.6 months, changes were seen in the numerical scale pain scores (p=0.001, Oswestry Disability Index (p=0.017 and physical component of SF-36 (p=0.036. In the final evaluation, 64.2% of the patients (9/14 presented minimal disability, and 35.8% (5/14, moderate disability. CONCLUSION: Aggressive treatment of postoperative infections after spinal lumbar fusion avoids removal of the instrumentation and allows the maintenance of the vertebral stability. Despite the complications, the patients presented improvement with regard to pain, functional capacity and preoperative quality of life.

  4. Transverse shear effect in a circumferentially cracked cylindrical shell

    Science.gov (United States)

    Delale, F.; Erdogan, F.

    1979-01-01

    The objectives of the paper are to solve the problem of a circumferentially-cracked cylindrical shell by taking into account the effect of transverse shear, and to obtain the stress intensity factors for the bending moment as well as the membrane force as the external load. The formulation of the problem is given for a specially orthotropic material within the framework of a linearized shallow shell theory. The particular theory used permits the consideration of all five boundary conditions as to moment and stress resultants on the crack surface. The effect of Poisson's ratio on the stress intensity factors and the nature of the out-of-plane displacement along the edges of the crack, i.e., bulging, are also studied.

  5. Transient thermal stress problem for a circumferentially cracked hollow cylinder

    Science.gov (United States)

    Nied, H. F.; Erdogan, F.

    1982-01-01

    The transient thermal stress problem for a hollow elasticity cylinder containing an internal circumferential edge crack is considered. It is assumed that the problem is axisymmetric with regard to the crack geometry and the loading, and that the inertia effects are negligible. The problem is solved for a cylinder which is suddenly cooled from inside. First the transient temperature and stress distributions in an uncracked cylinder are calculated. By using the equal and opposite of this thermal stress as the crack surface traction in the isothermal cylinder the crack problem is then solved and the stress intensity factor is calculated. The numerical results are obtained as a function of the Fourier number tD/b(2) representing the time for various inner-to-outer radius ratios and relative crack depths, where D and b are respectively the coefficient of diffusivity and the outer radius of the cylinder.

  6. Accurate wall thickness measurement using autointerference of circumferential Lamb wave

    International Nuclear Information System (INIS)

    In this paper, a method of accurately measuring the pipe wall thickness by using noncontact air-coupled ultrasonic transducer (NAUT) was presented. In this method, accurate measurement of angular wave number (AWN) is a key technique because the AWN is changes minutely with the wall thickness. An autointerference of the circumferential (C-) Lamb wave was used for accurate measurements of the AWN. Principle of the method was first explained. Modified method for measuring the wall thickness near a butt weld line was also proposed and its accuracy was evaluated within 6 μm error. It was also shown in the paper that wall thickness measurement was accurately carried out beyond the difference among the sensors by calibrating the frequency response of the sensors. (author)

  7. Chordoma Of Lumbar Spine

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

    2010-10-01

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

  8. Lumbar facet syndromes.

    Science.gov (United States)

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

    2010-01-01

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

  9. Short-term clinical results of interspinous dynamic fixation of Coflex for the prevention of adjacent segment degeneration after lumbar fusion%棘突间动态稳定装置Coflex预防腰椎融合术后相邻节段退变的短期随访疗效观察

    Institute of Scientific and Technical Information of China (English)

    周盛源; 陈雄生; 贾连顺; 朱巍; 房雷; 蔡弢艺

    2012-01-01

    Objective To observe the short-term clinical results of the adjacent segment degeneration after the implantation of Coflex system at the interspinous space of adjacent segment to lumbar fusion.Methods Fifty patients with grade Ⅲ disc (Thompson MRI classification) of adjacent segment to lunbar fusion were included and divided alternately into two groups according to the order of hospitalization from January to November 2009.Coflex system was implanted at the interspinous space of adjacent segment to lumbar fusion in 25 patients as Coflex group,the other 25 patients did not have any surgical treatment were as control group.The followed up time was 2 years. Visual analogue scale (VAS) score of low back pain,changes of disc height and motion range of adjacent segment to lumbar fusion on X-ray imaging were evaluated by independent sample t-test or paired samples t-test.Results There were 22 patients in Coflex group and 21 patients in control group were followed up 2 years post-operation.The difference of VAS score between two groups was no significance ( P > 0.05 ).In Coflex group,the change of postoperative disc height was no significance (P > O.05 ),but the motion range was significantly reduced to 47% of the preoperative value ( t =7.99,P < 0.05 ). In control group,the postoperative disc height decreased slightly,without significant difference to the preoperative value ( P > 0.05 ). Between the two groups,no differences of the disc height and motion range were found before operation,but the differences of the disc height changes(t =6.7,P < 0.05 ) and motion rang ( t =- 14.5,P < 0.05 ) were significant in 2 years post-operation. No complications such as Coflex system loosen, immigration and spinal process fracture were occurred.Conclusions Coflex system can obviously limit the motion range and maintain the disc space height of adjacent segment to lumbar fusion,and prevent its degeneration in some degree.%目的 研究腰椎融合节段相邻退变节

  10. 单侧椎弓根钉联合椎体间融合器选择性治疗退行性腰椎病疗效观察%Curative effectiveness of unilateral pedicle screw with cage fusion between vertebrae in selective treatment of degenerative lumbar disease

    Institute of Scientific and Technical Information of China (English)

    周少怀; 方红育; 李宏亮; 范明宇; 卞峰; 任敏

    2015-01-01

    Objective To investigate the curative effectinvess of the lumbar posterior unilateral pedicle screw with cage fusion between vertebre in selective treatment of degenerative lumbar disease.Methods Forty-nine patients with lumbar degenerative disease,preoperative imaging data verified that patients with Intervertebral disc herniation and (or) unilateral lateral recess stenosis,and clinical manifestations mostly were waist pain,with or without symptoms of one side numbness and pain,after conservative treatment is invalid,utilized surgery treatment of the posterior unilateral pedicle screws fixation with cage of intervertebral bone graft fusion,24 cases of men,women,25 cases,aged 26 to 75 years old (average 54.2 years),0.5-3.0 years duration of the disease.Use Oswestry index (ODI) dysfunction and Japanese Orthopaedic Association (JOA) score method to evaluate the postoperative curative effect,on the basis of SUK method to evaluate the postoperative spinal fusion.Results The difference of preoperative and postoperative Oswestry disability index of all patients was statistically significant,according to Japanese JOA score method,optimal effect were 36 cases (73.4%),well effect were 9 cases (18.4%),ordinary effect were 2 cases (4.1%),poor effect were 2 cases (4.1%),according to the SUK standard confirmed that vertebral body bone graft fusion rate was 91.8%.2 patients appeared postoperative review set screw bolts loose,but internal fixation of pedicle screw without loose or breaking out,adjusted to replace the tail cap in parallel and with a fixed march did not appear loose again,the limb symptoms were significantly improved.Conclusion Unilateral pedicle screw with Cage fusion between vertebral in selective treatment of degenerative lumbar disease has the advantage of shorter operation time,less trauma,and well clinical curative effect.%目的 探讨腰椎后路单侧椎弓根螺钉联合椎体间融合器(Cage)选择性治疗退行性

  11. Treatment of Lumbar Degenerative Disease with Unilateral Decompression,Bone Graft Fusion and Unilateral Pedicle Screw Fixation%经单侧减压融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病

    Institute of Scientific and Technical Information of China (English)

    宋晋刚; 崔易坤; 苗艳; 尹振宇; 羊刚毅; 黄海锋

    2016-01-01

    目的:探讨经单侧行病变节段椎管减压、椎间植骨融合、单边椎弓根螺钉内固定治疗腰椎退变性疾病的临床疗效。方法我院2010年1月~2013年12月对35例腰椎退变性疾病采用经单侧减压、椎间植骨融合、单边椎弓根螺钉固定手术治疗。根据 JOA 评分法评估术后腰椎功能改善情况,采用视觉模拟评分(visual analog scale,VAS)评估术后疼痛缓解情况,腰椎正侧位 X 线片及 CT 扫描了解植骨融合情况。结果随访12~18个月,平均15个月。术前 JOA 评分(8.2±2.1)分,显著低于术后3个月(20.8±3.8)分(q =22.123,P <0.05)和术后12个月(21.7±3.9)分(q =23.703,P <0.05);VAS 评分术前(7.9±2.1)分,显著高于术后3个月(2.4±0.4)分(q =26.107,P <0.05)和12个月(2.3±0.3)分(q =26.582,P <0.05);JOA 评分和 VAS 评分随访期间无显著变化(P >0.05)。1年后椎间植骨融合率100%,未发现椎弓根螺钉松动、断裂、拔钉等异常。结论经单侧减压、椎间植骨融合联合单边椎弓根螺钉内固定治疗腰椎退变性疾病疗效满意,可在合适病例中推广应用。%Objective To investigate the clinical effects of unilateral vertebral canal decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation in the treatment of lumbar degenerative disease. Methods From January 2010 to December 2013,a total of 35 cases of lumbar degenerative disease were treated with unilateral decompression,intervertebral bone graft fusion,and unilateral pedicle screw fixation.The postoperative spine functions were evaluated with the JOA scores,the postoperative pain relief was evaluated with the VAS scores,and bone graft fusion was reviewed with lumbar X-ray and CT scanning. Results The patients were followed up for 12 -18 months (mean,15 months).The preoperative JOA scores (8.2 ±2

  12. Lumbar spine chordoma

    Directory of Open Access Journals (Sweden)

    M.A. Hatem, M.B.Ch.B, MRes, LMCC

    2014-01-01

    Full Text Available Chordoma is a rare tumor arising from notochord remnants in the spine. It is slow-growing, which makes it difficult to diagnose and difficult to follow up after treatment. Typically, it occurs in the base of the skull and sacrococcygeal spine; it rarely occurs in other parts of the spine. CT-guided biopsy of a suspicious mass enabled diagnosis of lumbar spine chordoma.

  13. Lumbar spine chordoma

    Science.gov (United States)

    Hatem, M.A.

    2015-01-01

    Chordoma is a rare tumor arising from notochord remnants in the spine. It is slow-growing, which makes it difficult to diagnose and difficult to follow up after treatment. Typically, it occurs in the base of the skull and sacrococcygeal spine; it rarely occurs in other parts of the spine. CT-guided biopsy of a suspicious mass enabled diagnosis of lumbar spine chordoma. PMID:27186250

  14. Laparoscopic lumbar spine surgery

    OpenAIRE

    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...

  15. Electrodiagnosis of lumbar radiculopathy.

    Science.gov (United States)

    Barr, Karen

    2013-02-01

    The evaluation of patients with suspected lumbar radiculopathy is one of the most common reasons patients are referred for electrodiagnostic testing. The utility of this study depends on the expertise of the physician who plans, performs, and completes the study. This article reviews the strengths and weaknesses of electrodiagnosis to make this diagnosis, as well as the clinical reasoning of appropriate study planning. The current use of electrodiagnostic testing to determine prognosis and treatment outcomes is also discussed.

  16. Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report.

    Science.gov (United States)

    Tamaki, Yasuaki; Sakai, Toshinori; Miyagi, Ryo; Nakagawa, Takefumi; Shimakawa, Tateaki; Sairyo, Koichi; Chikawa, Takashi

    2015-09-01

    A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD. PMID:26068274

  17. Complications in lumbar spine surgery: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Luca Proietti

    2013-01-01

    Full Text Available 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 Methods: From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients′ age and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14. 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed. Results: Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment ( P = 0.004, open surgical approach (open P = 0.001 and operative time ( P = 0.001 increased the relative risk (RR of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5, does not represent a predisposing risk factor to complications ( P = 0.006. Conclusion: Surgical decision-making and exclusion of patients is not justified only

  18. Suspected herniated lumbar disc - computed tomography in differential diagnosis of non-disc-related sciatica

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, T.; Koehler, D.; Treisch, J.; Claussen, C.; Felix, R.

    1984-07-01

    The most common reason a patient is referred for spinal CT examination is to exclude a ruptured intervertebral disc. Besides nerve root entrapment due to herniated disc, a number of unusual or unexpected conditions have been encountered in the course of CT lumbar spine studies. These include spondylolisthesis, spinal dysraphism, Paget's disease, and inflammatory, neoplastic, or metastatic lesions. The application of spinal (small-circle) target imaging includes the risk of overlooking soft tissue lesions that extend beyond the reconstruction circle. Therefore, complete (large-circle) circumferential abdominal scanning is recommended in case of a suspected extraspinal cause of sciatica.

  19. The use of circumferentially varying stagger guide vanes in an axial flow pump or compressor

    Science.gov (United States)

    Horlock, J. H.

    1990-04-01

    An actuator disk analysis is given of the flow through a guide vane and rotor combination. It is shown that changes in total pressure across the rotor are, in general, related to circumferential variations in guide vane outlet angle. In particular, known variations in inlet total pressure may be eliminated by suitable circumferential changes in guide vane stagger.

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

    Science.gov (United States)

    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

  1. Semi-restricted non-fusion system (Cosmic) in the treatment of lumbar degenerative disease:mid-term follow-up outcomes%半限制非融合钛钉内固定系统Cosmic治疗腰椎退行性疾病:中期随访结果

    Institute of Scientific and Technical Information of China (English)

    李尔楠; 匡正达

    2015-01-01

    背景:相比于坚强内固定,Cosmic半限制非融合系统可于术中减少对腰椎生理结构的破坏,保留手术节段部分活动度,维持节段稳定性,有助于预防毗邻节段退变。  目的:观察Cosmic半限制非融合系统治疗腰椎退行性疾病的中期随访结果。  方法:纳入腰椎退行性疾病患者21例,其中男10例,女11例,年龄19-63岁,均采用后路开窗减压,清除髓核,在手术节段置入Cosmic半限制非融合系统,评估治疗前后的目测类比评分、Oswestry 功能障碍指数,以及手术节段、毗邻上节段的椎间隙高度与活动范围。  结果与结论:所有患者治疗后接受随访15-48个月,未发生内固定松动、断裂与脱落,末次随访的目测类比评分、Oswestry功能障碍指数均低于治疗前(P OBJECTIVE:To observe the mid-term folow-up outcome of semi-restricted non-fusion system (Cosmic) in the treatment of lumbar degenerative disease. METHODS:21 patients with lumbar degenerative disease, including 10 male patients and 11 female patients, at the age of 19-63 years old, received posterior decompression by fenestration, nucleotomy, and Cosmic system internal fixation. Visual analogue scale score and Oswestry disability index were used for clinical evaluation. Intervertebral height and range of motion of surgical segment and the proximal adjacent segment were colected before and after operation. RESULTS AND CONCLUSION: Al the patients were folowed up for 15-48 months. No internal fixator loosening or rupture was found during the folow-up. The visual analogue scale score and Oswestry disability index at the last folow-up were lower than those before operation (P < 0.01). During the last folow-up, there were no significant differences in the intervertebral height of surgical segment and the proximal adjacent segment, and the range of motion of surgical segment was lower than that before operation (P < 0.01). No

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

    Institute of Scientific and Technical Information of China (English)

    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

  3. Analysis of circumferential waves on a water-filled cylindrical shell

    Institute of Scientific and Technical Information of China (English)

    FAN Wei; ZHENG Guoyin; FAN Jun

    2012-01-01

    The formation of scattering field from a water-filled cylindrical shell was studied. The analytic solutions of scattering field are derived using elastic thin shell theory and Sommerfeld-Watson Transformation (SWT) method. Complex wave-number poles of circumferential waves are found numerically, the phase speed and attenuation of circumferential waves between the situation of a hollow cylindrical shell and a water-filled cylindrical shell are compared. The synthesis of backscattering form functions which are sum of specular reflection component and circumferential waves is consistent with normal mode result. The calculated echo sequences of additional fluid circumferential waves are compared with experimental results. The results show that richer resonance peaks appeared in the backscattering form functions of a water-filled cylindrical shell and the formation of echo's structure are due to re-radiation effects of additional fluid circumferential waves.

  4. Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

    International Nuclear Information System (INIS)

    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.)

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.